Missouri’s abortion report for 2018 was released in December 2019, showing a significant drop in abortions from the previous year.
Changes in Missouri Abortions, 2017-2018
Information on Planned Parenthood’s Missouri market share is not publicly available.
Abortion Totals and Trends
A record low 2,910 abortions were reported as occurring in Missouri in 2018, down more than 25 percent from the previous year. Chemical abortions fell by an even greater margin, dropping 66 percent from 1,062 in 2017 to just 359 in 2018 (Fig. 1). The Charlotte Lozier Institute estimates that the state abortion rate declined to 2.5 abortions per 1,000 women of childbearing age in 2018, well below the national average (Fig. 2), although according to estimates from the Guttmacher Institute, abortions in Missouri tend to be underreported. In comparison, the number of abortions known to have been performed on Missouri residents (both in Missouri and in other states) fell by just 10 percent between 2017 and 2018.
State Report Summary
Much of the information in Missouri’s report is for abortions performed on Missouri residents, whether the abortions occurred in Missouri or in a different state. For example, though there were 2,910 abortions performed in the state of Missouri, there were 6,125 reported abortions performed on Missouri residents both in- and out-of-state in 2018. However, some states, including nearby Illinois, have not regularly reported abortions back to Missouri and, as a result, Missouri reports that there were actually an estimated 9,087 resident abortions in 2018.
Of the 6,125 abortions known to have been performed on Missouri residents, 10 percent were on girls under the age of 20. Nearly 60 percent were performed on women in their twenties (30 percent on women ages 20 to 24 and 30 percent on women ages 25 to 29). Twenty-eight percent of the abortions were on women in their thirties, and three percent were on women age 40 or older.
Non-Hispanic, white Missouri residents made up the largest racial group undergoing abortions in 2018, representing 49 percent of the 6,125 resident abortions. Thirty-eight percent of the abortions were on non-Hispanic black Missourians, and eight percent were on non-Hispanic women of a different race. Four percent of the abortions were performed on Hispanic women.
Eight percent of the Missouri residents who obtained abortions had 11 years of education or fewer. Thirty-seven percent had 12 years, and 34 percent had completed 13 to 15 years of schooling. Fourteen percent had 16 or more years of education, and six percent did not report their level of education. Thirteen percent of the abortions were performed on married women and 84 percent on single women, while three percent of the abortions were performed on women whose marital status was unknown. A majority (60 percent) of Missouri resident abortions were on women who already had living children. Twenty-five percent had one living child, and 35 percent had two or more.
Eighty-five percent of the abortions reported to have been performed on Missouri residents occurred in the first trimester (12 weeks of gestation or earlier). Fifty-seven percent were performed at eight weeks or earlier, 18 percent between nine and 10 weeks, and 11 percent from 11 to 12 weeks. Fifteen percent occurred in the second trimester or later. Five percent were performed between 13 and 14 weeks, and four percent each between 15 and 16 weeks and 17 and 19 weeks of gestation. One percent of the abortions performed on Missouri residents occurred at 20 weeks, and another one percent were performed at 21 weeks or later.
Forty-seven percent of the resident abortions were performed via curettage, and 41 percent were chemical abortions. Eleven percent were performed using dilation and evacuation, also known as dismemberment abortions. There was one instillation abortion, one hysterectomy or hysterotomy abortion, and two abortions performed using other, unspecified methods. One abortion was performed using an unreported method.
Abortions Occurring in Missouri
In 2018, 2,910 abortions were performed in Missouri on both residents and nonresidents. Over 59 percent of the abortions occurring in Missouri were performed on women in their twenties, with 30 percent on women ages 20 to 24 and 30 percent on women ages 25 to 29. Twenty-eight percent of Missouri abortions were on women in their thirties. Nineteen percent were on women ages 30 to 34, and nine percent on women ages 35 to 39. Ten percent of Missouri abortions were performed on girls under the age of 20, and less than three percent on women ages 40 and older.
Non-Hispanic, black women composed the largest racial group, undergoing 47 percent of the abortions reported in the state. Forty-two percent of the abortions were on non-Hispanic, white women, and eight percent were on non-Hispanic women of other races. Less than half a percent were performed on non-Hispanic women of unknown race, and two percent were on Hispanic women.
More than three-quarters of the abortions reported in Missouri (78 percent) occurred in the first trimester. Forty-two percent were performed at eight weeks of gestation or earlier, 21 percent between nine and 10 weeks, and 15 percent from 11 to 12 weeks of gestation. Seven percent of Missouri abortions occurred early in the second trimester between 13 and 14 weeks of gestation. Six percent were performed between 15 and 16 weeks, and five percent occurred from 17 to 19 weeks. Just under two percent were performed at 20 weeks, and almost two percent occurred at 21 weeks of gestation or later. In 2019, Missouri passed a bill with a series of provisions limiting abortion at different points in pregnancy, designed so that if one provision is challenged, the others remain in effect. The law also prohibits performing an abortion because a baby has been diagnosed with Down Syndrome or because of the baby’s race or sex. Currently the law is blocked by a court order, including the portion prohibiting abortions on babies with Down Syndrome, but the state has filed an appeal to the Eighth Circuit. The section of the law that prohibits abortions based on race or sex has not been enjoined.
Seventy percent of the abortions reported in Missouri were performed using curettage, compared to just 12 percent that were chemical abortions. Seventeen percent were dilation and evacuation procedures. There was one instillation abortion, one hysterectomy or hysterotomy abortion, and one abortion performed using an unreported method.
Currently, Missouri has one abortion center, which is operated by Planned Parenthood. The Planned Parenthood center has a history of unsafe conditions and licensing issues, and the state of Missouri has declined to renew its license, although Planned Parenthood has sued the state and the center has remained in operation while the case is ongoing.
Missouri has a requirement that patients be provided with a pelvic examination 72 hours in advance of their abortions in order to determine which abortion method would be best. Planned Parenthood has refused to comply consistently with this requirement. The state of Missouri has allowed for some flexibility by permitting exceptions to the requirement when a doctor determines that the examination is not medically indicated and notes his or her reasoning in detail in the patient’s medical history. However, Planned Parenthood has argued that pelvic examinations in advance of chemical abortions are unnecessary and has been referring women seeking chemical abortions out of state, which may have contributed to the low number of chemical abortions reported in 2018. Both neighboring Illinois and Kansas reported an increase in chemical abortions in 2018. In 2019, Planned Parenthood announced the opening of a new “mega-clinic” that had been secretly constructed right across the Illinois border from its Missouri center.
Abortion Complications in Missouri
2018 marked the second year of enforcement of Missouri’s abortion complication reporting law, which requires medical professionals to report any abortion complications they treat. The law was originally enacted in 1979 but was largely ignored until Missouri resumed enforcement in 2017.
In 2018, 131 abortion complication forms reporting 164 complications were submitted to the Missouri Department of Health and Senior Services (DHSS). The complications were treated in Missouri, but the abortions could have been performed in Missouri or in another state. Twenty-nine of the forms were for surgical abortions, 34 for chemical abortions, and 68 for unspecified abortion methods. The most common complication was pieces of the baby or placenta left behind in the woman’s uterus, with incomplete abortion occurring in 43 cases, retained products of conception occurring in 32 cases, and failed abortion (in which the pregnancy is ongoing) occurring in 22 cases. Many women also suffered from infection or fever, with 18 women experiencing endometritis, two women with parametritis, one with a pelvic abscess, and two with pyrexia (fever). There were also reports of bleeding and damage to reproductive organs; there were 15 cases of hemorrhaging, two uterine perforations, and one cervical laceration. There were 26 other, unspecified complications.
Twenty-two women were reported to have been hospitalized as the result of an abortion. Sixty-eight abortions performed in Missouri were known to have caused complications, resulting in a Missouri complication rate of 2.3 percent as calculated by the Department of Health and Senior Services.1
In its denial of Planned Parenthood’s license, Missouri noted that Planned Parenthood had been reporting complications inconsistently and suggested that this “likely has resulted, and will result, in fewer diagnosed abortion complications being reported”.
In the Charlotte Lozier Institute’s 2016 survey of abortion reporting across the country, Missouri’s reports were tied for 25th best. Since then, Missouri has improved its reporting by resuming enforcement of its complication reporting requirement. To improve its reporting further, Missouri could identify the states to which Missouri residents travel for abortions. The Show-Me State could also provide additional demographic information for all abortions performed in the state, including previous pregnancies and level of education, rather than including this information for abortions performed on resident women only.
- Statistics on abortion complications reported here represent a minimal number of deaths and complications, and the state acknowledges that this data may be incomplete.
- Abortion totals for 2011 and 2014 were revised in later reports, but because chemical abortion totals were not revised, the original numbers provided by the 2011 and 2014 abortion reports have been used to allow for comparison between total and chemical abortions.
- Starting with the 2018 abortion reports, abortion rates are calculated by the Charlotte Lozier Institute to allow for easier state-to-state and year-to-year comparisons. Rates were calculated by CLI using population estimates from the United States Census Bureau. The rates were calculated using the following formula: (total number of abortions performed in Missouri ÷ number of resident women ages 15-44) x 1,000. Rates may differ slightly from previous CLI articles due to revised population estimates.