The pattern emerges whenever a Republican-led state imposes new restrictions on abortion: People seeking the procedure cross state lines to find treatment in places with less-restrictive laws.
An unusual new provision, introduced by state Rep. Mary Elizabeth Coleman (R), would allow private citizens to sue anyone who helps a Missouri resident obtain an abortion out of state, using the novel legal strategy behind the restrictive law in Texas that since September has banned abortions in that state after six weeks of pregnancy.
Coleman has attached the measure as an amendment to several abortion-related bills that have made it through committee and are waiting to be heard on the floor of the House of Representatives.
Abortion rights advocates say the measure is unconstitutional because it would effectively allow states to enact laws beyond their jurisdictions, but the Republican-led Missouri legislature has been supportive of creative approaches to antiabortion legislation in the past. The measure could signal a new strategy by the antiabortion movement to extend its influence beyond the conservative states poised to tighten restrictions if the Supreme Court moves this summer to overturn its landmark precedent protecting abortion rights.
“If your neighboring state doesn’t have pro-life protections, it minimizes the ability to protect the unborn in your state,” said Coleman, who said she’s been trying to figure out how to crack down on out-of-state abortions since Planned Parenthood opened an abortion clinic on the Illinois-Missouri border in 2019.
A Supreme Court decision that undercuts Roe v. Wade, the 1973 Supreme Court ruling legalizing abortion across the United States, probably would create a national landscape that encourages patients to cross state lines for abortions, with Democrat-led states moving to protect abortion rights as Republican-led states further limit them.
The trend has been apparent in Texas, where the majority of people seeking abortions since the state’s six-week abortion ban took effect in September have been able to obtain the procedure at clinics in neighboring states, or by ordering abortion pills in the mail, according to a report from the Texas Policy Evaluation Project. Demand for abortions has skyrocketed in Oklahoma, Louisiana, New Mexico and other nearby states. Planned Parenthood clinics in states that border Texas reported that patient traffic increased by nearly 800 percent, and independent providers reported comparable increases.
Since Planned Parenthood opened its clinic on the Missouri-Illinois border in October 2019, 10,644 Missouri residents have received abortion care at the clinic, according to Planned Parenthood. By early 2021, the last remaining clinic in Missouri was typically providing between 10 and 20 abortions per month, according to preliminary data from the Missouri Department of Health.
Coleman said she hopes her amendment will thwart efforts by Missourians to cross state lines for abortions. The measure would target anyone even tangentially involved in an abortion performed on a Missouri resident, including the hotline staffers who make the appointments, the marketing representatives who advertise out-of-state clinics, and the Illinois and Kansas-based doctors who handle the procedure. Her amendment also would make it illegal to manufacture, transport, possess or distribute abortion pills in Missouri.
Olivia Cappello, the press officer for state media campaigns at Planned Parenthood, called the idea “wild” and “bonkers.” She called the proposal “the most extraordinary provision we have ever seen.”
If enacted, the measure almost certainly would face a swift legal challenge.
Elizabeth Myers, an attorney for Texas abortion rights groups in a court challenge to the six-week abortion ban, said states cannot regulate activities beyond their borders. She drew a parallel to marijuana laws, which also vary from state to state: While Texas lawmakers can outlaw marijuana, and punish anyone who uses the drug within Texas borders, she said, they have no jurisdiction over a Texas resident who uses marijuana in a state where its use is legal.
“A state’s power is over its own citizens and its own geographical boundaries,” Myers said. “These are limits imposed by the federal constitution and federal law.”
Coleman’s proposal still may succeed in deterring out-of-state abortions, said Myers. Like the Texas law, the proposal itself could have a chilling effect, where doctors in surrounding states stop performing abortions before courts have an opportunity to intervene, worried that they may face a flurry of lawsuits if they violate the law.
Coleman rejects arguments that her law is unconstitutional.
“That’s what they said about the Texas law, and every bill passed to protect the unborn for the last 49 years,” she said.
Coleman prayed outside the clinic on the Illinois-Missouri border on the day it opened, she said. Since then, she said, she’s been talking to “anyone who would listen” about legal strategies for decreasing the number of Missouri women who seek abortions in other states.
While Coleman says she has been happy to see the sharp decline in abortions in Missouri, she says she can’t fully celebrate the success when so many women are obtaining the same procedure a few miles away.
“It’s just tragic,” she said of the number of Missouri residents who get abortions in Illinois. “It feels very sad and heavy.”
Abortion clinics in states that support abortion rights are preparing for a surge of new patients if Roe is overturned. They are opening new locations and advocating for legislation that would allow them to accommodate more people. Lawmakers in several states have proposed bills this session that would allow nurse practitioners and nurse midwives to perform abortions, in addition to physicians, while others are planning to create statewide databases that will allow out-of-state patients to more easily plan their abortion care.
“We’ve got already half of states that have passed some kind of law to restrict or eliminate abortion access,” said California state Sen. Nancy Skinner (D), who has introduced legislation to help make California a “sanctuary state” for people seeking abortion access. “We definitely are and intend to be a national beacon for reproductive freedom and reproductive justice.”