Abortion was difficult to obtain in Missouri for years before the U.S. Supreme Court overturned Roe v. Wade.
Lawmakers enacted regulations that put hurdles on abortion care: Clinic doctors had to get admitting permission from nearby hospitals, patients had to listen to state-mandated counseling that discouraged abortions, and they had to wait 72 hours to get an abortion. Just 150 abortions were performed in the state in 2021, according to the Missouri Independent.
Missouri became the first state to make abortion illegal following the Supreme Court's decision in Dobbs v. Jackson Women's Health Organization in June 2022. The ban included an exception for medical emergencies, but doctors say it was unclear, poorly defined, and put patients' health at risk. The law carries prison sentences of five to 15 years for doctors and the suspension of their medical licenses.
A political action committee called Missourians for Constitutional Freedom formed last year to restore abortion rights. The group, along with Attorney General Andrew Bailey and Secretary of State Jay Ashcroft, both Republicans who oppose abortion rights, spent much of last year fighting in court over the ballot's title and financial summary.
Ashcroft's office has not yet confirmed whether the group's bill will appear on the ballot this fall. If it does, voters would decide whether to enshrine the right to abortion up until the fetus is viable, or later in pregnancy if a health care provider, in their “good faith judgment,” believes it is necessary to protect the patient's health or life.
Missouri doctors are joining the campaign to expand access to abortions and reduce government interference in their work. Dr. Iman Alsaden, chief medical officer for Planned Parenthood of the Great Plains, spoke at petition drives across the state, explaining how the ban has negatively impacted prenatal care. Dr. Alsaden has a history of providing abortions in restrictive areas and was working in Oklahoma when Texas passed its six-week ban in September 2021. However, due to the ban, she is not providing abortions in Missouri.
Alsaden is Iranian-American and comes from a medical family — his father is a doctor and his mother is a nurse — and was always there to help friends in need. He said he was initially hesitant to follow in his parents' footsteps because of the pain they felt treating sick patients.
In a conversation with States Newsroom in June, Dr. Alsaden spoke about why she practices obstetrics, how her identity influences her work, and how anti-abortion rhetoric impacts doctors and patients.
The following interview has been edited and condensed.
States Newsroom: What inspired you to become an obstetrician-gynecologist, specifically one who provides abortion care?
Iman Al-Saden: As an obstetrician-gynecologist, you will always be serving an underserved population. Reproductive people are treated very poorly in this country, and that is evident in the maternal mortality rate.
I believe in bodily autonomy and fundamental human rights. It's been great for me to blend that with my career in medicine and be kind of a physician activist. I'm queer. Growing up, I was always told, “You're in the wrong bathroom. You're dressed wrong. You're not girly. You can't do this or that.” But there was no voice to say, “Maybe it's because I'm not a girl, maybe it's because I don't like boys,” or anything like that, and I was silenced. But I always knew I was doing the right thing, and it was my body, my rights, my life, and I didn't understand why so many people cared about what I was doing with my life.
If I could make life a little more fair every day throughout my career, and give people the power to exercise their basic human rights, to take control of their lives, and to live the life they envision, then that was a very powerful idea to me.
SN: Many physicians in your position avoid the media and public political discourse, especially since the Dobbs decision. Why did you decide to support Missouri Constitutional Freedoms and its efforts to restore abortion rights up to fetal viability and allow abortions later in pregnancy for the patient's life and health?
IA: I recognize that “viability” legislation has its problems. But I think restoring abortion access to thousands of people who haven't had access to abortion for nearly a decade would be truly meaningful. And it would also mean that people would be able to get the care they need in the communities where they live. To me, that alone is enough to support this initiative. I believe people should be able to live the lives they want, and part of that is having the ability to control their lives and their bodies. Supporting this measure will hopefully restore that right and access to many who have struggled.
Rep. Cori Bush, Democrat of Missouri, speaks to reporters during a protest by lawmakers supporting abortion rights in Washington, D.C., on July 19, 2022. (Jennifer Shutt/States Newsroom)
SN: Currently, abortions are only permitted in Missouri in cases of medical emergency. Are you able to provide care in the state under that exception?
IA: No. I do not perform any abortions in Missouri and medical emergencies occur in hospitals. Currently, I do not practice medicine in any hospital in Missouri. These medical emergency laws are written in contradiction. It is certainly a huge obstacle to patient care because people are leaving septic pregnancies longer than necessary. I have heard people hesitate to treat ectopic pregnancies. The laws are interfering too much with medicine and creating dangerous situations for patients. It is really dangerous. The politicians should be ashamed of themselves.
SN: Missouri abortion opponents, including the secretary of state and attorney general, have opposed the petition and there were counter-attacks before the group turned in nearly 400,000 signatures in May. How has the anti-abortion movement's rhetoric perpetuated misconceptions about your work?
IA: There are too many to list. Let me start with the fact that when I walk into work, I'm called a killer. It's really dangerous to tie doctors' hands and prevent them from doing the right thing for their patients. When you're a doctor, your responsibility is to the patient, and the fact that the government is interfering with fair and proper medical practice is disgraceful. Doctors shouldn't be afraid to practice medicine. That fear that's been instilled in people is worsening patient outcomes. We're in a sad situation. We're in a public health crisis.
SN: How does the intensity of the political debate affect patients seeking reproductive health care?
IA: The impact on patients is unquantifiable. It's enormous. Anti-abortion laws impact people of lower socio-economic status, people of color, people who live in rural communities. The amount of resources it takes for someone to get in a car and drive 10 hours… You need a car. You need gas. You need a driver's license. You need to find someone to take care of the family that you were caring for, because we know that most people who get abortions are already parents. When you start making a long list of what it takes to get an abortion, it becomes a very huge list that very few people can actually do. I'm grateful that we have abortion funding. But at the same time, we must never lose sight of the fact that this care should be available where people live. People should not have to struggle to get basic medical care.
SN: How does your identity influence your work, especially when treating marginalized patients?
IA: Treating people with respect and care is easy for me because I'm part of a marginalized community, not economically, but socially and racially. It's really important to keep your identity in mind when you're a physician. We don't want to be complete robot physicians. But we also have to be careful of things like implicit bias. I try to say the same thing to all my patients, because I know that everyone has implicit biases. And one of the ways to reduce that is to treat people with the same level of respect and care, regardless of who they are and where they come from.
