Along with a dramatic change in congressional majorities on Election Day, an analysis from the National Conference of State Legislatures showed large shifts in legislative majorities around the country, flipping from a majority of Republican legislatures to majority Democratic.

Democrats also now hold a large number of trifectas, said the conference’s Katy Owens Hubler, meaning they control both chambers of the state legislature alongside a Democratic governor. Heading into the elections, Republicans held 23 trifectas nationwide, and that was cut down to 17. Democrats now will have 22 trifectas beginning in January.

“This is a high point for Democratic trifectas going back to before 1984,” said Owens Hubler, director of the elections and redistricting program at the organization.

NCSL, the nonpartisan organization that represents and supports state legislatures nationwide, held a press event on Friday to discuss the election results. Prior to the election, Republicans controlled 28 state legislative chambers while Democrats controlled 18. Now, Democrats will control 24 chambers and Republicans will have 21. It’s the largest shift for Democrats since 2010, according to NCSL.

Votes are still being counted in some races, and results remain unofficial until certified in the coming weeks.

The legislative chambers that flipped or are expected to flip from Republican to Democrat include Houses in Alaska, Georgia, Michigan, Minnesota, North Carolina and Texas, and the Senate in Pennsylvania. Both chambers flipped in Arizona, New Hampshire and Wisconsin. 

That leaves Alaska, Georgia, North Carolina and Texas as divided chambers that were previously both controlled by Republicans, although some races in Alaska and North Carolina remain too close to call.

“Going back to 2012, we have had both legislative chambers in all of the Southern states be red,” said Owens Hubler. “This new map … is pretty new and pretty different from the trend that we had been seeing for the last dozen years.”

At least five governor seats already officially turned from Republican to Democrat — Georgia, Iowa, Ohio, Nevada and Texas. Alaska is expected to elect a Democratic governor as well once all of the ballots are tabulated, the NCSL team said.

“If that is the case, we’re looking at 30 Democratic governors and 20 Republican governors,” Owens Hubler said. “Again, they haven’t had the majority of governors’ mansions since before 2010, and 30 is quite a large number for them.”

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

MERIDIAN, Idaho — It didn’t take long for doctors to see that something was amiss with Rebecca Crozier’s pregnancy.

At her eight-week ultrasound in 2025, they mentioned a possible neural tube defect, she said, but after some research, she thought it was something that could be managed or treated. 

“If it was a fixable problem, I was ready to quit my job and full-time care for a disabled child,” said Crozier, who is now 27. “That was something that we were prepared to do.”

In the time between the two ultrasounds, she had a dream that she was carrying a baby girl, and she and her husband named her Haven.

The couple lived in eastern Idaho at the time, and drove two hours to the Boise area to see the maternal-fetal medicine specialists at St. Luke’s, the state’s largest health system. Now at 11 weeks’ gestation, the specialists told her Haven had anencephaly, which occurs when the brain does not develop normally and the skull is left open, exposing brain tissue to amniotic fluid that causes the tissue to dissolve. It is a fatal condition.

“She was missing a lot of brain tissue,” Crozier recalled. “They were very clear that this baby will not go home with you. You will not take this baby home. This baby will die in the hospital if the baby survives that long.”

In many states, even ones with abortion bans, Crozier would have had the option to terminate the pregnancy. But Idaho’s near-total prohibition includes no exceptions for fatal anomalies. It’s one of 11 states that do not have exceptions for anencephaly or other fatal anomalies. 

Next Tuesday, Idahoans will vote to determine whether the state’s near-total abortion ban should remain the law. Proposition 1, the title of the citizen-led ballot measure, would restore access to abortion until fetal viability, which was the state law before the U.S. Supreme Court’s decision to overturn Roe v. Wade in 2022. 

Idaho is the only state this election cycle with an initiative that would restore access in a state with a ban. In Missouri, voters will consider a different initiative — to reinstate a near-total ban after passing a constitutional amendment in 2024 allowing abortion access until viability. 

If Idaho’s measure passes, patients like Crozier would no longer have to leave the state for an abortion.

According to the Cleveland Clinic, the rate of anencephaly among newborns is about 1 in 10,000, and those babies die within a few hours or days. Most cases end in miscarriage or stillbirth; the fatal birth defect affects about 1 in 1,000 pregnancies. 

Crozier’s was among them. 

“They told me that I could try and continue my pregnancy and that they would handle my care from then on, or I could just not choose … which was in and of itself a choice,” Crozier said. “We went back to our hotel and we called our families and told them, ‘Something is very, very wrong, and we have to decide what we want to do here.’” 

In a post on Facebook this past July, Crozier’s husband, Kris, disclosed their choice. He wrote that if they had decided to continue the pregnancy, every appointment thereafter could potentially be the one where they discovered Haven had died. 

“For us, our choice wasn’t whether to let her go or whether she would pass. It was when she would die,” he wrote.

‘Because I loved her’

Dr. Duncan Harmon, the maternal-fetal medicine specialist who diagnosed Crozier in Boise, said he counseled about the high risks of miscarriage or stillbirth with the pregnancy and other risks to Crozier’s health with higher levels of amniotic fluid. And while termination was an option, he said, he couldn’t provide it for her in Idaho. She would have to go out of state and navigate insurance, lodging and any other logistics on her own.

“It’s truly awful that patients can’t receive care in their home state, being surrounded by their primary care team, surrounded by their support people in their time of grief,” Harmon, who now practices in the Southeast, told Stateline.

After a few days of discussion with her husband, Crozier recalled, they decided it was best not to continue the pregnancy for the sake of both her health and their future fertility options. 

“I didn’t want my first experience with motherhood to be watching her struggle. I wanted it to be doing something really hard because I loved her,” she said.

But making that decision was only the first step. Idaho is the only state in the West with a near-total ban, but the travel distances between clinics are vast, and those clinics are often overloaded. Calls to clinics in California, Oregon and Washington all yielded appointments that were several weeks away. 

The couple have family members who live in Utah. Crozier called clinics in Utah, where abortion is permitted up to 18 weeks, and got an appointment at a hospital within two weeks. Her mom flew in from California to be by her side.

“There was a lot of coordinating with the funeral home, actually, because we had to figure out how to get her transported back to Idaho,” Crozier said. 

The funeral home suggested the couple pick out a few items to cremate with the remains, including a security blanket with a white bunny at the top, so that there were enough ashes for the urn. Crozier held the items right up until it was time. 

She spent $3,000 out of pocket for the procedure, which was not covered by her insurance, and another $1,000 for the urn and cremation, including the costs to transport the  remains across state lines. In the recovery room, Crozier asked about footprints and handprints, but learned Haven was too tiny and the tissue too soft.

“I got really upset, and they had to bring my husband in,” she said. 

For the next year, they kept the full story extremely private and only told a few close friends and family members. Everyone else just knew that Haven had died. The couple opened up  over the summer, including on social media, in support of Idaho’s ballot initiative. But Crozier found that some people’s responses were more dismissive than she’d imagined they would be. 

“A lot of people were like, that’s not really an abortion, that doesn’t really count,” Crozier said. 

Since the summer, the Croziers have been vocal online and in person about the initiative, telling Haven’s story and trying to convey that an abortion ban like Idaho’s affects many people in situations like theirs. 

“With Prop 1 being on the ballot, I feel like people have this kind of idea in their brain of what people who have abortions are like, and I feel like I kind of break that mold for a lot of people,” Crozier said. 

“The whole situation was just so heartbreaking, and on top of being in that situation, having to go out of state and to hide what had really happened from friends and family for fear of being judged.”

More babies born with this anomaly under abortion bans

Dr. Kerri Brackney, a maternal-fetal medicine specialist in Tennessee who is a member of the American Association of Pro-Life Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, said anencephaly diagnoses are not uncommon, and they are usually clearly identifiable early in pregnancy. 

The diagnosis does come with risks, Brackney said, including a buildup of amniotic fluid that can cause preterm labor or high blood pressure, but she said it’s typically manageable.   

“The vast majority of patients I care for are able to find some beauty in the hard,” she said. “It doesn’t take away the hard, doesn’t take away the pain, but unfortunately neither does abortion.”

Idaho is losing OB-GYNs. Doctors who remain are trying to shoulder the extra burdens.

Tennessee also has a near-total abortion ban with no fetal anomaly exceptions, and Brackney said more anencephaly babies are being delivered because of the ban, giving doctors a better sense of what it looks like at full term delivery. Brackney said she is honest with patients about the prognosis, and said the longest she’s seen a baby with anencephaly live after delivery is a couple of weeks. 

She has had patients who chose to leave the state and terminate, even though she doesn’t recommend it, and said she will refer a patient to a reputable clinic in another state if that’s what they decide to do.

“But I also really try to encourage my patients that, No. 1, I think they’re stronger than they realize and we can walk through any hard situation with them,” Brackney said. “They’re not alone, and we can help them to find even the small bits of beauty and joy that are found in a very hard journey.”

Brackney said she thinks patients grieve better over the long term when they “follow their pregnancies to their natural conclusion,” whether that’s a miscarriage, stillbirth or death in the hours or days after delivery. She doesn’t think exceptions for fatal anomalies like anencephaly are necessary in states with abortion bans.

“Sometimes moms find stillbirths to be a gift, where they didn’t have to decide and it happened naturally,” she said.

Early on in Idaho’s campaign, polls showed relatively high support for a ballot initiative to restore reproductive rights, including a Boise State University School of Public Service poll last November showing 61% support. A year later, recent polls have tightened considerably or shown more support on the opposing side, after the Church of Jesus Christ of Latter-day Saints donated $1 million and the Roman Catholic Diocese of Boise donated $300,000, helping to usher in a wave of messaging against the measure.

A public memorial

Most of the Facebook posts from the Croziers over the summer didn’t make huge waves. But in early October, Rebecca Crozier made another one that was more direct, complete with multiple photos of her pregnant belly, her ultrasounds and Haven’s memory box. 

She wrote that she was affected by Idaho’s abortion laws and recounted her story, and encouraged people to vote yes on the ballot measure. 

The post quickly went viral. It was shared more than 2,700 times, with almost as many comments. Although it was a political post, she also felt it was a way she could permanently memorialize the baby she never got to meet. 

“I kept telling my friends and my family that I was scared that people were going to forget about her,” Crozier said. “That we would get pregnant, and we would have other kids, or that time would go on and that she would be forgotten. 

“And it felt like a way that I could remind myself and other people that she was real, and she mattered to me.”  

The Croziers are still trying for a healthy pregnancy.

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

Editor’s Note: This story will be included in The Aftermath, an upcoming collaborative project with PBS News Hour and Stateline collecting the personal stories of patients harmed by abortion bans since 2022. If you would like to share your story, please email kmoseley@stateline.org. 

New preliminary research from the University of Michigan shows women living in states with post-Dobbs abortion bans may be more likely to shoulder costs for employer-sponsored health insurance premiums,  with federal data reflecting a 5.4% increase in annual premium expenditures for those women after 2022, when most abortion bans went into effect.

The study used national data from the U.S. Census Bureau’s 2019-2025 Current Population Survey Annual Social and Economic Supplement to compare individual medical out-of-pocket costs for women of reproductive age between 18 and 44. The study, which hasn’t yet been published in a peer-reviewed journal, received financial support from the Center for Reproductive Rights, an advocacy group based in Washington, D.C. 

“State abortion bans were associated with an increase in women’s likelihood of paying out-of-pocket for health insurance premiums,” the study said.

The findings also showed even higher premium expenditures for Black and Hispanic women, at 12.8% and 13.7%, respectively. The findings were not present among men, and the majority of the women in the sample had incomes above 250% of the federal poverty level.

“Our results are suggestive that post-Dobbs abortion bans led to insurers passing more premium costs to beneficiaries,” the study said. “Our findings shed light on the more far-reaching effects of abortion bans, quantifying the extent to which they pose an economic burden to individuals and families.”

Costs associated with pregnancy, childbirth and postpartum care averaged $20,416 nationally, including $2,743 in out-of-pocket expenses for women enrolled in employer plans over 2021-2023, according to previous research.

Joelle Abramowitz, an associate research scientist at the University of Michigan and co-author of the study, said the population survey — which is used to calculate poverty and health insurance coverage rates — was one of few sources that could offer recent insights. 

“What we see is, prior to the bans, the outcomes were looking comparable, and then after the bans were implemented, we see them diverge, with more women paying health insurance premiums in the ban states,” said Abramowitz, an economist and co-director of Michigan Federal Statistical Research Data Centers. .

Ten states with near-total abortion bans — Alabama, Arkansas, Indiana, Kentucky, Louisiana, Mississippi, North Dakota, Tennessee, Texas and West Virginia — were included in the study and compared with five states that did not implement bans: Massachusetts, Michigan, New York, Pennsylvania and Washington. States that expanded Medicaid during that time frame — Idaho, Missouri, Oklahoma and South Dakota — were excluded from the analysis to isolate the effects of the bans from Medicaid changes.

Abramowitz said there could be several factors increasing premium costs for female patients. One is that in states with bans, pregnancies that might have been terminated before the bans became deliveries with the potential for more complications and higher risks.

Prior research has shown that abortion bans are also associated with a higher rate of negative maternal and infant health outcomes, including admissions to a neonatal intensive care unit, as well as higher rates of  cesarean procedures, all of which can increase costs for insurers that get passed along through higher premiums. 

“I think this is an example of one way that these policies have more far-reaching effects beyond just the individuals who are directly affected by them,” Abramowitz said.

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

In the early months of 2022, Democrats in Congress came close to passing an appropriations bill that did not include a provision barring federal funding for abortions — maybe the closest it had ever come in more than 40 years.

But those who wanted the Hyde Amendment included won the battle in the end. Three months later, the U.S. Supreme Court made its decision in Dobbs v. Jackson Women’s Health to allow states to regulate abortion access. That year, the 50-year precedent of a constitutional right to abortion ended, and the 50-year precedent of no federal tax funding to pay for abortions endures.

The Hyde Amendment was first passed Sept. 30, 1976, three years after the Roe decision. The clause — which isn’t a constitutional amendment — is named for Republican U.S. Rep. Henry Hyde of Illinois. It marked one of the first legislative victories for anti-abortion groups after Roe v. Wade guaranteed abortion access up to fetal viability. 

In the decades since, it has been added to every appropriations bill passed by Congress, restricting federal Medicaid dollars from paying for abortion care except in limited cases of rape, incest and to prevent a pregnant patient’s death. The result has left countless people without a way to pay for the procedure, which advocates for abortion access say causes more abortions to happen later in pregnancy and unnecessarily endangers patients’ health.

Abortion opponents say the Hyde Amendment has prevented 2.7 million abortions. An estimated 300,000 abortions per year were covered by federal dollars prior to the Hyde Amendment. While there aren’t any major organizations that have published how much the federal government has saved by not funding abortion care, advocates say it costs the government more not to fund it because of the extra costs added to medical care and public assistance programs.

As more polls and strategists indicate Democrats could take over congressional majorities in the U.S. House of Representatives and the U.S. Senate in January, some anti-abortion advocates fear such a change could be the most serious threat to Hyde’s future since the party nearly repealed the amendment in 2022. 

“If there becomes a pro-abortion majority in Congress, then Hyde is going to be one of the first things to go, probably, especially because it’s been in the spotlight more recently,” said Gavin Oxley, spokesperson for Americans United for Life, a national anti-abortion organization.

Advocates from each side of the issue have pushed for Congress to either codify Hyde into law or codify its repeal, but neither side has been successful. Because of filibuster rules that are usually used in the U.S. Senate on controversial pieces of legislation, legislation would likely need 60 votes to pass, a tall order in a highly polarized environment.

Oxley said anti-abortion advocates aren’t worried just about Democrats, though. During negotiations over legislation that would have extended subsidies for premiums under the Affordable Care Act, President Donald Trump told congressional Republicans in January that they needed to be “a little flexible” on including the Hyde Amendment. The bill never came to fruition and the subsidies expired, but the incident worried anti-abortion groups such as Oxley’s.

“If we get a pro-abortion majority (in Congress), then I would be concerned,” Oxley said. “There are some Republicans who may not be as committed to protecting Hyde.”

Anti-abortion groups tout polls showing strong support for keeping federal dollars from funding abortion care, but few nonpartisan polls have been conducted on the issue, and no major nonpartisan polls have surfaced in the years since 2022, when 13 states implemented near-total abortion bans. A 2016 Politico poll conducted by the Harvard T.H. Chan School of Public Health found 58% of likely voters opposed using Medicaid to fund abortions. 

When other polls commissioned by pro-abortion rights organizations have framed the question with language specific to how Hyde works, which is that a pregnant patient covered by Medicaid can have pregnancy care and childbirth covered but not the cost of an abortion, support for repealing the Hyde amendment goes up. A 2015 poll found that 62% of voters said Medicaid should cover abortion services.

Effects extend beyond abortion procedures 

Amanda Jean Stevenson, associate professor of sociology and director of population at the University of Colorado, Boulder, said many scholars have tracked the fallout of the Hyde Amendment since its inception, but it’s difficult to trace pregnancy complications or deaths back to Hyde.

Many abortion rights advocates point to the case of Rosie Jimenez, a 27-year-old Texas woman who was denied care at a clinic in 1977 because of her Medicaid status and instead sought care from an unlicensed midwife. She died from an infection after spending a week in intensive care. Her daughter, Monique, was 4 years old at the time and now advocates for policy change.

“It’s very easy for some people to say (Rosie Jimenez’s death) was caused by the Hyde Amendment,” Stevenson said. Had Medicaid benefits covered the abortion, “she probably would’ve had that option for safer care.”

Jimenez’s case happened a few months after Hyde was first included in an appropriations bill, but it didn’t change its inclusion in future bills. Many scholars have documented the effects of low-income patients being denied coverage for abortions, but it hasn’t resulted in policy change, Stevenson said.

“People set out to find out about the impact of it, they find that it has a big adverse impact, and that doesn’t matter. It doesn’t change the policy or people’s opinion of it, it doesn’t change anything, really,” she said. “Evidence continues to be generated, and it continues to be ignored.”

Marlene Gerber Fried, co-founder and the former president of the National Network of Abortion Funds, said it would be nice to think that a change in Congress would bring about the end of Hyde, but she’s heard optimism of that kind before. When former Democratic President Bill Clinton took office in 1993, abortion-rights advocates also expected change.

In the years since, Fried said, the Hyde Amendment has been a “fault line” in the abortion rights space, even as some abortion rights advocates think they are gaining ground with public opinion.

“It’s not that they were against public funding, they just thought it wasn’t going to get to a win,” Fried said.

Researchers say Hyde doesn’t just affect the direct costs of abortion procedures. River Robbins, a doctoral candidate in applied medical anthropology and adjunct instructor at the University of South Florida, said his dissertation research has shown not having access to federal funding affects other services available at individual clinics. Independent clinics provide 58% of all abortions nationwide, according to data from the Abortion Care Network.

Many clinics serve low-income communities and people of color, including patients who need interpreters or other language or disability services. While hospital networks have access to funding that helps them provide those services, such money is not available to clinics that primarily exist to provide abortion care. 

Hyde won’t be the end of funding challenges, advocates say 

Now that access to abortion is extremely limited in more than a dozen states, even fewer people can rely on Medicaid to cover abortion costs. Those who can’t access abortion care at home often must travel to another state, where their local Medicaid program dollars won’t apply. That has put extra burdens on local and regional abortion funds and other philanthropic organizations to fill the funding gaps. Sometimes health clinics just take a loss rather than denying someone an abortion.

“We know that our providers don’t turn folks away, and sometimes that comes at great cost to their clinics and their ability to operate,” said Kelsey Ryland, policy counsel for the National Abortion Federation.

Chelsea Souder, co-owner of Hope Clinic in Illinois, said she hopes the Hyde Amendment will be permanently repealed in the near future, but that even if it is, there will still be many gaps in funding for abortion care. 

Even in states with access, including some of the most accessible states in the country like Illinois, state Medicaid coverage is often inadequate to cover costs by itself, especially for those who need care later in pregnancy. Souder said 85% of her clinic’s revenue does not come from patients who pay out of pocket or with Medicaid — it comes from abortion funds or donors, which she said is not sustainable.

“Making abortion actually accessible and affordable is where the focus has to be,” Souder said.

According to health policy institute KFF, 21 states allow their state Medicaid program to cover abortion costs, and some have expanded those policies since Roe fell. But reimbursement rates for providers continue to be low, regardless of where the clinic is located, and they are exceedingly low for abortions later in a pregnancy.

Dr. Diane Horvath, chief medical officer at Partners in Abortion Care in Maryland, said the clinic ran an experiment of accepting all state Medicaid patients for a year and a half, starting in 2024. Despite strong state support for abortion access at any stage in pregnancy, the low reimbursement rates for care beyond the second trimester resulted in a loss to the clinic of $1.2 million during that time. That includes cost increases for supplies and labor, since the clinic hasn’t increased prices for patients.

“For most of these patients, we lose at least $4,000 a patient,” Horvath said. “A hospital might be able to recover more and spread loss over different departments, but I don’t have another clinic, I don’t have another place I can draw funds from.”

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

As physicians continue to navigate care for patients with complex pregnancies in states with abortion bans, a group of maternal-fetal medicine specialists has developed new guidelines to help providers in those states navigate legal risks for themselves and medical challenges for their high-risk patients. 

Maternal-fetal medicine specialists handle some of the most high-risk pregnancies, including patients with high blood pressure, diabetes, cancer, fetal anomalies or other complications. In states with abortion bans, those conditions can become even more dangerous for a patient if a doctor is unsure when they can terminate a pregnancy without potentially jeopardizing their medical license or facing criminal penalties that can include jail time.

“Individuals at high risk for pregnancy-associated morbidity and mortality have unique needs for reproductive health services, including abortion care,” the Society for Maternal-Fetal Medicine wrote in a special statement published this month. 

Ten states plus the District of Columbia allow abortion access without gestational restrictions, while 13 states ban abortion at all stages. Following the implementation of those bans since 2022, many hospital systems and clinics have offered different interpretations of how to avoid legal jeopardy under the bans and what qualifies under exceptions, leading to confusion and delays in care that have been documented in many states nationwide. 

To mitigate those problems, the guidelines encourage providers and administrators to set up referral networks across state lines, work to find agreement on what is permissible under state law and counsel patients on their options even in states with restrictions to deliver the highest-quality care. 

“We are uniquely positioned as high-risk pregnancy experts to make that case to our leaders,” said Dr. Justin Lappen, a maternal-fetal medicine specialist in Ohio who chaired the committee that developed the statement. “And a statement like this would give providers and our colleagues some confidence to be leaders in this space.”

The Society for Maternal-Fetal Medicine and the American College of Obstetricians and Gynecologists agree that access to abortion and counseling about options is the standard of care for obstetric patients, but there are conscientious exceptions for doctors who do not want to provide abortion care. 

Some doctors choose to affiliate with the American Association of Pro-Life Obstetricians and Gynecologists, and offer their own guidance about approaching complications, which still includes termination in some situations. The group is officially a partner of the Alliance Defending Freedom and several anti-abortion groups, as well as the Alliance for Hippocratic Medicine, which is the group that sued to revoke federal approval of one of two drugs used to terminate a pregnancy or treat miscarriages.

A representative from the American Association of Pro-Life Obstetricians and Gynecologists could not be reached for comment before publication.

Worse outcomes for high-risk patients

Nationwide, women in states with bans have reported difficulties receiving care when experiencing pregnancy complications. 

One of the most common emergencies occurs when a patient’s amniotic sac breaks before a fetus is viable. If left untreated, it can quickly turn into a deadly infection. The statement noted that after Texas passed Senate Bill 8 in 2021 banning abortion at an early gestation, waiting to treat patients in those medical situations dramatically increased negative health outcomes. According to research cited in the statement, complications such as blood transfusion, intensive care admission and serious infection resulted in 57% of cases, versus comparable research in states without restrictions that showed a complication rate of 33%. In all of the cases, the fetus did not survive.

Federal judge’s order allowing an Idaho doctor to perform certain abortions is put on hold

The guidance states hospitals and clinics should expand their abortion care to the extent allowed by law, and recognize maternal-fetal medicine specialists as sources of best care practices. It also instructs providers to work with legal teams in their networks to understand the federal Emergency Medical Treatment and Labor Act and when it may require abortion care, as well as encouraging training for basic termination procedures. 

Dr. David Hackney, a maternal-fetal medicine specialist in Ohio who published a book in August about navigating high-risk pregnancy care under Dobbs, said the statement will be useful for many providers nationwide.

“We don’t always focus enough on hospital administration, care and systems, but there’s always so much that can be done in those regions that is almost — if not more — important,” Hackney said.

After the Dobbs decision in June 2022, Hackney said, many individual healthcare systems didn’t know what to do when faced with certain situations where termination might be needed, and set a patchwork of policies that increased confusion for providers. But in the years since, providers and administrators in some healthcare systems have come together to reach informal agreements about what they are comfortable doing within the confines of an abortion ban.

“You have some defense if everyone has agreed to do the same thing,” he said.

When laws are unclear, he said, people will most often lean toward over-complying, which can create worse outcomes for the patient. 

“Even outside of abortion, medical care tends to work better when you have consensus and you have common best practices, even if it’s on a regional level,” he said. 

‘When they need me, they call me’

Many specialists’ cases aren’t emergencies, but rather pregnancies that put a patient at risk because of underlying health conditions, whether they existed before a pregnancy or developed during pregnancy, or late-term diagnoses of fetal anomalies that upend a wanted pregnancy. 

In those cases, the maternal-fetal organization says, patients should be told that their options include termination, even if that can’t happen in their home state.

Dr. Leilah Zahedi-Spung, a maternal-fetal medicine specialist who co-authored the special statement, moved to Colorado from Tennessee in 2023 after that state enacted a near-total abortion ban.

She said she saw firsthand how difficult it was in Tennessee to try to take care of patients without clarity around the law and without leadership that was willing or able to try to provide support. One goal of the statement is to help provide that kind of support to physicians, she said.

“We know you’re in a tough situation, we’re not blind to that. No one is blaming you for what you can and cannot do,” Zahedi-Spung said.

The society’s statement suggests that providers establish relationships with leaders within their clinical settings as well as in the community, region and state to agree on legal interpretations of abortion restrictions, particularly those who might hold leadership positions themselves. It also encourages doctors to establish referral networks locally and between states to ensure patient access.

“I have lots of people from Texas who have my phone number, and when they need me, they call me,” Zahedi-Spung said. “That is a system that works. And then those patients go back to safe providers who can take care of them.”  

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

The U.S. Food and Drug Administration says it’s helping manufacturers increase the supply of estrogen-based hormonal patches and acknowledged a current nationwide shortage as more women seek hormonal therapies for symptoms related to menopause.

In a release earlier this month, the FDA said it is expediting actions to increase supply, and said all six manufacturers are working to expand capacity and prioritize production of the patches.

“The FDA views increased interest in menopause treatment as an important development for women’s health and is working closely with manufacturers to help ensure that the supply of estradiol patches keeps pace with demand,” the release said.

Menopause typically occurs between the ages of 45 and 55, according to the National Institute on Aging, when a woman stops having menstrual periods. That hormonal change can cause symptoms such as hot flashes, night sweats, bone density loss, insomnia and more. Estradiol transdermal patches worn on the skin can replace estrogen lost through menopause and reduce those symptoms for some women.

Stateline reported in May that more awareness of menopause and its effects was leading to more states introducing legislation around the topic to mandate more insurance coverage for treatment and to create more workplace accommodations. At that time, the FDA did not list the patches in its list of shortages — this month marks the first time the agency has acknowledged a shortage. The American Society of Health-System Pharmacists first noted a shortage in January, two months after the FDA removed the treatment from its longtime “black box” warning status.

As of May, the National Menopause Foundation said more than 60 pieces of legislation related to menopause had been introduced nationwide this year. Twenty-six, and 26 states have enacted menopause-related laws since 2019, and more bills are expected to be introduced in the upcoming 2027 legislative sessions.

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