Missouri Abortion and Reproductive Care

If you have been reading my posts here on The Pulse, you know about this series, in which we  exploring United States in the aftermath of the Supreme Court of the United States (SCOTUS) decision on the Dobbs versus Jackson Women’s Health Organization abortion case. The Dobbs case involved Mississippi’s Gestational Age Act. Written to prohibit all abortions subsequent to 15 weeks gestation, with very few exceptions, the Mississippi was upheld in the highest court of the United States, but the ramifications have extended far beyond the borders of that one state. The majority opinion in Dobbs, representing the views of five of the nine SCOTUS justices, overturned the 1973 Roe v Wade decision. This means that SCOTUS no longer agrees that the US Constitution, by way of the Due Process Clause of the Fourteenth Amendment, protects privacy in a way that should prevent all states from prohibiting abortion. Consequently, the US is now a patchwork of differing legal situation surrounding reproductive care, which includes abortion, fertility treatment, and contraception.

Now, various pro-choice states, including New York, Connecticut, Illinois, Oregon, and Washington have been extremely supportive of abortion rights, as they were prior to Dobbs, but now are welcoming abortion seekers from other US states. Some pro-choice states, such as Oregon, even have budgeted funding to support travel and lodging for women who arrive from anti-abortion states. Additionally, there are organizations that help abortion seekers obtain funds to support travel and lodging. Sadly, the state that we’re discussing today, Missouri, the “Show Me State”, is not among these supportive states. In fact, the situation surrounding reproductive care and rights in Missouri is as bad as it can get. Prior to Dobbs, Missouri had a trigger law on the books a law that went into effect, triggered by the overturning of Roe. Abortion is prohibited throughout Missouri, throughout pregnancy. There is no point during pregnancy when Missouri would permit you to receive an abortion, and there are no exceptions for rape or incest.

But there is one thing about Missouri that could make things a little easier for abortion seekers compared with some other states with similar laws. Missouri is surrounded on three sides by states where abortion is legal. On the northern side, while Iowa and Nebraska both have anti-choice activists and politicians trying to end abortion, these states currently allow abortion up to 20 weeks of gestation. Moreover, Missouri’s east two major metropolitan areas, St. Louis and Kansas City both are located along a border with a pro-choice state. Abortion seekers in and around St. Louis, and anywhere in eastern Missouri can cross the Mississippi River into Illinois, where abortion is legal up to the point of fetal viability (24-26 weeks). Abortion seekers in and around Kansas City, Missouri can go to the neighboring city, Kansas City, Kansas, where abortion is legal up to 21 weeks and 6 days. Those in the southwest region of Missouri can travel to Wichita, Kansas, and those in the northwest can travel to Omaha or Lincoln, Nebraska, plus Des Moines, Iowa is close to all parts of northern Missouri.

If you live in Missouri, keep in mind that the anti-choice movement and its politicians realize that your state is surrounded by places that you can do to receive abortion care. Consequently, since March they have been trying to change the laws in ways that would either allow private citizens in Missouri to sue anyone who helps a Missouri resident obtain abortion care out-of-state. With the approaching November election, stay informed on the political situation and make sure to vote for leaders who would work to prevent the passage of any laws that would attempt to place obstacles to travel for abortion care. Practically speaking, it would be difficult to stop women from obtaining abortion out of state. While most of Illinois’ abortion providing facilities are in the Chicago area, there are also abortion clinics in the small cities directly across the river from St. Louis. Even if they are able to change things to that private citizens could sue people for helping Missouri residents obtain abortions, you can take public or private transportation across the border without telling anyone the reason for your trip. To stop this from happening, the state would have to mandate that all women of reproductive age take a pregnancy test prior to leaving the state and take another pregnancy test after returning. Such a scenario would be entirely impractical, even were enough people in the state legislature so disrespectful of basic privacy as to pass such a law.

In states where abortion is legal, you can have a medication abortion up to a gestational age of 77 days (11 weeks), but otherwise there are procedure abortions, meaning that the provider works with instruments to terminate the pregnancy. One such procedure is called a D&C, which stands for dilatation and curettage. Curettage is a kind of scraping of the inner lining of the uterus. Extracting a pregnancy, either viable or not, is only one of several reasons for performing a D&C. D&Cs can be performed for diagnostic reasons, such as when there’s a suspicion of abnormal cell growth in the endometrium. Therapeutic D&Cs can be performed for removing products of conception, but also for removing overgrowth of the uterine lining. D&C by itself is adequate only early in pregnancy, so after a certain point the next option is dilatation and suction. This means that, after the cervix is dilated, the doctor suctions out the products of conception.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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