How one lawmaker and one university could leave Missouri with just one abortion clinic

The University of Missouri made headlines recently for student protests over campus racism. But another factor in those protests was a controversy over Planned Parenthood — one that will have major consequences for abortion access in the entire state.

An administrative decision by the university could have the startling effect of leaving the entire state of Missouri with just one abortion clinic as of December 1. The university also canceled decades-old contracts that allowed nursing students to learn gynecological practices (excluding abortion) by completing clinical rotations at Planned Parenthood. One graduate student has even come under fire from a state lawmaker for researching the state's new 72-hour abortion waiting period law.

Strangely enough, all of these incidents go back to the same Republican state lawmaker. The story of how and why that happened is in many ways the story of how anti-abortion legislators are steadily restricting abortion access nationwide — and perhaps a preview of what they might do next.

One state lawmaker used the university as a weapon against Planned Parenthood

Wesley Hitt/Getty Images

Missouri state Sen. Kurt Schaefer (R-Columbia) is the head of the state Senate's Sanctity of Life Committee, which is investigating claims made in doctored videos that Planned Parenthood is illegally "selling" fetal tissue. Missouri's Planned Parenthood clinics don't even participate in fetal tissue research, and since Missouri's attorney general and investigations in other states have already found no wrongdoing, Schaefer's inquiry seemed destined to be a dead end. But Schaefer is still investigating — and his critics argue that those investigations unjustly pressured MU into revoking Planned Parenthood's license to perform abortions at its Columbia location.

Planned Parenthood operates the only two abortion clinics in Missouri: one in St. Louis on the state's eastern border, and one in Columbia near the university in central Missouri. The Columbia clinic got licensed to operate this summer after its new physician obtained "refer and follow" privileges to University of Missouri hospitals. Doctors aren't allowed to provide abortions in Missouri unless they obtain admitting privileges — an arrangement between a doctor and a nearby hospital that lets the doctor admit patients there.

But Schaefer claimed that the clinic's refer and follow privileges weren't sufficient under state law. (The state's health department director disagreed with him on that.) Furthermore, Schaefer told Vox, a public facility like the University of Missouri should have no business helping abortion providers get licensed in the first place. That violates state law by using public funds to assist with abortion, he said.

If Schaefer is right about this, it would create a Catch-22 for Planned Parenthood. Whether he's right is debatable. Missouri state law does bar state employees from "performing or assisting an abortion" and "encouraging or counseling a woman to have an abortion." But Schaefer targeted Mizzou for something much less direct than that; he told Vox the university probably broke the law by "using itself as the catalyst" so that "abortions could resume" at the Columbia clinic.

Depending on whom you ask, Schaefer either did his due diligence as a lawmaker to investigate a potential violation of state law, or he abused his position as the chair of the Senate Appropriations Committee to explicitly threaten the university's funding unless MU cut its ties to Planned Parenthood. (It's the former if you ask Schaefer and the latter if you ask his opponents and critics.)

Either way, the outcome was the same. Schaefer and his committee urged the university to review its agreements with Planned Parenthood. University administrators, including soon-to-be-resigned Chancellor R. Bowen Loftin, did just that. They decided that both of the university's major partnerships with Planned Parenthood — the contracts with nursing students and the entire category of "refer and follow" privileges — were unnecessary and outdated, and they ended both.

Students and advocates were outraged about both actions, but canceling the hospital privileges was an especially big deal. Without them, the Columbia clinic's new physician, Colleen McNicholas, can't even prescribe an abortion pill. This will once again make the St. Louis clinic the state's only place to get an abortion of any kind, medical or surgical.

Planned Parenthood is putting pressure on Chancellor Loftin (who announced his resignation after the racism protests) to reverse this ruling before he leaves. Planned Parenthood is also not ruling out legal action if the university won't budge. Refer and follow privileges are anything but outdated and unnecessary, argued Planned Parenthood of Kansas and mid-Missouri president Laura McQuade, and moreover the university's decision violated federal law by discriminating against a qualified doctor who provides abortions.

There's some reason to think Planned Parenthood could succeed. The university has already agreed to let a handful of nursing students get clinical experience at Planned Parenthood again, although those contracts are fewer in number and more limited than before. And the Associated Press reported on Tuesday that the university is preparing documents so that McNicholas can reapply for privileges. But the process still takes months, and time is running out.

Then Schaefer used Planned Parenthood as a weapon against the university

(Andrew Burton/Getty)

When MU cut ties to Planned Parenthood, Schaefer celebrated getting the university "out of the abortion business." But he wasn't finished after this victory. A month later, he had another target for his investigations into "public funding" of abortion — a graduate student's research.

Lindsey Ruhr is studying the effects on women of the state's 72-hour waiting period for abortions, which passed last year over the governor's veto. Her research isn't finished yet, and she says we don't know yet whether the results will show a positive, negative, or neutral effect on Missouri women.

But Schaefer wrote a letter to Chancellor Loftin objecting to Ruhr's dissertation research and demanding more information for an inquiry. Schaefer argued that the study probably breaks state law because, again, it uses public funds and public employees to aid abortion. He said the study is likely biased because Ruhr's adviser is on the board of Planned Parenthood, and he called the study a "marketing aid" for Planned Parenthood because study documents acknowledged that the research "may help" the local clinic "improve its services" for women seeking abortions.

The university stands by Ruhr's research and notes that she doesn't receive scholarships or grant money from the university. The local Planned Parenthood issued a statement accusing Schaefer of "using taxpayer funds for political grandstanding," and called on Loftin "to remain stalwart in the face of political interference with academic freedom."

In less than two weeks, Missouri women may be left with just one abortion clinic

Melina Mara/The Washington Post via Getty Images

Missouri has actually been left with just one clinic before. The Columbia Planned Parenthood stopped offering abortions in 2012 after its previous doctor moved away, and it took until July of this year to hire and credential McNicholas, the new doctor. But the university's actions will probably take all of that away on December 1, less than six months after the clinic finally started offering medication abortions again and just a month before it hoped to start offering surgical abortions.

That will once again leave St. Louis as the only place in the state of Missouri where women can obtain a safe, legal abortion of any kind. St. Louis is on the state's eastern border, and Columbia is roughly in the middle of the state.

If the Columbia clinic is forced to stop offering abortions, women in Columbia will once again have to drive 125 miles each way — even just to get a prescription for the abortion pill. Before that, they'll have to make an additional trip to whichever satellite clinic is closest to them to comply with the state's 72-hour "informed consent" waiting period law. (Weekends and holidays don't count toward the 72 hours.)

Many women who live too far away from St. Louis, or who can't afford to take enough time off work, will end up crossing state lines into Kansas or Illinois. There's a clinic just across the western border in Kansas, but women who go there still have to deal with Kansas's 24-hour waiting period. And if they need a later abortion because the fetus has a serious defect, Kansas bans abortion after 20 weeks.

Illinois has a clinic about 15 minutes away from the St. Louis location — still a long drive for women who live in the middle of the state, but at least it doesn't have a waiting period or a 20-week ban. After Missouri passed its 72-hour waiting period law last year, the director of that Illinois clinic said she anticipated hiring new staff to accommodate the many women who were likely to cross state lines.

This story gets to the heart of the nationwide fight over abortion access

The fight between Schaefer, Planned Parenthood, and the University of Missouri involves three major issues that will make or break women's access to abortion in the years to come:

1) Closing abortion clinics using obscure-sounding state regulations

Admitting privileges laws like Missouri's, which are on the books in 14 states, may sound routine and technical. But they have turned out to be a pretty efficient way to close abortion clinics.

Supporters of admitting privileges say they make abortion safer for women. Opponents, including the American Medical Association, say they actually serve no medical purpose and only close down safe clinics — like in Texas, where more than half of clinics have closed since 2013, or Mississippi, where the last remaining abortion clinic is fighting to stay open. That's why these and other restrictive laws will soon face a high-profile Supreme Court challenge — and why women's access to abortion hangs in the balance.

If the Supreme Court upholds laws requiring doctors to obtain admitting privileges in order to perform abortions, more states with anti-abortion legislatures will probably rush to pass them. And even more American women will be forced to drive hundreds of miles and pay hundreds of extra dollars to exercise what is supposed to be their constitutional right to an abortion.

2) Whether abortion restrictions should be informed by sound scientific evidence

Schaefer insists that he got involved in a graduate student's project because he wants to enforce the law and enact the will of the voters. To pro-choice advocates, it was a troubling infringement on intellectual freedom and a sign that Schaefer may not want the public to see possible evidence that a 72-hour waiting period harms women.

This isn't the first time anti-abortion lawmakers have been at odds with the scientific community. Abortion opponents frequently claim that abortion is a dangerous procedure that raises the risk of breast cancer and mental health issues. Major medical organizations reject these claims — yet doctors in some states are still forced by law to repeat them to their patients.

3) An ever-expanding definition of what "public funding for abortion" actually means

When Roe v. Wade legalized abortion, the pro-life movement started working to "get government out of the abortion business" — to at least end taxpayer funding for abortion if they couldn't ban it outright. They succeeded in this by passing the Hyde Amendment, which bans direct federal funding for abortions except in rare circumstances through public programs like Medicaid. But anti-abortion activists and politicians still push for more, and they often move the goalposts on what exactly constitutes "public funding for abortion."

When Republican members of Congress tried to defund Planned Parenthood recently, they argued that funding birth control or cancer screenings helps Planned Parenthood "keep the lights on" in order to perform abortions, so the government is really funding abortion even though it thinks it's not. That's what Schaefer argued about University of Missouri — that because it took actions that indirectly allowed legal abortion to continue, or even that might just make legal abortion look good, that means this public institution is illegally using public funding to aid and abet abortion.

"The idea of what is publicly funded abortion is like the Blob — it just eats up anything in its path," said Elizabeth Nash, the state issues manager at the Guttmacher Institute, which studies reproductive rights. "What is considered public funding of abortion has gotten really out of hand if legislators are entertaining the idea of barring a student from studying a state policy."

Nash said there isn't much research on the relationship between public university hospitals and abortion providers. Notably, Ohio has banned abortion providers from using public hospitals to satisfy their admitting privileges requirements — which codifies into law the kind of thing that Schaefer tried to argue was already the law in his state.

It's hard to say whether Schaefer's particular strategy of pitting universities against abortion providers in this way will spread to other lawmakers in other states. But other anti-abortion strategies have tended to catch on and spread to other states once they're introduced in one or two. The university could well become the next front in the abortion battles.

Correction: This article has been changed to note that women can travel to a satellite clinic closer to them in order to comply with the state's 72-hour waiting period and to clarify the distinction between "admitting privileges" required under Missouri state law and the "refer and follow" privileges obtained by McNicholas.

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