by Anna Spoerre, Missouri Independent
March 28, 2025

Missouri Planned Parenthood clinics remain unable to offer medication abortions after the state rejected their complication plans this week. 

Planned Parenthood Great Rivers, which operates clinics in the St. Louis region, Rolla and Springfield, and Planned Parenthood Great Plains, which operates clinics in Kansas City and Columbia, received a letter from the Missouri Department of Health and Senior Services on Thursday stating their complication plans did not meet state requirements.

The decision means that almost five months after voters approved a constitutional amendment restoring abortion rights, the most common method to terminate a pregnancy is not available in Missouri.

This rejection was based on the criteria of an emergency rule published the same day by the Missouri Secretary of State’s Office. 

That rule requires the complication plan for any facility prescribing abortion medication to more than 10 women a month must: 

Have an on-call OB-GYN who lives within 25 miles of the clinic available at all times for seven days after a patient takes the medication. This physician would be required to treat any complications that arise as a result of the medication unless the standard of care requires someone else to treat them. Provide for patients who live further than 25 miles from the clinic, the name of the emergency room and a physician “within a reasonable distance of the location where the patient will complete the abortion.”Submit the full names of all physicians involved in the local complication plans.

While three clinics —Columbia, Kansas City and St. Louis — have resumed some procedural abortions, Planned Parenthood leadership have said they will not begin prescribing medication abortions without an approved complication plan. 

Leadership with Planned Parenthood Great Rivers is still deciding on next steps, a spokesperson said. 

The Department of Health and Senior Services did not immediately respond to a request for comment.

In a statement in February, department spokeswoman Sami Jo Freeman said complication plans are “important to ensure the safety of patients because medication abortions will likely be completed at home without a physician present.” 

When the clinics submitted their complication plans in February, they did not include the names of any physicians involved. The proposals state that patients could contact the clinic at any time with concerns, including an after-hours line staffed by licensed nurses who can refer calls to an on-call physician. 

“If a potentially urgent complication is suspected based on the patient’s symptoms or the patient is not able to return to the health center in a timely way, the nurse will direct them to the emergency department (ED),” the initial plans submitted by Planned Parenthood read. 

With the patient’s consent, the proposal continued, the ER would be told the patient’s medical history if possible. Planned Parenthood would follow up with the patient the next day.

Across the country, abortion medication is the most common method used to end a pregnancy.

In 2023, nearly two-thirds of abortions in the United States took place using medication as opposed to in-clinic procedures, according to the Guttmacher Institute, a reproductive rights research group.   

In states where abortion is legal, medication that induces a miscarriage is available to patients in their first trimester of pregnancy. Patients typically take two doses of medication, the second of which is often taken at home. In recent years, a growing number of women have been ordering abortion medication from online providers in the United States and abroad, including to states where abortion remains illegal. 

According to the FDA, mifepristone is safe to use if taken as directed. Cramping and bleeding are common side effects of the medication. Those prescribed mifepristone are urged to call their doctor if they experience heavy bleeding, abdominal pain or a fever. The same guidance applies to those who recently underwent procedural abortions, experienced miscarriages or delivered a baby.   

Since the medication was approved for use 28 years ago, only 32 deaths have been reported associated with mifepristone, according to the FDA. 

Earlier this month, Missouri Attorney General Andrew Bailey issued a notice of an intent to serve a cease and desist letter to the Planned Parenthood clinics, doubling down on his demand that Planned Parenthood stop performing a type of abortion that its clinics aren’t actually offering patients.

Several Planned Parenthood clinics remained open even after the procedure was outlawed statewide in June 2022. The clinics primarily provide family planning services, cancer screenings and STI testing and treatment, including to patients on Medicaid. 

Shortly after Missourians in November narrowly approved Amendment 3, granting the constitutional right to an abortion, Planned Parenthood sued the state, arguing dozens of regulations on abortion providers were no longer constitutional. 

In mid-February, a Jackson County judge struck down most of the regulations, allowing Planned Parenthood to resume in-clinic procedural abortions for the first time in years. 

Abortion returns to Columbia, opening access for mid-Missouri for first time since 2018

The first abortion to happen in Missouri since the procedure was outlawed statewide in June 2022 took place in February at a Kansas City clinic. In early March, procedural abortions returned to the clinic in Columbia for the first time since 2018. 

And on Thursday, the clinic in St. Louis quietly performed its first two abortions since 2022. 

The clinic plans to take additional abortion patients who are earlier than 12 weeks gestation over the coming weeks, but the number of days abortion is provided in St. Louis will depend on physicians’ schedules, Nick Dunne, a spokesperson for Planned Parenthood, said Friday.

Staff at the St. Louis clinic did not initially indicate they would bring back procedural abortions this soon. 

“Ahead of the December ruling, our staff had been preparing to start providing medication abortion — including staff training, as well as ordering supplies and medications,” Dunne said in a statement. “Recognizing more recently that we were likely to face additional hurdles from state officials on medication abortion, our medical and patient services teams pivoted to allocating staff, equipment, and other necessary resources in order to begin offering procedural abortion again.” 

Planned Parenthood likely won’t be able to begin offering procedural abortions at its clinics in Rolla or Springfield until additional physicians are hired, Dunne said, adding that Planned Parenthood is “working aggressively” to expand their physician numbers.

There are currently two long-term staff physicians and one contracted physician at Planned Parenthood Great Rivers, which also oversees the clinic in Fairview Heights. The two long-term physicians are both based in the St. Louis area. 

Missouri Independent is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Missouri Independent maintains editorial independence. Contact Editor Jason Hancock for questions: info@missouriindependent.com.

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