The Planned Parenthood clinic in New Orleans was open for over 40 years but stopped seeing patients at the end of September after federal Medicaid funding cuts. Abortion opponents are looking for more ways to pull funds from the organization, despite legal abortion care making up a small portion of the services affiliated health centers provide. (Photo by Greg LaRose/Louisiana Illuminator) 

Anti-abortion organizations and Republican elected officials are searching for more ways to prevent Planned Parenthood from receiving federal resources after congressional Republicans successfully cut off federal Medicaid funding until at least July 2026.

Letters written by activist organizations and Republican elected officials show stated goals of barring Planned Parenthood health centers from receiving federal money of any kind and pulling them from the 340B drug pricing program. With it, Title X-funded centers can receive significant discounts on prescription drugs, allowing the purchase of more medications and the ability to reach more patients.

Anti-abortion activists also expect proposals for further restrictions on Planned Parenthood’s access to Medicaid in health care legislation in early 2026.

In July, Republican members of the House and Senate passed a sweeping budget reconciliation bill that included a one-year provision barring clinics from receiving federal Medicaid reimbursement if they offer abortion services and billed Medicaid more than $800,000 in fiscal year 2023. The rule largely affects Planned Parenthood because of the high dollar amount, but some large independent clinics have also been affected.

Since then, more than 20 Planned Parenthood clinics nationwide have closed their doors, many of which did not provide abortion services. Others have laid off staff, including in Ohio. Maine Family Planning, the state’s largest reproductive health care provider, also offered primary care services at three of its 18 clinics but discontinued those services at the end of October because of the funding loss.

Katie Rodihan, director of state advocacy communications for Planned Parenthood Action Fund, said in a statement that those actions would make medication more expensive and take away access to birth control, testing and treatment for sexually transmitted infections, and cancer screenings.

“These anti-abortion lawmakers are so hellbent on shutting down Planned Parenthood that they’re willing to sacrifice your health care,” Rodihan said. “No matter what attack anti-abortion groups and politicians launch, Planned Parenthood Action Fund will always be ready to fight back for patients.” 

Opposition to the organization receiving federal funding is rooted in a belief that its main purpose is to provide abortion care, when in fact abortion makes up about 4% of the services Planned Parenthood clinics provide nationwide, according to the most recent annual report. But anti-abortion groups and many Republican lawmakers object to federal dollars being associated with legal abortion care in any way, even if it’s not directly paying for the procedure except in limited circumstances under the law.

In late September, Oklahoma Republican Gov. Kevin Stitt sent a letter to the administrator of the federal Health Resources and Services Administration, a division of the U.S. Department of Health and Human Services, asking that the agency revoke Planned Parenthood’s 340B drug pricing eligibility and reject any future requests for that designation. The letter is also signed by the Republican governors of Alabama, Arkansas, Indiana, Iowa, Louisiana, Ohio, Tennessee, Utah, West Virginia and Wyoming.

Several Republican-led states, including Ohio and Indiana, have also recently tried to cut Planned Parenthood off of state Medicaid funding.  

“States across the country are acting to ensure taxpayer dollars are not used to fund or promote abortions, and in turn, these clinics are seeking roundabout ways to maintain their funding,” Stitt wrote. “Even if Planned Parenthood affiliates with pro-life laws refrain from using federal funds for abortion, the organization’s national infrastructure still benefits, enabling abortion expansion in states where abortion is legal … .”  

Instead, Stitt suggested that money be allocated to community health centers and rural hospitals.

The letter was sent five days before the government shutdown started on Oct. 1, and no action has been taken by the agency so far since reopening on Nov. 12.

Argument traces back to COVID loans

Students for Life of America, an anti-abortion group with more than 2,000 student chapters nationwide, is leading the effort to pressure Republican President Donald Trump and his administration to disqualify Planned Parenthood as a vendor with the federal government. Called “debarment,” the administrative process usually applies to vendors accused of wrongdoing — such as fraud, embezzlement, failure to perform or tax evasion — and is determined by  the U.S. General Services Administration.

A vendor who is debarred cannot receive federal money of any kind for a period of three years. There is also a lesser penalty of suspension, which lasts up to 12 months.

Kristi Hamrick, Students for Life’s vice president of media and policy, told States Newsroom that members started discussing the idea toward the end of Trump’s first term, but since it involves a long administrative process, there wasn’t enough time to pursue it before Democratic President Joe Biden took office.

Students for Life sent a letter to the U.S. Small Business Administration on Oct. 22, along with a letter to the president’s office signed by more than 50 other anti-abortion groups, encouraging them to start the process of debarment. There has not been a response from the small business agency so far, Hamrick said, but employees only returned to work recently following the 43-day shutdown.  

The letter to Trump is signed by other well-known anti-abortion organizations, including Susan B. Anthony Pro-Life America, Family Policy Alliance, Americans United for Life, Family Research Council and National Right to Life.

Along with allegations of financial fraud, the letter to the Small Business Administration accuses Planned Parenthood of a host of other violations, and mentions lawsuits filed against the organization led by Republican attorneys general in states like Missouri and Texas.   

Hamrick said the letter went to the agency because Republican U.S. Sens. Rand Paul of Kentucky, and Joni Ernst of Iowa wrote a letter of their own in March about alleged fraud committed by Planned Parenthood. They wrote that many of its affiliates — which are independent nonprofit organizations — applied for and received Paycheck Protection Program loans of about $120 million during the COVID pandemic.

The two senators said Planned Parenthood was not eligible for the loans because organizations with more than 500 employees were excluded. Planned Parenthood argued the national organization and the regional affiliates are separate — the affiliates applied individually — and guidance for the loans was later updated by the Biden administration to allow them. Most of the loans were forgiven.

Other entities were also accused of abusing the intent of the Paycheck Protection Program, including Catholic Charities USA, a humanitarian aid arm of the Catholic church with more than 3,000 employees. The Associated Press reported the organization and its member agencies received about 110 loans worth up to $220 million, which were forgiven.

Hamrick said Republicans in Congress should keep up their efforts to bar Planned Parenthood from Medicaid reimbursements, but there’s more that can be done.

“We won’t have to keep voting on whether or not Planned Parenthood can be funded in any one program, such as Medicaid, if they’re not eligible to be funded at all,” Hamrick said.

States still heavily affected by cuts

Hamrick said she hopes to see Republican lawmakers extend the Medicaid cuts for 10 years or more this time around, because this first round of cuts didn’t yield any “dire consequences.”

Dr. Chelsea Daniels, a member of the Committee to Protect Health Care’s Reproductive Freedom Task Force, disagrees. She moved out of Florida two months ago, where she worked in Miami for Planned Parenthood of Florida, and where she tried to help pass an amendment that would have enshrined a right to abortion into the state constitution. Although 57% of voters approved it, 60% is required by Florida law.

That demoralizing loss on top of many days where she had to tell people she legally couldn’t help them became too much. Florida has a six-week abortion ban, with exceptions for rape, incest, fatal fetal abnormalities and human trafficking. But Daniels said she routinely saw sexual assault victims who weren’t able to get an abortion regardless of any documentation they presented.

“Florida honestly just kind of pulverized me. I felt ground up by the end of it,” Daniels said.

She moved to California, and now practices as a family planning physician at Planned Parenthood of Orange and San Bernardino Counties. In her first week of employment there, the affiliate announced it would close its primary care practice because of the Medicaid cuts, laying off 77 staffers and sending 13,000 patients across seven clinics looking elsewhere for basic care such as treatment for high blood pressure, vaccines, annual wellness exams and diabetes management. The final day of service will be Dec. 10.

Daniels wasn’t part of the layoffs, but she said that loss of care for so many patients is devastating.

“I left Florida for good reason, but the state of the country writ large is not good,” Daniels said. “And I don’t think our federal government cares. They think it’s just collateral damage and punishment for anyone who’s ever been associated with Planned Parenthood.”

Health care providers march for abortion rights at a Madison rally in October 2022. (Photo by Baylor Spears/Wisconsin Examiner)

The Wisconsin State Senate passed SB 553 on Tuesday, Nov. 18, in their last floor session of the year. This bill, purportedly written to define abortion, is actually a covert attempt to exclude abortion from the broader scope of reproductive healthcare. 

Anti-abortion legislators pushing this bill are attempting to play to their religious base who voted them into office to promote an anti-abortion agenda. This is a failing strategy, however, when we’ve seen in countless elections around the country that abortion access is a winning issue, including in Wisconsin. 

The bigger problem, though, is how proponents of the bill are describing it as a way to allow physicians to safely provide care and clarify abortion restrictions, by excluding medical procedures intended to save a person’s life, such as C-sections, the removal of dead embryos, and treatment for ectopic pregnancy, to name a few, from the definition of “abortion.”

Lawmakers are misleading people into thinking that this bill will further define the nuances of care that physicians provide and actually allow, rather than restrict, the provision of care. 

This could not be farther from the truth. We have too many examples nationwide of physicians practicing in states hostile to reproductive rights who are unsure about what care is legal to provide, ultimately leading to unnecessary delays in caring for pregnant people. It is telling that physicians who provide miscarriage and abortion care were not called on to write the text of this legislation. 

Nationally, we have already seen pregnant people die preventable deaths while waiting for essential care for early pregnancy complications because lawmakers stirred confusion and meddled in healthcare decisions. This bill will amplify those dangers in our state, where 13.2 people out of 100,000 die in pregnancy, childbirth, or 42 days after termination of a pregnancy. A study by researchers at the University of Washington and Massachusetts General Hospital showed that these trends, across race, have been worsening in Wisconsin since 2010. 

Black birthing people in Wisconsin account for a disproportionate amount of the disparities in maternal mortality. Adding these racial and systemic inequities to a bill that will delay care for folks across the board, it’s nearly guaranteed that certain groups will have a greater share of these poor outcomes.

As a family medicine and obstetrics physician, I care for folks across the entire spectrum of pregnancy — including miscarriage and abortion. I want to emphasize the similarities in those two scenarios and how they significantly overlap. 

The procedure performed for abortion is identical to the procedure performed for a miscarriage. When a person has a miscarriage or an abortion in the first trimester, generally, a procedure called a “manual vacuum aspiration” or “MVA” can be performed to remove the pregnancy contents. For miscarriages or abortions that occur later in pregnancy, the procedure involves dilating the cervix and removing the pregnancy via a procedure called a dilation and curettage (D&C) or dilation and evacuation (D&E), based on gestational age. 

Additionally, when managing a miscarriage with medications, physicians use mifepristone and misoprostol — medications that lawmakers and anti-abortion activists are actively seeking to restrict because they’re used identically in first-trimester abortions. 

That is the underlying, root issue here: amplifying and reinforcing stigma and criminalization around abortion. 

Carving out the definition of abortion doesn’t actually create medical clarity for providers; instead, it creates a stigmatizing health care space where patients have to disclose and justify why they need certain essential health care. People deserve care and compassion, not judgment or punishment. 

Whether due to miscarriage, abortion, or self-managed abortion, pregnancy loss is not a crime. People should not fear jail time for getting the health care they need. SB 553 aims to differentiate abortion based on intent — a dystopian concept where politicians are in the private space of a doctor’s office. Wisconsinites currently have an opportunity to combat this stigma and call out politicians who are actively harming patients and the patient/provider relationship. 

In my practice already I have seen patients who are hesitant to disclose their pregnancy history for fear that sharing a history of needing abortion care could get them in trouble. Imagine how that influences future decisions to engage with health care providers around miscarriage, abortion and pregnancy complications. 

Wisconsin already heavily regulates how medications for miscarriage are prescribed, including a mandatory in-person dispensing requirement. Those of us who offer this care should not need to feel we must pit our medical expertise against legal jargon when it comes to providing normal, essential care. We need people to be able to trust their health care providers, and we need politicians to stop making laws that pigeonhole physicians into even narrower definitions of care. 

Now that this dangerous bill has been passed in the Senate, it will next head to the Assembly before ultimately landing on Gov. Tony Evers’ desk. In his seven years in office Evers has consistently vetoed anti-abortion legislation, and he has vowed to veto any bill that would limit access to abortion, including SB 553. 

As a physician, it’s devastating to rely on a single individual to preserve my ability to practice safe and necessary health care for countless people and families across the state without political interference. 

There is no other type of health care that is regulated in the unique, stigmatizing, harmful way that abortion care is. Our state politicians need to understand that health care decisions should remain between a patient and their trusted provider. SB 553 ignores that and should not become law. 

Federal regulations around mifepristone, which has provided abortion access across the United States, are being challenged in multiple lawsuits from opposing directions. (Getty Images)

Despite its strong safety record, the abortion and miscarriage drug mifepristone has been taken to court in several conflicting lawsuits, where some plaintiffs argue the drug should be easier to access, and others say it should be more restricted. 

The medication, sometimes prescribed through telehealth and sent to patients by mail, has provided abortion access across the United States and become a prime target for abortion opponents. 

A group of ongoing federal lawsuits challenges the U.S. Food and Drug Administration’s 2023 decision to maintain special requirements for the abortion pill, with a federal court in Washington upholding the FDA’s decision, a federal court in Hawaii asking the FDA to justify its decision, and a court in Virginia still to rule. Yet another lawsuit, filed Nov. 13 by the American Civil Liberties Union, challenges the FDA under the Freedom of Information Act, alleging the agency has, without giving a reason, refused to disclose the parameters of its mifepristone review and related communications with outside groups. 

For more information and updates on pending mifepristone cases, visit the Mifepristone Litigation and Federal Action Tracker from the Center on Reproductive Health, Law, and Policy at the University of California, Los Angeles.

Heidi Purcell et al. v. Robert F. Kennedy Jr. et al.

• Court: U.S. District Court for the District of Hawaii
• Claims: Originally named Chelius v. Wright and filed Oct. 3, 2017, by the American Civil Liberties Union on behalf of a family doctor and several medical associations, this lawsuit challenges the FDA’s mifepristone restrictions as unduly burdensome and arbitrarily restrictive, in violation of the Administrative Procedure Act.
• Stakes: This case could determine whether the FDA can continue requiring special certifications for patients and providers, which plaintiffs argue deter and delay care, and present privacy risks for patients and providers post-Roe. If plaintiffs succeed, mifepristone could become easier to dispense and access throughout the country.
• Status: On Oct. 30, Judge Jill Otake, nominated by Republican President Donald Trump, ruled the FDA did not properly justify its 2023 decision or consider all of the evidence when it decided to maintain current restrictions on mifepristone. She ordered the agency to reconsider its decision. Plaintiffs did not seek to vacate the regulations in its lawsuit, so for now they remain in place pending the outcome of the FDA’s review and response to the court. A joint status report from plaintiffs and defendants on how the case should proceed is due Dec. 4.

Whole Woman’s Health Alliance et al. v. U.S. Food and Drug Administration et al. 

• Court: U.S. District Court for the Western District of Virginia
• Claims: On May 8, 2023, abortion providers in Virginia, Montana, and Kansas challenged the FDA’s mifepristone rules as unduly burdensome and arbitrarily restrictive, similar to the claims in Purcell v. Kennedy.
• Stakes: If plaintiffs succeed in this case, mifepristone could become easier to dispense and access.
• Status: U.S. District Judge Robert S. Ballou, nominated by Democratic President Joe Biden, heard oral arguments on the motions for summary judgment in May but has not yet issued a decision.

Washington et al. v. FDA et al.

• Court: U.S. District Court for the Eastern District of Washington
• Claims: On Feb. 23, 2023, Washington and initially 11 other states challenged the FDA’s mifepristone regulations as burdensome and unnecessary.
• Stakes: Expanding mifepristone access was on the line in this case.
• Status: Terminated. Judge Thomas O. Rice, nominated by former Democratic President Barack Obama, ruled this summer that the FDA’s review and decision regarding the mifepristone restrictions was reasonable, not arbitrary or capricious.  

American Civil Liberties Union v. FDA

• Court: U.S. District Court for the District of Maryland
• Claims: On Nov. 13, 2025, the ACLU sued the FDA arguing it has not complied with the Freedom of Information Act. The nonprofit law firm in August sought  expedited records around the parameters of the FDA’s ongoing review of mifepristone and communications with outside groups. The ACLU alleges the agency has failed to provide a determination regarding the request.
• Stakes: Records released as part of this lawsuit could bring transparency to HHS’ review of the abortion pill.
• Status: The government has not yet filed a brief in response to the lawsuit, which has been assigned to Magistrate Judge Timothy J. Sullivan. 

Another group of lawsuits challenge state abortion pill restrictions, arguing that federal law, which allows medication abortions to be prescribed via telehealth and by the mail up to 10 weeks’ gestation, supersedes state laws.

GenBioPro v. Kristina Raynes et al.

• Court: U.S. Court of Appeals for the Fourth Circuit (on appeal from U.S. District Court for the Southern District of West Virginia)
• Claims: In 2023, mifepristone generic manufacturer GenBioPro sued West Virginia after the state criminalized abortion and explicitly banned prescription of mifepristone by telemedicine. The company argued federal law preempts West Virginia law and that Congress authorized only the FDA to impose restrictions on access to mifepristone.
• Stakes: A ruling in plaintiffs’ favor could have made abortion drugs easier to access in a state that has cut off access to pregnancy termination in most circumstances.
• Status: Terminated. District court Judge Robert C. Chambers, nominated by former Democratic President Bill Clinton, found in 2023 that the Food and Drug Administration Amendments Act did not preempt West Virginia’s abortion regulation. The U.S. Court of Appeals for the Fourth Circuit affirmed the lower court’s decision in July. 

Amy Bryant v. Timothy Moore et al.

• Court: U.S. Court of Appeals for the Fourth Circuit (on appeal from U.S. District Court for the Middle District of North Carolina)
• Claims: In 2023, North Carolina Dr. Amy Bryant sued her state over medication abortion restrictions, arguing the FDA’s mifepristone policy preempts state restrictions, which require in-person prescribing, dispensing and administering; prohibit providers other than physicians from prescribing mifepristone; mandate the scheduling of an in-person follow-up appointment; and require non-fatal adverse events reported to the FDA.
• Stakes: The case could limit states’ ability to restrict medication abortion.
• Status: Chief Judge Catherine C. Eagles, nominated by Obama, found that some restrictions were preempted by federal law but upheld other state requirements, including mandatory ultrasounds and waiting periods. The case is pending appeal.

Birthmark Doula Collective et al. v. Louisiana et al. 

• Court: Louisiana’s 19th Judicial District Court
• Claims: On Oct. 31, 2024, birth workers, medical professionals and a pregnant woman challenged a Louisiana law that classifies mifepristone and misoprostol as controlled dangerous substances, even though the FDA does not. They argue the classification delays access to these medications during emergencies, risking the health and safety of patients experiencing miscarriages.
• Stakes: Drugs used for emergencies during pregnancy could become easier for providers to access if plaintiffs prevail.
• Status: Pending in state trial court. In May, the court held a hearing on a motion to dismiss and ruled the challenge can proceed.

Another group of lawsuits seek to reimpose more restrictions on mifepristone and argue the FDA erred in its decision to allow abortion medication prescribed through telehealth and sent through the mail. Both cases cite anecdotes of women being coerced or drugged by partners to argue in-person visits are in the best interest of abortion patients. 

Missouri et al. v. FDA et al.

• Court: U.S. District Court of Eastern District of Missouri
• Claims: Originally filed Nov. 18, 2022 by a group of anti-abortion doctors and groups that claimed that mifepristone is highly dangerous and the FDA unlawfully loosened restrictions. The U.S. Supreme Court rejected the case last summer, determining plaintiffs did not have standing to sue and remanded it to lower courts.
• Stakes: If plaintiffs prevail, the FDA could bar telehealth and mail delivery of medication abortion, which would curtail access throughout the country.
• Status: The lawsuit was resurrected by attorneys general in Idaho, Kansas and Missouri. It was transferred last month from Trump appointee Matthew Kascmaryk’s court in Texas to Trump appointee Cristian Stevens’ court in Missouri. 

Louisiana et al. v. FDA et al.

• Court: U.S. District Court for the Western District of Louisiana Lafayette Division
• Claims: Filed Oct. 6, 2025, the state of Louisiana and resident Rosalie Markezich are suing to vacate the FDA’s 2023 decision to remove the in-person dispensing requirement. Markezich says she was coerced by a former partner to take the abortion pill, which she says he ordered in her name and received by mail.
• Stakes: If plaintiffs prevail, the FDA could bar telehealth and mail delivery for abortion medication, which could curtail access throughout the country.
• Status: The case is pending in district court before Trump appointee Judge David C. Joseph.

Read more about the FDA’s high-stakes abortion pill safety review.

Tomorrow, a look at efforts to both reinforce and crack shield laws across the country.

U.S. Health and Human Services Secretary Robert F. Kennedy Jr., shown here in September, cited a white paper funded and self-published without peer review by anti-abortion groups as grounds for federal scrutiny of a key abortion medication’s safety. (Photo by Andrew Harnik/Getty Images)

The U.S. Food and Drug Administration is facing increasing pressure from abortion opponents and advocates over how it regulates a drug that has become central to abortion access since Roe v. Wade was overturned three years ago.

Abortion medication manufacturers, health care providers and state attorneys general have continued to petition and sue the agency to loosen regulations for mifepristone, a key abortion drug. At the same time, anti-abortion policy leaders have successfully lobbied the Trump administration — on the basis of a self-published white paper funded by anti-abortion groups — to review mifepristone’s safety again and consider reviving old restrictions.

On Thursday, Nov. 13, the American Civil Liberties Union sued the FDA under a federal public records law for refusing to disclose the parameters of its new review, as well as communications with outside groups. 

Abortion opponents have called on the FDA to ban telehealth abortion, which has allowed abortion rates to rise slightly nationally despite state bans. A shift in mifepristone regulation could dramatically change abortion access throughout the country, and health advocates and litigators on both sides of this dispute are closely watching how the agency justifies any changes. 

Abortion-rights advocates have also seized on a recent federal ruling from a Trump-appointed judge, which orders the FDA to justify its 2023 decision to maintain restrictions on the abortion pill and argues the agency excluded from its review, without explanation, a wealth of research and evidence that it previously accepted.

Reproductive health legal experts say the action could prevent the anti-abortion white paper from being the main thing the agency considers before modifying its policy. 

“This is where the debate, both in the courts and the FDA, is taking place, around how it is considering evidence, making sure it is reviewing valid evidence and not junk evidence, and getting really reasoned explanations based in that evidence, as opposed to politics or ideology,” said Diana Kasdan, the legal and policy director for the Center on Reproductive Health, Law, and Policy at the University of California, Los Angeles School of Law. 

Where reproductive health legal experts say the abortion pill has been over-regulated for a drug with a high safety record, anti-abortion attorneys, like senior counsel Erik Baptist of the Christian-right powerhouse Alliance Defending Freedom, have been arguing that the drug’s risks are exacerbated by its increased availability. The law firm, which was integral to the overturning of Roe v. Wade, is also representing a Louisiana woman in an abortion medication lawsuit against the FDA. 

“The FDA’s actions have created an even more unsafe environment for women,” Baptist said. 
“We expect the Trump administration to zealously appeal this dangerous decision.”

‘It’s the same data set, essentially’

Putting pressure on FDA’s review team are national anti-abortion policy groups like Americans United for Life, one of several groups that criticized the agency for approving a new generic version of mifepristone this fall. The group is part of a coalition that helped produce and, at the end of April, publicize the white paper on mifepristone’s safety, which U.S. Health and Human Services Secretary Robert F. Kennedy Jr. soon after cited as the basis for ordering a new review of the drug. 

The Ethics and Public Policy Center’s self-published paper analyzed a commercially available data set of all-payer health insurance claims from 2017 through 2023 and found an 11% rate of severe adverse events — 22 times higher than the less than 0.5% rate that’s on the label for mifepristone. Reproductive health researchers have criticized the paper’s broad classification of serious adverse events while noting it also reports low rates of the most serious side effects associated with medication abortion, like sepsis (0.1%), transfusion (0.15%), and hospitalization related to the abortion (0.66%). Meanwhile more than 100 peer-reviewed studies have found low rates of serious adverse effects, including for abortion medication provided through telehealth.

The paper, which has also been cited by lawmakers like U.S. Sen. Josh Hawley of Missouri, did not go through a scientific peer review, and the Ethics and Public Policy Center would not disclose the exact data set used. Spokesperson Hunter Estes previously told States Newsroom the group was not legally permitted to provide the data set but that the paper’s description of it should be enough to replicate the study.  

Americans United for Life CEO John Mize said he hopes to see the paper peer-reviewed in the near future. But he said the coalition has for now achieved its goal of convincing the FDA to look at the same insurance claims data set analyzed by the Ethics and Public Policy Center and then do its own analysis.

“What we’ve been told is the FDA is doing their own internal analysis of the EPPC data,” Mize said. “It’s to be seen what the FDA does with methodology. That’s the important component, because the data is the data. It’s the same data set, essentially.”

HHS did not respond to questions about its ongoing mifepristone review or the federal judge’s recent order to review all of the safety data, instead directing States Newsroom to an Oct. 2 post on X from Kennedy defending both the FDA’s review of mifepristone and its approval of a second generic version. 

“Recent studies already point to serious risks when mifepristone is used without proper medical oversight,” Kennedy posted. “@US_FDA only approved a second generic mifepristone tablet because federal law requires approval when an application proves the generic is identical to the brand-name drug.”

But if the FDA’s review ultimately draws different scientific conclusions than the anti-abortion movement, Mize said his side won’t stop pursuing challenges to the drug. 

“If it comes out that it’s not nearly as dangerous as what EPPC is reporting, and the data appears to be quality and not skewed by politics, then personally, I might take a different perspective,” Mize said. “But I am still fairly confident that a drug that induces abortion at home without clinical oversight is probably something that needs a little bit more scrutiny. … We might continue to fine tune methodology and look at pursuing other avenues of peer review.”

Politicized science 

Anti-abortion policy and legal advocates have been lobbying for tighter restrictions on mifepristone since the drug was first approved in 2000, and especially since the FDA started dropping restrictions, such as allowing the regimen to be used until 10 weeks’ gestation instead of seven in 2016. After Roe v. Wade was overturned, the FDA under President Joe Biden’s administration permanently dropped the in-person dispensing requirement, allowing people to obtain the abortion pill via telehealth and through the mail. 

But the FDA maintained other regulations, as part of the drug’s Risk Evaluation and Mitigation Strategy, such as requiring prescribers, pharmacists and patients to sign forms agreeing to meet certain qualifications and acknowledging the drug’s common side effects, like heavy bleeding and nausea, and potential severe risks, like infection. Abortion providers have argued that some of the rules are unnecessary and burdensome.

Of the more than 20,000 prescription drug products approved by the FDA, less than 100 have REMS, and many of those are injectables with serious side effects like coma and death. In a quarter century, the FDA has reported 36 deaths associated with, but not necessarily caused by, mifepristone.

U.S. District Judge Jill Otake on Oct. 30 ordered the FDA to review all the relevant safety data on mifepristone, ruling that the agency erred years ago when it failed to justify maintaining strict rules on the drug despite a strong safety record after 25 years on the market. One week later, the U.S. Senate Democratic Caucus sent a letter to Kennedy and FDA Commissioner Martin Makary demanding the ongoing mifepristone review be based on science and evidence. 

“That court order reinforces that, in conducting this new review, FDA may not cherry-pick junk science serving an anti-abortion agenda, but must instead look at the full body of evidence both confirming mifepristone’s safety and underscoring the harms of the FDA’s onerous restrictions,” reads the letter obtained by NOTUS. The senators ask HHS to respond by Nov. 28, to questions about the evidence being considered and the methodology.

Anti-abortion research groups also produced new studies for their first legal attempt to reinstate restrictions on mifepristone in a lawsuit filed in 2022. The plaintiffs persuaded a Trump-appointed district court judge to order the FDA to change its policy on the basis of studies funded by the anti-abortion movement that were later retracted by the journal’s publisher because of their methodology. The U.S. Supreme Court rejected the case, not on the merits but because plaintiffs did not have proper standing. The high court is expected to consider similar questions again, as at least seven mifepristone-focused lawsuits work their way through the lower courts.

University of Pittsburgh law professor Greer Donley said that to meet the FDA’s policy on approving new drug regulations, the agency will need more than one or two outlier studies as justification. 

“To survive arbitrary and capricious review, they have to provide a reasoned decision that’s based on the facts, and if the facts taken as a whole suggest that this is a safe and effective drug, even though there’s one new paper out there that suggests it’s maybe a little less safe than it was before, they’re going to have to justify why that one paper outweighs the 50 papers on the other side that were published in peer-reviewed journals,” Donley said. “I don’t know how they could explain that.”

Donley has studied mifepristone regulation closely and said she watched the science around the medication become increasingly politicized, much more than other drugs. While controversial medicine, like gender-affirming care, involve drugs with multiple purposes, mifepristone was approved for the explicit purpose of ending a pregnancy. 

The FDA’s medication abortion regimen involves another drug, misoprostol, which was approved to treat ulcers, and is used off-label for abortions and miscarriages. It has not faced the same scrutiny as mifepristone. Abortion providers have said they would likely pivot to a misoprostol-only regimen if mifepristone were to become much harder to access, which it has even for miscarriages in states that have banned abortion entirely, like Kentucky and Louisiana.

Mifepristone manufacturer Danco Laboratories last year confirmed ongoing efforts to add miscarriage management as an approved use to its drug label. Were that to happen, it could be a game changer for access, Greer said.  

“It actually would be a pretty huge deal if they added it,” she said. “Because all of these attacks against mifepristone for abortion, even if they succeed, then mifepristone would theoretically remain on the market for miscarriage care, and then it could be used off-label for abortion.”

Read the latest on legal cases over mifepristone winding their way through the courts. 

Tomorrow, a look at efforts to both reinforce and crack shield laws across the country.

The Trump Administration yanked more than $65 million in Title X funding from clinics nationwide in April, and some of that funding is still frozen, leaving clinics struggling to offer free or low-cost contraception and other family planning services. Some states are suing to get the funding back, but Idaho officials chose to forego it due to a conflict with state law. (Getty Images)

The Idaho Department of Health and Welfare quietly declined the entirety of its annual $1.5 million federal Title X funding, leaving patients statewide without free and low-cost contraception and reproductive health care services from a key family planning program. 

Though thousands of Idahoans relied on the health care provided through Title X for over 50 years, the state made no public announcements as the decision took effect in April, leading to the closure of 28 out of 43 — about 65% — Title X-funded family planning clinics in public health districts throughout the state, according to the Idaho Department of Health and Welfare. 

After turning down the Title X money entirely, Health and Welfare said there are no plans for the state to make up the difference by increasing the family planning budget. 

In one district, Eastern Idaho Public Health, spokesperson Brenna Christofferson said contraception services are no longer available at all, which has only been communicated to existing Title X patients. Sexually transmitted infection testing and treatment, and breast and cervical cancer screenings are still provided using different funding sources.

Many of the clinics closed in eastern Idaho, including more populated cities such as Twin Falls and Idaho Falls, and more rural areas such as Salmon, Rexburg and Rigby. Title X services also ended at clinics like Terry Reilly Health Services in one of southwestern Idaho’s most populous areas of Nampa and Caldwell. 

The decision to forego the funds came at the same time the Trump administration yanked more than $65 million in Title X funding from Planned Parenthood clinics and some independent reproductive health clinics across the country, much of which is still frozen, including for Idaho’s last remaining Planned Parenthood in Meridian. Spokesperson Nicole Erwin said Planned Parenthood continues to fundraise to help offset costs and keep family planning services affordable on a sliding scale.

Although Idaho’s move came at the same time national attention was focused on the frozen funds, it was a separate decision, according to Health and Welfare.

“The discontinuation of Title X funding … was not related to the federal administration’s Title X policy changes earlier this year,” said AJ McWhorter, spokesperson for the Health and Welfare Department. “The department made the decision to decline the funding to remain compliant with current Idaho laws concerning parental rights and counseling on pregnancy options.”

Nationally, seven out of 16 grantees have had their funding restored, while others have been waiting nearly seven months for resolution, said Clare Coleman, president and CEO of the National Family Planning and Reproductive Health Association.

“For Idaho to walk away from the money doesn’t just disadvantage and imperil young people, it imperils all the people in the state,” she said. “It hurts women, it hurts men, and it hurts young people.”

Coleman’s organization sued the U.S. Department of Health and Human Services over the frozen funds, and the case is still pending. A coalition of 20 Democratic-led states sued federal government agencies in July to halt its actions related to several social safety net programs, including Title X. That case is paused while the government is shut down.

In 2023, U.S. Health and Human Services reported Title X provided care to nearly 3 million people nationwide, a 7% increase from the prior year. Under the program guidelines, people with family income levels at or below 100% of the federal poverty level can receive services free of charge, while those making up to 250% of the federal poverty level pay a discounted rate on a sliding scale.  

The program, established by Congress and signed by former Republican President Richard Nixon in 1970, is intended to prioritize low-income or uninsured people, including those who make too much to qualify for Medicaid, who may not otherwise have access to family planning and reproductive health services. Abortion services cannot be covered by Title X dollars.

Pregnancy options and parental consent 

The federal statute guiding the administration of Title X funds includes a section on adolescent services that says grantees cannot require the consent of parents or guardians before or after the minor has requested or received family planning services. Another section directs grantees to allow pregnant patients the opportunity to receive information and counseling regarding prenatal care and delivery, infant care, foster care, adoption and pregnancy termination. Idaho has a near-total abortion ban with few exceptions.

Idaho’s Legislature passed Senate Bill 1329 in 2024, requiring parental consent for “the furnishing of health care services” to a child, with the exception of lifesaving care. Idaho Capital Sun reported the law has also created difficulties for the state’s suicide hotline, because some minors need permission from a parent to receive certain services.

Coleman said the adolescent and pregnancy options requirements have long been part of Title X guidance, and it has not conflicted with state law because federal law should take precedence under the U.S. Constitution.

Idaho is one of at least two states that currently has no Title X funding, Coleman said, after Utah lost all of its Title X money when the Trump administration withheld funding from Planned Parenthood clinics, which were the only places offering those low-cost or free services. Planned Parenthood of Utah closed two of its centers — in Logan and St. George — in the wake of the decision to freeze funding. Logan is less than an hour away from eastern Idaho’s border.

Some states were temporarily left without Title X providers after the Trump administration’s actions in April, but the funding was restored at later dates for certain states, including Missouri and Mississippi. The federal health agency also restored funds in May for two states with abortion bans, Tennessee and Oklahoma, whose grants were revoked under Democratic President Joe Biden’s administration because of their refusal to include abortion among the options during pregnancy counseling. 

In a letter from HHS to Tennessee state officials providing notice of the award, the acting chief grants management officer wrote, “Tennessee is one of only two states to have lost funding for failure to comply with the Title X 2021 regulations requiring counseling and referral for abortion. The department is declining to enforce this provision against the state, and you may rely on this letter to that effect.” 

A total of 7,528 Title X clients were served across Idaho in 2024, McWhorter said. The 15 remaining family planning clinics are supported by other funds, and additional service sites may be added as funding becomes available. Those clinics are in two out of the state’s seven public health districts, which served about 1,400 people combined in 2024. 

The closures add another challenge in an already difficult landscape for sexual and reproductive health care in Idaho. A recent study found that 94 of 268 practicing OB-GYNs left Idaho between August 2022 and December 2024, and care is becoming harder to obtain, according to residents, who say wait times are longer and certain treatment is unavailable locally. 

Coleman said under Biden’s administration, when an entity lost Title X dollars for noncompliance or other reasons, there was an effort to reallocate the funding to another willing participant. Without that action, it would revert back to the U.S. Treasury, and the next opportunity for another Idaho entity to apply for Title X funding will be late 2026. 

Preventing unplanned pregnancies 

Amy Klingler, a clinician in rural eastern Idaho, told States Newsroom she was devastated by the closure of Eastern Idaho Public Health’s family planning clinic. She worked there in addition to another clinical job since 2006 and said there aren’t many other options for family planning care in that area of the state.

“Idahoans don’t trust doctors, but they trust their doctor,” Klingler said. “So when we see rural health care being eroded and doctors leaving Idaho or not coming to Idaho, I think that is really going to impact the health of people in our communities.”

The additional cuts to Planned Parenthood through Medicaid, along with overall Medicaid cuts that may force the closure of more rural hospitals and clinics, will force people to delay care until they are sicker and require more expensive medical care, Klingler said.

The minor consent for treatment bill had good intentions, she said, and in an ideal world, every child would feel comfortable talking to their family members about birth control. But she said she is confident there are young women who don’t get birth control because they don’t want to have that conversation with their parents. 

And with Idaho’s abortion ban, unplanned pregnancies either have to be carried to term or the person must go to another state where abortion is legal. It’s also a felony in Idaho for someone to take a minor to another state for an abortion without parental permission.

“Providing free birth control is really powerful if you’re trying to prevent unplanned pregnancies,” Klingler said.

On her last day at the family planning clinic in June, Klingler said the staffers cried together.

“We often ended the day by saying, ‘We did some really good work today,’” she said. “And to not be able to do that good work kind of hurts the heart.”

Idaho resident Lynlee Lord said she used nutrition assistance programs that helped ease some of the stress she was dealing with while pregnant in the aftermath of her partner’s death. Food insecurity can bring heightened risks of preeclampsia, preterm birth and NICU admission, research shows. (Courtesy of Lynlee Lord)

Millions nationwide could be cut off from access to government food assistance Saturday due to the shutdown, including those who are pregnant or have babies and young children.

That possibility brings back a lot of difficult memories for Lynlee Lord, a mom of three in rural Idaho. In 2014, when Lord was 24, her partner died by suicide. She was 11 weeks pregnant with his daughter and already had a 2-year-old son.

“I went from building my life with my best friend to not having anything, and having to move into income-based apartments,” Lord said.

She was also going to cosmetology school full-time in Boise, Idaho, nearly an hour away from where she lived, spending more than 12 hours away from home each day. She worked on her dad’s ranch and cleaned houses to earn gas money. She tried to keep her stress levels down, but the one thing she didn’t worry about was food, because she had benefits from the U.S. Department of Agriculture’s Supplemental Nutrition Assistance Program, or SNAP.

“It took a lot of pressure off of me,” she said.

Many studies have shown adequate nutrition is essential for a developing fetus, and a January study published in the Journal of the American Medical Association found food insecurity in pregnancy is associated with medical complications. The researchers defined food insecurity as being worried about running out of food before there’s money for more. Risks include preeclampsia, preterm birth and NICU admission. 

Those who did not have access to food assistance had the highest risk of complications, according to the January study. The increased rate was alleviated by food assistance. 

It’s unclear how many pregnant people use SNAP benefits on average, but the program helped feed 42 million Americans in 22 million households in the 2025 fiscal year, according to the USDA. A separate supplemental nutrition program for Women, Infants and Children — known as WIC — is often used simultaneously by participants. The federal government temporarily shored up WIC through October and promised more money, but whether the funding will last through November remains uncertain as the shutdown wears on.

The Trump administration has so far declined to use emergency funds to keep SNAP solvent while the government shutdown continues. Republican Senate Majority Leader John Thune said he won’t consider a Democrat-led standalone funding bill to keep the program going during the shutdown.

Though officials in some states are making moves to boost food assistance temporarily, others — including in Indiana and Tennessee — have refused to step in.

Lord doesn’t need food assistance anymore, but about 130,000 Idahoans still do and are set to lose their benefits starting on Saturday, Nov. 1. The Women, Infants and Children program, which helps families afford formula and other supplemental foods, could also soon run out of funds in certain states, including Idaho, the Idaho Capital Sun reported.

Instability and hard choices

Gestational diabetes — one of the more severe complications that can result from food insecurity — affects up to 10% of all pregnancies on average. The condition occurs when the placenta produces hormones that decrease insulin sensitivity, creating unstable blood sugars that necessitate a more strictly controlled diet and potentially the use of insulin or other medication to keep glucose levels in a normal range. Most cases are diagnosed in the third trimester, when the amount of insulin needed to keep blood sugars normal is at its peak.

Blood sugar can also be affected by stress, poor sleep, irregular meals and other physiological factors. If left untreated, or if glucose remains unstable through the last trimester of pregnancy, it can cause the fetus to grow too quickly, increasing the risk of stillbirth and other complications, like high blood pressure and low blood sugars in the baby after delivery.

Dr. Chloe Zera, chair of the Health Policy and Advocacy Committee for the Society of Maternal-Fetal Medicine, specializes in gestational diabetes and said she saw a patient on Tuesday who was worried about losing her SNAP benefits.

“Adding that on top of what is already a stressful diagnosis is incredibly challenging for people,” Zera said. “There’s so much guilt and shame and blame that goes along with gestational diabetes and diabetes in general in pregnancy.”

People with gestational diabetes who already have children and who are food insecure will also most often feed their children before themselves, Zera added.

“They’re going to make really hard choices that mean they have even less control over their nutrition,” she said.

Dr. Andrea Shields, an OB-GYN and maternal-fetal medicine specialist at the University of Connecticut, said uncontrolled gestational diabetes can cause low blood sugar in babies after delivery, which has been linked to neurodevelopmental issues later in life. If the SNAP benefits stop, she said, more people will have to get creative about finding ways to help pregnant patients without assistance from the federal government.

“This is a perfect example of why we pay taxes and why we want to help society in general, because we don’t need to create generational issues, which this will, because it impacts the unborn fetus,” Shields said.

Lord said if she was in the same situation today that she was 10 years ago, she might have had to consider an option that never crossed her mind at the time — an abortion. Even though it was her partner’s only child, and abortion is now banned in Idaho, Lord said she may have needed to find a way to end the pregnancy out of necessity, especially considering the costs of rent, child care, food and other expenses today.

“I would’ve probably picked my child that was living,” she said. “It was really scary for me back then, and I can’t even imagine in today’s world if that happened.”

UPDATE: This story was updated to include more information about WIC on Friday, Oct. 31. 

Advocates gather outside the Hippodrome Theater in Richmond, Virginia, this summer to protest Medicaid cuts. Medicaid covers nearly two-thirds of Black babies’ births in the U.S., federal data shows, and congressional cuts to the program are already limiting reproductive health care in Black and low-income communities. (Photo by Bert Shepherd/Courtesy of Protect Our Care PAC)

At least 90% of Black people surveyed for a new poll said Medicaid is important to them or their families, and more than half either have public insurance or a family member who relies on the program. 

“Medicaid is critical for so many things with regards to making sure that we’re healthy and addressing health disparities. By losing it or weakening it, it is just going to disproportionately harm our communities,” said Regina Davis Moss, the president and CEO of In Our Own Voice: National Black Women’s Reproductive Justice Agenda. 

Davis Moss’ organization commissioned the 10-state poll, which includes views from California, Florida, Georgia, Michigan, North Carolina, New Jersey, Nevada, Ohio, Pennsylvania and Virginia. Nonpartisan research firm PerryUndem conducted the survey between May and June and interviewed 500 Black adults in each state. 

The findings, shared exclusively with States Newsroom, show a significant number of Black people who want children are not yet planning to have them due to cost and health care concerns. 

Results were released just as several Planned Parenthood clinics that served Black patients with low incomes closed after a law took effect blocking certain reproductive health clinics affiliated with abortion providers from receiving Medicaid reimbursements until July 2026.

Louisiana’s Planned Parenthood clinics, which never offered abortions in their decades of service, closed on Sept. 30. Sixty percent of the Baton Rouge and New Orleans patients were Black and most have Medicaid insurance, States Newsroom reported. One of two Planned Parenthood locations in Memphis, where more than 60% of the population is Black, temporarily closed its doors during the first week of October due to Medicaid cuts, Tennessee Lookout reported. 

“Proximity is important, and the fact that these clinics have to close means that individuals needing their services will go without,” said Danielle Atkinson, executive director of Mothering Justice, a national advocacy group based in Michigan. 

Four Planned Parenthood clinics closed in her state this spring after the Trump administration cut millions of Title X family-planning funding, Michigan Advance reported.  

“They’ll go without STI testing. They’ll go without cancer screening. They’ll go without counseling,” Atkinson said. 

The ban on Medicaid for some reproductive health providers was part of a larger reconciliation package that is also set to slash nearly $1 trillion from Medicaid more broadly over the next decade. 

“Medicaid is a lifeline for Black women, girls and gender-expansive people,” Davis Moss said. The state and federal program covers nearly two-thirds of Black births, according to the U.S. Centers for Disease Control and Prevention, and almost half of all births nationwide. 

Maternal health advocates are bracing for the impact of Medicaid cuts on labor and delivery units, which have already been closing at a rapid pace over the last 10 years, especially in rural communities. A maternity ward in northeast Georgia, one of the states included in the poll, will close at the end of the month partially due to Medicaid cuts, Georgia Recorder reported in September. 

Findings from the In Our Own Voice poll also show that Black people of reproductive age — 18 to 44 in this case — want children but are not planning to have them, citing high costs of living. 

California had the biggest disparity of 28 percentage points: 56% want children but only 28% plan to have them. 

“I believe some of the reasons they said are not new issues that we are grappling with, but it’s deeply concerning because they are being exacerbated in this current administration,” Davis Moss said. 

At least 69% of Black people polled in each of the 10 states said they worry about being able to take care of children or more children than they already have, while at least 67% cited housing costs and 57% pointed to child care expenses. 

“In a lot of these states, the cost of child care is more expensive than a year of tuition, which is such a barrier for people to be able to: one, go into the workforce, two, have that early intervention and early education that really sets their children up for success, and three, give individuals and families the opportunity to go and explore careers and learning opportunities,” Atkinson said. 

Abortion restrictions played a factor in family planning, too, though in smaller numbers. At least 45% said they don’t want children because they or their loved one could die from pregnancy, while 43% worry about miscarriage care and 30% said abortion bans are stopping them from growing their families. 

Three of the states included in the poll — Florida, Georgia and North Carolina — have abortion bans stricter than 20 weeks. Voters in California, Michigan and Ohio approved reproductive rights amendments in recent years that secured the right to an abortion up to fetal viability, while Nevada and Virginia may have similar safeguards in place after the midterms. 

A majority of voters in each of the 10 states say abortion should be legal in all or most cases and at least 78% say Black women should make the decisions about pregnancy that’s best for them. 

Overall, at least half of Black adults polled are struggling with economic security. Black women of reproductive age were more likely to expect less safety and security throughout the rest of Republican President Donald Trump’s second term than Black men. 

“We’re getting ready to celebrate our 250 years, and all the things that we have fought for and all these things that we have gained in terms of civil rights and human rights, they are under threat like never before,” Davis Moss said. 

Hope Broussard, 20, sought care at a Planned Parenthood in Washington in 2023 when her IUD became lodged in her cervix and the clinics in her hometown of Sandpoint, Idaho, weren’t able to help. She now lives in Pullman, Washington. (Photo by Geoff Crimmins for States Newsroom)

Fifth in a five-part series. 

Hope Broussard’s intrauterine device should have brought relief from her severe periods. But at 17, it started causing debilitating pain.

At the Sandpoint, Idaho, clinic where the device was implanted, providers suspected it was embedded in her uterine wall, but lacked the ultrasound equipment to make a diagnosis.

Homeless with no insurance after her mother kicked her out, Broussard couldn’t enroll in Medicaid as a minor without a parent’s involvement. The women’s clinics in Sandpoint couldn’t help. Hospital bills were out of the question.

“The only people that were able to help me were Planned Parenthood,” Broussard said.

She sought care across the border in Washington, at the Spokane Planned Parenthood, where an ultrasound showed the IUD was coiled around her cervix. A specialist carefully removed it in a follow-up appointment and she paid $20 for everything because it was all she could afford.

“It really was my saving grace at the time,” said Broussard, who moved from Idaho to Pullman, Washington, in part because of that experience of being unable to access health care locally. “I have no idea what I would’ve done if I didn’t have that option available to me.”

Broussard is one of more than 2 million people nationwide who used Planned Parenthood for health care between 2023 and 2024, according to the national organization’s annual report. But how many people will be able to afford and access care is changing after a new federal provision prohibits some organizations that provide abortions from receiving Medicaid payments for at least a year. Nationally, Planned Parenthood estimates it could lose $700 million from Title X and Medicaid cuts, forcing affiliates to close some clinics, curtail services and stop accepting Medicaid patients.

Many Republican lawmakers and anti-abortion groups celebrated the provision passed by Congress in July that essentially targeted Planned Parenthood clinics nationwide for “defunding” because abortion care is part of clinical services in many states where access is mostly legal. Federal Medicaid dollars cannot be used to pay for abortions except in limited circumstances, and abortion care makes up a small percentage of overall care provided by clinics. Still, conservatives argue the mere association with any such clinics is equivalent to funding all abortion. 

“Planned Parenthood’s desperate ploy for our tax dollars only underscores why the One Big Beautiful Bill is such a historic win,” said Susan B. Anthony Pro-Life America President Marjorie Dannenfelser in a July statement. “It halted, for the first time, over half a billion taxpayer dollars from propping up the corrupt abortion industry.”

Democratic-led states are in troubleshooting mode 

In response, elected officials in some Democratic-led states, including Washington, Hawaii, Colorado and Massachusetts have publicly pledged to backfill the funding needed to allow Planned Parenthood clinics to keep accepting Medicaid and other low-income patients. In July, Washington Gov. Bob Ferguson committed to filling the $11 million gap Planned Parenthood expected to see.

Many states don’t begin their legislative sessions until January, so some of the plans aren’t official yet and still need to make it through the legislative process or the details of allocation are still in progress. That means clinics either have to absorb the costs for now with the promise of reimbursement, or change their payment options and services for the time being. For example Hawaii is moving to sliding-scale fees for some Medicaid patients, and in Maine, a major independent clinic is making changes to its services. 

Idaho’s border with Washington and Oregon is a point of contention among lawmakers across state lines, where the political views could hardly be more polarized between the hard-line conservatives in Idaho and progressive politics in the other two states. But for the people who need abortion care, or even a basic ultrasound, like Broussard, clinics in places like Spokane and Ontario, Oregon, are some of the last options available. 

Oregon lawmakers are also brainstorming ways that the state can provide reimbursement to Planned Parenthood for lost funding. Clinics across the state billed Medicaid nearly $17 million for services in 2024, according to the Oregon Capital Chronicle. 

Courtney Normand, the Washington state director for Planned Parenthood Alliance Advocates, said this latest move from Congress is adding to challenges from the first Trump administration when there were other cuts, along with health care system pressures from the COVID-19 pandemic, and the impact of increasing patient volumes after the U.S. Supreme Court’s Dobbs decision that upended federal abortion rights protections.

“It feels like the hits have just kept on coming in Washington, and that’s why access, affordability and stable funding is our key concern,” Normand said. 

Brita Lund, the health center manager at a Planned Parenthood in Seattle, worries about having to turn away patients if the federal Medicaid cuts and other strains on the health care system become too much to bear. She already feels like she spends too much time grilling a patient about their personal details at an appointment so the staff can find a way to get the treatment paid for by a specific pocket of funding. 

“Who is going to help these people if we’re not going to help them? I want someone to give me that answer,” Lund said. “It literally keeps me up at night.” 

While Washington state is known for being one of the most openly accessible for sexual and reproductive health, a budget crisis led legislators to cut 55% of the funding to the Abortion Access Project, about $8.5 million. Normand said it’s hard to know exactly why legislators made the decision, but some regretted it and are trying to find a solution for the upcoming session. Ferguson pledged to restore the funding as well. 

‘I know the state is supportive, it’s just about what their capacity is’

In Hawaii, Title X cuts from the Trump administration earlier this year amounted to about $2.1 million, said Jen Wilbur, Hawaii state director for Planned Parenthood Alliance Advocates. The state legislature acted quickly in April to approve a new $6 million family planning fund to offset that loss over the next two years, with $3 million specifically allocated to Planned Parenthood clinics. What the funding program will look like exactly is still to be determined, Wilbur said. The needs vary by island, and an assessment of what those needs are is underway.  

Hawaii has trended slightly more conservative than other blue states in recent elections, Wilbur said, but support from lawmakers still feels strong. She and other advocates are trying to game plan in the event that the federal government restricts access to mifepristone through the mail, which would severely affect access for the islands. 

But Wilbur worries about the long-term sustainability of the funding in a small state that already has many challenges with high cost of living, difficulty retaining providers and navigating the unknown. 

“We don’t even know how many more cuts are coming, so is any state really going to be able to sustain this going forward? I don’t know,” Wilbur said. “I know the state is supportive, it’s just about what their capacity is.” 

Short-term state fixes in Maine, Massachusetts 

New England, considered a hub for abortion access and low-cost reproductive health services, has been especially impacted by the federal Medicaid rule. It affects not only Planned Parenthood affiliates, but also two nonprofit health networks that offer wide-ranging health services primarily to Medicaid patients: Health Imperatives in Massachusetts and Maine Family Planning, which, like Planned Parenthood, has sued over the new policy. 

Maine’s legislature this summer appropriated about $6 million for family planning funding, to go to organizations like Planned Parenthood of Northern New England and Maine Family Planning, the largest reproductive health provider in the state with 18 clinics compared to Planned Parenthood’s four. But as Maine Morning Star reports, the temporary relief does not fully meet both organizations’ deficits, and Maine Family Planning this week announced it will end primary care services in Ellsworth, Houlton and Presque Isle at the end of October.

Still, both Maine Family Planning and Planned Parenthood of Northern New England say they will continue to see Medicaid patients free of charge for reproductive health and family planning services. 

Massachusetts Democratic Gov. Maura Healey also announced the state would deliver $2 million to Planned Parenthood League of Massachusetts, which is one of the co-plaintiffs in Planned Parenthood’s lawsuit against the federal government.

“We want the people of Massachusetts to know that if you need reproductive health care services, you should continue to seek this care,” Healey said in a news release. 

Massachusetts has been a leader in policy promoting access to reproductive health including abortions, which is legal in the state up to 24 weeks of pregnancy with exceptions for significant fetal abnormalities and the pregnant person’s health.  

But access to broad reproductive health care even in a city like Boston remains limited, especially for people living in poverty, said Dominique Lee, president and CEO of Planned Parenthood League of Massachusetts.

Lee told States Newsroom that making a primary care or OB-GYN appointment in the Boston area can mean having to wait 60 days, while Planned Parenthoods typically have same-day appointments. She noted that the communities with the least access to low-cost reproductive health services are concentrated in central and western Massachusetts, where Planned Parenthood has three clinics.

Lee said she is grateful for the $2 million in state funding, which she calls “short-term relief.” Because Medicaid funding represented about a quarter of her organization’s revenue, Lee said it is like a business losing its biggest customer. Her goal now is to figure out how the affiliate can sustain long term. She said they are brainstorming other revenue streams like offering vasectomies.

“We have gotten really good at contingency planning,” Lee said. “But it would be great to have a business model that is sustainable, that can withstand all of these attacks, and not have to worry about it. That would be a dream.”

The affiliate’s website notes that patients can no longer use their MassHealth or Medicaid Managed plans for care at Planned Parenthood clinics but says they are still seeing “all patients.”

Health Imperatives, which operates seven clinics in southern Massachusetts, is also looking at operations.

Health Imperatives CEO Julia Kehoe said the $19 million nonprofit serves about 23,000 people annually and offers social and psychiatric services to vulnerable populations. About 40% of what Health Imperatives does is offer low-cost sexual and reproductive health services for about 10,000 patients annually, Kehoe said. For now, they are continuing to see the same amount of patients and are working with the state government for funding help. 

But she said the organization is also looking at private funding because they are determined to continue seeing Massachusetts’ poorest residents, many of whom experience food insecurity in places like Nantucket, which is one of the nation’s wealthiest towns but where the main safety net for those who are not wealthy is a single Health Imperatives clinic. 

“I would never, ever make the decision to not see Medicaid patients,” Kehoe said. “We exist to provide services to people who fall through the cracks of mainstream systems of care. So we’re going to prioritize people who are on Medicaid or people who don’t have insurance. What I would do is, rather than further health disparities and wealth disparities in one of the most expensive states in the country, I would have fewer clinics.”

Correction: This article has been corrected to reflect that elected officials in Maine have not yet pledged to support family planning clinics with backfilled funding. The state passed a bill last session that provided family planning funding that was already needed before the congressional bill cut Medicaid funding.

Sarah Elgatian is a graduate student in rural Iowa, who like about 16 million women of reproductive age, uses Medicaid insurance and at times has relied on Planned Parenthood for routine gynecological treatment for infections and birth control, both in person and through its growing telehealth program. (Photo by Todd Welvaert for States Newsroom)

Fourth in a five-part series.

Sarah Elgatian was in too much pain to feel awkward. 

That morning in 2019, she was hunched over her toilet, feeling what she described as a “weird burning nausea,” abdominal pain and other symptoms. She remembered the Planned Parenthood telehealth ad she’d seen recently. Elgatian downloaded the app, and within a couple hours from her bathroom, she was video chatting with a health provider. She recalled that the doctor could tell she had a urinary tract infection just by looking at her face.

“They were like, yeah, those are textbook symptoms, and you are cringing,” said Elgatian, 35, who lives on the outskirts of Davenport, Iowa, where the nearest pharmacy is at least a 20-minute drive. But luckily, Elgatian’s spouse was able to get the antibiotics the Planned Parenthood provider prescribed, and with it, relief. “That was really scary, just because, if you’ve ever had a UTI, when they’re bad, they’re so bad.”

Elgatian, like about 16 million women of reproductive age, has Medicaid, the federal and state medical insurance program for people with low incomes, and therefore limited options when it comes to reproductive health. With even fewer options in rural Iowa, Elgatian, who is a graduate student, said at times she has relied on Planned Parenthood for routine gynecological treatment for infections and birth control, both in person and through its growing telehealth program.

Now that a new rule has eliminated hundreds of millions in Medicaid reimbursements to Planned Parenthood, reproductive health providers have turned to telehealth as part of the solution to offer low-cost health services due to reductions in clinic staff and services, or closures.  

Telemedicine gained momentum in the wake of the COVID-19 pandemic and the increasing health care deserts around the country. In the reproductive health space, it has expanded in the last few years, as the overturn of Roe v. Wade and the resulting policies prompted the closure of many physical clinics. By the end of 2024, 1 in 4 abortions was provided via telehealth, according to the Society of Family Planning, though there are ongoing efforts at the federal and state level to prohibit telehealth abortions.

“We’ve — overall as a trend — seen more patients taking advantage of telehealth, and I think it’s a combination of factors, particularly in rural areas where access to care can be very, very limited,” said Ruth Richardson, president and CEO of Planned Parenthood North Central States, which covers Iowa, Minnesota, Nebraska, North Dakota (which has no physical clinics) and South Dakota, and recently closed eight clinics after the Trump administration froze their federal family planning Title X grant funding. “That is something that we’ve seen as a trend even before the Medicaid defund occurred.”

At the same time, providers and advocates warn that telehealth — the virtual delivery of care using technology from video conferencing, phone- or computer-based apps, to text messaging — still leaves a huge gap in reproductive health care access, especially for patients without reliable Internet or who don’t have the financial resources necessary to participate, like a debit or credit card. Much of the care cannot be delivered virtually, such as treating certain STIs, intrauterine device insertion, performing vasectomies and procedural abortions, which are optional in the first trimester and necessary later in pregnancy.

“There’s a lot of people for whom telemedicine is not an option, and so I think it’s really important to note that it’s not a quick fix,” said Amy Hagstrom Miller, president and CEO of Whole Woman’s Health, which manages five physical clinics in Maryland, Minnesota, New Mexico, and Virginia that specialize in abortion and offer some gynecology services. It also has a virtual care practice in 10 states that offers primarily medication abortion. “It’s not the only fix, right? It’s got to be both and so that people truly have choice.”

Turning to telehealth 

In 2023, one-third of Iowa’s counties were considered maternal health deserts, according to the March of Dimes. That number will likely increase in the nonprofit’s next report. Earlier this year, Planned Parenthood North Central States shrunk its physical presence in Iowa from six to two clinics. The affiliate, Richardson said, stands to lose $11 million from the latest federal Medicaid change, after having served about 27,000 people on Medicaid — about one-third of their total patients — in 2024. 

Richardson said the affiliate’s health centers will continue to serve patients regardless of their insurance status and will work with them to understand their payment options. She said she is expecting their telehealth program to keep growing, especially after shuttering clinics in more rural areas like Bemidji, Minnesota. 

In the past year, the North Central States affiliate reported it saw 4,204 patients during 8,241 visits on the Planned Parenthood Direct app, a 12.9% increase in virtual care visits, and about 5% of the 87,631 total patients seen. Services offered during telehealth visits include birth control counseling and prescriptions, UTI treatment, gender-affirming care, emergency contraception and the abortion pill. Newer virtual care services were launched this past year, related to menopause, sexual wellness and early pregnancy complications.

Planned Parenthood has increased its telehealth presence across the nation in the last two years. Planned Parenthood Direct, launched about a decade ago and expanded nationally in 2019, provides both text-based and video-based care, and accepts Medicaid in some states.

Separately, Planned Parenthood affiliates run virtual health centers, which have expanded to more than 50 nationwide, said a Planned Parenthood Federation of America spokesperson. According to Planned Parenthood’s 2023-2024 annual report, patients booked more than 47,000 appointments through virtual health centers in the last fiscal year, and, on average, virtual health center patients are accessing care more than two days sooner than in-person appointments. Across all telehealth platforms, there were 142,000 appointments made, the spokesperson said. 

In Michigan the most popular Planned Parenthood clinic has no real walls or windows. The virtual clinic launched in 2023, and now sees the highest number of patients compared to the state’s 10 physical health centers, said Ashlea Phenicie, the chief external affairs officer at Planned Parenthood of Michigan, which in April closed three clinics in underserved areas and consolidated two health centers in Ann Arbor because of Title X cuts. 

Phenicie said Michigan’s virtual clinic is always more than 100% booked and offers evening and weekend appointments.

“I think that not only is it filling a need in communities where we don’t have brick-and-mortar health centers, but for many patients, this is how they prefer to access care,” Phenicie said. “It’s convenient. A lot of our patients will do it on their lunch break or, you know, before school or between work and picking up their kids. It lets them fit their health care into their everyday lives. It can also provide a degree of privacy and security. There’s no protesters who walk by when you’re visiting a telehealth provider or getting birth control through the PPDirect app.” 

In a new study in the journal Contraception, researchers from the Guttmacher Institute found that while many publicly funded family planning clinics offer some services via telehealth, Planned Parenthood clinics offer telehealth most frequently, and offer a wider variety of services. The researchers, who surveyed nearly 500 publicly supported family planning clinics, wrote that many health departments and federally qualified health centers need more support and infrastructure to implement telehealth, especially for contraceptive care. They noted that while the benefits of telehealth include convenience, low cost, and improved patient outcomes, difficulties include loss of patient-provider rapport, technology and workflow issues, and regulatory barriers.

And they warned: “If telehealth is implemented inequitably, it may deepen existing disparities.”

Barriers 

Research is still limited when it comes to telehealth delivery of broad reproductive health services. A 2023 study by researchers at Oregon Health & Science University found evidence suggesting telehealth care for intimate partner violence and contraceptive care can produce “equivalent clinical and patient-reported outcomes as in-person care.”

But many reproductive health care advocates and researchers agree that telehealth will likely not be enough to fill the gap left by closing physical clinics, and that there remain many barriers to accessing telehealth generally, related to age, language, financial resources, digital literacy, and access to technology and internet.

In 2023, the National Telecommunications and Information Administration reported that roughly 12% of people lived in households with no internet connection, while a National Digital Inclusion Alliance analysis of 2022 data showed that 24% of households lacked a home internet connection.

Last month the Journal of Medical Internet Research published a study examining telehealth usage patterns of nearly 10,000 adults in rural California that found people who are older, speak Spanish or rely on public insurance struggle the most to access virtual care. The researchers reported that rural health disparities are often more pronounced among rural populations of color, who make up about 20% of rural U.S. residents.

For Elgatian, her occasional use of telehealth has not erased her need for affordable in-person reproductive health care, something she’s currently worried is about to change in Iowa following the new Medicaid rule. In a pinch, her fail-safe — at least until recently — had been Planned Parenthood, the closest being more than an hour away in Iowa City, followed by just one other in-state option: the Des Moines clinic nearly three hours away. But it was the latter clinic that Elgatian was closest to while driving through last year and suddenly bleeding vaginally. It turned out to be related to uterine polyps and her IUD, something she likely wouldn’t have discovered via telehealth.

“I don’t yet know, personally, how this will pan out for me, but it seems likely that there will be a time when I will struggle to find care without being able to use Planned Parenthood,” she said.

Efforts to expand and improve telehealth

Since its founding four years ago, telehealth provider Hey Jane, which is not affected by the government’s new Medicaid exclusion, has provided care to more than 100,000 people and expanded beyond medication abortion to provide birth control, emergency contraception, treatment for vaginal infections, herpes, and UTIs, according to co-founder Kiki Freedman. Hey Jane operates in the District of Columbia and 22 states (California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Hampshire, New Jersey, New Mexico, New York, Ohio, Oregon, Rhode Island, Vermont, Virginia and Washington). It recently became a Medicaid provider for people in Illinois. 

Freedman said their services are offered on a sliding fee scale. And she said the platform allows patients to text with clinicians, which is popular with patients.

“They could be on their couch, watching a movie with their partner by their side, or whomever they need, and then just be chatting with us,” Freedman said. “That’s not something that you could get if you receive care in person and take the medication home with you, and then don’t have those ongoing touch points.”

Freedman said that Hey Jane has already seen an influx in patients since Congress passed the federal tax and spending cut bill and more clinics have closed, and that they are working on becoming Medicaid providers in more states — something that can be challenging for telehealth businesses without a physical facility. 

“We’ve continued to grow really fast over the past several years, and have just been hiring a lot and doing a lot of work on sort of our technical automation so that we can continue to meet the demand that has been rising,” Freedman said. “These acute events, like these terrible clinic closures, have definitely exacerbated that.”

Coming Friday: Democratic-led states try to backfill funding losses.

Correction: This article has been corrected to reflect that the mobile Planned Parenthood Direct app provides both text-based and video-based care.

Jess Deis, a nurse practitioner and nurse midwife in Kentucky and Indiana, learned she had cervical cancer after she qualified for Medicaid insurance in 2014. (Sarah Ladd/Kentucky Lantern)

Third in a five-part series.

It had been a decade since Jess Deis’ last women’s wellness exam when Kentucky expanded Medicaid and she finally qualified for the state insurance program.

Physicians recommend a cervical cancer screening — also referred to as a Pap smear, which is a swab of the cervix — as part of a wellness exam once every three to five years for women between the ages of 21 and 65. Deis, 43, was in her last semester of nursing school in 2014 when the test came back with abnormal results. Her doctor ordered additional testing.

“Then I got a call on a Sunday evening from a physician letting me know I had cervical cancer and I needed to see a specialist,” Deis said.

Cervical cancer is one of few cancers that has a known path of prevention after the approval of the first HPV vaccine in 2006. But that also means it falls at the intersection of three cultural issues that are facing strong political opposition — broad access to low-cost or free reproductive health care, access to vaccines for children, and sex education.

Kentucky had the highest cervical cancer incidence rate in the country between 2015 and 2019, according to medical research, and a mortality rate twice as high as the rest of the country. The state tied with West Virginia for the second-highest rate of 9.7 cases per 100,000 residents between 2017 and 2021. Oklahoma topped the list for that five-year period with 10.2 cases per 100,000, according to the National Cancer Institute.

Deis delayed the surgery to remove her uterus until after graduation, and later became a certified nurse practitioner. Now she provides Pap smears to patients multiple times a day at Planned Parenthood clinics in Kentucky and Indiana and other care via telehealth. She recently helped a patient who hadn’t been seen for a screening in 15 years discover she had advanced cervical cancer.

She is troubled by what could happen in the wake of the new Medicaid rule passed by Congress and signed by President Donald Trump in July that barred nearly all Planned Parenthood affiliates from receiving Medicaid reimbursements because some clinics in the nonprofit network provide abortions. Kentucky and Indiana both have abortion bans, but still have Planned Parenthood clinics to provide other reproductive health care.

“I don’t just worry; I know that there’s going to be more folks with stories like mine, but without the happy ending,” Deis said.

‘What we’re really talking about is our daughters getting cervical cancer’

The American Cancer Society recently reported the number of early cervical cancer cases has declined sharply among young people since the vaccine’s introduction nearly 20 years ago. But vaccine adoption rates for children are low in the states where rates are highest — about one-third of boys and girls between the ages of 13 and 17 were vaccinated in Mississippi as of 2020.

The vaccine is most effective when given before engaging in any kind of sexual activity for the first time, because it can prevent the sexually transmitted strains of HPV that present the highest risk of cervical cancer. More than 98% of cervical cancer cases are caused by HPV, and a 2024 study from the Journal of the National Cancer Institute found zero cases of cervical cancer in Scottish women born between 1988 and 1996 who were fully vaccinated against HPV between the ages of 12 and 13.

“We could make (cervical cancer) an eradicated disease,” said Dr. Emily Boevers, an Iowa OB-GYN. “But everything is falling apart at the same time.”

Boevers said limitations on Medicaid coverage and the loss of Title X family planning funding will make screenings and vaccines less accessible for the populations that need them the most, even if clinics don’t close as a result. But it will take years to see the consequences of these changes, she said, because it takes about 15 years on average for HPV to become cancer. 

“So what we’re really talking about is our daughters getting cervical cancer,” she said. 

Kentucky’s legislature acknowledged the importance of HPV vaccines as recently as 2019, when representatives passed bipartisan House Resolution 80, which encouraged females and males between the ages of 9 and 26 to get the HPV vaccine and everyone to “become more knowledgeable of the benefits of the vaccine.” Only four legislators voted against it.

But today, the U.S. Department of Health and Human Services is led by Secretary Robert F. Kennedy Jr., who has made false statements about the HPV vaccine’s safety and effectiveness and played a leading role in organizing a mass lawsuit against one of the vaccine’s manufacturers, Merck. The Associated Press reported the judge dismissed more than 120 claims of injuries from Gardasil, the name of one HPV vaccine, because of a lack of evidence. 

“Secretary Kennedy supports renewing the focus on the doctor-patient relationship and encourages individuals to discuss any personal medical decisions, including vaccines, with their healthcare provider,” a Health and Human Services spokesperson wrote to States Newsroom in September. “The American people voted for transparency, accountability, and the restoration of their decision-making power, and that is exactly what HHS is delivering.”

The response did not clarify whether Kennedy still thinks the vaccine is unsafe and what basis there is for that claim. 

Dr. Linda Eckert, a University of Washington School of Medicine professor and practicing OB-GYN, has an extensive background in immunizations and cervical cancer prevention. She served as a liaison for the American College of Obstetricians and Gynecologists to the CDC’s Advisory Committee on Immunization Practices until 2024. Members of the committee were recently dismissed by Kennedy’s agency and replaced by new members, several of whom have reportedly expressed anti-vaccine views. Eckert said the group had plans in motion to present to the ACIP in June a case for administering the HPV vaccine at the earliest age of 9 before it was disbanded. 

Although Black and Hispanic women are affected by cervical cancer at disproportionate rates because of systemic inequities, Eckert said the fastest rising group experiencing late-stage cancer is white women in the Southeast. But she added that Alabama was the first state in the country that launched a targeted campaign to eliminate cervical cancer. 

Treatment for the cancer once it develops can also be difficult to obtain, Eckert said. It can be expensive and require many follow-up visits, and usually leads to infertility either through hysterectomy or invasive radiation treatments. 

“It is a really devastating disease to treat,” Eckert said. “Even if you live, you are permanently changed.”

Recent study showed zero cases of cervical cancer after HPV vaccine 

Dr. Aisha Mays, founder and CEO of a Dream Youth Clinic in Oakland, California, said the services her clinic offers to young people for free includes most of the same services that Planned Parenthood clinics provide, including the HPV vaccine.

“That’s the work of Planned Parenthood and clinics like mine that are encouraging and doing regular Pap smear screenings and vaccines, and having really clear conversations with young people around the importance of these procedures,” Mays said.

The recent turn against vaccines by some segments of the public and members of President Donald Trump’s cabinet who doubt their effectiveness and baselessly claim that they cause injury and developmental issues like autism has made the promotion of HPV vaccines more difficult for Mays. Overwhelming evidence, including from the Centers for Disease Control and Prevention, shows that they are safe and effective.  

The vaccine can also protect against genital warts, anal cancer and oropharyngeal cancer, Mays said. There are about 40 strains of HPV in total that are known to infect the genitals, and more that can attach to certain patches of skin. Most people who have sex will come in contact with one or more of the strains by the time they reach their mid-20s or early 30s.

Mays’ clinic is largely funded by state and local grants, but it received more than $100,000 in federal funding for a sexual health education program through the U.S. Department of Health and Human Services’ Office of Population Affairs. It was a nationally distributed podcast hosted by adolescents, Mays said, and they chose topics to talk about related to sexual health, including HPV.

The program’s grant was one of many that have been cancelled under the Trump administration. An objective laid out in Project 2025, the blueprint document for the next Republican presidency written by conservative advocacy group the Heritage Foundation, was to ensure no subgrantees of sex education programs were promoting abortion or “high-risk sexual behavior” among adolescents. It also stated that any programming should not be used to “promote sex.”

HHS also terminated funding for one of California’s sexual health programs in August over the state’s refusal to remove references in the programming related to gender, including the idea that biological sex and gender identity are distinct concepts. Another directive of Project 2025 was to make sure biological sex is never conflated with gender identity or sexual orientation.

States with high rates of cervical cancer have low density of physicians

States with the lowest incidences of cervical cancer, including Massachusetts, New Hampshire, Connecticut and Minnesota, also have the highest density of physicians per capita. According to the Association of American Medical Colleges’ state physician workforce data, Massachusetts has the highest number of physicians per 100,000 people, and Oklahoma ranks in the bottom three.

Kentucky is in the bottom 15, and so is Indiana, where Marissa Brown works as a Planned Parenthood health center manager in Bloomington. Brown described her clinic as “an oasis in a desert” because there are few options for gynecological care in the area, and even fewer for obstetrics. Brown said they routinely see patients from rural areas two or more hours away, and many of them are coming for wellness exams that include cancer screenings.

Indiana used to have 38 Planned Parenthood clinics, but through 15 years of funding cuts and targeted anti-abortion legislation, the organization closed 21 of them between 2002 and 2017. In the years since then, another seven shut down to consolidate services. Many of them did not provide abortions.

“We hear a lot about patients coming in who can’t get into their gynecologist for four to 12 weeks,” Brown said. “We can do that in a few days to two weeks, and we have walk-in appointments too.”

Health Imperatives, a nonprofit network of seven community health clinics in southern Massachusetts, can no longer bill for Medicaid because they provide medication abortions and received about $800,000 in reimbursements for other services in 2023, like Planned Parenthood. One of Health Imperatives’ clinics is in Martha’s Vineyard, whose working-class residents have to work three to four jobs just to afford to live on the affluent island, said Julia Kehoe, the organization’s president and CEO.

More than a decade ago, she said she noticed a pattern: Their patients would come in for an annual gynecological exam, receive an abnormal cervical cancer screening, but not follow up, because the closest available specialist would require expensive travel off the island. Kehoe said that once their Martha’s Vineyard clinic purchased a colposcopy machine, from privately raised funds, in 2012, they started diagnosing some of their regular patients with now-advanced cancer.

“In the first year that we did colposcopies, we found four individuals who had stage three or four cancer, who we luckily were then able to connect up to Boston for critical care,” she said. “But if we had had that capacity earlier … we would have caught it earlier.”

States Newsroom reproductive rights reporter Sofia Resnick contributed to this report.

Coming Thursday: Telemedicine could help narrow the care gap in rural communities.

Child abuse, neglect or endangerment laws were used to charge hundreds of pregnant people with crimes in the two years after the U.S. Supreme Court overturned Roe v. Wade, underscoring the rise of fetal personhood laws, according to a new report. (Getty Images)

More than 400 people were charged with pregnancy-related crimes during the two years after the U.S. Supreme Court overturned federal abortion rights, research released Tuesday shows.

Prosecutors across the country often charged people with some form of child neglect, endangerment or abuse based on allegations of substance use during pregnancy, according to an annual report from the nonprofit Pregnancy Justice. 

Nearly three dozen cases were brought against people who miscarried or delivered stillborns, and in nine cases, pregnant people were accused of obtaining, attempting or researching abortion. 

“Prosecutors are wielding criminal laws to surveil and criminalize pregnant people, their behavior and their pregnancy outcomes,” Dana Sussman, Pregnancy Justice’s senior vice president, told States Newsroom.

Although charges against those experiencing pregnancy loss are less common, Sussman said she fears they could lead people to avoid seeking miscarriage care. 

For instance, a woman who miscarried at home was charged with abuse of a corpse in September 2023, Ohio Capital Journal reported. 

Brittany Watts was around 21 weeks pregnant when she went to the hospital but waited for hours and didn’t get help, according to the Capital Journal, and after she miscarried at home, she returned to the hospital, where staff called police. She was never indicted, and she filed a federal lawsuit in January against the city of Warren, police, hospital officials and hospital staff. 

“Rather than being able to grieve her loss, she was taken away in handcuffs. She was interrogated in her hospital bed while she was still tethered to IVs, and so she wants compensation for her own trauma, but most importantly, wants to make sure that this doesn’t happen to anyone else,” Rachel Brady, Watts’ attorney, told States Newsroom in June.

Watts’ lawsuit alleges local law enforcement and the hospital violated the Fourth and Fourteenth Amendment and the Emergency Medical Treatment and Active Labor Act (EMTALA), which requires hospitals that receive Medicare funding to provide stabilizing medical treatment regardless of a person’s ability to pay or insurance status. The defendants denied liability and the plaintiff’s claims, according to court documents filed in September. 

In this year’s report, pregnancy-related cases cropped up in 16 states, and states with strict abortion bans topped the list again: Alabama (192), Oklahoma (112) and South Carolina (62).

“If you are doing anything that exposes your pregnancy, your fetus to some real risk, perceived or assumed risk, in certain parts of the country, that is a felony,” Sussman said. 

Fetal personhood — the notion that fetuses, zygotes and embryos should have the same legal rights as human beings — comes into play when pregnant people struggling with addiction are drug tested during checkups or at labor and delivery units, Sussman said. 

“In several states, it’s become relatively common practice for people to be charged with a felony for child endangerment or neglect for simply testing positive” on toxicology tests, Sussman said. “And that carries years in prison, and of course, immediate family separation from your newborn and even from your other children in your home, in your family.” 

An investigation by The Marshall Project, Mississippi Today and three other news outlets in 2023 found that local law enforcement and prosecutors in Alabama, Mississippi, Oklahoma and South Carolina applied child abuse and neglect laws to fetuses when pursuing charges against pregnant women. 

Lawmakers in a few states have pitched legislation seeking to curb punitive approaches to addiction among expectant and new mothers. 

A bill advancing in the New York Legislature would require informed consent for drug testing and screening pregnant and postpartum patients unless it’s medically necessary. Legislation took effect in Washington state this summer that prevents the criminalization of pregnancy loss, and requires officials at jails, prisons and immigrant detention centers to report miscarriages and stillbirths to the state annually. Massachusetts legislators passed a law in December that prevents medical professionals from automatically referring substance-exposed newborns to the state Department of Children and Families. 

Prosecutors obtained information about pregnancy-related crimes from health care facilities in 264 out of 412 cases, even in incidents that did not allege substance use, according to the Pregnancy Justice report.

“If people are worrying about losing their children because of family separation through the child welfare system or by going to jail, they are not going to get the care that they need,” Sussman said. “Pregnancy is seen as a moment and a window of opportunity for people to get care. People are motivated, uniquely motivated, and we really squander that opportunity when we turn health care into a place of reporting.”