This story was originally published by The Kansas City Beacon.

Patients who arrive at an abortion clinic in Overland Park, Kansas, have often traveled long distances. Many began their journeys in Missouri, sometimes driving hours to their appointment.

“We’ve heard these stories from Missourians and other people in our region for years,” said Emily Wales, interim president of Planned Parenthood Great Plains. “They ask about how long they have to be there. ‘Can I make it back to pick up my kids tonight?’”

Many patients have to book hotel rooms to spend the night before traveling home.

Data shows that patients are coming in increasing numbers to Kansas from states including Missouri, Texas and Oklahoma for abortions as their home states restrict access.

But in August 2022, voters could change that with a constitutional amendment. If approved, it would add language to the Kansas Constitution to explicitly state there is no right to abortion and that the state legislature can regulate it.

Across the state line, recorded abortion procedures in Missouri have been decreasing for more than a decade. In 2020, 167 abortions were performed in the state, according to data from the Missouri Department of Health and Senior Services. That’s a decrease of 97% over the past 10 years.

Nationally, the number of abortions has steadily decreased for many years, but at rates much lower than the decrease in Missouri.

According to data from Kansas, 3,201 Missouri residents received abortions there in 2020.

Based on those numbers, fewer than 5% of abortions received by Missouri residents happened in the state. But the percentage is likely lower, as the Health Department has not finished gathering data on the number of abortions performed in other states for Missouri residents. Some Missouri patients travel to Illinois, which has fewer restrictions on abortions and where Planned Parenthood constructed a clinic in large part to meet demand from Missourians.

In Kansas, Missourians account for nearly half of all abortions performed since 2007. In some years, more Missourians received abortions in Kansas than Kansans.

The reason has to do with legislation in the two states. The Missouri General Assembly has passed a series of laws in recent years placing burdens on abortion providers and patients. Only one clinic, in St. Louis, currently performs abortions in Missouri — and its caseloads have sharply declined.

Although Kansas places some restrictions on abortion patients and providers, the fundamental right to abortion is currently protected by a 2019 state Supreme Court ruling where the court found the Kansas Constitution protects abortion, even in the absence of the federal Roe v. Wade.

Out of state

More patients sought abortion in Kansas in 2020 than in any year since 2011, after the greatest year-over-year increase in procedures since at least 2007. Out-of-state patients account for 84% of the increase. Providers attribute the jump to restrictive new laws in other states — particularly Texas and Oklahoma.

But even with more patients traveling from those states, Missouri still provides the largest out-of-state caseload at Kansas abortion clinics. For the past 13 years, 46% of abortions in Kansas were for patients who live in Missouri. In 2011 and 2012, more Missourians than Kansans received abortions in Kansas clinics.

“The Senate Bill 8 law passed in Texas this year has really led to a regional crisis,” Wales said, referring to the Texas law that essentially bans all abortions roughly a month after conception.

“People think, for the most part, that this is the first time people are traveling hundreds of miles and hours away to get care. But we’ve been living with that reality, especially in Missouri, for years now.”

Columbia and Kansas City clinics

When Wales started work at Planned Parenthood of the Great Plains in 2017, three clinics in Missouri provided abortions — in St. Louis, Columbia and Kansas City. Today, only the St. Louis clinic offers the service.

The Columbia clinic stopped performing abortions in 2015, when lawmakers passed a requirement for “local admitting privileges.” Essentially, if a procedure were to go wrong, the doctor who performed the abortion needed to be able to admit that patient to a local hospital. In Columbia, local hospitals would not grant admitting privileges.

Planned Parenthood’s Kansas City clinic stopped providing surgical abortions in 2016 because of building requirements about the width of doors and the spacing of smoke detectors and fire alarms. The Kansas City clinic could not comply, so after those restrictions went into effect, it provided only medication abortions.

But in Missouri, any patient receiving an abortion — including medication abortions — must see the same doctor twice within 72 hours to have that doctor read state-provided information about pregnancy and abortion. It was difficult for doctors — many of whom lived outside Kansas City — to be present for both appointments, Wales said, so the Kansas City clinic stopped providing abortion care altogether in 2018.

Wales said the 72-hour requirement is one of the biggest barriers to receiving an abortion in Missouri.

Kansas abortion amendment 

Though Kansas currently places some restrictions on abortion, including a 24-hour waiting period and the reading of certain state-mandated information before the procedure, more stringent restrictions are limited by the state’s constitution.

A 2019 state Supreme Court ruling says that the Kansas Constitution protects the right of women to “decide whether to continue a pregnancy.”

The ruling called into question more than a dozen abortion restrictions already passed by the Kansas Legislature.

But a ballot measure in August 2022 will challenge the 2019 ruling. Voters will decide whether to add a clause to the constitution stating explicitly that abortion is not a constitutional right in Kansas.

According to Danielle Underwood, communications director for Kansans for Life, which opposes abortions, regulations currently “presumed unconstitutional” include a ban at 22 weeks of gestation, as well as a requirement for consent from both parents for abortions performed on minors. In cases of incest, the mother of the minor would still have to consent.

Underwood said that under the 2019 ruling, abortion in Kansas could be “unlimited” and “unrestricted.” Wales disagreed with that characterization and said abortion providers in Kansas must follow a number of regulations.

Disproportionate impact 

Zach Gingrich-Gaylord, interim director of communications for Trust Women, an abortion provider with clinics in Wichita, Kansas, and Oklahoma City, said Kansas currently regulates abortion, but these regulations have to be for the medical benefit of patients, as opposed to regulation for moral reasons. In practice, however, many of the regulations are arbitrary, he said.

“It’s not the case that this practice of health care is wildly unregulated,” Gingrich-Gaylord said.  “In fact, it’s rife with arbitrary regulations and constraints that have no benefit medically to it.”

He gave the example of the state-provided materials that must be read to patients, which he said include medically inaccurate information connecting abortion to breast cancer. If Kansas voters pass the amendment next August, Gingrich-Gaylord said, Kansas legislators could go the way of Missouri and Texas and also severely limit abortion.

Many potential restrictions — for example, a longer waiting period — would have a disproportionate impact on out-of-state patients traveling to Kansas, he said.

‘Abortion tourists’ or ‘medical refugees’?

Underwood, with Kansans for Life, said a situation where patients travel to Kansas for abortion care is not in the best interests of Kansans.

“We don’t want to see Kansas become a destination state for abortion,” she said. “We don’t want to be a tourist attraction that they would be marketing to women from all these surrounding states and trying to bring them across our border to perform abortions here.”

But abortion providers reject the description of these trips as “tourism.” Wales describes them as refuge from draconian restrictions elsewhere.

“It makes (these patients) functionally medical refugees … the idea that you have to be on the run from your own state restrictions is pretty horrifying,” she said. “Especially the patients we’re seeing from Texas, I think that’s how they feel.”

Many patients from other states arrive in Kansas fearful of legal trouble for seeking an abortion out of state, Wales said. She mentioned one patient who was pulled over by a police officer on the drive from Texas to Kansas. The woman was terrified that the officer would forbid her to cross the state line, Wales said. In reality, Texas patients cannot be prosecuted for seeking an abortion outside Texas.

For the time being, Missouri has not restricted residents’ access to abortion in other states. One proposed bill, SB 603, would have claimed legal jurisdiction for any pregnancy that was conceived within state lines or in which the parents were Missouri residents at the time of conception. This bill was introduced in the last legislative session, but it never went to a vote.

Meanwhile, faced with increasing numbers of out-of-state patients, Planned Parenthood clinics in Kansas are trying to schedule as many appointments as they can, but the need outweighs their capacity. Wait times for an abortion can be up to four weeks, which can be too late if patients don’t know they are pregnant until the second trimester.