Developments in Abortion, Autonomy, and Access:
This week’s Reproductive Health Digest covers escalating attempts to criminalize reproductive healthcare providers, litigation challenging access to medication abortion, proposed legislation restricting abortion in Wyoming and Arizona, a new draconian anti-trans law out of Kansas, and multiple stories around the politics of abortion access in the run-up to the midterm elections. 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.
If you’d rather not receive the bi-weekly Reproductive Health Digest but still want to get other L4GG emails, you can opt out of just this newsletter here.
Legislation & Litigation:
Overview:
In late February, a Louisiana federal court heard arguments over the question of whether the FDA erred in removing in-person dispensing requirements for medication abortion;
Texas Attorney General Ken Paxton has brought another suit against a California shield provider and a telehealth organization in his ongoing effort to block access to abortion options for Texans;
Last month, a Texas court heard arguments in its case against a midwife for allegedly providing illegal abortions, but the defense argues that the state’s case is exceedingly weak;
Wyoming lawmakers are moving forward with legislation to ban abortion after detection of fetal cardiac activity;
Kansas has begun enforcing one of the most draconian anti-trans bills in the country; and
Arizona lawmakers have proposed a slew of abortion restrictions, despite Arizonans voting to constitutionally protect access to care.
Federal Court Hears Argument About Access to Mifepristone:
Late last month, the Western District of Louisiana heard arguments in a case seeking to limit access to the common abortion pill mifepristone. The lawsuit, brought by Louisiana Attorney General Liz Murrill, is one of multiple cases challenging the legality of the drug.
During the Covid-19 pandemic, in-person dispensing requirements for mifepristone were temporarily lifted. That change was later made permanent based on a finding that allowing telehealth eased access to care and posed no significant safety risks to patients. Louisiana is now asking the court to reinstate in-person dispensing requirements. If successful, this would severely limit telehealth access to care even in states where abortion is legal and protected.
During arguments, Louisiana asserted that removal of in-person requirements increases risks of harm to patients and allows for the medication to flow into states that ban abortion, circumventing those states’ laws. When forced to take a position in the case last month, the FDA under the Trump Administration asked for the judge to temporarily halt the case’s progress while the agency undertakes a review of mifepristone’s safety record - a review that has been heavily criticized for being politically motivated and ignoring mifepristone’s sound scientific record. Manufacturers GenBioPro and Danco Laboratories intervened in the case, affirmatively arguing for continued telehealth access to mifepristone. The companies point the court to the drug’s excellent safety record and the lack of evidence that in-person dispensing is medically necessary. They also cautioned against allowing Louisiana to reshape the national regulatory landscape for an FDA-approved drug - a move that could open the doors to increased non-expert scrutiny of other long-approved medications. The court did not indicate when it will make its ruling, but the outcome of the case will significantly impact ongoing fights over medication abortion in and out of the courtroom.
Texas Attorney General Sues California Shield Provider and Medication Abortion Organization:
In our last Digest, we reported on the first lawsuit filed under HB7, Texas’s newly enforced medication abortion ban. In that case, a Texas man amended his prior lawsuit alleging that California shield provider Dr. Remy Coeytaux sent medication abortion pills into the state to add a count under HB7. Texas Attorney General Ken Paxton has now filed an additional lawsuit against Dr, Coeytaux and Aid Access and its founder, alleging violations of HB7 and Texas’s abortion ban. AG Paxton has lodged separate but similar lawsuits against Delaware and New York providers. Texas now asks the court to prohibit Dr. Coeytaux and Aid Access from shipping medication abortion across state lines and into Texas. Lawsuits like this one, Louisiana’s litigation against the FDA, described above, and individual lawsuits against shield providers, are a part of a multi-faceted and coordinated effort to severely restrict or wholly withdraw access to medication abortion - particularly for individuals living in ban states.
Texas Hears Arguments in Case Charging Midwife with Providing Illegal Abortions:
On February 19th, the Fifteenth Court of Appeals in Texas heard arguments in a case accusing a Houston-area midwife of performing abortions in violation of Texas law. Last year, Maria Rojas and several of her associates were indicted on felony charges, in what appears to be the first attempted prosecution of a healthcare provider for allegedly violating a state’s abortion ban post-Roe. The state has brought both a civil and criminal case against Rojas, and she faces a sentence of up to life in prison if she is found guilty.
Rojas’s attorneys, however, argue that the state’s case is exceedingly weak. They point to the lack of any credible eyewitness or documentary evidence indicating that illegal abortions were performed at Rojas’s clinics, and explain that a statement by a person identified as “E.G.” who claimed to have been given abortion pills lacks any concrete corroborating evidence and amounts to hearsay. Further, although a bottle of misoprostol was found on the premises, this does not necessarily indicate that abortions were being performed. Misoprostol is routinely used in miscarriage management, and Rojas was legally allowed to prescribe it under supervision of a physician. And, investigators have not put forth any evidence that they found mifepristone, the drug that typically accompanies misoprostol in a medication abortion, or surgical abortion tools. Despite the lack of evidence proving the State’s case, AG Paxton has aggressively smeared Rojas and her affiliates, using inflammatory and racially charged language. Rojas’s clinics are currently closed, and she is out on a $1.4 million bond.
Wyoming Takes Steps to Ban Abortion After Fetal Cardiac Activity:
In January, the Wyoming Supreme Court struck down the state’s abortion bans on the grounds that they violate the Wyoming Constitution’s guarantee of individuals’ rights to healthcare decisionmaking. In response, the legislature is now attempting to pass a “heartbeat” ban, which would prohibit abortion at approximately 6-weeks gestational age - a point at which many people do not even know they are pregnant. HB 126, championed by fetal personhood proponent Chip Neiman, only includes an exception for medical emergencies. It would not allow abortion in cases involving fatal fetal abnormalities or circumstances of rape or incest.
The bill has passed through the legislature with relative ease and now only requires one more vote in the House. It will then go before Republican Governor Mark Gordon. Although the law would almost certainly be subject to swift legal challenge, it is unclear how the state’s courts would rule on a 6-week gestational ban, as opposed to the previously struck total abortion ban.
Kansas Begins Enforcing Draconian Anti-Trans Law:
Last month, Kansas passed one of the most draconian anti-trans laws in the country. SB 244, passed over the veto of Governor Laura Kelly, bars trans people from using restrooms consistent with their gender identity, and implements a bounty hunter-style provision allowing individuals who believe they have encountered a trans person in a public restroom to bring a lawsuit for monetary damages. Additionally, the law prohibits changing gender markers on a person’s driver’s license and invalidates driver’s licenses that have already been updated to reflect a person’s gender identity, effective immediately.
Kansans who had legally changed the gender markers on their licenses have received letters informing them of this change in the law and stating that “the Legislature did not include a grace period for updating credentials. That means that once the law is officially enacted, your current credentials will be invalid immediately, and you may be subject to additional penalties if you are operating a vehicle without a valid credential.” In other words, Kansas is restricting the ability of transgender Kansans to drive, without providing any justification or explanation of how the state is harmed by individuals using validly issued licenses with accurate gender markers. The law was swiftly challenged by the ACLU on multiple constitutional grounds.
Arizona Republicans Move Forward with Abortion Restrictions, Despite Recent Court Ruling:
In early February, an Arizona court issued a ruling striking down a number of medically unnecessary restrictions on abortion. These included 1) a law requiring patients to make two separate trips to their healthcare provider and wait at least 24 hours before receiving care; 2) laws banning abortions sought as a result of certain fetal diagnoses; and 3) a ban on the use of telemedicine for abortion services. The court found that the struck provisions were unconstitutional in light of the constitutional amendment protecting reproductive rights that Arizonans passed in November 2024.
The clear expression of the people’s will, and the court’s recent ruling have not deterred anti-abortion lawmakers in the state, however. Republican legislators have filed a notice of appeal challenging the February ruling and introduced a wave of abortion-restrictive legislation. The Arizona Center for Investigative Reporting found “16 [proposed bills] in play this session, including proposals seeking to advance fetal personhood and impose new limits on medication abortion, among other restrictions affecting public universities, schools and state health programs.” This move by lawmakers to restrict the efficacy and scope of the 2024 reproductive rights amendment is a strategy mirrored in states across the country. For example, despite having passed an abortion-rights measure in 2023, Ohioans are still battling in court over restrictions on care. And, in Missouri, anti-abortion lawmakers are asking voters to repeal an abortion rights amendment that they passed in 2024.
Trend and Policy Watch:
Texas Attorney General Threatens Mental Health Providers:
Texas Attorney General Ken Paxton has threatened mental health providers who treat transgender or gender non-conforming minors. Although Texas already bans gender-affirming care for minors, AG Paxton issued an opinion on February 27th, declaring that mental healthcare providers are similarly prohibited from “transitioning” minors - though it is unclear what conduct would fall under this asserted prohibition. In his published statement on the opinion, he stated that “[a]ny radical facilitating the ‘transitioning’ of our kids is committing child abuse,” and that the opinion “should send a clear warning there will be consequences for any medical professional, whether a doctor or therapist, who is illegally ‘transitioning’ Texas kids.” The opinion will inevitably have its intended effect: chilling the speech and therapeutic efforts of mental health professionals treating minors for issues related to gender.
Virginia Towns Using Zoning Laws to Restrict Abortion:
Although abortion is legal in Virginia - making it a singular stronghold of access in the South - certain towns have begun weaponizing zoning laws to enact restrictions. For example, in Lynchburg, the City Council recently enacted a zoning ordinance prohibiting clinics that provide abortion services from operating near certain locations, such as schools, parks and churches. The ordinance renders nearly all of Lynchburg off-limits, highlighting the ways in which laws seemingly unrelated to healthcare can be used to choke off access. Similarly, in Roanoke County, the Board of Supervisors passed a resolution in February instructing the planning commission to examine how it could limit the locations of abortion clinics. Reportedly, the resolution “was included on the board’s consent agenda, usually reserved for routine, procedural items that all parties have previously agreed on.” Individuals in both Lynchburg and Roanoke County have criticized the political maneuvering for lacking transparency.
Abortion Absent From State of the Union Address:
President Trump’s State of the Union Address, delivered on February 24th, conspicuously skirted the issue of abortion, with the word not being mentioned a single time. Although President Trump has previously referred to himself as “the most pro-life president in history” and proudly touted his administration’s anti-abortion agenda, he has been remarkably quiet on the subject in the past several months. Notably, multiple anti-abortion groups and leaders have publicly expressed discontent with the President’s failure to take more aggressive action to ban abortion at the federal level in his second term and called on the administration to restrict access to mifepristone, following medication abortion’s post-Roe rise in popularity. The administration’s silence likely reflects a calculation that aggressively taking on abortion would hurt the President and his allies politically in an already-contentious midterm year.
Surgeon General Candidate Espouses Anti-Birth Control Views:
President Trump’s nominee for surgeon general, wellness influencer Dr. Casey Means, faced intense scrutiny during her confirmation hearing before the Senate. Dr. Means, who would act as the top doctor in the country, was asked to answer for her history of anti-vaccine and anti-birth control statements and positions. She was specifically pressed on issues related to whether parents should have their children vaccinated, the efficacy of the flu vaccine, and debunked links between autism and vaccines. She was also questioned about her history of statements criticizing birth control, including referring to birth control pills as disrespectful to human life. At this time, it is unclear whether Means will garner the votes necessary to secure the position.