REPRODUCTIVE HEALTH DIGEST (6/5/25)

Developments in Abortion, Autonomy, and Access: 

This week’s Digest goes through the federal government’s decision to rescind guidance directing hospitals to provide emergency abortions, new lawsuits filed by reproductive rights advocates in Arizona and Kansas, and litigation developments in Kentucky and Missouri. We also discuss new research about the safety and efficacy of gender-affirming care, the closure of Planned Parenthood clinics, and trends in pregnancy criminalization. Please read on to the end for the news that you need to know. 

Want access to a detailed analysis of the abortion law in every U.S. state and territory? Please view our free Policy Resource Hub for Reproductive Health, an exclusive legal database where we update the state of the law every single day - so you’re always up to speed.

Reproductive Rights and Health Equity News: 

This week’s must-read: 

On Tuesday, the Trump Administration announced its decision to rescind Biden-era guidance directing hospitals to provide emergency abortion care regardless of state-level abortion laws. Under the federal Emergency Medical Treatment and Active Labor Act (EMTALA), all hospitals that receive Medicare funding are required to provide stabilizing treatment to any patient that presents with an emergency. In response to the Dobbs decision and the wave of state abortion bans that followed, the Biden Administration issued guidance clarifying hospitals’ continued obligation to stabilize patients–even if the treatment required is an abortion that may conflict with a state’s abortion ban. The Biden-era guidance did not create any new abortion rights, it merely allowed providers to treat patients facing acute medical crises without fear of being prosecuted under their states’ laws. By rescinding that guidance, the Trump Administration places the lives of pregnant patients at immediate risk and further confuses the question of when providers can and cannot safely intervene. 

Legislation & Litigation: 

• Overview: 

• Following the passage of an abortion rights constitutional amendment last November, Arizona providers have filed a new lawsuit challenging remaining restrictions on care; 

• The Missouri Supreme Court has issued a decision overturning lower court rulings that allowed abortion to resume in the state; for the time being, care has once again been paused; 

• In Texas, a dangerous bill that would have further restricted access to medication abortion has seemingly failed to cross the legislative finish line this session; 

• The ACLU has voluntarily dismissed its lawsuit challenging Kentucky’s abortion ban; and 

• A lawsuit has been filed in Kansas challenging the state’s laws interfering with end of life choices for pregnant patients. 

• Arizona Providers File Lawsuit Challenging Remaining Arizona Abortion Restrictions: 

• Two Arizona physicians and the Arizona Medical Association have brought a new lawsuit challenging remaining restrictions on abortion care in the state. Last November, Arizona voters passed Proposition 139, an abortion rights amendment legalizing care until ‘fetal viability.’ In light of those new constitutional protections, a state court struck down the prior 15-week abortion ban; however, multiple medically unnecessary restrictions remain on the books. These restrictions include 1) a prohibition on abortion because of nonfatal genetic conditions; 2) a requirement that a patient receive an ultrasound 24-hours prior to an abortion; and 3) a ban on telehealth abortion care, including for medication abortion. Removing these restrictions would significantly improve access to care in the state, particularly for individuals who cannot travel to an in-person clinic or take multiple days off of work to comply with the current waiting period. Democratic Arizona Attorney General Kris Hayes will now have to determine whether the state intends to defend the laws. 

• Missouri Supreme Court Overturns Lower Court Rulings that Allowed Abortion to Resume in the State: 

• The Missouri Supreme Court issued a ruling last week functionally reinstating the state’s abortion ban. Last November, voters made Missouri the first state to overturn a total abortion ban through citizen-led ballot initiative. However, that victory has faced relentless opposition from anti-abortion lawmakers in the months since, including an attempt to outright overturn the amendment. The most recent blow comes from the state supreme court, which ordered a lower court to lift an injunction blocking medically unnecessary abortion restrictions, including an abortion clinic licensing requirement. The supreme court argued that the lower court had applied the wrong legal standard. The previous lifting of the licensure requirement had allowed abortions in the state to resume for the first time since Dobbs. However, in light of the latest ruling, clinics once again were forced to cancel appointments and cease providing care. Advocates are hopeful that this is only a temporary setback, and that the lower court will issue a renewed injunction allowing care to resume. 

• Dangerous Texas Bill Restricting Medication Abortion Fails to Move Forward: 

• As the Texas legislative session comes to a close, it seems efforts to pass a dangerous anti-abortion bill will end with it–at least for this year. SB 2880 would have further restricted access to mifepristone by allowing citizens to sue individuals who manufacture or distribute the medication in Texas. The bill clearly aimed to eliminate Texans’ ability to access care from out-of-state providers and organizations. However, despite its previous forward progress, SB 2880 failed to be scheduled for a floor vote prior to the deadline, likely ending any chance of its imminent passage. The bill is highly likely to be reintroduced in the next legislative session. 

• The ACLU has Dismissed its Lawsuit Challenging Kentucky’s Abortion Ban: 

• The ACLU has voluntarily dismissed its lawsuit challenging Kentucky’s abortion ban. The suit was brought on behalf of a pregnant woman who later traveled out of state to receive care. No legal explanation was offered for the voluntary dismissal; however, the ACLU issued the following statement: “people have the right to control their own bodies without government interference, and we will never stop fighting to restore abortion access in Kentucky. We are strategizing our next steps in this fight. In the meantime, our work to address the commonwealth’s maternal mortality rates and lack of widespread paid leave coverage will continue as long as Kentucky remains a forced-birth state.”

• Lawsuit Filed in Kansas Challenging Law Interfering with End-of-Life Choices for Pregnant Patients:

• A group of physicians and women in Kansas have filed a lawsuit challenging the state’s regulations on end-of-life treatment in cases involving pregnant patients. Kansas law allows the state to interfere with or override a pregnant patient’s advance directive, regardless of the fetus’s gestational age. In other words, if a person has indicated that, in the event of an incapacitating accident or illness, they do not wish to be kept on life support, the state can disregard that directive in the interest of preserving fetal life. The Kansas plaintiffs argue that this is unconstitutional and violates equal protection, privacy, autonomy, and freedom of speech rights. Ethical and legal questions around end-of-life care for pregnant patients have been brought to the forefront of public discourse in recent weeks following reporting about a braindead pregnant woman in Georgia who is being kept alive in an attempt to gestate her fetus to viability. 

Trend and Policy Watch: 

• A Utah Study Ordered by Republicans Finds that Gender-Affirming Care for Minors is Safe and Effective:  

• Over two years ago, Utah Governor Spencer Cox put a “moratorium” on the provision of gender-affirming care for minors. At the same time, he ordered the Utah health department to undergo a systematic review of medical evidence around the safety and efficacy of such treatment. That review is now complete and publicly available, and its findings are clear – gender-affirming care is a safe and effective treatment for gender dysphoria. As reported by Mother Jones, the authors of the review summarized their findings in the following way: “[t]he consensus of the evidence supports that the treatments are effective in terms of mental health, psychosocial outcomes, and the induction of body changes consistent with the affirmed gender in pediatric [gender dysphoria] patients. The evidence also supports that the treatments are safe in terms of changes to bone density, cardiovascular risk factors, metabolic changes, and cancer…It is our expert opinion that policies to prevent access to and use of [gender-affirming hormone therapy] for treatment of [gender dysphoria] in pediatric patients cannot be justified based on the quantity or quality of medical science findings or concerns about potential regret in the future, and that high-quality guidelines are available to guide qualified providers in treating pediatric patients who meet diagnostic criteria.” 
  
  The Utah review’s findings contrast with guidance issued in a letter from the Department of Health and Human Services urging healthcare providers to follow a highly-criticized government-issued report, rather than existing clinical practice guidelines. The HHS report was produced in response to the Trump Administration’s executive order disavowing government support for gender-affirming care and referring to it as “chemical and surgical mutilation.” 
  

• Investigations into Miscarriages Continue: 

• Law enforcement in Toledo, Ohio are reportedly investigating fetal remains found at an apartment complex. The coroner examined the fetal tissue and found that it was nonviable and at an early stage of development–in other words, the remains of a miscarriage. Although this story on its own may not seem important, it is a part of an ongoing trend of law enforcement investigating women for miscarriages, and in some cases even arresting and charging women with crimes like abuse of a corpse. Just this week, a West Virginia prosecutor indicated that criminal charges could be levied against women who miscarry, depending on how they dispose of fetal remains. It is unclear at this time whether the investigation into the Toledo incident is ongoing; however, the fact that law enforcement was involved at all is cause for concern. 

• Texas Police Have Reportedly Used a Nationwide License Plate Tracking System to Track a Woman Who Self-Managed An Abortion:

• In Texas, the Johnson County Sheriff’s Office reportedly used a nationwide surveillance system comprising more than 83,000 license plate readers to try and track down a woman who self-managed an abortion. The search was initiated after the woman’s family contacted law enforcement with concerns that she would “bleed to death,” and it extended into states where abortion is legal. Although the sheriff involved stated that they were not attempting to stop the woman from leaving the state, reproductive rights advocates warn that such surveillance could be used to track, monitor and criminalize people traveling for abortion care. 

• Planned Parenthood is Shuttering Over 20 Clinics Across Seven States As it Faces Renewed Threats: 

• Planned Parenthood is reportedly shuttering over 20 clinic locations across seven states as it faces renewed threats, including loss of Title X funding and a reconciliation bill that calls for its ‘defunding.’ In Iowa alone, four of the six remaining clinics are set to close, including the one clinic that provides abortion services. The organization has been forced to lay off employees and limit services offered, impacting access to cost-effective healthcare for countless Americans. The CEO of Planned Parenthood North Central States, Ruth Richardson, gave the following statement: [w]e have been fighting to hold together an unsustainable infrastructure as the landscape shifts around us and an onslaught of attacks continues.” 

REPRODUCTIVE HEALTH DIGEST (5/22/25)

Developments in Abortion, Autonomy, and Access: 

This week’s Reproductive Health Digest goes through litigation developments out of South Carolina, Florida, Missouri, and Michigan. We also walk through legislation out of Georgia and Texas, Missouri’s ongoing efforts to reverse the abortion rights ballot measure passed by voters last year, and Louisiana’s second case against a New York shield provider. Finally, we outline major reproductive healthcare news and policy developments at the federal and state levels, including a sweeping attempt to defund abortion and gender-affirming care. Please read on to the end for the news that you need to know. 

Want access to a detailed analysis of the abortion law in every U.S. state and territory? Please view our free Policy Resource Hub for Reproductive Health, an exclusive legal database where we update the state of the law every single day - so you’re always up to speed.

Reproductive Rights and Health Equity News: 

• This week’s must-read: This week’s Must-Read from ProPublica underscores the critical role that institutional support for clinician decision-making plays in patient outcomes. ProPublica’s analysis of post-abortion ban sepsis rates in Texas found that, despite rates skyrocketing statewide, the numbers differed drastically between Houston and Dallas. The key difference appears to be that Dallas hospitals and institutions have taken an active role in creating workable protocols and supporting their physicians in providing emergency abortion care, while Houston hospitals have taken a far more conservative approach to pregnancy terminations. 

Legislation & Litigation:

• Overview:

  • The South Carolina Supreme Court has issued a ruling finding that the state’s ban on abortion after detection of fetal cardiac activity applies around the 6-week mark; 

  • Missouri Lawmakers passed a resolution that will ask voters to undo the abortion rights constitutional amendment that they passed via citizen-led ballot measure last November; 

  • A Florida court has found that the state’s judicial bypass law–the legal process by which a minor can seek a court’s permission to obtain an abortion–unconstitutionally infringes upon the rights of Florida parents; 

  • Georgia Governor Brian Kemp has signed a bill banning state funding from going to support gender-affirming care for trans inmates; 

  • A Missouri Court has ruled that Planned Parenthood must turn over de-identified patient records relating to the provision of gender-affirming care; 

  • A Michigan Court has struck down certain medically unnecessary barriers to care, including a 24-hour waiting period, restrictions on who can perform abortions, and biased counseling requirements;  

  • Louisiana has opened up a second case into New York shield provider Dr. Margaret Carpenter; 

  • SB 31, a Texas bill purporting to clarify the state’s abortion ban, has passed another critical hurdle; and 

  • A federal court has struck down Pregnant Workers Fairness Act workplace protections for abortion patients. 

The South Carolina Supreme Court Upholds the State’s “Heartbeat” Ban at 6-weeks: 

• The South Carolina Supreme Court has issued a ruling finding that the state’s ban on abortion after detection of fetal cardiac activity applies around 6-weeks gestational age. Planned Parenthood argued that, because the chambers of the fetal heart have not formed by 6 weeks, the law’s use of the phrase “repetitive rhythmic contraction of the fetal heart” means that abortion must be permitted until closer to 9 weeks, when the fetal heart comes together and rhythmic contraction begins. While the court acknowledged the medically ambiguous nature of the law’s phrasing, it turned to the legislative record and found that both sides appeared to clearly understand and represent that the heartbeat bill was functionally a 6-week abortion ban at the time of its original consideration by the general assembly.  South Carolina’s ban will remain unchanged for the time being. 

• Missouri Lawmakers Ask Voters to Undo Abortion Protections: 

• Missouri lawmakers continue to push to repeal the state’s new abortion rights constitutional amendment. This week, the Missouri Senate used a rare mechanism to end a Democrat-led filibuster and force a vote on House Joint Resolution 73, which will ask voters to once again ban most abortions in the state. The Resolution comes mere months after Missouri voters soundly passed a constitutional amendment protecting pre-viability abortion rights and overturning a total abortion ban. The secondary measure will either appear on the 2026 ballot or go before voters via special election. 

• Missouri lawmakers’ attempts to turn back the clock on the 2024 amendment have been broadly criticized as an anti-democratic attempt to supersede the will of the people. Senate Minority Leader Doug Beck criticized the Resolution, stating that “24 Republican Senators decided that they think what’s best for Missourians” over Missourians own votes on the issue. 

• Florida Court Invalidates Judicial Bypass for Minors: 

• Florida’s Fifth District Court of Appeals issued an opinion last week finding that the state’s judicial bypass procedures unconstitutionally violate parental rights. States that require parental involvement for a minor to access abortion care also have procedures in place for judicial bypass–the process by which a minor can petition the court for permission to get an abortion without parental consent or notification. Judicial bypass is often utilized in cases where the minor cannot safely involve a parent or guardian. It has been an established norm since the U.S. Supreme Court determined in 1979 that the rights of parents must be balanced against the constitutional right of pregnant people to access abortion, and therefore states that mandate parental involvement must also provide an alternative avenue to care.

• The Florida court in the present case found, however, that judicial bypass procedures–with the exception of those in place for victims of abuse–violate parents’ rights to make decisions about their children’s care. The opinion cited Dobbs to repudiate the idea that minors retain any independent right to access abortion care. The court invited the Florida Supreme Court to review its decision, where it will face a panel of justices hostile to abortion rights. The outcome of this case will likely create a strategic blueprint for other abortion-hostile states that are seeking to limit minors’ ability to access care.

• Georgia Governor Brian Kemp has Signed a Bill Banning Gender-Affirming Care for Trans Inmates: 

• Georgia Governor Brian Kemp has signed a law prohibiting the use of state funds for gender-affirming care for transgender inmates. SB 185, the bill in question, is discriminatory on its face. It explicitly allows identical treatment to be delivered to inmates for reasons other than gender dysphoria, including intersex inmates or inmates who are de-transitioning. The population of transgender inmates in Georgia prisons is exceedingly small, and removing their ability to access care subjects them to unnecessary harm and suffering while providing little to no benefit to the state. In response to the bill, Minority Caucus Chair Tanya Miller stated “[y]ou are wasting our time – better still, wasting the taxpayers’ money . . . solving problems that no one asked you for, that do not in fact exist.” 

• A Missouri Court has Ruled that Planned Parenthood Must Turn Over Patient Records Related to Gender-Affirming Care: 

• Attacks on the rights and privacy of trans people continue in Missouri, where a court has ruled that Planned Parenthood must turn over documents relating to gender-affirming care to the Attorney General’s office. Attorney General Andrew Bailey is purportedly seeking these records from Planned Parenthood and other providers as a part of an investigation into whether the provision of gender-affirming care in the state violates consumer protection laws. His office is alleging that clinics in the state may have engaged in “deception, fraud, false promises, misrepresentation, unfair practices, and/or the concealment, suppression or omission of material facts.” Planned Parenthood has declined to turn over patient records, arguing that this is a violation of patient privacy law and an improper use of consumer protection laws. Judge Rebeca Navarro-Mckelvey disagreed, finding that the investigation may proceed and Planned Parenthood can turn over de-identified records without violating HIPAA’s privacy protections. 

• A Michigan Court Has Struck Down the State’s 24-hour Waiting Requirement: 

• In 2022, Michigan became one of the first states to enshrine abortion rights into its constitution. The Reproductive Freedom for All Amendment (RFFA) prohibits the state from infringing upon or burdening the right to pre-viability abortion; however, it did not automatically unwind other restrictions on care that remain on the books. Advocates have brought those remaining challenges before the courts. Last week, in a win for reproductive freedom, a Michigan court struck down a 24-hour waiting period, as well as biased counseling requirements and a prohibition on advanced practice providers, like nurse practitioners and physicians assistants, providing abortion care. Judge Sima Patel found that the provisions infringed upon or burdened the right to access reproductive healthcare in violation of the RFFA. Judge Patel allowed a provision requiring screening for signs of coercion to remain in place. 

• Louisiana Opens  a Second Case Against New York Shield Provider:

• Louisiana Attorney General Liz Murrill is leading a second investigation into New York shield provider Margaret Carpenter, based on her alleged provision of abortion pills to a woman in Shreveport. To date, New York has refused to comply with cases brought against Dr. Carpenter by both Louisiana and Texas, citing its shield law’s protections from out-of-state investigations and extradition requests. These cases are currently in their early stages, but they will eventually lead to the first real test of whether shield laws can withstand judicial scrutiny. The Trump Administration has seemingly indicated its willingness to side with and potentially assist anti-abortion states.  

• Texas Abortion Clarification Bill Progresses: 

• A controversial bill purporting to clarify Texas’s abortion ban has cleared another hurdle. It now only faces one more procedural vote before it will go to Governor Abbott, who has indicated his support for the measure. SB 31 does not expand access to care in the state or establish new exceptions; instead, it removes the words “life-threatening” from the current language of the life or health exception and states that an emergency does not need to be imminent or irreversible in order for a doctor to intervene. The bill had drawn criticism from both sides, with anti-abortion lawmakers raising concerns that it would give doctors a free pass to perform abortions, and pro-choice advocates arguing that it fails to meaningfully provide relief from the current ban’s deficiencies. 

• Federal Court Strikes Down Workplace Accommodations for Abortion Patients:

• On Wednesday, a federal judge issued an order striking down the Biden Administration’s rule applying the Pregnant Workers Fairness Act to employees needing abortions. The rule did not require employers to provide paid leave or other direct support; it merely required employers to provide unpaid leave unless doing so would constitute undue hardship. Wednesday’s Order found that the EEOC exceeded its statutory authority in promulgating the rule. 

Trend and Policy Watch: 

• House-Passed Reconciliation Bill Drastically Expands Efforts to Defund Abortion and Gender-Affirming Care. 

• Anti-abortion and anti-trans rights lawmakers have long been engaged in state and federal-level efforts to defund Planned Parenthood and other prominent care providers. But on Thursday, the House passed a reconciliation bill that includes a stunning escalation of these efforts. At the final hour, two provisions were added that would not only ban federal funding for minors, but would, as reported by Mother Jones, “ban Affordable Care Act health care plans from covering abortion and gender-affirming care for all Medicaid patients, including adults.” If passed, this reconciliation bill will effectuate the largest cuts to Medicaid in American history, depriving millions of people of essential care and effectively codifying a backdoor abortion ban for large swaths of the population. Experts report that initial proposals to ‘defund Planned Parenthood’ using the federal budget would cost taxpayers over $300 million. And, because the Hyde Amendment already blocks federal funding from going to abortion, defunded services would include things like preventative care, STI testing and treatment, cancer screening, contraception, and prenatal care. The current version of the reconciliation bill cannot be allowed to pass, and it is incumbent on each of us to raise our voices and demand accountability from our lawmakers. 

• A Woman Being Kept on Life Support in Georgia Raises Ethical and Legal Questions:

• As you have likely read in recent days, reports have come out that a brain dead Georgia woman’s body is being kept alive in an attempt to allow her pregnancy to continue until fetal viability. Although all of the details of the case are not known to the public, the circumstances raise serious questions around medical ethics, fetal personhood and the rights of pregnant people and their families to make medical decisions. Adriana Smith suffered brain death in February at around 8-weeks pregnant. However, Georgia’s abortion ban does not allow abortion after detection of fetal cardiac activity, and the fetus still had a heartbeat. The family reports that they were not given a choice in how to proceed after Ms. Smith’s death. The Georgia Attorney General has since released a statement saying that Georgia’s ban does not require a hospital to keep a brain dead patient on life support to sustain a pregnancy. 

• Secretary of Health and Human Services RFK Jr. Has Ordered a Review of the Safety of Mifepristone: 

• Secretary of Health and Human Services RFK Jr. has ordered Food and Drug Administration Commissioner Dr. Martin Makary to conduct a “complete review” of the safety of mifepristone. Despite decades of usage and over 100 scientific studies on the drug’s safety and efficacy, the Trump Administration appears to be ordering this review based on a recently released report from a right-wing group. This report purports to show that over 10% of women who take mifepristone suffer serious complications–a number far higher than the less than 1% of patients shown by credible data. However, the report has been broadly criticized for a lack of transparency and scientific rigor. Even the report’s own supporters have admitted its severe limitations; Dr. Christina Francis, CEO of the American Association of Pro-Life OBGYN’s stated that the report is “not a study in the traditional sense” and “not conclusive proof of anything.” 

REPRODUCTIVE HEALTH DIGEST (5/8/25)

Developments in Abortion, Autonomy, and Access: 

This week’s Repro Health Digest is a bit shorter than usual, as our team has been partially out of office–but, we are determined to still hit the highlights and cover the most important updates from the past two weeks. This week’s Digest discusses the ongoing legal battle over access to mifepristone, litigation around the rights of minors, positive and negative state legislative developments, and the government’s sustained attack on the rights of trans people. As always, please read on to the end for the news that you need to know. 

Want access to a detailed analysis of the abortion law in every U.S. state and territory? Please view our free Policy Resource Hub for Reproductive Health, an exclusive legal database where we update the state of the law every single day - so you’re always up to speed. 

Reproductive Rights and Health Equity News: 

This week’s must-read: This week’s must-read from the Guardian examines how the idea of abortion ‘abolitionism,’ a movement that champions fetal personhood and endorses treating abortion as homicide, has entered the mainstream of American anti-abortion politics. At least 12 states have introduced legislation that would open the door to criminally charging pregnant people for abortion–a charge that carries the death penalty in several of these states. And, the scope of who is being targeted for punishment and what conduct is punishable continues to widen as more extreme views and voices gain traction. 

Legislation & Litigation: 

• Overview: 

• The Trump Administration is continuing the Biden Administration's efforts to dismiss a case challenging FDA approval of mifepristone on jurisdictional grounds; 

• Lawmakers in Vermont and Colorado have passed legislation strengthening protections for reproductive healthcare in their respective states; 

• A Missouri abortion text hotline is challenging the state’s parental involvement requirements; 

• Alabama’s abortion funds have resumed providing assistance following a decision finding that the state cannot prosecute groups for helping people obtain lawful out-of-state care; 

• Nevada has paused enforcement of its parental notification law while Planned Parenthood seeks to stay the law pending appeal; 

• A federal court has declined to allow Guam’s attorney general to revive a total abortion ban in the territory; 

• The Texas Senate is continuing to advance a bill that purports to clarify the medical exceptions to the state’s total abortion ban; 

• Virginia Governor Glenn Youngkin has once again vetoed protections for contraception in the state; and 

• The Supreme Court will allow the Trump Administration to enforce its trans military ban. 

• The Trump Administration Continues to Urge Dismissal of Case Challenging Mifepristone on Jurisdictional Grounds: 

• On Monday, the Department of Justice filed a brief continuing to urge the Northern District of Texas to dismiss a case challenging FDA’s approval of mifepristone for medication abortion. The case was initially filed in 2022 by the Alliance for Hippocratic Medicine, a group of anti-abortion doctors and medical groups. The Supreme Court dismissed their claims last year for lack of standing, finding that the parties could not demonstrate how they had been injured by FDA’s actions. In a bid to keep the case alive, Idaho, Kansas and Missouri moved to intervene before the district court. The Biden Administration argued for dismissal on the grounds that the intervenor states similarly lacked standing and were not properly venued in the Northern District of Texas. While that motion was pending, however, the federal administration changed from Biden to Trump, raising the question of whether the new administration would continue to defend the suit. 

• On Monday, the government filed its reply brief, wherein it continued to urge the Biden Administration’s position and argue for dismissal. Although the government’s continued defense of the case is welcome, whether it signals an intention to preserve access to mifepristone remains an open question. While the law involved in this case plainly cuts against the Idaho, Kansas and Missouri’s current arguments, the government’s brief left open the possibility of the states filing an independent challenge in a proper jurisdiction. 
  

• Vermont and Colorado Lawmakers Pass Legislation Strengthening Protections for Reproductive Healthcare in Their States:

• Lawmakers in both Vermont and Colorado have passed legislation to strengthen protections for providers and recipients of reproductive healthcare in their states. 

• In Vermont, legislators passed a bill that would streamline access to medication abortion by allowing providers to use an online questionnaire for prescription purposes, further regulate advertising around reproductive health care under existing consumer protection laws, and put in place additional privacy protections for providers. In Colorado, Governor Polis signed two new bills protecting abortion rights. The first repeals a prohibition on the use of state funds for abortion, following the passage of an abortion rights amendment last November. The second increases protections for providers by allowing them to remove their individual names from prescriptions and requiring subpoenas seeking patient information to affirm that the information is not sought for the purpose of  investigating lawful healthcare. 
  

• A New Lawsuit is Challenging Missouri’s Parental Involvement Requirements: 

• Abortion support text line ‘Right By You’ has filed a lawsuit in Missouri seeking to overturn two of the state’s restrictions on minors accessing care. The lawsuit argues that these statutes violate the recently-passed reproductive rights constitutional amendment. Together, the challenged laws require parental consent and notification prior to a minor obtaining an abortion and prohibit the provision of practical or financial support to a minor without the requisite parental involvement. The lawsuit challenging parental involvement requirements comes as Missouri Attorney General Andrew Bailey continues to argue for enforcement of additional medically unnecessary restrictions on abortion in the state. 

• Alabama Abortion Fund Resumes Providing Assistance:

• For the first time in almost three years, the Yellowhammer Fund has resumed funding abortion in Alabama. The Fund’s mission has been in legal limbo for the past several years while litigation unfolded over the state’s ability to prosecute groups for helping patients obtain out of state care. In April, Judge Myron Thompson ruled against the state, finding that such prosecutions would violate constitutionally protected rights to speech and travel. This is an important victory both for Alabamians and nationally, as states across the country test whether they can extend their abortion bans beyond their own borders. 

• Nevada has Paused Enforcement of its Parental Notification Law: 

• As we reported in April, U.S. District Court Judge Anne Traum ruled last month that, in light of the Dobbs decision, Nevada can revive its parental notification requirements for minors seeking abortions in the state. Although the law was set to go into effect on April 30th, Judge Traum has granted Planned Parenthood’s request to pause enforcement of the law while it seeks a stay from the Ninth Circuit Court of Appeals pending appeal. 

• A Federal Court Declines to Allow Guam to Revive its Abortion Ban:

• Last week, the Ninth Circuit issued a ruling dismissing Guam Attorney General Douglas Moylan’s attempt to revive a total abortion ban. The Court determined that a Guam Supreme Court decision finding the ban to be legislatively repealed rendered the case moot. The U.S. Supreme Court has declined to review the Guam Supreme Court’s ruling. 

• The Texas Senate has Advanced a Bill that Purportedly Clarified the State’s Abortion Ban: 

• The Texas Senate is moving forward with a controversial bill that Republican lawmakers claim will help clarify the state’s abortion ban. Prompted by reports of Texans dying or facing devastating health outcomes as a result of the current ban’s vague language, the amended law would clarify that a medical emergency need not be imminent or actively causing injury to the patient at the time of treatment. Critics of the bill argue that, in practice, it will make little meaningful difference to doctors and patients. They also point to the fact that the amendment fails to create exceptions for lethal fetal anomalies or cases of rape or incest   

• Virginia Governor Glenn Youngkin has Once Again Vetoed Protections for Contraception: 

• Virginia Governor Glenn Youngkin has once again vetoed a bill that would expressly protect the right to full-spectrum contraception in the state. Although Governor Youngkin claims that the bill is unnecessary and anti-choice actors continue to insist that concerns about the future of birth control access are alarmist exaggerations, Republican lawmakers at the state and federal levels have repeatedly blocked protective bills. Some of those same lawmakers have erroneously claimed that contraception methods like IUDs and emergency contraception are ‘abortifacients,’ or abortion-causing drugs. 

• The Supreme Court Supreme Court Will Allow the Trump Administration to Implement its Trans Military Ban:

• The U.S. Supreme Court ruled this week that the Trump Administration’s ban on transgender service members may go into effect while legal challenges continue to play out in the lower courts. The opinion was unsigned and provided no legal reasoning for the Court’s determination. Justices Sotomayor, Kagan and Jackson dissented. If implemented, the ban would not only block trans people from joining the military, it would also force out those currently serving. 

REPRODUCTIVE HEALTH DIGEST (4/24/25)

Developments in Abortion, Autonomy, and Access: 

In this week’s Reproductive Health Digest, we discuss legislative developments in Texas, Missouri, and Nebraska, as well as litigation in both state and federal courts. We also report on new data on the numbers of abortions performed across the country and the impacts that federal funding freezes are having on Title X clinics. As always, please read on to the end for the news that you need to know. 

Reproductive Rights and Health Equity News: 

Legislation & Litigation:

• Overview: 

  • An Idaho judge has issued a limited ruling purporting to clarify the scope of the state’s abortion ban; 

  • The status of abortion in Wyoming continues to shift, as a judge blocks restrictions on care, and the state supreme court considers the constitutionality of proposed bans; 

  • Texas has proposed legislation to prohibit state funds from going to any entity or individual who provides practical support for abortion seekers; 

  • The Trump Administration has sued Maine over the state’s refusal to exclude trans girls from girls sports teams; 

  • Missouri lawmakers have advanced a proposed constitutional amendment that would repeal the abortion rights amendment passed by voters last year; 

  • The parties to an Arizona challenge to a fetal personhood law have voluntarily dropped their suit; 

  • The Nebraska legislature is advancing burial and cremation requirements for aborted fetuses; 

  • Texas legislators want to test wastewater for birth control and abortion medication; and

  • A federal judge has ruled that a group of Catholic employers do not have to comply with certain federal protections for pregnant and LGBTQ+ workers.

Idaho Judge Issues Limited Ruling Allowing Emergency Abortions:

• This week, an Idaho state court judge issued a ruling purporting to clarify the scope of the state’s abortion ban and its exception for the life of the patient. The Center for Reproductive Rights brought this lawsuit on behalf of four patients who were denied emergency abortions, two Idaho physicians and the Idaho Academy of Family Physicians. Collectively, the plaintiffs argue that Idaho’s abortion ban, which only permits abortion to save the patient’s life, violates Idaho’s Declaratory Judgment Act and the state’s constitutional guarantees of life, happiness and safety. In a limited ruling, state District Judge Jason Scott found that abortion is not prohibited if the patient’s pregnancy or health condition puts them at a “non-negligible risk of dying sooner without an abortion,” even if death is not imminent or assured. 

• The Status of Abortion in Wyoming Continues to be in Flux: 

• The legality of abortion in Wyoming continues to be in flux with legal fights playing out across multiple courts. As we previously reported, although abortion remains legal until viability, cumbersome state requirements have rendered it functionally unavailable. However, earlier this week, Wyoming’s only remaining abortion clinic resumed abortion care after a judge halted medically unnecessary laws requiring abortion clinics to be licensed as outpatient surgical centers and patients to have an ultrasound prior to obtaining medication abortion. 

• As care resumes in the state, the Wyoming Supreme Court is considering the constitutionality of two abortion bans that a state judge blocked in November of last year. The arguments in the case turn on whether a 2012 state constitutional amendment guaranteeing the right of individuals to make healthcare decisions encompasses the right to choose abortion. That amendment was passed in response to the Affordable Care Act. The Wyoming Supreme Court heard oral arguments in the case on April 16th; it will likely hand down its ruling within a few months. 
  

• Texas Attempts to Pass Further Restrictions on Funding for Logistical Support for Abortion: 

• The Texas Legislature is once again attempting to tighten the noose on abortion access both inside and outside of the state. Although abortion is banned and unavailable in Texas except in emergency cases, the state is attempting to pass a law that would expand the definitions of “abortion provider” and “abortion assistance entity” and block state funds from going to entities or individuals assisting with the logistics of out-of-state abortion access. Abortion assistance is defined expansively in the bill and would effectively encompass any and all practical support including travel, child care, counseling, lodging, or reimbursement for the cost of the abortion, regardless of where it takes place. The proposed legislation takes clear aim at abortion funds in the state, as well as other entities and individuals who would help pregnant Texans leave the state to obtain lawful care.  

• Trump Administration Sues Maine Over Inclusion of Transgender Girls in School Sports: 

• The Trump Administration is escalating its attack on trans rights with a lawsuit against Maine over the state’s inclusion of transgender girls in girls' sports. The Justice Department has asked the court to direct schools in the state to prohibit participation on girls' teams by minors who were not born female. The Administration argues that their inclusion violates Title IX’s anti-discrimination provisions. Maine officials disagree, contending that the Trump Administration’s position would force the state to violate its own human rights laws. In response to Maine’s refusal to comply with its demands, the Administration has threatened to pull funding for education in K-12 schools. It also attempted to freeze Department of Agriculture funds; however, that move has been blocked by a federal court. 

• Missouri Lawmakers Advance Proposed Amendment to Undo Recently-Passed Abortion Rights Amendment: 

• Last year, Missouri voters made history by being the first state to undo a total abortion ban via citizen-led ballot measure. However, undeterred by the clearly expressed will of the people, Missouri lawmakers are moving forward with a secondary proposed constitutional measure asking voters to repeal the first. House Resolution 2454 does not state at what gestational age abortion would be banned, but it does specify exceptions for cases of rape or incest prior to 12 weeks, fatal fetal anomalies and medical emergencies. Opponents of the Resolution argue that lawmakers are attempting to make an end-run around the outcome of last November’s election, but those supporting the bill insist that they are merely giving voters a second chance. 

• Arizona Parties Voluntarily Drop Lawsuit Against State Fetal Personhood Law: 

• Parties to an Arizona lawsuit challenging a fetal personhood measure have voluntarily dismissed the case. The contested law purported to give fetuses the same rights as Arizona residents; however, it never went into effect as a result of ongoing litigation. The parties agreed that the current challenge was rendered moot by the passage of an abortion rights ballot measure last November. 

• Nebraska Legislature Advances Burial Requirements for Aborted Fetuses: 

• The Nebraska Legislature is advancing LB632, a  bill that would mandate certain burial and cremation requirements following an abortion. The bill would not apply to fetal remains resulting from a miscarriage or stillbirth. Proponents of the bill insist that it is about supporting the dignity of the fetus; however, critics argue that its true purpose and effect is to penalize the pregnant person and shame patients who seek abortion. The measure also raises concerns about heightened surveillance and criminalization of pregnant people and their providers. 

• Texas Legislators Want to Test Wastewater for Birth Control and Medication Abortion: 

• The Texas Senate has introduced a bill that would require wastewater testing for hormones found in abortion medication, gender-affirming care and hormonal birth control. Author of the bill Senator Bryan Hughes cited concerns about hormones leading to health risks and environmental contamination, a claim championed by anti-abortion group Students for Life. Health experts have found no credible evidence that mifepristone and other targeted medications are entering the water supply in high levels, and advocates point to the fact the lawmakers raise no similar concerns about far more commonly used medications like Tylenol and ibuprofen. 

• A Federal Judge Has Ruled that A Group of Catholic Employers Do Not Have to Comply with Certain Protections for Pregnant and LGBTQ+ Workers: 

• Federal Judge Daniel Traynor issued a ruling earlier this week finding that a group of Catholic employers do not have to comply with an updated Pregnant Workers Fairness Act Rule and Title VII guidance regarding discrimination on the basis of reproductive choices, gender identity and sexual orientation. The new Pregnant Workers Fairness Act rule requires reasonable accommodations for pregnant employees–including those seeking abortion or fertility treatments. It does not obligate employers to provide paid time off or other direct support for abortion seekers. But, it would require the employer to provide unpaid leave unless doing so would cause undue hardship. The challenged Title VII guidance bars workplace discrimination on the basis of a person’s gender identity or sexual orientation. The Diocese of Bismarck and the Catholic Benefits Association brought their lawsuit last August arguing that both of these provisions violate their beliefs about the Catholic Church’s teachings on reproductive rights and LGBTQ+ issues. Judge Traynor agreed, finding that the requirements substantially burden the Plaintiffs freedom of religion. 

Trend & Policy Watch: 

• Center for Medicare and Medicaid Services Issues Guidance Directing States  Not to Use Medicaid Funds for Gender-Affirming Care for Minors:

• Continuing the Administration’s attack on trans rights and access to gender-affirming care, the Center for Medicare and Medicaid Services (CMS) has issued a letter urging states not to use medicaid funding for gender-affirming care for minors. Although Dr. Mehmet Oz, the Administrator for CMS, alleges that there is insufficient evidence to support the efficacy and safety of gender-affirming care, the treatment is supported by all major American medical associations. 

• Title X Clinics Are Beginning to Close Following Loss of Federal Funding: 

• Clinics are beginning to close their doors following the Trump Administration’s decision to freeze millions of dollars in Title X grant funding. The funding freeze targeted nine Planned Parenthood affiliates, and the Administration cited concerns about the group’s position on diversity, equity and inclusion–including statements stressing its “commitment to black communities.” Although the government purported to give the groups ten days to demonstrate compliance with anti-discrimination laws, the groups who responded within the deadline reported that they have received no new information. As a result of the funding freeze, countless patients will lose access to cost effective reproductive healthcare, including contraception, preventative care, and pregnancy testing. 

• Abortion Continues to Rise in the U.S.: 

  • Data released by the Guttmacher Institute on April 15th shows a slight increase in abortions nationwide, with significant variability from state-to-state. The data also shows how abortion laws in one state impact other states in the region. For example, when abortion decreased in Florida after the state passed a 6-week ban, numbers spiked in Virginia, where abortion is permitted until about 26 weeks. The continued national rise in abortions is attributable in large part to individuals traveling to access care and the increased accessibility of medication abortion.

REPRODUCTIVE HEALTH DIGEST (4/10/25)

Developments in Abortion, Autonomy, and Access: 

In this week’s Reproductive Health Digest, we discuss an important Supreme Court case about Medicaid and Planned Parenthood, newly introduced and passed state legislation, developing policy trends, and updated reporting and analysis on public opinion about reproductive healthcare and abortion. As always, we welcome your feedback on how we can best make this Digest suit your needs and support your work. Please read on to the end for the news that you need to know.

Want access to a detailed analysis of the abortion law in every U.S. state and territory? Please view our free Policy Resource Hub for Reproductive Health, an exclusive legal database where we update the state of the law every single day - so you’re always up to speed. 

This Week’s Must Read:

This week’s must-read is a long, but important, one. The National Women’s Law Center has published a new report outlining the myriad strategies being employed to undermine access to birth control post-Roe. Access to abortion and access to birth control are inextricably intertwined issues, and there are many ways to erect barriers to contraception that don’t require passing a sweeping ban. The strategies described in the Report are ongoing in many states, and we will be watching closely as the policy landscape develops. 

Legislation & Litigation: 

Overview: 

• On April 2nd, the U.S. Supreme Court heard oral arguments in a case about Medicaid funding for Planned Parenthood that will have sweeping implications for the rights of Medicaid recipients nationwide; 

• Texas is considering a bill that purports to clarify its abortion ban, but it has met resistance from both sides of the aisle; 

• North Carolina lawmakers have proposed a total abortion ban; 

• Texas has filed a lawsuit against San Antonio, arguing that the city’s allocation of funds for abortion travel violates state law; 

• The Oklahoma House has passed a bill that would treat the possession and delivery of abortion-inducing medications as a drug trafficking offense; 

• A federal judge has ruled that the Alabama Attorney General cannot prosecute people for helping individuals obtain lawful out-of-state abortion care; 

• Nevada is poised to reinstate parental notification requirements for minors seeking abortion care in the state; and 

• The Illinois House has passed novel protections for abortion medications.

• U.S. Supreme Court Hears Case About Medicaid Funding for Planned Parenthood:

  • As we reported in our last Digest, the U.S. Supreme Court heard oral arguments on April 2nd about whether individual patients have standing to bring a lawsuit challenging the denial of Medicaid funding for Planned Parenthood. Federal law allows Medicaid recipients to obtain care from any qualified provider. But, South Carolina Governor Henry McMaster has sought to block funding from going to Planned Parenthood, despite conceding its qualifications. The outcome of this case will have far-reaching consequences for Medicaid recipients’ ability to choose their provider without political interference from the state. 

  • Oral arguments centered on whether or not the specific language in the relevant Medicaid provision gives individuals the ability to enforce their federally-conferred right to see a qualified provider of their choosing. John Bursch, arguing on behalf of South Carolina, urged that it does not, because the Medicaid statute doesn’t use the word “right” or its “functional equivalent.” During arguments, several of the Justices appeared skeptical of this argument, with Justice Kagan pointing out that the Medicaid Provision was revised specifically to include a freedom of choice requirement. Justice Barrett appeared to echo the concern that the state’s argument would roll back this congressionally created right. A decision in the case is expected this summer. 
    

• Texas Considers Abortion Bill ‘Clarification’: 

• The Texas legislature’s consideration of a bill purporting to clarify the state’s abortion ban has sparked controversy. The bill, SB 31, does not expand access to abortion, but–according to its proponents–clarifies when a doctor is able to intervene and provide care to protect their patient. Specifically, the measure removes the words “life-threatening” from the exception for the life or health of the pregnant person and states that an emergency does not need to be imminent or irreversible in order for a doctor to act. The latter change is intended to address cases where doctors have been forced to wait until their patient gets “sick enough” before they are able to provide care. 

• Proponents of the law argue that it is a clear-cut measure that merely provides needed clarity. However, it has drawn opposition from both sides of the aisle. During a House committee meeting, some lawmakers raised concerns that the amendment could be used as a loophole for clinicians to provide ‘abortion on demand.’ Conversely, pro-choice groups point to the law’s potential to bolster arguments that a 1925 pre-Roe abortion ban can be revived and enforced. Abortion advocates have also raised concerns that these kinds of clarification bills give anti-choice legislators political cover while failing to meaningfully address the healthcare crisis precipitated by post-Roe abortion bans. 
  

• North Carolina Proposes Total Abortion Ban: 

• North Carolina lawmakers have introduced a total abortion ban, entitled the “Human Life Protection Act of 2025.” The bill would ban abortion at all gestational ages with only an exception to save the life of the pregnant person. At present, abortion is banned in North Carolina after 12 weeks, with exceptions for rape, incest, lethal fetal anomalies and the life or health of the pregnant person. If passed, the Human Life Protection Act would significantly curtail access in the state and further strangle reproductive healthcare in the South, where most states already ban abortion. 

• Texas Files Lawsuit Against San Antonio Over Allocation of Funds for Reproductive Healthcare: 

• Texas Attorney General Ken Paxton has filed a lawsuit against San Antonio, based on the city’s allocation of $100,000 for reproductive health. The money, which was recently approved by the San Antonio City Council, will be used for out-of-state abortion travel. Although none of the money will directly fund abortion, Paxton alleges that the funding is a “misuse of public funds” and an attempt to “circumvent state law and take the innocent lives of unborn children.” He is requesting a temporary restraining order and injunctive relief on the grounds that the city has violated Texas’s Gift Clause, Human Life Protection Act, and other pre-Roe abortion statutes. 

• Oklahoma House Passes Abortion Medication ‘Trafficking’ Bill:

• The Oklahoma House has passed a bill that would treat the possession or delivery of “abortion-inducing drugs” as a drug trafficking offense, subject to up to $100,000 in fines and 10 years in prison. The bill would not allow for the prosecution of someone possessing the drugs for their own use, and it would not apply to cases where the intended use of the drug was lawful, such as to treat an ectopic pregnancy or manage a miscarriage. Several other states where abortion is banned have passed similar restrictions on access to medication abortion. The measure will now go to the state senate for consideration. 

• Federal Court Rules Alabama Attorney General Cannot Prosecute People for Helping Others Obtain Lawful Out-of-State Abortions: 

• In a critical victory out of Alabama, District Court Judge Myron Thompson has ruled that Alabama Attorney General Steve Marshall cannot prosecute people for helping others obtain lawful out-of-state abortion care. Following the Dobbs decision, Marshall repeatedly threatened that individuals who helped others cross state lines for abortions could be prosecuted under the state’s conspiracy and abortion statutes. Judge Thompson’s decision found that these threats violated constitutionally protected speech and travel rights. The Court’s ruling allows providers to once again freely and openly counsel their patients on their lawful healthcare options. Alabama is likely to appeal this decision up to the 11th Circuit Court of Appeals, but Judge Thompson’s decision is an important precedent as anti-choice states test the boundaries of their abortion restrictions. 

• Nevada Poised to Revive Parental Notification Requirement for Minors: 

• Nevada appears poised to revive a long-dormant 1985 parental notification requirement for minors seeking abortion care. Although the law has been blocked by an injunction for decades, a group of district attorneys argued that the Dobbs decision rendered it once again enforceable. U.S. District Court Judge Anne Traum agreed. The law is set to take full effect on April 30th; however, it is likely that advocates will request that it remain blocked while they litigate its constitutionality. 

• Illinois House Passes Protections for  Medication Abortion: 

• The Illinois House has passed a novel piece of legislation bolstering protections for medication abortion. In anticipation of potential federal restrictions, the bill would allow healthcare providers to continue providing abortion medication as long as the World Health Organization recommends it, even if the FDA revokes its approval. FDA approval of mifepristone is the subject of ongoing litigation, and the Trump Administration has indicated its interest in Health and Human Services Secretary Robert F. Kennedy Jr. reviewing the safety of abortion pills.

Trend & Policy Watch:

• Missouri Rejects Planned Parenthood’s Complication Plan: 

  • In Missouri, where voters overturned a total abortion ban last November, the state continues to erect roadblocks to access. In late March, the Missouri Department of Health sent a letter to Planned Parenthood Great Rivers informing them that their complication plans did not meet state requirements. Under an emergency rule published that same day, the state requires facilities that prescribe medication abortions to more than 10 patients a month to set forth a complication plan that meets certain strict requirements. Following the rejection of their plan, Planned Parenthood renewed its challenge to the complication plan requirements, citing Missouri’s “endless end-runs around” the abortion ballot measure passed 5 months ago. 

• Wisconsin Supreme Court Race is a Victory for Reproductive Rights: 

• Wisconsin scored a victory for reproductive rights with the election of Judge Susan Crawford to the state Supreme Court. Judge Crawford has a history of supporting abortion rights, including previously representing Planned Parenthood in litigation. Her election secures a liberal majority on the court at a time when it has two cases about an 1849 abortion ban before it. 

• States Show Appetite to Prosecute Abortion-Seekers: 

• Trends across state legislatures show an appetite to increase restrictions on abortion, including prosecuting the pregnant person themselves, a line that the anti-abortion movement has historically been unwilling to cross. Although few, if any, of these bills are likely to pass this session, the increase in their volume and their repeated introductions in state legislatures year after year show an alarming trend. 

• Study Shows Low Support for Fetal Personhood: 

• Recent analysis from the National Women’s Law Center shows that support for fetal personhood is low. And, the more people learn about its implications, the less supportive they are. The analysis also shows that there is significant  concern around government interference in pregnancy decisions, and that support for abortion and reproductive choice remains high. 

• Emergency Contraception Will Be Available for Free in England: 

• In an effort to reduce healthcare inequalities, England is set to make emergency contraception, or the morning after pill, free. In the United States, emergency contraception is legal and available over the counter at many pharmacies, but the medication’s cost can be a barrier to access. It has also become a subject of significant post-Roe political debate, with some lawmakers inaccurately casting it as an abortion-causing drug and calling for it to be restricted or made illegal. 

• American Doctors Go to Mexico to Receive Abortion Training: 

• American doctors and medical students are turning to other countries, including Mexico, to gain comprehensive abortion training and experience. Even in abortion-supportive states, residents frequently receive minimal abortion training, as medical schools run by large hospitals often take risk-averse approaches to providing training for fear of losing funding or other support. 

REPRODUCTIVE HEALTH DIGEST (3/27/25)

Developments in Abortion, Autonomy, and Access: 

Welcome back to the Reproductive Health Digest, and thank you for bearing with us while we took a week off. We are jumping right back in with important developments in federal and state litigation, legislative changes and challenges across the country, and policy updates that continue to shape American public health. As always, please read on to the end for the news that you need to know. 

Want access to a detailed analysis of the abortion law in every U.S. state and territory? Please view our free Policy Resource Hub for Reproductive Health, an exclusive legal database where we update the state of the law every single day - so you’re always up to speed. 

This Week’s Must Read:

This week’s must-read comes from Jezebel. The piece discusses how restrictions on reproductive care increase the dangers faced by victims of domestic abuse and make the jobs of advocates and supporters more difficult and legally uncertain. As Sara Ainsworth, senior legal and policy director at If/When/How, explained, homicide is the leading cause of death for pregnant people in America and abuse often escalates during pregnancy, but now “between fears for their own safety, or confusion about how these very new, untested laws are going to be enforced,” the work of supporting victims has become a minefield. 

Legislation & Litigation: 

Overview: 

• The Department of Justice has dropped a challenge to Idaho’s total abortion ban under EMTALA; however, St. Luke’s has stepped in as a new plaintiff;  

• On April 2nd, the Supreme Court will hear oral arguments in a case about whether states can deny Medicaid Funding for Planned Parenthood; 

• Kentucky Governor Andy Beshear has vetoed a bill purporting to clarify the state’s abortion ban; 

• A Federal Court has blocked the Trump Administration’s attempt to strip funding for all gender-affirming care for minors; 

• The South Dakota Legislature, alongside several other states legislatures, is attempting to restrict access to citizen-led ballot measures; 

• Texas has arrested a midwife and her colleagues on charges of allegedly providing unlawful abortions; 

• An Arizona court has permanently blocked the state’s 15-week abortion ban, further clearing the way for full implementation of the new constitutional amendment protecting pre-viability access; 

• Wyoming is taking actions to further restrict access to abortion; and 

• Ohio’s ban on gender-affirming care for minors has been blocked by an appeals court.

• The Department of Justice Drops EMTALA Challenge to Idaho’s Abortion Ban: 

• The Department of Justice under the Trump Administration has dropped a Biden-era lawsuit challenging Idaho’s right to restrict emergency abortion care under its abortion ban. For a recap of the history of the case, read here. In anticipation of the Administration’s move, St. Luke’s Health System filed its own lawsuit, preserving the challenge. On Thursday, March 20th, a federal judge issued a preliminary order shielding St Luke's-affiliated clinicians from liability for providing emergency abortions under EMTALA during the pendency of the litigation. 

• Medicaid Funding for Planned Parenthood To Go Before the Supreme Court: 

• The Supreme Court is set to hear oral arguments on April 2nd over Medicaid funding for Planned Parenthood patients. Although federal law requires states to allow Medicaid recipients to obtain care from any qualified provider, South Carolina Governor Henry McMaster has sought to block Medicaid funding for Planned Parenthood, labeling it an abortion clinic. The state concedes that Planned Parenthood providers are competent to provide care. Planned Parenthood provides a broad spectrum of non-abortion related reproductive healthcare including pregnancy and STI testing, prenatal care and preventative care. 

• Although the case plainly arises out of abortion policy, the specific legal issue before the Supreme Court turns on a technical question about whether individual patients can bring suit to enforce the implicated Medicaid provisions. The Court’s ruling in this case will have broad implications outside of the abortion context, impacting access to care for Medicaid patients nationwide. 

• Kentucky Governor Vetoes Abortion ‘Clarification’ Bill: 

• Kentucky Governor Andy Beshear has vetoed a Republican-supported bill that purported to clarify the state’s total abortion ban. The bill set forth a list of emergency conditions wherein a doctor may take action “separating a woman from her unborn child.” However, opponents of the bill argue that no list can adequately account for the complicated medical realities of pregnancy and that bills like HB 90 undermine providers’ independent medical judgment, replacing it with that of non-expert legislators. The Republican supermajority may override Governor Beshear’s veto. 

• A Federal Court has Blocked the Trump Administration’s Executive Order Targeting Gender-Affirming Care:

• A federal judge has extended a block on the Trump Administration’s Executive Order purporting to pull federal funding for medical institutions that provide gender-affirming care to individuals under the age of 19. Judge Lauren King found that the orders improperly encroach upon Congressional authority over federal funding and violate the Equal Protection Clause by discriminating on the basis of sex and transgender status. The Administration’s aggressively implemented anti-trans agenda has faced significant setbacks in courts across the country. 

• South Dakota Legislature Attempts to Restrict Ballot Measures: 

• Lawmakers in South Dakota have introduced several measures to restrict the state’s citizen-led ballot initiative process. Governor Larry Rhoden vetoed one of the proposed changes, which would have required signatures to be gathered from every legislative district, effectively giving any one district veto power over an initiative. A second proposal would move the deadline to submit signatures from May to February of the election year, narrowing the window for activists to gather the necessary number of signatures. This is before the Governor for his signature. A third proposal will go before voters in November, 2026; if passed, it would raise the threshold to pass a ballot measure from a simple majority to 60%. 

• Other states, including Florida, are similarly attempting to tighten access to the ballot initiative process. The Fairness Project warns that over 100 anti-ballot initiative bills have been introduced across 15 different states. This wave of restrictions follows the use of the citizen-led ballot measure process to protect abortion rights in seven states in the 2024 elections. 

• Texas Arrests Midwife and Colleagues for Alleged Provision of Unlawful Abortions: 

• Texas has made its first arrests under its total abortion ban. Houston-area midwife Maria Margarita Rojas and two of her colleagues were arrested for allegedly providing unlawful abortions at three clinics. The clinics have been temporarily shut down, and Rojas’s midwifery license has been suspended. If charged, Rojas could face up to twenty years in prison. 

• These arrests mark an escalation in Texas’s vigorous efforts to enforce its anti-abortion laws. Texas has also brought a lawsuit against New York Doctor Maggie Carpenter, attempting to hold her liable for providing medication abortions to Texans. New York has refused to enforce the judgment against Dr. Carpenter–citing the state’s shield laws. Attorney General Ken Paxton has vowed to prosecute individuals who perform illegal abortions “to the full extent of the law.” 

• Arizona Permanently Blocks 15-week Ban:

• An Arizona court has permanently blocked the state’s previously enforced 15-week abortion ban. Maricopa County Judge Frank Moskowitz held that the 15-week ban was rendered unconstitutional by the passage of a 2024 abortion rights ballot initiative. 

• Abortion Care in Wyoming Further Restricted: 

• Wyoming has instituted new requirements for abortion clinics and providers. Governor Mark Gordon recently signed a bill mandating that facilities that provide abortions be licensed as surgical centers, leading the state’s only remaining abortion clinic to pause care. Although Gordon vetoed a bill requiring pregnant people to have an ultrasound 48-hours prior to receiving a medication abortion, the legislature overrode his veto. Although abortion remains legal until viability in Wyoming, it is functionally extremely difficult to access, with many patients forced to leave the state to obtain care. 

• Ohio’s Ban on Gender-Affirming Care Blocked by Appeals Court:

  • An Ohio appeals court has permanently blocked the state’s ban on gender-affirming care for minors, holding that it is unconstitutional. In a majority opinion authored by Judge Carly Edelstein, the court noted that the state’s ban does not outlaw the use of identical drugs for other purposes–it only does so in the context of gender-affirming care. Judge Edelstein also referred to parents’ rights to make care decisions about their children’s health without excessive interference from the state. The state will pursue an appeal of the decision.

Trend & Policy Watch:

• Texas’ Abortion Ban Has Adverse Impacts on Colorado Patients:

  • Highlighting the ripple effects of abortion bans, a new study from JAMA finds that Texas’s ban has caused delays and disruptions in care for Coloradans. According to the study, Texas’s 2021 ban taking effect caused a surge in demand in Colorado, resulting in Coloradans being 83% more likely to have second-trimester abortions as appointments bottlenecked and care was delayed. 

  • States without abortion bans have taken action to try and address the shortage of providers. In New York, for example, Senator Liz Krueger and Assembly Member Harvey Epstein have introduced a bill to create a state-funded training program. Maryland has similarly started training advanced practice clinicians, including nurse practitioners, to administer abortion care. 

• How State Abortion Policies are Shaping Decision-Making: 

• New data from the Institute for Women’s Policy Research shows how state-level abortion bans and restrictions are impacting individual decision making–particularly for people who plan to have children. In one striking finding, the data showed that one in ten adults have or know someone who has relocated or applied to a job in another state because of a state’s abortion ban. This number doubles for individuals who plan to have children. The research also shows that employees heavily prioritize how their employer handles reproductive health care coverage, meaning that they are less likely to move for or stay in a job where care is not prioritized. 

• Trans Healthcare Preemptively Curtailed In Light of Administration’s Orders:

• Some hospitals and health care providers are preemptively complying with the slew of anti-trans executive orders handed down by the Trump Administration. In response to the Administration’s January Order entitled “Protecting Children From Chemical and Surgical Mutilation,” which seeks to defund gender-affirming care for people under 19, several hospitals across the country have paused or ceased providing such care. Despite the sweeping language of the Administration’s executive order, it does not actually change existing law or supplant state regulations, and it is currently blocked by litigation. Preemptive over-compliance by health care institutions creates unnecessary patient harm and may result in institutions violating state anti-discrimination laws. 

• Appointment of FDA Commissioner Raises Questions About Mifepristone:

• The appointment of Dr. Marty Makary as commissioner for the FDA is raising concerns about the future of mifepristone. During his confirmation hearings, he refused to commit to any action regarding the pill, including preserving access to it. Advocates worry that the Trump Administration will direct the FDA to reassess mifepristone’s availability, despite its exemplary safety and efficacy records. 

REPRODUCTIVE HEALTH DIGEST (2/27/25)

Developments in Abortion, Autonomy, and Access: 

This week’s Digest goes through important litigation developments impacting abortion access in states across the country, including a decision out of Missouri that paves the way for abortion to resume for the first time in years. We also discuss emerging research in the public health space post-Dobbs and policy battles that are ongoing at both the state and federal levels. As we continue to report on the news that is shaping the reproductive health landscape, we encourage you to share this resource with anyone in your own networks who may benefit from its analysis. 

Want access to a detailed analysis of the abortion law in every U.S. state and territory? Please view our free Policy Resource Hub for Reproductive Health, an exclusive legal database where we update the state of the law every single day - so you’re always up to speed. 

This Week’s Must Read:

This week’s must-read story comes out of Missouri, where Republican lawmaker Phil Amato has proposed legislation that would mandate surveillance of pregnant people “at risk” of seeking an abortion. Specifically, the bill would require the state to “maintain a central registry of each expectant mother who is at risk for seeking an abortion . . . and make the same available to a prospective adoptive parent.” It is unclear how the state would define “at risk” pregnant people, but the creation and maintenance of a registry would clearly require surveillance of individuals’ private medical decisions and detailed demographic information. Last year, Missourians passed an abortion rights ballot initiative, legalizing pre-viability abortion; however, anti-abortion lawmakers continue to work to limit the scope of those protections. 

Legislation & Litigation: 

Overview: 

• A Missouri judge has overturned a state abortion clinic licensure requirement, allowing abortion clinics to reopen in the state; 

• Louisiana and Texas are continuing to pursue criminal and civil legal actions against a New York abortion provider; 

• The Eighth Circuit Court of Appeals has issued a ruling allowing a lawsuit challenging the Pregnant Workers Fairness Act’s protections for abortion patients to move forward; 

• An Indiana judge has temporarily blocked individual abortion records from being made public; 

• The Kansas Legislature has overridden Governor Kelly’s veto of a ban on gender-affirming care for minors; 

• The Georgia Supreme Court has sent a case over the state’s abortion ban back to the lower court to reevaluate the plaintiffs’ standing; 

• Montana lawmakers have introduced a bill that would criminalize traveling out of state for abortion care; and 

• GenBioPro, the manufacturer of generic mifepristone, has moved to intervene in the lawsuit challenging the FDA’s approval of the drug.

  Missouri Judge Issues Ruling Allowing Clinics to Reopen:

• A Missouri Judge has issued a ruling striking down the state’s clinic licensure requirement, which had functionally blocked abortion clinics from reopening in the state. Abortion has been largely unavailable in Missouri since 2022, when the Dobbs decision triggered the state’s abortion ban. However, last November, Missourians voted to pass an abortion rights ballot measure, which restored pre-viability access. Despite the passage of this measure, legislation severely restricting the conditions under which abortions could be performed remained on the books, including a requirement that clinics be licensed by the State. This medically unnecessary requirement meant that clinics like Planned Parenthood were unable to resume providing services. The ruling striking this requirement led Planned Parenthood to announce that it would resume services in Missouri. The state is likely to appeal. 

• Louisiana and Texas Continue to Pursue Legal Actions Against New York Doctor: 

• Texas and Louisiana continue to pursue legal actions against New York abortion provider Dr. Maggie Carpenter. Under the protection of New York’s shield law, Dr. Carpenter prescribed abortion pills to patients in Texas and Louisiana - two states with abortion bans in place. Texas brought a civil lawsuit against Dr. Carpenter in Collin County, Texas,  arguing that she violated Texas’s abortion ban and practiced medicine in the state without proper licensure. The Judge in the case issued a default judgment ordering her to pay $100,000 in penalties and enjoining her from continuing to prescribe medication abortion to Texas patients. New York is standing behind Dr. Carpenter and refusing to participate in the out-of-state investigation into her provision of reproductive care, consistent with the requirements of its shield law. 

• Similarly, Louisiana has brought criminal charges against Dr. Carpenter based on her provision of care and is seeking her extradition to the state. New York Governor Kathy Hochul has declined to extradite, saying she would not sign the order, “not now, not ever.” 

• As we have reported on previously, the cases against Dr. Carpenter represent the first legal clashes between abortion ban states and shield law states. They will shape the future of these protections. Although the path forward is unsettled, legal action attempting to force New York’s participation in the out-of-state cases is all but certain.

• Eighth Circuit Allows Lawsuit Challenging Abortion Protections to Move Forward: 

• The Eighth Circuit Court of Appeals has issued a ruling allowing a lawsuit challenging the Pregnant Workers Fairness Act’s application to abortion accommodations to move forward. The PWFA requires reasonable workplace accommodations for pregnant people, including time off for appointments for prenatal care or miscarriage recovery. Under the Biden Administration, the EEOC published guidance explaining that the PWFA’s pregnancy accommodations requirement also requires covered employers to allow time off to obtain an abortion and recover. The rule does not require the employer to pay for the procedure or even provide paid time off. Seventeen states brought a lawsuit challenging the rule, arguing that it illegally broadens the scope of the PWFA. A lower court dismissed the lawsuit for lack of standing; however, the Eighth Circuit revived it, finding that the states have a justiciable interest because they are regulated by the rule. Whittling away at employment protections is one tactic used by anti-abortion states and actors to narrow reproductive freedom and access to care.

• Indiana Judge Temporarily Blocks Abortion Records from Being Made Public: 

• In the last Digest, we reported on Indiana’s dangerous decision to make individual abortion records public and the legal challenge that immediately followed. In a piece of good news, a Marion County judge has issued a temporary restraining order blocking the Indiana Department of Health from releasing the records for at least 10 days, while the case is considered. The providers behind the lawsuit argue that, in light of how few abortions are being performed in Indiana under the state’s ban, the patient information included in a pregnancy termination report could be reverse-engineered to identify individual patients, endangering their safety and privacy interests.

• Kansas Legislature Overrides Governor’s Veto of Gender-Affirming Care Ban:

• The Kansas legislature voted to override Democratic Governor Laura Kelly’s veto of a gender-affirming care ban for minors. Kansas is now the 27th state to attempt to ban such care, and the federal government has issued a slew of orders in the past month tightening restrictions and erasing protections for the trans community. Advocates and families of transgender youth are likely to challenge the law in court. 

• Georgia Supreme Court Sends Case Over Abortion Ban To Lower Court to Reconsider Standing:

• The Georgia Supreme Court is sending a challenge to the state’s heartbeat ban back to the trial court on the question of standing. The ban has been the subject of litigation for several years, with advocates arguing that it is unconstitutional under Georgia’s privacy protections. However, in January, the Georgia Supreme Court issued a decision in a separate case that altered state jurisprudence on the question of third-party standing. In light of that ruling, the justices voted to send the case back to the trial court to reconsider whether the plaintiffs, including lead plaintiff SisterSong Women of Color Reproductive Justice Collective, are properly before the court. 

• Montana Introduces Bill Criminalizing Traveling Out of State for Abortion Care: 

• A bill introduced in Montana would make it a criminal offense to travel out of state to receive abortion care - even when that care is legal. Relying on misleading “trafficking” language, House Bill 609 would criminalize transporting, or aiding a person in transporting, “an unborn child that is currently located in [Montana]” to obtain an abortion that would be illegal in Montana. If passed, this would be the first time that a state has criminalized the act of traveling out of state for legal abortion care. Unlike abortion trafficking bills passed in Tennessee and Idaho, this law is not cabined to assisting minors over state lines; instead, it defines the fetus itself as the trafficked party. 

• At present, Montana allows abortion until fetal viability. However, under HB 609,  if a person were to discover a fetal anomaly later in pregnancy and travel out of state for healthcare, they could be prosecuted and face jail time of up to five years.  Although it is unclear at this time how much support the bill has, at a hearing, two proponents testified in favor of the bill, while over two dozen offered comments opposing it. We will continue to report on this bill as it moves through the legislative process. 
  

• The Manufacturer of Generic Mifepristone Moves to Intervene in Lawsuit:

• GenBioPro, the manufacturer of generic mifepristone, has filed a motion to intervene in Missouri et al. v. FDA, the case previously known as Alliance for Hippocratic Medicine v. FDA. The previous iteration of the case was thrown out by the U.S. Supreme Court for lack of standing. But, Northern District of Texas Judge Matthew Kacsmaryk allowed Missouri, Kansas, and Idaho to continue the suit, despite glaring issues in the states’ standing and venue arguments. GenBioPro seeks to defend the FDA’s approval of mifepristone and preserve access to the drug. 

Trend & Policy Watch:

• ProPublica Reporting Shows Sepsis Rates in Pregnant People Skyrocketed Under Abortion Bans:

  • New reporting from ProPublica shows that rates of sepsis in pregnant Texans have dramatically increased under the state’s abortion bans. Using the methodology detailed in the reporting linked above, their findings showed an increase in sepsis rates of 55% from comparable time periods before and after the state’s first abortion ban went into effect. The “surge was most pronounced in cases in which the fetus may still have had a heartbeat when the patient arrived at the hospital.” Post-Dobbs, countless stories have been reported of pregnant patients being denied miscarriage care until fetal cardiac activity ceases, as their providers fear legal reprisal for acting too early under the law. ProPublica’s reporting is particularly critical as the Texas Maternal Mortality and Morbidity Review Committee has declined to review pregnancy outcomes data for 2022 and 2023. 

• Progressive States Work to Pass Marriage Equality:

• Several states are working to pass ballot measures constitutionally protecting marriage equality amidst rising concerns over the security of lgbtq+ rights. At least nine states have introduced measures aimed at undoing marriage equality protections. Lawmakers in Michigan, Idaho, Montana, North Dakota and South Dakota have called on the Supreme Court to reverse Obergefell, the decision that legalized gay marriage. Four other states have proposed legislation that would create “covenant marriage” - a category of marriage available only between one man and one woman. In response, advocates across the country hope to take the issue directly to the voters via ballot measure, a strategy that is likely to yield success, as data shows that the vast majority of Americans continue to support marriage equality. 

• Comprehensive Update on Policy Developments at the Federal Level: 

• The federal government has undergone a fundamental paradigmatic shift in the past month. Through a slew of executive actions, the government has aggressively targeted trans rights and so-called “gender ideology”, moved to dismantle diversity, equity, and inclusion efforts in the public and private sectors, and attempted to implement widespread funding freezes. For a comprehensive update on where things stand one month into the new administration, read here. 

• Cuts to USAID Threaten the Lives of Thousands of Pregnant People Worldwide: 

• On January 20th, the new administration issued a 90-day pause in U.S. foreign development assistance, halting urgent work worldwide and threatening the lives of thousands of pregnant people. This freeze in funding disrupts critical programs that distribute contraception, provide life-saving healthcare for pregnant women, and facilitate healthcare initiatives for low-income and developing nations. According to Amy Friedrich-Karnik, director of federal policy at Guttmacher Institute, “[e]very single day that the freeze is in place, there are 130,000 women who are being denied contraceptive care.” Guttmacher estimates that if the USAID funding lasts the full 90 days, around 4.2 million women will experience unintended pregnancies, and “8,340 will die from complications during pregnancy and childbirth.” 

• Education Opportunities Around Patients’ Rights and ICE in Healthcare Settings:

• Before we end this week’s Digest, we wanted to uplift two trainings being hosted by coalition partner organizations on the subject of how to protect patients when ICE enters healthcare settings. Please see below for more details:

• On Tuesday, March 4 at 5:30pm PST / 8:30pm EST - Service Employees International Union (SEIU) is hosting a workshop designed specifically to provide healthcare providers with legal guidance and resources for responding to ICE in healthcare settings. Register and join to learn more about how you can assert your rights as a physician while defending patient care.

• On Thursday, March 6 at 5:00pm PST / 8:00 pm EST - Doctors For America (DFA) is hosting a training designed to understand how immigration status impacts healthcare access and how our Healthcare Advocacy Toolkit can be used in clinical settings. Attendees will have a chance to discuss civic engagement with patients and examine potential threats under new federal immigration policies. Register here.

REPRODUCTIVE HEALTH DIGEST (2/13/25)

Developments in Abortion, Autonomy, and Access: 

This week’s Digest dives into ongoing attacks against the trans community from the federal government, proposed legislation regulating abortion and reproductive rights at the state level and litigation developments in state and federal courts. Please read on for the news that you need to know. 

Want access to a detailed analysis of the abortion law in every U.S. state and territory? Please view our free Policy Resource Hub for Reproductive Health, an exclusive legal database where we update the state of the law every single day - so you’re always up to speed. 

This Week’s Must Read:

This week’s must-read from Mother Jones discusses the history of mifepristone and its FDA approval. Post-Dobbs, anti-abortion groups have challenged the legality of the medication in court, arguing that it is unsafe and was rushed through the FDA’s approval process. However, the drug’s actual history tells a different story, revealing how political and social factors around abortion resulted in a much longer and more convoluted approval process than is typical and underscoring the inaccuracy of legal arguments attacking its safety record. 

Legislation & Litigation: 

Overview: 

• Indiana abortion providers file lawsuit to protect patient privacy;

• D.O.J. withdraws from Skrmetti case challenging the constitutionality of bans on gender-affirming care; 

• Colorado and New York shore up shield laws; 

• Missouri lawmakers attempt to overturn newly-passed constitutional protections for abortion; 

• New Hampshire scraps 15-week abortion ban proposal; 

• South Carolina Supreme Court hears oral arguments around the state’s abortion ban; 

• Kansas and Montana consider fetal personhood legislation; and 

• House Republicans introduce a federal abortion ban.

• Providers in Indiana File Lawsuit to Protect Patient Privacy: 

  • Two Indiana doctors have filed a lawsuit challenging the Indiana Department of Health’s agreement to make individual abortion reports public, citing concerns about patient privacy. The two providers are asking the Marion County Superior Court to enter a temporary restraining order blocking the public release of the records on the grounds that, with so few abortions being performed in the state, the information contained therein could be reverse-engineered to determine the identities of individual patients. Following the implementation of Indiana’s total abortion ban, the state began issuing quarterly aggregated data on abortions, in order to preserve patient confidentiality; however, anti-abortion activists have pushed to reverse that policy. The court held an emergency hearing on the matter on February 11th. 

• DOJ Withdraws Its Support for Gender Affirming Care for Minors:

• The U.S. Department of Justice under the new Trump Administration has withdrawn from U.S. v. Skrmetti, the case challenging the constitutionality of gender-affirming care bans for minors. The Supreme Court heard oral arguments in the case late last year, and a change in DOJ’s position on the issue was anticipated in light of the new administration’s extreme anti-trans agenda. The individual plaintiffs in the case remain, and despite its withdrawal, the DOJ has urged the Court to issue a ruling. The Court’s decision, which is anticipated in early summer, will determine the constitutionality of a swath of anti-trans laws nationwide. 

• Colorado and New York Shore Up Shield Laws: 

• Blue states, including Colorado and New York, are shoring up their abortion shield laws as hostile states ramp up efforts to stem the flow of medication abortion across state lines. In New York, a doctor has been sued by the state of Texas and indicted by a grand jury in Louisiana for mailing abortion bills to patients in those states under the protection of New York’s shield law. In response, New York Governor Kathy Hochul has vowed that she will not issue an extradition order for the doctor and signed new legislation allowing individual providers to keep their names off of prescriptions. The legal showdown between New York, Texas, and Louisiana will mark the first true test of the strength of shield laws. 

• In Colorado, Democratic lawmakers are similarly attempting to strengthen their state’s protections. They have introduced legislation that would expand Colorado’s existing laws by 1) anonymizing names on prescription labels; 2) prohibiting local governments from working with out-of-state authorities on issues related to abortion care; and, 3) allowing the state’s AG to “block hostile actions and allow for retaliatory civil lawsuits against states.” 

• Missouri Lawmakers Attempt to Overturn Newly Passed Abortion Protections: 

• Last November, Missourians voted to enshrine abortion rights in the state constitution, becoming the first state to overturn a total abortion ban through the ballot initiative process. However, anti-abortion lawmakers are not content to let the will of the people stand. Instead, they have introduced a new resolution that, if passed, would undo the protections of Amendment 3 and reinstate a total abortion ban, with narrow exceptions for rape, incest, medical emergencies and serious fetal anomalies. Lawmakers behind the new resolution insist that voters did not fully understand the implications of passing the abortion ballot measure. 

• New Hampshire Will Not Pass a 15-week Abortion Ban: 

• A New Hampshire bill that would have instituted a 15-week ban in the state has been withdrawn by its sponsors, who cited a “flaw” in the bill that prevented it from moving forward. Abortion is currently legal until 24 weeks, and although the state’s governor is a Republican, she has vowed to veto any legislation that would further restrict access to care in the blue state. 

• South Carolina Supreme Court Hears Oral Argument Over Heartbeat Bill: 

• Abortion was back before the South Carolina Supreme Court this week for the third time in as many years. On Wednesday, the court heard arguments on the question of whether the state’s ban on abortion after detection of fetal cardiac activity applies at 6 weeks, as previously determined, or at 9 weeks. Planned Parenthood argued that, because the law does not specify 6 weeks, medical terminology must control, and doctors do not consider there to be a fetal heartbeat until at least 9 weeks. They also argued that the use of the word “fetal” weighs in favor of a later cut-off, as 6 weeks gestational age is still medically considered an embryo. During arguments, the judges repeatedly called out the fact that attorneys and advocates on both sides of the law previously referred to it as a 6-week abortion ban, but it is unclear how heavily that history will factor into the court’s ultimate determination. 

• Montana and Kansas Advance Fetal Personhood Legislation:

• Montana, Kansas, and other state legislatures are considering proposed fetal personhood measures, which would grant legal rights to embryos and fetuses. Montana’s proposed law would give embryos legal status from the moment of conception, banning abortion outright, increasing pregnancy criminalization, and interfering with access to IVF. The fact that the bill would disrupt IVF in the state was acknowledged by its sponsor, who stated that he doesn’t have a solution for infertility that doesn’t involve “killing so many human beings.” This anti-IVF argument was echoed by at least one doctor who testified that IVF destroys human lives. 

• In Kansas, lawmakers are attempting to pass a less direct but still concerning fetal personhood bill. HB 2062 would grant pregnant people the right to child support from the moment of conception. Although the anti-abortion groups supporting the bill argue that it will protect pregnant people’s financial security, detractors point out that it would codify fetal personhood into state law and create few rights that do not already exist elsewhere in the state code. 

• House Republican Introduces National Abortion Ban:

  • Missouri Republican Eric Burlison has introduced the “Life At Conception Act” in the House of Representatives. If passed, the bill would codify fetal personhood by extending equal protection rights to fetuses, functionally banning abortion nationwide. The law would throw the legality of IVF into question and create legal uncertainty around proper protocol for miscarriage care and the treatment of other pregnancy-related medical conditions. Although it is highly unlikely to pass, as there is not enough support in Congress for extreme fetal personhood legislation, it is an important political and ideological indicator of how far anti-abortion lawmakers are willing to go.

Trend & Policy Watch:

• Several States Push For Schools to Use Misleading “Baby Olivia” Video as Educational Tool: 

  • Several states are looking to mandate the use of a misleading video about fetal development as an educational tool in schools. The video, featuring “Baby Olivia” was created by anti-abortion groups and shows a medically inaccurate depiction of what takes place in the womb during different stages of pregnancy. 

• Hospitals and Clinics Preemptively Cancel Gender-Affirming Care Procedures: 

• In response to President Trump’s executive orders attacking the trans community, several hospitals have reportedly begun canceling gender-affirming care procedures for individuals under the age of 19. Many of the relevant executive orders are currently being challenged in court, and several state attorneys general have issued warnings that hospitals discontinuing gender-affirming care may be in violation of state anti-discrimination laws. 

• Federal Judge Orders Agencies to Restore Purged Webpages: 

• A federal judge has issued a temporary order requiring HHS, CDC and FDA to restore webpages that were deleted pursuant to a Trump executive order targeting “gender ideology.” The pages deleted included information about HIV treatment and prevention, youth risk behaviors, lgbtq+ health, and contraception. The judge found that the plaintiff, Doctors for America, was likely to succeed in its claim and emphasized that the party who is ultimately harmed is everyday Americans losing access to healthcare information.

• U.S. Military Begins Blocking Transgender People from Entering Service: 

• Newly appointed Defense Secretary Pete Hegseth has begun implementing Donald Trump’s Executive Order attempting to halt the participation of transgender people in the U.S. military. Secretary Hegseth has reportedly directed the military not to integrate new transgender recruits and to block gender-affirming care for current service members. Lambda Legal and the Human Rights Campaign have filed a lawsuit on behalf of trans servicemembers, arguing that the new order is unconstitutional and harms military readiness. 

REPRODUCTIVE HEALTH DIGEST (1/30/25)

Developments in Abortion, Autonomy, and Access: 

This week’s Digest goes through efforts to curtail reproductive rights and bodily autonomy at the federal level, proposed state legislation that would further restrict access to abortion, updates on litigation and constitutional amendments, and a look at the trends that we are watching. Please read on to the end for the news that you need to know.

Want access to a detailed analysis of the abortion law in every U.S. state and territory? Please view our free Policy Resource Hub for Reproductive Health, an exclusive legal database where we update the state of the law every single day - so you’re always up to speed. 

Note: Last year, the “Abortion Laws by State” portion of our Policy Resource Hub was behind a login wall. We have since removed that login requirement, and the Hub is now fully open and available to the public at the above link.

This Week’s Must Read:

This week’s must-read comes from Vermont, where a new lawsuit alleges facts showing that Vermont has been tracking the pregnancies of pregnant people who it sees as potentially unsuitable parents. In an alarming account of pregnancy surveillance and criminalization, the lawsuit sets forth how Vermont’s child welfare agency received unproven allegations about a pregnant woman’s mental health and proceeded to seek and take custody of the unborn child before she was even born. The patient had no idea that custody of her child had been decided without her involvement or consent until her newborn was removed from her care immediately after birth.

Legislation & Litigation: 

Overview: 

• North Dakota abortion ban to remain on hold pending litigation; 

• Lawsuit challenging FDA’s approval and regulation of mifepristone to move forward in Texas-based federal court; 

• Abortion rights are enshrined in the Maryland Constitution; 

• Indiana, North Dakota, Mississippi, Oklahoma, South Carolina, Nebraska, and other states introduce legislation that would further limit reproductive freedom; and 

• The first week of the Trump Administration brings a flurry of executive orders taking aim at bodily autonomy, reproductive rights and health equity.

• North Dakota Abortion Ban to Remain on Hold:

  • Last December, a North Dakota state judge struck down the state’s abortion ban as unconstitutional. In defending its abortion ban, the state asked the North Dakota Supreme Court to allow the law to take effect pending appeal. Last week, the court rejected that request, meaning that the ban will remain blocked. Although this means that abortion technically remains legal until viability, no abortion providers remain in the state, and abortion is only functionally available in emergency situations. 

• Lawsuit Challenging Mifepristone to Move Forward: 

• Judge Matthew Kacsmaryk, a notoriously anti-abortion federal judge out of the Northern District of Texas, has ruled that three Republican states can move forward with their challenge to the legality of the abortion pill mifepristone. Last year, the U.S. Supreme Court threw out the original lawsuit brought by The Alliance for Hippocratic Medicine, finding that the group of anti-abortion doctors and groups lacked constitutional standing to bring their claim, as they were unable to show any injury caused by FDA’s actions. Prior to the Court’s decision, Kansas, Idaho, and Missouri joined the lawsuit in the Northern District, arguing that their states’ interests were harmed by the accessibility of mifepristone. Although the original plaintiffs voluntarily dropped the suit in light of the Supreme Court’s ruling, Judge Kacsmaryk has issued a striking ruling allowing the three states to file an amended complaint and continue the lawsuit in a Texas-based federal court. The continuation of the lawsuit in this way conflicts with decades of well-established precedent regarding jurisdiction, venue, and standing. 

• Abortion Rights Enshrined in Maryland: 

• In November, voters in Maryland passed an abortion rights amendment enshrining the right into the state constitution. Last week, Maryland Governor Wes Moore signed a proclamation officially amending the constitution. Although abortion was already protected by statute in the state, a constitutional amendment provides more permanent and immovable protections. 

• States Take Legislative and Executive Action That Would Limit Abortion Rights: 

• Indiana: Indiana Governor Mike Braun has signed an executive order that strengthens the requirement that pregnancy terminations be documented and individually reported to the state’s Department of Health. Currently, the Indiana DOH reports quarterly aggregated data on abortion. However, anti-abortion groups and lawmakers want to make each individual report public, raising concerns about the ability to reverse-engineer that information to identify abortion patients, as so few abortions are being performed in the state. 

• Indiana, North Dakota, Oklahoma, and South Carolina Introduce Legislation to Prosecute Abortion Patients: At least four states have introduced legislation allowing abortion patients to be prosecuted for homicide. Although abortion restrictions have long involved penalties for abortion providers, the prosecution of the patients themselves has traditionally been a line that anti-abortion actors are unwilling to cross. However, with the national political climate surrounding abortion growing more extreme and an abortion-hostile federal administration in power, state legislators are showing an appetite for more severe and punitive legislation. In addition to these homicide bills, several states have also introduced bills shoring up the idea of fetal personhood. 

• Abortion Trafficking in Mississippi: A Mississippi bill would make it a felony to assist a minor out of state for an abortion. This proposed legislation follows on the heels of Idaho and Tennessee’s similar ‘abortion trafficking’ laws, both of which are currently blocked in whole or in part. 

• Nebraska Restrictions on Medication Abortion: In Nebraska, legislation has been introduced that would make it significantly more difficult to obtain a medication abortion. Under the proposed law, patients would be subjected to a number of non-medically standard requirements, including in-person visits both before and after receiving the medication, and onerous testing and documentation requirements.  

• Trump Administration’s Executive Orders Take Aim at Bodily Autonomy, LGBTQ+ Rights, and Abortion Access: 

• The first two weeks of the second Trump Administration saw a flurry of executive orders, a large swath of which take aim at lgbtq+ rights, health equity and access, and bodily autonomy generally. Although many of these orders will be, or already have been, challenged in court, they reflect a clear federal agenda of rolling back civil rights protections and placing the authority over individual liberties in the hands of the executive branch. 
  
  One of the most striking executive orders declares, in contravention of reality, that there are only two sexes and that sex and gender are unchangeable and immutable, effectively denying the existence of trans and gender-diverse people. The order also contained (scientifically inaccurate) fetal personhood language by defining a woman or a man as a person belonging, at conception, to the sex that produces the large reproductive cell and small reproductive cell, respectively. Following this order redefining sex and gender, the administration also handed down directives banning trans people from serving in the military and attempting to revoke federal funding for any gender-affirming care for people under the age of 19. 
  
  In addition to attempting to roll back rights for LGBTQ+ people, the new administration also issued several orders targeting DEI programs, threatening to enforce a harsh anti-DEI agenda against both the public and private sectors. 
  
  Although the Administration has not yet taken a direct shot at eliminating abortion rights, it has signaled its hostility to reproductive freedom in other crucial ways. One Executive Order, signed on January 24th, orders strict enforcement of the Hyde Amendment, the law prohibiting federal funding from being used for abortion. Additionally, The Administration has reinstated the ‘Mexico City Policy,’ otherwise known as the Global Gag Rule, whereby NGOs that receive funding from the U.S. must certify that they do not promote or provide abortion care. 

Trend & Policy Watch:

• Government Website Offering Reproductive Health Information Taken Offline: 

  • The government-run website Reproductiverights.org appears to have been taken offline in the first week of the Trump Administration. The website was created in 2022 and included information about access to birth control, insurance coverage for preventative healthcare, including HIV and cancer screening, and the legal status of abortion across the states. 

•  Social Media Platforms Censor Access to Abortion Pill Information: 

• Social media platforms Instagram and Facebook are facing scrutiny for censoring, suspending, or blocking posts and profiles related to medication abortion access. For example, Aid Access, a prominent abortion pill provider’s page, was suspended, making it unsearchable even by those who follow them. Hey Jane, Women Help Women and Just the Pill faced similar obstacles. Although Meta stated that the profiles and posts were targeted for violating community standards regarding guns, drugs, and other restricted goods, abortion pills are FDA-approved, commonly used, and entirely legal in many states across the country, and it is unclear how provision of information about the drugs would violate any stated policy. 

• Recent Data Indicates that Support for Access to Medication Abortion is Growing: 

• New data from the Journal of the American Medical Association (JAMA) shows that support for access to medication abortion is growing. A sample of women aged 15 to 49 were surveyed in 2021, before the Dobbs decision, and again in mid-2023; results showed 6% increased support for both access to abortion pills prior to pregnancy, to be taken in the event of a pregnancy, and over-the-counter no-prescription access to the medication. 

• Anti-Abortion Activists Look to Men to Report Their Partners’ Abortions:

• In the years following the Dobbs decision, anti-abortion activists have failed to stem the flow of abortion pills to pregnant people in ban-states. It now appears that the groups are ramping up a strategy of encouraging women’s partners to report them for abortions. According to John Seago, the president of Texas Right to Life, “The strategy right now is to tell dads that if you’re the father of a child victim of an abortion, you have legal rights, there may be a way to hold these people accountable.” Reportedly, the group will use a social media advertising campaign to reach these men. Already, Texas Attorney General Ken Paxton has filed a lawsuit against a New York doctor based on a report from a “biological father” of his partner’s abortion. 

• New Mexico Supreme Court Decision May Tee Up Supreme Court Challenge: 

• In our last Digest, we reported on the New Mexico Supreme Court’s ruling striking down local abortion bans in the state. These local bans rely on an erroneous interpretation of the Comstock Act to attempt to block the sending or receipt of abortion pills through the mail, even in states like New Mexico, where abortion is legal under state law. The ruling from New Mexico’s highest court may allow anti-abortion activists to bring the issue of whether and how Comstock should be enforced to the U.S. Supreme Court, where it could find a favorable audience with the conservative majority. 

• State Department Halts Issuance of New Passports for Trans Americans:

• The U.S. State Department under Marco Rubio has stopped issuing new or renewed passports for transgender Americans seeking to change their gender marker on their documentation. For those who have already submitted their passport application, this means that their critical documents – including their previous passport and birth certificate – are in the possession of the State Department without a clear path for return. Without guidance from the Administration, thousands of Americans are now left in legal limbo, including those who are currently traveling. This action comes in direct response to the new Administration’s Executive Order denying the existence of transgender people and seeking to effect a near-total erasure of their rights and protections. 

REPRODUCTIVE HEALTH DIGEST (1/16/25)

Developments in Abortion, Autonomy, and Access: 

Welcome back and Happy New Year from all of us here at L4GG–we hope that all of our readers had a restful and restorative holiday break. We know that the year before us brings a great deal of legal uncertainty, and we will be working hard to provide as much clarity as possible along the way. This week’s Digest covers some final 2024 developments and the latest news from the first two weeks of 2025. Below, we will discuss litigation developments out of Missouri, South Carolina, Indiana, Idaho, and New Mexico, proposed legislation filed in several abortion-restrictive states, and policy and data trends to watch as we begin a new year and new legislative sessions. Please read on to the end for the news that you need to know. 

Want access to a detailed analysis of the abortion law in every U.S. state and territory? Please view our free Policy Resource Hub for Reproductive Health, an exclusive legal database where we update the state of the law every single day - so you’re always up to speed. 

Note: Last year, the “Abortion Laws by State” portion of our Policy Resource Hub was behind a login wall. We have since removed that login requirement, and the Hub is now fully open and available to the public at the above link.

This Week’s Must Read:

This week’s must-read comes from a late-2024 guide published by ProPublica. The guide outlines in practical terms what pregnant individuals, especially those in ban states, should know about access to miscarriage care. The guide was created in consultation with pregnant people impacted by abortion bans who shared what they wished they had known in order to advocate for themselves and their care.

Legislation & Litigation: 

Overview: 

• Planned Parenthood in Missouri is fighting in court to block licensure laws preventing clinics from reopening; 

• The New Mexico Supreme Court has struck down local abortion bans; 

• The Texas Legislature has pre-filed several bills aimed at removing access to medication abortion; 

• An Indiana provider has filed a lawsuit challenging the state’s abortion reporting requirements; 

• Indiana is considering legislation tightening up its already strict abortion ban; 

• South Carolina providers have filed a religious freedom claim against the state’s abortion ban; 

• Virginia lawmakers are working to enshrine abortion rights into the state’s constitution; and 

• St. Luke’s in Idaho has filed a lawsuit challenging the state’s abortion ban under EMTALA. 

• Missouri’s Abortion Landscape Changes Post-Constitutional Amendment:

• In the November election, Missourians voted to pass Amendment 3, a constitutional amendment enshrining pre-viability abortion rights into the state constitution. Immediately following passage, Planned Parenthood filed a lawsuit challenging the state’s total abortion ban and related care restrictions, arguing that they were rendered unconstitutional by the new Amendment. 

• On December 20, 2024, the court granted a preliminary injunction blocking the abortion ban and multiple restrictions, including biased counseling requirements, certain medication abortion restrictions, a mandatory waiting period, and the telemedicine ban. The Court stopped short of enjoining in-person reporting requirements, same-physician requirements, and physician-only requirements, which bar advanced practice clinicians like nurse practitioners from performing abortions. Importantly, the court also left in place licensure requirements for abortion-providing health centers, which mandate medically unnecessary compliance with standards similar to those for ambulatory surgical centers. These licensure requirements functionally block clinics from reopening and care from resuming in the state. Planned Parenthood has filed a motion asking the court to reconsider, arguing that the licensure requirements discriminate against abortion facilities and patients by imposing onerous restrictions that do not apply to any other medical facility or procedure.

• New Mexico Rules Against Local Abortion Bans:

  • The New Mexico Supreme Court has ruled against local county and town ordinances that seek to ban the sending or receipt of abortion medications. Abortion is legal in New Mexico, and the state serves as a stronghold of access for pregnant patients fleeing abortion-ban states–most notably, Texas. Following the Dobbs decision, several counties along the New Mexico-Texas border passed local ordinances aimed at blocking abortion clinics from accessing or prescribing abortion medications through the mail, citing the 19th Century Comstock Act, a long-dormant vice law that prohibits the mailing of materials used for abortion. These localities were specifically concerned with patients crossing state lines from Texas to access care.

  • Last week, the New Mexico Supreme Court struck down the ordinances on the grounds that they violate the legislature’s authority over the regulation of reproductive health care; it did not reach the constitutional question in the case. Although counties and municipalities have a great deal of latitude to self-regulate, their regulations cannot openly violate state law. The Court found that legal schemes like the ones at issue in this case operate to punish conduct that is affirmatively and preemptively protected by state law.

• Texas Legislature Proposes Bills Targeting Medication Abortion:

  • The Texas Legislature is considering a series of pre-filed bills aimed at eliminating access to medication abortion. Although abortion is banned throughout pregnancy in Texas, some patients have been able to obtain medication abortions through telehealth providers in shield states, or by self-managing their abortions with pills sourced from underground channels. Texas is now attempting to close those avenues to care. 

  • The first of the proposed bills would make it a violation of deceptive trade practice laws to send abortion pills without a prescription from an in-state doctor and a prior in-person examination. Another takes aim at constitutionally protected speech by allowing private citizens to bring lawsuits against internet service providers in the state who host websites with information about how to obtain abortion pills. The third would reclassify mifepristone and misoprostol as controlled substances, making them far more difficult to access, even for non-abortion-related purposes. Louisiana passed a nearly identical reclassification bill last year, and the law has already created challenges for patients experiencing miscarriages and their providers. New Orleans has reportedly had to launch a new tool to help providers locate misoprostol and mifepristone following multiple reports of patients being unable to fill prescriptions necessary to manage medical events such as miscarriage, postpartum hemorrhage, and IUD insertion.

• Indiana Provider Files a Lawsuit Challenging Reporting Requirements: 

  • Indiana doctor Christina Scifres has filed a lawsuit challenging the state’s abortion reporting requirements as a violation of the federal HIPAA Reproductive Health Care Privacy Rule. Promulgated in response to Dobbs, the Rule prohibits the disclosure of patients’ reproductive health care information for the purpose of investigating the receipt or provision of lawful care. Dr. Scifres’ suit argues that the state’s reporting requirements are designed to ensure compliance with the state’s abortion restrictions and identify violations, and are therefore in conflict with the Rule’s federal privacy protections. 

  • The HIPAA Reproductive Health Care Privacy Rule is currently being challenged in two separate lawsuits– one brought by the state of Texas, and the other by an individual Texas doctor. The Rule is at high risk of being modified or rescinded by the incoming Trump Administration.

• Indiana Bill Would Further Restrict Access to Care:

• A bill proposed in Indiana, where a total abortion ban is already in place, would further restrict access to care. If passed, it would outlaw the use of medication abortion, even in the limited cases that fall into one of the ban’s exceptions. It would also add a new requirement to the state’s rape or incest exception, mandating that victims sign an affidavit attesting to the crime perpetrated against them under threat of perjury prior to receiving care. 

• South Carolina Providers File Religious Freedom Challenge to Abortion Ban: 

• A group of South Carolina doctors have filed a federal lawsuit arguing that the state’s ban on abortion after detection of fetal cardiac activity is a violation of their religious freedom. Although the law typically protects a provider’s right to assert moral or religious objections to providing abortion care, this lawsuit flips that argument on its head. The providers argue instead that the law’s narrow provisions, which leave them unsure whether and when they can intervene in patient care in emergencies, violate their religious beliefs regarding care for others and placing their patients’ needs before their own. For example, one of the providers in the lawsuit described a circumstance where a patient came to her needing a pregnancy termination because of a kidney disease; however, the doctor’s hospital refused to approve the procedure, and the patient became more and more sick. This violated the doctor’s sincerely held beliefs and caused her to suffer, knowing that she could have helped her patient, but the law prohibited her from acting consistent with her conscience and training. 

• Virginia Democrats Work to Enshrine Abortion Rights:

• Virginia’s House of Delegates has passed a resolution that, if ultimately successful, would enshrine abortion rights and marriage equality into the state’s constitution. In Virginia, proposed constitutional amendments must be passed twice, “with a legislative election sandwiched between each legislative session,” after which the public can vote on the question. If abortion rights are enshrined in Virginia’s constitution, it will solidify the state as a rare stronghold of abortion access in the otherwise restrictive South.

• St. Luke’s Health System Files Federal EMTALA Lawsuit In Idaho:

• St. Luke’s Health System in Idaho has filed a federal complaint seeking to preserve protections for emergency abortion care, despite the state’s total abortion ban. The Biden Administration filed a similar lawsuit against Idaho in 2022, arguing that the law’s failure to include an exception for the health of the pregnant person violates the Emergency Medical Treatment and Active Labor Act’s (EMTALA) requirement that stabilizing care be provided to any patient in order to preserve their life or health. However, with the incoming change in federal administration, it is likely that the federal government will not continue to pursue the lawsuit against Idaho. Accordingly, St. Luke’s lawsuit seeks to ensure that the state’s ban remains blocked for cases involving emergencies, regardless of the new administration’s actions in the case. 

Trend & Policy Watch:

New Data Shows that Young People Are Moving Away from States with Abortion Bans: 

• New research from the National Bureau of Economic Research suggests that young people are moving away from states with strict abortion bans and restrictions in place. Data shows that before the overturn of Roe, these same states were actually losing fewer residents than other states; however, following the Dobbs decision, the number of single-person households leaving abortion ban states significantly increased. If this change in state-to-state migration patterns continues, it will impact the economic stability of ban states by making it more challenging to attract and retain workers and throwing economic markers like housing markets and tax bases into flux. 

That young people, particularly those who are financially able to relocate, would factor reproductive freedom into their decisions about where to live is consistent with anecdotal evidence post-Dobbs about how decision-making frameworks are changing. The ability to control one’s reproductive journey is integral to life and career planning and stability. And, states that ban abortion are more likely to also take a restrictive approach to other individual liberties, like LGBTQ+ rights and racial and gender equity. 

• Biden Administration Signs Defense Spending Bill that Blocks Care Coverage for Transgender Dependents of Service Members: 

• In late 2024, the Biden Administration signed a version of the National Defense Authorization Act (NDAA) that included a provision banning TRICARE, the military health care program, from covering gender-affirming care for service members’ dependents. The NDAA funds the military for the 2025 fiscal year, and although President Biden signed it into law with the anti-trans provision in place, he stated that he “strongly opposes” the restriction. The restriction, which was pushed through by Republican members of Congress, will deprive thousands of minors of necessary health care.

• Biden Administration Withdraws Proposed Rule for Over-the-Counter Contraceptive Coverage: 

• The Biden Administration has withdrawn its proposal to expand the Affordable Care Act’s requirement that private health insurance plans offer coverage for certain kinds of contraception. The expansion would have required plans to also cover over-the-counter birth control, including the newly FDA-approved OPill. It seems that the withdrawal of the proposed rule came down to a matter of timing, as the rulemaking process–the process by which federal agencies create and amend rules– is complex and time-consuming. The Administration’s notice of withdrawal indicated that the federal departments involved “have determined it is appropriate to withdraw the proposed rules” to “focus[] on other matters.” 

• Texas Doctor Denies Allegations That He Provided Gender-Affirming Care in Violation of State Law: 

• A Texas doctor targeted by Attorney General Ken Paxton has denied allegations that he provided gender-affirming care to minors in violation of state law. Dr. Hector Granados, a pediatric endocrinologist practicing in El Paso, is one of three doctors that Paxton sued over alleged violations of the law last year. Granados was reportedly puzzled when he first heard of the allegations against him, and he has stated that he follows the law and ceased providing gender-affirming care to minors after the state passed its ban.

• Data Shows that Fatal Newborn Abandonments Have Increased Following Texas’s Abortion Ban: 

• New data suggests that since Texas implemented its strict abortion policies, the “rate of abandoned babies in Houston has increased 500%.” Advocates for safe-haven laws, laws that allow new parents to surrender their baby to certain locations without risk of penalty, stress that a lack of education about these laws plays a significant role in the number of abandonment cases, as pregnant people who cannot access abortion care do not know about all other options available to them.

• Washington Aims to Implement Emergency Abortion Protections:

• As fights over emergency abortion care continue in the courts, Washington Governor Jay Inslee has issued a directive requiring the state’s Department of Health to shore up access to emergency abortion care. The rules would prohibit hospitals from 1) withholding care because of a person’s pregnancy and 2) prioritizing continuing the pregnancy or the health of the fetus over the well-being of the pregnant person, unless the patient directs the hospital to do so. 

REPRODUCTIVE HEALTH DIGEST (12/19/24)

Developments in Abortion, Autonomy, and Access: 

As 2024 comes to a close and we prepare for the new year, we are reflecting on everything that happened this year to shape the reproductive rights landscape at the local, state, and federal levels. This year, we saw litigation in federal and state courts over the constitutionality of abortion bans and the scope of state law exceptions to those bans. We also reported on arguments before the U.S. Supreme Court about access to medication abortion and emergency abortion care. During the November election, 7 states passed abortion rights ballot measures, expanding access in their states, while 3 states' measures failed to pass. States have passed highly restrictive, novel legislation that further limits care by creating the crime of “abortion trafficking” and re-classifying mifepristone and misoprostol as controlled substances. Meanwhile, access-protective states have shored up their shield laws and passed bills expanding access to care and reinforcing privacy protections.

In the new year, L4GG remains prepared and committed to fighting for safe, accessible, and equitable health care for all – a fight that we thank you for joining us in. But before we turn the page to 2024, we have some final important reproductive health updates to report on. Please read on to the end for the news that you need to know, and we will see you in 2025.

Want access to a detailed analysis of the abortion law in every U.S. state and territory? Subscribe to our free Policy Resource Hub for Reproductive Health, an exclusive legal database where we update the state of the law every single day - so you’re always up to speed.

This Week’s Must Read:

This week’s must-read comes from the Marshall Project’s investigation into a pattern of hospitals reporting pregnant patients for positive drug tests after administering standard medications for pain, anxiety, or blood pressure management during childbirth. The report details stories of patients who temporarily lost custody of their children after being given drugs like morphine or fentanyl in their epidurals and subsequently reported for positive drug tests. In one story, an Oklahoma woman was reported for testing positive for methamphetamine, and her children were removed from her custody and placed in foster care–only for a confirmation test to prove that the positive result was caused by heartburn medication prescribed in the hospital. 

At a time of increasing pregnancy criminalization and surveillance, stories like these highlight the urgency of preserving patient privacy and separating the therapeutic patient-clinician relationship from the criminal justice system.

Legislation & Litigation: 

• Texas Challenges New York Shield Law: 

• In a landmark piece of litigation, Texas Attorney General Ken Paxton has filed a civil lawsuit against a New York doctor for prescribing medication abortion pills to a woman in Texas. The lawsuit seeks up to $250,000 in damages and marks the first open challenge to abortion rights “shield laws.” These laws, enacted by about 26 states post-Dobbs, seek to protect providers from civil, criminal, and professional consequences related to the provision of reproductive or gender-affirming health care. New York's law is one of several that not only protects care delivered in the state but also attempts to shield providers who send pills into ban states. 

• The use of telehealth for medication abortion has been a lifeline for pregnant people in states with restrictions in place, and regardless of its final holding, this lawsuit will have a chilling effect on would-be prescribers. It will also test the strength of shield laws in court for the first time, pitting New York’s protections against Texas’s restrictions. It is unclear what the outcome will be, but Texas will argue that providers not licensed in Texas are facilitating illegal abortions within its borders, while New York will argue that its state laws permit the provision of that care and block Texas from imposing liability. If Texas is able to succeed in its own courts, New York will then likely argue that it does not have to enforce that judgment within New York state borders. This case will have a broad impact on shield law development and usage nationwide, and we will continue to report on the story as the litigation advances. 

• Supreme Court Agrees to Hear Case About Medicaid Funding for Planned Parenthood: 

• The Supreme Court has agreed to hear a case out of South Carolina challenging Medicaid funding for Planned Parenthood’s non-abortion services. In 2018, South Carolina’s Governor determined that abortion clinics were not qualified Medicaid providers for non-abortion family planning and health care services, including cancer screening, exams, and contraceptive counseling and provision. Planned Parenthood sued, arguing that the state had erred in concluding that it was not a qualified Medicaid provider, and the Fourth Circuit Court of Appeals agreed. The Court will hear the narrow question of whether the Medicaid Act’s any-qualified provider provision confers a private right upon a Medicaid beneficiary to choose a specific provider. The outcome of this case will have significant consequences for decades-long efforts to defund Planned Parenthood at the state level. 

• Oral Arguments Heard in Idaho Case About Emergency Abortion:

• Earlier this year, the U.S. Supreme Court threw out a challenge to Idaho’s abortion law under the Emergency Medical Treatment and Active Labor Act (EMTALA), sending it back to the lower courts. The case centers around questions of federal preemption, as Idaho’s abortion ban only permits abortion to save the life of the patient, and EMTALA federally obligates hospitals receiving Medicare funding to provide stabilizing care to patients to preserve their life or their health. Sometimes, that care is an emergency abortion. At this time, Idaho’s law is blocked for cases of emergency abortions under EMTALA. \

• Last week, the Ninth Circuit Court of Appeals, the federal appellate court over Idaho, heard arguments in the case. The panel appeared divided, with several of the judges seeming skeptical of the state’s argument that it could supplant federal law with a state abortion ban and others asking questions indicating interest in the idea that EMTALA includes a fetal personhood mandate that creates an equal duty of care to both the patient and the fetus or embryo. Zooming out, it is important to remember that this case is not about overturning Idaho’s abortion ban and restoring access in the state. It is about Idaho’s right to defy federal law in order to deny pregnant patients abortions in narrow circumstances in which the patient's health, but not their life, is in jeopardy. 

• It is not clear when the Ninth Circuit will issue its ruling; however, it is possible that the incoming Trump Administration will drop the lawsuit altogether. In that case, providers, medical groups, or groups of patients could attempt to keep the litigation alive. 
  

• Idaho Abortion Trafficking Ban Partially Reinstated: 

• Idaho’s abortion trafficking law, which criminalizes assisting a minor out of state to obtain an abortion without their parent's consent, has been partially reinstated by the Ninth Circuit Court of Appeals. The law, which was passed in 2023, was blocked while the courts considered its constitutionality. Specifically. The law imposes a prison sentence of 2-5 years on individuals who “recruit,” “harbor,” or “transport” a minor out of state with the intention of helping them obtain an abortion. In its Opinion, the Court found that the provisions relating to ‘harboring’ or ‘transporting’ a minor is likely constitutional and can go into effect, but blocked the prohibition on ‘recruitment,” holding that it swept too broadly and could apply to First Amendment-protected speech including legal advice, the provision of information and mere encouragement of or support. 

• Tennessee has passed a nearly identical abortion trafficking law that is currently blocked by litigation, and other states have introduced or are considering such legislation. The Ninth Circuit’s ruling will likely inform the crafting of future restrictions in other states and will almost certainly create a chilling effect on those who might otherwise help family members or friends to obtain lawful out-of-state abortions. 

• Missouri Abortion Rights Amendment Held up in Court: 

• In the November election, Missouri became the first state to successfully vote to overturn a total abortion ban using the ballot initiative process. The day after the election, Planned Parenthood filed a lawsuit challenging the existing ban and related restrictions, and in a subsequent hearing, it asked the court to freeze the ban so that care could resume. The judge has not yet issued a ruling, leaving abortion functionally unavailable in the state for the time being. Missouri Attorney General Andrew Bailey has stated that the new amendment, which legalizes abortion until viability, renders the total ban unconstitutional, but he argues that other medically unnecessary restrictions, such as waiting periods, should remain in place. Meanwhile, the Missouri legislature has introduced a slate of bills that would restrict access to abortion, including one that asks voters to define life as beginning at conception. Lawmakers are also attempting to raise the threshold for the future passage of citizen-led ballot measures, presumably in response to the passage of the abortion rights measure. 

• Arizona Advocates File Lawsuit to Remove 15-week Ban: 

• Abortion is now available in Arizona until fetal viability following the passage of the state’s abortion rights ballot measure. Although providers have resumed providing abortions until viability, the amendment remains subject to litigation, as advocates argue that it renders the previous 15-week ban unconstitutional. This process of unwinding existing bans will have to play out in every state that has passed an amendment expanding care beyond what was previously statutorily permitted. 

• Supreme Court Hears Oral Arguments About Gender-Affirming Care Bans: 

• On Wednesday, December 4th, the U.S. Supreme Court heard oral arguments in U.S. v. Skrmetti, a case challenging the constitutionality of Tennessee’s ban on gender-affirming care for minors. The Biden Administration and the plaintiffs argue that the ban violates the Equal Protection Clause by unconstitutionally discriminating on the basis of sex. 26 states currently have bans on gender-affirming care for minors in place, and the arguments in Skrmetti mark the first time that the high court has taken up the issue. The outcome of the case will not only determine the legality of bans on gender-affirming care but will signify the court’s inclination to further narrow privacy and bodily autonomy rights post-Dobbs. 

• During arguments, the justices appeared split, with several of the traditionally conservative justices questioning whether the law discriminates on the basis of sex (despite its overt references to biological sex) and appearing skeptical of the well-established science and research supporting gender-affirming care. Other justices, perhaps most notably Justice Ketanji Brown Jackson, peppered the attorney for Tennessee with questions about how a law that facially discriminates on the basis of a person’s biological sex cannot be considered a sex-based classification that triggers heightened scrutiny. The arguments also included lines of questioning about the history of discrimination against the transgender community, primarily interrogated by Justice Barrett. The attorney for Tennessee also argued that any policy disagreement with the bans should be sorted out through the democratic process, prompting Justice Sotomayor to comment that it is difficult for a group that makes up less than 1% of the population to garner the political capital needed to protect their rights through the democratic process. 

• The case will likely be decided by the summer, and its outcome will have far-reaching implications. Notably, while the Supreme Court mulls over the question of Tennessee’s ban, Montana’s Supreme Court upheld an injunction on its gender-affirming care ban, finding that it is likely unconstitutional and interferes with an individual’s rights “to make medical judgments affecting her or his bodily integrity and health in partnership with a chosen health care provider.” 

• Ohio Attorney General Appeals Ruling Striking State Abortion Ban: 

  • Ohio Attorney General Dave Yost is appealing a decision striking the state’s 6-week abortion ban as unconstitutional in light of Ohioans’ passage of an abortion rights ballot measure last year. Although the 6-week ban was passed in 2019, it only briefly went into effect post-Dobbs, and, by the Attorney General’s own admission, it was invalidated by the abortion rights amendment. Regardless, the State continues to expend resources defending it, arguing that certain restrictions on abortion should remain in place.

Trend & Policy Watch:

• South Carolina Legislators Introduce Bill to Punish Abortion with the Death Penalty: 

• South Carolina legislators have once again introduced a bill that would classify abortion as homicide, subjecting patients who terminate their pregnancies to the possibility of the death penalty. This is not the first time that this legislation has been introduced, and although it is unlikely to pass, it is a critical reminder of what is at stake in this fight. If passed, the bill would not penalize miscarriages; however, that would still mean that individuals under investigation would have to somehow prove the circumstances surrounding their pregnancy loss. Since Dobbs, we have seen countless stories of pregnant patients in emergencies being denied medical care as their providers justifiably fear severe penalties under abortion bans. Thus far, however, states have stopped short of criminalizing the patient themselves–doing so would dangerously chill patients from seeking care for pregnancy complications or loss, endangering their lives and health. 

• Nebraska Constitutionally Enshrines its Abortion Ban: 

• Nebraska’s Governor has officially signed proclamations affirming the passage of an amendment enshrining the state’s 12-week abortion ban into the constitution. As a reminder, voters in November had two competing abortion amendments before them – one would have expanded access until viability, while the other enshrined the current 12-week ban, with exceptions for rape, incest, or life of the patient, but no exception for fetal anomalies. The anti-choice measure passed, but questions remain about the impact of misleading tactics employed by anti-choice groups.

• Texas Will Not Report on Maternal Deaths for 2021-2024: 

• The Texas Maternal Mortality Committee has announced that it will not review deaths from 2021 to 2023, stating as justification that it wants to examine the most contemporary cases. This decision faced backlash, as the years in question cover the implementation of the state’s 6-week and total abortion bans and represent the most significant change in reproductive health policy in the state of Texas in decades. Clear data about the impacts of abortion bans on maternal health care is critical for lawmakers, medical personnel, and advocates alike. And the state’s failure to adequately examine the clinical fallout of its bans does a disservice to anyone whose care was impacted by the change in law. 

• Michigan Proposes Legislation to Protect Reproductive Health Data Privacy: 

• In response to the incoming administration and increased concern about abortion and pregnancy surveillance, the Michigan legislature is looking to shore up privacy protections for reproductive health data. Governor Whitmer is supporting a bill that would, among other things, require businesses to only use tracked reproductive health data for the service the business or organization provides and inform users of how their data may be used. Signed consumer consent would be required prior to a user’s data being sold. Importantly, the bill would also prohibit the use of location information and ad targeting that could be used to identify individuals visiting reproductive health care clinics. Similar preemptive plans for state-level protections for abortion and health care are underway in several states across the country. 

• Congress Advances Defense Bill with Anti-Trans Provision: 

• Congress has passed a version of the National Defense Authorization Act (NDAA) that includes a provision banning TRICARE, the military health program, from covering gender-affirming care for the dependents of service members. With an incoming administration that ran on an anti-trans rights platform, federal restrictions on care are likely to increase in the coming years. The Supreme Court’s ruling in the Skrmetti case, discussed above, will play a significant role in shaping the outcome of future anti-trans legislation. 

• Ohio Legislature Sends ‘Parents Bill of Rights’ to Governor’s Desk: 

  • The Ohio legislature has passed a so-called ‘parents bill of rights”; it will now go to the governor’s desk, where it is expected to be signed. The law requires schools to notify parents if a student requests to be called by a different pronoun or asks for counseling. It also requires parents to be notified about instruction involving “sexuality content,” which the bill defines as instruction relating to “sexual concepts or gender ideology.” Advocates for LGBTQ+ youth warn that this kind of legislation is dangerous for youth and takes away their ability to go to a trusted adult for support without fear of their safety and privacy being jeopardized.

REPRODUCTIVE HEALTH DIGEST (11/27/24)

Developments in Abortion, Autonomy, and Access: 

This week’s Digest is coming to you a little earlier and shorter than usual as a result of the upcoming holiday, but we still have a great deal of news to cover. Anti-abortion groups have begun bringing lawsuits challenging state abortion protections, access-friendly states are responding to the election with multiple strategies to strengthen their abortion rights guardrails, and ProPublica has reported on yet another death resulting from Texas’s abortion bans. Please read to the end for the news that you need to know. 

Want access to a detailed analysis of the abortion law in every U.S. state and territory? Subscribe to our free Policy Resource Hub for Reproductive Health, an exclusive legal database where we update the state of the law every single day - so you’re always up to speed.

This Week’s Must Read:

Unfortunately, this week’s must-read is yet another report of a woman killed by a state abortion ban. Propublica reported this week on the preventable death of 35 year old Porsha Ngumezi. When Ngumezi began experiencing significant bleeding 10 weeks into her pregnancy, she drove to an emergency room in Sugar Land, Texas, where it became clear that she was having a miscarriage. Despite heavily bleeding for hours, she was not offered a D&C–a standard procedure to complete a miscarriage that allows the uterus to close and bleeding to stop. ping bleeding. Instead, she was given misoprostol, a medication that is effective for low-risk miscarriages but may not be fast acting enough for cases involving a medically unstable patient. Ngumezi’s cause of death was found to be hemorrhage. 

Texas doctors face up to life in prison for violating the state’s abortion law. Although the Texas legislature seeks to lay the blame for harm resulting from the ban at the feet of doctors, the state cannot write, pass and vigorously defend a vague, non-medical abortion ban that threatens doctors with life in prison and then claim ignorance or feign confusion over the well-documented consequences of that law.

Legislation & Litigation: 

• Minnesota Anti-Abortion Groups Suing Over State’s Abortion Protections:  In Minnesota, a group of ‘pregnancy health centers’ doctors and individuals have filed a federal lawsuit challenging Minnesota’s abortion laws, which are some of the most accommodating in the country. In a lengthy complaint, the plaintiffs allege that the state’s laws violate the Fourteenth Amendment, because they interfere with the constitutionally protected relationship between parent and child–in other words, they argue that abortion is analogous to termination of parental rights. The lawsuit also makes certain fetal personhood arguments, including that Minnesota’s abortion laws deprive pregnant patients of the protection of the state’s murder statute, which criminalizes the intentional killing of a fetus in utero, with an exception for abortion. 

• Illinois Anti-Abortion Groups Bring Lawsuit Over State’s Coverage Requirement: The Thomas More Society, a conservative legal firm, has filed a lawsuit on behalf of several anti-abortion groups challenging Illinois’ requirement that insurance companies cover abortion. The lawsuit makes several arguments, including that the requirement violates the plaintiffs’ constitutional right to freely exercise their religious beliefs. The complaint also alleges that the rule violates the federal Comstock Act, because telehealth abortions are covered under the Illinois requirements. With the change in administration and the likely installment of anti-abortion politicians in key cabinet positions, legal challenges to abortion protections are likely to increase in frequency. 

• Wyoming Abortion Ban Judged Unconstitutional: Wyoming Judge Melissa Owens has struck the state’s total abortion ban and its ban on medication abortion as unconstitutional. Although the two laws have never gone into effect as a result of ongoing litigation, In her November 18th ruling, Judge Owens  found that the laws violate Wyoming’s constitutional provision guaranteeing  citizens the right to make their own healthcare decisions. Ironically, that constitutional amendment was originally passed in response to the state’s concerns about the Affordable Care Act, or Obamacare. 

• Federal Appeals Court Allows Indiana’s Ban on Gender Affirming Care for Minors: The Seventh Circuit Court of Appeals  has ruled that the state’s ban on gender-affirming care for minors is likely to pass constitutional muster and can go into effect. Their ruling overturns the district court’s order blocking the State’s prohibition on hormone therapy and puberty blockers for minors from going into effect, while allowing it to enforce its prohibition on gender-affirming surgeries. The plaintiffs’, a group of transgender minors and their families and medical providers, challenged the constitutionality of the ban, arguing that it discriminates against transgender minors without sufficient governmental justification. The Court disagreed, declining to “constitutionalize” what it erroneously characterized as a “heavily debated medical treatment.” Nearly every major medical association supports gender-affirming care as a safe and effective treatment for transgender individuals.

Trend & Policy Watch:

• Texas Proposes Legislation to Limit Access to Websites that Host Abortion Information: Texas Representative Steve Toth has once again introduced legislation that, among other things, would prohibit internet providers in Texas from hosting websites that provide information about abortion. The law specifically targets abortion funds.  If passed, it would make it a criminal offense to pay or reimburse “costs associated” with abortion, and would prohibit merely providing information on how to obtain medication abortion. The bill's intended purpose of chilling any speech related to abortion, regardless of whether the speech is constitutionally protected, and criminalizing those who might help someone obtain an abortion is revealing of how far anti-choice lawmakers will go if they can garner the political capital. And despite broad anti-choice insistence that abortion is best left to the states, this proposed legislation fits a growing pattern of ban states attempting to stop their citizens from obtaining resources, information, or support to travel out of state and obtain lawful care. 

• Texas Looks to Reclassify Abortion Drugs as Controlled Substances: Texas appears to be following Louisiana’s lead in attempting to pass a law reclassifying mifepristone and misoprostol as controlled substances. The two drugs, commonly used for medication abortions, and have excellent safety and efficacy records.  the states attempts at reclassification will place burdensome restrictions on accessing the drugs even in non-abortion related contexts. Doctors have explained that these burdens place patient care at risk.  

• Georgia Maternal Mortality Review Board Disbanded: Georgia has disbanded its Maternal Mortality Review Board, following reporting from ProPublica on two Georgia women who died as a result of the state’s abortion ban. Public Health Commissioner Dr. Kathleen Toomey stated that the information shared with ProPublica violated state law and confidentiality requirements, although an investigation has not identified how the information regarding the deaths was disclosed. Although the state will reopen applications for the committee soon, concerns have been raised about the chilling effect that the disbanding may have on information sharing and the loss of critical data that may occur while the MMRC is disbanded. 

• Maryland Expands Abortion Care Training: Maryland is implementing a program to train more advanced practice clinicians, including registered nurses, to provide abortion care. This training will help meet the needs of patients in rural counties that currently lack abortion providers and is responsive to the increase inpatients traveling to Maryland from states with abortion bans.   

• ACOG Guidance on Self-Managed Abortion: The American College of Obstetricians and Gynecologists has released new guidance on best practices for clinicians treating patients who may have undergone self-managed abortions (SMA). The guidance is aimed at preserving the sanctity of the clinician-patient relationship, preserving patient privacy and reducing risks of criminalization.   

• Oregon Stockpiling the Abortion Pill: In anticipation of an incoming administration hostile to abortion rights, Oregon has stockpiled enough abortion pills to last through 2028. Governor Tina Kotek has expressed her continued commitment to securing reproductive freedom for Oregonians, even as the federal landscape changes. 

• Anti-Abortion Groups Make Their Post-Election Goals Known: Post-election, Students for Life of America, a powerful anti-abortion group, has released its “Make America Pro-Life Again” agenda. The wishlist prioritizes restricting access to medication abortion restricting funding for abortion, including by reinstating a previous Trump Administration rule prohibiting Title X clinics from counseling patients about abortion. 

• Texas Challenge to Heartbeat Bill Could Be Thrown Out: Texas abortion rights advocates have been challenging the constitutionality of the state’s 6-week abortion ‘bounty-hunter’ law since 2021. Despite success at the state trial and appellate level, the Texas Supreme Court has now issued a ruling finding that the lower courts failed to consider whether the abortion rights plaintiffs had proper standing to bring their challenge. The case will now go back before the Third Court of Appeals for consideration of that question.

REPRODUCTIVE HEALTH DIGEST (11/15/24)

Developments in Abortion, Autonomy, and Access: 

We took a hiatus from our bi-weekly Digest last week while everyone’s attention was focused on voting, the election results, and processing what those results mean for the future of reproductive health and justice. This week, we are back to report on the wins and losses with state abortion rights ballot measures, update you on new and ongoing litigation, and walk through policy trends that we are watching as we prepare for a new federal administration. Please read on for the news that you need to know. 

Want access to a detailed analysis of the abortion law in every U.S. state and territory? Subscribe to our free Policy Resource Hub for Reproductive Health, an exclusive legal database where we update the state of the law every single day - so you’re always up to speed.

This Week’s Must Read:

Media coverage of reproductive rights news this week has largely revolved around the election results; however, in the interim since our last Digest, ProPublica published two reports of Texas women who died as a result of the state’s abortion bans. These women, Josseli Barnica and Nevaeh Crain, should not have lost their lives, and if they had been able to receive the care that their doctors were trained to provide, they would still be here with their families. Instead, Texas’s extraordinarily harsh anti-abortion laws and climate of fear and criminalization meant that their doctors were unable to intervene to save them. 

Nevaeh Crain, 18, died of sepsis during a miscarriage. Prior to her death, she was sent home from two different hospitals despite her rapidly worsening condition and clear signs of infection. Josseli Barnica, 28, suffered a similar fate when she began experiencing a miscarriage at 17 weeks pregnant. Instead of receiving prompt care for her miscarriage, the medical team was forced to wait until there was no fetal heartbeat. As a result of that delay, Barnica developed a preventable infection and died days after delivery. 

As we face an uncertain future for reproductive freedom, we must keep these women’s names and stories in mind. It is our obligation, even in the face of immense setbacks, to continue this fight to ensure that what happened to them is not forgotten and is never repeated.

Ballot Initiatives:

Last week, 10 states voted on abortion rights. 7 out of those 10 states passed their measures, enshrining protections for reproductive rights into their state’s constitutions. The results of each race are discussed below. 

• Arizona

• Arizonans voted to pass Proposition 139, enshrining pre-viability abortion rights into the state constitution. The measure also requires that post-viability abortion be permitted when necessary to preserve the physical or mental health of the pregnant person. Currently, abortion is banned in the state after 15 weeks; however, earlier this year, the Arizona Supreme Court issued a ruling finding that an 1864 total abortion ban was enforceable. Although that ban was subsequently repealed legislatively, the court’s actions likely galvanized support for passing constitutional protections for reproductive health care. 

• Colorado: 

• Although abortion is already legal in Colorado, voters passed an amendment enshrining those protections into the state constitution. In addition to prohibiting state and local governments from impeding a person’s right to access abortion, the ballot measure also rolls back an old rule barring the use of state funds for abortion. Combined with the state’s shield laws, the new amendment solidifies Colorado’s status as a stronghold for reproductive rights. 

• Florida:

• After a hard-fought race, Florida’s abortion rights ballot measure unfortunately did not pass. Florida has an unusually high passage threshold, requiring 60% of the vote. “Yes” votes on the measure garnered just over 57%, and the amount of support that the measure received at the ballot box is indicative of the continued popularity of abortion rights. The measure’s near-passage is particularly commendable in light of the state’s relentless attempts to block it, utilizing nearly every lever of government. Abortion will now continue to be banned in the state after 6 weeks. 

• Maryland: 

• Similar to Colorado, Maryland’s laws already protect the right to abortion care; however, enshrining those rights in the constitution strengthens them and substantially protects them from changing state administrations. To that end, voters in Maryland passed its abortion rights ballot measure last week. It creates a fundamental right to reproductive freedom in the state and prohibits the state from interfering with that right either directly or indirectly. This language will likely make it more difficult for anti-choice legislators to pass TRAP laws that have the purpose and effect of making access more difficult, even while it remains legal. 

• Missouri: 

• Missouri is the only state with a total ban to pass an abortion rights ballot measure, restoring pre-viability abortion rights for Missourians. Once in effect, the measure will protect abortion rights pre-viability and bar governmental discrimination based on reproductive healthcare. Early reports indicate that Planned Parenthood in the state is hoping to resume abortion services as early as December. 

• Nebraska: 

• In Nebraska, where two competing measures were on the ballot, voters unfortunately passed an anti-choice measure enshrining the state’s current 12-week abortion ban. The other measure, which would have protected abortion rights pre-viability failed to pass. Throughout the ballot measure process, there has been reporting about signature gatherers engaging in willfully misleading conduct to misrepresent the 12-week measure as a pro-choice amendment and questions remain as to whether confusion played a significant role in the outcome of the election. 

• Nevada: 

• Nevadans voted to approve a ballot measure protecting abortion rights pre-viability; however, because of the state's procedural requirements for amending the constitution, it will require another passing vote in 2026 prior to the constitution actually being amended. Abortion is currently legal until viability in the state. 

• New York:

• In New York, voters passed a landmark state equal rights amendment. In addition to protecting abortion rights, it will prohibit discrimination on the basis of pregnancy, pregnancy outcomes, and reproductive healthcare decisions, as well as ethnicity, national origin, age, disability, sexual orientation, gender identity, and gender expression. This creates a critical legal foundation for protecting the equal protection, privacy, and due process rights of New Yorkers from both in and out-of-state government interference. 

• South Dakota: 

  • In South Dakota, an abortion rights ballot measure that would have effectively codified the Roe standard did not pass. Abortion will continue to be totally banned in South Dakota.

Legislation & Litigation: 

• Wisconsin Hears Oral Argument on 1800’s Ban: 

• This week, the Wisconsin Supreme Court heard oral arguments on the question of reviving an 1849 abortion ban that was previously struck as unenforceable. Sheboygan County District Attorney Joel Urmanski asked the high court to overrule that decision. However, with the election of Justice Janet Protasiewicz, the court currently has a liberal majority and is likely to rule against the ban. During oral arguments, the justices appeared unpersuaded that a 175-year-old law, enacted when women had zero political agency, should supersede a duly passed 1985 law prohibiting abortion post-viability. The justices will soon hear a separate case on whether the state constitution protects the right to abortion. 

• Ohio Strikes Down 6-Week Ban: 

• Following last year’s passage of Ohio’s abortion rights amendment, a judge has struck down the state’s ban on abortion after 6-weeks. Judge Christian Jenkins found that the ban was unconstitutional in light of the new amendment and issued a permanent injunction on its enforcement. This process of challenging legislation in light of newly passed abortion rights amendments will be repeated throughout the other states that passed amendments during last week’s election. 

• Louisiana Faces Lawsuit Over Abortion Pill Reclassification: 

• Louisiana is facing a lawsuit over the state’s reclassification of abortion medication drugs mifepristone and misoprostol as controlled substances. The reclassification places medically unnecessary restrictions on the drugs and makes it more difficult to access them in emergency situations, like postpartum hemorrhage. The plaintiffs in the case point to the fact that abortion is already entirely banned in Louisiana and argue that the reclassification does nothing to advance abortion restrictions, but instead places unnecessary burdens on the healthcare system, which will inevitably harm patients and providers. You can read the complaint in full here. 

• Biden Administration Pushes Back in Ongoing Mifepristone Lawsuit: 

• The Biden Administration is opposing Idaho, Missouri and Kansas’s attempt to revive the Alliance for Hippocratic Medicine lawsuit seeking to restrict access to mifepristone. The case, which went up to the Supreme Court earlier this year, was thrown out for lack of standing–meaning that the original plaintiffs could not show that they were actually injured by the FDA’s approval of mifepristone, and the case has to be dismissed. Now, Idaho, Missouri, and Kansas are seeking to revive the case with an Amended Complaint. However, the Biden Administration and the defendants in the case correctly argue that the three states, who do not independently have standing, cannot intervene in a case where the original plaintiffs have been found to lack standing. And, even if the states could somehow create standing where there is none, they are not properly venued in the Northern District of Texas, as none of the events related to the lawsuit occurred there, nor are the defendants or plaintiffs located there. 

• Pregnant Kentucky Woman Challenges State’s Abortion Bans:

  • A pregnant Kentucky woman seeking abortion care has filed a lawsuit challenging two of the state’s abortion bans. She argues that the laws in question infringe on the state’s constitutionally protected rights to privacy and self-determination. In addition to vindicating her own legal rights, she is seeking to certify a class of all pregnant people in Kentucky who are unable to access abortion, alleging that all suffer medical, constitutional, and irreparable harm as a result of the laws. The challenged bans prohibit abortion at all gestational ages and subject providers to criminal prosecution if they are found to be in violation.

Trend & Policy Watch: 

• The Biden Administration Proposes Expanded Birth Control Coverage: The Biden Administration has proposed a new rule that would expand Affordable Care Act coverage for birth control. The rule would require private health plans to cover over-the-counter birth control without cost sharing, and improve coverage for prescription birth control. As the country faces the looming potential of a federal abortion ban, access to low or no-cost birth control is critical. 

• Parental Rights and Abortion: In the run-up to last week’s election, anti-abortion activists and politicians continued the rhetoric that expanding abortion rights would detract from parental rights. This is a messaging strategy that has been employed to push back against both abortion rights and trans rights for minors. And while it may be an effective tactic, it is not accurate. The passage of abortion ballot measures does little to affect state requirements for minors obtaining care, and minors in every state already have the right to circumvent parental notice and consent requirements via the judicial bypass system. 

• Texas and Trans Rights: Odessa, a small Texas city, has passed an ordinance authorizing a $10,000 ‘bounty’ on transgender people using the bathroom that correlates with their gender identity. Mimicking the state’s abortion bounty hunter law, it grants individual citizens a private right of action to bring suit, with no need to show that they have suffered any harm. This continues an alarming trend of Texas taking aggressive state and local steps to curtail the rights of the LGBTQ+ community. Recently, Texas began rejecting name and gender changes on drivers’ licenses and collecting information on those who request such changes. And, A.G. Paxton has filed several lawsuits against doctors that he alleges have provided gender-affirming care in violation of the state’s ban. 

• Amarillo Voters Reject Anti-Abortion Measure: Voters in Amarillo, Texas have soundly rejected a city-level abortion travel ban. If passed, the proposal would have made it unlawful to use city roads to travel out of state to obtain legal abortion care–effectively attempting to trap abortion seekers in state. Although the Amarillo measure lost by a wide margin of 20 points, other counties in Texas have already passed abortion travel bans. 

• Connecticut Abortion Hotline: In the wake of last week’s election and the reality of an incoming abortion-hostile administration, Connecticut has taken steps to launch a hotline offering free legal advice to residents seeking reproductive health care information. The hotline will be staffed by attorneys from major law firms across the state.

• Georgia Woman Tells Story of Miscarriage Under an Abortion Ban: Another woman has spoken out about her experience of being unable to receive timely and efficient miscarriage care during an acute health crisis. In this case, Avery Davis Bell suffered a second-trimester miscarriage and was forced to wait for hours while her condition deteriorated to a point where her care team could legally intervene. She survived–but not before losing significant amounts of blood. She was also required to consent to Georgia’s 24-hour abortion waiting period, because the doctors remained unsure about whether she was sick enough in the eyes of the law to waive the requirement.  You can read her story here. 

• Emergency Contraception Sales Surge: In the wake of last week’s election, sales of emergency contraception have surged. Reportedly, Winx Health saw a 966% increase in sales of the morning-after pills in the days after the election, and Wisp, a reproductive telehealth company, had a 1000% increase from November 5-6.

REPRODUCTIVE HEALTH DIGEST (10/24/24)

Developments in Abortion, Autonomy, and Access: 

This week’s Digest goes through reproductive rights litigation developments out of Tennessee, Texas, Florida, and Washington, ballot initiative updates as election day looms closer, and developments in health equity policy, research, and politics. Please read on to the end for the news that you need to know. 

If you are interested in learning more, join L4GG’s Reproductive Justice Staff Attorney Alyssa Morrison, Professor Ederlina Co, and Senior Staff Attorney for the ACLU of Southern California Minouche Kandel for a free webinar discussing recent developments in a post-Roe legal landscape. You can register for that here. 

Want access to a detailed analysis of the abortion law in every U.S. state and territory? Subscribe to our free Policy Resource Hub for Reproductive Health, an exclusive legal database where we update the state of the law every single day - so you’re always up to speed.

This Week’s Must Read:

This week’s must-read comes from the Intercept’s reporting on drug-sniffing dogs intercepting abortion pills being sent through the mail in Mississippi. With the rise of abortion bans, abortion seekers, particularly those in ban states and rural areas, increasingly rely on medication abortion, telemedicine, and self-managed abortion to access care. The use of narcotic-detection dogs to ensnare those sending or receiving abortion pills by mail presents a dystopian view of what a future of increased pregnancy surveillance would look like. 

Legislation & Litigation:

• Tennessee’s Abortion Ban:  The Tennessee Chancery Court in Davidson County ruled last week that the life or health exception to the state’s total abortion ban lacks clarity and must encompass certain specific conditions. The court found that providers cannot be disciplined for performing an abortion in cases of preterm premature rupture of the membranes (PPROM), dilation of the cervix prior to viability, and fatal fetal diagnoses that severely threaten the pregnant person’s life or health. The court stopped short of issuing a broad order permitting doctors to perform emergency abortions in accordance with their good faith medical judgment. 

• Florida Battles over Abortion Ballot Measure: Floridians Protecting Freedom, the group behind the push for Florida’s abortion rights ballot measure, is fighting back against attempts by the State to defeat the amendment. Led by Florida Governor Ron DeSantis, Florida’s Health Department issued cease-and-desist letters to local news channels earlier this month threatening prosecution if they continued to air an ad in support of Amendment 4. Floridians Protecting Freedom filed a lawsuit arguing that the state’s actions are a clear First Amendment violation. In a strongly worded order, federal Judge Mark E. Walker agreed, condemning the state’s actions as political censorship and writing “[t]o keep it simple for the State of Florida: it's the First Amendment, stupid.” Notably, the former general counsel of the Florida Health Department resigned a week after the letters were sent, stating that “a man is nothing without his conscience.” 

  On Tuesday, lawyers for the Florida Department of Health filed the state’s opposition to Floridians Protecting Freedom’s request for a temporary injunction, arguing that the group’s ad contains false factual information and is not protected by the First Amendment. 

• Two Conflicting Cases about Access to Mifepristone: Washington Attorney General Bob Ferguson and the attorneys general of 18 other states have filed a motion for summary judgment in support of access to mifepristone. They are urging a federal judge to rule without a trial that the FDA’s restrictions on the use of mifepristone for medication abortions are unlawful. In their motion, they point to decades of evidence and scientific consensus about the safety and efficacy of the drug and argue that the current restrictions are unnecessary and unsupported by credible evidence. 

  While Washington, joined by a coalition of abortion-supportive states, urges the judiciary to increase access to mifepristone, the states of Kansas, Missouri, and Idaho are attempting to revive the Alliance for Hippocratic Medicine’s legal efforts to restrict access to the drug. In a proposed amended complaint, filed in front of Judge Matthew Kacsmaryk in the Northern District of Texas, Amarillo Division, the three states ask the Court to, among other things, reinstate in-person dispensing requirements and roll back use of the drug from 10 weeks to 7 weeks gestational age. The states argue that they have standing where the previous plaintiffs did not because access to medication abortion frustrates state abortion bans and law enforcement efforts. 

• Texas Man Drops Wrongful Death Lawsuit Against Ex-Wife’s Friends: Texas man Marcus Silva, who sued his ex-wife’s friends for helping her obtain an abortion, has dropped his lawsuit, with no resolution in either party’s favor. The lawsuit was brought with the help of anti-abortion attorney Jonathan Mitchell, the architect of Texas’s unique abortion ‘bounty hunter’ law. Silva alleged that his ex-wife’s two friends had participated in a conspiracy to bring about the wrongful death of “Baby Boy Silva” by helping her obtain abortion medication to terminate her pregnancy.  He argued that self-managing an abortion constitutes murder under Texas law. The two friends countersued Silva, alleging that he knew about the pills and did nothing to stop the abortion, and his wife purportedly produced text messages showing him using the threat of the lawsuit as a bargaining tool to get back together. 

  Although the case was nearing trial, both sides have now dropped their suits. Despite the outcome, these kinds of cases are deeply dangerous; they allow abusers to weaponize state law to control and intimidate their partners. Attorneys like Mitchell have built entire careers out of bringing lawsuits that sow fear and confusion with the purpose of deterring individuals from accessing care.

Ballot Initiatives:

• Fundraising for Abortion Ballot Measures: Data shows that abortion-rights ballot measures nationwide have raised almost 8 times as much as anti-abortion groups. However, whether this spending will translate into success on election day remains to be seen. Uncertainty is particularly high in Florida, where a 60% passage rate is required for the amendment to succeed. With only weeks left until election day, it is more important than ever that we collectively work to educate, advocate, and organize in our communities about the importance of access to comprehensive reproductive health care. 

• Florida Department of Health Interferes with Ballot Initiative: The Florida Department of Health has sent a cease and desist letter to a local TV station over an ad promoting the abortion rights ballot initiative that will appear before voters in November. The ad depicts a Florida woman telling the story of how she was diagnosed with a brain tumor while pregnant and needed an abortion in order to save her life. The state’s cease and desist letter threatens criminal charges and argues that the ad is misleading in its implication that the state’s abortion ban places pregnant people’s lives and health in jeopardy. This latest attempt by the Florida government to block Amendment 4 comes on the heels of reporting about police officers going to people’s homes to inquire about the validity of their signatures in favor of the amendment petition.

Trend & Policy Watch:

• North Carolina Election: Abortion rights advocates in North Carolina are hopeful that this year’s election will yield down-ballot votes for democratic candidates supportive of abortion rights. Currently, Republicans hold a supermajority capable of overriding Democratic Governor Roy Cooper’s veto. If the makeup of the legislature remains the same, it is likely that more abortion restrictions will be passed into law during next year’s legislative session. 

• Maternal Healthcare and Extreme Heat: Rising heat levels induced by climate change are worsening maternal health conditions and outcomes in the U.S., particularly for black women. Extreme heat increases the risks of pregnancy complications, including hypertension and cardiovascular conditions, and maternal mortality. As climate change worsens, it will compound pre-existing inequities in related areas like public health, a reality that lawmakers attempting to craft solutions must contend with.  

• Idaho and Gender-Affirming Care: Idaho Attorney General Raul Labrador has announced that he is investigating the American Academy of Pediatricians in relation to gender-affirming care for minors. In the letter, he argues that providers should not be permitted to recommend gender-affirming care to the parents of trans children, arguing that such care amounts to “medical experimentation on children.” This position contradicts vast medical consensus demonstrating the safety and efficacy of gender-affirming care for gender-diverse individuals. 

• Military Readiness and Anti-LGBTQ+ Policies: House Democrats argue that provisions relating to LGBTQ+ service members and their dependents should be removed from Congress’s annual defense bill. The provisions include restrictions on gender-affirming care, pride flags, drag performances, and educational materials that depict gender non-conforming individuals. Opponents of these provisions argue that they are discriminatory, entirely unnecessary, and detract from military readiness and retention by forcing service members to worry about their health, their families, and their safety rather than focusing on their jobs. 

• Anti-Abortion Researchers Sue Over Retraction: Anti-abortion researchers whose studies were heavily relied upon in the lawsuit attempting to revoke the FDA’s approval of mifepristone have sued academic publisher Sage for retracting several of the studies. The studies purported to show that mifepristone is not safe for use in medication abortion. However, Sage based its retractions on discovery of serious methodological flaws and undisclosed conflicts of interest, such that the authors’ conclusions were rendered unreliable. The researchers allege that they have suffered severe reputational damage as a result and ask Sage to come to the arbitration table and rescind the retractions. They are represented by Alliance Defending Freedom (the group behind the lawsuit challenging the FDA’s approval of mifepristone) and conservative law firm Consovoy McCarthy. 

• Texas OB-GYNs Considering Leaving the State: A new report from Manatt Health details how the state’s total abortion ban is impacting reproductive healthcare providers. A majority of OB-GYNs do not feel that they can provide the highest-quality care to pregnant patients under the current law, and 1 in 5 has considered leaving the state. Providers have been leaving ban states across the country, and medical students are less likely to matriculate to those states, worsening healthcare deserts and provider shortages. Research indicates that abortion bans are causing significant professional stress as doctors fear legal repercussions for providing standard care. 

• U.S. Supreme Court’s New Term:The U.S. Supreme Court began its term this week. For a rundown of important cases before the Court in the coming months, including a case that will determine the future of gender-affirming care and the reach of Dobbs, read here.

REPRODUCTIVE HEALTH DIGEST (10/10/24)

Developments in Abortion, Autonomy, and Access: 

This week’s Digest details litigation developments in Georgia, California, Texas, and Guam, as well as the reclassification of mifepristone and misoprostol as controlled substances in Louisiana. We also walk through policy and political developments in the reproductive health landscape. Please read on to the end for the news that you need to know.

Want access to a detailed analysis of the abortion law in every U.S. state and territory? Subscribe to our free Policy Resource Hub for Reproductive Health, an exclusive legal database where we update the state of the law every single day - so you’re always up to speed.

This Week’s Must Read:

Reproductive rights and justice are deeply intersectional issues, impacting and being impacted by nearly all other issue areas. At present, we are witnessing how the effects of climate change are worsening an already fraught healthcare landscape in the South, as Florida, North Carolina, and Georgia grapple with the effects of Hurricane Helene and Hurricane Milton. You can read about how these extreme weather events are impacting access to care, here. 

Legislation & Litigation:

• Georgia Abortion Ban Struck and Reinstated: In the last two weeks, Georgia’s 6-week abortion ban was struck down by the Fulton County Superior Court and then swiftly reinstated by the state supreme court. 
  
  On September 30th, Fulton County Superior Court Judge Robert McBurney issued an order striking Georgia’s 6-week abortion ban as unconstitutional, briefly allowing abortions to resume until about 22 weeks gestational age. In his opinion, Judge McBurney held that women have a right to pre-viability abortion, writing that “the liberty of privacy means that [the pregnant person] alone should choose whether to serve as human incubators for the five months leading up to viability[;] it is not for a legislator, a judge, or a Commander from the Handmaid’s tale to tell [them] what to do with their bodies during this period.” He also criticized an originalist approach to interpreting the state constitution that inherently excludes women and people of color, explaining that “any rooting around for original public meaning from that era would yield a myopic white male perspective on an issue of greatest salience to women, including women of color.” 
  
  Although Judge McBurney’s opinion was a win for reproductive rights and allowed a brief respite for pregnant people in the state, it predictably was swiftly overturned by the Georgia Supreme Court. Georgia Attorney General Chris Carr immediately asked the state supreme court to place Judge McBurney’s decision on hold pending appeal, and on Monday the high court granted that request. Georgia providers have resumed practicing under the 6-week ban. 

• California Sues Hospital for Failing to Provide Care: California Attorney General Rob Bonta filed a lawsuit against a Catholic hospital challenging their alleged refusal to provide emergency abortion care to a woman whose water broke at 14 weeks. Although her pregnancy was nonviable, and the doctors confirmed that the twin fetuses would not survive, the hospital would not provide care based on an apparent policy of not performing abortions when there is detectable fetal cardiac activity.  The woman was sent away with a bucket of towels for the car ride, and she subsequently hemorrhaged before receiving care at another hospital in the area. A.G. Bonta alleges that the hospital’s actions amount to discrimination against pregnant patients and violate state law requiring hospitals to provide emergency care. He is seeking a court order requiring the hospital to cease denying medically necessary abortions. 
  
  Although several individual women have filed lawsuits against hospitals based on their failure to provide emergency care, this case appears to be the first time that a state has taken a hospital to court. It is also a reminder that even in states like California where abortion is legal and protected, dangerous barriers to accessing care still exist.  

• Louisiana Classifies Abortion Medications as Controlled Substances: Louisiana’s classification of common medication abortion drugs mifepristone and misoprostol as controlled substances took effect on October 1st. Doctors have warned about the consequences for patient care of classifying these substances in the same category as drugs like Valium and Xanax. In many cases, drugs like misoprostol need to be immediately available for miscarriage care or to treat acute conditions like postpartum hemorrhage. However, once a medication is classified as a controlled substance, it must be locked away in a specific location, requiring specific procedures for access, and a distinct patient order. In response to the reclassification, doctors have described running drills to see how long it will now take to get the medications to patients who need them. 
  
  Abortion is already banned in Louisiana, and these drugs do not carry a risk of abuse or dependency; their classification is a purely political move designed to make easier the criminalization of abortion seekers and those who might help them. Although anti-abortion activists tout these kinds of policies as pro-life, the medical reality is that locking these drugs away makes pregnant patients less safe in a clinical setting and erects unnecessary barriers to standard reproductive health care. 

• Supreme Court Allows Texas to Block Emergency Abortions: The Supreme Court has declined to hear a Texas case about how federal requirements for emergency care intersect with the state’s total abortion ban. After the Dobbs decision overturned Roe, the Biden Administration issued guidance advising that hospitals must continue to provide emergency stabilizing care consistent with the Emergency Medical Treatment and Active Labor Act (EMTALA), including abortion care if that is what is medically indicated, regardless of state abortion bans. Texas responded by filing a lawsuit arguing that the Administration’s guidance was improper.  The lower courts agreed. The Fifth Circuit wrote that EMTALA does not govern the practice of medicine and does not require pregnancy termination. The Court went further by opining that EMTALA imposes “equal stabilization obligations” to both the mother and the fetus, putting doctors in the position of choosing whose care to prioritize while failing to understand the reality that fetal care depends on maternal care. 
  
  This case is extremely similar to Moyle v. United States, a case out of Idaho that the Supreme Court dismissed without considering the merits of the issue months ago. In declining to take the case out of Texas, the Court has once again passed on an opportunity to answer the urgent question of whether patients have a federal right to abortion in emergency life-endangering circumstances. The court’s failure to answer this question is an abdication of its duty and places the lives of pregnant people in ban states in jeopardy. 

• The Supreme Court Declines to Hear Abortion Case out of Guam: The U.S. Supreme Court has declined to hear a case aimed at overturning abortion rights in Guam. The case, brought by Attorney General Douglas Moylan, asked the Court to overturn a Guam Supreme Court ruling finding that a 1990 total abortion ban has been repealed by the Guam legislature. In other words, A.G. Moylan sought to reinstate the abortion ban, and the Supreme Court’s refusal to hear the case means that the 1990 abortion ban remains blocked. Guam attorney Anita Arriola responded with a statement that A.G. Moylan’s appeal to the Supreme Court was a “vain bid” to “further his own agenda at the expense of the people of Guam,” and that it demonstrated “how far he is willing to go to strip Guamamians of their rights and freedoms.” 

• Texas Attorney General Sues City of Austin:  Texas Attorney General Ken Paxton has brought a lawsuit against the city of Austin based on its budget allocation of $400,000 for supporting reproductive health by reimbursing individuals who are forced to travel out of state. Although traveling to obtain legal abortion care is entirely lawful, A.G. Paxton argues in the lawsuit that the funds are improper as they do not serve the public interest. Mayor Kirk Watson responded with a statement that “Ken Paxton is once again exploiting the great power of his office to attack and undermine the fundamental rights of women to try and score a few political points in the process.”
  

Ballot Initiatives:

• Fundraising for Abortion Ballot Measures: Data shows that abortion-rights ballot measures nationwide have raised almost 8 times as much as anti-abortion groups. However, whether this spending will translate into success on election day remains to be seen. Uncertainty is particularly high in Florida, where a 60% passage rate is required for the amendment to succeed. With only weeks left until election day, it is more important than ever that we collectively work to educate, advocate, and organize in our communities about the importance of access to comprehensive reproductive health care. 

• Florida Department of Health Interferes with Ballot Initiative: The Florida Department of Health has sent a cease and desist letter to a local TV station over an ad promoting the abortion rights ballot initiative that will appear before voters in November. The ad depicts a Florida woman telling the story of how she was diagnosed with a brain tumor while pregnant and needed an abortion in order to save her life. The state’s cease and desist letter threatens criminal charges and argues that the ad is misleading in its implication that the state’s abortion ban places pregnant people’s lives and health in jeopardy. This latest attempt by the Florida government to block Amendment 4 comes on the heels of reporting about police officers going to people’s homes to inquire about the validity of their signatures in favor of the amendment petition.

Trend & Policy Watch:

• North Carolina Election: Abortion rights advocates in North Carolina are hopeful that this year’s election will yield down-ballot votes for democratic candidates supportive of abortion rights. Currently, Republicans hold a supermajority capable of overriding Democratic Governor Roy Cooper’s veto. If the makeup of the legislature remains the same, it is likely that more abortion restrictions will be passed into law during next year’s legislative session. 

• Maternal Healthcare and Extreme Heat: Rising heat levels induced by climate change are worsening maternal health conditions and outcomes in the U.S., particularly for black women. Extreme heat increases the risks of pregnancy complications, including hypertension and cardiovascular conditions, and maternal mortality. As climate change worsens, it will compound pre-existing inequities in related areas like public health, a reality that lawmakers attempting to craft solutions must contend with.  

• Idaho and Gender-Affirming Care: Idaho Attorney General Raul Labrador has announced that he is investigating the American Academy of Pediatricians in relation to gender-affirming care for minors. In the letter, he argues that providers should not be permitted to recommend gender-affirming care to the parents of trans children, arguing that such care amounts to “medical experimentation on children.” This position contradicts vast medical consensus demonstrating the safety and efficacy of gender-affirming care for gender-diverse individuals. 

• Military Readiness and Anti-LGBTQ+ Policies: House Democrats argue that provisions relating to LGBTQ+ service members and their dependents should be removed from Congress’s annual defense bill. The provisions include restrictions on gender-affirming care, pride flags, drag performances, and educational materials that depict gender non-conforming individuals. Opponents of these provisions argue that they are discriminatory, entirely unnecessary, and detract from military readiness and retention by forcing service members to worry about their health, their families, and their safety rather than focusing on their jobs. 

• Anti-Abortion Researchers Sue Over Retraction: Anti-abortion researchers whose studies were heavily relied upon in the lawsuit attempting to revoke the FDA’s approval of mifepristone have sued academic publisher Sage for retracting several of the studies. The studies purported to show that mifepristone is not safe for use in medication abortion. However, Sage based its retractions on discovery of serious methodological flaws and undisclosed conflicts of interest, such that the authors’ conclusions were rendered unreliable. The researchers allege that they have suffered severe reputational damage as a result and ask Sage to come to the arbitration table and rescind the retractions. They are represented by Alliance Defending Freedom (the group behind the lawsuit challenging the FDA’s approval of mifepristone) and conservative law firm Consovoy McCarthy. 

• Texas OB-GYNs Considering Leaving the State: A new report from Manatt Health details how the state’s total abortion ban is impacting reproductive healthcare providers. A majority of OB-GYNs do not feel that they can provide the highest-quality care to pregnant patients under the current law, and 1 in 5 has considered leaving the state. Providers have been leaving ban states across the country, and medical students are less likely to matriculate to those states, worsening healthcare deserts and provider shortages. Research indicates that abortion bans are causing significant professional stress as doctors fear legal repercussions for providing standard care. 

• U.S. Supreme Court’s New Term:The U.S. Supreme Court began its term this week. For a rundown of important cases before the Court in the coming months, including a case that will determine the future of gender-affirming care and the reach of Dobbs, read here.

REPRODUCTIVE HEALTH DIGEST (9/26/24)

Developments in Abortion, Autonomy, and Access: 

This week’s Digest begins by featuring the devastating recent reports from ProPublica about the deaths of two Georgia women as a result of the state’s abortion ban. We also discuss litigation outcomes in Arizona, North Dakota and Tennessee, developments with abortion ballot initiatives, and policy updates. Please read to the end for the news you need to know. 

Want access to a detailed analysis of the abortion law in every U.S. state and territory? Subscribe to our free Policy Resource Hub for Reproductive Health, an exclusive legal database where we update the state of the law every single day - so you’re always up to speed.

This Week’s Must Read:

Last week, ProPublica released two breaking stories of women who lost their lives to Georgia’s abortion ban. These women’s deaths were both entirely preventable had they received the care that they desperately needed and deserved. We remember them and recommit to fighting for full, accessible abortion access, in their names.

Amber Thurman died of complications related to sepsis after the hospital failed to provide her with a simple and standard procedure to remove retained fetal tissue after a legal medication abortion. She leaves behind a 6-year-old son. 

Candi Miller was a mother of three who suffered from a systemic illness that her doctors told her made pregnancy dangerous for her health. Miller sought to self-manage her abortion after becoming unexpectedly pregnant at 41, but when the abortion did not expel all of the fetal tissue, she did not go to the hospital for fear of Georgia’s laws. Without those laws, she would have received the simple treatment that she needed, and her children would still have their mother.

Unfortunately, we know that while these may be the first direct deaths reported post-Dobbs, they will certainly not be the last. Anti-abortion activists are already exploiting these women’s stories to push lies about the dangers of taking abortion pills, arguing that it was abortion, not abortion bans, that killed Candi and Amber. However, complications due to self-managed abortions are a known, infrequent risk that is always treatable with proper medical care. Further, D&Cs are a standard, safe and common treatment for both abortions and miscarriages, and we owe it to these women to tell the truth about their deaths: but for Georgia’s abortion ban, they would both be alive and with their families today. 

Amber and Candi’s lives mattered. Their families’ suffering matters. Their stories matter. We have an obligation to honor their memories by continuing to speak up and speak out to ensure that what happened to them can never happen again.

Legislation & Litigation:

• Arizona 1864 Abortion Ban Repealed: Arizona’s 1864 abortion ban has officially been repealed. The state’s supreme court issued a ruling earlier this year finding that the Civil War-era law, written before Arizona even had statehood, was an enforceable abortion ban. However, after some political maneuvering, legislators voted to repeal the law, with Governor Katie Hobbs signing the repeal bill. Abortion is currently legal until 15 weeks gestational age; however, In November, Arizonans will have the opportunity to vote on whether to enshrine abortion rights into the state’s constitution. 

• North Dakota Abortion Ban Repealed: As we reported on in our last Digest, North Dakota Judge Bruce Romanick issued a ruling striking down the state’s abortion ban as unconstitutional. Today, he signed an order officially repealing the ban. Shortly after the order was handed down, attorneys for the state filed a motion asking the court to allow the ban to remain in place until the state supreme court can hear the case. A hearing on that motion is set for October 10. 

• North Dakota and the Pregnant Workers Fairness Act: Two weeks after a North Dakota judge struck down the state’s abortion ban, federal Judge Daniel Traynor issued an order finding that over 8,000 Catholic employers are relieved from compliance with requirements under the Pregnant Workers Fairness Act to provide time off for IVF treatments and abortion. Judge Traynor ruled that the federal government cannot enforce those rules against the Catholic Benefits Association and the Catholic Diocese in Bismarck during the pendency of litigation. In the opinion, Judge Traynor found that the regulations likely infringed upon the Catholic employers’ freedom of religion. He employed openly religious language, writing that “[i]t is a precarious time for people of religious faith in America,” and describing the “dire assessment” that the current American climate  “has been described as a post-Christian age.” To be clear, the challenged rules would not require employers to pay for IVF or abortions or to even provide paid time off; it neutrally requires that employers accommodate time off for pregnancy-related conditions, which have been interpreted to include IVF and abortion. 

• Tennessee Abortion Trafficking Law Blocked:

  In a piece of good news out of the South, a federal judge has issued a preliminary injunction

  blocking Tennessee’s ‘abortion trafficking’ law, which went into effect earlier this summer. The law, which is written using broad imprecise language, criminalizes assisting a minor out of the state to obtain an abortion without the consent of their parent; the minor’s own consent to the abortion is not a defense to prosecution. In fact, the law still applies in cases where the minor’s parent is the one who impregnated them–allowing the perpetrator to pursue charges. Judge Aleta Trauger ruled on First Amendment overbreadth grounds, writing that the plaintiffs “do not just have a right to speak their message; they have a right to live in a state where that message can be repeated by all who find it valuable to all who wish to hear it. Otherwise, there would be no actual freedom of speech—just freedom of a few speakers to address a silenced populace. The First Amendment guarantees more[.]” Tennessee’s law mirrors a nearly identical Idaho law that has also been temporarily blocked.
  

Ballot Initiatives:

• Nebraska: The Nebraska Supreme Court has ruled that both the state’s pro-choice ballot initiative and the anti-abortion initiative will appear before voters in November. Opponents of the pro-choice measure, which would enshrine pre-viability abortion rights, brought a lawsuit arguing that it violated the state’s requirement that each measure contain only one subject. They alleged that the measure contained three subjects: 1) abortion pre-viability; 2) abortion post-viability; and 3) women’s health. The court rejected this argument, writing that the “fact that the drafters…have made certain choices regarding the specific limits, parameters, and definitions does not mean that each such provision is a separate subject.” These kinds of last-minute legal arguments to invalidate ballot measures before November are happening in nearly every red state with abortion on the ballot. 

• Arizona Polling: A New York Times/Siena College poll now shows that 58% of state voters support the pro-choice ballot measure that will be on Arizona’s November ballot; Arizona requires only a simple majority for a measure to pass. 

• South Dakota: In South Dakota, a trial over the validity of a pro-choice ballot initiative will not happen until after the November election, at which point voters will have made their choice. The delay in trial appears to be due to a scheduling mixup with the court. If passed, the amendment would effectively codify the Roe trimester framework.

Trend & Policy Watch:

• 56% Rise in Texas Maternal Mortality: New research from the Gender Equity Policy Institute shows a shocking rise in maternal mortality in Texas following the state’s enactment of abortion bans. From 2019 to 2022, “the rate of maternal mortality cases in Texas rose by 56%, compared with just 11% nationwide during the same time period.” Although there was a national spike in maternal mortality during the COVID-19 pandemic, deaths in Texas continued to rise sharply, surpassing national averages, after the state passed SB8, its notorious pre-Dobbs heartbeat bill. Texas’ abortion ban means that more women are forced to remain pregnant, regardless of pre-existing or developing risks to their health. And, with the bans in place, and doctors leaving ban states en masse, pregnant people are less likely to seek and obtain maternal care. This increase in maternal mortality is accompanied by a rise in fetal and infant deaths, as pregnant people are forced to carry doomed pregnancies to term.

• Abortions Fell Nationwide After Florida Enacted Ban: Research from The Guttmacher Institute shows the nationwide impact of Florida’s 6-week abortion ban. Prior to the 6-week ban taking effect, abortion was legal in Florida until 15 weeks, making it a critical access point for abortion seekers in the South. However, following the 6-week law’s enforcement, the average number of abortions nationally fell by over 7%, with more than a third of that being directly correlated to Florida’s ban. In November’s election, Florida could revive access to abortion in the state and reopen a crucial option for pregnant Southerners if its abortion rights ballot measure passes.  The initiative requires 60% of the vote to pass into law. 

• Nevada and Medicare Funding for Abortion: Abortion is currently legal in Nevada until ‘viability;’ however, gestational limits are not the only barriers to accessing care. For many, the ability to pay for an abortion is an insurmountable obstacle. Following a favorable court ruling finding that the denial of coverage violated state equal protection laws, Nevada will now become the 18th state to allow Medicaid funds to be used for abortion care, supporting access for lower-income patients. This is a huge step forward for the bodily autonomy and self-determination of Nevadans.  

• Pregnancy Criminalization Post-Dobbs: A new report from Pregnancy Justice, an organization that tracks and fights pregnancy criminalization, found that in the first year after Dobbs, 210 pregnant people “faced criminal charges for conduct associated with pregnancy, abortion, pregnancy loss, or birth.” This is the highest number recorded in a single year. The majority of the cases occurred in states with fetal personhood laws on the books and involved substance use while pregnant, regardless of whether any actual evidence of harm to the fetus was present. However, several of the cases also involved the criminalization and investigation of miscarriages that happened outside of a medical setting–an incredibly common occurrence. In addition to opening the doors for states to pass abortion bans and restrictions, the Dobbs decision also appears to have empowered law enforcement and prosecutors to act more boldly in investigating and criminalizing pregnancy outcomes and conduct while pregnant. 

• Traveling for Abortion Care: For those trapped in abortion-ban states, traveling to obtain care can be a legally and logistically treacherous endeavor. Patients must navigate a complex web of legal restrictions and requirements, while coordinating travel, child care, time off work, and expenses. States are also attempting to restrict the right to travel to obtain lawful healthcare. Idaho and Tennessee have already passed “abortion trafficking” laws that criminalize helping a minor across state lines to obtain an abortion without parental consent (both of those laws are currently blocked by court orders). And, a number of Texas towns have enacted abortion travel bans that make it unlawful to use their roads to travel for abortion care. In practice, these Texas city ordinances, as well as state-level abortion trafficking laws for minors, are likely legally unenforceable, but the fear and intimidation are the point. 

• Congress and Emergency Abortion Care: This week, Senate Democrats attempted to advance a resolution federally guaranteeing the right to emergency medical care, including abortion, on the heels of reporting about the deadly consequences of abortion bans. However, Senator James Lankford of Oklahoma blocked the efforts, arguing that such a resolution is not necessary. The refusal to entertain legislation that merely protects abortion rights in medical emergencies is dramatically out of step with consistent data on Americans’ opinions about access to abortion. 

• Threats to IVF: Last week, Senate Republicans once again voted to block a bill that would have created federal protections for IVF. Although anti-abortion activists continue to insist that warnings about legal threats to fertility treatments and contraception are fear-mongering, the refusal to codify basic protections highlights the need for continued vigilance. 

• RHITES New Resource on Telehealth for Medication Abortion: The Reproductive Health Initiative for Telehealth Equity and Solutions (RHITES) and the National Health Law Program (NHeLP) have released a new map detailing state policies for telehealth medication abortion access for Medicaid enrollees. You can find that resource here.

REPRODUCTIVE HEALTH DIGEST (9/12/24)

Developments in Abortion, Autonomy, and Access: 

This week’s Digest highlights several important reproductive health resources for providers, activists, and fellow reproductive rights advocates. We also discuss breaking news out of North Dakota, new and ongoing state and federal litigation impacting the accessibility of reproductive health care across the country, and updates on anti-democratic attacks against abortion rights ballot initiatives. Please read to the end for the news that you need to know.

This Week’s Must Read:

This week, rather than highlighting a ‘must-read,’ we are using this space to uplift key resources from our partners and colleagues in the fight for reproductive justice:

• RHITES Updated Map of State Policies Impacting the Provision of TMAB (Telehealth for Medication Abortion): The first resource that we are highlighting comes from our partners at the Reproductive Health Initiative for Telehealth Equity and Solutions (RHITES). Focusing on the intersection of reproductive rights and justice and telehealth, RHITES works to “bridge equity gaps and integrate equitable policy and advocacy strategies in reproductive telehealth solutions.”

  RHITES updated Map of State Policies Impacting the Provision of TMAB is a vital resource for tracking and understanding access to telehealth abortion at the state level. To learn more, join RHITES on September 19th for their webinar “Innovating Under Pressure: Leveraging Telehealth for Abortion Care in a Post-Dobbs World.” With panelists from across the reproductive healthcare space, the webinar will cover trends in TMAB provision, shield law protections, and leveraging telehealth to reach marginalized communities in restrictive environments. Register for the webinar here.  

• UCLA School of Law Center on Reproductive Health, Law, and Policy’s State Law Guide on Shield Laws for Reproductive Health and Gender-Affirming Health Care:  States across the country have passed shield laws in response to abortion and gender-affirming care bans. Although these shield laws have many similarities, they differ in exactly what they protect and how they purport to do so. This comprehensive guide provides critical shield law analysis, mapping which states have enacted them, how they each operate, and what they do and do not protect. 

• L4GG’s Policy Resource Hub for Reproductive Health: L4GG’s Policy Hub tracks abortion laws in every U.S. state and occupied territory, every single day, providing you with a free, reliable, and up-to-date source of truth on the state of reproductive rights. You can sign up for the Hub here.

Legislation & Litigation:

• Judge Strikes Down North Dakota’s Abortion Ban: On Thursday, North Dakota Judge Bruce Romanick issued a ruling striking down the state’s abortion ban. He found  that the ban unconstitutionally infringes “on a woman’s fundamental right to procreative autonomy” and is not narrowly tailored “to promote women’s health or to protect unborn human life.” His decision determined that North Dakotans have a fundamental right to abortion pre-viability. He also found that the law was unconstitutionally vague with respect to its exceptions. Although this is a huge win for abortion rights, Judge Romanick’s decision is certain to be appealed by the state. 

• Texas Sues Over HIPAA Protections for Reproductive Health Data: Texas Attorney General Ken Paxton has filed a lawsuit against the U.S. Department of Health and Human Services (HHS), challenging a new HIPAA rule aimed at protecting reproductive health care data. The rule, which is set to take effect on December 23rd, protects patient health information relating to lawfully provided reproductive health care from disclosure. It was promulgated by the Biden Administration in response to increased post-Dobbs threats of investigation and criminalization for patients forced to travel to other states to receive care. Paxton’s lawsuit argues that the new rule exceeds HHS’s authority and interferes with the state’s investigative abilities. The lawsuit similarly argues for the invalidation of a 2000 HIPAA privacy rule relating to the provision of patient information for purposes of government investigation more generally. 
  
  Abortion is currently banned in Texas. It merits reiterating that the HIPAA rules that Texas seeks to overturn only protect information related to lawful care. In other words, Attorney General Paxton’s lawsuit does not seek to vindicate the state’s ability to investigate unlawful activity, but rather to obtain information on legally obtained health care.. This kind of state-sponsored surveillance of individual medical decision making is chilling and should act as a reminder of the importance of continued advocacy for bodily autonomy without government interference. 

• Abortion And Birth Control Access in Alaska: Alaska Judge Josie Garton has struck down a state requirement that abortions be provided only by licensed physicians. In the case, Planned Parenthood argued, and Judge Garton agreed, that there is no medical justification for prohibiting advanced practice clinicians, including physician assistants and registered nurses, from providing certain common abortion services, including medication abortion. Judge Garton found that the restriction burdened patients’ access to care, particularly in a state with large rural areas where access to doctors can be limited. 
  
  As Judge Garton moved to improve reproductive health care in the state, Alaska’s Governor Mike Dunleavy vetoed a bipartisan bill that would have expanded Alaskans’ access to contraception. The bill would require insurers to cover up to a year’s worth of contraception at a time, reducing the need for frequent travel to a pharmacy and easing barriers for victims of domestic violence. In a letter regarding the veto, Governor Dunleavy stated without explanation his belief that the legislation was “bad policy.” 

• Title X Funding Restrictions in Oklahoma: The Supreme Court has allowed HHS to block Title X funding to Oklahoma because of the state’s refusal to comply with a requirement that it provide pregnant patients with comprehensive information about their options, including abortion. The 10th Circuit previously ruled that Oklahoma could satisfy its obligation by merely providing patients with a national hotline number that gives information about all pregnancy options. However, Oklahoma argues that even providing a general pregnancy options hotline is in conflict with its abortion ban. As a result of the state’s failure to comply, HHS will withhold those funds this year. 

• Abortion Restrictions Blocked in Ohio: Last Digest, we reported on an Ohio judge blocking certain medically unnecessary abortion restrictions in the state, including a 24-hour waiting period. A Hamilton County Judge has now granted a preliminary injunction blocking laws that prohibit advanced practice clinicians from providing medication abortion and interfering with the prescription of mifepristone consistent with medical evidence. The court found that these laws are likely unconstitutional under the newly passed Reproductive Freedom Amendment to Ohio’s Constitution. This process of unwinding state restrictions on abortion after the passage of a constitutional amendment will likely be repeated in any state that votes to enshrine abortion rights this November. 

• Gender-Affirming Care at the Supreme Court: As we have reported previously, gender-affirming care is currently before the Supreme Court in U.S. v. Skrmetti, with arguments likely to take place sometime in December. This is the first time that the Supreme Court has had the opportunity to directly consider the constitutionality of bans on gender-affirming care for minors, and the outcome of the case will impact laws passed in almost half of U.S. states. Dozens of conservative politicians have filed an amicus brief arguing in favor of the health care bans, while California Attorney General Rob Bonta has led a coalition of 20 states in opposing the restrictions. While this case sits before the Supreme Court, litigation over gender-affirming care bans continues in the lower courts. Last week, the 11th Circuit Court of Appeals ruled to allow Alabama to enforce its ban, clearing the way for other states in the Circuit, including Florida, to begin to enforce their own bans. Meanwhile, advocates in South Carolina have filed a lawsuit challenging that state’s ban. Although the text of the question presented in Skrmetti is limited to gender-affirming care, the case will be one of the first opportunities that the high court has had to consider the appropriate scope of Dobbs and its impact on equal protection rights outside of the abortion context. 

• Indiana Judge Declines to Broaden State Abortion Ban: Judge Kelsey Hanlon of Indiana ruled against Planned Parenthood on Wednesday, declining to expand the life or health exception to the state’s abortion ban. Although she acknowledged the impossible position that providers have been placed in, she stopped short of finding that the narrow exception violates the constitutional rights of Indiana patients.
  

Ballot Initiatives:

• The States Where Abortion is On the Ballot:  For a quick overview of where abortion is on the ballot in November, take a look at this piece from Truthout. 

• South Dakota Ballot Measure in Court: The lawsuit against South Dakota’s abortion rights amendment is moving forward, despite the trial being set for after early voting begins. Although Secretary of State Monae Johnson has already certified the measure, Life Defense Fund–an anti-abortion group–is challenging the validity of the signatures, arguing that Dakotans for Health, the group behind the measure, failed to comply with certain state laws. Life Defense Fund argues that the measure can be invalidated after the fact, even if voters pass it in November. Dakotans for Health has decried the effort as undermining voter confidence and interfering with the election process

• Oral Argument Held over Nebraska Abortion Measure: Nebraska’s Supreme Court heard oral arguments on Monday over the state’s abortion rights ballot measure. Opponents of the measure argue that it violates the single-subject rule, a state law requiring each measure to only include one subject. They purport that the measure deals with separate issues because it would allow abortion until viability, and then permit abortions to save the patient’s life or health post-viability. Of course, this argument would render nearly every abortion law in the country invalid, as almost all states impose differing restrictions as pregnancy progresses. As a reminder, there will also be a pro-life abortion measure on the ballot in November; if passed, it would constitutionally enshrine the state’s current ban on abortion after 12 weeks. Proponents of the pro-choice measure argue that if it is struck based on the single-subject rule, then the 12-week measure must also be struck. 

• Missouri Ballot Measure Before the State Supreme Court: Following a week of intense legal maneuvering, Missouri’s Supreme Court held on Tuesday afternoon that the state’s abortion rights measure can appear on the ballot. The fate of the initiative was thrown into question following a lower court's ruling that it failed to comply with a requirement to list the laws that would be impacted if the measure passes. Although state law requires an initiative petition to include all existing laws that would be repealed by the measure, attorneys supporting the measure argue that it is in full compliance, as the amendment would not literally repeal any current abortion laws, it would instead create a new superseding law. The process of reconciling a new constitutional amendment with existing laws is not unique; Ohio is currently going through the process following the passage of its own abortion rights amendment last year. 

• Florida Police Questioning Petition Signers: Florida has ramped up its efforts to block the passage of an abortion rights ballot initiative. Reportedly, police have been questioning voters on their signatures supporting the measure, in some cases showing up at peoples’ homes. Governor DeSantis did not deny these reports and instead defended the police investigations as being aimed at guaranteeing the fairness of the November election.

Trend & Policy Watch:

• Support for Families Low in Abortion Ban States: Research conducted by Northwestern Medicine in Chicago finds that states with abortion bans are also the states that provide the least support to families. Researchers looked specifically at what types of social safety nets exist for parents and families, including paid parental leave, supplemental nutritional programs, and childcare assistance for low-income families, and compared that against the state’s abortion restrictions. Notably, Idaho–the state that is currently fighting to deny pregnant people the right to emergency abortions–was found to be the least family-supportive state. 

• South Dakota Releases Video Purporting to Clarify Abortion Ban: South Dakota’s Department of Health has released a legally mandated video purporting to clarify the bounds of the state’s abortion ban. The video fails to provide any meaningful guidance on when abortion is and is not lawful in the state; instead, it functionally recites the text of the law and provides non-medical disclaimers and generalities about the structure of the law. The lack of meaningful state guidance on the parameters of abortion bans has led to disastrous results across the country. 

• Data Theft At a Clinic Providing Abortions in Attleboro, Massachusetts: Four Women’s Health Center in Attleboro, Massachusetts has brought a lawsuit against a crisis pregnancy center, alleging data theft. The lawsuit stems from several instances of pregnant people using the clinic’s online chat service and subsequently being contacted to make an appointment at the CPC across the street, Abundant Hope. Four Women’s Health Center alleges that the CPC infiltrated their online systems and stole patient information. Crisis pregnancy centers are well known for attempting to intercept would-be abortion patients using misleading and outright deceptive tactics. 

• Abortion Drugs as Controlled Substances Threatens Healthcare in Louisiana: Providers in Louisiana are concerned about their ability to treat patients for non-abortion-related conditions now that mifepristone and misoprostol are set to be restricted as controlled substances. Although the Louisiana Department of Health sent out a memo attempting to clarify how misoprostol may continue to be used, Louisiana providers are not reassured. Like so many other abortion restrictions, the re-classification of mifepristone and misoprostol is not based in the realities of medical practice and threatens providers with liability without giving them meaningful guidance on how to manage a substantial change in standard treatment protocols. There is also no medically sound, apolitical justification for re-classifying these drugs as controlled substances; they are not dependency-forming and their safety and efficacy records have been well documented for decades.

REPRODUCTIVE HEALTH DIGEST (8/29/24)

Developments in Abortion, Autonomy, and Access: 

This week’s Digest goes through developments in reproductive health litigation, legislation, ballot initiatives and policy. As we draw closer to the November election, contests over state abortion ballot initiatives are heating up, with several anti-abortion groups launching last-minute challenges. Additionally, policy surrounding reproductive health care, bodily autonomy and LGBTQ+ rights continues to develop at both the state and federal levels. Please read on to the end for the news that you need to know.

Want access to a detailed analysis of the abortion law in every U.S. state and territory? Subscribe to our free Policy Resource Hub for Reproductive Health, an exclusive legal database where we update the state of the law every single day - so you’re always up to speed

This Week’s Must Read:

This week’s must-read is about the people whose lives have been upended by post-Dobbs abortion bans. Last week, Amanda Zurawski, Kaitlyn Joshua and Hadley Duvall all spoke to a packed audience at the DNC about their experiences with pregnancy, miscarriage, sexual assault and abortion care. Each of these women are living reminders of why access to full-spectrum reproductive health care is critical and the horrifying consequences that follow from its prohibition. 

Legislation & Litigation:

• Ohio Blocks 24-Hour Waiting Period: After passing the Ohio Reproductive Freedom Amendment via ballot initiative last year, advocates in the state have been working to repeal abortion restrictions that remain on the books. Last week, an Ohio county judge blocked certain medically unnecessary requirements, including a 24-hour waiting period, in-person visit requirement, and state-mandated information. The judge found that these provisions are inconsistent with the reproductive rights now constitutionally guaranteed to Ohioans. Other states voting on abortion in November will face similar ongoing legal battles if their respective amendments pass into law. 

• Title IX Remains Blocked: The Title IX rule promulgated by the Biden Administration to protect LGBTQ+ students remains blocked in over half of the states, with the Supreme Court declining to allow the rule to take full effect while litigation is pending.  The new rule was announced in April of this year and is intended to protect LGBTQ+ students in an increasingly hostile national climate. Although the rule went into effect on August 1st, federal judges have blocked its enforcement in 26 states, severely undercutting its impact. 

• New York and Abortion Pill Reversal: An anti-abortion group and two crisis pregnancy centers in New York secured a preliminary victory last week, with a federal judge ruling that they can counsel pregnant patients about the controversial “abortion pill reversal” treatment. The treatment remains largely untested and its safety and efficacy are unproven. New York’s Attorney General Letitia James has sought to crack down on potential misinformation and disinformation being spread by CPCs. However, despite the experimental nature of the treatment, the judge in the case found that anti-abortion plaintiffs are protected by the First Amendment to the U.S. Constitution. 

• Austin Texas Sued Over Abortion Fund: The city of Austin Texas allocated $400,000 to help Austin residents pay for the costs associated with accessing out of state abortion care, including travel, lodging and childcare. A former city council member has brought a lawsuit asking for that allocation to be blocked on the grounds that taxpayer dollars cannot be legally used for abortion-related activities, even when the abortion takes place out of state and is entirely legal. A similar legal battle is playing out in San Antonio Texas, as the city seeks to implement a reproductive justice fund.
  

Ballot Initiatives:

Arkansas Ballot Initiative Rejected: The Arkansas Supreme Court has upheld state election officials' rejection of a pro-choice ballot initiative. The Court found that Arkansans for Limited Government, the group behind the initiative, erroneously submitted documentation of paid signature gatherers separately rather than as a single bundle. Organizers had gathered over 100,000 signatures–enough to make the ballot–but as a result of the courts’ ruling, Arkansans will not have the opportunity to vote on the measure in November. This is the latest in a string of anti-choice efforts to stop abortion ballot initiatives from going before voters in the fall. AFLG stated in response to the ruling that, although they are “outraged” by the outcome, the “effort has generated a wave of fiercely engaged Arkansas women” who will “remember this in November.” AFLG is urging supporters to cast their votes for candidates who supported the ballot measure. 

• Missouri’s Ballot Initiative Challenged by Both Sides: Missouri’s ballot initiative is facing last-minute challenges from both sides of the issue. Proponents of the initiative are challenging the secretary of state’s ballot language, which distorts the intent and impact of the ballot measure. The language approved by Secretary of State Ashcroft states that the measure would allow abortion “at any time of pregnancy,” would prohibit any government regulation of abortion and would remove protections for pregnant people. In actual fact, the ballot measure would effectively restore the Roe standard, allowing for government regulation of abortion post-viability. While pro-choice advocates fight for fair ballot language, opponents of the measure argue that it should be rejected on the grounds that it fails to specify all of the laws potentially impacted by the amendment’s passage and purportedly contains more than one subject. They make the case that voters should be deprived of the opportunity to vote directly on the issue because the use of the phrase “fundamental right to reproductive freedom” is “unlimited in scope” and too broad to be permitted on the ballot. Similar challenges have been rejected in other states. 

• Abortion on the Ballot in Montana: In some good news, the Montana Secretary of State has certified that abortion will be on the ballot in November. If passed, the measure would preserve the right to pre-viability abortion in the state. 

• Nebraska Dueling Ballot Measures: In Nebraska, multiple abortion ballot initiatives will appear before voters in November. One initiative, advanced by pro-choice advocates in the state, would enshrine the right to abortion until fetal viability, significantly expanding access in the state. The second initiative would effectively enshrine the current ban on abortion after 12 weeks, prohibiting abortions in the second and third trimester. This 12-week ballot initiative is backed by anti-abortion groups and seeks to persuade voters to make the current post-Dobbs reality in Nebraska the permanent status quo. Groups on the ground are working to ensure that voters are clear on which of the two initiatives supports reproductive health care in the state. 

• Idahoans Consider 2026 Ballot Initiative: Following the disastrous fallout from Idaho’s total abortion ban, advocates have launched efforts to explore the possibility of a 2026 ballot initiative to restore reproductive rights to the state. Because of Idaho’ state laws, this effort would be to craft legislation for voters to directly consider, rather than a constitutional amendment. Currently, Idaho has one of the strictest abortion laws in the country, permitting abortion only to save the pregnant person’s life. This past term, the state went before the U.S. Supreme Court to defend its right to deprive Idahoans of the right to health-preserving emergency abortions. Testimony in that case included reports of Idahoans having to be air-lifted out of state to obtain care in severe emergencies.

• Florida Ballot Initiative Faces Challenges: The Florida Supreme Court has ruled to allow a financial impact statement for the abortion rights ballot initiative to remain in place. Floridians Protecting Freedom argued that the language should be blocked–as written, it warns voters of consequences including decreasing the state’s live births, and potentially leading to state and federal taxpayer funding for abortion in the state. For the amendment to pass, it will have to garner at least 60% of the vote in November.

Trend & Policy Watch:

• Ohio and Fetal Personhood: An Ohio lawmaker has introduced fetal personhood legislation that would allow embryos or fetuses to be claimed as dependents for tax purposes. Although this kind of legislation is often touted as pro-family, in practice it legally codifies the idea that the state considers a fetus or embryo to have the rights as a child under the law. 

• Abortion Polling: New polling from KFF shows that support for abortion remains high and is relatively consistent across party and religious lines, while disapproval of severe abortion bans and restrictions continues to be widespread. The research also showed that a person’s reported political affiliation had little statistical relation to whether or not that person has had an abortion in their life. 

• Abortion Bans and Mental Health Exceptions: At present, 14 states are enforcing near-total abortion bans across the country, each with varying exceptions for extreme circumstances such as the life or health of the pregnant person. However, noticeably absent (and explicitly excluded in some cases) from the definition of health of the pregnant person is mental health. This failure to recognize mental health as a legitimate medical reason for terminating a pregnancy is inconsistent with recent research showing that mental health is one of the leading causes of pregnant and postpartum mortality. Complicating things further, several medications used to treat certain common mental health disorders may create an increased risk of birth defects, making them potentially incompatible with continuing a pregnancy. 

• Planned Parenthood During the DNC: Planned Parenthood drew national attention last week when its mobile clinic provided free vasectomies, emergency contraception and medication abortions in Chicago near where the Democratic National Convention took place. Planned Parenthood explained that the use of the mobile clinic furthers its mission of expanding access to “care, no matter where.”

• Texas and Trans Rights: Texas, under the leadership of Attorney General Ken Paxton, is once again moving to restrict the rights of trans Texans to live safe and affirming lives. A new rule will reportedly not allow trans drivers in Texas to change the gender markers on their drivers license, even with a certified court order. The internal email showing the change in rule also directed DPS employees to report the names and ID numbers of individuals requesting to change the sex reflected on their license, creating concern about information gathering on trans Texans at a time when efforts to restrict the rights of trans people around the country have reached a fever pitch. 

• Florida and LGBTQ+ Visibility:Florida’s tourism marketing agency has quietly pulled its LGBTQ+ Travel section from its website, despite historically being a popular spot for LGBTQ+ visitors. This continues a concerning trend of the Florida government diminishing the rights and visibility of LGBTQ+ Floridians.

REPRODUCTIVE HEALTH DIGEST (8/15/24)

Developments in Abortion, Autonomy, and Access: 

In this week’s Digest, we have broken down our reporting by category, covering all of the federal, state and local legislation, litigation, policy, and ballot initiative news that you need to know. As always, we strive to make this Digest the most effective and efficient resource that it can be, and we welcome any feedback from our readers.

Want access to a detailed analysis of the abortion law in every U.S. state and territory? Subscribe to our free Policy Resource Hub for Reproductive Health, an exclusive legal database where we update the state of the law every single day - so you’re always up to speed

This Week’s Must Read:

This week’s must read takes a critical look at the potential reach of fetal personhood laws–laws that seek to grant an embryo or fetus full legal rights–and the anti-abortion movement’s strategy to weaponize them against reproductive rights. In addition to nullifying abortion rights, fetal personhood laws would place the personhood of the pregnant person in direct conflict with that of the fetus and produce a whole host of legal and practical absurdities and harms. If a case over the constitutionality of fetal personhood laws ends up before the current Supreme Court, the Court could issue a ruling that casts a national shadow on all aspects of reproductive health care. 

Legislation & Litigation:

• Montana and Minors’ Access to Abortion: On Wednesday, the Montana supreme court ruled that minors’ fundamental right to privacy, including autonomy over their own medical decisions, renders parental consent requirements for abortion unconstitutional. The decision was unanimous and comes at a time when parental rights have been wielded as an argument against the right of minors to obtain health care. The full opinion is available here. 

• Idaho and EMTALA: Following the U.S. Supreme Court’s dismissal of Moyle v. United States as improvidently granted, the Ninth Circuit Court of Appeals has set oral argument in the case for the week of December 9th, 2024. In this case, the Biden Administration argues that Idaho’s total abortion ban, which only includes an exception for the life of the pregnant person, is preempted to the extent it conflicts with the Emergency Medical Treatment and Active Labor Act’s (EMTALA) broader federal obligation to provide stabilizing care to preserve a patient's life and health. The Supreme Court’s dismissal allowed the Ninth Circuit’s previous injunction on the law to go back into place, temporarily granting Idahoan patients access to emergency care. The court will now receive briefing and oral arguments that will determine the future of emergency healthcare for pregnant people in the state. How the court rules will set a critical example for other states, like Texas, that are litigating over the question of whether states’ abortion bans supersede federal emergency health care provisions. The case is all but certain to end up back before the U.S. Supreme Court in the coming years. 

• Texas and Emergency Healthcare: Two Texas women have filed complaints against Texas hospitals in federal court, after being denied treatment for their ectopic pregnancies, resulting in the loss of their fallopian tubes. The complaints are brought pursuant to EMTALA. Although Texas is currently enforcing a total abortion ban, the law allows for the termination of ectopic pregnancies; however, providers and hospitals have been hesitant to provide even legal care out of fear of civil and criminal liability. In states with severe abortion bans in place, the futility of exceptions is clear. Stories of pregnant people being turned away in emergency circumstances, having to be airlifted out of state, or not being able to access care under rape or incest exceptions have been ceaseless. This new case comes on the heels of a similar lawsuit brought by Mylissa Farmer against the University of Kansas Health System, after the hospital failed to provide her with emergency treatment in the midst of a severe pregnancy complication. 

• Oklahoma and Title X: Oklahoma is asking the U.S. Supreme Court to step in in a dispute over Title X funding and abortion referrals. The Department of Health and Human Services is enforcing a requirement that states receiving Title X family planning grants must offer a call-in number to a family planning hotline that includes information about abortion. However, citing Dobbs and anti-discrimination law, Oklahoma argues that this requirement amounts to discrimination against entities that do not provide abortions. Previously, the 10th Circuit Court of Appeals found that HHS had the authority to enforce its requirement, reasoning that merely providing a phone number for a hotline that includes information about abortion, among other family planning options, does not amount to mandating abortion referrals. 

• Illinois: Illinois Governor JB Pritzker has signed 3 new abortion-protective bills into law, continuing the state’s role as a bastion of access in the region. The first bill, HB 581, grants the Illinois Department of Public Health authority to investigate hospitals for EMTALA violations. HB 4867 extends state anti-discrimination protections under the Illinois Human Rights Act to people for their reproductive health decision, including abortion. The third bill, HB 5239 strengthens the state’s existing shield law by prohibiting state and local jurisdictions from disclosing information or utilizing resources to assist in out-of-state investigations into legal reproductive healthcare. The new protections come weeks after neighboring state Iowa began enforcing its ban on abortion after detection of fetal cardiac activity and in anticipation of a potential republican presidency that could hamstring abortion rights nationwide. 

• California and Abortion Pill Reversal: A San Diego Catholic nonprofit has filed a federal lawsuit against California Attorney General Rob Bonta seeking to block his efforts to crack down on crisis pregnancy center misinformation. The group argues that AG Bonta’s activities suppress their First Amendment rights. Abortion pill reversal (APR) is not FDA approved and major medical associations including the American College of Obstetricians and Gynecologists do not support the practice based on the lack of evidence demonstrating its safety and efficacy.  
  

• Ohio and Gender Affirming Care: An Ohio County judge has ruled that the state’s ban on gender affirming care for minors under the age of 18 can go into effect. The devastating ruling is causing families of trans minors to consider leaving the state in order for their children to continue to access life-saving care. Over half of U.S. states have now banned or limited access to gender affirming care for minors.
  

Ballot Initiatives:

• Missouri: Missourians will have the opportunity to vote directly on abortion rights in November, making it the eighth state to put abortion on the ballot this year. If passed, the amendment would protect the right to abortion “pre-viability” (around 24-weeks gestational age), with exceptions for the life or health of the pregnant person at any point in pregnancy. At present abortion is completely banned in Missouri. For more insight into the impact of Missouri’s abortion ban, you can read Missouri ob-gyn Dr. Iman Alsaden’s discussion of the public health repercussions of limiting access to reproductive health care. 

• Arizona: Despite ongoing litigation attempting to block Arizona’s abortion rights ballot initiative, it appears that the measure will appear before voters in November. On Monday, Arizona’s Secretary of State certified the signature count, which Arizona for Abortion Access reports is the highest signature count ever recorded for a citizen initiative in the state’s history. If passed, the amendment would extend abortion protections from the current 15 weeks to around 24 weeks, with exceptions. Although advocates are optimistic about the initiative’s likelihood of success, Arizona Right to Life continues to attempt to block it. The group is asking the state Supreme Court to find that the legally required initiative summary misled petition signers, re-urging arguments that were already rejected by a Maricopa County Superior Court judge. Anti-abortion activists were handed a small win by the state’s supreme court this week, with the court finding that the use of the phrase “unborn human being,” rather than the scientifically accurate “fetus,” can be used in the pamphlet that voters will see.

• South Dakota: Although it appears likely that South Dakotans will see abortion on the ballot in November, Life Defense Fund, an anti-abortion group, is continuing its litigation efforts to stop the measure from being put to a vote. The case was previously dismissed, but the group has now added Secretary of State Monae Johnson as a defendant and renewed their lawsuit, arguing that Dakotans for Health failed to comply with applicable laws in circulating its petition. The litigation is unlikely to be resolved prior to the deadline for the secretary of state to certify ballot questions to county auditors, but Life Defense Fund argues that even if the amendment makes it onto the ballot, the secretary of state’s office could refuse to count any votes towards it. Dakotans for Health has decried the efforts as “another in a series of desperate measures” to silence voters’ voices on the amendment. South Dakota is currently under a total abortion ban; if passed, the amendment would effectively codify the Roe trimester framework.

Trend & Policy Watch:

• Abortion Bans and HIPAA: Experts warn about the lack of privacy protections for patient information at crisis pregnancy centers (CPCs). Although these centers often misleadingly imply that they are bound by HIPAA and may offer some semi-medical services, such as pregnancy testing or free ultrasounds, the vast majority of them are not bound by patient privacy laws. Patients need to be aware that these centers may be collecting and sharing data that could aid in pregnancy and abortion investigation and criminalization. Data collection and sharing is particularly concerning in the present legal environment, as several states are seeking to ban interstate travel for abortion care and crack down on those who self-manage abortion within their own state. 

• Florida: The impact of Florida starting to enforce its 6-week abortion ban has been devastating, not just for Floridians, but for patients all over the country who lost a critical access point. Data from the National Abortion Federation shows that calls for help with traveling out of state have increased 575% in the 2 months since the ban went into effect. Brittany Fonteno, CEO of NAF described the aftermath as “devastation and chaos.” 

• Self-Managed Abortion: A new study from Advancing New Standards in Reproductive Health (ANSIRH) shows continuation in the trend of more pregnant people self-managing their abortions. As more and more states restrict access to abortion, the cost and time burdens for accessing care are rising, forcing pregnant people to travel long distances, navigate multiple legal landscapes, take time off work, find child care, and expend significant financial resources. Self-managed abortion, which typically involves taking mifepristone and/or misoprostol outside of a clinical setting, allows pregnant people to undergo their abortions at home with the safety net of their support systems around them. While all people should have access to safe and equitable health care,  data shows that mifepristone and misoprostol are both safe and reliable methods for ending a pregnancy at home in its early stages. 

• Amnesty International Finds Abortion Bans Violate Human Rights: A new report from Amnesty International details how the post-Dobbs legal landscape in the U.S. has created a human rights crisis in violation of international law. The report highlights the stories of impacted individuals and outlines how preventing access to abortion harms the health, wellbeing and autonomy of pregnant people, particularly those in already marginalized communities. The report calls on the U.S. to restore and protect the right to abortion and ensure that health care is accessible by all on equal terms and without discrimination.

• Iowa’s Maternal Health Care Crisis: As Iowa begins to enforce its ban on abortion after detection of fetal cardiac activity (around 6-weeks gestational age), the state will be forced to contend with its worsening maternal health care crisis. Iowa has the lowest per capita ratio of ob-gyn providers to patients of any state in the country, and over 1/3 of the state’s counties are considered maternity care deserts. The lack of providers will inevitably worsen with the ban in place, as the past two years have demonstrated a measurable trend of medical students and residents gravitating away from states with abortion bans in place and providers choosing or being forced to leave to practice elsewhere. 

REPRODUCTIVE HEALTH DIGEST (8/1/24)

Developments in Abortion, Autonomy, and Access: 

This week’s Digest discusses the implementation of Iowa’s 6-week abortion ban, a ruling out of Nebraska that impacts both abortion rights and gender-affirming care, updates on ballot initiative battles across the country, and much more. Please read on to the end for the news that you need to know. 

Want access to a detailed analysis of the abortion law in every U.S. state and territory? Subscribe to our free Policy Resource Hub for Reproductive Health, an exclusive legal database where we update the state of the law every single day - so you’re always up to speed

This Week’s Must Read:

This week’s must-read comes from Vox and outlines the current crisis facing our Supreme Court. Although the Court only heard two reproductive rights-specific cases this term, the Court’s decisions across the board illustrate an alarming unraveling of critical and well-established democracy-protecting precedent and a stunning disregard for judicial consistency. The impact of the Court’s decisions this term will be felt across broad issue areas, undermining the stability and security of many of our most fundamental rights. 

Legal Analysis: 

• Iowa: Iowa’s near-total abortion ban took effect on Monday, July 29th, banning abortion at six weeks, before most Iowans will even know they are pregnant. Although there are narrow exceptions to the law to preserve the life of the pregnant person or in some cases of rape, incest or fatal fetal abnormalities, the reality is that the vast majority of patients will now be forced to leave the state to obtain care.

• Nebraska and Single-Subject Rule: The Nebraska Supreme Court has issued a ruling upholding the state’s law that combines a 12-week abortion ban and prohibition on gender-affirming care for individuals under 19 years old, saying the law did not violate the single-subject rule because both were forms of health care.

• The Ninth Circuit Court of Appeals and Mifepristone Access: The Ninth Circuit Court of Appeals has declined a group of 7 GOP-led states’ request to intervene in a case involving access to the abortion pill mifepristone,

Legal Analysis:

• Iowa:

  • Iowa started enforcing its 6-week abortion ban on Monday, July 29th. The law bans abortion with narrow exceptions after detection of a “fetal heartbeat”–a medically inaccurate term for the electrical impulses that can be heard via ultrasound very early in pregnancy prior to the chambers of the fetal heart actually forming. These electrical signals typically become detectable around 6 weeks gestational age, a point in pregnancy before many people are even aware that they are pregnant. Previously, abortion in Iowa was permitted until 20 weeks. 

  • The fetal heartbeat law was originally passed in 2023 and briefly went into effect prior to the ACLU challenging it, and a district court blocking its enforcement during litigation. However, the Iowa Supreme Court determined, using rational basis review, that the law met constitutional muster and could once again take effect. The ban includes narrow exceptions for vaguely defined medical emergencies, and, if the fetus is less than 20 weeks post-fertilization, for cases of rape or incest when reported to law enforcement, or for fetal abnormalities incompatible with life. Of course, in practice these exceptions will do little to meaningfully expand patients’ access to necessary care. And, they impose cruel non-medical requirements that take decisional autonomy for when and how to report a crime away from victims of rape or incest who require abortion care. 

  • With Iowa losing abortion access, other states are  preparing to take on an influx of new patients. Patients’ closest in-person access points will now be Illinois and Minnesota, both of which have protective abortion laws in place. For individuals less than 12 weeks along, they may also be able to access care in Nebraska. Iowa is now the fourth state to impose a 6-week abortion ban, joining the ranks of Florida, South Carolina and Georgia.

• Nebraska and Single Subject Rule:

  • The Nebraska Supreme Court issued a decision last Friday finding that the state legislature did not act improperly in combining a ban on gender-affirming care for individuals under 19 with a 12-week abortion ban. The law in question, LB 574, was originally introduced as a ban on gender-affirming care; however, after the state legislature failed to pass a 6-week abortion ban, it amended the gender affirming care law to also include a 12-week abortion ban. This allowed the state to restrict abortion access despite the legislative hurdles faced by the 6-week ban. 

  • Planned Parenthood, represented by the ACLU, brought a lawsuit challenging LB 574 as a violation of the single subject rule, a Nebraska constitutional requirement that a bill only contain one subject. The groups argued that gender-affirming care restrictions and abortion restrictions lack the necessary similarity to be appropriately addressed in one bill. They also argued that the two bills were combined in order to secure enough votes for passage, when the issues would have failed separately. However, the court disagreed, finding that the bill’s contents fell under the title of “public health and welfare” and were sufficiently connected to proceed under one piece of legislation. 

  • In November, Nebraskans will likely have the opportunity to vote directly on the issue of abortion, as advocates work to get it onto the ballot. The ballot  measure  proposed by Protect Our Rights would restore abortion rights until fetal viability, with exceptions for the life or health of the pregnant person after that point.

• Ninth Circuit and Mifepristone Access:

  • The Ninth Circuit Court of Appeals, the appellate court over much of the western United States, including Washington, has declined a group of 7 GOP-led states’ requests to intervene in a case about access to mifepristone. This ruling comes after the U.S. Supreme Court threw out Alliance for Hippocratic Medicine’s challenge to the FDA’s approval of mifepristone on standing grounds. 

  • Last February, in direct contrast to Alliance for Hippocratic Medicine’s case, 10 states led by Washington brought a lawsuit alleging that the federal government has imposed unduly harsh restrictions on use of mifepristone that are not justified by the drug’s stellar safety record. Idaho then led a group of conservative states in moving to intervene in that lawsuit. The states argued that they would be harmed in myriad ways by the elimination of in-person dispensing requirements for the drug. After a district court ruled against Idaho’s coalition, the states appealed up to the Ninth Circuit. 

  • The Ninth Circuit panel’s decision found that the states lacked standing because the connection between FDA’s actions and any alleged harm incurred by the states was too attenuated and relied on the independent actions of other actors, including doctors and patients. The Court also found that to allow the states to intervene would effectively grant any state the right to intervene in any lawsuit related to FDA regulation of a drug. Judge Matthew Kacsmaryk, out of the Northern District of Texas, came to the opposite conclusion in the states’ request to intervene in the Alliance for Hippocratic Medicine v. FDA case, opening the door for the states to attempt to revive the litigation that the Supreme Court recently rejected on standing grounds. Because SCOTUS did not rule on the merits of the case, new litigants will try to once again challenge the FDA’s approval of the drug, asserting refreshed standing arguments to support their claims. 

More News in Access:

• Utah: The Utah Supreme Court ruled today to uphold an injunction on the state’s 2020 trigger ban, which would functionally ban all abortion in the state. The ban has been on hold while litigation challenging it plays out, with the lower court judge finding that the risk of harm to patients is too high to allow the law to take effect prior to resolution of the question of its constitutionality. 

• Arizona: A Maricopa County Judge has ruled that the phrase “unborn human being” cannot be used in the voter information packet for the ballot initiative seeking to enshrine pre-viability abortion rights into the state’s constitution. Arizona for Abortion Access successfully argued that the wording violated the state’s requirement that the language must be “impartial,” with Judge Whitten finding that the phrase “unborn human being” was partisan and must be replaced with politically neutral language. The decision is all but certain to be appealed.  

• Montana: Montana county-level election officials have verified that advocates submitted enough signatures to advance an abortion rights ballot initiative to the voters in November. Recently, Montana advocates faced resistance from the Montana Secretary of State, who announced that the votes of so-called “inactive” voters should not count towards the total. However a state district judge blocked enforcement of that newly announced rule, citing the need to broadly interpret citizens’ constitutional right to participate in direct democracy. 

• New Hampshire: New Hampshire Governor Chris Sununu signed anti-trans legislation banning transgender girls from playing on the girl’s sports teams at their schools. The schools are required to look at students’ birth certificates to determine eligibility for participation on certain teams. 

• Kansas: In Kansas, providers are temporarily relieved from compliance with a law requiring them to ask their patients invasive questions about why they are seeking an abortion. If enforced, the law would require providers to inquire into their patients’ reasons for seeking care, including, among other things, whether it was because of career or school plans, financial reasons, or not wanting a disabled child. Questions like these are obviously divorced from any medical necessity–instead, they allow the state to gather data on private decision making and stigmatize patients who may not otherwise have chosen to disclose their reasoning. 

• Kansas: Kansas woman Mylissa Farmer has sued the University of Kansas Health System for its failure to provide her with emergency care, as it is legally obligated to under the Emergency Medical Treatment and Active Labor Act (EMTALA). This case comes after the Supreme Court failed to definitively rule on the question of whether state abortion bans can override federal EMTALA obligations. 

• Arkansas: In Arkansas, advocates continue to battle over whether they have submitted sufficient signatures to support their abortion-protective ballot initiative. Arkansas Secretary of State John Thurston rejected the proposed ballot initiative, asserting that  Arkansans for Limited Government failed to comply with technical requirements for a ballot initiative. The group is challenging that rejection in court. Although the Arkansas Attorney General asked the court to dismiss the case, the court has not yet issued a ruling on that request, instead ordering the state to begin counting signatures. If the court agrees with the Attorney General’s argument and declines to include signatures collected by paid canvassers in the final count, the amendment will have fallen short of the threshold needed to go before voters in the fall. 

• Florida: The Florida Supreme Court has indicated that it will move quickly on two cases involving the financial impact statement attached to a proposed abortion rights ballot initiative. The conflict revolves around the initial financial statement, which became outdated when the state supreme court ruled on Florida’s 6-week abortion, and the subsequent revised statement, which Floridians Protecting Freedom alleges is politicized and inaccurate. 

• North Carolina: North Carolina Judge Catherine Eagles has issued another decision on the state’s abortion ban, ruling that the requirement that the location of a pregnancy be documented prior to prescribing abortion pills should be permanently blocked. Judge Eagles simultaneously restored a previously blocked provision of the law that requires all abortions after 12 weeks gestational age to take place in the hospital. 

• Amarillo: Voters in Amarillo, Texas will decide in November whether to make theirs the next “sanctuary city for the unborn,” prohibiting people from helping others to travel through Amarillo to access abortion care and making it illegal to possess abortion pills within the city. Although Texas is already enforcing a total abortion ban, several localities have enacted these local bans. Their enforceability is uncertain; however, the chilling effect that they have on citizens’ freedom of choice and movement is ultimately the point. 

• Title X and Birth Control: Texas Attorney General Ken Paxton has sued the Biden Administration over Title X rules requiring certain healthcare entities to provide contraception to minors without the need for parental consent. Paxton argues that this rule is in violation of a Fifth Circuit ruling in a case originally heard and ruled on by Judge Matthew Kacsmaryk. Cases like this are emblematic of the concerns raised by reproductive justice advocates about looming threats to contraception access, fertility treatments and other forms of reproductive healthcare. 

• Title IX and LGBTQ+ Rights: The Biden Administration’s Title IX rule extending anti-discrimination protections to LGBTQ+ students has been blocked  by the 11th Circuit Court of Appeals. The 11th Circuit’s ruling overturns a district court’s ruling finding that the GOP-led states were unlikely to succeed in showing that the Administration’s rule was unreasonable or unjustified. The rule’s protections are now blocked in over half of U.S. states. 

• Abortion Storytelling: A Wisconsin woman is opening up about her experience with abortion and how it changed her perspective and political views on the topic. Storytelling is a critical part of the movement for reproductive freedom, humanizing the issue and centering the voices of those with lived experience. 

• Vice President Kamala Harris on Abortion: As the Biden Administration’s top voice on reproductive rights, Vice President Harris’s move into the presidential race as the presumptive democratic nominee marks a moment where the national conversation around the future of abortion rights could see a significant shift. This is particularly true as leading conservative voices continue to disagree about the proper role of the federal government in abortion rights. 

• The Supreme Court and Chevron Deference: The Supreme Court’s decision this year overruling Chevron Deference opened the door for courts to second guess expert agency judgment in all areas, including healthcare. Experts are weighing in on the current and potential future consequences of that landmark decision. An abortion hostile federal administration could weaponize the overturn of Chevron to direct executive agencies to limit access to abortion and marginalize the rights of pregnant people.