Physician David Mehr addressed a dozen voters gathered Saturday morning at the Columbia headquarters of Missourians for Constitutional Freedom, the coalition behind a proposed amendment would enshrine the right to abortion in Missouri’s constitution.
Meanwhile, physicians greeted volunteers in St. Louis County, and still more gathered in Kansas City, as part of the coalition’s final get-out-the-vote campaign before the Nov. 5 election.
“I’ve cared for women my entire life,” Mehr told the group of volunteers in Columbia. “It’s important that we keep this decision between a woman and her doctor.”
Mehr works at University of Missouri Health Care but spoke as an individual and not on behalf of the hospital.
An hour later, he was navigating a thicket in a northwest Columbia neighborhood, looking for the right door to knock on. By the end of the day, he and his canvassing partner had knocked on 44 doors.
Like other states with abortion bans, Missouri’s state law carves out exceptions “in cases of medical emergency.” Medical professionals who perform abortions deemed unnecessary can be found guilty of a Class B felony and have their license revoked or suspended.
“There’s no definition of what a medical emergency might be,” said Betsy Wickstrom, a high-risk obstetrician who works in Kansas City. “So if my patient is bleeding and her cervix is open, there’s still cardiac activity, how much do I need to let her bleed?”
Wickstrom preferred not to disclose her hospital affiliation. Her reluctance was shared by doctors who gathered in St. Louis on Saturday and reflects a broader trend of doctors keeping their workplaces hidden when talking about abortion, identified in a 2023 study.
Last month, a group of 800 medical professionals from Missouri, including 500 physicians, signed a letter supporting the abortion-rights amendment, which appears on the ballot as Amendment 3.
No doctor in any state has been criminally prosecuted for performing an abortion during a medical emergency, according to an article published last month by the Association of American Medical Colleges. However, doctors across the country have warned that lack of clarity about what constitutes a medical emergency compromises their ability to offer emergency abortions.
In August, a group of OB-GYN medical residents in Missouri anonymously published an article in the Journal of Graduate Medical Education describing their shock and fear entering the profession in a state with a strict abortion ban.
“Because the text of the law reads so punitively, it has struck fear into clinicians and caused life-saving care to be unnecessarily delayed or blatantly refused,” the authors wrote.
Since abortion became illegal in Missouri in 2022, the state has seen a more than 25% drop in applications for OB-GYN medical residencies, according to a May report by the Association of American Medical Colleges.
In a widely publicized case from 2022, two hospitals, including one in Missouri, turned away Missouri resident Mylissa Farmer when she sought care after her water broke at just 18 weeks of pregnancy. Last year, the Centers for Medicare and Medicaid found the two hospitals — Freeman Hospital West in Joplin and the University of Kansas Health System in Kansas City, Kansas — violated federal law when they denied Farmer care.
Numerous other examples of women being denied emergency medical care have appeared in news media since the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization ended the constitutional right to an abortion.
Health care professionals opposed to abortion argue that media reports promote an exaggerated narrative that abortion bans jeopardize women’s access to emergency care.
“All state laws allow for maternal fetal separations to be done (through whatever means necessary) in order to save the life of the mother,” Christina Francis, an OB-GYN and CEO of the American Association of Pro-Life OB-GYNs, wrote in testimony for a U.S. Senate Finance Committee hearing in September.
Decisions in medicine are rarely black-and-white. When a woman’s water breaks early enough that the fetus’ viability is remote, abortion is the standard of care, said Wickstrom. When a woman is closer to 20 weeks, factors like bleeding, signs of infection and how much amniotic fluid is in the uterus are considered.
Some women want to wait, and a doctor guides the patient through that choice.
“Of course we do that, because the point is choice. The point is that it is her body to determine for herself what’s right for her, and we come alongside her and support her and guide her through what is right for her,” Wickstrom said.
If a woman does not want to continue the nonviable pregnancy, the fetus has a heartbeat and her condition is not considered an emergency, she has to leave the state for an abortion, Wickstrom said. In Kansas City and St. Louis, women can get to clinics that offer abortion care in Kansas and Illinois more easily than those in mid-Missouri.
Wickstrom brings her metal water bottle to work at a hospital in Kansas City. She keeps it on display when she talks to patients so they can see the stickers adorning it: Just above a cutout of Taylor Swift is a sticker that reads “ABORTION RESOURCES,” followed by a list of phone numbers and website URLs.
Wickstrom said she struggles to speak frankly with women who have high-risk pregnancies about their options.
“You’ve got to dance around it a lot more,” she said, “because the waters are muddy.”
This story originally appeared in the Columbia Missourian. It can be republished in print or online.