Missouri’s top health official said Tuesday the state monitored detailed personal information about Planned Parenthood patients, in some cases reviewing women’s menstrual cycles, with the aim of identifying those who had failed abortions.

Randall Williams, the state health director, said his goal was protecting patient safety. But critics called it an invasion of women’s privacy and demanded his resignation and an investigation by the governor.

Williams, an OB/GYN, testified as part of a week-long state hearing to determine whether the state’s lone abortion clinic can keep its license, the Kansas City Star reported. Williams said he had a state health inspector review information that included medical identification numbers, dates of procedures and the gestational ages of fetuses. The review also included the date of each patient’s last period but did not include their names, the Star reported.

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Williams said he attempted to use that data to determine if women who went in for follow-up appointments after abortions at Planned Parenthood of the St. Louis Region and Southwest Missouri suffered complications. He sought the information after state officials refused to renew the clinic’s license in June, citing concerns over multiple “failed abortions,” which required additional procedures, and a patient who suffered life-threatening complications.

State health officials are not subject to medical privacy laws, and Williams has legal access to Planned Parenthood abortion reports that contain information about menstrual cycles, said Bonyen Lee-Gilmore, director of state media campaigns for Planned Parenthood Federation of America. Nonetheless, the revelation has alarmed lawyers, women’s health experts and abortion rights activists.

Rep. Crystal Quade (D), minority leader in the Missouri House of Representatives, called on Gov. Mike Parson (R) to “immediately investigate whether patient privacy was compromised or laws broken and determine if this is a person who Missourians can be comfortable having in position of public trust.”

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“Based on the politics of the state and the passing of an egregious abortion ban bill, I don’t have a lot of hope that the governor is going to make this a priority,” Quade said in an interview.

The governor’s office did not immediately respond to a request for comment.

Parson signed a restrictive law this year that banned abortions after the eighth week of pregnancy. The law was blocked by a federal court.

Williams’s department released a statement Wednesday evening dismissing as false claims that it tracks the menstrual cycles of women seeking abortions. But it confirmed that it gets the data as part of the information it collects from Planned Parenthood.

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“Per practice, the reports are reviewed when a complication is reported for an abortion procedure,” the statement said. “In order to ensure that our laws and health care standards are being met, reports from abortion facilities, by law, must be reviewed.

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“In this case, Planned Parenthood was not compliant with the complication report requirement for failed abortions. Regulators realized this, and as a result they used the tools they had to protect the health of those who seek abortions at Planned Parenthood.”

The tracking of women’s periods recalls China’s practice when it limited families to one child to control population growth, said Arthur Caplan, a bioethicist at New York University Langone Health.

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The Chinese government kept details about women’s contraceptive use and whether people were sterilized, pregnant, married or single. “When a government official monitors your reproductive behavior, you are perilously close to replicating totalitarian regime,” Caplan said.

Women’s health experts emphasized that abortion is a safe medical procedure and said a follow-up appointment after an abortion does not necessarily indicate that an abortion failed.

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This is not the first time Williams’s actions have come under fire by reproductive health advocates. In June, Missouri ended a mandate that patients getting abortions have pelvic exams at least three days prior to the procedure, which required them to undergo multiple invasive exams just days apart.

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Reproaction, an abortion and reproductive rights advocacy group, said it is collecting signatures calling on Williams to resign.

Ariana Eunjung Cha contributed to this report.

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