Government & Politics

The shifting geography of abortion: Missouri women looking to Illinois, Kansas for care

Twenty-seven abortions were scheduled last Thursday at the Hope Clinic, and the license plates on cars parked in front of the low-rise building with bulletproof doors tell the story: Missouri. Missouri. Illinois. Illinois. Missouri.

The 45-year-old Granite City, Ill. clinic, located 10 minutes from downtown St. Louis, draws about half of its patients from Missouri. With the state’s new ban on abortions after eight weeks of pregnancy scheduled to take effect Aug. 28, and its lone provider — Planned Parenthood of St. Louis — fighting in court to keep its license, Hope Clinic is poised to play an even more significant role for women in the region.

In the last two weeks, the clinic has been inundated with calls. Patients, looking to schedule appointments, were confused. During an appointment, one asked if abortion was still legal in Missouri. (It’s legal in all 50 states, still.)

“There’s a lot of fear,” said Hannah Dismer, a counselor with the clinic. “Patients are scared.”

Stoking concern is a new set of state laws barring abortion at all but the earliest stages of pregnancy, before many women are even aware they are pregnant. Six states have passed bans that are effective once a fetal heartbeat can be detected, sometimes as early as six weeks. Alabama has virtually outlawed abortions.


Missouri is part of this rapidly shifting geography of abortion. With legislation signed last month by Gov. Mike Parson, it joins Arkansas, Kentucky and Tennessee as states that have adopted “trigger” provisions in the last year. Those measures would immediately ban nearly all abortions if Roe v. Wade were to be overturned by the U.S. Supreme Court.

Missouri’s new law is the latest in a series of restrictions over the last two years that have caused abortion providers to largely withdraw from the state. Rather than administer invasive and often uncomfortable pelvic exams prior to abortions using oral medication, for example, the St. Louis clinic now only provides surgical abortions.

Even without the new ban, abortions in Missouri are at an historic low, according to state data: 2,910 in 2018, down from 5,416 five years earlier.

It doesn’t mean fewer Missouri women are seeking abortions. They’re just more likely to cross a state line. They accounted for about half of the 7,263 abortions performed in Kansas last year, according to Kansas Department of Health and Environment.

“The status quo for us for a long time is that we see a lot of Missourians already,” said Rachel Sweet, Planned Parenthood Great Plains regional director of policy.

Though Kansas has more providers than Missouri, they are clustered in Overland Park, in the Kansas City metro area, and Wichita.

“That doesn’t mean Kansas is, like, this beacon for access,” Sweet said. “That (distance)’s still a burden for a lot of people who don’t live in those metro areas.”

On Missouri’s eastern border, Illinois has become a destination for those seeking to terminate. In 2017, about 5,500 of the 39,329 abortions in Illinois were for out-of-state patients, according to Illinois Department of Public Health. It does not keep track of patients’ home states.

Illinois lawmakers delivered a bill to Democratic Gov. J.B. Pritzker Friday night establishing a “fundamental right” to abortion, even if Roe were to be overturned.

“When women don’t have access because their state feels (women) are second-tier citizens who can’t make their own decisions, obviously they have to find somewhere to go for safe legal medical procedures,” said Illinois state Rep. Katie Stuart, whose district includes the Granite City clinic. “I think Missouri should feel ashamed they have treated women as second-class citizens. That’s the real issue there.”

In the coming weeks, the Hope Clinic is looking to add more staff and open up more appointment slots, according to executive director Dr. Erin King.

Missouri’s new law has already had some effect.

The day Parson signed the sweeping abortion bill, Hope Clinic received calls from the state’s sole abortion provider, Planned Parenthood of St. Louis, about rescheduling some of their patients, according to Alison Dreith, the clinic’s deputy director.

Though most of the bill is effective Aug. 28, a requirement that minors notify both parents in certain circumstances before terminating a pregnancy was enforceable upon the Parson’s signature.


Though Thursday was a half-day for the clinic, it hummed with activity.

Walking from their cars, women passed a handful of anti-abortion activists sitting on lawn chairs and holding signs with photos of mangled fetuses.

“Momma, your baby doesn’t need that,” one called out to a woman from the edge of the parking lot. “This moment will enslave you forever.”

She kept walking. A security guard glanced at her ID before letting her slip behind doors.

Security concerns are a constant. In 1983, the clinic’s founder, Dr. Hector Zevallos, and his wife were kidnapped from their Edwardsville, Ill., home and held bound in a bunker by three men affiliated with Army of God, a terrorist group. The couple was freed after eight days.

In 1993, another Another Army of God member, Rachelle “Shelley” Shannon, shot and wounded Wichita abortion doctor George Tiller. She was released from jail last year. Ten years ago last Friday, Tiller was murdered by anti-abortion zealot, Scott Roeder, who shot him in the head at point-blank range while he was serving as an usher at his church.

The Granite City facility was rebuilt specifically as an ambulatory surgical center for abortions, with bullet-and bomb-proof materials, a windowless first floor and a layout that hinders free movement.

Yet, despite the unwanted attention, Hope Clinic maintains a public profile almost unheard of for an abortion provider.

Its billboard near the state line says, “Welcome to Illinois where you can get a safe, legal abortion.” Some staff said they proudly wear jackets embossed with the clinic name when grocery shopping or out elsewhere in the community. In light of attacks on access to abortion, it was one small show of support, they said.

The clinic has also opened its doors to several members of the media.

“People always are surprised when they come in here and they tell me it’s just like a hospital,” Dreith said.

On Thursday morning, more than a dozen women, of all ages, sat inside a large waiting room on the second floor. Some, with friends or partners, scanned through paperwork on clipboards while others scrolled their phones.

Encouraging posters, telling the women they were amazing and kind, lined the walls. Black buttons that said “abortion is normal” dotted recovery rooms and staff offices. Baskets of saltine crackers sat out for pregnant women fighting nausea.

A woman wearing an orange T-shirt that said “Jesus hearts me” periodically glanced around. A man wearing a Cardinals cap looked down at his interlocked fingers on his lap.

Tears filled the eyes of a woman who walked into the waiting room with a man. With a troubled face, he held her as they disappeared into a consultation room.

To protect privacy, when it was time for a patient to be seen, a staff member called out only the patient’s first name and the first letter of their last.

Dismer, a life-long Missourian, said she has counseled patients from all over the country and beyond.

Recently, one woman drove nine hours to terminate her pregnancy. The youngest patient she has counseled was 13.

Several of her patients have made their way to the clinic because of rape. Emergency contraceptives taken in the days after an assault can fail, including when a woman has already ovulated, Dismer said.

The ban in Missouri after eight weeks doesn’t offer exceptions for rape or incest. But two months doesn’t give a lot of women enough time to process a period of denial many face after assault, Dismer added.

“The amount of trauma people go through after an assault, it can interfere with memory, it can interfere with basic functioning, let alone worrying about pregnancy,” Dismer said.

Dismer was 14 when she was sexually assaulted. Had it led to pregnancy, she said, her depression would have made it too much to handle.

“Honestly, I think I would be dead,” Dismer said.

She wasn’t always approving of abortion. The 25-year-old grew up Catholic in Springfield, Mo., and her views reflected her “very, very conservative” hometown.

After her own assault, she went on to work with survivors of sexual violence. Over the years, her conversations with women have shifted her view from no abortion, to abortion in the case of rape and incest, to no restrictions on access.

Dismer said her job isn’t to change beliefs, but to support women through the process.

Last week, after speaking with a client, she stepped out of her office to give the woman and her partner time to talk privately. Later they left, having made the decision not to terminate.

“I tell this to patients all the time: ‘I’ve never met a bad person in my office,’” Dismer said. “I’ve met good people sometimes making easy choices, but a lot of times, making hard choices.”

Joseph Bustos contributed to this report.

Crystal Thomas covers Missouri politics for The Kansas City Star. An Illinois native and a graduate of the Missouri School of Journalism, she has experience covering state and local government.