The lawmaker who represents Christian county in the Missouri state legislature has little doubt as to why there is just one remaining abortion clinic in his state.
“They don’t exist right now because, over the years, other ones have been closed because there’s no demand for them,” said Kevin Elmer, a Republican member of Missouri’s House of Representatives. “There’s nothing that precludes anybody from opening multiple abortion clinics around the state.”
That’s not strictly true.
Elmer is the architect of the latest piece of legislation in a legal war of attrition to limit access to abortions in a state that already has some of the toughest in the US. The latest restrictions have contributed to the closure of three abortion clinics in Missouri since 2011, and the only one that remains is in St Louis.
The latest bill, which Elmer described as “the pinnacle of my legislative career”, requires any woman seeking a termination in Missouri to attend an initial consultation, during which she is presented with materials designed to discourage abortion, and then to wait at least 72 hours before the operation. Missouri is one of only three states with such a lengthy waiting period.
“I think that those that are adamant about having an abortion performed are going to go through with it,” said Elmer. “But there are a great deal of stories, personal testimony, of situations where you’ve got a mother and perhaps there are some outside influences that are pressuring her and 72 hours gives her more time to reflect on that, gives her more time to discuss the options with other family members and alleviate some of those pressures.”
The state’s Democratic governor, Jay Nixon, vetoed the measure because it did not include an exemption for pregnancies through rape or incest, the lack of which he described as “extreme” and “a callous disregard for women who find themselves in horrific circumstances”. But the legislature overrode him and the law took effect this month.
Elmer said he sees it as another step towards putting Missouri’s last abortion clinic out of business.
“I don’t view abortion as a choice that should be out there,” he said. “I think that it’s reasonable to expect that, for those that are against any abortion at all, you’re going to see them continually try to change the playing field that would favour mothers choosing to keep their children. Does this piece of legislation end the battle? No. It’s just another step in where we’re progressing to.”
Paula Gianino, the president of Planned Parenthood for St Louis and Southwest Missouri, which runs the remaining clinic, described Elmer as part of a faction of the Missouri legislature “completely obsessed with this issue”.
“Every year, and especially in the last three years, we’ve had 30-plus anti-choice, anti-women House bills introduced in the legislature. We fight them back,” she said. “We are the only provider of abortion care in the entire state of Missouri because of the laws. Virtually everything you see happening in Texas, with ambulatory surgery centre laws, with physicians having to have hospital privileges, with waiting periods, we’ve had these in effect in Missouri for decades. There used to be other providers and they closed because of these laws.”
Missouri legislators have used tactics similar to those seen in other states including Texas where the US supreme court earlier this month blocked the enforcement of some new measures, including onerous building code requirements for abortion clinics. Still, the number of clinics has fallen sharply in the state and across the US as legislatures passed more than 200 restrictions on abortion over the past three years.
Members of the Missouri legislature are pushing still more restrictions: under consideration are bills requiring a woman to view an ultrasound of her unborn child before an abortion, allowing medical institutions to refuse emergency contraception to women who have been raped and giving financial benefits to organisations that use what Planned Parenthood calls “religiosity, misinformation, and unfulfilled promises of assistance to persuade women to continue their pregnancy”.
The day after the US Congress passed President Obama’s health reforms in 2010, the Missouri legislature waded in with a law that barred any insurance plan, private or public, from offering abortion coverage.
“The Missouri legislature has never acted so fast on any issue,” said Gianino.
That followed an earlier law that sought to force women who wanted an abortion to tell their employers, if their health insurance was through their place of work.
Missouri already required a 24-hour waiting period for terminations. Elmer said the tripling of the waiting time was necessary to give women time to absorb the additional information – or propaganda as pro-choice advocates see it – they are now required to view.
“When they first implemented the 24-hour waiting period we didn’t have all the additional restrictions that were added a few years ago – well, requirements is what it was – where the doctors and people performing the procedures have to provide a great deal of information to the mother for her consideration,” he said.
Gianino said the impact of the law will not be so much to reduce the number of abortions as delay them. She said that when the 24-hour waiting period was introduced eight years ago, Planned Parenthood saw an increase in later terminations.
“Three days matters a great deal. Three days becomes longer for some women, it forces women to have abortions later in pregnancy which quite honestly is against all medical advice and it’s really against common sense and public sentiment,” she said.
Pro-choice activists acknowledge that the new requirements do not in themselves constitute an insurmountable obstacle for most women. But combined with a slew of other restrictions – from a bar on private medical insurance paying for abortions in Missouri to expensive requirements for surgeries – it is becoming increasingly difficult to obtain terminations, particularly for women forced to travel considerable distances to reach the only clinic.
The Republican state senator John Lamping, the sponsor of a law to block a federal requirement that health insurance include contraception, said it may be true that the law imposes financial hardship and makes it more difficult to obtain an abortion but that is its intent.
“I understand the argument they’re making but what the legislation sets to do is decrease the number of abortions. If that’s a burden it may place on a woman in respect to having to wait for 72 hours, I’m sure that pro-life groups would say that, whatever the financial cost is, if it means less children are aborted it’s well worth the costs,” he said.
Lamping points to figures showing falling number of abortions in Missouri as evidence that the laws are having the intended effects. The number of terminations has been falling, as in other states. The Planned Parenthood clinic performed about 5,900 abortions last year. Gianino says the drop is attributable in large part to better education about and access to contraception.
Anti-abortion protesters outside the entrance to Planned Parenthood in St Louis – what they call the “funnel for all the abortions in Missouri” – describe the new law as a “huge victory for life”.
“The Missouri legislature has done an amazing job of considering the needs of women,” said Mary Serafino of the Coalition for Life. “I’d like to see abortion outlawed and this place closed down.”
But the US supreme court may yet prove an obstacle to that ambition. Mississippi’s legislature has tried to close the state’s only abortion clinic with a law requiring its doctors to have admitting privileges at a local hospital but a federal court blocked the move in July on the grounds it would “effectively extinguish” a woman’s constitutional right to an abortion within Mississippi’s borders.
Elmer is not deterred.
“I hold out hope that it would happen one day. I don’t think it’s going to happen tomorrow or next year or two years from now. I think that attitudes continue to change with regard to the issue of abortion. I hold out hope that we shift that to the point where the law’s changed totally. But I don’t think that it’s going to happen tomorrow,” he said.
Asked if attempting to shut down St Louis’s last abortion clinic doesn’t intrude on constitutional rights, Lamping was uncertain.
“I don’t have the capacity or the wherewithal to understand it from a constitutional perspective. I don’t know. That’s something for attorneys and the courts,” he said.
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