For the past eight years, Missouri has had a 24-hour wait rule for abortions: Women seeking to end a pregnancy must visit a clinic for an initial health consultation before waiting 24 hours to have the procedure.
On Friday, a new state law goes into effect that triples the wait time. The law includes no exemptions for rape or incest, which is one reason Gov. Jay Nixon, a Democrat, vetoed it. But the state legislature last month overrode his veto.
The law's supporters say a 72-hour waiting period gives women a chance to consider other options. Pam Fichter, president of Missouri Right to Life, said the 72 hours are a reflection period.
“We know that when mothers have the time to review their options, they’re more likely to choose life for their unborn child,” Fichter said. “And this additional time that the law will allow will give mothers great opportunities to seek assistance and help them bring a healthy baby into the world.”
But more time isn’t what women who are seeking an abortion need, said the Rev. Rebecca Turner, the executive director of Faith Aloud. The St. Louis-based network of 40 people from a variety of religions counsels hundreds of women anonymously over the phone every year.
“[These women] have already been through the anguish about what to do about their pregnancy; they’ve already come to their decision. They don’t need to go back home and think about it after talking to the clinic,” Turner said.
Turner added that in recent weeks, dozens of women have called Faith Aloud after being told by Planned Parenthood that they would have to wait more time to have an abortion.
“The emotion in their voices — it’s a desperation, it’s a sadness, it’s a sense of hopelessness,” Turner said. “It’s such an insult to women that somehow our legislators think that (women) don’t think about an abortion before they actually have one."
Turner said that for many of the women she counsels, the 72-hour law means they have to arrange for transportation, child care, and time off from work for two trips to a clinic that can be miles away. Others may be survivors of rape, teenagers living in dangerous homes or women living in poverty.
“They risk losing their jobs, they risk being outed in their communities. It becomes a very, very public decision for them,” Turner said.
On average, an abortion costs about $500 or more, but Missouri law forbids health insurance or Medicaid from covering the procedure. Although Planned Parenthood of the St. Louis Region and Southeast Missouri is able to provide some financial assistance, many women still have to pay out-of-pocket costs. The funding law does include exceptions for cases of incest, rape and the health of the mother.
Dr. Colleen McNicholas, a physician for Planned Parenthood, said that for many of her patients, the 72-hour wait will likely be longer.
“In practice, it can be more than that, depending on the day of week they get consented or how far away they live, arranging their travel time with taking off work or finding additional childcare,” McNicholas said.
“But what we know from the 24-hour waiting period that we’ve been operating under for some years now, any mandated delay in access really has implications that are far more reaching.”
For women living in rural areas, McNicholas says the law is even more of a burden. The average patient travels 100 miles to Planned Parenthood in St. Louis, the state’s only licensed abortion clinic.
“Most of the women in Missouri live in a county where they don’t have a provider. Every other medical service we find to be, as a medical community, totally unacceptable. And we’re always looking for ways of improving access to rural communities, except in this sort of situation,” McNicholas said.
McNicholas worries that the delay forces women to terminate their pregnancy later, which could be riskier. For example, a woman who presents in the eighth week of gestation may be forced to have a surgical abortion because the abortion pill is effective only up to nine weeks.
In September, the American Journal of Public Health published a survey that included 231 women who had been turned away from abortion clinics in the US, because they were too far along in their pregnancy. 58% said they delayed seeking out the procedure because of travel and procedure costs.
Elizabeth Nash is the state policy analyst for Guttmacher Institute, a Washington D.C.-based think tank that supports reproductive rights. She said that since the 1980s, Missouri has passed some of the strictest abortion laws in the country.
“When a restriction is enacted, it really sets up an environment for hostility around abortion and increases stigma around abortion, which in of itself creates a culture where it’s harder to provide abortion services,” Nash said.
Planned Parenthood has said it will not immediately appeal the 72-hour law in court. Instead it will seek to expand the locations throughout Missouri where women can give their informed consent, requiring only one trip to St. Louis or out of state for the procedure itself.
Alongside Utah and South Dakota, Missouri is now one of three states in the country with a mandatory 72-hour waiting period for abortions. Alabama passed a 48-hour waiting period this year, and eight other states have 24-hour waiting periods that require two in-person trips to a clinic.
“It does look like this is a new trend among abortion restrictions, so it’s not surprising to see these states at the forefront,” Nash said. “By extending the waiting period, all the issues that were found with a two-trip requirement in a 24-hour waiting period are going to be exacerbated.”
