Missouri health officials’ efforts to shut down the last abortion clinic within state borders are “a denial of basic healthcare services”, the New York congresswoman Carolyn Maloney said at a House oversight committee hearing on Thursday.
Missouri took “extreme actions” to limit reproductive rights, the panel heard. Tactics included tracking patients’ periods and medically unnecessary pelvic exams, amounting to “state-sponsored abuse”, Maloney said.
“I cannot begin to describe my disgust at these violations of privacy and breaches of trust by government officials,” said Maloney. “Sadly, Missouri’s actions are not taking place in isolation. Other states have pushed for similar restrictions.”
Six US states have only one abortion clinic.
Starting last summer, Missouri’s health department ramped up administrative efforts to close a Planned Parenthood facility in St Louis. The state demanded interviews with physician interns at the clinic, and forced the facility to perform medically unnecessary pelvic exams.
Ultimately, the state denied the clinic its operating license. Clinic officials appealed to an administrative hearing court in Missouri.
There, the “pro-life” head of the health department, Randall Williams, revealed investigators made a spreadsheet including patients’ last known periods, in an effort to find incomplete procedures.
“Our primary goal has always been trying to keep these doors open,” Dr Colleen McNicholas, chief medical officer of the St Louis Planned Parenthood, said before her congressional testimony.
Requirements to perform unnecessary pelvic exams, in which doctors insert fingers into the vagina, “are asking us to violate medical ethics”, McNicholas said. “There has to be a line somewhere and this is the line.”
The state dropped the requirement that physicians perform additional pelvic exams after public outcry. In May, the health department told a conservative news site the medically unnecessary pelvic exam “heightens the safety of abortions”.
They do not, said the American College of Obstetricians and Gynecologists, calling the procedures “unwarranted, invasive and not supported by medical evidence”.
Republicans’ sole witness at the hearing was Allie Beth Stuckey, a podcaster and host at the conservative outlet Blaze TV. Stuckey has argued in the past that the issue of abortion is a “spiritual battle”, and there is “not a single good argument” for the procedure.
“There could be some very sophisticated academic arguments out there that I haven’t heard,” Stuckey said in a July episode of her podcast. “Now, I obviously would not find them persuasive, but maybe I would find them somewhat logical.”
Last summer, a slew of states including Missouri attempted to ban abortion before most women even know they are pregnant. The bans are patently unconstitutional and have been blocked in court. Abortion remains legal in all 50 US states.
Maloney said she believed “these states have been emboldened by the Trump administration’s systemic attacks on reproductive healthcare and general disrespect for women”. Since Donald Trump has taken office, his administration has systematically sought to restrict access to birth control and abortion.
The administration also sought to limit international aid for sexual health services including abortion, and has worked to have the phrase “sexual and reproductive health” removed from multiple UN agreements.
Since the US supreme court case Planned Parenthood v Casey in 1992, which found grounds for states to restrict abortions, states have worked to limit women’s access to abortion through so-called Trap laws, or “targeted regulation of abortion providers”.
In Missouri, women face expensive and time-consuming hurdles to obtain an abortion, thanks to state lawmakers’ efforts to “chip away” at access using this strategy. A woman who wants an abortion in Missouri must receive state-mandated counseling meant to deter her, then wait 72 hours between her first visit to a clinic and the time she can have an abortion.
Women cannot use private health insurance to pay for their abortion, nor can they use public insurance. Nor can women obtain an abortion if their stated reason is a genetic abnormality.
However, those are only legislative efforts to stop women from obtaining abortions. McNicholas said Missouri’s recent efforts represent a new front in state abortion deterrence: using the licensing process to end access.
“Although that was the strategy for the last 10 years or so in the midwest and the south, we have seen a much bolder approach,” said McNicholas. “The other piece is through the health department.”
In just one example, Planned Parenthood clinic director Kiwani Shannon testified in administrative court about an inspector trying to force the clinic to move a wall shelf, which had been approved by the state in 2018.
Williams, the head of Missouri’s health department, is a certified obstetrician and gynecologist who said he has never performed an abortion. Williams was appointed by a Republican governor in 2017. Previously, Williams worked in North Carolina, where he was caught up in a drinking water contamination scandal.