ST. LOUIS — Over a year ago, Missouri voters approved enshrining abortion rights into the state constitution. Lawyers won court cases, blocking clinic restrictions. Providers promised that Missourians could access abortions close to home.

But today, appointments are hard to come by at the three Planned Parenthood clinics — in Kansas City, St. Louis and Columbia — that offer procedural abortions. Of the hundreds of Missourians seeking abortions each month, the vast majority are still traveling out of state.

State data requested by the Post-Dispatch shows that 80 abortions had taken place in Missouri clinics this year through October.

In contrast, at least 2,000 Missourians sought abortions across state lines between July and September alone, according to data gathered by the Missouri Abortion Fund from eight out-of-state clinics. The fund helps Missourians cover the cost of the procedure.

“It’s very sporadic and unpredictable” in Missouri, said Stephanie Kraft Sheley, director of the Right By You text line that helps people navigate their pregnancy choices.

In total, about 12,000 Missourians a year typically travel to Illinois and Kansas for abortions, according to recent data gathered by the Guttmacher Institute.

The numbers don't include medication abortions using pills ordered online or from states with shield laws. Medication abortion, which accounts for more than 60% of all abortions, is not available at Missouri clinics because state health officials have not approved clinics’ plans for handling complications.

Kraft Sheley said she’s only been able to help two clients get abortion appointments in Missouri because patients can’t wait long periods of time.

“I’ve been told, 'It’s not a service we regularly offer. We don’t know when the next time we offer it will be. If it’s not showing it’s available online, then we don’t have a provider available,'” Kraft Sheley said.

Officials with Missouri’s abortion providers — Planned Parenthood Great Plains and Planned Parenthood Great Rivers — are saying little about their appointment schedules.

Dr. Margaret Baum, chief medical officer for the Great Rivers affiliate operating the clinic in St. Louis, said appointments are offered “consistently” and “on a regular basis.” When pressed, she said appointments have recently been available one day a week.

Officials with the Great Plains affiliate, which operates the clinics in Kansas City and Columbia, later emailed a statement to the Post-Dispatch on behalf of themselves and Great Rivers, stating, “Patients are accessing care every week.”

Baum said a remaining state rule — which prevents advanced practice nurses from providing abortions, like they do in other states — hinders the expansion of appointments at clinics.

She said providers hope to end the physician-only requirement and others at a trial scheduled in January. While some abortion restrictions have been temporarily blocked while awaiting the trial, the court will decide whether those restrictions and others violate the right to an abortion in the state constitution and should remain in place.

The remaining restrictions and public confusion make rebuilding services “extremely difficult,” especially after not being able to provide abortions for more than six years, the providers wrote in their statement.

“Reintegrating abortion care into our health centers takes time while providers grow capacity and expand training,” the statement read.

In addition, Baum said, the Great Rivers affiliate must continue to focus resources on its clinic across the state line in Illinois, about 15 minutes from St. Louis. That facility has long served patients from Missouri and states across the South.

But some abortion advocates say a lack of transparency about accessibility in Missouri is causing confusion.

After a narrow ballot win last year and a campaign strategy that divided abortion advocates, providers initially celebrated and vowed immediate access. Those vows continued after later court rulings.

For example, after a Feb. 14 court decision that blocked what providers said was their last obstacle, Emily Wales, president of Planned Parenthood Great Plains, said, “Abortion care will be restored immediately. The people voted, the court responded, and we will do our part: serving Missourians in their home state."

More recently, Abortion Action Missouri, an advocacy organization that led last year’s campaign to pass Amendment 3, celebrated “one year of legal abortion across Missouri” with posts on social media and by organizing parties. Abortion Action did not respond to requests for comment.

Kraft Sheley said the messages are frustrating for Missourians who have to travel out of state because of the lack of appointments.

“I see a lot of celebration, but I don't see a lot of honesty about where we are today,” she said.

Robin Frisella, community engagement director for the Missouri Abortion Fund, also called the celebrations confusing.

"We have concerns over folks getting the wrong messaging about if abortion is available and how available it is in the state,” Frisella said. “And truthfully, I think we'd like to see more transparency around that.”

'Extremely confusing'

The Missouri Abortion Fund, a nonprofit, helps with the cost of abortions, which are not covered by Medicaid or private health insurance in Missouri except in limited circumstances. So far this year, the Missouri Abortion Fund has helped 1,500 Missourians, nearly all of whom had to travel out of state, said director Jessica Lambrecht.

“You're continuing to see people leave because getting an abortion is time-sensitive, and so patients can't wait,” Lambrecht said.

The Missouri Abortion Fund spent about $50,000 a month helping patients this year. Donations have decreased by about 5%, or $150,000, this year, said Frisella, the community engagement director.

“Folks make the assumption that Missourians have easier access to abortion and that abortions have returned to the state,” Frisella said. “Abortion isn't quite as top of mind for folks, and they're not allocating their donations to abortion-related organizations.”

Instead, Frisella said, donors are focused on political efforts. Already, abortion advocates are organizing against a Republican-led ballot initiative next November that would repeal Amendment 3 and reinstate a ban on most abortions.

Pamela Merritt, executive director of Medical Students for Choice, which has seven chapters in Missouri, was surprised that clinics were not prepared to quickly ramp up the number of appointments, especially in mid-state locations far from clinics.

Merrit questions whether the $31.5 million in campaign contributions toward passing Amendment 3 could have been better spent.

“The reason for the ballot (issue) was to give Missourians access to the full spectrum of reproductive health care in their home territory, in their community. And that should have been a mapped-out, planned-out thing from day one,” Merritt said.

Baum, of Planned Parenthood, argued that purchasing more equipment and hiring staff initially was too risky while awaiting court rulings after Amendment 3 passed.

“We have to think strategically about making large investments in a place in which there is a possibility we could be shut down again,” Baum said.

She also said the Planned Parenthood affiliates have been "super responsive and transparent” about their legal efforts. She blames the confusion on state agencies and politicians fighting to keep restrictions.

“Why would this not be extremely confusing for the people of Missouri?” Baum said.

Ashley Jaworski, 36, of Manchester, volunteered with last year’s Amendment 3 campaign. She said she and other volunteers are “painfully aware of the slow rollout” of abortion access in Missouri. She blames the lengthy court battles required to end restrictions.

“Meaningful abortion access hasn’t been available in Missouri for many years,” Jaworski said, “so it will just take time to build the infrastructure back up.”

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