As they await a federal decision on a potential nationwide ban on telehealth abortions, anti-abortion activists plan to push more states to require women to visit a doctor’s office, get an ultrasound or wait before they can get abortion pills.

Under its current guidelines, the U.S. Food and Drug Administration does not require in-person visits, ultrasounds or waiting periods for women seeking abortion pills. Nevertheless, 10 states without total abortion bans still require them.

One of those states is Florida. The state only allows abortion up to six weeks — which is before many women discover they are pregnant. Under state law, women must first get an ultrasound and then wait at least 24 hours before receiving pills or a procedure. By that time, they might be beyond the six weeks threshold.

“Floridians are already under a time clock,” said Lana’e Hernandez, a case manager for the Florida Access Network, an abortion fund that helps women pay for their abortions and travel to other states if they fall outside Florida’s narrow window.

“I see a lot of clients having to then travel out of state and take even more time off of work, adding another barrier to accessing care because of those laws combined.”

Medication abortion typically involves two drugs: mifepristone and misoprostol. The FDA approved the two-drug regimen in 2000 and gradually loosened restrictions as safety reviews showed a low risk of serious and life-threatening conditions. During the COVID-19 pandemic in 2021, the Biden administration suspended enforcement of the rule that patients had to take the medication in person, and the FDA officially removed that requirement in 2023.

But anti-abortion organizations and attorneys general have challenged these changes in ongoing federal lawsuits. And in 2025, activist groups successfully pressured the Trump administration’s FDA to review the safety data again.

On Wednesday, the FDA is expected to update the public on the progress of this review, though the agency is not expected to issue a final ruling on telehealth access to the pills. The Washington Sun recently reported that the Trump administration wants to delay any potentially controversial actions around abortion until after the midterm elections. The administration has also delayed multiple ongoing federal lawsuits until after the review.

Abortion rights advocates say reversing telehealth access to medication abortion would have a huge impact across the country. Medication abortions now account for about 65% of all abortions, and roughly 28% of all abortions are through telehealth, according to KFF, a health research group.

Critical elections

In statehouses, the midterm elections could determine whether more states will seek to restrict medication abortion.

Meanwhile, Democratic control of Congress could doom President Donald Trump’s nominee for FDA commissioner. During her confirmation hearing last month, nominee Heidi Overton would not say whether she would recommend changes to mifepristone regulation, but in the past she has expressed anti-abortion views and written that the medication is dangerous.

National anti-abortion leaders told Stateline they will not be satisfied if the FDA determines that mifepristone is safe and can be administered via telehealth.

“There are comorbidities that come with mifepristone, like ectopic pregnancies that need to be diagnosed prior to the actual provision of mifepristone, and right now under the FDA system, that’s not working,” said Bradley Kehr, vice president of legal affairs of Americans United for Life. “So states are stepping in to say that they have serious concerns, and they’re taking action for the safety of their citizens.”

Peer-reviewed studies overwhelmingly show a low risk of serious adverse events for medication abortions up to 10 weeks’ gestation, including via telehealth. But national anti-abortion groups have pointed to examples of coercion and non-peer-reviewed white papers to argue the risks are more significant than what the FDA has reported, and that ultrasounds should be required before the pills are administered.

Hernandez of the Florida Access Network said ultrasounds might be appropriate for women who have irregular periods or are at risk for an ectopic pregnancy, but that they should not be universally mandated by lawmakers. According to the American College of Obstetricians and Gynecologists, for patients with regular menstrual cycles and no risk factors for ectopic pregnancy, a clinical examination or ultrasound is not necessary before taking abortion pills.

“These are conversations that you should be having with your medical professional and not the government mandating you to do one thing or another,” Hernandez said. “You should be able to trust your physician to tell you whether you need an ultrasound or not to have an abortion.”

Abortion rights advocates say abortion is being singled out even as more medical care is being delivered via telehealth.

“When it comes to telehealth for abortion care specifically, a lot of those concerns, I think are coming from a place that’s really informed by abortion stigma,” said Kimya Forouzan, the principal state policy advisor of the Guttmacher Institute, a research and policy organization that supports abortion rights. “Receiving medication abortion via telehealth is not different than any other form of telehealth care.”

Existing restrictions

In addition to Florida, Alaska, Georgia, Iowa, Missouri, Nebraska, North Carolina, South Carolina, Utah and Wisconsin require ultrasounds or other in-person requirements before medication abortions. In-person requirements can include an initial in-person exam, in-person counseling, a requirement that the pills be dispensed in person or a requirement that the first dose be taken in person.

Thirteen other states (Alabama, Arkansas, Idaho, Indiana, Kentucky, Louisiana, Mississippi, North Dakota, Oklahoma, South Dakota, Tennessee, Texas and West Virginia) ban all abortions.

In Alaska, Missouri and Wisconsin, plaintiffs have challenged the laws on state constitutional grounds. Wyoming last year enacted a law requiring ultrasounds and a 48-hour waiting period before medication abortions. But a state district judge overturned the law in June, ruling that it violated a constitutional amendment protecting healthcare decisions, and that the state “offered no cogent evidence illustrating that a waiting period is necessary for any purpose.”

At the federal level, plaintiffs have argued that state regulations on abortion pills should not supersede the federal guidelines.

“The FDA sets the bar, and states don’t get to impede access to an FDA-approved medication,” said Kirsten Moore, director of the Expanding Medication Abortion Access (EMMA) Project, which tracks litigation related to medication abortion.

In an ongoing federal lawsuit over North Carolina’s restrictions, the plaintiffs argue that the state law conflicts with the FDA’s regulatory authority. A federal judge in 2024 ruled that the state could not ban the mailing of abortion pills, since federal rules allow it. But the judge upheld the state’s ultrasound requirement and its waiting period.

The case is pending appeal, with oral arguments scheduled for later this month at the 4th U.S. Circuit Court of Appeals, which last year upheld medication abortion restrictions in West Virginia, which bans all abortions and explicitly telehealth abortions. In that case, plaintiff generic mifepristone manufacturer GenBioPro argued the state’s ban violated the federal regulation of abortion pills, but the appeals court affirmed the lower court’s decision that FDA regulations did not preempt the state’s abortion ban.

Earlier this year, Iowa also enacted a law requiring abortion-inducing medication to be prescribed in person and dispensed in a medical setting.

Beaufield Berry, executive director of the Iowa Abortion Access Fund, said that since the law went into effect, her group has gotten more calls from people asking for financial help to travel out of state. She said there are two abortion clinics left in the state, both in central Iowa, making it especially difficult on people in rural areas.

“It’s really hard for some people to be able to make an appointment to go get an ultrasound, and then if they do that, then they’re running up against that six-week clock,” Berry said.

“For an in-person visit, that’s transportation, missing work, finding childcare. And in many cases, the act of having an abortion, you may not have support,” she said. “They may be underage, and so that creates even more barriers to getting an in-person meeting.”

Different strategies

Kehr of Americans United for Life said anti-abortion state lawmakers are still figuring out their individual strategies for restricting access to abortion medication. He cited the 10th Amendment, which gives states the authority through their police power to protect their citizens, as a legal justification for mandating ultrasounds or in-clinic visits before abortion pills are dispensed.

“Other states are taking different approaches, whether it’s the ultrasound provision to check for ectopic pregnancies and things like that, or the actual consideration of abuse that’s occurring,” Kehr said.

“We’ve had multiple stories of men forcing their pregnant girlfriends or wives to take mifepristone. So looking at it from an abusive perspective or a coercive perspective, states are really looking at the gamut of options under the 10th Amendment powers.”

Model legislation developed by the National Right to Life Committee, known as the Abortion Pill Provider Liability Education (APPLE) Act, and introduced this year in New Jersey and Ohio, would require abortion-pill prescribers to inform patients about the risks of the drugs, as well as her right to sue the provider if she faces complications.

The National Right to Life Committee also supports in-person visits and mandatory ultrasounds.

“Requiring a healthcare provider to confirm, locate, and date a pregnancy before prescribing a dangerous mixture of abortion-inducing drugs is a bare-minimum safety standard, and we believe it should apply in every state,” Ingrid Duran, director of state legislation for the National Right to Life Committee, wrote in an email.

Also looming in the background are interstate fights over so-called shield law providers prescribing medication virtually. Attorneys general in Alabama, Arkansas and Louisiana filed lawsuits last week targeting shield laws and in California, Massachusetts and New York, and individual doctors prescribing abortion pills to women in states with abortion bans.

“A woman can’t possibly receive fully informed consent specific to her when the dispensing provider doesn’t even know how far along she is in her pregnancy because the risk is different depending on how far along she is,” said Dr. Christina Francis, an OB-GYN based in Fort Wayne, Indiana, who is CEO of the American Association of Pro-Life Obstetricians and Gynecologists, which has opposed abortion pills since they were first approved in 2000.

“We believe that women deserve fully informed consent, and that necessarily involves an ultrasound when we’re talking about pregnancy.”

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

The U.S. Food and Drug Administration says it’s helping manufacturers increase the supply of estrogen-based hormonal patches and acknowledged a current nationwide shortage as more women seek hormonal therapies for symptoms related to menopause.

In a release earlier this month, the FDA said it is expediting actions to increase supply, and said all six manufacturers are working to expand capacity and prioritize production of the patches.

“The FDA views increased interest in menopause treatment as an important development for women’s health and is working closely with manufacturers to help ensure that the supply of estradiol patches keeps pace with demand,” the release said.

Menopause typically occurs between the ages of 45 and 55, according to the National Institute on Aging, when a woman stops having menstrual periods. That hormonal change can cause symptoms such as hot flashes, night sweats, bone density loss, insomnia and more. Estradiol transdermal patches worn on the skin can replace estrogen lost through menopause and reduce those symptoms for some women.

Stateline reported in May that more awareness of menopause and its effects was leading to more states introducing legislation around the topic to mandate more insurance coverage for treatment and to create more workplace accommodations. At that time, the FDA did not list the patches in its list of shortages — this month marks the first time the agency has acknowledged a shortage. The American Society of Health-System Pharmacists first noted a shortage in January, two months after the FDA removed the treatment from its longtime “black box” warning status.

As of May, the National Menopause Foundation said more than 60 pieces of legislation related to menopause had been introduced nationwide this year. Twenty-six, and 26 states have enacted menopause-related laws since 2019, and more bills are expected to be introduced in the upcoming 2027 legislative sessions.

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

Nearly five years ago, Chase Johnson was cured of breast cancer — but not of the profound anxiety that it would return.

When Johnson was originally diagnosed in 2021, the resident of Cary, North Carolina, was only 31 — nearly a decade away from the age at which regular mammograms are recommended — and she had no history of breast cancer in her family. She only got screened because her dog, Cato, kept poking her chest with his nose, which helped her discover a lump.

Doctors discovered that Johnson had stage 2B triple-negative breast cancer, a rare and aggressive form. They treated her with chemotherapy, radiation, and surgery, and in 2022, they declared her cancer free. Her oncologist warned her, however, that there was a 40% chance the cancer would return.

Anxious about that prospect, Johnson enrolled in a clinical trial at the Cleveland Clinic testing a new breast cancer vaccine, developed in partnership with Anixa Biosciences. That vaccine has shown positive early results: In nearly three-quarters of the participants, including Johnson, it has generated an immune response.

“It’s just so promising and as a patient, it gave me a lot of hope,” said Johnson, now 37. “I feel much more protected having done it.”

In the past two decades, there has been steady progress in developing vaccines for cancer. The vaccine Johnson is taking isn’t one of them, but researchers are especially excited about the potential of mRNA vaccines, which use synthetic genetic instructions to teach a person’s immune system how to recognize and destroy unique proteins found on cancer cells.

Just last month, pharmaceutical companies Moderna and Merck announced that a personalized mRNA cancer vaccine, combined with an immunotherapy drug, had succeeded in a late-stage trial for skin cancer. The news raised hopes that a wave of new cancer vaccines could be just over the horizon.

But will Americans be willing to take them?

Many doctors and researchers are concerned that vaccine misinformation — amplified by the Trump administration — and the resulting increase in vaccine hesitancy could blunt the impact of the new vaccines. In particular, they cite the false claim, which originated with mRNA COVID vaccines, that mRNA vaccines can super-charge tumors, creating so-called turbo cancer. 

Many point to the human papillomavirus (HPV) vaccine as a cautionary tale.

Some strains of HPV, which is spread through sexual contact, can cause cancer of the cervix, vagina, vulva, penis, anus, mouth, throat, head or neck. In 2006, the U.S. Food and Drug Administration approved an HPV vaccine for girls and women ages 9 to 26, and three years later the agency expanded approval to include boys and young men. Ideally, vaccination should occur before a person is sexually active.

The HPV vaccine is safe and extremely effective. But decades of misinformation, some of it spread by state and federal lawmakers, has reduced uptake: For four years in a row, vaccination rates for teenagers have not budged, and there is wide variation among states.

“I don’t think we can overstate the impact that the pandemic and the misinformation and disinformation around vaccines has had on all vaccines, including HPV vaccine,” said Dannell Boatman, an assistant professor at the West Virginia University Cancer Institute.

A 2024 study Boatman co-authored, funded by Merck, found that the HPV misinformation on social media platforms was most pervasive in the users’ comments.

“There were some really wild conspiracy theories about girls in India being killed with the HPV vaccine,” Boatman said. “We also were able to identify a lot of mistrust of authority.”

Boatman said she expects a similar dynamic with breast cancer vaccines, especially since some people already are spreading misinformation that mammograms can cause cancer. But she hopes an ongoing study on “inoculation theory” will help researchers combat false claims.

“Basically, you forewarn someone that they’re going to be exposed to misinformation,” she said, “and then you refute it or provide them just a little bit of evidence about why it doesn’t work.”

History of lawsuits

Before he joined the Trump administration, U.S. Department of Health and Human Services Secretary Robert F. Kennedy Jr. filed complaints and lawsuits against Merck, the maker of the HPV vaccine, and claimed on social media that the “vaccine appears to be increasing the risk of cervical cancer in vaccinated age groups just as COVID vaccines raise the risk of COVID.”

Early in his tenure, Kennedy dismissed all 17 members of the HHS vaccine advisory panel, replacing some of them with vaccine skeptics. Under his leadership, HHS also has altered the child vaccine schedule for certain diseases, including HPV. So far, those changes have been blocked in federal court.

HHS did not respond to a Stateline request for comment.

Last month, after signing an executive order separating the measles, mumps and rubella (MMR) vaccine into three separate shots, Republican President Donald Trump suggested, falsely, that each individual vaccine could fill a “bottle of soda.” The administration has also proposed cutting funding for vaccine research and studies on vaccine hesitancy.

Epidemiologist Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said Kennedy’s appointment spurred the creation of the Vaccine Integrity Project, a partnership between the center and the American Medical Association that tries to bolster public trust in vaccines. The project has published evidence reviews of some of the vaccines criticized by the Trump administration.

“To a young parent today who wants to do the right thing, they want to protect their child, they’re so confused because they hear from the leaders in public health in their government talk about these vaccines killing people,” Osterholm said.

“The credibility of 80 years of public health work of vaccines in this country is threatened because of confusion.”

In May, the center published an evidence review showing that HPV vaccines are not associated with serious side effects and reduce the risk of cervical cancer by 80% in individuals who are vaccinated by age 16, and by 66% in people vaccinated after 16.

Resistance from state lawmakers 

But the HPV vaccine has long faced resistance from some conservative lawmakers, who associate it with teen sex.

Last year, 78% of U.S. teenagers ages 13-17 had received at least one dose of the HPV vaccine and 63% had completed the full HPV vaccination series. But in some conservative-leaning states, the rates were much lower: The complete vaccination rate in Mississippi was only 31%. Oklahoma (46%), Kentucky (50%), Arkansas (52%) and South Carolina (55%) also had particularly low rates.

At the other end of the spectrum were Rhode Island (85%), Hawaii (82%) and Massachusetts (80%).

Some states, including Alabama and Oregon, have made recent efforts to boost their  HPV vaccine rates.

But other states, including Iowa, have enacted laws limiting access to the HPV vaccine.  Republican Gov. Kim Reynolds in May signed a law prohibiting Iowans under 18 from consenting to vaccinations related to sexually transmitted diseases and infections, including HPV.

Idaho Democratic state Rep. Brooke Green said anti-vaccine sentiment is increasing among residents of her state — and among her legislative colleagues. As a survivor of breast cancer, Green is excited about the prospect of new cancer vaccines, but she fears that rising hesitancy could be hurdle to widespread adoption.

She noted that Idaho Republicans introduced a bill this year that would have established a two-year moratorium on mRNA immunizations for children and pregnant women. Similar bills were introduced in at least a dozen other states, though none were enacted.

This year, lawmakers in 34 states introduced 209 bills seeking to loosen vaccination rules, limit access to certain kinds of vaccines or sow doubt about their safety, according to a recent analysis by The New York Times.

“We are seeing several attempts to address some of the scientific tools that are used to create vaccines, mRNA vaccines and so forth,” Green said. “As a cancer patient, these are life-saving tools that are helping us.”

“I’m thrilled to see these new innovative advancements in medicine for these vaccines. Now, is it going to be widely accepted?” said Green, who was first diagnosed with breast cancer in 2024, a week before her mother was diagnosed with the same cancer.

“There will be some hesitation and some pushback. But look at the flip side: ‘Do you want breast cancer or do you not? Do you want skin cancer? Do you not?’”

Chase Johnson, meanwhile, said her anxiety has significantly decreased, especially after celebrating five years in remission this summer.

“I think I’ll always have some sort of low-grade anxiety about it,” Johnson said. “But it’s definitely at a much lower level than it was before vaccination. It’s given me a great, great amount of peace of mind.”

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