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ST. LOUIS — Planned Parenthood provided abortions Thursday at its ÃÛÑ¿´«Ã½ clinic for the first time since Missouri voters approved overturning the state’s near-total ban on the procedure.

The clinic had three abortion appointments scheduled Thursday after weeks of court battles striking down old abortion regulations, retraining staff and moving equipment and staff from a busy sister clinic in Illinois, a state where abortions have remained legal, said Dr. Margaret Baum, interim chief medical officer for ÃÛÑ¿´«Ã½-based Planned Parenthood Great Rivers.

“I am really excited that this is happening, and I am excited this is happening at our Central West End location because I have a very clear memory of over 2½ years ago providing the last abortions in Missouri,� Baum said. “It really in some ways feels full circle that I now get to be providing abortions again at the same location.�

Before the state’s abortion ban went into effect in June 2022, the clinic in ÃÛÑ¿´«Ã½ had for several years been the sole abortion provider in Missouri — the only one able to meet the state’s increasingly onerous abortion regulations.

Decades earlier, in 1984, Missouri recorded more than 20,000 abortions at 26 clinics across the state. By 2020, that had dwindled to 167 as clinic after clinic shuttered, and Great Rivers opened its Fairview Heights clinic just 15 minutes away from ÃÛÑ¿´«Ã½.

“Over time we went from having six days a week of busy abortion services in ÃÛÑ¿´«Ã½, to a few days a week, to towards the end — probably our last year of providing abortion services — there were only two physicians providing abortion services maybe twice a month,â€� Baum said.

The last abortion provided at the clinic was on June 18, 2022, she said. Less than a week later, the U.S. Supreme Court overturned Roe v. Wade, ending the constitutional right to an abortion and returning authority on whether to allow the procedure to individual states.

Immediately after the high court’s ruling, Missouri became the first state to ban abortion except in cases of medical emergencies because of a trigger law the state Legislature already had in place.

That changed in November, when Amendment 3 passed with 51% of the vote, which enshrined into the state constitution the right to an abortion up to fetal viability, when a fetus might survive outside the uterus.

On Thursday, after years of the first floor exam and recovery rooms sitting mostly empty, people sat in the waiting room of the ÃÛÑ¿´«Ã½ clinic, and televisions blared once again with information about birth control and talking to testing for sexually transmitted diseases.

“I’m very excited to see patients on this floor,� said Great Rivers’ President Margot Riphagen, as she shared smiles and thumbs-ups with other clinic staff as they arrived at work.

Riphagen used the moment to praise the 1,800 volunteers who collected more than 380,000 signatures in just three months to get Amendment 3 on the ballot after a series of political hurdles, and who hit the streets campaigning for abortion access.

“Now,� Riphagen said, “we are finally able to do it.�

‘People should have a choice’

One of the patients scheduled for an abortion Thursday agreed to share her story in the waiting room with the Post-Dispatch, under the condition of anonymity.

The 32-year-old woman was coming from a jail two hours away in Rolla, where she said she was being held on drug-trafficking charges. She said she is addicted to fentanyl, which she took to cope with “traumas and pains.�

Before she was arrested, she said, she had an abortion scheduled in Illinois. But the judge would not release her for that appointment.

The woman said her lawyer was able to get permission for her to come to ÃÛÑ¿´«Ã½ for the procedure. Volunteers with Midwest Access Coalition, an abortion fund that helps with traveling logistics and expense, drove her to the clinic and is covering the cost of a hotel stay nearby before the woman must return to the jail.

She is homeless, she said, after a March 14 tornado destroyed her apartment in Rolla. She already has two young children, who are staying with her mom. She is also considered high-risk, since her first pregnancy ended with a stillbirth.

“People should have a choice,� the woman said, “so they are not forced to have a child they can’t take care of.�

After getting examined, the women ended up being further along in gestation than she thought. She had to travel further to the Fairview Heights clinic, which is equipped for the more advanced procedure.

Her experience shows how abortions are still limited in Missouri as providers continue to fight regulations in court, inform the public about access and juggle staffing needs.

For the past few weeks, Planned Parenthood Great Plains has been providing procedural abortions up to 12 weeks as staff is available at its midtown Kansas City and Columbia clinics. Patients must call to make an appointment.

Great Rivers is also only taking appointments over the phone for procedural abortions up to 12 weeks at its ÃÛÑ¿´«Ã½ clinic. Days will depend on demand and staff availability, Baum said.

Obstacles remain

Medication abortion — involving taking two sets of pills up to 48 hours apart — is still unavailable in Missouri. Providers say they are required to first submit “complication plans� to the state health department for approval before they can dispense the medication.

The Planned Parenthood affiliates submitted their complication plans on Feb. 20 and 21. Baum said they were told they would finally learn Friday whether the plans are approved, but they expect denials.

Three weeks after submitting their plans, the Department of Health and Senior Services issued an “ that outlined a lengthy list of new requirements that must be included in complication plans. The rule went into effect Thursday.

On March 12, Missouri Attorney General Andrew Bailey issued a “cease and desist� order against the Planned Parenthood clinics, barring them from providing medication abortions even though they are not yet, arguing that the providers will likely violate regulations in the future. It is unknown how long the order is in place.

“We do anticipate more and more of this to keep getting in the way of medication abortion,� Riphagen said, and Great Rivers’ lawyers are looking at ways to fight the obstacles.

In addition, abortion providers face an uncertain future with anti-abortion state lawmakers filing dozens of bills aiming to restore the abortion ban despite the successful ballot.

Two measures that have emerged in the Capitol would ask voters to revive the near-total ban. The proposals from state Sen. Adam Schnelting, a Republican from St. Charles, and Rep. Melanie Stinnett, R-Springfield, would reinstate the ban with an exception for victims of rape or incest who seek an abortion in the first 12 weeks gestation but who first report the assault to police. Both also ban health care for transgender minors and allow abortions during an ectopic pregnancy.

Stinnett’s proposal could come up on the House floor as soon as next week.

That’s why Riphagen, as she welcomed staff Thursday at the ÃÛÑ¿´«Ã½ clinic, said she felt a range of emotions.

“I’m both excited that we are able to provide care here in Missouri and a little bit anxious and uneasy about what is happening in the Legislature,� she said. “The fight will continue.�

Kurt Erickson of the Post-Dispatch contributed to this report.

Editor’s note: Dr. Margaret Baum’s title was incorrect in an earlier version of this story. The emergency rules on complication plans were issued by the Department of Health and Senior Services, not Attorney General Andrew Bailey.