Kate Dineen assumed she would always have access to reproductive healthcare because of where she lived. It came as a shock when she was denied an abortion in 2021 because of gestational limits to the procedure in Massachusetts law.

Dineen was 33 weeks into her pregnancy, the third trimester, when a routine ultrasound detected a problem with the fetus’s brain. An MRI showed that her son, whom she’d named Teddy, had suffered a catastrophic stroke in utero. A pediatric neurologist gave her the news over a Zoom call during the COVID-19 pandemic.

“I said, ‘What’s the best-case scenario? Is there any chance of a normal, healthy outcome?’ And he kind of cast his gaze downward and muttered, ‘No,’” Dineen said. “I had this fear that I was going to go into labor in Massachusetts, and there was going to be nothing I could do aside from watching my son suffer an unknown fate.”

Dineen’s story is rare among those seeking an abortion, and it’s one of the least-discussed types of abortion. Researchers and doctors say later abortions are complicated, expensive and difficult to access, with very few clinics nationwide that can or will provide them. Later abortions also are heavily criticized by anti-abortion groups and Republican elected officials, who often say states without viability limits allow doctors to kill a baby after birth, which is false.

In the four years since the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, access to all abortion in more than a dozen states has dramatically decreased. During that same time, some clinics have expanded later abortion offerings, and advocates — including Dineen — are pushing for many of the 21 states that have bans after 18 weeks to drop them.

Some project optimism about the support for repealing gestational bans, while others are taking a more incremental approach based on their assessments of political realities and general discomfort about the subject even from abortion-rights advocates. Other abortion-rights advocates continue to focus on expanded access earlier in pregnancy, including ballot initiatives to reverse abortion bans.

Frances Kissling, president of Catholics for Choice from 1982 to 2007, said laws that put some limitations on abortion after fetal viability strike the right balance in providing exceptions for certain circumstances without taking an extreme view.

“I think it works better for everybody if no one takes an absolutist position on this,“ Kissling said. “In a sense, there are no good answers, but it certainly is not good to take the position that no limitations in the third trimester would ever be acceptable.”

Kissling’s approach is at the heart of a split among abortion-rights advocates that has developed since Dobbs — whether to return to the way laws were made after the U.S. Supreme Court decided Roe v. Wade, which allowed abortion access to be limited after fetal viability, or whether to push for more.

Dineen’s pregnancy was well past Massachusetts’ cutoff of 24 weeks, around the time that the medical community recognizes a fetus can potentially survive, with medical intervention, outside of the womb.

The state law at the time included exceptions past that point for lethal fetal anomalies, but Dineen’s case was refused by the hospital where she sought care because doctors said they couldn’t guarantee the fetus wouldn’t survive after birth. She had to drive 500 miles to Bethesda, Maryland.

“It was something that I was just so floored by; I felt so naïve,” Dineen said.

‘We see all of these’

The most recent data from the federal Centers for Disease Control and Prevention, from 2022, showed about 1.1% of abortions nationwide took place after 21 weeks of pregnancy, although that total reflects voluntary reporting from only 46 states. More than 93% of abortions happen in the first trimester, before 13 weeks. But thousands of people will still need abortion options later in pregnancy every year for a host of reasons.

Nine states have laws protecting abortion access throughout pregnancy, but only four of those — Colorado, Illinois, Maryland and New Mexico — plus Washington, D.C., have clinics that provide abortion past 32 weeks, meaning people experiencing a problem like Dineen’s most often have to travel. Nationwide, about 20 clinics provide abortions past 24 weeks.

Among the states that protect access throughout pregnancy is Alaska. But unlike the other states, doctor availability at any stage is extremely limited, with two Planned Parenthood clinics statewide, neither of which provides abortion after 18 weeks.

Political rhetoric about third trimester abortion is misleading, experts say

One new all-trimester clinic opened in New Mexico since Dobbs, and a new clinic replaced Boulder Abortion Clinic in Colorado after it closed in 2025. The former chief operating officer of the Boulder clinic, Alicia Moreno, is now executive director of RISE Collective and said about two-thirds of the clinic’s patients come from other states or from Canada. Many times, they are patients like Dineen, who received grave news about a wanted pregnancy.

Other patients must seek a later abortion clinic because they were delayed by logistics such as time off work, travel and financial barriers, while still others are delayed because of abortion bans or bureaucratic hurdles, such as a healthcare provider taking weeks to determine whether a patient qualifies for a legal exception.

Or in some cases, she said, people go to an anti-abortion crisis pregnancy center without knowing what those centers are and are “led on for weeks” until they exceed the state’s legal limit.

“We see all of those on a weekly basis,” Moreno said.

Patients also include preteens and teenagers, who are more likely to not know they are pregnant until later.

National anti-abortion group Americans United for Life takes the view that there is never a good reason to terminate a pregnancy after fetal viability and that it should not be permitted.

Public support for legal abortion in all or most cases stood at 64%, according to a July 2025 AP-NORC poll, but it dropped significantly when broken out by trimester. A 2023 Gallup poll showed support for legal abortion in the second and third trimesters at 37% and 22%, respectively.

Support for legal access is lower for a person who just doesn’t want to be pregnant, such as Ayesha Perry-Iqbal, who didn’t discover she was pregnant until 24 weeks in 2021, referred to as a cryptic pregnancy.

“I was obviously in shock and was not sure what it was that I wanted to do because I felt like since I was past the limit in California, I didn’t really have a choice,” said Perry-Iqbal, who is from Wales but now lives in Los Angeles.

A doctor told Perry-Iqbal she could still go to Colorado. Amid feelings of guilt and frustration, she decided she didn’t want to have a child.

“When I sat down and was like, ‘Actually this is not something I want, this is not the path I deserve, and this is not the story that I want for my child,’ I decided to do what was best for me,” she said. “It didn’t sit well with a lot of people.”

She remembers arriving in a private car at the back of the health clinic to avoid protesters and walking through two different layers of security before making it to the waiting room. It made her feel like she was doing something wrong.

Culture changes

It’s been a decade since Erika Christensen had her own later abortion. At 31 weeks, her fetus was no longer growing and wasn’t swallowing. Doctors said her baby would not be able to breathe outside her body, and was likely to die shortly after birth. Terminating the pregnancy meant Christensen had to travel from her home in New York to Colorado.

Three years later, Christensen and her husband, Garin Marschall, founded Patient Forward and became staunch advocates for removing barriers to later abortion care. She remembers searching for options in 2016 and thinking of it as a desert, whereas now there are more clinics offering services later with more diverse staff and more public discussion of the issue.

As red states pass new abortion restrictions, Minnesota looks to shed them all

“It’s a completely different culture than it was 10 years ago,” Christensen said. “That is progress, even as we have so many more barriers to eliminate.”

Even in states that have made it easier to provide later abortion care since Dobbs, such as in Minnesota, where the legislature repealed laws targeted at abortion providers in 2023, the costs become prohibitive.

Later abortion care requires many more expensive medications, specialized equipment and other services, and healthcare costs keep going up while reimbursement rates remain stagnant or lag behind.

But costs can be more easily addressed than cultural norms. Amy Hagstrom Miller, president and CEO of Whole Woman’s Health, has one abortion clinic in Minneapolis, as well as others in Maryland, New Mexico and Virginia. She said more needs to be done to increase understanding of the complexities around later abortion and why it happens.

“The stigma gets compounded the later in pregnancy you are, even in places that are really progressive,” Hagstrom Miller said. “You hear people say, ‘Why did they wait so long, why didn’t they do something about it sooner?’”

Looking to the future

Patient Forward and other abortion-rights groups have been vocally opposed to ballot initiatives that include language about fetal viability, including in Missouri, where voters narrowly passed an initiative in 2024 to overturn the state abortion ban, and in Idaho, where a question that would overturn its near-total ban will likely be on the ballot later this year.

Initiatives that passed in Arizona and Nevada also allow the government to restrict access after fetal viability.

But some push back on allowing abortions at later stages, including Melanie Folwell, executive director of Idahoans United for Women and Families and lead organizer of the state’s initiative. The ballot language includes a line that says it is not a violation of reproductive freedom and privacy to regulate abortion after fetal viability except in cases of medical emergency, and Folwell said criticisms from national organizations on that subject are unwelcome.

“It’s disappointing that the national political class is painfully out of touch with our reality on the ground. I’d invite them to take a break from firing off press releases and selling tote bags and spend some time knocking doors with our grassroots volunteers in Chubbuck or Coeur d’Alene or Caldwell,” Folwell said. “This is the real work right now and we’re proud to be doing it.”

In Massachusetts, Kate Dineen says she is working to ensure other people aren’t denied care the way she was. In 2022, she successfully lobbied to change the language about legal abortion after 24 weeks to include an additional exception for “grave fetal diagnoses,” which she said has already allowed more patients to access later care.

The next step, she said, is a full repeal of the 24-week limit. Dineen said she’s excited that the bill, titled the Prioritizing Patient Access to Care Act, is moving through the state House and Senate.

“When we start talking about number of weeks and severity of fetal diagnosis or quality-of-life projections, we’ve already lost the conversation. We shouldn’t be talking about any of that,” Dineen said. “It’s about who gets to decide — the government, or the pregnant person.”

Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org.

The National Family Planning and Reproductive Health Association and a family planning organization in Pennsylvania filed a lawsuit against the U.S. Health and Human Services agency on Thursday alleging that it is politicizing the Title X grant funding program and violating the intent of the law.

Attorneys from the Pennsylvania chapter of the American Civil Liberties Union and the national organization are representing the national family planning association and the Family Health Council of Central Pennsylvania. The Family Health Council is a network of 19 service providers across 24 counties in central Pennsylvania that provide family planning services to more than 31,000 low-income residents every year, according to the complaint.

Clare Coleman, president and CEO of the National Family Planning and Reproductive Health Association, told Stateline on Thursday that the organization chose the Pennsylvania network to participate in the lawsuit in part because it has been a grantee of funds since the beginning of the Title X program in 1970 and serves a large number of people. 

“We’re very grateful that they were willing to stand with us,” Coleman said.

The case is assigned to U.S. District Judge Yvette Kane, an appointee of former Democratic President Bill Clinton.

Title X, established by Congress and signed by former Republican President Richard Nixon, is a grant program prioritizing low-income or uninsured people, including those who make too much to qualify for Medicaid, who may not otherwise have access to family planning and reproductive health services. That includes services such as contraception, pregnancy tests, testing for sexually transmitted infections and wellness exams. Abortion services cannot be covered by Title X dollars.

The complaint takes issue with the 2027 Notice of Funding Opportunity for Title X, which was released in April. Potential awardees must submit applications by January for consideration in the next funding cycle.

The funding opportunity language states that all applicants must first meet an “alignment review” to determine their eligibility for a grant. That alignment is based on the priorities laid out by the U.S. Department of Health and Human Services, the Office of the Assistant Secretary for Health and the Office of Population Affairs. Those priorities include ending diversity, equity and inclusion efforts and gender-affirming care. The complaint notes that the decision regarding an applicant’s eligibility cannot be appealed.

Contraception services dropped after ‘defunding’ provision hit clinics

Coleman said those priorities directly conflict with the ones that were laid out in the last funding round under former President Joe Biden, whose administration emphasized the importance of health equity efforts and the inclusion of gender-affirming care for transgender patients. Coleman said that means it could be impossible for some applicants to be awarded funds, and that it would favor new applicants.

“We believe that the funding announcement is designed to favor the kind of providers the administration would rather see in the program,” Coleman said, which could include clinics with a religious mission, such as crisis pregnancy centers or major Catholic healthcare organizations.

The complaint also says those requirements directly conflict with the Title X statute, which mandates that HHS consider factors such as how many patients will be served, how much the services are needed locally and whether the applicant can make rapid and effective use of grant funds. The family planning organizations say the new application process is meant to further the Trump administration’s political agenda instead of fulfilling Congress’ mandate to “offer a broad range of acceptable and effective family planning methods and services” to patients.

The guidance associated with the funding notice also shifts the focus of the Title X grants from expanding access to services like contraception to strengthening “family formation” and assisting clients in “achieving healthy pregnancies.” Clinics are instructed to prioritize and promote natural methods of family planning, such as menstrual cycle tracking, which is less effective at preventing pregnancy than contraception, according to the American College of Obstetricians and Gynecologists.

“The (funding notice) enables defendants to pick winners and losers based on political alignment, as opposed to merit and the ability to provide high-quality Title X services,” the complaint reads. “This is not how federal grants should be awarded, and, specifically, this is not how Congress instructed defendants to make Title X grants.”

A hearing for the case will likely be scheduled in the coming weeks.

Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org.

A survey of more than 3,800 people nationwide who gave birth in 2023 and 2024 found those using Medicaid described worse outcomes than those on private insurance, that access to care remains limited for some, and that women often feel unheard and disregarded during pregnancy and labor and delivery.

The Listening to Mothers survey, conducted by the nonpartisan nonprofit National Partnership for Women and Families, was released earlier this month. The partnership says the survey is the largest of its kind, and it’s the fourth time the organization has published this type of survey since 2002. The organization says its survey represents approximately 90% of the childbearing population, defined as those at least age 18 who gave birth in a U.S. hospital to a single baby whom they lived with.

The survey highlighted what it called “hard-won gains” in policy changes, such as the expansion of Medicaid coverage from 60 days to 12 months postpartum in all but one state, as well as expanded state paid leave programs and new investments in maternal health and perinatal quality. But it said those gains are threatened by hospital maternity units closing in many states, as well as deep cuts to Medicaid programs at the state and federal levels.

Report: Arkansas child well-being improves in some areas but lags behind overall

“While preventing catastrophic outcomes rightly commands attention, surviving childbirth is the floor and not the ceiling,” the survey said. “Extensive evidence shows that precious few childbearing families are getting the care and support they need to truly thrive.”

Most respondents — 61% — said they received prenatal care by eight weeks’ gestation, which is earlier than the generally accepted recommendation to see a provider before 10 weeks. About 19% said they saw a provider between nine and 11 weeks, while 21% didn’t see one until after 12 weeks, which is past the end of the first trimester. About 1% said they received no prenatal care at all.

Among those respondents, 25% indicated they were unable to receive prenatal care as early as they wanted to, and about one-third of those were covered by Medicaid. The most common reasons for receiving care later were that no earlier appointments were available and that the provider wanted to see the patient at a later gestation. Others said they had to find a clinic accepting new patients or accepting Medicaid, or they had to wait to be enrolled in Medicaid.

Medicaid patients also had higher rates of complications such as high blood pressure and gestational diabetes during pregnancy, and higher rates of mental health issues such as depression and substance abuse disorders. 

About 43% of respondents said they received less than optimal care during pregnancy because their knowledge and experiences were not valued, while 42% said their providers did not respond in a timely manner to requests for help, and 40% said they generally felt unheard by providers.

About 6% of respondents said some kind of discrimination played a role in those feelings, with the most common area being discrimination based on race, including a lack of respect for the pregnant patient’s culture. American Indian and Alaska Native groups were most likely to report a lack of respect for their culture.

Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org.

Carrie Frail was in the process of leaving an abusive relationship when she discovered she was pregnant. Her partner told her he could hit her in the stomach until she had a miscarriage, and it would save some money.

“I firmly believe he would have killed me at some point, whether accidentally or intentionally,” Frail said.

She had a medication abortion at a Planned Parenthood clinic in St. Louis, Missouri, in 2008 while serving in the U.S. Air Force. She was relieved to have the option of using medication instead of a procedure, and it let her take less time off work. It wasn’t an easy decision, she said, but she knew if she hadn’t done it, she never would have been able to get away from that partner.

“I was too wrapped up mentally and emotionally in my life with him that … I needed to be able to leave without giving him a phone number or letting him know where I was,” Frail said. “I still believe that an abortion saved my life.”

Access to telehealth prescriptions of mifepristone, one of two drugs used to terminate a pregnancy in the first trimester or to treat miscarriages, is threatened by an ongoing lawsuit in Louisiana. That state government has sued the U.S. Food and Drug Administration, trying to strike down the agency’s 2023 rule allowing the medication to be dispensed without an in-person visit.

Researchers, advocates and survivors of domestic violence say it’s vital to keep telehealth access available for people in abusive relationships who need discreet abortion options. The Louisiana lawsuit, however, argues in part that mifepristone has been weaponized against pregnant women in abusive relationships and shouldn’t be available by telehealth.

The 5th U.S. Circuit Court of Appeals temporarily blocked the FDA’s 2023 rule in early May, making in-person visits required for mifepristone prescriptions for two days before the U.S. Supreme Court paused that decision on emergency appeal. The court, with the exceptions of Justices Samuel Alito and Clarence Thomas, decided to keep the rule in place while the appeals case proceeds. But the rule could still be struck down again later, and the full case may end up in front of the Supreme Court.

Data from the federal Centers for Disease Control and Prevention’s National Intimate Partner and Sexual Violence Survey from 2023-24 showed about 34% of women and 17% of men experienced physical or sexual violence or stalking by an intimate partner. Those figures could be higher because of hesitance to report incidents of abuse. States with high rates of violence include many with near-total abortion bans, including Arkansas, Indiana, Oklahoma, Tennessee and West Virginia — meaning residents who are victims of reproductive coercion have less access to abortion medication.

Pregnancy is a time of heightened risk in a relationship with domestic abuse, according to research, and intimate partner violence is a leading non-obstetric related cause of death among pregnant and postpartum women. Those risks are highest among Black and Indigenous people in the United States.

Reproductive coercion 

The lawsuit over mifepristone access includes Louisiana resident Rosalie Markezich as a plaintiff, who says the availability of the drug without an in-clinic visit allowed her boyfriend to order the pills in 2023 and pressure her to take them. In her written statement in the case, Markezich said the pressure caused ongoing trauma, and that if she’d had to see a doctor beforehand, she could have told the provider she didn’t want an abortion and the pills would never have been prescribed.

Anti-abortion groups, including Susan B. Anthony Pro-Life America and Family Research Council, submitted amicus briefs to the U.S. Supreme Court about the type of coercion Markezich said she experienced. The telehealth option prevents in-person screenings for coercion, Susan B. Anthony Pro-Life America said, and the in-person requirement provided “a line of defense” against reproductive coercion. Family Research Council also argued that because the FDA’s initial approval of the telehealth provision did not include a thorough study of how it could be used for coercion, it should be struck down.

Liz Tobin-Tyler, professor of health services, policy and practice at the Brown University School of Public Health, said people in abusive relationships very commonly experience what researchers call reproductive coercion. According to the American College of Obstetricians and Gynecologists, that includes situations in which a partner tries to control when and how pregnancy occurs, either by intentionally causing a pregnancy or forcing someone to end it, as with Markezich.

Coercion can also occur when a partner interferes with contraceptive methods, such as trying to force the use of a certain method or intentionally failing to use contraception. Tobin-Tyler said sometimes the abusive partner attends medical appointments to try to influence decisions related to birth control and other medical care discussions.

“It all comes back to that aspect of control,” she said.

Robin Turner, Montana director at gender equity organization Legal Voice, said what happened to Markezich was terrible, but that Louisiana could prosecute Markezich’s partner under existing laws, including harm induced by drugs. She said reinstating the in-person requirement for mifepristone would harm many other people because it would apply nationwide.

“It’s not a reasonable or proportional way to address what happened to the client,” Turner said. “We have to take what happened to the plaintiff seriously — and understand that taking that (access) away is not effective.”

Turner co-authored a brief for Legal Voice submitted to the U.S. Supreme Court during the emergency appeal proceedings that centered on the importance of access to mifepristone for people in relationships marked by domestic violence.

“A lot of what being in these relationships is about is your world getting smaller, and we don’t want our systems to imitate the dynamics of abuse. But that’s what happens when the government takes away the access to the healthcare that they need,” Turner told Stateline.

Safety planning for hotline callers

Kaelah Oberdorf, 24, said she was on birth control when she discovered she was pregnant in 2023 in upstate New York.

She was in an emotionally abusive relationship, struggling financially and still recovering from the postpartum depression she experienced after having her first child when she was 20, despite thinking that she couldn’t get pregnant because of a medical condition. The depression was so severe she had to be hospitalized. She decided that ending the pregnancy was the right thing to do for her mental health and the daughter she already had.

“I didn’t want to be tied to him for life, I didn’t want my daughter, or any of my children, to be tied to him for life,” said Oberdorf, who now lives in Georgia. “I already had a living child who did not need to be kept in that situation, and if I’d had another one, even if I left him, I mentally would not have been able to handle it.”

Research also shows that pregnant and postpartum women in rural areas experience higher rates of intimate partner violence, possibly because they’re farther from in-person medical care, which could contribute to lower rates of preventive screenings for abuse.

Elizabeth Ling, associate director of legal services at nonprofit hotline If/When/How, which offers reproductive legal aid, estimated the hotline receives between five and 10 calls a week from people who talk about experiencing intimate partner violence, whether it’s physical, emotional or some form of coercion. She said callers in rural communities are some of those who need access to medication abortion by telehealth and via mail because they are often the furthest away from a clinic and can’t travel because a partner is actively watching their movements.

If/When/How talks callers through their legal options and counsels them about legal risks, which Ling said is a top concern for people in abusive relationships. It’s common for them to be fearful of their partner reporting them for having an abortion, which can bring unwanted attention from police and investigations even if it doesn’t result in charges.

The hotline also helps people make a safety plan for receiving abortion medication, talking through steps such as where medication will be mailed, who has access to that mailbox and how to navigate a situation with a partner tracking their movements.

“Abortion pills really are a lifeline for those who call and share their experiences with us,” Ling said.

Frail, who still lives in Missouri, now has a daughter and a son who are in their 20s. She has left many voicemail messages recently for Republican U.S. Sens. Josh Hawley and Eric Schmitt, who have advocated for the withdrawal of FDA approval for mifepristone and called for federal investigations into drug manufacturers. In her messages, she says that being able to choose when she had her children made her a better parent.

“I know if I had not had an abortion, I would not have ever been able to get away from that abusive partner,” Frail said.

Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org.

Pregnant patients experiencing miscarriage who live in states with abortion bans have fewer options for healthcare management, according to a new study published by the Journal of the American Medical Association.

The study, published May 18, found a shift away from managing miscarriages with a two-drug approach that includes mifepristone — which has been the subject of numerous legal battles that are still playing out in federal courts — and toward approaches that include only misoprostol, which has a lower rate of effectiveness.

The states with abortion bans had a nearly 3% increase in expectant management, the study showed, which means a health provider monitors the condition without prescribing any form of treatment to see whether the condition resolves without intervention. The study was conducted by researchers in the Department of Obstetrics and Gynecology at Oregon Health and Science University.

Among those patients who received medication, there was a nearly 14% increase in the use of misoprostol-only regimens, which goes against the American College of Obstetricians and Gynecologists’ recommendation of using a combination of mifepristone and misoprostol as the most preferred method of managing miscarriages. Used together, the medications are the most effective at completing expulsion of pregnancy tissue and reducing side effects such as bleeding and cramping.

The expectant management approach, the study said, could increase the risk of hemorrhage and retained pregnancy tissue, which can cause infection if it is not removed.

The method of treatment for a miscarriage is the same two-drug regimen that is used to terminate a pregnancy before 12 weeks. A group of anti-abortion doctors unsuccessfully tried to revoke the U.S. Food and Drug Administration’s approval of mifepristone altogether in 2023, and government officials in Louisiana are trying to strike down a 2023 rule enacted by the FDA that allows the drug to be prescribed by telehealth and mailed to a patient. That case is ongoing.

Using healthcare claims data, the study included nearly 123,600 commercially insured patients who had a miscarriage before 77 days’ gestation between the beginning of 2018 and the end of September 2024. That time frame includes 53 months of data from the years before the U.S. Supreme Court’s Dobbs decision in June 2022 to allow states to regulate abortion access, and 27 months after at least a dozen states implemented abortion bans.

The states with bans that affect pregnancies at six weeks of gestation or earlier are Alabama, Arkansas, Georgia, Idaho, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas and West Virginia. They were compared with 18 other states that do not have bans before fetal viability, which is generally considered to be about 24 weeks.

Some of those states with bans have gone further in adding criminal penalties to the use of mifepristone for abortion, which doctors have said affects abortion patients as well. Louisiana classified mifepristone and misoprostol as controlled substances in 2024, which meant providers had to start treating the storage and access to the medication much differently. Patients have tried to fill a prescription for misoprostol at major pharmacies in Louisiana, only to be told it’s unavailable, Louisiana Illuminator reported.

“It’s definitely getting more and more challenging to provide for patients and provide for them adequately,” Dr. Nicole Freehill, an OB-GYN in New Orleans, told Stateline in March. “That criminalization, more than anything, has created so many problems, because so many providers are just afraid to act.”

Mississippi enacted a law in April adding mifepristone and misoprostol to the state’s drug trafficking law, making it a crime punishable by up to 10 years in prison to distribute or intend to distribute the drugs. Lawmakers said the law would help limit the number of people sending the medications through the mail.

Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org.

When Jacqueline Perez started experiencing symptoms of menopause in her early 50s, the brain fog was so severe, she thought she had early-onset dementia.

Perez, who founded a website dedicated to normalizing aging for women, said she gained more than 30 pounds and struggled with depression for months before she found a health provider who tested her hormone levels and recommended hormone replacement therapy for low estrogen.

That was nearly a decade ago, and in the years since, Perez said the culture around menopause treatment has changed dramatically.

“We still have a long way to go, in my opinion, but I think at least we’re on the path,” she said.

Menopause refers to the time when a woman stops having menstrual periods, which typically occurs between the ages of 45 and 55, according to the National Institute on Aging. The associated changes in hormones can cause hot flashes, night sweats, joint problems, bone density loss, insomnia, mood changes and more.

Lawmakers and advocates alike told Stateline the topic of menopause used to be taboo, but there has been a generational shift in recent years that has led to more legislation in statehouses around the country, providing more access to treatments and preventive care as well as more educational opportunities for healthcare providers.

Claire Gill, founder and president of the National Menopause Foundation, started the nonprofit in 2019 and said over the course of the past seven years, public awareness of the issue and interest from clinicians has noticeably increased.

And in November, the U.S. Food and Drug Administration removed its most severe “black box” warning from hormone replacement therapy for menopause and perimenopause after new research that the presumed risks of cancer, stroke and dementia from its use, once thought to be high, came from a flawed study. In the months since, the demand for the therapy has led to a nationwide shortage of certain products such as the estrogen patch.

Gill said more than 60 pieces of legislation related to menopause have been introduced nationwide this year, and 26 states have enacted a menopause-related law since 2019. There tend to be four categories of the legislation: mandating insurance coverage for treatments, workplace accommodations, awareness campaigns and healthcare provider education.

The subject is bipartisan: Lawmakers in liberal-leaning Illinois, Oregon and Washington have approved bills requiring insurance coverage, but so has conservative Louisiana.

Gill said the insurance conversation is especially significant, because bone density tests are only covered in existing laws when a person reaches the age of 65 and is eligible for Medicare. But women lose up to 20% of bone density in the first five years after menopause, which happens at an average age of 52. That’s a big gap that puts a woman at increased risk for fractures.

“I’m excited that we’re taking time and focusing more on the role that estrogen plays from head to toe in women, and not just looking at it as, ‘Oh, women get hot flashes,’” Gill said. “It’s so much more than that, and we can do more to protect our hearts and our brains and all of our organs — and prevent hot flashes.”

Getting providers to listen

In June 2025, Democratic state Sen. Lori Urso sponsored a bill that made Rhode Island the first state to require workplace accommodations, such as a modified work schedule, for menopause and its related conditions. It was added to the same part of employment law about women who are pregnant or nursing.

Urso said she had a challenging time personally with menopause, and she wasn’t sure she was going to be able to continue functioning at the necessary level to keep doing her job. When she introduced her bill in committee last year and detailed why symptoms could make it difficult to work, several of the men who were present at the hearing followed her out of the room, stunned by what they’d heard.

Menopause coverage bills meet mixed fates in state legislatures

“They said, ‘Oh my god, I had no idea about any of this,’” Urso said.

In the year since, Urso has watched a flurry of bills spread to other states. Many of them, including another bill from Urso that’s under consideration this year, would mandate insurance coverage for treatments related to menopause and perimenopause, the years leading up to menopause when some symptoms can start.

Others are proposing bills similar to Urso’s workplace accommodations law, with the aim of instituting more education requirements for doctors, directing health departments to conduct a public awareness campaign, or telling agencies to study the issue and make recommendations.

“I don’t think I invented something, I think I just made it okay, and helped open up a necessary dialogue out there,” Urso said.

Urso’s bill to mandate insurance coverage is still pending in the Rhode Island Legislature, but others have already made it law, including in New Jersey.

A new generation

Democratic Assemblywoman Heather Simmons said she was looking at legislation in other statehouses around the country and found the insurance mandates to be inconsistent. She decided to draft a version for New Jersey that she wanted to be the most comprehensive bill in the country, covering hormonal, non-hormonal and preventive treatments for perimenopause and menopause on state-regulated insurance plans.

It was signed into law in January, passing alongside another bill that allows healthcare providers to earn continuing education credits for menopause-related topics.

Although Simmons said her healthcare providers are generally very good and her insurance is excellent, she faced an uphill battle when going through menopause. She said she would ask about symptoms and whether they could be related to menopause, and her providers would shrug their shoulders. Not for a lack of caring, she said, but lack of knowledge.

“I’m just so grateful that my generation and the generations that follow me are saying no, we deserve better than that, we can do better than that,” Simmons said. “We’re not afraid to talk about it anymore.”

Simmons’ bill also includes behavioral health services for those diagnosed with depression or other conditions, and counseling for those who don’t have a formal diagnosis. It also covers pelvic floor therapy, and bone health screenings and treatments.

Her next step, she said, is to make sure that insurance carriers can’t deny testosterone prescriptions for women who need it just because it’s an off-label use.

Testosterone was a hormone replacement therapy that Pennsylvania Democratic state Rep. Melissa Shusterman needed to help her feel like herself again.

Shusterman has introduced four bills this session related to perimenopause and menopause, including insurance coverage for preventive  care for hip fractures and a joint government study to review workplace policies for state employees. Four other related bills are pending from other representatives, including one that would mandate Medicaid coverage for menopause treatments.

“All of this is going to help women in the long run, which means mothers are happier, women are happier and partners are happier, and that makes us healthier as a society,” Shusterman said.

Advocates like Gill, who is also CEO of the Bone Health & Osteoporosis Foundation, say their goal is to stay committed to pushing the boulder up the hill when it comes to passing more laws and creating more awareness of this phase of life. Too many women still think they have dementia or cancer before they realize it might be perimenopause, she said.

Gill noted the entire budget for women’s health research under the National Institutes of Health has long been about 10% of its total budget — that includes juvenile and post-menopausal ages. The gap in health research was already wide, she said, and amid cuts to federal agencies and projects under President Donald Trump’s administration, a recent report from the Washington Post showed a 31% decrease in projects funded in 2025 that contained the word “women.”

“There’s always been a need to increase that (budget) … and now we’re cutting the dollars,” Gill said.

“The important thing is that there are both immediate and long-term things that can be done at the local, state and federal level that can bring about not just better quality of life and symptom treatment for women, but also longer-term health benefits for women,” she said.

Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org.

The U.S. Supreme Court decided Thursday to preserve telehealth access to the abortion drug mifepristone until after the U.S. 5th Circuit Court of Appeals has ruled on the merits of the high-stakes federal lawsuit Louisiana v. Food and Drug Administration.

Justices Samuel Alito and Clarence Thomas issued dissenting opinions.

In his dissent, Thomas said the rule violates the Comstock Act, a long unenforced 1873 law that bans the mailing of “obscene” material. During the 2024 presidential campaign, President Donald Trump said he didn’t support using the Comstock Act to stop mail delivery of abortion pills, saying he thought the federal government should have nothing to do with the issue.

Mifepristone’s manufacturer “makes a passing reference to the possibility of lost sales,” Alito wrote in his dissent. “But lost sales in states where abortifacients are generally illegal are not ‘irreparable injuries’ that can justify granting a stay.”

Abortion-rights advocates around the country called the decision a relief after two weeks of uncertainty.

On May 1, the appellate court sided with Louisiana, where state officials sued the FDA in October, arguing that a rule allowing telehealth access to mifepristone, one of two drugs used to terminate a pregnancy in the first trimester or to treat miscarriage, undermines the state’s abortion ban. Danco Laboratories and GenBioPro, two manufacturers of mifepristone, filed emergency appeals, leading the Supreme Court to issue a 10-day stay on May 4, extended until today.

“Though today’s decision means that mifepristone remains available through telehealth for now, this fight is not over,” said Dr. Camille A. Clare, president of the American College of Obstetricians & Gynecologists, in an emailed statement. “The chaos and confusion wrought by competing decisions and the revocation and restoration of access on an almost daily basis do real harm to patients and to the clinicians who care for them.”

Abortion opponents decried Thursday’s decision.

“Women deserve better than dangerous abortion drugs sent through the mail without physician oversight or in-person support,” said Jor-El Godsey, president of Heartbeat International, a major network of anti-abortion crisis pregnancy centers. “A state like Louisiana that values life in its laws should be able to protect its smallest residents as well as their moms.”

The FDA’s approved two-drug regimen via telemedicine is an increasingly common abortion method, especially for people living in parts of the country where abortion is banned or difficult to access.

Last month, a federal district court paused the lawsuit at the request of the FDA until after the completion of a safety review on mifepristone. That review was prompted by non-peer reviewed, anti-abortion research and in spite of the drug’s record of safety and efficacy since 2000. The state appealed to the 5th Circuit.

Due to multiple ongoing efforts to restrict or block mifepristone, abortion providers have told Stateline they are ready to eventually switch to a misoprostol-only method, which researchers have found to be as safe as the two-drug regimen but typically involves more symptoms and is slightly less effective.

National groups have tried to pressure the Trump administration to drop the Biden-era rule allowing telehealth abortion and called for the head of FDA Commissioner Marty Makary for reportedly slow-walking a safety review of the drug until after the midterm elections. Makary resigned on Tuesday, and anti-abortion groups wasted no time in getting Acting Commissioner Kyle Diamantas on the phone.

Live Action founder and president Lila Rose, in a written statement, said she talked to the acting commissioner on Wednesday and that he said he was morally opposed to abortion. “Diamantas told me that reviewing the abortion pill is a top priority for him and the administration,” Rose posted on X.

Students for Life of America President Kristan Hawkins wrote a similar message to supporters in an email on Thursday, saying Diamantas will be the “most pro-life FDA commissioner in American history.”

But many doctors around the country say curbing access to telehealth abortion is likely to cause harm to people in states with bans who may face more barriers to obtaining an abortion without that option.

“Women will be forced to travel long distances — at times hundreds of miles — to access safe, essential health care at a doctor’s office, no longer having the option to receive mifepristone via telemedicine,” wrote Rob Davidson, an emergency physician in Michigan and executive director of the Committee to Protect Health Care, in a letter asking the Supreme Court to maintain access to telehealth abortion. The letter was cosigned by more than 2,200 physicians.

Stateline reporter Sofia Resnick can be reached at sresnick@stateline.org.  Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org. 

Advocates and opponents of abortion access say they’re wondering what happens next in a critical telehealth medication case that created chaos and confusion over the past week after an appeals court blocked nationwide access to the drug and, days later, U.S. Supreme Court Justice Samuel Alito issued a temporary stay.

Alito’s stay preserves telehealth access until May 11. But it’s unclear what happens next for patients and providers.

The Supreme Court on Monday temporarily blocked the 5th U.S. Circuit Court of Appeals’ Friday ruling to suspend a federal rule allowing telehealth prescriptions of the drug mifepristone while the lawsuit Louisiana v. U.S. Food and Drug Administration unfolds. Abortion providers are determined to continue providing the service, though potentially without mifepristone, the drug at the center for the case, which has had a high record of safety and efficacy since 2000.

Anti-abortion advocates have pushed to reverse the 2023 policy, enacted under former Democratic President Joe Biden, that allowed the FDA to drop its requirement that a patient see a provider in person before the medication can be prescribed. One similar national case already failed unanimously before the Supreme Court, but anti-abortion advocates are hoping this time around, with a more tailored approach, they will be successful.

Abortion-rights advocates say they’re prepared for whatever might happen in the courts, with contingency plans and a message that abortion will still be available even if the particular medication — mifepristone — is not.

Has the abortion pill been banned?

No. Mifepristone is still a legally approved FDA drug commonly used to terminate a pregnancy before 10 weeks’ gestation and is used off-label to treat miscarriages.

Is telehealth abortion still legal?

Yes, for now. Under the U.S. Supreme Court’s administrative stay that expires on May 11, it is still legal to obtain abortion medication through telemedicine under the FDA’s regulations. Mifepristone is commonly used with a second drug, misoprostol, in medication abortions. The case doesn’t include misoprostol.

Who would be affected if telehealth access is struck down?

According to the Society of Family Planning’s #WeCount report, 27% of all abortions in the first six months of 2025 were obtained through telehealth, adding up to more than 162,000 cases.

Mifepristone is also used for patients experiencing a miscarriage; those patients also would have to visit a provider in person.

The ruling would apply nationwide, meaning that health providers couldn’t prescribe mifepristone without an in-person visit with the patient, even in states with abortion access.

What are the arguments on each side in Louisiana v. FDA?

Louisiana says the Biden-era policy undermines a state law banning abortion, and that the federal rulemaking process allowing telehealth prescriptions was flawed.

The Food and Drug Administration says the state doesn’t have standing to sue, but also notes that it’s taking more time to review the drug’s safety.

Two mifepristone drugmakers, meanwhile, have intervened on the FDA’s side.

What could happen next?

The Supreme Court has many options available moving forward, but a few options are most likely, said Katie Keith, founding director of the Center for Health Policy and the Law at the Georgetown University Law Center. The justices could extend the stay when it expires May 11, or the court could make a longer-term ruling.

That could mean sending it back to the 5th U.S. Circuit Court of Appeals, with or without upholding the initial ruling blocking the 2023 provision while the appeals case proceeds. Or justices could decide to take up the case and bypass the rest of the 5th Circuit appeal.

If it did that, the manufacturer defendants Danco Laboratories and GenBioPro have asked for an expedited process with a decision by June. That seems unlikely, Keith said, but the court has conducted expedited cases related to abortion before, such as the Moyle v. United States case in 2024 related to the federal Emergency Medical Treatment and Labor Act.

What will providers do if they can’t use the combination of mifepristone and misoprostol?

Brittany Fonteno, president and CEO of the National Abortion Federation, said providers have been preparing since 2023 for the possibility of losing access to mifepristone. There have long been plans to switch to a misoprostol-only protocol, which is the main method of pregnancy termination across much of the world, she said.

“A lot of providers had created these policies and just needed to dust them off,” Fonteno said.

Dr. Angel Foster, co-founder of the Massachusetts Medication Abortion Access Project, which provides telehealth abortions to patients in all 50 states, said she and her team spent the weekend scrambling to contact patients waiting on medication abortion pills they had ordered before the ruling, and implementing a contingency plan that many abortion providers have been planning for since the lawsuits against mifepristone began in 2023.

That contingency involves pivoting from the FDA-approved mifepristone-misoprostol regimen to a misoprostol-only regimen.

Early Monday, Foster said her team was getting ready to ship misoprostol-only packages to patients at 2 p.m., but after the Supreme Court stayed the appeals court’s ruling on Monday morning, she said they were able to switch back to the mifepristone-misoprostol regimen.

Foster also said her organization was inundated with requests for pills that people could stockpile — people who didn’t need an abortion but were worried about losing access to the pills. Normally that’s a small fraction of the requests they receive, she said, but on Tuesday, they sent out more than had been sent in the entire month of April.

“Over the last two days, we’ve had a huge increase in the number of people from Louisiana requesting pills, especially pills for future use,” Foster said.

What are the pros and cons of the misoprostol-only regimen?

Dr. Maya Bass, a family physician in New Jersey who also provides abortions in Delaware, said misoprostol-only regimens are still safe and highly effective, but that the regimen has a lower efficacy rate than the combination of the two drugs and comes with potentially more side effects and risks.

Misoprostol-only regimens vary between 85% and 90% effective, while the combination is between 93% and 99% effective. The effective rates are lower as the gestational age increases.

The combination works well, Bass said, because mifepristone stops the hormone that allows the pregnancy to continue and signals to the body that the pregnancy is over. The misoprostol then helps soften the cervix and prompts the uterus to contract and expel the pregnancy tissue.

Without that hormonal signal, Bass said, a higher dose of misoprostol is needed to empty the uterus. The usual side effects of nausea, diarrhea, chills and sometimes fevers can be more severe because of the higher dosage. And it may lead to more people needing to seek in-person follow-up care to fully remove all of the pregnancy tissue, which can cause infection if it stays in the uterus.

“A lot of the people who are using telehealth for their medication abortion are not necessarily in places where they can safely access that care,” Bass said. “So it is concerning that we might be relying more on a regimen that means that many more people needing to seek care.”

What are the details of the legal arguments?

Louisiana officials, including Republican Attorney General Liz Murrill, argue that the state is harmed by the 2023 telehealth policy because it undermines a state law banning abortion at all stages of pregnancy, with few exceptions that don’t include rape or incest. The state also challenged the Food and Drug Administration’s process in deciding to eliminate the in-person dispensing requirement, saying it was based on flawed or nonexistent data.

The state also said the rule has resulted in $92,000 in Medicaid bills from two women who went to the emergency room because of complications related to mifepristone in 2025. And the state says the rule harmed the other plaintiff in the case, Louisiana resident Rosalie Markezich, who said her ex-boyfriend ordered the medication online and pressured her into taking it. That wouldn’t have been possible if the medication had to be dispensed through an in-person visit, the state argues.

“The priority of safety supersedes the priority of access, and that is what ultimately, I believe, needs to be looked at directly,” Sarah Zagorski, senior director of public relations at Americans United for Life, told Stateline on Wednesday. The anti-abortion organization submitted a brief supporting Louisiana’s case to the U.S. Supreme Court this week.

The FDA’s response has been to try to dismiss the claims in part on the grounds that Louisiana doesn’t have standing to sue, but agency officials have also said they are in the middle of conducting a safety review of mifepristone and need more time.

GenBioPro and Danco Laboratories, two of the manufacturers of mifepristone, intervened as defendants in the case, which can happen when the party that is sued may not be willing to fully defend the case for various reasons.

The two companies argue that Louisiana does not have proper standing to sue because the state does not prescribe or use mifepristone and is an “unregulated party” as it relates to the 2023 telehealth provision. They also noted that the FDA reviewed 15 studies evaluating medication abortion outcomes for more than 55,000 patients before approving the rule, “all of which supported the safety and effectiveness of dispensing mifepristone by mail, courier, or through pharmacies.”

How does this compare to the 2023 case Alliance for Hippocratic Medicine v. FDA?

Both lawsuits were designed to restrict access to mifepristone. The plaintiffs in the Alliance for Hippocratic Medicine case included a group of anti-abortion doctors who said they would be harmed by having to care for people who took mifepristone. They also argued that the FDA’s approval of the drug was improper.

The 5th U.S. Circuit Court of Appeals was involved in that case as well, and determined that the FDA should roll back its decision to ease restrictions on the drug, including the 2023 telehealth rule. But the U.S. Supreme Court unanimously decided in June 2024 that the Alliance plaintiffs didn’t have proper standing and sent it back to the lower court.

After that ruling, the attorneys general of Missouri, Idaho and Kansas stepped in as plaintiffs, and the case was transferred to Missouri’s U.S. district court, where it’s still pending.

The Louisiana case is more limited because it would strike down one provision of mifepristone regulation, noted Jenna Hudson, senior counsel at the Center for Reproductive Rights. The Alliance plaintiffs sought to revoke the drug’s approval altogether.

Stateline reporters Kelcie Moseley-Morris can be reached at kmoseley@stateline.org and Sofia Resnick can be reached at sresnick@stateline.org.  

The U.S. Supreme Court issued a temporary stay on an appeals court ruling from Friday that was blocking remote access to an abortion drug, restoring access until at least May 11.

The administrative stay, issued by Justice Samuel Alito, pauses Friday’s decision by the 5th Circuit Court of Appeals. That ruling blocked a 2023 rule adopted by the U.S. Food and Drug Administration allowing mifepristone, one of two drugs used to terminate a pregnancy before 10 weeks and to treat miscarriages, to be prescribed without an in-person visit with a health care provider and also allowed it to be mailed to recipients in states with abortion bans.

“The administrative stay is temporary, and I am confident life and law will win in the end,” said Louisiana Republican Attorney General Liz Murrill in a statement. 

Thirteen states have near-total abortion bans, including Louisiana. Murrill sued the FDA in October, saying the rule undermines the state’s laws and causes financial harm because the state paid $92,000 in Medicaid bills for two women who needed emergency care in 2025 from complications related to mifepristone. 

In the years since the 2022 U.S. Supreme Court decision allowing states to regulate abortion access, telehealth prescriptions of abortion medication have become increasingly popular, with more than 27% of all abortions provided that way in 2025, according to data from the Society of Family Planning.

“While this is a positive short-term development, no one can rest easy when our ability to get this safe, effective medication for abortion and miscarriage care still hangs in the balance,” said Julia Kaye, senior staff attorney for the Reproductive Freedom Project at the American Civil Liberties Union, in a statement. “The Supreme Court needs to put an end to this baseless attack on our reproductive freedom, once and for all.”

The case could follow a similar pattern to one that played out in 2023, after U.S. District Court Judge Matthew Kacsmaryk of Texas issued a ruling that would have revoked access to the abortion drug mifepristone altogether. 

The U.S. Supreme Court intervened shortly after that ruling and kept mifepristone available while the case proceeded in the 5th Circuit appeals court, which eventually decided that more restrictions were warranted, but not pulling the drug’s approval. The Supreme Court officially took the case several months later, and unanimously ruled in June 2024 that the plaintiffs suing the FDA did not have standing, keeping access to mifepristone intact.

Responses from the attorneys in the latest case are expected to be filed with the Supreme Court by Thursday, according to Alito’s order.

Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org.

One of the main methods of obtaining abortion medication for those living in states with bans is now blocked nationwide, after a federal appeals court decision issued Friday afternoon.

The 5th Circuit Court of Appeals blocked a U.S. Food and Drug Administration rule from 2023 that allowed mifepristone, one of two drugs used to terminate a pregnancy before 10 weeks and to treat miscarriages, to be dispensed without an in-person visit with a health provider. 

In the years since, states with abortion access have increased their telemedicine offerings to prescribe the medication remotely and send it through the mail. Many of those states also enacted shield laws to prevent officials from states with abortion bans from prosecuting or investigating their providers — meaning many patients have been able to receive the medication across state lines.

Louisiana judge preserves telehealth abortion access provision for now, puts case on hold

The block will remain in effect as the lower court case proceeds, but the FDA could file an emergency appeal to the U.S. Supreme Court in the coming weeks.

More than 27% of all abortions were provided through telehealth appointments in the first six months of 2025, according to the Society of Family Planning, a research and advocacy group that publishes a report called #WeCount. Nearly 15,000 abortions per month were provided under shield laws during that same time frame, according to the report.

Louisiana Republican Attorney General Liz Murrill sued the FDA in October, seeking to strike down the 2023 provision, and the lower court declined to do so in early April. U.S. District Judge David C. Joseph said then that the stay was premature while the FDA completed a safety review of mifepristone, but allowed state officials the opportunity to re-file the motion after that review was complete. The state appealed that decision to the 5th Circuit.

“Every abortion facilitated by FDA’s action cancels Louisiana’s ban on medical abortions and undermines its policy that ‘every unborn child is human being from the moment of conception and is, therefore, a legal person,’” Friday’s decision said.

There were no dissenting opinions among Judge Leslie Southwick, an appointee of former Republican President George H.W. Bush, and Judges Stuart Kyle Duncan and Kurt D. Engelhardt, both appointees of Republican President Donald Trump.

Without access to telemedicine and the opportunity to receive the medication through the mail, people in 13 states with near-total abortion bans may have to travel to another state to get an abortion.

There is a misoprostol-only abortion pill protocol that some providers can use, but it is slightly less effective and requires a higher dosage, which can increase side effects.

“Reinstating in-person dispensing requirements would force people to travel farther, take more time off work, and absorb costs that are simply too high. For people living in states already hostile to abortion access, many of which are home to Black women and families, this is not health care,” said Regina Davis-Moss, CEO of advocacy group In Our Own Voice: National Black Women’s Reproductive Justice Agenda, in a statement. 

Murrill said in a statement on Friday that former Democratic President Joe Biden’s administration facilitated “illegal mail-order abortion pills.”

Nearly 1 in 4 people seeking abortions out of state chose Illinois. Here’s why.

“Today, that nightmare is over, thanks to the hard work of my office and our friends at Alliance Defending Freedom. I look forward to continuing to defend women and babies as this case continues,” Murrill said, crediting the advocacy legal organization that helped in the case.

The court also found Friday that the 2023 rule injures Louisiana by causing it to spend Medicaid funds for emergency care for women harmed by using the drug. The state identified $92,000 paid by Medicaid for two women who needed emergency care in 2025 from complications “caused by out-of-state mifepristone.”

Numerous studies have shown mifepristone is safe to use, with very low complication rates. A combined review of 10 years’ worth of studies between 2005 and 2015 found that severe outcomes requiring blood transfusion and hospitalization occurred in less than 1% of cases.

“We are alarmed by this court’s decision to ignore the FDA’s rigorous science and decades of safe use of mifepristone in a case pursued by extremist abortion opponents. We are reviewing the court’s order in detail,” said Evan Masingill, CEO of GenBioPro, one of the main manufacturers of mifepristone, in a statement. “We remain committed to taking any actions necessary to make mifepristone available and accessible to as many people as possible in the country, regardless of anti-abortion special interests trying to undermine patients’ access.”

Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org.

Three years after a miscarriage that caused a severe, nearly septic infection because a Tennessee hospital denied her an abortion, Katy Dulong was looking forward to telling her story in a trial that was scheduled to begin Monday.

But this week, the state appealed to a higher court based on a new law passed by the legislature in March, and the court put the trial on hold indefinitely. It will now be months before the lower court can proceed.

Dulong had complications that led to a miscarriage in November 2022 at 16 weeks of pregnancy, long before fetal viability. Under the state’s abortion ban, which had only been in place for a few months, the hospital sent her home to miscarry on her own. When that didn’t happen, severe infection started to set in 10 days later, when she was able to get doctors to agree to help. The experience left her with post-traumatic stress disorder.

Tennessee bill expands attorney general rights to appeal case rulings

The delay in the legal case feels like the state trying to silence her and the other plaintiffs, she said.

“It’s shocking to me that there’s anyone in this world that would have such opposing views to think that our voices don’t matter,” Dulong said in an interview. “How are they taking away our voice right now?”

In a motion to dismiss in February, the state argued it couldn’t be sued by the plaintiffs under a term called sovereign immunity, and in April, the Tennessee Legislature passed a law making it harder to sue the state on the constitutionality of a state or government action. Legislators passed another bill allowing the state to automatically appeal a decision related to sovereign immunity.

Nicolas Kabat, a staff attorney at the Center for Reproductive Rights who has been working on the case with the plaintiffs, said the state has tried to have the case dismissed four times without success, and said this is just the latest move to delay the trial. But he said the latest laws passed by the legislature allowing automatic appeals in the middle of a case, on the eve of a trial, make the situation unique.   

“There is nothing unusual about appealing an appealable order,” said Phil Buehler, press secretary for Tennessee Republican Attorney General Jonathan Skrmetti, in an email Thursday.

Similar lawsuits are ongoing or have already been resolved in several states with bans, including Texas and Idaho, where state residents have challenged the law based on their personal experiences. Plaintiffs in Idaho won their case in April 2025, when a judge said the near-total abortion ban does not mean a pregnant patient’s death has to be imminent or “assured” to perform an abortion. Complaints are also pending related to Texas hospitals allegedly not complying with federal law mandating emergency room treatment for a patient who needs an abortion as stabilizing care.

Women with serious pregnancy complications sue over state abortion bans

Allie Phillips, the lead plaintiff in Tennessee, joined several other women to sue the state in September 2023, alleging that the abortion ban put their health and lives in jeopardy when they were pregnant. They asked the state to clarify the law so that health is considered in an abortion decision, not just an immediate threat to a pregnant patient’s life. The way the law is written, attorneys argue, is too vague to allow for those exceptions.

Phillips and Nicole Blackmon, another plaintiff, had fetuses with anomalies related to the development of vital organs. Blackmon couldn’t afford to travel out of the state for an abortion, and eventually had to stop working because the pregnancy was affecting her health. She delivered a stillborn baby in her seventh month of pregnancy. Phillips raised enough money to seek an abortion in New York, only to find when she got there that the fetus had already died.

After the court granted a temporary block on the law as it relates to pregnancy complications, the state passed several laws that affected the case. The first bill, meant to clarify the state’s health exception for an abortion, was enacted in April 2025 but didn’t solve the issue, Kabat said. The language still wasn’t clear enough, and the court agreed and allowed the suit to continue.

Kabat said the legal team will continue its effort to clarify Tennessee’s laws so that stories like Dulong’s don’t happen to others.

“No matter how long this takes, we’re going to get the trial, we’re going to get these stories heard and we’re going to seek accountability from the state,” Kabat said.

Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org. 

At Family Planning Associates in Chicago, in the office where staff take phone calls from potential abortion patients, a U.S. map colored in with red and green dry-erase markers notes the latest status of abortion access in every state. The map can change at any time.

In the center of the map’s biggest sea of red is Illinois, outlined in green — showing it’s a state with strong abortion access — surrounded by several states that ban or severely restrict abortion. Illinois is the destination for nearly 1 in 4 people traveling to another state for abortion care, according to a report from the Guttmacher Institute, an advocacy and research organization that supports abortion access and tracks data nationwide.

“Illinois really became kind of a haven state for the Midwest and much of the South immediately post-Dobbs,” said Megan Jeyifo, executive director of the Chicago Abortion Fund, which provides logistical and financial support to people who need abortions.

The state’s geography explains part of its popularity; in five of the six border states, abortion is either banned or largely inaccessible. But Illinois also is among the states that have put in place new policies — along with millions of dollars — to welcome patients who aren’t their residents. Advocates and providers say other safe-haven states should replicate the investments.

That’s happened most recently in Maine and Washington state, where governors approved funding to support family planning and abortion care, including for out-of-state patients.

Since the U.S. Supreme Court’s 2022 Dobbs v. Jackson Women’s Health Organization decision that overturned the constitutional right to abortion and allowed states to regulate the procedure, 13 states have implemented near-total abortion bans, and seven others have bans after six to 12 weeks. Although about one-quarter of people who need an abortion now obtain medication by telemedicine, many who live in states with bans still have to travel elsewhere for various reasons, including fear of prosecution.

Guttmacher’s data showed that fewer people traveled for care in the past two years than the peak of 170,000 who traveled in 2023, the year after Dobbs.

That number fell to about 155,000 in 2024, including 35,000 who went to Illinois, the data showed. Last year, an estimated 142,000 abortion patients traveled out of state, with a fairly consistent number, about 32,000, going to Illinois.

The next-highest destination after Illinois was North Carolina, followed by New Mexico and Kansas.

Guttmacher and other advocates attribute part of that decrease in the national numbers to wider availability of telehealth access to abortion medication that can be mailed to patients in other states. There were an estimated 1.1 million abortions across the United States in 2025, about the same amount as 2024 but the highest number since 2009, according to Guttmacher.

Shield laws protect health care providers in many states, including California, Illinois and New York. Those laws have prevented Republican attorneys general in other states, such as Texas and Louisiana, from trying to punish providers who prescribe the drugs.

Louisiana has unsuccessfully tried to charge and extradite doctors from California and New York, and is also suing the federal government to remove the provision that allows abortion medication to be prescribed by telehealth. A federal judge put the case on hold for now as the U.S. Food and Drug Administration completes a safety review.

Policy changes in Illinois

Illinois’ “haven” status is derided by anti-abortion groups, who call the state’s policies extreme.

“The abortion industry in Illinois is the wild west, which is clear by these numbers,” said Mary Kate Zander, president and CEO of Illinois Right to Life, to the Chicago Sun-Times, speaking about the Guttmacher report.

One state changing its laws to restrict abortion access can lead to a significant influx of patients traveling to clinics in other states. Dr. Allison Cowett, chief medical and advocacy officer for Family Planning Associates, said when six-week abortion bans went into effect in Florida and Georgia in May and October of 2024, respectively, many more patients from the South started coming to Chicago.

“Within the first few months after Dobbs, we had more than 1 in 3 patients coming from outside Illinois, and that has maintained for those three, almost four years,” Cowett said.

Illinois also borders Indiana, which has a near-total abortion ban in place. Cowett said Indiana residents were the largest percentage of out-of-state abortion patients at her clinic before 2022, and it has stayed that way.

Restricting, cutting Medicaid funding shifts more reproductive health care to telemedicine

Jeyifo said when she started as a volunteer with the Chicago Abortion Fund in 2016, the organization couldn’t financially support large numbers of out-of-state patients because Illinois didn’t invest in access the way it does now. The biggest change came in 2018, when Illinois allowed its state Medicaid program to cover abortion procedures.

“We would not have been able to expand our support outside of Illinois residents without that coverage,” Jeyifo said.

Nineteen other states allow their Medicaid program to cover abortion procedures, according to KFF, a health policy research group.

In 2023, Democratic lawmakers in Illinois allocated $10 million from the state health department to establish the Complex Abortion Regional Line for Access, known as CARLA, a hotline for the Chicago Abortion Fund and four area hospitals to help coordinate care. Jeyifo said more than 1,000 people have received assistance through that hotline in the years since.

The state has also helped fill in lost Medicaid funding after Congress passed a provision blocking federal Medicaid payments to certain abortion providers, mainly targeting Planned Parenthood, and it has helped pay for training and other programs that help connect people with care.

In January, the state launched a new partnership with the Chicago-based Michael Reese Health Trust to establish the Prairie State Access Fund, which will provide aid to out-of-state patients in need of reproductive and gender-affirming health care.

“(Illinois) is this model for other receiving states around the country to take up and learn about, because the proximity on a map is important, but the resources that are available once you get to a place are so much more important,” Jeyifo said.

Finding nearby states

The Guttmacher report showed 62,000 of the 142,000 people who traveled came from states with near-total bans, more than double the number who traveled from those states before 2022. But it has declined over the past year, down from 74,000 who traveled from those states in 2024.

The next-highest state for travelers, North Carolina, is relatively close to Georgia and Florida. The number of out-of-state travelers has remained steady there since 2024, even though North Carolina has a 12-week ban and a three-day waiting period for abortions.

In New Mexico and Kansas, about two-thirds of all abortions provided were for people traveling from outside the state, but those numbers are going down. New Mexico is often a destination for people from Texas, and Kansas borders Oklahoma, two states with strict bans. Kansas also borders Missouri; voters in 2024 passed a constitutional amendment legalizing abortion, but access has not returned, and lawmakers are trying to reverse the amendment in this year’s midterm elections.

Family Planning Associates is one of the largest independent abortion clinics in Illinois. It expanded its staff — including doctors, nurses and front desk workers — during the first year after Dobbs from about 40 people to more than 70 to handle the new patient volume, Cowett said. The clinic also expanded its physical space by about two-thirds.

Many of those who come from the South have never left their home state, Cowett said, and it can be overwhelming for them to come to a big city during an already emotional event. The abortion fund and others help supply a closet in the clinic that is stocked with toiletries, basic clothing, shoes and other items to assemble care packages for patients.

The state has also provided security infrastructure grants to nonprofits to protect against potential attacks, such as a clinic firebombing in Peoria, Illinois, in 2023, two days after Democratic Gov. JB Pritzker signed abortion protections into law. No one was in the building at the time.

Such aid was especially important for the Choices: Center for Reproductive Health clinic in Carbondale, a city at the southern tip of Illinois and the intersection of neighboring states with strong anti-abortion laws: Arkansas, Kentucky and Tennessee.

It’s a much shorter drive to Carbondale for people in those states than it is to Chicago, said Jennifer Pepper, Choices president and CEO, and it’s a more familiar, smaller area.

The state grant allowed them to harden the physical security of the clinic in Carbondale, Pepper said, which is something they haven’t been able to do for their sister location in Memphis, Tennessee. That clinic provides birth control, wellness exams and midwifery services, but receives no state support.

“We’ve never had state support in all of our 52 years in Tennessee,” Pepper said.

State assistance

Other states with Democratic leadership and protective abortion laws are starting to approve more funding to support reproductive health care.

Maine Gov. Janet Mills signed a budget bill Friday that includes funding for lost Medicaid reimbursements and creates an ongoing $5 million annual appropriation for family planning services. Washington Gov. Bob Ferguson signed a law in late March establishing a new revenue source for abortion care by implementing a tax on health insurance companies that is expected to generate about $10 million in the first year and about $2 million in each subsequent year.

Jeyifo, of the Chicago Abortion Fund, said she hopes to see more of those efforts in other states with laws that are supportive of reproductive health care, including ones with Democratic leadership that could be doing more to expand clinic availability and rescind waiting periods, such as the 24-hour waiting requirement that still exists in Wisconsin before a patient can get an abortion.

“So many states in our region could be doing more just for their own residents, let alone people traveling,” Jeyifo said.

Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org.