Post-Roe World

“When I first heard the news I was honestly devastated. The past few yearsthe news has just been really dark: politically, racially, sexually. It’s all been really hard to watch. I feel like America has gone into a state of regression and I’m really losing hope that things will get better,” said CHS sophomore Brooke Lytle.

On Jun 24, 2022, Missouri’s Right to Life of the Unborn Child Act, which was passed in 2019, became enforceable law, after the Supreme Court overturned nearly 50 years of precedent by siding with the state of Mississippi in Dobbs v. Jackson Women’s Health Organization.

“My emotional reaction, abortion is healthcare for women. Full stop. I look at it as a confirmation of the patriarchy, of misogyny and almost like a subservience of women to men, which I find abhorrent, immoral, unethical, just plain wrong,” said CHS biology teacher Adam Bergeron.

The court’s decision to side with the state of Mississippi was not unexpected, as a draft of the decision was leaked a month and a half prior to the official release of the decision. The case was based on the constitutionality of Mississippi’s Gestational Age Act, which bans abortions except in cases of fetal abnormality or medical emergency, after 15 weeks of gestation. In 2018, Jackson Women’s Health Organization sued the state of Mississippi, on the basis that pre-viability abortion restrictions were unconstitutional. The current standard for fetal viability, or the gestational age when a fetus could theoretically survive outside the uterus with significant medical intervention is approximately 23 to 24 weeks.

Both the US District Court in the Southern District of Mississippi and the Fifth Circuit Court of Appeals sided with Jackson Women’s Health Organization, based on the precedent of constitutionality of pre-viability abortions set by Roe v Wade and Planned Parenthood v Casey. Conservative activists and strategists spent decades working to overturn these two rulings, by passing legislation at the state level and picking judges for the Supreme Court. Finally, their dreams were realized as jurisdiction over abortion rights was returned to the states following the Dobbs decision.

This, however, was not always the case. In the immediate aftermath of Roe v Wade, the abortion rights landscape was very different.

“My abortion took place in the 80s. And abortion rights were very secure. I don’t think you can even relate to this in your life. But there wasn’t a big powerful national movement, like there were in subsequent days. It was sort of a moment where abortion rights were very available. And, you know, compared to the way it was even like, five years ago, there are all these restrictions on abortions that didn’t exist. It’s just the fact that I did have these rights, that I know you’re not gonna have that kill me,” said CHS parent Nancy Bell.

According to data from the Missouri Department of Health and Senior Services, abortions in Missouri hit a peak in 1980, and have been steadily falling since. Even prior to the Dobbs decision, abortion restrictions in the US were on the rise. According to the Guttmacher Institute, 483 new abortion restrictions were enacted in various states between 2011 and 2019. Some of these restrictions included mandated counseling, mandated waiting periods, mandated counseling and ultrasounds as well as parental notification for minors. Missouri’s so-called “trigger law” to ban abortion was unenforceable prior to the Dobbs decision but was passed by the Missouri legislature in 2019. Even prior to the Dobbs decision, Missouri had only one abortion clinic in the entire state.

Current Missouri law defines abortion as “the intentional destruction of life of an embryo or fetus in his or her mother’s womb or the intentional termination of pregnancy of a mother with an intention other than to increase the probability of a live birth or to remove a dead or dying unborn child.” This is interpreted by most doctors, law enforcement, patients and lawyers to mean that abortion is illegal except in cases of life endangerment of the mother or of other fetuses in the uterus. Health care providers who perform abortions can be charged with a Class B felony, which carries a sentence of five to 15 years in prison and a loss of license. Patients who undergo abortions are not supposed to be prosecuted under this law. This makes legal abortion within the state of Missouri almost impossible.

“What I will find most interesting about this is when we will see the first pregnant teenager walking the halls of high school,” said Bergeron.

The Legal Lens

At its peak in 1982, Missouri was home to 29 different clinics offering abortions. Now in 2022, only one remains. The Planned Parenthood located on Forest Park Parkway in St. Louis was the last standing healthcare facility providing abortions in the state of Missouri.

However, after the overturning of Roe vs. Wade last June which left the legality of abortion up to the states, Missouri joined other states in banning abortions with little to no exceptions.

Many women in Missouri seeking abortions found it easier to travel a few extra miles across the river to Fairview Heights, IL to receive an abortion the same day, due to Missouri’s 72-hour mandatory waiting period. When the Fairview Heights Planned Parenthood location opened in 2020, abortions in Missouri drastically dropped.

According to the Missouri Department of Health and Human Services, only 39 surgical abortions were performed in Missouri in 2020, compared to the 4,660 abortions performed in Missouri in 2019. Now, traveling to out of state for an abortion is a legal necessity, rather than a choice based on convenience.

Women in rural areas of Missouri face even more restrictions on their access to abortion. Many will drive hundreds of miles across state lines in order to get one. “In my area, St. Louis is five hours away and I live close to the Iowa border. Most women that live where I do will go to Des Moines or Omaha to get an abortion,” said Jessica Piper, a former English teacher running for state legislature in Missouri.

Piper lives in northwestern Missouri, and fears that access to abortion for women in her community may become even more challenging. “MO Representative Mary Elizabeth Coleman is writing a law right now to keep pregnant people in the state so they can’t get an abortion, and that would really affect women in my area trying to get an abortion,” said Piper. Representative Coleman has recently introduced legislation in Missouri that would allow private citizens to sue anyone who helps a Missouri resident obtain an abortion outside the state of Missouri.

Piper is also concerned that the lack of access to abortion in rural Missouri will force many women into keeping their pregnancies and cause greater economic issues down the road. “Women in rural Missouri just don’t have the same access (to care) and they don’t have the same access to knowledge. Often, it’s too far to drive to a clinic or too expensive so people end up having the baby is what I have noticed. And then they are born into a world where they can’t have Medicaid or food stamps and everyone looks at them like a welfare mom but at the same time everyone told them to do this,” said Piper.

The end of abortion was a long time coming in Missouri. In 2019, Missouri Governor, Mike Parson passed a law banning abortion. The law, known as “Right to Life of the Unborn Child,” which instantly made abortion in Missouri illegal when Roe vs. Wade, a 1973 Supreme Court decision making abortion a constitutional right was overturned.

Not only does this law have no exceptions for cases of rape or incest and bans abortions, but it also targets medical professionals. According to the law, anyone who performs an abortion is subject to a Class-B felony and suspension or revocation of their professional license.

Many fear next to come is restrictions on other reproductive and social freedoms, such as access to contraception, and same sex marriage. St. Louis University law professor Marcia McCormick explains, “So beyond abortion, it’s going to have effects on contraception, it’s going to have effect on prenatal care and high risk pregnancies and the ability of doctors to treat their patients more generally. But it’s also the way that it’s written is going to provide ammunition for people who want to rollback other rights, like rights to same sex marriage, possibly rights to interracial marriage, access to contraception and more. This decision has the potential to be extremely far reaching,” said McCormick. Additionally, the way this particular decision undermines the equal protection clause of the 14th amendment leaves various civil liberties extremely vulnerable to challenge by state or national legislators. The same legal basis that was used to overturn Roe v Wade could be used to overturn Obergefell v Hodges, which legalized same-sex marriage, or Loving v Virginia, which legalized interracial marriage.

While there are numerous immediate impacts on women across Missouri due to this decision, the real change is yet to come, and may impact a far broader swath of the population.

Abortion at Clayton

When she was 19 years old, Nancy Bell had an abortion. And she told no one. Going to get the procedure alone, with no need for parental permission in 1986, her rights as a woman in the U.S were extensive. Now, at age 55, the need to tell her story is as prominent at this time as ever. For, the rights she knew as a young adult did not stand the test of time. “It was an incredibly harrowing, difficult thing to do. Now I feel very strong and secure enough to tell that story,” said Bell. “I don’t believe there’s anything wrong with what I did. And I don’t believe there’s anything wrong with abortion. I think abortion is healthcare, and people need to have access to it.”

Bell, CHS parent, reproductive-rights activist, and SLU professor, experienced something that not many can relate to. Currently attending the Ethical Society for activist training and advocating for women’s rights through her platform in the theater industry, Bell always knew she wanted to create a better world for her children. So, in June of 2022, when the landmark decision by the Supreme Court to overturn Roe v Wade took place, Bell was ready to advocate for her rights, as she felt a drive for change that housed more relevance today than any previous time.

“I felt ready to fight,” said Bell. “I also felt a great deal of concern for my fellow women and other people who can get pregnant. I felt a great amount of solidarity for LGBTQ citizens and my friends in those communities because the ruling really threatens them as well.”

Bell’s abortion experience at a young age was defined by a lack of trust, control, and authority over her own situation and body. But now, as an adult in a world where safe abortion isn’t a readily available option, the need for support is where her efforts come in to play. “I mean, women are so pissed off, you have no idea. Like I would happily go to jail for a woman for [helping her receive access.] I think a lot of women feel that way,” said Bell.

As emotions are running high, and communities start to stand in solidarity with each other, Bell notes that communication and understanding is key at a time like this. Listening to each other, and finding common ground isn’t just a suggestion, but should rather be a way of coming about any conversation regarding this topic.

Bell said, “To bear witness to what your own truth is, in a responsible, open way, a way that does not slam the door for dialogue, is how other people hear you. As members of a community where the female population are primarily impacted through this legislation, managing civil discourse relies heavily on the ways we as humans approach conversations.

Oftentimes, anger and hostility towards others comes from a place of misunderstanding and fear, so realizing that early on and adapting conversations with that knowledge is principle. While Bell’s personal story led to her current beliefs and stances on abortion, other members of the Clayton community came about their stances through second-hand experiences.

Adam Bergeron, CHS Biology teacher and father of two, would’ve been a father of three after his wife underwent in-vitro fertilization. However, with his wife enduring a high-risk pregnancy and receiving a doctor recommendation to undergo selective reduction of one of the embryos, a medical abortion ensued. “There was a day where I watched our OBGYN insert a syringe into my wife’s uterus, and inject a solution of potassium chloride into the heart of my daughter, so as to preserve the lives of [my twin children] Ben and Celia and the life of my wife,” said Bergeron. “Yeah, I don’t know if that’s legal anymore.”

While safe access to reproductive healthcare touches a sensitive spot in Bergeron’s life, he realizes how others’ understanding, or lack thereof, of human biology, can get in the way when it comes to comprehending abortion. Bergeron noted, “If that is your understanding of human reproduction of biology, you might have a very strong opinion that you actually are indeed killing a baby. And you would want to do everything in your power to stop that from happening, right?” Zooming in on the legality aspects, Bergeron also discussed how the debate over abortion and bodily autonomy, “speaks to men’s presupposition that in some way, shape or form they know better than women do. My personal opinion on this is to be an advocate for women, because I have lived through and experience where that particular procedure saved the lives of the people that I loved the most.”

The impacts from the monumental decision this summer have hit the youth population especially hard. In late June, CHS Junior Maria Mohr was out of the country  when Roe v Wade was overturned, she described how it was “like I was watching my country shut down, as the one I was in just kept going forward like nothing was happening. When I saw the first person post about it, I did not think it was real. And then I looked it up and could feel a genuine sense of doom.”

Similarly, Senior Claudia Taylor talked about how the decision impacted her mental health. “When the decision was finally made, I felt extremely betrayed, lost, and hopeless,” said Taylor. “I had a hard time paying attention at work, I had trouble sleeping, and my mind was constantly overrun with thoughts of the worst case scenario.” The conversation about abortion with other peers is a thought hovering on everyone’s minds, since being back at school.

CHS freshman Gretchyn Miller said, “I haven’t heard many people talking about Roe vs Wade or anything about abortion in general. It’s a bit surprising since I’m in high school now and everyone is older.”

Another concern coming from CHS students and community members is ensuring a proper sex education curriculum is in place to educate the youth population. CHS Sophomore Brooke Lytle said, “I think a lot of people that are sexually active have very little knowledge about the human body and our reproductive systems, and its very problematic.”

Abortion Providers

At 9:16 a.m. on June 24, 2022, Missouri Attorney General Eric Schmitt tweeted an announcement: “Following the SCOTUS ruling overturning Roe v. Wade, Missouri has just become the first in the country to effectively end abortion with our AG opinion signed moments ago.” Earlier that morning, the Supreme Court had issued a ruling in Dobbs v. Jackson Women’s Health Organization, overturning Roe v. Wade and Planned Parenthood of Southeastern Pa. v. Casey and holding that the Constitution does not confer a right to abortion. This ruling did not come as a surprise, especially for people who work in reproductive healthcare like Sarah Felts.

“Being prepared for it logistically and operationally is very different than being prepared for it emotionally, just speaking for myself,” said Felts, Digital Strategy Manager at Planned Parenthood of the St. Louis Region & Southwest Missouri. “I knew this was going to happen and have been, like many of my colleagues, trying to explain that this was the end goal of a lot of the legislation in Missouri and in other states. And that still didn’t prepare me for how I was going to feel when the decision came down.”

The foundation for a post-Roe abortion ban in Missouri was laid years before Schmitt’s tweet that morning.

“In Missouri, we have been basically living in a functionally post-Roe reality for several years now,” said Felts. In 2019, the state passed a law that imposed significant barriers on people seeking abortion care, including mandatory waiting periods, parental consent, and restrictions on insurance coverage for abortions.

“They basically created this super complex obstacle course deliberately designed to stop people from getting abortion care,” said Felts. “So most folks after 2019 who needed an abortion, they were already leaving the state to get care elsewhere.” Where were most people from St. Louis going to seek abortions? The two locations providing abortions closest to the St. Louis area are Hope Clinic for Women in Granite City, IL and Planned Parenthood of Fairview Heights in Fairview Heights, Illinois. These clinics were already busy before the Dobbs decision, and now even more people are coming from farther away.

Becca Wilson is the Supervising RN at Hope Clinic, and explained that the clinic has been experiencing double to triple the number of patients since abortion became illegal in Missouri. “Patients are very much more stressed because they’re having to come by plane, train, automobile, all the financial burden, more time off, so it seems like we’re dealing with a lot more mental health crises and stuff like that,” said Wilson.

“We’re doing the same thing, just doing a lot more of it and for a bigger patient demographic.” Compared to the next-day scheduling that Hope Clinic used to be able to provide, most patients now have to wait three weeks for appointments. Both patients and staff at Hope Clinic have felt the stress of the post-Roe reality. Wilson explained that many nurses and other clinic personnel are experiencing more severe mental health challenges at work. “If you take something that’s already very emotionally labor intensive and then you just increase it in volume and increase people’s stress from the outside world, it becomes a place where […] it’s just way easier to push people over the edge,” she said.

For many licensed nurses who perform abortions, their livelihood has also been threatened. Rebecca Johnson*, a nurse at the Planned Parenthood in St. Louis, has now had to permanently move to the Fairview Heights clinic in Illinois. “That has definitely become a concern of mine that it’s going to become a problem for me to go to Illinois for work,” Johnson said. “In Texas, they will report you for things like that, so we were all very concerned.” Wilson added that this fear has become more prevalent in the medical community. “It’s just changed things a little bit as far as what type of risk doctors are willing to take to provide services because they don’t want to compromise their licenses,” she said.

Because of the heightened barriers and risks to obtaining abortion services, providers, advocacy organizations and funds have been working to increase collaboration and capacity. The Regional Logistics Center, run by Hope Clinic and Planned Parenthood of the St. Louis Region & Southwest Missouri, is a collaborative effort that opened in January 2022. The group works with patients who have an appointment for reproductive care at either clinic to ensure they have transportation, childcare and financial aid.

Plans for a new clinic in Carbondale, IL are also in the works. “Even though everything is very bleak, there are just so, so many good, smart people doing a lot of really important work to make sure that people are still able to access care,” said Wilson.

Although many abortion providers are finding it hard to stay hopeful, they are also pragmatic in looking ahead to the future.“We didn’t get here overnight,” said Felts. “This has been decades in the making for Missouri. Missouri was for a long time one of the most restrictive states in the country when it came to abortion. A lot of restrictions that popped up in other states were pioneered in Missouri. And with that in mind, we’re not going to get out of this overnight. She envisions a transformative future for abortion access, one that goes beyond the protections provided by Roe v. Wade. “It doesn’t look like going back to before these restrictions were in place,” she said. “It looks like going to a place that’s built out of equity as opposed to just a legal right.”

Healthcare

Aside from standard abortion procedures such as dilation & evacuation, vacuum aspiration, mifepristone medication, there are a few other medical procedures that can result in the end of a pregnancy. Many of which have become grey areas in states with trigger laws.

In medical terms they are considered abortions and in the case of an ectopic pregnancy the mother will die if the necessary procedure is not preformed in a timely matter. An ectopic pregnancy is a pregnancy that occurs outside of the uterus. Treatment for an ectopic pregnancy includes medication or surgery depending on how far along the pregnancy is.

If the pregnancy is still early on, the mother will be given methotrexate, which stops the growth of the fertilized egg. After receiving this injection, the egg absorbs into the body within a few weeks and surgery is not necessary. The other alternative if the pregnancy is further along is a surgical procedure, the most common surgery used to treat an ectopic pregnancy is a laparoscopy. The surgery consists of small incisions in the lower stomach and a small tube being put into the stomach to retrieve the ectopic pregnancy. If the doctor sees that as a result of the pregnancy there is damage to the fallopian tube, it is then removed in order to save the mothers life.

Another way to end a pregnancy is by medication. Mifepristone is extremely effective for pregnancies prior to twelve weeks of gestation; it’s also easier as the pill is available at Planned Parenthood locations. Depending on the state in which you live, the pill can also be shipped to your home after a telehealth conference, increasing its convenience. If it doesn’t work, thats when one would go to an abortion clinic for the abortion procedure. “The most common regimen used for medication abortion is a two medication regimen approved by the FDA that includes the medications mifepristone and misoprostol,” said Express Scripts pharmacist Susan Pepper. “Mifepristone is available as a brand name medication (Mifeprex) that is only indicated to terminate pregnancy. Mifepristone is also available as the brand name medication Korlym, which is indicated for patients with Cushing’s syndrome. There are also generic versions of mifepristone available. Misoprostol is indicated for the prevention of ulcers for patients who take NSAIDs, but is used off  label as part of this regimen to end pregnancy. It is available as a brand name medication (Cytotec) as well as generically.”

Another gray area for physicians in states with trigger laws is dilation and curettage, or a D&C procedure. A D&C would be performed if a woman has a miscarriage and not all of the remaining tissue is able to leave the body naturally. Not performing a D&C within a timely manner after a miscarriage can lead to serious health complications such as infection and prolonged bleeding.

According to Mayo Clinic, about 10 to 20 percent of known pregnancies end in miscarriage. In states with trigger laws, miscarriage treatment is still legal, but that does not mean that it’s readily available. In many religious hospitals, doctors have to follow a doctrine which restricts them from giving any type of abortion care or procedures, even one for a miscarriage.

Other doctors, who fear losing their license, won’t perform these procedures as well. Many states are pushing for legislation to make miscarriage treatment and abortion pills to be illegal. In Missouri, there is a proposed bill (House Bill 2810) which, “would make using, prescribing and even ordering abortion inducing devices or drugs a Class A felony.”

This story was originally published on The Globe on October 18, 2022.