By the end of the week, women in Missouri may live in a state without a single abortion clinic. While restrictive laws in states like Alabama have made headlines, Missouri shows the other side of the anti-abortion strategy: steadily shave away at abortion rights. You don’t need to outlaw the procedure outright if you can make getting a safe, legal one nearly impossible.
The reason there’s only one remaining clinic in Missouri in the first place is because the state has tried to regulate abortion out of existence. A series of unnecessary rules and regulations makes it harder both for women to access abortions and for medical professionals to provide them. Missouri’s misogynistic laws already don’t trust women to make their own decisions – they mandate that any woman seeking an abortion in the state has to come to a clinic, request the procedure, and then go home and think about it for three days before it can be legally proffered. They also require that young people under the age of 18 notify both parents and get the notarized consent of at least one parent before they can terminate a pregnancy – a serious hardship for girls who live with abuse, or who don’t have a good relationship with their parents, or who don’t want to be mothers but want to keep their medical decisions private.
Physicians in Missouri who provide abortions have to have admitting privileges to a hospital within 15 minutes of a clinic, an absurd requirement for a medical procedure that is incredibly safe. Admitting privileges create an unnecessary barrier to care – clinics that aren’t within 15 minutes of a hospital, for example, simply cannot exist in Missouri, which means even less service for already-underserved communities. It’s rare that patients have to be admitted to hospitals after an abortion; it’s more common that a hospital referral will come because a doctor discovers an ectopic pregnancy or another condition that requires additional treatment, for which admitting privileges make little difference. One study on admitting privileges for physicians at abortion clinics found that they made no difference for patients receiving care. But they do make it harder for doctors to offer that care.
Missouri also requires doctors to perform invasive and unnecessary pelvic exams before they can prescribe women abortion-inducing medication. A pelvic exam is not the standard of care for prescribing this medicine, and is simply another barrier erected to make abortion more difficult, expensive and, in this case, physically invasive. Consider this: The state of Missouri requires that women have their vaginas unnecessarily penetrated before they can have a medical procedure that is common the world over. This is nothing short of abusive.
If Missouri’s last clinic closes, women will have to travel out of state to end their pregnancies. But that, too, creates significant hardships. That kind of travel costs money. It requires owning a car. Depending on how far women go, it may necessitate a hotel room. It requires taking time off of work. It makes abortion particularly inaccessible for poor women, for women who are already raising children on their own, and for women in vulnerable situations, like abusive relationships. These laws won’t end abortion. They will just make it harder, more painful, and more expensive.
Missouri also recently passed a ban on abortions after eight weeks. That ban isn’t what’s causing this clinic closure – the ban violates Roe v Wade and is therefore unenforceable – but it is representative of the two-pronged strategy that opponents of women’s healthcare have used. One tactic is to regulate abortion out of existence, so that even with Roe v Wade in place and the right to legal abortion technically guaranteed, access to abortion dries up. The other is to pass extreme laws outlawing abortion wholesale, or close to it, and hoping these laws move up the courts to eventually overturn Roe. The entire goal is to make it impossible for women to have safe access to a procedure that one in four American women will have in her lifetime.
The Planned Parenthood in St Louis is the last bastion of abortion care for Missouri women. It’s devastating that it’s even come to this, and shameful that the state is focusing such intense efforts on restricting abortion rather than dealing with, say, Missouri’s abysmal maternal mortality rates. A woman in Missouri is more than four times likelier to die during pregnancy or childbirth than a woman in Massachusetts. These rates are exacerbated by the fact that Missouri makes healthcare hard to get for women, and a significant share don’t get any prenatal care in the first trimester. While Missouri politicians are busying themselves trying to make abortion impossible for vulnerable women to get, nearly 70% of the state’s counties don’t have an OB/GYN at all, leaving women who want to continue their pregnancies in a lurch.
That’s also representative of the national “pro-life” movement, which does virtually nothing to preserve or improve the lives of women and children, but does a whole lot to make abortion inaccessible. Illegal and inaccessible abortions, we know, drive up rates of maternal mortality. “Pro-life” laws are often coupled with harder-to-access contraception around the world – one dirty secret of the anti-abortion movement is that its activists often oppose contraception as well, even though it’s the most effective way to prevent unwanted pregnancy and, by extension, abortion.
Very little about this anti-abortion strategy of chipping away at women’s rights while also bringing the hammer down on them wholesale is about preserving life. It is entirely about punishing and controlling women. And if we want to see where anti-abortion advocates are going, soon-to-be-clinic-less Missouri is the place to look.