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Women in states with abortion bans are the biggest users of abortion telemedicine

Clinicians are providing medication abortion through telehealth services even to people in states where abortion is banned, thanks in part to shield laws in states where abortion is still legal. (Natalie Behring/Getty Images)

As conservative lawmakers work to restrict online access to abortion medication, a new report shows how popular it has become for women who live in states that have outlawed abortion.

Researchers from the University of Texas at Austin led a team that analyzed 15 months of prescription data from Aid Access, one of the largest online abortion telemedicine providers.

They found 84% of Aid Access’s more than 118,000 online prescriptions went to patients living in abortion-ban states.

The South and Midwest had the highest rates of patients accessing telemedicine abortion. Rates were also greater in high-poverty areas or where people would have to travel more than 100 miles to reach an abortion clinic, according to the report, which published this month.

Aid Access is able to mail abortion medications to residents in all 50 states — even those in states with abortion bans — thanks to shield laws in Democratic-led states. Shield laws are designed to minimize the legal risks for people who provide or access abortions across state lines.

Currently, 22 states and Washington, D.C., have reproductive care shield laws, either through legislation or by executive order, according to a report from University of California, Los Angeles School of Law.

Eight of those states — California, Colorado, Maine, Massachusetts, New York, Rhode Island, Vermont and Washington — specifically protect telehealth abortion providers regardless of where their patient is located.

Shield laws, along with difficulty accessing in-person abortion services in abortion-ban states, have contributed to a rise in medication and telehealth abortions since the U.S. Supreme Court overturned the federal right to abortion in 2022, clearing the way for state bans. With telehealth abortion, patients have a virtual appointment with a clinician who can prescribe abortion medication, which is then filled by a licensed pharmacy and mailed to the patient.

Research has shown telehealth medication abortion is effective and safe, and comparable to in-person medication abortion.

Medication abortion accounted for nearly two-thirds of all clinician-provided abortions in states without bans in 2023, the most recent data available from the Guttmacher Institute, a research and policy organization focused on advancing reproductive rights.

But as abortion medication use rises, so have conservative efforts to ban it.

This year, more than a dozen states introduced bills to bar access to medication abortion by criminalizing its sale, purchase or distribution, according to Guttmacher.

One such bill in Texas, which could have been a blueprint for medication abortion restriction in other states, was specifically aimed at groups like Aid Access. It would have allowed private citizens to sue for at least $100,000 anyone who provided abortion pills in Texas. The bill passed the Texas Senate but died in the House in May.

Earlier this year, the state of Louisiana criminally charged a New York physician under its abortion ban law for allegedly providing abortion pills to a Louisiana teen via telehealth. New York, which passed a shield law in 2023, refused Louisiana’s request to extradite the doctor.

Last month marked the first federal test of shield laws, when a Texas man sued a California doctor for allegedly mailing abortion pills to his partner.

This week, a Texas woman filed a federal lawsuit against Aid Access and against a man who she said impregnated her, then spiked her drink with abortion pills. She is also suing the Dutch doctor who founded Aid Access, alleging Aid Access and its founder mailed abortion-inducing drugs in violation of Texas and federal law.

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

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org.

Despite federal shift, state health officials encourage COVID vaccines for pregnant women

In this photo illustration, a pharmacist holds a COVID-19 vaccine. States and clinicians are working on getting correct information on vaccines to vulnerable groups amid shifting federal guidance. (Photo illustration by Joe Raedle/Getty Images)

Heading into the respiratory illness season, states and clinicians are working to encourage pregnant patients to get COVID-19 vaccinations, even though the U.S. Department of Health and Human Services no longer recommends that they should.

Along with being older and having an underlying health condition, pregnancy itself is a risk factor. Pregnant women are more vulnerable to developing severe illness from COVID-19. They’re also at high risk for complications, including preterm labor and stillbirth. The vast majority of medical experts say getting the shot is safe and effective — much safer than having the illness.

But HHS Secretary Robert F. Kennedy Jr. announced in May that the agency would no longer recommend that pregnant women get the vaccine. Before testifying before Congress in June, Kennedy circulated a document on Capitol Hill claiming higher rates of fetal loss after vaccination. But the authors of those studies told Politico that their work had been misinterpreted.

Experts say the federal shift puts the onus on state health agencies to ramp up vaccine guidance and outreach. Clinicians and public health organizations are trying to dispel misinformation and make sure information reaches low-income people and people of color, who had higher maternal death rates during the pandemic. During the first two years of the pandemic, the virus contributed to a quarter of maternal deaths, according to federal data.

“We are severely disappointed,” said Dr. Neil Silverman, a professor of clinical obstetrics and gynecology at the University of California, Los Angeles David Geffen School of Medicine. He has studied vaccines and pregnancy for the past 15 years and specializes in high-risk pregnancies.

Silverman called the federal shift a “public health tragedy on a grand scale.”

RFK Jr. ends COVID vaccine recommendation for healthy children, pregnant people

Vaccinations against COVID-19 help prevent severe illness in pregnant people as well as their newborns, who are too young to get vaccinated, Silverman said. In what’s called passive immunity, vaccinated mothers pass on antibodies to their babies through the placenta and through breast milk.

“State public health agencies are probably going to have to implement vaccine guidance that differs from the federal recommendations. And that’s going to be an interesting can of worms,” said OB-GYN Dr. Mark Turrentine, a professor of obstetrics and gynecology at the Baylor College of Medicine in Texas.

Turrentine serves on a board of the American College of Obstetricians and Gynecologists that focuses on immunization and infectious diseases. He said his recent pregnant patients who had COVID-19 hadn’t gotten the vaccine.

“The change in guidance on the federal level just really makes a lot of confusion, and it makes it very challenging to try to explain to individuals why all of a sudden the difference,” Turrentine said.

Wisconsin keeps recommendation

Wisconsin Department of Health Services recommendations continue to include pregnant people among those recommended to get the COVID-19 vaccine.

“Vaccination either before conception or early during pregnancy is the best way to reduce maternal and fetal complications,” DHS says on its COVID-19 vaccine web page for parents.

Erik Gunn

A slew of public health organizations have been making a concerted effort to dispel vaccine myths. They include the Society for Maternal-Fetal Medicine, a Washington, D.C.-based nonprofit organization of maternal-fetal experts. At a news briefing the society held this month, clinicians stressed the safety and long-standing science behind COVID-19 vaccines, as well as the shots for RSV and the flu. Cases of RSV and the flu tend to peak in the winter months, while in recent years COVID-19 cases have spiked in the summer and the winter.

Dr. Brenna Hughes, an OB-GYN who chairs the organization’s infectious diseases and emerging threats committee, pointed to survey data from the federal Centers for Disease Control and Prevention showing that less than a third of eligible pregnant patients received COVID-19 shots, and only 38% received RSV shots for the 2023 to 2024 season. Less than half — 47% — received flu shots, and 59% received TDAP (whooping cough) vaccines.

CDC data shows that for last year’s and this year’s season, only between 12% and 14% of pregnant patients got the COVID-19 vaccine.

“The complications from the infection are so much greater than the complications and the very few and typically minor adverse events that might occur from the vaccine,” said microbiologist Sabra Klein, a professor of molecular microbiology and immunology at the Johns Hopkins Bloomberg School of Public Health.

In June, the American College of Obstetricians and Gynecologists and 30 other professional health organizations signed a letter urging insurers to continue covering the COVID-19 shot for pregnant women, and have continued to urge coverage since then.

CVS Caremark, one of the nation’s three major pharmacy benefit managers, told Stateline it will continue covering the vaccine for pregnant women. The Arizona, California and North Carolina state Medicaid agencies also told Stateline they are still currently covering COVID-19 vaccines for pregnant women.

Doulas, midwives and lawmakers challenge erasure of Black women in maternal health care

Dr. Kimberly Fortner, president-elect of the Infectious Diseases Society for Obstetrics and Gynecology, said during the maternal-fetal medicine briefing that she hopes medical groups’ joint messaging will bolster insurers.

“Hopefully by us linking arms, that can then help develop consistency so that insurers will continue to pay for the vaccine,” she said.

Exacerbating disparities

Dr. Ayanna Bennett, director of the District of Columbia Department of Health, said the federal government’s new stance has upended “a system that’s been stable for a very long time.”

Bennett said her agency used federal pandemic aid to shore up vaccine outreach efforts to communities of color. Now that flow of money is ending.

The changes in federal guidance and funding will “almost certainly exacerbate” maternal health disparities, said Marie Thoma, a perinatal epidemiologist and an associate professor in the University of Maryland Department of Family Science who researches pregnancy and COVID-19.

Black and Indigenous women died at higher rates. The virus exacerbated existing racial disparities in maternal health — and created new ones: Latina mothers, who generally see low rates of maternal mortality, saw deaths surge to 28 per 100,000 in 2021. Their rate was about 12 per 100,000 in 2018, according to federal data.

“We are going in with some exposure already that we didn’t have during the start of the pandemic. So, there will be some protection, but now that will erode,” said Thoma. “If we’re not getting vaccines, or if people are hesitant to take them, we could see some increase.”

Silverman said the administration’s efforts to strip mentions of race from government policies makes it difficult for institutions to reach populations at greatest risk. He called the dismissal of decades of data “saddening and infuriating.”

“The politicization of the vaccine process, or access to it, is what concerns me the most,” said Dr. Yvette Martas, a Connecticut OB-GYN who chairs the board of directors of the Hispanic Health Council.

Many women “are trying to navigate an economic system that’s not always in their favor in terms of also providing access to the kind of educational material that they need,” she said.

Not just COVID-19

In June, Kennedy ousted all 17 members of the CDC’s vaccine advisory committee, replacing them with some members who are vaccine skeptics.

The change is creating chaos. Some states have vaccine laws, such as mandates for kids and coverage statutes, that are specifically tied to the committee’s decisions.

The politicization of the vaccine process, or access to it, is what concerns me the most.

– Dr. Yvette Martas, a Connecticut OB-GYN who chairs the board of directors of the Hispanic Health Council

The Vaccine Integrity Project at the University of Minnesota called on frontline health workers, health officials and professional societies to “counter the spread of inaccurate and confusing vaccine information.”

At a news briefing this month held by the Association of State and Territorial Health Officials, representatives from Alabama, Connecticut and Washington, D.C., said they will continue to recommend vaccines.

Alabama’s state health officer, Dr. Scott Harris, said clinicians will be instrumental in getting correct vaccination information to patients.

“We don’t think that we necessarily have the same authoritative voice that we might have had a decade ago in trying to guide people in what to do, but we do believe that people trust their health care providers in most cases and are certainly willing to listen to them,” he said at the briefing.

Bennett said she is hopeful that strong, consistent messaging from respected medical organizations will help combat confusion.

“Having established groups like the American Academy of Pediatrics or the American College of Obstetrics and Gynecology make very firm recommendations that keep us essentially not changed from where we have been, I think, should reassure families,” she said.

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org.

Trump illegally froze 1,800 NIH medical research grants, Congress’ watchdog says

The James H. Shannon Building (Building One) on the NIH campus in Bethesda, Maryland. (Photo by Lydia Polimeni,/National Institutes of Health)

The James H. Shannon Building (Building One) on the NIH campus in Bethesda, Maryland. (Photo by Lydia Polimeni,/National Institutes of Health)

President Donald Trump’s freeze on $8 billion of congressionally appropriated funding to the National Institutes of Health was illegal, the Government Accountability Office reported Tuesday.

Orders Trump signed in the early days of his return to office and related administration directives violated the Impoundment Control Act by failing to spend money that Congress, which holds the power of the purse under the Constitution, had approved, the GAO report said.

Roughly 1,800 grants for health research were held up by the administration, the report said.

Trump’s Inauguration Day order ceased funding for a variety of health research grants that related to diversity, equity and inclusion, transgender issues or environmental harms. The Department of Health and Human Services issued a memo directing its agencies, including NIH, to cease publishing notices in the Federal Register of meetings of grant review boards.

GAO, an independent investigatory agency that reports to Congress, called those meetings “a key step in NIH’s grant review process.” HHS has since restarted notices of the meetings.

From February to June, the NIH released $8 billion less than it obligated in the past two years, representing a drop-off of more than one-third, according to the GAO. The gap between 2025 spending and that of previous years continued to grow, GAO said, with NIH obligating a lower amount of grant funding each month.

Illegal impoundment

The failure to fund grant awards violated the Impoundment Control Act and the Constitution, which certified Congress as the branch of government responsible for funding decisions, said GAO.

If a law is passed by Congress and signed by a president, it must be carried out by the executive branch, the watchdog said.

“The President must ‘faithfully execute’ the law as Congress enacts it,” the report said. “Once enacted, an appropriation is a law like any other, and the President must implement it by ensuring that appropriated funds are obligated and expended prudently during their period of availability unless and until Congress enacts another law providing otherwise. … The Constitution grants the President no unilateral authority to withhold funds from obligation.”

There are specific circumstances that allow for a funding freeze — a rescissions law, such as the one Congress passed last month to defund public broadcasters and foreign aid, is one example — but they did not apply to this case, the GAO said.

Delays may be permissible to allow a new presidential administration to ensure grants are awarded based on its priorities. But a complete block on funding is illegal, the GAO said. There is no evidence that other grant awards — or any other type of funding at HHS — took the place of the $8 billion in unspent grant money, the report said.

“While it can be argued that NIH reviewed grants to ensure that funds were spent in alignment with the priorities of the new administration, NIH did not simply delay the planned obligations of the funds,” the GAO said. “Rather, NIH eliminated obligations entirely by terminating grants it had already awarded.”

GAO can sue the executive branch based on its findings. The report noted there is already litigation from other parties over the frozen grants.

Dems call for reinstatement

Congressional Democrats responded to the report by harshly criticizing Trump and White House Office of Management and Budget Director Russ Vought and calling for the funds’ release.

“This is simple – Congress passed and the President signed into law investments in NIH research to help find cures and treatments for cancer, Alzheimer’s disease, ALS, diabetes, mental health issues, and maternal mortality,” U.S. House Appropriations Committee ranking Democrat Rosa DeLauro of Connecticut said in a statement. “But now, GAO has determined that President Trump and OMB Director Vought illegally withheld billions in funding for research on diseases affecting millions of American families—research that brings hope to countless people suffering.”

Senate Appropriations Vice Chair Patty Murray, a Washington state Democrat, said in a statement the funding freeze “dangerously set back” efforts to cure cancer, Alzheimer’s and other diseases.

“Today’s decision affirms what we’ve known for months: President Trump is illegally blocking funding for medical research and shredding the hopes of patients across the country who are counting on NIH-backed research to propel new treatments and cures that could save their lives,” Murray said. “It is critical President Trump reverse course, stop decimating the NIH, and get every last bit of this funding out.”

An HHS spokesperson deferred a request for comment Tuesday to OMB.

An agency investigated by the GAO is generally given a draft of the watchdog’s findings and asked to respond.

The HHS response, obtained by States Newsroom, said grant reviews were back on schedule, though it did not address grant obligations.

“Despite the short delay in scheduling and holding peer review and advisory council meetings to allow for the administration transition, NIH has been on pace with its reviewing grant applications and holding meetings and has caught up from the pause when compared to prior years,” the response said.

GAO’s summary of the HHS response said the department had restarted meetings of grant review boards and provided some “factual information” but did not justify the lack of grant spending or provide current status of payments for previously approved grants. 

TSD Conference Topics Plan to Cover Unique Aspects of Transporting Students

The Transporting Students with Disabilities and Special Needs (TSD) Conference in Frisco, Texas this fall looks to address the unique challenges and considerations of transporting this at-risk population.

Providing the best care for the students, empowering the transportation staff, and building an operational culture of communication and clear policies will be discussed by industry veterans, transportation consultants, and school district and bus company staff members.

In the driver training category, session topics include how to model behavior interventions in transportation settings, training for empathy of children’s needs, providing training for the service of medically fragile riders, and other proactive training educational discussions.

For upholding legal requirements and federal standards, speakers will plan to address topics such as impact of the updated National School Bus Specifications and Procedures on operations, alternative transportation, Medicaid reimbursement funding, and developing policies for proper and safe usage of student restraint and seclusion practices.

To address collaborating with contractors or other resources to aid student transportation, examples of topics include how to avoid one-size-fits-all solutions, how to create successful partnerships between school districts and contractors, and the OT/PT Transporter Forum on multidisciplinary policy development.

In addition to the hands-on training classes that cover wheelchair securement, school bus evacuations and use of child safety restraint systems on school buses, instructors from the Texas School for the Deaf will provide training for student transporters on using American Sign Language to communicate.

For a full list of 2025 TSD conference topics, visit tsdconference.com.

Save $100 on regular conference registration with Early Bird registration by Oct. 3. The TSD Conference will be held November 6-11 in Frisco, Texas at the Embassy Suites Dallas-Frisco Hotel and Convention Center. Find more information on daily agenda, unique experiences, hotel and registration at tsdconference.com


Related: TSD Conference Registration is Open for Event in November
Related: TSD Evacuation Class Emphasizes Importance of Training
Related: (STN Podcast E236) TSD 2024 Recap: Supporting Students with Special Needs as Unique People

The post TSD Conference Topics Plan to Cover Unique Aspects of Transporting Students appeared first on School Transportation News.

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