A trial over Missouri’s abortion laws began Monday in the Jackson County Courthouse in Kansas City, Missouri. Experts are looking at a case that could impact abortion access in the Midwest and South. (Photo: Kevin Hardy/Stateline)
KANSAS CITY, Mo. — The outcome of a lawsuit over Missouri’s abortion laws could reach far beyond the state, potentially creating novel accessibility for women in the Midwest and South who cannot access abortion services close to home.
As a judge weighs constitutionality from a litany of state abortion restrictions, the stakes for Missouri women are clear: The decision could make abortion access harder for almost everyone in the state or vastly expand it in ways not seen in decades. It would allow women in a dozen nearby states with abortion bans to travel shorter distances to access the procedure.
“Opening and restoring rights in Missouri would help alleviate some of the pressure that other states have been under since so many Southern states have banned abortion,” said Julie Burkhart, co-owner of Hope Clinic in Granite City, Illinois. “It seems logical that we would see a change in patient migration patterns in the country.”
Burkhart said her clinic, about a 15-minute drive from downtown St. Louis, Missouri residents make up about half of all patients. Although Missouri voters in 2024 enshrined the right to abortion in the state constitution, access to it remained very circumscribed due to restrictive state regulations. Planned Parenthood’s three clinics in the state only offer procedural abortions.
Many of these state laws will face legal scrutiny this week when a Missouri judge considers the constitutionality of regulations targeting abortion providers. These include a 72-hour waiting period between initial visits and procedures, mandatory pelvic exams for medication abortions, and a ban on telemedicine visits for medication abortions.
It seems logical that we will see a change in patient migration patterns in the country.
– Julie Burkhart, co-owner of Hope Clinic in Granite City, Illinois, which provides abortion services to many out-of-state patients
Planned Parenthood chapters in Missouri say the state’s restrictions are unconstitutional under a voter-approved 2024 constitutional amendment. For decades, state restrictions destroyed Missouri’s provider networks, circumscribed appointment availability and ultimately forced a halt to abortions in 2022 before a circumscribed number of abortions resumed after the 2024 ballot.
Experts and advocates are closely monitoring the Missouri case, which is expected to be appealed regardless of the outcome because of its practical implications for access in the region. Although many women now rely on abortion medications, procedural abortion is still crucial for those who want to have an abortion at a later date or prefer the procedure in a clinic.
But the two-week jury trial in downtown Kansas City also tests lawmakers’ ability to enact laws so restrictive that they effectively ban abortion – a practice used by anti-abortion lawmakers in other states who want to restrict access to the procedure.
“Judges don’t operate in a vacuum,” Burkhart said, “… and we know for a fact that judges are looking beyond their state lines for information and guidance. I think this is of national importance.”
This is especially true in other states that also have disputes over abortion access, including Arizona, Michigan and Ohio, said Rebecca Reingold, associate director of the O’Neill Institute for National and Global Health Law at Georgetown University.
Although state judges are not bound by the rulings of judges in other states, their deliberations may be based on court rulings, particularly on novel legal issues or areas of law that are subject to change.
“There is no doubt that advocates and policymakers in other states facing similar legal challenges are closely monitoring the litigation over Missouri’s abortion laws,” Reingold said.
Restrictions on abortion
In the early days of the trial, Planned Parenthood leaders argued that ever-changing state laws and agency regulations drastically limit access, create unnecessary bureaucracy and pose risks to the privacy of their patients.
Dr. Margaret Baum, medical director of St.-based Planned Parenthood Great Rivers. Louis, stated that Missouri’s requirements apply specifically to abortion and not to any other types of medical care.
“I commercially perform vasectomies…And I don’t have to have a complication plan, contact a primary care physician, or even ask a patient how many miles they live from a health center.”
The opening day of Missouri’s abortion rights trial focuses on decades of state restrictions
Baum said state-mandated abortion reporting rules require clinicians to ask about each patient’s race, education level, marital status and location – and none of that information is relevant to her care.
Baum testified that Planned Parenthood Great Rivers would like to offer abortion services in Springfield. Access in this region would provide an option for rural Missourians and could also facilitate residents of nearby Arkansas, Oklahoma and Texas, where abortion is almost universally banned.
But the organization’s facilities there do not meet state abortion regulations in terms of physical features, including hallway size, door size and the number of seats in recovery rooms, Baum testified.
State attorneys defended Missouri’s restrictions as common-sense safeguards intended to protect vulnerable women. The attorney general’s office has argued that the risk of complications from abortion justifies additional state regulation – even though medical professional associations say it is generally protected. The AG’s office also argued that Planned Parenthood faced a conflict of interest because of its financial motivations.
“Abortion is a business,” Deputy Attorney General Peter Donohue said Monday during procedural arguments. “Your Honor, the plaintiffs are asking for the deregulation of their profession to make more money.”
It was expected that later in the trial, the state would call doctors and anti-abortion activists as witnesses.
Patients traveling for care
Since the U.S. Supreme Court’s June 2022 ruling that invalidated federal constitutional protections for abortion, the number of abortions nationwide has increased slightly, according to the nonprofit health research organization KFF.
The group points to an expansion of telehealth that could offer more affordable medication abortions through virtual visits.
Under the 2022 ruling and subsequent state abortion bans, patients experience higher travel costs for abortions and delays in health care. tests published in July in the American Journal of Public Health.
Researchers at the University of California, San Francisco found that travel times to access abortion increased from 2.8 hours to 11.3 hours for residents of states with abortion bans. Travel costs increased from $179 to $372. More than half of respondents said their abortion care required an overnight hotel stay, up from 5% before the abortion ban.
In 2024, an estimated 7,880 Missourians traveled to Illinois and 3,960 to Kansas to access abortion services. Guttmacher Institutea research and policy organization focused on promoting reproductive rights.
These Missourians were among about 155,000 people who crossed state lines to access abortion care this year, representing 15% of all abortions performed in states without blanket bans.
Constant uncertainty
Regardless of the outcome, the Missouri case is expected to be appealed. Even if the plaintiffs are ultimately successful, it could take a long time to restore the statewide care network, said Isaac Maddow-Zimet, a data analyst at the Guttmacher Institute.
“This is particularly the case in states where there is a lot of legal uncertainty or restrictions that go into effect and then expire,” he said. “It’s not a quick thing to open a clinic. It’s not even necessarily a quick thing to expand the type of services or the number of people the clinic can accept.”
Kimya Forouzan, the organization’s chief state policy adviser, said Missouri’s landscape is proof that lawmakers can drastically limit abortion access without enacting outright bans. And despite overwhelming votes to change the constitution, legal battles may ensue.
Forouzan said that even if state laws are deemed unconstitutional, lawmakers will likely continue to push anti-abortion measures. She noted that several bills have already been introduced in this year’s just-convened legislative session and that Republican lawmakers are pushing for votes means of repeal Reproductive rights amendment of 2024
“There is enormous pressure to pass as many restrictions as possible and see what happens after that and how things play out. … Time will tell, but we know they are continuing to push restrictions,” she said.
Stateline reporter Kevin Hardy can be reached at: khardy@stateline.org. Missouri freelance reporter Anna Spoerre can be reached at: asspoerre@missouriindependent.com.
This story was originally produced by state linewhich is part of States Newsroom, a nonprofit news network that includes the Ohio Capital Journal and is supported by grants and a coalition of donors as a 501c(3) public charity.
