The Associated Press

JEFFERSON CITY, Mo. — Missouri has a long-established reputation as one of the nation’s foremost anti-abortion states.

As evidence: the abortion rights group NARAL Pro-Choice America gives Missouri an “F.” The anti-abortion group Americans United for Life had ranked Missouri the seventh-best nationally, until last year’s voter approval of a stem cell research amendment dropped the state in the group’s rankings.

So it’s probably not surprising that Missouri’s abortion laws have frequently reached the U.S. Supreme Court — sometimes being upheld, other times overturned.

Now Missouri could be poised to again test judicial precedent with its abortion laws.

A measure set to take effect Aug. 28 will require any medical clinic performing more than five first-trimester abortions a month, or any abortions later in pregnancy, to be licensed as an “ambulatory surgical center.”

That means abortion clinics will be subject to a wide-range of state health department regulations governing their personnel, equipment, cleanliness and the physical characteristics of their facilities. Missouri’s existing regulations for outpatient surgery centers even set such things as minimum hallway widths and parking lot spaces.

Planned Parenthood of Kansas and Mid-Missouri claims it could cost up to $2 million to renovate its Columbia clinic to comply with the new law. The alternative is to stop offering abortions there, leaving a St. Louis clinic as Planned Parenthood’s only site for surgical abortions in the state.

Supporters of the new law say it is intended to ensure the health and safety of women, an assertion disputed by opponents.

This is not the first time Missouri has tried to restrict where abortions can be performed.

On June 15, 1983, the U.S. Supreme Court struck down a Missouri law that required abortions after 12 weeks of pregnancy to be performed in hospitals.

The court said the Missouri law — like a similar Akron, Ohio, ordinance it struck down the same day — unreasonably infringed on a woman’s constitutional right to abortion. In the Ohio case, which served as the lead opinion, the Supreme Court said the hospital abortion requirement burdened women financially, potentially costing them twice as much money as would an outpatient clinic.

But the Supreme Court left the door open for further regulation. On that same day, it upheld a Virginia law that required second-trimester abortions to be performed either at traditional hospitals or outpatient hospitals, the description of which generally matches that of an ambulatory surgical center.

After the Supreme Court loss, Missouri lawmakers in 1986 tried again to limit where abortions could be performed. That law required any abortion at the 16th week of pregnancy or later to occur in a hospital.