Tabitha Crowe’s first child was due in February 2025, but she had a miscarriage in August. (Courtesy of Tabitha Crowe) 

Editor’s Note: This is the sixth installment of an occasional States Newsroom series called When and Where: Abortion Access in America, profiling individuals who have needed abortion care in the U.S. before and after Dobbs. The first installment can be found here, the second installment is here, the third is here, the fourth is here, and the fifth is here.

By Sofia Resnick

Tabitha Crowe said she woke up around 4 a.m. one Thursday in August covered in blood. She was visiting her parents in southern Louisiana when she started miscarrying her first pregnancy. She said her mom and dad drove her to a nearby hospital while she fought dizziness from the blood loss in their back seat.
“I didn’t even know I could bleed that much,” Crowe told States Newsroom.

Over the course of the next few days, Crowe said she passed baseball-sized blood clots and experienced extreme pain and dizziness in two different hospitals, while never being offered a common miscarriage procedure, even after she requested it.

An estimated 10 to 20% of known pregnancies in the U.S. end in miscarriage. In about 80% of miscarriages, women are able to expel the pregnancy tissue naturally over a period of one to eight weeks, according to the American College of Obstetricians and Gynecologists. When intervention is necessary in the first trimester, ACOG recommends abortion medications or procedures such as vacuum aspiration or dilation and curettage (D&C). Later in pregnancy, recommended termination procedures include dilation and evacuation (D&E), which has a high safety record but is condemned by anti-abortion groups and banned in some states.

But increasingly, women say they are being denied routine miscarriage care in states like Louisiana, where doctors face imprisonment if they perform an abortion unless a woman is at risk of dying, and where common miscarriage drugs are now more difficult to access. Doctors in Louisiana and Texas have also reported a rise in patients whose pregnancies are no longer viable receiving more risky and invasive terminations, such as Cesarean sections and inductions, in lieu of abortion procedures. It’s a change in practice some doctors involved in the anti-abortion movement endorse.

And in cases like Crowe’s — where death might not be imminent but failing to intervene could increase the risk for infection or other issues — some doctors are telling patients to finish their miscarriages at home.

“I think they were waiting for me to get in bad enough health,” said Crowe, who attributes her experience to Louisiana’s abortion ban, though she said no medical staff mentioned the law or responded to her requests for a D&C.

But waiting for patients’ conditions to worsen can sometimes be fatal, according to an ongoing investigation by ProPublica, which has reported on five deaths linked to abortion bans, most recently a young mom in Texas who spent hours in the ER but was never offered a D&C that could have saved her life.

As stories emerge linking abortion bans to adverse health effects, some state health departments are working to make these stories harder to learn about.

In Georgia, officials recently dismissed all 32 members of the state’s Maternal Mortality Review Committee following ProPublica’s reporting that the committee linked two women’s deaths to Georgia’s six-week abortion ban. The state said it would reset the committee through a new application process and is considering measures to ensure patient confidentiality.

In Texas, ProPublica reported that at least three women have died because of delays in care caused by the state’s abortion bans. Despite these reported deaths, Texas’ Maternal Mortality and Morbidity Review Committee said it wouldn’t examine any pregnancy-related deaths from 2022 and 2023, the first two years after the state’s near-total abortion ban took effect, according to the Washington Post.

Idaho, shortly after banning abortion, disbanded its Maternal Mortality Review Committee in 2023 after members recommended expanding Medicaid. The recently re-established committee is now backlogged and focused on publishing 2023 data in January before tackling 2022 data. The committee’s last report, based on 2021 data, showed the state’s maternal mortality rate had doubled in recent years and most of the deaths were preventable.

Crowe said her experience has moved her to speak out for better reproductive health care.

“For me to have a miscarriage for the first time, it’s already a very scary process,” said Crowe, who said she eventually got the care she needed outside of Louisiana. “You go to a hospital, you expect care, you expect some type of answers on what’s going on. And I didn’t get that.”

‘I had a sense it was because of the abortion laws’

Crowe and her husband, Noah Holesha, live on the Eglin Air Force Base in the Florida Panhandle. Crowe said her husband is in the Army and she was medically discharged from the military in 2023 and now works as a caretaker. The two married in 2022 and were expecting their first baby in February.

But on the way to LSU Health Lallie Kemp Medical Center in Independence, Louisiana, on Aug. 8, Crowe said she felt she would never get to meet this baby. Two weeks earlier, her 10-week-old fetus only measured 6 weeks. Now in the emergency room, Crowe said medical staff gave her pain medicine, cleared her blood clots, and discharged her to finish miscarrying naturally.

Two days later at her parents’ house, Crowe said she woke up with 10 out of 10 pain.

“I was in excruciating pain again, like screaming and crying pain,” she said.

She said her parents took her back to Lallie Kemp, where they transferred her to St. Tammany Parish Hospital Emergency Department in Covington, about a 45-minute drive, because it was the nearest hospital with a dedicated OB-GYN unit.

“Lallie Kemp Medical Center complies with federal patient privacy laws and therefore cannot discuss specific patients’ care,”  Dr. Matloob Rehman, the hospital’s medical director, said in an email. “Lallie Kemp is a small, rural hospital without a full complement of specialists, including obstetrical surgery. If a patient is in need of such care, it is Lallie Kemp’s practice to refer or transfer the patient to a hospital that can provide such services.”

At St. Tammany, Crowe said she spent the day receiving pain medicine and transvaginal ultrasounds and having her vaginal canal cleared of clots. Medical records Crowe shared with States Newsroom indicate she was given misoprostol to evacuate her uterus, which Crowe said she was not aware of. She said the ultrasounds were still showing she had not completed the miscarriage. Crowe’s cousin had recently miscarried, so she and her family knew to ask for a D&C.

“They did ultrasounds and all that, but they didn’t help make sure that the miscarriage was completing,” Crowe said. “We kept telling them, ‘Hey, can y’all just do this D&C, so like we can be done with this pain?’ They wouldn’t answer.”

Crowe’s sister, a nurse in Texas, where abortion is also banned, suggested in a text that maybe it was because of Louisiana’s abortion ban that she wasn’t being offered a D&C.

“I had a sense it was because of the abortion laws, because by the time they did the canal sweep of blood clots, they didn’t even want to listen that I was in pain anymore. They were like, brushing it off, like, you’ll be fine,” Crowe said. “Even if them not doing it was wasn’t because of the abortion laws, I still didn’t get the treatment that I needed.”

Crowe said she was still dizzy and in pain when St. Tammany released her late on Aug. 10. Her St. Tammany hospital medical records say her miscarriage was completed at St. Tammany, which Crowe disputes. Medical records from the hospital in Florida, where she received the D&C, say the patient had an “incomplete miscarriage with evidence of retained POC [products of conception] on TVUS [transvaginal ultrasound], continued bleeding and anemia.”

The St. Tammany Health System Communications Department declined to comment on Crowe’s account, citing patient confidentiality, and said in a statement: “At St. Tammany Health System, we place our patients and their families’ wellbeing first. Patient privacy rights are established by the Federal Health Insurance Portability and Accountability Act (HIPAA). In compliance with this act, we are not at liberty to provide information or comment.”

Crowe decided to drive the four hours back to Florida. She said her pain had ebbed, but soon after she got home, her husband rushed her to Eglin Air Force Base emergency department, where she said she received a D&C the following day.

The Eglin hospital did not respond to requests for comment.

Crowe said she was still dizzy in the weeks following, and she was confused and angry, believing — without confirmation — that she was denied health care she needed because of a new abortion law. She said she started reaching out to malpractice attorneys, reproductive rights groups, even President-elect Donald Trump.

“I sent everybody emails.” Crowe said. “I reached out to Congress. I reached out to the office of Trump. I reached out to lawyers. It wasn’t anger that I’ve lost the child — because I had a feeling I was going to lose the child — but it was the anger of they didn’t give their 100% care. I was getting in bad shape, health-wise, because of it.”

Louisiana abortion laws affect miscarriage care

Louisiana was one of the first states to ban abortion after the U.S. Supreme Court overturned Roe v. Wade in 2022. And it’s the first, followed by Texas, to reclassify two abortion and miscarriage medications — mifepristone and misoprostol — as controlled substances, even though they haven’t been shown to cause addiction or dependence. In late October, health care workers sued the state, arguing that the new law is unconstitutional and has added barriers to emergency care.

One of the legal advocacy groups representing plaintiffs in that case, Lift Louisiana, co-published a report with Physicians for Human Rights with detailed interviews from patients, doctors and clinicians of how the state’s abortion ban has changed reproductive health care in Louisiana. The report found that some OB-GYN practices are now deferring prenatal care until beyond the first trimester, when miscarriage care is more common. Some clinicians reported an increase in patient referrals from rural hospitals for routine care.

“To avoid the risk of criminal penalties under the bans, nearly every clinician relayed an account

in which they and/or their colleagues delayed abortion care until complications worsened to

the point where the patient’s life was irrefutably at risk,” the report reads.

Crowe said she was grateful she was able to get treated, not a given in Florida, which has a six-week abortion ban and where patients have also reported being denied miscarriage treatment. But she lives on a military base, under federal jurisdiction. With a soon-to-be GOP majority in Washington, D.C., anti-abortion activists are pushing Trump to restrict pregnancy termination at military hospitals.

Though she personally disagrees with abortion after the first trimester, Crowe said she now believes in abortion rights.

“Growing up, I was always pro-life, because I always wanted to have a kid and all that,” Crowe said. “I was also the type that’s like, I’m not going to judge you if you do. Now I’m like … the choice to have an abortion is important because some women … we need this procedure done to save our lives, too. My child was already lost; it lost its life. Because of the abortion laws, you’re keeping me from having my life. … I couldn’t grieve because I was in so much pain.”

GET THE MORNING HEADLINES.

SUBSCRIBE

Donald Trump spoke at the March for Life rally in January 2019 during his first term as president. (Mark Wilson | Getty Images)

The 2024 election results created complicated new realities for reproductive rights in the U.S., with Americans even in a few red states overwhelmingly voting to protect the right to have an abortion while also overwhelmingly electing anti-abortion representatives in state houses, courts, Congress and the White House.

With a Republican trifecta coming to the nation’s capital in January, anti-abortion activist groups are planning for the first potentially friendly presidential administration since the 2022 Dobbs v. Jackson Women’s Health Organization decision overturned Roe v. Wade and eliminated a 50-year federal right to terminate a pregnancy. They aim to end other federal and state protections while vastly expanding restrictions on reproductive health care.

Though many anti-abortion leaders are skeptical of President-elect Donald Trump’s commitment to their cause, they say they are willing to compromise to maintain influence in his administration. Some groups are strategizing how to end-run Trump’s campaign pledge not to enact any federal abortion bans — by heavily restricting medication abortion or trying to ban a common abortion procedure.

“I don’t think we have a champion here for pro-life causes,” said longtime anti-abortion organizer Rev. Patrick Mahoney. “What we have here is someone who will not work against us and try to crush us. We will not see pro-choice federal judges.”

The director of the Christian Defense Coalition and the chief strategy officer of Stanton Public Policy Center told States Newsroom that he is not a supporter of Trump and disagrees with his rhetoric on immigrants. But Mahoney said he is happy Democratic presidential nominee Kamala Harris lost. The vice president had vowed to try to restore federal abortion rights and throughout her career has advocated for reproductive rights. As California attorney general, she prosecuted anti-abortion activists charged with illegally recording abortion providers about a decade ago.

“We can have an opportunity now to begin the second phase after Roe was overturned,” Mahoney said. “We knew overturning Roe was only a starting line, not a finishing line.”

Live Action president Lila Rose was one of the few prominent anti-abortion leaders who called out Trump before the election, after he criticized Florida’s six-week abortion ban and vowed to veto a federal ban. In late August, Rose told Politico she would write in a presidential candidate and would encourage her millions of followers to do the same if Trump did not change course. On her podcast, the millennial activist recently revealed that she met with Trump and asked him to say he would vote against Florida’s abortion-rights amendment, which he did. Days before the election, Rose endorsed Trump on X.

Live Action did not respond to an interview request.

Nationally, three out of 10 abortion-rights measures failed: Florida’s proposed amendment had the highest threshold to clear, but got 57% out of the required 60% of the vote. It would have reversed the ban that reproductive rights advocates say has decimated abortion access in the Southeast.

Another anti-abortion leader willing to compromise with the incoming president and Congress is Steven Aden, general counsel at Americans United for Life, the policy shop behind many state and federal abortion restrictions. Aden said he was disappointed the Republican Party removed from its platform a previous commitment to a federal ban.

However, he said his group was still able to inject critical language into the current platform that effectively supports states establishing fetal personhood through the U.S. Constitution’s 14th Amendment, which grants equal protection under the law. The platform also says Republicans “will oppose Late Term Abortion,” a political term used to refer to abortions in the second and third trimesters, the rarest but most restricted types of abortions in the U.S.

“We had direct input into the Trump campaign and framing the pro-life language in the party platform,” Aden told States Newsroom. “The platform language was much pared down, but we believe that the pro-life language preserves the essence of the party’s position on the pro-life issue, and we’re proud of that, and look forward to continuing to work with the incoming Trump administration.”

Federal reproductive rights protections in question

Early into his term, Democratic President Joe Biden began reversing blocks on federal funding domestically and globally for reproductive health organizations that also provide or refer for abortions. Leading up to and following the Dobbs decision, the Biden administration loosened restrictions to the medication abortion regimen, a combination of mifepristone and misoprostol, which has become the most common way of terminating pregnancy in the U.S. during the first trimester. The U.S. Food and Drug Administration allowed abortion medication to be obtained via telemedicine and dispensed directly at pharmacies.

Nearly half the country has partially or fully banned abortions. But abortion numbers have risen since before Dobbs, researchers have reported, attributing the increase in part to expanded access to telemedicine abortion and to more people using online abortion clinics that mail abortion drugs from states with so-called shield laws to those with bans.

Anti-abortion groups Susan B. Anthony Pro-Life America and Students for Life of America recently unveiled memos asking the Trump administration to pull regulatory levers that especially target abortion drugs.

Under the U.S. Department of Health and Human Services, regulations could include:

• The FDA reinstating medication abortion restrictions, such as requiring multiple in-person appointments and revoking telemedicine. Or altogether revoking the 2000 approval of mifepristone.

• Reversing guidelines that under the federal Emergency Medical Treatment and Labor Act, emergency departments at hospitals enrolled in Medicare — even in states with abortion bans — must offer pregnant patients the medical treatment necessary to stabilize an “emergency medical condition.” This law is the subject of an ongoing lawsuit deferred by the U.S. Supreme Court earlier this year. In sharp contrast to the mainstream medical community, anti-abortion advocates argue these guidelines are unnecessary and would allow doctors to broadly interpret a health emergency to mean anything.

When asked about stories of alleged denied care, maternal deaths, and doctor confusion related to state abortion bans, Aden chalked up the problem to a misinterpretation of state laws, which he said should be clarified to address these problems, while noting several times, “I’m not a doctor.” Americans United for Life’s recommended health-exception language in part says abortion should be allowed “to preserve the life of a pregnant woman or to address a serious risk of substantial and irreversible impairment of a major bodily function.”

“That’s a health exception with teeth,” Aden said. “It doesn’t allow for a free-ranging, quote unquote, ‘mental health’ exception that would swallow the rule.”

• Funding a study on the potential health effects of abortion pills in the water system from patients miscarrying in their toilets after taking medication abortion drugs. Anti-abortion leaders like Mahoney said they were disappointed with Trump’s pick for HHS secretary, Robert F. Kennedy Jr., who has previously said he supports abortion rights. But Mahoney said he’s hoping to appeal to Kennedy’s skepticism of FDA drug approvals. “How do chemical abortions being flushed down the drain affect our water supply? We’re definitely going to push hard on that,” Mahoney said.

• Revoking a rule requiring health clinics that receive federal family planning Title X grants to offer referrals for abortion clinics, which is also the subject of an ongoing federal lawsuit. It is already prohibited to use federal funds for abortions unless the pregnancy is the result of rape or incest, or has become fatal. Activists also want to defund Planned Parenthood, the largest reproductive health center network, and extend tax credits to anti-abortion pregnancy centers.

Trump’s pick to lead the Centers for Medicare and Medicaid Services, which manages the country’s largest health programs, is Dr. Mehmet Oz, who opposes abortion.

The U.S. Department of Justice could:

• Enforce part of the 19th century Comstock Act to prohibit the mailing of abortion-inducing drugs. Aden said enforcing this law would likely mean cracking down on online abortion clinics like Aid Access.

• Revoke or refuse to enforce the federal Freedom of Access to Clinic Entrances Act,  enacted because of the sometimes-violent anti-abortion protests of the 1980s and 1990s. One of several activists sentenced to prison for staging a clinic blockade in Washington, D.C., Lauren Handy was also involved in obtaining aborted fetuses outside the same clinic. Trump had indicated he would potentially pardon Handy and fellow blockaders. Activists have said they will also ask the DOJ to investigate the doctor at the abortion clinic from where Handy obtained the fetuses, of whom she and other activists have accused, without evidence, of infanticide.

The U.S. Departments of Defense and Veterans Affairs could:

• Revoke policies that expanded abortion access for veterans and members of the Military.

The U.S. Agency for International Development could:

• Reinstate the so-called Mexico City Policy, which barred federally funding international organizations that provide or refer for abortions.

As they brace for the potential impact of Dobbs without a federal safety net, reproductive justice activists are working to expand access and fight anti-abortion laws, while also protecting new state wins. The election results did not change the fact that most people want abortion access, said Fatima Goss Graves, president and CEO of the National Women’s Law Center, during a recent media press briefing organized by the progressive Robert Wood Johnson Foundation.

“Donald Trump won the election, but so did abortion, and people need to hold this incoming administration to its word that it would not restrict abortion,” Graves said. “We have to square the idea that millions of people in the United States voted for reproductive freedom … but they also will be experiencing a situation that will become even more dire, and that people will feel scared and hopeless in this period.”

Arguments for a national abortion ban

Aden said AUL would support a federal “dismemberment” bill, referring to a proposed ban on a common second-trimester abortion procedure known as dilation and evacuation, or D&E. This procedure involves dilating the cervix and removing the contents of the uterus, typically performed beginning around 12 weeks. It would be a way to effectively get a 12- or 15-week ban without calling it that.

Despite its safety and efficacy record, the D&E procedure has been banned in several states, over the objection of the American Medical Association and the American College of Obstetricians and Gynecologists. It’s part of an old anti-abortion playbook, which under Republican President George W. Bush resulted in a federal ban on another later abortion procedure — dilation and extraction, or D&X — by reframing it as “partial-birth” abortion, which the U.S. Supreme Court upheld in 2007’s Gonzales v. Carhart decision.

Abortion foes describe D&Es as a gruesome procedure, or as Aden puts it, “tearing 13-week-old humans apart limb from limb.” Anti-abortion doctors recommend more risky and invasive procedures like C-sections, even when the abortion is medically indicated.

If D&Es are banned, there would be fewer options for later abortions, which are sometimes necessary, said reproductive-health legal expert Rachel Rebouché, dean of Temple University School of Law in Philadelphia. She noted that some of the U.S. Supreme Court justices have indicated support for abortion restrictions for reasons of preserving fetal dignity rather than preserving maternal health.

“That litigation, from the anti-abortion perspective, depends on saying the fetus is a person with rights that attach at a certain point, if not from conception,” Rebouché told States Newsroom. “Dobbs opens the door wide open for those kinds of regulations. … But the question is, is there a role for the federal government to enact a nationwide ban that would curtail the rights of states that have not gone the way of Idaho or Texas or others?”

Aden said that for now AUL will be more focused on the incremental approach to abortion restrictions, as well as calling for expanded child and prenatal tax credits and other social supports. The attorney, who was 11 when Roe was decided in 1973, is expecting another half-century of litigation over abortion with the hopes that one day the U.S. Constitution gives personhood rights to the unborn, regardless of the stage of that pregnancy. Aden said a so-called Human Life Amendment is likely impossible in the near term, needing approval from two-thirds of both houses of Congress. He said U.S. culture is not there yet.

“It would require a cultural sea change in the way that the majority of Americans view human life in the womb,” Aden said. “That’s our second generational goal. Having won our first generational goal of overturning Roe, we’d love to see the day when every life is welcomed and protected in law. And if that’s through a constitutional amendment, then we’re here for that.”

GET THE MORNING HEADLINES.

SUBSCRIBE

Medication abortion has become the most common method of abortion since the 2022 Dobbs decision ended the federal right to abortion. (Getty Images)

Researchers whose anti-abortion-funded studies were used to argue for restrictions on medication abortion — and then were retracted on methodological grounds — are now taking legal action against academic publisher Sage, which pulled their papers in February.

Represented by conservative law firms Consovoy McCarthy and Alliance Defending Freedom, the latter of which sued the Food and Drug Administration over abortion drugs in 2022, the researchers claim Sage’s retractions were unjustified and politically motivated and have led to “enormous and incalculable harm” to their reputations. They asked the Ventura County Superior Court in California to compel Sage to arbitrate with the researchers.

“Sage punished these highly respected and credentialed scientists simply because they believe in preserving life from conception to natural death. These actions have caused irreparable harm to the authors of these articles, and we are urging Sage to come to the arbitration table — as it is legally bound to do — rescind the retractions and remedy the reputational damage the researchers have suffered at the hands of abortion lobbyists,” said ADF senior counsel Phil Sechler in the recent announcement.

A representative for Sage declined to comment on the pending litigation.

A representative for the anti-abortion think tank Charlotte Lozier Institute, which employs the petitioning researchers, declined to comment. The nonprofit serves as the research arm of the influential Susan B. Anthony Pro-Life America, which works to elect federal and state anti-abortion lawmakers.

The three studies at the center of the dispute were published in the journal “Health Services Research and Managerial Epidemiology,” between 2019 and 2022. Two of them featured prominently in a federal lawsuit aimed at restricting abortion pills, which the U.S. Supreme Court rejected this summer but continues to make its way through the lower courts.

States Newsroom was the first to report last year that Sage had opened an investigation after pharmaceutical sciences professor Chris Adkins contacted the journal with concerns that the researchers had misrepresented their findings. In the 2021 paper, the researchers looked at Medicaid data in 17 states between 1999 and 2015 and tracked patients who had had a procedural or a medication abortion and counted each time they went to an emergency department in the 30 days following those abortions. Their finding that emergency room visits within 30 days following a medication abortion increased 500% from 2002 to 2015 was frequently cited by plaintiffs and judges in the FDA case and used to conclude that the abortion-inducing drug mifepristone is dangerous. But Adkins and other public health experts told States Newsroom that the researchers inflated their findings, and appeared to conflate all emergency department visits with adverse events.

These concerns prompted Sage to re-examine the peer review process and to identify that one of the initial peer reviewers was an associate scholar with the Charlotte Lozier Institute. The publisher then enlisted a statistician and two reproductive health experts to newly peer review all three articles.

“Following Committee on Publication Ethics (COPE) guidelines, we made this decision with the journal’s editor because of undeclared conflicts of interest and after expert reviewers found that the studies demonstrate a lack of scientific rigor that invalidates or renders unreliable the authors’ conclusions,” Sage said announcing the retractions, which notes that the experts found that the papers had “fundamental problems with the study design and methodology,” “unjustified or incorrect factual assumptions,” “material errors in the authors’ analysis of the data,” and “misleading presentations of the data.”

In a petition to compel arbitration filed late last week, the studies’ lead author James Studnicki and nine co-authors argue that Sage has delayed arbitration in violation of California contract law. They say they’ve had difficulty publishing new research since the retractions. As examples, the petition notes that in March a free online archive and distribution server for unpublished, non-peer-reviewed manuscripts refused to post one of the petitioners’ manuscripts and that in April a journal rejected the same manuscript, “citing similar pretextual reasons that HSRME used in its retraction.”

“These rejections are just the tip of the iceberg but reveal the enormous and incalculable harm that Sage’s retraction has inflicted on the Authors’ reputations and their ability to publish research and scholarship,” reads the court petition. “As scientists, the Authors’ credibility is their lifeblood, but Sage has destroyed the Authors’ hard-earned professional reputations.”

Studnicki, Charlotte Lozier’s vice president and director of data analytics, was on the editorial board of “Health Services Research and Managerial Epidemiology” until last fall, but the journal’s editor-in-chief dismissed him after the journal and Sage decided to retract the papers. The blog Retraction Watch reports that the journal is no longer accepting new submissions.

Medication abortion has become the most common method since the 2022 Dobbs decision ended the federal right to abortion.

Despite claims by the Charlotte Lozier Institute that medication abortion is unsafe, when administered at 9 weeks gestation or less, the FDA-approved regimen has a more than 99% completion rate, a 0.4% risk of major complications, and around 30 reported associated deaths over 22 years. Common symptoms include heavy bleeding and cramping, diarrhea, and nausea, and sometimes medical intervention is necessary to avoid infection. ProPublica recently reported on two women in Georgia who suffered rare complications of medication abortion, but whose deaths were ruled preventable and were attributed to the state’s near-total abortion ban.

GET THE MORNING HEADLINES.

SUBSCRIBE

The U.S. Supreme Court ruling in Dobbs v. Jackson Women’s Health Organization in June 2022 ended federal abortion rights. (Sofia Resnick/States Newsroom)

Editor’s note: This five-day series explores the priorities of voters in Arizona, Georgia, Michigan, Nevada, North Carolina, Pennsylvania and Wisconsin as they consider the upcoming presidential election. With the outcome expected to be close, these “swing states” may decide the future of the country.

Dr. Kristin Lyerly’s placenta detached from her uterus when she was 17 weeks pregnant with her fourth son in 2007. Her doctor in Madison, Wisconsin, gave the devastated recent medical school graduate one option: to deliver and bury her dead child. But she requested a dilation and evacuation abortion procedure, knowing it would be less invasive and risky than being induced. And she couldn’t fathom the agony of holding her tiny dead baby.

But Lyerly’s doctor declined, giving her a direct window into the many ways Americans lack real choice when it comes to their reproductive health decisions. At the time of this miscarriage, Lyerly was getting a master’s degree in public health before beginning her residency. She was able to get a D&E at the same hospital by a different doctor. As an OB-GYN, she soon would learn how much abortion is stigmatized and limited throughout the country, but also regularly sought after and sometimes medically necessary, including among her many conservative Catholic patients in northeastern Wisconsin.

And then, on June 24, 2022, the U.S. Supreme Court ended federal abortion rights, prompting states such as Wisconsin to resurrect dormant abortion bans from the 19th and 20th centuries. Lyerly’s job changed overnight. She stopped working as an OB-GYN in Sheboygan and moved her practice to Minnesota. She became a plaintiff in a lawsuit over an 1849 Wisconsin feticide law being interpreted as an abortion ban, which has since been blocked.

When a congressional seat opened up in a competitive Wisconsin district this year, the 54-year-old mother of four joined the post-Dobbs wave of women running for office to restore reproductive rights, which this election cycle includes another OB-GYN and a patient denied abortion care. Lyerly’s decision to run is emblematic of the nationwide backlash against the Dobbs decision, which altered the reproductive health care landscape, with providers, patients and advocates turning to the ballot box to change the laws to restore and broaden access.

Wisconsin is among seven swing states expected to determine the country’s next president and federal leaders. And in many ways they’re being viewed as referendums on how much the right to have an abortion can move the needle in a tight presidential election.

“What we’ve seen in every election since the Dobbs decision is that abortion is at top of mind for voters — and it’s not just helping voters decide who or what to vote for. It’s actually a turnout driver,” said Ryan Stitzlein, vice president of political and government relations at national lobbying group Reproductive Freedom for All. The group is investing in down-ballot races in conservative districts such as Lyerly’s, buoyed by cash and momentum from Democratic presidential nominee Kamala Harris’ reproductive-rights-focused campaign.

Anti-abortion money is also flowing through the swing states, led by lobbying groups Susan B. Anthony Pro-Life America and Women Speak Out PAC. Some of their messaging, adopted by Republican presidential nominee Donald Trump and many GOP candidates, often paints Democrats as champions of infanticide, focusing on the rarest and most controversial type of abortions, those performed in the third trimester.

But aside from that rhetoric, many Republican candidates have been quiet on an issue that for years motivated their staunchest supporters.

SBA Pro-Life America declined an interview for this story but shared a press release outlining the organization’s strategy trying to reach 10 million voters in Montana, Ohio and all of the battleground states except for Nevada. The group endorsed 28 House candidates total this cycle, and a fifth of them are in North Carolina. One of North Carolina’s endorsed candidates in a toss-up race is Republican GOP challenger Laurie Buckhout, who does not mention her abortion stance on her campaign website, and did not return a request for comment.

“Our field team is talking to persuadable and low propensity pro-life voters to urge them to cast their votes against the party that endorses abortion in the seventh, eighth and ninth months,” said SBA’s national field team director Patricia Miles in the press statement.

But throughout this election cycle, polls in the swing states have shown bipartisan support for abortion rights, especially when voters are educated about what abortion bans do. Voters in more than half of the states expected to determine the presidential winner have, to varying degrees, lost access to abortion. And abortion-rights activists across these states told States Newsroom they are determined to protect that access, or to get it back.

Arizona sees backlash after GOP upholds Civil War-era abortion ban

In Arizona, the Dobbs decision resurrected a Civil War-era ban that allowed abortions only to save a pregnant patient’s life.

Legislators repealed the law, but abortion-rights supporters fought for more certainty. This fall, Arizonans will vote on a proposed ballot measure that would protect access until fetal viability, around 24 weeks of pregnancy.

Now, two of the judges who upheld the abortion ban — Justices Clint Bolick and Kathryn King — are up for reelection, in races infused with national cash by groups such as RFA and Planned Parenthood. Also on the ballot is Proposition 137, which would give lifetime appointments to state judges. The Republican-initiated measure has garnered controversy in part because it is retroactive to this year’s election, so if approved, any retention bids would be nullified even if the majority votes to unseat the judge.

Ballot organizers turned in more than 800,000 signatures, double the required number, and overcame opponents’ legal challenges to qualify the abortion-rights ballot measure, Proposition 139. Abortion is legal up to 15 weeks of pregnancy, but there are many state restrictions that the Arizona Abortion Access Act would eliminate, such as a ban on any abortions sought for fetal genetic abnormalities and a blocked law from 2021 granting personhood status to fertilized eggs.

Recent deaths reignite controversy over Georgia’s abortion ban

This month, ProPublica reported on the deaths in 2022 of two Georgia women who suffered rare complications after they obtained mifepristone and misoprostol for early-term medication abortions. Both were trying to navigate a new state law that banned abortions at about six weeks of pregnancy and threatened medical providers with up to a decade in prison.

In one case, doctors at an Atlanta-area hospital refused for 20 hours to perform a routine dilation and curettage, a D&C, to clear the patient’s uterus when her body hadn’t expelled all the fetal tissue. In the other, a woman who had ordered the pills online suffered days of pain at home, fearful of seeking medical care. Both women left children behind.

Georgia’s law permits abortion if the patient’s life is at risk, but medical providers have said the law’s language is unclear, tying their hands and threatening the health of patients who have high-risk pregnancies.

Their cases, which a state medical review committee found to be “preventable,” have galvanized activists in the state.

Harris spoke at length about the women, Amber Nicole Thurman and Candi Miller, at a recent campaign event in Atlanta. She blamed their deaths on Georgia’s law, calling it “the Trump abortion ban,” because the former president appointed three justices he’d promised would overturn Roe v. Wade.

“This is a health care crisis, and Donald Trump is the architect of this crisis,” Harris said. “Understand what a law like this means: Doctors have to wait until the patient is at death’s door before they take action. … You’re saying that good policy, logical policy, moral policy, humane policy is about saying that a health care provider will only start providing that care when you’re about to die?”

Trump has not commented on the deaths. He has repeatedly said this year that abortion access should be left to the states. He has dismissed the idea of a federal abortion ban, but during the presidential debate, he refused to say whether he would veto such legislation.

At a recent rally in North Carolina, Trump addressed “our great women” (a demographic he’s trailing among), saying, “you will no longer be thinking about abortion, because it is now where it always had to be, with the states, and with the vote of the people.”

Abortion was a driving concern in this spring’s qualifying process for Georgia’s 2024 legislative elections — the first opportunity for aspiring state lawmakers to jump on the ballot in response to their state’s severe abortion restrictions.

Melita Easters, the executive director and founding chair of Georgia WIN List, which endorses Democratic women who support abortion rights, was already calling this year’s general election “Roevember” back when President Joe Biden was still the party’s nominee.

But Easters told States Newsroom that having Harris on the ticket instead has elevated the issue of reproductive freedom even more and “has breathed new life into down-ballot campaigns.” Easters said she is especially encouraged after a Democratic state House candidate in Alabama who ran on abortion rights flipped a Huntsville seat during a special election in March.

Michigan Democrats continue betting on abortion after 2022 successes

Michigan was one of the earliest states post-Dobbs to show that abortion rights could be a strong election-winning issue.

Months after the Supreme Court’s ruling, Michiganders overwhelmingly approved a ballot measure to protect abortion rights in the state constitution; reelected Democratic Gov. Gretchen Whitmer, who vowed to prioritize reproductive freedom; and voted for Democratic majorities in both chambers, giving the party a legislative trifecta for the first time in 40 years. In 2023, the legislature repealed a 1931 abortion ban that was still on the books and passed the Reproductive Health Act, expanding abortion access in the state.

This year, state and national abortion-rights groups have campaigned in toss-up congressional districts across Michigan, warning that a federal ban would supersede the state’s protections.

State judicial races, meanwhile, have attracted millions of dollars, as they could determine partisan control of the Michigan Supreme Court. Democrats secured a slim 4-3 majority on the state Supreme Court in 2020 after Republican-nominated justices controlled the court for most of the last few decades.

Nevada reproductive rights activists hope ballot initiative improves turnout

In Nevada, abortion remains legal through 24 weeks and beyond for specific health reasons. In 2023, the state’s Democratic-led legislature passed a law shielding patients and providers from out-of-state investigations related to abortion care; it was signed by Republican Gov. Joe Lombardo.

Seeking to cement these rights in the state constitution, reproductive health advocates mobilized a ballot initiative campaign, which they hope will drive voter turnout that would affect the presidential and down-ballot races. Constitutional amendments proposed through an initiative petition must be passed by voters twice, so if voters approve Question 6 in November, they will have to approve it again in 2026.

In the state’s closely watched U.S. Senate race, Democratic Sen. Jacky Rosen currently edges Republican Sam Brown, who has had inconsistent positions on abortion and reproductive rights but opposes the abortion-rights measure.

National anti-abortion groups Susan B. Anthony Pro-Life America and Students for Life of America have notably not focused on Nevada in their campaign strategies.

Growing Latinx voting bloc in North Carolina 

In North Carolina many Democrats are campaigning in opposition to a 12-week abortion ban that the Republican-majority legislature passed last year after overriding Democratic Gov. Roy Cooper’s veto.

In a high-profile race for governor, Democratic Attorney General Josh Stein faces Republican opponent Lt. Gov. Mark Robinson, who has previously said he believes “there is no compromise on abortion,” according to NC Newsline. The lieutenant governor is now facing calls to withdraw from the race over comments made on a pornography website years ago, and Stein has started racking up endorsements from prominent state Republicans.

Iliana Santillan, a political organizer who supports abortion rights, has focused on mobilizing Latinos, a growing voting bloc in the state. The executive director of progressive nonprofit El Pueblo and its political sister group La Fuerza NC told States Newsroom she’s talked to many young women motivated to secure their own reproductive rights, including her college-age daughter. She said the Latinx community faces additional reproductive care barriers such as language and transportation, with undocumented immigrants scared to cross state lines without a driver’s license.

Santillan also said there’s a misconception that all Latinos are against abortion because they’re Catholic, when in reality opposition to abortion skews among older voters.

“With older folks, the messaging that we’ve tested that has worked is: ‘We don’t want politicians to have a say in what we do with our bodies,’” Santillan said.

Motivated voters in Pennsylvania

Pennsylvania, with its 19 electoral votes, is the largest swing state and considered essential to win the White House.

In a poll conducted this month by Spotlight PA and MassINC Polling Group, abortion ranked as the fifth most-important concern in the presidential race for likely voters, with 49% naming it as among their top issues.

The issue is far more important to Democrats, however, with 85% calling it a top issue compared with 17% of Republicans. Among those who aren’t registered with either major party, 49% called it a top issue.

In 2022, voters surprised pundits by sending enough Democrats to the state House to flip it blue. Voters were responding to the Dobbs decision, Democratic Gov. Josh Shapiro told Pennsylvania Capital-Star at a recent Harris campaign event.

Shapiro also won in 2022, and so far his administration has supported over-the-counter birth control pills and ended the state’s contract with a network of anti-abortion counseling centers. He said his administration would not defend a current state law that prohibits state Medicaid funding from being used for abortions.

Abortion isn’t protected under Pennsylvania’s state constitution, but it remains legal up to 24 weeks’ gestation, and clinics there have seen an influx of out-of-state patients.

Wisconsin abortion services resume

After more than a year without abortion access, reproductive health clinics in Wisconsin resumed abortion services in September 2023, shortly after a judge ruled that the 1849 state law that had widely been interpreted as an abortion ban, applied to feticide and not abortion. A state Supreme Court race a few months earlier saw Justice Janet Protasiewicz win in a landslide after campaigning on reproductive freedom.

Seven months later when Republican U.S. Rep. Mike Gallagher announced his resignation, Lyerly threw her hat in the ring, running as the only Democrat in the 8th District. She now faces businessman Tony Wied. Although in the past it was considered a swing district, it has leaned conservative in recent election cycles. With the redrawn maps and national support, Lyerly said it’s a competitive race.

“We have the potential to really fix, not just reproductive health care, but health care,” Lyerly told States Newsroom. “Bring the stories of our patients forward and help our colleagues understand, build those coalitions and help to gain consensus that’s going to drive forward health care reform in this country.”

Wied’s campaign website does not mention abortion or his policy proposals related to health care, though the words “Trump-endorsed” appear prominently and abundantly throughout the site. Wied hasn’t said much about the issue beyond it should be a state issue, but the two are scheduled to debate this Friday night. His campaign declined an interview.

Currently the only OB-GYNs who serve in Congress oppose abortion. If Lyerly wins in November, she would not only change that (potentially alongside Minnesota Sen. Kelly Morrison) but also could help flip party control in the U.S. House of Representatives.

Most Wisconsin voters oppose criminalizing abortion before fetal viability, according to a poll this year by the University of Maryland’s Program for Public Consultation.

Patricia McFarland, 76, knows what it’s like to live without abortion access. For more than 50 years, the retired college teacher kept her pre-Roe abortion a secret, having grown up in a conservative Irish Catholic family like many of her suburban Milwaukee neighbors.

McFarland told States Newsroom she has been politically active most of her life, but the Dobbs ruling dredged up the physical and emotional trauma from the illegal procedure she had alone in Mexico City. Now, McFarland rarely leaves home without her “Roe Roe Roe Your Vote” button, engaging anyone who will talk to her about the dangers of criminalizing pregnancy.

The mother and grandmother said she’s been canvassing and doing informational sessions with her activist group the PERSISTers, as well as the League of Women Voters. As she has warned fellow Wisconsities about the federal power over their reproductive freedom, she said the enthusiasm for abortion rights in her state is palpable.

“For women my age,” McFarland said, “we don’t want our grandchildren to lose their ability to decide when to become a mother.”

Georgia Recorder’s Jill Nolin contributed to this report.

GET THE MORNING HEADLINES.

SUBSCRIBE