GRANITE CITY, ILLINOIS ― The phone did not stop ringing all day at Hope Clinic for Women, an abortion clinic in Illinois located just over the Mississippi River from St. Louis, Missouri.
The callers wanted to know: Was abortion still legal? Could they please come in for an appointment? And how soon?
“People are frantic because they don’t understand what’s happening,” said Erin King, an OB-GYN and the executive director of Hope Clinic for Women. “They’re panicked. You can hear their stress level.”
In Missouri, the only remaining abortion clinic is expected to shutter its doors at the end of the week, handing the anti-abortion movement a victory of epic proportions. For the first time since Roe v. Wade was decided in 1973, Missouri will become the only state in the U.S. where women cannot access legal abortions.
And so Hope Clinic, positioned across state lines but just 10 minutes from downtown St. Louis, was bracing for an influx of patients.
Already, more than 50 percent of the women the clinic serves come from Missouri. Many travel to Illinois to circumvent Missouri’s onerous regulations, which can be both costly and emotionally taxing. In Missouri, a woman who wants an abortion must travel to the one remaining clinic, provide informed consent, wait 72 hours before her procedure, and undergo a pelvic exam even if she is having a medication abortion. That last requirement is at odds with the American College of Obstetricians and Gynecologists, which says the decision should be left up to the provider.
In past years, as the number of abortions in Missouri has decreased, Illinois has provided more and more care to out-of-state patients. Now, King was trying to work out how they could accommodate an even larger volume.
“Obviously our first concern is the patients,” she said. “We are looking at having extra staff, expanding our clinic hours, and looking at our schedule to see what we can do.”
The news of the potential closure comes days after Missouri Gov. Mike Parson signed a bill that bans abortion at eight weeks of pregnancy, with no exceptions for rape or incest. Similar bills have passed in Georgia, Ohio, Kentucky and Mississippi this year; Alabama went further, virtually outlawing abortion outright. On Wednesday, Louisiana sent a six-week abortion ban to the governor’s desk. None of the bills have gone into effect, and all are expected to face legal challenges.
Missouri’s eight-week ban blatantly violates past Supreme Court decisions that say abortion is legal until a fetus reaches viability. But it’s not the reason the last standing abortion clinic in the state, located in St. Louis, is poised to close.
Instead, it was plain old bureaucracy.
On Tuesday, Planned Parenthood announced that Missouri’s health department said it will not renew the clinic’s annual license because it is violating state regulations. Planned Parenthood says many of the regulations are arbitrary and medically unnecessary, and are being used to harass providers and make it nearly impossible to access abortion.
On the other side of the river, David Eisenberg, medical director of the Planned Parenthood of the St. Louis Region, the abortion clinic that is about to be shut down, was sitting in an empty recovery room, doing back-to-back media interviews.
“Patients are scared that they can’t access the care that they need, which is basic reproductive health care,” he told HuffPost. “Many of them don’t know that we can still provide care through the end of the day Friday, and they don’t know that we are doing everything in our power to fight back against this overly burdensome regulatory environment.”
Eisenberg also happens to be King’s husband. Between the two of them, they intimately know the differences between accessing care in Missouri and Illinois. They get to see, on a daily basis, the impact of the additional hurdles: what it means for a woman to wait an extra three days once she’s decided to terminate her pregnancy, experience the trauma of an unnecessary pelvic exam before taking an abortion pill in the comfort of her home, and bear the costs of traveling to the only abortion clinic in the state.
Eisenberg said he would be performing abortions on Thursday and Friday. But he wasn’t sure what would happen to patients who were scheduled to come in to provide informed consent for the procedure. Under state law, they would need to wait 72 additional hours before obtaining an abortion. But it was unclear if the clinic would be open then.
As part of the informed consent process, he said, he was legally required to discuss the immediate and long-term risks associated with abortion, the potential impact on subsequent pregnancies, and any potential for adverse psychological effects.
“I am not sure I understand what that means,” he said frankly. “There are lots of people I’ve taken care of over the years who have never had any kind of adverse psychological effects as a result of an abortion. But I can tell you they have experienced adverse psychological effects from waiting to get basic health care, from having to pay out-of-pocket, and from having to go through the protesters who stand on the sidewalk, thinking they know something about my patient’s life and what’s best for them.”
The march to shut down the St. Louis clinic has been a long time coming. Over the years, anti-abortion legislation has made it harder to perform the procedure.
“Missouri has a long, long history of trying to restrict abortion and abortion clinics,” said Elizabeth Nash, who tracks state reproductive health policy for the Guttmacher Institute. “The Health Department has, as I understand it, been particularly harsh interpreters of the statutes and regulations. There are states where clinics can work with the Health Department to ensure safety and good medical practice, but Missouri’s Health Department isn’t like that.”
Missouri was the first state to require that a doctor have admitting privileges at a hospital in order to perform abortions, she said. Then it changed the law so that the hospital must be within 30 miles. It was also one of the first states to ban abortion coverage in health plans. Between 2011 and 2018, Missouri added a slew of restrictions, including extending the waiting period, limiting abortion provision to physicians, prohibiting the use of telemedicine for medication abortion and requiring that fetal tissue be buried or cremated.
“There’s no evidence that any of the restrictions they have enacted improve health, but they do have the outcome of reducing abortion,” King, the director of Hope Clinic, said. “If you’re trying to say that it’s doing anything other than that, it’s just a complete lie.”
The regulations mean that doctors are tied up in paperwork and have less time for patients, King said. And as soon as doctors comply, the state changes the rules.
Eisenberg said he was saddened by Gov. Parson’s decision to defend the impending closure of the clinic during a Facebook Live press conference on Wednesday.
“He is choosing to be obstructive in the practice of medicine, rather than do what would actually promote the health and well-being of Missourians, like expand Medicaid and increase access to family planning services,” he said.