Dozens of people gathered in front of the St. Louis health clinic on Thursday to support Planned Parenthood, chanting and holding signs with slogans such as “Health care happens here” and “Shame on you Governor Parson.” Gov. Mike Parson (R) is an ardent antiabortion proponent.

AD

AD

“We’re still here, because abortion is health care,” Kawanna Shannon, the director of surgical services at Planned Parenthood in St. Louis, told reporters. “We’re still here because blocking access to abortion in Missouri threatens the health, rights and lives of people of color and LGBTQ people across our state.”

Had the license from the state’s Department of Health and Senior Services expired as scheduled on Friday, Missouri would have been the first state since 1974 left without a licensed abortion clinic, leaving some women to travel hundreds of miles and across state borders for access to the procedure.

The threat of losing the clinic prompted Planned Parenthood, which operates it, to declare a “state of emergency for women’s health.”

AD

“I’m a doctor & my job is to take care of women in this country,” Leana Wen, the organization’s president, said in a statement Thursday. “I am declaring a state of emergency for women’s health in America. Unlike a state of emergency that is called after natural disasters, this is a man-made disaster that is putting women’s lives in danger.”

AD

The end of abortion services at the health center would mark a milestone in the state-by-state battle over abortion rights, one that has intensified in 2019 as conservative lawmakers across the country have pushed increasingly strict bans on the procedure. Emboldened by President Trump’s two appointments to the Supreme Court, many have set their sights on antiabortion groups’ ultimate prize: toppling the landmark 1973 Roe v. Wade decision that legalized abortion nationwide.

Advocates worry that Missouri could be a harbinger of future efforts to close clinics, especially in the handful of states that have only one abortion facility left.

AD

“This is not about health care. This is about politics,” said David Eisenberg, the medical director for Planned Parenthood of the St. Louis Region and Southwest Missouri, in an interview Thursday. “We cannot expect the courts to be our last line of defense.”

AD

Even before the judge granted the request for a stay on Friday, which came in response to a Planned Parenthood lawsuit, the state already had imposed more-restrictive policies than most: Last week, Parson signed into law a measure that bans abortions after eight weeks of pregnancy and provides no exceptions for victims of rape or incest, only for medical emergencies.

Parson said on Twitter that the bill would make Missouri “the most Pro-Life state in the country!”

AD

Existing laws, such as ones that require women to undergo counseling and then wait 72 hours before they can get an abortion, made it difficult for poor patients and rural residents to access services. And a requirement that doctors have partnerships with local hospitals limited the number of physicians who could perform the procedure.

AD

It was these regulations that caused the St. Louis clinic its greatest troubles.

“The rules around providing abortion care have been so onerous and egregious over the decades that it hadn’t really mattered that states like Alabama and Missouri started passing outright bans,” Eisenberg said. “Abortion has been effectively regulated out of existence in Missouri.”

AD

At a news conference Wednesday, Parson told reporters that the state had “serious health concerns” about the St. Louis clinic. That day, the Missouri Department of Health and Senior Services released a statement that said its annual inspection, conducted in March, found “potential deficient practices,” including noncompliance with a requirement that doctors give patients a pelvic exam three days before the procedure and what the agency called “failed surgical abortions.”

AD

The agency said it asked to interview seven physicians about the problems it found, but five declined. The health department director, Randall Williams, said Planned Parenthood had demonstrated an “unprecedented refusal” to cooperate, and Parson said it shouldn’t get any “special treatment.”

Planned Parenthood, meanwhile, said its clinic “has maintained 100 percent compliance” with the law, and Eisenberg said its doctors now adhere to the pelvic exam regulation, meaning they end up administering the invasive checkup twice, once days before the procedure and again on the day of it. Doing so is an “insulting, totally unnecessary and medically unethical treatment,” he said.

AD

Even if the clinic could no longer offer abortions, the health center would remain open, offering testing for sexually transmitted diseases, cancer screening and other services.

AD

Wen has accused the governor of “weaponizing the inspections process” to advance an antiabortion political agenda and has vowed to fight back — by organizing both protests and voters. But until then, she said, more than 1 million women of reproductive age will live in a state with no access to abortion services.

And abortion care denied can have grave consequences, wrote David Grimes in his book, “Every Third Woman in America.”

“Refusal of abortion does not eliminate the problem underlying the request,” he wrote. “Many women will, at considerable expense, travel to get care. Others abort themselves or turn to the back alley.”

AD

If the St. Louis center stops providing abortions, Missouri women would have to cross state lines. The nearest facilities are in Granite City, Ill., just across the Mississippi River, and in Kansas, more than 250 miles west of St. Louis.

AD

Patients who travel to Granite City will probably drive on a highway that illustrates the deep divide in the abortion debate. This spring, the facility, Hope Clinic, bought a billboard along Interstate 55 that reads, “Welcome to Illinois, where you can get a safe, legal abortion.”

Illinois lawmakers have also advanced legislation protecting abortion access. On Tuesday, the Illinois House of Representatives passed its Reproductive Health Act, which removes restrictions on certain late-term abortions.

AD

“To our neighbors in Illinois who hear the news around the country and worry that this war on women is coming to Illinois, I say, not on my watch,” said Rep. Kelly Cassidy, the Democrat who sponsored the bill, during a chamber debate.

But protesters in St. Louis said Missourians shouldn’t have to leave their home state for safe abortion care. Eisenberg, who has worked at the clinic for a decade, never thought it would come to this.

AD

“I knew it wasn’t going to be easy, but I could have never imagined I’d be saying to patients, ‘I don’t know if I’ll be able to do your abortion this week,’” he said Thursday. “I walked around the clinic today feeling like I need to have ‘I’m sorry’ written on my forehead.”

The experience has taught him the importance of local activism: that it’s the laws passed in statehouses that will have more impact than court decisions from Washington. It’s a lesson, he said, that those who live in the Dakotas, Kentucky, West Virginia and Mississippi — each a state where a lone clinic remains — would do well to learn.

“People worry about what happens when Roe v. Wade is overturned,” Eisenberg said. “I have said for years, it doesn’t matter. What matters is what’s happening at the state level, because that’s what will be the law of the land.”

Marisa Iati and Eli Rosenberg contributed to this report.