Developments in Abortion, Autonomy, and Access:
This week’s Digest opens with the breaking news that a group of anti-abortion Attorneys General have asked the Supreme Court to strike down state shield laws in a move with major Constitutional implications. We break down a trial in California around so-called ‘abortion pill reversal,’ Tennessee’s investigations into reproductive healthcare providers and advocacy groups, a Sixth Circuit decision partially blocking Tennessee’s abortion trafficking law, a new Oklahoma lawsuit challenging the state’s abortion ban, and a federal court’s dismissal of a challenge to changes in Title X funding. We then discuss global trends in medication abortion access, state and federal politics around abortion, and Illinois’ newly-launched Reproductive Healthcare Hub. As always, please read on to the end for the news that you need to know.
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Legislation & Litigation:
Overview
Three Republican states have filed a lawsuit asking the Supreme Court to strike down shield laws protecting reproductive healthcare;
Trial has ended in a California lawsuit over anti-abortion groups’ promotion of so-called abortion pill reversal;
Tennessee Attorney General Jonathan Skrmetti is reportedly investigating reproductive healthcare providers and advocacy groups, issuing sweeping requests for patient, provider, and donor information;
The Sixth Circuit Court of Appeals has upheld a partial block on Tennessee’s abortion trafficking ban;
Two Oklahoma women filed a lawsuit challenging the state’s abortion ban after being denied care for devastating fetal diagnoses; and
A federal court has dismissed a case challenging harmful changes to Title X funding.
Republican States Ask Supreme Court to Strike Shield Laws:
In a move that reproductive rights advocates have long anticipated, a group of anti-abortion states have filed a lawsuit at the U.S. Supreme Court, asking justices to strike state shield laws on sovereignty grounds. Louisiana, Arkansas, and Alabama have asked the Court to take the extraordinary step of exercising original jurisdiction over the case, skipping over fact-finding and legal analysis normally performed by the lower federal trial and appellate courts. In the complaint, the states argue that California, Massachusetts and New York’s shield laws have resulted in “one of the most dramatic and sweeping interstate conflicts in modern history.” They argue that their sovereign interests are infringed upon by blue state shield laws and compare the mailing of medication abortion to the mailing of fentanyl or anthrax, asserting that the harm from loss of life is the same because the plaintiff states “protect unborn babies from the moment of conception.” The states also invoke Dobbs to support their claim that shield states’ laws “brazenly seek[] to subordinate pro-life states’ laws” in contempt of the Supreme Court’s ruling purporting to return the abortion issue to individual states.
Simultaneous with filing their complaint before the Supreme Court, the plaintiff states have also filed a lawsuit in the Western District of Louisiana against a host of reproductive healthcare providers and organizations. This complaint argues that the defendants have violated a host of consumer protection laws by, among other things, making the evidence-based claim that medication abortion is safe and effective and endorsing the FDA-approved view that in-person dispensing is not medically necessary. The states characterize their restrictive laws as protective of “the lives and health of unborn babies and their mothers,” ignoring the well-documented deaths and devastating health outcomes that have resulted directly from abortion bans.
Telehealth abortion has served as a lifeline for individuals in red states who need care - particularly those for whom traveling out of state is an impossibility. The stakes in this case are incredibly high for access to healthcare, bodily autonomy and the rule of law.
Trial Concludes in California Lawsuit About “Abortion Pill Reversal” Advertising:
Closing arguments concluded in California’s false advertising lawsuit against anti-abortion groups Heartbeat International and RealOptions Obria. The trial spanned six weeks of arguments about the promotion of high-dose progesterone treatments marketed to counteract and reverse medication abortions. State prosecutors argue that the organizations take advantage of individuals in emotional turmoil by touting the procedure as safe and effective without credible scientific backing or adequate warnings about potential side effects. The state is seeking $20 million in penalties and an injunction under California’s False Advertising and Unfair Competition laws. Alameda County Superior Court Judge Patrick McKinney is expected to issue a decision within three months, delivering a ruling that could define state authority over crisis pregnancy center communications.
Tennessee Investigating Reproductive Healthcare Providers and Advocacy Groups:
Tennessee Attorney General Jonathan Skrmetti is reportedly investigating reproductive healthcare providers and advocacy groups in the state. On September 23rd, Planned Parenthood affiliate Planned Parenthood of Tennessee and North Mississippi (PPTNM) filed a petition asking a Tennessee court to block the state’s request for patient records and donor and physician information. The state’s investigation also seeks information related to gender-affirming care for minors, a service that the Planned Parenthood affiliate states it does not currently and has never provided. Although Tennessee is enforcing a total abortion ban, Skrmetti alleges that the state believes that PPTNM has committed multiple violations of state law, including consumer protection laws and laws prohibiting gender-affirming care for minors and in-state telehealth abortion.
Abortion Care Tennessee (ACT), an abortion fund that helps individuals to access lawful out-of-state abortion care, is facing a similar investigation. As TN Repro News reports, the abortion fund received a request for information including “internal information, communications, and processes related to self-managed abortion and abortion pills by mail,” and a requirement for “all ACT staff, volunteers, and board members to fill out an affidavit about any verbal conversations they’ve had with anyone about abortion pills by mail or self-managed abortion,” including the details of those conversations and whether they believe it led to the person purchasing medication. This sweeping request raises alarming patient privacy and first amendment concerns. ACT has filed a petition to stay AG Skrmetti’s requests.
Taken together, these investigations appear to be an attempt by the state to intimidate patients and providers and chill the free flow of abortion-related speech. They also come on the heels of a Sixth Circuit decision upholding a partial block of Tennessee’s abortion trafficking law, as discussed in greater detail below. ACT’s petition argues explicitly that the state’s escalation was motivated in part by developments in the 6th Circuit case.
Federal Appeals Court Strikes Tennessee’s Abortion “Recruitment” Provision:
The U.S. Court of Appeals for the Sixth Circuit affirmed a lower court ruling blocking the “recruitment” provision of Tennessee’s 2024 “Underage Abortion Trafficking Act.” The law sought to impose criminal penalties on adults who “recruit” unemancipated minors to obtain abortions without parental consent, including lawful out-of-state care. State Representative Aftyn Behn and attorney Rachel Welty challenged the provision, arguing that it improperly criminalized speech about healthcare. In its decision, the appellate panel held that the prohibition constitutes unconstitutional viewpoint discrimination and is facially overbroad under the First Amendment. By upholding the permanent injunction, the court ensured that individuals and advocates in Tennessee may continue providing information and counsel regarding legal abortion options without facing prosecution.
Patients and Providers Harmed by Oklahoma’s Abortion Ban File Suit:
A group of Oklahoma patients and healthcare providers have filed a lawsuit challenging the state’s total abortion bans, which only permit abortion to save the patient’s life. In the complaint, two women detail how, faced with devastating fetal diagnoses, they were forced to flee the state to access care. Following fertility treatment, Magon Hoffman was “thrilled” to discover that she was pregnant in September 2022; however, several months into her pregnancy she learned that her daughter had anencephaly. She was reportedly told that her two options were to either leave the state or continue the pregnancy and likely watch her daughter die after birth. At great personal and financial cost, she chose to travel to New Mexico for care. Another plaintiff in the case, Sheena Hamlin, learned at her 21-week anatomy scan that her child had a number of lethal conditions - she was told that, if she continued the pregnancy, the baby would “suffocate almost as soon as the umbilical cord was cut.” She chose to travel to Illinois. The case also names the two women’s physicians, who are suing on behalf of both themselves and their patients. The complaint alleges a host of constitutional violations, including equal protection, substantive due process, and the fundamental right to life and liberty.
Federal Court Dismisses Lawsuit Challenging Political Restrictions on Title X Family Planning Grants:
U.S. District Judge Jennifer P. Wilson dismissed a lawsuit brought by the National Family Planning and Reproductive Health Association (NFPRHA) and the Family Health Council of Central Pennsylvania, holding that the healthcare providers faced insufficient concrete harm to establish a justiciable controversy. The plaintiffs, represented by the ACLU, challenged an HHS notice of funding opportunity for fiscal year 2027. They argued that the new process imposes politicized criteria, requiring grant applicants to align with administration priorities such as ending diversity initiatives and gender-affirming care, while shifting focus away from effective contraception toward menstrual cycle tracking. Although federal officials removed a threshold provision that allowed immediate rejection based on political alignment, the court’s procedural dismissal leaves the remaining grant requirements in place. Advocates warn that the new criteria threaten to displace long-standing, experienced Title X administrators in favor of new ideologically-motivated applicants, such as religious organizations and crisis pregnancy centers.
Trend and Policy Watch:
Mifepristone to be Legalized in South Korea:
Although we rarely use this Digest to discuss international developments in reproductive health, it is worth comparing how progress in other countries maps onto recent U.S. regressions. While the U.S. is facing relentless attacks on access to mifepristone, South Korea has announced plans to approve and introduce medication abortion. The first phase will reportedly begin in early 2027, and will likely comprise a combination of mifepristone and misoprostol for use during the first 9 weeks of pregnancy. Although South Korea has a fraught history of severely restricting abortion, its Constitutional Court ruled in 2019 that a near-total abortion ban was unconstitutional. The recent announcement has been met with mixed responses. Advocacy groups have applauded the move as a step forward but cautioned against instituting medically unnecessary barriers to accessing the medications, while conservative groups have voiced their objections and insisted that the government should focus its efforts on supporting mothers.
Utah Supreme Court Justice Recuses Himself from Challenges to New Judicial Panels:
Utah Supreme Court Justice John Nielson recused himself from hearing challenges to the state legislature’s newly created three-judge panels, reversing his previous stance in a lawsuit brought by Planned Parenthood Association of Utah. Planned Parenthood requested Nielson’s disqualification because he had previously represented Pro-Life Utah while in private practice. Nielson also voluntarily disqualified himself from a separate challenge to the judicial panels arising from a redistricting lawsuit due to his prior legal consultations with lawmakers. A lower court judge will be selected to fill Nielsen’s seat for the upcoming October 5th oral arguments, which will determine whether the Legislature had the authority to create the special panels to hear constitutional challenges.
Nominee for FDA Commissioner Faces Questions about Abortion:
During her Senate confirmation hearing, Trump’s nominee for FDA Commissioner, Dr. Heidi Overton, faced questions about her record on public health. Dr. Overton was tapped for the role following Dr. Marty Makary’s departure earlier this year - she is currently the deputy director of the White House Domestic Policy Council, and has seemingly been active in the administration’s anti-vax agenda. In the past, she has also been critical of medication abortion, raising concerns about her fitness to impartially run the agency in charge of its regulation. During her hearing, she was pressed on whether and how she would regulate medication abortion if confirmed. In response, she stated that “[a]ccording to FDA standards, the drug is safe and effective as labeled today,” avoiding taking a more direct stance. At one point, Senator Patty Murray, D-Wa., asked Dr. Overton if she believes that intrauterine devices (IUDs), a common form of contraception, are ‘abortifacients,’ or substances intended to cause an abortion. Dr. Overton did not answer directly and instead stated that she would make decisions according to standards of safety and efficacy. The anti-abortion right has recently gained substantial ground in arguing that certain forms of contraception are abortifacients and should be regulated as such. Following the hearing, over 2,500 physicians signed onto a letter opposing Dr. Overton’s confirmation, stating that “a vote to confirm [her]is an attack on abortion access, vaccine access, and public health.”
Illinois Launches Online Hub to Expand Access to Reproductive Healthcare Resources:
The State of Illinois launched a new resource - the Reproductive HealthCare Hub - to assist residents and out-of-state patients in navigating their options, including abortion services, contraception, and maternal care. The online portal offers a centralized platform to evaluate care pathways, locate low-cost or free treatment options, and understand state legal protections under the Illinois Reproductive Health Act and the Illinois Human Rights Act. With one in four out-of-state patients traveling to Illinois for abortion care, state officials created the hub to counteract misinformation and streamline access to services. To protect user confidentiality, the site incorporates enhanced privacy controls, including a quick exit feature that aligns with state medical privacy protections established under the Reproductive Health Records Privacy Act.