A up-to-date analysis shows that more than 80,000 Alabamians lost access to a federal anti-hunger program after Congress passed up-to-date restrictions.

According to Center for Budget and Policy Prioritiesleftist think tank based in Washington, D.C., participation in the Supplemental Nutrition Assistance Program (SNAP) dropped 11% between July 2025, when President Donald Trump signed a law imposing up-to-date restrictions on the program, and May of last year.

The study also found that more than 23,000 children lost access to SNAP, representing 29% of the total decline.

“It’s heartbreaking,” said LaTrell Clifford Wood, a hunger policy advocate at Alabama Arise, a nonprofit that serves lower-income households in the state. “The first thought is that it is heartbreaking to see our families harmed by greed based on a single number that does not measure what it is intended to measure.”

A message seeking comment was sent Wednesday to the Alabama Department of Human Resources, which administers SNAP in Alabama.

Under the Budget Reconciliation Act passed by Congress in July, the funding formula placed a greater financial burden on states. In the past, the federal government funded all food benefits and shared the costs of administering the program equally with states.

The Conciliation Act increased the states’ share of administrative costs from 50% to 75%, potentially forcing states to shoulder some of the benefits. If states achieve a SNAP error rate of at least 6%, they will pay a portion of the program’s financial benefits. Error rates don’t necessarily indicate fraud, Wood said.

“They are a measure of underpayments and overpayments in state departments,” Wood said. “They are not based on the actions of the members of our community who use this program, and it is extremely unfair to engage with people who use these programs with these feelings.”

States with an error rate greater than 6% will pay between 5% and 15% of the cost of benefits. People using higher rates could withdraw as much as 25% of the benefit.

Alabama state officials said in April that the state error rate was 10%. Under the reconciliation bill, it could cost the state between $174 million and $261 million.

Nationwide, about 4.5 million fewer people received federal food assistance between July 2025 and April of this year, a decline of about 11% over nine months, according to Ty Jones Cox, vice president for food assistance at the Center on Budget and Policy Priorities.

“SNAP is in the midst of the largest and fastest decline in participation in decades,” Jones Cox said. “And it is not because there is less need that we face a hunger crisis that Congress has the power to alleviate.”

This is the largest decline since 1997, when Congress imposed keen cuts to food aid programs.

“This decline is even exceeding government projections,” Jones Cox said.

The Congressional Budget Office estimated that about 3 million fewer people would participate in SNAP in a typical month under the up-to-date restrictions.

Much of the loss can be explained by actions states have taken in preparation for changes to SNAP rules, Jones Cox said.

“People need food assistance today as much as they did a year ago, and they are simply being cut off from assistance as states try to limit their exposure to the massive new cuts they face due to cost changes resulting from the Reconciliation Act,” Jones Cox said. “This is the reality on the ground – states are rushing to comply with the costly provisions of harmful reconciliation laws.”

In response, Jones Cox said states are erecting additional barriers to support reduce the potential error rate. Some states require applicants to submit additional documentation with shortened certification periods, Jones Cox said, which could deny benefits to eligible people.

“What happens with additional documentation, like a single-person household, you can usually put that on the application and states accept it,” Jones Cox said. “You say, ‘This is my income.’ Now they say, ‘Make sure no one else lives with you.’ Which is very complicated.

Some states now require a person’s neighbor or other person to sign documents confirming that the applicant lives alone.

The budget reconciliation bill also increased the working age from 54 to 64. The program also excluded some immigrants eligible to stay in the country from participating.

BOISE, Idaho – Suzanne Gallus is a Catholic mother of seven who has been pregnant 12 times. For the past year, she has been asking residents to sign a petition to aid restore access to abortion in one of Idaho’s most conservative areas.

At a July 2 event at the Idaho Capitol, Gallus told a crowd of other volunteers and supporters that while knocking on doors in northern Idaho, she spoke to about 400 people and learned that even those who personally believed strongly against abortion were willing to sign up and vote yes.

“People have always been very open with a lot of stories, and maybe not at all about them,” Gallus later told Stateline. “It might have been about a niece or a cousin or their grandmother, but not all of them were abortion stories. A lot of them were about adoption or infertility.”

Despite Idaho’s status as a deeply conservative state — President Donald Trump won it by nearly 37 percentage points in 2024 — an estimated one-quarter, or 28%, of the more than 110,000 signatures collected by the group spearheading the proposed reproductive freedom and privacy bill come from registered Republicans.

According to campaign data, more than 33% of signatories are unaffiliated voters, 37% are Democrats and about 1% are Libertarians. Those shares could be higher or lower after the Idaho Secretary of State’s office approves the petition to put the proposal on the November ballot.

Idaho Initiativewhich would restore access to abortion “without government interference” for as long as the fetus is viable and protect fertility treatments and other forms of reproductive care such as contraception, is one of three abortion-related measures scheduled to be on the state ballot in November. A elementary majority is required for adoption. The state allows residents to submit proposals for laws, but not changes to the constitution.

In Nevada, voters will be asked to confirm an abortion rights initiative they passed as early as 2024, which is required by state law. Virginia voters will be asked to approve a measure proposed by the legislature that would add the right to reproductive freedom to the state constitution.

Two other ballot initiatives in Colorado and Missouri banned abortion rather than restoring access. The Missouri Legislature returned to the issue after voters narrowly approved an amendment in 2024 establishing a right to abortion until fetal viability. This year, lawmakers put a bill on the November ballot that would again ban abortion as well as gender-affirming health care for minors.

Colorado’s initiative to eliminate the state’s constitutional right to abortion has not yet officially qualified for the ballot.

Republican signatures

Gallus, an Idaho State volunteer, lives in Rathdrum, a town of fewer than 10,000 people north of more populated Coeur d’Alene, where leaders of the local Kootenai County Republican Central Committee helped move the state party continue to the right over the last decade. North Idaho delegates were among those in 2022 I voted down a proposed amendment to the Idaho Republican Party platform to allow abortion to save a pregnant woman’s life.

In overdue June, a local conservative blogger published a list of the names of more than 4,000 Kootenai County petition signers, about half of whom were Republicans, obtained through a public records request. The blog post accused Republicans who signed their name of being “RINOs,” or Republicans in name only.

Melanie Folwell, the lead organizer of the initiative, said many people she encountered while canvassing were reluctant to sign the petition, in part because it is a public document, but said they would vote for it in November.

“They were afraid of retaliation for signing the contract,” she said.

Statewide vote conducted by the School of Public Service at Boise State University found that nearly 61% of Idahoans strongly or somewhat supported the proposed Reproductive Freedom and Privacy Act, while about 28% were somewhat or strongly opposed and nearly 12% were unsure. Support among Republicans was about 45%, with 66% support from independent voters.

This is about the same level of support for the right to legal abortion until it becomes enforceable nationwide polls have been noting since 2022, when the U.S. Supreme Court decided Dobbs v. Jackson Women’s Health, which allowed states to regulate access to abortion for the first time since 1973. Boise State poll in 2025 showed that 55% of residents support legal access to abortion for at least the first trimester, and 20% believe it should be completely banned.

Supporters of a ballot measure to end Idaho’s strict abortion ban raised nearly $110,000. signatures

Idaho’s starter law banning almost all abortions went into effect in August 2022 after the Dobbs decision. Since then, the state has been at the center of many stories about the unintended consequences and legal disputes that can arise from an abortion ban. One study found that 114 of 268 physicians practiced obstetrics left the state after the ban came into force and were replaced by only 20, representing a net loss of 94 in two years.

The state government continued to fight against mandating federal law stabilizing care for every person who comes to the emergency room, which, according to many doctors, in some cases is associated with termination of pregnancy. Idaho’s abortion law does not provide an exception to protect the health of a pregnant patient, despite previous legislative efforts to add one.

Signature verification will likely take a week or longer, but Folwell is confident that organizers will meet and exceed the required threshold of approximately 71,000 qualified signatures. The group collected over 110,000 signatures.

David Ripley, executive director of Idaho Chooses Life, also acknowledges this is a reality. In a statement, he told Stateline it appears the measure will be on the ballot in November and said it represents a fundamental choice for Idaho.

“Idaho Chooses Life will fight this radical proposal with all the resources at our disposal. We are confident that Idaho will reject this measure once it understands the serious harm it will do to our future,” Ripley said in a statement.

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Gender division

Signatories are split roughly evenly between registered Democrats and Republicans, but about 65% are women. Nearly 20% of these women were over the age of 65, with the second largest group being women aged 36 to 45 (11.5%). The largest percentage of men who signed the contract – 10.8% – were also over 65 years of age.

“Sometimes we’ve heard women say, ‘I can’t believe we’re here,’ because they have a broader view of history because they lived in a time before Roe became the law of the land,” Folwell said. “They understand what this loss is.”

John Eckert, the initiative’s regional organizer in southeastern Idaho, knocked on doors in some of the state’s most rural and religious areas. According to the Association of Religion Data Archives, Idaho has the second-largest population of residents identifying as members of The Church of Jesus Christ of Latter-day Saints, and many of these members live in the southeastern region of the state that borders Utah.

“I found quite a few people who were very opposed to it initially,” Eckert told Stateline. But after asking them a few questions and describing some of the problems Idaho faces as a result of the ban, he said people often agree to sign the petition and let voters decide in November.

“It’s very Idaho to me,” Eckert said.

Back home in Rathdrum, Gallus said she now saw abortion as part of a tower of blocks stacked together. It does not see silos of pregnancy, abortion or fertility, because breaking any of these blocks could destabilize the entire tower.

“We have been conditioned for the last 50 years to think of abortion as a silo, but it is not,” Gallus said. “This polarized discussion on this topic has put the issue in a separate silo, and now we are seeing the fruits of that.”

Stateline reporter Kelcie Moseley-Morris can be reached at: kmoseley@stateline.org.

The Trump administration has withdrawn subsidies for teen pregnancy prevention and repurposed a program intended to reduce unintended pregnancies to promote childbearing. But in recent months, several states, including Republican-led states, have protected or expanded access to contraception.

Sponsor of the Georgia Republican camp. Beth Camp Bill to expand access to contraception in her state after her daughter faced a two-month delay in renewing her contraceptive prescription. novel law, passed in April and signed in May by Republican Gov. Brian Kemp, allows pharmacists to prescribe contraceptive methods, such as contraceptive pills and injections, directly to patients without a doctor’s signature.

Current law in Georgia requires patients to receive a prescription for contraceptives from their doctor, which they can then fill at a pharmacy. Camp said the novel policy could assist augment access to contraception in areas where there is a shortage of primary care providers.

“We have a huge challenge in our state when it comes to access to medical staff,” Camp – he told the House of Representatives Health Committee earlier this year. “For me, it just opens up a whole new stream of opportunities for women in terms of accessing contraception.”

In Maryland, it was signed into law by Democratic Gov. Wes Moore in May standard Requires institutions of higher education and community colleges to submit an annual report on access to contraception to the Maryland Commission on Higher Education. It also requires the commission to submit a report to the General Assembly on contraceptive access and requires each community college to provide students with access to all over-the-counter contraceptive methods.

Republican Governor of Tennessee Bill Lee signed Act a in March bipartisan bill this requires private health plans to cover a year’s supply of contraceptives. The state’s TennCare Medicaid program already provides A 12-month supply of contraceptives. The solution is to enter into force on July 1, 2027.

And Democratic Virginia Gov. Abigail Spanberger signed the agreement in April novel law establishing the right to contraception and allowing citizens to sue if their rights are violated. Spanberger also signed different law imposing an obligation on health insurance companies to cover the costs of prescription and over-the-counter contraceptives without cost sharing. Both laws entered into force this month.

Stateline reporter Sofia Resnick can be reached at: sresnick@stateline.org.

Several laws restricting access to drugs that can be used to terminate a pregnancy and other laws restricting minors’ access to sexual and reproductive health care – including the HPV vaccine – go into effect on Wednesday, July 1, in Iowa, Mississippi and Tennessee.

Earlier this year, state legislatures considered multiple bills that would have added legal restrictions to mifepristone and misoprostol, but only a few became law. The 13 states that have passed near-total abortion bans already have restrictions in place, but some have proposed more in connection with modern methods of obtaining medications online or via telehealth.

There is also an ongoing federal lawsuit that will decide whether U.S. Food and Drug Administration rules allowing mifepristone to be dispensed via telehealth will remain in effect. This ruling will apply throughout the country.

Governor Kim Reynolds signs bills restricting access to abortion pills and the HPV vaccine

Kimya Forouzan, chief state policy adviser at the Guttmacher Institute, said the increased efforts to restrict access underscore the importance of shield laws in states protecting access to abortion.

Legislation strengthening the state’s shield law goes into effect today in Hawaii. Those provisions include prohibiting the utilize or disclosure of a patient’s health information to investigate someone who has received reproductive or gender-affirming care, as well as adding malpractice insurance and contract health care coverage for providers in the state to prevent excessive rate increases, Forouzan said.

Iowa

Iowa modern law requires in-person dispensing of medications, including mifepristone and misoprostol, which limits access to telehealth. Mifepristone and misoprostol are usually used in combination to terminate a pregnancy in the first trimester or to treat miscarriages. Iowa has a six-week abortion ban, before many people realize they are pregnant.

The law also made changes to the reporting of abortion and pregnancy loss, requiring a health care provider to report to the state whether a patient took mifepristone or misoprostol within 14 days of pregnancy loss. It doesn’t require a patient to provide such information to a doctor or force a doctor to ask questions, Forouzan said, but it can come up when a patient asks questions or raises concerns.

“The reporting requirement really raised alarm bells for us because we know that mandatory state reporting of abortions can cause a lot of harm and increase the sense of surveillance that patients experience,” Forouzan said.

Lawmakers also passed a bill prohibiting Iowans under the age of 18 from consenting to vaccinations related to sexually transmitted diseases and infections. Shipment reported from Iowa Capital that Republican lawmakers found the bill consistent with other state vaccine laws – HPV and hepatitis B vaccines were previously exempt. Science has shown HPV vaccine prevents several strains of human papillomavirus, which can be transmitted during sexual activity and potentially cause cervical and other cancers.

Mississippi

The Mississippi has passed law in April, adding mifepristone and misoprostol to the state’s drug trafficking law, making distribution or intent to distribute drugs a felony punishable by up to 10 years in prison. This goes into effect today.

Republican lawmakers in Mississippi say the bill is intended to prevent mifepristone and misoprostol from being shipped to residents and undermine the state’s abortion ban, but providers say it causes more harm, especially to patients who have experienced miscarriages.

Dr. Bhavik Kumar, a family medicine physician in Texas, told Stateline in March that the law creates confusion and prevents patients from seeking timely care and providers from providing care out of fear.

“Providers suddenly have to think about regulations and policies that have nothing to do with patient safety,” Kumar said.

Tennessee

Tennessee has added modern restrictions on medication abortions that allow the state’s attorney general to bring civil lawsuits and impose financial penalties for violating the state’s medication dispensing requirements for in-person abortions.

Tennessee has a near-total abortion ban, but some states have tried to enforce those laws against prescribing providers to their residents, such as Louisiana, where the attorney general unsuccessfully tried to extradite a provider on charges.

The law provides for a fine of $10,000 per violation, up to $1 million.

Stateline reporter Kelcie Moseley-Morris can be reached at: kmoseley@stateline.org.

This year, more states have gone beyond established counseling and medications to assist first responders deal with post-traumatic stress.

Firefighters, police officers and paramedics routinely witness fatal accidents, violent crimes and other traumatic events that can leave lasting psychological scars.

“When you work in the fire service or any first responder industry, especially the military, a lot of things accumulate over time and you see so many things that the crazy stuff starts to at least seem normal,” said Jason Cerrano, a retired firefighter and paramedic with more than 20 years of experience in Missouri. Cerrano is currently the director of commercial research and development at IDEX Fire & Safety.

Earlier this month in Ohio, Republican Gov. Mike DeWine signed legislation that would create a Traumatic Injury Commission to review applications from eligible first responders for assist with medical costs.

Maryland took a different approach this year, passing a law that protects firefighters, emergency medical technicians, paramedics and other first responders from employment discrimination based on their legal off-duty operate of medical marijuana.

The modern law, which goes into effect in October, applies to registered medical marijuana patients who test positive for cannabis metabolites but are not found to be impaired while on duty.

Several other states are investigating modern therapies.

Connecticut’s modern law expands a pilot program at Yale University examining psilocybin-assisted therapy, allowing any state resident 18 years of age or older to participate, provided they meet clinical eligibility criteria established by Yale University’s Institutional Review Board. The pilot program was previously narrow to veterans, retired first responders and frontline healthcare workers.

Missouri legislators advanced AND Bill allowing veterans and first responders in approved research studies to receive the psychedelics psilocybin and ibogaine, under medical supervision, for post-traumatic stress disorder (PTSD) and other mental health conditions. In May, the Legislature adjourned before lawmakers could send the bill to the governor.

Stateline reporter Amanda Watford can be reached at: awatford@stateline.org.

WASHINGTON — Republicans celebrated last year when they banned Planned Parenthood’s Medicaid operate for a year, predicting that the financial fallout would devastate the organization.

A year later, as part of the “big, beautiful” law expires on July 4, GOP lawmakers are trying to find a way to keep the nationwide ban in place, though they won’t be able to do so before the deadline.

This means states will now decide whether people enrolled in the lower-income program can again receive routine health care services at Planned Parenthood clinics that are still open.

Nora Walsh-DeVries, vice president of policy and legislative affairs at Planned Parenthood Action Fund, said the law forced the organization to close nearly 30 health care centers.

“The consequences for us are truly terrible, and some of them are unfortunately irreversible,” she said. “It’s also difficult to deal with what happened last year knowing that Republicans are going to permanently defund us.”

She said some Planned Parenthood clinics tried to find ways to continue treating people enrolled in Medicaid, but that ultimately proved “unsustainable” and not something any facility could handle.

The result meant that “tens of thousands of patients were denied access to essential care services like cancer screenings, which I think we can all agree is something we should want people to get when they need it, where they need it and how they need it,” Walsh-DeVries said.

Ultimately, the impact was less widespread than Planned Parenthood had originally anticipated when its president announced statement just days before the bill goes into effect, “nearly 200 Planned Parenthood health clinics in 24 states across the country are at risk of closure.”

The expiration will not impact abortion access for those enrolled in Medicaid because a decades-old appendix to government spending laws that, with confined exceptions, blocks the operate of taxpayer dollars for abortions, remains in effect.

Republicans see the closures as a victory and are trying to extend the provision in an attempt to close more Planned Parenthood clinics. They believe that any health care organization that provides abortions, even if they are not largely funded by taxpayer dollars, should not be covered by any federal health programs.

Pressure from conservatives

The House Freedom Caucus, a collection of far-right Republicans, wrote to Speaker Mike Johnson in overdue June urging him to include a similar ban in another party-line bill.

“Americans rightly expect a Republican-led Congress to deliver real results, not excuses or half-measures,” they wrote. “After years of broken promises, voters trusted us with majorities in both the House and Senate. This is our last and best chance to prove they were right to send us here to fight for them.”

They added that the next reconciliation bill must prohibit “federal funding of abortion providers to ensure that taxpayer dollars are not used to subsidize the radical abortion industry.”

Susan B. Anthony Pro-Life America President Marjorie Dannenfelser and other anti-abortion organizations are lobbying Republicans to again block Medicaid funding for Planned Parenthood.

“Condemning big abortion is now the default expectation of the pro-life movement,” Dannenfelser said in a statement. “Back in Washington, Republicans must do everything they can through reconciliation to once again block taxpayer revenue from going to Planned Parenthood and abortion providers.”

Republicans used a intricate budget reconciliation process to pass their “big, beautiful” law and a $70 billion package to fund immigration enforcement. The special process allowed GOP leaders to bypass procedural Senate votes that would otherwise require bipartisanship, as long as each provision affects federal revenues or spending that is not deemed “merely incidental” by that chamber’s parliamentarian.

A tight system

Subasri Narasimhan, director of research at the Center for Reproductive Health, Law and Policy at the University of California, Los Angeles, says there are often no other health centers that can cover the gaps left by the closure of Planned Parenthood or the failure to reimburse a person enrolled in Medicaid.

“We have a pretty tight health care system in many different ways, but we have an extremely tight system when it comes to reproductive health care,” Narasimhan said.

She said some state governments have tried to plug budget holes created over the past year, although they ultimately were unable to fully offset the loss of federal funds.

She said Republicans’ reinstatement of the same ban on Medicaid payments for non-abortion health care services would likely cause more people in the program to delay or skip preventive care altogether.

“We’re looking at people who are quite vulnerable and often rely on Planned Parenthood as their primary source of care,” she said. “So there is no way to look for another health center.”

Kathleen Adams, a professor at the Rollins School of Public Health at Emory University, said that if the program can vary by state, it will, and this was no exception.

“I see states finding contingency funds, other ways to give funds to Planned Parenthood, to kind of keep that part of their system active,” she said.

There are also other programs and clinics, such as federally qualified health centers and safety net providers, that Adams said could play a role in filling some of the gaps.

“I remain heartened about the Planned Parenthood provisions because states are aware of these issues,” she said. “And if they don’t provide access to contraceptives, they are more likely to experience unintended pregnancies or pregnancies among uninsured women.”

State action

– wrote Laurie Sobel, deputy director of women’s health policy at KFF post that after the nationwide moratorium expires, a overdue June 2025 Supreme Court ruling will allow state governments to block certain health care providers, such as Planned Parenthood, from participating in their Medicaid programs.

“This ruling marked a significant departure from established interpretations of the Medicaid ‘free choice of provider’ provision, which guarantees enrollees the right to obtain care from any qualified and willing Medicaid provider,” Sobel wrote.

Sobel’s analysis found that Alabama, Arizona, Arkansas, Florida, Iowa, Kansas, Louisiana, Mississippi, Missouri, Nebraska, Oklahoma, South Carolina and Texas have blocked or attempted to block Medicaid reimbursements to Planned Parenthood.

She wrote that other states “may follow suit” after the nationwide Medicaid ban expires on July 4.

Mylissa McNeill never expected to become a mother. But when she found out she was pregnant in the spring of 2022, at the age of 41, she and her partner were elated and excited about the prospect of motherhood to a little girl they planned to name Maeve.

On June 24, 2022, about a month after McNeill discovered she was pregnant, the U.S. Supreme Court overturned the Dobbs ruling in Roe v. Wade, eliminating the constitutional right to abortion and authorizing states to ban it. Missouri was the first state to implement a ban; at the time, McNeill was living in Joplin, Missouri.

In August 2022, McNeill suffered a miscarriage. It was the beginning of a health crisis that plagues her to this day, which she blames, at least in part, on hospitals’ reluctance to provide miscarriage care, which may conflict with state abortion bans.

Missouri’s law banned almost all abortions but allowed abortion providers who were charged or sued under the law to avoid punishment by arguing that they were acting in a “medical emergency” to prevent the death of a pregnant woman or “to prevent a serious risk of significant and irreversible physical impairment of a major bodily function.”

Missouri’s ban is no longer in effect – it was overturned by voters in 2024 – but such language is typical: All 13 states with current abortion bans allow the procedure to protect the life of the pregnant woman. Some, but not all, prohibitions also have exceptions designed to protect the woman’s health.

But patients and providers do argued in trials challenging the bans, arguing that such exceptions are too ill-defined to give doctors and hospitals enough certainty to provide timely care. McNeill believes her ongoing health problems are due to delayed care.

In early August 2022, less than two months after Missouri’s ban went into effect, McNeill’s water broke after about 18 weeks. She says her OB-GYN told her the pregnancy was no longer viable, so she sought an abortion and miscarriage treatment procedure known as dilation and curettage, or D&C, at hospitals in Missouri and Kansas (where abortion was legal). However, doctors refused to provide miscarriage care even though they were able to detect fetal heart activity.

After three days of bleeding and pain, McNeill finally received treatment at an Illinois hospital. McNeill said that when she underwent another tubal ligation to prevent a future pregnancy, medical staff told her she had scarring from an infection that developed after her water broke.

“When they were there, they saw what happened,” McNeill said. “The infection went outside my uterus. It went to my liver, and my liver is permanently attached in multiple places. It’s attached to my uterus; it’s attached to the lining of my stomach.”

McNeill says the lingering effects of the infection include severe bouts of vomiting and significant financial difficulties as she struggled to pay for care without indefinite health insurance.

“I’m literally bursting every blood vessel in my skin… That kind of pain is… there’s no word for it,” said McNeill, who shared photos with Stateline of her red-spotted face and magenta nose. “This delay really upset me because the women died in less time than I did, and this delay and the infection I contracted while waiting three days destroyed my life.”

Last year, states included: Texas, Kentucky AND Tennessee has passed legislation to provide additional clarity on medical exceptions to their prohibitions, but confusion persists in these and other states. Stories of denial of care for miscarriage they continue to appearincluding in a completely modern lawsuit in Texas, AND several deaths partly attributed to restrictions on abortion, including in Georgia and Texas. The research has been linked abortion restrictions leading to more maternal deaths and injuries.

“The four years since the Dobbs decision (v. Jackson Women’s Health Organization) have unfortunately confirmed what obstetrician-gynecologists already knew: abortion care is inextricably linked to reproductive health care,” Molly Meegan, legal director and general counsel of the American College of Obstetricians and Gynecologists, said in a statement.

“Bannings and restrictions on abortion care have resulted in patients across the country being denied care, even in the event of pregnancy loss or miscarriage.”

A modern study published last month by Journal of the American Medical Association found that since the Dobbs decision, in states where abortion bans have gone into effect, treatment for miscarriages has moved away from medical intervention toward a wait-and-see approach.

But anti-abortion groups blame doctors and abortion rights advocates for creating confusion over medical exceptions to abortion bans, insisting that it is clear what is a medically indicated abortion and what is a purely elective one.

“As the architects of most of the nation’s pro-life laws, Americans United for Life has made clear that no one prevents women from receiving life-saving care for miscarriage. Efforts to suggest otherwise are made in bad faith,” said Gavin Oxley, a spokesman for the group.

(*4*)

Dr. Susan Bane, an OB/GYN in Greenville, North Carolina, who is on the list management for the American College of Obstetricians and Gynecologists Pro-Life told Stateline that doctors – especially the American College of Obstetricians and Gynecologists – wrongly blamed abortion bans for denying medical care to women who are pregnant or miscarrying.

“There is nothing, and I mean zero, in any of these laws that say he has to die or have septicemia,” Bane said. “I’ve done this hundreds of times over the last 30 years, while the baby was alive, I sat at the bedside and had a painful conversation with a woman who said, ‘I’m so sorry, but if we don’t go into labor, I’m worried you’ll both die.’

She said her organization supports the state’s laws, just like the one logged in South Dakota earlier this year, they redefined “abortion” as the intentional ending of the life of an “unborn child.” Supporters say such laws will enable doctors to deal with miscarriages, ectopic pregnancies and other pregnancy-related emergencies.

“It’s sad that there is no further explanation, but the guilt actually started with my profession.” Bane said.

But Meegan said attempts to introduce health exemption laws do not protect all patients.

“There is no law or exception that explains the vast variety of medical situations that can occur during pregnancy,” she wrote. “And there is no additional legislation that could repair the harm caused by abortion bans beyond repealing the bans themselves.”

McNeill said she lost her job and the health insurance that came with it after her miscarriage. She filed a lawsuit and then settled with a hospital in Missouri that she said resulted in her being denied timely care. However, she is still searching for relief from her health problems and claims to have incurred significant medical debt.

She and her husband moved to Arkansas and then Kansas in search of the financial stability that had eluded them since her miscarriage nearly four years ago.

“With this whole illness, I’m in the multi-million dollar debt and not covered by insurance for a long period of time,” McNeill said. “Now that my credit is ruined, I will never be able to buy a house again with this health.”

Stateline reporter Sofia Resnick can be reached at: sresnick@stateline.org.

National Family Planning and Reproductive Health Association and the Pennsylvania Family Planning Organization filed a lawsuit against the U.S. Health and Human Services Agency, accusing it of politicizing the Title X grant funding program and violating the intent of the law.

Lawyers from the American Civil Liberties Union of Pennsylvania and the national organization represent the National Family Planning Association and the Central Pennsylvania Family Health Council. The complaint says the Family Health Council is a network of 19 providers in 24 central Pennsylvania counties that provide family planning services to more than 31,000 low-income residents each year.

Clare Coleman, president and CEO of the National Association for Family Planning and Reproductive Health, told Stateline on Thursday that the organization chose the Pennsylvania-based network to participate in the lawsuit in part because it has been a recipient of funds since the beginning of the Title X program in 1970 and serves a vast number of people.

“We are very grateful that they were willing to stand with us,” Coleman said.

The case was assigned to U.S. District Judge Yvette Kane, an appointee of former Democratic President Bill Clinton.

Title X, established by Congress and signed into law by former Republican Party President Richard Nixon, is a grant program primarily targeting low-income or uninsured people, including people who earn too much to qualify for Medicaid, who might otherwise not have access to family planning and reproductive health services. This includes services such as contraception, pregnancy tests, tests for sexually transmitted infections and medical examinations. Abortion services cannot be covered by Title X dollars.

The complaint concerns the above-mentioned 2027 Title X Funding Opportunity Noticewhich was released in April. Potential winners must submit applications by January for consideration in the next funding cycle.

The funding opportunity language states that all applicants must first complete an “adjustment review” to determine eligibility for the grant. This adjustment is based on priorities identified by the U.S. Department of Health and Human Services, the Office of the Assistant Secretary for Health, and the Office of Population Affairs. These priorities include ending diversity, equity and inclusion efforts, and gender-affirming care. The complaint states that a decision regarding an applicant’s eligibility cannot be appealed.

Contraceptive services have plummeted after a “shutdown” hit clinics

Coleman said these priorities directly conflict with those outlined in the last round of funding under former President Joe Biden, whose administration emphasized the importance of health equity efforts and the inclusion of gender-affirming care for transgender patients. Coleman said this means funding may not be available to some applicants and will favor fresh applicants.

“We believe the funding announcement is intended to favor providers that the administration would prefer to see in the program,” Coleman said, which could include clinics with a religious mission such as pregnancy crisis centers or major Catholic health care organizations.

The complaint also argues that these requirements are in direct conflict with the Title X statute, which requires HHS to consider factors such as the number of patients served, the degree of local demand for services, and whether the applicant can quickly and effectively utilize grant funds. Family planning organizations say the fresh application process is designed to support the Trump administration’s political agenda rather than to fulfill Congress’s mandate to “offer patients a broad range of acceptable and effective family planning methods and services.”

Funding Notice Guidelines as well changes focus Title X grants, ranging from expanding access to services such as contraception to strengthening “family building” and helping clients “achieve a healthy pregnancy.” Clinics have been instructed to prioritize and promote natural family planning methods such as menstrual cycle tracking, which the Center for Pregnancy Prevention says is less effective than contraception. American College of Obstetricians and Gynecologists.

“(The Notice of Funding) allows defendants to select winners and losers based on political affiliation rather than merit and ability to provide quality Title X services,” the complaint says. “This is not how federal grants should be awarded, and this is especially not how Congress instructed defendants to award Title X grants.”

A hearing in this case will likely take place in the coming weeks.

Stateline reporter Kelcie Moseley-Morris can be reached at: kmoseley@stateline.org.

Carrie Frail was in the process of leaving an abusive relationship when she discovered she was pregnant. Her partner told her he could punch her in the stomach until she miscarried, which would save her some money.

“I firmly believe he would have killed me at some point, either accidentally or on purpose,” Frail said.

In 2008, while serving in the United States Air Force, she performed a medical abortion at the Planned Parenthood clinic in St. Louis, Missouri. She was relieved that she could operate medication instead of surgery, which meant she could take less time off work. She said it wasn’t an simple decision, but she knew that if she didn’t make it, she would never be able to break free from this partner.

“I was too wrapped up in his life mentally and emotionally that… I had to be able to leave without giving him my phone number and telling him where I was,” Frail said. “I still believe that abortion saved my life.”

Access to telehealth prescriptions for mifepristone, one of two drugs used to terminate pregnancies in the first trimester or treat miscarriages, is at risk following an ongoing lawsuit in Louisiana. The state’s government has sued the U.S. Food and Drug Administration in an attempt to invalidate the agency’s 2023 rule allowing drugs to be dispensed without an in-person visit.

Researchers, advocates and survivors of domestic violence say it is critical to provide access to telehealth for people in abusive relationships who need considerate abortions. However, the Louisiana lawsuit argues in part that mifepristone has been used as a weapon against pregnant women in abusive relationships and should not be available through telehealth.

The 5th U.S. Circuit Court of Appeals temporarily blocked the FDA’s 2023 rule in early May, requiring in-person visits for mifepristone prescriptions for two days, before the U.S. Supreme Court stayed that decision on an emergency appeal. The Court, with the exception of Justices Samuel Alito and Clarence Thomas, decided to maintain this principle while the appeal case is pending. However, this rule may later be overturned again and the entire case may end up before the Supreme Court.

Data from the federal Centers for Disease Control and Prevention’s National Intimate Partner and Sexual Violence Survey from 2023–24 showed that approximately 34% of women and 17% of men had experienced physical or sexual violence or stalking by an intimate partner. These numbers may be higher due to a reluctance to report incidents of violence. Among the states with high rates of violence are many states with near-total abortion bans, including Arkansas, Indiana, Oklahoma, Tennessee and West Virginia, which means residents who are victims of reproductive coercion have less access to abortion drugs.

Research shows that pregnancy is a time of increased risk in a relationship where domestic violence has occurred, and intimate partner violence is the leading non-obstetric cause. cause deaths among pregnant and postpartum women. This risk is highest among Black and Indigenous people in the United States.

Reproductive coercion

The plaintiff in the mifepristone access lawsuit is Louisiana resident Rosalie Markezich, who claims that the drug’s availability without a clinic visit allowed her boyfriend to order the pills in 2023 and pressure her to take them. In her written statement on the matter, Markezich stated that the oppression caused ongoing trauma and that if she had had to see a doctor sooner, she could have told the doctor that she did not want an abortion and the pills would never have been prescribed.

Anti-abortion groups, including Susan B. Anthony Pro-Life America and the Family Research Council, submitted amicus briefs to the U.S. Supreme Court about the type of coercion Markezich said she experienced. The telehealth option prevents in-person screening for coercion, Pro-Life America’s Susan B. Anthony said, and the in-person attendance requirement provides a “line of defense” against reproductive coercion. The Family Research Council also argued that because the FDA’s initial approval of the telehealth service did not include a thorough examination of how it could be used for coercion, it should be rejected.

Liz Tobin-Tyler, a professor of health services, policy and practice at the Brown University School of Public Health, says people in abusive relationships often experience what researchers call reproductive coercion. According to American College of Obstetricians and Gynecologistswhich includes situations in which the partner tries to control when and how the pregnancy occurs, either intentionally causing the pregnancy or forcing someone to terminate it, as in the case of the Markezis.

Coercion may also occur when a partner interferes with contraceptive methods, for example by trying to force a particular method or by deliberately not using contraception. Tobin-Tyler said sometimes an abusive partner attends doctor visits to try to influence decisions about birth control and other discussions about medical care.

“It all comes down to the control aspect,” she said.

Robin Turner, Montana director of the gender equality group Legal Voice, said what happened to Markezich was terrible, but Louisiana could prosecute Markezich’s partner under existing laws, including for drug harm. She said restoring the requirement to administer mifepristone in person would harm many more people because it would apply nationwide.

“This is not a reasonable or proportionate way to deal with what happened to the client,” Turner said. “We need to take seriously what happened to the plaintiff and understand that depriving him (of access) is not effective.”

Turner is co-author of A miniature in the Legal Voice case filed with the U.S. Supreme Court during extraordinary appellate proceedings that focused on the importance of access to mifepristone for people in domestic violence relationships.

“A lot of being in relationships like this is that the world is getting smaller and we don’t want our systems to mimic the dynamics of harassment. But that’s what happens when the government takes away their access to the health care they need,” Turner told Stateline.

Safety planning for people calling the hotline

Kaelah Oberdorf, 24, said she was using birth control when she discovered she was pregnant in 2023 in upstate New York.

She was in an emotionally abusive relationship, was struggling financially, and was still recovering from postpartum depression she experienced after giving birth to her first child at age 20, even though she thought she couldn’t get pregnant due to her medical condition. The depression was so severe that it required hospitalization. She decided that ending her pregnancy would be the right thing for her mental health and the daughter she already had.

“I didn’t want to be tied to him for the rest of my life, I didn’t want my daughter or any of my children to be tied to him for the rest of my life,” said Oberdorf, who now lives in Georgia. “I already had a living child who didn’t need to be kept in such a situation, and if I had another one, even if I left him, I wouldn’t mentally be able to cope with it.”

Studies also show that pregnant and postpartum women in rural areas they are more likely to experience violence from their partnerperhaps because they are located further from in-person medical care, which may contribute to lower rates of sexual harassment screening.

Elizabeth Ling, deputy director of legal services at the nonprofit If/When/How hotline, which offers reproductive legal assistance, estimated that the hotline receives five to 10 calls a week from people who say they have experienced intimate partner violence, whether it is physical, emotional or other forms of coercion. She said callers from rural communities are some of the people who need access to medication abortion via telehealth and mail because they are often closest to the clinic and unable to travel because their partner is actively monitoring their movements.

If/When/How talks to callers about their legal options and advises them on legal risks, which Ling says is a major concern for people in abusive relationships. They are often afraid that their partner will report the abortion to them, which may attract police attention and investigations, even if it does not result in charges.

The hotline also helps patients prepare a safety plan for taking abortion medications, going through steps such as where to ship the medications, who has access to that mailbox and how to deal with a partner spying on their movements.

“Abortion pills really are a lifesaver for those who call and share their experiences with us,” Ling said.

Frail, who still lives in Missouri, now has a daughter and a son who are both 20 years aged. Most recently, she left multiple voicemails for Republican senators Josh Hawley and Eric Schmitt, who advocated withdrawing FDA approval for mifepristone and called for federal investigations of drugmakers. In her messages, she claims that being able to choose when she gives birth to her children has made her a better parent.

“I know that if I hadn’t had an abortion, I would never have been able to be free from this abusive partner,” Frail said.

Stateline reporter Kelcie Moseley-Morris can be reached at: kmoseley@stateline.org.