In 2015, the Planned Parenthood clinic in Columbia reached out to every OBGYN in Missouri with a request. Would any of the doctors be willing to help provide abortion services?
The responses were similar, said Emily Wales, president and CEO of Planned Parenthood Great Plains, which operates the Columbia location.
“Could this affect my practice?” the physicians asked. “Could this put me at risk?”
No providers agreed to come on board, Wales outlined in testimony this week as part of a trial focused on the constitutionality of Missouri’s dozens of regulations on abortion clinics and providers.
Three days into the trial, witnesses have illustrated how layers of regulations enacted in recent decades by a legislature intent on pushing abortion from the state ultimately succeeded in “making compliance confusing or impossible, and abortion gradually unavailable,” said Eleanor Spottswood, an attorney with Planned Parenthood Federation of America.
The dearth of physicians willing to provide abortion services — and who could meet the state’s rules — played a significant role.
“There are very few abortion providers in the state of Missouri and this community in general,” Dr. Selina Sandoval, associate medical director at Planned Parenthood Great Plains, testified Wednesday. “We know that a lot of this is related to the criminal penalties and the constant harassment and threat that abortion providers are under. I experience this regularly, almost daily, when I’m working.”
Testimony has painted a timeline of providers often sent scrambling for support as they tried to gain or maintain licensure required through the Missouri Department of Health and Senior Services. By 2022, when a near-total abortion ban went into effect in Missouri, there was no longer any point.
In late 2024, Missourians enshrined abortion protections in the state constitution. Planned Parenthood and the ACLU of Missouri sued the state a day later with the goal of striking down a few dozen abortion regulations they say are now unconstitutional under the new amendment.
Last year, Jackson County Judge Jerri Zhang, who is presiding over the bench trial, agreed to temporarily block some of the regulations until a final conclusion could be reached at trial. This allowed Planned Parenthood to again begin providing procedural abortions at three locations: Kansas City, Columbia and St. Louis. Medication abortions remain unavailable due to regulations that remained in place ahead of trial.
Among the myriad abortion regulations passed by the state legislature over the years is a requirement that only physicians perform abortions.
Lifting this requirement and allowing advanced practice clinicians, including nurse practitioners, would double the number of abortion providers in the state, and could pave the way for offering abortion at additional Planned Parenthood clinics, Wales said in her testimony.
Another law requiring physicians to have admitting privileges and a transfer agreement at a local hospital has also greatly inhibited Planned Parenthood providers over recent years, providers testified.
In 2012, the Columbia clinic employed two doctors with admitting privileges at two local hospitals. But both ultimately left the clinic, Wales said, because of harassment. Protestors showed up at one doctor’s home, she testified. They also showed up at the other doctor’s private practice.
Similarly, Wales testified, Planned Parenthood tried and failed to recruit a specialized sonographer to either its Kansas City or Columbia clinics after a new state statute requiring these more skilled and more expensive professionals be used.
Meanwhile, Planned Parenthood’s relationship with the state health department became increasingly “combative,” Wales testified, saying that both planned and surprise on-site health inspections intensified over the years. Some staff resigned as a result, Wales said.
Sandoval’s testimony detailed how hospitals are wary of giving abortion providers admitting privileges because of politics and OBGYNs fear potential criminal penalties if they provide abortions.
Until the passage of the reproductive rights amendment, health care providers who performed abortions not deemed necessary under Missouri’s emergency exception could be charged with a class B felony, which means up to 15 years in prison. Their medical licenses could also be suspended or revoked.
By the time the U.S. Supreme Court overturned the constitutional right to an abortion in June 2022, there was only one clinic in Missouri still providing abortions.
Dr. Margaret Baum, chief medical officer with Planned Parenthood Great Rivers, based in eastern Missouri, Springfield and Illinois, was among the last doctors providing abortions there when Roe v. Wade was overturned.
Baum knows the risks. When she walks into work, she said protestors have called her name, as well as her husband’s, who is also an abortion provider. They have plans in place for their children in the event they are ever both prosecuted.
“When these laws came into place, we had a very serious discussion about whether or not we could continue to provide abortion in Missouri,” she testified.
The trial, which is expected to span 10 days, returns for the fourth day of testimony on Thursday. Attorneys for Planned Parenthood are expected to call more clinic employees to the stand.
