It’s Open Season on Abortion Access, and Missouri Is Leading the Charge

Protestors standing outside of the Planned Parenthood clinic in St. Louis.
Protestors standing outside of the Planned Parenthood clinic in St. Louis. FLICKR/ PAUL SABLEMAN

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Protestors gather outside of Hope Clinic in Granite City, Illinois. - KAYLA CALAC
Protestors gather outside of Hope Clinic in Granite City, Illinois.

Katie was using birth control when she learned that she was pregnant almost a decade ago. When she first thought her birth control may have failed, she took a home pregnancy test that came back positive. After that, she scheduled an appointment at a Planned Parenthood clinic to confirm the result.

"My birth control failed, because there is no such thing as an entirely foolproof form of birth control," she says. (Failure rates for birth control vary from method to method, according to the Centers for Disease Control and Prevention, with a statistical likelihood of failure ranging from 0.01 to 27 percent depending on the method.)

Katie was in a happy relationship at the time, but she knew she didn't want to have children with her then partner. "He left the decision entirely up to me," she says.

Her choice was to have an abortion. About a week later, she returned to the Planned Parenthood facility for an exam and to recieve the medication and instructions for usage to have a medication abortion at home. Unlike a surgical abortion, medication abortion is taken orally.

"It induces basically a pretty heavy period, so it flushes out the inside of your uterus," Katie says. "It's not a fun experience by any means; I spent what I would describe as kind of an uncomfortable day at home. But afterward I was totally fine, and I've never regretted the decision that I made."

Katie was living on the East Coast at the time and recalls no barriers for care, no mandatory waiting period and no protestors harrassing her.

"I was lucky in that I didn't have any waiting periods; I didn't have any misinformation that my doctor was required to give me the way that they have in a lot of states," Katie says. "There were no protestors or anyone blocking me from having access to the clinic — it felt very safe, always, and felt very easy to come and go to get the services that I needed."

Nine years later, Katie says she feels very fortunate to have been able to make this choice about her health care and family planning.

"I don't take for granted the fact that my experience was relatively stress free and mundane, and I really think that everyone who needs reproductive health care should have that kind of experience," she says. "I was confident in my decision, and I was confident in the medical care that I received."

Katie has been a pro-choice activist for years, she says, and has long supported the work of Planned Parenthood and other pro-choice advocacy groups. A few years ago, while discussing her support of reproductive rights with her paternal grandmother, Katie learned that in the 1920s or 1930s, her paternal great-grandmother had an abortion. Her great-grandmother was married and living in Brooklyn when she learned she was pregnant, and although she wanted children eventually, she was not yet ready to become a mother.

"I was surprised, because you don't hear too many stories about folks in the early 1900s having had access to reproductive services like that," Katie says. "She was able to find access to reproductive care and had an abortion and then later, when she was ready, went on to have the family that she wanted, one of those girls being my grandmother."

In Katie's view, through her great-grandmother being able to make a choice about her own family planning, she was able to build a better life for herself and her family down the road. Abortion was not legal at the time, of course, but it was happening across the country despite the procedure not being generally included in obstetrics and gynecology training for physicians, according to reporting by the Guttmacher Institute.

"I literally wouldn't be here if it weren't for reproductive services access," Katie says. "I was kind of floored — I come from a long line of smart, strong women who make the decisions that they need to for themselves and for their health. It felt kind of validating — I made the same decisions, and I know that my decision was the right thing, and my great-grandmother did the same thing."

At first Katie didn't tell many people about her abortion. She says her reasons were mixed — she did worry about the stigma she might face from some people in her life, but she also viewed it as a medical procedure that just felt private. Fairly recently, though, she's become comfortable sharing her story. Not long ago she participated in a stop on the NARAL Listening Tour and was encouraged watching people connect in real time about their different experiences accessing reproductive health care services.

"It felt like a really comfortable atmosphere where people were able to share their experiences," Katie says. "We talked a lot about our experiences with sex education, because that's a foundational element of how someone thinks about their reproductive health care, and then moved on to other topics, culminating in talking about the current state of affairs in Missouri legislation and in the country, and what opportunies people have through NARAL to help build the world that we want to see both locally and on a larger scale."

When you lie, people die!"

That chant thundered through the Missouri House on an unseasonably warm day last May. A group of activists roared in unison from the chamber gallery overlooking the House floor, many of them clad in white T-shirts proclaiming "Stop the Bans" in orange type.

Tempers and emotions were high that day following the passage of HB 126, or the "Missouri Stands for the Unborn Act," which had already passed in the state House and Senate and was now given final legislative approval before heading to the governor's desk. The bill bans all abortions in Missouri, including those that are the product of rape or incest, at eight weeks of pregnancy. With lawmakers aware that the eight-week gestational ban would almost certainly be challenged, the bill suggests a series of alternative bans at fourteen, eighteen and twenty weeks of pregnancy.

The only exception outlined in the bill is in cases where the mother's life is in danger. In addition to those provisions, "trigger" language was included that if Roe v. Wade is ever overturned federally, abortion in Missouri would be banned at every stage of pregnancy outside of medical emergencies.

The legislation includes an emergency clause requiring two-parent consent for minors seeking abortions. (Missouri currently requires one-parent consent for minors.) The bill also includes provisions banning abortion due to the sex or race of the fetus, or a Down syndrome diagnosis. The latter provisions are often called "reason bans" and aim to restrict the reasons patients can seek abortions, although critics say they're hard to prove or enforce and only serve to further reduce abortion access.

On May 24, less than a week after the Missouri General Assembly approved HB 126, Governor Parson signed the bill into law. Religious groups and anti-abortion politicians and citizens alike heralded the decision.

"By signing this bill today, we are sending a strong signal to the nation that, in Missouri, we stand for life, protect women's health and advocate for the unborn," Parson said in a release. "All life has value and is worth protecting."

Just days later, Republican Senator Andrew Koenig, who represents District 15 in St. Louis County and managed the passage of the bill, was featured on Politically Speaking, a weekly podcast produced by St. Louis Public Radio. In the episode, host Jason Rosenbaum questioned Koenig about the law.

"I think this is important because the Fourteenth Amendment says that every person has a right to life," Koenig said. "When you peer inside the womb, all the evidence points to that life exists. And why eight weeks? Because at that point in time there's a heartbeat and so, literally, inside the womb, you have the heartbeat of an unborn child and you also have, you know, the mother has her own heartbeat, so you have two separate heartbeats at that point in time."

When Rosenbaum asked Koenig to specify why there were no exceptions written into the bill for survivors of rape or incest — noting that even President Trump, who is anti-abortion, supports such exceptions — Koenig doubled down on his belief that a fetus has the same constitutional rights as a pregnant woman in all circumstances.

"Rape or incest are horrific acts; I think that you can't go far enough on the punishment on the people who do these acts. They're just completely horrific. But one bad act doesn't ... we shouldn't do another bad act because one bad act happened."

The host also questioned Koenig on the far-reaching nature of HB 126. "Was the reason that Republicans in particular went along with this because Trump is president and there's a feeling with the judiciary changing that there needs to be a more aggressive posture on this issue?" Rosenbaum asked.

"This is a unique bill," Koenig responded. "It's a little different than other heartbeat bills that you've seen across the states. What makes this bill different is that we've made legal arguments that have never been argued in court. We consider, at eight weeks, to be a viable pregnancy; there's a 95 percent chance that the child will make it to birth at the point in time that heartbeat is detected."

What Koenig and his colleagues consider a viable pregnancy, though, doesn't align with the scientific and medical definitions accepted by most doctors. A fetus is usually considered viable — meaning it could live outside the womb — at 22 to 24 weeks from a woman's last menstrual period, although factors can vary in every case.

A study led by neonatologist Dr. Noelle Younge in 2017 in The New England Journal of Medicine proposed that fetuses born outside the womb after 22 weeks could survive in clinics with advanced neonatal units. That study, however, which was conducted over twelve years, found that only 1 percent of babies born at 22 weeks survived without neurodevelopmental impairment.

"With the 22-weekers we didn't see a lot of difference," Younge told Reuters Health in 2017.

Prior to the proposal of HB 126, abortion was legal in Missouri up to 22 weeks.

There are signs that Missouri politicians — both Republicans and Democrats — who supported HB 126 may have overplayed their hands. One Republican member of the Missouri House, Shamed Dogan, who represents the 98th District in St. Louis County, voted no.

"I really struggled with this one," Dogan told the St. Louis Post-Dispatch at the time. "I wanted to, as we talked about earlier, include rape or incest exceptions."

Dogan wasn't alone in his concerns. Conservative allies also saw the legislation as too extreme, including David Humphreys. The prominent Joplin-based businessman and generous donor to the Missouri Republican Party opposed the lack of exceptions for survivors of rape or incest.

Pro-choice advocates immediately rallied to oppose HB 126 with a referendum proposal, or public state-wide vote, one of which was filed by the American Civil Liberties Union on May 28. Another referendum filed against HB 126 came from The Committee to Protect the Rights of Victims of rape or incest, a petition Humphreys supported with a $1 million donation.

"I support the committee's referendum petition to overturn HB 126," Humphreys said in a statement last summer. "Abortion is a very personal subject with complicated moral issues for all involved. With no consideration given to victims of rape or incest, this legislation's impact reflects bad public policy with negative consequences for Missourians. As such, I support the committee's effort to protect women in the case of rape or incest."

Due to the emergency clause in the bill requiring two-parent consent, though, that provision in the bill immediately became law after it was signed by Governor Parson. And that opened the door to a bit of political gamesmanship by Missouri Secretary of State Jay Ashcroft. The Republican at first refused to approve referendum proposals, claiming he didn't have the legal authority to approve them because of the bill's emergency clause.

When an appeals court disagreed, ruling that Ashcroft could not deny the referenda, he waited for more than two months to release the petitions needed to begin gathering signatures. According to Andrew Koenig's interview with St. Louis Public Radio on June 3, that move by Ashcroft was intentional to block a public vote.

"What we did in the bill is actually preempt that type of situation by putting an emergency clause in there, so there can't be a referendum," Koenig told Politically Speaking.

Ashcroft finally released them in mid-August, which gave petitioners just fourteen days to collect the needed 100,000 signatures. Critics insisted Ashcroft had intentionally slow-walked the petition to undercut their efforts.

The secretary of state defended the move in a press release specifically outlining the timeline afforded to the ACLU petition. "The referendum process is available for bills that have not yet become law, and a portion of the bill had become law," Ashcroft said at the time. "I had no other choice than to reject the referendum when it was originally filed."

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