JEFFERSON CITY, Mo. — The number of pill abortions in Missouri decreased last year after the state began requiring pelvic exams on patients prior to the procedure, according to statistics from the Department of Health and Senior Services.

According to the state, Missouri doctors performed 359 pill abortions in 2018, down from at least 982 pill abortions the year before.

The 2017 figures available do not include all pill abortions, also known as medication abortions, that took place in November and December of that year, said Lisa Cox, spokeswoman for the DHSS.

Dr. Randall Williams, director of the DHSS and a licensed obstetrician, said at least part of the reduction was due to fewer women choosing to have pill abortions in Missouri after the state began enforcing a pelvic exam requirement early last year.

“Certainly, there’s that factor,” Williams said. “After about March or April … the medication abortions went to Illinois.”

The St. Louis Post-Dispatch reported in December that women were traveling to Illinois to undergo medication abortions after Missouri began enforcing the pelvic exam rule.

Pelvic exams are conducted on a woman’s internal and external genital area. Patients can find them uncomfortable.

The American College of Obstetricians and Gynecologists, or ACOG, says the decision to undergo a pelvic exam prior to a pill abortion should be made between a physician and patient – putting the group at odds with the state, which requires the exams even if both the doctor and the patient think it is unnecessary.

“Any decision to perform a pelvic exam should include a discussion of the potential benefits and risks, and emphasize shared decision making between a patient and provider – patient understanding and consent to the procedure are paramount,” a statement from ACOG, drawn from its pelvic exam guidance, said.

“We think that our job is to ensure the safety of women undergoing these procedures,” Williams said in December. “We think part of that is doing a pelvic exam prior to the procedure, whether it be medical or surgical — as good, standard medical practice.”

State regulations have long required pelvic exams prior to abortions, but Dr. David Eisenberg, medical director at Planned Parenthood in the Central West End, said the rules had not been updated in the last several years to reflect the growth of abortions by medication, which are nonsurgical and are completed at home.

The DHSS and Republican lawmakers argue generally that the state’s requirements – ranging from requiring doctors to have admitting privileges at hospitals to a suite of new rules approved in 2017 – are designed to protect the health and safety of women.

Abortion rights advocates describe such rules as not-so-veiled attempts at making abortion unfeasible through regulation.

Now, encouraged by a solid conservative majority on the U.S. Supreme Court, Missouri lawmakers on Friday passed, and the governor signed, one of the nation’s toughest abortion laws in an attempt to overturn Roe v. Wade, the landmark case that legalized abortion nationwide.

If abortions were to stop at the state’s only abortion clinic in St. Louis, even more women could be traveling to Illinois to receive an abortion.

Illinois performed 5,528 abortions on out-of-state patients in 2017, up from 4,543 in 2016, according to the Illinois Department of Public Health.

The state does not provide a state-by-state breakdown of patients, and 2018 data was not available. Nor were numbers on medicated versus surgical abortions.

According to Missouri statistics, in 2017 there were 3,903 abortions completed in Missouri, at least 982 of which were medication abortions, or roughly a quarter of all abortions.

Last year, there were 2,911 abortions completed in Missouri, and 359 of those were medication abortions, or 12.3% of all abortions, according to the state.