The fascist juggernaut continues to attack the rights and livelihood of most Americans while guarding zealously the many subsidies and benefits that are provided to the rich. Here I highlight issues around reproductive and abortion rights and look at both the endless attacks by the right-wing and their allies among the theocratic forced-pregnancy / forced-birth advocates, and some of the actions taken to protect women's reproductive and abortion rights taking place mostly in the “Blue States” of course. Many of these articles are pretty short, and all are pertinent I hope some of our readers and posters take a look at ones that look interesting to them.
1). “Please—No More 'Big Tent' Talk”, Oct 23, 2025, Jessica Valenti & Kylie Cheung, Abortion, Every Day, at < https://jessica.substack.com/
2). “The Bill That Could Make Crisis Pregnancy Centers Untouchable”, Oct 22, 2025, Jessica Valenti, Abortion, Every Day, fat < https://jessica.substack.com/
3). “The Cruel Calculus of America’s Anti-Abortion Machine”, Oct 24, 2025, Anon, Her Safe Harbor, at < https://hersafeharbor.
4).“Idaho loses 35% of OBGYNs after abortion ban takes effect”, Oct 23, 2025, Amber Nelson & McKay Cunningham discuss abortion with Idaho Matters host Gemma Gaudette, Idaho Matters on Boise State Public Radio, NPR, duration of audio 21:05, at < https://www.
5). “Idaho Attorney General seeks to dismiss lawsuit challenging state abortion law”, Oct 24, 2025, Barclay Idsal, KIVI TV 6, Boise Idaho, at < https://www.kivitv.com/
6). “Federal funding freeze prompts Planned Parenthood closures, raising concerns about healthcare access in Iowa: Four of Iowa’s six Planned Parenthood locations have closed after defunding under the Trump administration”, Oct 21, 2025, Genevieve DiChiara, Assistant News and Politics Director, The Daily Iowan, at < https://dailyiowan.com/2025/
7). “Penn researchers find rise in sterilizations following removal of federal abortion protections”, Oct 24, 2025, Advita Mundhra, The Daily Pennsylvanian, at < https://www.thedp.com/article/
8). “Kansas navigates post-Dobbs world with state abortion restrictions in limbo”, Oct 23, 2025, Anna Kaminski, The Kansas Reflector, at < https://kansasreflector.com/
9). “Staffers Fear a Southern Planned Parenthood Faces a 'Dangerous Threat From Within': One new leader called herself 'pro-life' and another asked about partnering with anti-abortion groups”, Oct 21, 2025, Nina Martin & Kiera Butler, Mother Jones, at < https://www.motherjones.com/
10). “NC House Passes Legislation to End Medicaid Funding for Planned Parenthood”, Oct 23, 2025, Anon, NC Political News, at < https://www.ncpoliticalnews.
11). “Texas Banned Abortion. Then Sepsis Rates Soared. ProPublica’s first-of-its-kind analysis is the most detailed look yet into a rise in life-threatening complications for women experiencing pregnancy loss under Texas’ abortion ban”, Feb. 20, 2025, Lizzie Presser, Andrea Suozzo, Sophie Chou & Kavitha Surana, Propublica, at < https://www.propublica.org/
12). “Are Abortion Bans Across America Causing Deaths? The States That Passed Them Are Doing Little to Find Out. The same political leaders who enacted abortion bans oversee the state committees that review maternal deaths. These committees haven’t tracked the laws’ impacts, and most haven’t finished examining cases from the year the bans went into effect”, Dec. 18, 2024, Kavitha Surana, Mariam Elba, Cassandra Jaramillo, Robin Fields, & Ziva Branstetter, Propublica, at < https://www.propublica.org/
~~ recommended by desmond morista ~~
Introduction: Item 1). “Please—No More ….”, and Item 2). “The Bill That Could ….” are both articles from the essential substack newsletter Abortion, Every Day, and cover a variety of aspects of the ongoing struggle around reproductive issues. Item 3). “The Cruel Calculus ….” provides a succinct analysis of what is really going on in the political struggle of the far-right to end access to both contraceptives and abortion services in the entire U.S.; not just in the Dark Ages Red States that are already nearly at the point the forced-pregnancy / forced-birth advocates want to impose on all of us. The essay in Item 3 notes that the deaths and the cruelty and the focus on attacking people in the bottom half of the socioeconomic hierarchy of the U.S. is intentional, not an inadvertent effect or an aberration.
The majority of the links here are to articles that discuss specific events and struggles that are taking place in states ranging from Idaho, Item 4).“Idaho loses 35% ….”, (BTW, the current loss of 35% of the state's OBGYNs is up from the figure of 25% a couple of years ago) and Item 5). “Idaho Attorney General ….”; to Iowa, Item 6). “Federal funding freeze ….”;
to Pennsylvania, Item 7). “Penn researchers find ….”; to Kansas, Item 8). “Kansas navigates post-Dobbs ….”; and to the SouthEastern U.S. in general, Item 9). “Staffers Fear a Southern ….”; to North Carolina, Item 10). “NC House Passes Legislation ….; to Texas, Item 11). “Texas Banned Abortion ….”.
The last article Item 12). “Are Abortion Bans ….”, looks at the number of deaths of women that have been caused by the Trump Abortion Bans around the U.S. Nobody has done a comprehensive study of these deaths, that certainly number around 2,000 or more since the first Texas Vigilante / Bounty Hunter forced-pregnancy / forced-birth laws in 2021; and it will be impossible to really investigate it because several of the Dark Ages Red States have stopped collecting statistics about these deaths, and the Federal Agencies, such as the CDC aren't recording such data either. Also some of the state-level scientific committees that are still in operation have been filled with extremist forced-pregnancy / forced-birth operatives.
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Please—No More 'Big Tent' Talk
Click to skip ahead: In the States, news from Pennsylvania, Idaho, Kansas, Iowa, and more. In the Nation, the Trump administration is ending abortion access for detained immigrants, and a response to a ‘big tent’ approach on women’s health. Ballot Box has some quick hits. Stats & Studies has research on the rise in sterilizations post-Dobbs and where Christians stand on abortion. You Love to See It highlights a new organization created to protect shield state abortion providers. Movement Shake-Up outlines what’s happening at a Georgia Planned Parenthood. Finally, Clinic Watch has news from Ohio, North Carolina, New Jersey, and Colorado.
In the States
Pennsylvania Democrats have advanced a slate of reproductive rights bills, including one to enshrine abortion rights in the state constitution. Among other protections, the measures would shield patients’ medical records, bar Pennsylvania courts from enforcing out-of-state abortion judgements, and stop outside officials from arresting people in Pennsylvania for so-called abortion ‘crimes’.
Then there’s H.B. 1957, which would add a Reproductive Rights Amendment to the state constitution. What I appreciate most about the proposed amendment is that Democrats avoided the usual trap of including language about ‘viability’—an arbitrary standard only ever used to deny vital care.
In the past, we’ve seen pro-choice ballot measure campaigns worry that without limiting language, they’ll be accused of supporting abortion ‘up until birth’. But as we’ve learned again and again—conservatives are going to say that no matter what. We might as well fight for the policies we want and for the care our communities need. (For more on the danger of ‘viability’ language, read Pregnancy Justice’s report, “The Viability Line.”)
Here’s what Pennsylvania’s amendment would say:
“Every individual has the fundamental right to exercise personal reproductive liberty and make and effectuate decisions regarding the individual’s own reproduction, including the ability to choose or refuse to prevent, continue or end the individual’s pregnancy, the right to choose or refuse contraceptives and the right to choose or refuse fertility care, all without discrimination on the basis of race, age, disability, sex, sexual orientation, gender identity, religion or relationship status. The Commonwealth may not deny, burden, infringe upon or abridge this right unless justified by a compelling State interest achieved by the least restrictive means.”
I don’t love that last sentence, but I’ll leave it alone for now.
To get before voters, a constitutional amendment in Pennsylvania has to pass the legislature in two consecutive sessions. Given the Republican-controlled state Senate, we’re not there yet—but it’s a start!
Let’s move on to Idaho, where Attorney General Raúl Labrador is trying to get a legal challenge to the state’s abortion ban thrown out. This is the same guy who fought all the way to the Supreme Court for the right to deny women life-saving abortions, so nothing he does surprises me anymore.
Some background: Idaho’s ban is among the strictest in the nation. Since it took effect, the state has lost more than a third of its OBGYNs, and doctors have been forced to airlift patients out of state for emergency, life-saving care.
That’s why the Lawyering Project and Legal Voice filed a suit on behalf of maternal-fetal medicine specialist Dr. Stacy Seyb last year. The case argues that the U.S. Constitution protects abortion when pregnancy is doomed or dangerous—when it threatens someone’s health, worsens an existing condition, could lead to suicide, involves a fatal or severe fetal diagnosis, or when reducing a multifetal pregnancy would help remaining fetuses survive.
All of which sounds pretty fucking reasonable! Yet Labrador—who’s accused doctors of lying about the threats to women’s health to make “a political statement”—filed a motion to dismiss this week. And he’s falling back on a familiar tactic Abortion, Every Day has warned about since 2022: blaming doctors for not ‘understanding’ the law.
In a release, Labrador claimed that Dr. Seyb didn’t adequately “educate himself” about Idaho’s ban, saying, “his patients suffered from his lack of understanding, not because of our laws.”
We’ll keep you posted as the case moves forward. Just remember: this is the anti-abortion playbook—shirk blame, attack doctors, and pretend to care about women.
Speaking of anti-abortion politicians who pretend to give a damn: we’re still waiting on a ruling in the trial that will determine abortion access in Kansas. Republicans there are trying to enforce the so-called “Women’s Right to Know Act”—a bundle of restrictions that includes waiting periods, mandates that doctors lie about abortion risks, and even rules about the font size and color of clinic documents.
Providers also have to ask patients invasive personal questions about why they’re having an abortion and report those answers to the state.
The Kansas Reflector has a good rundown of the case, including some pretty devastating testimony: Lynnette Ranney—who ran the front desk at one of the plaintiff clinics—testified that they had to turn away patients up to ten times a week over meaningless paperwork issues. If someone showed up with a form printed in the wrong color, their 24-hour waiting period started all over again.
One patient, a rape survivor who traveled from Texas, brought the wrong forms. By the time she could reschedule, she was too far along to legally get an abortion in Kansas.
“It was devastating,” Ranney said. “It was so hard to be the person that says, ‘Hey, I know you’ve got a lot going on, but, sorry, we can’t help you.’”
And remember: Republicans are pushing these restrictions even after the Kansas Supreme Court affirmed a constitutional right to abortion—and despite voters overwhelmingly rejecting an anti-abortion ballot measure in 2022.
We’ll update you as soon as Judge Christopher Jayaram issues his ruling.
Finally, between the end of Roe and the beginning of the new Trump administration, Iowa is really suffering. The Daily Iowan has a must-read piece on the real-life consequences of the state’s growing reproductive and maternal health care deserts—driven in part by the closure of four Planned Parenthood clinics since Roe fell.
According to the Iowa Rural Health Association, more than a third of counties in the state now qualify as maternal health deserts. As Iowa Democrats Chair Rita Hart put it, “Iowa Republicans continue to prioritize legislation that drives physicians away from our state…We cannot afford to lose more providers.”
Quick hits:
The Women’s Rights & Empowerment Network (WREN) has released a new report on the Status of Women and Girls in South Carolina;
The Wyoming Tribune Eagle on the CARE Act, calling out Republicans for fabricating a “phony pregnancy center crisis”;
Jezebel on the Michigan women suing over the state law that prevents pregnant women’s end-of-life directives from being honored;
And Missouri Republicans are trying to do away with citizen-led ballot initiatives, which we’re sure has nothing to do with Amendment 3’s November win.
In the Nation
The government has been shut down for weeks now, but the anti-abortion agenda remains as cruel as ever. The far-right Daily Signalreports that the Trump administration plans to ban unaccompanied minors detained in ICE centers from accessing abortion care.
This, unfortunately, is in line with what we saw in Trump’s first term—when immigrant minors in federal custody who asked for abortions were deliberately sent to crisis pregnancy centers (CPCs). Trump’s Office of Refugee Resettlement (ORR) even kept a list of “Trusted Providers in HHS Cities”—almost all of them CPCs. A 2017 ACLU lawsuit revealed that ORR had a policy of forcing detained immigrants considering abortion to receive ‘counseling’ at these fake clinics instead.
In 2022, the Biden administration proposed the “Unaccompanied Children Program Foundational Rule,” which required ORR to ensure detained children had access to medical care—including transportation across state lines when necessary for abortion care. Now, after pressure from the Daily Signal and other conservatives, Trump’s team is moving to reverse it.
The cruelty of what comes next is unthinkable: detained immigrant women and girls being forced to stay pregnant and give birth—in facilities where they’re already traumatized, and where many arrived after facing sexual violence along the southern border.
For more on abortion access and immigrant communities—including the extensive policing and surveillance they encounter—read Kylie’s July report:
Earlier this week we told you about 51&, a new organization claiming to build a “big tent” around women’s health by steering clear of abortion. Former Planned Parenthood leader Dawn Laguens has since offered a thoughtful—and pointed—response: “Neutrality isn’t safe; it’s a blind spot.”
You should read her full piece, but here are our favorite parts:
“Staying silent on abortion signals to employees, consumers, and investors that a company will hedge on women’s autonomy whenever it feels politically convenient. The real opportunity is in credibility. …
There’s a false bargain here: women might get attention for heart disease, autoimmune disorders, or maternal mortality, but only if we stay quiet about reproductive rights. That’s not pragmatism. Women shouldn’t have to pay for progress in one area of health by giving up power over another. Our rights—and our health care—come as a full set.”
And, FWIW: one of 51&’s co-founders served as CEO and board member of a PAC that backed RFK Jr. for president. That’s right—the same RFK Jr. who’s voiced support for a national abortion ban and now serves in the most anti-abortion presidential administration in recent history.
Ballot Box
Stats & Studies
While the loudest anti-abortion extremists often invoke Christianity, the conservative, Christian nationalist Family Research Council just published a survey showing that one-in-five Christian respondents have paid for, encouraged, or chosen to have an abortion themselves. Only a quarter of respondents agreed that “abortion is not acceptable under any circumstances.”
This, of course, shouldn’t be surprising. One in four women have abortions, and abortion patients represent all faiths.
Meanwhile, a new study from the University of Pennsylvania shows that sterilizations in the state have been on the rise since 2022. Researchers looked at nearly a half million permanent contraception procedures between January 2019 and March 2023, and found a significant increase in demand after Dobbs came down in 2022.
The authors say their research highlights “the unseen fallout” stemming from abortion bans, including not just the denial of care, but the ripple effects, as people change their reproductive decisions more broadly.
You Love to See It
Dobbs has created the need for all kinds of new modes of advocacy—including stronger protections for doctors who ship abortion pills into banned states. Enter: Reproductive Futures, a new group of attorneys, advocates, and abortion providers working to boost and protect telehealth access.
In recent months, we’ve witnessed anti-abortion states go to extreme lengths to test and challenge shield laws, including Texas’s ongoing lawsuit against New York’s Dr. Margaret Carpenter, and Louisiana’s arrest warrants for Carpenter and a California-based physician. Texas also just passed HB 7, a bill that allows anyone who sends abortion pills into the state to be sued for $100,000.
One of Reproductive Futures’ founders, human rights attorney Julie F. Kay, told the Washington Post that their goal is simple: helping providers continue to offer telemedicine abortion care no matter what. “What we’ve seen coming out of states like Texas is really stretching the law to its breaking point and beyond,” Kay said. “How can I get the law out of their way?”
This is exactly the organization we need for the times we’re in.
Movement Shake-Up
All eyes in the reproductive rights movement are on Planned Parenthood Southeast (PPSE), where former and current staff are raising alarms about the organization’s leadership—even suggesting it’s been infiltrated by the anti-abortion movement. On Monday, the Atlanta-based organization announced it has hired a law firm to investigate “troubling allegations” that recent staffing changes have led to serious mismanagement.
Earlier this month, a petition titled “Save Planned Parenthood Southeast”—calling for the resignation of CEO Mairo Akposé—garnered hundreds of signatures.
“What was once a trusted institution—providing lifesaving reproductive healthcare and fearless advocacy across Georgia, Alabama, and Mississippi—is now under immediate and dangerous threat from within.”
Staff allege they were called on to de-center abortion, and that the organization terminated crucial policy, advocacy, and public education positions. Reporting from Mother Jones and the Atlanta Journal-Constitution also lay out concerns that the new leadership isn’t actually supportive of the organization’s mission—pointing out that the new VP for external affairs allegedly floated the idea of collaborating with Students for Life, an extremist anti-abortion group. And Akposé’s hire for executive director described herself in an interview as “pro-life” as recently as 2022.
Those behind Save PPSE also say that leadership decided not to participate in Atlanta’s Pride Parade, and that Akposé wouldn’t use the pronouns of trans and nonbinary staffers.
In response, Akposé told Mother Jones:
“My faith has guided me. The same faith grounds my belief in bodily autonomy and reproductive freedom—in every person’s right to access quality, compassionate care, including abortion care, and to receive accurate information that empowers them to make the best choices for their lives.”
We’ll keep you updated as we learn more, but it’s clear that this is pretty heartbreaking for all involved. As Kaylah Oates-Marable, the former Georgia state director for PPSE, put it:
“To talk on the record about these things hurts because of how much I love what we do. I love this organization with my whole heart. I would never say anything to tarnish an organization that I care for to the depths of my soul.”
Clinic Watch
Ohio 🟡
Axios reports that two Ohio Planned Parenthood affiliates are fighting back against state attacks on their Medicaid funding.
Planned Parenthood of Greater Ohio (PPGOH) and Planned Parenthood Southwest Ohio Region (PPSWO) are already dealing with the Trump administration’s ‘big beautiful bill’, which prevents them from getting Medicaid reimbursements. But they’ve also been targeted by the Ohio Department of Medicaid (ODM)—which told the groups that they face termination of their Ohio Medicaid provider agreements.
PPGOH and PPSWO general counsel Melissa Cohen says that terminations are usually reserved for “bad actors” or criminal conviction, and that the move by the state could prevent the groups from future Medicaid eligibility. That’s why the affiliates are fighting back; they’ve asked for an administrative hearing to contest the decision, the first Planned Parenthood affiliates to do so.
Good for them.
North Carolina 🟠
Republicans in North Carolina also aren’t counting on the Trump budget bill alone to defund Planned Parenthood. Legislators there are advancing legislation to ban the reproductive healthcare providers from getting state Medicaid reimbursements—and bill sponsors are using language that suggests they may plan to reroute some of that funding to crisis pregnancy centers.
Rep. Neal Jackson, for example, said, “By partnering with community clinics, we’re expanding access to care while keeping our commitment to North Carolina families and the unborn.” Sure, he could mean credible healthcare clinics—but remember that there’s a concerted effort right now to frame crisis pregnancy centers as reasonable alternatives to Planned Parenthood. (In no small part because conservatives want to make it harder for women to get birth control.)
New Jersey 🟢
Great news out of New Jersey, which is on the brink of opening its first all-trimester abortion clinic. While abortions past 21 weeks are rare, patients may need abortion later in pregnancy under a wide range of circumstances including medical emergencies, fatal fetal abnormalities, patients who are very young, or those who faced barriers to earlier care.
To respond to that need in New Jersey, Luminosas Wellness Collective hopes to open a facility in Hudson County next summer.
Colorado 🟢
Speaking of full access to care: Earlier this week, we shared the wonderful news that former employees of Colorado’s Boulder Abortion Clinic (BAC) have launched the RISE Collective—a reproductive care clinic offering all-trimester abortions.
The bad news is that since their announcement, anti-abortion groups and conservative outlets have been doggedly harassing the clinic—spouting the usual, vile bullshit. If you can, donate to RISE here.
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The Bill That Could Make Crisis Pregnancy Centers Untouchable
Right now, the nation’s anti-abortion power players are testing out their next major strategy in Wyoming—and they’re betting no one will notice. Republican lawmakers there are advancing a bill crafted by Alliance Defending Freedom (ADF), the group responsible for the end of Roe. The CARE Act would effectively outlaw the regulation of anti-abortion crisis pregnancy centers, even allowing the groups to sue state leaders who try to stop them.
Giving fake clinics unprecedented and unchecked power would be bad enough, but the CARE Act goes even further. The legislation is part of a broader plan to informally ban birth control and eliminate abortion ban exceptions for women’s lives. Conservative lawmakers have already passed ADF’s blueprint in Montana, introduced it in South Carolina, and are pushing near-identical legislation in Congress. As is often the case, this isn’t just about one state or one strategy—the bill is a multi-pronged effort, doing several jobs at once for ADF and the anti-abortion movement.
Let’s start with the power that the CARE Act bestows on fake clinics.
Making Crisis Pregnancy Centers Indestructible
Crisis pregnancy centers (CPCs) are already barely regulated in anti-abortion states, yet they rake in hundreds of millions in taxpayer dollars. Only a fraction of that money reaches women, who often have to ‘earn’ basic supplies like diapers through Bible study classes. The rest goes to staff salaries, travel—even exercise equipment.
Research has shown for years that these centers routinely lie to women about their health and pregnancies, and accountability organizations report that CPCs falsely tell women their private medical information is HIPAA-protected. (They’re not real medical clinics, so the federal privacy law doesn’t apply.)
Despite all this public money with virtually no oversight, conservatives still paint CPCs as the real victims. ADF and other groups have filed a flood of free speech lawsuits recently, claiming the fake clinics have a First Amendment right to lie about ‘abortion reversal’—or that holding them accountable for deceptive ads is censorship.
That’s the same argument behind Wyoming’s CARE Act. ADF attorney Denise Burke says the bill “was designed to protect Wyoming’s pregnancy centers from censorship or discrimination.” In reality, this legislation would make it illegal—and expensive—to interfere with the groups in any way. Damages would start at $5,000, and anti-abortion activists and groups could sue for up to “three times the actual damages sustained.”
The goal is simple: to make crisis pregnancy centers unregulated and untouchable, freeing them up to spread conservatives’ extremist agenda nationwide. And a tremendous part of that agenda is quietly and informally banning birth control.
Attacks on Contraception
Republicans won’t ban birth control outright—at least not yet. They’re smart enough to know it would be a political disaster. Besides, they don’t need a law explicitly banning contraception; they just have to make it impossible to get. I warned about the central role CPCs would play in that strategy back in 2023:
Since the end of Roe, conservative lawmakers and activists have pushed CPCs as reasonable replacements for the real clinics their laws have shuttered. (Republicans even introduced the CARE Act as a supposed solution to Wyoming’s growing maternal health deserts.)
It’s the same justification they’ve used for the exponential increase in taxpayer funding for the centers: Republicans claim they’re simply meeting the post-Dobbs moment to support women, and showing that their ‘pro-life’ bonafides go beyond banning abortion. Last month, anti-abortion Charlotte Lozier Institute even released a ‘study’ arguing that women don’t really need Planned Parenthood clinics because “alternative providers”—like crisis pregnancy centers—can fill the healthcare gap.
But CPCs aren’t real medical clinics. Sure, some offer ultrasounds or dollar-store pregnancy tests handed out by volunteers in lab coats, but most don’t have medical staff or provide actual reproductive care.
They certainly don’t offer contraception. In fact, their policies forbid them from even mentioning birth control unless it’s to warn about its supposed dangers.
Under the CARE Act, it would be illegal to require the centers to offer contraception, refer women somewhere else for birth control—or even post a sign with information about contraception.
In communities where CPCs are the only available ‘care’, birth control would effectively disappear. And that’s the point: to run real reproductive healthcare providers out of town—along with any birth control access—and replace them with ideologues who refuse to even talk about contraception.
I also can’t help but wonder if the CARE Act’s language about ‘discrimination’ is meant to open the door for CPCs to access Title X funds. That’s certainly what Project 2025 was getting at. Last year, I flagged that the conservative roadmap calls for ending “religious discrimination in grant selections” for Title X:
What that means in plain English is that they want to give those millions of family planning dollars to crisis pregnancy centers and other religious groups that oppose birth control.
And now, here we are. But the danger to women’s health doesn’t end with contraception. Let’s talk about the CARE Act’s language on ‘separation procedures.’
Ending Exceptions for Women’s Lives
One of the most chilling truths about the anti-abortion movement is that it wants to do away with exceptions for women’s lives—and one of the tactics to make that happen is hidden in plain sight within the CARE Act.
Buried in the bill, you’ll find the term ‘pre-viability separation procedure’, defined as “a medical procedure performed by a licensed physician to remove an unborn child from the mother’s uterine cavity” before fetal viability.
If you’re a regular reader, you’ve heard about “separation procedures” before. For anyone who hasn’t, watch my video explainer here or read about the term here. The short version is that this is a completely invented term—created with the sole purpose of claiming abortion is never necessary to save a woman’s health or life.
Rather than allowing patients with life-threatening pregnancies to get standard abortion care—which is safer, easier, and less painful—conservatives want doctors to force women into c-sections or induced labor, even when it’s too early for a fetus to survive. Sometimes even when a fetus has died.
Why would anyone want women to undergo major abdominal surgery or a traumatic vaginal delivery when there’s no chance for fetal survival? Because the anti-choice movement wants to ‘prove’ abortion is never medically necessary. If they have to torture and kill women in the process, so be it.
I first came across ‘separation’ a few years ago in a “Glossary of Medical Terms” from the American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG), an extremist group that doesn’t believe in life-saving abortions. Since then, I’ve watched the term show up in bill after bill—Republicans quietly codifying the fiction in as many places as possible.
The result has been catastrophic, with doctors in states like Louisiana increasingly performing c-sections or forcing patients into labor out of fear of prosecution. In an affidavit, one physician described a patient whose water broke at 16 weeks. Denied a standard abortion procedure, she was made to deliver a nonviable fetus over several excruciating hours: “She was screaming—not from pain, but from the emotional trauma she was experiencing.” The patient hemorrhaged and lost nearly a liter of blood.
The more places Republicans are able to enshrine ‘separation’, the easier it is for them to argue that this kind of nightmare is normal.
The ultimate goal? End any and all abortion exceptions, even for women’s lives. I laid out what that looks like, step-by-step, last year. Redefining and replacing abortion with ‘separation’ is a huge piece of the puzzle:
The CARE Act
I’ll have more on where the CARE Act is headed in Wyoming in tomorrow’s daily report. In the meantime, consider this another reminder that when ADF writes a bill, it’s never just about one state or one piece of legislation.
Nearly two years ago, I warned that Republicans were making a big bet on crisis pregnancy centers—counting on the fake clinics to fix their image problem with women voters while seeding an extreme anti-abortion agenda across the country.
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The Cruel Calculus of America’s Anti-Abortion Machine
Anti-abortion leaders love to cloak themselves in the language of morality, sanctity, and “life.” But make no mistake: what is unfolding across the United States is not about babies. It is about control. It is about stripping women—and all people capable of pregnancy—of bodily autonomy in order to reassert hierarchies of power that were never about compassion, only domination.
The Human Cost They Pretend Not to See
The devastation is no longer hypothetical—it’s happening in real time.
Amanda Zurawski, a Texas woman, nearly died when her water broke at 18 weeks. Because Texas law bans abortion unless a patient is “in immediate danger of death,” doctors refused to provide care until she developed a life-threatening infection. She spent three days in the ICU, survived sepsis, and has permanent fertility damage. She is now suing the state.
In Oklahoma, a woman was denied care for an ectopic pregnancy until her fallopian tube ruptured—because staff feared prosecution if they acted “too soon.”
In Mississippi, a woman was arrested after experiencing a stillbirth at home; prosecutors attempted to argue her miscarriage was a criminal act of “fetal endangerment.”
And the broader numbers tell an even starker story:
In Texas, the maternal death rate rose 33% from 2019–2023, while the national rate dropped 7.5% in the same period [ProPublica].
Between 2019–2022, Texas maternal mortality increased 56%, compared to an 11% rise nationally [Texas Standard].
Infant deaths under age 1 in Texas rose 12.9% from 2021–2022, versus a 1.8% increase nationwide [PubMed].
States with abortion bans saw 478 excess infant deaths and 59 excess pregnancy-associated deaths after Dobbs [PRB].
Nearly 1,400 cases of pregnancy-related criminalization have been documented between 2006–2022, with at least 22 prosecutions in the year after Dobbs [Pregnancy Justice].
In Texas, 46.5% of counties are maternity care deserts, with no full obstetric services [Wikipedia].
This is not the preservation of life—it is the destruction of it.
The Political Utility of Cruelty
Why press forward when the evidence shows bans kill women? Because cruelty is the point. These laws aren’t accidental overreaches—they are tools of political control.
Heartbeat bills (6-week bans) are medically meaningless—an embryo at six weeks does not have a heart. But politically, they create a framework to criminalize abortion before most people know they’re pregnant.
Fetal personhood laws aim to give fertilized eggs constitutional rights—threatening IVF, contraception, and even miscarriage management. Every pregnancy becomes subject to surveillance and suspicion.
Criminalization of providers ensures fewer doctors will practice in hostile states, further collapsing health systems. Texas now faces OB/GYN shortages in over half its counties.
This is not incompetence—it’s design.
Who Pays the Price
It’s not the politicians’ daughters. They will always have access to private care. Those paying are:
Poor women, particularly in rural areas where hospitals already struggle to stay open.
Black and brown communities, already overpoliced and medically underserved.
Survivors of rape and incest, forced to carry pregnancies against their will.
Families facing tragedy, like fatal fetal anomalies, who are denied compassionate options.
These bans don’t stop abortion. They stop safe abortion. They return us to a world of septic wards, back-alley procedures, and needless funerals.
The Sanctimony of the Cruel
What enrages most is not just the policies—it’s the performance of virtue behind them.
The same politicians who rail against “government overreach” write laws to monitor uteruses. The same lawmakers who claim to protect “children” slash Medicaid, gut food programs, and cut maternal health funding. The same religious leaders who preach compassion push women into poverty, trauma, and death.
This is not hypocrisy. It is strategy. Their sanctimony is camouflage for their cruelty.
Where We Stand
To see this clearly is to strip away their false piety and name it plainly: a campaign of coercion. A system in which women’s pain is politically expedient, their deaths acceptable collateral. A project of control masquerading as morality.
And we should be enraged.
Because bans don’t end abortion. They end safety. They end dignity. They end lives.
Our Reminder to You
If you are scared, you are not alone. If you feel abandoned, know that thousands of others are in the same fight. And if you feel powerless, remember this:
They can imagine a thousand ways to block us.
We can imagine a thousand ways to burn it down — and build better.
In care and defiance,
📞 Call us: 302-660-1273
🌐 Visit: HerSafeHarbor.com
✉️ Email: contact@hersafeharbor.com
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This bill is one of their most ambitious swings toward that goal yet.
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Idaho loses 35% of OBGYNs after abortion ban takes effect
In the wake of the U.S. Supreme Court’s 2022 decision to overturn Roe versus Wade, Idaho’s strict abortion trigger law took effect, allowing abortion only in cases where the mother’s life is at risk or in instances of rape or incest with a documented police report.
Now a recent study published in the Journal of the American Medical Association has found a dramatic shift in our state’s medical landscape.
Between August 2022 and December 2024, Idaho lost 35% of its OBGYN physicians who practiced obstetrics. That’s nearly one in three doctors who delivered babies either leaving the state, retiring, or stopping obstetrics care altogether.
And with Idaho already ranking among the lowest in the nation for OBGYNs per capita, this raises major concerns about access to maternity care, especially in the more rural areas of Idaho.
Amber Nelson, executive director of the Idaho Coalition for Safe Healthcare, and McKay Cunningham, graduate professor and director of the Master of Applied Public Policy at the College of Idaho, joined Idaho Matters to talk more about this issue.
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Idaho News 6 Boise Twin Falls (KIVI)
BOISE, Idaho — The Attorney General of Idaho, Raúl Labrador, recently filed a summary judgment that seeks to have a legal case challenging Idaho's abortion law, the Defense of Life Act, thrown out.
The lawsuit, which was brought by Dr. Stacy Seyb of the St. Luke's Health System, argues that despite the Supreme Court's repeal of Roe v. Wade, the U.S. Constitution still protects abortions when medically necessary to protect the mother's health. Dr. Seyb is a maternal-fetal medicine specialist for St. Luke's.
As the current Idaho abortion laws are written, Seyb claims that mothers are subject to unnecessary medical risks due to the restrictive nature of the state's abortion law.
That law may prevent mothers from having an abortion before a stillbirth, when a miscarriage is inevitable, and in a variety of other medical instances.
In the summary judgment, Labrador says that Dr. Seyb contradicted himself via his own testimony before going on to claim that the physician "never understood Idaho’s law nor read the January 2023 Idaho Supreme Court decision clarifying the state’s abortion laws."
Labrador states that the Idaho Supreme Court nullified Seyb's claims when it modified legal language within the legal statute to allow doctors to utilize "good faith medical judgment” in cases where abortion may be necessary to protect the mother's health.
Labrador says, "“Dr. Seyb did not educate himself on what Idaho law permits, which is required of every doctor in Idaho."
The case, Seyb v. Members of the Idaho Board of Medicine, remains pending before the U.S. District Court for the District of Idaho.
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Federal funding freeze prompts Planned Parenthood closures, raising concerns about healthcare access in Iowa
Following the closure of four Planned Parenthood clinics in Iowa, access to reproductive health care — which was strained due to an existing OBGYN shortage in the state — is becoming increasingly limited.
The closures follow the elimination of federal dollars flowing to Planned Parenthood providers nationwide who offer family planning services, sexual health screenings and treatment, gender affirming care, abortion services, and other sexual health services.
President Donald Trump froze federal funding to Planned Parenthood earlier this year, a wishlist item for conservative Republicans who disagree with providing federal funding to organizations that also provide abortion care, though federal dollars don’t pay for abortion care.
On Sept. 11, the First Circuit allowed the Trump administration to block Medicaid patients from using their insurance at Planned Parenthood health centers nationwide, effectively defunding Planned Parenthood North Central States, or PPNCS, including Iowa, among other Planned Parenthood providers.
This decision comes after Trump signed his “One Big Beautiful Bill Act” into law on July 4, which enacted a massive reconciliation package enforcing trillions in spending cuts to pay for tax cuts.
After the Trump administration announced plans to temporarily freeze and review federal funding for Planned Parenthood and its affiliates, U.S. Sen. Joni Ernst, R-Iowa, renewed her effort to pass the Protect Funding for Women’s Health Care Act.
“I am adamantly pro-life and would much rather see the dollars go to actual women’s health care,” Ernst said in an interview with The Daily Iowan on April 7.
The bill would permanently block federal tax dollars from going to Planned Parenthood or any of its related organizations or clinics.
“I am committed to defending the most vulnerable among us,” Ernst said in a March 27 news release. “That’s why I will always stand up to protect taxpayer dollars from funding any organization that takes the life of an unborn child. I’m glad the Trump administration is working to end the left’s radical abortion-on-demand agenda.”
The four locations that have closed are in Cedar Rapids, Sioux City, Urbandale, and Ames — leaving two locations available for health care resources: Iowa City and Des Moines.
According to the Iowa Rural Health Association, more than a third of Iowa’s counties are considered a maternal health desert, meaning they have no hospital or birth center offering obstetric services and no obstetric providers.
Obstetric services are a medical specialty focusing on the care of women during pregnancy, childbirth, and the postpartum period.
“Iowa Republicans continue to prioritize legislation that drives physicians away from our state,” Iowa Democrats Chair Rita Hart said in a statement to the DI. “We cannot afford to lose more providers.”
According to a news release from Planned Parenthood, these closures leave 15 health centers within the North Central States, along with virtual care that is available seven days a week and serves almost 20,000 patients a year as of May 2025.
Title X funding freeze jeopardizes care
In April, Planned Parenthood North Central States was notified of a freeze of $2.8 million in Title X funding.
According to the Planned Parenthood Action Fund webpage, Title X served roughly 2.8 million people in 2023, two-thirds of whom had incomes at or below the federal poverty level, and nearly one-third lacking health insurance.
The program was created in 1970 to provide low-or no-cost birth control and reproductive health care to low-income individuals, and was created with bipartisan support, the webpage stated.
“The program was designed to ensure quality family planning is available to everyone, regardless of their ability to pay,” the webpage said.
Title X services include birth control, cervical and breast cancer screenings, family planning education, basic infertility services, STI testing and treatment, and wellness exams.
In some cases, people who get services through the program don’t even know Title X exists, the webpage said.
The program requires health care providers to use a sliding-fee scale — a system where the cost of a product or service is based on a person’s income and household size.
RELATED: Iowa Sen. Ernst affirms support for Planned Parenthood funding freeze
Patients with income levels at or below 100 percent of the federal poverty level qualify for free reproductive health services.
The Iowa Rural Health Association said even in regions with some health care access, issues like workforce shortages, limited transportation, and a lack of specialty care can delay or block patients from receiving necessary treatment.
In a statement to The Daily Iowan, President and CEO of Planned Parenthood North Central States, Ruth Richardson, said for more than 90 years, Planned Parenthood has served as a key provider of Title X services in Iowa.
“While the federal government has currently blocked patients from using Medicaid to access our care, we will continue to serve everyone who turns to us, regardless of their insurance status, and work with patients to understand their payment options.” Richardson said. “At Planned Parenthood we continue to fight for us all.”
In 2024, Medicaid helped 27,000 PPNCS patients receive more than 300,000 birth control options, 2,500 long-acting reversible contraceptives, 70,000 STI tests, and 1,000 cervical cancer screenings, according to Planned Parenthood’s website.
Richardson said, despite ongoing attacks on reproductive rights, “our patients remain our top priority.”
Recent investments include expanding the Des Moines Health Center to double its capacity, broadening virtual care access statewide, and ensuring abortion services are available in both Des Moines and Iowa City.
Although federal restrictions currently prevent Medicaid patients from using their coverage, Planned Parenthood emphasized its commitment to serve everyone who seeks care, reaffirming “Iowans deserve accessible health care no matter their race, income, gender identity, or zip code.”
Planned Parenthood advocates of Iowa said Iowa politicians have greatly reduced access to sexual and reproductive health care, including passing a near-total abortion ban.
Planned Parenthood, nationally, will continue to “proudly provide” the full range of reproductive health care, including abortion.
“There is not now, and has never been, a plan to stop providing abortion care in the hopes of preserving federal funding. Providing abortion care everywhere it’s still legal is not up for negotiation,” Planned Parenthood said in a news release.
Under the present federal administration and Congress, the attacks are worsening.
Planned Parenthood said the attack is targeted because, among other things, Planned Parenthood advocates for sexual and reproductive rights and Planned Parenthood health centers provide abortion care where it is legal.”
In 2024, the state’s “fetal heartbeat” law does not violate the state constitution. The law bans abortion after around six weeks of pregnancy.
According to The State Court Report, the “fetal heartbeat” law addresses a 2023 law prohibiting abortion when there is a “detectable fetal heartbeat.”
According to a Planned Parenthood release, six months after the ban, the number of abortions in Iowa dropped 60 percent while Iowans traveling to Nebraska and Minnesota
increased 239 percent.
Pro-life advocates say closures are “a great thing”
Maggie DeWitte, executive director of Pulse Life Advocates, said she views the recent Planned Parenthood closures as “a great thing” and said “the state of Iowa does not need abortion clinics.”
DeWitte said women can receive quality, comprehensive medical care from the nearly 55 pregnancy resource centers located across the state.
“We don’t believe abortion is health care,” DeWitte said.
She said the pregnancy resource centers “are providing all of the same services Planned Parenthood provides without the devastating service of abortion.”
Kristi Judkins, executive director of Iowa Right to Life, said she believes the closures are the result of major political shifts reshaping reproductive health care in Iowa and nationwide.
Judkins said many pregnancy resource centers have expanded to meet women’s needs across the state.
“Those clinics are largely supported in their communities by individuals, groups, [and] companies that believe there is a support system that needs to be in place,” she said. “As pro-lifers, we have to put our money where our mouth is.”
Judkins said her personal experience with abortion shaped her perspective and the compassion she brings to her work.
“[It] was a decision made prior to my husband and I getting married,” she said. “What I didn’t know then is the one thing I know now — fetal development and understanding and appreciating the development of the unborn child within the womb.”
She said after her abortion, she experienced suicidal tendencies and depression, but through faith and post-abortion healing ministries, she came to terms and grieved the memory of the child she gave up to abortion.
Now, Judkins said her goal is to meet others with empathy.
“Hopefully [I can] explain and communicate the truth that I wished I had back then,” Judkins said.
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Penn researchers find rise in sterilizations following removal of federal abortion protections
A new study led by Penn researchers found that rates of permanent contraception have increased in Pennsylvania since the removal of federal protections for abortion access.
Published this month in “O&G Open,” the study analyzed more than 450,000 permanent contraception procedures in Pennsylvania from January 2019 to March 2023. Researchers also found a statistically significant increase in sterilization rates following the Dobbs v. Jackson Women’s Health Organization decision that reversed Roe v. Wade, particularly among more-educated, higher-income women as well as those who live further from abortion care.
“I see patients throughout all different phases of their lives,” corresponding author and obstetrics and gynecology assistant professor Alice Abernathy said in an interview with The Daily Pennsylvanian. “Shortly after the Dobbs decision dropped, I had a number of patients come in to request permanent tubal contraception procedures. We wondered if it was just a fluke, or if people were really changing some of their decisions as a result.”
The work, supported by the Leonard Davis Institute of Health Economics at Penn, explores what its authors describe as “the unseen fallout” of abortion-policy shifts: a change in reproductive behavior that goes beyond simple access to abortion itself.
“I think it’s really important to conduct research that’s directly responsive to the type of care that we provide, the practice environment that we work in, and ultimately the patients to whom we’re accountable for taking the best care of,” Abernathy added. “There are a lot of people who are struggling with similar questions.”
Using insurance claims data, the research team applied interrupted time-series analyses to track changes in tubal ligation and vasectomy cases among individuals aged 15 to 44 during the period of the study, comparing trends before and after the removal of federal protections for abortion access.
“While the study design chosen is good, the only limitation is that it can’t really assess whether another factor at the time affected it,” biostatistics and epidemiology professor Nandita Mitra told the DP. “But in this case, it’s hard to imagine what else would be true.”
The study also found that increases in permanent contraception were not evenly distributed across populations. Women in areas with higher educational attainment, lower poverty rates, and greater distance from abortion-care facilities experienced the largest proportional rise in procedures.
“There’s a long and shameful history of forced sterilization in the United States, which has led to a mandated 30-day waiting period for people with Medicaid insurance, which can serve as a barrier,” Abernathy said. “Those with higher incomes may simply find it easier to act on their desire for permanent contraception.”
Past campus discourse has reflected similar concerns about reproductive autonomy. In 2023, student organizations and advocacy groups at Penn expanded efforts to promote reproductive justice following the Dobbs decision, hosting educational events and resource drives to raise awareness about access to contraception and abortion care.
“We need to destigmatize these conversations around miscarriage, around abortion, and empower people to feel comfortable speaking with their communities, with their physicians, with their lawmakers, to make sure they can access the care that they want and should be supported in,” Abernathy added.
Kansas navigates post-Dobbs world with state abortion restrictions in limbo • Kansas Reflector
OLATHE — The Kansas abortion trial with wide-reaching implications for state lawmakers and health care providers wrapped Friday with arguments over the two sides’ differing definitions of pain, humanity and consciousness.
“These are not easy issues,” Judge Christopher Jayaram said at the close of the day’s proceedings.
“I take this responsibility with understanding the gravity to which I am charged,” he said.
His comments were preceded by seven days of testimony from ethicists, doctors, researchers, people who have received abortions, an animal biologist and a neonatologist as each side of the case denounced or defended state abortion restrictions.
The rules date to 1997, when Kansas legislators passed the Women’s Right to Know Act with the stated motivation of fully informing women of the risks of abortion by mandating providers comply with a list of requirements, including a 24-hour waiting period to complete consent forms, specific typefaces and page colors for paperwork, large display signs in private offices with state-approved language, informing patients a fetus at 20 weeks can feel pain, which is disputed, and a 30-minute wait between first meeting with a physician and undergoing an abortion.
Providers and advocates argue that the law stigmatizes abortions and interferes with their ability to provide them. The case also includes more recent laws, House Bill 2749 from 2024 and House Bill 2264 from 2023, that never went into effect because a judge blocked them as part of the pending lawsuit. Sometimes called the reasons mandate, the 2024 law required providers to give patients the opportunity to select from a list of reasons for obtaining their abortion and report that data to the state. The 2023 law required doctors to tell patients their abortions were reversible, which has not been conclusively proven by science.
The defendants and plaintiffs represented the most prominent sides of a long-running national dispute, a confrontation brought into focus by the U.S. Supreme Court’s 2022 Dobbs decision eliminating the constitutional right to an abortion. Abortion in Kansas is allowed up to 22 weeks of gestation, and Kansas has some of the most permissive abortion policies among red states, in large part, due to the August 2022 statewide vote that affirmed abortion as a state constitutional right.
Farr Curlin, a professor at Duke University and a medical ethicist, testified on Oct. 16 for the state.
“Physicians are, like the public, divided about abortion,” Curlin said.
What has made abortion so controversial is the “arbitrary hostility toward one class of human beings,” he said, referring to fetuses. He argued the state’s laws advance an ethical interest in preserving the rights and life of a fetus while increasing oversight of abortion providers. He does not support abortion in most instances.
Curlin said that the scientific community doesn’t agree on when human life begins.
The state presented witnesses who supported its language classifying fetuses as “living, separate, whole and unique human beings” based on their clinical practices, research or other studies. Abortion providers and experts for the plaintiffs rebutted that language.
Experts and doctors also disputed claims regarding fetal pain and abortion pill reversal.
Steven Ralston, an OB-GYN and the director for maternal fetal medicine at George Washington University, testified that a difference exists between pain and reflex.
“Pain is an emotional response to some kind of unpleasant sensation,” he said.
He and other witnesses fielded questions about nociception, the body’s physiological response to stimuli that could cause tissue damage. Pain is the resulting subjective experience. The American College of Obstetricians and Gynecologists says science conclusively establishes that fetuses cannot experience pain until after 24-25 weeks. Nociception develops earlier, beginning at around 7 weeks. The state’s attorneys and witnesses used nociception as proof of fetal pain before 25 weeks. But the scientific community is not in agreement.
“It’s not an emotional response to what’s happening,” Ralston said. “It’s a reflexive response to what’s happening.”
Research into “abortion pill reversal,” which involves ingesting progesterone after taking mifepristone in an attempt to continue the pregnancy, is underdeveloped. In small studies, taking mifepristone alone, without the follow-up of misoprostol, the second step in a medication abortion, can prove dangerous.
Selina Sandoval, an OB-GYN for Planned Parenthood in Kansas, said in an Oct. 16 interview following brief testimony that the state mandating abortion providers to inform patients about abortion pill reversal requires doctors “to give misinformation” to patients. It’s not something she said she feels comfortable telling patients is an option, she said.
Being a part of the case was important to Sandoval. She said she has noticed how care has improved since the state’s restrictions were enjoined.
“I’ve personally seen the harms that the Women’s Right to Know Act has caused my patients,” she said.
A patient once told her she took buses for 19 hours to get to a Kansas clinic from Texas, she said. Affordability, work, child care and travel considerations all factor into the decision to get an abortion, Sandoval said. She called the state’s restrictions discriminatory.
“No other area of health care is under this amount of scrutiny,” Sandoval said.
An enormous case
Brittany Jones, the president of conservative Christian group Kansas Family Voice, sat in on much of the trial. She said in an interview it was one of the most unusual trials she has seen.
Jones took issue with the way the judge defined facets of evidence or objections in the case. The witness proceedings involved numerous objections from both sides that evoked differing reactions from the judge.
“From that standpoint, I mean, the judge appeared — I’m not going to assume anything — but he appeared very biased,” she said. “And appeared to be making rulings that were very biased and not based on the law. They were based on his opinions about abortion as a whole.”
The case at hand is a big one, Jones said.
“It started out as a big case when it included our entire informed consent law going back to 1997, that’s never been challenged, that has helped so many women in Kansas,” she said.
As the judge added more laws to the case, it grew in size and magnitude.
“We really don’t have a great idea of what strict scrutiny looks like in Kansas, how it’s applied in these cases, and so it has huge implications for how the Legislature can go about protecting women and life in the state,” Jones said.
She said Kansas has always been a leader, often at the center of the national conversation on abortion. It is one of the first states to try to figure out how to operate in the post-Dobbs era, she said.
Lynnette Ranney ran the front desk from 2018 to 2023 at the private Overland Park clinic that is a plaintiff in the suit. That was before and after Dobbs, but before Kansas’ restrictions were blocked. She was in charge of ensuring patients had filled out the correct paperwork and that they met all the state requirements. She described in court the anger, frustration and eye rolls from patients toward the state’s long list of requirements.
If patients brought in the required forms in the wrong color or the wrong forms altogether, the 24-hour waiting period would begin again.
“We would have to turn the patient away,” Ranney said. “We would print off new ones, give them their 24-hour timeframe, and try to reschedule them.”
One patient broke a door at the clinic after being turned away for blurry paperwork, Ranney testified
These issues arose at least 10 times a week, she estimated. She said she spent at least seven hours each workday on paperwork. In Ranney’s current role at a skin cancer center, she said, she spends about five minutes on similar tasks.
Once the paperwork and the 24-hour wait were completed, patients then waited an additional 30 minutes from the time they first saw their provider before they could proceed with an abortion. The clinic would set kitchen timers, Ranney said.
Ranney described to the court a patient who traveled to Kansas from Texas. She was seeking an abortion after being subject to sexual assault. When she showed up for the appointment, she brought the wrong consent forms, Ranney said. By the time the clinic could reschedule her appointment, she was too far along in her pregnancy to be seen, she said.
“It was devastating,” Ranney said. “It was so hard to be the person that says, ‘Hey, I know you’ve got a lot going on, but, sorry, we can’t help you.’”
National interest
A handful of national groups are involved in the case. On the plaintiff’s side, the Planned Parenthood Federation of America and the Center for Reproductive Rights argued on behalf of Traci Lynn Nauser, a Kansas OB-GYN, her clinic, and Comprehensive Health of Planned Parenthood Great Plains. On the state’s side, the conservative Christian advocacy firm Alliance Defending Freedom and Colorado-based firm First and Fourteenth.
Allison Pope, an attorney for the alliance and a native Kansan, said in a September press release that the state’s restrictions help women be fully informed about their pregnancies before choosing to get an abortion.
“Informed consent laws make this possible and reflect the longstanding will of the people of Kansas, but Planned Parenthood has made it clear that its goal is to withhold critical information from women,” she said.
Kansas Attorney General Kris Kobach, who is a defendant in the case, said in the alliance’s press release that the state restrictions provide the “best possible care” for Kansas women and children.
“Planned Parenthood has always cared more about its bottom line than women’s health and is actively working to hide important health information from women that could be a matter of life or death,” he said. “We are urging the court to uphold this commonsense protection that prioritizes the lives of women and their children in Kansas.”
Planned Parenthood and other medical organizations across the country have long recognized abortion as reproductive health care.
Both sides of the case rested on Friday, and a decision from Jayaram is pending.
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NC House Passes Legislation to End Medicaid Funding for Planned Parenthood
Oct 23
Raleigh, NC — Today, the North Carolina House of Representatives passed Senate Bill 378, "Align Medicaid Eligibility with Federal Law," which prohibits Medicaid funding for Planned Parenthood.
Senate Bill 378 brings North Carolina into compliance with the recently enacted "One Beautiful Bill," which requires the state’s Medicaid program to remove Planned Parenthood as an approved provider.
Rep. Dean Arp said, "Senate Bill 378 makes clear that public dollars will no longer flow to abortion providers like Planned Parenthood, ensuring our Medicaid program focuses instead on health care providers who offer comprehensive care for women without undermining the values of North Carolinians."
Rep. Neal Jackson said, "Senate Bill 378 ensures that our Medicaid funds support real healthcare rather than organizations that profit from abortion. By partnering with community clinics, we’re expanding access to care while keeping our commitment to North Carolina families and the unborn."
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Texas Banned Abortion. Then Sepsis Rates Soared.
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Pregnancy became far more dangerous in Texas after the state banned abortion in 2021, ProPublica found in a first-of-its-kind data analysis.
The rate of sepsis shot up more than 50% for women hospitalized when they lost their pregnancies in the second trimester, ProPublica found.
The surge in this life-threatening condition, caused by infection, was most pronounced for patients whose fetus may still have had a heartbeat when they arrived at the hospital.
ProPublica previously reported on two such cases in which miscarrying women in Texas died of sepsis after doctors delayed evacuating their uteruses. Doing so would have been considered an abortion.
The new reporting shows that, after the state banned abortion, dozens more pregnant and postpartum women died in Texas hospitals than had in pre-pandemic years, which ProPublica used as a baseline to avoid COVID-19-related distortions. As the maternal mortality rate dropped nationally, ProPublica found, it rose substantially in Texas.
ProPublica’s analysis is the most detailed look yet at a rise in life-threatening complications for women losing a pregnancy after Texas banned abortion. It raises concerns that the same pattern may be occurring in more than a dozen other states with similar bans.
To chart the scope of pregnancy-related infections, ProPublica purchased and analyzed seven years of Texas’ hospital discharge data.
“This is exactly what we predicted would happen and exactly what we were afraid would happen,” said Dr. Lorie Harper, a maternal-fetal medicine specialist in Austin.
She and a dozen other maternal health experts who reviewed ProPublica’s findings say they add to the evidence that the state’s abortion ban is leading to dangerous delays in care. Texas law threatens up to 99 years in prison for providing an abortion. Though the ban includes an exception for a “medical emergency,” the definition of what constitutes an emergency has been subject to confusion and debate.
Many said the ban is the only explanation they could see for the sudden jump in sepsis cases.
The new analysis comes as Texas legislators consider amending the abortion ban in the wake of ProPublica’s previous reporting, and as doctors, federal lawmakers and the state’s largest newspaper have urged Texas officials to review pregnancy-related deaths from the first full years after the ban was enacted; the state maternal mortality review committee has, thus far, opted not to examine the death data for 2022 and 2023.
The standard of care for miscarrying patients in the second trimester is to offer to empty the uterus, according to leading medical organizations, which can lower the risk of contracting an infection and developing sepsis. If a patient’s water breaks or her cervix opens, that risk rises with every passing hour.
Sepsis can lead to permanent kidney failure, brain damage and dangerous blood clotting. Nationally, it is one of the leading causes of deaths in hospitals.
While some Texas doctors have told ProPublica they regularly offer to empty the uterus in these cases, others say their hospitals don’t allow them to do so until the fetal heartbeat stops or they can document a life-threatening complication.
Last year, ProPublica reported on the repercussions of these kinds of delays.
Forced to wait 40 hours as her dying fetus pressed against her cervix, Josseli Barnica risked a dangerous infection. Doctors didn’t induce labor until her fetus no longer had a heartbeat.
Physicians waited, too, as Nevaeh Crain’s organs failed. Before rushing the pregnant teenager to the operating room, they ran an extra test to confirm her fetus had expired.
Both women had hoped to carry their pregnancies to term, both suffered miscarriages and both died.
In response to their stories, 111 doctors wrote a letter to the Legislature saying the abortion ban kept them from providing lifesaving care and demanding a change.
“It’s black and white in the law, but it’s very vague when you’re in the moment,” said Dr. Tony Ogburn, an OB-GYN in San Antonio. When the fetus has a heartbeat, doctors can’t simply follow the usual evidence-based guidelines, he said. Instead, there is a legal obligation to assess whether a woman’s condition is dire enough to merit an abortion under a prosecutor’s interpretation of the law.
Some prominent Texas Republicans who helped write and pass Texas’ strict abortion bans have recently said that the law should be changed to protect women’s lives — though it’s unclear if proposed amendments will receive a public hearing during the current legislative session.
ProPublica’s findings indicate that the law is getting in the way of providing abortions that can protect against life-threatening infections, said Dr. Sarah Prager, a professor of obstetrics and gynecology at the University of Washington.
“We have the ability to intervene before these patients get sick,” she said. “This is evidence that we aren’t doing that.”
A New View
Health experts, specially equipped to study maternal deaths, sit on federal agencies and state-appointed review panels. But, as ProPublica previously reported, none of these bodies have systematically assessed the consequences of abortion bans.
So ProPublica set out to do so, first by investigating preventable deaths, and now by using data to take a broader view, looking at what happened in Texas hospitals after the state banned abortion, in particular as women faced miscarriages.
“It is kind of mindblowing that even before the bans researchers barely looked into complications of pregnancy loss in hospitals,” said perinatal epidemiologist Alison Gemmill, an expert on miscarriage at Johns Hopkins Bloomberg School of Public Health.
In consultation with Gemmill and more than a dozen other maternal health researchers and obstetricians, ProPublica built a framework for analyzing Texas hospital discharge data from 2017 to 2023, the most recent full year available. This billing data, kept by hospitals and collected by the state, catalogues what happens in every hospitalization. It is anonymized but remarkable in its granularity, including details such as gestational age, complications and procedures.
To study infections during pregnancy loss, ProPublica identified all hospitalizations that included miscarriages, terminations and births from the beginning of the second trimester up to 22 weeks’ gestation, before fetal viability. Since first-trimester miscarriage is often managed in an outpatient setting, ProPublica did not include those cases in this analysis.
When looking at stays for second-trimester pregnancy loss, ProPublica found a relatively steady rate of sepsis before Texas made abortion a crime. In late 2021, the state made it a civil offense to end a pregnancy after a fetus developed cardiac activity, and in the summer of 2022, the state made it a felony to terminate any pregnancy, with few exceptions.
In 2021, 67 patients who lost a pregnancy in the second trimester were diagnosed with sepsis — as in the previous years, they accounted for about 3% of the hospitalizations.
In 2022, that number jumped to 90.
The following year, it climbed to 99.
ProPublica’s analysis was conservative and likely missed some cases. It doesn’t capture what happened to miscarrying patients who were turned away from emergency rooms or those like Barnica who were made to wait, then discharged home before they returned with sepsis.
Our analysis showed that patients who were admitted while their fetus was still believed to have a heartbeat were far more likely to develop sepsis.
Sepsis Rates Spiked for Patients Whose Initial Diagnosis Didn’t Include Fetal Death
For patients in Texas hospitals who lost a pregnancy, about half were not diagnosed with fetal demise when they were admitted, meaning that their fetus may still have had a heartbeat at that time. Those patients saw a dramatic increase in sepsis after the state banned abortion.
Years abortion was banned
Sepsis rate for hospitalizations without fetal death
With fetal death
6.9%
3.7%
3.1%
2.1%
“What this says to me is that once a fetal death is diagnosed, doctors can appropriately take care of someone to prevent sepsis, but if the fetus still has a heartbeat, then they aren’t able to act and the risk for maternal sepsis goes way up,” said Dr. Kristina Adams Waldorf, professor of obstetrics and gynecology at UW Medicine and an expert in pregnancy complications. “This is needlessly putting a woman’s life in danger.”
Studies indicate that waiting to evacuate the uterus increases rates of sepsis for patients whose water breaks before the fetus can survive outside the womb, a condition called previable premature rupture of membranes or PPROM. Because of the risk of infection, major medical organizations like the Society for Maternal-Fetal Medicine and the American College of Obstetricians and Gynecologists advise doctors to always offer abortions.
Researchers in Dallas and Houston examined cases of previable pregnancy complications at their local hospitals after the state ban. Both studies found that when women weren’t able to end their pregnancies right away, they were significantly more likely to develop dangerous conditions than before the ban. The study of the University of Texas Health Science Center in Houston, not yet published, found that the rate of sepsis tripled after the ban.
Dr. Emily Fahl, a co-author of that study, recently urged professional societies and state medical boards to “explicitly clarify” that doctors need to recommend evacuating the uterus for patients with a PPROM diagnosis, even with no sign of infection, according to MedPage Today.
UTHealth Houston did not respond to several requests for comment.
ProPublica zoomed out beyond the second trimester to look at deaths of all women hospitalized in Texas while pregnant or up to six weeks postpartum. Deaths peaked amid the COVID-19 pandemic, and most patients who died then were diagnosed with the virus. But looking at the two years before the pandemic, 2018 and 2019, and the two most recent years of data, 2022 and 2023, there is a clear shift:
In the two earlier years, there were 79 maternal hospital deaths.
In the two most recent, there were 120.
Caitlin Myers, an economist at Middlebury College, said it’s crucial to examine these deaths from different angles, as ProPublica has done. Data analyses help illuminate trends but can’t reveal a patient’s history or wishes, as a detailed medical chart might. Diving deep into individual cases can reveal the timeline of treatment and how doctors behave. “When you see them together, it tells a really compelling story that people are dying as a result of the abortion restrictions.”
Texas has no plans to scrutinize those deaths. The chair of the maternal mortality review committee said the group is skipping data from 2022 and 2023 and picking up its analysis with 2024 to get a more “contemporary” view of deaths. She added that the decision had “absolutely no nefarious intent.”
“The fact that Texas is not reviewing those years does a disservice to the 120 individuals you identified who died inpatient and were pregnant,” said Dr. Jonas Swartz, an assistant professor of obstetrics and gynecology at Duke University. “And that is an underestimation of the number of people who died.”
The committee is also prohibited by law from reviewing cases that include an abortion medication or procedure, which can also be used during miscarriages. In response to ProPublica’s reporting, a Democratic state representative filed a bill to overturn that prohibition and order those cases to be examined.
Because not all maternal deaths take place in hospitals and the Texas hospital data did not include cause of death, ProPublica also looked at data compiled from death certificates by the Centers for Disease Control and Prevention.
It shows that the rate of maternal deaths in Texas rose 33% between 2019 and 2023 even as the national rate fell by 7.5%.
A New Imperative
Texas’ abortion law is under review this legislative session. Even the party that championed it and the senator who authored it say they would consider a change.
On a local television program last month, Republican Lt. Gov. Dan Patrick said the law should be amended.
“I do think we need to clarify any language,” Patrick said, “so that doctors are not in fear of being penalized if they think the life of the mother is at risk.”
State Sen. Bryan Hughes, who once argued that the abortion ban he wrote was “plenty clear,” has since reversed course, saying he is working to propose language to amend the ban. Texas Gov. Greg Abbott told ProPublica, through a spokesperson, that he would “look forward to seeing any clarifying language in any proposed legislation from the Legislature.”
Patrick, Hughes and Attorney General Ken Paxton did not respond to ProPublica’s questions about what changes they would like to see made this session and did not comment on findings ProPublica shared.
In response to ProPublica’s analysis, Abbott’s office said in a statement that Texas law is clear and pointed to Texas health department data that shows 135 abortions have been performed since Roe was overturned without resulting in prosecution. The vast majority of the abortions were categorized as responses to an emergency but the data did not specify what kind. Only five were solely to “preserve [the] health of [the] woman.”
At least seven bills related to repealing or creating new exceptions to the abortion laws have been introduced in Texas.
Doctors told ProPublica they would most like to see the bans overturned so all patients could receive standard care, including the option to terminate pregnancies for health considerations, regardless of whether it’s an emergency. No list of exceptions can encompass every situation and risk a patient might face, obstetricians said.
“A list of exceptions is always going to exclude people,” said Dallas OB-GYN Dr. Allison Gilbert.
It seems unlikely a Republican-controlled Legislature would overturn the ban. Gilbert and others are advocating to at least end criminal and civil penalties for doctors. Though no doctor has been prosecuted for violating the ban, the mere threat of criminal charges continues to obstruct care, she said.
In 2023, an amendment was passed that permitted physicians to intervene when patients are diagnosed with PPROM. But it is written in such a way that still exposes physicians to prosecution; it allows them to offer an “affirmative defense,” like arguing self-defense when charged with murder.
“Anything that can reduce those severe penalties that have really chilled physicians in Texas would be helpful,” Gilbert said. “I think it will mean that we save patients’ lives.”
Rep. Mihaela Plesa, a Democrat from outside Dallas who filed a bill to create new health exceptions, said that ProPublica’s latest findings were “infuriating.”
She is urging Republicans to bring the bills to a hearing for debate and discussion.
Last session, there were no public hearings, even as women have sued the state after being denied treatment for their pregnancy complications. This year, though some Republicans appeared open to change, others have gone a different direction.
One recently filed a bill that would allow the state to charge women who get an abortion with homicide, for which they could face the death penalty.
Do you live in a state that has passed laws affecting abortion in the last few years? In the time since, have you or a loved one experienced delayed health care while pregnant or experiencing a miscarriage?
ProPublica would like to hear from you to better understand the unintended impact of abortion bans across the country. Email our reporters at reproductivehealth@propublica.org to share your story.
We understand this may be difficult to talk about, and we have detailed how we report on maternal health to let you know what you can expect from us.
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Are Abortion Bans Across America Causing Deaths? The States That Passed Them Are Doing Little to Find Out.
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In states with abortion bans, ProPublica has found, pregnant women have bled to death, succumbed to fatal infections and wound up in morgues with what medical examiners recorded were “products of conception” still in their bodies.
These are the very kinds of cases state maternal mortality review committees are supposed to delve into, determining why they happened and how to stop them from happening again.
But panels in states that have recently imposed strict bans on abortion have done little to uncover whether the laws are contributing to maternal deaths, including tracking delays in care for pregnancy complications and making these problems known, a ProPublica investigation shows.
In fact, we found that in a few states, political leaders who backed the bans have stood in the way of measuring their consequences.
They have dismissed committees, slowing down their work. They have weeded out members openly critical of abortion bans and supportive of transparency.
Texas has gone as far as to legally prohibit its committee from reviewing deaths that are considered abortion-related. This could include some miscarriage care, health officials told ProPublica.
In two deaths of Texas women that ProPublica investigated, Porsha Ngumezi and Josseli Barnica had already miscarried when they were given misoprostol to help complete the process. The committee does not review cases that involve that drug because it’s also used for abortions, said committee chair Dr. Carla Ortique: “If they received medication, if they received any procedure, we will not get those records.” Chris Van Deusen, the spokesperson at the Texas Department of State Health Services, would not say whether Ngumezi’s and Barnica’s deaths would be reviewed.
Other state committees have not made changes to systematically examine the role abortion bans are playing in maternal deaths, officials acknowledged, though some said they might note it as a contributing factor if it appears in the records. “If the committee discovers a trend that raises a particular concern, it could decide to include that information in its reports,” South Carolina officials said.
Some noted that they follow guidelines from the Centers for Disease Control and Prevention, and that those recommendations don’t direct committees to consider abortion access or delays in abortion care. Indiana’s law directs committee members to determine whether the person who died had an abortion and whether that contributed to their death; it does not focus on delays in access to abortion care.
States can direct their committees to look at any important health issue; Texas’ panel added new questions to its process to help capture the role of the coronavirus pandemic in deaths, for example.
ProPublica asked governors in 15 states with strict abortion bans whether committees should examine the impact of the laws on maternal deaths; most did not respond. None directly answered the question or advocated for specific changes. (Read their responses here.)
“We’re not acting like we want to know the answer to this question. And that concerns me,” said Caitlin Myers, an economics researcher at Middlebury College who is studying the impact of abortion access on maternal health. “However you feel about the ethics of abortion, we should want to understand how these policies are affecting women’s health.”
Experts interviewed by ProPublica say state maternal mortality review committees are uniquely well-positioned to examine the impacts of abortion bans on maternal health. The panels are often made up of practicing OB-GYNs, cardiologists and nurses, and they can also include doulas, medical examiners and experts in mental health, substance abuse and domestic violence. They review summaries of medical records to determine whether deaths were preventable and to identify contributing factors. This allows researchers and government officials to see patterns and come up with ways to improve the country’s poor maternal health outcomes.
Committees are not systematically tracking an issue that came up throughout ProPublica’s reporting on deaths in states with abortion bans: delays and denials of procedures, like dilation and curettage, which are used to empty the uterus during miscarriages to avoid hemorrhage and infection. The procedures are also used for abortions, and doctors face prison time for violating restrictions. Women have died after they could not access these procedures, ProPublica found.
Nevaeh Crain, a teenager whose organs were failing, was made to wait 90 minutes for a second ultrasound to confirm fetal demise. Amber Thurman suffered for 20 hours while sepsis spread. And Barnica was subjected to serious infection risks for 40 hours while doctors monitored the fetal heartbeat until it stopped.
Studying such delays “needs to be a part of these kinds of reviews,” said Dr. Daniel Grossman, a leading reproductive health care researcher and professor of obstetrics and gynecology at the University of California San Francisco.
Grossman has collected dozens of accounts from health care providers detailing substandard treatment and poor outcomes in states that banned abortion. But he and others recognize who is ultimately in charge of state maternal mortality review committees.
“I can’t imagine the states that passed restrictions saying, ‘Now we want to know if that caused any deaths,’” said Eugene Declercq, a professor at Boston University’s School of Public Health who serves on Massachusetts’ maternal mortality review committee. “The clinicians and the public health people might want to know, but the political leaders would be aghast.”
Even if they start to pursue such answers, states are years behind in reviewing deaths, ProPublica found in a survey of 18 states with the most restrictive abortion laws. Most have not finished reviewing deaths from 2022, the year most bans became effective after the Supreme Court overturned the constitutional right to abortion. Two states are still reviewing 2021 deaths. Three states — Florida, North Dakota and South Dakota — did not respond.
Most States With Abortion Bans Are Years Behind in Reviewing Maternal Deaths
Reviews typically lag years behind deaths because of the time it takes state health department employees to learn of cases, track down records and wrestle them free from hospitals and doctors before they summarize and redact them for review. “We have one person in the entire state that has to collect all that data. Literally one,” said Dr. Stacie Geller, a founding member of Illinois’ committee. “I live in fear of her retiring.”
The CDC, which has pumped tens of millions of dollars into helping states establish these committees and standardizing their work, has tried to reduce the backlog by setting a goal for committees that receive funding to review cases within two years. However, there’s no way to compel states to do so, and not all have caught up.
Such lags matter more in places where there has been a seismic shift in abortion access, experts told ProPublica, because there isn’t a full understanding yet of the laws’ effect on maternal health care.
Marian Knight leads the United Kingdom’s maternal mortality review program, widely seen as the world’s best. She said if there were a major legal shift like this in her country, she and her colleagues would adapt to track the impact in close to real time. “I would be monitoring that in the same way as I did during COVID, where we were analyzing data weekly and feeding it in,” Knight said.
As of last month, only five states — Iowa, West Virginia, Indiana, Georgia and Tennessee — had finished reviewing cases from 2022, ProPublica found. None had yet published a report on its findings for that year.
Seven other states were still examining 2022 cases: Alabama, Oklahoma, South Carolina, Mississippi, Missouri, Arkansas and Louisiana.
Idaho, Texas and Kentucky had not yet started looking at cases from that year.
Even though North Dakota did not respond to ProPublica’s survey, reporters found that its committee, formed by state legislation in 2021, has never met to review cases, according to two members.
In some instances, state officials are responsible for delays.
Idaho disbanded its committee in summer 2023 after a conservative group argued it was unnecessary and attacked members for recommending that the state expand Medicaid for postpartum patients. The move froze the group’s work until last month, when a reconstituted, smaller committee met for the first time. Two members who had spoken out against the ban’s impacts on maternal health, and are suing the state over it, were not brought back onto the committee. The state is defending its anti-abortion laws; the Idaho Attorney General has said he “will not stop protecting life in Idaho.”
It is unclear how long Georgia’s reviews will be stalled after state officials dismissed its committee last month, citing a violation of confidentiality rules after ProPublica reported on internal documents in stories about two preventable deaths examined by the group. The Georgia Department of Public Health said in a letter about the dismissal that this would not result in any delays to the committee’s responsibilities.
In a move that confused maternal research experts, Texas’ committee said it would not review data from 2022 and 2023 and begin with reports from 2024 to get a more “contemporary” view of deaths. The committee has skipped years in the past to address gaps, and at its recent meeting, Ortique, the chair, said that the decision had “absolutely no nefarious intent.” The period it plans to skip includes two of the preventable deaths ProPublica reported.
Dr. Romy Ghosh, an OB-GYN in Austin, Texas, pleaded with the maternal mortality review committee at a public meeting this month to reconsider its decision to skip those years.
“There’s been a lot of fear in my patients. They wonder, can I save their life if something goes wrong?” she said. “I think that this information will tell us there’s either nothing to worry about or it will be damning.”
Between the decision to skip years and the legal prohibition against examining cases involving abortion-related care, it appears Texas will not review any of the three preventable deaths ProPublica identified.
There is a limit to how much committee members can push back against state leaders.
When Texas delayed publishing its maternal mortality report in 2022, an election year, then-committee member Nakeenya Wilson, a community advocate, spoke out, saying “withholding data that does not make us look good is dishonorably burying those women.”
The next session, Texas lawmakers passed a bill changing the requirements for the position that Wilson held, effectively removing her from the committee. State officials appointed Dr. Ingrid Skop, a Texas OB-GYN who is the vice president of a prominent anti-abortion organization.
Wilson said maternal mortality review committees must be free to speak candidly about patterns they see in maternal deaths and to release information in a timely fashion.
“If it’s not the committee, then who is it?” she said. “There has to be increased accountability.”
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