The Missouri Pelvic Exam Rule For Abortions, Explained

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They passed a law banning abortion after eight weeks and refused to renew the license of the only clinic within the state providing the procedure. Now Missouri's anti-abortion state officials are continuing to ramp up their efforts to cut access to the procedure in the state. Abortion providers say Missouri's state health department requires them to perform pelvic exams on any patient seeking an abortion, even those set to receive a medication abortion or non-surgical procedure. In fact, health care providers have argued that Missouri's pelvic exam rule for abortions is invasive and medically unnecessary.

Encouraged by the Trump administration's recent appointment of two conservative justices to the U.S. Supreme Court, Missouri joined a handful of states last month in passing legislation aimed at banning abortion in the early stages of pregnancy. The bill Gov. Mike Parson signed bans abortion after eight weeks with no exceptions for rape or incest. While it has yet to go into effect, the law would see abortion providers — but not people who obtain abortions — punished with prison sentences ranging from five to 15 years, according to Time magazine. The American Civil Liberties Union (ACLU) of Missouri filed a lawsuit challenging the law earlier this week.

Reproductive rights advocates argue that Missouri has imposed additional regulations on clinic, patients, and health care providers in an attempt to hinder access to abortion. One example is the state's pelvic examination for abortion rule, which is laid out in Missouri's Abortion Facility Rules that were last updated in April 2018.

What The Rule Says

Dr. David Eisenberg, the medical director for Planned Parenthood of the St. Louis Region and Southwest Missouri, the state's only abortion clinic, told The Los Angeles Times that state officials mandate physicians perform pelvic exams before every abortion procedure, even medication abortions.

The rule reads:

A written medical history shall be obtained for each patient. A health assessment including a pelvic examination shall be performed. Pregnancy shall be confirmed by clinical evidence and laboratory tests. This information shall be used in determining the duration of gestation, identifying preexisting medical or other complications, and detecting any factors which could influence the choice of the procedure, anesthesia, or preoperative and postoperative management.

In cases where the patient is scheduled to undergo an in-clinic abortion, an examination is already performed immediately before to the procedure, according to Planned Parenthood. State officials have claimed the rule making pelvic exams mandatory for anyone seeking an abortion was established in the interest of the patient's safety, per The Los Angeles Times. Abortion advocates and providers, however, maintain such procedures are often medically unnecessary and invasive.

Why Doctors Are Calling It "Assault"

Speaking on MSNBC's The Rachel Maddow Show, obstetrician Colleen McNicholas likened Missouri's mandatory pelvic examinations to "state-sanctioned ... sexual assault," arguing that anti-abortion state lawmakers were essentially forcing providers to do things they know to be medically and ethically inappropriate.

"For patients who've had a history of trauma, for example, I mean, it's just re-traumatizing them all over again," she said of the examinations. "The state continues to put us into a position where we are really choosing between what we know is medically and ethically appropriate, and I would put avoiding unnecessary pelvic exams squarely in that box."

An official opinion released by the American College of Obstetricians and Gynecologists' Committee on Gynecologic Practice noted that "pelvic examinations should be performed when indicated by medical history or symptoms" and that the "decision to perform a pelvic examination should be a shared decision between the patient and her obstetrician–gynecologist or other gynecologic care provider."

Dr. Amy Addante, an obstetrician and gynecologist based in Missouri, spoke out against the rule earlier this week on Twitter, saying it "broke" her as a physician to perform one on an already upset patient.

"Today I was forced by the state of Missouri to perform an unnecessary pelvic exam on a patient terminating her pregnancy for a fetal anomaly," Addante wrote. "She is heartbroken over her situation and I was forced to do an invasive, uncomfortable exam. It broke me as a physician to do this to her."

What's Next?

It's unclear exactly what will happen next, as much is likely to depend on the outcome of two legal cases currently pending in Missouri. The ACLU of Missouri announced Thursday that it had filed a lawsuit against Missouri's secretary of state, Jay Ashcroft, for his rejection of a referendum application to overturn the state's eight-week abortion ban. In papers filed in court, the ACLU asked the judge to issue a temporary restraining order and preliminary injunction against the ban until the matter could be fully resolved.

In a separate case regarding the state's refusal to renew the clinic's license to perform abortions, a judge issued a temporary restraining order last week, allowing the Planned Parenthood clinic to remain open, at least for now. But as long as the clinic stays open doctors there will, for the time being, also be required to continue to perform state-ordered pelvic exams on any patient seeking an abortion.