ST. LOUIS — The divide between red and blue states on abortion policies — in particular the contrast between Missouri and Illinois — played out on the national stage Tuesday morning as the Senate Judiciary Committee debated emerging reproductive health issues in a post-Roe America.
Top Missouri and Illinois lawmakers and doctors from the St. Louis region questioned experts and testified during the panel discussion that lasted nearly three hours.
"Women's health, in some cases their lives, are at risk," committee chairman Dick Durbin (D-Illinois) said in his opening remarks.
Dr. Colleen McNicholas, the Chief Medical Officer from Planned Parenthood in St. Louis, took the witness stand and said traffic from out-of-state patients has tripled at clinics like the facility in Fairview Heights.
"Almost overnight, our Illinois clinic has seen appointments triple," she said.
Illinois' Lieutenant Governor Juliana Stratton described Illinois as an "island" in the Midwest, and told the committee that, "the number of out-of-state patients has doubled since Roe v. Wade was overturned."
Senators Mike Lee (R-Utah) and John Cornyn (R-Texas) cited statistics that showed racial disparities in the total number of abortion procedures.
"Black babies are at greater risk of being aborted than white babies," Senator Lee said.
Expert witnesses responded that systemic racism embedded in the country's health care and economic systems drive maternal mortality rates higher and push women in poverty farther away from being able to care for children.
Senator Cornyn pressed University of California-Berkeley law professor Dr. Khiara Bridges on her claims of systemic racism, and asked her, "Do you see any 'systemic racism' associated with the prevalence of abortion for Black babies as opposed to non-Black babies?"
"The higher rates of unintended pregnancy that lead to higher abortion rates among Black people is a result of structural racism, systemic racism," Dr. Bridges replied.
"I understand systemic racism not to be bogeymen who are trying to dupe Black people into abortion care," she said. "I understand structural racism to be the systems that have made it so that Black people disproportionately bear the burdens of poverty in this country; the systems that have denied them the basics that they need in order to live humane lives, like food, clothing, shelter, health care."
Senator Cory Booker (D-New Jersey) asked Ms. Stratton to respond to the notion raised by Republican members that "allowing women to have access to safe abortion care is somehow racist to African Americans."
Stratton called the GOP characterization "cruel" and "contradictory" as she described ways many red states reduce access to health insurance coverage for people living in poverty and drive maternal and infant mortality rates higher.
"This is not about helping," Stratton said. "This is only going to cause harm and cause immeasurable suffering."
The discussion illustrated the various ways politicians and doctors are still coming to grips with what post-Roe America looks like in each corner of the country.
While Republicans in the U.S. Senate defend the Supreme Court's decision to return that debate to the states, local Democrats accuse Republicans in Missouri of delaying that debate from taking place in Jefferson City while women need urgent medical care.
"Doctors are hesitating," Rep. Peter Merideth (D-St. Louis) said. "They need clarity.
Merideth has supported calls from legislative Democrats to demand Republicans in the majority call a special session to clarify the law.
Under a strict interpretation of Missouri law, prosecutors could press criminal charges against a woman or a doctor who takes or prescribes contraception. Governor Mike Parson has suggested the state's Department of Health and Senior Services will clarify that's not the case.
"I think he's suggesting that by regulation, they'll be able to change the criminal code, which isn't really how criminal statutes work," Merideth explained.
McNicholas said Planned Parenthood called on President Biden to take federal action to through the Department of Health and Human Services to protect women making that trip across state lines from facing criminal prosecution in their home states.
She also highlighted the medical emergencies women can sometimes face in Missouri hospitals where doctors take cues from corporate lawyers on when they can perform an abortion, sometimes waiting until after internal bleeding begins before they begin a procedure.
"OBGYNs are sitting on patients in emergency rooms while they bleed, while their vital signs become unstable, while they're waiting for hospital lawyers to decide, 'Is this patient sick enough,'" McNicholas said.
Republicans defended the Supreme Court's decision, attacked Democrats' views on abortion as radical, and argued abortion policies should be determined by local elections and set in statehouses across the country.
"It gives to voters the decision what the law should be pertaining to life and pertaining to abortion," Senator Josh Hawley (R-Missouri) said.
"These are the same states that are stopping people from voting," Bridges responded.
Cornyn highlighted the human characteristics taking shape later in the pregnancy once the fetus has been determined viable.
"What I don't understand is the argument that an unborn child has zero value the day before it's delivered, but then has value the day after it's born," Cornyn said.
Stratton declined to engage Cornyn's question about fetal viability, and instead said women should be left to make personal decisions for themselves with their doctors.
"It is not a politician's determination," Stratton said. "It should be that individual's decision with their health care professional."
At one point, Hawley and Dr. Bridges sparred over gender politics when the professor referred to "people who can become pregnant."
When Hawley asked if she meant "women," she called his line of questioning "transphobic," and warned denying the existence of pregnant transgender men in this discussion could expose them to violence.
Senator Tom Cotton (R-Arkansas) asked each witness if they denounce acts of violence targeted at crisis pregnancy centers. Every witness who testified before the panel denounced acts of violence targeted at abortion providers and anti-abortion clinics, though two of them described abortion and forced birth as forms of violence themselves.
Missouri's abortion ban gives special power to Attorney General Eric Schmitt to prosecute women who seek abortions or doctors who perform them. Health care providers have suggested Schmitt could put clinicians at ease with issuing an opinion or explanation clarifying when a mother's life is indeed at risk during a medical emergency. Schmitt's office has not responded to questions about which cases he might prosecute.
"Yet again, we're seeing he doesn't do his actual job," Merideth said. "He's focused on campaigning."
The sharp contrast of opinions illustrated the divide between how America's health care and legal systems define and value degrees of harm.
"The way our statutes define harm is they treat a harm to a two-celled fertilized egg as equivalent -- or, frankly, more important -- as taking priority over the health of the mother," Merideth said. "And so for a doctor, they're told they're supposed to treat both of these as equal. Or, frankly, treat the fetus as more important than the mother's life."