Hope Broussard, 20, sought care at a Planned Parenthood in Washington in 2023 when her IUD became lodged in her cervix and the clinics in her hometown of Sandpoint, Idaho, weren’t able to help. She now lives in Pullman, Washington. (Photo by Geoff Crimmins for States Newsroom)

Fifth in a five-part series. 

Hope Broussard’s intrauterine device should have brought relief from her severe periods. But at 17, it started causing debilitating pain.

At the Sandpoint, Idaho, clinic where the device was implanted, providers suspected it was embedded in her uterine wall, but lacked the ultrasound equipment to make a diagnosis.

Homeless with no insurance after her mother kicked her out, Broussard couldn’t enroll in Medicaid as a minor without a parent’s involvement. The women’s clinics in Sandpoint couldn’t help. Hospital bills were out of the question.

“The only people that were able to help me were Planned Parenthood,” Broussard said.

She sought care across the border in Washington, at the Spokane Planned Parenthood, where an ultrasound showed the IUD was coiled around her cervix. A specialist carefully removed it in a follow-up appointment and she paid $20 for everything because it was all she could afford.

“It really was my saving grace at the time,” said Broussard, who moved from Idaho to Pullman, Washington, in part because of that experience of being unable to access health care locally. “I have no idea what I would’ve done if I didn’t have that option available to me.”

Broussard is one of more than 2 million people nationwide who used Planned Parenthood for health care between 2023 and 2024, according to the national organization’s annual report. But how many people will be able to afford and access care is changing after a new federal provision prohibits some organizations that provide abortions from receiving Medicaid payments for at least a year. Nationally, Planned Parenthood estimates it could lose $700 million from Title X and Medicaid cuts, forcing affiliates to close some clinics, curtail services and stop accepting Medicaid patients.

Many Republican lawmakers and anti-abortion groups celebrated the provision passed by Congress in July that essentially targeted Planned Parenthood clinics nationwide for “defunding” because abortion care is part of clinical services in many states where access is mostly legal. Federal Medicaid dollars cannot be used to pay for abortions except in limited circumstances, and abortion care makes up a small percentage of overall care provided by clinics. Still, conservatives argue the mere association with any such clinics is equivalent to funding all abortion. 

“Planned Parenthood’s desperate ploy for our tax dollars only underscores why the One Big Beautiful Bill is such a historic win,” said Susan B. Anthony Pro-Life America President Marjorie Dannenfelser in a July statement. “It halted, for the first time, over half a billion taxpayer dollars from propping up the corrupt abortion industry.”

Democratic-led states are in troubleshooting mode 

In response, elected officials in some Democratic-led states, including Washington, Hawaii, Colorado and Massachusetts have publicly pledged to backfill the funding needed to allow Planned Parenthood clinics to keep accepting Medicaid and other low-income patients. In July, Washington Gov. Bob Ferguson committed to filling the $11 million gap Planned Parenthood expected to see.

Many states don’t begin their legislative sessions until January, so some of the plans aren’t official yet and still need to make it through the legislative process or the details of allocation are still in progress. That means clinics either have to absorb the costs for now with the promise of reimbursement, or change their payment options and services for the time being. For example Hawaii is moving to sliding-scale fees for some Medicaid patients, and in Maine, a major independent clinic is making changes to its services. 

Idaho’s border with Washington and Oregon is a point of contention among lawmakers across state lines, where the political views could hardly be more polarized between the hard-line conservatives in Idaho and progressive politics in the other two states. But for the people who need abortion care, or even a basic ultrasound, like Broussard, clinics in places like Spokane and Ontario, Oregon, are some of the last options available. 

Oregon lawmakers are also brainstorming ways that the state can provide reimbursement to Planned Parenthood for lost funding. Clinics across the state billed Medicaid nearly $17 million for services in 2024, according to the Oregon Capital Chronicle. 

Courtney Normand, the Washington state director for Planned Parenthood Alliance Advocates, said this latest move from Congress is adding to challenges from the first Trump administration when there were other cuts, along with health care system pressures from the COVID-19 pandemic, and the impact of increasing patient volumes after the U.S. Supreme Court’s Dobbs decision that upended federal abortion rights protections.

“It feels like the hits have just kept on coming in Washington, and that’s why access, affordability and stable funding is our key concern,” Normand said. 

Brita Lund, the health center manager at a Planned Parenthood in Seattle, worries about having to turn away patients if the federal Medicaid cuts and other strains on the health care system become too much to bear. She already feels like she spends too much time grilling a patient about their personal details at an appointment so the staff can find a way to get the treatment paid for by a specific pocket of funding. 

“Who is going to help these people if we’re not going to help them? I want someone to give me that answer,” Lund said. “It literally keeps me up at night.” 

While Washington state is known for being one of the most openly accessible for sexual and reproductive health, a budget crisis led legislators to cut 55% of the funding to the Abortion Access Project, about $8.5 million. Normand said it’s hard to know exactly why legislators made the decision, but some regretted it and are trying to find a solution for the upcoming session. Ferguson pledged to restore the funding as well. 

‘I know the state is supportive, it’s just about what their capacity is’

In Hawaii, Title X cuts from the Trump administration earlier this year amounted to about $2.1 million, said Jen Wilbur, Hawaii state director for Planned Parenthood Alliance Advocates. The state legislature acted quickly in April to approve a new $6 million family planning fund to offset that loss over the next two years, with $3 million specifically allocated to Planned Parenthood clinics. What the funding program will look like exactly is still to be determined, Wilbur said. The needs vary by island, and an assessment of what those needs are is underway.  

Hawaii has trended slightly more conservative than other blue states in recent elections, Wilbur said, but support from lawmakers still feels strong. She and other advocates are trying to game plan in the event that the federal government restricts access to mifepristone through the mail, which would severely affect access for the islands. 

But Wilbur worries about the long-term sustainability of the funding in a small state that already has many challenges with high cost of living, difficulty retaining providers and navigating the unknown. 

“We don’t even know how many more cuts are coming, so is any state really going to be able to sustain this going forward? I don’t know,” Wilbur said. “I know the state is supportive, it’s just about what their capacity is.” 

Short-term state fixes in Maine, Massachusetts 

New England, considered a hub for abortion access and low-cost reproductive health services, has been especially impacted by the federal Medicaid rule. It affects not only Planned Parenthood affiliates, but also two nonprofit health networks that offer wide-ranging health services primarily to Medicaid patients: Health Imperatives in Massachusetts and Maine Family Planning, which, like Planned Parenthood, has sued over the new policy. 

Maine’s legislature this summer appropriated about $6 million for family planning funding, to go to organizations like Planned Parenthood of Northern New England and Maine Family Planning, the largest reproductive health provider in the state with 18 clinics compared to Planned Parenthood’s four. But as Maine Morning Star reports, the temporary relief does not fully meet both organizations’ deficits, and Maine Family Planning this week announced it will end primary care services in Ellsworth, Houlton and Presque Isle at the end of October.

Still, both Maine Family Planning and Planned Parenthood of Northern New England say they will continue to see Medicaid patients free of charge for reproductive health and family planning services. 

Massachusetts Democratic Gov. Maura Healey also announced the state would deliver $2 million to Planned Parenthood League of Massachusetts, which is one of the co-plaintiffs in Planned Parenthood’s lawsuit against the federal government.

“We want the people of Massachusetts to know that if you need reproductive health care services, you should continue to seek this care,” Healey said in a news release. 

Massachusetts has been a leader in policy promoting access to reproductive health including abortions, which is legal in the state up to 24 weeks of pregnancy with exceptions for significant fetal abnormalities and the pregnant person’s health.  

But access to broad reproductive health care even in a city like Boston remains limited, especially for people living in poverty, said Dominique Lee, president and CEO of Planned Parenthood League of Massachusetts.

Lee told States Newsroom that making a primary care or OB-GYN appointment in the Boston area can mean having to wait 60 days, while Planned Parenthoods typically have same-day appointments. She noted that the communities with the least access to low-cost reproductive health services are concentrated in central and western Massachusetts, where Planned Parenthood has three clinics.

Lee said she is grateful for the $2 million in state funding, which she calls “short-term relief.” Because Medicaid funding represented about a quarter of her organization’s revenue, Lee said it is like a business losing its biggest customer. Her goal now is to figure out how the affiliate can sustain long term. She said they are brainstorming other revenue streams like offering vasectomies.

“We have gotten really good at contingency planning,” Lee said. “But it would be great to have a business model that is sustainable, that can withstand all of these attacks, and not have to worry about it. That would be a dream.”

The affiliate’s website notes that patients can no longer use their MassHealth or Medicaid Managed plans for care at Planned Parenthood clinics but says they are still seeing “all patients.”

Health Imperatives, which operates seven clinics in southern Massachusetts, is also looking at operations.

Health Imperatives CEO Julia Kehoe said the $19 million nonprofit serves about 23,000 people annually and offers social and psychiatric services to vulnerable populations. About 40% of what Health Imperatives does is offer low-cost sexual and reproductive health services for about 10,000 patients annually, Kehoe said. For now, they are continuing to see the same amount of patients and are working with the state government for funding help. 

But she said the organization is also looking at private funding because they are determined to continue seeing Massachusetts’ poorest residents, many of whom experience food insecurity in places like Nantucket, which is one of the nation’s wealthiest towns but where the main safety net for those who are not wealthy is a single Health Imperatives clinic. 

“I would never, ever make the decision to not see Medicaid patients,” Kehoe said. “We exist to provide services to people who fall through the cracks of mainstream systems of care. So we’re going to prioritize people who are on Medicaid or people who don’t have insurance. What I would do is, rather than further health disparities and wealth disparities in one of the most expensive states in the country, I would have fewer clinics.”

Correction: This article has been corrected to reflect that elected officials in Maine have not yet pledged to support family planning clinics with backfilled funding. The state passed a bill last session that provided family planning funding that was already needed before the congressional bill cut Medicaid funding.

Sarah Elgatian is a graduate student in rural Iowa, who like about 16 million women of reproductive age, uses Medicaid insurance and at times has relied on Planned Parenthood for routine gynecological treatment for infections and birth control, both in person and through its growing telehealth program. (Photo by Todd Welvaert for States Newsroom)

Fourth in a five-part series.

Sarah Elgatian was in too much pain to feel awkward. 

That morning in 2019, she was hunched over her toilet, feeling what she described as a “weird burning nausea,” abdominal pain and other symptoms. She remembered the Planned Parenthood telehealth ad she’d seen recently. Elgatian downloaded the app, and within a couple hours from her bathroom, she was video chatting with a health provider. She recalled that the doctor could tell she had a urinary tract infection just by looking at her face.

“They were like, yeah, those are textbook symptoms, and you are cringing,” said Elgatian, 35, who lives on the outskirts of Davenport, Iowa, where the nearest pharmacy is at least a 20-minute drive. But luckily, Elgatian’s spouse was able to get the antibiotics the Planned Parenthood provider prescribed, and with it, relief. “That was really scary, just because, if you’ve ever had a UTI, when they’re bad, they’re so bad.”

Elgatian, like about 16 million women of reproductive age, has Medicaid, the federal and state medical insurance program for people with low incomes, and therefore limited options when it comes to reproductive health. With even fewer options in rural Iowa, Elgatian, who is a graduate student, said at times she has relied on Planned Parenthood for routine gynecological treatment for infections and birth control, both in person and through its growing telehealth program.

Now that a new rule has eliminated hundreds of millions in Medicaid reimbursements to Planned Parenthood, reproductive health providers have turned to telehealth as part of the solution to offer low-cost health services due to reductions in clinic staff and services, or closures.  

Telemedicine gained momentum in the wake of the COVID-19 pandemic and the increasing health care deserts around the country. In the reproductive health space, it has expanded in the last few years, as the overturn of Roe v. Wade and the resulting policies prompted the closure of many physical clinics. By the end of 2024, 1 in 4 abortions was provided via telehealth, according to the Society of Family Planning, though there are ongoing efforts at the federal and state level to prohibit telehealth abortions.

“We’ve — overall as a trend — seen more patients taking advantage of telehealth, and I think it’s a combination of factors, particularly in rural areas where access to care can be very, very limited,” said Ruth Richardson, president and CEO of Planned Parenthood North Central States, which covers Iowa, Minnesota, Nebraska, North Dakota (which has no physical clinics) and South Dakota, and recently closed eight clinics after the Trump administration froze their federal family planning Title X grant funding. “That is something that we’ve seen as a trend even before the Medicaid defund occurred.”

At the same time, providers and advocates warn that telehealth — the virtual delivery of care using technology from video conferencing, phone- or computer-based apps, to text messaging — still leaves a huge gap in reproductive health care access, especially for patients without reliable Internet or who don’t have the financial resources necessary to participate, like a debit or credit card. Much of the care cannot be delivered virtually, such as treating certain STIs, intrauterine device insertion, performing vasectomies and procedural abortions, which are optional in the first trimester and necessary later in pregnancy.

“There’s a lot of people for whom telemedicine is not an option, and so I think it’s really important to note that it’s not a quick fix,” said Amy Hagstrom Miller, president and CEO of Whole Woman’s Health, which manages five physical clinics in Maryland, Minnesota, New Mexico, and Virginia that specialize in abortion and offer some gynecology services. It also has a virtual care practice in 10 states that offers primarily medication abortion. “It’s not the only fix, right? It’s got to be both and so that people truly have choice.”

Turning to telehealth 

In 2023, one-third of Iowa’s counties were considered maternal health deserts, according to the March of Dimes. That number will likely increase in the nonprofit’s next report. Earlier this year, Planned Parenthood North Central States shrunk its physical presence in Iowa from six to two clinics. The affiliate, Richardson said, stands to lose $11 million from the latest federal Medicaid change, after having served about 27,000 people on Medicaid — about one-third of their total patients — in 2024. 

Richardson said the affiliate’s health centers will continue to serve patients regardless of their insurance status and will work with them to understand their payment options. She said she is expecting their telehealth program to keep growing, especially after shuttering clinics in more rural areas like Bemidji, Minnesota. 

In the past year, the North Central States affiliate reported it saw 4,204 patients during 8,241 visits on the Planned Parenthood Direct app, a 12.9% increase in virtual care visits, and about 5% of the 87,631 total patients seen. Services offered during telehealth visits include birth control counseling and prescriptions, UTI treatment, gender-affirming care, emergency contraception and the abortion pill. Newer virtual care services were launched this past year, related to menopause, sexual wellness and early pregnancy complications.

Planned Parenthood has increased its telehealth presence across the nation in the last two years. Planned Parenthood Direct, launched about a decade ago and expanded nationally in 2019, provides both text-based and video-based care, and accepts Medicaid in some states.

Separately, Planned Parenthood affiliates run virtual health centers, which have expanded to more than 50 nationwide, said a Planned Parenthood Federation of America spokesperson. According to Planned Parenthood’s 2023-2024 annual report, patients booked more than 47,000 appointments through virtual health centers in the last fiscal year, and, on average, virtual health center patients are accessing care more than two days sooner than in-person appointments. Across all telehealth platforms, there were 142,000 appointments made, the spokesperson said. 

In Michigan the most popular Planned Parenthood clinic has no real walls or windows. The virtual clinic launched in 2023, and now sees the highest number of patients compared to the state’s 10 physical health centers, said Ashlea Phenicie, the chief external affairs officer at Planned Parenthood of Michigan, which in April closed three clinics in underserved areas and consolidated two health centers in Ann Arbor because of Title X cuts. 

Phenicie said Michigan’s virtual clinic is always more than 100% booked and offers evening and weekend appointments.

“I think that not only is it filling a need in communities where we don’t have brick-and-mortar health centers, but for many patients, this is how they prefer to access care,” Phenicie said. “It’s convenient. A lot of our patients will do it on their lunch break or, you know, before school or between work and picking up their kids. It lets them fit their health care into their everyday lives. It can also provide a degree of privacy and security. There’s no protesters who walk by when you’re visiting a telehealth provider or getting birth control through the PPDirect app.” 

In a new study in the journal Contraception, researchers from the Guttmacher Institute found that while many publicly funded family planning clinics offer some services via telehealth, Planned Parenthood clinics offer telehealth most frequently, and offer a wider variety of services. The researchers, who surveyed nearly 500 publicly supported family planning clinics, wrote that many health departments and federally qualified health centers need more support and infrastructure to implement telehealth, especially for contraceptive care. They noted that while the benefits of telehealth include convenience, low cost, and improved patient outcomes, difficulties include loss of patient-provider rapport, technology and workflow issues, and regulatory barriers.

And they warned: “If telehealth is implemented inequitably, it may deepen existing disparities.”

Barriers 

Research is still limited when it comes to telehealth delivery of broad reproductive health services. A 2023 study by researchers at Oregon Health & Science University found evidence suggesting telehealth care for intimate partner violence and contraceptive care can produce “equivalent clinical and patient-reported outcomes as in-person care.”

But many reproductive health care advocates and researchers agree that telehealth will likely not be enough to fill the gap left by closing physical clinics, and that there remain many barriers to accessing telehealth generally, related to age, language, financial resources, digital literacy, and access to technology and internet.

In 2023, the National Telecommunications and Information Administration reported that roughly 12% of people lived in households with no internet connection, while a National Digital Inclusion Alliance analysis of 2022 data showed that 24% of households lacked a home internet connection.

Last month the Journal of Medical Internet Research published a study examining telehealth usage patterns of nearly 10,000 adults in rural California that found people who are older, speak Spanish or rely on public insurance struggle the most to access virtual care. The researchers reported that rural health disparities are often more pronounced among rural populations of color, who make up about 20% of rural U.S. residents.

For Elgatian, her occasional use of telehealth has not erased her need for affordable in-person reproductive health care, something she’s currently worried is about to change in Iowa following the new Medicaid rule. In a pinch, her fail-safe — at least until recently — had been Planned Parenthood, the closest being more than an hour away in Iowa City, followed by just one other in-state option: the Des Moines clinic nearly three hours away. But it was the latter clinic that Elgatian was closest to while driving through last year and suddenly bleeding vaginally. It turned out to be related to uterine polyps and her IUD, something she likely wouldn’t have discovered via telehealth.

“I don’t yet know, personally, how this will pan out for me, but it seems likely that there will be a time when I will struggle to find care without being able to use Planned Parenthood,” she said.

Efforts to expand and improve telehealth

Since its founding four years ago, telehealth provider Hey Jane, which is not affected by the government’s new Medicaid exclusion, has provided care to more than 100,000 people and expanded beyond medication abortion to provide birth control, emergency contraception, treatment for vaginal infections, herpes, and UTIs, according to co-founder Kiki Freedman. Hey Jane operates in the District of Columbia and 22 states (California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Hampshire, New Jersey, New Mexico, New York, Ohio, Oregon, Rhode Island, Vermont, Virginia and Washington). It recently became a Medicaid provider for people in Illinois. 

Freedman said their services are offered on a sliding fee scale. And she said the platform allows patients to text with clinicians, which is popular with patients.

“They could be on their couch, watching a movie with their partner by their side, or whomever they need, and then just be chatting with us,” Freedman said. “That’s not something that you could get if you receive care in person and take the medication home with you, and then don’t have those ongoing touch points.”

Freedman said that Hey Jane has already seen an influx in patients since Congress passed the federal tax and spending cut bill and more clinics have closed, and that they are working on becoming Medicaid providers in more states — something that can be challenging for telehealth businesses without a physical facility. 

“We’ve continued to grow really fast over the past several years, and have just been hiring a lot and doing a lot of work on sort of our technical automation so that we can continue to meet the demand that has been rising,” Freedman said. “These acute events, like these terrible clinic closures, have definitely exacerbated that.”

Coming Friday: Democratic-led states try to backfill funding losses.

Correction: This article has been corrected to reflect that the mobile Planned Parenthood Direct app provides both text-based and video-based care.

Jess Deis, a nurse practitioner and nurse midwife in Kentucky and Indiana, learned she had cervical cancer after she qualified for Medicaid insurance in 2014. (Sarah Ladd/Kentucky Lantern)

Third in a five-part series.

It had been a decade since Jess Deis’ last women’s wellness exam when Kentucky expanded Medicaid and she finally qualified for the state insurance program.

Physicians recommend a cervical cancer screening — also referred to as a Pap smear, which is a swab of the cervix — as part of a wellness exam once every three to five years for women between the ages of 21 and 65. Deis, 43, was in her last semester of nursing school in 2014 when the test came back with abnormal results. Her doctor ordered additional testing.

“Then I got a call on a Sunday evening from a physician letting me know I had cervical cancer and I needed to see a specialist,” Deis said.

Cervical cancer is one of few cancers that has a known path of prevention after the approval of the first HPV vaccine in 2006. But that also means it falls at the intersection of three cultural issues that are facing strong political opposition — broad access to low-cost or free reproductive health care, access to vaccines for children, and sex education.

Kentucky had the highest cervical cancer incidence rate in the country between 2015 and 2019, according to medical research, and a mortality rate twice as high as the rest of the country. The state tied with West Virginia for the second-highest rate of 9.7 cases per 100,000 residents between 2017 and 2021. Oklahoma topped the list for that five-year period with 10.2 cases per 100,000, according to the National Cancer Institute.

Deis delayed the surgery to remove her uterus until after graduation, and later became a certified nurse practitioner. Now she provides Pap smears to patients multiple times a day at Planned Parenthood clinics in Kentucky and Indiana and other care via telehealth. She recently helped a patient who hadn’t been seen for a screening in 15 years discover she had advanced cervical cancer.

She is troubled by what could happen in the wake of the new Medicaid rule passed by Congress and signed by President Donald Trump in July that barred nearly all Planned Parenthood affiliates from receiving Medicaid reimbursements because some clinics in the nonprofit network provide abortions. Kentucky and Indiana both have abortion bans, but still have Planned Parenthood clinics to provide other reproductive health care.

“I don’t just worry; I know that there’s going to be more folks with stories like mine, but without the happy ending,” Deis said.

‘What we’re really talking about is our daughters getting cervical cancer’

The American Cancer Society recently reported the number of early cervical cancer cases has declined sharply among young people since the vaccine’s introduction nearly 20 years ago. But vaccine adoption rates for children are low in the states where rates are highest — about one-third of boys and girls between the ages of 13 and 17 were vaccinated in Mississippi as of 2020.

The vaccine is most effective when given before engaging in any kind of sexual activity for the first time, because it can prevent the sexually transmitted strains of HPV that present the highest risk of cervical cancer. More than 98% of cervical cancer cases are caused by HPV, and a 2024 study from the Journal of the National Cancer Institute found zero cases of cervical cancer in Scottish women born between 1988 and 1996 who were fully vaccinated against HPV between the ages of 12 and 13.

“We could make (cervical cancer) an eradicated disease,” said Dr. Emily Boevers, an Iowa OB-GYN. “But everything is falling apart at the same time.”

Boevers said limitations on Medicaid coverage and the loss of Title X family planning funding will make screenings and vaccines less accessible for the populations that need them the most, even if clinics don’t close as a result. But it will take years to see the consequences of these changes, she said, because it takes about 15 years on average for HPV to become cancer. 

“So what we’re really talking about is our daughters getting cervical cancer,” she said. 

Kentucky’s legislature acknowledged the importance of HPV vaccines as recently as 2019, when representatives passed bipartisan House Resolution 80, which encouraged females and males between the ages of 9 and 26 to get the HPV vaccine and everyone to “become more knowledgeable of the benefits of the vaccine.” Only four legislators voted against it.

But today, the U.S. Department of Health and Human Services is led by Secretary Robert F. Kennedy Jr., who has made false statements about the HPV vaccine’s safety and effectiveness and played a leading role in organizing a mass lawsuit against one of the vaccine’s manufacturers, Merck. The Associated Press reported the judge dismissed more than 120 claims of injuries from Gardasil, the name of one HPV vaccine, because of a lack of evidence. 

“Secretary Kennedy supports renewing the focus on the doctor-patient relationship and encourages individuals to discuss any personal medical decisions, including vaccines, with their healthcare provider,” a Health and Human Services spokesperson wrote to States Newsroom in September. “The American people voted for transparency, accountability, and the restoration of their decision-making power, and that is exactly what HHS is delivering.”

The response did not clarify whether Kennedy still thinks the vaccine is unsafe and what basis there is for that claim. 

Dr. Linda Eckert, a University of Washington School of Medicine professor and practicing OB-GYN, has an extensive background in immunizations and cervical cancer prevention. She served as a liaison for the American College of Obstetricians and Gynecologists to the CDC’s Advisory Committee on Immunization Practices until 2024. Members of the committee were recently dismissed by Kennedy’s agency and replaced by new members, several of whom have reportedly expressed anti-vaccine views. Eckert said the group had plans in motion to present to the ACIP in June a case for administering the HPV vaccine at the earliest age of 9 before it was disbanded. 

Although Black and Hispanic women are affected by cervical cancer at disproportionate rates because of systemic inequities, Eckert said the fastest rising group experiencing late-stage cancer is white women in the Southeast. But she added that Alabama was the first state in the country that launched a targeted campaign to eliminate cervical cancer. 

Treatment for the cancer once it develops can also be difficult to obtain, Eckert said. It can be expensive and require many follow-up visits, and usually leads to infertility either through hysterectomy or invasive radiation treatments. 

“It is a really devastating disease to treat,” Eckert said. “Even if you live, you are permanently changed.”

Recent study showed zero cases of cervical cancer after HPV vaccine 

Dr. Aisha Mays, founder and CEO of a Dream Youth Clinic in Oakland, California, said the services her clinic offers to young people for free includes most of the same services that Planned Parenthood clinics provide, including the HPV vaccine.

“That’s the work of Planned Parenthood and clinics like mine that are encouraging and doing regular Pap smear screenings and vaccines, and having really clear conversations with young people around the importance of these procedures,” Mays said.

The recent turn against vaccines by some segments of the public and members of President Donald Trump’s cabinet who doubt their effectiveness and baselessly claim that they cause injury and developmental issues like autism has made the promotion of HPV vaccines more difficult for Mays. Overwhelming evidence, including from the Centers for Disease Control and Prevention, shows that they are safe and effective.  

The vaccine can also protect against genital warts, anal cancer and oropharyngeal cancer, Mays said. There are about 40 strains of HPV in total that are known to infect the genitals, and more that can attach to certain patches of skin. Most people who have sex will come in contact with one or more of the strains by the time they reach their mid-20s or early 30s.

Mays’ clinic is largely funded by state and local grants, but it received more than $100,000 in federal funding for a sexual health education program through the U.S. Department of Health and Human Services’ Office of Population Affairs. It was a nationally distributed podcast hosted by adolescents, Mays said, and they chose topics to talk about related to sexual health, including HPV.

The program’s grant was one of many that have been cancelled under the Trump administration. An objective laid out in Project 2025, the blueprint document for the next Republican presidency written by conservative advocacy group the Heritage Foundation, was to ensure no subgrantees of sex education programs were promoting abortion or “high-risk sexual behavior” among adolescents. It also stated that any programming should not be used to “promote sex.”

HHS also terminated funding for one of California’s sexual health programs in August over the state’s refusal to remove references in the programming related to gender, including the idea that biological sex and gender identity are distinct concepts. Another directive of Project 2025 was to make sure biological sex is never conflated with gender identity or sexual orientation.

States with high rates of cervical cancer have low density of physicians

States with the lowest incidences of cervical cancer, including Massachusetts, New Hampshire, Connecticut and Minnesota, also have the highest density of physicians per capita. According to the Association of American Medical Colleges’ state physician workforce data, Massachusetts has the highest number of physicians per 100,000 people, and Oklahoma ranks in the bottom three.

Kentucky is in the bottom 15, and so is Indiana, where Marissa Brown works as a Planned Parenthood health center manager in Bloomington. Brown described her clinic as “an oasis in a desert” because there are few options for gynecological care in the area, and even fewer for obstetrics. Brown said they routinely see patients from rural areas two or more hours away, and many of them are coming for wellness exams that include cancer screenings.

Indiana used to have 38 Planned Parenthood clinics, but through 15 years of funding cuts and targeted anti-abortion legislation, the organization closed 21 of them between 2002 and 2017. In the years since then, another seven shut down to consolidate services. Many of them did not provide abortions.

“We hear a lot about patients coming in who can’t get into their gynecologist for four to 12 weeks,” Brown said. “We can do that in a few days to two weeks, and we have walk-in appointments too.”

Health Imperatives, a nonprofit network of seven community health clinics in southern Massachusetts, can no longer bill for Medicaid because they provide medication abortions and received about $800,000 in reimbursements for other services in 2023, like Planned Parenthood. One of Health Imperatives’ clinics is in Martha’s Vineyard, whose working-class residents have to work three to four jobs just to afford to live on the affluent island, said Julia Kehoe, the organization’s president and CEO.

More than a decade ago, she said she noticed a pattern: Their patients would come in for an annual gynecological exam, receive an abnormal cervical cancer screening, but not follow up, because the closest available specialist would require expensive travel off the island. Kehoe said that once their Martha’s Vineyard clinic purchased a colposcopy machine, from privately raised funds, in 2012, they started diagnosing some of their regular patients with now-advanced cancer.

“In the first year that we did colposcopies, we found four individuals who had stage three or four cancer, who we luckily were then able to connect up to Boston for critical care,” she said. “But if we had had that capacity earlier … we would have caught it earlier.”

States Newsroom reproductive rights reporter Sofia Resnick contributed to this report.

Coming Thursday: Telemedicine could help narrow the care gap in rural communities.

Child abuse, neglect or endangerment laws were used to charge hundreds of pregnant people with crimes in the two years after the U.S. Supreme Court overturned Roe v. Wade, underscoring the rise of fetal personhood laws, according to a new report. (Getty Images)

More than 400 people were charged with pregnancy-related crimes during the two years after the U.S. Supreme Court overturned federal abortion rights, research released Tuesday shows.

Prosecutors across the country often charged people with some form of child neglect, endangerment or abuse based on allegations of substance use during pregnancy, according to an annual report from the nonprofit Pregnancy Justice. 

Nearly three dozen cases were brought against people who miscarried or delivered stillborns, and in nine cases, pregnant people were accused of obtaining, attempting or researching abortion. 

“Prosecutors are wielding criminal laws to surveil and criminalize pregnant people, their behavior and their pregnancy outcomes,” Dana Sussman, Pregnancy Justice’s senior vice president, told States Newsroom.

Although charges against those experiencing pregnancy loss are less common, Sussman said she fears they could lead people to avoid seeking miscarriage care. 

For instance, a woman who miscarried at home was charged with abuse of a corpse in September 2023, Ohio Capital Journal reported. 

Brittany Watts was around 21 weeks pregnant when she went to the hospital but waited for hours and didn’t get help, according to the Capital Journal, and after she miscarried at home, she returned to the hospital, where staff called police. She was never indicted, and she filed a federal lawsuit in January against the city of Warren, police, hospital officials and hospital staff. 

“Rather than being able to grieve her loss, she was taken away in handcuffs. She was interrogated in her hospital bed while she was still tethered to IVs, and so she wants compensation for her own trauma, but most importantly, wants to make sure that this doesn’t happen to anyone else,” Rachel Brady, Watts’ attorney, told States Newsroom in June.

Watts’ lawsuit alleges local law enforcement and the hospital violated the Fourth and Fourteenth Amendment and the Emergency Medical Treatment and Active Labor Act (EMTALA), which requires hospitals that receive Medicare funding to provide stabilizing medical treatment regardless of a person’s ability to pay or insurance status. The defendants denied liability and the plaintiff’s claims, according to court documents filed in September. 

In this year’s report, pregnancy-related cases cropped up in 16 states, and states with strict abortion bans topped the list again: Alabama (192), Oklahoma (112) and South Carolina (62).

“If you are doing anything that exposes your pregnancy, your fetus to some real risk, perceived or assumed risk, in certain parts of the country, that is a felony,” Sussman said. 

Fetal personhood — the notion that fetuses, zygotes and embryos should have the same legal rights as human beings — comes into play when pregnant people struggling with addiction are drug tested during checkups or at labor and delivery units, Sussman said. 

“In several states, it’s become relatively common practice for people to be charged with a felony for child endangerment or neglect for simply testing positive” on toxicology tests, Sussman said. “And that carries years in prison, and of course, immediate family separation from your newborn and even from your other children in your home, in your family.” 

An investigation by The Marshall Project, Mississippi Today and three other news outlets in 2023 found that local law enforcement and prosecutors in Alabama, Mississippi, Oklahoma and South Carolina applied child abuse and neglect laws to fetuses when pursuing charges against pregnant women. 

Lawmakers in a few states have pitched legislation seeking to curb punitive approaches to addiction among expectant and new mothers. 

A bill advancing in the New York Legislature would require informed consent for drug testing and screening pregnant and postpartum patients unless it’s medically necessary. Legislation took effect in Washington state this summer that prevents the criminalization of pregnancy loss, and requires officials at jails, prisons and immigrant detention centers to report miscarriages and stillbirths to the state annually. Massachusetts legislators passed a law in December that prevents medical professionals from automatically referring substance-exposed newborns to the state Department of Children and Families. 

Prosecutors obtained information about pregnancy-related crimes from health care facilities in 264 out of 412 cases, even in incidents that did not allege substance use, according to the Pregnancy Justice report.

“If people are worrying about losing their children because of family separation through the child welfare system or by going to jail, they are not going to get the care that they need,” Sussman said. “Pregnancy is seen as a moment and a window of opportunity for people to get care. People are motivated, uniquely motivated, and we really squander that opportunity when we turn health care into a place of reporting.”