A federal judge in Texas on Sunday paused a lawsuit seeking to revoke nationwide approval of the abortion drug mifepristone, saying the case won’t be heard until at least Dec. 1 and granting the U.S. Food and Drug Administration’s request for a stay to continue its safety review of the drug.

The Republican attorneys general of Florida and Texas filed a lawsuit against the FDA last December seeking to permanently revoke the agency’s initial approval of mifepristone from 2000, along with subsequent decisions over the years that eased access for patients. Florida and Texas had agreed to the FDA’s request for a stay. 

If a judge were to rule in favor of Florida and Texas, the medication would become unavailable in all states, regardless of abortion laws.

In the same ruling, U.S. Chief District Judge Reed O’Connor, an appointee of former President George W. Bush, denied a motion to dismiss the case from distributor Danco Laboratories and GenBioPro, one of the drug’s main manufacturers. The company’s attorneys intervened as defendants in April. O’Connor’s ruling will delay any action in the case until after the midterm elections.  

“We expect the FDA’s review of mifepristone to not contradict the decision they made in 2023 that reaffirmed our product is safe and effective,” GenBioPro CEO Evan Masingill said in a statement Monday. “GenBioPro will continue to use all legal and regulatory tools available to ensure Americans’ access to reproductive care.”

The lawsuit by Florida and Texas is one of three suits pending in federal courts that would change nationwide access to mifepristone, and it’s the most sweeping in its goals. 

Florida and Texas’s lawsuit cites in part the federal Comstock Act, a 150-year-old anti-obscenity law that made it illegal to send any materials that could induce an abortion through the mail. That law has not been enforced for many decades. Anti-abortion groups recently called for new U.S. Attorney General Todd Blanche to revisit the Comstock Act’s prohibition. 

Mifepristone, one of two drugs most commonly used to terminate a pregnancy before 10 weeks’ gestation and to treat miscarriages, has repeatedly shown in scientific studies to be safe and effective, but the FDA began another safety study in June and announced it would take about six months to complete. 

The 5th U.S. Circuit Court of Appeals will hear oral arguments Sept. 9 in a case from Louisiana seeking to remove a rule allowing the medication to be dispensed without an in-person visit to a provider, and the attorneys general in Missouri, Idaho and Kansas have asked a federal judge in Missouri to roll back the rules to what they were before 2016. Prior to that year, the drug was only approved for use before seven weeks’ gestation and required three in-person office visits.

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

BOISE, Idaho — The group leading the effort to restore abortion access by ballot initiative in Idaho has filed a lawsuit against state officials over proposed language that will appear on the ballot and in a state-issued voter pamphlet.

Idahoans United for Women and Families, the nonprofit organization that drafted the initiative — now called Proposition 1 — says the “yes” and “no” statements as prepared by Idaho officials violate the law guiding the initiative process and are confusing and misleading. Attorneys filed the lawsuit to the Idaho Supreme Court late Wednesday night.

Idaho Secretary of State Phil McGrane stressed that the issue needs to be quickly resolved to meet upcoming ballot deadlines. The voter pamphlet must be printed by September 25, according to the law, and ballots need to be mailed to military and overseas voters about a week before that. McGrane said the state has paused production amid the litigation on the 850,000 copies of the voter pamphlet that need to be printed and mailed.

“There was a good-faith effort to try and reflect each of the sides of the pro and con statements that were submitted to us,” McGrane told Stateline by phone on Thursday. “I think one of the biggest challenges that we’re going to see with Proposition 1 is that it’s a very complicated issue with a lot of nuance … and this isn’t a simple issue to consolidate down into a short, one-sentence statement.”

Following the law, McGrane developed the language for the statements with Idaho Attorney General Raúl Labrador, who has been outspoken in his anti-abortion views for many years and recently appealed a federal judge’s decision that would protect abortion access in cases of threats to a pregnant patient’s physical and mental health.

Labrador told Stateline in an emailed statement that his duty alongside the secretary was to clearly and concisely explain the effects of a “yes” or “no” vote and to fully inform Idaho voters, and said they applied the same legal standard to every measure that has been on the ballot.

“Idaho voters deserve a straightforward explanation of what their vote will do,” Labrador said.

Idaho Supreme Court orders officials to revise abortion ballot initiative language, impact statement

There have been similar legal fights over abortion ballot language in other states. Activists on both sides of the issue in Missouri, for example, have spent years arguing over ballot language, both on the 2024 citizen-led amendment that restored legal access to abortion, and on the 2026 amendment referred by the legislature that would reinstate the ban.

Similar battles between Republican state officials and initiative organizers played out in Ohio, Arizona and Montana between 2023 and 2024. Voters in all three of those states ultimately approved amendments to protect abortion rights.

It’s also not the first time Idahoans United for Women and Families has sued the state over ballot language. In April 2025, the Idaho Supreme Court heard arguments in the lawsuit, including whether the short ballot title and fiscal impact statement should be revised, and unanimously sided with Idahoans United on those two elements.

Under Idaho law, the ballot must include a clear and concise statement about the effect of a “yes” or “no” vote, and the voter pamphlet must include a complete copy of the initiative text, its fiscal impact, and arguments for or against the measure with rebuttals.

But the ballot won’t include the full text of the initiative or the arguments for and against — just the long and short titles of the initiative, statements about fiscal impacts and the “yes” or “no” statements.

“In the two decades we’ve had a yes/no statement on the ballot, they’ve never looked like this,” said Melanie Folwell, lead organizer for Idahoans United, in a statement. “And it’s not because our initiative is longer or more complex than past initiatives.”

According to a copy of the voter pamphlet pages drafted by the Idaho state officials, a “no” vote “would make no change to Idaho’s current law, which protects the life of the unborn while allowing abortion in reported cases of rape or incest, or when necessary to protect the life of the mother.”

The “yes” side said it would “create reproductive rights, including a right to abortion before a fetus’ ability to survive and after a fetus’ ability to survive in cases of medical emergency, and provide liability protections for healthcare providers.”

The complaint says the “no” statement is not “clear and concise,” and said the “yes” statement is similarly inadequate because it describes viability in a different way than the other parts of the ballot language.

Missouri appeals court rewrites ballot proposal to clarify a ‘yes’ would end right to abortion

They also argue the “no” statement does not adequately describe Idaho’s abortion law, which is a criminal statute that carries felony punishment for providers, and they said it does not accurately describe the exceptions.

The group is asking the court to order that the statements be simplified to say that a “yes” vote means the proposition will become state law, and a “no” vote means state law regarding abortion will remain unchanged.

Attorneys asked the court to make a decision by September 11.

This story has been updated to more accurately reflect the outcome of the Idaho Supreme Court ruling in the first lawsuit over the initiative ballot language in 2025. Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org.

A federal court ruling out of Idaho has potential implications for exceptions in abortion bans nationwide and could eventually end up before the U.S. Supreme Court to decide.

U.S. District Judge B. Lynn Winmill ruled earlier this month that the 14th Amendment of the U.S. Constitution provides a narrow right for a pregnant patient to obtain an abortion if the pregnancy could be a risk to their health, including their mental health. It’s the first ruling since the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health in 2022 to find that the U.S. Constitution includes a right to abortion access in certain situations.  

Mary Ziegler, a legal historian and law professor at the University of California, Davis School of Law, said Winmill’s ruling could be the beginning of a “slow erosion” of the Dobbs decision, similar to the way that anti-abortion advocates used lawsuits and legislation to chip away at the law established by Roe v. Wade after it was decided in 1973.

Supreme Court justices appear split over whether to protect abortion care during emergencies

“They kind of worked over the course of decades to do a death by a thousand cuts, chipping away at its breadth,” Ziegler said. “This may be kind of a funhouse mirror version of that.”

For years, anti-abortion state officials and advocacy groups used various legal tactics to diminish access to abortion nationwide after Roe v. Wade determined that the procedure was a constitutional right. Over time, state legislatures passed procedural laws that made it more difficult for providers to offer abortion services, as well as so-called “fetal pain” laws, and worked up to passing the six-week and 15-week abortion bans that eventually led to Dobbs. 

Two years ago, U.S. Supreme Court justices were asked to consider whether Idaho could set aside federal law mandating stabilizing care in an emergency if that stabilizing care, in a doctor’s opinion, was to terminate a pregnancy. Now the question could be whether any pregnancy scenario where a patient’s physical or mental health is threatened is something that all states can regulate under Dobbs.

Health exceptions

Out of the 13 states that have near-total abortion bans, five have no exception for preserving a pregnant patient’s health, including Idaho, Arkansas, Mississippi, Oklahoma and South Dakota. 

All 13 have an exception to save a pregnant woman’s life, but doctors say there most often is no clear moment when they can easily say a person will die without an immediate abortion. Instead, doctors are left to guess whether terminating a pregnancy to save a patient would cost them their license to practice or land them in prison.

Even in states with health exceptions, some doctors hesitate to act because of the ban,  opting for delays that can cause medical complications such as organ damage or fertility loss. An Arkansas woman said she was denied an abortion during a miscarriage in 2024, resulting in a days-long ordeal that eventually led to her being transferred out of state to Kansas, where abortion is legal.

Winmill’s legal decision blocks enforcement of Idaho’s near-total abortion ban when a pregnancy is terminated under those circumstances. Idaho Attorney General Raúl Labrador, a Republican, appealed the decision to the 9th U.S. Circuit Court of Appeals on Wednesday, and also asked Winmill to pause that injunction while the decision is appealed.

“The state’s interest in protecting unborn children from unjustified abortion is irreparably harmed by the order, and public interest and equity support a stay for that same reason,” Idaho Assistant Solicitor General Aaron Green wrote in the request for a stay.

The attorney general and leadership at the Idaho Family Policy Center, a religious organization that helped craft the legislation that established the state’s ban, have expressed confidence that Winmill’s decision will be reversed quickly.

“The Fourteenth Amendment protects the basic rights that are part of the historical fabric of our nation, not a right to take the life of an innocent child in the womb, an act that was a crime at the time that the Fourteenth Amendment was ratified,” said Caleb Pirc, general counsel for the Idaho Family Policy Center, in a statement. “We fully expect Judge Winmill’s attempt to shoehorn a right to abortion into the Constitution to be swiftly rejected on appeal.” 

Supreme Court watch

Dr. Stacy Seyb, a maternal-fetal medicine specialist  for Idaho’s largest health system, St. Luke’s, sued state officials and the Idaho Board of Medicine in 2024, arguing that the state’s near-total ban prevented him from providing appropriate care to all of his patients. Maternal-fetal medicine specialists handle the most high-risk pregnancies, including patients carrying multiples and those with conditions such as high blood pressure and gestational diabetes.  

In his ruling, Winmill wrote that although Dobbs allowed states to regulate abortion access, that case was about elective abortions, and that his ruling was about a pregnant woman’s ability to seek care under “the most difficult and tragic circumstances,” almost always when the woman wanted the pregnancy.

U.S. Supreme Court ruling reinstates ability to perform emergency abortions in Idaho under ban

“By banning health-preserving abortion, Idaho attempts to deny this fundamental right on the basis that the threat of harm comes from a fetus, which depends on the woman for survival,” Winmill wrote. “But a pregnant woman’s health is not a state resource to be allocated at the legislature’s whim. The Fourteenth Amendment exists precisely to prevent subjugation like this.”

Winmill discussed the history of abortion bans in his opinion, writing that when the 14th Amendment was ratified in 1868, the states and territories that restricted abortion also included exceptions for therapeutic purposes when a doctor was acting in good faith.

But Winmill went further than many judges have gone by including a pregnancy’s threats to mental health, something that only Alabama has recognized as an explicit healthcare exception for abortions among states with bans, according to KFF. There, a psychiatrist is required to diagnose a pregnant patient with a serious mental illness that could result in their death or the death of the fetus in order to qualify for that exception.

“The brain is an organ of the body, and healthcare providers use empirical tools to reliably assess the risk of suicidality and the most effective treatments,” Winmill wrote. “It is an affront to human dignity to bar pregnant women from receiving life-saving care on the basis that the threat comes from a mental health condition rather than a physical health condition.”

Idaho’s role

Idaho has been at the center of the national debate about when health conditions take priority over an abortion ban since the first year after the Dobbs decision. 

The U.S. Department of Justice under former President Joe Biden sued Idaho to require that it acknowledge a federal law known as the Emergency Medical Treatment and Active Labor Act — better known as EMTALA — in the context of patients who come to the emergency room with pregnancies that may need to be terminated to prevent infection or other adverse health outcomes.

The U.S. Supreme Court heard that case in late April 2024, but sent it back to the lower appellate court in June, saying it was too early in the process for justices to have considered ruling on it. The case was later dropped by the DOJ under President Donald Trump, but St. Luke’s filed its own lawsuit against the state that is still ongoing. That case is also before Winmill in federal court.

At the time of the EMTALA arguments, Idaho officials had argued that if it allowed women to get a legal abortion in an emergency room, anyone could come to a hospital’s emergency department  and threaten to harm themselves.  

Tanya Pellegrini, co-director of litigation at The Lawyering Project and one of the attorneys who represented Seyb in this month’s case, said that wasn’t true under EMTALA, and it won’t be true following Winmill’s ruling. 

“I think the order really speaks for itself in terms of why mental health should not be treated differently from physical health,” Pellegrini said.

Ziegler said she won’t be surprised if Seyb’s case ends up before the Supreme Court in the near future, because it strikes at the heart of questions about the Dobbs decision that have yet to be fully resolved.

“It’s a really important question that they’ll have to address sooner or later,” Ziegler said. 

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

A federal judge in the District of Columbia issued an order Wednesday blocking U.S. Health and Human Services from implementing sweeping changes to grants under the Teen Pregnancy Prevention Program while a lawsuit proceeds, but dozens of existing grants that were canceled this summer will remain so for now, unless the administration chooses to reinstate the funds.  

The agency canceled 53 out of 67 grants under the program at the end of June, affecting grantees in more than two dozen states, including Louisiana, New York, Oklahoma and Texas. Grantees were given no advance notice and were told their programs did not align with agency priorities — most were told their programs normalized or promoted sexual activity for minors. The grants were canceled two years before their expiration dates.

Following the cancellations, three affected grantees and sex education advocacy group SIECUS: Sex Ed for Social Change filed a lawsuit in the District of Columbia federal court district on July 14. U.S. District Judge Christopher Cooper, an appointee of former President Barack Obama, said the plaintiffs are likely to succeed in the case, warranting his decision to block the Trump administration’s actions. 

But Cooper said it’s unclear whether he can order the restoration of nearly $70 million in canceled funds, and that other court cases need to be resolved before he can move forward with that kind of action.

Congress established the Teen Pregnancy Prevention Program in 2010 as a national, evidence-based grant program that would fund diverse programs working to prevent teen pregnancy using methods that have repeatedly shown to be effective. Grant recipients typically offer educational programs about preventing pregnancy or identifying healthy relationships, and provide referrals for community and healthcare resources as needed. 

Since then, teen pregnancy rates have fallen about 72%, which researchers say is the biggest contributor to the overall drop in national birth rates.

To replace the canceled grants, HHS published two notices for new programs that focused less on preventing pregnancy and more on fertility tracking, “body literacy” goals and “reproductive goals counseling.”

“HHS is perfectly entitled to formulate its own views about how to stem teen pregnancy — or even whether it is worth preventing at all — and to pursue policy initiatives consistent with its viewpoint,” Cooper wrote in his ruling. “But it is not at liberty … to impose conditions on grant recipients that Congress did not intend or that are unreasonable or unexplained. The preliminary record suggests that HHS has done just that.”

Cooper said HHS could choose to reissue the grant funding opportunities under the previous guidelines, but it can’t move forward with the new ones while the lawsuit proceeds.

The judge also noted that in July 2025, HHS issued a notice telling grantees to revise their programs to align with current executive orders, including by deleting any references to health equity and inclusivity, and offered guidance about what it considered medically accurate and age appropriate content. 

Three grantees sued over the notice, saying it was contrary to the statute guiding the program as established by Congress, and another D.C. judge agreed, vacating the guidance and blocking its implementation. 

“As the saying goes, ‘When at first you don’t succeed, try, try again.’ HHS has taken this adage to heart,” Cooper wrote this week, citing the 2025 court case. “Unfazed by the adverse ruling, HHS issued new (grant funding notices)  that repackaged the vacated policy changes and imposed additional grant parameters.”

The administration could appeal the decision in the coming weeks. Stateline has requested comment from HHS officials.

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

A group of leading anti-abortion organizations sent a letter to newly confirmed U.S. Attorney General Todd Blanche urging him to review the U.S. Department of Justice’s authority to use  a 150-year-old anti-obscenity law to prevent people from obtaining abortion medication or other related materials through the mail.

Advancing American Freedom, a conservative advocacy group founded by former Republican Vice President Mike Pence, authored the Aug. 7 letter. It is co-signed by four major anti-abortion organizations, including Susan B. Anthony Pro-Life America, Americans United for Life and Students for Life of America. The nearly 30 other signees include the North Carolina House of Representatives, the Oklahoma Council of Public Affairs and The Conservative Caucus.

The Comstock Act, enacted in 1873, made it illegal to send “obscene material” by mail, which included any “article or thing designed, adapted or intended for producing abortion.” The Comstock Act is considered a “zombie law,” meaning it hasn’t been repealed, but has not been enforced in many decades. In 2022, during the Biden administration, the U.S. Department of Justice issued legal guidance stating that Comstock did not prohibit the mail of certain abortion drugs when the sender does not intend for the recipient to use them unlawfully.

“Not only does this language appear nowhere in the Comstock Act but, as a practical matter, a sender’s subjective intent and a recipient’s intended use are unknowable, making the Comstock Act a dead letter,” the letter to Blanche said.

The groups thanked Blanche for pledging to evaluate the 2022 opinion and said they look forward to the result of his review.

In a conference call hosted by the White House Faith Office on July 30, Blanche told thousands of religious leaders that he was committed to advancing policies that would outlaw abortion in every state.

In 2022, the U.S. Supreme Court’s Dobbs v. Jackson Women’s Health decision cleared the way for states to regulate abortion access for the first time in 50 years, prompting more than a dozen states to enact near-total abortion bans. In the wake of that ruling, the U.S. Food and Drug Administration in 2023 changed its rules on mifepristone, one of two drugs typically used to terminate a pregnancy before 10 weeks and to treat miscarriages.

Mifepristone halts the pregnancy, while a second drug, misoprostol, physically clears the uterus.

The new FDA rules allowed mifepristone to be dispensed without a visit to an in-person provider, which made it easier for people in states with bans to obtain the medication from online sources and receive the pills in the mail.

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.

Anti-abortion groups and Republican state attorneys general have sued the FDA trying to reverse the 2023 rules or establish legal authority to enforce Comstock. A Texas judge in 2023 ruled that Comstock was enforceable, but the U.S. Supreme Court eventually overturned that ruling.

If the challenges to FDA rules around mifepristone are successful, abortion-rights advocates have said they would continue prescribing misoprostol, which is effective on its own.

But enforcement of Comstock would apply to any equipment needed to perform abortions. Abortion-rights legal advocacy organization Center for Reproductive Rights said that could make supplies difficult or illegal to obtain for any type of obstetrical care, including miscarriages and pregnancy complications.

Gavin Oxley, spokesperson for Americans United for Life, told Stateline by email that the restrictions should extend to those categories and not just mifepristone.

“Any drug or instrument mailed with the intention of abortion falls under the law’s authority, proactively protecting women from new or adapted abortion methods, including misoprostol-only abortions,” Oxley said. “Righting the politicized Biden-era OLC opinion denying the strict application of Comstock must be an immediate priority for General Blanche.”

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

Acting U.S. Attorney General Todd Blanche is one step closer to confirmation after the Republican Judiciary Committee voted to advance his appointment on a party-line vote on Tuesday, and based on promises he made to faith leaders around the country last week, that means national anti-abortion actions may be one step closer as well.

In a conference call hosted by the White House Faith Office on July 30 with thousands of religious leaders around the country, Blanche said he was committed to achieving policy solutions so that the U.S. Supreme Court’s Dobbs decision “becomes permanent in every single state.”

A recording of the call was publicly available on YouTube as of Tuesday, posted by Intercessors of America, a religious group in Virginia, but was removed by late Tuesday afternoon.

Blanche told the participants he is working “hand in hand” with U.S. Health and Human Services, the U.S. Food and Drug Administration and President Donald Trump’s White House team to fulfill those goals.

His comments come amid ongoing attempts to restrict access to mifepristone, one of two drugs approved by the FDA to terminate early pregnancies and to treat miscarriages. The state of Louisiana sued the FDA in October seeking to rescind a 2023 rule that allowed mifepristone to be dispensed without a visit to a provider in person. That rule has allowed people in states with abortion bans to order the pills by mail through telehealth visits with providers in states that don’t have bans.

The FDA has said it is conducting a safety review of mifepristone that won’t be ready until at least December.

“If states have said, ‘We are going to protect the unborn and we’re going to protect every life from the moment of conception,’ we’re putting practices and policies in place so that other states and other organizations can’t attack that and they can’t do things like they’re doing with mail-order drugs,” Blanche said on the faith call.

Health care providers who support abortion care have said they intend to keep prescribing misoprostol, the other drug used to end a pregnancy or treat miscarriages, even if mifepristone is restricted.

But anti-abortion activists and others have also called on the Trump administration to enforce the Comstock Act, a long-dormant law passed in 1873 that restricted the mailing of “obscene” materials. The law includes language prohibiting mailing anything “designed, adapted, or intended for preventing conception or producing abortion.” If that law were to be enforced, it could bar access to the mailing of both medications.

Blanche did not mention the Comstock Act in the call, but the administration has been pressured by anti-abortion groups to do more.

Blanche said the process of achieving his goals takes a lot of time, but he assured the faith leaders it will happen.

“We don’t have complete victory yet, but we will have victory, and victory will be soon and it will be permanent,” he said.

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

A new study examining pollution levels across a 16-year span found that while general pollution levels from sources such as cars and industry have significantly declined, recent increases in wildfire smoke air pollution have offset those gains and could be contributing to negative outcomes for pregnant women and babies such as low birth weight and preterm births.  

Published by Frontiers in Environmental Health, the study included data from about 64.5 million pregnancies between 2003 and 2019, covering more than 2,800 counties in 48 states. Even in regions that are not strongly associated with wildfire, such as the southeast region of the U.S., wildfire pollution rates grew substantially during that time period. The study did not account for any movement between counties or regions during pregnancy, or whether pregnant people used any protection against smoke such as masks, air filters or temporary relocation.

Idaho Gov. Little declares wildfire disaster emergency, authorizes Guard to help along Oregon border

Wildfire pollution is included in the same type of pollution as exhaust from cars or industrial outputs, but the study authors looked at two models of pollutants, one of which removed all fire-related pollution to determine how much of it was correlated with wildfire. Over the study period, about 65% of the days that recorded pollution levels above the National Ambient Air Quality Standard could be attributed to wildfire smoke.

Menglu Liang, leading author of the study and assistant clinical professor of biostatistics at the University of Maryland, said in a news release that efforts to reduce other forms of pollution have not been in vain.

“Those gains have genuinely protected pregnant people and unborn babies, and without them, exposures today would be considerably worse,” Liang said. “What our findings show is that wildfire smoke is offsetting a growing share of these hard-won improvements.”

The study time period does not include some of the most recent, most explosive wildfire seasons in the United States and Canada, such as 2020, 2024 and this year. By mid-July this year, there were more than 800 wildfires burning across Canada, leading to hazardous levels of wildfire smoke across parts of the Midwest and northeast, and in late July, a rash of wildfires across Oregon created hazardous air over much of the northwest. 

Recent reports show Oregon is on track to have its worst fire season on record, with nearly 1.8 million acres already burned and at least two months left of the peak season. The previous record was set in 2024, with 1.9 million acres burned.

The study found that some regions were disproportionately affected by the smoke, including in the Northwest, where rates of pollution from wildfire more than doubled over that period. The study noted that the burdens were highest in low-income, rural areas with significant populations of American Indian and Alaska Native communities, and areas with maternity care shortages.

 Recent studies have correlated wildfire smoke exposure with an increased risk of preterm birth, low birth weight and other negative outcomes such as stillbirth and some congenital anomalies. Scientists believe the body’s inflammatory responses to wildfire smoke can be harmful to the placenta, which is central to fetal survival, and some of the pollutants could cross the placental barrier and affect fetal growth and development.

“These outcomes matter well beyond the delivery room and harms experienced before birth can echo for decades,” Liang said in the release. “That makes prenatal exposure a particular public health concern.”

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

A federal judge in Virginia ruled Thursday that the U.S. Food and Drug Administration did not sufficiently justify restrictions imposed in 2023 on a drug used to terminate early pregnancies, adding another layer of complexity to a string of legal cases with opposing goals that could affect future abortion access.  

The lawsuit was filed in 2023 by abortion providers in Kansas, Montana and Virginia to challenge the restrictions as excessive, unwarranted and inconsistent with other legal requirements. A similar case in Hawaii was already decided in October, with a federal judge also finding that the restrictions were arbitrary.

In Virginia, U.S. District Court Judge Robert Ballou, an appointee of former President Joe Biden, said the FDA failed to conduct an appropriate review of the 2023 restrictions on mifepristone, which include rules that prescribing pharmacies and clinicians must be specially certified and prescribers and patients must sign a form acknowledging the medication’s risks.

“The 2023 REMS modification is unlawful and must be remanded to the FDA for review,” Ballou wrote, using the acronym for the FDA’s Risk Evaluation and Mitigation Strategies protocols.

Amy Hagstrom Miller, president and CEO of lead plaintiff Whole Woman’s Health Alliance, based in Virginia, said in a statement Friday that eliminating those three restrictions would help clinic staff focus on patient needs instead of “excessive paperwork.”

“I have worked in abortion care for over 30 years, and I can attest that these regulations serve no medical purpose, nor do they add value to our patients’ experience of abortion,” Hagstrom Miller said in the statement.

The FDA did not immediately respond to a request for comment from Stateline on Friday.

Ballou did not give a timeline for a review of the restrictions, but the FDA has said it is conducting a broader safety review and has sought to dismiss cases related to mifepristone regulation until it completes that review. Trump administration officials told the Wall Street Journal in June that the review was expected to take about six months, meaning it would conclude after the national midterm elections.

Katie Keith, founding director of the Center for Health Policy and the Law at the Georgetown University Law Center, said the Virginia and Hawaii decisions mean the FDA has been ordered by two courts to reconsider its restrictions and more thoroughly explain why they are necessary.

“They’re going to have to look at everything these various courts are telling them to look at,” Keith said.

But the two rulings come at the same time the administration is receiving pressure from anti-abortion groups to further restrict access to mifepristone, even in states where abortion is legal.

The 2023 rules, which were decided under the Biden administration, also eased restrictions to allow mifepristone to be dispensed without an in-person provider for the first time. That helped expand national access to the medication, which is one of two drugs typically used to end a pregnancy before 10 weeks and to treat miscarriages, and allowed people who live in one of the 13 states with near-total abortion bans to continue to receive it by mail.

That expanded access prompted three other lawsuits from attorneys general in states with abortion bans that are still pending in federal courts. In Louisiana, the 5th U.S. Circuit Court of Appeals is considering whether to strike down the provision allowing telehealth prescriptions, and will hear oral arguments in the case in September.

The 5th Circuit initially granted an emergency request from Louisiana to block telehealth access to the medication, but after drug manufacturers appealed the decision to the U.S. Supreme Court, the justices reversed the circuit court ruling. That stay from the high court will remain in place as the case continues.

Two other cases with different implications for the future of mifepristone are ongoing. One is in Missouri, joined by attorneys general from Idaho and Kansas, where they have asked the court to return all of the restrictions to what they were in 2016. The other is in Texas, joined by Florida’s attorney general, asking the federal court to revoke the drug’s approval entirely.

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

The Trump administration has a new plan for teenagers learning about pregnancy: Beginning this summer, it will steer millions of dollars toward organizations that focus on anatomy, fertility tracking, hormonal production and “reproductive goals counseling.”

The plan will also emphasize abstinence from sex and the importance of marriage. 

In doing so, it will pivot away from programs that serve populations in areas with the greatest need and that use particular evidence-based programming to reduce teen pregnancies — and some say the new language puts a greater focus on planning for pregnancy rather than preventing it.

The new grant application terms are consistent with an approach called restorative reproductive medicine that has become popular among conservative groups, including those who identify with Make America Healthy Again initiatives.

The approach discourages the use of any type of contraception and instead focuses on fertility awareness methods, usually in the context of couples trying to get pregnant without medical intervention such as in vitro fertilization or other treatments. That typically means not using any birth control and instead tracking indicators such as cervical mucus, body temperature and other physical symptoms to monitor the menstrual cycle. 

Academic studies have repeatedly shown that abstinence-only approaches result in higher rates of teen pregnancy and births, even after adjusting for other socioeconomic factors.

Congress created the Teen Pregnancy Prevention Program in 2010, and has renewed funding for it on a bipartisan basis over the past 16 years, including the 2026 budget bill, despite President Donald Trump’s office targeting the program for defunding. 

During that time, teen birth rates declined by about 72%, according to federal Centers for Disease Control and Prevention data, and much of the drop in the overall national birth rate is because teen birth rates have fallen so sharply. Experts say more comprehensive sex education, better access to contraception for girls and general behavioral trends around sex explain that shift. 

Amy Friedrich-Karnik, director of federal policy at the reproductive rights-focused Guttmacher Institute, said the new language in the teen pregnancy program is similar to the new funding opportunity released for Title X, which is a more than 50-year-old grant program designed to help low-income populations receive reproductive healthcare.

“We do think that fertility awareness-based methods should be explained to patients and they should have the right to understand what those options are,” Friedrich-Karnik said, describing the administration’s approach. “But (patients) need to also be aware of the full options that are available and the pluses and minuses of every option that is out there.”

Body literacy modules

The intent of the program, according to the original law, was for grants to fund “medically accurate and age-appropriate programs that reduce teen pregnancy” and then to continue the programs shown to be most effective through rigorous academic evaluation. According to the Department of Health and Human Services’ Office of Population Affairs, those programs were developed for children and young adults between the ages of 10 and 24 and the people in their lives who support them.

Most of the grants that were canceled this year were programs implementing the methods proven effective in reducing teen pregnancy, while others were more research based, in which additional strategies are tested and refined. Several of those programs were canceled as well in states such as Louisiana, Texas and Washington.

A separate federal grant program called Sexual Risk Avoidance Education exists for abstinence-only programs, but the evidence-based criteria for Teen Pregnancy Prevention is much higher, said Rachel Fey, vice president of policy at national reproductive rights advocacy organization Power to Decide. She sees the new funding opportunity for teen pregnancy prevention as an extension of the sexual risk avoidance program — one of the pillars of the new description tells grantees to “incorporate sexual risk avoidance education.”

The funding notice requires applicants to pass an “alignment review” with agency priorities that is conducted by political appointees, a new process that the U.S. Office of Management and Budget is trying to implement for federal financial assistance across the government.

Applicants for the new teen pregnancy program are required to teach body literacy, including two distinct modules about anatomy and reproduction for girls and boys. 

Grace Stark, editor-in-chief of a Texas-based nonprofit called Natural Womanhood that promotes fertility awareness and restorative reproductive medicine, told Stateline by email that the new funding opportunity’s focus could be helpful, as it “encourages young people of both sexes to consider their reproductive goals now and in the future, and how their current health and lifestyle choices can impact those future goals.”

The female module must include instruction about the menstrual cycle and the patterns and key indicators of the phases of the cycle, and recognize ovulation as the “central event and primary indicator of hormonal health and fertility.” It must also include the advantages and disadvantages of “ovarian suppression” compared to approaches that address “root causes.” 

Restorative reproductive medicine focuses on identifying underlying conditions that contribute to infertility or other reproductive health-related problems, according to the International Institute of Restorative Reproductive Medicine. It refers to conventional approaches that use treatments that “suppress normal physiology,” such as various forms of birth control, and claims that RRM works with the body to treat problems. 

Republican U.S. Sen. Cindy Hyde-Smith of Mississippi introduced a bill in Congress in 2025 that would have directed federal health agencies to promote such training for medical students and professionals through existing funding opportunities in Title X and the HHS Office of Population Affairs. That bill didn’t advance.

Joely Pritzker, who has been a family nurse practitioner for more than 20 years and is the senior director of healthcare for Power to Decide, said the “ovarian suppression” language likely refers to one of the most common ways birth control works, which is to temporarily suppress ovulation. Typically, in medical practice, ovarian suppression refers to lowering the estrogen produced by the ovaries, sometimes to prevent or treat breast cancer.

Pritzker said most people in the reproductive health world would support the idea of teaching young people about their bodies, but said it comes down to how that information is interpreted and applied, and that the new program design is unclear about those intentions. Not wanting to use hormonal birth control is different from discouraging the use of it entirely, she said.

“I genuinely don’t know what (body literacy) means to the folks who wrote these proposals, other than based on everything else we know, there is an assumption that if people knew more about their bodies, they would choose not to use, for example, hormonal birth control,” Pritzker said, adding that the assumption is false.

Stark, of Natural Womanhood, said body literacy can help young people notice signs of reproductive health issues,“which (restorative reproductive medicine)-trained healthcare professionals can help diagnose and treat to improve current health and protect future fertility — and future reproductive health plans.”

The American College of Obstetricians and Gynecologists warns against leaning on restorative reproductive medicine in fertility discussions, saying it can be “ineffective and redundant” and unnecessarily delay a patient in seeking medical treatment when it is presented as the sole or best approach. 

The male health module, according to the federal grant funding notice, includes an emphasis on understanding how testosterone is a hormone that is responsive to sleep, physical activity and environmental factors. Instruction must include the physiology of arousal, and address how “repeated or artificially stimulated arousal may affect neural development and behavior over time,” seemingly referring to masturbation.

Testosterone has been a heavy focus of the Trump administration. HHS Secretary Robert F. Kennedy Jr. frequently refers to lower sperm counts among men, including teen males, despite no scientific evidence backing up those claims when it comes to young men. He cites it as a reason for birth rates that have remained flat or lowered slightly every year since 2015, though experts say the lower national birth rate is actually because of the lower teen pregnancy and birth rates. 

U.S. Department of Defense Secretary Pete Hegseth also announced last week that military men over the age of 30 would receive annual testosterone level checks, which doctors say could actually be counterproductive to military readiness and could risk infertility. 

The teen pregnancy prevention programs must also include counseling on reproductive goals, and “should affirm marriage and parenthood as meaningful and value components of adult life,” the federal description says.

New recipients could include crisis pregnancy centers 

Ginger Mullaney, CEO of former youth services grantee Healthy Futures of Texas, said its nearly $2 million grant funded 11 programs that served various populations, including young in foster care, and runaway and unhoused youth. The grant was cancelled, which shocked her, she said, because the group had already adapted all of its materials and programs to comply with new executive orders around diversity, equity and inclusion and other administration priorities. The new curriculum had been approved.

“We felt like we had already made all the necessary changes to comply,” Mullaney said.

Earlier this month, Healthy Futures was still deciding whether it would apply for the new round of funding. It’s not an easy task, she said, in part because the government documents no longer include a list of approved programs that qualify for the funding. Mullaney said there used to be a list of more than two dozen programs that the agency approved because they had been academically evaluated for effectiveness, but that list is gone now. However, the instructions still tell applicants they must use an evidence-based program. 

“We don’t know what (programs are) considered evidence based,” Mullaney said.

The new funding opportunity also awards more points to applicants that have never been awarded funds before.

Alison Macklin, director of public affairs at sex ed advocacy group SIECUS, said based on what she has seen at the local level, the new funding opportunity is paving the way for crisis pregnancy centers to apply for and receive federal dollars. 

Crisis pregnancy centers are anti-abortion organizations that typically offer free ultrasounds, pregnancy tests and parenting classes with a religious mission, and most often do not provide or refer for contraception. States Newsroom found earlier this year that the centers have received nearly $500 million in taxpayer dollars from state and federal sources since the U.S. Supreme Court’s decision to overturn Roe v. Wade in 2022.

“They’ve been given an inch, so they’re trying to take a mile, is what it seems to me,” Macklin said.

‘Losing trusted relationships’

In mid-May, staff at Children’s Aid said they expected their $936,700 Teen Pregnancy Prevention Program grant to be renewed for another year after meeting with U.S. Health and Human Services and receiving nothing but positive feedback about their program. It was eligible for funding through 2028.

But at the end of June, they received another letter letting them know the grant was canceled, effective immediately.

“It was an overnight shutdown with no transition period for staff, or for young people that were relying on these resources,” said Rhonda Braxton, vice president of health and wellness at Children’s Aid, a 170-year-old organization in New York City.

It was one of 53 grantees that received letters from the federal government agency notifying them that their funding had been terminated without notice. Most were told their programs were now misaligned with federal agency priorities and that they normalized sexual activity for minors. Three affected grantees and SIECUS: Sex Ed for Social Change filed a lawsuit challenging the action on July 14. 

Braxton said the abrupt termination is expected to result in nine people losing their jobs, six of whom worked full time, and will affect the 1,200 young people who were served each year in areas such as the South Bronx, Harlem and Washington Heights. A group of high school-aged peer educators also found themselves suddenly without the summer job they’d planned to have with Children’s Aid.

“These young people are losing trusted relationships in an era of misinformation and distrust,” Braxton said.

She said they’ve made the decision not to apply for the new funding because it seems to be aligned with promoting abstinence-only initiatives, and, “Our experience has been that that’s not evidence-based programming.”

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