Mylissa McNeill never expected to be a mother. But when she learned she was pregnant in the spring of 2022, at age 41, she and her partner were happy and excited at the prospect of parenting a little girl they planned to name Maeve.

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

In August 2022, McNeill miscarried. It was the beginning of a health crisis that plagues her to this day and that she blames, at least in part, on hospitals’ reluctance to provide miscarriage management care that might run afoul of state abortion bans.

Missouri’s law prohibited nearly all abortions, but it allowed abortion providers who were charged or sued under the law to escape punishment by arguing that they acted in a “medical emergency” to prevent the death of the pregnant woman or to avert “a serious risk of substantial 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Missouri’s ban is no longer in effect — it was overturned by voters in 2024 — but such language is typical: All 13 states that currently have abortion bans allow the procedure to protect the life of the pregnant woman. Some, but not all, of the bans also have exceptions to protect the health of the woman.

But patients and providers have argued in lawsuits challenging the bans that such exceptions are too ill defined to give doctors and hospitals enough confidence to provide timely care. McNeill believes that her persistent health problems are the result of delayed care.

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

After three days of bleeding and aching, McNeill finally received treatment at a hospital in Illinois. When she had a subsequent tubal ligation to prevent future pregnancies, McNeill said medical staff told her she had scar tissue resulting from an infection she developed after her water broke.

“While they were in there, they saw what happened,” McNeill said. “The infection went outside of 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 my stomach lining.”

McNeill says the lingering effects of that infection include severe bouts of vomiting and significant financial hardship as she has struggled to pay for care without steady health care coverage.

“I literally break all the blood vessels in my skin. … This kind of pain is — there’s no word for it,” said McNeill, who shared with Stateline pictures of her face covered in red splotches, her nose magenta. “The delay is what really upset me, because women have died with less time than I had, and that delay and the infection that I did get from this by waiting three days, it destroyed my life.”

Last year, states including Texas, Kentucky and Tennessee enacted laws designed to provide additional clarity on medical exceptions to their bans, but confusion persists in those states and others. Stories of denied miscarriage care continue to emerge, including in a brand-new lawsuit in Texas, and several deaths have been attributed in part to abortion restrictions, including in Georgia and Texas. Research has linked abortion restrictions to higher rates of maternal death and injury.

“The four years since the Dobbs (v. Jackson Women’s Health Organization) decision have unfortunately proven what OB-GYNs already knew: abortion care is inextricable from reproductive health care,” Molly Meegan, chief legal officer and general counsel for the American College of Obstetricians and Gynecologists, wrote in a statement.

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

A new study published last month by the Journal of the American Medical Association found that since the Dobbs decision, in states where abortion bans took effect, miscarriage management has shifted away from medical intervention toward more of a “wait-and-see” approach.

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

“As architects of the majority of the nation’s pro-life laws, Americans United for Life has been very clear that none prevent women from receiving life-saving miscarriage care. Efforts to suggest otherwise are made in bad faith” said Gavin Oxley, a spokesperson for the group.

“Doctors who delay or altogether deny medical treatment must be held accountable for the harm they inflict upon women. If doctors are not clear on this four years after Dobbs, they clearly have not been listening.”

Dr. Susan Bane, an OB-GYN in Greenville, North Carolina, who is on the board of directors for the American Association of Pro-Life Obstetricians and Gynecologists, told Stateline that doctors — especially the American College of Obstetricians and Gynecologists — have unfairly blamed abortion bans for the denial of medical care to pregnant or miscarrying women.

“There’s nothing, I mean zero, about any of these laws that say you have to have her dying or septic,” Bane said. “I’ve done this hundreds of times in the last 30 years, where the baby was alive, and I sat at the bedside and had an excruciating conversation with a woman to say, ‘I am so sorry, but if we don’t move towards delivery, I’m worried both of you will die.’”

She said her organization supports state laws, like one signed in South Dakota earlier this year, that redefine “abortion” as the intentional ending of the life of the “unborn child.” Supporters say such laws will allow doctors to manage miscarriages, ectopic pregnancies and other pregnancy-related emergencies.

“It’s sad that more clarification isn’t happening, but the blame really started right in my profession.” Bane said.

But Meegan said attempts to legislate health exceptions fall short of protecting all patients.

“There is no law or exception that can account for the immense variety of medical situations that can present in pregnancy,” she wrote. “And there is no additional legislation that can undo the harm created by abortion bans short of repealing the bans themselves.”

McNeill said that following her miscarriage, she lost her job and the health insurance that came with it. She sued and then reached a settlement with the Missouri hospital that she believes denied her prompt care. But she continues to search for relief from her health problems, and says she has racked up substantial medical debt.

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

“My debt is in the millions with all of this illness without coverage for long periods,” McNeill said. “Now that my credit is destroyed, I’ll never be able to buy a house again while in this health.”

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

A federal poverty-fighting program focused on reducing unintended pregnancies is about to undergo a major overhaul.

Reproductive health clinics use Title X federal grant money to provide birth control, cancer screenings and testing and treatment for sexually transmitted infections to people with little or no health insurance. Title X money cannot be used for abortions.

The Guttmacher Institute estimates that Title X, which was signed into law by Republican President Richard Nixon in 1970, has prevented almost 20 million unintended pregnancies and 9 million abortions. It has also helped reduce child poverty, according to the group, which supports abortion rights.

But President Donald Trump has taken aim at the program, which has long been a target for abortion opponents. Since regaining the White House, Trump has temporarily blocked and then restored grants to certain reproductive health clinics, and proposed a U.S. Department of Health and Human Services budget with no funding for the program.

The department’s recently issued funding guidelines for Title X grants represent a significant mission shift.

Instead of expanding access to contraception, the focus of Title X will be “to strengthen family formation and assist clients in achieving healthy pregnancies,” according to the new guidance. That will align the program with the administration’s efforts to increase the U.S. birth rate.

The new rules say Title X will prioritize educating Americans about natural methods to avoid pregnancy and overcome infertility, and will promote “body literacy education” and “informed, preventive, and restorative approaches to reproductive health.” Some conservative groups tout an obscure alternative treatment for infertility called “restorative reproductive medicine,” which is based on the idea that the underlying causes of infertility can be treated through lifestyle changes and improving a person’s overall health.

The guidance directs Title X clinics to promote “fertility-awareness-based methods,” such as period-tracking apps, which the American College of Obstetricians and Gynecologists says can be helpful for getting pregnant but less effective at preventing pregnancy. It also calls on clinics to offer counseling on male fertility issues and to address environmental causes of infertility, including pornography use. And it includes a prohibition on DEI efforts and warns grantees that federal money cannot be used to “facilitate or incentivize illegal immigration.”

Anti-abortion groups support the changes, but many health policy researchers say they will disproportionately harm low-income and minority women, who are more reliant on Title X services and are more likely to have unintended pregnancies. Researchers also say the new guidelines are unlikely to achieve the administration’s “pronatalist” goal of reversing declining birth rates.

Corinne Rocca, an epidemiology professor at the University of California, San Francisco, said the way to do that would be to spend more on childcare subsidies and other social programs to help new parents.

“Policies that help people and families feel supported to meet their childbearing preferences … would actually help people who are open to the prospect of childbearing to do so,” Rocca said.

Rocca co-authored a study published in JAMA Network Open last fall suggesting Black and Hispanic women are less likely than other racial groups to be able to choose if, when and how to start a family.

Clinics must reapply for funding under these new guidelines by Jan. 9, 2027. HHS did not respond to a request for comment.

During his first term, Trump banned Title X clinics from referring patients to other providers for an abortion or even mentioning it as an option. He also prohibited grantees from offering family planning services and abortions in the same building. As a result, many grantees quit the program, including about a dozen state health departments and all participating Planned Parenthood chapters.

The program served about 844,000 fewer patients in 2019 than it did in 2018, when it served 3.9 million patients, according to HHS. About 225,000 fewer patients received oral contraceptives; about 50,000 fewer received hormonal implants; and about 86,000 fewer received IUDs.

The reframing of Title X that is reflected in the new guidelines was a recommendation laid out in the controversial blueprint known as Project 2025, created by the conservative think tank Heritage Foundation as a guide for the second Trump administration.

In line with Project 2025’s recommendations, HHS says Title X grantees will no longer be required to counsel or refer for abortions, and tells applicants that relationship counseling should encourage marriage as a precursor to having children.

“In a time when we are facing a rapidly declining birth rate that falls far short of the replacement fertility rate, we should be doing all we can to encourage and support family formation and fertility,” Dr. Christina Francis, CEO of the American Association of Pro-Life Obstetricians and Gynecologists, told MedPage Today in April.

“Women deserve accurate information about their fertility and their health — and this includes highlighting the many benefits of pregnancy and motherhood.”

Some abortion opponents have criticized Title X for promoting certain forms of contraception, such as IUDs, that they view as abortifacients. A spokesperson for the National Right to Life Committee said the organization does not take a stance on contraception that prevents fertilization, “however, National Right to Life does oppose any device or drug that would destroy a life already created at fertilization.”

“If there is any doubt, we recommend that a woman speak with her doctor to determine if an agent would cause an abortion,” the spokesperson said in an email.

But Leonard Lopoo, a professor at the Maxwell School of Citizenship and Public Affairs at Syracuse University who has studied fertility and family policies for the past three decades, said the federal government could help families achieve their family planning goals by expanding pregnancy prevention and infertility treatments at all income levels.

“When you’re trying to take away the funding for someone who doesn’t want to have a child, that’s not the same as providing funding to support someone who does,” Lopoo said.

As a Black woman and researcher focused on Black maternal health at Ibis Reproductive Health, Terri-Ann Thompson is better informed than most on the ways having children can be disproportionately more dangerous and less affordable for women who look like her.

But she says what she wasn’t expecting to uncover — during research for a study she co-authored in the journal Frontiers in Public Health this spring — is how much the fear of negative medical and criminal justice outcomes makes many Black women in Georgia and North Carolina scared of pregnancy.

“I was very surprised to see that folks were actually thinking about the context within which a Black child is born and raised well before they even contemplated starting a family,” Thompson said. “We had a lot of, just, stories of folks saying, ‘Why would I want to bring a child into this context; how does one prepare Black women to bring a child into this context?’”

Thompson said her team’s findings show how much Black women depend on low-cost access to long-acting reversible contraceptives such as IUDs.

“We have people who drove very, very far just to get a sliding scale to either get an IUD placed, an IUD removed, or to even get on birth control pills,” Thompson said.

“If the administration moves forward with these restrictions, what we are doing is we are removing access to contraceptives for a population that is at higher risk.”

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

The Society for Maternal-Fetal Medicine published new clinical guidance this week affirming that acetaminophen, better known by its brand Tylenol, should be the “first-line” defense against pain and fever during pregnancy. 

The directive contradicts the Trump administration’s notice to physicians last year cautioning against the use of the primary pain reliever recommended for pregnant women, following the president’s unsupported claims that the medication could lead to autism in children.

The national professional association for maternal-fetal medicine specialists, clinicians and scientists continues to recommend acetaminophen as the “first-line medication” to treat pain and fever during pregnancy. The federal government’s statements prompted the organization to review its 2017 guidance finding acetaminophen safe to use during pregnancy. 

Trump ties autism to Tylenol use in pregnancy despite inconclusive scientific evidence

“Although some studies have reported associations between maternal acetaminophen use and adverse neurodevelopmental outcomes in offspring, methodological limitations preclude conclusions about causality, and the biological mechanism for such an effect remains unestablished,” reads the statement, following a comprehensive review of recent and historical scientific literature. 

The organization’s guidance cautions patients to “use the lowest effective dose of acetaminophen for the shortest duration necessary,” while emphasizing that untreated maternal fever carries well-documented risks to the fetus, especially in the first trimester.

At a news conference last September, President Donald Trump said his administration had found acetaminophen use during pregnancy to be a likely contributing environmental cause of autism. 

Health and Human Services Secretary Robert F. Kennedy Jr. has directed the U.S. Food and Drug Administration to shift its research into autism toward potential environmental causes. 

Even though medical experts and the drug manufacturer have said there is no proven link, the FDA immediately said it would initiate a process for a label change for Tylenol and similar products to “reflect evidence suggesting that the use of acetaminophen by pregnant women may be associated with an increased risk of neurological conditions such as autism and ADHD in children.”

The label has not yet changed. But the September news conference has had consequences.  

A month later, Texas’ Republican Attorney General Ken Paxton, who is running for U.S. Senate, sued Johnson and Johnson, alleging the pharmaceutical company failed to warn pregnant consumers about the risk of taking Tylenol.

And a study in The Lancet published in March found that emergency department orders for acetaminophen for pregnant patients fell 10% in the months following Trump’s statement, while there was no change in the acetaminophen orders for comparable women who were not pregnant.

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

An anti-abortion group last month sued seven Utah fertility clinics, claiming their disposal of embryos as part of the in vitro fertilization process violates the state’s wrongful death law.

The ministry Voice for the Voiceless believes it has a strong case because Utah is one of four states — Alabama, Louisiana and Missouri are the others — that have both a “fetal personhood” law and a civil wrongful death law that, the group contends, might apply to frozen embryos.

Other states offer opportunity for similar lawsuits: At least 10 have either a fetal personhood law — giving a fetus, embryo or fertilized egg the same legal rights as a person who has been born — or a wrongful death statute that might include frozen embryos, according to Pregnancy Justice, a group that tracks the issue and advocates for the rights of pregnant women, including the right to abortion.

“There’s a number of states that have laws like Utah’s that find that a person exists at a certain point, and that is conception,” said Frank Mylar, the attorney representing Voice for the Voiceless. He also represents another plaintiff, an anonymous woman from Ogden, Utah, who alleges in the lawsuit that she underwent an IVF procedure at one of the seven fertility clinics and was not informed that unused embryos would be discarded or about options to put her embryos up for adoption.

“Once that egg is fertilized, it actually at that point becomes a human being that’s entitled to rights,” Mylar said in an interview. “So every state that has that as a law, what we’re doing in this lawsuit would be very much applicable.”

The lawsuit illustrates the divide among many in the anti-abortion movement. Followers of a conservative philosophy known as “pronatalism” believe it’s imperative for Americans to have more babies. They want easier access to IVF, and President Donald Trump campaigned on making IVF more affordable.

So far, he has negotiated steep discounts on three IVF drugs and proposed allowing employers to provide separate health insurance coverage for fertility benefits, including lab tests, medications, genetic testing and IVF.

But the IVF process often involves discarding embryos, creating a conundrum for people who support IVF but believe that life begins at fertilization and oppose abortion. For anti-abortion purists, those embryos are unborn children, so disposing of them is no different from abortion.

The split on the political right drew attention in February 2024, when the Alabama Supreme Court, which consists of nine Republicans, ruled 8-1 that the state’s wrongful death statute applied to embryos. That decision cleared the way for couples to pursue lawsuits if their frozen embryos were destroyed. It temporarily halted IVF at Alabama clinics. It also ignited a national uproar and prompted the Republican-led Alabama legislature to immediately step in to protect IVF providers from legal liability.

But court cases and legislative efforts in multiple states show that the IVF debate is ongoing.

In Indiana and Ohio, courts have weighed whether frozen embryos are people or property in cases involving former partners who disagreed on what to do with their embryos when they separated.

In Kentucky, a judge earlier this month struck down language in the state’s abortion ban defining human life as beginning at conception, handing a victory to a Jewish woman who argued that the ban violated her religious freedom by putting her at risk of prosecution if she pursued IVF. The state has appealed the case.

In Kansas, a proposed bill this year would have made it illegal to destroy a fertilized embryo, though it died in committee. And Tennessee last year became the first state in the South to enact a law explicitly affirming the right to access IVF and birth control.

Kulsoom Ijaz, a senior policy counsel for Pregnancy Justice, predicted that IVF opponents will continue to use fetal personhood language to challenge the fertility procedure. Ijaz said that when fetal personhood language appears in one area of state law, “it inspires legislators to align their laws across the board, with these equal-protection-for-the-unborn bills.”

Then, she said, “courts use these definitions to then make case law in other areas of the law.”

Risa Cromer, an anthropology associate professor at Purdue University who focuses on medicine and reproductive politics, described personhood language as “a threat for broad swaths of reproductive health care needs that remain highly popular, IVF being one of them.”

“Personhood doesn’t explicitly implicate abortion miscarriage management, treatment for ectopic pregnancy, contraception, or IVF. In judicial interpretation, it absolutely is proving to be a threat,” Cromer said.

Utah lawsuit

IVF involves retrieving a woman’s eggs from her body and then fertilizing them with sperm in a laboratory. Any embryos that result can then be either transferred to her uterus or frozen for future use. Unused embryos can also be adopted, but many are discarded. And storing frozen embryos can be costly, from hundreds to thousands of dollars per year.

Louisiana is the only state that bans the destruction of IVF embryos. But fertility clinics have gotten around the 1986 law by shipping unused embryos out of state for storage.

The lawsuit says Voice for the Voiceless is morally opposed to IVF. But it also claims the clinics could perform IVF without discarding embryos by only creating as many embryos as will be implanted into their clients.

Mylar, the attorney, said defendants could change their clinic policies to comply with the state’s wrongful death statute “if they basically said, ‘Our intent is that you have every one of these fertilized eggs, and we’re not going to willingly or negligently or intentionally let them die.’”

Voice for the Voiceless President Kriss Martenson, named as a plaintiff, said in an interview that he does not believe IVF could be practiced without violating the law. He said the lawsuit is a strategic effort to apply fetal personhood language to IVF and to abortion at all stages. The lawsuit says the organization, which it describes as a nonprofit, has legal standing because of its efforts opposing abortion in Utah.

Martenson said he was inspired to file the Utah lawsuit by the 2024 Alabama Supreme Court decision and by the combination of Utah’s fetal personhood and wrongful death laws.

A victory in the lawsuit “could strengthen the legal arguments that the state has a constitutional obligation to protect human life from the moment of fertilization,” Martenson said. “So that’s what I’m showing in Utah, and I think that could affect other states.”

Discarding embryos

Disposal of embryos is common in IVF because for each single fertilization effort, multiple embryos are created to maximize the chance of success. Typically only one or two are transferred to a patient’s uterus, however, to prevent high-risk pregnancies of multiple fetuses. Some embryos are discarded because of chromosomal issues or genetic diseases, discovered during genetic screening in the lab. The Utah lawsuit charges that this is “akin to eugenics.”

Stateline contacted all of the clinics named in the lawsuit, but one declined to comment and the others did not respond in time for publication. The defendants have not yet filed written responses to the lawsuit. The seven clinics are: Conceptions Fertility Center, East Bay Fertility Center, Reproductive Care Center, Utah Center for Reproductive Medicine, Utah Fertility Center, Utah Fertility Specialists and Wellnest Fertility Clinic.

Susan Crockin, an adjunct professor at Georgetown University Law Center who teaches assisted reproductive technology law, said it is standard practice to inform IVF patients about their options around unused embryos. If the lawsuit is successful, Crockin said, it could severely curtail patient choice.

“The one thing that I think gets lost in this debate often is that a number of embryos that are not used for procreation … because they potentially have a genetic anomaly that is incompatible with life,” Crockin said. “So if every IVF embryo is considered a legally recognized person, I don’t understand what these anti-abortion, anti-IVF advocates would have us do with these embryos that will be sitting in cryopreservation tanks, or will not be making a viable human being.”

She added that “conflating every attempt to have a family with ‘every embryo in a freezer deserves to be put into a deserving womb’ feels very dangerous.”

Cromer, of Purdue University, noted that “the vast majority of religious Americans are supportive of access to IVF.” Cromer is a fellow at the Public Religion Research Institute, which found in a 2024 survey that majorities of white evangelical Protestants, Hispanic Protestants and Latter-day Saints both oppose laws that would make IVF illegal and strongly support laws declaring that human life begins at fertilization.

“So, these kinds of lawsuits, while there might be political opportunity for particular jurisdictions, such as the state of Utah, (are) completely out of step with what most Americans — religious Americans — want for themselves, their families and their neighbors,” Cromer said.

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

The U.S. Supreme Court decided Thursday to preserve telehealth access to the abortion drug mifepristone until after the U.S. 5th Circuit Court of Appeals has ruled on the merits of the high-stakes federal lawsuit Louisiana v. Food and Drug Administration.

Justices Samuel Alito and Clarence Thomas issued dissenting opinions.

In his dissent, Thomas said the rule violates the Comstock Act, a long unenforced 1873 law that bans the mailing of “obscene” material. During the 2024 presidential campaign, President Donald Trump said he didn’t support using the Comstock Act to stop mail delivery of abortion pills, saying he thought the federal government should have nothing to do with the issue.

Mifepristone’s manufacturer “makes a passing reference to the possibility of lost sales,” Alito wrote in his dissent. “But lost sales in states where abortifacients are generally illegal are not ‘irreparable injuries’ that can justify granting a stay.”

Abortion-rights advocates around the country called the decision a relief after two weeks of uncertainty.

On May 1, the appellate court sided with Louisiana, where state officials sued the FDA in October, arguing that a rule allowing telehealth access to mifepristone, one of two drugs used to terminate a pregnancy in the first trimester or to treat miscarriage, undermines the state’s abortion ban. Danco Laboratories and GenBioPro, two manufacturers of mifepristone, filed emergency appeals, leading the Supreme Court to issue a 10-day stay on May 4, extended until today.

“Though today’s decision means that mifepristone remains available through telehealth for now, this fight is not over,” said Dr. Camille A. Clare, president of the American College of Obstetricians & Gynecologists, in an emailed statement. “The chaos and confusion wrought by competing decisions and the revocation and restoration of access on an almost daily basis do real harm to patients and to the clinicians who care for them.”

Abortion opponents decried Thursday’s decision.

“Women deserve better than dangerous abortion drugs sent through the mail without physician oversight or in-person support,” said Jor-El Godsey, president of Heartbeat International, a major network of anti-abortion crisis pregnancy centers. “A state like Louisiana that values life in its laws should be able to protect its smallest residents as well as their moms.”

The FDA’s approved two-drug regimen via telemedicine is an increasingly common abortion method, especially for people living in parts of the country where abortion is banned or difficult to access.

Last month, a federal district court paused the lawsuit at the request of the FDA until after the completion of a safety review on mifepristone. That review was prompted by non-peer reviewed, anti-abortion research and in spite of the drug’s record of safety and efficacy since 2000. The state appealed to the 5th Circuit.

Due to multiple ongoing efforts to restrict or block mifepristone, abortion providers have told Stateline they are ready to eventually switch to a misoprostol-only method, which researchers have found to be as safe as the two-drug regimen but typically involves more symptoms and is slightly less effective.

National groups have tried to pressure the Trump administration to drop the Biden-era rule allowing telehealth abortion and called for the head of FDA Commissioner Marty Makary for reportedly slow-walking a safety review of the drug until after the midterm elections. Makary resigned on Tuesday, and anti-abortion groups wasted no time in getting Acting Commissioner Kyle Diamantas on the phone.

Live Action founder and president Lila Rose, in a written statement, said she talked to the acting commissioner on Wednesday and that he said he was morally opposed to abortion. “Diamantas told me that reviewing the abortion pill is a top priority for him and the administration,” Rose posted on X.

Students for Life of America President Kristan Hawkins wrote a similar message to supporters in an email on Thursday, saying Diamantas will be the “most pro-life FDA commissioner in American history.”

But many doctors around the country say curbing access to telehealth abortion is likely to cause harm to people in states with bans who may face more barriers to obtaining an abortion without that option.

“Women will be forced to travel long distances — at times hundreds of miles — to access safe, essential health care at a doctor’s office, no longer having the option to receive mifepristone via telemedicine,” wrote Rob Davidson, an emergency physician in Michigan and executive director of the Committee to Protect Health Care, in a letter asking the Supreme Court to maintain access to telehealth abortion. The letter was cosigned by more than 2,200 physicians.

Stateline reporter Sofia Resnick can be reached at sresnick@stateline.org.  Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org. 

The U.S. Supreme Court on Monday extended a highly anticipated stay blocking an appellate court’s pause on telehealth abortion access until May 14.

The U.S. Food and Drug Administration’s approved medication-abortion regimen remains available via telehealth until then, following a week of uncertainty among abortion patients and providers.

“With this critical temporary administrative stay extended, we hope that some of the chaos and confusion inflicted on patients and providers last weekend will be abated,” said Evan Masingill, CEO of abortion-pill manufacturer GenBioPro, one of the defendants in the case, in a statement.

On May 4, the Supreme Court temporarily stayed the 5th Circuit Court of Appeals’ ruling to reinstate the FDA’s in-person dispensing requirement for mifepristone that the Biden administration officially lifted in 2023. Over the past week, several doctors groups submitted friend-of-the-court briefs arguing that cutting off access to mifepristone could harm many women seeking abortions and miscarriage management. Republican attorneys general from 23 states, meanwhile, urged the Supreme Court not to allow providers to send mifepristone through the mail. 

People in states with abortion bans or diminished abortion access continue to depend on abortion providers prescribing FDA’s approved mifepristone-misoprostol regimen through telemedicine and sending it to patients by mail.

According to new preliminary findings from the Society of Family Planning, telehealth abortion comprised 28% of all abortions at the end of 2025, an increase from 25% at the end of 2024.

Attorneys representing Louisiana have argued that in addition to undermining a state abortion ban, the federal rulemaking process allowing telehealth prescriptions of medication abortion was flawed.  

University of Michigan law professor Samuel Bagenstos, who served as general counsel of the U.S. Department of Health and Human Services at the time the Biden-era rule was implemented, said the policy was well considered and based on evidence. 

“The 2023 update was the result of an incredibly careful, deliberate, time-consuming, painstaking process to make sure that they were following what the evidence was,” Bagenstos said. If, the plaintiffs were to prevail, he added, ending telehealth access to mifepristone nationwide would have “really harmful effects on women across the country, as well as really destabilizing effects on the drug approval system.” 

Louisiana’s lawsuit against mifepristone has nationwide implications and could threaten residents in states with abortion access and so-called abortion shield laws, such as Maryland. 

Regardless of what happens in this case, abortion providers told Stateline they are determined to continue providing telehealth abortions, though potentially without mifepristone. Dr. Angel Foster, a telehealth provider in Massachusetts, a shield law state, said in the past week, about 100 patients have requested pills for future use, compared with 34 in the entire month of April. She said constantly changing rules around abortion access followed by sensational news headlines continue to create confusion for people seeking termination or miscarriage management.

“I live and breathe abortion at this point, and I find it can be hard to keep up with the ever-changing legal environment and the way that things are getting framed and phrased,” Foster said. “When you’re a patient and what you see are just the headlines, and you’ve got to figure out what it means for you, it’s really complicated.”

Editor’s note: This story has been updated to correct the number of Republican attorneys general who asked the Supreme Court to keep mifepristone from being prescribed via telehealth visits. It should be 23. 

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

Advocates and opponents of abortion access say they’re wondering what happens next in a critical telehealth medication case that created chaos and confusion over the past week after an appeals court blocked nationwide access to the drug and, days later, U.S. Supreme Court Justice Samuel Alito issued a temporary stay.

Alito’s stay preserves telehealth access until May 11. But it’s unclear what happens next for patients and providers.

The Supreme Court on Monday temporarily blocked the 5th U.S. Circuit Court of Appeals’ Friday ruling to suspend a federal rule allowing telehealth prescriptions of the drug mifepristone while the lawsuit Louisiana v. U.S. Food and Drug Administration unfolds. Abortion providers are determined to continue providing the service, though potentially without mifepristone, the drug at the center for the case, which has had a high record of safety and efficacy since 2000.

Anti-abortion advocates have pushed to reverse the 2023 policy, enacted under former Democratic President Joe Biden, that allowed the FDA to drop its requirement that a patient see a provider in person before the medication can be prescribed. One similar national case already failed unanimously before the Supreme Court, but anti-abortion advocates are hoping this time around, with a more tailored approach, they will be successful.

Abortion-rights advocates say they’re prepared for whatever might happen in the courts, with contingency plans and a message that abortion will still be available even if the particular medication — mifepristone — is not.

Has the abortion pill been banned?

No. Mifepristone is still a legally approved FDA drug commonly used to terminate a pregnancy before 10 weeks’ gestation and is used off-label to treat miscarriages.

Is telehealth abortion still legal?

Yes, for now. Under the U.S. Supreme Court’s administrative stay that expires on May 11, it is still legal to obtain abortion medication through telemedicine under the FDA’s regulations. Mifepristone is commonly used with a second drug, misoprostol, in medication abortions. The case doesn’t include misoprostol.

Who would be affected if telehealth access is struck down?

According to the Society of Family Planning’s #WeCount report, 27% of all abortions in the first six months of 2025 were obtained through telehealth, adding up to more than 162,000 cases.

Mifepristone is also used for patients experiencing a miscarriage; those patients also would have to visit a provider in person.

The ruling would apply nationwide, meaning that health providers couldn’t prescribe mifepristone without an in-person visit with the patient, even in states with abortion access.

What are the arguments on each side in Louisiana v. FDA?

Louisiana says the Biden-era policy undermines a state law banning abortion, and that the federal rulemaking process allowing telehealth prescriptions was flawed.

The Food and Drug Administration says the state doesn’t have standing to sue, but also notes that it’s taking more time to review the drug’s safety.

Two mifepristone drugmakers, meanwhile, have intervened on the FDA’s side.

What could happen next?

The Supreme Court has many options available moving forward, but a few options are most likely, said Katie Keith, founding director of the Center for Health Policy and the Law at the Georgetown University Law Center. The justices could extend the stay when it expires May 11, or the court could make a longer-term ruling.

That could mean sending it back to the 5th U.S. Circuit Court of Appeals, with or without upholding the initial ruling blocking the 2023 provision while the appeals case proceeds. Or justices could decide to take up the case and bypass the rest of the 5th Circuit appeal.

If it did that, the manufacturer defendants Danco Laboratories and GenBioPro have asked for an expedited process with a decision by June. That seems unlikely, Keith said, but the court has conducted expedited cases related to abortion before, such as the Moyle v. United States case in 2024 related to the federal Emergency Medical Treatment and Labor Act.

What will providers do if they can’t use the combination of mifepristone and misoprostol?

Brittany Fonteno, president and CEO of the National Abortion Federation, said providers have been preparing since 2023 for the possibility of losing access to mifepristone. There have long been plans to switch to a misoprostol-only protocol, which is the main method of pregnancy termination across much of the world, she said.

“A lot of providers had created these policies and just needed to dust them off,” Fonteno said.

Dr. Angel Foster, co-founder of the Massachusetts Medication Abortion Access Project, which provides telehealth abortions to patients in all 50 states, said she and her team spent the weekend scrambling to contact patients waiting on medication abortion pills they had ordered before the ruling, and implementing a contingency plan that many abortion providers have been planning for since the lawsuits against mifepristone began in 2023.

That contingency involves pivoting from the FDA-approved mifepristone-misoprostol regimen to a misoprostol-only regimen.

Early Monday, Foster said her team was getting ready to ship misoprostol-only packages to patients at 2 p.m., but after the Supreme Court stayed the appeals court’s ruling on Monday morning, she said they were able to switch back to the mifepristone-misoprostol regimen.

Foster also said her organization was inundated with requests for pills that people could stockpile — people who didn’t need an abortion but were worried about losing access to the pills. Normally that’s a small fraction of the requests they receive, she said, but on Tuesday, they sent out more than had been sent in the entire month of April.

“Over the last two days, we’ve had a huge increase in the number of people from Louisiana requesting pills, especially pills for future use,” Foster said.

What are the pros and cons of the misoprostol-only regimen?

Dr. Maya Bass, a family physician in New Jersey who also provides abortions in Delaware, said misoprostol-only regimens are still safe and highly effective, but that the regimen has a lower efficacy rate than the combination of the two drugs and comes with potentially more side effects and risks.

Misoprostol-only regimens vary between 85% and 90% effective, while the combination is between 93% and 99% effective. The effective rates are lower as the gestational age increases.

The combination works well, Bass said, because mifepristone stops the hormone that allows the pregnancy to continue and signals to the body that the pregnancy is over. The misoprostol then helps soften the cervix and prompts the uterus to contract and expel the pregnancy tissue.

Without that hormonal signal, Bass said, a higher dose of misoprostol is needed to empty the uterus. The usual side effects of nausea, diarrhea, chills and sometimes fevers can be more severe because of the higher dosage. And it may lead to more people needing to seek in-person follow-up care to fully remove all of the pregnancy tissue, which can cause infection if it stays in the uterus.

“A lot of the people who are using telehealth for their medication abortion are not necessarily in places where they can safely access that care,” Bass said. “So it is concerning that we might be relying more on a regimen that means that many more people needing to seek care.”

What are the details of the legal arguments?

Louisiana officials, including Republican Attorney General Liz Murrill, argue that the state is harmed by the 2023 telehealth policy because it undermines a state law banning abortion at all stages of pregnancy, with few exceptions that don’t include rape or incest. The state also challenged the Food and Drug Administration’s process in deciding to eliminate the in-person dispensing requirement, saying it was based on flawed or nonexistent data.

The state also said the rule has resulted in $92,000 in Medicaid bills from two women who went to the emergency room because of complications related to mifepristone in 2025. And the state says the rule harmed the other plaintiff in the case, Louisiana resident Rosalie Markezich, who said her ex-boyfriend ordered the medication online and pressured her into taking it. That wouldn’t have been possible if the medication had to be dispensed through an in-person visit, the state argues.

“The priority of safety supersedes the priority of access, and that is what ultimately, I believe, needs to be looked at directly,” Sarah Zagorski, senior director of public relations at Americans United for Life, told Stateline on Wednesday. The anti-abortion organization submitted a brief supporting Louisiana’s case to the U.S. Supreme Court this week.

The FDA’s response has been to try to dismiss the claims in part on the grounds that Louisiana doesn’t have standing to sue, but agency officials have also said they are in the middle of conducting a safety review of mifepristone and need more time.

GenBioPro and Danco Laboratories, two of the manufacturers of mifepristone, intervened as defendants in the case, which can happen when the party that is sued may not be willing to fully defend the case for various reasons.

The two companies argue that Louisiana does not have proper standing to sue because the state does not prescribe or use mifepristone and is an “unregulated party” as it relates to the 2023 telehealth provision. They also noted that the FDA reviewed 15 studies evaluating medication abortion outcomes for more than 55,000 patients before approving the rule, “all of which supported the safety and effectiveness of dispensing mifepristone by mail, courier, or through pharmacies.”

How does this compare to the 2023 case Alliance for Hippocratic Medicine v. FDA?

Both lawsuits were designed to restrict access to mifepristone. The plaintiffs in the Alliance for Hippocratic Medicine case included a group of anti-abortion doctors who said they would be harmed by having to care for people who took mifepristone. They also argued that the FDA’s approval of the drug was improper.

The 5th U.S. Circuit Court of Appeals was involved in that case as well, and determined that the FDA should roll back its decision to ease restrictions on the drug, including the 2023 telehealth rule. But the U.S. Supreme Court unanimously decided in June 2024 that the Alliance plaintiffs didn’t have proper standing and sent it back to the lower court.

After that ruling, the attorneys general of Missouri, Idaho and Kansas stepped in as plaintiffs, and the case was transferred to Missouri’s U.S. district court, where it’s still pending.

The Louisiana case is more limited because it would strike down one provision of mifepristone regulation, noted Jenna Hudson, senior counsel at the Center for Reproductive Rights. The Alliance plaintiffs sought to revoke the drug’s approval altogether.

Stateline reporters Kelcie Moseley-Morris can be reached at kmoseley@stateline.org and Sofia Resnick can be reached at sresnick@stateline.org.  

Some anti-abortion state lawmakers are pushing to revise the definition of “abortion” so abortion bans don’t apply to cases in which the death of an “unborn child” is the result of medical care provided to the pregnant woman.

In the four years since the U.S. Supreme Court allowed states to ban abortion, stories continue to emerge of women with doomed pregnancies who developed life-threatening infections, had to travel to another state, or even died because doctors were afraid to provide what was once considered standard pregnancy-loss care.

Thirteen states have abortion bans, and all of them include a medical exception that allows abortions to protect the life of the pregnant woman. Some, but not all, of the bans also have exceptions to protect the health of the woman.

But patients and providers have argued in lawsuits challenging the bans that such exceptions are too ill defined to give doctors and hospitals the confidence to provide timely care. As a result, they say, providers end up denying care until the woman’s condition deteriorates to a point where the exceptions definitely apply, jeopardizing her health and future fertility.

Last year, states including Texas, Kentucky and Tennessee enacted laws designed to provide additional clarity. Confusion persists in those states and others, however, and research has linked abortion restrictions to higher rates of maternal death and injury.

The latest measures, crafted and promoted by national anti-abortion groups, would redefine “abortion” as the intentional ending of the life of the “unborn child.” Supporters say they would clear the way for doctors to manage miscarriages, ectopic pregnancies and other pregnancy-related emergencies.

“No one wants a physician to hesitate or pause and further endanger the life of the mother,” said Ingrid Duran, director of state legislation for the National Right to Life Committee, which has advocated for all of the measures, in a written statement. “This is why providing clearer language in defining terms can be beneficial.”

But reproductive rights advocates and many OB-GYNs say the real purpose of the bills is to fortify abortion bans that are broadly unpopular, even in states with full bans, and under legal challenge in multiple states. They argue the new measures are still too vague because they hang on the intentions of individual physicians, and many of the same procedures and medicines used in abortions are used to treat miscarriages.

They also say the language in the bills could grant embryos legal rights, thereby making some fertility treatments illegal.

“If you’re trying to define what is and is not an abortion, and you’re creating really specific, narrow guidelines, it could really unintentionally classify some pregnancy-related procedures as abortion care, and therefore within the law not medically necessary,” said Elias Schmidt, state legislative counsel for the Center for Reproductive Rights, an advocacy group.

South Dakota is first

In March, South Dakota became the first state to enact such a law. Its measure states that the state’s abortion ban only applies to “the intentional termination of the life of a human being in the uterus,” and not to medical treatment that results in “the accidental or unintentional death of the unborn child,” treatment to resolve a miscarriage or ectopic pregnancy, “the removal from the uterus of a deceased unborn child,” or a medical procedure that aims to save the fetus.

To the concern of fertility-treatment advocates, the law also defines “human being” as “an individual living member of the species of Homo sapiens, including the unborn human being during the entire embryonic and fetal ages from fertilization to full gestation.”

A similar bill introduced in Missouri defines abortion as “the act of using or prescribing any instrument, device, medicine, drug, or any other means or substance with the intent to destroy the life of an embryo or fetus in his or her mother’s womb.” It explicitly exempts miscarriage management and treatment for ectopic pregnancies from the definition.

And a bill in Utah, where abortion is still legal up to 18 weeks’ gestation, would regulate how an abortion procedure is recorded in a patient’s chart, distinguishing between an elective abortion and a medically indicated abortion. It defines the latter as an abortion “to remove a deceased fetus,” resolve an ectopic pregnancy, or to avert the death or “serious physical risk of substantial impairment of a major bodily function of a woman.”

Wisconsin’s legislature recently voted not to advance a similar bill this past legislative session.

Blame for the confusion

Anti-abortion groups blame doctors and abortion-rights advocates for creating the confusion around the medical exceptions in abortion bans, insisting it is clear what is a medically indicated abortion and what is purely elective.

“The fact that we’re in a place now that states actually have to define (abortion) is a result of my field, particularly (the American College of Obstetricians and Gynecologists) not clarifying it,” said Dr. Susan Bane, vice chair of the board of the American Association of Pro-Life Obstetricians and Gynecologists, which is made up of about 7,500 physicians and other medical professionals who oppose abortion.

The organization has launched a medical education and messaging campaign arguing that abortion bans do not prevent necessary health care.

According to Bane, the main difference between an induced abortion and medically indicated termination is that in the first case, “you want a dead baby at the end of whatever you do.”

The author of the South Dakota law, Republican state Rep. Leslie Heinemann, said he sponsored the measure to quell some of the criticism that the medical exceptions in his state’s ban were ill defined. He admitted he underestimated how difficult it would be to codify in law when care for a miscarriage is necessary.

“Even the medical community had trouble with helping define some of the issues,” he said.

The version of the bill that became law names only a few conditions and leaves the rest up to the discretion of physicians, who must exercise “appropriate and reasonable medical judgment that performance of an abortion is necessary to preserve the life of the pregnant female” to avoid felony charges.

Heinemann insisted his measure would not restrict fertility treatments or birth control. But reproductive health and legal experts say that by defining the beginning of human life as “the entire embryonic and fetal ages from fertilization to full gestation,” it could have that effect.

“Embedding personhood language into state laws does really bring up concern around contraceptive access and IVF access,” said Kimya Forouzan, principal state policy adviser for the Guttmacher Institute, a think tank that supports abortion rights.

“As personhood provisions grow in the state code, it brings up the question: At what point are we granting the legal rights of a person and placing those rights above the individual themselves?”

Dr. Amy Kelley, an OB-GYN in Sioux Falls, South Dakota, who was the chair of the South Dakota chapter of the American College of Obstetricians and Gynecologists from 2023 to 2025, said lawmakers ignored her and other doctors’ concerns that the amended abortion ban is still too vague.

“The whole point of medicine is to prevent people from becoming on the brink of death, right? So are they expecting us to wait until that?” Kelley said. “It’s still not very clear, and the definition for miscarriage and ectopic is also not the one we wanted. It’s just not helpful.”

Kelley said that since her state enacted an abortion ban, she often waits longer to terminate a pregnancy for medical reasons, and will sometimes send patients out of state for care. She noted that the new law doesn’t explain what level of risk to the pregnant woman justifies terminating a pregnancy.

“They want to say elective abortions are not allowed. But what do they consider elective?” she said. “Let’s say they have a heart condition and their risk of dying in pregnancy is 40%. Is that an elective abortion because their risk is not 100%?”

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