Despite Missouri voters overwhelmingly supporting the constitutional right to abortion nearly five months ago, Planned Parenthood clinics in the state are still unable to offer medication abortion services. This ongoing situation stems from the state government's recent disapproval of the clinics' plans for handling complications.

Planned Parenthood Great Rivers, which operates clinics in St. Louis, Rolla, and Springfield, and Planned Parenthood Great Plains, which runs clinics in Kansas City and Columbia, received letters last Thursday from the Missouri Department of Health and Senior Services stating that their submitted complication management plans did not meet the state's requirements.

This decision is based on emergency rules issued the same day by the Missouri Secretary of State's office. These rules mandate that any facility prescribing more than 10 medication abortions per month must have a complication management plan that includes the following:

Ensuring a board-certified or board-eligible OB/GYN physician is available 24 hours a day for seven days post-medication, residing within 25 miles of the clinic. This physician must be able to treat any complications arising from the medication, except when standard treatment guidelines necessitate care from another specialist.
For patients residing more than 25 miles from the clinic, providing the name of a local emergency room and information on a physician "within a reasonable distance" of where the patient will complete the abortion.
Submitting the full names of all physicians involved in the local complication management plan.
While three clinics in Columbia, Kansas City, and St. Louis have resumed some surgical abortions, Planned Parenthood leaders have stated they will not begin prescribing medication abortions without an approved complication management plan.

A spokesperson for Planned Parenthood Great Rivers said the organization is still determining its next steps. The Missouri Department of Health and Senior Services did not immediately respond to a request for comment.

Earlier in February, Sami Jo Freeman, a spokeswoman for the Department of Health and Senior Services, stated in a release that "because medication abortions can occur at home, often without direct physician oversight, complication management plans are crucial to ensure patient safety."

When Planned Parenthood clinics submitted their complication management plans in February, they did not include the names of the physicians involved. The submitted plans stated that patients could contact the clinic anytime with concerns, and after hours, a licensed nurse would answer calls and connect with an on-call physician. It also noted that "depending on the patient’s symptoms, if a potentially urgent complication is suspected or if the patient is unable to return to a medical center in a timely manner, the nurse will instruct the patient to go to an emergency department (ED)." With the patient’s consent, the ED would be informed of the patient’s medical history if possible, and Planned Parenthood would follow up with the patient the next day to check on their progress.

Medication abortion is the most common method of ending a pregnancy in the United States. According to the Guttmacher Institute, a research organization that supports abortion rights, nearly two-thirds of abortions in the U.S. in 2023 were medication abortions rather than surgical procedures. In states where abortion is legal, patients in the early stages of pregnancy can receive prescriptions for abortion-inducing drugs, typically taken in two rounds, with the second medication often taken at home. In recent years, there has been a rise in individuals ordering abortion pills online from U.S. and international providers, even in areas where abortion is outlawed.

According to the U.S. Food and Drug Administration (FDA), mifepristone is safe when used as directed. Cramping and bleeding are common side effects, and patients prescribed mifepristone are advised to contact their doctor if they experience heavy bleeding, abdominal pain, or fever – the same guidance given to women who recently had a surgical abortion, experienced a miscarriage, or gave birth. The FDA has reported only 32 deaths associated with mifepristone in the 28 years since the drug was approved for use.

Earlier this month, Missouri Attorney General Andrew Bailey indicated his intention to send cease-and-desist letters to Planned Parenthood clinics, reiterating his demand that they stop providing specific types of abortion procedures that he claims they do not actually offer.

Several Planned Parenthood clinics have remained open in Missouri since the state outlawed abortion statewide in June 2022. These clinics primarily offer family planning services, cancer screenings, and testing and treatment for sexually transmitted diseases, including for Medicaid patients.

Shortly after Missourians narrowly approved Amendment 3 in November 2023, enshrining abortion rights in the state constitution, Planned Parenthood sued the state, arguing that dozens of regulations on abortion providers were no longer constitutional. In mid-February, a Jackson County judge struck down most of those regulations, allowing Planned Parenthood to resume in-clinic surgical abortions for the first time in years.

The first abortion performed in Missouri since the state outlawed the procedure statewide in June 2022 took place at a Kansas City clinic in February. In early March, the Columbia clinic also resumed surgical abortions for the first time since 2018. And last Thursday, the St. Louis clinic quietly performed two abortions for the first time since 2022.

Nick Dunne, a spokesperson for Planned Parenthood, said Friday that the St. Louis clinic plans to see additional abortion patients under 12 weeks of pregnancy in the coming weeks, but the days on which abortions will be offered will depend on physician availability. St. Louis clinic staff had not previously indicated they would resume surgical abortions this quickly.

"Prior to the December ruling, our staff had been preparing to begin offering medication abortion, which included staff training as well as ordering supplies and medications," Dunne said in a statement. "Recognizing the likelihood that state officials would create additional barriers to medication abortion, our medical and patient services teams pivoted to redeploy staff, equipment and other necessary resources to begin offering surgical abortion again."

Dunne added that Planned Parenthood will not be able to begin offering surgical abortions at its Rolla or Springfield clinics until it hires additional physicians, noting that Planned Parenthood is "actively working" to increase its physician numbers. Planned Parenthood Great Rivers, which also manages the Fairview Heights clinic, has two long-term physicians and one contract physician, both of the long-term physicians are based in the St. Louis area.

The Missouri state government's decision to disapprove Planned Parenthood's medication abortion plans highlights the persistent political and administrative barriers despite the public's desire to restore abortion rights. The content and timing of the new regulations are particularly drawing criticism, with many questioning whether they are intended to delay the provision of abortion services.