Developments in Abortion, Autonomy, and Access:
This week’s Reproductive Health Digest walks through litigation developments in a Texas case challenging medication abortion access, a ruling striking down Arizona restrictions on abortion, key examples of anti-abortion legislation being introduced at the state level, and continued legal battles over the right to gender-affirming care. We also discuss policy developments around veterans’ coverage for abortion, the FDA’s study of mifepristone’s safety record, and the Texas Medical Board’s new course for physicians about the state’s abortion laws. As always, please read on to the end for the news that you need to know.
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Legislation & Litigation:
Overview:
A Texas man who is suing California Dr. Remy Coeytaux for mailing abortion pills to his ex-partner has amended his lawsuit to add the first claims brought under Texas’s new medication abortion ban;
An Arizona court has struck down several medically unnecessary abortion restrictions, including a ban on telehealth, as unconstitutional in light of the state’s abortion rights amendment;
Iowa lawmakers have introduced a slate of anti-abortion legislation, including two total abortion bans; and
California has filed a lawsuit against a hospital for its decision to cease providing gender-affirming care services to patients under 19.
Texan Man Files First Lawsuit Under New Texas Medication Abortion Ban:
In December of last year, Texas’ medication abortion ban, HB7, went into effect. The law uses a ‘bounty hunter’ mechanism that financially incentivizes private citizens to sue anyone who provides abortion pills to Texans without a valid prescription. Texas is already enforcing a total abortion ban; however, abortion pills prescribed via telehealth have acted as a lifeline for individuals in need of care - HB 7 was passed as an attempt to block that route to access.
Last year, Texas man Jerry Rodriguez filed a lawsuit against Californa Dr. Remy Coeytaux for allegedly sending Rodriguez’s former partner abortion pills, and earlier this month, he amended that lawsuit to add a claim under HB7. This appears to be the first lawsuit brought pursuant to the new law. Rodriguez is seeking both financial damages and an order blocking Dr. Coeytaux from continuing to mail medication abortion into Texas. Dr. Coeytaux is operating under protection of California’s shield law, and California has thus far refused to comply with the lawsuit, with Governor Newsom stating that California “will not allow extremist politicians from other states to reach into California and try to punish doctors based on allegations that they provided reproductive health care services. Not today. Not ever.” Battles over the enforceability of shield laws are playing out in multiple legal forums, and whether these protective laws can ultimately withstand judicial scrutiny will play a fundamental role in the abortion access landscape moving forward.
Arizona Strikes Down Abortion Restrictions:
Earlier this month, Arizona Judge Gregory Como issued a ruling permanently striking down several medically unnecessary abortion restrictions in the state. In November 2024, Arizonans voted to amend their constitution to add protections for the right to pre-viability abortion care. However, the constitutional amendment did not automatically undo the many restrictive abortion laws that remained on the books and functionally blocked patients from accessing care. Like other states that have passed constitutional amendments, Arizonans have had to fight in court to see their rights fully realized. The restrictions struck by Judge Como this month include 1) a law requiring patients to make two separate trips to their health care 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 rescission of the 24-hour waiting period and the prohibition on telehealth in particular remove significant barriers to accessing care – particularly for patients who live in rural areas, or do not have the resources to travel and take time away from work, family, and other obligations. A spokesperson for the Arizona Senate President stated that they would appeal the ruling.
Iowa Lawmakers Introduce Anti-Abortion Legislation:
Less than a month into Iowa’s legislative session, lawmakers have introduced a number of bills that would significantly roll back access to abortion in the state. Iowa is currently enforcing a so-called ‘heartbeat ban’ that prohibits abortion after approximately 6 weeks gestational age. Although it is not yet clear how much traction each of the measures has in the general assembly, it is important to note that both houses of Iowa’s legislature are Republican controlled, and the state is run by a Republican governor adamantly opposed to abortion.
The first bill, HF 2332, would enact a total abortion ban and define the intentional ending of a pregnancy as “feticide”, punishable as a class A felony. A second proposed total abortion ban, HF 2316, goes even further and would punish abortion at all gestational ages as homicide and apply all of Iowa’s criminal and civil laws to a fetus from the time of fertilization. In other words, it would be a full realization of fetal personhood in state law. A third bill, SSB 3115 would tighten up on access to medication abortion by requiring an in-person visit prior to prescription. It would also add new informed consent requirements to Iowa law, including requiring prescribing physicians to screen for abuse or coercion. A similar proposed screening requirement was recently shot down by the Nebraska legislature on the grounds that it would place an additional burden on providers and was unnecessary in light of existing state protections against trafficking and abuse.
California Brings Suit Against Hospital for Ceasing Providing Gender-Affirming Care:
On January 30th, Attorney General Rob Bonta filed a lawsuit against Rady Children’s Health after the hospital announced that it would cease providing gender-affirming care for patients under the age of 19. Rady is only the latest in a large number of healthcare systems and hospitals ceasing care in light of the Trump Administration’s attacks on trans health. AG Bonta’s lawsuit alleged that Rady violated a binding merger agreement that required it to continue to provide all existing levels of healthcare, including gender-affirming care, until 2034. On Wednesday, a judge issued a ruling temporarily requiring Rady to continue providing care. Although many Californians have lauded the lawsuit as an important step taken by the state to protect care, others have questioned why - in a state that protects gender-affirming care and has strong anti-discrimination laws - the suit was brought on narrow contract-based grounds, rather than resting on California civil rights law.
Trend and Policy Watch:
Texas Medical Board Rolls Out Training on When Doctors Can Provide Abortions:
As ProPublica reports, the Texas Medical Board has started training its doctors on when they can legally provide care under the state’s multiple abortion bans. For years, providers and medical groups in the state have requested meaningful guidance on how to navigate the law - and for years, the Texas Medical Board has failed or declined to provide it. Last year, Texas passed SB 31, the ‘Life of the Mother Act,’ which sought to clarify the state’s exception for the life of the pregnant person. SB 31 also put in place requirements for the Texas Medical Board to create an educational course for providers around what state law prohibits and permits. That course is now available to physicians in the state. SB 31 was passed, in large part, in response to outcry from the medical community about the exceedingly dangerous uncertainty created by Texas’s vague and highly punitive bans. Since the implementation of its abortion bans, Texas has faced soaring sepsis rates and multiple cases of patients dying after failing to receive abortion care.
Democrats Are Fighting Back on Abortion Access for Veterans:
Last year, the Trump Administration rescinded abortion access for veterans and their dependents - including for cases involving threats to the patients health or instances of rape and incest. The new policy, which was implemented immediately by the VA, rolled back Biden-era guidance permitting abortion coverage in limited cases where the pregnant person’s life or health was threatened or where the pregnancy was a result of sexual assault. This coverage was particularly important in light of the disproportionate rates of sexual assault faced by servicemembers. Democratic lawmakers are now using the Congressional Review Act to push back on the new policy. As Planned Parenthood reports, “Sen. Blumenthal introduced the CRA resolution in the Senate along with Sen. Patty Murray (D-WA) and Senate Democratic Leader Chuck Schumer (D-NY), and Rep. Julia Brownley (D-CA) and Rep. Mark Takano (D-CA) are leading the charge in the House.” Other lawmakers have since joined the effort.
California Passes Legislation Giving $90 Million to Reproductive Health Clinics:
California Governor Gavin Newsom has signed a measure giving $90 million in emergency grant funding to Planned Parenthood and other reproductive health clinics. The funding was passed in response to the Trump Administration’s slashes to Medicaid and rescission of federal funding for Planned Parenthood and other clinics. The defunding of Planned Parenthood is currently being challenged in court, and multiple states have stepped up in similar ways as California to fill the gaps, but the loss of funding has already devastated access to affordable reproductive healthcare.
Republican Lawmaker Reportedly ‘Fuming’ at FDA’s Failure to Expedite its Review of Mifepristone’s Safety:
As we have reported on previously, the FDA, under the leadership of Commissioner Dr. Marty Makary, has committed to taking steps to review the safety of common abortion drug mifepristone. Mifepristone has been the subject of an onslaught of anti-abortion attacks because of its role in the continued availability of abortion post-Roe. Recently, anti-abortion lawmakers and groups have expressed frustration and anger at the Trump Administration for not taking more aggressive action to curb abortion access nationwide. Now, Sen. Josh Hawley is reportedly “fuming” after a meeting with Dr. Makary that left him with the impression that Dr. Makary is “not serious” about the review and that it may take the FDA years to complete it. Major policy changes to restrict access to abortion have proven to be extremely politically unpopular, and the Trump Administration is likely factoring the impact of such a move on the midterm elections into its calculus on the question.