Analysis: Missouri poised to become third state with 72-hour abortion waiting period

A Lake St. Louis state legislator made national headlines this session when he likened the decision to have an abortion to buying a car.

During an April 8 committee hearing on HB 1307, a measure that would triple Missouri's mandatory waiting period for having an abortion, the bill's co-sponsor Rep. Chuck Gatschenberger, R-Lake St. Louis, said:

"Well, yesterday, I went over to the car lot over here. I was just going to get a key made for a vehicle. And I was looking around because I'm considering maybe buying a new vehicle. Even when I buy a new vehicle - this is my experience, again - I don't go right in there and say I want to buy that vehicle, and then, you know, you leave with it."

The car-shopping advice went viral.

Rep. Stacey Newman, a member of the Committee on Children, Families, and Persons with Disabilities, pressed Gatschenberger about his remark later in the April 8 hearing, demanding he clarify if an abortion and a new car could possibly be equated.

"I did not say that," Gatschenberger said. "I'm saying my decision to accomplish something is, I get the input in it. And that's what this bill does, is give more information for people."

His followup didn't appease the national media. The video clip made the blog rounds at publications ranging from Mother Jones to Cosmopolitan.

It wasn't the first time this legislative session that a Republican had compared the decision to have an abortion to making an informed purchase.

A month before, Sen. David Sater, R-Cassville, compared his version of the bill, which had just ground to a halt in the Senate, to another nonmedical procedure.

"To have some extra time to reflect on that is important. We have laws such as if you sign a contract to buy a condominium, there is a period within which you can decide, "OK, I've kind of made the wrong decision,'" Sater said. "Sometimes your initial thought on something is not the right one."

Sater had a link for his comparison. Property law allows prospective owners to withdraw from a contract or for owners to reconsider selling within 72 hours of signing.

HB 1307, which passed the Senate on Tuesday morning, would mandate women take that same period before an abortion. An amended bill, which would require a woman to watch a video as part of her informed consent materials, passed the House in March. The Senate chose to adopt the unamended version, thus sending it back to the House. That bill passed the House 111-39 on Wednesday.

Gov. Jay Nixon on Thursday called the bill an "extreme proposal,' but didn't say whether he would veto it.

Missouri is one of 26 states that has a mandatory waiting period for abortions, currently a 24-hour wait. While most waiting periods end at 24 hours, Alabama passed legislation last month that doubled its existing restriction to 48 hours. In 2012, Utah became the first state to adopt a 72-hour wait. A year later, South Dakota followed suit. If House Bill 1307 becomes law, Missouri would join them as having the longest mandatory waiting period in the country.

Whether it's a Camry or a condo, with each comparison, abortion-rights activists are quick to point out that these mounting legislative restrictions are simply efforts to block women's access to abortion, not inform women.

Why 72 hours?

Inspired by Sater's bill, Rep. Kevin Elmer, R-Nixa, filed his essentially identical House version early in the session. It is his first time sponsoring anti-abortion legislation.

"I thought it was something that looked from the legal perspective like it's going to meet constitutional muster and looks like an incremental step toward protecting life," Elmer said. "Seventy-two hours is what I latched onto because I'd seen the other states do that, and other than that, I can't say there is a particular reason why it's three days versus two days."

Under the 24-hour wait period, a woman receives a state-created informed-consent booklet. The 22 pages detail procedural risks, fetal development and resources available to women who choose to continue with the pregnancy. It also includes a statement that life begins at conception, making Missouri one of only five states to include personhood in written or verbal counseling. Elmer and Sater said the 72-hour wait would allow women to digest the informed-consent information in the booklet.

"I think that this waiting period helps eliminate some of the emotional decision and make a more reasoned decision," Elmer said. "In the end, if there are a couple of more children born and their lives are saved, that's a positive thing."

But opponents see the waiting period as a daunting hurdle for women. Elizabeth Nash, state issues manager at the Guttmacher Institute, gave her personal analysis behind the decision.

"My sense has been over the last couple of years that the goal is to make abortion out of reach for women," she said. "There is this piling on that's happening in the sense that states are now adopting restriction after restriction after restriction, and now creating a pile that women must navigate in order to access abortion services."

Women seeking an abortion would need to travel to Missouri's only free-standing abortion clinic in St. Louis to receive the information booklet in person. Then, they would either have to stay in St. Louis for three days or make the trip home and back again. Nash outlined a complicated process: arranging for time off work, traveling, possible hotel stays and even childcare, which could be a hefty financial setback.

"I think what we see with most abortion restrictions is the burden (of travel and work arrangements) falls on low-income women more so than richer women," Nash said.

Even with these potential obstacles, women's health advocates believe that there is little evidence that the increased waiting time would reduce the abortion rate. A literature review published by the Guttmacher Institute in 2009 postured that abortion rates were only viably affected by sex education and increased funding for family planning. Nash said there have not been adequate improvements in these preventative areas.

"Why don't we work on access to family planning and access to comprehensive education? The reason is because abortion opponents are also not too happy with family planning or sex ed," Nash said.

Women have the option of crossing state lines to receive the procedure without the 72-hour wait. Illinois and Iowa do not have a wait time, but women would still have to wait 24 hours if they went to Kansas, Oklahoma or Arkansas.

The Bixby Center for Global Reproductive Health is conducting the only existing research on the effects of 72-hour mandatory waiting periods. Sarah Roberts, a public health social scientist with the Bixby Center, is studying the effect of Utah's 72-hour wait.

Participants in the study fill out surveys when they go for their informational visit, with a follow-up questionnaire sent out three weeks after the initial trip. Roberts said women were experiencing increased stress when forced to dwell on the decision and anxiety about the procedure itself.

"Just the stress of how the procedure is going to go because you just want to get it over with. I couldn't sleep for three nights," Roberts read from one of the open-ended questions.

Roberts' preliminary findings reinforced the logistical hurdles outlined by Nash. Utah requires two trips to the same abortion clinic, which forces women to navigate a web of work and school schedules, transportation arrangements and child care. Roberts also noted that during the extended waiting period, women experienced nausea and other ongoing pregnancy symptoms.

Because data are still being collected, Roberts could not say if the waiting period had an effect on abortion rates.

Leader in restrictions

Missouri has a longstanding reputation as an abortion battleground. In 1990, it became one of the first states to ban Planned Parenthood from receiving state funding. Missouri was also an early adopter of "partial-birth" abortion bans, a type of late-form abortion, which were enacted at the federal level four years after Missouri 1999 bill was voted on.

Of the numerous challenges the state has aimed at Roe v. Wade, Missouri was successful in chipping away at the ruling by passing a law that banned public facilities from being used for abortion and required doctors to perform a fetus viability test after 24 weeks. This sparked a 1989 Supreme Court case, Webster v. Reproductive Health Services, which upheld the right for states to place limitations on abortion access. The case is a point of pride for Missouri Right to Life, one of the most active anti-abortion lobbying groups in the state.

"We've had some important legislation that resulted in some major court cases and courts decisions, so we've been very active in that," said Patty Skain, the executive director of Missouri Right to Life. "I don't know if we're in the top five, but certainly we're in the top 10 states in the country as far as our protective bills."

Missouri Right to Life works closely with legislators to pass anti-abortion bills. When developing the language for his Senate version of the 72-hour mandatory waiting bill, Sater conferred with Missouri Right to Life and other anti-abortion groups to decide on an appropriate waiting period.

Skain echoes Sater and Elmer's intentions with the 72-hour waiting period bill: to give women enough time and education about the procedure to make the best decision. But she is also clear about the overarching goal of her group.

"If we could, we would ban abortion because we believe that children have a constitutional right to life," she said.

Banner year

It has been a banner year for the Missouri Right to Life's cause, with 32 anti-abortion bills filed this session. Skain believes that the uptick reflects a changing attitude toward the procedure.

"I think more and more people are beginning to understand the damage that abortion does," she said. "Here in Missouri, it's just a belief that life is sacred and not really a religious issue, but unborn children are human beings. They have human DNA, and they deserve to be protected by the U.S. Constitution."

According to a 2012 Associated Press exit poll, Missouri voters are evenly split on abortion: 51 percent believe abortion should be legal all or most of the time. Using 2011 data collected by the Guttmacher Institute, Missouri falls well below the national average of 16.9 per 1,000 women who obtain abortions, at 5 per 1,000.

The legislature has seen bills this session that would tighten ultrasound procedures, demand more detailed financial documentation, require two-parent consent for minors obtaining abortion and tighten criminal penalties for medical malpractice. There is also a measure that would quadruple the number of inspections for the lone abortion clinic in Missouri.

Colleen McNicholas, an abortion provider in St. Louis, has testified against several pieces of the legislation this session, including the 72-hour waiting bill.

"One of the successful strategies that anti-choice people have been able to capitalize on is sort of taking an issue or piece of legislation and framing it in a way that at sort of first glance the public is like, "Oh yeah, of course I want things to be safer for abortion clinics. Of course I want people to really think about their decision before they make it,'" she said. "Really when you get on the ground and in the trenches with these women that are having these procedures, all of those things are already happening."

Judging by the sheer volume of bills aimed at tightening abortion restrictions and procedures, a large part of Missouri's elected representatives don't agree with McNicholas' assertion.

Newman, who has been a key abortion rights advocate in the House, sees the legislature's vehement push as a vie for constituent votes on an election year.

"Last year the theme was firearms. This year it is "let's protect women, let's restrict access,'" Newman said.