Last October, Missouri became the third state to require a three-day abortion delay. Dr Colleen McNicholas, who works at the state’s only remaining abortion clinic in St Louis, describes what the new laws have meant for American women

Whenever Dr Colleen McNicholas pulls into the parking lot of Planned Parenthood, the last abortion clinic in Missouri, she makes a sharp turn into the empty spot closest to the gate.



“I try to park here every time, so that patients don’t have to,” she says.

A few feet away, just beyond the black metal fence that surrounds the lot, a half dozen anti-abortion protesters are gathered with signs imploring women to “Stop! Save your baby” and to “Smile, your mom chose life.”

Facebook Twitter Pinterest Dr Colleen McNicholas. Photograph: Whitney Curtis/The Guardian

A slim woman in a baseball cap hands out pamphlets for an “abortion alternatives” facility five blocks down the road.

McNicholas, a 34-year-old obstetrician-gynecologist and clinical researcher at Washington University of St Louis, has been providing abortion services at the city’s Planned Parenthood for four years. She waves hello to the protesters as she walks by.

Missouri women have long faced obstacles to accessing abortion, McNicholas says, making her way through the parking lot and into the boxy, brown Planned Parenthood building, where she is waved through metal detectors at the front door. The protesters are merely the most visible.

One in five women drives more than 100 miles round trip to get an abortion at the St Louis clinic, according to internal figures. Since 2009, they have had to make the trip twice – once for state-mandated counseling and an ultrasound and then again, 24 hours later, for the procedure itself.

Last October, in a move that grabbed national attention, Missouri lawmakers tripled the length of time women must wait in between those visits – from 24 hours to 72. The law has created new financial and logistical challenges, especially for low-income women and those coming from outside the city.

“What many women would do before is drive here and maybe stay with a friend, or maybe they could afford a hotel for one night, and then have the procedure the next day,” McNicholas says. “Well that’s really no longer feasible, because they can’t take four days off work and they don’t have the money to pay for three nights of hotels.”

As more states pass longer waiting periods and require multiple clinic visits, similar calculations are being made by women across the US.

Facebook Twitter Pinterest Planned Parenthood of the St Louis region is the only abortion provider in the state of Missouri. Photograph: Whitney Curtis/The Guardian

When Missouri enacted its new waiting period law last fall, it became only the third state to require a 72-hour delay, joining Utah and South Dakota. (The law has no exceptions for cases of rape, incest or fetal anomaly.) Since then, two other states followed its lead and others are playing catch-up.



In the first five and a half months of 2015, 14 states introduced abortion waiting-period legislation – either proposing or extending delays. Five of those bills have been enacted into law, more than in any previous year, according to the Guttmacher Institute, a reproductive rights thinktank based in Washington DC.

Oklahoma and North Carolina also extended their abortion waiting periods from 24 hours to 72. Unlike Missouri, however, these states don’t require an in-person visit for counseling. Instead, counseling materials can be delivered by mail or consent given by phone to initiate the wait – a less onerous arrangement for women.

Tennessee and Arkansas each enacted a 48-hour waiting period with mandatory in-person counseling. Florida, the country’s third most populous state, enacted a 24-hour in-person delay. The ACLU of Florida and the Center for Reproductive Rights are fighting to stop that law from going into effect.

When the new laws go into effect, 28 states will have abortion waiting periods on the books. Fifteen of those laws will require women to make two trips to a clinic.

Legislators backing these laws say the intent is to give women time – or, in Missouri’s case, more time – to think about their decision.

“It’s an opportunity … to say, ‘Wait a minute, I don’t want to do that. I want to give a child a chance for life,’” Missouri representative Jeanie Riddle said in September. The Guardian contacted three of the co-sponsors of the Missouri bill. None provided comment by the publication of this article.

But opponents say such arguments belittle women’s decision-making abilities.

“No woman comes to the decision to have an abortion without having thought about it ahead of time,” said Kelli Garcia, senior counsel at the National Women’s Law Center. “By the time a woman decides to call and make an appointment, she’s made her decision. She has consulted friends or family – the people she trusts who are going to help her make that decision.”

A 2013 study by the Texas Policy Evaluation Project, surveyed 318 women seeking abortion services in the state. It found that Texas’s 24-hour waiting period and counseling law, which requires women to make two trips to a clinic, did little to change their minds.

Ninety-two percent of the women reported feeling “sure of their decision or that abortion was a better choice for them” when they made their appointment. After receiving counseling and an ultrasound, that number remained unchanged.

The Texas study did, however, find that the law levied an emotional and financial toll on women. “The extra visit is burdensome for some women and adds additional cost to the procedure,” the authors concluded.

In states with few abortion providers, where women must travel to access care – like Texas or Missouri – costs add up. Women coming from out of town must pay for gas, lodging and, often, childcare for each trip they make. (Nationwide, the majority of women who have abortions already have children.) In Missouri, they must then pay out-of-pocket for the procedure too, because state law bans insurance from covering abortion.

Longer waiting periods only exacerbate these financial obstacles to abortion access. They also require women to spend more time away from family and other support structures.

Facebook Twitter Pinterest Abortion opponents protest outside Planned Parenthood in St Louis. Photograph: Whitney Curtis/The Guardian

More than 3,100 women have had abortions at the Planned Parenthood in St Louis since the 72-hour waiting period went into effect last October, according to internal numbers.



That’s about 200 fewer procedures than in the same period last year, but the decrease is in line with with a downward trend in abortions in the state since 2008, the clinic says.

“Many women are still coming to us, but they’re jumping through more hoops and spending more money on the way,’’ McNicholas says, sitting in a brightly decorated conference room on the third floor of Planned Parenthood.

Because they often can’t afford to take time off work and stay in St Louis, patients who travel from out of town more often choose to go back home between visits. They “save up a little more money and little more time off work” before coming back, McNicholas says. That can mean they have the procedure “a little bit later”.

A longer delay might mean the difference between being able to get a medication abortion and no longer being eligible. In the extreme, the delay may also force women up against another state law: the 22-week abortion ban. In that case, they would need to travel out of state to get the procedure.

Soon before Missouri’s extended wait period took effect, McNicholas saw two patients late in their second trimester, she recounts. Both women were pregnant by choice, but had been recently informed that their fetuses had severe abnormalities.

Because a three-day delay would have pushed them past 22 weeks, McNicholas would have been barred from providing their care.

“For those patients, the law becomes more than a burden, it’s a true elimination of the possibility to have an abortion,” she says.