Crossing the Line

But pro-life activists are also well aware of the potential fallout. "We certainly would not be brokenhearted" if access to abortion were limited, Fichter says, while reasserting that such a result "was not the original intention of the bill."

Pro-choice advocates fear that is exactly what will happen. The cost of upgrading facilities would be so high, they argue, that abortion clinics would be forced to find significant new sources of funding—or shut their doors. One Planned Parenthood administrator at a facility in Columbia, Mo., told the Los Angeles Times that the necessary upgrades would cost $1 million; the facility's annual budget, the administrator said, is $780,000. The law could force the closure of two of Missouri's three active abortion clinics. Cecile Richards, president of Planned Parenthood, says that's no accident. "I think they're being totally disingenuous," she says of the legislation's supporters. "They're trying to create this gantlet for women to go through and aren't in the business of providing health care at all."

Hile, who has lobbied on abortion issues in both the Missouri and Illinois legislatures, believes this is the latest in a series of moves aimed at cutting access to abortion providers. "The crux of this whole issue right now is it's not about Roe v. Wade and overturning it," says Hile. The battle today is all about "limiting abortion care and making it more difficult for women to receive abortion care."

Missouri is not the only state where anti-abortion activists are taking aim at access. In Minnesota, Mississippi and Texas, state regulations require women to undergo counseling prior to an abortion that includes information about a suspected link between abortion and breast cancer. The studies on the subject have been conflicting, however, and the National Cancer Instituteconcluded in 2003 that "induced abortion is not associated with an increase in breast cancer risk."

Should the Missouri bill pass, Hope Clinic expects to see its annual flow of more than 6,000 patients increase considerably. Already 40 percent of the women seeking abortions and family planning come from out of state, many from Missouri. Some go to Hope Clinic because of its proximity to St. Louis. But others seek out the Illinois facility specifically to avoid Missouri's more stringent laws—which include a measure requiring women to undergo in-person counseling 24 hours before an abortion. That provision drove one young woman (her name has been withheld for privacy reasons) to cross the border recently. "In Missouri there was going to be a two-day process," says her mother, who accompanied her daughter to Illinois for the procedure. Critics say the two-day toll is too much of an emotional burden for some women; others may not be able to afford to take that time off from work.

For now, opponents of the new measure are hoping it does not survive court scrutiny. When the bill passed this summer, Planned Parenthood of Kansas and Mid-Missouri filed a lawsuit challenging the constitutionality of regulating abortion clinics as surgical outpatient centers. The federal judge hearing the case issued a temporary injunction, calling on the clinics and health department to negotiate the required upgrades. The injunction allows clinics to continue practicing for the time being but makes no guarantee about the future; a more definitive ruling is expected in about two months. If the provision remains in place, pro-choice advocates vow to try to take the issue to the U.S. Supreme Court if need be.