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Current Missouri Law
The following, pro-active bills were approved and are in effect.
Expedited Partner Therapy: Enacted in 2010 (RSMo 191.648), this law allows physicians to treat the partner of a patient diagnosed with Chlamydia or gonorrhea without an existing physician/patient relationship in order to curb the growing rate of STIs.
HPV Education: Enacted in 2010 (RSMo 167.182), this law charges DHSS with developing and distributing information to schools intended for parents and guardians of girls entering 6th grade about HPV and cervical cancer, and about the availability of a vaccine to prevent HPV. The schools may send the information directly to parents/guardians, but not via the student.
The following, pro-active bill was approved and is pre-empted by federal law.
Contraceptive Equity: Enacted in 2001. Health plans that cover prescription drugs must cover all FDA-approved contraceptive drugs and devices on the same basis. The law allows employers with moral, philosophical, or ethical opposition to contraception to ‘opt-out’ of coverage, but requires that employees be offered the opportunity to purchase coverage. This law is not superseded by the Federal Affordable Care Act.
Special Note on Family Planning Services/Funding: Each year, the legislature votes on a budget. In 1993, the state established a family planning program for low-income, uninsured women using general revenue funds. Recent appropriations bills have contained domestic gag rule language to withhold state family planning funding from family planning providers who maintain an affiliation with an abortion clinic that provides abortions with private, non-governmental funds. Planned Parenthood has won every legal attempt to keep it out of the program. In 2003, as the only way to win, the legislature eliminated the program entirely, depriving some 30,000 low-income women access to basic, primary and preventive health services. A lawsuit - Shipley v. PPSLR and PPKM – brought by an individual, was heard before the MO Supreme Court in April, 2006. The suit was an attempt to force the affiliates to pay back funds received and used for the provision of mandated medical services under their state-awarded contracts through the state family planning program in fiscal years 1999-2000 and 2002-2003. The case was finally dismissed in fall 2006. In the 2007 session, a bill was passed to allow women up to 185% FPL to receive family planning services under Medicaid. The waiver application was approved.
The following restrictions to abortion and sex education have been approved by the Missouri General Assembly and are currently enforced as law:
72-hour mandatory delay and two-physician visit requirement: A 24-hour mandatory delay was enacted in 2003 (RSMo 188.039), challenged in court, went into effect 2006. On October 10, 2014 a law tripling that delay to 72 hours went into effect. Requires a woman seeking an abortion to complete the informed consent process with a "qualified professional” at least 72-hours in advance of the procedure and to sign the informed consent form at that time.
Post-Viability Ban: Enacted in 1974 and amended in 1979 and 2011 (RSMo 188.030). No abortion may be performed after viability unless necessary to preserve a woman’s life or health (pregnancy would cause a serious risk of substantial and irreversible physical impairment of a major bodily function of the pregnant woman). A physician may not perform an abortion on a woman carrying a fetus of 20 or more weeks’ gestation without performing a test to determine whether the fetus could survive outside the womb. A second physician must attend a post-viability abortion to provide medical attention to any live born child.
Informed Consent/State Mandated Information: Enacted in1979 and amended in 2003 (RSMo 188.039) and 2010 (RSMo 188.027, 188.039). As with any other medical procedure, women seeking an abortion have always been required to be given information about risks and to sign an informed consent form. Current statute now requires a "qualified professional” to discuss, in person, any ‘indicators and contra-indicators, and risk factors including any ‘psychological, or situational factors’ which could ‘predispose the patient to or increase the risk of experiencing one or more adverse physical, emotional, or other health reactions…in either the short or long term’ and to sign a form 24-hours in advance. In addition, the qualified professional must present the woman with state-developed brochures detailing fetal development at 2-week increments from conception to birth, describing abortion methods, paternity laws, child support, alternatives to abortion, and displaying the statement: "The life of each human being begins at conception. Abortion will terminate the life of a separate, unique, living human being.” The woman must be offered the opportunity, 24 hours in advance, to view an active ultrasound and listen to the fetal heartbeat if audible. Abortion providers must also post a sign stating that "public and private agencies [are] willing to help you carry your child to term and to assist you and your child after your child is born […]”
Minors’ Restriction: Enacted in 1979 and amended 1986 (RSMo188.028). An unemancipated female under the age of 18 may not obtain an abortion without the informed, written consent of one parent or guardian, or a waiver of that requirement by a court. The law contains no exception for a minor’s life or health.Insurance Restriction: Enacted in 1983 and restated in 2008 (RSMo 376.805). Health insurance policies must exclude coverage of abortions unless necessary to save the woman’s life. Coverage may only be obtained through an optional rider at additional cost. Insurers may limit to whom the rider is offered. It is unclear if these riders exist. The statute was modified in 2010 to extend the same prohibition (without rider) in the new Health Insurance Exchange established in the federal Affordable Care Act.
Ban on Public Funds, Employees, and Facilities: Enacted in 1986 (RSMo 188.215—ban on public facilities; RSM0 188.210—ban on public employees; and, RSMo 188.205—ban on public funds). A woman eligible for state medical assistance may not obtain public funds for an abortion unless it’s necessary to preserve her life. No public employee, within the scope of her/his employment, may participate in the performance of an abortion not necessary to save the woman’s life. No publicly-funded facility may be used to assist, counsel, or perform an abortion unless it is to preserve a woman’s life, even if the woman were to pay for the procedure with her own money.
Physician-Only Requirement: Enacted in 1974 and amended in 2005 (RSMo 188.080). Only a physician, licensed by the state to practice medicine in the state and having clinical privileges at a hospital which offers obstetrical or gynecological care, may perform an abortion.
Conscience-Based Exemption: Enacted in 1973 (RSMo197.032). No physician, nurse, midwife or hospital may be required to admit or treat a woman for the purpose of an abortion if admission or treatment is contrary to moral, ethical or religious beliefs or established policy.
Medical Emergency exception: Originally defined in 1974 (HB 1211). Reaffirmed most recently in 2007 in HB 1055 and again in 188.015. The definition of "medical emergency” as it relates to abortion restriction exceptions is ‘substantial and irreversible impairment of a major bodily function’ or ‘to avert death.’
Teen Health Endangerment: Enacted in 2005; Court limited reach in 2007 (Planned Parenthood of KS v. Nixon, 220 SW 3d 732); presently stated in RSMo 188.250). This law creates civil liability for trusted adults – including clergy, family members, teachers, mentors or health care providers – who "cause, aid or assist” a young woman who – for good reason – cannot involve a parent in her decision to have an abortion. While upholding the framework of the law, in May 2007, the Court dramatically limited its reach, ruling that medical professionals, such as Planned Parenthood and clergy, may provide minors with full information about their reproductive health options. The Court had to narrow the statute’s scope in order to uphold the law, and suggested that any future attempts by the legislature to restrict speech would be found unconstitutional. The court, however, upheld restrictions that will continue to create risks for teens.
Alternatives to Abortion: The Alternatives to Abortion program has been administered by the state Department of Health and Senior Services, and funded through annual appropriations, for many years. In 2007, the program (RSMo 188.325) and an ‘awareness program’ (RSMo 188.335) were codified in statute. The ‘alternatives to abortion’ program explicitly prohibits family planning services and codifies funding for crisis pregnancy centers that are not required to provide full or medically and factually accurate information regarding pregnancy options.
Sex Mis-Education: Passed in 1999, the law stated if schools opted to teach sex education, the curriculum must be medically and factually accurate, abstinence based and include information about contraception. In 2007 the law was amended to allow public school districts opting to teach sex education to choose curriculum that is medically and factually accurate, age-appropriate (presenting abstinence as preferred) that include contraception and disease prevention information, OR they may follow the federal abstinence-only guidelines that require contraception information focus only on failure rates. The law also seeks to prevent school districts from having staff or materials from organizations that "refer for abortions”; which would include most family planning clinics and ob/gyn practices. In 2015, the law was amended to require materials relating to sexual education include information regarding sexual predators, online predators, and the consequences of inappropriate text messaging.
Missouri Abortion Procedure Ban: Passed in 1999, the law was challenged in court and did not go into effect until May 2007. This legislation creates the crime of ‘infanticide’ and could criminalize a physician for performing abortions necessary to protect the woman's health with up to 10 years in prison.
Targeted Regulation of Abortion Providers (TRAP): Any provider that performs 5 or more first trimester abortions – surgical or medication – must be licensed under the ambulatory surgical center (ASC) regulations. The bill was passed in 2007 (RSMo 197.200), but challenged in federal court by PPKM; a preliminary injunction was issued barring the state from enforcing the law. Subsequently, PPKM filed suit in Missouri state courtchallenging the application of surgical regulations to facilities that don’t provide surgical abortion, but that do prescribe the medication abortion (commonly known as RU 486 or the abortion pill). A settlement was negotiated in June 2010 requiring PPKM to make modifications to one facility and allowing both it and another facility to be licensed as abortion facilities under the ASC regulations. Because of the injunction, PPKM was able to continue providing abortion services throughout this process.
Fetal Anesthesia: Passed in 2010 (RSMo 188.027), and defying medical science, abortion providers must inform a woman seeking an abortion at 22 weeks or greater that the fetus may feel pain and that she may receive fetal anesthesia prior to the abortion.
Abortion Reporting: Passed in 2011, Missouri now requires providers to report any abortions performed at 20 weeks or greater to the Board of Healing Arts; a total of 63 such abortions were performed in 2009. The law eliminates certain health exceptions that protected women facing serious pregnancy-related complications; changes the factors physicians must consider before performing a post-viability abortion; and creates criminal penalties for physicians not following the new regulations. Previously, the law already required physicians to test for viability after 20 weeks and banned abortion after viability unless the physician determined the woman’s life or health to be in danger.
Restrictions on Non-Surgical Abortion via Telemedicine: Passed in 2013, Missouri now prohibits non-surgical abortions (sometimes referred to as RU486 or the abortion pill) via telemedicine. The law now requires the initial dose of the drug to be administered in the same room and in the physical presence of the prescribing physician. Furthermore, all reasonable efforts shall be made to ensure the patient returns for a follow-up visit.
Legislation currently enjoined:
Contraceptive Coverage: Passed in 2012, vetoed by Governor Nixon, and overturned by the MO Legislature (RSMo 191.724) allows employers to deny contraceptive coverage in their employee’s health insurance plans. This law is currently enjoined and not in effect as it is in direct contradiction to the Federal Affordable Care Act.