The announcement that a Planned Parenthood clinic in Missouri is on the verge of shutting down—which would make the state the first to have no abortion providers—is the culmination of a decade-long campaign of surveillance and speculative complaints by activists.

The Planned Parenthood Reproductive Health Services clinic sits just outside Forest Park, in the upscale Central West End neighborhood of St. Louis. As the only abortion provider in the state, it is responsible for serving an estimated 1.1 million women. To keep up, the clinic brings in two attending physicians, two other doctors, and a rotating team of fellows and residents throughout the year.

Like most abortion clinics in the United States, the clinic is the target of omnipresent protesters—self-proclaimed “sidewalk counselors” who line the pavement outside the gray brick building. But these protesters don’t just stand there with signs; they log every ambulance that enters and leaves—taking careful note of whether its sirens are on, if its lights are flashing, even the sounds patients make when they are loaded onto the stretcher.

Planned Parenthood says it uses ambulances as a precaution and that they are not necessarily a sign that a medical procedure has gone awry. Also, the organization points out, there is no way for outsiders to know how many of the transports are for abortion-related complications—which Planned Parenthood estimates is the case less than half the time.

But in the hands of anti-abortion activists, the ambulance visits are weaponized. The protesters pass their observations on to extremist groups like Operation Rescue, which turn them into dramatic blog posts about the “outrageous” number of ambulance rides. Anti-abortion groups use that flawed data in demonstrations and rallies, and local groups turn them into pamphlets to give state officials, in hopes of spurring an investigation.

“We don’t want to see anyone suffer from harm, and we’re really concerned that’s going on at this clinic,” Cheryl Sullenger, vice president of Operation Rescue, told The Daily Beast. “If that abortion clinic closes, that’s going to do a whole lot of women some good.”

On Tuesday, it appeared the protesters could get their wish. Planned Parenthood announced Missouri’s health department was “refusing to renew” its license to provide abortions, meaning the clinic would have to close down.

As CBS News first reported, the state is investigating “deficient practices” at the clinic and has demanded interviews with all seven physicians who practice there. On a conference call Tuesday, Planned Parenthood CEO Leana Wen said the organization had offered interviews with the two attending doctors, but could not force the other five to comply. Some of the doctors that the health department requested interviews with were medical residents or trainees, Wen said, and had been told they could face criminal charges or review of their licenses as a result of their testimony.

Still, the health department refused to budge: If all providers could not be interviewed, the license would not be renewed.

“ This is not a drill. This is not a warning. This is real and it is a public health crisis. This will be the first time since 1974, the year after Roe v. Wade was decided, that safe, legal abortion care will be inaccessible to people in an entire state. ”

“This is not a drill. This is not a warning. This is real and it is a public health crisis,” Wen said. “This will be the first time since 1974, the year after Roe v. Wade was decided, that safe, legal abortion care will be inaccessible to people in an entire state.”

The news of the closure came four days after Missouri Gov. Mike Parson signed one of the strictest abortion laws in the country, banning the procedure after eight weeks gestation. The law is facing a court challenge, and has yet to take effect. But Missouri has long been slowly chipping away at abortion access for years, through laws requiring 72-hour waiting periods and parental consent for minors. In the decade between 2008 and 2018, the number of abortion clinics in the state dropped from five to two. It fell to one in October, when the state enacted a law requiring abortion providers to have admitting privileges at hospitals within 15 minutes of their clinics.

As the number of clinics dwindled, anti-abortion groups homed in on the remaining providers. Operation Rescue began filing open records requests with the state in 2009, asking for health inspection reports and ambulance records from the RHS clinic. In 2013, it took the St. Louis Fire Department to court to obtain the records, then quickly posted them on its blog.

The group says it has recorded 74 ambulance transports for "medical emergencies" in the last 10 years—a characterization Planned Parenthood says is simply not true. The organization says that emergency services are needed in less than one-tenth of a percent of its abortion-related procedures—a lower rate than for other outpatient procedures including wisdom teeth extraction or a colonoscopy. The rate for St. Louis is consistent with its national rates, Planned Parenthood says.

But that hasn’t stopped anti-abortion groups from using the other numbers. At the “MO Show Me Life Rally” this year, Students for Life activists demanded the governor launch an investigation into the clinic, citing Operation Rescue’s data. At the same time, local anti-abortion group Team PLAY took the ambulance reports and distributed them to anti-abortion lawmakers like Sen. Paul Wieland and Rep. Nick Schroer in booklet form. Wieland and four other legislators appeared at protests with Team PLAY activists across the state where Planned Parenthood was hoping to expand abortion access in 2017.

Team PLAY also provided the information to the state attorney general and governor’s office, according to Bonnie Lee, a retired nurse who works with the organization. Both Lee and fellow organizer Kathy Forck said state Solicitor General John Sauer used the numbers during oral arguments in a case against Planned Parenthood in 2017. Forke told The Daily Beast that the group also filed a formal complaint with the attorney general’s office in 2016. Asked whether her group had filed any more recent complaints, however, she declined to comment on advice of her lawyer, saying the issue was ongoing.

Planned Parenthood said it will shut the doors in St. Louis on June 1 if the state does not approve its license. In the press call, Wen accused the state of “weaponizing of the licensing process” and said Planned Parenthood had filed a lawsuit asking for a restraining order to stay open. A hearing is scheduled for Wednesday afternoon.

“Our job at Planned Parenthood is to care for the women, men and all people in this country, and we will not stop now,” Wen said.