Abortion-rights supporters march Thursday, May 30, 2019, in St. Louis. A St. Louis judge heard an hour of arguments Thursday on Planned Parenthood's request for a temporary restraining order that would prohibit the state from allowing the license for Missouri's only abortion clinic to lapse at midnight Friday. File photo: AP Photo/Jeff Roberson.

St. Louis - Missouri was set Friday to become the first US state in half a century without abortion services unless a court steps in at the last moment to keep its sole remaining abortion clinic in operation.

Unless the courts rule in its favour in an emergency motion, the St Louis clinic will lose at midnight (0400 GMT) its license to perform the procedure.

Early Friday, it opened as usual. Only one anti-abortion activist could be seen at the entrance offering alternative "resources" for patients.

While all may seem calm from the outside, Planned Parenthood is mobilising to keep the clinic it manages in service.

On Thursday, it gathered more than a thousand protesters in the streets of St Louis and asked for a reprieve from Circuit Judge Michael Stelzer, who was due to issue his ruling later in the day.

In the meantime, the powerful family planning group is denouncing what it calls a "nationwide crisis."

"The state of women's health is an emergency and a nationwide crisis — and we need to respond with everything we've got," it said in a tweet.

Beyond Missouri, several states with conservative majorities are chipping away at abortion rights, even though access has been guaranteed nationwide since a 1973 US Supreme Court decision.

- 'Deficient practices' -

The high court allows states to place some limits on abortion so long as they do not result in an "undue burden" for women.

The term is interpreted very differently from one state to another, and abortion access is generally much more readily available in western and northeastern parts of the country than in the South and the Midwest.

Missouri's Republican Governor Mike Parson recently welcomed a drop in the number of abortions from 20,000 to 3,000 in his state, which is home to six million people.

He has accused Planned Parenthood of "actively and knowingly violating state law on numerous occasions" and refused to renew the clinic's license.

Sanitary authorities say they found "deficient practices" at the clinic during a routine inspection in March and have asked to question all doctors who performed abortions there over the past year.

But some have refused, fearing they would be incriminated without knowing the accusations against them.

- 'Red line' -

The state is "weaponising the licensing and regulating process... They are trying to fine the line that Planned Parenthood won't cross," said M'Evie Mead, director of policy at the local Planned Parenthood chapter.

The Missouri case comes as more than a dozen US states -- including recently Alabama, Georgia, Mississippi and Louisiana -- passed laws restricting abortion as part of a concerted strategy to push the issue before the Supreme Court.

The top US court is now dominated by a conservative majority, including two justice appointed by President Donald Trump. Its landmark Roe v Wade decision allows for conditions to be placed on abortion only after the first trimester of pregnancy.

The states restricting abortion access have generally sought to roll back when the procedure is permitted, to as early as when a heartbeat is first detected -- around six weeks of gestation when many women do not yet know they are pregnant.

Most of the measures are expected to face legal challenges -- and eventually end up before the Supreme Court.

Six conservative states, Missouri included, now only have a single abortion clinic, compared to more than 150 in California.

Earlier this month, Missouri lawmakers passed a bill banning abortion after eight weeks of pregnancy, including in cases of rape and incest.

They also required doctors at abortion clinics to be affiliated with a hospital and to perform perineal exams even for drug-based abortions.

Mead denounced the measures as "frankly medically unnecessary and inappropriate rules."

AFP