An Abortion Fault Line

On a Saturday morning in October, Hope Clinic draws a crowd of 100 protesters, some with signs depicting fetuses, others with Catholic rosaries—and all shouting and chanting outside the purple-trimmed building where abortions are performed in Granite City, Ill.

The protests are jarring to incoming patients. But they do little, if anything, to affect Allison Hile, the clinic's director of information and education. "I am so proud of what we do," says Hile, who has been counseling patients for 28 years. Hile has, after all, seen much worse at her clinic. She remembers the wreckage the day after it was bombed in 1982—the blast destroyed a third of the facility's physical plant. And she remembers when a pro-life extremist kidnapped one of the clinic's doctors that same year, holding him and his wife blindfolded for eight days. For over a decade now Hile has endured the presence of pro-life activist Angela Michael, who lives in an RV parked outside the clinic. Under the guise of being a Hope Clinic employee, Michael leads women into her trailer (billed as offering "A Window to the Womb") for ultrasounds and a chance to talk them out having an abortion. (Hile says she can find no record of Michael being a registered nurse in Missouri or Illinois.) After all that, a group of noisy protesters seems relatively benign.

But soon Hile and the rest of the staff at Hope Clinic may have more than shouts and signs to contend with. The clinic sits on the state line between Illinois and Missouri. And while it's just a 10-minute drive over the Mississippi River from Granite City to St. Louis, the ideological distance between the cities is far greater when it comes to abortion law. On the Missouri side of the river, lawmakers take a dim view of abortion rights. The pro-choice group NARAL gives the state an F in its rankings, while Illinois gets a C+. "Illinois law is in every aspect and way better than Missouri," says Pamela Sumners, executive director of NARAL Pro-Choice Missouri. "That's a pretty big river separating us."

While Hope Clinic may be governed by Illinois's more lenient laws, a large percentage of its patients come from Missouri for family planning and abortion services. So this summer, when the Missouri state legislature passed House Bill 1055, a law that Gov. Matt Blunt has called "one of the strongest pieces of pro-life legislation in Missouri's history," Hope Clinic began preparing for the possible ripple effects. As Hile explains it, should the new law pass constitutional muster—a decision that could be made within the next two months—it would likely leave the entire state of Missouri with one abortion clinic, at least for a time. And that could create an unmanageable influx of patients for Hope. "We'd be overwhelmed if we had to see not only the women who come to us now but many others," says Hile.

The Missouri bill is not an outright ban on abortion but rather a regulation that financially squeezes practitioners who perform the procedure to the point where many will no longer be able to function. The bill reclassifies any facility that performs five or more abortions each month as a surgical outpatient center, meaning it must comply with a number of specifications for things like hallway widths and ceiling heights.

Pro-life groups hail the legislation as a way to protect women's health—by ensuring that facilities are prepared to handle abortions, which are, after all, surgical procedures. "Women who seek abortions deserve to have the same level of surgical care," says Pam Fichter, president of Missouri Right to Life. "To not give them that same basic level of care would be a great disservice to women who are seeking abortions." The bill's sponsor, state Rep. Therese Sander, describes the regulation as an attempt to provide "the best possible service to women in crisis pregnancy no matter which way they choose go, whether life or abortion."

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 Institute concluded 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.

One contentious aspect of the Missouri bill is already in place. Anyone who works at an abortion clinic, or at an organization that refers patients to abortion clinics, is now barred from teaching sexual education in Missouri public schools. Hile, who holds a master's in sexual health, has spoken on condoms and safe sex at Oakville High School in St. Louis for 26 years. This year she won't be able to return to Oakville, but educators who promote abstinence until marriage, like those supplied by Lutheran Family and Children's Services of Missouri, are still allowed in the public schools of Missouri. The Lutheran agency believes the provision is necessary to prevent a conflict of interest. "They say they won't talk about abortion, but once they get in the classroom, who knows?" says Christine Reams, the group's director of community services. "It opens up too many doors having them there."

At the end of the day, Hile wishes there weren't a need for her clinic. "When women stop coming to us, we can find something else to do," she says. But after 28 years of counseling dozens of women each day, she is not optimistic; increasingly restrictive legislation only gives her more reason to think that numbers will not be declining. "You need to have people who are certified and educated in the area and comfortable enough to answer student's questions and answer them with respect and accuracy," says Hile. Now that she can't go to Missouri as an educator, she fears that even more women will be coming to her—after it's too late. Only time will tell whether her fears are well founded.