Federal health officials temporarily froze Title X family-planning funds for some Planned Parenthood clinics, which provide reproductive health services ranging from birth control to STI testing, across the nation this week. (Photo by Michael M. Santiago/Getty Images)
More than 1 million people seeking care such as contraception or testing for sexually transmitted diseases and cancer could be affected by the Trump administration withholding more than $27 million in Title X funding to Planned Parenthood clinics nationwide, according to estimates from the Guttmacher Institute.
Planned Parenthood state affiliates said they were notified that the funding they receive under the Title X family-planning program would be temporarily frozen, Politico first reported Monday night.
The U.S. Department of Health and Human Services, which is responsible for managing and distributing Title X funds, told States Newsroom via email that it is reviewing all Title X grant recipients to make sure they comply with federal law and President Donald Trump’s executive orders. The department is concerned about “the compliance of several awardees” that together receive $27.5 million, according to an HHS spokesperson, who added, “HHS expects all recipients of federal funding to comply with federal law.”
Letters received by some affiliates detailed possible violations of federal civil rights laws and executive orders recently issued by Trump, including the administration’s efforts to prohibit diversity, equity and inclusion initiatives and provide care regardless of a person’s immigration status.
“It is difficult to overstate how ridiculous it is that the administration is premising this funding freeze on a ‘DEI review,’” said Amy Friedrich-Karnik, Guttmacher’s director of federal policy, in a statement. “The entire point of the Title X program is to address disparities in access to contraception and other sexual and reproductive health care, including serving people with low incomes and those from other historically underserved communities. We need to see this for what it is — a direct attack on health equity.”
The Title X program was established in 1970 to provide reproductive health care for anyone who needs it. Federal law prohibits use of federal funds for abortion. Planned Parenthood clinics offer a broad range of non-abortion services.
No final decisions have been made regarding Title X funding for Planned Parenthood.
Affiliates in Alaska, California, Idaho, Hawaii, Maine, Mississippi, Missouri, Montana, Oklahoma, Tennessee, Utah and others reported receiving the notification, representing thousands of people served at each clinic every year and millions in funds. Guttmacher’s data shows that 83% of people who visited Title X-funded clinics in 2023 had family incomes at or below 250% of the federal poverty level.
In Missouri and Oklahoma alone, Title X funding totals nearly $8.5 million, according to a news release from Missouri Family Health Council.
“Withholding these critical funds, even temporarily, threatens the essential sexual and reproductive health care communities depend on,” said Michelle Trupiano, executive director of the council.
Kat Mavengere, spokesperson for Maine Family Planning, said the agency also received notice of a freeze affecting $1.92 million in funds. Planned Parenthood of Northern New England is a sub-grantee of Maine Family Planning. Mavengere told States Newsroom the notice from HHS identified two items on their website “related to documents that detail our commitment to health equity” as reasons for the funding review.
Nicole Clegg, CEO of the Northern New England Planned Parenthood affiliate, said it receives about $900,000 in funds between Maine and New Hampshire from the family-planning organization.
If people can’t seek basic reproductive health services at no cost, including wellness exams, Clegg said they go without.
“We’ve seen that. When Planned Parenthoods leave communities, the data just speaks to increases in STI transmission, increases in unintended pregnancy … there are very real consequences to a community when we’re no longer there,” Clegg said.
A recent poll conducted by Perry Undem showed 77% of respondents were opposed to the idea of the Trump administration cutting funding for services like birth control for people with low incomes.
During his first term, Trump also cut Title X funds to clinics that provided abortions or referred people for abortions in 2019, causing one-third of participating providers to leave the program, according to KFF. The Biden administration reversed the policy two years later.
The U.S. Supreme Court is scheduled to hear arguments Wednesday in a case that will determine whether South Carolina government officials can remove Planned Parenthood clinics from the state’s Medicaid program because the organization provides abortions. If the court rules in South Carolina’s favor, other states that have tried to drain the organization’s funding for decades may follow suit.
Anti-abortion organizations celebrated the news of the Title X freeze for some Planned Parenthood clinics on Tuesday, including Susan B. Anthony Pro-Life America, which has been pushing efforts to “defund” Planned Parenthood in recent weeks in its fundraising emails. SBA was also involved in the drafting of the Heritage Foundation’s blueprint for the next conservative presidency, Project 2025, and identified this action as a priority.
“This is a big step in the right direction,” President Marjorie Dannenfelser told States Newsroom in a statement. “We thank President Trump for this bold action and urge further steps to eliminate all taxpayer funding for Planned Parenthood.”
Multiple Republican-led states have sued to rescind a federal rule keeping the records of those who sought legal reproductive care private, while a federal judge in Texas is questioning the constitutionality of the federal HIPAA law in its entirety. (Photo by Wichayada Suwanachun/Getty Images)
The decades-old federal law protecting the privacy of individual health information is threatened by multiple lawsuits that seek to throw out a rule restricting disclosure of information in criminal investigations, including for those seeking legal abortion and other reproductive health care.
In one of the cases, the Texas federal judge who has been at the center of several anti-abortion court battles appears to question the constitutionality and legality of the health privacy act in its entirety.
The Health Insurance Portability and Accountability Act — or HIPAA — established in 1996 to protect the privacy and security of patient health information, includes some exceptions under limited conditions, such as law enforcement investigations. But after the U.S. Supreme Court ended federal abortion rights in 2022 and more than a dozen states passed abortion bans, advocates worried that such records could be used by state officials and law enforcement to investigate and prosecute patients seeking an abortion and those who help them.
Health officials under former President Joe Biden’s administration enacted a HIPAA rule to keep health information private when the patient was in a state with legal access and the care was obtained legally. In order to release information related to this type of care, the entity subject to HIPAA rules must sign a document stating it is not released for one of the prohibited purposes.
“These cases may have been prompted by this newer rule, but they threaten more broadly the entire HIPAA system on which we all rely when accessing medical care,” said Carrie Flaxman, senior legal adviser for Democracy Forward, a nonprofit legal organization.
Two lawsuits seek to rescind that most recent rule, while another brought by Texas Attorney General Ken Paxton goes a step further, asking the court to remove the general rules established in 2000 about how much health information can be disclosed to law enforcement.
“The threats to the 2000 privacy rule would be a seismic shift that could erode patients’ trust entirely in their providers and dissuade them from wanting to seek out health care and be transparent about their symptoms,” said Ashley Emery, a senior policy analyst for the nonprofit Partnership for Women and Families. “A law enforcement officer could pressure a psychiatrist to share patient notes from therapy sessions without a subpoena, without a warrant, if the 2000 privacy rule is invalidated.”
The state of Missouri sued to rescind the Biden rule in January, and the state of Tennessee filed a similar action the same day that 14 other Republican attorneys general joined as plaintiffs: Alabama, Arkansas, Georgia, Idaho, Indiana, Iowa, Louisiana, Montana, Nebraska, North Dakota, Ohio, South Carolina, South Dakota and West Virginia. All but three of those states either heavily restrict or outright ban abortion, and if the lawsuits are successful, records kept by doctors and pharmacists in other states could be subpoenaed.
All of the lawsuits are filed against the U.S. Department of Health and Human Services, which is now under Republican President Donald Trump and HHS Secretary Robert F. Kennedy Jr. The Trump administration has so far followed the direction of the conservative Heritage Foundation’s Project 2025, which calls for the most recent HIPAA rule to be rescinded.
Amarillo judge ordered briefing on HIPAA’s constitutionality and legality
Three cases are still in motion, including one with a physician as the plaintiff. Dr. Carmen Purl, the sole owner of Dr. Purl’s Fast Care Walk In Clinic in Dumas, Texas, sued HHS because she said the rule creates a conflict with the laws requiring her to report child abuse.
“I consider both a pregnant woman and her unborn child to be human persons, and both are entitled to medical care and deserve the protection of the law,” Purl said in court documents. “I believe … that elective abortions harm patients’ health and public health.”
U.S. District Judge Matthew J. Kacsmaryk
The location of Purl’s clinic puts her in the judicial district that has only one federal judge — U.S. District Judge Matthew Kacsmaryk, a Trump appointee. Most federal cases are assigned randomly to a group of judges in a district, but since Kacsmaryk is the only one, many advocates and attorneys have accused law firms like Alliance Defending Freedom, who is representing Purl in the case, of “judge shopping,” or finding a plaintiff in a certain area for the purpose of putting it in front of an ideologically friendly judge.
On Dec. 22, Kacsmaryk granted an injunction blocking enforcement of the rule against Purl while the case proceeds, and he is still considering whether to permanently block the law.
As part of the decision, Kacsmaryk also ordered the parties to submit briefs explaining how recent U.S. Supreme Court rulings that delegate more authority to Congress over administrative agencies “affect the constitutionality or legality of HIPAA and HHS’s authority to issue the 2024 rule.”
Kacsmaryk presided over a lawsuit in 2023 brought by a group of anti-abortion doctors seeking to revoke the U.S. Food and Drug Administration’s approval of mifepristone, one of two drugs commonly used to terminate pregnancies in the first trimester and to treat miscarriages. Kacsmaryk ruled in favor of removing its approval, but the U.S. Supreme Court unanimously overruled him in 2024.
Purl added that she thinks gender-affirming care is harmful to children, never medically necessary and a matter of concern for public health, though she has never treated a child with gender dysphoria. In the process of providing routine medical care, she said she could learn that a child was being subjected to gender-affirming treatments or procedures that could constitute child abuse, and she would be obligated to report it.
Purl’s clinic has fewer than 20 employees, and she has been licensed to practice family medicine in Texas since 1986. In that time, she said she has treated many patients who have been victims of abuse and neglect, and estimates she has personally treated more than 100 pediatric patients who were victims of sexual abuse.
“I have treated hundreds of girls under the age of consent who were either pregnant or reported sexual activity. During my career, I have delivered babies from mothers as young as 12 years old,” Purl wrote.
Purl said she has responded to Child Protective Services investigations between 10 and 12 times, and she fears that providing full, unredacted patient records in response to an entity such as CPS would violate the 2024 rule and subject her and the clinic to civil and criminal penalties, which often means hefty fines.
In a response filed by HHS in December, before Trump’s second term began, the department said the rule does nothing to prevent Purl from reporting suspected child abuse, and denied the other harms Purl said she would incur.
“Given the nature of her medical practice, Dr. Purl is highly unlikely to ever encounter a conflict between her obligations under state law and under the Rule,” the department said in court documents.
AGs from ban states are testing newly enacted shield laws
The Texas case led by Paxton has been on hold since February, after the U.S. Department of Justice asked the court to delay scheduling until the new administration could determine how to proceed. U.S. District Judge James Wesley Hendrix, a Trump appointee, ordered the parties to file a status report by May 1.
Attorneys general in states with abortions bans have already attempted to prosecute providers in other states for prescribing abortion pills via telehealth and prosecute women who obtained an abortion in another state without the consent of a male partner. Louisiana Gov. Jeff Landry signed an extradition warrant for a doctor in New York for prescribing and mailing abortion pills to residents of the state.
New York is one of 17 Democratic-led states that has a shield law to protect providers and patients from out-of-state legal actions for reproductive care and gender-affirming care, and the state government has so far refused to comply with Louisiana’s law enforcement efforts.
The coalition of states that joined Tennessee’s lawsuit claim the privacy rule harms their ability to investigate cases of waste, fraud and abuse, and “sharply limits state investigative authority.”
Chad Kubis, spokesperson for Tennessee Attorney General Jonathan Skrmetti, told States Newsroom via email that the office could not comment for this story because of the ongoing litigation.
“The final rule will hamper states’ ability to gather information critical to policing serious misconduct like Medicaid billing fraud, child and elder abuse, and insurance-related malfeasance,” the complaint says.
Attorneys at Democracy Forward have asked the courts to allow the clients they are representing to intervene as defendants in all four cases, arguing that the new administration is likely to either not defend the cases at all or defend them inadequately. They are representing the cities of Columbus, Ohio, and Madison, Wisconsin, as well as Doctors for America, an activist organization of physicians and medical students. None of the judges have ruled on their motions yet.
Partnership for Women and Families filed an amicus brief with 23 other advocacy organizations to support upholding the rule.
“We can’t count on the Trump administration to defend this regulation, given its longstanding record of hostility toward reproductive health and rights,” Emery said.
It’s possible the new leadership at HHS will rescind the 2024 rule, Emery said, but the lawsuits alone are concerning enough because of the threat posed to privacy protections. That’s part of the goal, said Emery and Flaxman — to present the threat and sow fear and intimidation in patients and providers. And the method of launching multiple lawsuits in various jurisdictions fits a pattern that has been observed in the fight for abortion rights, Emery said.
“Anti-abortion extremists’ legal campaign against HIPAA’s reproductive health privacy protections is designed to test out different legal venues and arguments to obtain the most favorable outcome possible,” she said.
Doctor who has been investigated before says intimidation tactics have an effect
Indiana OB-GYN Dr. Caitlin Bernard knows what it’s like to be the target of an investigation, and said she’s still in court fighting new attempts to instill fear in doctors and patients.
Indiana Dr. Caitlin Bernard waits for a question from the Attorney General’s Office at a medical licensing hearing on May 25, 2023. (Photo by Whitney Downard/Indiana Capital Chronicle)
Bernard was an abortion provider in Indiana before the state enacted its ban in August 2023. She reported in 2022 that she had provided a medication abortion to a 10-year-old rape victim who traveled to Indiana from Ohio when the state briefly had a ban in place. She was accused of violating patient privacy laws and investigated by Indiana Attorney General Todd Rokita, and the state licensing board fined her $3,000 and reprimanded her for the incident after Rokita asked the board to revoke her license to practice medicine. She was not found to have violated patient privacy and kept her license.
“Now my case is held up as an example of what can happen to you if you speak out about abortion bans,” Bernard said. “I’ve spoken to many physicians across the country who are intimidated by that. They say, ‘Look at Dr. Bernard and what happened to her.’”
Now, Bernard is part of a lawsuit against the state to categorize terminated pregnancy records as medical records in state law that cannot be released to the public. Indiana has historically treated abortion reports as public record with certain details redacted, but Bernard said with the ban in place and so few people qualifying for its limited exceptions, that policy should change. The records include demographic information like age, ethnicity and education level, as well as information such as diagnoses and the date, location and physician who provided care.
“It also includes the county, so you could imagine in these very small counties, somebody could absolutely figure out who that person is,” Bernard said.
Ashley Emery, senior policy analyst at Partnership for Women and Families, said the lawsuits take aim at a deeply needed line of defense against abortion criminalization, and said it will disproportionately affect immigrants, people of color and low-income populations. Trust is already low between marginalized people and health care providers, Emery said, and this would further erode that trust.
“These challenges to HIPAA are designed to take protections away from patients and try to allow anti-abortion politicians to have more control, and I think that power deficit is really important to note, and it should be very chilling,” she said.
A volunteer clinic escort holds a sign outside a Planned Parenthood clinic in Columbia, South Carolina, on Friday, March 28. (Photo by Skylar Laird/SC Daily Gazette)
U.S. Supreme Court justices will hear arguments Wednesday about whether South Carolina can remove Planned Parenthood clinics from the state’s Medicaid program because they offer abortions in a case that could imperil health care options for patients with low incomes.
At the center of the lawsuit is a conflict over whether a section of the Medicaid Act gives people who use Medicaid the right to choose their providers.
“While it might be just South Carolina’s name on this court case, it will have huge impacts nationwide,” said Vicki Ringer, Planned Parenthood South Atlantic’s director of public affairs in the state. “It will allow all of these red states that have been trying so hard to close down Planned Parenthood, and it will take away medical care for so many low-income people throughout our region of the country.”
Opponents of Planned Parenthood said Republican South Carolina Gov. Henry McMaster should be able to direct Eunice Medina, the new head of the state Department of Health and Human Services, to remove the organization’s Charleston and Columbia clinics from the list of qualified Medicaid providers.
If the court rules broadly, it could allow other states to make the same move — and some already have. The case is also part of a broader strategy across the country to drain Planned Parenthood funding for all services, including reproductive health care aside from abortion. Efforts by abortion-rights opponents to do so go back decades in the United States.
Republican President Donald Trump’s administration has taken interest in the case, Medina v. Planned Parenthood South Atlantic. The acting U.S. solicitor general will argue in favor of South Carolina health officials during a portion of the Supreme Court hearing this week.
Lawyers for Alliance Defending Freedom, a conservative advocacy firm instrumental in majoranti-abortion cases that have appeared before the Supreme Court, represent South Carolina officials in the lawsuit.
“This case is about whether states have the flexibility to direct Medicaid monies to best benefit low-income women and families,” John Bursch, senior counsel and vice president of appellate advocacy at Alliance Defending Freedom, said in an email.
Planned Parenthood’s two South Carolinaclinics offer abortion up to six weeks in compliance with state law. But staff also provide birth control, emergency contraception, prenatal and postpartum exams and STI testing and treatment, among other services.
“Being able to deny Medicaid patients the ability to select their own qualified provider tells low-income women, especially, that once again ‘You’re not important. Your decision-making doesn’t matter. We are here to decide for you what is best,’” Ringer said.
The picture in South Carolina
McMaster’s executive order against clinics that also offer abortions — deeming them “unqualified to provide family planning services” — has been blocked by lower courts since 2018. Throughout a nearly seven-year court battle, appellate judges have repeatedly ruled in favor of Planned Parenthood South Atlantic, and the Supreme Court has rejected requests to take up the case — until now.
“South Carolina has made it clear that we value the right to life. Therefore, taxpayers should not be forced to subsidize abortion providers who are in direct opposition to their beliefs,” McMaster said in a Feb. 10 statement.
Nearly half — 48% — of South Carolinians surveyed in May 2024 oppose the six-week ban that’s in place, while 31% support it, and the rest were not sure or refused to answer, according to a Winthrop University poll last year.
Arguments in the case over Medicaid funding for South Carolina Planned Parenthood clinics are unfolding against a backdrop of ongoing efforts to drain funding state by state, and in Congress. (Photo by Skylar Laird/SC Daily Gazette)
Ringer said South Carolina lawmakers’ anti-abortion positions are at odds with residents’ views on the issue.
“It’s political pandering, but it’s to a population that doesn’t agree with them,” she said. “They think because they’re elected, then that means we’re an anti-abortion, so-called ‘pro-life’ state.”
Like many states, South Carolina only allows Medicaid coverage of abortion in cases of rape, incest or to save a patient’s life.
Julia Walker, a spokesperson for the regional affiliate, said 10% of patients who routinely visit the South Carolina clinics for family-planning services use Medicaid.
Just 0.2% — $88,464 — of the $35 million the state spent on Medicaid-covered family-planning services went to Planned Parenthood in the 2022-2023 fiscal year, SC Daily Gazette reported. Medicaid is a reimbursement program, meaning providers foot the bill and seek at least partial reimbursement for an appointment or procedure.
A case study in Texas
Arkansas, Missouri and Texas — Republican-led states — have ended some clinics’ Medicaid eligibility for reproductive health care services because they provided abortions at one time or are affiliated with Planned Parenthood.
Still, clinic doors remain open in those states, despite ongoing lawsuits and right-wing wrangling that blocked Medicaid patients.
“Let’s be clear about where Texas was even before they cut Planned Parenthood out of Medicaid,” said Melaney Linton, president and CEO of Planned Parenthood Gulf Coast, which still has six locations in the greater Houston area. “Texas already was suffering some of the nation’s worst rates of maternal and infant mortality, and highest under and uninsured populations.”
Most of Houston is in Harris County, an area that has one of the highest Black maternal death rates nationwide. Black women in the county had a pregnancy-related mortality rate of 83.4 deaths per 100,000 live births from 2016 to 2020, according to a report last year.
The maternal mortality rate in Texas from 2018 to 2021 was 28.1, compared with 23.5 nationwide, according to federal data.
A judge ruled in March 2021 that Texas could stop Planned Parenthood from receiving Medicaid funds. Linton said the state’s actions cut off an estimated 8,000 Planned Parenthood patients.
“Politicians like to talk about how they care about women and infants and families,” Linton said. “If they did, they would do everything they can to make sure that women have more access to birth control, not less.”
Six months after Texas suspended Planned Parenthood’s Medicaid funds for reproductive health care services, the state enacted a six-week abortion ban. Teen birth rates skyrocketed in Harris County and across the entire Lonestar State for the first time in 15 years, data shows.
Linton said what happens in Texas is often replicated in other parts of the country, and the same will probably hold true for the South Carolina case before the U.S. Supreme Court this week.
“Every American should be concerned about that,” she said.
But public clinics are struggling financially, said Dr. Katherine Farris, the chief medical officer at Planned Parenthood in the Carolinas and the Virginias, in a news conference Friday. A patient may have to wait three months for an intrauterine device appointment at some of them, but at Planned Parenthood, she said, the patient can walk in and get an IUD insertion the same day.
Ringer and Linton also said finding a provider that accepts Medicaid and can see a new patient promptly is not so simple.
“Doctors who at one time did take Medicaid aren’t anymore. It is a losing prospect for many providers,” Ringer said. “I’ve seen what Medicaid reimburses, and for many of the services we provide, we lose money on them. But because we are a safety-net provider, that means we provide care to people no matter what. If you can or can’t pay, we are going to take care of you.”
South Carolina and Texas are 2 of 10 states that have not expanded Medicaid under the Affordable Care Act passed in 2010, Stateline reported.
When Planned Parenthood’s Texas affiliates were removed from Medicaid eligibility, Linton said the Gulf Coast staff tried to connect their Medicaid patients to other health care providers.
“Unfortunately, what our patients told us is that sometimes it took them three months or more calling around the 20 or 30 practices to find someone who would even take them. Many times they didn’t provide the birth control method that that patient had been accustomed to receiving,” Linton said.
Bursch and other Alliance Defending Freedom attorneys argue that if Planned Parenthood stopped providing abortions in South Carolina, Medicaid funding could be restored.
Planned Parenthood Federation of America attorney Catherine Peyton Humphreville said that South Carolina does allow some abortions to be provided in the state.
“At no point has anyone asserted that Planned Parenthood South Atlantic is not complying with South Carolina law,” Humphreville said.
No one has questioned the quality of care that the organization provides, they said, and the idea that Planned Parenthood can be punished for simply advocating abortion “has serious First Amendment issues.”
On Capitol Hill
Anti-abortion Republicans in Congress are pushing bills to “defund Planned Parenthood” and other abortion providers, including independent clinics, nationwide. Unlike previous sessions when Congress faced gridlock, legislation could advance this year given the GOP trifecta of power in Washington, D.C.
U.S. Missouri Sen. Josh Hawley filed legislation on Jan. 16 that would prohibit federal funding from going to organizations that provide abortions, referrals and the like, with the stated intention of cutting funds from “Planned Parenthood and abortion providers across the nation.” A 2019 rule passed by the Trump administration blocked $60 million in federal funds from flowing to the organization, Hawley said, before the rule was rescinded under Biden.
The Hyde Amendment, a provision approved annually by Congress since 1977, already prevents federal funds from covering the costs of abortion unless the pregnancy stemmed from rape or incest, or the patient could die in child birth.
Planned Parenthood Federation of America President and CEO Alexis McGill Johnson said the organization is prepared to defend itself from both state-level and national attacks.
“The most immediate focus is going to be on the Medicaid defund [bills] in Congress, and that has a direct tie to the Supreme Court case,” McGill Johnson said. “That fight looks like doing everything we can to defeat, delay, to litigate, to mitigate every effort that is trying to put sexual and reproductive health care out of reach.”
Jayanta Bhattacharya, President Donald Trump's nominee to be director of the National Institutes of Health, speaks at his confirmation hearing before the Senate Committee on Health, Education, Labor and Pensions on Capitol Hill on March 5, 2025 in Washington, D.C. (Photo by Andrew Harnik/Getty Images)
This report was updated at 7:59 p.m. EDT.
WASHINGTON — The U.S. Senate confirmed President Donald Trump’s nominees to lead the Food and Drug Administration and the National Institutes of Health.
Senators voted 53-47 along party lines Tuesday evening to confirm Jayanta Bhattacharya as director of the NIH before voting 56-44 to approve Martin Makary as FDA commissioner.
Democratic Sens. Dick Durbin of Illinois as well as Maggie Hassan and Jeanne Shaheen of New Hampshire were the only three members of their party to vote for Makary.
Shaheen said during an interview Wednesday that while she has reservations about how the Trump administration might try to change access to medication abortion, she felt Makary was qualified to lead the FDA.
“Well, I’m very concerned about what this administration might do about mifepristone,” Shaheen said. “But, I thought it was important to have someone in that role who has the scientific background and ability to run the agency.”
Hassan declined to answer questions about her vote when asked about it Wednesday afternoon by States Newsroom. Her office declined to send a written statement from the senator, offering only a response from a spokesperson.
“The opioid epidemic has devasted communities across New Hampshire, and the FDA has made mistakes over the years that fueled this epidemic,” the spokesperson wrote in an email. “Senator Hassan voted for Dr. Makary as Commissioner of the FDA following his clear commitment to ensuring that the agency learns from its past mistakes and acts aggressively to tackle this crisis.”
Senate confirmation came just weeks after the Health, Education, Labor and Pensions, or HELP, Committee voted to advance Makary and Bhattacharya.
Sen. John Hickenlooper, D-Colo., voted in committee to send Makary’s nomination to the floor, but switched to opposing his confirmation on Tuesday.
Hickenlooper said during a brief interview with States Newsroom on Wednesday that he ultimately couldn’t support Makary over his comments about medication abortion. But he said nothing significant happened between his yes vote in committee and his no vote on the floor.
“I agonized over it. I could have easily gone back and voted yes,” Hickenlooper said. “You know, at some point when I see him, I’ll apologize and say, ‘You know, that was a hard vote for me. But I really wish you would have been more demonstrative about specifically mifepristone, because I think that’s a big issue that the FDA is going to take on.’”
Hickenlooper said he spoke with his staff and his wife over Makary’s comments about access to medication abortion before he cast his no vote on the Senate floor.
“I realized that he serves at the pleasure of the president, so what the president says he’s probably going to have to do,” Hickenlooper said. “But for me, I just became more and more uncomfortable that he wouldn’t make a few statements to say that, you know, this is not something that is a medical reinterpretation for political purposes. He should have said something.”
Abortion pill
Makary will have considerable authority at the FDA to determine if access to medication abortion remains as it is now, if the agency changes prescribing guidelines, or even pulls its approval.
During his confirmation hearing in early March, Makary testified he hadn’t yet decided how he would approach that aspect of the job.
“I have no preconceived plans on mifepristone policy except to take a solid, hard look at the data and to meet with the professional career scientists who have reviewed the data at the FDA,” Makary said at the time.
Medication abortion is a two-drug regimen consisting of mifepristone and misoprostol that accounts for about 63% of all pregnancy terminations within the United States, according to research from the Guttmacher Institute.
The FDA originally approved mifepristone in 2000 and changed its prescribing guidelines in 2016 and 2021. It is currently approved for use up to 10 weeks gestation and can be prescribed via telehealth and shipped to patients.
Sixteen major medical organizations — including the American College of Obstetricians and Gynecologists, the American Medical Association and the Society for Maternal-Fetal Medicine — affirmed to the U.S. Supreme Court last year that mifepristone is safe and effective.
“The scientific evidence is overwhelming: major adverse events occur in less than 0.32% of patients,” the medical organizations wrote in a 45-page brief. “The risk of death is almost non-existent.”
Goals for NIH
Bhattacharya testified during his confirmation hearing that he has five goals for the NIH, including focusing the agency’s research on chronic diseases and funding the “most innovative biomedical research agenda possible.”
“The NIH is the crown jewel of American biomedical sciences, with a long and illustrious history of supporting breakthroughs in biology and medicine,” Bhattacharya said at the time. “I have the utmost respect for the NIH scientists and staff over the decades who have contributed to this success.”
But, he said, “American biomedical sciences are at a crossroads” following the coronavirus pandemic.
Bhattacharya said during his hearing he would ensure NIH’s scientific research is replicable, that it has a culture that respects “free speech in science and scientific dissent” and that it regulates “risky research that has the possibility of causing a pandemic.”
“While the vast majority of biomedical research poses no risk of harm to research subjects or the public, the NIH must ensure that it never supports work that might cause harm.”
The national fertility rate — calculated as the total number of live births per 1,000 women of reproductive age — has been declining steadily in the United States over the past decade, from 62.5 in 2013 to 54.5 in 2023, according to the Centers for Disease Control and Prevention. (Photo by Oscar Wong/Getty Images)
Clare Barkley of Ohio always pictured having a second baby. But watching the erosion of reproductive rights and fights over public education and health care, she said the world feels like it’s in upheaval and isn’t sure she wants to roll the dice.
Kristen Witkowski, a North Carolina mom of two, has had several life-threatening complications related to her pregnancies. She might have considered having a third child but is now so terrified of getting pregnant again, she said she wishes she’d had her fallopian tubes tied during her second Cesarean section.
And Brenna Craven Dumas, a mother of two in Arizona who had high-risk pregnancies, wanted to be so sure she didn’t have another, she got her tubes tied and asked her husband to get a vasectomy.
These women live in states that currently or previously had abortion bans, and cited those policies as part of or the primary reason for their fertility decisions.
The national fertility rate — calculated as the total number of live births per 1,000 women of reproductive age — has declined steadily in the United States over the past decade, from 62.5 in 2013 to 54.5 in 2023, according to the Centers for Disease Control and Prevention. The data shows the decline is present in every state to varying degrees. During the same time frame, rates have fallen steeply in states with abortion bans, including Idaho, where the rate dropped from 71.8 to 57.5, and Arizona, which fell from 66.3 to 54.1.
Those falls in fertility have been top of mind for elected politicians tied to President Donald Trump’s second-term administration. It is a central piece of Project 2025, the blueprint for Trump’s presidency as written by the conservative Heritage Foundation and several anti-abortion organizations.
In a memo issued on Jan. 29 by new U.S. Department of Transportation Secretary Sean Duffy, programs supported or assisted by transportation funds have been directed to give preference to communities with marriage and birth rates higher than the national average. As a congressman for Wisconsin, Duffy supported and co-sponsored many anti-abortion bills, including a bill to defund Planned Parenthood.
Vice President JD Vance has expressed concern over declining fertility rates for several years, and repeatedly drew attention during the 2024 presidential election for negative comments he made about women without children and society as a whole becoming too detached from the ideal of becoming a parent. He has argued that policies limiting or prohibiting abortion access, which he supports, are not contributing to the rates, and advocates for higher taxes for those who don’t have children and for expanding the child tax credit to help families.
“Our society has failed to recognize the obligation that one generation has to another is a core part of living in a society to begin with,” Vance said at the annual anti-abortion March for Life event in January. “So, let me say very simply: I want more babies in the United States of America.”
Why fertility rates are lower
Phillip Cohen, a sociology professor at the University of Maryland who specializes in population science, said birth rates have been declining for centuries as modern culture shifted away from using children as a source of labor.
“So that gets you down from eight children per woman to three or four, and then the question is, what makes you continue to go all the way down to very low numbers?” Cohen said.
In the past two decades, he attributes the decline to positive and negative factors. People have more opportunities to spend their time in other ways, especially women, along with more career and life goals that previously were more difficult or impossible to pursue. Although some women manage both a career and a family, there is often pressure to choose one for financial, societal or individual reasons.
The negative factors that are driving down rates, Cohen said, are the expenses of having children, uncertainty and risk.
“(There is) concern about being able to raise children who are competitive in an increasingly unequal world and who can succeed in a society where the penalty for not succeeding seems to be growing,” Cohen said. “If you’re worried about how your kids are going to turn out, and Americans really are … then you can increase your chances of your children succeeding by having fewer of them.”
That rings true for Katie T. in Alabama. Growing up in Alabama as one of four children, she always thought that she would have a big family — probably five kids.
But with the past few years of political developments, including Trump’s re-election, the economy and five months of being a first-time mom, she has decided one baby is enough.
She and her husband are “one and done” after their son, who was born in August. Throughout her pregnancy, Katie said she was already stressed about living in a state with a near-total abortion ban in case anything went wrong, especially as a pregnant woman close to 35, the age when pregnancies are medically considered higher risk. The closest state with broad abortion access is Virginia, which is about 10 hours away by car.
“After I had my baby, I went in for my first checkup to talk about birth control options, and I talked with my husband at length about how I just don’t think (more kids are) in our future anymore,” said Katie T., who asked not to use her last name out of fear of retaliation in her community for her political beliefs.
Not only that, but finances also weighed heavily.
“We are realizing now that daycare is a literal second mortgage payment, and we just can’t afford that,” she said.
Not having a sibling for her son is a disappointment, she said. Her siblings are all older than her, and she describes growing up essentially as an only child, so it was important to her for a long time to have more than one child. But facing a reality of political fights over vaccines and the education system, along with more potential restrictions to reproductive health care, Katie said she had an eight-year birth control implant placed right after the election.
“I hope he will forgive us one day for that,” she said.
‘If something happens, where do we go from there?’
Kiley DeVor, 28, moved from California to Idaho to obtain a degree in physical therapy, and she specializes now in pelvic floor therapy. She and her husband bought a house, thinking they could stay in Idaho for a while, until the U.S. Supreme Court issued the Dobbs decision in June 2022 and Idaho implemented its near-total abortion ban. The state has been at the center of several abortion-related lawsuits in the past two years, including a Supreme Court case in June about whether abortions that are performed during a medical emergency are subject to prosecution under the state law. That matter is still pending in the 9th Circuit U.S. Court of Appeals.
During that time, DeVor said she’s discovered other health issues in addition to endometriosis she’s had for many years that may make conceiving a child more challenging.
“I’m just like, man, it is going to be incredibly difficult for us to get pregnant, so that’s one hurdle, and then if something happens, where do we go from there?” she said. “If we have to use IVF or IUI, if I have to travel out of state and spend another 10 or 20 grand to get the care I need, that’s just not feasible.”
DeVor’s husband started a general contracting business in Idaho that has done well, but she said he doesn’t want to risk starting a family in the state either and would rather wait until they can move somewhere she knows her health care will be protected.
“It’s been an interesting experience of moving to a state where people say, ‘We don’t want big government,’ but at the same time telling people, this is what you can and can’t do,” DeVor said.
Idaho economist doesn’t see worrying trends so far in population movement
Though one recent study from the National Bureau of Economic Research said the 13 states with total abortion bans are collectively losing 36,000 residents per quarter based on change of address data from the U.S. Postal Service, it’s unclear how many of those departures are related to politics. According to data from the American Community Survey, nearly 82,000 people moved to Idaho in 2023, while nearly 65,000 moved away, for a net increase of about 16,700 residents.
Jan Roeser, a regional economist at the Idaho Department of Labor, said the state’s population growth has slowed over the past two years, but it had accelerated greatly during the COVID pandemic between 2020 and 2022.
It’s possible that more young people are leaving the state, Roeser said, as seven districts announced or considered school closures in the first half of 2023 because of declining enrollment, according to Idaho Education News. But Idaho is among the eight youngest states in the nation, she said, and one of the leading states for job growth.
“We’d all like to be able to jump up and move just based on our beliefs, but the reality hits that most of us need a job,” Roeser said. “So really, economic opportunity is what I believe allows people to be able to make that final decision, because it’s expensive, and it’s disorienting.”
Until she starts seeing indicators like a spike in layoffs or a decline in enrollment at state universities, Roeser isn’t too concerned about outmigration. But she does worry about the steady decline of fertility rates.
“There’s not much you can do about it, of course, and it takes a long time to reverse once it starts,” she said. “It’s not something you can solve by coming up with public policy.”
Cohen said abortion bans may lead to a small increase in births initially since access is harder to reach, but in the long run, he expects it to contribute more to decreases because it creates uncertainty and fear about pregnancy.
Economically, increasing fertility rates would be a financial drain and potentially hamper growth, he said. That doesn’t mean policies that make it easier to have more children aren’t worth having, but they shouldn’t be done in the interest of increasing births.
“It’s one of the great victories of human development that we allowed people to lower their birth rates,” he said.
‘I’m not going to let them get me down’
For some people, having more children is almost an act of resistance.
Rachel West, a 34-year-old resident of central Texas, had a baby five months ago after a three-year struggle to conceive. She wants at least one more, but knows it might be a stressful experience again because of where she lives. Texas has a near-total abortion ban, along with an attorney general who has attempted to prosecute women who left the state to have an abortion. Cities in Texas have also tried to institute travel bans to prevent women from crossing state lines for abortions.
At the beginning of her pregnancy, West said there were concerns that her embryo was ectopic, when a baby grows in the fallopian tube rather than the uterus. Ectopic pregnancies are not viable and require termination to prevent infection and loss of fertility.
“We did have to think through what that would look like, if we would have to terminate, if we would have trouble finding somebody,” she said. “It was scary, we were just kind of spiraling at home trying to figure out what we would do.”
As someone who struggled to get pregnant the first time, West has also been concerned about efforts to restrict or ban IVF, just in case it becomes an option she has to utilize. But all of the news developments haven’t deterred her from the idea of having another.
“We’ve always wanted to have at least two, maybe three kids, and I would be very frustrated if because of laws in Texas, I had to change my personal life that dramatically,” West said. “It’s almost a prideful thing, where I’m like, I’m not going to let them get me down.”
President Donald Trump signed the orders at the end of a week where he was mostly silent on abortion. But after lobbying by anti-abortion movement leaders, Trump on Thursday pardoned nearly two dozen activists for blockading abortion clinics and earlier Friday gave a video speech at the anti-abortion March for Life. (Photo by Anna Moneymaker/Getty Images)
In a move that global health workers say will likely have devastating consequences for women and girls throughout the world, President Donald Trump has reinstated a policy that bans foreign aid workers from offering information about abortion, and doubled down on an existing domestic policy that bans federal funding for abortion.
The so-called Mexico City Policy, which Trump reinstated Friday night with an executive order, was first introduced in 1984 under Republican President Ronald Reagan, and bans foreign non-governmental organizations (NGOs) that receive U.S. family planning funds from promoting abortion as a method of family planning and from abortion-related counseling and referrals. It is known by reproductive rights advocates as the “global gag rule,” and it has been rescinded and reinstated as presidential administrations have changed parties for many years.
“We saw the devastating impact of the global gag rule during the last Trump administration when contraception and vital reproductive services were cut off. There was a spike in pregnancy-related deaths, reproductive coercion, and gender inequality worldwide,” said Rachana Desai Martin, chief government and external relations officer at the Center for Reproductive Rights, in a statement. “Many clinics and health programs shuttered, leaving vulnerable populations with nowhere to get birth control, pregnancy care and other vital health services.”
Reinstatement of the policy was prescribed in Project 2025, a nearly 1,000-page blueprint document authored by the Heritage Foundation and many other organizations, including several anti-abortion groups.
“To stop U.S. foreign aid from supporting the global abortion industry, the next conservative administration should issue an executive order that, at a minimum, reinstates [the policy] and … closes loopholes by applying the policy to all foreign assistance, including humanitarian aid, and improving its enforcement,” page 261 of the document reads. “The executive order … should be drafted broadly to apply to all foreign assistance.”
The executive order includes the statement, “I direct the Secretary of State, in coordination with the Secretary of Health and Human Services, to the extent allowable by law, to implement a plan to extend the requirements of the reinstated memorandum to global health assistance furnished by all departments or agencies.”
Advocates within foreign assistance organizations said the change will affect not only abortion access, but comprehensive reproductive health services, including HIV prevention and treatment, contraception access, screening for sexually transmitted diseases and cancers, and treatments for other infectious diseases.
“An expanded Mexico City Policy will have wide-reaching impacts on women and girls’ access to life-saving healthcare,” Janeen Madan Keller, policy fellow and deputy director of global health policy at the Center for Global Development, said in a statement. “As research shows, the Mexico City Policy reduces access to contraception which — counter to the policy’s intended goal — leads to more unplanned pregnancies and higher abortion rates.”
Madan Keller added that when Trump reinstated the rule during his first term in 2017, other donors were able to bolster the United Nations Population Fund’s budget and blunt any negative effects.
“However, with many donors now slashing aid budgets, it’s unclear whether they would cover the shortfall,” she said.
On the same day as the executive orders, the Trump administration rejoined the so-called Geneva Consensus Declaration, a global agreement launched by the U.S. and five other countries in 2020, which states that there is no international right to abortion and countries are not obligated to finance or facilitate it, according to a document obtained by Politico. The pact also includes Brazil, Egypt, Hungary, Indonesia and Uganda.
Hyde Amendment
Trump issued another executive order on Friday titled, “Enforcing the Hyde Amendment,” referring to a federal provision prohibiting the use of federal funds such as Medicaid to pay for abortions. Hyde does, however, allow funding in cases of rape, incest or to save a patient’s life. The order said the prior Democratic administration of President Joe Biden “embedded forced taxpayer funding of elective abortions” in a variety of federal programs, and rescinded two of Biden’s executive orders from 2022 that aimed to increase access to abortion.
Trump signed the orders at the end of a week where he was mostly silent on abortion. But after days of lobbying by anti-abortion movement leaders, Trump on Thursday pardoned convicted abortion-clinic blockaders and earlier Friday gave a last-minute video speech at the anti-abortion March for Life.
Project 2025 references the Hyde Amendment several times, citing Biden’s 2022 executive order that allowed the U.S. Health and Human Services secretary to find ways to assist pregnant people traveling across state lines to receive abortion care. The Biden administration subsequently interpreted Hyde to only apply to the abortion procedure itself.
Page 471 of the document calls for HHS to withdraw that guidance and for the U.S. Department of Justice to withdraw and disavow its interpretation of the amendment that was issued in September 2022. It also says HHS should complete a full audit to determine compliance with the amendment and permanently codify the Hyde Amendment in law rather than approving it as part of an appropriations process every year.
Republican U.S. Sens. John Kennedy of Louisiana and Roger Wicker of Mississippi introduced a bill in early January to codify the amendment and establish “a single, government-wide standard that bars federal tax dollars from financing abortions.” It’s unclear if that bill is an attempt to fully cut Medicaid funding for Planned Parenthood, which relies heavily on those funds to provide sexual and reproductive health services like contraception and screenings, including in states with abortion bans. Cutting that funding is a directive from Project 2025, as well.
People attending the annual March for Life rally watch a pre-taped video recording of President Donald Trump on the National Mall during the annual March For Life. (Kent Nishimura/Getty Images)
WASHINGTON — President Donald Trump delivered his Day One promise to the anti-abortion movement four days into his second term: He pardoned nearly two dozen anti-abortion activists convicted of federal offenses that included using physical force to block access to and invade abortion clinics, as well as for threats to clinic staff and patients. And after months of Trump distancing himself from the abortion issue and a week of lobbying by anti-abortion leaders, the president and Vice President J.D. Vance spoke at the movement’s annual March for Life rally on Friday.
“I am proud to be the first president ever to have joined you in person,” Trump said in a video recorded in the Oval Office, referring to his 2020 appearance, to the cheers of an estimated tens of thousands of activists and students gathered on the National Mall.
But the president failed to offer specific federal policy plans to further the movement’s goal of banning abortion nationally and gave what appeared to be a scripted speech that evoked religious language, referring to every child as “a beautiful gift from the hand of our creator.” He touted the controversial Dobbs v. Jackson Women’s Health Organization decision that ended federal abortion rights and the pardons he issued Thursday. Trump insisted, as he did throughout his campaign, that the abortion issue has returned “to the state legislatures and to the people, where it belongs.”
“In my second term, we will again stand proudly for families and for life. … We will work to offer a loving hand to new mothers and young families, and we will support adoption and foster care,” Trump said, but did not offer specific plans. As during his campaign, he accused Democrats of supporting abortion until “after birth,” a falsehood.
Vice President J.D. Vance, who spoke on stage after Trump, to raucous applause, referred to the anti-abortion movement as “our movement” and emphasized the need for government to make it easier for people to afford kids. Vance also did not name any policy plans the administration would pursue, beyond potentially raising the child tax credit. Vance said he and the president support the recent abortion bill that passed the U.S. House this week, which would have created penalties for health care professionals who don’t provide medical care for babies born after an attempted abortion. U.S. Senate Democrats blocked the bill arguing it was unnecessary and could have prevented parents from making decisions.
Vance, who was criticized during the presidential campaign for his comment about “childless cat ladies,” doubled down on the idea that a “culture of radical individualism” has taken root in this country and called for more Americans to reproduce.
“Our society has failed to recognize the obligation that one generation has to another is a core part of living in a society to begin with,” Vance said. “So, let me say very simply: I want more babies in the United States of America.”
Concerns about Trump’s anti-abortion commitment
Many activists at the march celebrated the return of a presidential administration friendlier to the anti-abortion cause than the Biden administration. Several sported red Make America Great Again hats, while others expressed reservation about Trump, following his shifted abortion language during his presidential campaign.
“When Trump went kind of more pro-choice, really, for a lot of us, we felt abandoned,” said Bryan Gebhart, a parent helping to chaperone about 45 students bussed from St. Francis DeSales High School in Columbus, Ohio. He told States Newsroom he didn’t vote for Trump, but for the American Solidarity Party, a minor political party based on Catholic teachings.
“I would like to see an end of abortion at the federal level,” Gebhart said, noting that banning abortion nationally is a long-term effort and unlikely to be realized during Trump’s second term.
Activists with the national anti-abortion group Students for Life of America gathered at the March for Life in Washington, D.C., on Friday, Jan. 24, 2025. (Sofia Resnick/States Newsroom)
Already, Trump has received praise from anti-abortion leaders. In its first week, his administration scrubbed information from its national health site about reproductive rights and abortion access and withdrew the U.S. from the World Health Organization, which anti-abortion news outlet LifeNews referred to on X to as the “Pro-Abortion World Health Organization.”
But some anti-abortion leaders are also concerned that the new administration is not fully committed to their cause. For the first time since federal abortion rights were overturned in 2022, Republicans control the White House, Congress and the U.S. Supreme Court. But unlike his major policy pronouncements in other areas, Trump has not signaled any major federal actions to limit abortion. In fact, he has repeatedly said he would veto a federal abortion ban, would not prohibit the mailing of medication abortion via the Comstock Act of 1873 and says he supports in vitro fertilization, something many in the anti-abortion movement oppose. Trump continues to take credit for overturning Roe v. Wade, despite the decision’s unpopularity, but campaigned as a moderate on abortion, which he says is a state issue.
“This is not just a states’ rights issue; this is a federal issue that must be remedied by this court or by a constitutional amendment,” said Mark Harrington, who runs the Ohio-based Created Equal group, on Wednesday at an event in front of the Supreme Court to commemorate the 52nd anniversary of the Roe decision. Several leaders said they were disappointed by the lack of a statement from the White House on the anniversary.
Harrington later told States Newsroom he plans to speak out if Trump does not deliver on some of the movement’s major asks, such as eliminating family-planning federal funding to reproductive health organizations and reinstating regulations to abortion drugs.
“We have to be a witness, calling truth to power and reminding him that we helped him get elected, and he better come through for us and the unborn or else — obviously, he’s not getting reelected, but his successor is not going to get our support,” Harrington said. “We’re not going to lay down and play dead, I hope. But a lot of people have been lured to sleep because of Trump’s popularity.”
Terrisa Bukovinac’s Progressive Anti-Abortion Uprising group is affiliated with several of the activists who were serving prison sentences for blockading abortion clinics until the Trump pardons. Bukovinac told States Newsroom that while she is grateful for Trump’s action, she no longer considers Trump and Vance to be “pro-life.”
“Trump has come out in favor of the abortion pill, and so has Vance,” Bukovinac told States Newsroom. “Trump has been clear, and I believe him when he says that he has no intention of setting any kind of federal abortion restrictions. I mean, that’s what we’re fighting for. That’s what the movement is trying to do, and Trump is like, no. So it’s not ideal, but I am optimistic about the things that we can get, … like get FACE repealed.”
The U.S. Department of Justice said Friday it would scale back on prosecuting abortion-clinic protest cases under the Freedom of Access to Clinic Entrances Act, according to the Washington Post.
Bukovinac said her group will continue to fight for full repeal of the law, which Democratic President Bill Clinton signed into law in 1994 after a spate of deadly abortion protests. The Biden administration cracked down on a resurgence of these tactics of physically blocking reproductive health clinics and then resisting arrest and prosecuted dozens under the federal law, including attacks on anti-abortion pregnancy centers, which the law also protects. Anti-abortion activists have claimed the Biden administration disproportionately prosecuted those who oppose abortion.
The Chicago-based nonprofit legal group the Thomas More Society filed petitions on behalf of 21 of the 23 pardoned individuals, arguing Biden’s Justice Department weaponized the law, which is also how Trump has justified his more than 1,500 day-one pardons and commutations of individuals who invaded the U.S. Capitol on Jan. 6, 2021, some of whom violently attacked police officers.
Brittany Fonteno, the CEO and president of the National Abortion Federation, which tracks violence and harassment at abortion clinics, told States Newsroom she is concerned the Trump administration is going to turn a blind eye to dangerous events at abortion clinics.
“What we’ve seen is that over the years, and in particular after the Dobbs decision, there has been a stark increase in violence and disruption from anti-abortion activists and advocates,” Fonteno said. “We’ve seen an increase in burglaries and arson and threats to abortion providers, and we anticipate that that will only increase with this new administration, as anti-abortion extremists are empowered and emboldened to try to create a culture of fear around abortion care.”
‘Personhood’ advocates seize on ‘conception’ language in executive order on gender
Aside from the anti-abortion pardons, none of Trump’s many executive orders issued during his first week in office concerned abortion.
Thus many in the anti-abortion movement are far from confident that Trump will make abortion more difficult to access, let alone get closer to their larger goal of enshrining fetal personhood rights in the U.S. Constitution.
But some leaders were reassured by a different executive order Trump signed, related to another Christian-right issue: gender. He issued an order on his first day in office that says the U.S. will only recognize two genders, declares that “‘Female’ means a person belonging, at conception, to the sex that produces the large reproductive cell,” and “‘Male’ means a person belonging, at conception, to the sex that produces the small reproductive cell.”
Anti-abortion groups, such as Students for Life of America, viewed the order as a win for the so-called fetal personhood doctrine.
Other leaders have praised some of Trump’s appointees for their anti-abortion positions such as Attorney General appointee Pam Bondi and Secretary of State appointee Marco Rubio.
Though many were disappointed that Trump’s Health and Human Services appointee Robert F. Kennedy Jr. has supported abortion rights, they are still working to wield influence in this critical agency.
Students for Life of America president Kristan Hawkins posted this week on X that an alum from her group “will be serving in a key role at HHS! This is a great sign for life saving measures to come!” She also posted a picture of herself holding a “Defund Planned Parenthood” sign alongside Republican Speaker of the House Mike Johnson, who also spoke at the March for Life. Hawkins wrote in the post, “Speaker Mike Johnson is on board! Planned Parenthood, we’re coming for you next.”
Reproductive rights supporters marched in Phoenix to mark Roe v. Wade’s anniversary in January 2024. Arizona voters approved an amendment restoring abortion access up to fetal viability in the fall. (Photo by Gloria Rebecca Gomez/Arizona Mirror)
Erika Christensen decided to become a patient advocate for abortion later in pregnancy after she had to travel from New York to Colorado to get a third-trimester abortion.
Christensen found out her wanted pregnancy wasn’t viable around 30 weeks. At that time in 2016, New York banned abortion after 24 weeks of pregnancy, and only allowed abortions after that limit to save a patient’s life.
She and her husband were able to borrow thousands of dollars from her mother and put last-minute travel funds on a credit card to access abortion care across the country, Christensen told States Newsroom.
“At every stage, I realized how many pieces had to be in the perfect place for me to be able to do that, to be able to get this urgent health care that I desperately needed,” she said.
When she and her husband returned home to New York, a lawyer at the state American Civil Liberties Union affiliate reached out and asked if they wanted to be advocates. They led a grassroots effort to get legislation passed in 2019 that protected abortions after 24 weeks for fetal abnormalities and to preserve a patient’s health.
The Reproductive Health Act also decriminalized abortion later in pregnancy and allowed health care providers besides physicians to perform abortions. Former Democratic Gov. Andrew Cuomo signed the bill into law on Jan. 22, 2019, the anniversary of the U.S. Supreme Court’s Roe v. Wade ruling that protected the right to an abortion nationally.
This year would have marked the 52nd anniversary of Roe, which ensured abortion rights until fetal viability, when a fetus can survive outside the womb — generally thought to be around 24 weeks. Only about 1% of all abortions in the United States happen after that point, typically for medical reasons, research shows.
But a conservative-majority bench overturned Roe nearly three years ago, upending abortion access across the nation with the Dobbs v. Jackson Women’s Health Organization decision. States rolled out a patchwork of varied health care restrictions.
Twelve states ban most abortions today, while voters in 10 approved ballot measures enshrining the right into state constitutions. Most of the states with constitutional protections have fetal viability limits.
“Advocates, activists and folks in the movement have different opinions about how we reach the ideal policy on reproductive rights and justice, and initiatives and laws may vary from state to state depending on the political realities that we see,” said Ashley All, president of Kansas Coalition for Common Sense, who has worked on several successful abortion-rights initiatives.
Some within the reproductive rights movement argue that gestational bans on abortion later in pregnancy cause patients harm, and say that the protections of Roe — the 1973 Supreme Court said abortion is a privacy right based on the due process clause of the 14th Amendment — are insufficient.
Renee Bracey Sherman is the founder of the nonprofit WeTestify, a nonprofit devoted to evaluating and shifting the narrative around abortion.
“Allowing the public to vote on personal medical decisions is wrong and completely ridiculous,” she said. “But somehow it’s acceptable with abortion, and then doubly acceptable when it comes to later abortion. We have a population that does not understand how anatomy works, how pregnancy works, how abortions happen, and why people need later abortions.”
In pregnancy, “viability” isn’t straightforward and can be used in more than one way. The word can reference whether a pregnancy is expected to develop normally or if it could lead to a miscarriage, according to the American College of Obstetrics and Gynecology. And fetal viability is the point in pregnancy when a fetus is able to survive outside of the womb. Premature babies have a 42% to 59% chance of survival at 24 weeks, according to ACOG and the Society for Maternal-Fetal Medicine.
ACOG, the national OB-GYN organization, “strongly opposes policy makers defining viability or using viability as a basis to limit access to evidence-based care” and said the decision to terminate a pregnancy should be between patients and medical providers.
Viability language in policymaking stemmed from the Roe decision in 1973, according to Adrienne Ramcharan, assistant director of state policy at Physicians for Reproductive Health and MiQuel Davies, the former public policy director at the organization.
“While this framing was built into the law, researchers and medical providers who care for pregnant people recognize that viability is not a set point in time,” Ramcharan and Davies wrote in August 2024. “Instead, it occurs along a continuum shaped by an individual’s medical history, access to medical care, and demographic characteristics among other things.”
Later abortion care is criminalized and stigmatized, Christensen said, causing the cost of care to go up. Plus, abortion providers willing to offer the procedure later in pregnancy are scarce.
“I have the benefit of having directly experienced a viability ban and knowing in my core how unjust it was, how my humanity was erased, my dignity was erased,” Christensen said.
She is the co-author of a memo published last year titled Abortion Justice Now. The authors wrote that they reject efforts to restore Roe-era limits into abortion policy.
“Gestational and viability limits will disproportionately impact the most marginalized among us, either denying them critical care or pulling families toward financial instability,” they wrote. “These limits will result in an inequitable ability to exercise rights, allow for criminalization in pregnancy, and ultimately reinforce the dangerous assertion that the government has any role in regulating a pregnant person’s body.”
Abortion opponents, including doctors, sometimes hinge their argument on the concept of fetal viability.
“I think, certainly, beyond the point where a child can survive outside of his or her mother, there would never be a reason you would need to intentionally end that child’s life,” Dr. Christina Francis, chief executive officer at the American Association of Pro-Life Obstetricians and Gynecologists, told lawmakers on a U.S. Senate committee in June, States Newsroom reported.
“You would simply deliver that baby,” Francis said. “You’d take care of mom and you’d take care of baby in an appropriate way.
Patients may seek abortion after fetal viability for several reasons: They receive a fetal fatal diagnosis later in pregnancy, giving birth could risk their life or health, they couldn’t access or afford an abortion earlier, or they didn’t know they were pregnant, according to ACOG.
Polling shows that Americans support abortion in most cases, but not necessarily after fetal viability. A June 2023 poll from Gallup found that 69% of respondents said abortion should be legal in the first three months of pregnancy, while 37% said it should be legal in the second trimester and 22% in the third.
But the nonpartisan public opinion research firm PerryUndem found last year that most public polling on abortion later in pregnancy lacks context. Of those who heard stories about women with complications later in pregnancy who needed to travel out-of-state for abortions, 69% said abortion should be legal in all cases.
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