Abortion returns to southwest Missouri after more than two decades without local access

The Springfield location is the fifth Planned Parenthood clinic to begin offering the medication after a June court decision struck down several abortion regulations as unconstitutional, opening the door to in-clinic medication abortion access again in Missouri for the first time since 2018. Medication abortion appointments at the clinic can be made up to 12 weeks into pregnancy.

“Everyone deserves to have access to abortion care close to home,” Dr. Margaret Baum, chief medical officer of Planned Parenthood Great Rivers, said in a statement. ” … Too many people struggle to get time off work or save up money to travel, and it impacts their ability to access timely care. That’s why it has been a top priority for (Planned Parenthood Great Rivers) to expand access in the Missouri Ozarks.”

Medication abortion is the most common method for ending pregnancy in the United States, used in about two-thirds of abortions. Federal challenges to the mifepristone, including efforts spearheaded by Missouri leaders, are ongoing.

Abortion has been legal in Missouri since November 2024, when voters approved a reproductive-rights amendment protecting abortion up to the point of fetal viability. This fall, voters will be asked if they want to reinstate an abortion ban after lawmakers voted to place a proposed constitutional amendment on the ballot that would ban the procedure with limited exceptions for survivors of rape and incest and for medical emergencies. 

Missouri Attorney General Catherine Hanaway has filed a notice of intent to appeal the June decision striking down dozens of state regulations on abortion providers — known as TRAP laws, or “targeted regulation of abortion providers” laws —  as medically unnecessary. Planned Parenthood and the ACLU of Missouri also filed an intent to appeal the remaining upheld regulations.

Springfield Healthcare Center, a for-profit clinic that offered abortion services, closed Oct. 20, 2005, after about 30 years in business. The closure came weeks after then-Gov. Matt Blunt signed a special-session bill requiring abortion providers to hold admitting privileges at a hospital within 30 miles, though the administrator said the two were unrelated.

Expanded pain management options

The Springfield clinic this week also began offering nitrous oxide to help manage pain during the placement of intrauterine devices as well as for procedures such as biopsies, colposcopies, vasectomies and cancer screenings. This clinic does not currently perform procedural abortions.

Baum said the decision to add nitrous oxide was driven largely by provider and patient feedback at the Springfield office. The inhaled gas does not have long-term sedation effects, so patients are safe to drive themselves home immediately after the procedure.

When it came time for Ashley Mann, 41, of Springfield, to have her IUD replaced last spring, she kept replaying her experience 10 years prior at a clinic in her hometown.

Mann said she was advised to take ibuprofen prior to the appointment, but she wasn’t offered any other options. The extreme cramping started during the placement and continued for hours after.

“I was cramping and crying and in tears as I was driving home,” she said. 

This time, hoping to keep her anxiety at bay, she was determined to find a provider with more pain management options.

A few months ago, Mann called the Planned Parenthood clinic in Springfield and was told they couldn’t provide what she was looking for. She also called Mercy Hospital Springfield and was told they could give her valium. As a self-pay patient, Mann said she was quoted $1,200 to have the procedure done at Planned Parenthood and $1,900 to have it done at the hospital. 

Around the same time, she and her husband, who both work remotely, planned a trip to Amsterdam. Mann wondered if she could get a new IUD in the Netherlands instead.

In May, while on a working vacation, she paid 160 euros to get her new birth control placed. This included lidocaine spray followed by an injection to numb her cervix. 

“If you know it’s gonna be painful and you have the ability to prevent some kind of suffering, like, why wouldn’t you want to do that?” she said.

Now, two months later, Mann’s local Planned Parenthood clinic in Springfield offers some of the relief she was seeking.

Each person’s experience with an IUD placement is different. Whether and how they experience discomfort or pain can depend on their genetics, medical and surgical history, and history of trauma. 

“There’s just a falsehood that there’s a dichotomy in terms of, ‘oh, it’s excruciating pain or it’s nothing,’” said Dr. Catherine Cansino, an OB-GYN and complex family planning specialist in California and a fellow of the American College of Obstetricians and Gynecologists. “
When in reality, people experience pain very differently, and in the same way, the effects of an anesthetic can address their pain in varying ways.”

Cansino has placed countless IUDs. In the past few years, she’s increasingly heard from patients requesting pain relief. But expansion of options can be slow-going.

“Really it comes down to ‘how can we better address the pain that women experience, the discomfort that women experience?’” she said. “Don’t even get me started about the speculum, right? I mean, we just have very limited options.” 

Last year, the American College of Obstetricians and Gynecologists released new guidance for pain management options for in-office uterine and cervical procedures. The year prior, the CDC released similar advice.

“There is an urgent need for clinicians to better understand pain management options and recognize and address patient pain, and for patients to have more autonomy over pain control options for their health care,” the American College of Obstetricians and Gynecologists guidance reads. 

In recent years, there’s been a growing chorus of women sharing their experiences on social media and asking providers for options to help navigate any pain they might experience. 

Springfield patients still have fewer choices than those at Planned Parenthood’s clinic in St. Louis’ Central West End, about 200 miles northeast. When a judge’s initial order last year allowed Planned Parenthood clinics in Missouri to resume procedural abortions for the first time since 2022, it also opened the door for expanded pain management options for non-abortion care there.

Now staffed with a nurse trained in procedures involving anesthetics, the Central West End clinic began offering IV sedation for patients seeking other reproductive healthcare, such as the placement of IUDs.

Basic options — breathing techniques and ibuprofen — are available at most providers. In St. Louis, patients can also choose local anesthetic that requires an injection that numbs the cervix, oral prescription medication, or, now, IV sedation. 

A patient can also be fully sedated in an operating room. It’s more rare, and more expensive, but Baum said the clinic can often help cover the expense when needed. 

Missouri maternal deaths remain mostly preventable, sixth state report finds

The Planned Parenthood affiliate has offered IV sedation at its Fairview Heights clinic in Illinois, where abortion has long been legal, since 2024. Planned Parenthood Great Plains, which operates clinics in the Kansas City area and in Columbia, offers pain management options including lidocaine and Valium.

The most important part of this change, Baum said, is giving patients some choice over how the procedure plays out.

Baum said she once had a patient who needed a colposcopy, or an in-depth exam of the cervix. Afterward, the patient said she never wanted to get another exam because of how painful it was. Now Baum can call that patient back and offer the exam again, this time with sedation.

In Missouri, where she has worked as a doctor and abortion provider for decades, Baum said she thinks about the future of healthcare access for her patients “every day.”

“We are eager to expand, we are eager to provide all of the services to people,” she said. “We have to keep in mind resources. When we expand, we have to think ‘is this going to change again?’” 

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