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

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

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

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

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

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

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

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

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

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

Body literacy modules

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

New recipients could include crisis pregnancy centers 

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

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

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

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

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

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

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

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

‘Losing trusted relationships’

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

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

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

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

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

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

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

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

WASHINGTON — Republicans celebrated last year when they barred Medicaid payments from going to Planned Parenthood for one year, predicting the financial impact would hollow out the organization. 

A year later, with that section of the “big, beautiful” law set to expire July 4, GOP lawmakers are trying to find a way to keep the nationwide prohibition in place, though they won’t be able to accomplish that before the deadline. 

That means states will now determine whether people enrolled in the program for lower-income individuals can, once again, get routine healthcare services from the Planned Parenthood clinics that remain open.  

Nora Walsh-DeVries, vice president of political and legislative affairs at Planned Parenthood Action Fund, said the law forced the organization to close nearly 30 of its healthcare centers.

“The impact is really horrible for us and some of it is unfortunately irreversible,” she said. “And it’s tough to try to deal with what’s happened in this past year, kind of also knowing that there is an intention from Republicans to permanently defund us.”

Some Planned Parenthood clinics, she said, tried to find ways to keep treating Medicaid enrollees, but ultimately that was “unsustainable” and not something every affiliate could manage. 

The result meant “tens of thousands of patients have been denied access to basic care services like cancer screenings, which I think we can all agree is something we should want people to get when they need it, where they need it, how they need it,” Walsh-DeVries said. 

The impact was ultimately less widespread than Planned Parenthood originally predicted, when its president said in a statement just days before the law took effect that “nearly 200 Planned Parenthood health centers in 24 states across the country are at risk of closure.”

The expiration won’t have an impact on abortion access for Medicaid enrollees, since a decades-old rider on government spending bills, which blocks taxpayer dollars from going to abortion with limited exceptions, remains in place. 

Republicans view the closures as a victory and are trying to renew the provision in an attempt to shutter more Planned Parenthood clinics. They believe any healthcare organization that provides abortions, even if those largely aren’t covered by taxpayer dollars, shouldn’t be included in any federal health programs. 

Pressure from conservatives

The House Freedom Caucus, a collection of far-right Republicans, wrote to Speaker Mike Johnson in late June, pressing him to include a similar prohibition in another party-line bill. 

“The American people rightfully expect a Republican-led Congress to deliver real results, not excuses or half-measures,” they wrote. “After years of broken promises, voters have entrusted us with majorities in both the House and Senate. This is our last and best chance to prove they were right to send us here to fight for them.”

They added that another reconciliation bill must prohibit “federal funding for abortion providers to ensure that taxpayer dollars are not being used to subsidize the radical abortion industry.”

Susan B. Anthony Pro-Life America President Marjorie Dannenfelser and other anti-abortion organizations are lobbying Republicans to again block Medicaid funding from going to Planned Parenthood.

“Defunding Big Abortion is now the default expectation of the pro-life movement,” Dannenfelser wrote in a statement. “When they return to D.C., Republicans must do all they can through reconciliation to once again block taxpayer dollars from Planned Parenthood and abortion businesses.”

Republicans used the complex budget reconciliation process to enact their “big, beautiful” law and the $70 billion package to fund immigration enforcement. The special process allowed GOP leaders to get around procedural votes in the Senate that would otherwise require bipartisanship as long as each provision has an impact on federal revenues or spending that is not deemed “merely incidental” by that chamber’s parliamentarian.

Strained system

Subasri Narasimhan, research director at the Center on Reproductive Health, Law, and Policy at UCLA Law School, said there often aren’t other health centers to cover the gaps left when a Planned Parenthood closes or is no longer reimbursed for treating a Medicaid enrollee. 

“We have a pretty strained healthcare system in so many different respects, but we’re looking at an extremely strained system when it comes to reproductive healthcare,” Narasimhan said. 

Some state governments, she said, tried to cover the budget holes created during the last year, though ultimately weren’t able to fully replace the loss of federal funding. 

Republicans reinstituting the same prohibition on Medicaid payments for non-abortion healthcare services, she said, would likely lead more people on the program to delay or skip preventative care altogether. 

“We’re looking at folks who are quite vulnerable and often use Planned Parenthood as their primary source of care,” she said. “And so there’s no option to look for another health center.”

Kathleen Adams, professor in the Rollins School of Public Health at Emory University, said that if a program can vary state to state, it will, and this was no exception. 

“What I’m seeing is the states are finding emergency funds, other ways to channel funds to Planned Parenthood to sort of keep that part of their system active,” she said. 

There are also other programs and clinics, like federally qualified health centers and safety-net providers, that Adams said could play a part in filling some of the gaps.

“I don’t lose heart so much as we might otherwise about these provisions to Planned Parenthood because states are aware of these issues,” she said. “And if they don’t provide access to contraceptives, they’re more likely to get unintended pregnancies, or pregnancies amongst uninsured women.”

State action

Laurie Sobel, associate director for Women’s Health Policy at KFF, wrote in a post that after the nationwide moratorium expires, a Supreme Court ruling from late June 2025 will allow state governments to block certain healthcare providers, like Planned Parenthood, from participating in their Medicaid programs. 

“This ruling marked a significant departure from longstanding interpretations of the Medicaid ‘free choice of provider’ provision, which guarantees enrollees the right to obtain care from any qualified and willing Medicaid provider,” Sobel wrote.

Alabama, Arizona, Arkansas, Florida, Iowa, Kansas, Louisiana, Mississippi, Missouri, Nebraska, Oklahoma, South Carolina and Texas have either blocked or tried to block Medicaid reimbursements to Planned Parenthood, according to Sobel’s analysis.

Other states, she wrote, “may follow suit” once the nationwide Medicaid prohibition expires July 4.

Several laws restricting access to medications that can be used to terminate a pregnancy and others placing limits on minors’ access to sexual and reproductive healthcare — including the HPV vaccine — take effect Wednesday, July 1, in Iowa, Mississippi and Tennessee.

Many bills were considered in state legislatures earlier this year that would have added legal restrictions to mifepristone and misoprostol, but only a few made it into law. The 13 states that have near-total abortion bans already have restrictions in place, but some have proposed more in the wake of new methods of obtaining the medications online or by telehealth.

A federal lawsuit is also ongoing that will determine whether the U.S. Food and Drug Administration’s rules allowing mifepristone to be dispensed via telehealth will remain in place. That ruling will apply nationwide.

Gov. Kim Reynolds signs laws restricting access to abortion pills, HPV vaccine

Kimya Forouzan, principal state policy adviser at the Guttmacher Institute, said the increased efforts to restrict access underscore the importance of shield laws in states that protect abortion access. 

In Hawaii, provisions strengthening the state’s existing shield laws also take effect today. Those provisions include prohibiting the use or disclosure of patient health information to investigate someone who received reproductive or gender-affirming care and adding malpractice insurance and healthcare contract protections for providers in the state to prevent exorbitant rate increases, Forouzan said.

Iowa

Iowa’s new law requires medications including mifepristone and misoprostol to be dispensed in person, restricting access by telehealth. Mifepristone and misoprostol are typically used in combination to terminate a pregnancy in the first trimester or to treat miscarriages. Iowa has a six-week abortion ban, which is before many people know they are pregnant.

The law also made changes to abortion and pregnancy loss reporting, requiring a provider to report to the state whether a patient took mifepristone or misoprostol within 14 days of a pregnancy loss. It does not require the patient to tell the provider that information, nor does it compel the provider to ask, said Forouzan, but it might come up when a patient is asking questions or raising concerns.

“The reporting requirement is something that really has raised alarm bells for us because we know that mandatory state reporting of abortion has a potential to cause a lot of harm and increase the feelings of surveillance that patients experience,” Forouzan said.

Lawmakers also adopted a law prohibiting Iowans under age 18 from consenting to vaccinations related to sexually transmitted diseases and infections. Iowa Capital Dispatch reported that Republican lawmakers said the bill aligned with other state laws on vaccines — the HPV and hepatitis B vaccines were previously exempt. Science has shown the HPV vaccine prevents several strains of human papillomavirus that can be transmitted through sexual activity and potentially cause cervical and other cancers. 

Mississippi

Mississippi passed a law in April adding mifepristone and misoprostol to the state’s drug trafficking law, making it a crime punishable by up to 10 years in prison to distribute or intend to distribute the drugs. It takes effect today.

Republican lawmakers in Mississippi have said the intent of the bill is to keep mifepristone and misoprostol from being sent to residents and undermining the state’s abortion ban, but providers say it creates more harm, especially for patients experiencing miscarriages.

Dr. Bhavik Kumar, a family medicine physician in Texas, told Stateline in March that the law causes confusion and prevents patients from seeking timely care and providers from administering care out of fear.

“Healthcare providers are suddenly having to think about laws and rules that have nothing to do with patient safety,” Kumar said.

Tennessee

Tennessee added new restrictions to medication abortion that allow the state attorney general to bring civil lawsuits and impose fines for violations of the state’s in-person dispensing requirements for medication abortion. 

Tennessee has a near-total abortion ban, but some states have tried to enforce these laws against providers for prescribing medications to their residents, such as Louisiana, where the attorney general tried unsuccessfully to extradite a provider on charges.

The law allows for $10,000 fines per violation, up to $1 million.

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

Kate Dineen assumed she would always have access to reproductive healthcare because of where she lived. It came as a shock when she was denied an abortion in 2021 because of gestational limits to the procedure in Massachusetts law.

Dineen was 33 weeks into her pregnancy, the third trimester, when a routine ultrasound detected a problem with the fetus’s brain. An MRI showed that her son, whom she’d named Teddy, had suffered a catastrophic stroke in utero. A pediatric neurologist gave her the news over a Zoom call during the COVID-19 pandemic.

“I said, ‘What’s the best-case scenario? Is there any chance of a normal, healthy outcome?’ And he kind of cast his gaze downward and muttered, ‘No,’” Dineen said. “I had this fear that I was going to go into labor in Massachusetts, and there was going to be nothing I could do aside from watching my son suffer an unknown fate.”

Dineen’s story is rare among those seeking an abortion, and it’s one of the least-discussed types of abortion. Researchers and doctors say later abortions are complicated, expensive and difficult to access, with very few clinics nationwide that can or will provide them. Later abortions also are heavily criticized by anti-abortion groups and Republican elected officials, who often say states without viability limits allow doctors to kill a baby after birth, which is false.

In the four years since the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, access to all abortion in more than a dozen states has dramatically decreased. During that same time, some clinics have expanded later abortion offerings, and advocates — including Dineen — are pushing for many of the 21 states that have bans after 18 weeks to drop them.

Some project optimism about the support for repealing gestational bans, while others are taking a more incremental approach based on their assessments of political realities and general discomfort about the subject even from abortion-rights advocates. Other abortion-rights advocates continue to focus on expanded access earlier in pregnancy, including ballot initiatives to reverse abortion bans.

Frances Kissling, president of Catholics for Choice from 1982 to 2007, said laws that put some limitations on abortion after fetal viability strike the right balance in providing exceptions for certain circumstances without taking an extreme view.

“I think it works better for everybody if no one takes an absolutist position on this,“ Kissling said. “In a sense, there are no good answers, but it certainly is not good to take the position that no limitations in the third trimester would ever be acceptable.”

Kissling’s approach is at the heart of a split among abortion-rights advocates that has developed since Dobbs — whether to return to the way laws were made after the U.S. Supreme Court decided Roe v. Wade, which allowed abortion access to be limited after fetal viability, or whether to push for more.

Dineen’s pregnancy was well past Massachusetts’ cutoff of 24 weeks, around the time that the medical community recognizes a fetus can potentially survive, with medical intervention, outside of the womb.

The state law at the time included exceptions past that point for lethal fetal anomalies, but Dineen’s case was refused by the hospital where she sought care because doctors said they couldn’t guarantee the fetus wouldn’t survive after birth. She had to drive 500 miles to Bethesda, Maryland.

“It was something that I was just so floored by; I felt so naïve,” Dineen said.

‘We see all of these’

The most recent data from the federal Centers for Disease Control and Prevention, from 2022, showed about 1.1% of abortions nationwide took place after 21 weeks of pregnancy, although that total reflects voluntary reporting from only 46 states. More than 93% of abortions happen in the first trimester, before 13 weeks. But thousands of people will still need abortion options later in pregnancy every year for a host of reasons.

Nine states have laws protecting abortion access throughout pregnancy, but only four of those — Colorado, Illinois, Maryland and New Mexico — plus Washington, D.C., have clinics that provide abortion past 32 weeks, meaning people experiencing a problem like Dineen’s most often have to travel. Nationwide, about 20 clinics provide abortions past 24 weeks.

Among the states that protect access throughout pregnancy is Alaska. But unlike the other states, doctor availability at any stage is extremely limited, with two Planned Parenthood clinics statewide, neither of which provides abortion after 18 weeks.

Political rhetoric about third trimester abortion is misleading, experts say

One new all-trimester clinic opened in New Mexico since Dobbs, and a new clinic replaced Boulder Abortion Clinic in Colorado after it closed in 2025. The former chief operating officer of the Boulder clinic, Alicia Moreno, is now executive director of RISE Collective and said about two-thirds of the clinic’s patients come from other states or from Canada. Many times, they are patients like Dineen, who received grave news about a wanted pregnancy.

Other patients must seek a later abortion clinic because they were delayed by logistics such as time off work, travel and financial barriers, while still others are delayed because of abortion bans or bureaucratic hurdles, such as a healthcare provider taking weeks to determine whether a patient qualifies for a legal exception.

Or in some cases, she said, people go to an anti-abortion crisis pregnancy center without knowing what those centers are and are “led on for weeks” until they exceed the state’s legal limit.

“We see all of those on a weekly basis,” Moreno said.

Patients also include preteens and teenagers, who are more likely to not know they are pregnant until later.

National anti-abortion group Americans United for Life takes the view that there is never a good reason to terminate a pregnancy after fetal viability and that it should not be permitted.

Public support for legal abortion in all or most cases stood at 64%, according to a July 2025 AP-NORC poll, but it dropped significantly when broken out by trimester. A 2023 Gallup poll showed support for legal abortion in the second and third trimesters at 37% and 22%, respectively.

Support for legal access is lower for a person who just doesn’t want to be pregnant, such as Ayesha Perry-Iqbal, who didn’t discover she was pregnant until 24 weeks in 2021, referred to as a cryptic pregnancy.

“I was obviously in shock and was not sure what it was that I wanted to do because I felt like since I was past the limit in California, I didn’t really have a choice,” said Perry-Iqbal, who is from Wales but now lives in Los Angeles.

A doctor told Perry-Iqbal she could still go to Colorado. Amid feelings of guilt and frustration, she decided she didn’t want to have a child.

“When I sat down and was like, ‘Actually this is not something I want, this is not the path I deserve, and this is not the story that I want for my child,’ I decided to do what was best for me,” she said. “It didn’t sit well with a lot of people.”

She remembers arriving in a private car at the back of the health clinic to avoid protesters and walking through two different layers of security before making it to the waiting room. It made her feel like she was doing something wrong.

Culture changes

It’s been a decade since Erika Christensen had her own later abortion. At 31 weeks, her fetus was no longer growing and wasn’t swallowing. Doctors said her baby would not be able to breathe outside her body, and was likely to die shortly after birth. Terminating the pregnancy meant Christensen had to travel from her home in New York to Colorado.

Three years later, Christensen and her husband, Garin Marschall, founded Patient Forward and became staunch advocates for removing barriers to later abortion care. She remembers searching for options in 2016 and thinking of it as a desert, whereas now there are more clinics offering services later with more diverse staff and more public discussion of the issue.

As red states pass new abortion restrictions, Minnesota looks to shed them all

“It’s a completely different culture than it was 10 years ago,” Christensen said. “That is progress, even as we have so many more barriers to eliminate.”

Even in states that have made it easier to provide later abortion care since Dobbs, such as in Minnesota, where the legislature repealed laws targeted at abortion providers in 2023, the costs become prohibitive.

Later abortion care requires many more expensive medications, specialized equipment and other services, and healthcare costs keep going up while reimbursement rates remain stagnant or lag behind.

But costs can be more easily addressed than cultural norms. Amy Hagstrom Miller, president and CEO of Whole Woman’s Health, has one abortion clinic in Minneapolis, as well as others in Maryland, New Mexico and Virginia. She said more needs to be done to increase understanding of the complexities around later abortion and why it happens.

“The stigma gets compounded the later in pregnancy you are, even in places that are really progressive,” Hagstrom Miller said. “You hear people say, ‘Why did they wait so long, why didn’t they do something about it sooner?’”

Looking to the future

Patient Forward and other abortion-rights groups have been vocally opposed to ballot initiatives that include language about fetal viability, including in Missouri, where voters narrowly passed an initiative in 2024 to overturn the state abortion ban, and in Idaho, where a question that would overturn its near-total ban will likely be on the ballot later this year.

Initiatives that passed in Arizona and Nevada also allow the government to restrict access after fetal viability.

But some push back on allowing abortions at later stages, including Melanie Folwell, executive director of Idahoans United for Women and Families and lead organizer of the state’s initiative. The ballot language includes a line that says it is not a violation of reproductive freedom and privacy to regulate abortion after fetal viability except in cases of medical emergency, and Folwell said criticisms from national organizations on that subject are unwelcome.

“It’s disappointing that the national political class is painfully out of touch with our reality on the ground. I’d invite them to take a break from firing off press releases and selling tote bags and spend some time knocking doors with our grassroots volunteers in Chubbuck or Coeur d’Alene or Caldwell,” Folwell said. “This is the real work right now and we’re proud to be doing it.”

In Massachusetts, Kate Dineen says she is working to ensure other people aren’t denied care the way she was. In 2022, she successfully lobbied to change the language about legal abortion after 24 weeks to include an additional exception for “grave fetal diagnoses,” which she said has already allowed more patients to access later care.

The next step, she said, is a full repeal of the 24-week limit. Dineen said she’s excited that the bill, titled the Prioritizing Patient Access to Care Act, is moving through the state House and Senate.

“When we start talking about number of weeks and severity of fetal diagnosis or quality-of-life projections, we’ve already lost the conversation. We shouldn’t be talking about any of that,” Dineen said. “It’s about who gets to decide — the government, or the pregnant person.”

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

Mylissa McNeill never expected to be a mother. But when she learned she was pregnant in the spring of 2022, at age 41, she and her partner were happy and excited at the prospect of parenting a little girl they planned to name Maeve.

On June 24, 2022, about one month after McNeill discovered she was pregnant, the U.S. Supreme Court overturned Roe v. Wade in its Dobbs ruling, eliminating the constitutional right to an abortion and empowering states to outlaw it. Missouri was the first state to enact a ban; at that time, McNeill was living in Joplin, Missouri.

In August 2022, McNeill miscarried. It was the beginning of a health crisis that plagues her to this day and that she blames, at least in part, on hospitals’ reluctance to provide miscarriage management care that might run afoul of state abortion bans.

Missouri’s law prohibited nearly all abortions, but it allowed abortion providers who were charged or sued under the law to escape punishment by arguing that they acted in a “medical emergency” to prevent the death of the pregnant woman or to avert “a serious risk of substantial and irreversible physical impairment of a major bodily function.”

Missouri’s ban is no longer in effect — it was overturned by voters in 2024 — but such language is typical: All 13 states that currently have abortion bans allow the procedure to protect the life of the pregnant woman. Some, but not all, of the bans also have exceptions to protect the health of the woman.

But patients and providers have argued in lawsuits challenging the bans that such exceptions are too ill defined to give doctors and hospitals enough confidence to provide timely care. McNeill believes that her persistent health problems are the result of delayed care.

In early August 2022, less than two months after Missouri’s ban took effect, McNeill’s water broke at about 18 weeks. She says her OB-GYN told her the pregnancy was no longer viable, and she sought an abortion and miscarriage management procedure known as dilation and curettage, or D&C, in hospitals in both Missouri and Kansas (where abortion was legal). However, doctors declined to provide miscarriage care while they were able to detect fetal cardiac activity.

After three days of bleeding and aching, McNeill finally received treatment at a hospital in Illinois. When she had a subsequent tubal ligation to prevent future pregnancies, McNeill said medical staff told her she had scar tissue resulting from an infection she developed after her water broke.

“While they were in there, they saw what happened,” McNeill said. “The infection went outside of my uterus. It went to my liver, and my liver is permanently attached in multiple places. It’s attached to my uterus; it’s attached to my stomach lining.”

McNeill says the lingering effects of that infection include severe bouts of vomiting and significant financial hardship as she has struggled to pay for care without steady health care coverage.

“I literally break all the blood vessels in my skin. … This kind of pain is — there’s no word for it,” said McNeill, who shared with Stateline pictures of her face covered in red splotches, her nose magenta. “The delay is what really upset me, because women have died with less time than I had, and that delay and the infection that I did get from this by waiting three days, it destroyed my life.”

Last year, states including Texas, Kentucky and Tennessee enacted laws designed to provide additional clarity on medical exceptions to their bans, but confusion persists in those states and others. Stories of denied miscarriage care continue to emerge, including in a brand-new lawsuit in Texas, and several deaths have been attributed in part to abortion restrictions, including in Georgia and Texas. Research has linked abortion restrictions to higher rates of maternal death and injury.

“The four years since the Dobbs (v. Jackson Women’s Health Organization) decision have unfortunately proven what OB-GYNs already knew: abortion care is inextricable from reproductive health care,” Molly Meegan, chief legal officer and general counsel for the American College of Obstetricians and Gynecologists, wrote in a statement.

“Bans and restrictions on abortion care have resulted in patients across the country being denied care, even in instances of pregnancy loss and miscarriage.”

A new study published last month by the Journal of the American Medical Association found that since the Dobbs decision, in states where abortion bans took effect, miscarriage management has shifted away from medical intervention toward more of a “wait-and-see” approach.

But anti-abortion groups blame doctors and abortion-rights advocates for creating confusion around the medical exceptions in abortion bans, insisting it is clear what is a medically indicated abortion and what is purely elective.

“As architects of the majority of the nation’s pro-life laws, Americans United for Life has been very clear that none prevent women from receiving life-saving miscarriage care. Efforts to suggest otherwise are made in bad faith” said Gavin Oxley, a spokesperson for the group.

“Doctors who delay or altogether deny medical treatment must be held accountable for the harm they inflict upon women. If doctors are not clear on this four years after Dobbs, they clearly have not been listening.”

Dr. Susan Bane, an OB-GYN in Greenville, North Carolina, who is on the board of directors for the American Association of Pro-Life Obstetricians and Gynecologists, told Stateline that doctors — especially the American College of Obstetricians and Gynecologists — have unfairly blamed abortion bans for the denial of medical care to pregnant or miscarrying women.

“There’s nothing, I mean zero, about any of these laws that say you have to have her dying or septic,” Bane said. “I’ve done this hundreds of times in the last 30 years, where the baby was alive, and I sat at the bedside and had an excruciating conversation with a woman to say, ‘I am so sorry, but if we don’t move towards delivery, I’m worried both of you will die.’”

She said her organization supports state laws, like one signed in South Dakota earlier this year, that redefine “abortion” as the intentional ending of the life of the “unborn child.” Supporters say such laws will allow doctors to manage miscarriages, ectopic pregnancies and other pregnancy-related emergencies.

“It’s sad that more clarification isn’t happening, but the blame really started right in my profession.” Bane said.

But Meegan said attempts to legislate health exceptions fall short of protecting all patients.

“There is no law or exception that can account for the immense variety of medical situations that can present in pregnancy,” she wrote. “And there is no additional legislation that can undo the harm created by abortion bans short of repealing the bans themselves.”

McNeill said that following her miscarriage, she lost her job and the health insurance that came with it. She sued and then reached a settlement with the Missouri hospital that she believes denied her prompt care. But she continues to search for relief from her health problems, and says she has racked up substantial medical debt.

She and her husband moved to Arkansas and then Kansas in search of the financial stability that has eluded them since her miscarriage almost four years ago.

“My debt is in the millions with all of this illness without coverage for long periods,” McNeill said. “Now that my credit is destroyed, I’ll never be able to buy a house again while in this health.”

Stateline reporter Sofia Resnick can be reached at sresnick@stateline.org.

A federal poverty-fighting program focused on reducing unintended pregnancies is about to undergo a major overhaul.

Reproductive health clinics use Title X federal grant money to provide birth control, cancer screenings and testing and treatment for sexually transmitted infections to people with little or no health insurance. Title X money cannot be used for abortions.

The Guttmacher Institute estimates that Title X, which was signed into law by Republican President Richard Nixon in 1970, has prevented almost 20 million unintended pregnancies and 9 million abortions. It has also helped reduce child poverty, according to the group, which supports abortion rights.

But President Donald Trump has taken aim at the program, which has long been a target for abortion opponents. Since regaining the White House, Trump has temporarily blocked and then restored grants to certain reproductive health clinics, and proposed a U.S. Department of Health and Human Services budget with no funding for the program.

The department’s recently issued funding guidelines for Title X grants represent a significant mission shift.

Instead of expanding access to contraception, the focus of Title X will be “to strengthen family formation and assist clients in achieving healthy pregnancies,” according to the new guidance. That will align the program with the administration’s efforts to increase the U.S. birth rate.

The new rules say Title X will prioritize educating Americans about natural methods to avoid pregnancy and overcome infertility, and will promote “body literacy education” and “informed, preventive, and restorative approaches to reproductive health.” Some conservative groups tout an obscure alternative treatment for infertility called “restorative reproductive medicine,” which is based on the idea that the underlying causes of infertility can be treated through lifestyle changes and improving a person’s overall health.

The guidance directs Title X clinics to promote “fertility-awareness-based methods,” such as period-tracking apps, which the American College of Obstetricians and Gynecologists says can be helpful for getting pregnant but less effective at preventing pregnancy. It also calls on clinics to offer counseling on male fertility issues and to address environmental causes of infertility, including pornography use. And it includes a prohibition on DEI efforts and warns grantees that federal money cannot be used to “facilitate or incentivize illegal immigration.”

Anti-abortion groups support the changes, but many health policy researchers say they will disproportionately harm low-income and minority women, who are more reliant on Title X services and are more likely to have unintended pregnancies. Researchers also say the new guidelines are unlikely to achieve the administration’s “pronatalist” goal of reversing declining birth rates.

Corinne Rocca, an epidemiology professor at the University of California, San Francisco, said the way to do that would be to spend more on childcare subsidies and other social programs to help new parents.

“Policies that help people and families feel supported to meet their childbearing preferences … would actually help people who are open to the prospect of childbearing to do so,” Rocca said.

Rocca co-authored a study published in JAMA Network Open last fall suggesting Black and Hispanic women are less likely than other racial groups to be able to choose if, when and how to start a family.

Clinics must reapply for funding under these new guidelines by Jan. 9, 2027. HHS did not respond to a request for comment.

During his first term, Trump banned Title X clinics from referring patients to other providers for an abortion or even mentioning it as an option. He also prohibited grantees from offering family planning services and abortions in the same building. As a result, many grantees quit the program, including about a dozen state health departments and all participating Planned Parenthood chapters.

The program served about 844,000 fewer patients in 2019 than it did in 2018, when it served 3.9 million patients, according to HHS. About 225,000 fewer patients received oral contraceptives; about 50,000 fewer received hormonal implants; and about 86,000 fewer received IUDs.

The reframing of Title X that is reflected in the new guidelines was a recommendation laid out in the controversial blueprint known as Project 2025, created by the conservative think tank Heritage Foundation as a guide for the second Trump administration.

In line with Project 2025’s recommendations, HHS says Title X grantees will no longer be required to counsel or refer for abortions, and tells applicants that relationship counseling should encourage marriage as a precursor to having children.

“In a time when we are facing a rapidly declining birth rate that falls far short of the replacement fertility rate, we should be doing all we can to encourage and support family formation and fertility,” Dr. Christina Francis, CEO of the American Association of Pro-Life Obstetricians and Gynecologists, told MedPage Today in April.

“Women deserve accurate information about their fertility and their health — and this includes highlighting the many benefits of pregnancy and motherhood.”

Some abortion opponents have criticized Title X for promoting certain forms of contraception, such as IUDs, that they view as abortifacients. A spokesperson for the National Right to Life Committee said the organization does not take a stance on contraception that prevents fertilization, “however, National Right to Life does oppose any device or drug that would destroy a life already created at fertilization.”

“If there is any doubt, we recommend that a woman speak with her doctor to determine if an agent would cause an abortion,” the spokesperson said in an email.

But Leonard Lopoo, a professor at the Maxwell School of Citizenship and Public Affairs at Syracuse University who has studied fertility and family policies for the past three decades, said the federal government could help families achieve their family planning goals by expanding pregnancy prevention and infertility treatments at all income levels.

“When you’re trying to take away the funding for someone who doesn’t want to have a child, that’s not the same as providing funding to support someone who does,” Lopoo said.

As a Black woman and researcher focused on Black maternal health at Ibis Reproductive Health, Terri-Ann Thompson is better informed than most on the ways having children can be disproportionately more dangerous and less affordable for women who look like her.

But she says what she wasn’t expecting to uncover — during research for a study she co-authored in the journal Frontiers in Public Health this spring — is how much the fear of negative medical and criminal justice outcomes makes many Black women in Georgia and North Carolina scared of pregnancy.

“I was very surprised to see that folks were actually thinking about the context within which a Black child is born and raised well before they even contemplated starting a family,” Thompson said. “We had a lot of, just, stories of folks saying, ‘Why would I want to bring a child into this context; how does one prepare Black women to bring a child into this context?’”

Thompson said her team’s findings show how much Black women depend on low-cost access to long-acting reversible contraceptives such as IUDs.

“We have people who drove very, very far just to get a sliding scale to either get an IUD placed, an IUD removed, or to even get on birth control pills,” Thompson said.

“If the administration moves forward with these restrictions, what we are doing is we are removing access to contraceptives for a population that is at higher risk.”

Stateline reporter Sofia Resnick can be reached at sresnick@stateline.org.