After she learned her fetus was affected by a rare, severe abnormality that would result in her pregnancy ending either in stillbirth or a baby whose life necessitated immediate medical intervention, a small business owner from Missouri and her husband decided the "greatest act of love" they could take as parents would be to terminate the pregnancy. In deciding to terminate the pregnancy, the couple didn't expect politics to play a role in their experience — but that's exactly what happened.
"Libby's story is heartbreakingly linked with the political landscape in Missouri — something I never thought I would have to navigate when learning the most devastating news of our life," Jennifer Box said in emotional testimony before the House Oversight and Reform Committee. "This meant I moved at the direction of the government."
Box said because the fetal abnormality was detected late in her pregnancy, she had little time to elect to have the pregnancy terminated. Though she had to move quickly, she was forced to confront a litany of onerous restrictions aimed at delaying her care or blocking it altogether, such as mandatory waiting periods, private and public insurance bans and informed-consent laws.
"My doctor's Catholic hospital, where I had delivered my two older boys, refused to care for me. We had to pay thousands of dollars out of pocket because of the state's insurance bans against abortion coverage. And, perhaps the most surprising, our procedure was rushed due to the state's consent and mandatory delay laws," she told lawmakers. "In order for me to access care from the same physician I consented with, as required by the state's nonsensical and arbitrary same-physician law, I had to have the procedure almost exactly three days later or my physician would not be available again until after my pregnancy was too far along to terminate in Missouri."
Box is just one of many individuals in Missouri who have had to jump through hoops to receive an abortion. She testified before Congress as part of a hearing on what the panel's acting chairwoman, Rep. Carolyn Maloney, D-N.Y., called "draconian steps to violate women's rights by restricting access to reproductive health services, including abortion." (The hearing was Maloney's first as acting chairwoman, a role she assumed after the death of Rep. Elijah Cummings, D-Md.)
Over the past year, Missouri has taken some of the most extreme actions to limit access to reproductive health care. It is one of six states with just one remaining abortion provider — and it's at risk of becoming the first state in the country without a single provider.
Dr. Colleen McNicholas, chief medical officer at Planned Parenthood of the St. Louis Region and Southwest Missouri, also testified before the panel. Her clinic in St. Louis — the state's one remaining abortion provider — has been at the center of a months-long battle with Republican Gov. Mike Parson's administration. Parson, who earlier this year signed a law that bans abortions in the state after the eighth week of pregnancy, has said he has "serious health concerns" about the facility.
At a hearing in October to determine the fate of Missouri's last remaining abortion clinic, Missouri officials testified that they believed the clinic wasn't following the law and putting patients at risk. According to St. Louis Public Radio, McNicholas "conceded that 'doctors are allowed to make mistakes,' but she said the four patients who suffered complications at the clinic represented a tiny fraction of the thousands who receive care at the clinic each year."
During that hearing, it was also revealed that officials had tracked personal information about Planned Parenthood patients, in some cases monitoring some women's menstrual cycles, in an effort to identify those who had failed abortions. (After significant public backlash, the state suspended the practice. State health officials admitted last month that their inspections processes are driven by pressure from anti-abortion legislators and advocates.)
"Despite the reality that abortion is safe, Missouri politicians have layered restriction upon restriction in a deliberate attempt to end abortion access. And over the last 30 years, Missouri has gone from nearly 30 clinics that provide abortion to just one today," McNicholas said at Thursday's hearing.
She noted Dr. Randall Williams, the director of Missouri's state health department, ordered Planned Parenthood to perform two pelvic exams on every patient seeking an abortion at least 72 hours before the procedure, even if the patient is receiving a nonsurgical medical abortion.
The exam requires a doctor to insert a metal speculum into a patient's vagina to examine her cervix. The doctor will then insert fingers into the patient's vagina while pressing on the patient's abdomen to feel her reproductive organs. Though it only takes a few minutes, the procedure is uncomfortable and unpleasant. Doctors have said that before a medication abortion, there is no medical reason for this invasive measure, which can be traumatizing, especially when it is performed only because of a state mandate and without regard for medical science.
McNicholas, whose clinic defied the practice and described it as "inhumane," told lawmakers on Thursday, "my colleagues and I could not in good conscience force patients to take off their clothes unnecessarily and endure an extra, state-mandated vaginal exam."
Thursday's hearing came as a growing number of states are passing restrictive abortion laws.
"I believe these states have been emboldened by the Trump administration's systemic attacks on reproductive health care and general disrespect for women," Maloney, the panel's chairwoman, said Thursday. "It is time to let women speak, and it is time for everyone to listen. It is time for the elected representatives here in Congress and in state houses across the country to protect the right to privacy and a woman's right to abortion services rather than attack it, undermine it and try to eliminate it."
Since 2010, state lawmakers have passed hundreds of abortion restrictions, intended to undermine Roe v. Wade, the landmark 1973 Supreme Court decision that established a federal protection for abortion. But what is unique to this moment is that state legislators have admitted that they are are pushing extreme and restrictive measures to set up a direct challenge to Roe.
Over the past year, anti-abortion legislations in Alabama, Georgia, Kentucky, Louisiana, Mississippi, Ohio and Missouri have passed laws that would prohibit nearly all abortions. They have been emboldened by the transformation of the Supreme Court with the confirmation of Justice Brett Kavanaugh, which secured a conservative majority on the nation's highest court for decades to come.
These measures — which include the criminalization of abortion and unnecessary requirements on patients, clinics and providers — have disproportionately impacted those who already significant inequality in health care: People of color, low-income individuals, LGBTQ individuals and those who live in rural areas.
"The resulting shortage of abortion providers has led to longer waiting times for appointments and increased travel to clinics, which often result in increased associated costs — such as long-distance travel, a hotel stay in a different city, additional child care costs and more time off of work," explained Fatima Goss Graves, president and CEO of the National Women's Law Center. "People seeking abortion in these states often must pay out of pocket for the abortion care itself, since these same legislatures have also banned insurance coverage of abortion. The impact of this web of restrictions means that, for many people already, the right to abortion has been decimated."