ELISSA NADWORNY, HOST:
This week, I traveled to Missouri, where abortion access is in limbo. Voters there passed a constitutional amendment last month to allow abortion up to the point of fetal viability - usually about 24 weeks into a pregnancy. That new amendment technically went into effect this week, but so far, clinics haven't started abortion care. That's because there are a number of state laws and regulations still on the books restricting it, including a near-total ban, even in cases of rape or incest. Abortion rights supporters went to court this week to ask a judge to block those laws from being enforced. A ruling is pending. And since the judge has yet to issue her ruling, clinics that have abortion facilities...
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NADWORNY: ...Like the Planned Parenthood Central West End Health Center in St. Louis that I visited, are still on hold.
COLLEEN MCNICHOLAS: These are our three procedure rooms.
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MCNICHOLAS: And as you can see, they look essentially like your OB-GYN's office.
NADWORNY: Dr. Colleen McNicholas, an OB-GYN at the clinic and the chief medical officer for Planned Parenthood Great Rivers, gives us a tour of the space.
MCNICHOLAS: So right now we're standing in the recovery room.
NADWORNY: A dozen or so brown medical recliners sit empty. We continue down the hall.
MCNICHOLAS: This is a small waiting room here. Back when we had - were seeing several thousand patients for abortion care, we did have...
NADWORNY: But then Missouri doubled down on laws and regulations that made it very difficult to get one. That was before the U.S. Supreme Court's Dobbs decision overturned the federal protections that made abortion legal and accessible across the U.S. and before the state's near-total ban. Planned Parenthood says in 2021, there were only about 150 abortions statewide.
MCNICHOLAS: When I was born, the state of Missouri had more than two dozen places to get an abortion. By the time I started my medical training at the university here, there were less than a handful. And by the time I was fully practicing as an OB-GYN, there was two. For the couple of years before the Dobbs decision, there was one, and you're standing in it.
NADWORNY: That doesn't mean Missourians have stopped seeking abortions. In fact, in the last six months of 2023, about 6,000 people from Missouri traveled out of state to access abortions. That's according to data from the WeCount project, which supports abortion rights. Mostly, they traveled to neighboring states like Illinois and Kansas. Here's McNicholas.
MCNICHOLAS: The need for abortion has never been driven by its legality. Missourians were getting abortions, just not in this state.
NADWORNY: This clinic in St. Louis has partner clinics just across the Missouri River in Illinois, a 15-minute drive away. They'll set up an appointment for you and also provide a ride. But last month, voters approved an amendment that says, in part, quote, "the government shall not deny or infringe upon a person's fundamental right to reproductive freedom." It specifically includes abortion care in that. It was one of a handful of Republican-led states that voted in support of abortion rights this fall. How that new amendment will impact those old laws is now in front of a judge. And it's not just the total ban that's still on the books, but also things like a 72-hour waiting period, a law that requires only doctors - and not certified midwives or nurse practitioners - to perform abortions and a ban on using telehealth to access abortion medication. The Republican attorney general aims to keep enforcing some of those laws. Here's Missouri Solicitor General Josh Divine after the hearing this week.
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JOSH DIVINE: I'm hoping the judge will just let this go to trial as cases normally do, and we'll be able to show why the other side is not going to win. I mean, we're going to take everything through appeals and fight this all the way.
NADWORNY: One of the state's arguments is that the right to reproductive freedom includes the right to childbirth, so preventing abortions is part of that. They argue, without these restrictions, like the waiting period, it may infringe on a woman's right to give birth, or with fewer regulations, women might be pressured to get an abortion. Outside the courts, Republican lawmakers have already introduced efforts to return the question of abortion restrictions to voters for next year. Sam Lee is a lobbyist who opposes abortion and who has worked in Missouri for decades. He notes the amendment passed last month with just under 52% support.
SAM LEE: Because Missouri was so close, that many of us in Missouri think we could overturn this if we come up with the right language to put in the Constitution. But we'll have to see.
UNIDENTIFIED PROTESTER: Our Father, who art in Heaven, hallowed be thy name. Thy kingdom come...
NADWORNY: Back at the Planned Parenthood clinic in St. Louis, protesters who oppose abortions have assembled outside.
BRIAN WESTBROOK: We stand here in prayer, and we stand here in vigil to ask God to intervene for those women.
NADWORNY: Brian Westbrook is the founder of a group called Coalition for Life.
WESTBROOK: We are both a prayerful group, but also we provide those real tangible resources.
NADWORNY: People from the group are handing out flyers advertising an abortion reversal hotline and information on crisis pregnancy centers. Back before the total ban, protesters came daily. After the law took effect, they stopped coming. But with the new amendment, they're back.
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NADWORNY: Inside the clinic...
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UNIDENTIFIED STAFF MEMBER: Thanks. Thanks.
NADWORNY: ...Staff members are stacking up abortion medicine that just came in, sorting them and storing them in cabinets.
LAQUETTA COOPER: This is mifepristone, and this is miso - the medication abortion.
NADWORNY: Dr. McNicholas is also getting consent forms ready, informational pamphlets and brightly colored laminated tags.
MCNICHOLAS: These are just, like, little placards we would attach to the patient's chart.
NADWORNY: Does this feel like you're kind of, like, opening a time machine?
MCNICHOLAS: A little bit, sort of, right? I mean, it's been a couple of years since we've done abortion care back here.
NADWORNY: The majority of abortions in the U.S. are done using medication, and they expect that to be true here, too.
MCNICHOLAS: So in order to start tomorrow, we have to have the medicine. So we're just sort of restocking and making sure we have everything ready for patients tomorrow.
NADWORNY: They're optimistic they can provide safe and efficient abortion care soon. McNicholas says she's used to the wait - and the start and stop - of abortion access.
MCNICHOLAS: Are we going to face more fight? Yes. Do we anticipate that the state is going to try and restrict and limit and attack access? Yes. But that's a fight that we have fought before, and we will be ready to do it again.
NADWORNY: For now, she says, her staff will be ready whenever the order from the judge comes down.
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NADWORNY: This story was produced by NPR's Marisa Peñaloza.
(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.
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