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The countdown is on,” Amy Hagstrom Miller, CEO of Whole Woman’s Health, tweeted in early June. Throughout the month, abortion rights supporters checked SCOTUS blog or Twitter promptly at 10 AM, anxious for the decision that would reverberate across the country. Pro-choice activists had been waiting more than 20 years for the Supreme Court to clarify how far state governments can go in regulating abortion before their laws created an “undue burden” on women. If the justices allowed the restrictions challenged in Whole Woman’s Health v. Hellerstedt, they would be allowing states to make it nearly impossible to provide abortions within their borders.


Finally, on June 27, the Supreme Court handed down its decision. Hagstrom Miller descended the court’s steps smiling, with her fist in the air, and the crowd on the pavilion chanted, “We stopped the sham!” Nancy Northup, CEO of the Center for Reproductive Rights, called the ruling a “game changer.” All day, Alison Dreith, the executive director of NARAL Missouri, felt a strange physical sensation she couldn’t pinpoint. A colleague told her it was “because we won and we don’t know what winning feels like.”

But as Dreith wrote in an email to supporters that week, the ruling did not “magically fix” similar laws in 25 other states, including Missouri. Texas’ HB2 was struck down because Whole Woman’s Health’s lawsuit climbed up the courts. This summer, following the landmark ruling, Planned Parenthood began a campaign to repeal laws in eight states, including Missouri, to challenge laws similar to HB2. On one hand, this is a new era: The Supreme Court limited at least one variety of abortion restriction and put abortion rights on firmer ground. On the other, it meant more of the same: abortion rights advocates relying on the courts to dismantle anti-choice policies they don’t have the political strength to squash in state houses.


In Missouri, there’s a ban on insurance coverage of most abortions, requiring those who want such coverage to pay an additional fee for a rider. There’s also a mandatory 72-hour waiting period and a parental consent requirement for minors, among other restrictions. Since the 1970s, Jefferson City has been a testing ground for anti-choice legislation. Missouri passed forerunners to Texas’ HB2 back in 2007 and 2010; the anti-abortion legal organization Americans United for Life includes similar bills among the model legislation it shops around the country. The state now has one clinic, down from four in 2010.

That’s why, over the first five months of 2016—Missouri’s legislative session for this year— Alison Dreith has logged an estimated 4,000 miles traveling to and from the capitol building in Jefferson City, often leaving St. Louis at 6 AM to drive the 130 miles, testify against restrictions, meet with legislators, or hold press conferences—and then, chain-smoking and stress-crying on her drive home. It’s also why, in 2014, Laura McQuade, a New Jersey native, traded in a position at the Center for Reproductive Rights, where she could have worked in a glass-paneled, 22nd-floor office overlooking the Statue of Liberty, to instead run Planned Parenthood Kansas and Mid-Missouri (now reconfigured as Planned Parenthood Great Plains) from a cinderblock building where the beige blinds are always drawn.

“I was keenly aware that what was happening in the United States was happening on the state level,” McQuade says. “But also that Missouri and Kansas really are the belly of the beast. I decided to put my money where my mouth was.”

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The challenges Dreith and McQuade face include a massive flood of anti-abortion legislation passed by an overwhelmingly anti-choice assembly. (Not all of the eight Democratic state senators reliably vote pro-choice.) But the onslaught of bills is not their only problem. While the conventional wisdom is that the passage of such laws is inevitable in some states, six months of research into how pro-choice and anti-abortion organizations deploy their resources shows that this is only partly true. Anti-abortion extremism is able to flourish in some statehouses across the country in part because in the very regions where abortion restrictions consolidate power for conservative lawmakers, pro-choice advocates have had the fewest resources to fight back.

In Missouri, there are at least 14 anti-abortion organizations, four of which are located within walking distance of the dome in Jefferson City, and six of which have dedicated lobbyists who supply model bills and chat with legislators in the capitol’s gray limestone hallways throughout the legislative session. In contrast, this year there were only three primary lobbyists focused on advocating for abortion rights in Jefferson City: Alison Dreith from NARAL, M’Evie Mead from Planned Parenthood, and Sarah Rossi from the ACLU, who also covers many other issues and tracked roughly 500 bills this session alone. (Those three drive in from the cities on the state’s western and eastern edges—Kansas City and St. Louis, dense with progressives and moderates and underrepresented in the assembly after new electoral districts were adopted in 2012.) Although it has a political arm, Planned Parenthood, the largest abortion-rights presence in Missouri, is primarily a healthcare provider here, and most of its local staff works for its health centers and education programs.


It’s a similar situation across the country. “After Roe v. Wade [pro-choice feminists] primarily stayed focused on the national level and really conceded—not intentionally—but conceded the states to the pro-life movement,” says Alesha Doan, associate professor of political science at University of Kansas and author of Opposition and Intimidation: The Abortion Wars and Strategies of Political Harassment. National pro-choice organizations still focus their efforts on the federal level, and rely on centralized legal teams to stamp out onerous laws. Those organizations’ regional affiliates, like Planned Parenthood Great Plains, are separate entities tasked with raising most if not all of their own funds.

As a result, large swaths of the country are missing the muscle to stop anti-abortion measures before they’re enacted. Over the past year, I have contacted local pro-choice organizations in the 18 states the Guttmacher Institute considers “extremely hostile to abortion rights” to take stock of their presence on the ground. It’s hard to pinpoint exactly how many staffers are focused on pushing against anti-abortion legislation because so many advocates, especially in red states, double as clinic directors or fundraisers, or work for volunteer-run or multi-issue organizations. Pro-choice advocates I reached in 15 of those 18 states each told me there were very few people who worked regularly in the statehouses to fight anti-abortion legislation. They also say that while national groups provide consultations over the phone and will send lawyers for some court cases, for the day-to-day work of fighting legislation, supporting local candidates, or attracting staff they receive little to no financial support from national bodies.


In those same states, meanwhile, a wide range of entities, from progressive political groups to private businesses and foundations, have not embraced the cause of abortion rights. Planned Parenthood and independent abortion clinics have entered the political arena because so few others will stick their necks out for abortion access. “Abortion rights are like an afterthought to the broad progressive movement,” says Pamela Merritt of Reproaction, an advocacy group.


I drove down an unlit county road to arrive in Jefferson City, a grid of steep hills overlooking a river, to watch the legislative session in Missouri and see firsthand the underlying reasons abortion rights have diminished so steadily across our country. Under the capitol dome, I watched the few men and women working day after day to keep abortion an option. “There’s never a point at which we stop fighting,” Rossi tells me. “We’re hanging on by the skin of our teeth.”



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Familiar images of feminist advocacy feature a telegenic Wendy Davis in her pink sneakers, cheered on from the gallery in Austin, Texas, as she filibustered an earlier version of HB2 in 2013, or a million people walking together, arms linked or waving coat hangers, on the Mall in D.C. at the March for Women’s Lives in 2004. These are symbols of Americans’ most vaunted ideals: the heroic individual; the solidarity of the masses. And yet no single woman can dismantle a legal framework with personal courage alone. A crowd of protesters is visually powerful and can sometimes force the hands of elected officials, but in many states, reproductive rights supporters have not seen that effect. In Texas, not long after Davis’ 13-hour filibuster, HB2 was voted into law. This summer, after abortion rights supporters danced to Beyoncé and chanted “The people! United! Will never be defeated!” Texas officials began brainstorming new restrictions.


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The real battle over abortion is now waged through mind-numbing bureaucratic minutiae—and that is by design. Back in the 1980s, as anti-abortion attorneys realized they wouldn’t be able to immediately overturn Roe, so they decided to chip away at abortion rights very slowly. Those attorneys anticipated that the public would not revolt against legislators if they revised abortion laws piecemeal. “You can’t really get people really excited about, you know, how wide a hallway should be,” Dreith says, even though such restrictions have shuttered clinics across the country. Fighting for women’s rights today means sweating the small stuff, without a cheering crowd, for months on end. Before Missouri’s 2016 legislative session had even begun, 10 bills that would restrict women’s access to reproductive healthcare had been pre-filed. Those bills, and more like them, would consume the next five months.


Dreith, now in her mid-thirties, came of age traveling the world to protest the International Monetary Fund, The World Bank, and NAFTA, listening to punk, and, along the way, covering herself in tattoos of her folk heroes—Cat Stevens on her arm, Johnny Cash on her back. She knew herself as someone inclined to carry the world’s burdens on her shoulders, so when offered the director position she worried about stress. But NARAL’s national office promised to give her guidance, so she took the leap.

On any given Tuesday, from January to May, Dreith might need to drive 130 miles to testify against one or more of at least 20 separate bills in the front of a crowded hearing room, surrounded by people who call abortion murder, and she won’t know until the previous Friday afternoon whether she’ll be dealing with, say, HB 1370, which would raise the bar on the state’s parental consent law, or HB 1815, which would prohibit abortions in response to a fetal “genetic abnormality.” In the first weeks of the year, when Missouri’s legislative session begins, it’s anyone’s guess which pieces of legislation the House and Senate leadership will move forward. And even if a bill seems like an obvious priority, the public—and even a lobbyist like Dreith—has little idea when it will be discussed: Missouri law requires only 24 hours’ notice before a public hearing. That’s not much time to write testimony with evidence, line up credible witnesses, and rehearse responses to anticipated questions.


That first Tuesday of the legislative session, Senate Hearing Room Two overflowed before 8 AM, and anticipation hung in the air as members of the Seniors, Families and Children Committee filed into their elevated seats in the front of the room. Anxiety over “trafficked baby body parts” was palpable. Back in July, the anti-abortion Center for Medical Progress had released a now-discredited series of videos, purportedly showing Planned Parenthood staff discussing selling fetal remains in graphic terms for profit. A week later, the Missouri Senate had formed a “Sanctity of Life” committee, tasked with investigating local Planned Parenthood affiliates, headed by Senator Kurt Schaefer, then a Republican candidate for Attorney General. Nationwide, meanwhile, legislators did the same, with Congress and at least 13 other states calling for their own investigations.

Progressive donors to Planned Parenthood: “Why don’t you just stop providing abortions, since all the brouhaha is about abortions?”


The Sanctity of Life Committee aggressively questioned Department of Health and Senior Services employees over the course of at least a month. Schaefer raised his voice as he threatened to hold the department’s director in contempt because she would not turn over confidential documents. All Republican members of the Sanctity of Life Committee declined to be interviewed during the legislative session.

Even before the videos, anti-abortion organizers had no trouble rounding up a crowd in Jefferson City. Missouri Right to Life frequently holds well-attended rallies and lobby days. In July, Sanctity of Life Committee members joined anti-abortion protesters in the capitol rotunda in behind a sign that read “GET MIZZOU OUT OF THE ABORTION BUSINESS!!” and demanded that the University of Missouri withdraw the admitting privileges it had just granted Planned Parenthood’s clinic in Columbia.


The scuffle over admitting privileges is exactly the kind of tedious tug-of-war that matters tremendously: Missouri law requires that a physician have the ability to admit patients to local hospitals in order to perform abortions, just as Texas did, before the Supreme Court struck down HB2. The University of Missouri—whose annual funding is partly decided by the Appropriations Committee chaired by Schaefer—acquiesced to Schaefer and the Sanctity of Life Committee. No hospital would offer Planned Parenthood’s Columbia clinic admitting privileges. Missouri was down to one abortion clinic again.

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The State Attorney General’s office, which conducted its own investigation, found no evidence that the local Planned Parenthood had sold or improperly handled fetal remains, but that finding did nothing to temper officials who alleged that Planned Parenthood was selling “baby body parts.” Planned Parenthood’s Laura McQuade said that one of the most common questions supporters—even donors—asked her as the videos dominated the news cycle was: “Why don’t you just stop providing abortions, since all the brouhaha is about abortions?”

It was no surprise, then, that before Missouri’s 2016 legislative session even began, at least two bills implying that Planned Parenthood might be mishandling “baby body parts” had been pre-filed. Senate Bill 644 would have required abortion providers, when they perform terminations, to send the whole embryo or fetus to a pathologist, ostensibly so the state could ensure that no part of an aborted fetus had been sold.


During the hearing, legislators openly voiced anti-abortion beliefs. Senator Jeanie Riddle, who represents District 10, a rural area just northeast of Jefferson City, repeated myths about the local Planned Parenthood being unsafe and echoed stock language used by “40 Days for Life” organizer Kathy Forck, who says she names and baptizes aborted babies outside the Planned Parenthood clinic in Columbus, Missouri. At one point during the hearing, Riddle (who declined to be interviewed for this article) began questioning Dr. David Eisenberg, medical director of Planned Parenthood of St. Louis Region and Southwest Missouri, making clear that she was not evaluating the bill based on the state’s interest in protecting women’s health, as federal law requires:



Senator Riddle: But you said it’s one of the safest procedures, abortion, that it’s a very safe procedure. Dr. Eisenberg: Yes, ma’am. Senator Riddle: I just think the babies wouldn’t say that, probably. Dr. Eisenberg: I’m an obstetrician gynecologist and I frequently take care of two patients, the woman and the baby— Senator Riddle: I don’t believe abortion is safe for the child. [Chairman David Sater nods.]

After the hearing adjourned, I rode the elevator with four men—two anti-abortion lobbyists and two legislators’ aides who happened to step in with us. One lobbyist shook his head; Eisenberg’s argument that fetal tissue donation could contribute to life-saving research, he said, was like the Nazis’ experiments on the disabled. “Ends justify the means,” one aide said. “Repugnant,” said the other.


The second half of January was much like the first. Dreith hurried to prepare testimony against multiple bills, including The Unborn Child Protection from Dismemberment Abortion Act—a proposed ban on dilation and evacuation (D&E) procedures, which are done after the first trimester, most often because of health risks to the mother or grave fetal anomalies. Talking about late-term procedures, Dreith explains, “is a really hard thing to do, especially if you never know what the committee is going to ask you.” Dreith spent weeks consulting with experts at NARAL’s national office.

Then Dreith got a call from Rachel Goldberg, who in December had traveled from her home in Missouri to Colorado to terminate a much-wanted pregnancy at 26 weeks, after testing confirmed that her fetus had multiple life-threatening deformities. Goldberg was angry that legislators would create conditions that would force her to travel so far, need to take out a $10,000 loan to pay for the procedure out-of-pocket, and grieve in a hotel room. “This is the worst thing that could possibly ever happen to me and these people who had never met me were making it so much worse,” she said. She resolved to get involved with the abortion-rights movement. On February 2, during the two-hour drive to Jefferson City seeing anti-abortion billboards only redoubled her commitment. She remembers thinking, I need to go there and I need to speak.


Before Goldberg could testify, though, the committee questioned Planned Parenthood’s lobbyist M’Evie Mead for 32 minutes—mostly about whether the health care provider is trafficking dead “baby body parts.” “The video recordings were authentic,” committee chair Diane Franklin said, after she read aloud from a report from by The Heritage Foundation and the Alliance Defending Freedom, both socially conservative organizations that work to oppose abortion rights.

“It was really shocking for me,” says Goldberg, who grew up in Connecticut. “They were more interested in attacking personally the people who were against the bill than actually learning any new information.” Anticipating hostile questions, with the hearing clock running out, Goldberg decided not to testify.


“All hearings are pretty similar,” Dreith says, adding that for the culture to change, district lines need to be redrawn so that moderates and progressives have equitable representation. But igniting public passion over the details of redistricting is another Herculean task. In the meantime, Dreith anticipates that this winter legislators will pre-file bills to “try to work around the Supreme Court ruling,” since Missouri has always been an early testing ground for new kinds of abortion restrictions. Focusing on that legislation will mean, again, that she has fewer resources to devote to long-term electoral work. “I wish more foundations thought to invest here,” she says. “And I wish our legislators respected science.”



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State legislators didn’t always publicly align themselves with protesters who claim to baptize dead babies in parking lots. Throughout the 1960s, the women’s movement had been making inroads on repealing abortion laws state by state, and in 1973, in Roe v. Wade, the Supreme Court legalized abortion nationwide. In those days, the chances of creating a groundswell against abortion rights seemed as bleak as beating back that wave does now for advocates like Dreith. “It was a very lonely struggle for me personally to push and keep something alive at the local level,” says Therese Sander, who was an early member of Missouri Right to Life in the late 1970s.


Abortion rights advocates, meanwhile, assumed the Supreme Court had settled the issue and turned their attention to other feminist causes. But national anti-abortion strategists linked with local activists to build grassroots networks. National Right to Life dispensed advice and materials to volunteers like Sander, who borrowed her parents’ slide projector to show pictures of fetuses to neighbors.

Missouri Right to Life, and its counterparts in other states, consolidated political influence slowly. Planned Parenthood had been in Missouri since 1932, NARAL since 1969. But nationwide the Catholic Church funded many anti-abortion efforts, and provided supportive audiences and countless potential volunteers. After Roe, as Sander was doggedly leafleting parking lots, the national Republican party decided to adopt the anti-abortion cause to poach religious conservatives from the Democratic Party. When those Republican strategists took on abortion, a dense grassroots network was waiting for them.


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Today, Missouri Right to Life’s presence lattices the whole state. (The group did not reply to multiple calls and emails requesting an interview.) Its political arm consistently out-fundraises Planned Parenthood and NARAL’s local political arms—and it is just one of many local anti-abortion organizations. Its political wing endorses candidates and ranks legislators based on whether they “would be the best and most effective voice for the unborn.” Missouri Right to Life has two regional offices plus at least 10 local volunteer chapters that can mobilize people to show up to lobby days, rallies and the polls. After being elected to the assembly, Sander sponsored the 2007 omnibus bill that required abortion clinics to meet the same standard as ambulatory surgical centers.


Enough anti-abortion groups are at work in Missouri that they each can focus on a single strategy if they choose—Missouri Family Network primarily lobbies, for example, while 40 Days for Life protests outside clinics, Concerned Women for America’s “legislative liaisons” propose bills, and Vitae helps anti-abortion centers market to pregnant women.

Local pro-choice advocates, meanwhile, did not inherit similar networks. Each of their local chapters has to generate most of its own funding, meaning that pro-choice political advocacy groups in many red states run on a shoestring compared to those in states where there is already strong public support for reproductive rights. In New York State, where abortion restrictions are rarely proposed, five regional Planned Parenthood organizations—registered as 501(c)(4) nonprofits under the IRS and therefore able to engage in political activities—had a combined revenue totaling nearly $700,000 in 2013, compared with Planned Parenthood’s (c)(4) for all of Missouri, which took in $113,314 that year, according to tax filings.


Other states’ Planned Parenthood Action funds are working on similarly modest budgets. Meanwhile, NARAL’s New York political arm (not its national office, which is in D.C.) raised roughly $1.5 million in 2013. Its Missouri affiliate, meanwhile, raised $29,045, in a state, as McQuade puts it, where abortion “access is threatened hourly.”

Planned Parenthood Federation of America declined to respond to multiple interview requests to discuss their state political strategy. However, a spokesperson did send a statement underscoring that this fall Planned Parenthood has invested $30 million to hire 800 staffers and run advertisements in six swing states crucial to the federal elections, including two of the 18 the Guttmacher Institute classifies as “extremely hostile” to abortion rights. Dawn Laguens, executive vice president of Planned Parenthood Federation of America, wrote that Planned Parenthood’s mission is “to ensure all people have access to essential reproductive care, no matter where you live” and to that end “nearly half of our health centers are in rural or underserved areas.” Laguens wrote, “We’re fighting restrictions law by law—state by state— using every tool we have—including in the courts and in state legislatures.”


“To take out exemptions for rape or incest was just so awful that it just overtook me.” — Alison Dreith, executive director of NARAL Missouri

NARAL Pro-Choice America focuses its resources on states that are both important to federal elections and have state assemblies that could swing pro-choice, explains States Communications Director James Owens. “You have to make choices about what you do with limited resources,” Owens says. “You can look at these handful of states where the state legislatures and the federal races do overlap and that’s where our movement needs to be.” The national office has worked to build a political infrastructure in states like Colorado and Iowa, which have “an outsized impact” on reproductive rights nationwide, Owens says.


This year, when Dreith wanted a fellow staff person, she had to apply for grants. She received enough to support one and a half staffers for a year, plus two community organizers on a shorter contract. But she doesn’t have a consistent staff to mobilize voters for the long haul. “Missouri Right to Life has power because they represent guaranteed votes,” Pamela Merritt of Reproaction says.

When the legislative session begins and the anti-abortion floodgates open, Dreith doesn’t have the resources to do much more than provide “a record of dissent,” as Doan puts it. Anti-abortion crusaders were especially visible this year because of the Center for Medical Progress videos and the upcoming elections, a number of people told me. Sam Lee, a lobbyist who has been writing anti-abortion legislation since the ‘80s, says the dominant view in Jefferson City is that “our legislation should be put out there as sort of a litmus test or a voting record.”


All those bills meant Dreith, Mead, and Rossi kept returning to Jefferson City last winter with the deck stacked against them. The pace picked up as spring arrived. On March 29, public hearings were held for two pieces of legislation, including HJR 98, which would give voters an opportunity to change the state constitution granting embryos personhood rights from the moment of conception.

Courts in other states have struck down similar laws. Representative Mike Moon, the resolution’s sponsor, was given at least two weeks’ notice for his hearing date, which is unusual. Personhood USA, a Colorado-based organization, sent a representative to testify, and during the hearing Moon displayed on the hearing room wall a video of a fetus from an advanced pregnancy, describing what he said was the fetus yawning and sucking its fingers. The committee voted to move forward with the resolution, without exceptions for rape, incest, or life of the woman.


That was an especially hard day for Dreith. “To take out exemptions for rape or incest was just so awful that it just overtook me,” she says, explaining that she was raped as a 18-year-old college student. After the hearing, in a progressive assembly member’s office where advocates were working against a bill that would allow discrimination against LGBTQ Missourians, she cried. Driving home, as usual, she listened to the most depressing music she could find, like Elliot Smith or The Cure’s slow tracks—“anything that will force a tear from my eye”—for catharsis. “You just have to let it out sometimes,” she says. Women’s “rights are the ones that are always being traded, thrown under the bus,” and the most harm is “done to the most disenfranchised women.”

This spring, the legislature also focused its efforts on Planned Parenthood. Throughout March and April, Kurt Schaefer—the attorney general candidate—repeatedly threatened to hold Mary Kogut, CEO of Planned Parenthood of St. Louis and Southwest Missouri, in contempt, a charge that could carry fines or jail time if she didn’t provide what Planned Parenthood described as private medical documents to the Sanctity of Life Committee. (The committee did vote to hold her in contempt; Schaefer did not agree to be interviewed during the reporting of this piece.) Later in April, the assembly sent the governor a budget that rejected more than $8 million in federal money so that the state could refuse to reimburse Planned Parenthood for providing preventative care to Medicaid patients but allocated $4.3 million to the Alternatives to Abortion Program, including anti-abortion crisis pregnancy centers.


In April, the legislature also advanced anti-abortion bills almost every day it was in session. “It’s been rapid response since I came in,” Dreith said. On May 5, as local Planned Parenthood advocates held a press conference criticizing the assembly’s priorities in a basement hearing room, the House began debating HJR 98, the fetal personhood amendment.

As one representative read Bible passages and several others argued over whether abortion is as brutal as slavery, Goldberg and other Planned Parenthood volunteers slipped into the upper gallery. Their hands were clasped over their mouths as the House passed the resolution 110 to 37. With just a few days of session left, the Senate wouldn’t have time to vote on it. But by hurrying the resolution to the floor, House leadership had taken the temperature of the legislative body: An overwhelming majority was willing to support a resolution that would make all abortions illegal, with no exception for the life of a woman.


A week later, the session ended. The assembly had voted to strip funds from Planned Parenthood, but it had not passed any of the myriad potential abortion restrictions.

Dreith doesn’t want “no new restrictions” to count as a victory. Yet she knows that an assembly that supports Missourians’ right to access abortion is a distant dream. “We obviously are right in the capitol every day,” Dreith says. “We’re knocking on doors. We’re doing things in the community. But when we continually lose and [abortion] rights are being chipped away, how do we show folks that we actually are fighting for them?”


This article was reported in partnership with The Investigative Fund at The Nation Institute.

Meaghan Winter is a freelance journalist based in New York. Her work is included in The Best American Magazine Writing 2016.