The landscape of abortion rights in Missouri is now in the hands of a Jackson County Circuit Court judge weighing a critical decision for reproductive rights.
Over 10 days of testimony, Judge Jerri Zhang heard from regional Planned Parenthood leadership, insurance experts, medical ethicists, doctors and nurses who spoke passionately about the care they provide, and women who regretted getting the procedure. The trial painted a vivid and emotional picture of abortion care in Missouri over the past few decades.
“We presented facts and evidence and testimony that really solidifies what Missouri voters put into our constitution just over a year ago,” American Civil Liberties Union of Missouri Legal Director Gillian Wilcox told the judge, “which is that abortion is health care.”
While both sides disagreed on the laws, attorneys from the plaintiffs and defense agreed the case comes down to which laws are common sense for women’s health, and what the burden of proof is — something both sides emphasized in closing arguments Monday.
“Look very carefully at the black letter text of the law, not how plaintiffs have characterized it,” said Peter Donohue, deputy solicitor general for Missouri. “Simply apply the stories you’ve heard, stories of the actual women who’ve had an abortion.”
A decision could take some time. Zhang has allowed both parties until April 10 to submit post-trial briefs. Part of the matter Zhang will need to interpret is what Missourians voted for in November 2024, when they passed a constitutional amendment to legalize abortion up to fetal viability.
State attorneys framed that result as voters wanting abortion to be available but regulated. Planned Parenthood attorneys told Zhang those guardrails already exist within medical standards and that voters want unfettered access.
While that amendment is currently in effect, many state regulations on abortion providers are still in place. Some were temporarily blocked by Zhang in a series of decisions over the past year, allowing procedural abortions to resume. Medication abortions remain on hold, but Planned Parenthood is seeking a more permanent resolution to that matter.
In addition to a near-total state abortion ban that went into place following the overturn of Roe v. Wade, Planned Parenthood and the American Civil Liberties Union of Missouri are suing to get several other laws off the books, including requirements that:
- clinics providing abortions be within 30 miles or 15 minutes of a hospital where the clinic’s doctors have admitting privileges;
- pelvic exams be performed before every procedure, even medication abortions;
- restrict the use of telemedicine for medication abortions;
- a complication plan be created for medication abortions;
- providers offering medication abortion carry tail insurance effective for 21 years after an abortion takes place.
If Zhang strikes down these laws and others like them — particularly ones limiting medication abortion, telemedicine, and the tail insurance statute — abortion access could immediately expand.
Protections or restrictions?
During the first week of trial, the main focus was on Planned Parenthood health care providers, who told the judge about being accosted by protestors while shepherding patients to their car, and detailing how state regulations made it increasingly difficult for women to access needed care.
The second week turned to state witnesses, who painted a very different picture. Among them were several women who sought abortions, some decades ago, before providers and clinics were more heavily regulated.
Former Kansas City resident Stephanie Jacobson told the judge Tuesday of last week that she had her first of two abortions in 1978, when she was 16. She said she never really had a chance to interact with the provider, outside of a recollection of the doctor telling her to lay still.
Later, she attended an abortion recovery program, many of which are run or funded by anti-abortion organizations.
“My decision took a toll on my life with the anger, shame and guilt, feeling loneliness,” she said. “I couldn’t speak about it with anyone for several years.”
Jacobson later founded Bulletproof Alliance, whose mission, according to their website, is to “make abortion inconceivable.”
Another witness for the state, Crystal Lane, told the court Wednesday that she had an abortion in 2009, during a divorce, because she didn’t want to bring a child into a volatile situation.
Lane said she wasn’t coerced into the procedure and she went to a pregnancy crisis center prior, where she noted she was informed of alternatives. But, Lane said, at Planned Parenthood, she “wasn’t told how it would affect” her. She recounted troubles with drug and alcohol addiction, which she said she dealt with prior to and after the procedure.
Both Jacobson and Lane testified that a current state law that requires abortion providers to give an informed consent packet written by the Missouri Department of Health and Senior Services would have been valuable to them. The packet includes detailed drawings, and statements about when life begins and when a fetus feels pain.
Doctors from Planned Parenthood and organizations like the American College of Obstetricians and Gynecologists say the guidance in the packets is rife with misinformation that could violate patient-provider trust.
Planned Parenthood attorneys also cast doubt on the qualifications, ideologies, and anti-abortion associations of state experts, including some who claimed giving birth would be better for a patient's mental health than getting an abortion, even for girls as young as 10 years old or the victims of rape.
State experts also testified to the value of a 72-hour waiting period between the initial appointment and an abortion.
“People find themselves in situations where they see a commercial, or feel a pain, and think they know what they want,” said hospital and palliative care Dr. Farr Curlin, who teaches bioethics and medicine at Duke University. “It can take time to explain to people what they have, what all the options are, and then to make sure the patient really understands.”
Curlin also told the judge he does not believe abortion is ever ethical, except to save a mother's life. He described medication abortion as poison.
Will state regulations stand?
State regulations require clinics that provide abortions to meet certain physical requirements, like hallway and door size or the type of changing room available, for which DHSS regularly must inspect. Planned Parenthood employees told the judge these inspections were intense and overly frequent, exceeding the same standards applied to other health care.
In her testimony, Planned Parenthood facilities manager Vicki Casey said John Langston, a DHSS employee who leads the team conducting these investigations, told her by phone that they faced scrutiny that went above and beyond what was normal.
On the stand, Langston did not recall the conversation, but did note he once expressed frustration to supervisors about the process.
“It was taking up a larger amount of my time than I had anticipated,” he said.
According to Langston, inspections of abortion facilities occurred yearly, while facilities like ambulatory surgical centers only had inspections every 3 to 4 years. He also said many of the inspections were in response to unfounded complaints by anti-abortion protestors.
Whether these types of rules serve a common-sense purpose or they only seek to impede access to health care is now up to Zhang, and any decision is likely to be appealed.
And even if this court decision does expand abortion access in Missouri, this year’s November ballot will include a measure that would undo the 2024 amendment voters approved.
“While we wait for a decision, procedural abortion is legal and available in Missouri,” said Planned Parenthood Great Rivers CEO and President Margot Riphagen. “Folks can make appointments online.”
