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Missouri’s Reproductive Surveillance Practices Are Hidden in Plain Sight

Recently, news broke that the director of the Missouri state health department, Dr. Randall Williams, maintained a spreadsheet of patients’ menstrual cycles as part of an investigation into Planned Parenthood. State governor Mike Parson has declined to investigate the matter, and the state’s sole abortion clinic is at risk of closure – again. While the situation has rightfully drawn the ire of reproductive justice advocates, it doesn’t really come as a surprise. Not because I have grown so used to the abuse of authority in the United States and lack of regard for patients’ autonomy and privacy, but because I have actually read something like it before.

In July, I looked into the healthcare systems of five states, including Missouri, to see how they approached reproductive health. There were some bright spots, and there were also several glaring issues. I briefly touched on the restrictions placed on abortion facilities but did not go into detail. In hindsight, I should have.

In Mississippi, a condition of licensure for an abortion facility is to allow the state health department unfettered access to patients’ medical records. It’s dubious practice, but it’s also legal. Right there in the fine print. Upon learning about the situation in Missouri, I revisited their standards for abortion facilities and found that as of April 2018, all facilities must produce individual reports for each abortion performed and submit them to the state health department within 45 days. (In my last article on this subject, I speculated on how and why the state had information on “repeat” abortions – now we know.) In contrast, other states may request that infectious disease or complications are reported in a timely manner, but not individual procedures. (Notably, Missouri began investigating Planned Parenthood because they allegedly did not file a complication report.) State departments still maintain the right to access patient records as they wish, but in writing, it would appear that those records are only accessed in case of inspection and not examined regularly.

So, while Missouri’s menstrual cycle spreadsheet is terrifying and has horrible implications in the realms of patient privacy and state surveillance, it is not shocking.

There’s a lot to be learned from public records. You can learn about demographics, trends and policies that may not necessarily be discussed on a daily basis. It’s easy to get caught up in the most recent laws being passed, especially with how fast the news cycle moves, but we also need to focus on what’s already there. We may not know why officials decide to compile certain information – like patients’ menstrual cycles – but we can figure out how they do it.

Most regulations on abortion facilities state that medical records must contain a patient’s clinical and identifying information, informed consent and information about the fetus, including gestational age. Missouri is no exception. If abortion providers in Missouri must provide timely reports of each abortion performed, it’s not unreasonable to hypothesize that these reports contain gestational age, which would give insight as to when a patient’s last menstrual period occurred. The department would then be able to draw further conclusions from medical records. Of course, I am not an employee of the Missouri state health department, so I cannot know for sure whether this is true. But this raises the question of how much of government proceedings truly occur behind the scenes, and how much of them can be gleaned from the information right in front of us.

Health surveillance is normal; reporting occurrences of illness, injury and other conditions help us keep track of patterns and reveal whether we should be concerned about something. However, Missouri’s “period spreadsheet” is not normal and should not be treated as such.

Featured image via Pexels on Pixabay

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