1). “Pregnant? The State Can Ignore Your Advance Directive”, May 21, 2025, Jessica Valenti, Abortion, Every Day, at < https://jessica.substack.com/
2). “I was wrong-and I am outraged: A follow-up to my newsletter from today”, May 20, 2025, Dr. Jennifer Lincoln, The Birth Book Companion, at < https://drjenniferlincoln.
3). “Texas Jailed a Miscarriage Patient for Five Months”, May 20, 2025, Jessica Valenti, Abortion, Every Day, at < https://jessica.substack.com/
4). “Her miscarriage showed the limits of California’s abortion protections. Where you live matters”, May 21, 2025, Kristen Hwang, CalMatters – The Mercury News, at < https://www.mercurynews.com/
5). “Report: Abortion Providers Are Confronting a New Wave of Extremism: 'It shouldn’t take someone being murdered for a law to be enforced' ”, May 20, 2025, Laura C. Morel, Mother Jones, at < https://www.motherjones.com/
6). “Why so many clinics that provide abortion are closing, even where it's still legal”, May 16, 2025, Kate Wells, NPR, Audio version duration 4 mins, at
~~ recommended by dmorista ~~
Introduction by dmorista: The pace of events taking place, as the U.S. and much of The West slides into the joyless fascist mire, is overwhelming; but there is a constant struggle between women fighting to maintain their basic rights (and reproductive healthcare and abortion access are the central issue). As usual Jessica Valenti is working hard to keep up with the relentless attacks and lies.
In Item 1)., “Pregnant? The State Can Ignore ….”, Valenti reports on the little known fact that in the overwhelming majority of states “Advance Directives” that women have signed and put on record are automatically overridden, when women get pregnant. Or can be overridden at the whim of local and/or state law enforcement or other authorities. A consequence of these dictatorial laws is playing out in Georgia right now where a brain dead pregnant woman is being kept on “life-support” without any attempt to involve her family in the decision. And, as another horrific side effect the cost of this outlandishly expensive and basically unwanted medical intervention, undertaken because the woman was 9-weeks pregnant, the expenses will be borne by her family and will financially ruin and impoverish them. Item 2)., “I was wrong-and I am outraged: ….”, the outstanding Jennifer Lincoln an OB/GYN in Oregon reacts to the news of the outrageous situation for the family of Adriana Smith by admitting that she had not been aware of this terrible situation and that women's advance directives written up by her patients were routinely being callously overridden.
In Item 3)., “Texas Jailed a Miscarriage Patient ….” Valenti discusses the incredibly cruel and vicious treatment of a woman who suffered a miscarriage at a fast-food restaurant and who was jailed for 5 months. In both this case in San Antonio and in Georgia the women are both African-American. In Item 4). “Her miscarriage showed ….”, the article discusses the case of a white woman who lives in rural Northern California who was denied adequate treatment for a miscarriage at a Catholic Hospital. This is the notorious case in which when she left the Emergency Room at Catholic owned Providence Hospital in Eureka,California, still in pain the staff gave her a bucket and some cloths to use “in case something happens in the car”. Her husband drove her to a secular hospital where she underwent immediate surgery. She has filed a lawsuit about this case of mistreatment.
In the same basic discussion there are an endless stream of disinformation and propaganda emanating from the Forced-Pregnancy / Forced-Birth operations largely designed to make young women feel guilty about an abortion decision. While much of this is online and involves everything from Tik-Tok to Facebook the old style Billboards in Texas placed along highways leading from the Dark Ages Red State Texas, to New Mexico where women can obtain needed abortion care.
Item 5)., “Report: Abortion Providers ….” documents the new wave of violence and intimidation that the Forced-Pregnancy / Forced-Birth operatives are mounting against Abortion clinics. Item 6). “Why so many clinics ….”, discusses the problems that are making abortion clinics close. The major increase in medication abortion and the difficulty and expense of running abortion clinics in a society where right-wing fanatics have been emboldened by the Trump Abortion Bans and the Trump Regime and in an era when the majority of abortions are medication abortions that largely take place at home.
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Pregnant? The State Can Ignore Your Advance Directive
Click to skip ahead: Criminalizing Care connects the dots on the rise in post-Roe arrests. Conservative Cruelty notes that we’re still waiting to hear from the nation’s leading anti-abortion group on Adriana Smith, along with some troubling legal news about advance directives and pregnancy. In the States, news from Texas, New Hampshire, and more. All About Louisiana looks at anti-abortion legislation seeking to expand civil liability. Anti-Abortion Glossary reports on the latest around ‘coercion’. In the Nation, supporting Planned Parenthood and a new ruling on workplace protections for abortion patients.
Criminalizing Care
If you missed yesterday’s breaking story, please read it below: A Texas woman, Mallori Patrice Strait, was jailed for nearly five months—charged with abuse of a corpse after miscarrying in a public restroom.
Her case echoes prosecutions we’ve seen across the country—like Brittany Watts in Ohio and Selena Maria Chandler-Scott in Georgia. These are not just a handful of horrifying outliers. According to Pregnancy Justice, over 200 pregnancy-related arrests took place in just the first year after Roe fell.
And these cases all follow a pattern. Instead of arresting women on suspicion of abortion, law enforcement accuses them of ‘abuse of a corpse’ or ‘abandoning a dead body’—charges based on how they handled their miscarriages. This gives Republicans the cover they need to claim they don’t prosecute women for abortions, while punishing patients all the same.
And let’s be clear about who’s being targeted. It’s women of color—like Strait, Watts, and Chandler-Scott; and women who are low-income, unhoused, or young. In March, a Pennsylvania teenager was investigated for burying her fetus in her backyard. And in 2023, a 17-year-old in Nebraska was sentenced to 90 days in jail for doing the same.
And those are just the stories we know about.
Something else to keep in mind as more of these cases come to light: you’ll notice that many involve women later in pregnancy. That’s not just a consequence of fetal personhood—but ‘viability’ laws and standards that allow state interference at a certain point in pregnancy.
But our bodies don’t become less ours at 24 weeks. And fetal personhood is wrong at any point in pregnancy.
If you are facing investigation or arrest over a pregnancy outcome—or just need information about pregnancy criminalization—go to Pregnancy Justice. You can also get free legal advice from If/When/How’s Repro Legal Helpline: 844-868-2812
Conservative Cruelty
I’m tempted to post a countdown clock at this point: It’s been a full week since the country learned about Adriana Smith—and still, not a peep from the country’s most powerful anti-abortion organization, Susan B. Anthony Pro-Life America.
Smith, whose body is being kept on life-support in a Georgia hospital against her family’s wishes, was 9 weeks pregnant when she was declared brain dead. Doctors told Adriana’s family that the state’s 6-week ban prevents them from allowing her to pass away naturally and peacefully.
Some anti-abortion groups have issued statements—with most just trying to duck responsibility. But SBA? Silent. And that silence speaks volumes.
It’s not just that the organization is afraid of political backlash, though that’s certainly part of it. My guess is that SBA president Marjorie Dannenfelser hasn’t distanced herself from Adriana’s torment because she supports it. In fact, I’m willing to bet she agrees with Students for Life president Kristan Hawkins—one of the few anti-abortion leaders to say out loud that Adriana’s body should be used as an incubator.
She just doesn’t want to say it in public. Not with voters watching, anyway.
As Mary Ziegler writes at Slate today, the idea that conservatives didn’t see this coming is absurd:
“Adriana Smith’s case isn’t an oversight. It’s just one example of what fetal personhood means.”
There’s only so long SBA can stay quiet, because their absence is starting to be very noticeable.
Tick tock, Marjorie. ⏰⏰⏰⏰
I don’t need to tell you why independent feminist media is more important than ever. You read it in the headlines every day. Help Abortion, Every Day keep going by signing up for a paid subscription:
In related news: I thought I was pretty well versed on all things pregnancy and abortion, but this news from Dr. Jennifer Lincoln truly shocked me: over 30 states have laws that override your advance directive if you’re pregnant.
An advance directive is supposed to be a binding legal document. It lays out your wishes for medical care—like whether or not you’d like to be kept on life support—if you become incapacitated. But Lincoln reports that in most states those wishes can be thrown out if you’re pregnant; and in nine states—Alabama, Indiana, Kansas, Michigan, Missouri, South Carolina, Texas, Utah, and Wisconsin—advance directives for pregnant people are automatically invalidated.
That’s not some small legal loophole! That’s the state declaring that your body no longer belongs to you.
Lincoln has a map on her Substack, and I’ll be digging more into this. But it’s a gut-wrenching reminder: Pregnant people in this country are treated like second-class citizens—when we’re treated like people at all.
In the States
Don’t be fooled by today’s headlines about Texas. The state legislature advanced Senate Bill 31 this afternoon—the legislation Republicans claim will clarify (🚩) the state’s abortion ban and protect doctors who provide life-saving care. But despite GOP talking points (and far too many credulous headlines), the truth is a lot darker.
Abortion, Every Day first reported on SB 31 back in March, warning that it was a Trojan Horse—a bill designed to bring back a 1925 abortion ban that could be used to prosecute abortion funds, helpers, and even patients. AED’s reporting created a domino effect of coverage that put pressure on lawmakers to amend the bill and walk that plan back.
Their original plans foiled, Republicans have since shifted their attention to another bill—SB 2880—where they’re still trying to revive that century-old ban. And SB 31? Still a big problem!
The bill allows Texas Republicans to pretend that they’ve ‘softened’ their stance and offered legal clarity to doctors, even though it doesn’t actually expand exceptions. What’s more, the bill requires doctors to take a continuing education course about the state’s abortion ban—designed and taught by an organization hand-picked by Texas Republicans.
Translation: anti-abortion activists will be teaching doctors when and how they’re allowed to save a woman’s life.
How do I know? Because we’ve seen this before! When South Dakota Republicans passed a similar requirement, the state teamed up with the extremist American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG) to create their ‘educational’ materials for doctors.
This is an organization that insists abortion is never medically necessary—and recommends c-sections for women with life-threatening pregnancies rather than safer, faster, less painful abortions. So maybe not the best folks to be giving medical advice!
Per usual, Texas is a testing ground for what anti-abortion groups want nationally. These so-called ‘Med Ed’ bills—which are becoming a trend—let lawmakers pretend they’re working with doctors to clarify care, when what they’re really doing is establishing a terrifying new norm: that the government gets to dictate when and how doctors treat their patients in medical emergencies.
So no, I won’t be celebrating SB 31. And I wish more headlines and publications were asking tougher questions.
Meanwhile, New Hampshire Republicans are pushing legislation that would create a formal citizen-led process for banning books in public schools. Good times!
Right now, New Hampshire school boards have oversight of book complaints; under HB 324, parents (or any individual) could file a challenge against a book, and the school would have to respond within 10 days. There would even be an appeal process if the person who brought the challenge doesn’t like the school’s answer.
Bill sponsor Rep. Glenn Cordelli said the legislation “is about making sure that our children, your children, have books that are age appropriate.” In a moment when conservatives are attacking books or lessons that even mention LGBTQ people, we know what ‘age appropriate’ is code for.
Finally, The Mercury News has a profile of Anna Nusslock, the California woman suing a Catholic hospital who denied her miscarriage treatment. Nusslock was just 15-weeks pregnancy when her water broke: there was no chance for her twin fetuses’ survival and she was more at risk the longer she stayed pregnant. But because there were still audible fetal heart tones, Providence St. Joseph Hospital refused to give her care.
Her story is just wrenching—it’s also a reminder that these bans and policies can impact you no matter where you live. Learn more about how Catholic hospitals’ anti-abortion policies hurt and kill women in AED’s past coverage.
Quick hits:
Wisconsin Democrats are trying to expand access to contraception;
A new study shows an increase in North Carolina’s out-of-state abortion patients;
Where New Jersey gubernatorial candidates stand on abortion rights;
And more on the parental consent fight in Florida.
All About Louisiana
Yup, Louisiana needed its own section today. Abortion is already completely banned in the state, but Republicans there aren’t done. They’re pushing even more restrictive and punitive laws—all in an effort to terrify anyone thinking about getting out-of-state care or ordering abortion pills.
Like their conservative counterparts across the country, Louisiana Republicans are furious that pregnant people have found ways to access abortion despite the state ban. So they’re working overtime to shut all of that down.
Their latest move? House Bill 575, legislation that would dramatically expand civil liability around abortion. It would allow patients, the fetus’s father, and even grandparents to sue anyone who “performs, causes, aids, or abets an abortion.”
Yes, really.
Bill sponsor Rep. Lauren Ventrella calls it the “Justice for Victims of Abortion Drug Dealers Act,” a title that had me rolling my eyes so hard I’m pretty sure I sprained something. Under this legislation, plaintiffs could sue for at least $100,000, plus damages for emotional distress and attorney fees.
Ventrella wants voters to think this is about stopping shady out-of-state doctors—the so-called “abortion drug dealers.” But many of those blue state providers are protected by shield laws. In reality, her bill would most likely impact Louisiana doctors providing legal emergency care.
Here’s how it could play out: A pregnant woman shows up at the hospital after her water breaks far too early. To prevent infection and sepsis, her doctor performs a (legal) abortion. But her mother-in-law, who’s there in the room, decides the doctor acted too soon—and convinces herself that a healthy baby could have been born if they’d just waited. (It’s not medically sound, but since when has that stopped anyone?)
Under this bill, that mother-in-law could sue the doctor.
Even if the court ultimately sides with the doctor, she’s now been through months or years of legal hell. And the next time she’s treating a miscarrying patient, maybe she hesitates—delaying care for fear of being sued again, putting her patient at risk.
It’s especially dangerous because HB 575 removes malpractice protections for providers. So now doctors are expected to make split-second medical decisions during emergencies with a legal target on their backs.
The bill is headed to a state Senate committee next, so I’ll keep you posted. In the meantime, take action against the legislation here, and listen to the latest episode of the Seriously?! podcast with Michelle Erenberg and Ellie Schilling of Lift Louisiana to learn more:
Anti-Abortion Glossary
Another wackadoo bill is making its way through the Louisiana legislature—and it’s a perfect example of one of the anti-abortion movement’s favorite buzzwords: coercion.
Last month, I flagged HB 425, which would expand the state’s definition of ‘coerced’ abortion—most notably around “extortion.”
Rep. Josh Carlson’s bill is so broad that a parent who refuses to pay for college for their pregnant teen—or a roommate who wants to end a lease with their pregnant friend—could be guilty of ‘coercion.’
I can’t stress enough how much conservatives love this word. They started to float it in earnest back in 2023, when leading anti-abortion activists identified the term as the GOP’s most promising talking point because “no one is openly in favor of coerced abortions.”
Since then, we’ve seen it everywhere—especially when Republicans are doing something shitty. Louisiana Republicans arresting a mom for helping her teen daughter get an abortion? We’re stopping coercion! Passing restrictions to delay abortion care in Michigan? We’re just making sure no one was coerced!
Montana lawmakers used it as an excuse when they were pushing a bill to charge women who got out-of-state abortions with ‘trafficking’ their own fetus. New FDA chief Marty Makary dropped the word when talking about potential restrictions on mifepristone. And anti-abortion activists even used it to argue against emergency abortions in hospitals—claiming the Biden administration was somehow coercing doctors by requiring them to save women’s lives.
All of which is to say: the anti-abortion movement thinks this term is their ticket out of voter backlash. It sounds compassionate. It polls well. And it just so happens to give cover to some of the cruelest laws in the country.
So if you’re working on abortion rights messaging, take note: coercion is the word we’ll be up against.
In the Nation
I really hate this news: A federal judge has struck down a provision of the Pregnant Workers Fairness Act (PWFA) that requires employers to make “reasonable accommodations” for workers who have abortions. U.S. District Judge David Joseph ruled that the Equal Employment Opportunity Commission (EEOC) overstepped its authority when it included abortion as a pregnancy-related condition deserving of workplace protections.
Now, let’s be clear here: The EEOC’s guidance only applied to businesses with more than 15 employees, it didn’t require employers to pay for an abortion—or to even give employees paid time off! In reality, the regulation was about ensuring workers can take time off for abortion appointments and recovery without fear of losing their jobs.
But asking employers to be decent human beings is a step too far for Republicans, who want the legal right to discriminate against abortion patients.
And while conservative leaders have insisted that workers who need ‘medically necessary’ abortions can still have paid time off—how exactly will that work? Are employees going to be required to prove to their boss that they’re sick enough to need an abortion?
Honestly, fuck these guys.
Finally, I was one of over 250 people who signed a letter in support of Planned Parenthood today—published as a full-page ad in The New York Times. As you all know well, Republicans are trying to shut down the reproductive health organization, and attack the country’s most vulnerable communities in the process. This week, don’t forget to ask your member of Congress to step up and fight for Planned Parenthood. Read the full list of supporters here.
Quick hits:
NPR on why abortion clinics are closing, even in pro-choice states;
Mother Jones on the increasing violence against abortion providers and clinics;
And in international news, The Guardian on why abortion rights are getting more perilous in the UK.
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I was wrong-and I am outraged
Earlier today I sent out an extra edition of my newsletter talking about why it’s so important to have an advance directive if you’re pregnant. This was inspired by the tragic story of Adriana Smith in Georgia (who at 9 weeks of pregnancy suffered a stroke, was declared brain dead, but is being kept alive on life support so she can grow her fetus—without any input from her mother).
Well, imagine my surprise when someone sent me this via DM:
As you can probably tell from my reaction, I was completely caught off guard. At first, I felt embarrassed—Does everyone know this but me? How do I not know this as an OBGYN?—and then I got angry.
Angry that it’s true. Angry that I consider myself well-informed on reproductive rights and still didn’t know. Angry that if this is the reality, why aren’t we shouting it from the rooftops? Why aren’t we louder about the fact that in some places, a pregnant person can be legally reduced to an incubator—kept alive against their will?
And then I realized: this isn’t different from any other abortion ban. Because whether you’re forcing someone to carry a pregnancy to term or forcing someone to remain on life support to sustain a fetus, the outcome is the same: the pregnant person’s body and autonomy are no longer their own.
And once the baby is born? That same system often walks away. States that push these bans rarely show the same urgency when it comes to maternal health, Medicaid coverage, or ensuring those children are fed, housed, or cared for. The hypocrisy is staggering.
But I digress.
Here’s what I’ve learned. I’m livid—and I want you to know it too. Because this is part of a broader, quieter threat: fetal personhood. And the more people who understand it, the better chance we have of pushing back.
The frightening reality of advance directives in pregnancy
As I explained in today’s previous newsletter, an advance directive is a legal document that spells out your medical care preferences in case you’re ever unable to speak for yourself—like whether or not you’d want to be kept on life support if there’s no chance of full recovery.
Enter “pregnancy exclusions”
Over 30 states have pregnancy exclusions that can override your advance directive if you’re pregnant. In nine states, your wishes are flat-out invalidated, no matter the stage of pregnancy or the fetus’s chances of survival. That means if you’re incapacitated, you could be kept on life support against your stated wishes—all because you’re 6 weeks pregnant.
A study published in JAMA in 2019 looked at how different states take pregnancy into account when deciding to follow or ignore advanced directives in incapacitated patients. As you can see below, the darker the state, the worse the pregnancy exclusions. This map turned my stomach.
DeMartino ES, Sperry BP, Doyle CK, Chor J, Kramer DB, Dudzinski DM, Mueller PS. US State Regulation of Decisions for Pregnant Women Without Decisional Capacity. So here’s what I now know about pregnancy and advanced directives. It ruined my day, and it might ruin yours too—but it means once we know about it, we can give voice to it:
Nine states (Alabama, Indiana, Kansas, Michigan, Missouri, South Carolina, Texas, Utah, and Wisconsin) automatically invalidate all advance directives for pregnant people—no matter how early the pregnancy or whether the fetus could survive—forcing life support even against explicit wishes.
Sent to me by a follower who practices law in Texas More than 30 states have some form of “pregnancy exclusion” in their advance directive laws, meaning your wishes may be ignored if you’re pregnant, especially regarding life-sustaining treatments like ventilation or tube feeding.
Alaska, Georgia, and Oklahoma require physicians to test for pregnancy before withdrawing life-sustaining treatment from women of childbearing age. WTF.
My conclusion: we really do hate pregnant women in this country. Certain politicians and politician-adjacent folks (yes, Elon) seem hell bent on us having more babies. They want us to have huge families, and they just seem so perplexed as to why we aren’t. Gee, I wonder if it’s because if I end up in a coma in Texas when I’m 10 weeks pregnant my family might have to watch me suffer as I am maintained on life support against my wishes?
Couldn’t be that.
What to do next
Don’t lose hope. Court victories (like in Colorado in 2021) have led to new laws removing pregnancy exclusions. They recognize that they violate constitutional rights to refuse unwanted medical treatment—hooray for human rights!
Here’s what you can do if you’re pregnant or planning to become pregnant to protect yourself:
Get informed: Know your state’s laws when it comes to advance directives in pregnancy.
Talk to your healthcare team and loved ones: Make your wishes crystal clear. Even if the law isn’t on your side, your care team and family should understand your values and preferences.
Advocate for change: Laws can change! Contact your legislators (here) and support organizations fighting for patient autonomy. Speak up. Share this on social media. Tell your friends. We can’t fight what we don’t know is happening —which even I didn’t until earlier today.
Document everything: Even if your advance directive could be invalidated, it’s still worth completing one and stating your wishes about pregnancy. It helps guide your loved ones and medical team in tough situations. Consider including language about how you want it to be followed even if you are pregnant. While this may not guarantee it will be, it certainly can’t hurt in a court of law if the situation arises.
Am I still embarrassed that I didn’t know how widespread pregnancy exclusions are? No—and you shouldn’t be either if this is new to you. I’m grateful to the readers and followers who, like the person who DM’d me, are paying attention, asking questions, and teaching me right alongside the learning I’m trying to share.
Let’s work to lift up these messages and fight for what truly are just basic human rights.
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Five Months in Jail—for a Miscarriage
Click to skip ahead: In Criminalizing Care, a Texas woman spent five months behind bars for her miscarriage. Language Matters digs into abortion as an ‘intention’. Care Crisis reminds readers that OBGYNs are being forced to travel to Texas for their certifying exams. In the States, news from Maine, Kansas, Missouri, and more. In the Nation, the White House’s bullshit moves on IVF, the attacks on Planned Parenthood, and more.
Criminalizing Care
I’m sorry to hit you with another nightmare story, but this is important: Texas kept a woman in jail for nearly five months after she miscarried in a public bathroom.
Five. Months.
According to Bexar County court records, Mallori Patrice Strait was arrested for ‘abuse of a corpse’ on December 19, 2024. She was just released last week, after prosecutors dropped the case due to insufficient evidence.
I said this on Friday, but I’ll say it again: We don’t need to imagine a dystopian future where women are being used as incubators and arrested for miscarriages, because that future is already here.
I first wrote about Strait’s story in January, pointing out the similarities to Brittany Watts’ case. Watts was arrested for ‘abuse of a corpse’ in Ohio after she lost her pregnancy at home. Her story was splashed across local crime pages, with lurid headlines declaring that she had “clogged” her toilet trying to “flush” a newborn.
Strait was treated the same way—with sensationalist headlines stating that she “spent hours” trying to flush her “baby girl” down the toilet. They even published her mug shot. If only it ended there.
After a judge set her bond at $100,000, Strait spent the next five months—including her 34th birthday—behind bars. While she was in jail, a local crisis pregnancy center took custody of her fetal remains. They named the fetus, and gave it a public funeral. (I know, nauseating.)
Just days ago, the district attorney finally filed a motion to dismiss. The Bexar County Medical Examiner had determined Strait had miscarried and that her fetus died in utero. The DA’s office said there was “no direct evidence” that Straight tried to flush anything.
So why the fuck was she in jail?
We know why: The people criminalized for their pregnancy outcomes tend to be marginalized—they’re often women of color, low income, immigrants, unhoused, or have substance abuse issues. Black women, in particular, are targeted by law enforcement and hospital staff. (When someone is arrested on pregnancy-related charges, they’re most often turned in by a healthcare provider.)
These prosecutions follow a very predictable pattern, so we know who is most at risk.
But let’s recap for a moment: Texas arrested a woman for a miscarriage, jailed her for nearly half a year, let an anti-abortion group name and bury her fetus—and then quietly dropped the charges once they realized they never had a case to begin with.
As Karen Thompson, legal director of Pregnancy Justice, put it:
"You cannot undo the harms of ignorant law enforcement responses to a miscarriage. You cannot undo the fear Ms. Strait felt. You can't undo the time she lost in jail. You can't undo the trauma. It isn't okay to have to recover from something that never should have happened."
Let’s be clear: This is what abortion bans and fetal personhood laws do.
It’s been less than two months since a Georgia woman was arrested for how she disposed of her miscarriage. Even after public outrage forced the DA to drop the charges, he still threatened her with prosecution, saying, “I do not condone the way the remains were handled.”
But this isn’t just about criminalization. The same fetal personhood used to charge Strait and the young woman in Georgia is also behind the torture of Adriana Smith and her family. These are all the predictable consequences of treating embryos and fetuses like people.
To learn more, read Pregnancy Justice’s “Unpacking Fetal Personhood,” and mark your calendars (6/19) for my livestream conversation with law professor Mary Ziegler, author of Personhood: The New Civil War over Reproduction.
Abortion, Every Day subscribers get access to the country’s leading abortion rights experts. You don’t need to go to a panel or conference—just upgrade your subscription and join the conversation in comments, live-chats and livestreams:
Language Matters
I told you yesterday that Republicans and anti-abortion groups are desperate to distance themselves from Adriana Smith—the brain dead Georgia woman being kept alive against her family’s wishes because she’s pregnant.
Leading organizations like Susan B. Anthony Pro-Life America have tried to ignore Adriana’s story, remaining silent. Others are shirking responsibility by claiming Georgia’s abortion ban doesn’t require the hospital to keep Adriana on life support.
As conservatives spin themselves nauseous, I want to highlight something important in the language those latter groups are using. Take this quote from Georgia Attorney General Chris Carr:
“There is nothing in the LIFE Act that requires medical professionals to keep a woman on life support after brain death. Removing life support is not an action ‘with the purpose to terminate a pregnancy.’” (Emphasis mine)
That phrase—an action with purpose—isn’t just legalese. It reflects a rhetorical shift I’ve been warning about for years: intention. Anti-abortion activists want to divorce abortion from healthcare by defining it as an intention, rather than a medical intervention. That way, they can say that it’s not really an abortion if someone ends a life-threatening or nonviable pregnancy—allowing Republicans to dodge political backlash.
Most importantly, the hope is to further divide us into good women who wanted to be pregnant and bad women who didn’t. The truth, of course, is that an abortion is an abortion is an abortion.
But consider the implications if Republicans are successful in defining abortion as an intention: if someone has a stillbirth but did a Google search for abortion clinics when they first got that pregnancy test back—could that spark an investigation into whether or not a patient caused their pregnancy loss? You can see why they’re so eager to make that rhetorical change.
Before we move on to the next section, just a fun fact for your evening: While Susan B. Anthony Pro-Life America refuses to comment on what’s happening to Adriana Smith, they did find time to give a “Medal of Courage and Sacrifice” to Lauren Handy, the woman who was found with five fetuses in her Washington, DC home. Charming.
Care Crisis
This summer, hundreds of OBGYNs will travel to the headquarters of the American Board of Obstetrics & Gynecology (ABOG) to take their certifying exams—in Texas.
That’s right, ABOG is forcing OBGYNs—many of whom provide abortions—to travel to one of the most dangerous states in the country for abortion providers. The penalty for performing an abortion in Texas is life in prison; this year, the state arrested its first abortion provider.
And while ABOG’s certifying exams aren’t legally required, being ‘board-certified’ is only theoretically voluntary—most hospitals and practices require OBGYNs have certification in order to work there. So if an OBGYN wants to keep working, they’re forced to take on legal, ethical, and—if they’re pregnant—medical risks by traveling to Texas.
That’s to say nothing of the physical danger providers face. Violence against clinics and healthcare providers has skyrocketed since the end of Roe. So maybe it’s not the best idea to have hundreds of OBGYNs descend on a publicly-listed building at the same time in a state filled with anti-abortion sentiment and lax gun laws??
I first wrote about ABOG’s requirement that OBGYNs travel to Texas back in 2023. I had hoped that by now—given the increase in criminalization and violence—that the group would be allowing doctors to take the test virtually. (Which is what they did during Covid.) But as I noted in my previous reporting, there’s a reason ABOG doesn’t want to make that accommodation: The organization just spent $34 million dollars on a new building—a 126,000-square-foot space for offices, a conference center, and—you guessed it—a testing facility.
Just a total nightmare. Read more in my 2023 piece below, and if you’re an OBGYN traveling to Texas this year, feel free to let us know how you’re feeling in comments.
“…Republicans’ childcare policy, like their pro-natalist policy, is based on one goal: undoing the historic gains in women’s rights and status, and pushing American women out of the workforce, out of public life, out of full participation in society—and into a narrow domestic role of confinement, dependence and isolation.”
- Moira Donegan, The Guardian
In the States
Some terrific news out of Maine today: The state House advanced a bill that would allow providers to keep their names off of prescription bottles of abortion medication. The legislation is meant to add an extra layer of legal and personal protection for healthcare providers, who are being targeted by anti-abortion states with criminal and civil charges.
Washington and New York have passed similar laws allowing providers to keep their names off prescription labels and other states (like Illinois) are considering the same.
This is an incredibly important protection for abortion providers. Because remember, Dr. Maggie Carpenter—who was brought up on criminal abortion charges in Louisiana and civil charges in Texas—was identified by law enforcement from her from patients’ prescriptions.
As Maine Rep. Sally Cluchey points out, providers are also being threatened and harassed: “They have been stalked, targeted with bomb threats and harassed at their homes. In far too many cases these incidents escalate into death threats.”
The bill will now move to the state Senate, and hopefully we’ll see a few other states (cough, California, cough) advance similar legislation.
Meanwhile, an abortion rights group in Kansas is suing the state over new Republican rules that make it harder for citizen-led initiatives to get on the ballot. You probably remember that Kansas voters staved off an anti-abortion amendment in 2022, kicking off a long streak of pro-choice ballot measure wins.
Anti-abortion legislators don’t want Kansas voters to have a chance to codify a measure of their own, so they’ve passed new restrictions on financial contributions for constitutional amendments. Kansans for Constitutional Freedom—which fought back against the 2022 anti-abortion amendment—filed a complaint in federal court last week.
Finally, since we’re talking about attacks on democracy: If you want some extra credit reading on how Missouri Republicans are trying to override the will of voters by repealing Amendment 3, KOMU has an overview, Ballotpedia lays out how Missouri will be the first state to decide whether to repeal abortion rights that they just enshrined, and WaPo has an easy to share video on what went down.
Quick hits:
Pro-choice judge Chris Taylor announced today that she’s running for the Wisconsin Supreme Court;
Parenthood has launched vasectomy services in two Hawaii centers;
And more on the parental consent fight in Florida.
In the Nation
A White House official told the Associated Press that the White House is reviewing a list of recommendations to expand access to IVF. Donald Trump has glommed onto IVF as a potential save from voter backlash over abortion bans—calling himself the “fertilization president.” (🤮)
But the ultra-conservative, anti-abortion extremists populating the Trump administration aren’t exactly keen on expanding fertility treatments—which go against their religious beliefs. So here’s what we can expect from the White House when they finally do release an agenda or action on IVF: lots of lip service lauding growing families, without any policies that will actually help those families afford treatments or make clinics’ work safer or easier.
In fact, it’s much more likely that the administration will advance regulations on clinics under the guise of protecting “health and safety standards.” If you want a preview, just check out the IVF Protection Act that Republicans introduced last year. The bill introduced by Sens. Katie Britt and Ted Cruz defined IVF in a way that excluded the process most at risk from conservative policies: discarding embryos. (Discarding embryos is a normal part of the fertility treatment process—but the anti-abortion movement opposes it.)
Their bill also included language that protects states’ ability to restrict what happens to frozen embryos—setting the stage for restrictions similar to anti-abortion TRAP laws:
“Nothing in the IVF Protection Act shall be construed to impede States from implementing health and safety standards regarding the practice of in vitro fertilization.” (Emphasis mine)
We know, for example, that anti-abortion lobbyists want states to impose limits on how many embryos can be created, and dictate how those embryos can be used.
All of which is to say: Keep an eye out on what exactly the Trump administration says about IVF—and make sure to read past the headline and the hype.
Finally, I know we’re all watching the war on Planned Parenthood play out in Congress, where Republicans are trying to strip the reproductive healthcare group of Medicaid reimbursements and Title X funds. The move would effectively shut down access to contraception, STI testing, cancer screenings and basic preventive care for millions of low-income Americans.
Which, of course, is the point.
What’s more, the Congressional Budget Office says these moves would increase the federal deficit by $300 million over the next decade, thanks to higher costs from unintended pregnancies and fewer preventive health services.
And while House Speaker Mike Johnson has made noise about redirecting federal funding to crisis pregnancy centers, we know those groups don’t provide actual healthcare—and that they refuse to even talk about birth control.
Even some Republicans are balking: Rep. Mike Lawler and Rep. Brian Fitzpatrick have voiced concern, knowing that stripping away care doesn’t play well with voters. But they’re the exception.
Maybe that’s because anti-abortion groups are threatening any Republicans that don’t all in line and vote to strip low-income Americans of healthcare. Kristi Hamrick from Students for Life said in a statement, “Wobbly GOP members need to remember that we will not forget any act of betrayal that allows Planned Parenthood and all abortion vendors to continue to prop up their disreputable operations with our hard-earned tax money.”
The House Rules Committee is set to meet tomorrow to discuss the budget reconciliation package that includes these provisions, so I’ll be keeping a close eye.
Quick hits:
The Washington Post has a Styles section piece on EMILY’s List gala;
A new study shows that TikTok is spreading misinformation about birth control;
And a chilling piece from Jezebel on how the UK police are being trained to investigate abortion patients. (I’ll have more on this tomorrow.)
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Her miscarriage showed the limits of California’s abortion protections. Where you live matters
Anna Nusslock at her home in Eureka on Feb. 14, 2025. Providence St. Joseph Hospital refused Nusslock an emergency abortion after she had a miscarriage at 15 weeks pregnant, despite serious risks to her health. (Alexandra Hootnick for CalMatters) Loading your audio article
By Kristen Hwang, CalMatters
Anna Nusslock never wanted to be the face of a new kind of reproductive rights battle in California, but when a small Catholic hospital refused to provide an abortion that would end her miscarriage, Nusslock girded herself for a long and difficult conflict.
Nusslock felt her civil rights were being violated, she said, even as she lay in the hospital bed curled in on herself, bleeding and mourning the loss of her twin girls. The doctor had said that her pregnancy needed to be terminated immediately to protect her from infection and other serious complications but hospital policy prohibited it, according to two lawsuits filed by Nusslock and California Attorney General Rob Bonta.
“I am planning to fight this for the rest of my life,” Nusslock said in an interview with CalMatters.
Both complaints allege that Providence, the Catholic health system that owns St. Joseph Hospital in Eureka, illegally denied Nusslock emergency abortion care and discharged her instead. They also allege that multiple pregnant women have been denied abortions at St. Joseph Hospital during medical emergencies.
The disputes playing out in a small courtroom in Eureka highlight the limits of California’s efforts to protect abortion rights since the Supreme Court in 2022 repealed federal protections granted under Roe vs. Wade. They also reveal geographic disparities in patients’ access to reproductive health care after dozens of California hospitals shuttered their maternity wards over the past decade.
Providence has denied the state’s allegations and argued that it provided appropriate care to Nusslock. It contends that its actions are protected by religious liberties that are enshrined in the U.S. Constitution. Humboldt County Superior Court Judge Timothy Canning earlier this month rejected a bid by Providence to dismiss the state’s lawsuit. Providence has filed a request to dismiss Nusslock’s civil suit, which is ongoing.
Catholic companies own about 13% of hospitals in California, but operate 20% of the state’s maternity wards, according to a CalMatters analysis of state data. In the rural northern counties, they represent an even greater share at 35%.
Large corporations such as CommonSpirit (Dignity), Providence, Trinity and Scripps are the most prominent Catholic health care systems in the state.
Providence St. Joseph Hospital in Eureka on Feb. 14, 2025. Photo by Alexandra Hootnick for CalMatters In Humboldt County where Nusslock lives, Providence now owns the only hospital with an obstetrics department. The next closest maternity ward is 86 miles north along a winding, mostly two-lane stretch of Highway 1.
Last year, Nusslock arrived at Providence St. Joseph Hospital bleeding and in pain but still hopeful her pregnancy could be saved, according to the state’s complaint. Her water had broken at 15 weeks – too early for the twins to survive on their own – and tests indicated Nusslock had an infection and high blood pressure, the complaint says.
Multiple doctors said her condition was dangerous and she needed immediate treatment but Providence refused to intervene because her twins still had fetal heart tones, according to the complaint. Nusslock was discharged with a bucket and towels “in case something happens in the car,” according to the complaint and a declaration filed by Nusslock.
Nusslock’s husband drove her to another hospital about 20 minutes away where she began hemorrhaging and underwent immediate surgery, according to court documents. That hospital, Mad River Community Hospital in Arcata, has since permanently closed its labor and delivery ward, leaving St. Joseph alone in the county.
California’s constitution protects abortion rights, but religiously affiliated hospitals, clinics and individual providers are not required to provide them if they have moral objections. State law, however, requires hospitals to provide emergency services to any person who requests help whose life may be in danger or at risk of “serious injury or illness.”
Anna Nusslock and her husband Daniel Nusslock at home in Eureka on Feb. 14, 2025. Providence St. Joseph Hospital refused Nusslock an emergency abortion after she had a miscarriage at 15 weeks pregnant, despite serious risks to her health. Photo by Alexandra Hootnick for CalMatters In an unsigned statement, a Providence spokesperson said the hospital is clear about not performing elective abortions but does allow “medically necessary interventions to protect pregnant patients who are miscarrying or facing serious life-threatening conditions” in an emergency.
“This is consistent with the California Emergency Services Law and the Emergency Medical Treatment and Labor Act. It is also consistent with the Catholic Ethical and Religious Directives, which include discussion of the importance of the physician-patient relationship as well as the circumstances in which certain medical procedures that could result in fetal death may be allowed in a Catholic hospital,” according to the statement provided to CalMatters.
The Catholic Health Association, a trade group representing Catholic health facilities, did not respond to repeated questions about personal belief protections and the expansion of Catholic hospitals.
Religious liberty at heart of hospital’s defense
On a rainy day in February, Harvey Rochman, lead attorney for Providence, argued that religious freedoms protect Providence’s alleged actions.
“The elephant in the room so to speak on this case is there is no court that has ordered a Catholic hospital to perform an abortion under circumstances that the hospital has determined is contrary to the hospital’s faith,” Rochman said during the hearing in Eureka.
The hospital denies that it discriminated against Nusslock or improperly denied care to her. Rochman argued that federal law allows secular hospitals to transfer patients if they do not have the expertise or technical ability to perform a procedure, which is no different from a faith-based hospital saying it cannot perform a procedure that “contravenes” its beliefs.
“The current jurisprudence of the U.S. Supreme Court…is the religious rights have the same significance as the secular,” Rochman said during the hearing.
Catholic hospitals nationwide must adhere to the “Ethical and Religious Directives for Catholic Health Care Services” developed by the U.S. Conference of Catholic Bishops. The directives prohibit abortion in almost all circumstances.
Anna Nusslock speaks about how Providence St. Joseph Hospital denied her an emergency abortion despite serious risks to her life at a rally for reproductive healthcare before a California v. St. Joseph hearing at the Humboldt County Superior Court in Eureka on Feb. 14, 2025. Photo by Alexandra Hootnick for CalMatters 
People rally in support of reproductive health care outside of the Humboldt County Superior Court in Eureka on Feb. 14, 2025. Photos by Alexandra Hootnick for CalMatters Martine D’Agostino, a deputy attorney general representing the state, argued that the case was about Providence St. Joseph Hospital denying women emergency health care “at great risk to their lives.”
State law prohibits hospitals from transferring patients for non-medical reasons, such as lack of insurance. D’Agostino argued that St. Joseph Hospital did not stabilize Nusslock and illegally discharged her.
“The record details harrowing experiences of several women who were turned away from St. Joseph’s emergency department,” D’Agostino said. “The attorney general brought this case to ensure that St. Joseph Hospital follows the law that emergency health care must be provided to women of this county.”
In declarations filed with the court, multiple doctors allege that other St. Joseph patients have experienced close calls similar to Nusslock’s miscarriage.
One doctor who delivers babies at Providence St. Joseph Hospital said in a declaration that he has had three patients other than Nusslock who needed emergency pregnancy terminations during miscarriages that he was not able to carry out. The declaration states “…the Chaplain told me, that under no circumstances was I to terminate a pregnancy at Providence Hospital.”
Another doctor who later treated Nusslock at Mad River Community Hospital said one to two patients each year would come to the hospital’s now-closed obstetrics department having been turned away from Providence in the midst of a miscarriage.
Another woman has anonymously filed a civil lawsuit in Humboldt Superior Court against Providence alleging similar circumstances to Nusslock. In February, lawyers for Providence filed papers asking a judge to dismiss the case.
Differences in how hospitals treat miscarriage
Although Nusslock’s case is not unique, experts say patient experiences at Catholic hospitals vary widely.
“People always ask me ‘Why are people not dying all over the place?’ And it’s because it’s not exactly that extreme,” said Lori Freedman, a sociologist and bioethicist at UC San Francisco who has extensively researched patient and doctor experiences at Catholic health systems.
Frequently, doctors at Catholic institutions, many of whom are not Catholic, find workarounds to prevent patients from dying, Freedman said. An ethics committee headed by a priest or other religious figure at each hospital decides in the moment whether doctors can intervene. They may wait until the woman develops a fever (a sign of infection), until her bleeding increases or until the fetus dies, Freedman said.
The Ethical and Religious Directives at Catholic hospitals allow pregnancy termination for a “proportionately serious pathological condition of a pregnant woman,” but ethics committees at each hospital can have different interpretations of where to draw the line, Freedman said.
This approach, however, is often shocking to obstetricians in non-religious hospitals, Freedman said.
“When you talk to someone in a really high-quality obstetric service, their jaw drops because they’re like, ‘Well it’s not just die or not die,’” Freedman said. “What kind of level of suffering and risk are you going to require, before the intervention you know is going to happen is allowed to happen?”
Providence St. Joseph Hospital in Eureka on Feb. 14, 2025. Photo by Alexandra Hootnick for CalMatters The Catholic Health Association states in a policy brief that “Our deeply held religious and moral convictions are the source of both the work we do and the limits on what we will do.”
Those religious and moral convictions include a mandate to continue the “healing ministry of Christ,” to care for the poor, and to advocate for marginalized groups like immigrants, according to the Ethical and Religious Directives.
They also state that the “Catholic health care ministry is rooted in a commitment to promote and defend human dignity; this is the foundation of its concern to respect the sacredness of every human life from the moment of conception until death.”
Maryam Guiahi, an obstetrician in Santa Barbara who has previously worked in Catholic institutions in Chicago, said that’s where Catholic policies begin to conflict with modern secular medical ethics that place different emphasis on patient autonomy and avoiding harm.
In cases like Nusslock’s, in which the amniotic fluid sac breaks before the fetus is viable, terminating the pregnancy is typically the safest option and the standard of care, Guiahi said.
Guiahi said Catholic hospitals sometimes don’t allow doctors to tell patients that an abortion is an option.
“I’ve been in secular institutions and we can give that information. We can let people decide what they want, and some people will choose to continue and hope and see what happens, but other women don’t want to go through that,” Guiahi said.
Not telling patients all of the risks and options compromises their ability to consent and can lead to avoidable complications like infection and hemorrhaging, Guiahi said.
Guiahi said she never saw a patient die after being denied an emergency abortion at the Catholic hospital she worked at, but sometimes patients would come back septic and require care in the intensive care unit.
“To me, medicine is about ‘to do no harm.’ I don’t know many medical situations where we wait till people get sick in order to intervene,” Guiahi said.
Moving to have a baby
Nusslock is making plans to leave Eureka during her next pregnancy. She and her husband still desperately want to start a family, but she can’t drive past Providence St. Joseph Hospital without getting dizzy. She said she has been diagnosed with post-traumatic stress disorder.
“I still have that voice in the back of my head just screaming, ‘you’re bleeding to death,’” Nusslock said.
Most likely Nusslock said she’ll find a place in the Bay Area to live during her pregnancy.
Having few options to give birth reflects a larger loss of maternity services in California. The northern counties, including where Nusslock lives, have lost a third of their birthing hospitals since 2012, according to a CalMatters database on maternity care.
Statewide, 59 hospitals have stopped delivering babies in the same time period, creating broad swaths of maternity deserts particularly in rural and low-income communities.
Nearly 80% of those closures have been secular hospitals, increasing the influence of Catholic health care.
Anna Nusslock at home in Eureka on Feb. 14, 2025. Providence St. Joseph Hospital refused Nusslock an emergency abortion after she had a miscarriage at 15 weeks pregnant, despite serious risks to her health. Photo by Alexandra Hootnick for CalMatters During the February court hearing, Providence lawyer Rochman said that a core mission of the Eureka hospital is to keep labor and delivery services available “when it may not be financially sensible to do so.”
In a statement, a Providence spokesperson said “providing high-quality labor and delivery services” is a “top priority” for the organization in Humboldt County and throughout the nation.
But having an operating maternity ward doesn’t mean all services are available. The Ethical and Religious Directives also prohibit the use of contraceptives to prevent pregnancy, including sterilization for both males and females, and in vitro fertilization.
Josie Urbina, an obstetrician with UC San Francisco Health who specializes in complex family planning, said this creates an unequal patchwork of services in the state.
“It’s unfortunate that in rural parts of California, which happen to be dominated by religious hospitals, that the standard of care is not being followed,” Urbina said. “It’s really just detrimental to patient care.”
For Nusslock, who moved to Eureka 10 years ago and quickly fell in love with the towering redwoods and small-town feel, the lawsuits are about ensuring her experience doesn’t happen to anyone else, she said in an interview with CalMatters.
“These are good people. These are people worth protecting,” Nusslock said. “If they’re going to give me an opportunity to speak for them and fight for them, I’m going to take every opportunity I can.”
CalMatters Data Reporter Erica Yee contributed to this story.
Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.
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Report: Abortion providers confront a new wave of extremism
Bryan Olin Dozier/NurPhoto/ZumaGet your news from a source that’s not owned and controlled by oligarchs. Sign up for the free Mother Jones Daily.In November 2023, while an abortion provider in the South was on vacation, someone broke into their home, shattered the windows, and scribbled “Baby Killer” on a whiteboard. The case is still open.
That same year, a man crashed his car into a new abortion clinic in Danville, Illinois, trying to start a fire. A few months after that, someone left a one-star Google review for a Florida clinic that read, “I have a bomb waiting to go off.” The clinic was evacuated and the FBI was called to investigate.
These incidents, highlighted in a recent report from the National Abortion Federation, are among hundreds of threats and attacks experienced by abortion providers across the US in the nearly three years since Roe v. Wade was overturned. The end of Roe “emboldened anti-abortion extremists,” NAF reports, leading to “an immediate spike in major incidents,” including arsons, burglaries, and death threats.
Violence has remained high, NAF says, even as dozens of clinics have shut down in states where abortion has been banned or greatly restricted. In 2023 and 2024, NAF members reported 621 trespassing incidents, 296 death threats, 169 acts of vandalism, and almost 130,000 protests targeting their facilities—but the actual numbers are likely much higher. “Providers and clinic staff are experiencing intense burnout and fatigue as a consequence of today’s abortion landscape and may not have the resources, staff, or capacity to track incidents,” the report says. “Sadly, many clinic staff also normalize the unacceptable harassment, threats, and violence they endure, which likely contributes to underreporting.”
Meanwhile, NAF’s members have been bracing for new attacks after President Donald Trump pardoned nearly two dozen anti-abortion activists convicted of targeting providers in recent years. I spoke by phone with Melissa Fowler, NAF’s chief program officer, about the report and the kinds of harassment and threats that abortion providers and patients can expect to encounter for the foreseeable future. Our interview has been lightly condensed and edited for clarity.
The most common incidents in the NAF report were vandalism, trespassing, death threats, and harassment. Do any particular anti-abortion strategies stand out in terms of their approach to targeting abortion providers?
For the last couple of years, there has been a strategy just to try and make it as difficult as possible for patients to access care. That can take the form of obstructing people’s access to entrances, invading clinics, and trying to delay access to care, as well as acts of vandalism and arson designed to actually destroy the physical locations of clinics.
The Trump administration has made clear it plans to dramatically scale back enforcement of the Freedom of Access to Clinic Entrances Act, known as the FACE Act, which was passed in 1994. When you look ahead, what impacts could this have on the kinds of violence and disruption that abortion providers experience?
The FACE Act has been an important tool that has led to a decrease in some of the more significant acts of violence that we saw in the ’90s. When you think about the significance of FACE, you have to think about the landscape that necessitated its drafting. After Roe v. Wade was handed down in 1973, we saw an increase in anti-abortion attacks that escalated to large-scale obstructions and blockades. The FACE Act was passed in response to that increasing violence and harassment, and it did lead to an immediate decrease in some of those types of activities. It’s never been enough, but it has been an important tool when enforced.
And in the last few years, we have seen some enforcement and some individuals actually being charged with FACE violations and convicted. Unfortunately, the Trump administration pardoned many of those individuals early this year, which sends a very frightening message to our providers across the country. What we’ve seen this year has been unprecedented, with the Department of Justice saying that they’re only going to enforce the FACE Act in grave circumstances. It shouldn’t take someone being murdered for a law to be enforced.
“Unfortunately, the Trump administration pardoned many of those individuals early this year, which sends a very frightening message to our providers across the country.”
In the ’80s and ’90s, we saw extreme violence against providers that resulted in the murders of several doctors. How does what we saw back then compare to what we’re seeing today?
We are seeing people in the anti-abortion movement calling for a return to those days, calling for people to go back to the large-scale blockades and obstructive events that took place in the early ’90s. Some of the people who were pardoned have already stated that they plan to go back and invade clinics and practice acts of obstruction. So I think we could see a return to that, especially if people know that the FACE Act is not going to be enforced.
One thing that struck me about the NAF report was that attacks and threats can happen anywhere—in red states or blue states. Are there any differences in what providers face depending on their location, or is it pretty much the same across the board?
It really varies. What we’ve seen since the Dobbs decision has been a shift, where some of the states that historically have been more protective of abortion are seeing more incidents of harassment and targeting of providers. This is because when clinics closed in some states, the people who targeted those clinics are now traveling—or have even moved to new communities—to target the clinics that remain open.
We’ve been working with a number of our members since Dobbs who are in areas that are usually more protective and friendlier for providers, and they’re now experiencing an increase in some of these activities, like protests and obstruction. It really can happen anywhere because anti-abortion individuals are focused on wherever there are clinics. Some of it is still happening in the states where abortion is banned, where some of those clinics that are open for other services continue to be targeted as well. Some of them are seeing pregnant patients who are getting an ultrasound and then coming up with a plan on how they’re going to travel and access [abortion] care. So they’re trying to target those patients.
Based on this report, what kinds of harassment and other problems are likely to face abortion providers in the near future?
Since the inauguration, some providers talk about seeing a shift in their protesters—they’re more aggressive and more of them are present. They seem to be emboldened by the pardons and the actions from this administration. I think providers are bracing for that—for increased targeting and a lot more hostility. I think providers are also preparing for more clinic invasions, as some of the people who are pardoned return to those activities.
Providers are trying to think about community support and working with local law enforcement because we know there’s not going to be a lot of support federally. Even now, when the landscape has changed so dramatically and we’ve had so many clinics close in really hostile places, there still remains this constant campaign of harassment and violence targeting providers in places where abortion remains legal. It shouldn’t be the way that things are. This shouldn’t be part of the job when you choose to be an abortion provider. States that have wanted to be actively protective of the legal right to abortion need to make sure providers are safe and can run sustainable practices in those states.
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Why so many clinics that provide abortion are closing, even where it's still legal
From
By
Kate Wells
Residents of Marquette, a city in Michigan's Upper Peninsula, gathered outside Planned Parenthood to celebrate and thank staffers as they finished the last day of patient care on April 23.
Bobby AnttilaOn the last day of patient care at the Planned Parenthood clinic in Marquette, Mich., a port town on the shore of Lake Superior, dozens of people crowded into the parking lot and alley, holding pink homemade signs that read "Thank You!" and "Forever Grateful."
"Oh my god," physician assistant Anna Rink gasped, as she and three other Planned Parenthood employees finally walked outside. The crowd whooped and cheered. Then Rink addressed the gathering.
This story was produced in partnership with KFF Health News.
"Thank you for trusting us with your care," Rink called out, her voice quavering. "And I'm not stopping here. I'm only going to make it better. I promise. I'm going to find a way."
"We're not done!" someone called out. "We're not giving up!"
But Planned Parenthood of Michigan is giving up on four of its health centers in the state, citing financial challenges.
That includes the one in Marquette, the only clinic that provided abortion in the vast, sparsely populated Upper Peninsula. For the roughly 1,100 patients who visited the clinic each year for anything from cancer screenings to contraceptive implants, the next-closest Planned Parenthood will now be a nearly five-hour drive south.
It's part of a growing trend: At least 17 clinics closed last year in states where abortion remains legal, and another 17 have closed in just the first five months of this year, according to data gathered by ineedana.com. That includes states that have become abortion destinations, like Illinois, and those where voters have enshrined broad reproductive rights into the state constitution, like Michigan.
Experts say the closures indicate that financial and operational challenges, rather than future legal bans, may be the biggest threats to abortion access in states whose laws still protect it.
"These states that we have touted as being really the best kind of versions of our vision for reproductive justice, they too struggle with problems," said Erin Grant, a co-executive director of the Abortion Care Network, a national membership organization for independent clinics.
"It's gotten more expensive to provide care, it's gotten more dangerous to provide care, and it's just gotten, frankly, harder to provide care, when you're expected to be in the clinic and then on the statehouse steps, and also speaking to your representatives and trying to find somebody who will fix your roof or paint your walls who's not going to insert their opinion about health care rights."
But some abortion-rights supporters question whether leaders are prioritizing patient care for the most vulnerable populations. Planned Parenthood of Michigan isn't cutting executive pay, even as it reduces staff by 10% and shuts down brick-and-mortar clinics in areas already facing health care shortages.
Hannah Harriman, a nurse with the Marquette County Health Department, previously worked for Planned Parenthood in Marquette for 12 years. Now that the Planned Parenthood clinic is closed, the county will offer family planning services 1½ days a week, but that won't be enough, she says.
Victoria Tullila for KFF Health News"I wish I had been in the room so I could have fought for us and I could have fought for our community," said Viktoria Koskenoja, an emergency medicine physician in the Upper Peninsula, who previously worked for Planned Parenthood in Marquette.
"I just have to hope that they did the math of trying to hurt as few people as possible and that's how they made their decision. And we just weren't part of the group that was going to be saved," Koskenoja said.
Why clinics are closing now, three years after Roe was overturned
If a clinic could survive the fall of Roe v. Wade, "you would think that resilience could carry you forward," said Brittany Fonteno, president and CEO of the National Abortion Federation.
But clinic operators say they face new financial strain, including rising costs, limited reimbursement rates and growing demand for telehealth services.
Clinics are also bracing for the Trump administration to again exclude them from Title X, the federal funding for low- and no-cost family planning services, as the previous Trump administration did in 2019.
Planned Parenthood of Michigan (PPMI) says the cuts are painful but necessary for the organization's long-term sustainability.
The four clinics being closed are "our smallest health centers," said Sarah Wallett, PPMI's chief medical operating officer. While the thousands of patients those clinics served each year are important, she said, the clinics' small size made them "the most difficult to operate."
The clinics being closed had offered medication abortion, which is available in Michigan up until 11 weeks of pregnancy, but not procedural abortion.
Planned Parenthood of Illinois (a state that has become a post-Roe v. Wade abortion destination) shuttered four clinics in March, pointing to a "financial shortfall."
Planned Parenthood of Greater New York is now selling its only Manhattan clinic, after closing four clinics elsewhere in the state last summer due to "compounding financial and political challenges."
Planned Parenthood Association of Utah, where courts have blocked a near-total abortion ban and where abortion is currently legal until 18 weeks of pregnancy, announced it will close two centers in May.
This spring, the Trump administration began temporarily freezing funds to many clinics, including all Title X providers in California, Hawaii, Maine, Mississippi, Missouri, Montana and Utah, according to a KFF analysis.
While the current Title X freeze doesn't yet include Planned Parenthood of Michigan, PPMI's chief advocacy officer, Ashlea Phenicie, said it would amount to a loss of about $5.4 million annually, or 16% of its budget.
But Planned Parenthood of Michigan didn't shut down any clinics the last time the Trump administration froze its Title X funding. Leaders said that's because the funding was stopped for only about two years, from 2019 until 2021, when the Biden administration restored it.
"Now we're faced with a longer period of time that we will be forced out of Title X, as opposed to the first administration," said PPMI President and CEO Paula Thornton Greear.
At the same time, the rise of telehealth abortion has put "new pressures in the older-school, brick-and-mortar facilities," said Caitlin Myers, a Middlebury College economics professor who maps brick-and-mortar abortion clinics across the United States.
Balancing cost and care
Until a few years ago, doctors could prescribe abortion pills only in person. Those restrictions were lifted during the pandemic, but it was the Dobbs decision in 2022 that really "accelerated expansions in telehealth," Myers said. "Because it drew all this attention to models of providing abortion services."
Suddenly, new online providers entered the field, advertising virtual consultations and pills shipped directly to your home. And plenty of patients who still have access to a brick-and-mortar clinic prefer that option. "Put more simply, it's gotta change their business model," she said.
A nurse practitioner works at a Planned Parenthood clinic in Fairview Heights, Ill., where she confers via teleconference with patients seeking medication abortions on Oct. 29, 2021. The two medications used in the process are mifepristone and misoprostol.
Jeff Roberson/AP PhotoHistorically, about 28% of PPMI's patients receive Medicaid benefits, according to Phenicie. And like many states, Michigan's Medicaid program doesn't cover abortion, leaving those patients to either pay out-of-pocket or rely on help from abortion funds, several of which have also been struggling financially.
"When patients can't afford care, that means that they might not be showing up to clinics," said Fonteno of the National Abortion Federation, which had to cut its monthly budget nearly in half last year, from covering up to 50% of an eligible patient's costs to 30%.
"So seeing a sort of decline in patient volume, and then associated revenue, is definitely something that we've seen," Fonteno said.
Meanwhile, more clinics and abortion funds say patients have delayed care because of those rising costs. According to a small November-December 2024 survey of providers and funds conducted by ineedana.com, "85% of clinics reported seeing an increase of clients delaying care due to lack of funding."
One abortion fund said the number of patients who've had to delay care until their second trimester "has grown by over 60%" spanning six months in 2024.
The Planned Parenthood–Marquette Health Center closed in April, along with three other health centers in Michigan. Now, patients who need in-person care will need to drive almost five hours to the nearest Planned Parenthood clinic.
Victoria Tullila for KFF Health NewsEven when non-abortion services like birth control and cervical cancer screenings are covered by insurance, clinics aren't always reimbursed for the full cost, Thornton Greear said.
"The reality is that insurance reimbursement rates across the board are low," she said. "It's been that way for a while. When you start looking at the costs to run a health care organization, from supply costs, etc., when you layer on these funding impacts, it creates a chasm that's impossible to fill."
Yet, unlike some independent clinics that have had to close, Planned Parenthood's national federation brings in hundreds of millions of dollars a year, the majority of which is spent on policy and legal efforts rather than state-level medical services.
The organization and some of its state affiliates have also battled allegations of mismanagement, as well as complaints about staffing and patient care problems. Planned Parenthood of Michigan staffers in five clinics unionized last year, with some citing management problems and workplace and patient care conditions.
Asked whether Planned Parenthood's national funding structure needs to change, PPMI CEO Thornton Greear said: "I think that it needs to be looked at, and what they're able to do. And I know that that is actively happening."
The gaps that telehealth can't fill
When the Marquette clinic's closure was announced, dozens of patients voiced their concerns in Google reviews, with several saying the clinic had "saved my life," and describing how they'd been helped after an assault, or been able to get low-cost care when they couldn't afford other options.
Planned Parenthood of Michigan responded to most comments with the same statement and pointed patients to telehealth in the clinic's absence:
"Please know that closing health centers wasn't a choice that was made lightly, but one forced upon us by the escalating attacks against sexual and reproductive health providers like Planned Parenthood. We are doing everything we can to protect as much access to care as possible. We know you're sad and angry — we are, too.
"We know that telehealth cannot bridge every gap; however, the majority of the services PPMI provides will remain available via the Virtual Health Center and PP Direct, including medication abortion, birth control, HIV services, UTI treatment, emergency contraception, gender-affirming care, and yeast infection treatment. Learn more at ppmi.org/telehealth."
PPMI's virtual health center is already its most popular clinic, according to the organization, serving more than 10,000 patients a year. And PPMI plans to expand virtual appointments by 40%, including weekend and evening hours.
"For some rural communities, having access to telehealth has made significant changes in their health," said Wallett, PPMI's chief medical operating officer. "In telehealth, I can have an appointment in my car during lunch. I don't have to take extra time off. I don't have to drive there. I don't have to find child care."
Yet even as the number of clinics has dropped nationally, brick-and-mortar facilities still account for about 80% of clinician-provided abortions, according to the most recent #WeCount report looking at April-June 2024.
Hannah Harriman, a Marquette County Health Department nurse who previously spent 12 years working for Planned Parenthood of Marquette, is skeptical of any suggestion that telehealth can replace a rural brick-and-mortar clinic. "I say that those people have never spent any time in the U.P.," she said, referring to the Upper Peninsula.
Some areas are "dark zones" for cell coverage, she said. And some residents "have to drive to McDonald's to use their Wi-Fi. There are places here that don't even have internet coverage. I mean, you can't get it."
Telehealth has its advantages, said Koskenoja, the emergency medicine physician who previously worked for Planned Parenthood in Marquette, "but for a lot of health problems, it's just not a safe or realistic way to take care of people."
She recently had a patient in the emergency room who was having a complication from a gynecological surgery. "She needed to see a gynecologist, and I called the local OB office," Koskenoja said. "They told me they have 30 or 40 new referrals a month," and simply don't have enough clinicians to see all those patients. "So adding in the burden of all the patients that were being seen at Planned Parenthood is going to be impossible."
Koskenoja, Harriman, and other local health care providers have been strategizing privately to figure out what to do next to help people access everything from Pap smears to IUDs. The local health department can provide Title X family planning services 1½ days a week, but that won't be enough, Harriman said.
And there are a few private "providers in town that offer medication abortion to their patients only — very, very quietly," Harriman said. But that won't help patients who don't have good insurance or are stuck on waitlists.
"It's going to be a patchwork of trying to fill in those gaps," Koskenoja said. "But we lost a very functional system for delivering this care to patients. And now, we're just having to make it up as we go."
This story comes from NPR's health reporting partnership with Michigan Public and KFF Health News.
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