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Denise Baker, a reproductive health assistant at Planned Parenthood Great Plains prepares patient paperwork behind the clinic’s front desk on June 21, 2024, in Overland Park, Kansas(Anna Spoerre\/Missouri Independent).<\/p>\n
Planned Parenthood and the Missouri Attorney General\u2019s Office agree on one thing: abortion is legal in Missouri.<\/span><\/p>\n That\u2019s where the agreement ends.<\/span><\/p>\n A 10-day trial that wrapped Monday in Kansas City laid bare decades of conflict over the state\u2019s abortion laws. Dozens of restrictions \u2014 targeted regulation of abortion providers, or TRAP, laws \u2014 are being challenged as unconstitutional under Missouri\u2019s voter-approved reproductive rights amendment.<\/span><\/p>\n The outcome of this case will determine the future of abortion access in Missouri. In the months ahead, Jackson County Judge Jerri Zhang will decide which restrictions survive\u2014 and which vanish.<\/span><\/p>\n Eleanor Spottswood, an attorney with Planned Parenthood Federation of America, argues the laws were designed to result in abortion being \u201cregulated out of existence.\u201d She described rules that create logistical nightmares for patients and ethical dilemmas for providers \u2014without making procedures safer.<\/span><\/p>\n Assistant Solicitor General Alexandria Overcash pushed back, calling Missouri\u2019s abortion regulations\u00a0 \u201cbasic, common sense requirements\u201d necessary to protect patients.<\/span><\/p>\n Here is a look at some of the key arguments presented in court over the last two weeks.<\/span><\/p>\n <\/strong><\/p>\n \t<\/p>\n A physician is <\/span>required<\/span><\/a> to distribute <\/span>Missouri\u2019s informed consent booklet <\/span><\/a>to patients prior to an abortion. This booklet begins with the statement: \u201cThe life of each human being begins at conception. Abortion will terminate the life of a separate, unique, living human being.\u201d<\/span><\/p>\n This law is temporarily blocked by an injunction issued by Zhang in July.<\/span><\/p>\n Several witnesses called by the attorney general\u2019s office testified that abortion can have negative impacts on mental health. Three women discussed abortions they had in the 1970s and 80s, and each described either having thoughts of self-harm or actually attempting suicide after struggling with depression, anxiety and nightmares.<\/span><\/p>\n Multiple long-term studies have found no strong relationship between negative mental health outcomes and abortion, instead saying it <\/span>varies by personal and social context<\/span><\/a>. The more common negative mental health outcome, researchers say, is one of shame from feeling judged by family and friends.<\/span><\/p>\n The women who testified about their abortions also said if they had been given an informed consent booklet and had seen pictures of fetal development, they wouldn\u2019t have gone through with the procedure.\u00a0<\/span><\/p>\n The booklet also contains a section suggesting a fetus can feel pain as early as eight weeks. This claim is not supported by scientific study. The <\/span>American College of Obstetricians and Gynecologists says a multitude of studies have established that fetuses cannot feel pain until<\/span> closer to viability<\/span><\/a>, around 24 weeks of pregnancy.<\/span><\/p>\n Witnesses called by Planned Parenthood testified that the state-mandated language is medically inaccurate, and that reading it to women harms the patient-provider relationship.\u00a0<\/span><\/p>\n <\/strong><\/p>\n \t<\/p>\n Patients are <\/span>required<\/span><\/a> to have an initial appointment at least 72 hours prior to having their abortion. At this appointment, a doctor walks them through the state\u2019s informed consent language.<\/span><\/p>\n This law is temporarily blocked by an injunction issued by Zhang in July.<\/span><\/p>\n The attorney general\u2019s office said this \u201creflection period\u201d is crucial to ensure a woman has time to consider all her options, and to make sure she\u2019s not being coerced into an abortion.\u00a0<\/span><\/p>\n Dr. Margaret Baum, chief medical officer with Planned Parenthood Great Rivers in the St. Louis region, testified that the waiting period made it exceedingly difficult to coordinate care, especially for those traveling to the clinic from other parts of the state.\u00a0<\/span><\/p>\n <\/strong><\/p>\n \t<\/p>\n The <\/span>law<\/span><\/a> requires the same physician who conducts the initial appointment must also perform the abortion no sooner than 72 hours later, and that only physicians may perform the procedure.<\/span><\/p>\n This law is temporarily blocked by an injunction issued by Zhang in July.<\/span><\/p>\n The state said this is necessary to ensure continuity of care for patients and maintain physician oversight for a procedure it considers uniquely complex.<\/span><\/p>\n Planned Parenthood witnesses argued the law sharply limits access, especially in rural areas where clinics often lack full-time OB-GYNs.\u00a0\u00a0<\/span><\/p>\n Advanced practice clinicians, such as nurse practitioners and midwives, are permitted to perform abortions in Illinois and deliver babies in Missouri without a doctor present.\u00a0<\/span><\/p>\n <\/strong><\/p>\n \t<\/p>\n Under this <\/span>law<\/span><\/a>, abortion clinics are <\/span>inspected by the state health department<\/span><\/a>, which has the authority to revoke the license if any requirements are not met. This includes dozens of requirements, ranging from annual fire drills to infection control protocols and patient record-keeping.\u00a0<\/span><\/p>\n These requirements are temporarily blocked by an injunction issued by Zhang in July.<\/span><\/p>\n The Missouri Department of Health and Senior Services says if this requirement was struck down, the state would no longer have any oversight authority over abortion clinics, though patients could still file complaints to the Board of Healing Arts or any other professional state licensing boards.\u00a0<\/span><\/p>\n Peter Donohue, Missouri\u2019s deputy solicitor general, justified the requirement that hallways be six feet wide so a group of \u201cbig, burly EMTs\u201d can get through with a gurney during an emergency. The state also made note of a 2018 health inspection at the Planned Parenthood clinic in Columbia that found \u201cblack mold and bodily fluid\u201d in tubing.\u00a0<\/span><\/p>\n Witnesses called by Planned Parenthood disputed this characterization.<\/span><\/p>\n Emily Wales, president and CEO of Planned Parenthood Great Plains, which operates clinics in central and western Missouri, said these physical requirements, including recovery room specifications, have prevented her organization from expanding abortion availability outside of Kansas City and Columbia.\u00a0<\/span><\/p>\n EMTs know how to get patients out of any location, Baum testified, including homes and office buildings that don\u2019t have wide hallways.\u00a0<\/span><\/p>\n <\/strong><\/p>\n \t<\/p>\n As part of the <\/span>licensing process, <\/span><\/a>Planned Parenthood must submit a complication plan for approval by <\/span>the state health department<\/span><\/a>. This requires that an OB-GYN be on-call 24\/7 to treat any complications that arise after abortion medication is administered for patients who live within 25 miles of the clinic.\u00a0<\/span><\/p>\n For those farther away, clinics must have an agreement in place with a local physician.<\/span><\/p>\n Evidence presented at trial showed roughly <\/span>1% of the 53,000 Missourians<\/span><\/a> who had abortions at the neighboring Planned Parenthood clinics in Kansas and Illinois in the past decade experienced a complication.\u00a0<\/span><\/p>\n The state brought forward a bevy of witnesses who argued that abortion complications are undercounted and that such plans are necessary to protect women.<\/span><\/p>\n Planned Parenthood already has internal recommendations for addressing patient complications, Baum said, including a nursing line that\u2019s staffed 24\/7 to answer patient questions. She said prior to the abortion, patients are informed of possible complications and told to go to the closest emergency room if they feel there\u2019s a true emergency. Abortion complications are rare.\u00a0<\/span><\/p>\n These requirements are still being enforced, and medication abortion is not currently available in Missouri.\u00a0<\/span><\/p>\n <\/strong><\/p>\n \t<\/p>\n Abortion providers <\/span>must submit to a pathologist <\/span><\/a>all pregnancy tissue removed during an abortion for special review.<\/span><\/p>\n This law is temporarily blocked by an injunction issued by Zhang in July. Baum testified that Planned Parenthood\u2019s guidelines already recommend providers examine fetal tissue to confirm consistency with the estimated gestational age, and that sending tissue to pathology is standard practice when an abnormality is suspected.<\/span><\/p>\n The state said the requirement is necessary to catch any medical abnormalities, such as molar pregnancies, which require further treatment.<\/span><\/p>\n Wales testified that requiring every tissue sample to be packaged and mailed adds time and expense. About a decade ago, when her clinics were still performing procedural abortions under this statute, she said it added $40 per procedure, a cost that was passed on to the patient.\u00a0\u00a0<\/span><\/p>\n <\/strong><\/p>\n \t<\/p>\n The state\u2019s <\/span>licensing rules <\/span><\/a>\u00a0require physicians to perform a pelvic exam before administering mifepristone, the first step in a medication abortion, and at least72 hours prior to a procedural abortion.\u00a0<\/span><\/p>\n This law is temporarily blocked by an injunction issued by Zhang in July.<\/span><\/p>\n A <\/span>2019 memo<\/span><\/a> from the state health department explained that pelvic exams are used to gather information that \u201c<\/span>could influence the choice of the procedure or the method.\u201d<\/span><\/p>\n No OB-GYNs who testified for Planned Parenthood believed this requirement was medically necessary, calling it invasive and abusive. Because mifepristone is administered orally, Baum testified there\u2019s no medical reason for a patient to undress. Patients who are miscarrying, she noted, aren\u2019t required to undergo this exam before being prescribed the same medications.<\/span><\/p>\n <\/strong><\/p>\n \t<\/p>\n State law prohibits physicians from using telehealth to prescribe mifepristone and misoprostol, the medications used to end early pregnancies.\u00a0\u00a0<\/span><\/p>\n This law is still being enforced. Planned Parenthood leadership has said that if this law is enjoined, they are prepared to quickly begin prescribing medication abortion again.\u00a0<\/span><\/p>\n The state argued it\u2019s necessary for patients to first come to the clinic to have an ultrasound to confirm they don\u2019t have an ectopic pregnancy.\u00a0<\/span><\/p>\n In states allowing telemedicine abortion, Baum said, patients are first screened for ectopic pregnancy. Higher-risk patients, including those using IUDs, are directed to in-person care. She said medication abortion does not increase ectopic risks and may help detect them sooner.<\/span><\/p>\n Dr. Daniel Grossman, director of Advancing New Standards in Reproductive Health at the University of California-San Francisco, testified that rare complications occur only after the full two-drug regimen, not during the initial in-office dose of mifepristone.<\/span><\/p>\n <\/strong><\/p>\n \t<\/p>\n State law requires doctors who prescribe abortion medication to have an agreement with a local hospital allowing them to treat the same patient there if needed.<\/span><\/p>\n The state argued that because it\u2019s possible to be hospitalized following an abortion, such agreements guarantee the best care for patients. <\/span>Bleeding and cramping are expected side effects<\/span><\/a> of both medication and procedural abortions. Hemorrhaging and infection are among the rare complications.\u00a0<\/span><\/p>\nInformed consent<\/h4>\n
![\"\"](\"https:\/\/missouriindependent.com\/wp-content\/uploads\/2024\/03\/031224_antiabortion4-300x180.jpg\")
72-hour waiting period<\/h4>\n
![\"\"](\"https:\/\/missouriindependent.com\/wp-content\/uploads\/2026\/01\/IMG_9725-300x200.jpg\")
Same physician requirement<\/h4>\n
Abortion-facility licensing requirements<\/h4>\n
Medication abortion complication plans<\/h4>\n
![\"\"](\"https:\/\/missouriindependent.com\/wp-content\/uploads\/2025\/03\/IMG_8172-300x180.jpg\")
Fetal tissue pathology<\/h4>\n
Mandatory pelvic exams\u00a0<\/h4>\n
![\"\"](\"https:\/\/missouriindependent.com\/wp-content\/uploads\/2026\/01\/IMG_7653-scaled.jpg\")
Telemedicine ban<\/h4>\n
Admitting privilege and written transfer agreement\u00a0<\/h4>\n