What The Hell America!

COLUMBIA, Missouri —  Celeste Athon had played softball from the day she was old enough to sign up for a local youth league. She’d never felt like this before. 

Athon, a second base player for the local Stephens College, found herself tired much faster. Even sprinting just a few feet left her short of breath. She didn’t know what was happening — why her performance was suddenly slipping in this sport that she loved, that she’d spent her whole life playing. It didn’t make sense. 

Until she missed her period.

Even as she watched the pregnancy test turn positive, Athon knew she couldn’t keep the pregnancy; the 20-year-old college student works at a nearby department store to support herself. Staying pregnant would mean moving back in with her parents — her hometown, two hours away and home to fewer than 500 people, made this college town seem like a metropolis — and giving up on her team and on her degree. She was too young to have a kid, she thought. 

Athon heard that abortion was legal in Missouri now. But until a teammate told her, she hadn’t realized she could get an abortion right here, in Columbia — she’d believed she would have to head to Kansas City or St. Louis. As of March, instead of traveling two hours each way — a distance that would require missing school, missing practice, possibly spending the night at a hotel in another city — she could drive all of seven minutes. Instead of a multi-day affair, her abortion could be done in a matter of hours. 

So on a Monday in March, Athon played three hours of softball, a double-header against another local school. She hit a triple — her first of the season — before scoring one of her team’s six runs. The following morning — the one day a week she didn’t have practice — she woke up to a series of good-luck texts from her friends. She put on the bracelet her sister had mailed her, part of a care package that included bath bombs, fuzzy socks and a candle. 

Her boyfriend, who had come into town the night before from St. Louis, drove her to the clinic, where he paid the $775 fee. There, she learned she was 5 weeks and 5 days pregnant. 

And, then, after a short procedure, she wasn’t. 

“It was a lot easier than I expected to get help and support,” she said. “I was really scared I was gonna have to go through a million different steps. But they made it really easy here.”

Athon was one of the first dozen people to have received an abortion in Missouri since the November election, when voters backed a proposal to add abortion rights protections to the state constitution. Missouri, one of the quickest states to outlaw abortion after the fall of Roe v. Wade, was the first where voters overturned a near-total ban. Almost all of those initial patients were seen in Columbia.  

But Missouri is now on the frontlines of the anti-abortion movement’s growing effort to reverse abortion rights state by state, trying to undo the ballot measures voters approved to enshrine abortion rights. Those efforts brewing in the capitol, Jefferson City — not even 50 miles from Columbia — have added another layer to the challenges abortion providers in the state, who are building infrastructure from scratch to provide care for people like Athon.

Well before Roe’s fall, abortion here was difficult to access, the result of a years-long project by the state’s Republican-run legislature to regulate providers out of business. In 2021, the last year before Roe’s overturn, only one clinic — a Planned Parenthood in St. Louis — offered abortions; the state only recorded 150 abortion procedures that year. Most people seeking care traveled to Illinois or Kansas. Or they simply stayed pregnant.

Last November’s election results could flip that dynamic, making experiences like Athon’s the norm rather than the exception. The past few months have been a scramble for Missouri’s reproductive health clinics: recruiting physicians, training employees in clinics and, critically, trying their best to spread the word to residents that they don’t need to leave their home state for abortions.

Most employees at Columbia’s Planned Parenthood have never worked at a clinic that offers abortion. They are learning what kind of medical supplies to order, shadowing colleagues across the border in Kansas. Nurses are commuting into town to teach the clinic staff the ins and outs of abortion care, details like how to read ultrasounds and properly assess how far along a pregnancy is.

As they rebuild abortion services, facilities in Columbia, St. Louis and Kansas City — the only other clinics in the state currently offering abortion with any kind of consistency — are only providing the procedure for patients in their first trimester, despite the Missouri constitution establishing protections until fetal viability, which typically occurs around 23 to 25 weeks.

“I’ve learned different names of many different instruments — like dilators. I didn’t know that there were different ones,” said the Columbia clinic’s manager Krissy, who asked that her last name be withheld because of harassment directed against abortion providers. “I had a child, and I didn’t know about all this. It’s all new to me.”  

There are no local doctors who work at the clinic, frequently the site of protests by a small but dedicated cohort of anti-abortion activists. So instead, they can only provide abortions whenever a physician is available to travel into town. The day of Athon’s abortion, Dr. Iman Alsaden, who is based in Kansas City, was delayed driving into Columbia by a flat tire, though they eventually made it in. Five patients, including Athon, came to the clinic and received abortions that day, half of all the people who had made appointments. The others never showed up.

Even with the limitations on providers, there is hope.

“It’s like a new relationship energy. Everyone’s so bubbly, and like, ‘Oh my gosh, we’re empowered,’” said Macy Thompson, a nurse who typically practices in Overland Park, Kansas, just across the Missouri border. “It’s happening, and it’s really exciting, and it’s really frenetic and colorful.” 

Thompson, who had been coming in to train staff and help provide abortions, said she made sure each patient knew: You’re the second person in all of Missouri to get an abortion since the election. You’re the fourth. You’re the fifth. Maybe, some employees said, this clinic could provide abortions as often as once a week, seeing people from across the state or even the region. 

But that might be too ambitious, said Alsaden, who is also the chief medical officer for Planned Parenthood Great Plains and the only doctor on staff for the organization who has traveled to Columbia. Their job entails providing abortions at several other clinics, including at the Overland Park clinic, which has been bustling since near total abortion bans in Oklahoma and Texas — followed by the fall of Roe — sent waves of out-of-state patients to Kansas. 

This clinic could soon provide abortions twice a month, Alsaden said, but even that is only if Planned Parenthood can find more doctors who are licensed to provide abortions in Missouri and willing to do so in Columbia, specifically. 

For now, patients who need abortions on those other days are still being redirected out of state, to Kansas — sometimes passing Columbia on their way to a further off appointment. 

“We want to eventually expand, but I think that is something that is going to take a little bit longer,” Alsaden said. 

Even maintaining this equilibrium is precarious. 

Every morning, the clinic’s team huddle includes a brief discussion on what staff are legally allowed to do and what is still constrained by state law, as Missouri’s courts continue to deliberate which of the state’s old anti-abortion statutes can remain intact and which must be struck down. 

The state government has prevented clinics from providing abortion through medication, a popular and simple method of terminating pregnancies, until they submit state-mandated complication plans and purchased additional malpractice insurance, even though decades of research shows that complications from the two-drug regimen are incredibly rare. The plans, which are not typically required for most types of medical care, must be reviewed by the state health department. Planned Parenthood Great Plains submitted a plan in February, which the state rejected in March. The organization is challenging the insurance and complication plan requirement in state court. 

In the interim, patients in Missouri can only receive abortions through a minor surgical procedure. It’s safe and effective, but slightly more time-intensive to offer and requires a specially trained physician to provide, further limiting how many abortions the clinic facility can provide. 

“Patients have called wanting medication abortion appointments that we’ve had to turn away,” said Vicki Casey, who started working at the Columbia clinic 20 years ago. Casey is the only person on staff who remembers a time when they provided abortions. 

Even as providers try to expand their footprint, or even just establish one, Republican lawmakers in Jefferson City are pushing to reverse the state’s new abortion protections. If successful, their efforts could provide a model for conservative lawmakers in other states where voters have recently protected the procedure: Arizona, Ohio, Kansas, Kentucky.

Missouri Republicans, who hold supermajorities in both legislative chambers, have filed more than a dozen anti-abortion bills this legislative session, ranging from a six-week ban to a bill that would classify abortion pills as controlled substances to legislation that would treat abortion as homicide. But the idea closest to becoming law is one to put a new measure before Missouri’s voters that asks them to amend the state’s constitution so that it prohibits most abortions. 

If the measure is approved to appear on Missouri’s ballot, Gov. Mike Kehoe, a Republican, would decide when residents could vote. Missouri’s legislative session ends in May, leaving only weeks for the legislature to advance bills. 

Republicans in favor have argued that voters didn’t understand what they were doing when they voted to protect abortion rights in November, claiming that critics have exaggerated the harms of the state’s near-total ban. They also say that Amendment 3 has legalized abortion at all stages of pregnancy, removing all regulations on the procedure — despite the litany of restrictions clinics like the Columbia facility are still navigating.

“The depiction that was made that if we didn’t pass Amendment 3, women would be dying in our hospitals from an inability to receive medical care,” Adam Schnelting, a Missouri state senator, said during a hearing on one such repeal proposal. “That was misleading.”

Reports have shown that in other states with similar bans, people have died or suffered serious health consequences from being denied abortions. In Missouri, one hospital was penalized for turning a woman away during a medical emergency that required an abortion — she had to travel to Illinois. 

The GOP’s efforts have drawn sharp criticism from abortion rights supporters and Democrats in the legislature, who uniformly oppose the measure. A hearing in the state’s House of Representatives for one repeal option included four hours of testimony, with people from across Missouri traveling to Jefferson City to voice their opposition. 

“The women and the men of Missouri — and the people, not just women and men — have proven this is a thing they want,” said Bailey Wallace, a school librarian aide in St. Louis, who submitted written testimony to the state in support of abortion rights. “I think it’s not going to go away quietly. I think people are going to fight.”

It’s a fight abortion opponents are ready for. In Missouri, the abortion rights amendment passed with only 51.6 percent of the vote, a slim majority despite supporters pouring tens of millions of dollars into campaigning for the measure. The summary language for one proposed amendment, which passed the state’s House of Representatives in April, and which could receive Senate approval this week, would not say it is allowing the state to ban most abortions, despite that being the likely end result — instead suggesting the amendment would let the state “ensure women’s safety during abortions.”

“The people of Missouri are smart. They have the ability to understand what’s going on if it’s explained to them,” said Dr. Selena Sandoval, the associate medical director for Planned Parenthood Great Plains, who lives in Missouri and provides abortions across the border in Kansas. Still, “There’s a lot of effort from politicians to muddy the waters and not be clear about what’s going on.”

And anti-abortion lawmakers are attempting to drum up opposition by connecting the procedure to another political target. 

Their proposed constitutional amendment would also ban gender-affirming health care for transgender minors — medical care that is already illegal in the state and that polling suggests is less popular than abortion. Only about 1 in 4 Missouri voters support allowing hormone therapy for trans minors, per an August 2023 poll from St. Louis University; polling published last year, meanwhile, found that about half of all voters supported undoing the state’s abortion ban.

“Voters should have another chance,” said Brian Westbrook, the executive director of Coalition Life, an anti-abortion group in Missouri that campaigned against Amendment 3. “From my conversations with lawmakers, I think primarily it’s going to be related to the abortion discussion, but the transgender discussion is certainly in this dialogue.”

Abortion opponents have sought before to connect abortion rights to gender-affirming care, including in the November election in Missouri. But this would be the first time a state attempted to outlaw both abortion and gender-affirming care in one constitutional amendment, at a moment when Republicans across the country, including President Donald Trump, have focused their energies on enacting anti-trans policies.

If Republicans are able to focus their campaign on gender-affirming care specifically, they may have a better chance of undoing Amendment 3, said Steven Rogers, a pollster at St. Louis University. 

“You bring up the youth transgender issues, and it is really unpopular in Missouri,” Rogers said, despite how rarely minors actually receive gender-affirming health care. 

And with Amendment 3, despite outspending abortion opponents, he said, “they barely won when public opinion was on their side.”

Abortion rights groups in Missouri and national organizations alike said they are prepared for a vigorous campaign if this question returns to voters. But liberal donors are more reluctant to contribute than were a year ago, said Kelly Hall, who heads The Fairness Project, a national advocacy group that supports progressive ballot measure campaigns. 

“It’s too simplistic to say everyone is sitting it out, but we need to have strong cases for what’s effective and that’s a reasonable request to have,” she said. “These things are resource-intensive, and the stakes are high and the impact of winning is high.”

The abortion operation that the clinic staff in Columbia is working to build could come to a shrieking halt. That crosses their minds, certainly.  But most of the time, staff are focused less on the legislature and more on their day-to-day challenges: finding a way to get more people abortions while they can. 

“I don’t think about it until I have to, until they tell me, this is what’s happening, and this is what we have to change,” Casey said. “I’m just on the bright side and say we’re doing it, until they tell us we can’t.”

For Athon, those stakes are visceral in a way they weren’t even a few months ago. This past November, she didn’t vote on Amendment 3. Though most Columbia residents backed the measure, she didn’t feel informed enough to weigh in. 

Things are different now, she said — it’s easier to imagine what it would mean if abortion rights were gone, how it would shape her own life. “Honestly, it would be really awful,” she said.

“If it wasn’t Missouri, and I had to go out of state?” she said. “I don’t know what I would have done.”