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.
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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.”