Cori Bush was roughly 100 miles southwest of her St. Louis congressional district in the city of Rolla, campaigning not for her own re-election, which is all but guaranteed, but for abortion rights. “They partied because this state was the first,” she said to a crowd of supporters and abortion rights activists under a picnic pavilion. Missouri was the first state to ban abortion after the Supreme Court overturned Roe v. Wade on June 24. But, she added, “we are the ones left to organize, left to galvanize, we are the ones to mobilize the community and make sure that they know that not only are we fighting and standing up for ourselves, we are standing up for our children’s children.” Nestled about midway between the cities of St. Louis and Springfield, the 20,000-person town is one of the final stops on Bush’s “Roe the Vote: Reproductive Freedom Tour”—an eight-stop get-out-the-vote campaign that wrapped up one month ahead of the midterms. It is also something of a ground zero for the next chapter in the fight to retain and restore access to reproductive health services and rights in the United States.
On November 1, Planned Parenthood will open the doors to a new clinic, one of the first brick and mortar clinics to open after the fall of Roe—and it is opening in Rolla. For now it can’t provide abortions but will offer basic primary and preventive care, such as permanent sterilization and contraceptive services. It is part of a long-term strategy to close the ever-widening gap in reproductive care between “haven” states and abortion-restrictive states, and expand Planned Parenthood’s footprint in Missouri instead of dissolving it. “Missouri has long been a state that has abdicated responsibility to its constituents and that spans all sexual and reproductive health care,” Dr. Colleen McNicholas, the chief medical officer of Planned Parenthood of the St. Louis Region and Southwest Missouri in St. Louis, told me. McNicholas said she would have described Missouri “as existing in a post-Roe reality” even before the Dobbs decision, as elected and appointed officials have hacked away at reproductive rights and access in recent decades. As of 2018, there had been only one abortion clinic in Missouri—the Planned Parenthood clinic in St. Louis—where Bush, at the age of 17, received an abortion after getting pregnant following a sexual assault.
That’s now the story in many states across the nation where women’s health clinics have been forced to shutter as states pass more restrictions around abortion. Within the first 100 days of the Dobbs decision, more than two dozen abortion clinics shut down entirely, and an additional 40 clinics stopped providing abortion services, according to an analysis released earlier this month from the Guttmacher Institute, a research and policy organization that supports sexual and reproductive health. Fourteen states now lack any abortion providers. Without these clinics, many of which provided a range of reproductive health services other than abortion, including tests for sexually transmitted infections and Pap smears, women in the most abortion-restrictive states are left with fewer places to receive basic reproductive care. A spokesperson for Planned Parenthood could not at this time state a national strategy to expand clinics in abortion-restrictive states but said that conversations around opening new facilities were happening at the state level. A new Planned Parenthood clinic opened in Kansas in October. In Missouri, the decision to open in Rolla was made to continue access to reproductive health care “regardless of the politics of the state,” Julie Lynn, the spokeswoman for Planned Parenthood of the St. Louis Region and Southwest Missouri, said. Still, it’s hard to divorce its opening from the political climate around women’s reproductive rights.
The new Planned Parenthood in Rolla will open in the same building once occupied by Tri-Rivers Family Planning, once a Planned Parenthood affiliate, which closed its doors in September after 50 years of operation. Planned Parenthood will also have a mobile abortion clinic—an RV—which will operate in neighboring Illinois (about 100 miles away), where abortion remains legal. The decision to open the facility in Rolla sends a clear message: Planned Parenthood is here to stay. “We saw expansion in Rolla as an important way to signal not just to our patients—but also to the legislature—that we aren’t going away and we’re gonna continue to expand where we can, while we build power to bring back abortion care,” McNicholas said. “There’s so much work to do in Missouri to help bring people access to basic reproductive health care. And the truth is, Missourians deserve and want that.”
At a recent campaign event for Democratic Senate hopeful John Fetterman of Pennsylvania, the CEO of Planned Parenthood Action Fund, Alexis McGill-Johnson, acknowledged bluntly the challenges providers and facilities face. “The reality is that if this plays out according to their time line, 24 states will never be able to absorb the abortions for 50 states,” she told Vanity Fair—“this” being the anti-abortion movement. Physicians in abortion-restrictive states refer patients outside their borders to so-called haven states, but the realities there are stark as well. “Those clinics are really overwhelmed and really underwater. And so getting into those clinics is really hard,” said one ob-gyn in a state with an abortion ban, who requested anonymity out of fear of repercussions.
There is still a near-daily drip of tragic individual stories. Last week, in Missouri, Mylissa Farmer made headlines. At 17 weeks and five days into her pregnancy, doctors told her her water had broke prematurely and the baby would have no chance of survival if delivered then. They recommended ending the pregnancy. But at the Freeman Hospital in Joplin, that wasn’t an option. Under the Missouri ban, where there are no exceptions for rape or incest, there’s a narrow window for those experiencing medical emergencies that could endanger the patient’s life or severely compromise the patient’s health. It was in this gray area—What constitutes a life-threatening emergency?—where Farmer and her partner, Matthew McNeill, found themselves. The couple was left scrambling and, ultimately, Farmer was able to receive care at a clinic across the border in Illinois. “It was awful, you know? We were just going through so much. We didn’t want this,” Farmer told The Springfield News Leader. “But at the same time, we had no choice.”
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The new Planned Parenthood in Rolla wouldn’t be able to address Farmer’s condition. But the decision to open another Planned Parenthood family planning center in Rolla could go a long way to increase health care availability in rural areas and ensure that potentially life-threatening cases are caught early. Notably Missouri ranks in the top 10 of states with the highest maternal mortality rates in the country. Approximately, 75% of such deaths were determined preventable, according to an annual report by the Missouri Department of Health and Senior Services. “When you look at the role that Planned Parenthood specifically plays, for example, in the Title 10 network, we provide an outsized proportion of the care that folks who are uninsured or underinsured utilize when accessing basic reproductive health care,” McNicholas said. “The two must be tied together. If you want to reduce abortion access, you must increase access to things like basic primary and preventive care.”
Speaking in Rolla, Bush hailed the opening of the Planned Parenthood clinic but didn’t ignore this reality: “We are standing up for our legacy and they can’t toss us these bull crap crumbs of ‘medical emergency’ and all of this.” Bush’s declaration was met by an attendee calling out, “It’s bullshit.”
This post was originally published in Vanity Fair.
