Editor’s Note: Rafia Zakaria is the author of “The Upstairs Wife: An Intimate History of Pakistan” (Beacon 2015) and “Veil” (Bloomsbury 2017). She is a columnist for Dawn newspaper in Pakistan and The Baffler. The views expressed in this commentary are her own. View more opinion on CNN.
There is only one clinic left to provide abortions in the state of Missouri – and soon there may be none at all. On Friday May 31, the Planned Parenthood Clinic located in St. Louis is expected to stop providing abortions because a state health department has refused to renew the license it needs to continue offering abortion services.
“This is not a drill,” Planned Parenthood Federation of America CEO Leana Wen said in a statement. “Missouri would be the first state in the country to go dark – without a health center that provides safe, legal abortion care.” Planned Parenthood has filed a lawsuit seeking a restraining order against the agency in the hopes that a court can step in and allow the clinic to continue its operations.
CNN has reached out repeatedly to the governor’s office and the state health department for comment but has not received a response. The governor, Mike Parson, held a press conference on Wednesday where he said inspectors found “numerous violations of state laws and regulations” at the clinic and that the state will not renew Planned Parenthood’s license unless the clinic “complies with the law. … No one is receiving special treatment.” He also cautioned that a judge ruling in favor of Planned Parenthood would be “reckless.”
Yet, whether or not the restraining order is granted, a new strategy of state level anti-abortion advocates is now revealing itself. The novel tactic of utilizing a state health department to refuse to renew an operating license to an abortion clinic (usually a routine procedure) can prompt an immediate halt to abortions while legal challenges to restrictive new laws languish and linger in the court system.
The strategy is clever because it pits local and state officials against a federal directive. State-level health officials are far more likely to be influenced by state politics and pressure. In the case of Missouri, the administration of Gov. Mike Parson has already made its staunch anti-abortion stance well known. In the same week that the clinic’s license is due to expire, Parsons signed into law a bill that would ban all abortions after eight weeks.
That law, which is already facing legal challenges, seems to be his administration’s overt move against the provision of legal abortions in the state. The more covert move is to use an opaque licensing procedure to stop abortions immediately, instead of in August when the new law would have taken effect. Even better, this covert strategy has the added benefit of potentially being shrugged off as red tape.
The message in all of it is clear: whatever federal courts may do, local officials can create all kinds of hurdles that cause clinics, such as this last one, to stop offering abortion care or close their doors entirely.
Missouri is not the only state to have a single clinic left to provide abortions. Kentucky, West Virginia, Wyoming, North and South Dakota and Mississippi all have only one clinic left providing abortion services. All are red states that have made attempts to limit abortion procedures that have either been struck down or are still undergoing review by the courts. On May 24, for instance, a federal judge blocked a Mississippi bill that would have, come July, banned all abortions after the detection of a fetal heartbeat. The Mississippi bill is similar to other so-called heartbeat bills that have been passed in Ohio, Georgia, Kentucky and Iowa – all of which have yet to come into effect.
Under this two-track strategy, while access to abortion is restricted by pressuring providers in the short term, legislative majorities can pass bills that severely limit a woman’s right to choose, in the hope that one of these will eventually come before the new conservative majority in the US Supreme Court and spell the end of Roe v. Wade.
Because most state level health department licensing procedures are little known and not often challenged, it’s conveniently difficult to discern whether license denials are innocuous (owing to red tape) or intentional (owing to opposition to abortion rights). All of it is, in simple terms, like a perfect crime, with a ready alibi, few clues and no way of proving intent.
There will of course be victims – the women whose lives are impacted by not being able to access abortion care. While the Missouri clinic will continue to operate after Friday, providing services other than abortions (unless a local court intervenes and forces the license to be issued), there will no longer be any recourse for women who need the procedure in the entire state. They will either have to travel to other states, or worse still, pursue illegal procedures – and take on all the health risks that come with them.
According to the Bixby Center for Global Reproductive Health at the University of California San Francisco “limited access to abortion makes it more likely that self-induction will become more common.” Another study published in the medical journal “Contraception” further warns that abortion restrictions lead women to turn to “a variety of less effective and more dangerous means of ending a pregnancy on their own, including taking herbs and self-inflicting abdominal trauma.”
Given all of this data, it seems anathema that the state health department in Missouri, or really in any state, would so disregard the reproductive welfare of millions of women by refusing license renewals to facilities that provide abortions. It is, however, a sign of the political profligacy of our time – one in which a zealous and self-aggrandizing anti-abortion movement is willing to use any means possible and go to any lengths to deny women control over their own bodies.