Women practice yoga during a community yoga class in Tulsa, Okla., in 2021. New research produced by the University of Michigan finds an association between higher out-of-pocket health insurance expenses and states with abortion bans, with data showing differences were even higher for Black and Hispanic women. (Photo by Michael B. Thomas/Getty Images)
New preliminary research from the University of Michigan shows women living in states with post-Dobbs abortion bans may be more likely to shoulder costs for employer-sponsored health insurance premiums, with federal data reflecting a 5.4% increase in annual premium expenditures for those women after 2022, when most abortion bans went into effect.
The study used national data from the U.S. Census Bureau’s 2019-2025 Current Population Survey Annual Social and Economic Supplement to compare individual medical out-of-pocket costs for women of reproductive age between 18 and 44. The study, which hasn’t yet been published in a peer-reviewed journal, received financial support from the Center for Reproductive Rights, an advocacy group based in Washington, D.C.
“State abortion bans were associated with an increase in women’s likelihood of paying out-of-pocket for health insurance premiums,” the study said.
The findings also showed even higher premium expenditures for Black and Hispanic women, at 12.8% and 13.7%, respectively. The findings were not present among men, and the majority of the women in the sample had incomes above 250% of the federal poverty level.
“Our results are suggestive that post-Dobbs abortion bans led to insurers passing more premium costs to beneficiaries,” the study said. “Our findings shed light on the more far-reaching effects of abortion bans, quantifying the extent to which they pose an economic burden to individuals and families.”
Costs associated with pregnancy, childbirth and postpartum care averaged $20,416 nationally, including $2,743 in out-of-pocket expenses for women enrolled in employer plans over 2021-2023, according to previous research.
Joelle Abramowitz, an associate research scientist at the University of Michigan and co-author of the study, said the population survey — which is used to calculate poverty and health insurance coverage rates — was one of few sources that could offer recent insights.
“What we see is, prior to the bans, the outcomes were looking comparable, and then after the bans were implemented, we see them diverge, with more women paying health insurance premiums in the ban states,” said Abramowitz, an economist and co-director of Michigan Federal Statistical Research Data Centers. .
Ten states with near-total abortion bans — Alabama, Arkansas, Indiana, Kentucky, Louisiana, Mississippi, North Dakota, Tennessee, Texas and West Virginia — were included in the study and compared with five states that did not implement bans: Massachusetts, Michigan, New York, Pennsylvania and Washington. States that expanded Medicaid during that time frame — Idaho, Missouri, Oklahoma and South Dakota — were excluded from the analysis to isolate the effects of the bans from Medicaid changes.
Abramowitz said there could be several factors increasing premium costs for female patients. One is that in states with bans, pregnancies that might have been terminated before the bans became deliveries with the potential for more complications and higher risks.
Prior research has shown that abortion bans are also associated with a higher rate of negative maternal and infant health outcomes, including admissions to a neonatal intensive care unit, as well as higher rates of cesarean procedures, all of which can increase costs for insurers that get passed along through higher premiums.
“I think this is an example of one way that these policies have more far-reaching effects beyond just the individuals who are directly affected by them,” Abramowitz said.
This story was originally produced by Stateline, which is part of States Newsroom, a nonprofit news network which includes Wisconsin Examiner, and is supported by grants and a coalition of donors as a 501c(3) public charity.
A new poll from The 19th and YouGov sheds light on how young men and women are shaped by certain historical moments and tend to diverge on issues of gender and reproductive rights. (Brandon Bell/Getty Images)
Editor’s note: This story is part of Gen Z at the Ballot Box, a collaboration between States Newsroom and The 19th.
Brenna Vandergeest was a teenager when her grandmother told her about Dobbs v. Jackson Women’s Health Organization, the Supreme Court case that ended the federal right to an abortion. She said it lit a fire in her, one that has shaped her politics.
“I think that really flipped a switch in my head because knowing as a woman that rights that had been protected for years and years have now been overturned — it really made me upset,” Vandergeest said. “It really drove my view on reproductive rights because I do believe that only a woman should have a say over her body, and it shouldn’t be up to the government.”
Now a senior at Neumann University, a small private Catholic school in Pennsylvania, the 21-year-old said she would describe herself as a progressive liberal with Democrat-leaning views who is most passionate about reproductive rights, healthcare and how the government responds to addiction and recovery.
Every generation has an ideological gender gap — and Gen Z is no different. A new poll from The 19th and YouGov sheds light on how young men and women are shaped by certain historical moments and tend to diverge on issues of gender and reproductive rights. Gen Z women are more likely than Gen Z men to consider themselves feminist, identify as liberal and Democrat, support abortion access, and believe society should not return to traditional gender norms, according to the new poll.
The 19th/YouGov poll was conducted online from Sept. 18-24 among 2,357 adults, including an oversampling of 18- to 29-year-olds. The margin of error for the overall sample is ±2.5 points.
Gen Z women are more likely to say they’re Democrats, 37% to 21% of men. Among Gen Z men, about 38% are Republican and 27% political independents. For Gen Z women, 29% are Republicans and 21% are independents.
The poll also found that 38% of Gen Z women and 28% of Gen Z men describe themselves as liberal; 26% of Gen Z women and 34% of Gen Z men identify as conservative.
Claire Gothreau, an assistant professor of political science at Lebanon Valley College, said the ideological gender gap is not unique to Gen Z. Women have tended to identify as more liberal and Democratic than men for decades, and a greater proportion of women than men have voted for the Democratic presidential candidate in every election since 1980, she said.
“What does appear especially interesting about Gen Z is the combination of ideology, gender identity, feminism and political participation,” Gothreau said. “Young women have come of age politically during a period in which issues related to gender and reproductive rights have been really prominent. The #MeToo movement, the first Trump presidency and the Dobbs decision all occurred during the formative political years of Gen Z women.”
The #MeToo movement, founded in 2006 by activist Tarana Burke, brought a reckoning for powerful men at its public peak in 2017 and 2018. The movement led to changes in laws and policies to address abuse, but it also drew a cultural backlash that contributed to President Donald Trump’s second term. The president, who has been accused by dozens of women of sexual misconduct, was found liable of sexual abuse in May 2023.
Supporting reproductive rights
While the majority of Gen Zers say abortion should be always or mostly legal, women were more likely to say so than men, 69% to 51%. Almost half of men versus 31% of women say it should be mostly or always illegal.
Paige McCord-Hyman, a 20-year-old junior at Neumann University, said she identifies as a Democrat with progressive views. The issue she’s most passionate about is also reproductive rights. When Roe v. Wade was overturned in 2022, McCord-Hyman said her mother was experiencing pregnancy complications at the time, taking a toll on her mom and the rest of the family.
“It’s not that every woman should get an abortion,” McCord-Hyman said. “Whatever your religious views are, whatever your moral views are — that’s perfectly fine. But I feel like the Dobbs decision was taking away the choice. It wasn’t even in the cards anymore, and I feel like that’s not something that a man should have any say over. And even taking gender out of it, nobody should have a say in what I choose to do with my body.”
A return to traditional roles
According to the poll, 43% of Gen Z women and 51% of Gen Z men think society would benefit from a return to traditional gender roles.
Roy Dawes, an associate professor of political science at Gettysburg College, said that while young women have been quickly adopting anti-patriarchal attitudes, some young men have started to feel alienated. And these men are finding community online, he added.
“Young men are desiring a return to more traditional roles,” Dawes said. “Social media algorithms exacerbate this by segregating young men and women, with young men highly susceptible to online influencers with anti-feminist and often misogynistic messages.”
Dawes also pointed out that young women are outpacing their men counterparts in academic and professional achievement, which also contributes to Gen Z men’s feeling of social and economic stagnation.
“These factors have combined to have an impact on the context of the heterosexual dating world with an increase in remaining single and a decrease in more traditional marriage and reproductive patterns,” Dawes said.
Tyler Daniel, a visiting assistant professor of political science at Roanoke College, said social media, algorithms and YouTube specifically have created deeply divided political echo chambers for Gen Z, the generation that grew up on the Internet.
“It would be an oversimplification to say that social media algorithms are the sole driving force behind the gender divide, but they present a fascinating first look into how cultural narratives shaped by social media are significantly impacting the generation aptly understood to be the social media generation,” Daniel said.
A backlash to feminism
When it comes to feminism, 49% of Gen Z women and 20% of Gen Z men consider themselves feminists, the poll found.
Vandergeest, who considers herself a feminist, said she notices a lot of toxic masculinity on social media in particular. The men in her classes at her university are typically more respectful in person, she said.
“But I have seen a lot online that males are looking for more of a traditional view of a woman, meaning a housewife with no job, no college — just bear the kids and make dinner,” Vandergeest said.
Vandergeest said she thinks this desire is just a modern backlash to feminism.
“I think that men think that feminism is something that they should be threatened by, but it’s not,” Vandergeest said. “Feminism is something where we just want to be equal. It was never that we wanted to be better than the men. We want to have the same rights, and I think that scares people and causes them to be more hateful, have more traditional views and have that incel look on women.”
In her book, “The Politics of Gen Z,” political scientist Melissa Deckman found that young women are more likely to identify as feminists. They are also more likely to participate in politics — voting, protesting, organizing and donating, according to Deckman.
Vandergeest said women in her generation are driven by the desire for equality, from the Civil Rights Movement to women’s rights and reproductive rights, and they are starting to pay attention thanks to the plethora of information available on social media.
“I think going down the line we need more people, especially women, to be in politics,” Vandergeest said. “So I do plan to run once I graduate for some political position, and I think that others should follow in our footsteps. I think our generation needs to be the stepping stone for the generations under us. They need to see what it’s really like to have rights and fight for them.”
This story was originally produced by News From The States, which is part of States Newsroom, a nonprofit news network which includes Wisconsin Examiner, and is supported by grants and a coalition of donors as a 501c(3) public charity.
Volunteer clinic escorts stand in a line before a kneeling anti-abortion demonstrator at a clinic in Louisville, Ky., in 2021. Advocates from each side of the abortion issue have pushed for Congress to either codify the Hyde Amendment into law or codify its repeal, but neither side has been successful. (Photo by Jon Cherry/Getty Images)
In the early months of 2022, Democrats in Congress came close to passing an appropriations bill that did not include a provision barring federal funding for abortions — maybe the closest it had ever come in more than 40 years.
But those who wanted the Hyde Amendment included won the battle in the end. Three months later, the U.S. Supreme Court made its decision in Dobbs v. Jackson Women’s Healthto allow states to regulate abortion access. That year, the 50-year precedent of a constitutional right to abortion ended, and the 50-year precedent of no federal tax funding to pay for abortions endures.
The Hyde Amendment was first passed Sept. 30, 1976, three years after the Roe decision. The clause — which isn’t a constitutional amendment — is named for Republican U.S. Rep. Henry Hyde of Illinois. It marked one of the first legislative victories for anti-abortion groups after Roe v. Wade guaranteed abortion access up to fetal viability.
In the decades since, it has been added to every appropriations bill passed by Congress, restricting federal Medicaid dollars from paying for abortion care except in limited cases of rape, incest and to prevent a pregnant patient’s death. The result has left countless people without a way to pay for the procedure, which advocates for abortion access say causes more abortions to happen later in pregnancy and unnecessarily endangers patients’ health.
Abortion opponents say the Hyde Amendment has prevented 2.7 million abortions. An estimated 300,000 abortions per year were covered by federal dollars prior to the Hyde Amendment. While there aren’t any major organizations that have published how much the federal government has saved by not funding abortion care, advocates say it costs the government more not to fund it because of the extra costs added to medical care and public assistance programs.
As more polls and strategists indicate Democrats could take over congressional majorities in the U.S. House of Representatives and the U.S. Senate in January, some anti-abortion advocates fear such a change could be the most serious threat to Hyde’s future since the party nearly repealed the amendment in 2022.
“If there becomes a pro-abortion majority in Congress, then Hyde is going to be one of the first things to go, probably, especially because it’s been in the spotlight more recently,” said Gavin Oxley, spokesperson for Americans United for Life, a national anti-abortion organization.
Advocates from each side of the issue have pushed for Congress to either codify Hyde into law or codify its repeal, but neither side has been successful. Because of filibuster rules that are usually used in the U.S. Senate on controversial pieces of legislation, legislation would likely need 60 votes to pass, a tall order in a highly polarized environment.
Quotation
There are some Republicans who may not be as committed to protecting Hyde.
– Gavin Oxley, spokesperson for Americans United for Life
Oxley said anti-abortion advocates aren’t worried just about Democrats, though. During negotiations over legislation that would have extended subsidies for premiums under the Affordable Care Act, President Donald Trumptold congressional Republicans in January that they needed to be “a little flexible” on including the Hyde Amendment. The bill never came to fruition and the subsidies expired, but the incident worried anti-abortion groups such as Oxley’s.
“If we get a pro-abortion majority (in Congress), then I would be concerned,” Oxley said. “There are some Republicans who may not be as committed to protecting Hyde.”
Anti-abortion groups tout polls showing strong support for keeping federal dollars from funding abortion care, but few nonpartisan polls have been conducted on the issue, and no major nonpartisan polls have surfaced in the years since 2022, when 13 states implemented near-total abortion bans. A2016 Politico poll conducted by the Harvard T.H. Chan School of Public Health found 58% of likely voters opposed using Medicaid to fund abortions.
When other polls commissioned by pro-abortion rights organizations have framed the question with language specific to how Hyde works, which is that a pregnant patient covered by Medicaid can have pregnancy care and childbirth covered but not the cost of an abortion,support for repealing the Hyde amendment goes up. A 2015 poll found that 62% of voters said Medicaid should cover abortion services.
Effects extend beyond abortion procedures
Amanda Jean Stevenson, associate professor of sociology and director of population at the University of Colorado, Boulder, said many scholars have tracked the fallout of the Hyde Amendment since its inception, but it’s difficult to trace pregnancy complications or deaths back to Hyde.
Many abortion rights advocates point to thecase of Rosie Jimenez, a 27-year-old Texas woman who was denied care at a clinic in 1977 because of her Medicaid status and instead sought care from an unlicensed midwife. She died from an infection after spending a week in intensive care. Her daughter, Monique, was 4 years old at the time and now advocates for policy change.
“It’s very easy for some people to say (Rosie Jimenez’s death) was caused by the Hyde Amendment,” Stevenson said. Had Medicaid benefits covered the abortion, “she probably would’ve had that option for safer care.”
Named after Republican U.S. Rep. Henry Hyde of Illinois, the Hyde Amendment was first passed Sept. 30, 1976. (Photo by Chip Somodevilla/Getty Images)
Jimenez’s case happened a few months after Hyde was first included in an appropriations bill, but it didn’t change its inclusion in future bills. Many scholars have documented the effects of low-income patients being denied coverage for abortions, but it hasn’t resulted in policy change, Stevenson said.
“People set out to find out about the impact of it, they find that it has a big adverse impact, and that doesn’t matter. It doesn’t change the policy or people’s opinion of it, it doesn’t change anything, really,” she said. “Evidence continues to be generated, and it continues to be ignored.”
Marlene Gerber Fried, co-founder and the former president of the National Network of Abortion Funds, said it would be nice to think that a change in Congress would bring about the end of Hyde, but she’s heard optimism of that kind before. When former Democratic President Bill Clinton took office in 1993, abortion-rights advocates also expected change.
In the years since, Fried said, the Hyde Amendment has been a “fault line” in the abortion rights space, even as some abortion rights advocates think they are gaining ground with public opinion.
“It’s not that they were against public funding, they just thought it wasn’t going to get to a win,” Fried said.
Researchers say Hyde doesn’t just affect the direct costs of abortion procedures. River Robbins, a doctoral candidate in applied medical anthropology and adjunct instructor at the University of South Florida, said his dissertation research has shown not having access to federal funding affects other services available at individual clinics. Independent clinics provide 58% of all abortions nationwide, according to data from the Abortion Care Network.
Many clinics serve low-income communities and people of color, including patients who need interpreters or other language or disability services. While hospital networks have access to funding that helps them provide those services, such money is not available to clinics that primarily exist to provide abortion care.
Hyde won’t be the end of funding challenges, advocates say
Now that access to abortion is extremely limited in more than a dozen states, even fewer people can rely on Medicaid to cover abortion costs. Those who can’t access abortion care at home often must travel to another state, where their local Medicaid program dollars won’t apply. That has put extra burdens on local and regional abortion funds and other philanthropic organizations to fill the funding gaps. Sometimes health clinics just take a loss rather than denying someone an abortion.
“We know that our providers don’t turn folks away, and sometimes that comes at great cost to their clinics and their ability to operate,” said Kelsey Ryland, policy counsel for the National Abortion Federation.
Chelsea Souder, co-owner of Hope Clinic in Illinois, said she hopes the Hyde Amendment will be permanently repealed in the near future, but that even if it is, there will still be many gaps in funding for abortion care.
Even in states with access, including some of the most accessible states in the country like Illinois, state Medicaid coverage is often inadequate to cover costs by itself, especially for those who need carelater in pregnancy. Souder said 85% of her clinic’s revenue does not come from patients who pay out of pocket or with Medicaid — it comes from abortion funds or donors, which she said is not sustainable.
“Making abortion actually accessible and affordable is where the focus has to be,” Souder said.
According to health policy institute KFF, 21 states allow their state Medicaid program to cover abortion costs, and some have expanded those policies since Roe fell. But reimbursement rates for providers continue to be low, regardless of where the clinic is located, and they are exceedingly low for abortions later in a pregnancy.
Dr. Diane Horvath, chief medical officer at Partners in Abortion Care in Maryland, said the clinic ran an experiment of accepting all state Medicaid patients for a year and a half, starting in 2024. Despite strong state support for abortion access at any stage in pregnancy, the low reimbursement rates for care beyond the second trimester resulted in a loss to the clinic of $1.2 million during that time. That includes cost increases for supplies and labor, since the clinic hasn’t increased prices for patients.
“For most of these patients, we lose at least $4,000 a patient,” Horvath said. “A hospital might be able to recover more and spread loss over different departments, but I don’t have another clinic, I don’t have another place I can draw funds from.”
This story was originally produced by Stateline, which is part of States Newsroom, a nonprofit news network which includes Wisconsin Examiner, and is supported by grants and a coalition of donors as a 501c(3) public charity.
A sign outside a hospital's maternal-fetal medicine department sets aside parking for patients. The Society for Maternal-Fetal Medicine issued guidance earlier this month encouraging physicians who care for high-risk obstetric patients in states with abortion bans to establish systems of care and build agreements between providers and healthcare administrators to provide the highest level of care. (Photo by Kelcie Moseley-Morris/Stateline)
As physicians continue to navigate care for patients with complex pregnancies in states with abortion bans, a group of maternal-fetal medicine specialists has developed new guidelines to help providers in those states navigate legal risks for themselves and medical challenges for their high-risk patients.
Maternal-fetal medicine specialists handle some of the most high-risk pregnancies, including patients with high blood pressure, diabetes, cancer, fetal anomalies or other complications. In states with abortion bans, those conditions can become even more dangerous for a patient if a doctor is unsure when they can terminate a pregnancy without potentially jeopardizing their medical license or facing criminal penalties that can include jail time.
“Individuals at high risk for pregnancy-associated morbidity and mortality have unique needs for reproductive health services, including abortion care,” the Society for Maternal-Fetal Medicine wrote in a special statement published this month.
Ten states plus the District of Columbia allow abortion access without gestational restrictions, while 13 states ban abortion at all stages. Following the implementation of those bans since 2022, many hospital systems and clinics have offered different interpretations of how to avoid legal jeopardy under the bans and what qualifies under exceptions, leading to confusion and delays in care that have been documented in many states nationwide.
To mitigate those problems, the guidelines encourage providers and administrators to set up referral networks across state lines, work to find agreement on what is permissible under state law and counsel patients on their options even in states with restrictions to deliver the highest-quality care.
“We are uniquely positioned as high-risk pregnancy experts to make that case to our leaders,” said Dr. Justin Lappen, a maternal-fetal medicine specialist in Ohio who chaired the committee that developed the statement. “And a statement like this would give providers and our colleagues some confidence to be leaders in this space.”
The Society for Maternal-Fetal Medicine and the American College of Obstetricians and Gynecologists agree that access to abortion and counseling about options is the standard of care for obstetric patients, but there are conscientious exceptions for doctors who do not want to provide abortion care.
Some doctors choose to affiliate with the American Association of Pro-Life Obstetricians and Gynecologists, and offer their own guidance about approaching complications, which still includes termination in some situations. The group is officially a partner of the Alliance Defending Freedom and several anti-abortion groups, as well as the Alliance for Hippocratic Medicine, which is the group that sued to revoke federal approval of one of two drugs used to terminate a pregnancy or treat miscarriages.
A representative from the American Association of Pro-Life Obstetricians and Gynecologists could not be reached for comment before publication.
Worse outcomes for high-risk patients
Nationwide, women in states with bans have reported difficulties receiving care when experiencing pregnancy complications.
One of the most common emergencies occurs when a patient’s amniotic sac breaks before a fetus is viable. If left untreated, it can quickly turn into a deadly infection. The statement noted that after Texas passed Senate Bill 8 in 2021 banning abortion at an early gestation, waiting to treat patients in those medical situations dramatically increased negative health outcomes. According to research cited in the statement, complications such as blood transfusion, intensive care admission and serious infection resulted in 57% of cases, versus comparable research in states without restrictions that showed a complication rate of 33%. In all of the cases, the fetus did not survive.
The guidance states hospitals and clinics should expand their abortion care to the extent allowed by law, and recognize maternal-fetal medicine specialists as sources of best care practices. It also instructs providers to work with legal teams in their networks to understand the federal Emergency Medical Treatment and Labor Act and when it may require abortion care, as well as encouraging training for basic termination procedures.
Dr. David Hackney, a maternal-fetal medicine specialist in Ohio who published a book in August about navigating high-risk pregnancy care under Dobbs, said the statement will be useful for many providers nationwide.
“We don’t always focus enough on hospital administration, care and systems, but there’s always so much that can be done in those regions that is almost — if not more — important,” Hackney said.
After the Dobbs decision in June 2022, Hackney said, many individual healthcare systems didn’t know what to do when faced with certain situations where termination might be needed, and set a patchwork of policies that increased confusion for providers. But in the years since, providers and administrators in some healthcare systems have come together to reach informal agreements about what they are comfortable doing within the confines of an abortion ban.
“You have some defense if everyone has agreed to do the same thing,” he said.
When laws are unclear, he said, people will most often lean toward over-complying, which can create worse outcomes for the patient.
“Even outside of abortion, medical care tends to work better when you have consensus and you have common best practices, even if it’s on a regional level,” he said.
‘When they need me, they call me’
Many specialists’ cases aren’t emergencies, but rather pregnancies that put a patient at risk because of underlying health conditions, whether they existed before a pregnancy or developed during pregnancy, or late-term diagnoses of fetal anomalies that upend a wanted pregnancy.
In those cases, the maternal-fetal organization says, patients should be told that their options include termination, even if that can’t happen in their home state.
Dr. Leilah Zahedi-Spung, a maternal-fetal medicine specialist who co-authored the special statement, moved to Colorado from Tennessee in 2023 after that state enacted a near-total abortion ban.
She said she saw firsthand how difficult it was in Tennessee to try to take care of patients without clarity around the law and without leadership that was willing or able to try to provide support. One goal of the statement is to help provide that kind of support to physicians, she said.
“We know you’re in a tough situation, we’re not blind to that. No one is blaming you for what you can and cannot do,” Zahedi-Spung said.
The society’s statement suggests that providers establish relationships with leaders within their clinical settings as well as in the community, region and state to agree on legal interpretations of abortion restrictions, particularly those who might hold leadership positions themselves. It also encourages doctors to establish referral networks locally and between states to ensure patient access.
“I have lots of people from Texas who have my phone number, and when they need me, they call me,” Zahedi-Spung said. “That is a system that works. And then those patients go back to safe providers who can take care of them.”
This story was originally produced by Stateline, which is part of States Newsroom, a nonprofit news network which includes Wisconsin Examiner, and is supported by grants and a coalition of donors as a 501c(3) public charity.
The number of women who died after an ectopic pregnancy has spiked in recent years, a ProPublica analysis found. The mounting deaths in Centers for Disease Control and Prevention data have drawn little scrutiny or response.
Such deaths typically occur in the first trimester, after a pregnancy fails to properly implant in the uterus and begins to develop elsewhere, most commonly inside a fallopian tube. The embryo grows until it causes the organ to rupture, triggering catastrophic bleeding.
With prompt and appropriate medical care, maternal health experts say, women should not die. Yet ProPublica’s analysis found a stark and baffling increase: Almost 200 women with the condition died from 2020 to 2025, compared with about 100 in the previous six years.
“A death related to ectopic pregnancy should really be a never event,” said Dr. Alice Abernathy, an OB-GYN in Philadelphia.
Deaths involving an ectopic pregnancy are presented as a rate within three-year intervals to meet data suppression thresholds. Source: ProPublica analysis of CDC WONDER multiple cause of death and natality data. (LUCAS WALDRON/ProPublica)
While chaos and access issues at hospitals during the COVID-19 pandemic likely contributed to at least some of the deaths, the surge has persisted, raising serious questions about the role of the most significant disruption to maternal healthcare in the years since: state restrictions on abortion.
To treat an ectopic pregnancy, which is almost never viable, doctors must terminate it. But lawsuits and federal complaints have alleged that some medical providers are hesitating or flat-out refusing to do that in states where they face criminal penalties for performing an abortion. Patients described their terror.
“I genuinely thought I was going to die,” said Kyleigh Thurman, whose right fallopian tube ruptured after she struggled to get ectopic care in Texas in 2023.
“There were a few times I asked my husband if I was going to die,” Leitaea Lowrimore of Oklahoma said in a lawsuit after being denied treatment for an ectopic pregnancy at multiple hospitals in February. “I kept thinking about our kids.”
To determine whether these issues go beyond anecdotes, ProPublica analyzed the data collected from every state by the CDC to look for patterns. The analysis shows a growing divide for women in states with strict abortion bans compared with those without.
While the uptick in ectopic deaths occurred nationwide, the climb has been much steeper in states that banned abortion after the Supreme Court overturned Roe v. Wade in 2022.
Deaths involving an ectopic pregnancy are grouped into three-year periods to meet data suppression thresholds. States with abortion bans that begin at six weeks of pregnancy or earlier are considered to have a strict ban. For the list of states in each group, see the methodology. Source: ProPublica analysis of CDC WONDER multiple cause of death and natality data. (Lucas Waldron/ProPublica)
ProPublica shared its analysis with more than a dozen maternal health experts, including leaders in the field, who were unaware of the spike; early pregnancy complications are chronically underresearched.
While they cautioned that abortion bans alone can’t explain the national rise, maternal health experts said any examination of the spike should include the documented delays in care caused by the laws, including for ectopic pregnancies.
In Thurman’s case, despite clear signs of an ectopic pregnancy, two emergency departments sent her home without resolving the complication. Regulators in 2025 found that one of the hospitals, Ascension Seton Williamson, failed to properly screen Thurman for a suspected ectopic pregnancy and did not call in an OB-GYN, in violation of the hospital’s own policies and federal law that requires emergency departments to treat and stabilize patients before discharging them. Thurman has an ongoing lawsuit against Ascension Seton Williamson and the other hospital, Ascension Seton Highland Lakes, for medical malpractice.
Thurman had to have her fallopian tube removed after it ruptured. (Thurman is not related to Amber Thurman, who died in Georgia, which also has an abortion ban, after doctors delayed treating different pregnancy complications in 2022.)
“I’ve never been in a situation where I didn’t get healthcare when I needed it,” Thurman told ProPublica, comparing the condition to having “a time bomb you can’t control.”
A spokesperson for the Ascension Seton hospitals said in a statement, “When a patient experiences a serious or life-threatening condition during pregnancy, our clinicians provide medically indicated treatment, including treatment for an ectopic pregnancy.” The hospital has denied Thurman’s malpractice allegations in a court filing.
Ectopic pregnancies, while rare, have long been recognized as the leading cause of maternal deaths in the first trimester. The condition impacts up to 2% of pregnancies in the U.S. Because government agencies don’t require hospitals to track or report overall ectopic diagnoses, it is impossible to know whether the condition itself is becoming more common.
While rates for other pregnancy-related deaths also increased during the pandemic, those climbs have largely subsided.
Experts aren’t sure why ectopic deaths have continued to rise. Ectopic pregnancies are more common among older women, but the increase in deaths has been even more stark among younger women, the analysis showed.
Anti-abortion groups have suggested that the use of abortion pills prescribed online is leading to more undiagnosed ectopics because telehealth patients don’t receive an ultrasound. But studies havefound that ectopic rates are far lower among people who seek medication abortions than in the general population. Telehealth clinics ask questions that filter out patients at higher risk of ectopic pregnancy and follow up with those they treat to screen for symptoms, said Ushma Upadhyay, a researcher at the University of California, San Francisco, who studies telehealth abortion administration.
Experts told ProPublica that more research is required to determine the role of the abortion bans in the rise of ectopic-related deaths. Many states with bans, which generally provide less Medicaid funding and coverage to low-income women, have long had poorer maternal outcomes. “It’s a real challenge to try and tease out one thing out of the array of factors that undermine women’s health in these states,” said Eugene Declercq, a public health researcher at Boston University.
But experts said ProPublica’s data analysis, along with stories about delays in ectopic care, underscores the need to find out what is driving the deaths.
“Reproductive health is unusual across medicine when we consider how swiftly policy changes affect the care patients can receive,” said Dr. Courtney Schreiber, a professor of obstetrics and gynecology.
Caitlin Myers, an economist at Dartmouth College who studies abortion policy, said the deaths should be investigated: “This is a potentially profound consequence of the regulation,” she said.
How abortion bans interfere with ectopic care
Many state abortion bans include exceptions for ectopic pregnancies. But experts have worried that doctors are hesitating to offer treatment without an ironclad diagnosis, which clinicians say can take time and increase risks to the mother.
Ectopic pregnancy symptoms often begin with abdominal pain and bleeding, which send women to emergency rooms. There, doctors use ultrasounds to locate where the pregnancy has implanted.
However, embryos are often not visible on an ultrasound early in pregnancy. That could mean the pregnancy is ectopic, but it may also be a miscarriage or normal pregnancy that’s too small to see. Doctors can also assess whether the pregnancy is likely ectopic through blood tests over multiple days.
If the pregnancy is ectopic, the risk of rupture increases the longer treatment is delayed. In a state without a ban, a patient could decide at any point that that risk is not worth taking and opt to terminate the pregnancy.
In a state with a ban, however, that option may not exist. If doctors can confirm the pregnancy is ectopic through an ultrasound, they can protect themselves from having their decision to terminate questioned, perhaps by a zealous prosecutor. But waiting for this can delay treatment by days or even weeks.
“Seeing a mass is not the only reason to have high suspicion for an ectopic pregnancy,” said Dr. Rebecca Nerenberg, an emergency medicine doctor in New York and the clinical director at Access Bridge, which educates ER doctors on reproductive healthcare and has released evidence-based guidelines for diagnosing possible ectopic pregnancies.
Experts say that doctors should be able to offer treatment when other symptoms are present, such as plateauing pregnancy hormone levels, bleeding and abdominal pain. Patients can be treated with a procedure or a cancer drug that stops cells from growing.
But for women in states with abortion bans, getting that treatment can be difficult.
Lowrimore, who lives near the state border in Oklahoma, sought care at an Arkansas emergency department in February after experiencing abdominal pain and significant bleeding. She was sent home and told to return for more tests after being diagnosed with a “pregnancy of unknown location,” because an ultrasound could not show where her pregnancy had implanted, according to a lawsuit.
Lowrimore visited three different hospitals across both states over the following week as she began passing blood clots and the pain intensified, radiating up the left side of her body, according to the lawsuit.
The fact that the states’ abortion bans make exceptions for ectopic pregnancies did not help her, even though doctors acknowledged that was a possible diagnosis. In each visit, they didn’t treat her for that condition. One told her that intervening in her pregnancy could land him jail time — “10 years in the poky,” according to the suit. “I felt like my life was a risk he couldn’t afford,” she said in the lawsuit filing.
After consulting a lawyer, Lowrimore finally drove to a hospital in Kansas, where abortion is legal, and got an injection of the cancer drug called methotrexate within hours of arrival.
Lowrimore’s lawsuit, in which an OB-GYN and six women who were denied care are seeking to block the Arkansas abortion ban, is ongoing. Lowrimore also filed complaints under the same emergency medicine law as Thurman against the three hospitals. Regulators cited Mercy Hospital in Fort Smith, Arkansas, for failing to provide care during the eight hours Lowrimore waited to be seen. The other two hospitals were not found to have violated that law, and they did not respond to requests for comment.
A spokesperson for Mercy Hospital declined to comment on the case, saying that, “in tragic situations when a mother suffers from an urgent, life-threatening condition during pregnancy, Mercy provides all medically indicated treatment to save her life.”
Many experts predicted that ordeals like the ones Lowrimore and Thurman described would occur when abortion bans took effect. To see if more women with ectopic pregnancies are experiencing severe health outcomes, ProPublica analyzed hospital data from Texas, the most populous state to ban abortion.
In this new analysis, ProPublica found that 310 more patients in Texas experienced substantial blood loss after an ectopic pregnancy in 2023 and 2024 compared with 2018 and 2019, an increase of about 29%. Similar to ectopic deaths, the rise appeared to begin during the COVID pandemic, but the rate of complications remained elevated after hospital systems stabilized and the state passed its restrictive law. ProPublica is working to acquire similar data from states without abortion bans.
But new guidance from the Texas Medical Board includes only a case study with an ectopic pregnancy that can be seen in an ultrasound, remaining silent on the difficulty of early ultrasounds to detect where a pregnancy has implanted. This leaves open the possibility that a prosecutor could question whether such a case was really ectopic, in a state where doctors face up to 99 years in prison for performing illegal abortions.
A spokesperson for the Texas Medical Board said the course is not intended to cover all scenarios and that it “explains that imminent harm is unnecessary and specifically states that physicians who follow evidence-based medicine, standard emergency protocols, and proper documentation face minimal risk.” Asked whether a conclusive ultrasound image is necessary for an ectopic diagnosis, the spokesperson said, “The Board has consistently stated that providing commentary on every possible situation would be impractical.”
But Michelle Maloney, an attorney who represents Thurman and 13 other Texas women or their families who say they were denied care — including seven with ectopic pregnancies — said she still gets frequent calls from women who say they were denied care for pregnancy complications. “I don’t think specific exemptions address the massive gray areas that arise in pregnancy,” she said.
Solutions are unlikely to come from the states themselves. A previous ProPublica investigation found that states with strict bans are not studying whether their laws are contributing to maternal deaths. And others have not followed Texas in attempting to amend their bans.
Gaps in research, training and awareness
One of the biggest challenges to reducing ectopic pregnancy deaths nationwide is the lack of awareness, research and data.
No one, for example, is tracking whether women who experienced ectopic pregnancies also had one or more common risk factors, like a history of ectopic pregnancies, infertility or use of hormonal intrauterine devices, according to ProPublica’s review of maternal health statistics and interviews with experts.
Nor has any published research addressed the connection between recent ectopic pregnancy death rates and untreated infections like gonorrhea and chlamydia, which increased substantially during the first years of the pandemic before declining again. Those infections can cause pelvic inflammatory disease, which causes fallopian tube scarring and raises the long-term risk of developing an ectopic pregnancy.
It is unclear why the CDC and other federal agencies across two administrations have failed to publicly respond to the increase in deaths despite having access to the same information ProPublica analyzed. But experts say the country’s capacity to respond to it has been greatly reduced under President Donald Trump.
Robert F. Kennedy Jr., secretary of the Department of Health and Human Services, told Congress in April that improving maternal health outcomes is a priority. But the Trump administration has eliminated much of the staff devoted to researching the topic and cut hundreds of millions of dollars in government funding for healthcare research.
The CDC’s Division of Reproductive Health, for example, lost most of its 100 employees, according to a lawsuit filed by more than a dozen states’ attorneys general last year. The entire division that ran the Pregnancy Risk Assessment Monitoring System, a significant source of data for state and local governments as well as maternal health researchers, is on paid administrative leave. That includes many researchers who would have been responsible for investigating the rise in ectopic pregnancy deaths, according to current and former CDC employees.
“You’re losing the capacity to know what’s going on with pregnant women,” Lee Warner, the former chief of the Women’s Health and Fertility Branch at the CDC, said of the cuts at the division. “It’s going to take decades to build this capacity back.”
Funding cuts have also impacted efforts to raise awareness about the condition. Because ectopic pregnancies usually cause complications before standard prenatal care begins around 10 weeks, patients often rely on emergency departments, where doctors don’t typically have specialized training in pregnancy care. Experts say more training on high-risk early pregnancy conditions could help combat rising maternal mortality rates.
The CDC in 2025 also stopped funding a partnership with the American College of Obstetricians and Gynecologists to educate emergency medicine doctors about reproductive healthcare. The initiative, “Obstetric Emergencies in Nonobstetric Settings,” offers resources for emergency departments on caring for pregnant patients with cardiovascular disease, hypertension and eclampsia. An ACOG spokesperson said its foundation now funds the project, and that the organization is working on a set of guidelines for diagnosing and managing tubal ectopic pregnancies in the emergency department.
A spokesperson for HHS said the agency continues to track maternal mortality trends, investigate their causes and provide funding for research. “This important work is being accelerated across the Department to support healthy mothers, healthy babies, and strong families,” the spokesperson said.
The United Kingdom’s response to a similar spike in ectopic deaths during the pandemic shows just how much the U.S. is failing to do.
Researchers and officials there identified a surge in deaths in 2021 and 2022 in the U.K. and Ireland; 12 women died of an ectopic pregnancy during those years, which, as in the U.S. during this period, represented a near doubling of the death rate compared with previous years.
They investigated the causes and found a range of culprits, including overstretched emergency services and inadequate early pregnancy screenings, says Marian Knight, a professor at the University of Oxford who leads the U.K.’s maternal mortality reporting.
In 2024, Knight co-authored a maternal mortality report that focused on those deaths and offered policy recommendations. Knight worked with policymakers and a U.K. charity to raise awareness and help doctors and the general public recognize ectopic pregnancy symptoms. Officials also changed how patients experiencing ectopic pregnancy symptoms are prioritized when they call for an ambulance, leading to faster response times.
But the first step, said Knight, was identifying and investigating the issue. “If we’re not tracking and not just understanding the numbers, but understanding the why behind the numbers, we have no ability to respond,” Knight said.
The U.S. doesn’t do national maternal mortality reviews, said Boston University’s Declercq, who serves on the Massachusetts Maternal Mortality and Morbidity Review Committee. Instead, CDC epidemiologists review death and birth records to establish accurate national totals of pregnancy-related deaths, largely leaving state and local maternal mortality committees to take an in-depth look at individual cases and make recommendations to lawmakers and medical providers.
Declercq said his committee has not identified a notable increase in deaths from ectopic pregnancies in Massachusetts in recent years. In most states, these deaths are sporadic enough that they don’t, in isolation, show a notable trend.
It’s only at the national level that this increase in avoidable deaths becomes visible.
ProPublica’s analysis “raises concern that young women are dying from a preventable cause at an increasing rate,” Schreiber, the professor of OB-GYN, said. “That is not what we should be seeing in the United States of America.”
This story was originally produced by Arkansas Advocate, which is part of States Newsroom, a nonprofit news network which includes Wisconsin Examiner, and is supported by grants and a coalition of donors as a 501c(3) public charity.
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