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

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

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

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

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

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

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

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

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

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

South Dakota is first

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

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

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

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

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

Blame for the confusion

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

When an Alabama clinic’s only OB-GYN left the state to provide abortion care in Colorado, the head of operations thought the facility would have to close.

But Robin Marty, executive director at WAWC Healthcare in Tuscaloosa, hired a doctor in August who she called a “unicorn” — someone who’s from Alabama and, after training outside of the state, returned home to practice medicine.

Marty said Alabama’s near-total abortion ban could cause physicians to practice elsewhere after they finish their residencies.

“Doctors don’t want to worry about surveillance, potential arrests and other legal issues,” she said.

A study published in March found that applications to medical residency programs in states with abortion restrictions have declined compared to states where abortion remained mostly legal. The findings are an “early signal” that the U.S. Supreme Court’s decision nearly four years ago overturning federal abortion rights protections may exacerbate health care shortages, said lead author Dr. Anisha Ganguly.

A majority of doctors end up practicing medicine in states where they trained. Obstetrician and gynecology training programs typically take four years to complete, so the full scope of how abortion restrictions affect where physicians work after they complete their residencies remains to be seen.

Still, experts said the findings could spell trouble for the future of the reproductive health care workforce in states with abortion restrictions, some of which are already plagued with maternity care deserts.

Doctors say bans limit training, standards of care

OB-GYNs affiliated with Physicians for Reproductive Health who either trained or work in states with abortion bans told States Newsroom that restrictions after the Supreme Court decision hamstrung their ability to offer reproductive care and affected the education of medical residents.

Dr. Neha Ali grew up in Texas and trained there, too. But by the end of her OB-GYN residency’s second year, the state enacted SB 8, a six-week abortion ban that allowed residents in the state to sue providers or anyone who helped someone terminate a pregnancy. After the Dobbs decision in June 2022, a near-total abortion ban took effect in Texas.

“I knew I wanted to be an abortion provider before I started OB-GYN residency, and I chose to be in Texas for my residency training because I wanted to experience what that’s like in a state with barriers. But ultimately, the barriers became too large,” Ali said.

After she finished residency in 2024, Ali moved to Colorado, a state with strong abortion-rights protections, where she practices complex family planning.

Ali said she talks to medical students about her experience training in Texas, where she was not able to perform any dilation and evacuations — a second-trimester abortion procedure — during residency.

“I do think it’s very valuable to see what it’s like to be in a restrictive state and understand what that is like to be a provider there, but that doesn’t sell people on a residency for four years,” she said.

OB-GYN Dr. Louis Monnig trained in Kentucky before the state banned abortion.

“Making it difficult or putting up barriers to that training just limits the abilities of any doctor who provides reproductive care to have opportunities to get exposure and experience, and just get better at what they’re doing,” he said.

Monnig completed his residency in June 2023 and moved back to his home state of Louisiana because of his connections to the region and its health care disparities. “It felt like it was worth it to come back,” he said.

In October 2024, a Louisiana law classifying mifepristone and misoprostol as controlled dangerous substances took effect.

“It made me lose faith that lawmakers were doing any of these things to actually protect patients or patient safety,” he said.

The medications are used not only for abortions, but miscarriages and other conditions, too. The law has sowed confusion among health care providers and led some to practice emergency drills to access the drugs during obstetric emergencies, Louisiana Illuminator reported. Monnig said the law has “changed some of the day-to-day operational workflow for patient care,” especially for situations where misoprostol is used, such as labor induction and postpartum hemorrhaging.

Patients have faced issues when trying to get prescriptions filled: Pharmacists have called Monnig’s office to make sure a patient wasn’t having an abortion after he prescribed misoprostol for conditions such as cervical stenosis — when it’s difficult to insert a medical instrument in the cervical canal.

Drop in applications to ban states’ residency programs

Out of more than 22 million applications to 4,315 residency programs across the U.S., 67% were submitted to programs in states without abortion restrictions between 2018 and 2023, the new research showed. Thirty-three percent went to programs in states with restrictions.

Fewer women than men applied to train in states with abortion restrictions before the Supreme Court’s landmark abortion ruling, according to the study, and that disparity widened after more than a dozen states enacted abortion bans. The number of men applying to residency programs in states with abortion restrictions — mostly in the South and the Midwest — also decreased significantly.

“When there’s a decreased level of interest in these states, it suggests to us that there’s an evolving health care workforce shortage in these states,” said Ganguly, an internal medicine physician and an assistant professor at University of North Carolina’s Division of General Medicine and Epidemiology.

Many states with abortion bans — Idaho, Iowa and Georgia, for example — are also facing labor and delivery unit closures, particularly in rural areas where hospitals struggle with provider recruitment. Health officials in these states listed improvements to maternal health as a priority in their applications to the federal Rural Health Care Transformation Program, but solutions will take years to implement.

Shortages affect more than one specialty. Ganguly said OB-GYNs have historically offered the bulk of abortion-related care in the U.S., but it’s increasingly important in emergency medicine, family medicine and internal medicine. Primary care providers and emergency medicine doctors often diagnose pregnancy complications such as miscarriages, and internists help women who have chronic disease manage and plan for pregnancy.

Dr. Hector Chapa, an OB-GYN who teaches obstetrics and gynecology at Texas A&M University and is a member of the American Association of Pro–Life Obstetricians and Gynecologists, took issue with the study’s approach.

“It’s essential to understand that this study is not specific to OB‑GYN residency programs, and by grouping OB‑GYN with family medicine, internal medicine and emergency medicine, the study assumes that all specialties are affected equally, despite their very different levels of involvement in abortion. This broad grouping risks introducing bias into the results,” he said in a statement.

Ganguly said her team did examine applications to OB-GYN residency programs in isolation to affirm findings of a decline among applicants in abortion-restricted states. Looking at other specialties, too, was meant to provide clarity about how bans affect the health care workforce more broadly.

OB-GYN education and the maternal health care workforce

The latest study adds to a body of research examining how the Supreme Court’s decision on abortion in 2022 affected training after medical school, particularly for those specializing in reproductive health care.

In the 2023-2024 application cycle, the number of applicants to training programs in states with abortion bans decreased by 4.2% compared to the previous cycle, while there was less than a 1% decrease in applications to residency programs in states where abortion is legal, according to the American Association of Medical Colleges.

In some states, abortion bans have definitively led to an exodus of OB-GYNs and maternal fetal medicine specialists. Idaho lost 35% of its doctors who provide obstetrics between August 2022 and December 2024, according to a study published in July.

Having reproductive health providers flee states with abortion bans is “devastating,” according to Pamela Merritt, the executive director of Medical Students for Choice.

“It’s a public health disaster that we’re going to see the consequences of decades to come,” she said.

Merritt’s organization has chapters at several medical schools in states with abortion bans. She said students are not getting adequate training, and some are even discouraged from discussing abortion.

In February, Texas Tech University Health Sciences Center canceled a Medical Students for Choice chapter’s talk with an OB-GYN who wrote a book about providing abortion care later in pregnancy. School officials told The Texas Tribune hosting the event on campus was not in the university’s best interests.

“Everybody who graduates from medical school in Texas should know that there’s this thing called third-trimester abortion, that when the life of the mother is at risk, you legally can provide this care,” Merritt said.

Republican Gov. Greg Abbott signed legislation last year clarifying that doctors can offer pregnant women abortions during medical emergencies. The Texas Medical Board released guidelines for the abortion law this year, nearly half a decade after the state banned most abortions and at least four Texans died after being denied prompt abortion care, ProPublica reported.

Program helps residents in restrictive states get abortion care training

“Every single physician, nurse and health care provider needs to be educated about abortion care,” said Dr. Jody Steinauer, an OB-GYN and the director of the Bixby Center for Global Reproductive Health at the University of California in San Francisco. “This is a huge crisis in OB-GYN specifically: All OB-GYNs must have the competence and the skill to safely empty the uterus. Even if the individual is personally uncomfortable providing abortion care, they have to be able to empty the uterus to save someone’s life in an emergency.”

Steinauer leads the Ryan Residency Training Program, which works with OB-GYN residencies across the country to ensure comprehensive abortion and family planning rotations. Nearly a dozen states lack Ryan programs, and most of them have near-total abortion bans.

She said residencies in states with abortion bans are struggling to make sure their students have the skills to provide abortion: “We’re at risk of having a whole generation of OB-GYN graduates who are not skilled to provide the care they need to provide.”

To remedy this issue, the Ryan Program has helped to establish 20 partnerships with schools in abortion-restrictive states to train OB-GYN medical residents in states with reproductive rights protections.

Steinauer said the rotations are between two to four weeks and complicated to plan, but they help doctors learn procedural skills, how to manage medication abortions and counseling.

The rotations also help OB-GYNs navigate pain management during obstetric procedures, communicate effectively with abortion patients and familiarize themselves with ultrasounds, she said. These skills are important for providing the full spectrum of reproductive health care, from inserting IUDs to treating miscarriages, the doctor said.

“It’s such a refreshing experience for them to be working in a state without a ban, and they get to see abortion as normal health care,” she said.

Stateline reporter Elisha Brown can be reached at ebrown@stateline.org.

States with and without abortion bans are advancing bills that would shield anti-abortion pregnancy resource centers from certain government mandates and attempts at regulation, allowing them to sue for damages if any part of the law is violated.

At least four states introduced the legislation this session, and two of them, Kansas and Wyoming, made it law. Montana also passed a similar law in 2025. The bills are still pending in Oklahoma and New Hampshire.

They are based on model legislation drafted by the Alliance Defending Freedom, a conservative legal advocacy group that represented one of the large umbrella organizations for pregnancy centers around the country, National Institute of Family and Life Advocates, when the California government attempted to regulate the centers in 2018 by requiring signage to be placed informing clients of available abortion options at state-funded clinics.

“This really just reflects the legal reality that pregnancy care centers have been hauled into court when they’ve decided they are not interested in pushing abortion and (the government is) going to make them,” said Kristi Hamrick, vice president of media and policy for the anti-abortion group Students for Life Action.

Many crisis pregnancy centers are faith based, with a mission of preventing anyone who walks in from choosing an abortion. In a recent 50-state analysis, States Newsroom found that 21 states allocated more than $491 million of taxpayer funds to crisis pregnancy centers since the U.S. Supreme Court’s Dobbs decision in 2022 that upended federal abortion rights. Medical experts, including the American College of Obstetricians and Gynecologists, say the centers can endanger public health by delaying legitimate health care and some centers that advertise services like free ultrasounds can miss diagnoses like ectopic or molar pregnancies, which are nonviable and can be life-threatening conditions.

The centers have also been criticized by advocates for misleading potential clients about their services, making it look like they provide abortion care, and for promoting treatments like abortion pill reversal that are unproven and potentially dangerous.

California’s law, which the U.S. Supreme Court struck down in 2018 on free speech grounds, also mandated disclosure if the pregnancy resource center was unlicensed. Violators would be fined $500 for a first offense.

Hamrick said the center protection bills are an “inoculation” against what she called malicious lawsuits that would punish them for refusing to go against their anti-abortion mission.

Samantha Nagler, a legal fellow with the Equal Justice Works program at Gender Justice, said the bills are carving out an area of health care where providers can omit information during a visit and face no consequences for it.

“No other health care provider I can think of is just exempted from regulation,” Nagler said.

Israel Cook, legislative counsel for the Center for Reproductive Right’s policy and advocacy team, said this type of legislation is becoming more popular as reproductive rights advocates push for regulation of crisis pregnancy centers.

Colorado passed a law in 2023 making it a deceptive trade practice to disseminate any public advertisement that indicates a facility provides abortions or emergency contraceptives when they do not. The law included a similar provision barring advertisement of abortion pill reversal, but a federal judge blocked enforcement of that part of the law in August. Alliance Defending Freedom also assisted with that lawsuit.

“It’s very scary for (the centers) to not be on the hook for the kind of harm that they perpetuate,” Cook said.

Oklahoma sponsor: Law allows centers to ‘stay in their lane’

The bills prohibit a state or local government from adopting or enacting a law, rule, ordinance or any other type of regulation that would require a center to offer or perform abortion, make referrals for abortion or abortion medication, or post any type of advertisement or material promoting abortion or abortion medication. Every bill, with the exception of Kansas, also says the centers cannot be compelled to offer or refer for contraception.

The Kansas Legislature passed House Bill 2635 on March 12 and overturned a veto by Democratic Gov. Laura Kelly on Friday. Kelly said she vetoed it because Kansans already voted to keep the government out of private medical decisions in 2022, preventing lawmakers from passing an abortion ban. Kelly also opposes the funding that crisis pregnancy centers receive from the state on an annual basis — the legislature approved $3 million in 2025, on top of a $10 million tax credit program.

Oklahoma’s House of Representatives overwhelmingly passed a similar bill in early March, but it hasn’t yet been heard by the Senate. It was sponsored by Republican Rep. Denise Crosswhite Hader, who said it was legislation that allowed the centers to continue their mission.

Oklahoma’s bill prescribes the largest penalties with an allowance for treble damages, which means a successful lawsuit could yield three times the amount of damages proven in court. A pregnancy center would be entitled to at least $10,000.

“I don’t see abortion as care. I see abortion as ending a pregnancy,” she said on the House floor during debate. The centers want to help with continuing a pregnancy, she said, but when they avoid abortion, they’re getting sued, “and what we’re trying to do is help it so that they can stay in their lane and not fight lawsuits over and over.”

The state government allocated $18 million to a revolving grant fund for crisis pregnancy centers in 2024 that will last through November 2027.

Oklahoma has a near-total abortion ban, with no exceptions for rape or incest, only an exception to save a pregnant person’s life. With that in mind, Democratic Rep. Cyndi Munson told States Newsroom she doesn’t see the need for the legislation.

“If a private organization has a policy, they can stick to their policy. I don’t know why we need to put additional protections into law,” Munson said.

Meanwhile, Oklahoma’s health care struggles continue, according to Munson. The state ranked 46th in infant mortality in a report from the nonprofit March of Dimes, and 31st in maternal mortality. But reproductive health care in general can also be difficult to obtain. Munson said she recently had to wait an entire year to receive her annual gynecological exam because her provider is overbooked.

She worries that at a certain point, crisis pregnancy centers will be the only type of health care that’s left, especially in more rural parts of the state.

“Not every woman is looking for abortion access, but they all need reproductive health care,” Munson said.

When an Alabama clinic’s only OB-GYN left the state to provide abortion care in Colorado, the head of operations thought the facility would have to close. 

But Robin Marty, executive director at WAWC Healthcare in Tuscaloosa, hired a doctor in August who she called a “unicorn” — someone who’s from Alabama and, after training outside of the state, returned home to practice medicine. 

Marty said Alabama’s near-total abortion ban could cause physicians to practice elsewhere after they finish their residencies. 

“Doctors don’t want to worry about surveillance, potential arrests and other legal issues,” she said. 

A study published this month found that applications to medical residency programs in states with abortion restrictions have declined compared to states where abortion remained mostly legal. The findings are an “early signal” that the U.S. Supreme Court’s decision nearly four years ago overturning federal abortion rights protections may exacerbate health care shortages, said lead author Dr. Anisha Ganguly.

A majority of doctors end up practicing medicine in states where they trained. Obstetrician and gynecology training programs typically take four years to complete, so the full scope of how abortion restrictions affect where physicians work after they complete their residencies remains to be seen. 

Still, experts said the findings could spell trouble for the future of the reproductive health care workforce in states with abortion restrictions, some of which are already plagued with maternity care deserts. 

Doctors say bans limit training, standards of care

OB-GYNs affiliated with Physicians for Reproductive Health who either trained or work in states with abortion bans told States Newsroom that restrictions after the Supreme Court decision hamstrung their ability to offer reproductive care and affected the education of medical residents. 

Dr. Neha Ali grew up in Texas and trained there, too. But by the end of her OB-GYN residency’s second year, the state enacted SB 8, a six-week abortion ban that allowed residents in the state to sue providers or anyone who helped someone terminate a pregnancy. After the Dobbs decision in June 2022, a near-total abortion ban took effect in Texas.

“I knew I wanted to be an abortion provider before I started OB-GYN residency, and I chose to be in Texas for my residency training because I wanted to experience what that’s like in a state with barriers. But ultimately, the barriers became too large,” Ali said. 

After she finished residency in 2024, Ali moved to Colorado, a state with strong abortion-rights protections, where she practices complex family planning.

Ali said she talks to medical students about her experience training in Texas, where she was not able to perform any dilation and evacuations — a second-trimester abortion procedure — during residency. 

“I do think it’s very valuable to see what it’s like to be in a restrictive state and understand what that is like to be a provider there, but that doesn’t sell people on a residency for four years,” she said.

OB-GYN Dr. Louis Monnig trained in Kentucky before the state banned abortion. 

“Making it difficult or putting up barriers to that training just limits the abilities of any doctor who provides reproductive care to have opportunities to get exposure and experience, and just get better at what they’re doing,” he said. 

Monnig completed his residency in June 2023 and moved back to his home state of Louisiana because of his connections to the region and its health care disparities. “It felt like it was worth it to come back,” he said. 

In October 2024, a Louisiana law classifying mifepristone and misoprostol as controlled dangerous substances took effect. 

“It made me lose faith that lawmakers were doing any of these things to actually protect patients or patient safety,” he said. 

The medications are used not only for abortions, but miscarriages and other conditions, too. The law has sowed confusion among health care providers and led some to practice emergency drills to access the drugs during obstetric emergencies, Louisiana Illuminator reported. Monnig said the law has “changed some of the day-to-day operational workflow for patient care,” especially for situations where misoprostol is used, such as labor induction and postpartum hemorrhaging. 

Patients have faced issues when trying to get prescriptions filled: Pharmacists have called Monnig’s office to make sure a patient wasn’t having an abortion after he prescribed misoprostol for conditions such as cervical stenosis — when it’s difficult to insert a medical instrument in the cervical canal.

Drop in applications to ban states’ residency programs

Out of more than 22 million applications to 4,315 residency programs across the U.S., 67% were submitted to programs in states without abortion restrictions between 2018 and 2023, the new research showed. Thirty-three percent went to programs in states with restrictions. 

Fewer women than men applied to train in states with abortion restrictions before the Supreme Court’s landmark abortion ruling, according to the study, and that disparity widened after more than a dozen states enacted abortion bans. The number of men applying to residency programs in states with abortion restrictions — mostly in the South and the Midwest — also decreased significantly. 

“When there’s a decreased level of interest in these states, it suggests to us that there’s an evolving health care workforce shortage in these states,” said Ganguly, an internal medicine physician and an assistant professor at University of North Carolina’s Division of General Medicine and Epidemiology. 

Many states with abortion bans — Idaho, Iowa and Georgia, for example — are also facing labor and delivery unit closures, particularly in rural areas where hospitals struggle with provider recruitment. Health officials in these states listed improvements to maternal health as a priority in their applications to the federal Rural Health Care Transformation Program, but solutions will take years to implement. 

Shortages affect more than one specialty. Ganguly said OB-GYNs have historically offered the bulk of abortion-related care in the U.S., but it’s increasingly important in emergency medicine, family medicine and internal medicine. Primary care providers and emergency medicine doctors often diagnose pregnancy complications such as miscarriages, and internists help women who have chronic disease manage and plan for pregnancy. 

Dr. Hector Chapa, an OB-GYN who teaches obstetrics and gynecology at Texas A&M University and is a member of the American Association of Pro–Life Obstetricians and Gynecologists, took issue with the study’s approach. 

“It’s essential to understand that this study is not specific to OB‑GYN residency programs, and by grouping OB‑GYN with family medicine, internal medicine and emergency medicine, the study assumes that all specialties are affected equally, despite their very different levels of involvement in abortion. This broad grouping risks introducing bias into the results,” he said in a statement. 

Ganguly said her team did examine applications to OB-GYN residency programs in isolation to affirm findings of a decline among applicants in abortion-restricted states. Looking at other specialties, too, was meant to provide clarity about how bans affect the health care workforce more broadly.

OB-GYN education and the maternal health care workforce 

The latest study adds to a body of research examining how the Supreme Court’s decision on abortion in 2022 affected training after medical school, particularly for those specializing in reproductive health care. 

In the 2023-2024 application cycle, the number of applicants to training programs in states with abortion bans decreased by 4.2% compared to the previous cycle, while there was less than a 1% decrease in applications to residency programs in states where abortion is legal, according to the American Association of Medical Colleges. 

In some states, abortion bans have definitively led to an exodus of OB-GYNs and maternal fetal medicine specialists. Idaho lost 35% of its doctors who provide obstetrics between August 2022 and December 2024, according to a study published in July. 

Having reproductive health providers flee states with abortion bans is “devastating,” according to Pamela Merritt, the executive director of Medical Students for Choice. 

“It’s a public health disaster that we’re going to see the consequences of decades to come,” she said. 

Merritt’s organization has chapters at several medical schools in states with abortion bans. She said students are not getting adequate training, and some are even discouraged from discussing abortion. 

In February, Texas Tech University Health Sciences Center canceled a Medical Students for Choice chapter’s talk with an OB-GYN who wrote a book about providing abortion care later in pregnancy. School officials told The Texas Tribune hosting the event on campus was not in the university’s best interests.   

“Everybody who graduates from medical school in Texas should know that there’s this thing called third-trimester abortion, that when the life of the mother is at risk, you legally can provide this care,” Merritt said. 

Republican Gov. Greg Abbott signed legislation last year clarifying that doctors can offer pregnant women abortions during medical emergencies. The Texas Medical Board released guidelines for the abortion law this year, nearly half a decade after the state banned most abortions and at least four Texans died after being denied prompt abortion care, ProPublica reported. 

Program helps residents in restrictive states get abortion care training 

“Every single physician, nurse and health care provider needs to be educated about abortion care,” said Dr. Jody Steinauer, an OB-GYN and the director of the Bixby Center for Global Reproductive Health at the University of California in San Francisco. “This is a huge crisis in OB-GYN specifically: All OB-GYNs must have the competence and the skill to safely empty the uterus. Even if the individual is personally uncomfortable providing abortion care, they have to be able to empty the uterus to save someone’s life in an emergency.”

Steinauer leads the Ryan Residency Training Program, which works with OB-GYN residencies across the country to ensure comprehensive abortion and family planning rotations. Nearly a dozen states lack Ryan programs, and most of them have near-total abortion bans. 

She said residencies in states with abortion bans are struggling to make sure their students have the skills to provide abortion: “We’re at risk of having a whole generation of OB-GYN graduates who are not skilled to provide the care they need to provide.” 

To remedy this issue, the Ryan Program has helped to establish 20 partnerships with schools in abortion-restrictive states to train OB-GYN medical residents in states with reproductive rights protections. 

Steinauer said the rotations are between two to four weeks and complicated to plan, but they help doctors learn procedural skills, how to manage medication abortions and counseling. 

The rotations also help OB-GYNs navigate pain management during obstetric procedures, communicate effectively with abortion patients and familiarize themselves with ultrasounds, she said. These skills are important for providing the full spectrum of reproductive health care, from inserting IUDs to treating miscarriages, the doctor said. 

“It’s such a refreshing experience for them to be working in a state without a ban, and they get to see abortion as normal health care,” she said. 

Republican lawmakers in several states so far this year introduced bills that would legally treat abortion as homicide. 

The proposed laws could have implications not just for pregnancy termination but for certain fertility treatments or even some forms of contraception. Despite broad unpopularity, even within the mainstream anti-abortion movement, the measures continue to be introduced and debated in statehouses, concerning abortion-rights advocates. They fear the U.S. Supreme Court might someday consider the constitutionality of such a law, premised on giving legal personhood status to developing embryos. 

“Whether or not one of the laws, should it be enacted, makes it in front of the court, what it does is create an environment in which the court can seem as if it’s not being so extreme or stepping so far out of the mainstream,” said Madeline Gomez, managing senior policy counsel at Planned Parenthood Federation of America. “The court often likes to look to how many states have laws like this.”

While abortion-rights advocates are sounding the alarm on these abortion-homicide bills they say would exacerbate the consequences of state bans, supporters have grown more frustrated with anti-abortion groups and Republicans for not being fully committed to abolishing abortion. They belong to the movement’s steadily growing pro-prosecution wing and continue to develop policy and messaging strategies to promote abortion-homicide legislation.

“We obviously disagree with the pro-life movement in large part — some of their organizations have stopped bills of abolishing abortion in places,” said Virginia pastor Jason Garwood protesting outside this year’s March for Life, holding a poster calling for a ban on in vitro fertilization. “We’re obviously opposed to Democrats, but we’re also opposed to Republicans who are compromised on the issue, who say one thing and do another, Donald Trump being one of the foremost. … I mean, Republicans have Congress, and we don’t have a bill to abolish abortion yet.”

Like Garwood, anti-abortion leader Abby Johnson believes a cultural change in the U.S. on abortion will not happen without the fear of murder charges. She is planning to launch a “Make Abortion Murder Again” college tour at major state schools this spring to help convince the next generation of adults to accept a reality where embryos and fetuses will have the same legal rights as the women and girls carrying them.

“Do I want to see women in jail? No, I don’t,” Johnson said. “Because I don’t want women to have abortions. It’s like, do I want to see people in jail for drinking and driving? I don’t, but I don’t want people to drink and drive.”

Most people don’t want to see women jailed for abortion. A recent Pew Research Center poll shows 60% public support for abortion in most or all cases, with surveyed conservatives and Republicans much more likely to support making abortion illegal in most or all cases. 

But University of Maryland School of Public Policy researcher Steven Kull found that when voters are confronted with the reality of criminalizing abortions in all cases, the political divide can shrink. Kull led a study of swing state voters ahead of the 2024 presidential election in Arizona, Georgia, Michigan, Nevada, Pennsylvania and Wisconsin. Large bipartisan majorities in these states said they did not want abortion to be criminalized before fetal viability, including Republicans (between 57% and 70%, depending on the state). 

Nationally, among those who favored making abortion a crime, 5% said the doctor should be punished, 5% said the woman, and 10% said both.

A 2025 survey published by reproductive rights legal nonprofits Pregnancy Justice and the National Women’s Law Center found that 59% of likely voters said they opposed granting legal rights to embryos and fetuses after learning about the criminal implications of these policies. 

Prosecuted for pregnancy outcomes 

So far this year, Republican lawmakers in Illinois, Kentucky, South Dakota and Tennessee have introduced legislation that would treat abortion as homicide in law. Most efforts have already fizzled, including a controversial amendment to a Tennessee bill that would have penalized women who have abortions, including those who leave the state to end a dangerous pregnancy. 

Several legislatures saw abortion-homicide bills last year, including South Carolina, where support and the list of bill sponsors grew in 2026.

Some states already have some kind of personhood language on the books, while others, such as Arizona and Missouri, continue to consider it. And women have already been arrested and charged for crimes related to miscarriages and stillbirths, and for taking abortion pills.

In January a woman from Campton, Kentucky, where abortion is banned throughout pregnancy, was arrested and charged with fetal homicide after taking abortion pills and burying the remains near her home. Prosecutors dropped the homicide charges after a state attorney submitted a court filing saying the state’s fetal homicide laws cannot apply to pregnant women. She is still being charged with a misdemeanor related to concealing a birth.

Earlier this month in Georgia, where abortion is banned at around six weeks gestation, police charged a woman with attempted murder after she delivered a severely premature baby who died shortly after birth. As the Current has reported, one friend told a police officer the woman had taken the abortion-inducing drug misoprostol and a pain medication, but another friend contradicted that account to the news outlet and said she had only taken the pain medicine. 

The woman, a mother of two young boys, also faces a drug possession charge because the Georgia Legislature, like Louisiana’s and Texas’, has placed misoprostol on a list of “dangerous” medications, along with another abortion medication, mifepristone. Unlike other states, Georgia’s abortion ban does not explicitly exempt pregnant people from criminal charges.

As States Newsroom has reported, the most serious charges are often dropped in these types of cases, but the harms related to reputational damage and incarceration can be long-lasting.

“Postpartum people are being investigated and jailed while their mugshots are plastered across the news as they endure a deeply private and personal experience,” said Pregnancy Justice Senior Policy Counsel Kulsoom Ijaz in a statement. 

Ijaz co-authored a report earlier this year finding that between 2006 and 2024, states prosecuted at least 58 women after they lost pregnancies, including the handling of remains resulting from a miscarriage or stillbirth.

“Although many of these cases are eventually dropped, the damage can’t be undone,” Ijaz said.

Reproductive rights advocates say abortion-homicide bills would likely exacerbate issues created by existing state abortion bans, even for wanted pregnancies: When patients and providers fear legal prosecution, they might avoid necessary health care, including prenatal care and emergency procedures.

“By making abortion equivalent to murder or homicide, these bills are also trying to make it impossible for people to ask for help, impossible for people to offer that help,” Gomez said. “They’re meant to be isolating and stigmatizing and really saying this is the worst crime that we imagine in our code, and you should be scared to even talk about it or think about it or offer that help.”

The promise of penalty

The mainstream anti-abortion movement spent the last half-century helping to pass incremental, strategic federal and state laws that made abortion harder to access and more expensive, eventually ending federal abortion rights. But groups like Abolitionists Rising, End Abortion Now and the Foundation to Abolish Abortion are pushing for near-total bans, with only exceptions for spontaneous miscarriages and life-saving medical procedures. 

More mainstream leaders like Students for Life of America’s Kristan Hawkins say abortion-homicide laws would set the movement back in terms of cultural acceptance and are not the silver bullet their supporters believe they are. 

“Abortion won’t end overnight,” Hawkins wrote in a recent Substack article. “Abortions will tragically continue … just like murder and theft continue. But, at some point, there will be an investigation, arrest, and prosecution. … The story won’t be: ‘The Pro-Life Movement Wants Justice for the Preborn Baby.’ It will be: “The Pro-Life Movement Wants to Jail & Execute Women.’”

Advocates more in the middle of this growing divide include Abby Johnson, who once worked as a Planned Parenthood clinic director but has spent the past two decades encouraging abortion-clinic staff members around the country to quit their jobs with the help of her organization And Then There Were None. Her profile grew in 2019 with the release of the movie “Unplanned,” based on her autobiography about her experience working for Planned Parenthood. 

Its veracity was challenged by an investigative reporter, and Planned Parenthood says Johnson has a track record of spreading false information about the organization’s mission, and sexual and reproductive health care.  

Johnson has advocated in legislatures and courts, trying to eliminate abortion rights in her home state of Texas and throughout the U.S. Last month, she testified in an amicus brief arguing medication abortion is gruesome in the abortion pill case Louisiana v. FDA. 

She is the rare female leader among the male-dominated groups that advocate for harsh penalties for women who have abortions. Johnson said she values her friendship with Hawkins, especially after having lost other friends and partnerships in the movement as her anti-abortion stance has become more radical. But while she criticizes the so-called abortion abolitionists for lacking grace, she criticizes the mainstream movement for focusing on regulation and treating women like victims instead of trying to deter them with harsh penalties. 

“I don’t think we’re going to hug and kiss our way out of this baby murder,” Johnson told the audience of about 2,000 predominantly university and high school students at Students for Life of America’s annual National Pro-Life Summit in late January.

She said the March for Life declined to partner with her on her next movie after having sponsored “Unplanned.” She said they told her the new one was too graphic.

A spokesperson for March for Life did not confirm but shared a written statement: “March for Life deeply values our fellow movement leaders and the dedication they bring towards building a future where every life is welcomed and protected.”

Johnson said she hopes the movie and the college tour, which is still being planned, could make harsher abortion penalties more palatable across the country. Harsher penalties would have saved her from choices she regrets, she said. 

“If there would have been some sort of consequence for my action at the time, I wouldn’t have had an abortion,” Johnson said. “That would have changed the trajectory of my life.”

The U.S. Department of Health and Human Services on Thursday announced an investigation into 13 states that require health insurance plans to cover abortion care. 

In a news release, the agency said the investigation is based on allegations that the states are coercing health care entities to provide coverage of abortion “contrary to conscience” and in violation of a federal law known as the Weldon Amendment. 

“OCR launches these investigations to address certain states’ alleged disregard of, or confusion about, compliance with the Weldon Amendment,” said Paula Stannard, director of the HHS Office for Civil Rights in a statement. “Under the Weldon Amendment, health care entities, such as health insurance issuers and health plans, are protected from state discrimination for not paying for, or providing coverage of, abortion contrary to conscience. Period.”

But reproductive rights advocates say it is a tactic to make abortion harder to access in states that have fortified protections. 

“At a time when abortion care is getting harder and harder to access, we are deeply concerned that the few states that have taken steps to protect access are now under attack,” said Katie O’Connor, senior director of federal abortion policy at the National Women’s Law Center, in a written statement. “These investigations also follow a familiar pattern from the administration: attacking states that the president views as political threats.”

Earlier this year, HHS’ Office for Civil Rights clarified the Trump administration would interpret the Weldon Amendment to allow employers and insurance plan sponsors to opt out of covering or paying for abortions because of their personal beliefs, contradicting the Biden administration’s interpretation. The agency sent a letter to top officials in Illinois in January, alleging violations of the Weldon Amendment and the Coats-Snowe Amendment. The latter prohibits governments from discriminating against health care entities as it relates to abortion training or participation.  

The agency did not specify the states being investigated, but the Washington Post reports that states with abortion-related coverage requirements are: California, Colorado, Delaware, Illinois, Maine, Maryland, Massachusetts, Minnesota, New Jersey, New York, Oregon, Vermont and Washington, which all have Democratic governors except for Vermont. 

States defended their laws and criticized the probe as political, following the announcement.

“Donald Trump’s latest ‘investigation’ is nothing but a fishing expedition wasting taxpayers’ money,” said New Jersey Gov. Mikie Sherrill, the New Jersey Monitor reported. 

The Vermont Department of Financial Regulation said it is reviewing the federal government’s notice and working with other state agencies to prepare a response. 

“DFR does not believe that it has unlawfully coerced or discriminated against any insurer related to the coverage of abortions as outlined in the (federal government’s) request,” Commissioner Kaj Samsom told the VT Digger. “We stand firmly behind the law in question and the protections and choice it provides Vermonters.”

The Heritage Foundation floated the proposal to withhold Medicaid funding for states in violation of the Weldon Amendment in its controversial presidential administration blueprint Project 2025, which President Donald Trump disavowed during his campaign. 

Visits for contraception and cancer screenings at Planned Parenthood clinics have dropped by double-digits after Congress passed a bill cutting off Medicaid funding to certain reproductive health care providers last year, according to a new Democratic congressional report.

Between July 1 and the end of December, the report said emergency contraception distribution fell 10%, oral contraception distribution fell 27%, and IUD insertions fell 10%.

Republican members of the House and Senate passed a sweeping budget reconciliation bill in July that included a one-year provision barring clinics from receiving federal Medicaid reimbursement if they offered abortion services and billed Medicaid more than $800,000 in fiscal year 2023. The rule largely affected Planned Parenthood because of the high dollar amount, but some large independent clinics were also affected, such as Maine Family Planning and Health Imperatives in Massachusetts.

Since July, Planned Parenthood reported 20 clinics were forced to close because of the cuts. That was in addition to numerous clinics that had to close after the loss of Title X funds and other factors, bringing the total to 51 last year. The report said nearly 75% of those closures were in rural, medically underserved areas. About half were in the Midwest, including Indiana, Michigan and Ohio, affecting about 25,000 patients.

“Almost all, 48 of 51, that closed between January and December offered primary care, and nearly half were in primary care shortage areas,” the report said.

In recent months, the decline in services grew. The report also notes there were 20% fewer visits for birth control pills in November, and a drop of 36% for intrauterine devices in December, the steepest decline out of all services measured. Some clinics have reported dropping their IUD offerings because it is a costly birth control device to obtain that was normally covered by Medicaid, but it is also the most popular and preferred form of birth control.

The number of visits for breast cancer screening exams fell by 25% in December, according to the report, and testing for sexually transmitted infections fell 11% in November, both of which could result in delayed treatment that increases overall health care costs.

Twelve states have committed their own funding to help address the gap from federal Medicaid cuts, amounting to about $300 million, according to the report. That includes California, Colorado, Connecticut, Hawaii, Illinois, Massachusetts, Maine, Nevada, New Jersey, New Mexico, New York, Oregon, and Washington. But advocates for Planned Parenthood say it still leaves a significant shortfall, because health centers nationwide provided an estimated $700 million in care annually to Medicaid patients before the law went into effect.

U.S. Sen. Ron Wyden, a Democrat who represents Oregon and a ranking member of the Senate Finance Committee, said at Thursday’s press conference that he will vigorously oppose any reconciliation efforts to make the cuts permanent.

“We’re here to tell people who are opposing access to health care for women, no way. It’s not going to happen on my watch at the Finance Committee, period. Not going to happen,” Wyden said.

Federal law already prohibits providers from using federal dollars to pay for abortion care, with limited exceptions. Medicaid dollars paid for all of the other types of care that clinics provide, including contraception, testing and treatment for sexually transmitted infections, and screenings for breast and cervical cancer. Maine Family Planning also provided primary care services to about 1,000 patients statewide, but had to halt that program in October because of the cuts.

“The report makes clear that it actually costs money to see all these Planned Parenthood offices or providers close, and once they’re closed, it’s not as though you can just bring them back up,” said U.S. Sen. Mazie Hirono, a Democrat who represents Hawaii, at a news conference Thursday morning. “But once they’re closed, people still need this kind of care, and so they’re going to go to other providers, or they will go without — which results in undiagnosed illnesses and health care needs.”

Planned Parenthood Federation of America and two of its affiliates sued to block the law, but the effort was unsuccessful. Republicans in Congress have signaled a goal of extending the cuts and making them permanent, as outlined in the Republican Study Committee’s framework for the next budget reconciliation bill, released in January.

A coalition of major anti-abortion advocacy organizations, including Live Action, Heritage Action, National Right to Life and Susan B. Anthony Pro-Life America, signed a letter sent to House Republican leadership urging them to immediately begin the reconciliation process and make the cuts permanent.

“Since the enactment of the 2025 reconciliation law, multiple abortion businesses have already closed facilities or scaled back operations, demonstrating the measurable impact of the defunding provision,” the letter said.

As telehealth access to abortion medication has grown in the years after the U.S. Supreme Court’s Dobbs decision, anti-abortion groups and attorneys general from states with abortion bans are accelerating efforts to ban access to the medication, including by attempting to revoke the U.S. Food and Drug Administration’s approval.

Louisiana Attorney General Liz Murrill sued the FDA in October and asked the district court to strike down a 2023 provision allowing telehealth prescriptions for mifepristone, one part of a two-drug regimen commonly used to terminate a pregnancy before 10 weeks. Included in the lawsuit is Louisiana resident Rosalie Markezich, who said her boyfriend pressured her into taking the pills. 

Louisiana officials argue doctors in states without abortion bans should not be allowed to prescribe and mail the medication into a state where it is illegal, and say Markezich would not have been harmed if the 2023 provision hadn’t made it possible for the medication to be mailed to her boyfriend. Murrill asked the court to block the 2023 rule with a preliminary injunction, and if granted, it could limit access for people nationwide.

A ruling in that case is pending, along with another abortion pill lawsuit in Missouri about the FDA’s approval of a generic brand of mifepristone last year.

Aside from court cases, legislatures around the country are also considering legislation restricting or banning mifepristone, which is also used to treat miscarriage and high blood sugar for some patients. Louisiana designated the drug a controlled substance in the same category as Xanax and Valium, and South Carolina’s House of Representatives passed a similar bill in February.

Whether in court briefings or before state policymakers, plenty of talking points about abortion medication are repeated that are not based on scientific fact or evidence, according to experts. Here are some of the most common:

1. The rate of serious adverse events associated with mifepristone is less than 0.5%, according to extensive scientific study.

Republican lawmakers and anti-abortion interest groups have cited an April 2025 paper to argue that mifepristone is dangerous and results in a much higher rate of serious adverse events than the FDA reported. That paper, which was not peer reviewed, was published by the Ethics and Public Policy Center, a conservative advocacy group that partners with groups like Alliance Defending Freedom, the conservative legal firm that has led many anti-abortion lawsuits, including the Dobbs case.

The policy center’s report finds a nearly 11% rate of “serious adverse events” based on commercially available health claims data. Experts dispute that the center defined a serious adverse event the same way the FDA does, as a condition that requires hospitalization, is life-threatening, or causes disability and permanent damage or death.

Dr. Mitchell Creinin, an OB-GYN at the University of California Davis Health who has researched the safety of mifepristone since studies first began in 1992, said there is overwhelming evidence that the medication is safe and the rate of serious adverse events is extremely low. In a report published by the Society of Family Planning, Creinin identified errors in the way the policy center’s analysis calculated events, saying there was double counting of issues associated with the same patient, and found that the report was counting serious adverse events that don’t meet the FDA’s criteria, including going to the emergency room.  

“It’s all about playing with science to make it say what you want it to say,” Creinin said.

One of Creinin’s studies from 2015 combined all relevant published studies on mifepristone and misoprostol between 2005 and 2015, a total of 20 studies with 33,846 women through 70 days of gestation, and found severe outcomes requiring blood transfusion and hospitalization occurred in less than 1% of cases.

2. Testing for Rh blood status is unnecessary in early pregnancy.

A common argument from anti-abortion groups like Students for Life of America, including in its amicus brief to the Louisiana court, is that telehealth abortion care cuts off the opportunity for doctors to test a pregnant patient’s Rh status before an abortion, which they argue can threaten the health of future pregnancies. 

A doctor will test a pregnant patient’s blood at some point during pregnancy to determine if they are Rh-positive or negative. If a patient knows their blood type, such as A or O, the positive or negative sign associated with the type is the Rh factor. Sometimes the pregnant patient’s marker is positive and the fetus is negative, which can result in the patient’s body identifying the blood cells of the pregnancy as foreign. That can cause the pregnant patient to develop antibodies against the blood cells. There needs to be enough of these cells to create a reaction, which doesn’t occur until after the first trimester, around 12 weeks. A treatment can be given in those cases to prevent antibodies from forming. 

Those antibodies can also form after miscarriage, ectopic pregnancy and abortion, according to the American College of Obstetricians and Gynecologists, and it could affect future pregnancies.

But the organization said in its amicus brief to the court in Louisiana that the risk of serious outcomes related to Rh issues before 12 weeks’ gestation is low, and it affects a small minority of the population, so limiting access based on that rare outcome would be a “disproportionate response.”

Creinin said research shows there aren’t enough fetal cells in early pregnancy to mount an immune response, such as a 2023 study of 506 first-trimester abortion patients in which all but one of them were below the threshold for an immune response. Most countries worldwide do not recommend treatment in a patient with the condition in early pregnancy, and that is the recommendation in the U.S. as well.

“There’s all this really good evidence that says you don’t need to do it,” Creinin said.

3. A patient doesn’t need an ultrasound before taking mifepristone.

A pregnant person is not required to have an ultrasound or be seen by a provider in person in order to obtain mifepristone, according to the FDA. Ultrasounds weren’t required even before the FDA stopped requiring in-person visits, and most pregnant patients aren’t given an ultrasound for an early pregnancy until at least eight weeks’ gestation, even if they intend to keep it. Symptoms of ectopic pregnancy, when an embryo implants in a fallopian tube instead of the uterus, usually begin by seven to eight weeks of pregnancy, and mifepristone is only approved for use up to 10 weeks.

The mortality rate of ectopic pregnancy is extremely low, at less than 50 deaths per year, and if someone has significant risk factors for ectopic pregnancy, Creinin said, they should be evaluated earlier. That’s part of the counseling involved in a telehealth appointment.

4. Taking mifepristone at home does not disproportionately result in traumatic experiences.

Anti-abortion groups such as the Justice Foundation have submitted amicus briefs to the Louisiana court about people who said taking abortion medication and managing the treatment at home led to traumatic outcomes because they weren’t prepared for what they would see.

That can happen, said Jessie Losch, director of government affairs for the American Society of Reproductive Medicine, but most doctors will counsel a patient first on what to expect and what they might see after the pills are taken, including passing fetal tissue.

Losch acknowledged that there can be a gap between hearing about what to expect and seeing it in person, but that isn’t a reason to take the option away from those who benefit from being able to choose when and where the treatment occurs. That can be especially important for victims of abuse, Losch said.

“I understand why somebody might be taken by surprise at the reality of it, but we can’t control for that with legislation,” she said.

Although there are few recent scientific studies that specifically examine at-home abortion management, one Society of Family Planning study from 2022 with more than 3,100 participants found 98.4% were satisfied with the experience and about 95% thought self-managing was the right choice for them.

5. There is no evidence to support the idea that taking mifepristone is harmful for the environment.

This argument has largely come from the anti-abortion group Students for Life of America, which says mifepristone pollutes the water supply and contends the FDA should have done an environmental review including effects on endangered species before easing restrictions on the drug. Multiple states have considered legislation to create environmental restrictions around the drug or bills requiring providers to instruct patients to collect fetal tissue in medical waste kits and return it to the provider rather than flush it.

The U.S. Environmental Protection Agency may also conduct a review that could be used to restrict access in the future, States Newsroom reported.

Losch said she hasn’t found any evidence that mifepristone is either detectable in the water supply or that it has a detrimental effect on wildlife, including the hormonal structure of fish or other aquatic animals.

In 1996, the FDA Center for Drug Evaluation and Research issued a finding of no significant impact on the water supply from mifepristone.

“The Center … has concluded that the product can be manufactured, used and disposed of without expected adverse environmental effects,” the finding stated. That included endangered or threatened species.

Editor’s note: This is the first report in an ongoing series.

The patient came in with a belly full of blood, Dr. Leilah Zahedi-Spung recalled. Her pregnancy was ectopic, no longer viable, and could have killed her if left untreated. But when she went to a mobile pregnancy help center offering free care in an RV in St. Louis, she was told the pregnancy could be saved.

By the time she saw Zahedi-Spung days later, her fallopian tube had ruptured.

In North Lauderdale, Florida, Ieshia Scott was pregnant and in the throes of postpartum depression. She thought she’d arrived at an abortion clinic. She told the staff she might hurt herself if she had another baby. They told her God would give her strength.

A woman and her partner in Sheboygan, Wisconsin, went to a pregnancy help center by mistake. When they made it to a Planned Parenthood clinic across the street, the pregnant patient handed Dr. Kristin Lyerly a copy of the sonogram. But the scan was not of her uterus. It was her bladder.

All three patients had gone to crisis pregnancy centers, organizations that advertise free pregnancy tests and ultrasounds but dissuade women from pursuing abortions and contraceptive options. Since the U.S. Supreme Court ended national abortion access in June 2022, the centers have seen an infusion of taxpayer dollars in many Republican-led states. But medical experts have urged lawmakers to reconsider the state support, as the centers can endanger public health by “causing delays in accessing legitimate health care,” according to the American College of Obstetricians and Gynecologists. 

States Newsroom conducted a 50-state investigation examining state and federal budgets, as well as the tax records of these organizations, finding that while the magnitude of public funding for them is growing, oversight is not. 

Twenty-one states funneled nearly a half-billion dollars, or $491 million, of taxpayer money to crisis pregnancy center organizations between fiscal years 2022 and 2025. That figure does not include millions some states diverted from federal programs like Temporary Assistance for Needy Families, and it does not include multimillion-dollar tax credit programs launched after federal protections for abortion rights were overturned. 

Nearly $1.3 billion in local, state or federal government grants were awarded to 1,259 crisis pregnancy centers in total between 2019 and 2024, according to States Newsroom’s analysis of tax records. The actual figure may be higher, as digital records are not comprehensive or entirely up to date.

Yet that largesse hasn’t been matched by corresponding regulation. Oversight of taxpayer funding remains weak, either blocked by legislators or ignored by state agencies. 

The centers are most often faith-based nonprofits that say they provide much-needed support for pregnant clients at no cost. An estimated 2,633 crisis pregnancy centers were operating in the United States as of March 31, 2024, according to research from the University of Georgia. 

John Mize, CEO of Americans United for Life, argues that pregnancy centers are important for people who really don’t want an abortion, and for anyone who regrets their abortion to find support. 

“I am strongly of the opinion that most women that have abortions do it because they don’t feel like they have any other option,” Mize said.

But critics and researchers say the pregnancy centers mislead potential clients about their services or pose as medical clinics despite lacking proper licensure. They sometimes promote treatments like abortion pill reversal, which is unproven and potentially dangerous. 

“Often, patients are lured in by this idea of getting free care,” said Dr. Rachel Jensen, Darney-Landy complex family planning fellow at the American College of Obstetricians and Gynecologists. “It’s free, because it’s often subsidized by taxpayer dollars. Free health care sounds amazing. It should be available to all people. But the problem is, then, that the CPCs are unregulated — and they operate outside of ethical principles and best care practices.”

Firsthand accounts: ‘What’s your plan for this pregnancy?’ Comfort, shame and a missed diagnosis

Indiana state Sen. Shelli Yoder, a Democrat, said access to maternal health care in her state continues to decrease while support for crisis pregnancy centers increases. Indiana boosted its budget for the centers from $250,000 in 2021 to $2 million, then doubled it to $4 million by 2024. The state’s maternal mortality rate is among the worst in the country. 

“It’s not that these centers don’t serve a purpose. But they certainly are not a replacement for maternal health care, and they are not health care centers, and yet our state is using taxpayer money to fund them as if they are,” Yoder said. “And we are sending a message to moms, or to women, that they are health care centers, and they are not.”  

Zahedi-Spung was working an emergency room shift in 2019 at a St. Louis hospital, not too far from the pregnancy center housed in an RV and frequently parked in front of a Planned Parenthood clinic. She said she was horrified to learn the patient with the ruptured ectopic pregnancy had been told at the mobile crisis pregnancy center a few days before that it could be saved. A tubal ectopic pregnancy is never viable.

Today, Zahedi-Spung works in Colorado as a high-risk OB-GYN. But that experience in the ER still haunts her.

“They’re a private organization providing medical care without a medical license, so they are not liable for anything they tell anyone,” she said.

Andrea Trudden, spokesperson for Heartbeat International, one of the largest pregnancy center networks in the U.S., said that as of 2025, more than 75% of Heartbeat affiliates offer medical services and are different from pregnancy resource centers, which offer parenting classes and material aid but not medical services.

“Medical affiliates that provide limited obstetrical ultrasound or other services follow applicable state laws, professional standards, and clinical protocols,” Trudden said in a written statement.

According to a report from the Charlotte Lozier Institute, 37% of 2,775 crisis pregnancy centers provided testing for sexually transmitted infections, and 29% provided STI treatment in 2024. The institute, which is the research arm of one of the largest anti-abortion policy groups, Susan B. Anthony Pro-Life America, found that 81% of surveyed centers provided ultrasound services in 2024. The report notes that 28% of paid center staff have medical licenses, along with 12% of volunteers.

The only option for miles

In North Florida’s largely rural Wakulla County, there are no full-time practicing OB-GYNs. Wakulla Pregnancy Center is in Crawfordville, the county seat of about 4,800 people. Many women in the area lack transportation, said the center’s director, Pam Pilkinton. They have to travel about 20 miles north to Tallahassee for prenatal care.

Run by a local ministry, the center has a blue-and-white sign that advertises “Free Pregnancy Tests.” Inside, a cozy living room furnished with sofas leads to a counseling room and donation space, where moms peruse a range of free baby clothes and supplies. Most of the center’s clients have low incomes, and are on Medicaid or uninsured.

When Florida passed a six-week abortion ban in 2023, legislators simultaneously increased state funding for crisis pregnancy centers by 455% — from $4.5 million to $25 million. The following legislative session, they added another $4.5 million. 

The funds go to the Florida Pregnancy Care Network, which manages contracts with more than 100 crisis pregnancy centers across the state. The organization is required to report the amount and types of services provided and the expenditures to the governor and state legislature once a year. But it is not required to make any noncompliance findings public. 

The public money for centers in Florida doesn’t end there. Wakulla Pregnancy Center received a separate allocation in the 2025 budget of $136,000. According to the funding request, $60,000 is allocated for a building asbestos issue, and $58,000 pays for the salary and benefits of the executive director and client coordinator. The rest is for pregnancy tests, educational materials, ultrasound referrals and other supplies. 

But Pilkinton is clear about one point: The center does not provide medical care in this maternal health care desert. 

“We’re not a medical facility, and that is something that we let everyone know up front,” Pilkinton said. “We provide material support, education, information and peer counseling.”

That doesn’t include practices like referring a patient to an OB-GYN for prenatal care after a positive test, for example, “because we’re not a medical facility,” she said.

Wakulla County’s severe maternal hospitalization rates ranked among the worst in the state in 2023 and 2024.

Like in other states, maternal health care has continued to flounder in Florida — and shortages are likely to worsen. Nearly half of 1,500 OB-GYNs who responded to a state survey say they plan to stop delivering babies within the next two years. 

The money Florida allocated for pregnancy centers might have covered more maternity care across the state, said Democratic state Rep. Anna V. Eskamani.

“We do need to strengthen our safety nets when it comes to supporting new moms,” Eskamani said. “Instead of addressing those gaps and investing in those areas, we continue to dole out millions of dollars to these unregulated and often religiously affiliated anti-abortion centers that are not addressing any of these disparities.”

In previous legislative sessions, Eskamani filed bills to repeal state funding and introduce regulation of existing centers. The bills have yet to receive a hearing, but she and her colleagues have filed them again.

“These not-for-profit organizations run with very little federal or state oversight, and sometimes they don’t even have licensed medical staff on site,” she said. “At this point, it’s a blank check.”

Big checks, little oversight

Much of the state funding for pregnancy centers did not exist before the U.S. Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision ended federal protections for abortion rights in June 2022. 

Conservative-led states — such as Texas — that already allocated tens of millions to pregnancy centers have doubled or tripled their budgets for pregnancy resource groups since 2022. In Missouri, lawmakers have budgeted nearly $50 million since fiscal year 2022 from the general fund and federal block grant dollars. Texas’ allocation ballooned from $140 million in fiscal years 2024 and 2025 to $180 million in 2026 and 2027. 

In southwest Missouri, Republican state Rep. Christopher Warwick’s support of the centers is a focus of his reelection campaign.

“I think it’s important that we fund organizations that are willing to save life,” he said.

Read more: Federal funding for people in poverty heading to anti-abortion centers instead

Louisiana lawmakers directed $4 million from the state’s general fund to pregnancy centers for 2025, as part of its Pregnancy and Baby Care Initiative. But an audit found the state doled out the maximum amount per center allowed by state law — $100,800 — to most of the groups without requiring them to fully document how they spent it.

Auditors were concerned Louisiana paid the centers more than the cost of the actual services provided.

In Oklahoma, state auditors discovered in 2022 that an anti-abortion nonprofit called Oklahoma Pregnancy Care Network disbursed less than 7% of the $1.6 million it promised to nonprofits under the state’s Choosing Childbirth program. A month and a half before its contract was scheduled to end, the group had served 524 women, less than 6% of the 9,300 Oklahoma women it initially projected it would serve. An administrator with the nonprofit told The Oklahoman she was unaware there were problems.

Despite those findings, state lawmakers later directed nearly $18 million — a quarter of the state health department’s entire budget — toward Choosing Childbirth through November 2027. More than $4 million of it went to the Oklahoma Pregnancy Care Network. The network did not respond to States Newsroom’s requests for comment.

Inner workings

Lyerly, the OB-GYN in Sheboygan, Wisconsin, said the couple with the mislabeled sonogram came into her Planned Parenthood clinic in the early months of 2022. It wasn’t uncommon for patients with appointments at Planned Parenthood to accidentally go to the crisis pregnancy center across the street. This couple sought an abortion, she said, but came in with the ultrasound image of the woman’s bladder rather than her uterus. On top of the mislabeled ultrasound, they felt misled, because they were told the pregnancy was just a few weeks along when it was much more advanced.

“This was a challenging situation for them, was emotional and frustrating and upsetting to them, and it was so unnecessary,” said Lyerly. She stopped providing abortions in Wisconsin later that year when a state law banning the procedure went back into effect after the Dobbs decision.

Many centers are affiliated with umbrella organizations, including Care Net, Heartbeat International (formerly Alternatives to Abortion International) and National Institute of Family and Life Advocates, but often do not disclose that connection on their website. The parent companies provide guidance for operations, including yearly conferences, along with training for limited ultrasounds and other services. Training and funding for many of these centers’ ultrasound programs also come from national religious groups like Focus on the Family and the Knights of Columbus.

Heartbeat International is the largest of the three, with more than 4,000 affiliated service providers across the U.S. and in more than 100 countries, according to Trudden.

Trudden said Heartbeat International offers professional training and practical resources for affiliates, who determine their own governance, leadership and location and must agree to a set of standards also shared by Care Net and the National Institute of Family and Life Advocates. Those standards include practicing honesty and confidentiality with clients and complying with all legal and regulatory requirements. 

Some pregnancy centers are staffed with licensed professionals trained in sonography. The National Institute of Family and Life Advocates says it has trained more than 6,000 health care professionals “in the medical and legal ‘how to’s’ of limited obstetrical ultrasound.” But at its national conference last year, leaders discouraged centers from performing ultrasounds on women who they suspect have ectopic pregnancies to avoid liability. The guidance came in the wake of a lawsuit against a Massachusetts center, in which the plaintiffs alleged that center staff failed to diagnose an ectopic pregnancy that ruptured, prompting emergency surgery. The clinic reached a settlement with the patient. 

Some centers offer more medical services, like prenatal support and testing and treatment for STIs, such as Idaho’s Stanton Healthcare, which is accredited by the Accreditation Association for Ambulatory Health Care and does not receive any public funding. 

“We have caught ectopic pregnancies. … I can think of three in the last eight months off the top of my head,” said Angela Dwyer, Stanton’s director of client services. 

But advocacy groups such as Campaign for Accountability have raised alarms about how many clinics do not have to follow federal health privacy laws, including the Health Insurance Portability and Accountability Act, known as HIPAA.

Clinics that offer free services and do not bill insurance face no penalty for disclosing a client’s information. 

In contrast, Jessica Scharfenberg, CEO of Healthfirst Network in central Wisconsin, said if any of her 10 reproductive health clinics violated HIPAA, they would face steep federal fines and possible jail time for staffers. 

“If my entity broke HIPAA, we would have federal consequences, even though we also have an internal policy for it,” Scharfenberg said. “They have their internal policies. They break HIPAA, there’s no consequences for it.”

The websites of some centers give the appearance of being HIPAA compliant even though they aren’t, States Newsroom has reported. 

The other two main umbrella organizations did not respond to multiple requests for comment by email and phone. 

‘So much help’

In North Lauderdale, Ieshia Scott would stare at her 6-month-old, unable to hold the baby when she cried. Scott, who also had a 10-year-old, felt overwhelmed by a constant cloud of stress and sadness, all while trying to keep up with college classes.

When she found out she was pregnant again, Scott searched for an abortion clinic in the city, and a pregnancy resource center came up in the search results. That 2018 visit would last nearly three hours, during which she fielded dozens of questions about why she wanted an abortion. Scott had suicidal thoughts and was depressed but felt totally unheard. 

“I really was disregarded,” said Scott, now 36. “I was actually saying to her, like — ‘I don’t know, I might hurt myself, I might hurt the baby.’”

The center didn’t refer her to a psychiatrist, therapist or OB-GYN. The staff member instead reminded her of the Ten Commandments.

“I’m literally telling her, I can’t — I can’t do it. And she was like, ‘You can, you can. And there’s so much help.’”

Mental health is a contributing factor in about 23% of the nation’s maternal deaths, reports from the federal Centers for Disease Control and Prevention show.

Scott eventually went to a clinic to get the care she needed. But she worries for women who can’t. 

More than a dozen states passed abortion bans after Dobbs, and efforts continue nationwide to dismantle what access remains. Several states with abortion bans — including Missouri, South Carolina and Texas — have moved to cut Planned Parenthood out of state Medicaid programs as well, after the U.S. Supreme Court ruled last year that excluding the organization did not violate Medicaid’s provision requiring freedom of choice in providers. Florida legislators are also discussing cutting Planned Parenthood out of the state Medicaid program.

In 2025, at least 51 Planned Parenthood locations closed or limited medical services after losing state and federal support. Those communities lost access not only to abortion services but also to other reproductive and primary medical care. Independent clinics such as Maine Family Planning stopped offering primary care services for about 600 patients because of a funding loss of about $1.9 million, even though none of the Medicaid dollars were used for abortion.

‘Government handouts’

Lawmakers are not only opening public coffers to provide direct financial support to pregnancy centers, but they’re also creating tax breaks, drawing on federal sources and shifting funds meant to help low-income families to aid the anti-abortion organizations — with few regulations.

Some legislators have resisted stronger oversight. 

In Missouri, state Rep. Warwick opposed a colleague’s suggestion to require the centers to report how they spend their donations in a tax credit program, saying he wanted to limit bureaucracy. He said in a February 2025 legislative hearing that the tax credit keeps the state from having to “verify what programs work.” 

“I don’t think they’re funded enough to be able to mishandle their money,” he told States Newsroom in December. “At least not the ones I’m familiar with.”

Warwick proposed raising the tax credit for pregnancy center donations from 70% to 100% in 2025, meaning someone donating to a pregnancy center could reduce their state tax bill by the exact amount donated. 

The credits that Missourians redeemed shot up from about $2 million to an average of more than $7 million per year after lawmakers removed a cap on credits in 2021, according to a fiscal note attached to Warwick’s bill. State officials estimated a 100% tax credit just for pregnancy center donations would cost the state more than $10.7 million in the first year.

Missouri also funnels more than $2 million per year in state and federal dollars to pregnancy resource centers and similar organizations through its Alternatives to Abortion program. That’s in addition to what the centers receive from Missouri’s federal Temporary Assistance for Needy Families fund — $10.3 million in this fiscal year.

Although Warwick’s 100% pregnancy center tax credit failed, he plans to try again in this year’s session. “I don’t think it (a 100% tax credit) would significantly hurt the state, especially when we’re talking about protecting life, protecting the birth of children,” he said.

Nebraska Sen. Joni Albrecht, a Republican who also sponsored a six-week abortion ban, said the centers were a valuable investment when she sought to create a $10 million tax credit program that was revised down to $1 million in 2024. 

Of the 13 pregnancy centers approved for tax credits in Nebraska, four provided less than $150,000 in services, according to tax returns, and one had three consecutive state audit reports with findings of deficiencies in controlling and complying with federal grant funding requirements.

In Montana, a state without an abortion ban, Republican Gov. Greg Gianforte found another way to give taxpayer money to pregnancy centers by donating a portion of his annual salary. In 2020, he pledged to give his salary to nonprofit organizations and charities, and has for the past three years included pregnancy centers in that list for a total of more than $60,000.

Idaho state Sen. Ben Adams, a Republican who sponsored a bill to establish a grant fund of $1 million for crisis pregnancy centers in 2025, told States Newsroom he felt it was important to put resources into helping people choose to have a baby. 

“We have, for a very long time, primarily through the federal government, essentially funded abortion through funding for Planned Parenthood and all these different organizations,” Adams said. “We say we’re going to restrict a woman’s access to abortion and that we’re pro-life. Well then, we actually have to be investing in those folks who are choosing life and show them that we mean it when we say we want them to choose life.”

For decades, the Hyde Amendment, a provision Congress has renewed annually, has prohibited the use of federal funding for abortions, except in cases of rape, incest and to save the mother’s life.

Idaho is one of a few states with an abortion ban that isn’t providing government support for crisis pregnancy centers. Adams’ bill failed by one vote in committee and faced opposition from many constituents, including a former board chairman of a crisis pregnancy center in Idaho who said subsidizing nonprofit entities with taxpayer dollars is not the proper role of government.

“Providing taxpayer funds on either side of this moral question is inappropriate,” said John Crowder in his testimony to the legislative committee, prefacing his comments by saying he is a Christian who believes life begins at conception. “Such decisions to lend financial support should be left to churches and individuals, not the government.”

Based on his knowledge of the finances of that center, Crowder said, it was clear they could meet the goals of their mission with the donations they received and “without government handouts.” 

Stateline reporter Amanda Watford contributed to this report. 

This story is part of a reporting fellowship sponsored by the Association of Health Care Journalists and supported by the Commonwealth Fund.

States Newsroom’s investigation is ongoing. If you have had an experience with a crisis pregnancy center, please get in touch at cpcproject@statesnewsroom.com.

METHODOLOGY: To identify government grant funding received by nonprofit crisis pregnancy centers (CPCs), a team of States Newsroom reporters used multiple data sources. Reporters reviewed state and federal budgets and legislation to identify public funding allocated to CPCs between 2019 and 2025, with a particular focus on the period following the U.S. Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision in June 2022, as well as in prior years, as applicable. The team did not include federal funding from sources such as Temporary Assistance for Needy Families in the nationwide analysis, and state tax credit programs were also excluded.

Data reporter Amanda Watford cleaned and analyzed a publicly available dataset of CPCs originally collected by the nonprofit advocacy group Reproductive Health and Freedom Watch. Organizations that appeared to be permanently closed or did not report enough revenue to file a full IRS Form 990 were removed from the States Newsroom analysis. Watford extracted filings from ProPublica’s Nonprofit Explorer for about 2,000 organizations, covering 2019 to 2025. Government grant totals were only available for 217 organizations for 2023 and 2024 due to data infrastructure limitations. A separate analysis using the GivingTuesday 990 database captured basic financial and government grant data for 1,243 organizations between 2019 and 2023. Watford combined the 2019-2023 GivingTuesday data and 2023-2024 ProPublica data. The total amount of government funding provided to CPCs was calculated for each year, yielding a grand total of nearly $1.3 billion across 1,259 CPCs between 2019 and 2024.

This analysis is not comprehensive. Some IRS Form 990 filings were unavailable digitally, and some organizations did not report any government grant funding, so grant funding reported outside the available electronic filings was not fully captured. Financial information available through IRS Form 990 filings is self-reported by organizations to the IRS and is not independently audited. Additionally, there is a lag between when organizations are expected to file returns and when filings are publicly available. Due to these factors, the States Newsroom  findings likely undercount the total amount of public, government funding directed to CPCs. An estimated 2,633 CPCs were operating in the United States in 2024, according to research from the University of Georgia.

The bulk of the money Missouri gives to its crisis pregnancy centers comes from federal funds meant to assist families experiencing poverty with basic necessities and child care, Republican Rep. Jason Smith said on the U.S. House floor in January.

As many as $3 of every $4 for pregnancy centers in Missouri was from the federal Temporary Assistance for Needy Families program in 2024, and in the 2026 fiscal year, it will be $2 out of $3. The amount of TANF funding has steadily increased since 2022, from $4.3 million then to $10.3 million in fiscal year 2026. 

At least eight states have given TANF funds to crisis pregnancy centers in recent years, even before the U.S. Supreme Court overturned federal protections for abortion rights in 2022. According to data from the consulting firm Health Management Associates, more than $102 million from TANF went to the centers in those eight states between 2017 and 2023, including $22.5 million in Ohio, $11.75 million in Indiana and $12 million in Texas. 

The federal government gives TANF funds to each state as a lump sum, and states get to decide how to spend it. There are broad rules for how the funds can be used, but federal law specifies they should assist with facilitating housing or employment; prevent and reduce “out-of-wedlock pregnancies”; and help form and maintain two-parent families. The U.S. House passed a bill in January that would explicitly lay out that crisis pregnancy centers can be a recipient of the funds. It hasn’t been taken up by the Senate yet.

Diana Rodin, associate principal at Health Management Associates, said block grants like the ones associated with TANF can be used broadly, and there isn’t much oversight after the funds are distributed. 

“You have some states that might say in their state plan, ‘We are spending this much on our Alternatives to Abortion program,’ but there’s some states where it’s going to them (crisis pregnancy centers), but there’s nothing you can find,” Rodin said. 

Conservative advocacy groups and lawmakers say anti-abortion crisis pregnancy centers provide many free goods and services and are deserving of TANF funds. 

Former Democratic President Joe Biden’s administration proposed regulatory changes that would have required states to show how allocations to pregnancy centers accomplished the purpose of TANF but withdrew them in early January 2025, shortly before Republican President Donald Trump was sworn in. 

On the House floor, Smith said that if the Biden administration had been successful, it would have been detrimental. Yet most crisis pregnancy centers do not provide any medical services beyond nondiagnostic ultrasounds and do not provide prenatal care from physicians. 

“Think of what would’ve happened to maternal care in this country,” Smith said. “One of the few places women can get care and support would have been closed.”

More money on the way

Crisis pregnancy centers are nonprofit organizations, often affiliated with religious groups, that have a mission of preventing people from terminating a pregnancy. A nationwide States Newsroom analysis found that 21 states funneled nearly a half-billion dollars in public money to crisis pregnancy center organizations between 2022 and 2025, and more in the form of tax credit programs. That figure did not include the millions in TANF distributions allocated by those eight states. 

More pregnancy centers are also tapping into federal sources, such as grants for abstinence-only education programs, teen pregnancy prevention, and U.S. Housing and Urban Development funds. 

Read our investigation: Taxpayer dollars flood pregnancy centers. Oversight hasn’t followed.

Medical organizations, including the American College of Obstetricians and Gynecologists, object to the misleading and deceptive practices of many pregnancy centers. Federal audits have also shown that some are not properly managing the public funds they receive.

Two centers in California and Washington identified in States Newsroom’s analysis doubled the amount of grants received for abstinence-focused sex education programs in the past two years, according to federal records. In Louisiana, the Department of Children and Family Services shifted $2.26 million in TANF funds to its pregnancy center grant program for fiscal year 2026 after lawmakers cut the program’s state funding by the same amount because more than two-thirds of it went unused, according to a recent state audit.

Millions more in federal dollars are likely to be accessible if the Trump administration changes rules for Title X family planning funding, as it did during the first term in 2019, allowing organizations to receive funds without offering birth control. Under current rules, Title X requires clinics to prescribe birth control and provide other family planning services to low-income populations for free or at low cost. Most pregnancy centers do not prescribe or refer for birth control, which is considered an essential aspect of reproductive health care by the medical community. 

Clare Coleman, president and CEO of the National Family Planning and Reproductive Health Association, said she and her staff are prepared for the administration to propose a rule change that would allow providers to not offer or refer for birth control, abortion or other family planning services as a condition of receiving the funding. 

“We’re expecting it any day now,” she said. 

Crisis pregnancy centers and other anti-birth control organizations will be better prepared to apply for the funding if the change is adopted, Coleman said. “And that’s not something our folks really had to deal with before, so we’re quite concerned.”

Audit finds mismanagement

Federal records show millions of federal dollars flow to crisis pregnancy centers under the Title V Sexual Risk Avoidance Education program, which focuses on abstinence and relationship development for teens. Some states apply for the grant dollars, but individual organizations can also apply for a portion of the funding in a competitive award process. 

A major recipient is The Obria Group and its affiliates, including RealOptions in California. Obria, a chain of pregnancy centers that offers some medical services like testing and treatment for sexually transmitted infections, operates largely in states with strong protections for reproductive rights. Those states typically do not provide state funding for pregnancy centers, but the centers have tapped into federal funding. Under the first Trump administration, Obria received a $1.7 million grant from the Title X program, with the possibility of two more years of funding for a total of $5.1 million, despite Obria’s unwillingness to provide birth control. 

Obria did not respond to a request for comment from States Newsroom.

RealOptions has received nearly $4 million in Title V funding for an abstinence-only education program since 2020, federal records show, including $900,000 in 2024 and 2025 — double the amount received in prior years. 

 

 

A routine federal audit published in October found RealOptions had placed more than $127,000 of the funding in the wrong budget year. The company did not have adequate policies and procedures for ensuring federal awards were tracked, according to the audit, and RealOptions also failed to complete a form detailing how grant funds were spent as required by law.

In their findings, auditors said the lack of sufficient oversight on the funds created a “high risk” that the company would be out of compliance with federal regulations, and the errors would not be caught or corrected in a timely manner.

RealOptions did not respond to questions from States Newsroom about the audit.

Sex ed funding  

In Washington state, a crisis pregnancy center called Life Choices of Yakima runs a program with abstinence-focused funding called Think Twice Yakima. It has received at least $335,000 per year in Title V federal funding for the program since 2019, and partners with several local schools to administer the curriculum. In early December, the website included the logo of the Washington State Department of Children, Youth & Families in a list of its partners. 

When States Newsroom reached out to the state agency to ask about the partnership, spokesperson Nancy Gutierrez said it was not a partner, and the organization was asked to remove the logo, which it did. 

Life Choices of Yakima did not respond to a request for comment from States Newsroom. 

Like many of the abstinence programs, Life Choices uses a curriculum from the Dibble Institute, a nonprofit organization in Berkeley, California, that provides a spectrum of sex education materials for licensing. Kay Reed, president and executive director of the institute, said clients include Planned Parenthood and centers like Life Choices, as well as various universities and colleges. The Dibble Institute recently released an abstinence-only curriculum to align with executive orders from the Trump administration. 

The funding, Reed said, dates back to former President George H.W. Bush, a Republican. 

“It’s been around a long time, and it’s part of the push and pull between Republicans and Democrats,” she said. 

But the curriculum has grown more restrictive now than with prior administrations, Reed said, pushing for abstinence only “until marriage.” 

Federal housing dollars

Other crisis pregnancy center groups are moving into less common areas of federal funding. Georgia Wellness Group received $450,000 from U.S. Housing and Urban Development block grant funds in July to help build a maternity home in the Atlanta area. County commissioners approved the grant despite vocal opposition from community members, who called it a fake clinic and alleged it deceives people about its true anti-abortion intentions. 

At a public hearing in August, Georgia Wellness CEO Robin Mauck said the grant will be used to purchase a residential home to accommodate up to six women and their children for up to eight months after birth. In January, the group applied for nearly $636,000 in new HUD grant funding for the 2026 cycle, which is under consideration by the county. 

Firsthand accounts: ‘What’s your plan for this pregnancy?’ Comfort, shame and a missed diagnosis

The organization used to be affiliated with The Obria Group, a national chain of crisis pregnancy centers that has been criticized for its practices, including by a former leader of the organization. Mauck said at the August hearing that it was a relationship they used to help them “transition to prenatal care.” 

In addition to the HUD dollars, Georgia Wellness Group received more than $1.27 million from the Title V Sexual Risk Avoidance Education program between 2021 and 2023, and another $445,000 in 2024. U.S. Rep. Lucy McBath, a Georgia Democrat, helped the organization apply for the federal funding that year with a letter of support, when it was still affiliated with Obria Medical Clinics. The program received another grant of the same amount in 2025.

Attorneys for Georgia Wellness Group sent cease-and-desist letters to people for tying them to Obria during public hearings and for saying the group misleads patients about the services they provide. One of those letters was sent to Allison Glass, state campaign director for the Amplify Georgia Collaborative, a group of reproductive rights advocacy organizations. She shared a copy with States Newsroom.

“There’s a huge housing need in Georgia, and especially around Atlanta, for affordable housing, but that should not come with the shame and deception,” Glass said. “They are so good at being so deceptive about who they are and truly what kind of services they provide and what credentials they have, that they really have unfortunately been able to really dupe a lot of stakeholders and decision-makers in Georgia.” 

Glass said this is the first time she and other advocates know of in which a crisis pregnancy center has received HUD funding. 

Mauck did not respond to a request for comment from States Newsroom. 

The group is one of few crisis pregnancy centers that says it has medical professionals who are fully licensed and overseen by a board-certified OB-GYN, offering many more health services, including breast and cervical cancer screenings, sexually transmitted infection testing and treatment, and prenatal care. But Georgia Wellness does not list birth control as an offered service, only IUD removal. 

A former medical director for the organization, Dr. Marc Jean-Gilles, has said the clinic is misleading people about its ability to provide obstetrical care, because it does not have admitting privileges and patients are told to seek emergency services elsewhere when they are in labor. He also said surrounding hospitals refuse to coordinate care with the organization because of alleged unethical practices. Those statements were read aloud at the August public hearing to approve the first installment of HUD funding.  

Jean-Gilles told States Newsroom in February that he has no problem with the organization receiving HUD funding if they are using it to shelter people, but from a patient safety standpoint, he said all clinics providing prenatal care should be able to coordinate with local hospitals. 

“My whole take is, it doesn’t matter if you’re a crisis pregnancy center or not. I think when you delve into the realm of prenatal care and delivery, if you can’t provide a provider who’s going to deliver … then you’re doing a disservice to the patients,” Jean-Gilles said. 

Grant Adams, a staff member at Georgia Wellness, said any allegations that the organization misleads anyone about its clinical capabilities are false, as are claims that the youth outreach program is “abstinence only.” During the August public hearing, Adams, who teaches the program to Atlanta-area middle and high school students, said the curriculum includes “medically accurate information about contraception” and tells young people about the risks of early sexual activity so they can make healthy decisions. 

“It doesn’t matter how loud a claim is made, that doesn’t make it true. It doesn’t matter how often a claim is made, that doesn’t make it true,” he said. 

Stateline reporter Anna Claire Vollers contributed to this report.

This story is part of a reporting fellowship sponsored by the Association of Health Care Journalists and supported by the Commonwealth Fund.

States Newsroom’s investigation is ongoing. If you have had an experience with a crisis pregnancy center, please get in touch at cpcproject@statesnewsroom.com.

For nearly 60 years, crisis pregnancy centers have been a pillar of the anti-abortion movement.

Largely staffed by volunteers or part-time workers, these centers — sometimes referred to as pregnancy resource centers — offer limited services related to pregnancy and are guided by a religious mission to stop people from considering abortion.

States Newsroom conducted a 50-state investigation examining state and federal funding for these centers. Between 2022, when the U.S. Supreme Court overturned federal protections for abortion rights, and the end of fiscal year 2025, 21 states have funneled nearly a half-billion dollars to crisis pregnancy centers. Physicians and researchers told reporters they’re concerned about the magnitude of public money crisis pregnancy centers are receiving while Planned Parenthood clinics and other community clinics offering reproductive health care are defunded.

Read our investigation: Taxpayer dollars flood pregnancy centers. Oversight hasn’t followed.

As part of an ongoing series to shed light on the issue, States Newsroom spoke with dozens of doctors, patients and people who found themselves in crisis pregnancy centers. These are some of their stories.

Alabama

When Valkyrie Brodt, 30, became pregnant for the first time last year, she did an online search to find a clinic that would take someone without insurance. She and her husband were waiting to be approved for health insurance, and she was hoping to find a provider who would confirm her pregnancy and check that it looked healthy so far. In her search results, she found what she thought was a pregnancy-focused medical clinic a couple of blocks from the hospital in her hometown of Huntsville, Alabama. She booked an appointment. 

The couple arrived and began to fill out the clinic’s paperwork, but Brodt said something felt off.

“A lot of the questions were less about medical history and more so faith-based questions, and other questions like, ‘What’s your relationship with the baby’s father?’ ‘What’s your plan for this pregnancy?’ I think it did specifically ask what your religion was.

“At that point I realized, OK, this is clearly a Christian-run kind of place. I grew up Church of Christ, and I have a lot of religious trauma from the way that I grew up. I would not consider myself religious at this point. I’m very open-minded towards people who are religious, no bias other than just not wanting it shoved on me.

“I was also under the impression they were going to do the blood test analysis to confirm pregnancy, but it was just another urine sample. And I was like, well, I’ve already done four of these, and they were all positive.

“Then when they called us back, she (the clinic staffer) literally used the words ‘divide and conquer.’’’

Brodt was taken to one room, while a male counselor took her husband to another room. She said she understands why staff might want to separate them, in case of concerns about possible domestic violence or coercion. But Brodt said she was never asked about the couple’s relationship or whether she felt safe. The counselor confirmed that Brodt wanted to keep the baby, asked more faith-related questions, and told her that if she attended counseling sessions she could earn “baby bucks” to redeem on baby items from their store.

“At one point, towards the end, she (the counselor) said, ‘Well, if you know anybody who’s thinking about getting an abortion, send them our way.’ So it was very clear at that point that that was their goal. They gave us probably three or four different pamphlets, and only one of them was a piece of paper with the pregnancy confirmation on it. The rest was ministry stuff, like faith-based parenting classes.”

The clinic scheduled an ultrasound for her, but she and her husband decided not to go back.

“It felt very predatory to me as a 30-year-old woman that’s married. So I can’t imagine how it would feel to a teen mom or a single mom having to walk in there by herself.” 

Read more: Federal funding for people in poverty heading to anti-abortion centers instead

Idaho

Dr. Cate Heil knew people in her hometown who worked at crisis pregnancy centers, and she didn’t have much of an opinion about the centers, other than they seemed like good places for pregnancy counseling. 

That perspective changed.

During her training to become a family medicine physician in Idaho in 2020, she saw a 17-year-old patient who had gone to a pregnancy center, where she received a transabdominal ultrasound. The center told the patient there was “a lot of fluid.” 

“Based on her period, she would’ve been about eight weeks and three days. It didn’t seem like they told her much else. 

“We did a transvaginal ultrasound and saw some concerning things. This patient had a molar pregnancy, which shows up pretty characteristically on ultrasound and is considered a pre-malignancy. Her uterus at supposedly eight weeks was 1 centimeter above her pubic bone, which is much larger than would be expected. She underwent surgery the next week.

“It was concerning to me that this wasn’t recognized as something that’s abnormal. This is not quite an emergency, but it’s something that needs to be managed within a week or so, or needs immediate referral for a surgeon — and that made me nervous.

“Is there other stuff that we’re missing? This is a fairly rare thing, but it’s not unheard of, and it should be able to be recognized by people who are operating an ultrasound, in my opinion. … It made me want to double-check things when someone has gone to a crisis pregnancy center.”

Oregon

Emily Gartman wanted to keep her baby. Unexpectedly pregnant at 21, a friend recommended a pregnancy center, saying nice people would quickly confirm the pregnancy without an appointment. She took a test there, but before the results came back, Gartman said the staff asked her what she would do if she were pregnant. 

They showed her pictures of how an embryo develops into a fetus and told her that it would respond to painful stimuli at 13 weeks, an idea that is not supported by science. Multiple studies have shown that a fetus does not have the capacity to experience pain until at least 24 weeks’ gestation.

“They just kept driving home that if I got an abortion, my baby would be in pain. That it would feel itself being chopped up.

“I was 11 weeks pregnant, and they were clearly trying to make me feel like a piece of s— if I did get an abortion because I was hurting the baby. I wasn’t sure what I wanted to do, but they basically told me if I waited any longer, I wouldn’t have a choice.

“There’s a very high chance that I would’ve kept it. The person I was pregnant by had Marfan syndrome, and the thing I wanted to wait for was an amniocentesis.”

Severe forms of Marfan syndrome, a connective tissue disorder, can cause fatal heart problems. Gartman had wanted more information about her options. An amniocentesis is typically performed between 15 and 20 weeks of pregnancy.

“I ended up having that abortion three days later. I felt like if I didn’t do it right away, I was going to have no choice, and that they’d be right, that I would be a monster.”

Despite many years passing, Gartman, 45, of Portland, said the trauma she endured is one of the main reasons she never had any children. The shame stuck with her, she said, and she thought she had no right to try to have another baby after having an abortion.

“Seeing public money going to these places pisses me off a lot. That’s my money. I don’t want my money being used to do this to someone else.

“My experience with them has been to just tell everybody I know who’s going to go to them to just not do it. I would never set foot in one of those places again.”

North Carolina

After Carley Causey discovered she was pregnant last year, she wanted to know how far along she was. 

So she searched online for a place to “get an ultrasound to try and date how pregnant” she was. 

Causey, 36, said she had originally called an OB-GYN’s office, but she was told that she couldn’t get an appointment for at least seven weeks. 

“Well, most doctors’ offices won’t see you until you’re, like, 12 weeks pregnant. I did call, and they were like, like, not very helpful, because they were like, ‘You’re not far enough along,’” Causey said. 

So she ended up calling a crisis pregnancy center. 

“And this place is totally free. If you wanted to go to the ER and get an ultrasound, that’s like hundreds of dollars. And this is a community resource that charges you nothing, right?” 

Causey said center volunteers told her that it may be too early to do an ultrasound and that she could potentially have an ectopic pregnancy for which she would have to go to the emergency room. But she wanted a transvaginal ultrasound, and she found out that she was almost two months pregnant. 

Causey said her mom used to volunteer at “pregnancy support centers,” and she felt more comfortable going there. And as a Christian woman and family ministries director at a church in Durham, North Carolina, she said she felt awkward going to a place like Planned Parenthood, which she associated with abortion, although it offers a range of medical services. 

“I know that they (pregnancy centers) totally have this reputation of trying to scare women into not having abortions, but that’s just not been my experience with the people who work there,” Causey said. “And I want to give space for that, because I don’t know all these Christian pregnancy centers, but the truth is like, yeah, they do value life, but they also want to provide resources that make it seem possible.” 

Florida

Taylor Biro was sleeping under bridges all over Tallahassee when she found out she was pregnant in 2006. She called a local pregnancy center, telling them she was homeless and seeking an abortion. 

“I was 19 … I was pregnant, and I had no business having a child — I had a lot of difficult things going on around me at the time.

“I remember being very clear. I talked to them on the phone. I told them what I wanted to do. They said, ‘Great, come on in.’

“I went in, and they counseled me — and it ended up not being an actual place that helps, or had any means to help, with abortions. They were more like a faith-based group and wasted a lot of my time. I ended up passing the window when I was able to get an abortion.’’

It was “degrading” when she’d have to attend their classes to earn “mommy bucks” before she could have a few diapers — not even a full pack, she said. 

“Less than a week after I gave birth, I was working at a sandwich shop. I remember standing there taking someone’s lunch order, hoping the pad in my underwear was thick enough to last till my break. For the first five years of my son’s life, I worked four jobs and made less than $11,000 a year. I was exhausted and trying to hold on to some version of myself before all this.”

Being pregnant and giving birth as a homeless teen, Biro experienced violence.

“It forces you to play into relationships that you probably never would have had to endure. You don’t have all the safety nets. It opened me up to domestic violence; it opened me up to sexual violence.”

Biro went on to start her own drop-in center for runaway and homeless youth. She and her team raised money for teens who needed abortions and provided Plan B for those over age 18. 

After her experience with the crisis pregnancy center, she made diapers much more accessible for the new parents who came to the drop-in center, telling them: “You want to take five packs of diapers? Take six.”

She also worked with officers investigating sexual violence and human trafficking of youth, and helped write legislation requiring special training for law enforcement interviewing victims of sexual assault. Biro works with the National LGBTQ Task Force, and also founded Bread and Roses Collective, a team of grant writers for social justice organizations. Her child is now 18.

“It took me years to understand that the shame was never mine to carry. A Christian organization manipulated a homeless teenager into having a child when it was not safe, but (I) should be embarrassed? I know now that my struggle and trauma was not some penance for being young and irresponsible. But that experience, being tricked out of health care, was my origin story.

“It’s strange that even now, I feel compelled to preface it all by saying how much I love my son. As if naming my trauma or the loss of my autonomy could mean I love him less. That guilt buries stories like mine. We hear more about how a child ‘saved’ someone, when the truth is my life had meaning on its own.”

States Newsroom’s investigation is ongoing. If you have had an experience with a crisis pregnancy center, please get in touch at cpcproject@statesnewsroom.com.

Some Republican lawmakers have routinely proposed criminally prosecuting women for getting abortions since the U.S. Supreme Court overturned Roe v. Wade, despite bipartisan condemnation and criticism from national anti-abortion organizations. 

These bills never made it to the finish line, but they keep circulating in legislatures across the country. So-called “abortion abolitionists” who believe that abortion should be classified as homicide, and that fetuses, embryos and zygotes should have the same legal protections as people are often behind these measures, States Newsroom reported. 

This year, the Foundation to Abolish Abortion praised Republican lawmakers in Illinois, Kentucky and Tennessee who introduced bills that would punish people who get abortions. 

In Illinois, Republican Sen. Neil Anderson filed a bill that would have banned abortion from the moment of fertilization and classified abortion as homicide in the Democratic-led state. Anderson’s bill did not move past introduction, and he lost a leadership position in the chamber this month, Capitol News Illinois reported. 

In Tennessee, legislation concerning an anti-abortion monument was amended to criminalize abortion, potentially allowing women who seek abortion to be charged with murder. Sen. Mark Pody, the bill’s GOP sponsor, said he doesn’t have the votes in the Senate to pass the bill with the criminalization amendment, Tennessee Lookout reported. 

Elsewhere, proposals to crackdown on the availability of abortion medication — the most common way to terminate a pregnancy — are advancing in several Republican-led legislatures, while Democratic lawmakers are moving to fortify shield laws. 

Our reproductive rights reporting team will be tracking related bills through biweekly roundups as sessions continue this winter and into the spring. Depending on the partisan makeup of a state’s legislature and other state government officials, some bills have a better chance of passing and becoming law than others.

GOP legislators still introducing bills classifying abortion as homicide

Kentucky   

House Bill 714: Abortion is already illegal in Kentucky with no exceptions for victims of rape and incest. This bill, called the “Prenatal Equal Protection Act,” would go further by classifying abortion as homicide unless it’s needed to treat miscarriages or save a pregnant woman’s life. The penalties would be the same as those for killing a person, so violators could face anywhere from one year to life in prison. 

GOP Rep. Richard White introduced a similar bill last year that didn’t go anywhere. The Foundation to Abolish Abortion praised the new measure in a Tuesday news release. The organization criticized a Kentucky prosecutor’s decision last month to drop a fetal homicide charge against a woman who was accused of taking abortion medication.  

Status: Introduced in the House on Tuesday, Feb. 24, and sent to the Committee on Committees 

Sponsors: Republican Reps. Josh Calloway and Richard White  

South Carolina 

House Bill 3537: Legislation introduced by GOP Rep. Rob Harris would ban abortion from the moment of fertilization. Harris’ bill would also allow the prosecution of people who get abortions unless it’s necessary to manage miscarriages or save a pregnant person’s life. 

Harris filed this bill in previous legislative sessions, but it hasn’t gained traction, SC Daily Gazette reported. “Bills like these do nothing but terrify women out of wanting to get pregnant,” Tori Nardone, a woman who had to leave South Carolina to get an abortion for a fatal fetal anomaly, told lawmakers last month. “Please don’t make it worse than it already is.”

Status: Stalled in the House Judiciary Committee 

Sponsor: Republican Rep. Rob Harris 

South Dakota   

House Bill 1212: South Dakota bans abortion in most cases, but this bill would have codified abortion as fetal homicide in state law and defined abortion as a Class B felony, which carries punishment of up to life in prison and a fine of up to $50,000. The proposal included exceptions for miscarriage treatment or when a pregnant patient’s life is in danger.

The bill was deferred to the last day of the legislation session by the House Health and Human Services Committee, essentially preventing it from advancing.  

Status: Sidelined 

Sponsors: Rep. Tony Randolph and Sen. John Carley, Republicans 

Republican-led states push bills to crack down on abortion pills

Mississippi   

House Bill 1613: This legislation would make it illegal to sell, manufacture, distribute or dispense abortion-inducing drugs in the state, which bans all abortions unless the mother’s life or health is at risk, and if rape or incest is reported to law enforcement. 

Violators could face between one and 10 years in prison, and the state attorney general could enforce civil penalties against the person, too, Mississippi Free Press reported. The House passed the bill on Wednesday, Feb. 11. If the bill becomes law, it would take effect in July. 

Status: Referred to Senate Judiciary Committee last week 

Sponsors: Republican Reps. Kevin Horan and William Tracy Arnold 

South Dakota  

House Bill 1274: The state House passed a bill this week that would make dispensing, distributing, selling or advertising abortion pills and any other abortion-related “instrument” or “article” illegal, South Dakota Searchlight reported. 

Under the measure, the attorney general could seek penalties of up to $10,000 for each violation, and the money would go in a fund used to pursue anti-abortion litigation, according to Searchlight. South Dakota’s AG is already involved in a legal battle with a New York-based nonprofit over abortion medication ads it ran at gas stations across the state last year. 

Status: Approved in the House on Tuesday, Feb 24; in the Senate State Affairs committee 

Sponsors: Republican Reps. John Hughes and Greg Blanc 

Democratic lawmakers move to strengthen abortion-rights protections 

New Hampshire   

Senate Bill 551: New Hampshire, which has a Republican trifecta in government, is the only state in New England without a law that protects abortion providers and patients from out-of-state investigations into reproductive health care. Legislation introduced by Democratic Sen. Debra Altschiller in February would secure the right to reproductive health care and prohibit law enforcement from cooperating with investigations into related health care, New Hampshire Bulletin reported. 

The bill would make it illegal for the governor to comply with extradition requests for abortion providers and patients. It would also ban insurers from penalizing reproductive health care providers and let residents sue people or agencies that attempt to interfere with their reproductive rights, the Bulletin reported. 

Status: The Senate Judiciary Committee voted 3-2 on Tuesday, Feb. 17, that the bill was “inexpedient to legislate.” 

Sponsor: Democratic Sen. Debra Altschiller

Oregon   

House Bill 4088: An Oregon law approved in July 2023 protects providers who offer reproductive health care from losing their licenses, and shields patients and providers from related out-of-state investigations. Legislation introduced this year would beef up those safeguards. 

This bill would bar the governor from accepting extradition requests from other states against providers who offer legally protected reproductive health care and prohibit law enforcement from cooperating with interstate investigations into related care, Oregon Capital Chronicle reported. It would also block state officials from revoking midwifery licenses for people who face prosecution for reproductive health care in other states. 

Status: Approved by the House on Monday, Feb. 16; approved by the Senate Judiciary Committee Wednesday, Feb. 25

Sponsors: Rep. Lisa Fragala and Sen. Lisa Reynolds, Democrats 

There is a content warning on page 7 of a friend-of-the-court brief recently submitted in a high-stakes abortion medication case by women who say they were injured or traumatized from taking the pills. 

“Warning: these accounts are raw, graphic and real.”

About 30 mostly anonymous people recount their medication abortions, saying they were uninformed about what they would experience mentally and physically. The graphic accounts and bloody portraits are meant to bolster the argument that the practice is a barbaric and gruesome one that states have the authority to ban. The brief argues the problem is perpetuated by telehealth abortion. 

“We call it a particularly gruesome and barbaric procedure, the pill, because Dobbs allowed particularly gruesome and barbaric procedures to be prohibited by the states,” said attorney Allan Parker of the Justice Foundation.

It’s one of many arguments made in the main complaint, though not the focus of Tuesday’s oral arguments over a preliminary injunction that could, if granted, halt access to telehealth abortion throughout the country. But it’s one with a winning history for the anti-abortion movement, whose leaders are frustrated with rising abortion rates and the Trump administration’s failure to restrict the pills. 

But reproductive legal experts who support abortion rights say the gruesome or barbaric argument mischaracterizes the realities of medication abortion, which is approved to induce a miscarriage within the first 10 weeks of pregnancy. 

Abortion opponents are focused on disrupting national access built largely on shield laws and a Biden-era policy that has allowed women to have first-trimester abortions via medication at home with a remote physician consultation, even in states with bans. 

The Justice Foundation, which co-authored the brief alongside the National Association of Christian Lawmakers, recruits women who regret their abortions to testify in court and before legislatures and has collected nearly 5,000 legally admissible affidavits, according to the brief. 

The lawsuit was originally filed last year by Louisiana Attorney General Liz Murrill and co-plaintiff Rosalie Markezich, who said her partner ordered pills without her consent and then coerced her to take them.

The complaint cited the 2007 U.S. Supreme Court decision in Gonzales v. Carhart that upheld a federal ban on an abortion procedure called intact dilation and extraction, which at the time some doctors said was a preferable method for ending certain pregnancies, typically in the second trimester, without damaging the woman’s cervix. The anti-abortion movement effectively rebranded the method “partial-birth abortion.” In upholding the ban on this method, the Supreme Court opinion, which was referenced in the 2022 Dobbs decision overturning federal abortion protections, included a reference to it as “gruesome and inhumane.” 

While the intact dilation and extraction method was used later in pregnancy and in a minority of terminations, telehealth abortions early in pregnancy made up 27% of abortions in the U.S. in the first half of December, according to the Society of Family Planning.  

“What it feels like is happening with some of these briefs is that they’re going back to the last argument that worked in shaping popular opinion,” historian and law professor Mary Ziegler said. “Because while they managed to overturn Roe, that was not a success from a popular opinion standpoint.”

The argument that abortion is barbaric and gruesome is not likely to touch public opinion the same way it did two decades ago, she said, because unlike with intact dilation and extraction abortion, most women have experienced a medication abortion or a miscarriage and know what it’s like.  

“It would be hard, I think, to convince people that a procedure that’s happening in week seven, is equally barbaric,” Ziegler said. “The whole success of partial-birth abortion as a strategy is in the name, right? The argument was, This is happening late enough in pregnancy and close enough to birth that it resembles infanticide. And with abortion pills, for many people, it’s going to much more closely resemble a very early miscarriage.”

The potential to unleash chaos

Attorneys on either side of the abortion rights divide agree that the stakes are high in the Louisiana case, because a ruling would likely apply nationally and once again shake up the abortion access landscape in the U.S. If the court grants Louisiana’s request to force the U.S. Food and Drug Administration to reinstate old restrictions while litigation continues, the action could effectively ban telehealth abortion appointments, medication dispensation at retail pharmacies, and the mailing of abortion pills even in states where abortion remains legal.

Katie Keith, founding director of the Center for Health Policy and the Law at the O’Neill Institute at Georgetown University, said a ruling in plaintiffs’ favor could “unleash chaos and confusion in the market.”

“What would happen to medication that’s already on the shelves?” she asked. “And how quickly could folks move from telehealth to in-person dispensing again? And what guidance would FDA give? And how quickly would all this get appealed?” 

It would be extremely disruptive in a year when abortion providers have already seen a lot of chaos, she said. 

Dr. Angel Foster is the co-founder of the Massachusetts Medication Abortion Access Project, which provides telehealth abortion to all 50 states. She said plaintiffs’ claims do not match up with national and international data on medication and telehealth abortion or with her experience as a provider. 

“Louisiana has taken things that are exceptional and presented them as common, has tried to put the ugliest face on the abortion process as possible, and has mischaracterized the kind of care that telemedicine medication abortion providers are offering,” Foster said. 

Her organization has served more than 40,000 patients seeking abortion care since 2023, she said, 95% in states with abortion bans. Patients are counseled on what to expect in terms of pain and what they might see, and are screened for potential coercion and other issues. 

For example, if a patient lists her husband’s email address, Foster said she would call the patient directly to confirm the abortion is her choice. She said a bad actor could try to bypass their screening and force someone to take abortion pills without consent, which is already a criminal offense under existing law. 

“I don’t think that the remedy is to say that nobody should be able to get abortion pills by mail,” Foster said.  

National domestic violence awareness groups have filed a friend-of-the-court brief in the Louisiana case asking the court to deny plaintiffs’ request for an injunction. They note that reproductive coercion is not limited to abortion pressure but can also include a partner barring access to birth control or other health care. 

Beyond the federal courts, states continue to try to pass laws to ban or further restrict medication abortion. Attorneys general in Louisiana and Texas have led the charge in suing shield law providers in states without abortion bans. Texas’ attorney general filed a new lawsuit on Tuesday against California physician Rémy Coeytaux, telehealth abortion nonprofit Aid Access and its founder Dr. Rebecca Gomperts. 

Foster said she has not yet been sued but that her attorneys have been in close communication with Massachusetts’ attorney general over whether the state’s shield law would protect their practice depending on how the judge rules. 

“Our intent is to continue to provide medication abortion care with mifepristone and misoprostol for as long as we can legally do so,” she said. 

Will a federal judge let the Trump administration delay?

For now, Louisiana v. FDA is in limbo. After Louisiana filed its preliminary injunction request, the Trump administration asked the court to delay while it continues to review abortion pill safety — a review that was prompted by pressure and controversial research from the anti-abortion movement. 

Trump-appointed district Judge David Joseph on Tuesday did not indicate when he might rule on Louisiana’s request for an injunction but gave the federal government’s attorneys seven days to file a brief explaining how the FDA would take emergency action if the agency discovered mifepristone presents a public health risk during its review.

Anti-abortion activists have been frustrated with the administration’s efforts to delay the Louisiana case. 

“We are disappointed that the Trump administration is asking the court to pause our case and deny our clients immediate relief while the FDA takes another year to study the known harms of abortion drugs,” said Erik Baptist, senior counsel at Alliance Defending Freedom, which is representing Markezich, in a written statement.

With the approaching midterm elections, Ziegler said she’s curious what the administration will finally say about its position on abortion pills. 

“It’s our first look at what the Trump administration will do if the court doesn’t respond by just giving them more time,” Ziegler said. “Because so far, they’ve been essentially just avoiding it, by saying they’re thinking about it, and they need more time, and they’re studying the matter, and, you know, not really taking a side.” 

A hearing is set for Tuesday in a federal lawsuit led by Louisiana seeking to further restrict access to mifepristone by asking the courts to stop abortion pills from being mailed across the country. 

The Department of Justice has argued plaintiffs lack standing to bring the case and asked the judge to halt legal proceedings until the Food and Drug Administration wraps up a review of the medication. 

Hundreds of studies have concluded that the drug is safe and effective for abortions early in pregnancy, but a paper released by a conservative think tank last year compelled Health and Human Services Secretary Robert F. Kennedy Jr. to order a reevaluation of mifepristone.  

The state of Louisiana and a woman who said her ex-boyfriend made her take abortion medication sued the FDA in October and asked for a preliminary injunction against a 2023 rule that allows abortion pills to be prescribed through telehealth or mailed to patients, and pharmacies to apply for certification to dispense mifepristone. 

Julie Kay, the founder and CEO of legal advocacy group Reproductive Futures, told States Newsroom the lawsuits in Louisiana and elsewhere are “thinly veiled attempts” to block access to telehealth medication abortion. 

“We’ve seen that telemedicine abortion has become incredibly popular in all 50 states and particularly vital for women in under-resourced areas,” Kay said. 

Missouri, Idaho, Kansas, Texas and Florida are also suing the FDA over mifepristone’s regulations and asking the courts to restrict or rescind approval of the drug altogether.

Nearly 30% of abortions provided in the first half of 2025 were through telehealth, according to the Society of Family Planning’s latest #WeCount report. 

By June 2025, about 15,000 abortions per month were provided by physicians shielded by state laws, allowing them to prescribe abortion medication remotely to people living in states where abortion is banned or restricted, the report found. Shield laws protecting health care professionals from out-of-state investigations have held up in court so far, despite efforts from prosecutors in Texas and Louisiana. 

Republican Louisiana Attorney General Liz Murrill vowed to defend anti-abortion laws in her state, which has had a ban with no exceptions for rape or incest since August 2022. She indicted a California doctor in January, accusing him of mailing abortion pills to Rosalie Markezich, a plaintiff in the lawsuit before federal courts. 

Lawyers for Louisiana argue that the Biden administration’s decision to nix the in-person dispensation requirement for mifepristone is an affront to states that ban abortion. 

Alliance Defending Freedom Senior Counsel Erik Baptist framed the lawsuit as an intimate partner violence issue, saying Markezich’s former boyfriend ordered abortion pills online from Dr. Rémy Coeytaux in California without any in-person interaction. 

“So what this lawsuit would do is protect women across the country, in particular in Louisiana, from this mail-order abortion scheme that enables and emboldens people in coercive situations, such as men and abusers who can now obtain these drugs through remote means,” Baptist said. 

Reproductive coercion — when an abusive partner controls a person’s bodily autonomy — has been brought up in recent legal challenges to abortion pill access by other GOP attorneys general in bids to restrict mifepristone, according to Rachel Rebouché, a University of Texas at Austin law professor who specializes in reproductive rights. 

“There’s really not evidence that people are being coerced or forced into taking pills. It’s, of course, awful if someone has felt coerced, but I’m not sure it changes the argument of what the FDA should do as an agency committed to reviewing evidence,” Rebouché said. 

For their part, DOJ attorneys have said an injunction would interfere with the FDA review and Risk Evaluation and Mitigation Strategies, setting off an avalanche of other lawsuits. 

“Plaintiffs now threaten to short circuit the agency’s orderly review and study of the safety risks of mifepristone by asking this Court for an immediate stay of the 2023 REMS Modification approved three years ago,” they wrote in a memo filed on Jan. 27 in the U.S. District Court for the Western District of Louisiana. 

Kay said she views the Trump administration’s motion to pause the case as a legal delay tactic that is more about politics than science, because most Americans believe abortion should be accessible. A Pew Research Center poll from June 2025 showed 63% of respondents said abortion should be legal in all or most cases.

“This federal administration is very aware of that popularity, and I think they’re saying they want to wait until after the midterms,” Kay said.

Baptist said the FDA can conduct their review while the in-person requirement is restored. 

Mifepristone’s manufacturers intervened in the case earlier this month, Louisiana Illuminator reported. But unlike the federal government, GenBioPro and Danco, the companies behind the generic and name brand versions of the drug, asked the court to dismiss Louisiana’s lawsuit entirely. 

In a memo filed on Tuesday, Feb. 17, lawyers for the plaintiffs argued that the 2023 regulatory change “was intended to authorize a direct attack” on anti-abortion states. 

The filing also rejects arguments that Louisiana and Markezich lack standing in the same way that a group of anti-abortion doctors did in a lawsuit against the FDA over mifepristone’s previous regulations, according to a 2024 U.S. Supreme Court ruling. Justices rebuffed the Alliance for Hippocratic Medicine’s requests but did not rule on the merits of the case.

Baptist also said judicial panels on the 5th U.S. Circuit Court of Appeals in Louisiana — a conservative-leaning court where this lawsuit could go next — have twice ruled that it was “arbitrary and capricious” for the FDA to allow abortion medication without an in-person doctor visit. 

In Louisiana’s corner are major anti-abortion players: Students for Life of America, 60 Republican members of Congress, 21 GOP attorneys general and the Ethics and Public Policy Center filed briefs backing the state. 

Rebouché, the University of Texas professor, said there would be conflict between the federal courts if the district court judge rules in favor of Louisiana. There are nearly a dozen lawsuits over abortion pills seeking to restrict and deregulate mifepristone, States Newsroom reported.

Guttmacher Institute Principal Federal Policy Adviser Anna Bernstein said in a statement Friday that reinstating the in-person dispensation requirement for mifepristone would hinder abortion access. 

“If access to telehealth and mifepristone by mail is curtailed, more patients would be pushed toward in-clinic care, straining provider capacity and increasing wait times in an already chaotic landscape,” she said. “Given that travel is out of reach for many people, the result would likely be increased delays and more people unable to get the abortion care they need and deserve.” 

Kelcie Moseley-Morris contributed to this report. 

The Trump administration is using a law Congress passed in the 1990s after a wave of deadly violence at abortion clinics to prosecute demonstrators and reporters who were at a immigration-related church protest in Minneapolis last month. 

Independent journalists Don Lemon and Georgia Fort, along with several activists, are accused of violating a 1994 law that made physically obstructing access to reproductive health clinics and places of worship a federal crime. Lemon pleaded not guilty Friday, while Fort is set to be arraigned next week and has denied any wrongdoing. Other plaintiffs have vowed to fight the charges — they’re also accused of conspiring against churchgoers’ right to worship — and maintained they were exercising their First Amendment rights. 

Some abortion opponents say the law should be repealed entirely, even though the statute also protects access to anti-abortion crisis pregnancy centers. Reproductive rights advocates say getting rid of the law altogether could spur more attacks on clinics and providers, which already increased in recent years. 

“It would give an even stronger signal to the zealots who would wish to shut us down to intimidate and harm our clinic folks and patients,” said Julie Burkhart, who owns clinics in Wyoming and Illinois. 

The Minnesota indictment is only the second time that the Department of Justice has brought charges under the religious provision tucked in the Freedom of Access to Clinic Entrances Act. In September, the federal government filed a civil complaint against pro-Palestinian groups and demonstrators, accusing them of violating the FACE Act after they protested outside a New Jersey synagogue in 2024.

During a news conference announcing the charges, Harmeet Dhillon, the assistant attorney general for the DOJ’s civil rights division, said the New Jersey case was the “first time in history” the FACE Act was used to “prosecute an attack civilly on a house of worship.”  

While the Trump administration has started to use the FACE Act in religion-related cases, it has also relaxed enforcement of the law against people who interfere with access to abortion clinics. 

Republican President Donald Trump pardoned 23 anti-abortion protesters convicted of violating the law within weeks of taking office in January 2025, and the DOJ released a memo that stated abortion-related cases should only be pursued in “extraordinary circumstances,” such as death, serious bodily harm or severe property damage. 

“This sent a very clear signal to anti-abortion extremists that this administration was OK and even encouraged anti-abortion violence, and we’ve seen the same people that were pardoned within Trump’s first week in office go right back out and start harassing abortion providers and their patients, whether that is putting together blockades or clinic invasions,” National Abortion Federation President and CEO Brittany Fonteno told States Newsroom. 

FACE Act followed murder of abortion provider, clinic sieges 

Tactics by the anti-abortion movement were starting to reach a fever pitch in the U.S. before the FACE Act’s passage. In 1988, hundreds of protesters were arrested in Georgia during the “Siege of Atlanta,” where abortion opponents staged routine clinic blockades over a three-month period. In 1991, thousands of anti-abortion protesters were arrested by local officials for invading abortion clinics in Kansas during the “Summer of Mercy.” 

“We were literally unable to do our jobs,” said Burkhart, who worked in Wichita that summer with Dr. George Tiller, a provider who was later killed by an anti-abortion extremist. 

In 1993, Dr. David Gunn was murdered by an anti-abortion protester outside a Florida clinic, and six months later, Tiller was shot outside his Kansas clinic. Tiller survived that attack, but he was assassinated at his church in 2009.  

Sen. Ted Kennedy and then-Rep. Chuck Schumer, both Democrats, introduced the FACE Act in Congress alongside former Republican Rep. Connie Morella, and President Bill Clinton signed the legislation the following year. 

Legal experts said the religious part of the reproductive health law was added to broaden legislative support for the bill. 

The law protects reproductive health clinics and places of worship from being physically obstructed or damaged, and makes it a federal crime to intentionally injure, intimidate or interfere with access to those places. Violators face up to a year in prison or a $10,000 fine, and up to six months in prison for nonviolent obstruction. A defendant could face 10 years if they inflicted bodily harm or life behind bars if someone is killed.  

Mary Ziegler, an abortion historian and professor at the University of California, Davis School of Law, said the measure was modeled on other civil rights laws, which typically include protections for religious institutions. She said Congress already had a Democratic majority at the time, but the religious part of the law could have been added to avoid accusations of viewpoint discrimination. 

“Even people who saw themselves as pro-life were disturbed by some of the violence,” Ziegler said. 

After the law took effect, violence against abortion clinics declined by 30%, according to the National Abortion Federation. 

The power of anti-abortion groups like Operation Rescue, known for orchestrating mass clinic blockades, waned. 

“The FACE Act was created to suppress civil disobedience at abortion centers, so it’s had a massively negative impact on the anti-abortion movement,” said Terrisa Bukovinac, the founder of Progressive Anti-Abortion Uprising. 

Bukovinac’s group along with Students for Life of America and Alliance Defending Freedom have called for the law’s demise since the U.S. Supreme Court overturned the federal right to an abortion in June 2022. 

Trump reconfigures enforcement while abortion opponents call for repeal

Violence against abortion clinics increased after the Dobbs v. Jackson Women’s Health Organization decision. From 2021 to 2022, clinics saw a 100% increase in arsons, a 25% increase in invasions and a 20% increase in death threats or threats of harm, according to the National Abortion Federation. 

The Biden administration pursued enforcement of the FACE Act by prosecuting people convicted of blocking access to abortion clinics in Michigan, Tennessee and Washington, D.C. 

Trump pardoned all of those defendants. But for some abortion opponents, the Republican administration’s narrow use of the FACE Act does not go far enough. 

“It should be repealed because it’s a draconian law,” Bukovinac said. “There are local laws that address trespass, disorderly conduct, disruptions of churches, and various other violations of statutes, but the FACE law adds the full weight of the federal government in these situations.” 

Ziegler said the law isn’t a trespassing statute, it’s about conduct and obstruction. No legal challenges against the law have held up in court before or after Dobbs, she said. 

“If you’re shooting someone in the head because they’re trying to go to a synagogue or they’re trying to go into an abortion clinic — or you’re threatening to kill them or you’re physically blocking all the entrances — that’s not speech protected by the First Amendment,” Ziegler said. 

Matthew Cavedon, a criminal justice and religious liberty expert at the libertarian CATO Institute, has written that the law may be unconstitutional. He said the federal government has typically defended the FACE Act’s constitutionality based on the Commerce Clause and the 14th Amendment.

“Pro-lifers have made the point that in order to defend the FACE Act under the 14th Amendment, you have to have some sort of federal constitutional right to have an abortion,” Cavedon said. “Back in 1994 when the act passed, the Supreme Court said that you did have that right. It doesn’t anymore. That’s been reversed. So I think that’s a very strong argument.” 

U.S. Rep. Chip Roy, a Texas Republican, introduced a bill last year that would repeal the law. The House Judiciary Committee advanced the measure in June, States Newsroom reported. 

Roy did not respond to requests for comment, but during a hearing for the bill, he said he has been criticized by Trump administration officials who wanted to use the law to defend churches. 

“That’s not what my goal is,” he said. “My goal is to alleviate the politicization in the first place.”

Renee Chelian, the founder and CEO of Northland Family Planning Centers in Michigan, testified before the committee about the importance of the FACE Act and the invasion of one of her clinics during the first Trump administration. 

“Once the law went into effect, the violent blockades immediately stopped. This all ended when President Trump took office for his first term, emboldening extremists to resume their attacks,” she said. 

In August 2020, a group of protesters blocked the entrance to Chelian’s Sterling Heights clinics, preventing patients and staff from entering the clinic. 

“Patients were stuck in their cars, including three women who were coming in for abortions following the detection of fatal fetal anomalies,” Chelian said. One of those patients was losing amniotic fluid and needed to get to her appointment for the second day of her procedure, but protesters surrounded her car and chanted at her, her mother and her husband, according to the DOJ. 

Trump’s decision to pardon seven people who invaded her clinic “left us reliving our trauma and feeling abandoned by the government that is supposed to protect us,” Chelian told lawmakers. 

Last month, the Center for Reproductive Rights sued the Trump administration after the government did not respond to Freedom of Information Act requests about “selective enforcement” of the FACE Act and Trump’s pardons of 23 anti-abortion protesters convicted under the law. 

“This is straight out of the anti-abortion movement’s playbook,” said Sara Outterson, the center’s chief federal legislative counsel. “They know they can’t ban abortion outright in a number of states, so they’ll try everything they can to restrict access to care, including allowing criminals to harass people as they try to go in to get care.”