Developments in Abortion, Autonomy, and Access:
This week’s Digest goes through litigation developments involving religious freedom and abortion access, the reinstatement of Idaho’s total abortion ban, a new Wisconsin lawsuit challenging medically unnecessary abortion restrictions, oral arguments in the Fifth Circuit in a key case on medication abortion, and a Texas lawsuit alleging multiple state and federal violations of law in connection with the 2024 death of Tierra Walker. We also discuss changes to federal public health funding, a spike in ectopic pregnancy-related deaths, polling on Missouri’s anti-abortion ballot measure, and the EPA’s newly-announced plan to study drinking water for evidence of certain chemicals, including medication abortion, contraceptives, and other hormones. As always, please read on to the end for the news that you need to know.
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Legislation & Litigation:
Overview:
The Ninth Circuit has upheld a Washington law requiring insurance plans to cover abortions;
The Indiana Supreme Court heard oral arguments in a case challenging the state’s abortion ban on religious freedom grounds;
Idaho’s total abortion ban is once again in full effect;
The Fifth Circuit heard oral arguments last week in Louisiana v. FDA, a case seeking to reinstate in-person dispensing requirement for mifepristone;
Planned Parenthood of Wisconsin has filed a new lawsuit challenging the state’s 24-hour waiting period and physician-only requirement for abortions; and
A new lawsuit has been filed alleging multiple state and federal claims related to the 2024 death of Tierra Walker.
Ninth Circuit Upholds Washington Law Requiring Insurance Plans to Cover Abortion Services:
In a 2-1 decision, a Ninth Circuit panel rejected a First Amendment challenge brought by a local church against Washington’s 2018 Reproductive Parity Act. The Reproductive Parity Act mandates that health plans offering maternal care also cover abortion services. The majority held that the Parity Act is a neutral law of general applicability that rationally advances Washington’s compelling interest in ensuring equitable access to reproductive healthcare. Dismissing claims of religious hostility, the panel noted that the statutory framework explicitly shields objecting organizations from being forced to directly purchase or pay for abortion coverage. While the dissenting judge argued that the regulations unconstitutionally burden religious exercise, the majority affirmed that the state did not coerce religious compliance or violate church autonomy.
Indiana Supreme Court Hears Arguments on Whether Abortion Ban Violates Religious Freedom:
Last week, the Indiana Supreme Court heard oral arguments in a case challenging the state’s abortion ban on religious freedom grounds. The plaintiffs, Hoosier Jews for Choice and other anonymous individuals, filed the lawsuit in 2022, arguing that Indiana’s abortion ban interferes with the exercise of their sincerely held religious beliefs by prohibiting abortion in circumstances where their faith would counsel in favor of such care. The plaintiffs ground their arguments in the idea that, although some faith traditions believe that life begins at conception, others do not and may require the prioritization of the pregnant person’s health and life over that of the fetus. Previously, a lower court ruled in their favor, issuing an injunction blocking the abortion ban's application to plaintiffs in circumstances where it conflicts with their religious beliefs. The state appealed.
During last week’s arguments, Solicitor General James Barta disputed the idea that the abortion ban burdens religious exercise, arguing that the “nation’s long tradition of respect for religious exercise has never been understood to encompass a right to intentionally destroy human life.” He also questioned whether the plaintiffs had shown sufficient injury to bring the case given that none of them have been pregnant and required an abortion during the duration of the litigation. The ACLU, arguing for the plaintiffs, pointed to the fact that the plaintiffs have received abortions in the past for religious reasons and have been forced to change their behavior under the ban “to avoid pregnancies they would not be able to terminate even when religiously required.” The ACLU also argued that Indiana has undercut its own asserted compelling interest in protecting fetal life by permitting exceptions for non-religious reasons, such as instances involving rape or incest. During arguments, the judges heavily questioned both sides, probing how the state could craft a law that both protected its interest and allowed for religious exercise, and whether this case is similar to those that have found that religious entities do not have to cover contraception for their employees. How the court rules in this case will create important precedent on the question of whether religious freedom arguments can be wielded only to limit reproductive rights, but not to vindicate them.
Indiana Supreme Court Hears Arguments on Whether Abortion Ban Violates Religious Freedom:
Last week, the Indiana Supreme Court heard oral arguments in a case challenging the state’s abortion ban on religious freedom grounds. The plaintiffs, Hoosier Jews for Choice and other anonymous individuals, filed the lawsuit in 2022, arguing that Indiana’s abortion ban interferes with the exercise of their sincerely held religious beliefs by prohibiting abortion in circumstances where their faith would counsel in favor of such care. The plaintiffs ground their arguments in the idea that, although some faith traditions believe that life begins at conception, others do not and may require the prioritization of the pregnant person’s health and life over that of the fetus. Previously, a lower court ruled in their favor, issuing an injunction blocking the abortion ban's application to plaintiffs in circumstances where it conflicts with their religious beliefs. The state appealed.
During last week’s arguments, Solicitor General James Barta disputed the idea that the abortion ban burdens religious exercise, arguing that the “nation’s long tradition of respect for religious exercise has never been understood to encompass a right to intentionally destroy human life.” He also questioned whether the plaintiffs had shown sufficient injury to bring the case given that none of them have been pregnant and required an abortion during the duration of the litigation. The ACLU, arguing for the plaintiffs, pointed to the fact that the plaintiffs have received abortions in the past for religious reasons and have been forced to change their behavior under the ban “to avoid pregnancies they would not be able to terminate even when religiously required.” The ACLU also argued that Indiana has undercut its own asserted compelling interest in protecting fetal life by permitting exceptions for non-religious reasons, such as instances involving rape or incest. During arguments, the judges heavily questioned both sides, probing how the state could craft a law that both protected its interest and allowed for religious exercise, and whether this case is similar to those that have found that religious entities do not have to cover contraception for their employees. How the court rules in this case will create important precedent on the question of whether religious freedom arguments can be wielded only to limit reproductive rights, but not to vindicate them.
Ninth Circuit Temporarily Reinstates Idaho’s Full Abortion Ban Pending Appeal
Earlier this month, the Ninth Circuit Court of Appeals granted an emergency administrative stay reinstating Idaho’s ban and blocking a lower court ruling that had allowed a maternal-fetal medicine specialist to perform certain health-preserving abortions without fear of criminal prosecution. U.S. District Judge B. Lynn Winmill had previously enjoined the state from enforcing its near-total ban against Dr. Stacy Seyb in cases where a pregnancy threatens a patient’s physical health or poses a severe risk of self-harm. Following an appeal by Idaho Attorney General Raúl Labrador, the Ninth Circuit panel temporarily reinstated the state’s criminal penalties pending its consideration of emergency motions. While the panel emphasized that this administrative pause does not reflect its view on the ultimate legal merits, the decision leaves Idaho’s ban fully in effect with no protections for health-preserving care as appellate arguments approach.
Fifth Circuit Hears Oral Arguments in Louisiana v. FDA:
Last week, the Fifth Circuit Court of Appeals heard oral arguments in Louisiana v. FDA, one of several cases seeking to restrict access to medication abortion. Relying on disinformation about the alleged dangers of medication abortion and arguments about state sovereignty, Louisiana asked the 3-judge panel to force FDA to reinstate in-person dispensing requirements for mifepristone. Interestingly, Louisiana is not asking the court to broadly rescind telehealth prescribing of medication abortion, but merely to require the pills to be dispensed in person. Functionally, this would create a procedure whereby a patient could undergo medical screening and receive a prescription through telemedicine services but would then be required to travel in person to a healthcare facility just to pick up their medication. Earlier in the case, a different panel of Fifth Circuit judges issued an order briefly reinstating in-person dispensing requirements; however, the U.S. Supreme Court paused that order while litigation plays out.
The case is now back before the Fifth Circuit, and this time Louisiana faced a considerably more liberal panel, comprising judges appointed by Presidents Obama, Biden, and George W. Bush. The judges appeared skeptical of Louisiana’s theory of standing, which hinges on the idea that abortions facilitated by telehealth are taking place in the state despite its abortion ban. At multiple points, the judges questioned how this purported harm was caused by FDA rather than by the long chain of intervening actions and decisions of providers and patients. The judges also pressed counsel for FDA on the agency’s position on mifepristone’s safety and its process for modifying regulations for a particular drug. However, counsel repeatedly declined to provide any substantive answers, insisting on only addressing the standing question and arguing that the case should be put on hold until the agency concludes its own review.
Wisconsin Planned Parenthood Challenges Abortion Restrictions:
Last week, Planned Parenthood of Wisconsin filed a new lawsuit challenging the state’s mandatory 24-hour waiting period and requirement that only physicians perform abortions. Post-Dobbs, anti-abortion lawmakers and state officials in Wisconsin pushed to enforce a long-dormant 1849 abortion ban; however, last year, the Wisconsin Supreme Court sided with the state’s Democratic Attorney General and struck the ban as unconstitutional. Currently, abortion is legal in Wisconsin until 20 weeks gestational age, with certain exceptions.
Advocates are now seeking to undo remaining medically unnecessary restrictions on care, and the recent election of liberal justices to the state’s highest court has created a favorable judicial environment in which to do so. The newly-filed complaint alleges a host of constitutional deficiencies, including violations of the rights to privacy, bodily autonomy, and equal protection for both patients and providers. If successful, the case will be a substantial step towards establishing a fundamental right to abortion in the state.
Lawsuit Filed Over the Death of Tierra Walker, a Woman Denied Lifesaving Abortion Care:
Amplify Legal, the litigation arm of Abortion in America, has filed a new lawsuit in Texas alleging violations of state and federal law in connection with the preventable death of thirty-seven year old Tierra Walker in 2024. The lawsuit names as Defendants Texas Attorney General Ken Paxton and various health systems and individual doctors involved in Walker’s care.
When Walker found out she was pregnant, she was suffering from multiple chronic conditions, including asthma, hypertension and diabetes. She was repeatedly hospitalized during the first few months of her pregnancy and requested termination at multiple points as her health deteriorated. She died as a result of medically predictable cardiovascular complications and was reportedly found by her teenage son on his fifteenth birthday. The lawsuit argues that the defendants actions and inactions violated state and federal constitutional protections, EMTALA, and multiple state laws governing the practice of medicine. Walker is among a growing list of women who have lost their lives in Texas and elsewhere as a direct result of abortion bans that severely restrict the practice and provision of reproductive medicine.
Trend and Policy Watch:
HHS Cancels $38 Million in Grants for Infant Mortality, Postpartum Research, and Maternal and Infant Health:
In late August, the U.S. Department of Health and Human Services terminated $38 million in federal grants administered through HHS’s office of Minority Health. The cancelled grants funded work addressing urgent and well-documented healthcare disparities experienced by minority groups in areas including infant mortality, postpartum care, mental health, and maternal and infant health.
Impacted programs include organizations that engage in suicide prevention efforts, send nurses to visit and support postpartum parents and newborns, and provide healthy food to those in need. Reportedly, letters to the grantees stated that future awards would be focused on “reducing overmedicalization in health care by addressing the root causes of infertility,” including “hormonal imbalances, endometriosis, uterine fibroids, low sperm count, low testosterone levels and erectile dysfunction.”
New Polling Shows Missouri Voters Sharply Divided Over Amendment to Reinstate Abortion Ban:
According to the latest SLU/YouGov poll, Missouri voters are evenly divided on Amendment 3, the November ballot measure asking Missourians to reinstate a total abortion ban. Recent polling found that 44% of respondents oppose the measure and 43% are in support, well within the survey’s margin of error. The measure was placed on the ballot by state lawmakers to dismantle the constitutional right to reproductive freedom approved by voters in 2024 and enshrine restrictions on gender-affirming care for minors. Earlier polling showed voters favoring the legislative proposal by double digits, and the significantly narrowed gap underscores the need for sustained advocacy and voter education, particularly among undecided voters.
Reporting from ProPublica Shows that Ectopic Pregnancy Related-Deaths Have Skyrocketed Post-Dobbs:
New reporting from ProPublica shows that ectopic pregnancy-related deaths doubled from 2020-2025 as compared to the prior six years. Ectopic pregnancies occur when a fertilized egg implants outside of the uterus - most commonly in a fallopian tube - creating imminent risk of rupture, severe bleeding, and possible death. Although extremely dangerous, ectopic pregnancies are also treatable if diagnosed and addressed promptly.
ProPublica’s reporting analyzed the increased mortality rates and found that, although the initial spike may have been partially caused by disruptions to the healthcare system during the Covid-19 pandemic, the numbers have continued to rise. Unsurprisingly, mortality rates are significantly higher in states with abortion bans, where providers are forced to practice reproductive medicine under threat of severe criminal, civil, and professional penalties. Experts that ProPublica spoke to indicated that, although more research is required to fully understand the root of the problem, it is likely attributable to a combination of abortion bans, reduced Medicaid coverage, and a lack of research, investment, and reliable data.
EPA Yields to Political Pressure to Screen Drinking Water for Mifepristone, Contraceptives, and Gender-Affirming Hormones:
The Environmental Protection Agency announced it will conduct non-targeted screening of the national drinking water supply for a “broad array” of trace compounds, explicitly incorporating mifepristone, alongside contraceptives and gender-affirming hormone therapies. The inclusion of medication abortion follows sustained lobbying by anti-abortion groups seeking to classify reproductive healthcare pharmaceuticals as environmental pollutants. By framing medication abortion as a water contaminant, conservative lawmakers and anti-abortion organizations are actively working to weaponize environmental regulations to restrict access to healthcare. As Guttmacher Institute Principal Federal Policy Advisor Anna Bernstein pointed out, “singling out medication abortion while ignoring the agricultural and industrial pollutants that are proven threats to our health makes clear that these efforts are about restricting access to abortion, not protecting our water.”