In 2025, more than 360,000 abortions — about a third of all U.S. abortions last year — were provided by advanced practice clinicians rather than physicians, according to new data released by the Guttmacher Institute. (Photo by Anna Spoerre/Missouri Independent)
In 2025, more than 360,000 abortions — about a third of all U.S. abortions last year — were provided by advanced practice clinicians rather than physicians, according to new data released by the Guttmacher Institute, a think tank that researches and advocates for abortion access.
Twenty-five states and the District of Columbia allow abortions to be provided by health providers who are advanced practice clinicians, a category that includes physician associates, advanced practice registered nurses, nurse practitioners, certified midwives and certified nurse midwives.
The new findings show that abortions provided by advanced practice clinicians – which included both procedures and those by pill – accounted for nearly a third of all abortions nationwide last year, not counting self-managed abortions or those obtained outside the formal medical system. The organization says these types of providers fill a crucial access need at a time of OB-GYN shortages and more than a dozen state abortion bans.
“These data help to illustrate the critical role that (advanced-practice clinicians) play in providing abortions across the country, including in many underserved communities,” said Isaac Maddow-Zimet, Guttmacher data scientist and study lead, in a written statement. He added that such providers also provide counseling and follow-up care “even in states where they are not permitted to provide direct abortion services.”
Whether advanced practice clinicians can provide abortions varies by state laws and regulations, with many states limiting the types they can provide to aspiration procedures in the first trimester or pills. Twenty-five states and the District of Columbia allow at least some nonphysician occupations to provide abortions. The states include: Alaska, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Kansas, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Rhode Island, Vermont, Virginia and Washington.
Arizona, Pennsylvania and Wisconsin could also consider allowing those providers to offer abortions after Democrats won trifectas in this month’s midterm elections and promised to expand abortion access.
The American College of Obstetricians and Gynecologists recommends allowing advanced practice clinicians to provide abortions, saying in an issue brief that restricting abortion care provision to only physicians or board-certified OB-GYNs “are not based in science; improperly regulate medical practice; and impede patients’ access to quality, evidence-based health care.”
In 2016, the U.S. Food and Drug Administration changed the guidelines around the abortion drug mifepristone, permitting advanced practice clinicians such as midwives to prescribe mifepristone.
In the years since Roe v. Wade was overturned, several states, including Alaska, Michigan, North Carolina and Ohio, have struck down physician-only abortion laws.
An ongoing lawsuit brought by nurses and midwives in Arizona challenges laws barring them from providing abortion, saying they violate the state’s constitutional amendment enshrining abortion rights passed in 2024.
After striking down many of Missouri’s abortion restrictions earlier this year, a judge upheld that state’s physician-only law, noting the difference in training for different types of abortions.
This story was originally produced by Stateline, which is part of States Newsroom, a nonprofit news network which includes Wisconsin Examiner, and is supported by grants and a coalition of donors as a 501c(3) public charity.
Georgia Democratic Gov.-elect Keisha Lance Bottoms spoke last week at the state Capitol about her transition into office. In Georgia, Iowa and Texas, sweeping Democratic election wins could advance abortion access. (Photo by Ross Williams/Georgia Recorder)
Sweeping Democratic election wins could advance abortion access in states with tight restrictions, especially in Georgia, Iowa and Texas, where Democrats seized the governor’s office for the first time in decades.
All three states will have Democratic attorneys general, and in Georgia and Texas, Democrats will control the state House while Republicans retain the state Senate. Texas has a strict abortion ban, while Iowa and Georgia only allow it up to about six weeks of pregnancy.
Meanwhile, in Arizona, Michigan, Minnesota, Pennsylvania and Wisconsin, Democrats have won new “trifectas” — control of the governor’s office and both legislative chambers — creating new opportunities to expand abortion rights. Both Pennsylvania Democratic Gov. Josh Shapiro and Wisconsin Democratic Gov.-elect David Crowley have already pledged to codify abortion rights through state law or constitutional amendment.
Abortion rights supporters also won victories in three of the four states — Missouri, Nevada and Virginia — where abortion-related measures were on the ballot. The lone exception was Idaho, where voters preserved their state’s strict abortion ban.
State consequences are already on display in Texas, where Democratic Attorney General-elect Nathan Johnson has promised to stop suing telehealth abortion providers in other states. Johnson’s proclamation is a stark reversal of the policy of his Republican predecessor, Ken Paxton, who failed in his bid to become a U.S. senator.
“My hope in humanity has been restored a little bit, and I don’t think I even realized how much that was wearing on me behind the scenes for the last two years,” said Kaitlyn Kash, who left Texas in 2021 to obtain an abortion in Kansas after fatal fetal complications threatened her pregnancy and potentially her own health.
Kash was among several plaintiffs who joined the 2023 Zurawski v. Texas lawsuit seeking to clarify the state’s medical emergency exceptions to its abortion ban. In 2024, the Texas Supreme Court ruled 9-0 in favor of the state.
But future abortion cases could see different outcomes: Last week, Democrats won all four Texas Supreme Court seats that were up for election. That leaves the GOP with a narrow 5-4 advantage on the state Supreme Court.
“To not have a vindictive attorney general anymore is going to save lives,” Kash said, referring to actions Paxton has taken, including bringing legal actions against abortion providers inside and outside the state and petitioning the state Supreme Court to halt a court ruling allowing the termination of a nonviable pregnancy.
Less impact in Washington
Despite huge Democratic gains in Congress, the change at the federal level is likely to be less significant, at least in the short term. President Donald Trump won’t leave office until January 2029, and Democrats did not win a filibuster-proof 60 seats in the Senate, let alone the two-thirds majority in the House and Senate they would need to override a presidential veto.
“As long as Trump holds executive and veto powers, we have more work than celebrating to do,” said Brittany Fonteno, president and CEO of the National Abortion Federation in a written statement. “The next two years will be a critical time to prepare for the kind of governing power that will deliver real and lasting reproductive freedom.”
Nevertheless, national abortion rights leaders have signaled high expectations for candidates they helped send to Congress, and they want Democrats to fight to preserve telehealth abortion. If Dr. Heidi Overton, Trump’s controversial pick to oversee the U.S. Food and Drug Administration, is not confirmed during the upcoming lame duck session, abortion-rights advocates will look to the new Democratic-dominated Senate to block her nomination.
“The Senate just became the backstop,” said Gowri Buddiga, campaign director of Free & Just, an abortion rights advocacy group, in a written statement. “An FDA nominee who’s spent years calling medication abortion dangerous now has to get past a chamber that’s heard from the women these bans have hurt.”
Unlike the 2022 midterms, which were held just months after the U.S. Supreme Court struck down the federal right to an abortion, there is debate over just how important abortion was in this election. According to an exit poll conducted for The Associated Press, 39% of voters cited the economy as their top issue, 33% said it was the state of American democracy and 14% pointed to immigration. No other issue broke single digits and abortion was not among the top six.
But abortion law expert Mary Ziegler said that while abortion appears to have been less of a top-of-mind issue this year, that’s not because voters care less about it.
“It’s that there was nothing happening with abortion right now, and that isn’t just a fun coincidence,” said Ziegler, a professor at UC Davis School of Law. “That’s because the Trump administration has been trying really hard to kick down the road any litigation or federal restrictions that would have made it front of mind for voters again.”
Ziegler said there are certain avenues that congressional Democrats could explore to expand access to abortion federally. Even if those efforts fail, she said, they might benefit Democrats politically leading up to the next presidential election in 2028.
“While Republicans have successfully drawn attention away from abortion, they haven’t really actually made abortion a good issue for Republicans,” she said. “So I don’t see what the harm would be in passing a bill that would be popular and having Trump veto it and have J.D. Vance and Marco Rubio have to defend it, because it’s been very good for Republicans not to have to talk about this issue at all.”
For their part, anti-abortion organizations have blamed Republicans and Trump for not campaigning on the issue and ignoring an important voting base, pointing to the highly funded and victorious anti-abortion win in Idaho as evidence.
“Let’s be clear: the GOP didn’t run on abortion in 2026. It ran an ostrich campaign: a big elephant with its head buried in the sand,” wrote Students for Life of America President Kristan Hawkins in a subscriber email the day after Election Day.
Hawkins also noted that several prominent Republican congressional candidates who said they supported abortion rights, including U.S. Sen. Susan Collins of Maine, U.S. Rep. Mike Lawler of New York and U.S. Rep. Brian Fitzpatrick of Pennsylvania, lost their seats.
Storytelling strategy
Abortion rights advocates argue that many voters were moved by the personal stories they heard from candidates and their surrogates.
On the campaign trail in Texas, Democratic Gov.-elect Gina Hinojosa talked about her own nonviable pregnancy and argued that women and families should be able to make their own reproductive health decisions. She has publicly supported ending Texas’ abortion ban and restoring abortion access, a steep challenge given that Republicans still control the state Senate.
In Georgia, Turiya Tomlin-Randall campaigned for Democratic Gov.-elect Keisha Lance Bottoms and Democratic U.S. Sen. Jon Ossoff, who was reelected.
Tomlin-Randall lives in Kansas City, Missouri, but her sister Candi Miller was living in Georgia in 2022 when she became pregnant. Miller and her husband had three kids and Miller had lupus, diabetes and hypertension, which made pregnancy dangerous. But she was terrified of getting into legal trouble after Georgia passed its new law. She ordered abortion pills online, but when she started experiencing a life-threatening infection, she was too scared to go to the hospital and died at home in November 2022.
Tomlin-Randall said she only learned two years later that her sister’s death was connected to the state’s abortion law, because of ProPublica’s reporting on deaths related to abortion bans in Georgia and Texas.
“This journey has taught me so much more about the effects of the ban,” said Tomlin-Randall, who is now raising two of the three children Miller left behind. “I’ve learned that most women who have abortions aren’t having abortions because they just don’t want to have a child. A lot of the women that I’ve encountered had to have abortions for their own safety.”
Tomlin-Randall said she’s hopeful Bottoms will be a vocal advocate for abortion rights. Georgia Democratic Attorney General-elect Tanya Miller also has opposed the state’s six-week abortion ban and promised to defend access to legal reproductive health care. Miller defeated a prominent anti-abortion lawmaker in her race.
Lauren Peterson, co-founder and CEO of Abortion in America, which organizes storytellers and advocates for abortion rights, called abortion the “unsung hero” of this election. She said abortion storytelling is an effective political strategy.
“Our work is not over,” Peterson said. “Even in states where we won, we are going to have to now do the important work of holding people accountable to the promises they made.”
This story was originally produced by Stateline, which is part of States Newsroom, a nonprofit news network which includes Wisconsin Examiner, and is supported by grants and a coalition of donors as a 501c(3) public charity.
A teacher holds a student’s baby while his class completes coursework at a high school for young parents in Spokane, Wash. A new study finds that many girls and young women try to avoid pregnancy after sex with unproven methods. (Photo by Camilla Forte/The Hechinger Report)
To prevent pregnancy after sex, U.S. teenage girls and young women are more likely to rely on unproven strategies such as prayer, exercise and jumping up and down than they are on evidence-based methods such as Plan B emergency contraception, according to a new study.
The study, published in The Journal of Sex Research, is based on a survey of 1,259 girls and women between the ages of 15-29. A quarter of the 633 respondents who reported having sexual intercourse and were not pregnant said they had used a post-coital method to prevent pregnancy.
Of those, about 9% said they’d used evidence-based emergency birth control such as Plan B or a copper intrauterine device.
But about 16% used methods without proven efficacy, including prayer (9.4%), douching (6%), jumping up and down or exercising (3.3%), ingesting something by mouth (1.9%), punching one’s stomach or uterus (1.4%), taking medicine or vitamins (0.9%), inserting something vaginally (0.5%), or using an enema (0.2%). About one-fifth of this group used more than one method — praying and douching being the most common combination.
These types of methods were more common among minors and non-white respondents.
“There is a need to better understand what is underlying these practices or the use of these strategies,” said Riley J. Steiner, an associate professor at the University of Pittsburgh School of Medicine and one of the authors of the study.
“We really don’t want young people to be seen as misguided or to be judged for these practices,” she said. “They’re trying things, and so how do we best support them to meet what their goals are?”
The release of the study comes on the heels of the Trump administration cutting and reshaping programs such as Title X and the Teen Pregnancy Prevention Program, created to lower the rate of unintended pregnancy and to inform people of safe and effective options for preventing pregnancy.
In August, a federal judge blocked the U.S. Department of Health and Human Services from implementing sweeping changes to grants under the Teen Pregnancy Prevention Program, amid an ongoing lawsuit brought by Hennepin County, Minnesota; King County, Washington; an Iowa Planned Parenthood affiliate; and SIECUS: Sex Ed for Social Change, a nonprofit advocacy group. However, grant funding that has already been cut won’t be restored for now, the judge ruled.
The Trump administration has cast doubt on the safety of hormonal contraception, which is increasingly perceived as controversial on social media.
“In our current environment where there’s a lot of mis- and disinformation online and structural constraints that make it hard to access medically evidenced contraceptive methods, it does make sense that people are behaving in broader ways to try to manage that risk,” Steiner said.
But she also noted that the study found the lack of information on contraceptive methods was more likely to drive people to choose post-coital methods rather than concerns about hormones or an inability to obtain clinical care.
Meanwhile, sex education varies widely across the country. And this year several states modified their sex education policies, according to an analysis by SIECUS.
In Alabama, Republican Gov. Kay Ivey signed a law requiring sex education to be focused on promoting “sexual risk avoidance,” updated terminology for “abstinence-only” instruction. The law prohibits sex education before fourth grade and prohibits school districts from partnering with organizations that do not promote “sexual risk avoidance,” as well as organizations that provide or promote abortion.
Instructors are prohibited from teaching students about birth control, but parents can opt out of sex education classes.
Currently, 15 states offer abstinence-only sex education, according to SIECUS.
In Wisconsin, Democratic Gov. Tony Evers signed a law requiring instruction on adoption as part of sex education. In Arizona, Democratic Gov. Katie Hobbs vetoed a bill that would have required instruction on adoption and newborn safe-haven laws whenever contraception or sexually transmitted infections are mentioned. The state already requires instruction to refer to adoption and parenting as the “preferred choice” over abortion.
This story was originally produced by Stateline, which is part of States Newsroom, a nonprofit news network which includes Wisconsin Examiner, and is supported by grants and a coalition of donors as a 501c(3) public charity.
U.S. Health and Human Services Secretary Robert F. Kennedy Jr. announced a safety review of abortion medication last spring, following an anti-abortion pressure campaign urging the U.S. Food and Drug Administration to overturn a Biden-era rule allowing abortion pills to be prescribed via telemedicine. (Photo by Max Nesterak/Minnesota Reformer)
The U.S. Food and Drug Administration said late Wednesday that it expects to complete its long-awaited safety review of abortion pills by mid-December and issue a report evaluating the results by March 2027.
The agency disclosed the information in a court-mandated status report it submitted in the federal lawsuit Louisiana v. FDA. The timeline aligns with recent reporting that the Trump administration intends to delay controversial decisions around abortion until after the midterm elections.
U.S. Health and Human Services Secretary Robert F. Kennedy Jr. announced the review last spring, following an anti-abortion pressure campaign urging the FDA to overturn a Biden-era rule allowing abortion pills to be prescribed via telemedicine. More than a year later, national anti-abortion leaders are criticizing the administration for delaying action, and have signaled they would reject a review that finds medication abortion safe if they don’t find it to be thorough enough.
“The FDA’s court-ordered update on its abortion-drug study is alarming,” said Susan B. Anthony Pro-Life America President Marjorie Dannenfelser in a written statement released late Wednesday night. “Instead of the promised gold-standard study, the FDA is trying to peddle fool’s gold.”
The Trump administration has used the ongoing study to delay several federal lawsuits related to medication abortion regulation. Louisiana, as well as Missouri and Texas, sued the federal government, arguing that federal policies allowing mifepristone to be prescribed via telehealth and distributed by mail undermine state abortion bans. Six months ago, a federal district court in Louisiana granted the FDA’s motion to stay proceedings in the case until the government completed its review of the current mifepristone-misoprostol regimen.
The FDA says it is comparing the safety profile of medication abortion to the safety profile of surgical abortion and analyzing a variety of data sources within, and outside of, the FDA’s Sentinel system, a distributed database related to medical product safety.
The agency says it is also reviewing mifepristone’s Risk Evaluation and Mitigation Strategy (REMS), a drug-safety program the FDA uses for certain drugs. That includes reconsidering the agency’s 2023 decision allowing for telehealth abortion.
“Following completion of its study and review, FDA will decide whether changes to the Mifepristone REMS Program are necessary and, if applicable, initiate any such changes in accordance with established processes,” reads the status report submitted by the U.S. Department of Justice.
Mary Ziegler, a law professor at the University of California, Davis, expects the FDA’s review to be guided by politics rather than science.
“I think the fact that the Trump administration has not yet issued new restrictions on mifepristone is primarily because Republicans think it’s dangerous to do that politically,” Ziegler said. “I think if they do impose new restrictions, it’ll be to cater to the base.”
Anti-abortion groups have urged the administration not to wait until the study is complete to take action on abortion drugs, and warned they would not accept inaction even after the study is complete. They’ve also said they will continue to pursue abortion-pill restrictions in the states.
“The Pro-Life Movement is prepared to reject a methodologically flawed review where the agency has simply gone through the motions to rubber stamp the current REMS, or lack thereof,” said John Mize, CEO of Americans United for Life, in a written statement.
His group was involved in a movement-wide effort to produce and promote research on medication abortion, analyzing commercially available Medicaid insurance claims data. White papers produced by the Ethics and Public Policy Center and the Foundation for the Restoration of America found that about 11% of patients who took mifepristone experienced serious adverse events, which is 22 times higher than what’s on the current drug label for mifepristone. The papers, which were not published in peer-reviewed scientific journals, used a broader definition of serious adverse event than what the FDA uses.
Anti-abortion leaders told Stateline they have been expecting the FDA to conduct its own analysis of Medicaid insurance claims data as part of its review. They say the agency should not only use its internal systems, calling them insufficient.
“I’m certainly hopeful that the FDA is using more robust data sources like an insurance claims database,” said Dr. Christina Francis, CEO of the American Association of Pro-Life Obstetricians and Gynecologists, which was a plaintiff group in a previous lawsuit challenging the FDA’s regulation of abortion pills, which the U.S. Supreme Court dismissed over standing issues.
The Indiana OB-GYN said the FDA’s review is “long overdue” and said her practice has seen complications from abortion pills “at least on a monthly basis.”
Ushma Upadhyay, a professor at the University of California, San Francisco, who has co-authored several studies showing low rates of serious adverse health risks for medication and telehealth abortion, said it would be difficult to draw conclusions about telehealth abortion just from insurance claims data.
“Insurance claims are an excellent way to understand safety of many medications, and I also think it is useful in understanding the safety of medication abortion, but not specifically telehealth, because most of the telehealth abortion providers do not accept insurance,” Upadhyay said.
Ziegler said the results of the safety review are unlikely to change the debate over abortion pills.
“Mifepristone is one of the most studied, most politicized drugs in the country,” she said. “Obviously it’s not being studied because it hasn’t been studied.”
This story was originally produced by Stateline, which is part of States Newsroom, a nonprofit news network which includes Wisconsin Examiner, and is supported by grants and a coalition of donors as a 501c(3) public charity.
Under its current guidelines, the U.S. Food and Drug Administration does not require in-person visits, waiting periods or ultrasounds for women seeking abortion pills. Nevertheless, 10 states without total abortion bans still require them. (Photo by Anna Spoerre/Missouri Independent)
As they await a federal decision on a potential nationwide ban on telehealth abortions, anti-abortion activists plan to push more states to require women to visit a doctor’s office, get an ultrasound or wait before they can get abortion pills.
Under its current guidelines, the U.S. Food and Drug Administration does not require in-person visits, ultrasounds or waiting periods for women seeking abortion pills. Nevertheless, 10 states without total abortion bans still require them.
One of those states is Florida. The state only allows abortion up to six weeks — which is before many women discover they are pregnant. Under state law, women must first get an ultrasound and then wait at least 24 hours before receiving pills or a procedure. By that time, they might be beyond the six weeks threshold.
“Floridians are already under a time clock,” said Lana’e Hernandez, a case manager for the Florida Access Network, an abortion fund that helps women pay for their abortions and travel to other states if they fall outside Florida’s narrow window.
“I see a lot of clients having to then travel out of state and take even more time off of work, adding another barrier to accessing care because of those laws combined.”
Medication abortion typically involves two drugs: mifepristone and misoprostol. The FDA approved the two-drug regimen in 2000 and gradually loosened restrictions as safety reviews showed a low risk of serious and life-threatening conditions. During the COVID-19 pandemic in 2021, the Biden administration suspended enforcement of the rule that patients had to take the medication in person, and the FDA officially removed that requirement in 2023.
But anti-abortion organizations and attorneys general have challenged these changes in ongoing federal lawsuits. And in 2025, activist groups successfully pressured the Trump administration’s FDA to review the safety data again.
On Wednesday, the FDA is expected to update the public on the progress of this review, though the agency is not expected to issue a final ruling on telehealth access to the pills. The Washington Sun recently reported that the Trump administration wants to delay any potentially controversial actions around abortion until after the midterm elections. The administration has also delayed multiple ongoing federal lawsuits until after the review.
Abortion rights advocates say reversing telehealth access to medication abortion would have a huge impact across the country. Medication abortions now account for about 65% of all abortions, and roughly 28% of all abortions are through telehealth, according to KFF, a health research group.
Critical elections
In statehouses, the midterm elections could determine whether more states will seek to restrict medication abortion.
Meanwhile, Democratic control of Congress could doom President Donald Trump’s nominee for FDA commissioner. During her confirmation hearing last month, nominee Heidi Overton would not say whether she would recommend changes to mifepristone regulation, but in the past she has expressed anti-abortion views and written that the medication is dangerous.
National anti-abortion leaders told Stateline they will not be satisfied if the FDA determines that mifepristone is safe and can be administered via telehealth.
“There are comorbidities that come with mifepristone, like ectopic pregnancies that need to be diagnosed prior to the actual provision of mifepristone, and right now under the FDA system, that’s not working,” said Bradley Kehr, vice president of legal affairs of Americans United for Life. “So states are stepping in to say that they have serious concerns, and they’re taking action for the safety of their citizens.”
Peer-reviewed studies overwhelmingly show a low risk of serious adverse events for medication abortions up to 10 weeks’ gestation, including via telehealth. But national anti-abortion groups have pointed to examples of coercion and non-peer-reviewed white papers to argue the risks are more significant than what the FDA has reported, and that ultrasounds should be required before the pills are administered.
Hernandez of the Florida Access Network said ultrasounds might be appropriate for women who have irregular periods or are at risk for an ectopic pregnancy, but that they should not be universally mandated by lawmakers. According to the American College of Obstetricians and Gynecologists, for patients with regular menstrual cycles and no risk factors for ectopic pregnancy, a clinical examination or ultrasound is not necessary before taking abortion pills.
“These are conversations that you should be having with your medical professional and not the government mandating you to do one thing or another,” Hernandez said. “You should be able to trust your physician to tell you whether you need an ultrasound or not to have an abortion.”
Abortion rights advocates say abortion is being singled out even as more medical care is being delivered via telehealth.
“When it comes to telehealth for abortion care specifically, a lot of those concerns, I think are coming from a place that’s really informed by abortion stigma,” said Kimya Forouzan, the principal state policy advisor of the Guttmacher Institute, a research and policy organization that supports abortion rights. “Receiving medication abortion via telehealth is not different than any other form of telehealth care.”
Existing restrictions
In addition to Florida, Alaska, Georgia, Iowa, Missouri, Nebraska, North Carolina, South Carolina, Utah and Wisconsin require ultrasounds or other in-person requirements before medication abortions. In-person requirements can include an initial in-person exam, in-person counseling, a requirement that the pills be dispensed in person or a requirement that the first dose be taken in person.
Thirteen other states (Alabama, Arkansas, Idaho, Indiana, Kentucky, Louisiana, Mississippi, North Dakota, Oklahoma, South Dakota, Tennessee, Texas and West Virginia) ban all abortions.
In Alaska, Missouri and Wisconsin, plaintiffs have challenged the laws on state constitutional grounds. Wyoming last year enacted a law requiring ultrasounds and a 48-hour waiting period before medication abortions. But a state district judge overturned the law in June, ruling that it violated a constitutional amendment protecting healthcare decisions, and that the state “offered no cogent evidence illustrating that a waiting period is necessary for any purpose.”
At the federal level, plaintiffs have argued that state regulations on abortion pills should not supersede the federal guidelines.
“The FDA sets the bar, and states don’t get to impede access to an FDA-approved medication,” said Kirsten Moore, director of the Expanding Medication Abortion Access (EMMA) Project, which tracks litigation related to medication abortion.
In an ongoing federal lawsuit over North Carolina’s restrictions, the plaintiffs argue that the state law conflicts with the FDA’s regulatory authority. A federal judge in 2024 ruled that the state could not ban the mailing of abortion pills, since federal rules allow it. But the judge upheld the state’s ultrasound requirement and its waiting period.
The case is pending appeal, with oral arguments scheduled for later this month at the 4th U.S. Circuit Court of Appeals, which last year upheld medication abortion restrictions in West Virginia, which bans all abortions and explicitly telehealth abortions. In that case, plaintiff generic mifepristone manufacturer GenBioPro argued the state’s ban violated the federal regulation of abortion pills, but the appeals court affirmed the lower court’s decision that FDA regulations did not preempt the state’s abortion ban.
Earlier this year, Iowa also enacted a law requiring abortion-inducing medication to be prescribed in person and dispensed in a medical setting.
Beaufield Berry, executive director of the Iowa Abortion Access Fund, said that since the law went into effect, her group has gotten more calls from people asking for financial help to travel out of state. She said there are two abortion clinics left in the state, both in central Iowa, making it especially difficult on people in rural areas.
“It’s really hard for some people to be able to make an appointment to go get an ultrasound, and then if they do that, then they’re running up against that six-week clock,” Berry said.
“For an in-person visit, that’s transportation, missing work, finding childcare. And in many cases, the act of having an abortion, you may not have support,” she said. “They may be underage, and so that creates even more barriers to getting an in-person meeting.”
Different strategies
Kehr of Americans United for Life said anti-abortion state lawmakers are still figuring out their individual strategies for restricting access to abortion medication. He cited the 10th Amendment, which gives states the authority through their police power to protect their citizens, as a legal justification for mandating ultrasounds or in-clinic visits before abortion pills are dispensed.
“Other states are taking different approaches, whether it’s the ultrasound provision to check for ectopic pregnancies and things like that, or the actual consideration of abuse that’s occurring,” Kehr said.
“We’ve had multiple stories of men forcing their pregnant girlfriends or wives to take mifepristone. So looking at it from an abusive perspective or a coercive perspective, states are really looking at the gamut of options under the 10th Amendment powers.”
Model legislation developed by the National Right to Life Committee, known as the Abortion Pill Provider Liability Education (APPLE) Act, and introduced this year in New Jersey and Ohio, would require abortion-pill prescribers to inform patients about the risks of the drugs, as well as her right to sue the provider if she faces complications.
The National Right to Life Committee also supports in-person visits and mandatory ultrasounds.
“Requiring a healthcare provider to confirm, locate, and date a pregnancy before prescribing a dangerous mixture of abortion-inducing drugs is a bare-minimum safety standard, and we believe it should apply in every state,” Ingrid Duran, director of state legislation for the National Right to Life Committee, wrote in an email.
Also looming in the background are interstate fights over so-called shield law providers prescribing medication virtually. Attorneys general in Alabama, Arkansas and Louisiana filed lawsuits last week targeting shield laws and in California, Massachusetts and New York, and individual doctors prescribing abortion pills to women in states with abortion bans.
“A woman can’t possibly receive fully informed consent specific to her when the dispensing provider doesn’t even know how far along she is in her pregnancy because the risk is different depending on how far along she is,” said Dr. Christina Francis, an OB-GYN based in Fort Wayne, Indiana, who is CEO of the American Association of Pro-Life Obstetricians and Gynecologists, which has opposed abortion pills since they were first approved in 2000.
“We believe that women deserve fully informed consent, and that necessarily involves an ultrasound when we’re talking about pregnancy.”
This story was originally produced by Stateline, which is part of States Newsroom, a nonprofit news network which includes Wisconsin Examiner, and is supported by grants and a coalition of donors as a 501c(3) public charity.
More than half of women of reproductive age have seen or heard the false claim that hormones in contraceptives are harmful, according to a new KFF survey. (Photo by Kelcie Moseley-Morris/Stateline)
More than half of women of reproductive age have seen or heard the false claim that hormones in contraceptives are harmful, and about 4 in 10 have been exposed to the false idea that hormones in contraceptives limit your ability to get pregnant in the future, according to a new survey.
The survey by KFF, a nonprofit health research organization, also found that about a third of women between the ages of 18 and 49 have seen or heard the inaccurate assertion that natural family planning methods are just as effective as hormonal birth control, and a similar percentage have been exposed to the erroneous idea that emergency contraceptive pills cause abortions.
A large majority of reproductive age women said health care providers are their most trusted source for reliable health care information, with 85% saying they trust them a great deal or a fair amount. In contrast, only 26% said they trust U.S. Department of Health and Human Services Secretary Robert F. Kennedy Jr. for reliable health information, and 48% said they trust federal health agencies. About 25% said they trust AI tools and chatbots, and 14% said they trust social media and social media influencers.
Kennedy has made several statements related to reproductive and sexual health that contradict the medical consensus, including that prenatal exposure to Tylenol and COVID vaccines may be linked to autism. Under Kennedy, HHS has shifted the focus of federal family planning and pregnancy prevention grants away from expanding contraceptive services and toward promoting childbearing or what’s known as restorative reproductive medicine.
The KFF survey found that among 3,538 women of reproductive age, about 35% said they saw or heard something about contraception on social media in the past 12 months.
Of those who saw social media posts about contraception, 78% said they had used contraception in the past 12 months, with 62% using hormonal methods. Of those, 8% stopped and 9% started a new method because of something they saw or heard on social media.
But for a larger share of this group, contraception-related posts led to further consultation, either with a doctor (19%) or online or from AI (36%). Women ages 18 to 25 were more likely to consult AI or the internet (46%) compared with women ages 36 to 49 (29%).
Stateline reporter Sofia Resnick can be reached at sresnick@stateline.org.
This story was originally produced by Stateline, which is part of States Newsroom, a nonprofit news network which includes Wisconsin Examiner, and is supported by grants and a coalition of donors as a 501c(3) public charity.
Chase Johnson of Cary, North Carolina, is among the cancer survivors and patients participating in a clinical trial for a new breast cancer vaccine. New cancer vaccines could be coming, but doctors and researchers are worried that rising vaccine hesitancy, fueled in part by the Trump administration, could blunt their impact. (Photo courtesy of Chase Johnson)
Nearly five years ago, Chase Johnson was cured of breast cancer — but not of the profound anxiety that it would return.
When Johnson was originally diagnosed in 2021, the resident of Cary, North Carolina, was only 31 — nearly a decade away from the age at which regular mammograms are recommended — and she had no history of breast cancer in her family. She only got screened because her dog, Cato, kept poking her chest with his nose, which helped her discover a lump.
Doctors discovered that Johnson had stage 2B triple-negative breast cancer, a rare and aggressive form. They treated her with chemotherapy, radiation, and surgery, and in 2022, they declared her cancer free. Her oncologist warned her, however, that there was a 40% chance the cancer would return.
Anxious about that prospect, Johnson enrolled in a clinical trial at the Cleveland Clinic testing a new breast cancer vaccine, developed in partnership with Anixa Biosciences. That vaccine has shown positive early results: In nearly three-quarters of the participants, including Johnson, it has generated an immune response.
“It’s just so promising and as a patient, it gave me a lot of hope,” said Johnson, now 37. “I feel much more protected having done it.”
In the past two decades, there has been steady progress in developing vaccines for cancer. The vaccine Johnson is taking isn’t one of them, but researchers are especially excited about the potential of mRNA vaccines, which use synthetic genetic instructions to teach a person’s immune system how to recognize and destroy unique proteins found on cancer cells.
Just last month, pharmaceutical companies Moderna and Merck announced that a personalized mRNA cancer vaccine, combined with an immunotherapy drug, had succeeded in a late-stage trial for skin cancer. The news raised hopes that a wave of new cancer vaccines could be just over the horizon.
But will Americans be willing to take them?
Many doctors and researchers are concerned that vaccine misinformation — amplified by the Trump administration — and the resulting increase in vaccine hesitancy could blunt the impact of the new vaccines. In particular, they cite the false claim, which originated with mRNA COVID vaccines, that mRNA vaccines can super-charge tumors, creating so-called turbo cancer.
Many point to the human papillomavirus (HPV) vaccine as a cautionary tale.
Some strains of HPV, which is spread through sexual contact, can cause cancer of the cervix, vagina, vulva, penis, anus, mouth, throat, head or neck. In 2006, the U.S. Food and Drug Administration approved an HPV vaccine for girls and women ages 9 to 26, and three years later the agency expanded approval to include boys and young men. Ideally, vaccination should occur before a person is sexually active.
The HPV vaccine is safe and extremely effective. But decades of misinformation, some of it spread by state and federal lawmakers, has reduced uptake: For four years in a row, vaccination rates for teenagers have not budged, and there is wide variation among states.
“I don’t think we can overstate the impact that the pandemic and the misinformation and disinformation around vaccines has had on all vaccines, including HPV vaccine,” said Dannell Boatman, an assistant professor at the West Virginia University Cancer Institute.
A 2024 study Boatman co-authored, funded by Merck, found that the HPV misinformation on social media platforms was most pervasive in the users’ comments.
“There were some really wild conspiracy theories about girls in India being killed with the HPV vaccine,” Boatman said. “We also were able to identify a lot of mistrust of authority.”
Boatman said she expects a similar dynamic with breast cancer vaccines, especially since some people already are spreading misinformation that mammograms can cause cancer. But she hopes an ongoing study on “inoculation theory” will help researchers combat false claims.
“Basically, you forewarn someone that they’re going to be exposed to misinformation,” she said, “and then you refute it or provide them just a little bit of evidence about why it doesn’t work.”
History of lawsuits
Before he joined the Trump administration, U.S. Department of Health and Human Services Secretary Robert F. Kennedy Jr. filed complaints and lawsuits against Merck, the maker of the HPV vaccine, and claimed on social media that the “vaccine appears to be increasing the risk of cervical cancer in vaccinated age groups just as COVID vaccines raise the risk of COVID.”
Early in his tenure, Kennedy dismissed all 17 members of the HHS vaccine advisory panel, replacing some of them with vaccine skeptics. Under his leadership, HHS also has altered the child vaccine schedule for certain diseases, including HPV. So far, those changes have been blocked in federal court.
HHS did not respond to a Stateline request for comment.
Epidemiologist Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said Kennedy’s appointment spurred the creation of the Vaccine Integrity Project, a partnership between the center and the American Medical Association that tries to bolster public trust in vaccines. The project has published evidence reviews of some of the vaccines criticized by the Trump administration.
“To a young parent today who wants to do the right thing, they want to protect their child, they’re so confused because they hear from the leaders in public health in their government talk about these vaccines killing people,” Osterholm said.
“The credibility of 80 years of public health work of vaccines in this country is threatened because of confusion.”
In May, the center published an evidence review showing that HPV vaccines are not associated with serious side effects and reduce the risk of cervical cancer by 80% in individuals who are vaccinated by age 16, and by 66% in people vaccinated after 16.
Resistance from state lawmakers
But the HPV vaccine has long faced resistance from some conservative lawmakers, who associate it with teen sex.
Last year, 78% of U.S. teenagers ages 13-17 had received at least one dose of the HPV vaccine and 63% had completed the full HPV vaccination series. But in some conservative-leaning states, the rates were much lower: The complete vaccination rate in Mississippi was only 31%. Oklahoma (46%), Kentucky (50%), Arkansas (52%) and South Carolina (55%) also had particularly low rates.
At the other end of the spectrum were Rhode Island (85%), Hawaii (82%) and Massachusetts (80%).
Some states, including Alabama and Oregon, have made recent efforts to boost their HPV vaccine rates.
But other states, including Iowa, have enacted laws limiting access to the HPV vaccine. Republican Gov. Kim Reynolds in May signed a law prohibiting Iowans under 18 from consenting to vaccinations related to sexually transmitted diseases and infections, including HPV.
Idaho Democratic state Rep. Brooke Green said anti-vaccine sentiment is increasing among residents of her state — and among her legislative colleagues. As a survivor of breast cancer, Green is excited about the prospect of new cancer vaccines, but she fears that rising hesitancy could be hurdle to widespread adoption.
She noted that Idaho Republicans introduced a bill this year that would have established a two-year moratorium on mRNA immunizations for children and pregnant women. Similar bills were introduced in at least a dozen other states, though none were enacted.
This year, lawmakers in 34 states introduced 209 bills seeking to loosen vaccination rules, limit access to certain kinds of vaccines or sow doubt about their safety, according to a recent analysis by The New York Times.
“We are seeing several attempts to address some of the scientific tools that are used to create vaccines, mRNA vaccines and so forth,” Green said. “As a cancer patient, these are life-saving tools that are helping us.”
“I’m thrilled to see these new innovative advancements in medicine for these vaccines. Now, is it going to be widely accepted?” said Green, who was first diagnosed with breast cancer in 2024, a week before her mother was diagnosed with the same cancer.
“There will be some hesitation and some pushback. But look at the flip side: ‘Do you want breast cancer or do you not? Do you want skin cancer? Do you not?’”
Chase Johnson, meanwhile, said her anxiety has significantly decreased, especially after celebrating five years in remission this summer.
“I think I’ll always have some sort of low-grade anxiety about it,” Johnson said. “But it’s definitely at a much lower level than it was before vaccination. It’s given me a great, great amount of peace of mind.”
This story was originally produced by Stateline, which is part of States Newsroom, a nonprofit news network which includes Wisconsin Examiner, and is supported by grants and a coalition of donors as a 501c(3) public charity.
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