JEFFERSON CITY — Every seat was filled, people stood shoulder to shoulder and still more people sat listening in the adjoining hearing room as the Senate Health and Pensions Committee on Wednesday heard testimonies for and against a bill that would ban abortions if a fetal heartbeat or brain activity is detected.

The bill started in the House with just the fetal heartbeat restriction and was amended to include brain activity, said Rep. Nick Schroer, R-O’Fallon and the bill’s sponsor.

These restrictions would ban abortion before some women know they are pregnant, said Sara Baker, the legislative and policy director of the American Civil Liberties Union of Missouri, testifying against the bill.

The bill includes an exception for medical emergencies, which Schroer said could include danger to the life and health of the mother, but it includes no exceptions for cases of rape and incest.

If the bill becomes law, it would be one of the most restrictive abortion laws in the country and would likely be immediately challenged in the courts. Doctors who perform an abortion that violates the law could be imprisoned for up to 15 years. Women who have an abortion could not be charged with a crime.

Witnesses in favor of the bill outnumbered those against it 17 to six. Advocates for both sides shared personal stories with the committee, and those in favor of the bill said their abortions caused intense pain and suffering.

In 2007 at a Planned Parenthood clinic in Kansas City, Megan Colyer had an abortion that she described as noisy and painful.

“I was struck by such a magnitude of horror that I would never wish that on another soul,” Colyer said.

She was diagnosed with post-abortion syndrome, or post-traumatic stress disorder caused by abortion. She self-medicated with alcohol and considers herself lucky to have survived and recovered, she said.

Samantha Mayberry terminated a pregnancy conceived by rape and carried another one to term, she said.

“If I could take that abortion back, I would in a heartbeat,” she said.

Stephanie Jacobson, director of abortion recovery service H3Helpline, speaks to women every day who struggle after having abortions, and her own abortion 40 years ago took years to heal from, she said.

Witnesses against the bill said abortion was a painful but necessary decision for them and their families.

Kendall Martinez-Wright’s sister was raped and impregnated at the age of 10, and the family drove two hours to St. Louis to obtain an abortion for her in 2011.

“My mother, who is very God-fearing but strong-willed, helped my sister make the difficult decision, but at the end of the day the best decision,” Martinez-Wright said. “The consequences could have been much direr.”

Jennifer Box was 12 weeks pregnant when she learned that her daughter, Libby Rose Box, was high-risk for Trisomy 18, a life-threatening genetic condition caused by an extra chromosome. She chose to end the pregnancy at 15 weeks and still thinks of her child daily, she said.

“I wanted to share with you how bizarre it is to have the grief of your child tied up in a political issue, to find yourself sitting below a group of strangers, next to a stranger, and telling them your heartbreak, hoping that they won’t judge you, hearing them call you a murderer,” Box said.

She brought up the often-repeated question of who speaks for the unborn in political debates about abortion.

“My entire body wants to scream, ‘I do,’” Box said. “I speak for my unborn daughter because I’m her mother. I do not claim to speak for every unborn child, but I can tell you with certainty and with love that I am and always will be Libby’s mother, and her father and I speak for her.”

She “obsessively” considered the pain the abortion might have caused her daughter, she said.

“If it did, which medical evidence says it did not, it was a momentary pain to spare her a life of suffering,” Box said. “Is that heartbreaking? Absolutely.”

Each side of the issue included testimony from a medical doctor.

Family physician Josephine Glaser considered an abortion in 1995 during her first pregnancy because of the cost and time commitment of having a child while she and her husband were still in medical school and interviewing for residency, she said. She changed her mind due to the part of the 1995 Hippocratic oath that swears to protect human life “from fertilization to natural death,” and reject abortion, she said.

“Abortion is not consistent with ethical healthcare, as it violates the tenet that healthcare professionals do no harm,” Glaser said.

Mae Winchester, an obstetrician-gynecologist from Kansas City, brought a different medical perspective.

“Women, when pushed into the corner that this bill would create, will always find a way to have an abortion,” she said.

Data shows that abortion-related deaths are 34 times more frequent in areas with more restrictive abortion laws because unsafe abortions can be lethal, and Missouri already has the eighth-highest maternal mortality rate in the nation, Winchester said.

She disputed the sentence in the bill that states, “The detection of a heartbeat in an unborn child is a key indicator that he or she will likely reach viability and live birth.”

Many anomalies that could threaten viability cannot be detected within the first trimester of pregnancy, Winchester said.

The bill also states that a fetus can feel pain at 20 weeks, but “no decent scientific studies” suggest pain before the third trimester, she said.

“Unless a politician is a practicing physician in the field of women’s health, they do not have the medical knowledge or training to adequately counsel women on their pregnancy options,” Winchester said.

Sen. Andrew Koenig, R-Manchester, said abortion is a black-and-white issue, but Winchester said gray areas exist.

“There is a difference between being alive and having a life,” she said.

Other opponents of the bill approached it from a policy perspective. The federal court system has decided multiple times that the Fourteenth Amendment guarantees both a woman’s right to choose and the right to privacy, Baker said.

The bill violates the “undue burden” standard set by the 1991 U.S. Supreme Court case Planned Parenthood v. Casey, said Anna Martin, who studied public policy at the University of Missouri School of Law.

Missouri’s ongoing budget struggles mean passing this bill is “fiscally irresponsible” because it will face opposition in court that will cost the state, Martin said.

She pointed out that the bill states three times that if any part of it is found unconstitutional, it will be “severable” from the rest of the bill, which will remain in effect unless the courts invalidate it.

The state could improve reproductive health in ways that won’t face legal opposition, such as implementing Medicaid expansion, improving sex education in schools or increasing access to contraceptives, said M’Evie Mead, spokeswoman for Planned Parenthood Advocates in Missouri.

Instead, the bill seems to be “a Kavanaugh-induced political effort to ban abortion,” she said, referring to U.S. Supreme Court Justice Brett Kavanaugh, who was confirmed in October.

Representatives from Missouri Right to Life, Campaign Life Missouri, the Missouri Catholic Conference, the Missouri Southern Baptist Convention and Concerned Women for America of Missouri all testified in favor of the bill.

The committee also heard a bill sponsored by Sen. Jeanie Riddle, R-Mokane, that would require referrals for out-of-state abortions to come with specific printed information. Some of this material is medically inaccurate, and the entire pamphlet is biased and coercive, Winchester said.

“It has no place in the physician-patient relationship,” she said.