Abortion Reporting: Missouri (2019)
Missouri’s 2019 abortion report was released in December 2020. The report shows that Missouri abortions declined in 2019, reaching the lowest number ever reported in the state.
Changes in Missouri Abortions, 2018-2019
Information on Planned Parenthood’s Missouri abortion market share is not included in the abortion report.
Abortion Totals and Trends
Abortions performed in Missouri continued to decline in 2019 due to legal battles between the state and its single abortion center, hitting a new record low. From 2,910 in 2018 to 1,471 in 2019, the total number of abortions reported in the state fell by 49 percent, while chemical abortions dropped by a striking 96 percent (Fig. 1). Just 15 chemical abortions were reported in Missouri in 2019. The Charlotte Lozier Institute (CLI) estimates that Missouri’s 2019 abortion rate was 1.2 abortions per 1,000 women ages 15 to 44, far below the national rate (Fig. 2). Separately, Missouri reports abortions performed on Missouri residents, both those occurring in Missouri and those performed in other states. There were 4,660 abortions reported to have been performed on Missouri residents in 2019, although Missouri estimates that the true total was far higher and increased from 2018.
State Report Summary
Of the 4,660 abortions known to have been performed on Missouri women in 2019, the majority (60 percent) were performed on women in their twenties, with 30 percent on women ages 20 to 24 and another 30 percent on women ages 25 to 29. Twenty-eight percent were on women in their thirties, and three percent were on women age 40 or older. Nine percent of the abortions were on girls under the age of 20, including three percent on girls under the age of 18.
Just over half the abortions performed on Missouri residents, 51 percent, were on non-Hispanic white women, and 37 percent were on non-Hispanic black women. Six percent were on non-Hispanic women of other races, and five abortions were on non-Hispanic women of unknown race. Six percent were performed on Hispanic women.
Eight percent of the abortions were on women with fewer than 12 years of education. Thirty-six percent of the abortions were performed on women with 12 years of education, and 37 percent were on women with 13 to 15 years, while six percent were performed on women with 16 years of education or more. Level of education was not reported for two percent of the abortions. The vast majority of Missouri resident abortions (84 percent) were on unmarried women. Fourteen percent were on married women, and a little over one percent were on women of unknown marital status.
The majority of the Missouri women undergoing abortions already had children. Twenty-four percent of the abortions were performed on women with one living child, and 36 percent were on women with two or more children, compared to 40 percent on women with no children. Conversely, the majority of the abortions (64 percent) were performed on women with no previous abortions. Twenty-three percent were on women with one prior abortion, and 13 percent were on women with two or more previous abortions.
More than half the abortions (58 percent) were performed earlier than nine weeks of gestation. Seventeen percent occurred between nine and 10 weeks, and 11 percent were performed between 11 and 12 weeks of gestation, dropping to five percent between 13 and 14 weeks. Three percent were performed between 15 and 16 weeks, and four percent were between 17 and 19 weeks. One percent occurred at 20 weeks, and another one percent were reported at 21 weeks of gestation or later.
Chemical abortions made up the largest proportion of abortion procedures, representing 47 percent of the abortions performed on Missouri residents. The vast majority of the 2,189 chemical abortions must have occurred out-of-state, as only 15 chemical abortions were reported in Missouri. Forty-one percent were curettage abortions, and 12 percent were laminaria dilation and evacuation procedures. There were three intrauterine instillation abortions and four performed using other, unspecified methods, while eight abortions did not have the type of procedure reported.
Similar to the abortions performed on Missouri residents, the majority of the 1,471 abortions occurring in Missouri (58 percent) were performed on women in their twenties. Twenty-eight percent were on women in their thirties and four percent on women in their forties or older, while 10 percent were on girls under the age of 20 (four percent under the age of 18). Half the abortions were performed on non-Hispanic black women. Forty percent were on non-Hispanic white women, seven percent on non-Hispanic women of other races, and three percent on Hispanic women. Five abortions were performed on non-Hispanic women of unknown race.
Unlike the abortions performed on Missouri residents, just 27 percent of the abortions reported in Missouri were performed before nine weeks of gestation. Twenty-two percent were performed between nine and 10 weeks, and 19 percent were between 11 and 12 weeks. Likely due to the percentage of early chemical abortions that occurred out-of-state, a relatively large percentage of the abortions reported in Missouri occurred later in pregnancy. Eleven percent were reported between 13 and 14 weeks of gestation, while eight percent occurred between 15 and 16 weeks and seven percent between 17 and 19 weeks of gestation. Two percent of the abortions were performed at 20 weeks and four percent were performed at 21 weeks or later, for a total of six percent (88 abortions) at or after 20 weeks of gestation. In 2019, Missouri enacted a law to limit abortion at various points of pregnancy up to 20 weeks of gestation, whichever could withstand a legal challenge. The law is currently blocked by a court order, but the state has appealed to the Eighth Circuit.
Most of the abortions occurring in Missouri (73 percent) were curettage procedures, while one quarter were laminaria dilation and evacuation abortions. There were 15 chemical abortions, four intrauterine instillation abortions, and one hysterotomy or hysterectomy abortion. Three abortions were performed using other, unspecified procedures, and five were performed using unreported procedures.
Missouri requires medical professionals who treat abortion complications to report them to the Missouri Department of Health and Senior Services (MDHSS), regardless of whether the abortion occurred in Missouri or in a different state. In 2019, MDHSS received 93 abortion complication report forms with information on 112 complications. Thirty-seven percent of the forms were submitted for surgical abortions, 57 percent for chemical abortions, and six percent for abortions of unknown type. The most common complication was endometritis, occurring 22 times, followed by 21 cases of retained products of conception and 19 instances of failed abortion in which the pregnancy was undisturbed. The report does not indicate whether any babies were born from the 19 ongoing pregnancies, or whether these pregnancies were ended by a second abortion attempt. There were 17 cases of hemorrhaging, 13 incomplete abortions, three uterine perforations, and two cervical lacerations. Additionally, there were 13 unspecified complications, and two forms were received with no complications indicated. Twenty-nine women were hospitalized.
Twenty-four of the forms were submitted for abortions occurring in Missouri, which MDHSS used to calculate a Missouri complication rate of 1.6 percent.1 However, many complications were caused by abortions performed outside of Missouri. The total number of complication forms received for chemical abortions (53) far exceeded the number of chemical abortions performed in Missouri in 2019 (15), suggesting that the majority of chemical abortion complications resulted from abortions performed out-of-state. Missouri does not receive abortion complication reports from other states, so the number of abortion complications suffered by Missouri residents but treated outside of Missouri is unknown.
Most abortions performed on Missouri residents occur in other states, many of which then report the abortion data back to Missouri. There were 4,660 abortions performed on Missouri residents in Missouri or reported to Missouri by other states in 2019. However, not all states share individual record-level data with Missouri. In 2019, Illinois provided an estimate of abortions performed on Missouri residents, and Oklahoma provided a count of Missouri resident abortions. Missouri reports that when totals from Illinois and Oklahoma are included, there were an estimated 9,238 Missouri resident abortions in 2019.
In 2018, Missouri obtained reports of 6,125 abortions performed on Missouri residents, but estimated that including abortions performed on Missouri residents in Illinois, the true total was 9,087. State data later submitted by each state to the Centers for Disease Control (CDC) shows that there were 9,312 abortions reported to have been performed on Missouri residents in 2018, slightly higher than Missouri’s original estimate. Just 28 percent occurred in Missouri. Kansas reported the highest percentage, 35 percent of the total, followed closely by 34 percent in Illinois. Arkansas and Oklahoma reported 0.7 percent each, and 1.2 percent were reported by other states.
CDC data for 2019 is not yet available, but it is possible that Illinois has surpassed Kansas as the top destination for Missouri abortions. Kansas’ state abortion reports show approximately a hundred fewer abortions on Missouri residents in 2018 than in 2019, while Planned Parenthood opened a new abortion mega-center in Illinois in 2019 designed to draw women from Missouri. This could also partially explain why Missouri resident abortions reported back to Missouri in 2019 went down significantly, while Missouri’s estimate of the true total actually increased – Missouri’s estimate includes totals for both Oklahoma and Illinois in 2019. Consequently, the true impact of Missouri’s pro-life laws is difficult to gauge. Certainly, if Planned Parenthood had been able to operate centers on both sides of the Mississippi River at full capacity, total Missouri resident abortions could have been even higher.
In 2016, CLI surveyed abortion reporting across the country, and Missouri’s reporting tied for 25th best. To improve its reporting, Missouri could provide more context to its data by reporting the percentage of abortions performed in Missouri on nonresident women, as well as the states to which Missouri residents travel for abortions. Additionally, Missouri could report pregnancy history, level of education, and marital status for all women undergoing abortions in the state, as many other states do.
- Statistics on abortion complications reported here represent a minimal number of deaths and complications, and the state acknowledges that this data may be incomplete.
- Total abortions occurring in Missouri. 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.
- 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.