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Abortion Bans Throughout Pregnancy

Missouri bans a safe abortion procedure. Mo. Ann. Stat. § 565.300 (Enacted 1999).

When the law was enacted, a lower court enjoined its enforcement. However, in the wake of the Supreme Court’s decision in Gonzales v. Carhart, the lower court found the law constitutional and enforceable and lifted the injunction. Reprod. Health Servs. of Planned Parenthood of the St. Louis Region, Inc. v. Nixon, 429 F.3d 803 (8th Cir. 2005), vacated by 127 S.Ct. 1610, remanded to No. 04-2909 (8th Cir. May 29, 2007).

Missouri’s ban makes any abortion procedure that falls within a broad definition a felony, unless provided by a physician using procedures consistent with the usual and customary standards of medical practice to preserve the woman’s life. Mo. Ann. Stat. § 565.300 (Enacted 1999). A lower state court held that Missouri’s ban does not apply to a licensed physician’s provision of: (1) abortion prior to the time that a fetal heartbeat is detectable or abortion at any time when the fetus has no detectable heartbeat; (2) suction curettage; (3) vacuum aspiration; (4) hysterectomy abortion; (5) induction abortion; (6) hysterotomy abortion; and (7) dismemberment or nonintact dilation and evacuation abortion. State v. Reprod. Health Servs. of Planned Parenthood of the St. Louis Region, Inc., No. 004-00008 (Mo. Cir. Ct. Dec. 5, 2000).

Additionally, a state appellate court found that the ban could not be interpreted to include an exception to protect a woman’s health. State v. Reprod. Health Servs. of Planned Parenthood of the St. Louis Region, Inc., 97 S.W.3d 54 (Mo. Ct. App. 2002).

There is also a Federal Abortion Ban, which applies nationwide regardless of state law.

The federal ban prohibits certain second-trimester abortion procedures and has no exception for a woman’s health. In April 2007, the U.S. Supreme Court upheld the ban, making it the first time since Roe v. Wade that the court has upheld a ban on a previability abortion procedure.

Abortion Providers: Expansions & Restrictions – TRAP Laws

Missouri imposes extra restrictions on abortion providers, despite the fact that all health-care providers already must comply with a variety of federal and state regulations governing health, safety, building and fire codes, and zoning requirements.  

Restrictions on Where Abortion Services May Be Provided:

Among the most common TRAP regulations are those restricting the provision of abortion services to hospitals or other specialized facilities, which place medically unnecessary and costly requirements on doctors and can decrease the availability of abortion care for women. Missouri has such regulations, including:

Abortion providers must be located within 30 miles of a hospital, or face criminal penalties.  No exception is provided for rural areas.  Mo. Stat. Ann. § 188.080 (Original Statute Enacted 1974; Relevant Provision Enacted 2005).  A court issued a temporary restraining order prohibiting the state from enforcing this provision, but this order was dissolved after the clinic bringing suit shut down.  Springfield Healthcare Center v. Nixon, No. 05-4296-CV-C-NKL (W.D. Mo. Sept. 16, 2005) (issuing temporary restraining order), Springfield Healthcare Center v. Nixon, No. 05-4296-CV-C-NKL (W.D. Mo. Oct. 25, 2005) (dissolving temporary restraining order).  

All abortion providers must have staff privileges at a hospital within 15 minutes’ travel time or maintain a working arrangement with a hospital within such a distance.  Nothing requires the hospital to grant providers such an arrangement. Mo. Code Regs. Ann. tit. 19, §§ 30-30.060(1)(C)(4). A federal judge intervened in the enforcement of this law when the University of Missouri’s (former) chancellor revoked the existing admitting privileges it extended to a Planned Parenthood clinic. The judge granted the clinic additional time to secure admitting privileges at an alternate hospital. Unfortunately, the university’s new, interim chancellor refused to reconsider the privilege revocation. Planned Parenthood of Kansas and Mid-Missouri v. Lyskowski (Nov. 30, 2015).

Missouri regulations require each provider to be licensed as an “abortion facility” if 51 percent or more of its patients receive abortion care, or if 51 percent or more of its revenues are “from abortions or procedures related to abortions.”  Mo. Code Regs. Ann. tit. 19, §30-30.050(1)(A), (B), .050(2)(A). Facilities that were built after the rule was put into effect in 1987 must comply with dozens of medically unnecessary administrative, professional-qualification, patient- and employee-testing, and physical-plant requirements.  Mo. Ann. Stat. §§ 188.060 (Enacted 1974; Last Amended 1979), 188.080 (Enacted 1974; Last Amended 2005); Mo. Code Regs. Ann. tit. 19, §§ 30-30.060, 30-30.070.  These include particularly costly and onerous construction and design requirements, such as that procedure rooms must be at least 12 feet long and wide with ceilings at least nine feet high and doors at least 44 inches wide, corridors must be at least six feet wide, and separate counseling rooms are required and must be at least 10 feet long and wide.  Mo. Code Regs. Ann. tit. 19, §§ 30-30.070(2)(B), .070(2)(C), .070(2)(M), .070(2)(Z).  Facilities that existed at the time the regulations were enacted had to comply with other physical requirements that were slightly less cumbersome than those for facilities built after 1987.  Mo. Code Regs. Ann. tit. 19, § 30-30.070(3).  

Missouri passed another law that would require most, if not all, health-care facilities that provide abortion care in Missouri to become licensed “ambulatory surgical centers.” Mo. Ann. Stat. § 197.200. Becoming an ambulatory surgical center is a highly burdensome and unnecessary process that would force providers to make even more expensive and time-consuming changes to their facilities than are already required. This would likely result in abortion providers being shut down and patients forced to leave the state to receive abortion care.  On September 24, 2007, a court granted a preliminary injunction to stop the state of Missouri from immediately enforcing the law.  Planned Parenthood of Kansas and Mid-Missouri Inc. v. Jane Drummond, Jay Nixon, Daniel Knight, and James Kanatzar, No. 07-4164-CV-C-ODS (W.D. Mo. filed Sept. 24, 2007) (issuing preliminary injunction).  The court ordered abortion providers and the state to work together to modify the clinic regulations and return to the court in the event of an impasse.  Subsequently, a lawsuit was filed in a Missouri state court asking to exclude providers from the law who only prescribe the medical abortion pill (commonly known as RU 486 or mifepristone).  The state district court denied Planned Parenthood’s motion for summary judgment on the matter, citing the suit’s redundancy with the ongoing federal case.  In 2009, a Missouri court of appeals affirmed the lower court’s judgment that Planned Parenthood could not seek relief in the state courts while its federal suit was ongoing.  Planned Parenthood of Kansas and Mid-Missouri Inc. v. Jane Drummond, Jeremiah W. Nixon, and James F. Kanatzar, No. 0716-CV30805 (Mo. Cir. Ct. May 9, 2008), aff’d sub nom. Planned Parenthood of Kansas and Mid-Missouri Inc. v. Donnelly 2009 WL 2341890 (Mo. App. W.D. July 31, 2009).

A subsequent case was brought against Missouri’s ambulatory surgical center and admitting privileges requirements in November 2016, resulting in the law being blocked from going into effect. Comprehensive Health of Planned Parenthood Great Plains v. Hawley (May 2017).

Missouri has an unconstitutional and unenforceable statute that requires all abortion services after 16 weeks be provided in a hospital.  Mo. Ann. Stat. § 188.025 (Enacted 1974; Last Amended 1986).  The statute was declared unconstitutional in Reprod. Health Servs. v. Webster, 851 F.2d 1071 (8th Cir. 1988), aff’d in part and rev’d in part on other grounds, 492 U.S. 490 (1989).

An earlier version of the requirement mandating hospitalization for all abortion services after the 12th week also was declared unconstitutional.  Planned Parenthood Ass’n of Kansas City v. Ashcroft, 462 U.S. 476 (1983).

Restrictions on Who May Provide Abortion Services:

Missouri prohibits certain qualified health-care professionals from providing abortion services.

Only a physician licensed by the state to practice medicine in the state and having surgical privileges at a hospital that offers obstetrical or gynecological care may provide abortion services.  Mo. Ann. Stat. § 188.015(5) (Enacted 1974), Mo. Ann. Stat. § 188.020 (Enacted 1974; Last Amended 1979), Mo. Ann. Stat. § 188.080 (Enacted 1974; Last Amended 2005);  Mo. Ann. Stat. § 334.245(1) (Enacted 2010).

A court held that the provision requiring physicians providing abortion services to have surgical privileges at specified hospitals is constitutional.  Women’s Health Ctr. of West County, Inc. v. Webster, 871 F.2d 1377 (8th Cir. 1989).

A physician’s assistant may not provide abortion services.  Mo. Ann. Stat. § 334.735(3)(10) (Original Statute Enacted 1989; Relevant Provision Enacted 1998).

Biased Counseling

A woman may not receive abortion services until at least 72 hours after receiving a state-mandated lecture containing medically inaccurate information from the abortion provider. The provider is required to discuss with her the “indicators and contra-indicators, and risk factors including any physical, psychological, or situational factors for the proposed procedure and the use of medications, including but not limited to mifepristone, in light of her medical history and medical condition.” The law also requires the woman to receive materials that state that “the life of each human being begins at conception. Abortion will terminate the life of a separate, unique, living human being.” Mo. Rev. Stat. § 188.039 (Enacted 1979; Last Amended 2014).

An earlier version of the law, requiring a 24-hour mandatory delay, was challenged in two cases. The state supreme court decided that both the waiting period and the biased-counseling requirements are constitutional and enforceable. Reprod. Health Servs. of Planned Parenthood of the St. Louis Region, Inc. v. Nixon, 185.S.W.3d 685 (Mo. Feb. 28, 2006). A federal district court issued a preliminary injunction against the biased-counseling portion of the law. The injunction expired 10 days after the state court decision, so the biased-counseling law is in effect. Reprod. Health Servs. of Planned Parenthood of the St. Louis Region, Inc. v. Nixon, No. 03-4210-CV-C-SOW (W.D. Mo. Dec. 1, 2005) (order granting preliminary injunction).

In addition, an earlier law that has since been repealed provided that a woman may not receive abortion care until after the attending physician confirms whether she is pregnant and if so, informs her of the particular risks associated with the procedure, including alternatives to abortion. Mo. Ann. Stat. § 188.039 (Enacted 1979; Repealed 2003). A court held that this provision is unconstitutional. Reprod. Health Servs. v. Webster, 662 F. Supp. 407 (W.D. Mo. 1987).

Mandatory Delay

Missouri requires a woman seeking an abortion to wait 72 hours between the time she receives biased-counseling materials and when she can get the procedure. Mo. Rev. Stat. § 188.039 (Enacted 1979; Last Amended 2014).

Counseling and Referral Ban

No public funds may be used to provide abortion or abortion counseling unless necessary to preserve the woman’s life. Mo. Ann. Stat. § 188.205 (Enacted 1986).

No funds for insurance and services for uninsured children may be used to counsel or refer for abortion unless the procedure is necessary to preserve the woman’s life or the pregnancy is the result of rape or incest. No person or organization that counsels or refers for abortion, unless necessary to preserve the woman’s life or the pregnancy is the result of rape or incest, may receive funds under the Children’s Health Insurance Program. Mo. Ann. Stat. § 208.631 (Enacted 1998; Last Amended 2002), § 208.655 (Enacted 1998).

No funds expended under the Missouri Alternatives to Abortion Services program or the Missouri Alternatives to Abortion Public Awareness program may be used to provide, assist in, or refer for abortion services. None of these funds shall be granted to organizations or affiliates of organizations that provide, assist in, or refer for abortion services. Mo. Rev. Stat. §§ 188.325, .335 (Enacted 2007).

In addition, no genetic diagnostic evaluations, treatment, and counseling services provided by the department of health through contracts with tertiary genetic centers may refer for abortion, unless necessary to preserve a woman’s life. Mo. Ann. Stat. § 191.320 (Enacted 1985).

No public funds appropriated to the Life Sciences Research Trust Fund may be used to support a research project that involves abortion services, or used to counsel or refer for abortion services unless necessary to preserve a woman’s life. Mo. Ann. Stat. §§ 196.1100, .1127 (Enacted 2003).

No funds appropriated to and distributed by the Department of Social Services may be paid to any person or entity that performs, refers a patient, or develops or dispenses drugs or devices to induce an abortion which is not necessary to save the life of the mother. H.B. 11, 99th Gen. Assem., Reg. Sess. (Mo. 2017); Mo. Rev. Stat. § 170.015 (2016).

 

Crisis Pregnancy Centers & Anti-Choice License Plates

Missouri law provides for a “Choose Life” license-plate program that funnels money to anti-choice organizations. The program is operated by the state Department of Revenue and drivers are able to purchase the specialty license plate for a fee. A percentage of the fee is retained by the state to recoup administrative costs; the rest of the funds are directed to Choose Life of Missouri. Mo. Ann. Stat. § 301.3150, https://secure.acceptiva.com/?cst=9dcb1d.

In 2006, the state legislature’s Joint Committee on Transportation Oversight rejected the application for a “Choose Life” specialty license-plate program. Choose Life of Missouri challenged the decision claiming the state violated their free-speech rights. In 2009, the Eighth Circuit Court of Appeals ruled that the state’s rejection of the “Choose Life” license-plate program was unconstitutional. The court found that license plates are private speech so a law in which the government favors one position over another is viewpoint discrimination. Roach v. Davis, 08-1429 (8th Cir. 2009).

 

Crisis Pregnancy Centers: State Funds

Missouri funds crisis pregnancy centers (CPCs) directly through taxpayer funds. The funding stream is established through the “Missouri Alternatives to Abortion Services Program,” administered by the Office of Administration.  The program is allocated and authorized to use state funds, as well federal funds made available by the Temporary Assistance for Needy Families block grant. In FY’18, CPCs are eligible to receive $6,383,561 through these funding streams.  In a related measure, Missouri established the “Missouri Alternatives to Abortion Public Awareness Program,” which indirectly funds CPCs through the development and promotion of a state website exclusively providing information on CPCs, as well as funds to use television, radio, print media, and the internet to dispense information about CPCs.  In FY’18, CPCs are eligible to receive $75,000 through this funding stream.  Mo. Ann. Stat. § 188.325, .335 (Enacted 2007); H.B.11, Sec. 11.120, 2017 Mo. Gen. Assemb. Reg. Sess. (MO 2017).

(Note: Missouri also provides tax credits for individuals who donate to CPCs.  Total tax-deductible donations to CPCs are capped at $2.5 million, with individual donations capped at $50,000.  For purposes of NARAL Pro-Choice America statute tracking we consider this a direct funding measure.)

Insurance Coverage & Abortion

Missouri expressly prohibits plans in its state exchange from covering abortion services. Health-insurance policies offered in the state health-insurance exchange may not include abortion coverage, with no exception. Plans in the state exchange are also prohibited from offering abortion coverage through an optional rider for which an additional premium is paid, though there is no evidence that such separate policies exist. (Even if they did exist, offering women the “option” to pay for separate abortion coverage is a false promise because no one plans for an unplanned pregnancy.) Mo. Ann. Stat. § 376.805 (Enacted 2010).

Missouri prohibits statewide private insurance coverage of abortion services. Private health-insurance policies offered in the state may not include abortion coverage, with an exception only to save a woman’s life. Abortion coverage may be obtained only through an optional rider for which an additional premium is paid. However, insurers are not required to offer such riders and there is no evidence that such separate policies exist. (Even if they did exist, offering women the “option” to pay for separate abortion coverage is a false promise because no one plans for an unplanned pregnancy.) Mo. Ann. Stat. § 376.805 (Enacted 1983; Last Amended 2010). A court upheld the constitutionality of this law in Coe v. Melahn, 958 F.2d 223 (8th Cir. 1992).

 

Low-Income Women & Abortion

Missouri prohibits public funding for abortion for women eligible for state medical assistance for general health care unless the physician certifies that the woman’s life is endangered by a physical disorder, physical injury, or physical illness, including a life-endangering physical condition caused by or arising from the pregnancy itself, or the pregnancy is the result of rape or incest. Mo. Dep’t of Soc. Servs., Mo. HealthNet Division, Mo. Medicaid Provider Manual: Physician, § 13.40.I (Sept. 1, 1998) at http://www.dss.mo.gov/dms/providers.htm; Mo. Dep’t of Soc. Servs., Mo. HealthNet Division, Certification of Medical Necessity for Abortion (Aug. 1999), at http://www.dss.mo.gov/mhd/providers/index.htm.
Invalid and enjoined statutes prohibit public funds for abortion unless the procedure is necessary to preserve the woman’s life. Mo. Ann. Stat. §§ 188.205 (Enacted 1986), 208.152(1)(11) (Original Statute Enacted 1967; Relevant Provision Enacted 1973; Last Amended 1981; Renumbered 2005). A court held that this restriction conflicts with federal law prohibiting participating states from excluding abortion from the Medicaid program in cases of rape or incest, as well as life endangerment. The court declared that the state may not enforce the statute, so long as it accepts federal Medicaid funds. Stangler v. Shalala, No. 94-4221-CV-C-5 (W.D. Mo. Dec. 28, 1994).

The Missouri legislature enacted a bill that prohibits any funds distributed through the Department of Health for the Division of Maternal, Child and Family Health from being used to provide or refer for abortion services; specifically, organizations that receive state family-planning funds are prohibited from providing, assisting, or referring a patient for abortion services. H.B. 10, 94th Gen. Assem., Reg. Sess. (Mo. 2007) (Enacted 2007). To the extent that this law prohibits funding for abortion in cases of life endangerment, rape, or incest, it is in conflict with federal law.

 

Low-Income Women & Contraception

Consistent with the provisions of H.B.2011 (2016), Missouri will suspend its Section 1115 waiver for the Women’s Health Services Program which provides increased access to family-planning services. Between February and April 2017, all women enrolled in this federally funded program will be automatically enrolled in the Missouri Woman’s State-Funded Health Services Program, which will be fully financed by state funds. Eligibility requirements and available services will remain the same, allowing uninsured women aged 18 to 55 who have a net family income at or below 201 percent of the federal poverty level to receive family-planning and family planning-related services, pregnancy testing, and sexually transmitted disease testing and treatment. Additionally, the state will cover family-planning services for women losing eligibility after a 60-day postpartum period, regardless of income, for one year.

The Missouri Woman’s State-Funded Health Services Program will not cover or pay for services provided by an organization that also provides abortion services.

Public Notice of Suspension of Federal Expenditure Authority for Section 1115 family planning demonstration, at http://dss.mo.gov/mhd/waivers/1115-demonstration-waivers/files/missouri-women-health-services-waiver-suspension-notice-phase-out-plan.pdf. H.B.2011, 98th Leg., (MO 2016).

Missouri law requires MO HealthNet plans to cover dispensing a 12-month supply of oral contraceptives. MO HealthNet Pharmacy Manual at http://manuals.momed.com/collections/collection_pha/print.pdf (May 2017).

 

Post-Viability Bans

Missouri’s post-viability abortion restriction states that no abortion may be provided after viability unless necessary to preserve the woman’s life or physical health. A physician providing abortion care after 20 weeks gestational age must perform extensive viability testing and report such findings to the state health department. The physician must use the available method most likely to preserve the life and health of the fetus unless it poses a greater risk to the woman’s life or health than another available method. The physician must take all reasonable steps, consistent with good medical practice and with the procedure used, to preserve the life and health of the fetus unless such steps pose an increased risk to the woman’s life or health. A second physician must attend. Violation of this law is a class C felony punishable by a prison term of not less than one year and a fine of not less than $10,000. Mo. Ann. Stat. § 188.030 (Enacted 1974; Last Amended 2011).

The U.S. Supreme Court held that the second-physician requirement is constitutional. Planned Parenthood Ass’n of Kansas City, Mo. v. Ashcroft, 462 U.S. 476 (1983). In addition, another court held that the other provisions of this ban that predated the 2011 addition of the extensive fetal viability testing at 20 weeks are also constitutional. Planned Parenthood Ass’n of Kansas City, Mo. v. Ashcroft, 655 F.2d 848 (8th Cir. 1981).

NARAL Pro-Choice America supports the legal framework established in Roe v. Wade and does not oppose restrictions on post-viability abortion, such as Missouri’s, that contain adequate exceptions to protect the woman’s life and health.

Refusals of Medical Care

ABORTION REFUSAL CLAUSE

Missouri allows individuals, physicians, nurses, midwives, or hospitals to refuse to provide abortion services. Physicians, nurses, midwives, and hospitals can refuse to admit or treat a woman for the purpose of an abortion if admission or treatment is contrary to moral, ethical, or religious beliefs or established policy.

Refusal to treat or admit may not be a basis for a cause of action. No person or institution may be denied a public benefit or discriminated against in employment on the basis of refusal to advise, assist in, or provide abortion services.

No applicant, student, teacher, or school employee who objects in writing on grounds of conscience or belief may be required to pay any school fees that would in whole or part fund abortion services.

An employer, college, university, or hospital may not discriminate against an individual because of a refusal to provide, assist in, refer for, promote, procure, or counsel a woman to choose abortion if not necessary to preserve her life, except where an employer demonstrates an inability to reasonably accommodate the refusal to participate without undue hardship or where participation in abortion is a bona fide occupational qualification reasonably necessary to normal operations.

An individual injured by prohibited discrimination may bring a civil action for treble damages, costs, and attorneys’ fees.

Does the law require the refusing entity to notify the persons affected?  No.

Are there circumstances under which a refusal clause may not be exercised?  No.

Does the law require the refusing individual or entity to provide medically and factually accurate information or provide a referral for abortion services?  No.

Does the law provide a mechanism for women to otherwise obtain specific reproductive-health services, information, or referrals if an individual and/or entity exercises a refusal clause?  No.

Mo. Ann. Stat. §§ 188.100 to .120 (Enacted 1986), 197.032 (Enacted 1973).

INSURANCE COVERAGE FOR ABORTION REFUSAL CLAUSE

Missouri allows employers, plan providers, plan sponsors, health-care providers to refuse to provide coverage for abortion services. No employer, health-plan provider, health-plan sponsor, health-care provider, or any other person or entity shall be compelled to provide coverage for, or be discriminated against or penalized for declining or refusing coverage for, abortion in a health plan if it is contrary to their religious beliefs or moral convictions. (Missouri already has a law that prohibits coverage of abortion in private plans and the exchange. See Insurance Prohibition for Abortion entry.)

Does the law require the refusing entity to notify the persons affected? No, only whether an optional rider for abortion coverage has been purchased for the plan.

Are there circumstances under which a refusal clause may not be exercised?  No.

Does the law require the refusing individual or entity to provide medically and factually accurate information or provide a referral for abortion services?  No.

Does the law provide a mechanism for women to otherwise obtain specific reproductive-health services, information, or referrals if an individual and/or entity exercises a refusal clause?  Yes. Any health plan issued under the exception is required to provide clear and conspicuous written notice about optional riders for abortion.  However, nothing in the act requires an insurer to make such riders available and there is little evidence that insurers offer these products. Mo. Ann. Stat. §§191.724, 376.1199 (Enacted 2012).

INSURANCE COVERAGE FOR STERILIZATION REFUSAL CLAUSE

Missouri allows certain individuals or entities to refuse to provide coverage for sterilization. No employer, health-plan provider, health-plan sponsor, health-care provider, or any other person or entity shall be compelled to provide coverage for, or be discriminated against or penalized for declining or refusing coverage for, sterilization in a health plan if it is contrary to their religious beliefs or moral convictions.

Does the law require the refusing entity to notify the persons affected?  No.

Are there circumstances under which a refusal clause may not be exercised?  No.

Does the law require the refusing individual or entity to provide medically and factually accurate information or provide a referral for abortion services?  No.

Does the law provide a mechanism for women to otherwise obtain specific reproductive-health services, information, or referrals if an individual and/or entity exercises a refusal clause?  No.

Mo. Ann. Stat. §§191.724 (Enacted 2012).

PHARMACY REFUSAL CLAUSE

Missouri allows pharmacies to refuse to stock any prescription or nonprescription drug or device.

 

Does the law require the refusing individual or entity to notify the persons affected?  No.

Are there circumstances under which a refusal clause may not be exercised?  No.

Does the law require the refusing individual or entity to provide medically and factually accurate information or provide a referral for prescription services?  No.

Does the law provide a mechanism for women to otherwise obtain specific reproductive-health services, information, or referrals if an individual and/or entity exercises a refusal clause?  No.

Mo. Ann. Stat. §338.255 (Enacted 2012).

 

Young Women & Abortion – Parental Consent

Missouri law restricts young women’s access to abortion.

Is the law enforceable? Yes.

Who is considered a minor? A young woman under the age of 18.

What is required – parental consent or parental notice? Consent.

Who must provide consent? One parent.

Are there other trusted adults who may provide consent instead? No.

What is the process for obtaining consent? A young woman may not obtain an abortion unless the attending physician secures the written consent of one parent.

May the parental mandate be waived if a young woman is a victim of rape or incest? No.

May the parental mandate be waived if a young woman is a victim of child abuse? No.

May the parental mandate be waived if a young woman’s health is threatened? Yes, but only if the attending physician determines that a medical emergency exists, defined as a medical condition that necessitates immediate abortion care, for which a delay will create “serious risk of substantial and irreversible physical impairment of a major bodily function.”

May the parental mandate be waived under any other circumstances? Yes, the young woman may try to obtain permission from a judge.

If a young woman must obtain permission from a judge, what is the process? She must secure a court order stating either that she is granted majority rights for the purpose of consenting to the abortion or that an abortion is in her best interests.

Are there other significant requirements under the law? Yes. Under a statute enacted in 2005, anyone who “cause[s], aid[s], or assist[s]” a young woman to have an abortion without parental consent may be liable to the young woman and her parents. This liability applies even if the young woman complies with all laws in the state where she receives abortion care. The Missouri Supreme Court determined in May 2007 that the terms “aid or assist” as used in this statute do not apply to speech or expressive conduct, and thus do not prohibit the provision of abortion information or counseling. Parenthood of Kansas & Mid-Missouri v. Nixon, 220 S.W.3d 732 (Mo. 2007).

Has a court considered the constitutionality of this law? Yes. In September 2005, a federal district court issued a temporary restraining order that prohibits the enforcement of the statute enacted in 2005. Springfield Healthcare Center v. Nixon, No. 05-4296-CV-C-NKL (W.D. Mo. Sept. 16, 2005). In October 2005, the court dismissed the case, and dissolved the temporary restraining order after the clinic abruptly closed. Springfield Healthcare Center v. Nixon, No. 05-4296-CV-C-NKL (W.D. Mo. Oct. 25, 2005). In November 2005, a state court issued an injunction to prohibit the enforcement of this statute. The injunction also prohibited the state from investigating or acting on the provisions of the statute. Although the state court determined that the law could be interpreted in such a way that would make it constitutional, the court lacked the confidence to make this determination conclusively. Therefore, the state court issued the injunction, which remained in place until May 2007, when the Missouri Supreme Court determined that when narrowly construed, the statute is not unconstitutional. Planned Parenthood of Kansas & Mid-Missouri v. Nixon, No. 0516-CV25949 (Mo. Cir. Ct. Jackson County Nov. 17, 2005); Parenthood of Kansas & Mid-Missouri v. Nixon, 220 S.W.3d 732 (Mo. 2007).

Other information about the law: The U.S. Supreme Court held that a previous version of this law was constitutional. Planned Parenthood Ass’n of Kansas City, Mo. v. Ashcroft, 462 U.S. 476 (1983).

Mo. Ann. Stat. §§ 188.028 (Enacted 1979; Last Amended 1986), .015, .075 (Enacted 1974; Last Amended 2011), .250 (Enacted 2005).

Pro-Choice Missouri

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