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

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.

Nearly a quarter of pregnant women aren’t getting prenatal care in the early stages of pregnancy, according to a new analysis from the U.S. Centers for Disease Control and Prevention.

The share of pregnant women getting prenatal care had been improving: It rose between 2016 and 2021 to a high of more than 78%, but then declined to 75.5% by 2024, wiping out previous gains.

The trend is worrying because getting care early in pregnancy can improve the likelihood of a healthy pregnancy and baby.

The decrease in early prenatal care held true for nearly all race and ethnic groups, but the drops were sharpest for Native Hawaiian and Other Pacific Islanders, Black women and American Indian and Alaska Native women.

By 2024, less than half of Native Hawaiian and Other Pacific Islander mothers received prenatal care in their first trimester — the first three months of pregnancy.

Anne Markus, a professor at George Washington University’s Milken Institute School of Public Health, said that because the statistically significant decline began around 2021, two events could explain some of the decrease: the COVID pandemic, with its associated stay-at-home orders, and the U.S. Supreme Court’s Dobbs decision in 2022 that dismantled the constitutional right to abortion.

“Both disproportionately affected, and continue to affect, communities of color, and the decline in early entry into prenatal care has been disproportionately bigger for racial and ethnic minorities since 2021,” said Markus, whose work focuses on public policy and access to health care. She was not involved in the analysis.

A lack of early prenatal care has also been disproportionately seen in “very young women who are more likely to have a pregnancy that they do not want,” Markus said. “The Dobbs decision and the fear and uncertainty it generated could be particularly relevant in explaining this disproportionate effect observed in the data.”

The share of women getting late care — beginning in the seventh month of pregnancy or later — or no care at all increased in more than half of states from 2021-2024. Utah saw the biggest rise in late or no care, followed by Massachusetts and Rhode Island. The number of Utah women getting late or no prenatal care jumped 54%, up to nearly 6% of women.

More than 1 in 10 women had late or no prenatal care by 2024 in Florida, Georgia, Hawaii, New Mexico and Texas.

“Geographic and financial barriers to accessing care are often behind late entry to recommended care, including prenatal care,” Markus said.

Late or no prenatal care decreased in six states: Arkansas, New Hampshire, South Carolina, Tennessee, West Virginia and Wisconsin.

The CDC compiled the report based on information from birth certificates, and includes information for all births that occurred in the United States.

Stateline reporter Anna Claire Vollers can be reached at avollers@stateline.org.