IN 2008 Missouri had five abortion clinics. Today the state, which has 6m inhabitants—more than 1m of whom are women of child-bearing age—has one. On May 31st, a judge intervened to prevent that clinic, in the city of St Louis, from losing its licence to provide abortions. Were that to happen, and it yet may, Missouri would become the only American state since 1973—when the Supreme Court declared abortion a constitutional right—to have no abortion provider.
The clinic, which is run by Planned Parenthood, is threatened with closure because the state’s Department of Health and Senior Services (DHSS) has refused to renew its licence, which expires at midnight on May 31st. It had refused, said Governor Mike Parson at a televised press conference this week, because of a “series of deficiencies” it had found at the clinic. These ranged, he said, from [largely unspecified] concerns about patient safety to the clinic’s failure to comply with licensing procedures. Among those he cited the fact that of seven doctors who work at the clinic only two had agreed to be interviewed.
Planned Parenthood, the biggest provider of abortions in America, strongly refuted the suggestion the clinic was improperly run. In a lawsuit launched on May 28th it said that it had responded to every demand made by the DHSS. In a separate statement it described the department’s request to interview all the doctors who worked there as “inappropriate and suspicious”. The DHSS, it said, had “suggested this interrogation could lead to criminal proceedings…but refused to explain why or how”. Withholding the licence was another move in the state’s long-term effort to “restrict abortion access and deny Missourians their right to choose abortion”. In its lawsuit it asked for a temporary restraining order against the state.
On May 31st, the judge, Michael Stelzer of Missouri Circuit Court in St Louis, granted that. But the reprieve may only be temporary. He scheduled another hearing for June 4th. “Today is a victory for women across Missouri but this fight is far from over”, said Leana Wen, the president of Planned Parenthood, in a statement.
Missouri does seem to be exceptionally keen on stopping women from having abortions. Last week Mr Parson, a pro-life Republican, signed a law banning abortions after the eighth week of pregnancy. More than a dozen states have introduced similar bills banning abortion from the moment a heartbeat is detectable, which often happens before a woman realises she is pregnant. In six states such “heartbeat” bills have been passed. The most recent was Louisiana where on May 30th the Democratic governor, John Bel Edwards, bucked his party’s line to sign a heartbeat ban into law. Earlier this month Alabama passed an even more draconian law banning all abortions at any stage of pregnancy. This, like several heartbeat bills, has no exceptions for pregnancies that result from rape or incest.
Because these laws flatly violate Roe v Wade, the 46-year-old Supreme Court ruling which says abortion is legal until a fetus is viable, at around 24 weeks, they being are struck down in the courts. The lawmakers behind them hope that one case or another will make it to the Supreme Court where the new conservative majority will then use it to overturn Roe.
The threat to close Missouri’s last clinic is an example of a more insidious attempt to prevent abortion. Since 1992, when the Supreme Court in its Planned Parenthood v Casey ruling said states could not impose an “undue burden” on women seeking an abortion, pro-life activists have tested the limits of that by introducing regulations designed to impede access to abortion. Missouri has been at the vanguard of that effort. It has imposed a 72-hour waiting period between consultation and abortion—which is costly and stressful for women who have to travel long distances to get to St Louis—and strict limits on the use of insurance to cover abortions. The state also insists on intrusive pelvic examinations for medical abortions, which gynaecologists say are unnecessary.
In 2018, Missouri lost its second-to-last abortion clinic after it was unable to meet another state requirement—securing “admitting privileges” at a nearby hospital. Many hospitals do not allow doctors who work elsewhere to admit patients, not least because it is considered unnecessary.
But the success of such regulations and other fiddly licensing requirements is inarguable. Missouri is one of at least six states that have only one clinic left. “We are waking up to the effects of these regulations because the attack on Roe has become so obvious”, says Mary Ziegler, a professor at the Florida State University College of Law.
Autumn Katz, a lawyer for the Centre for Reproductive Rights, says that in most cases clinics have chosen to close before being stripped of their licences. “We have seen this so many times: states enforcing intentionally opaque licensing rules in an arbitrary manner that is designed to close clinics”, she says. Missouri’s case is a reminder, she adds, that states do not need to make abortions illegal to stop them.