Nearly 100 community-based organizations have lost their federal HIV-prevention grants this week as the Trump administration redirects dollars to state and local health departments.

The funding change represents a departure from the decades-old national HIV prevention strategy favored by most public health organizations.

President Donald Trump launched the Ending the HIV/AIDS Epidemic Initiative during his first term in office. Since 2021, the program has disbursed a total of nearly $240 million to 96 community-based organizations in 31 states, the District of Columbia, Puerto Rico and the U.S. Virgin Islands.

Those groups have used the money to pay for testing and pre-exposure prophylaxis (PrEP), a medication that people at high risk for HIV can take for protection during sex or injection drug use. Preventing new HIV infections and preserving access to treatment for those who have HIV helps prevent further transmission of the virus.

By prioritizing areas with the highest number of HIV diagnoses, the initiative sought to reduce HIV incidence by 75% in five years and by 90% by 2030. It continued under the Biden administration.

But now the Trump administration has shifted course.

Instead of granting money directly to community-based organizations, the administration is offering one-time grants to state and local health departments. It is encouraging the jurisdictions with the most HIV diagnoses to funnel at least 25% of the money to community groups, but there is no requirement that they do so. Health departments in areas with fewer diagnoses are being encouraged to send 10% of their money to community groups.

The state and local health agencies are required to spend whatever dollars they don’t pass on to community groups on HIV surveillance and PrEP access.

When the federal Centers for Disease Control and Prevention announced the availability of the original grants in 2020, it noted that since the late 1980s, it had partnered with community-based organizations to fight the spread of HIV because of “their accessibility, history and credibility in the community,” especially among Black and Hispanic people, gay and bisexual men and people who inject drugs.

“CDC has done this for a very long time, specifically because they know that community-based organizations are important players in the community,” said Lindsey Dawson, associate director for HIV policy at KFF, a nonprofit health research group.

“They’re a voice in the community that people trust, and these programs really are able to reach people who are at greatest vulnerability to HIV in a way that the state or federal or local government (would) not be able to do.”

When asked for an explanation of the change, the U.S. Department of Health and Human Services referred Stateline to the Office of Management and Budget. Neither OMB nor the White House press office responded to multiple requests for comment.

The National Alliance of State and Territorial AIDS Directors told Stateline that under the new grant program, the federal government will disburse approximately $90 million to state health departments through May 2027. Though that amount is nearly twice as much as the roughly $48 million per year that was handed out under the old grant program, community-based organizations are going to see less money, public health experts say.

In August, KFF estimated that overall, community-based organizations would need about 35% of the new money to match what they were getting before. The National Alliance of State and Territorial AIDS Directors estimates that percentage to be closer to 50%.

In Texas, health officials said the state plans to send about 23%, or about $1.2 million, of its $5.24 million grant to community-based organizations.

Jeffrey Campbell, chief executive officer of Allies in Hope — formerly called AIDS Foundation Houston — told Stateline that he expects his federal funding to be cut by $441,000, which could force him to lay off at least three staff members.

Under the old grant structure, half of all funding had been channeled to organizations in the South, which accounts for more than half of the nation’s HIV diagnoses.

But already, one organization in that region has announced it will have to shut down as a result of the funding change: PowerHouse Charlotte in North Carolina announced in August that it will close. For 16 years, that  organization has provided  free HIV and STD screenings, prevention services and community resources geared toward gay Black men.

In at least two states, Minnesota and Oregon, state health agencies wouldn’t be able to match the amount of money their community-based organizations were getting under the old system even if they gave 100% of their state grants to those groups, according to KFF.

“These community-based organizations are on the ground doing the work with the populations that need it,” said Carl Schmid, executive director at the HIV+Hepatitis Policy Institute, a public health nonprofit that tracks policies related to HIV prevention.

“Some states may have relationships with some of the existing grantees and may be fine, but others, they may not. And so there’s definitely going to be a lapse of funding.”

Emily Schreiber, senior director of policy at the National Alliance of State and Territorial AIDS Directors, said that under the new rules, states don’t have much time to establish new contracts with community-based organizations.

“(States) are trying to turn around things as fast as possible. But simply there (was) not enough time to get that funding through the contracting process and all of that by September 30th, which was really unfortunate,” she said.

“It’s not easy for a health department to create a whole new contracting process overnight. Even in the best-case scenario, this is not a perfect solution.”

Many health departments take between 45 and 90 days to scale new contracts and grants, said Toni Young, executive director and founder of Community Education Group, a nonprofit offering HIV community engagement, testing and outreach across rural West Virginia and the broader Appalachian region.

“We don’t have an infrastructure in many rural communities to address HIV,” she said.

Another challenge for community-based organizations is that because they won’t be getting money directly from the federal government, they will no longer be eligible for discounted drugs under the federal 340B program.

“When you took away this grant, you also took away their 340B status, which is the reason some have had to potentially close or at least stop this entire side of operations,” said Maximillian Boykin, manager of the Save HIV Funding Campaign.

“It leaves a lot of these places very fragile.”

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

For more than 35 years, the U.S. Centers for Disease Control and Prevention has surveyed American high school students every two years about their health and behavior.

The Youth Risk Behavior Survey, established in 1991, draws a nationally representative sample of students in grades 9 through 12 at public and private schools. Over the years, it has tracked a broad range of issues affecting teenagers, from substance use and sexual behavior to violence, mental health and other health risks.

But the CDC’s latest national report, a full-color publication with photos, graphics and high school success stories, offers a markedly different portrait of adolescent health than the one it published two years ago.

The 2025 Youth Risk Behavior Survey report focuses on five areas — diet, physical activity, sleep, digital behavior, and mental health and suicide risk — while largely leaving out national findings on substance use, sexual behavior, violence and disparities among student groups that were prominent in previous reports. 

The underlying survey data on the CDC’s website still contains many of those measures, including trends in alcohol and drug use, and sexual activity, but they are not part of the national report’s key findings.

The shift comes as Health and Human Services Secretary Robert F. Kennedy Jr. and the Trump administration have made preventing childhood chronic disease and promoting nutrition, physical activity and other health behaviors central to their “Make America Healthy Again,” or MAHA, agenda. Kennedy also chairs the presidential MAHA Commission, which has focused on the root causes of childhood chronic disease.

The 2025 report is also substantially shorter than the CDC’s previous national Youth Risk Behavior Survey report. It runs 36 pages, including the title page, table of contents and references, compared with 88 pages for the 2023 report, which also included some technical notes, references and appendices.

Dr. Jennifer Shuford, CDC’s deputy director and chief medical officer, touted changes in student attitudes toward nutrition, physical activity and mental health. 

“These are meaningful improvements, and they show that progress is possible when schools, families, and communities work together to support young people,” she said in a news release. 

“At the same time, too many students are still struggling with daily health behaviors that can negatively affect their long-term health,” Shuford said.

A focus on health and wellness

The 2025 report provides a snapshot of high school students’ health in 2025 and compares changes over the previous two and 10 years. Its five focus areas reflect behaviors and experiences the CDC says affect adolescent health now and into adulthood.

Some of the findings are encouraging. Thirty-nine percent of high school students said they ate fruit daily in 2025, up from 33% in 2023 and 34% in 2015. Sixty-three percent ate vegetables daily, compared with 58% in 2023 and 61% in 2015.

The share who said they drank plain water at least three times a day rose to 58% in 2025, up from 56% in 2021 and 49% in 2015, while daily soda consumption fell to 17% from 20% in 2015.

The share of students who played on a sports team also increased, reaching 58% in 2025 compared with 52% in 2023 and 49% in 2021.

Several measures of mental health and suicide risk improved as well. The share of students who reported persistent feelings of sadness or hopelessness fell to 33% in 2025, from 40% in 2023 and 42% in 2021. It was 30% in 2015.

The share who seriously considered attempting suicide fell from 22% in 2021 to 14% in 2025, while the share who made a suicide plan fell from a high of 18% in 2021 to 12% in 2025.

Female students continued to report higher rates of mental health and suicide risk than male students. In 2025, 43% of female students reported persistent feelings of sadness or hopelessness, compared with 24% of male students.

But the report also shows that several measures of youth health have worsened over the longer term.

Just 25% of high school students were physically active for at least 60 minutes a day in 2025, unchanged from 2023 and down from 27% in 2015. Twenty-four percent got at least eight hours of sleep on an average school night, compared with 27% in 2015.

Daily breakfast consumption fell from 36% in 2015 to 27% in 2025. The report also found long-term declines in daily physical activity, muscle-strengthening activity and daily physical education.

About 36% of students said they used social media every hour or more in 2025, little changed from 37% in 2023.

A different look at adolescent health

The latest report’s focus marks a significant change from the CDC’s 2023 national Youth Risk Behavior Survey report.

That report, published during the Biden administration and as the country was recovering from the COVID-19 pandemic, was organized around sexual behavior, substance use, experiences of violence, mental health and suicidal thoughts and behaviors. It also examined emerging issues including parental monitoring, social media use, racism in schools, unfair school discipline, school connectedness and unstable housing.

The 2023 report included more student demographic data broken down by sex, race and ethnicity, and sexual and gender identity. For the first time, the national survey asked students whether they identified as transgender, and the report highlighted disparities affecting LGBTQ+ students and marginalized racial and ethnic groups.

The 2025 report does not mention LGBTQ+ students or sexual and gender identity. It also provides fewer detailed demographic comparisons. The CDC says the new report includes only selected statistically significant demographic differences, while the underlying survey data remain available through the agency’s data system.

The new public-facing report does not mean the CDC stopped collecting underlying information about many of the issues featured in previous youth risk behavior reports. The agency continues to make the national dataset available publicly, including demographic information, through its online data tools.

Instead, the change is in how the CDC presents the findings nationally. That produces a different portrait of the nation’s high school students — one that captures some notable improvements while giving considerably less attention to several categories of health and risk that have been prominent in the CDC’s national youth surveillance reports for years.

Declines in substance use

For example, the decline in teen substance use that has unfolded over decades is absent from this year’s report, despite the 2025 data showing alcohol and marijuana use at or near historic lows.

About 20% of high school students reported current alcohol use in 2025, down from 22% in 2023 and nearly 52% in 1995. Current marijuana use also fell to about 13% in 2025, from 17% in 2023, while the share who had ever used marijuana dropped to about 25% in 2025 from 42% in 1995.

The share of students who had ever used other illicit drugs, including cocaine, inhalants, heroin, methamphetamines, ecstasy or hallucinogens, was 9.7% in 2025, essentially unchanged from 9.9% in 2023 and about 13% in 2015.

Vaping also continued its long-term decline. Current e-cigarette or vape use fell to 16% in 2025 from a high of nearly 33% in 2019. The share of students who had ever used these products also fell to 30% in 2025 from about 34% in 2023 and about 45% in 2015.

Sexual activity and school violence

The new report also gives little attention to several measures that have long been part of the CDC’s youth survey, including sexual activity and violence at school.

The share of high school students who reported being currently sexually active fell to about 19% in 2025, down from nearly 21% in 2023 and nearly 40% in 1995.

Other measures show longer-term declines but less consistent changes. The share of students who reported carrying a weapon on school property fell to about 3% in 2025, from more than 4% in 2023 and almost 10% in 1995.

The share who said they had been threatened or injured with a weapon, such as a gun or knife, at school was about 8% in 2025, compared with 9% in 2023 and about 8% in 1995. Bullying on school property was reported by 19.7% of students in 2025, roughly unchanged from 19.2% in 2023 and about 20% in 2015. Reported bullying hit a low of 15% in 2021.

Stateline reporter Amanda Watford can be reached at awatford@stateline.org.

The number of women who died after an ectopic pregnancy has spiked in recent years, a ProPublica analysis found. The mounting deaths in Centers for Disease Control and Prevention data have drawn little scrutiny or response.

Such deaths typically occur in the first trimester, after a pregnancy fails to properly implant in the uterus and begins to develop elsewhere, most commonly inside a fallopian tube. The embryo grows until it causes the organ to rupture, triggering catastrophic bleeding.

With prompt and appropriate medical care, maternal health experts say, women should not die. Yet ProPublica’s analysis found a stark and baffling increase: Almost 200 women with the condition died from 2020 to 2025, compared with about 100 in the previous six years.

“A death related to ectopic pregnancy should really be a never event,” said Dr. Alice Abernathy, an OB-GYN in Philadelphia.

While chaos and access issues at hospitals during the COVID-19 pandemic likely contributed to at least some of the deaths, the surge has persisted, raising serious questions about the role of the most significant disruption to maternal healthcare in the years since: state restrictions on abortion.

To treat an ectopic pregnancy, which is almost never viable, doctors must terminate it. But lawsuits and federal complaints have alleged that some medical providers are hesitating or flat-out refusing to do that in states where they face criminal penalties for performing an abortion. Patients described their terror.

“I genuinely thought I was going to die,” said Kyleigh Thurman, whose right fallopian tube ruptured after she struggled to get ectopic care in Texas in 2023.

“There were a few times I asked my husband if I was going to die,” Leitaea Lowrimore of Oklahoma said in a lawsuit after being denied treatment for an ectopic pregnancy at multiple hospitals in February. “I kept thinking about our kids.”

To determine whether these issues go beyond anecdotes, ProPublica analyzed the data collected from every state by the CDC to look for patterns. The analysis shows a growing divide for women in states with strict abortion bans compared with those without.

While the uptick in ectopic deaths occurred nationwide, the climb has been much steeper in states that banned abortion after the Supreme Court overturned Roe v. Wade in 2022.

ProPublica shared its analysis with more than a dozen maternal health experts, including leaders in the field, who were unaware of the spike; early pregnancy complications are chronically underresearched.

While they cautioned that abortion bans alone can’t explain the national rise, maternal health experts said any examination of the spike should include the documented delays in care caused by the laws, including for ectopic pregnancies.

In Thurman’s case, despite clear signs of an ectopic pregnancy, two emergency departments sent her home without resolving the complication. Regulators in 2025 found that one of the hospitals, Ascension Seton Williamson, failed to properly screen Thurman for a suspected ectopic pregnancy and did not call in an OB-GYN, in violation of the hospital’s own policies and federal law that requires emergency departments to treat and stabilize patients before discharging them. Thurman has an ongoing lawsuit against Ascension Seton Williamson and the other hospital, Ascension Seton Highland Lakes, for medical malpractice.

Thurman had to have her fallopian tube removed after it ruptured. (Thurman is not related to Amber Thurman, who died in Georgia, which also has an abortion ban, after doctors delayed treating different pregnancy complications in 2022.)

“I’ve never been in a situation where I didn’t get healthcare when I needed it,” Thurman told ProPublica, comparing the condition to having “a time bomb you can’t control.”

A spokesperson for the Ascension Seton hospitals said in a statement, “When a patient experiences a serious or life-threatening condition during pregnancy, our clinicians provide medically indicated treatment, including treatment for an ectopic pregnancy.” The hospital has denied Thurman’s malpractice allegations in a court filing.

Ectopic pregnancies, while rare, have long been recognized as the leading cause of maternal deaths in the first trimester. The condition impacts up to 2% of pregnancies in the U.S. Because government agencies don’t require hospitals to track or report overall ectopic diagnoses, it is impossible to know whether the condition itself is becoming more common.

While rates for other pregnancy-related deaths also increased during the pandemic, those climbs have largely subsided.

Experts aren’t sure why ectopic deaths have continued to rise. Ectopic pregnancies are more common among older women, but the increase in deaths has been even more stark among younger women, the analysis showed.

Anti-abortion groups have suggested that the use of abortion pills prescribed online is leading to more undiagnosed ectopics because telehealth patients don’t receive an ultrasound. But studies have found that ectopic rates are far lower among people who seek medication abortions than in the general population. Telehealth clinics ask questions that filter out patients at higher risk of ectopic pregnancy and follow up with those they treat to screen for symptoms, said Ushma Upadhyay, a researcher at the University of California, San Francisco, who studies telehealth abortion administration.

Experts told ProPublica that more research is required to determine the role of the abortion bans in the rise of ectopic-related deaths. Many states with bans, which generally provide less Medicaid funding and coverage to low-income women, have long had poorer maternal outcomes. “It’s a real challenge to try and tease out one thing out of the array of factors that undermine women’s health in these states,” said Eugene Declercq, a public health researcher at Boston University.

But experts said ProPublica’s data analysis, along with stories about delays in ectopic care, underscores the need to find out what is driving the deaths.

“Reproductive health is unusual across medicine when we consider how swiftly policy changes affect the care patients can receive,” said Dr. Courtney Schreiber, a professor of obstetrics and gynecology.

Caitlin Myers, an economist at Dartmouth College who studies abortion policy, said the deaths should be investigated: “This is a potentially profound consequence of the regulation,” she said.

How abortion bans interfere with ectopic care

Many state abortion bans include exceptions for ectopic pregnancies. But experts have worried that doctors are hesitating to offer treatment without an ironclad diagnosis, which clinicians say can take time and increase risks to the mother.

Ectopic pregnancy symptoms often begin with abdominal pain and bleeding, which send women to emergency rooms. There, doctors use ultrasounds to locate where the pregnancy has implanted.

However, embryos are often not visible on an ultrasound early in pregnancy. That could mean the pregnancy is ectopic, but it may also be a miscarriage or normal pregnancy that’s too small to see. Doctors can also assess whether the pregnancy is likely ectopic through blood tests over multiple days.

If the pregnancy is ectopic, the risk of rupture increases the longer treatment is delayed. In a state without a ban, a patient could decide at any point that that risk is not worth taking and opt to terminate the pregnancy.

In a state with a ban, however, that option may not exist. If doctors can confirm the pregnancy is ectopic through an ultrasound, they can protect themselves from having their decision to terminate questioned, perhaps by a zealous prosecutor. But waiting for this can delay treatment by days or even weeks.

“Seeing a mass is not the only reason to have high suspicion for an ectopic pregnancy,” said Dr. Rebecca Nerenberg, an emergency medicine doctor in New York and the clinical director at Access Bridge, which educates ER doctors on reproductive healthcare and has released evidence-based guidelines for diagnosing possible ectopic pregnancies.

Experts say that doctors should be able to offer treatment when other symptoms are present, such as plateauing pregnancy hormone levels, bleeding and abdominal pain. Patients can be treated with a procedure or a cancer drug that stops cells from growing.

But for women in states with abortion bans, getting that treatment can be difficult.

Lowrimore, who lives near the state border in Oklahoma, sought care at an Arkansas emergency department in February after experiencing abdominal pain and significant bleeding. She was sent home and told to return for more tests after being diagnosed with a “pregnancy of unknown location,” because an ultrasound could not show where her pregnancy had implanted, according to a lawsuit.

Lowrimore visited three different hospitals across both states over the following week as she began passing blood clots and the pain intensified, radiating up the left side of her body, according to the lawsuit.

The fact that the states’ abortion bans make exceptions for ectopic pregnancies did not help her, even though doctors acknowledged that was a possible diagnosis. In each visit, they didn’t treat her for that condition. One told her that intervening in her pregnancy could land him jail time — “10 years in the poky,” according to the suit. “I felt like my life was a risk he couldn’t afford,” she said in the lawsuit filing.

After consulting a lawyer, Lowrimore finally drove to a hospital in Kansas, where abortion is legal, and got an injection of the cancer drug called methotrexate within hours of arrival.

Lowrimore’s lawsuit, in which an OB-GYN and six women who were denied care are seeking to block the Arkansas abortion ban, is ongoing. Lowrimore also filed complaints under the same emergency medicine law as Thurman against the three hospitals. Regulators cited Mercy Hospital in Fort Smith, Arkansas, for failing to provide care during the eight hours Lowrimore waited to be seen. The other two hospitals were not found to have violated that law, and they did not respond to requests for comment.

A spokesperson for Mercy Hospital declined to comment on the case, saying that, “in tragic situations when a mother suffers from an urgent, life-threatening condition during pregnancy, Mercy provides all medically indicated treatment to save her life.”

Many experts predicted that ordeals like the ones Lowrimore and Thurman described would occur when abortion bans took effect. To see if more women with ectopic pregnancies are experiencing severe health outcomes, ProPublica analyzed hospital data from Texas, the most populous state to ban abortion.

In this new analysis, ProPublica found that 310 more patients in Texas experienced substantial blood loss after an ectopic pregnancy in 2023 and 2024 compared with 2018 and 2019, an increase of about 29%. Similar to ectopic deaths, the rise appeared to begin during the COVID pandemic, but the rate of complications remained elevated after hospital systems stabilized and the state passed its restrictive law. ProPublica is working to acquire similar data from states without abortion bans.

In response to ProPublica’s reporting on the deadly impacts of Texas’ abortion ban, the state passed the Life of the Mother Act in 2025, which attempted to clarify what kinds of abortions are allowed by the state’s law, explicitly adding ectopic pregnancies to the list.

But new guidance from the Texas Medical Board includes only a case study with an ectopic pregnancy that can be seen in an ultrasound, remaining silent on the difficulty of early ultrasounds to detect where a pregnancy has implanted. This leaves open the possibility that a prosecutor could question whether such a case was really ectopic, in a state where doctors face up to 99 years in prison for performing illegal abortions.

A spokesperson for the Texas Medical Board said the course is not intended to cover all scenarios and that it “explains that imminent harm is unnecessary and specifically states that physicians who follow evidence-based medicine, standard emergency protocols, and proper documentation face minimal risk.” Asked whether a conclusive ultrasound image is necessary for an ectopic diagnosis, the spokesperson said, “The Board has consistently stated that providing commentary on every possible situation would be impractical.”

But Michelle Maloney, an attorney who represents Thurman and 13 other Texas women or their families who say they were denied care — including seven with ectopic pregnancies — said she still gets frequent calls from women who say they were denied care for pregnancy complications. “I don’t think specific exemptions address the massive gray areas that arise in pregnancy,” she said.

Solutions are unlikely to come from the states themselves. A previous ProPublica investigation found that states with strict bans are not studying whether their laws are contributing to maternal deaths. And others have not followed Texas in attempting to amend their bans.

Gaps in research, training and awareness 

One of the biggest challenges to reducing ectopic pregnancy deaths nationwide is the lack of awareness, research and data.

No one, for example, is tracking whether women who experienced ectopic pregnancies also had one or more common risk factors, like a history of ectopic pregnancies, infertility or use of hormonal intrauterine devices, according to ProPublica’s review of maternal health statistics and interviews with experts.

Nor has any published research addressed the connection between recent ectopic pregnancy death rates and untreated infections like gonorrhea and chlamydia, which increased substantially during the first years of the pandemic before declining again. Those infections can cause pelvic inflammatory disease, which causes fallopian tube scarring and raises the long-term risk of developing an ectopic pregnancy.

It is unclear why the CDC and other federal agencies across two administrations have failed to publicly respond to the increase in deaths despite having access to the same information ProPublica analyzed. But experts say the country’s capacity to respond to it has been greatly reduced under President Donald Trump.

Robert F. Kennedy Jr., secretary of the Department of Health and Human Services, told Congress in April that improving maternal health outcomes is a priority. But the Trump administration has eliminated much of the staff devoted to researching the topic and cut hundreds of millions of dollars in government funding for healthcare research.

The CDC’s Division of Reproductive Health, for example, lost most of its 100 employees, according to a lawsuit filed by more than a dozen states’ attorneys general last year. The entire division that ran the Pregnancy Risk Assessment Monitoring System, a significant source of data for state and local governments as well as maternal health researchers, is on paid administrative leave. That includes many researchers who would have been responsible for investigating the rise in ectopic pregnancy deaths, according to current and former CDC employees.

“You’re losing the capacity to know what’s going on with pregnant women,” Lee Warner, the former chief of the Women’s Health and Fertility Branch at the CDC, said of the cuts at the division. “It’s going to take decades to build this capacity back.”

Funding cuts have also impacted efforts to raise awareness about the condition. Because ectopic pregnancies usually cause complications before standard prenatal care begins around 10 weeks, patients often rely on emergency departments, where doctors don’t typically have specialized training in pregnancy care. Experts say more training on high-risk early pregnancy conditions could help combat rising maternal mortality rates.

The CDC in 2025 also stopped funding a partnership with the American College of Obstetricians and Gynecologists to educate emergency medicine doctors about reproductive healthcare. The initiative, “Obstetric Emergencies in Nonobstetric Settings,” offers resources for emergency departments on caring for pregnant patients with cardiovascular disease, hypertension and eclampsia. An ACOG spokesperson said its foundation now funds the project, and that the organization is working on a set of guidelines for diagnosing and managing tubal ectopic pregnancies in the emergency department.

A spokesperson for HHS said the agency continues to track maternal mortality trends, investigate their causes and provide funding for research. “This important work is being accelerated across the Department to support healthy mothers, healthy babies, and strong families,” the spokesperson said.

The United Kingdom’s response to a similar spike in ectopic deaths during the pandemic shows just how much the U.S. is failing to do.

Researchers and officials there identified a surge in deaths in 2021 and 2022 in the U.K. and Ireland; 12 women died of an ectopic pregnancy during those years, which, as in the U.S. during this period, represented a near doubling of the death rate compared with previous years.

They investigated the causes and found a range of culprits, including overstretched emergency services and inadequate early pregnancy screenings, says Marian Knight, a professor at the University of Oxford who leads the U.K.’s maternal mortality reporting.

In 2024, Knight co-authored a maternal mortality report that focused on those deaths and offered policy recommendations. Knight worked with policymakers and a U.K. charity to raise awareness and help doctors and the general public recognize ectopic pregnancy symptoms. Officials also changed how patients experiencing ectopic pregnancy symptoms are prioritized when they call for an ambulance, leading to faster response times.

But the first step, said Knight, was identifying and investigating the issue. “If we’re not tracking and not just understanding the numbers, but understanding the why behind the numbers, we have no ability to respond,” Knight said.

The U.S. doesn’t do national maternal mortality reviews, said Boston University’s Declercq, who serves on the Massachusetts Maternal Mortality and Morbidity Review Committee. Instead, CDC epidemiologists review death and birth records to establish accurate national totals of pregnancy-related deaths, largely leaving state and local maternal mortality committees to take an in-depth look at individual cases and make recommendations to lawmakers and medical providers.

Declercq said his committee has not identified a notable increase in deaths from ectopic pregnancies in Massachusetts in recent years. In most states, these deaths are sporadic enough that they don’t, in isolation, show a notable trend.

It’s only at the national level that this increase in avoidable deaths becomes visible.

ProPublica’s analysis “raises concern that young women are dying from a preventable cause at an increasing rate,” Schreiber, the professor of OB-GYN, said. “That is not what we should be seeing in the United States of America.”

Jalapenos. Frozen berries. Beef. Alfalfa sprouts.

A summer of food recalls, including the record-shattering cyclosporiasis outbreak tied to iceberg lettuce that has sickened thousands, has raised many Americans’ fears of contracting a foodborne illness.

The recalls have focused attention on the Trump administration’s decision to cut funding and staff at several public health agencies, and prompted questions about whether those changes have made consumers more vulnerable.

In fact, this year’s tally of food recalls is roughly in line with the numbers in recent years. About 48 million people each year get sick from a foodborne illness. But experts worry that the scope, severity and scale of outbreaks and their associated food recalls are growing.

While the United States sees some cyclosporiasis cases every year, this year’s outbreak has crushed records: Since May, the federal Centers for Disease Control and Prevention has confirmed more than 17,000 cases, with another nearly 12,000 reported cases still under investigation. The outbreak has resulted in at least 922 hospitalizations and two deaths.

Federal officials have blamed this year’s multistate outbreak on processed iceberg lettuce from central Mexico. The lettuce was brought to the U.S. by Taylor Farms, a distributor that supplies foods to thousands of restaurants and grocery stores, including Target, Taco Bell, Whole Foods, Kroger, Walmart, Costco and Jack in the Box.

The CDC and the Food and Drug Administration are investigating at least six other clusters for which a source hasn’t yet been confirmed.

Cuts at the CDC and FDA haven’t necessarily increased consumers’ chances of food contamination or outbreaks, said Jennifer McEntire, a food microbiologist and the founder of a food safety consulting firm. However, McIntire said, “I do think the cuts may have influenced the way outbreaks unfold.”

“I think there are valid questions around the timing of the response, the time it took for agencies to recognize the outbreak and to start to investigate it, get boots on the ground in Mexico,” she said.

Darin Detwiler, a food safety expert and professor emeritus at Northeastern University, noted that the U.S. is seeing more recalls affecting multiple states, rather than a small area. He added that more recalls are being tied to a problem earlier in the food chain — such as contaminated irrigation water at a large lettuce farm rather than, say, improperly stored deli meat at a sandwich shop  — which can spread the pathogen to a far higher number of people and make it harder to track and contain.

“We’re seeing so many people impacted, so many states impacted, and the recalls are dragging on for a long time,” Detwiler. “There’s ambiguity or lack of transparency over who’s even behind a recall.”

The White House dismissed concerns about the federal government’s ability to handle outbreaks.

“The Trump Administration has never cut FDA food inspectors or other frontline personnel for domestic disease response,” White House spokesperson Allison Schuster told Stateline in an email. “President Trump’s top priority is the health and safety of the American people, and the federal government remains capable of robustly addressing any future outbreaks.”

Fewer staff, less funding

Last year, the Trump administration laid off thousands of employees at federal public health agencies including the CDC, which tracks and responds to disease outbreaks, and the FDA, which oversees and regulates food safety.

While some of the layoffs were reversed through lawsuits or by Congress, the nation’s health public agencies remain at diminished capacity. The CDC workforce has been reduced by 28% since December 2024, the month before Trump took office, according to a Stateline analysis of data from the U.S. Office of Personnel Management. Employee numbers at the FDA are down 23% during the same period.

Last year, U.S. inspections of foreign food facilities, such as the Mexican farming operation linked to the cyclospora outbreak, plummeted to historic lows following those staffing cuts. The FDA suspended a quality control program for food testing. And the parasite surveillance staff at the CDC, which responds to outbreaks, was downsized last year by the Department of Government Efficiency from 11 people to three.

Sandra Eskin, a food safety expert who worked in the office of food safety at the U.S. Department of Agriculture during the Biden administration, likened federal public health cuts to the game Jenga, where players construct a tower of wooden blocks and then remove the blocks one at a time while trying not to make the tower fall.

“I think that’s what we’re seeing,” said Eskin, who now leads a public health nonprofit called Stop Foodborne Illness, which advocates for stronger food safety policies. “Whether it’s cuts in staff, cuts in funding that trickle down to the states, or late responses to outbreaks — these are all pieces of wood in that game where you start pulling them out and then the whole thing collapses.”

The federal government also has delayed requiring companies to comply with new food safety rules, included in a law enacted more than a decade ago, that would help regulators track where food comes from and where it’s going during outbreaks.

Detwiler and other experts say the new rules could have helped speed the government’s sluggish response to the cyclospora outbreak investigation after Taylor Farms initially tried delaying the recall.

Last year, the Trump administration also drastically scaled back FoodNet, an early warning surveillance system that required tracking of infections caused by eight different foodborne pathogens. The federal-state collaboration is now only required to track two pathogens: salmonella and Shiga toxin-producing E.coli. The other six pathogens, including cyclospora, were made optional.

The CDC says the change was made because other surveillance systems monitor those pathogens. But McEntire and other food safety experts want them reinstated on FoodNet.

State impacts

Infectious outbreaks like cyclosporiasis are typically investigated by state and local health departments, which largely rely on federal dollars distributed through the FDA and CDC. Public health has been chronically underfunded for decades under several administrations, experts say.

But the Trump administration since last year has terminated $5.78 billion in CDC grants — funds that were appropriated by Congress but had not yet been spent.

Michigan, at the center of the cyclosporiasis outbreak with the highest number of cases and clusters, is one of 23 states (plus the District of Columbia) that successfully sued the Trump administration in June 2025 over federal funding cuts.

Changes to federal funding last year affected public health infrastructure across Michigan, a representative from the Michigan Department of Health and Human Services told Stateline. During the cyclosporiasis  outbreak, the state used its own resources to bolster local responses.

“While we are able to support this investigation on a local level, sustained investment in public health capacity is essential to ensuring Michigan can respond effectively to future regional and statewide public health threats,” said department spokesperson Lynn Sutfin.

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