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Missouri Could Become the First State in the Nation Without an Abortion Clinic

But it's far from the only state where a health department's efforts could effectively end abortion access.
Missouri Governor Mike Parson listens to a media question during a press conference to discuss the status of license renewal for the St. Louis Planned Parenthood facility on May 29th, 2019, in Jefferson City, Missouri.

Missouri Governor Mike Parson listens to a media question during a press conference to discuss the status of license renewal for the St. Louis Planned Parenthood facility on May 29th, 2019, in Jefferson City, Missouri.

Missouri's governor is accusing a Planned Parenthood abortion clinic in St. Louis of failing to cooperate with a health department investigation, two days before the clinic's license is set to expire.

The comments come after months of back and forth between the clinic and the Missouri Department of Health and Human Services over a series of licensing issues that threaten to close the only abortion provider in the state. If that happens, Missouri will be the first state in the nation without an abortion clinic. But it's far from the only state where a health department's actions have sought to shut down a clinic.

"The issues that we are talking about today are centered around two key issues: Planned Parenthood not following the law, and Planned Parenthood not protecting women's health," Governor Mike Parson said Wednesday, hours before a hearing was set to begin in a St. Louis Circuit Court over the case.

Two Planned Parenthood organizations—Planned Parenthood Federation of America and Reproductive Health Services of Planned Parenthood of the St. Louis Region—filed a lawsuit on Tuesday alleging that the state has been violating its own regulations and acting beyond its authority by demanding to interview seven physicians and one nurse, only two of whom agreed to be interviewed (some of the physicians were at the clinic for training, and none are clinic employees, Planned Parenthood said).

In mid-March, state health inspectors found "numerous violations of state laws and regulations" during an annual inspection, Parson said. These included issues with a fire drill and the location of emergency supplies, according to Planned Parenthood. Then, in early April, state officials again inspected the clinic after an alleged patient complaint. Parson said the investigation stemmed from "a series of instances that raised concerns about quality of care, patient safety, statutory and regulatory compliance."

In its lawsuit, Planned Parenthood says the state has never disclosed the nature of those instances, and it argues it has "fully complied" with the investigation and submitted multiple plans to address the state's concerns. But the governor maintained on Wednesday that a number of serious health concerns still exist at the Planned Parenthood St. Louis facility.

He argued the clinic shouldn't be given "special treatment" because it's the last abortion provider in the state and accused Planned Parenthood of waging a "media campaign" by publicizing the threatened end of abortion services in Missouri.

"This is not about the pro-life issue at all," Parson added.

Planned Parenthood disagrees. The clinic's closure would usher in "the world that the Trump administration and Republican public officials across the country have been pushing for—a world where abortion care is illegal and inaccessible in this country," Dr. Leana Wen, president and chief executive officer of Planned Parenthood Federation of America, said in a statement this week.

Dr. Colleen McNicholas, an OB-GYN at the St. Louis clinic, accused the governor of using inspections to "intimidate" doctors. "None of this has one bit to do with patient health or safety, but, rather, banning abortion. State officials continue moving the goal post on abortion providers until we can no longer provide care," she said in a statement.

The situation in Missouri is giving Brigitte Amiri a sense of déjà vu. Amiri, the deputy director of the American Civil Liberties Union's Reproductive Freedom Project, is among a team of lawyers working to keep Kentucky's last abortion clinic open after that state's health agency attempted to shut the clinic down based on a licensing dispute in 2017. In that case, a district court issued a temporary restraining order that has kept the clinic open in the years since.

"There are some states where the health department has become an anti-abortion political wing of the executive branch," Amiri says.

She points to Ohio, where health agencies have reinterpreted existing regulations in a way that has made it difficult, and in some cases impossible, for clinics to comply. Such efforts have flown under the national radar compared to, say, a sweeping cohort of so-called "heartbeat" bans outlawing abortion at about six weeks of pregnancy.

"A state does not need to ban abortion to eliminate access to abortion. And that is clear in the context of Missouri; it was clear in the context of Kentucky," Amiri adds. "There are other ways for anti-abortion politicians to quietly close clinics in a state, including potentially the last clinic in the state, short of banning abortion outright."

Missouri, Kentucky, and Ohio are among 23 states with clinic licensing laws, according to a 2018 analysis by Temple University, allowing health agencies to write regulations specifically for abortion clinics—a greatly under-appreciated aspect of controlling abortion access.

Already, Missourian women often cross state borders to get an abortion, to the Hope Clinic for Women in Granite City, Illinois, a 10-minute drive from downtown St. Louis. Alison Dreith, the clinic's deputy director and the former executive director of NARAL Pro-Choice Missouri, says about 55 percent of patients there are from Missouri.

"This didn't happen overnight," she says. She argues that the health department became particularly aggressive toward abortion clinics after the election of Republican Governor Eric Robert Greitens in 2017, and his appointment of Dr. Randal Williams, an OB-GYN and former health official in North Carolina, to lead Missouri's health department. Mallory Schwarz, NARAL Pro-Choice Missouri's incoming executive director, says the state's changing regulations for abortion clinics have created an "atmosphere of chaos" that leaves both patients and clinicians unsure of the status of abortion access in the state.

The optics of a health department's actions are far different from a politician's when it comes to restricting abortion, Dreith adds.

"Everybody who's against safe and legal abortion can say, 'Oh, we didn't outlaw abortion, the abortion provider is playing dirty or isn't following the rules or regulations and they shut themselves down,'" she says.