Abortion rights advocates and opponents in Missouri are watching closely as the U.S. Supreme Court decides the constitutionality of Texas abortion laws that are already in place in the Show-Me State.
The court heard arguments Wednesday on laws that require doctors who perform abortions to have privileges at a nearby hospital and require abortion clinics to meet the safety standards of outpatient surgical centers, both rules that have been on the books in Missouri for at least a decade.
Opponents of the laws say they place an undue burden on women seeking an abortion by reducing the number of providers able to meet the requirements. Supporters say the laws reinforce the state’s legitimate interest to protect the health and safety of women.
In 1986, Missouri became the first state to require abortion clinics to meet the same regulations as outpatient surgical centers. Since 2005, it has required that doctors performing abortions have privileges at a nearby hospital, also a first in the nation. Both laws have withstood legal challenges.
“Missouri has been almost like a test state for abortion restrictions,” said Pamela Merritt of St. Louis, co-director of the abortion rights group Reproaction. “These regulations are not about protecting patient health and safety. They are designed to close abortion clinics.”
The number of abortion providers in Missouri, including clinics, hospitals and doctors’ offices, reached a high of 29 in 1982. In 1992, there were 12. Now there is one abortion provider, a Planned Parenthood clinic in St. Louis, making Missouri one of five states with a single clinic.
Court observers say if the court strikes down the Texas laws, it opens the door for challenges in other states. If the court upholds the laws, similar laws in other states would be protected.
A more likely scenario is a 4-4 tie following the death in February of conservative Justice Antonin Scalia, considered likely to have tipped the vote to the anti-abortion side. The tie would leave the lower appeals court ruling in place, and uphold the laws in Texas and the other states in its circuit, Louisiana and Mississippi. Under a tie, the laws in Missouri and other states outside the circuit could still face legal challenges because it wouldn’t set a national precedent.
The laws in question are known as targeted regulation of abortion providers, or TRAP laws, a strategy of abortion opponents to use the legal system to create obstacles to the procedure with the stated intent of improving the health of women. More than 200 such restrictions have been passed by states in the past five years, including a 72-hour waiting period in Missouri.
Brian Westbrook, director of Coalition for Life St. Louis, said the standards for abortion providers “are just very basic common sense items that are in place to protect women.”
Missouri has long been at the forefront of the national abortion battle, including several key U.S. Supreme Court decisions:
- The court struck down Missouri laws requiring parental or spousal consent prior to an abortion in the 1976 case Planned Parenthood of Central Missouri v. Danforth. The laws were considered unconstitutional because they “delegated to third parties an absolute veto power which the state does not itself possess.”
- The court struck down a state requirement that second trimester abortions be performed in a hospital in 1983’s Planned Parenthood v. Ashcroft.
- In a pivotal 1989 case, the court upheld Missouri’s ban on abortions performed in public facilities or by public employees. At the time, abortions were performed at the University of Missouri’s medical school in Kansas City. The decision in Webster v. Reproductive Health Services enabled states to enact abortion restrictions and is considered the first major blow to Roe v. Wade, the 1973 case that determined a woman’s right to privacy under the Constitution included abortion.
The preamble to Missouri’s abortion laws, signed by Gov. John Ashcroft in 1986, says: “the life of each human being begins at conception; unborn children have protectable interests in life, health, and well-being.” The language is intended to guide Missouri legislators in their decisions on abortion laws. The preamble was upheld as part of the 1989 Webster case at the Supreme Court, because it didn’t directly place restrictions on abortion.
Missouri now has the nation’s sixth most stringent abortion laws, according to rankings by Washington-based Americans United for Life. The group writes sample legislation on abortion restrictions for state lawmakers. The group’s model language has been used in current proposed bills in Missouri involving bans on abortion after a fetal diagnosis of Down syndrome and requiring a parent’s notarized signature to consent to an abortion for a minor.
Abortions in Missouri have been steadily declining from a high of 19,482 in 1985 to 5,416 in 2013, the latest data available from the state health department. An additional 3,324 Missouri residents sought abortions in 2013 in other states, including Illinois and Tennessee, where the laws are less strict. A Planned Parenthood clinic in the Kansas City suburb of Overland Park, Kan., also serves women from Missouri.
According to Planned Parenthood, women travel an average of 100 miles round-trip for an abortion at the St. Louis clinic, and at least two visits are required by law. Abortions induced by medications are on hold at a second Planned Parenthood clinic in Columbia after the University of Missouri hospital revoked privileges for the clinic’s abortion provider.
The laws requiring physicians to have hospital privileges and that clinics function as surgical centers do not benefit the health or safety of patients and may harm women by delaying their abortions, according to briefs filed in the latest Supreme Court case by the American Medical Association and the American Congress of Obstetricians and Gynecologists.
The rate of serious complications from abortions is less than one-half of 1 percent, according to the Guttmacher Institute of reproductive health.
Other procedures with higher complication rates including liposuction, colonoscopies and oral surgeries are not required by law to be performed in surgical centers and are often completed in doctors’ offices. The most common type of abortion procedure, dilation and curettage, is the same procedure commonly performed after a woman suffers a miscarriage to clear the uterus. There are no laws regulating where or by whom the procedure must be performed when it involves a miscarriage. “We have to comply with these laws not because they make women healthier, but because of the politics of our state,” said Dr. David Eisenberg, medical director of Planned Parenthood in St. Louis.
Scott Keller, the attorney representing Texas at the Supreme Court, argued that abortion can be treated differently by legislators because of the public’s concern of the issue. In its brief to the Supreme Court, Americans United for Life states that abortion requires distinct oversight “because no other procedure involves the purposeful termination of potential life.”