June 10, 2019

DHSS responds to misinformation in media related to abortion services in Missouri

JEFFERSON CITY, Mo. -- A national media outlet has reported inaccurate information regarding the state of abortion services in Missouri. A pelvic examination has been required by a DHSS rule (19 CSR 30-30.060) since at least 1988 as part of the mandatory health assessment that must be used to detect factors that could influence the choice of the procedure, among other things. 

Since 1988, 19 CSR 30-30.060 has been amended only once, in 2018. As a result of that amendment, language regarding the health assessment was moved to section (2)(D) of the rule and reworded stylistically in part; however, it remained substantively the same. It now reads, "A written medical history shall be obtained for each patient. A health assessment including a pelvic examination shall be performed. Pregnancy shall be confirmed by clinical evidence and laboratory tests. This information shall be used in determining the duration of gestation, identifying preexisting medical or other complications, and detecting any factors which could influence the choice of the procedure, anesthesia, or preoperative and postoperative management."

Since 1979, Missouri has by statute (section 188.027 RSMo) prohibited abortions from being performed without a woman's informed consent. In 2003, the General Assembly enacted a 24-hour requirement in another statute also dealing with informed consent (section 188.039 RSMo). In 2010, the General Assembly amended section 188.027 RSMo to condition informed consent on the provision at least 24 hours prior to the abortion of specific information, including:

  • the proposed abortion method;
  • the immediate and long-term risks to the woman associated with the proposed abortion method, including uterine perforation; and
  • the risks to the woman in light of her medical history and medical condition.

In 2014, the General Assembly increased the informed-consent time from 24 hours to 72 hours prior to the abortion.

If, at the 72-hour mark, the physician-to obtain informed consent under section 188.027 RSMo-must inform the woman of (among other things) the proposed abortion method and the immediate and long-term risks to her, then a pelvic examination-which shall under 19 CSR 30-30.060(2)(D) be used to, among other things, detect factors that could influence the choice of the procedure-must also be done at the 72-hour mark. The information that the pelvic examination must be used to detect (including factors that could influence the choice of the procedure) could have a direct bearing on the information that must be provided at the 72-hour mark (including the proposed abortion method and the risks to the woman based on that method and her history and condition). The information from a pelvic exam could influence the choice of the procedure or the method, which would change the information provided for informed consent. Because the information for informed consent must be provided at least 72 hours before the abortion, a pelvic examination must occur at that time.

Therefore, the requirement to do the pelvic exam 72 hours prior to the procedure and detect factors that could influence the choice of the procedure is state law, not departmental policy, and has been since the aforementioned dates.

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