As COVID-19 took hold last spring, Republican governors in Oklahoma, Texas and Arkansas ordered limits on abortion in their states, citing the health crisis. Kansas Gov. Laura Kelly, a Democrat, did not.
The restrictions, and Kelly’s decision not to issue her own, made Kansas a regional spot for women seeking to end their pregnancies. The state experienced its largest increase in abortions in 15 years, interrupting a gradual decline over the past two decades.
The number of abortions rose to 7,542 last year from from 6,916 in 2019, according to statistics released by the Kansas Department of Health and Environment. And for the first time since 1973, the year Roe v. Wade guaranteed a federal right to abortion, more non-Kansas residents received abortions in the state than residents.
The number of out-of-state women receiving abortions grew nearly 16% while Kansas residents posted only a 3% increase.
Even as the pandemic recedes, the numbers offer a glimpse into Kansas’ possible future as an abortion rights stronghold in the Great Plains if Roe is struck down or severely curtailed. That could happen next spring or early summer if the U.S. Supreme Court, in a highly-anticipated decision, upholds a Mississippi ban on most abortions after 15 weeks of pregnancy.
Abortion would remain legal in Kansas because the state Supreme Court ruled in 2019 that the state constitution includes a strong right to end a pregnancy, separate from any federal protections. Regulations must withstand a strict level of scrutiny under the decision, meaning the state must have a compelling interest in them and they must be crafted in the least restrictive way possible.
Women from states with fewer protections for abortion rights — including, in some cases, near-total bans on the procedure — would likely travel in greater numbers to Kansas and other states with more robust access. Kansas’s 2020 abortion figures would become closer to the norm.
But that potential future is at the center of a fight over a proposed amendment to the Kansas Constitution removing the right to an abortion. Called “Value Them Both” — referring to mothers and children — by supporters, the amendment is set for a statewide vote in August 2022.
The success or failure of the measure could go far in determining the future of abortion rights in Kansas — and abortion access regionally.
“I could potentially see this as becoming a stronghold for personal privacy and medical care,” said Rep. Stephanie Clayton, an Overland Park Democrat.
“A lot of times we see people traveling from Third World countries to come to the United States for our medical care,” Clayton said. “Now this is an issue of people traveling from Third World states to come to Kansas for our medical care.”
Rep. Susan Humphries, a Wichita Republican who helped advance the amendment through the Legislature in January, said the pandemic-related rise in abortions in Kansas is an example of why the state needs to make sure it doesn’t become a destination for abortion. Without the amendment, the increase represents a “little bit of what’s to come.”
“What’s going on across the country we are seeing some tighter regulations for abortion, not just the Mississippi one but in other states,” Humphries said. “And yet Kansas, because of the Supreme Court decision, we’re going in the other direction. And that’s a concern.”
Texas, Oklahoma, Arkansas drive increase
Missouri women have long comprised the biggest share of non-Kansans traveling to the state for abortions — 82% in 2020.
But the numbers from Texas, Oklahoma and Arkansas have increased dramatically.
In 2020, 289 Texas residents, 277 from Oklahoma and 74 from Arkansas traveled to Kansas for abortions. In 2019, it was 25, 85 and 40, respectively.
All three states have governors who issued executive orders limiting abortion during the pandemic. Governors in at least 23 states imposed restrictions during the pandemic, according to the Guttmacher Institute, an organization supportive of abortion rights.
In turn, Kansas and other states, including Colorado, saw increases in out-of-state residents seeking abortions.
The data show that women will go to “great lengths” for access to abortion, even in the midst of a public health crisis, said Rachel Sweet, director of public policy for Kansas and Missouri at Planned Parenthood Great Plains, which operates an Overland Park clinic that offers abortion. Abortion is “time-sensitive, essential health care,” she said.
“I felt like it was a peek through that post-Roe or diminished Roe world and it was quite frightening, frankly,” said Julie Burkhart, founder and CEO of Trust Women, which operates clinics in Wichita and Oklahoma City.
The executive orders, Burkhart said, were “almost like watching a carpet rolling up.”
While Missouri Gov. Mike Parson didn’t order any pandemic-related abortion restrictions, the future of access to the procedure in the state is uncertain. A 2019 law signed by Parson is a near-total prohibition, banning abortion after eight weeks of gestation.
A federal court blocked the ban from going into effect after abortion rights advocates filed suit. But both supporters and opponents are preparing for the possibility the law could be validated if the U.S. Supreme Court upholds Mississippi’s ban.
The Missouri law includes triggers that ban abortion at 14, 18 and 20 weeks of pregnancy if the eight-week threshold is found unconstitutional. And it prohibits abortions for the reason of a fetus’ race, sex or diagnosis of conditions like fatal disorders or Down syndrome. There is no exception for victims of rape or incest.
When Parson signed the bill, he said “we are sending a strong signal to the nation that, in Missouri, we stand for life, protect women’s health, and advocate for the unborn.”
A Supreme Court decision in favor of Mississippi’s abortion law would likely allow a federal judge to uphold Missouri’s. For the state’s sole abortion provider, a Planned Parenthood clinic in St. Louis that sued over the law, hopes of abortion access in a post-Roe v. Wade future have so far rested in Illinois. There, Gov. JB Pritzer in 2019 signed a state law enshrining abortion as a “fundamental right” for women.
The number of Missouri women getting abortions in Illinois increased by more than 1,000 between 2018 and 2019, to nearly 4,500, according to a state health department spokeswoman. Data for 2020 was not yet available.
Clinics near St. Louis have seen a big difference.
Fifty surgical abortions were performed at the St. Louis clinic in 2020, down from the roughly 1,400 in Missouri the year before. Instead, 1,700 women sought abortions at a clinic that Reproductive Health Services of Planned Parenthood of the St. Louis Region opened across the river in 2019. The affiliate now sees 99% of its Missouri abortion patients in Illinois.
At a nearby clinic in Granite City, Illinois, which is about 10 minutes from downtown St. Louis, more than half the abortion patients are from Missouri. The clinic, an independent provider called the Hope Clinic, has opened new operating rooms, added a front desk and doubled the number of physicians in recent years to prepare for the Supreme Court decision.
“We’ll be taking care of the Midwest and the upper South as the one that kind of reaches all those states,” said deputy director Alison Dreith.
Kansas ‘very important’ for abortion access
The Missouri ban, as well as restrictions in other states, underscores the role Kansas could play in providing access to abortion in the future, but only if the state constitutional amendment is defeated. If Kansas voters approve the measure, state legislators will gain more leeway to regulate abortion providers.
Kansas’ leading anti-abortion group, Kansans for Life, said the 2020 statistics showed that passage of the amendment is “more important than ever.”
“626 more babies tragically lost than in the previous year, not to mention the violence inflicted on the mothers, comes when all of our pro-life laws are in danger of being removed,” said Jeanne Gawdun, KFL’s director of government affairs, said. “This report shows exactly why there must be reasonable regulations on the abortion industry.”
Abortion opponents fear the 2019 Kansas Supreme Court decision puts at risk requirements that parents be informed of a child’s abortion and bans on taxpayer-funded abortions. They argue the amendment will protect those laws.
Amendment opponents note that while the court opinion means abortion regulations must meet a “strict scrutiny” standard — a high threshold — it doesn’t mean all regulations are unconstitutional. They say the amendment would clear the way for additional, tougher restrictions.
More than a year away, the amendment vote is likely to lead to expensive campaigns but the outcome is uncertain. A 2014 Pew Research Survey showed the state evenly split on abortion with 49% believing the procedure should be legal in most or all cases and 49% who would like to see it illegal in most or all cases. The organization hasn’t surveyed the state since.
It’s also unclear how a U.S. Supreme Court opinion on the Mississippi ban — which could come in June 2022, just two months before the August vote — would affect support for the measure.
But the choice voters make will likely hold significant consequences for abortion access for not only Kansas but surrounding states.
“Kansas is a very important state when it comes to abortion access in the region,” said Elizabeth Nash, principal policy associate for state issues at the Guttmacher Institute.