‘I hope people really feel how meaningful this is,’ said Dr. Iman Alsaden, chief medical officer for Planned Parenthood Great Plains who on Monday performed the first abortions in years at the Columbia clinic
COLUMBIA — The doors of the only Planned Parenthood clinic in mid-Missouri opened up on Monday morning just like they have since 1970.
But for the first time since 2018, pregnant women from central Missouri received an abortion at their local clinic instead of traveling across state lines.
By 10 a.m., the first two patients had received ultrasounds to confirm gestational age and were provided with educational materials in preparation for their abortions. By day’s end, a total of four women received dilation and curettage procedures in which the embryo or fetus (depending on the gestational age) is removed from the uterus using suction.
“I hope people really feel how meaningful this is,” said Dr. Iman Alsaden, chief medical officer for Planned Parenthood Great Plains, which runs the Columbia clinic.
Missouri’s first elective abortion since voters in November enshrined reproductive rights into the state constitution was performed last month in Kansas City. But Monday’s procedures mark a turning point as the first time abortion has been available outside the major metro areas of the state since well before the U.S. Supreme Court struck down federal abortion protections.
Even a year ago, as they were helping gather signatures and advocate for the abortion-rights amendment, Alsadan said the idea of restoring access in in Columbia was “completely unbelievable.”
Alsadan is one of five physicians at Planned Parenthood Great Plains who perform abortions across their Kansas and Missouri clinics. On Monday, they drove in from Kansas City to help re-start the procedure and re-train staff in Columbia who for the past several years have only been providing family planning services, STI testing and treatment and cancer screenings.
So did Macy Thompson, a registered nurse based in the Overland Park, Kansas, clinic who made the trek to assist Columbia staff Monday. Her job was to help prepare patients before the procedure and then provide them with the information they needed once it was completed.
Her bright pink hair matched her scrubs as she sat at a desk inside the two-person recovery room Monday morning. She had recently told the first patients about what medication was available to them ahead of the procedure. Then Thompson informed them of common symptoms post-procedure, like cramping and some bleeding.
Beside her were “goody bags” for the patients: pads, underwear, a heat pack and “a big handful of condoms, just in case.” In the corner a speaker played music. She usually takes requests from patients.
“It’s not the fanciest,” Thompson said. “But we try to do a lot for comfort.”
Thompson considers herself more than a nurse. She also described her role as “a receiver of narratives.”
Many of the patients are having a bad day, she said. But not every story is sad, and she often reminds patients that they don’t have to justify their decision.
Her last parting gift to patients before they head home?
“I’m a big hugger,” Thompson said. “That’s the final step of the abortion process. Or a high-five.”
By late afternoon, the inside of the clinic was quiet. In the waiting room, at least 100 colorfully wrapped condoms sat in a plastic tub. Pamphlets on puberty, sex education, birth control, HIV and syphilis lined a wall.
Health center manager Krissy Lincoln sat at the front desk. Purple earrings with the words “Pro Choice AF” dangled above her shoulders.
“It’s a normal doctor’s office clinic,” she said. “It’s nothing that is unusual. It’s just a scary word — abortion — that people don’t like.”
The only obvious difference was a computer screen with a live video stream of the entrance to the clinic, including a view of some of the protesters gathered outside.
Protesters, or sidewalk counselors, aren’t uncommon outside the Columbia clinic. On Monday, about 20 people gathered outside the clinic’s tall fence in rotations. Many have been coming to pray outside the clinic for years.
“You have another choice,” one said through the fence to a patient walking into the clinic beside a volunteer Planned Parenthood clinic escort who shielded them from view with an umbrella.
Some cars honked in support. Others blared angry blasts as passengers shouted out windows at the small crowd.
“Get a life,” a passerby yelled as Connie Gerling, a longtime volunteer with 40 Days for Life, bowed her head and prayed.
She repeated one verse to herself on several occasions Monday: “Everything is possible with God.”
“Who decides when a baby is a baby?” she asked. “God made that decision.”
Bonnie Lee, a retired registered nurse who has been taking up residence outside the Columbia clinic since 2009, felt the heaviness of the day as she stood beside a rotation of about 20 other anti-abortion volunteers who rotated in and out Monday, watching as staff members walked in and out of the building.
“I pray for them because they cannot comprehend what they’re bringing down on themselves,” she said. “Whether it’s in this life or afterwards.”
Lee remains confident that abortion won’t remain legal for long.
“I believe a referendum on truth is out there,” she said, emphasizing her belief that a judge’s recent ruling dissolved all oversight of Planned Parenthood clinics.
Last month, Jackson County judge Jerri Zhang struck down the final few regulations for Missouri abortion providers, calling them “unnecessary” and “discriminatory.” This order opened the door for abortions to resume at every clinic in Missouri, though only the clinics in Kansas City and Columbia have re-started the procedure.
The state previously imposed licensing laws on Planned Parenthood clinics that the organization cited as so burdensome that they weren’t able to continue offering the procedure at most of their Missouri clinics even before abortion was outlawed in 2022.
This included a mandatory 72-hour waiting period between seeing a provider and having the same provider perform the abortion and a requirement that physicians performing the procedure have admitting privileges at nearby hospitals.
Abortion opponents, including Lee, often cite a 2018 state health inspection report at the Columbia clinic that found tubing used in procedural abortions contained “black mold and bodily fluid.” Planned Parenthood officials have disputed the characterization of the inspection and later said the equipment had been replaced and the issue resolved.
When Vicki Casey started at Planned Parenthood’s Columbia clinic in 2005, she said state inspections weren’t nearly as “politicized” or “weaponized.”
Now director of centralized operations for Planned Parenthood Great Plains, Casey said the two-decade difference is stark. A few years into the job, she noticed more protesters gathering outside, sometimes numbering in the hundreds. Inspection reports were “a little more over the top.” Each year, the job got harder as abortion regulations approved by the anti-abortion legislature piled on.
Patients took the brunt of the burden, Casey said.
Suddenly patients had to scramble to take off work twice, get child care twice, find funds to travel to the clinic twice. In 2018 the clinic ended abortions because it could no longer meet a state requirement that doctors performing abortions have admitting privileges at a hospital no more than 15 minutes from the clinic and the clinic’s license expired.
Casey called the decision “devastating.”
Monday was anything but for her.
Their goal is to get patients in and out in two hours. Prior to 2018, Casey said it took between four and six hours to get a patient through for an abortion procedure, pointing to the consent laws that slowed the process.
She’s stuck it out for two decades despite the near-constant changes.
“You have to believe in what you do,” Casey said. “I believe that abortion is health care and that there’s no difference between that and the other things that we do here.”
When Emily Wales, now CEO of Planned Parenthood Great Plains, started at the organization nearly eight years ago, she recalled a patient who lived about 30 minutes outside Columbia calling to push her appointment to later in the day after her child care plans fell through. The clinic adjusted her appointment time, and the woman came in later that day for her abortion before making it home in time to pick her kids up again.
“It’s the best example of why care has to be close,” Wales said, adding that for the first time in years, mid-Missourians are among the growing number of people who have reasonable access to an abortion clinic.
Zhang’s ruling, Wales said, put Planned Parenthood clinics on the same playing field as private OBGYN offices rather than holding them to similar standards as hospitals.
She said while the clinic itself is no longer licensed by the state, the physicians and nurses inside the building are, and they are instructed by oversight boards. She said the clinic also has to abide by requirements in order to keep its lab license, as well as municipal building codes.
“We’re just like going to your normal doctor’s office without an additional level of state oversight,” she said, adding that their equipment is inspected on a regular basis through an infection control process.
It’s a bit hard to believe abortion has returned to the clinic, Wales said, though the fight is far from over.
Planned Parenthood is still waiting on the state to approve or reject a complication plan for medication abortions, the most common type of abortion and the method preferred by most patients still in their first trimester.
She’s also closely watching the state’s elected officials.
This legislative session, dozens of bills have been filed seeking to restrict abortion rights. This includes multiple proposed constitutional amendments seeking to put an abortion ban on the ballot as soon as this year.
Wales oversees the Planned Parenthood affiliate where in 2009 Dr. George Tiller, an abortion doctor in Kansas, was shot and killed while attending church. She worries about the anti-abortion rhetoric she hears on a regular basis.
“When you have the state’s attorney general saying that Planned Parenthood should be eradicated or eliminated,” Wales said. “That kind of language does incite others potentially to violence.”