MERIDIAN, Idaho — It didn’t take long for doctors to see that something was amiss with Rebecca Crozier’s pregnancy.

At her eight-week ultrasound in 2025, they mentioned a possible neural tube defect, she said, but after some research, she thought it was something that could be managed or treated. 

“If it was a fixable problem, I was ready to quit my job and full-time care for a disabled child,” said Crozier, who is now 27. “That was something that we were prepared to do.”

In the time between the two ultrasounds, she had a dream that she was carrying a baby girl, and she and her husband named her Haven.

The couple lived in eastern Idaho at the time, and drove two hours to the Boise area to see the maternal-fetal medicine specialists at St. Luke’s, the state’s largest health system. Now at 11 weeks’ gestation, the specialists told her Haven had anencephaly, which occurs when the brain does not develop normally and the skull is left open, exposing brain tissue to amniotic fluid that causes the tissue to dissolve. It is a fatal condition.

“She was missing a lot of brain tissue,” Crozier recalled. “They were very clear that this baby will not go home with you. You will not take this baby home. This baby will die in the hospital if the baby survives that long.”

In many states, even ones with abortion bans, Crozier would have had the option to terminate the pregnancy. But Idaho’s near-total prohibition includes no exceptions for fatal anomalies. It’s one of 11 states that do not have exceptions for anencephaly or other fatal anomalies. 

Next Tuesday, Idahoans will vote to determine whether the state’s near-total abortion ban should remain the law. Proposition 1, the title of the citizen-led ballot measure, would restore access to abortion until fetal viability, which was the state law before the U.S. Supreme Court’s decision to overturn Roe v. Wade in 2022. 

Idaho is the only state this election cycle with an initiative that would restore access in a state with a ban. In Missouri, voters will consider a different initiative — to reinstate a near-total ban after passing a constitutional amendment in 2024 allowing abortion access until viability. 

If Idaho’s measure passes, patients like Crozier would no longer have to leave the state for an abortion.

According to the Cleveland Clinic, the rate of anencephaly among newborns is about 1 in 10,000, and those babies die within a few hours or days. Most cases end in miscarriage or stillbirth; the fatal birth defect affects about 1 in 1,000 pregnancies. 

Crozier’s was among them. 

“They told me that I could try and continue my pregnancy and that they would handle my care from then on, or I could just not choose … which was in and of itself a choice,” Crozier said. “We went back to our hotel and we called our families and told them, ‘Something is very, very wrong, and we have to decide what we want to do here.’” 

In a post on Facebook this past July, Crozier’s husband, Kris, disclosed their choice. He wrote that if they had decided to continue the pregnancy, every appointment thereafter could potentially be the one where they discovered Haven had died. 

“For us, our choice wasn’t whether to let her go or whether she would pass. It was when she would die,” he wrote.

‘Because I loved her’

Dr. Duncan Harmon, the maternal-fetal medicine specialist who diagnosed Crozier in Boise, said he counseled about the high risks of miscarriage or stillbirth with the pregnancy and other risks to Crozier’s health with higher levels of amniotic fluid. And while termination was an option, he said, he couldn’t provide it for her in Idaho. She would have to go out of state and navigate insurance, lodging and any other logistics on her own.

“It’s truly awful that patients can’t receive care in their home state, being surrounded by their primary care team, surrounded by their support people in their time of grief,” Harmon, who now practices in the Southeast, told Stateline.

After a few days of discussion with her husband, Crozier recalled, they decided it was best not to continue the pregnancy for the sake of both her health and their future fertility options. 

“I didn’t want my first experience with motherhood to be watching her struggle. I wanted it to be doing something really hard because I loved her,” she said.

But making that decision was only the first step. Idaho is the only state in the West with a near-total ban, but the travel distances between clinics are vast, and those clinics are often overloaded. Calls to clinics in California, Oregon and Washington all yielded appointments that were several weeks away. 

The couple have family members who live in Utah. Crozier called clinics in Utah, where abortion is permitted up to 18 weeks, and got an appointment at a hospital within two weeks. Her mom flew in from California to be by her side.

“There was a lot of coordinating with the funeral home, actually, because we had to figure out how to get her transported back to Idaho,” Crozier said. 

The funeral home suggested the couple pick out a few items to cremate with the remains, including a security blanket with a white bunny at the top, so that there were enough ashes for the urn. Crozier held the items right up until it was time. 

She spent $3,000 out of pocket for the procedure, which was not covered by her insurance, and another $1,000 for the urn and cremation, including the costs to transport the  remains across state lines. In the recovery room, Crozier asked about footprints and handprints, but learned Haven was too tiny and the tissue too soft.

“I got really upset, and they had to bring my husband in,” she said. 

For the next year, they kept the full story extremely private and only told a few close friends and family members. Everyone else just knew that Haven had died. The couple opened up  over the summer, including on social media, in support of Idaho’s ballot initiative. But Crozier found that some people’s responses were more dismissive than she’d imagined they would be. 

“A lot of people were like, that’s not really an abortion, that doesn’t really count,” Crozier said. 

Since the summer, the Croziers have been vocal online and in person about the initiative, telling Haven’s story and trying to convey that an abortion ban like Idaho’s affects many people in situations like theirs. 

“With Prop 1 being on the ballot, I feel like people have this kind of idea in their brain of what people who have abortions are like, and I feel like I kind of break that mold for a lot of people,” Crozier said. 

“The whole situation was just so heartbreaking, and on top of being in that situation, having to go out of state and to hide what had really happened from friends and family for fear of being judged.”

More babies born with this anomaly under abortion bans

Dr. Kerri Brackney, a maternal-fetal medicine specialist in Tennessee who is a member of the American Association of Pro-Life Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, said anencephaly diagnoses are not uncommon, and they are usually clearly identifiable early in pregnancy. 

The diagnosis does come with risks, Brackney said, including a buildup of amniotic fluid that can cause preterm labor or high blood pressure, but she said it’s typically manageable.   

“The vast majority of patients I care for are able to find some beauty in the hard,” she said. “It doesn’t take away the hard, doesn’t take away the pain, but unfortunately neither does abortion.”

Idaho is losing OB-GYNs. Doctors who remain are trying to shoulder the extra burdens.

Tennessee also has a near-total abortion ban with no fetal anomaly exceptions, and Brackney said more anencephaly babies are being delivered because of the ban, giving doctors a better sense of what it looks like at full term delivery. Brackney said she is honest with patients about the prognosis, and said the longest she’s seen a baby with anencephaly live after delivery is a couple of weeks. 

She has had patients who chose to leave the state and terminate, even though she doesn’t recommend it, and said she will refer a patient to a reputable clinic in another state if that’s what they decide to do.

“But I also really try to encourage my patients that, No. 1, I think they’re stronger than they realize and we can walk through any hard situation with them,” Brackney said. “They’re not alone, and we can help them to find even the small bits of beauty and joy that are found in a very hard journey.”

Brackney said she thinks patients grieve better over the long term when they “follow their pregnancies to their natural conclusion,” whether that’s a miscarriage, stillbirth or death in the hours or days after delivery. She doesn’t think exceptions for fatal anomalies like anencephaly are necessary in states with abortion bans.

“Sometimes moms find stillbirths to be a gift, where they didn’t have to decide and it happened naturally,” she said.

Early on in Idaho’s campaign, polls showed relatively high support for a ballot initiative to restore reproductive rights, including a Boise State University School of Public Service poll last November showing 61% support. A year later, recent polls have tightened considerably or shown more support on the opposing side, after the Church of Jesus Christ of Latter-day Saints donated $1 million and the Roman Catholic Diocese of Boise donated $300,000, helping to usher in a wave of messaging against the measure.

A public memorial

Most of the Facebook posts from the Croziers over the summer didn’t make huge waves. But in early October, Rebecca Crozier made another one that was more direct, complete with multiple photos of her pregnant belly, her ultrasounds and Haven’s memory box. 

She wrote that she was affected by Idaho’s abortion laws and recounted her story, and encouraged people to vote yes on the ballot measure. 

The post quickly went viral. It was shared more than 2,700 times, with almost as many comments. Although it was a political post, she also felt it was a way she could permanently memorialize the baby she never got to meet. 

“I kept telling my friends and my family that I was scared that people were going to forget about her,” Crozier said. “That we would get pregnant, and we would have other kids, or that time would go on and that she would be forgotten. 

“And it felt like a way that I could remind myself and other people that she was real, and she mattered to me.”  

The Croziers are still trying for a healthy pregnancy.

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

Editor’s Note: This story will be included in The Aftermath, an upcoming collaborative project with PBS News Hour and Stateline collecting the personal stories of patients harmed by abortion bans since 2022. If you would like to share your story, please email kmoseley@stateline.org. 

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.

New preliminary research from the University of Michigan shows women living in states with post-Dobbs abortion bans may be more likely to shoulder costs for employer-sponsored health insurance premiums,  with federal data reflecting a 5.4% increase in annual premium expenditures for those women after 2022, when most abortion bans went into effect.

The study used national data from the U.S. Census Bureau’s 2019-2025 Current Population Survey Annual Social and Economic Supplement to compare individual medical out-of-pocket costs for women of reproductive age between 18 and 44. The study, which hasn’t yet been published in a peer-reviewed journal, received financial support from the Center for Reproductive Rights, an advocacy group based in Washington, D.C. 

“State abortion bans were associated with an increase in women’s likelihood of paying out-of-pocket for health insurance premiums,” the study said.

The findings also showed even higher premium expenditures for Black and Hispanic women, at 12.8% and 13.7%, respectively. The findings were not present among men, and the majority of the women in the sample had incomes above 250% of the federal poverty level.

“Our results are suggestive that post-Dobbs abortion bans led to insurers passing more premium costs to beneficiaries,” the study said. “Our findings shed light on the more far-reaching effects of abortion bans, quantifying the extent to which they pose an economic burden to individuals and families.”

Costs associated with pregnancy, childbirth and postpartum care averaged $20,416 nationally, including $2,743 in out-of-pocket expenses for women enrolled in employer plans over 2021-2023, according to previous research.

Joelle Abramowitz, an associate research scientist at the University of Michigan and co-author of the study, said the population survey — which is used to calculate poverty and health insurance coverage rates — was one of few sources that could offer recent insights. 

“What we see is, prior to the bans, the outcomes were looking comparable, and then after the bans were implemented, we see them diverge, with more women paying health insurance premiums in the ban states,” said Abramowitz, an economist and co-director of Michigan Federal Statistical Research Data Centers. .

Ten states with near-total abortion bans — Alabama, Arkansas, Indiana, Kentucky, Louisiana, Mississippi, North Dakota, Tennessee, Texas and West Virginia — were included in the study and compared with five states that did not implement bans: Massachusetts, Michigan, New York, Pennsylvania and Washington. States that expanded Medicaid during that time frame — Idaho, Missouri, Oklahoma and South Dakota — were excluded from the analysis to isolate the effects of the bans from Medicaid changes.

Abramowitz said there could be several factors increasing premium costs for female patients. One is that in states with bans, pregnancies that might have been terminated before the bans became deliveries with the potential for more complications and higher risks.

Prior research has shown that abortion bans are also associated with a higher rate of negative maternal and infant health outcomes, including admissions to a neonatal intensive care unit, as well as higher rates of  cesarean procedures, all of which can increase costs for insurers that get passed along through higher premiums. 

“I think this is an example of one way that these policies have more far-reaching effects beyond just the individuals who are directly affected by them,” Abramowitz said.

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

As physicians continue to navigate care for patients with complex pregnancies in states with abortion bans, a group of maternal-fetal medicine specialists has developed new guidelines to help providers in those states navigate legal risks for themselves and medical challenges for their high-risk patients. 

Maternal-fetal medicine specialists handle some of the most high-risk pregnancies, including patients with high blood pressure, diabetes, cancer, fetal anomalies or other complications. In states with abortion bans, those conditions can become even more dangerous for a patient if a doctor is unsure when they can terminate a pregnancy without potentially jeopardizing their medical license or facing criminal penalties that can include jail time.

“Individuals at high risk for pregnancy-associated morbidity and mortality have unique needs for reproductive health services, including abortion care,” the Society for Maternal-Fetal Medicine wrote in a special statement published this month. 

Ten states plus the District of Columbia allow abortion access without gestational restrictions, while 13 states ban abortion at all stages. Following the implementation of those bans since 2022, many hospital systems and clinics have offered different interpretations of how to avoid legal jeopardy under the bans and what qualifies under exceptions, leading to confusion and delays in care that have been documented in many states nationwide. 

To mitigate those problems, the guidelines encourage providers and administrators to set up referral networks across state lines, work to find agreement on what is permissible under state law and counsel patients on their options even in states with restrictions to deliver the highest-quality care. 

“We are uniquely positioned as high-risk pregnancy experts to make that case to our leaders,” said Dr. Justin Lappen, a maternal-fetal medicine specialist in Ohio who chaired the committee that developed the statement. “And a statement like this would give providers and our colleagues some confidence to be leaders in this space.”

The Society for Maternal-Fetal Medicine and the American College of Obstetricians and Gynecologists agree that access to abortion and counseling about options is the standard of care for obstetric patients, but there are conscientious exceptions for doctors who do not want to provide abortion care. 

Some doctors choose to affiliate with the American Association of Pro-Life Obstetricians and Gynecologists, and offer their own guidance about approaching complications, which still includes termination in some situations. The group is officially a partner of the Alliance Defending Freedom and several anti-abortion groups, as well as the Alliance for Hippocratic Medicine, which is the group that sued to revoke federal approval of one of two drugs used to terminate a pregnancy or treat miscarriages.

A representative from the American Association of Pro-Life Obstetricians and Gynecologists could not be reached for comment before publication.

Worse outcomes for high-risk patients

Nationwide, women in states with bans have reported difficulties receiving care when experiencing pregnancy complications. 

One of the most common emergencies occurs when a patient’s amniotic sac breaks before a fetus is viable. If left untreated, it can quickly turn into a deadly infection. The statement noted that after Texas passed Senate Bill 8 in 2021 banning abortion at an early gestation, waiting to treat patients in those medical situations dramatically increased negative health outcomes. According to research cited in the statement, complications such as blood transfusion, intensive care admission and serious infection resulted in 57% of cases, versus comparable research in states without restrictions that showed a complication rate of 33%. In all of the cases, the fetus did not survive.

Federal judge’s order allowing an Idaho doctor to perform certain abortions is put on hold

The guidance states hospitals and clinics should expand their abortion care to the extent allowed by law, and recognize maternal-fetal medicine specialists as sources of best care practices. It also instructs providers to work with legal teams in their networks to understand the federal Emergency Medical Treatment and Labor Act and when it may require abortion care, as well as encouraging training for basic termination procedures. 

Dr. David Hackney, a maternal-fetal medicine specialist in Ohio who published a book in August about navigating high-risk pregnancy care under Dobbs, said the statement will be useful for many providers nationwide.

“We don’t always focus enough on hospital administration, care and systems, but there’s always so much that can be done in those regions that is almost — if not more — important,” Hackney said.

After the Dobbs decision in June 2022, Hackney said, many individual healthcare systems didn’t know what to do when faced with certain situations where termination might be needed, and set a patchwork of policies that increased confusion for providers. But in the years since, providers and administrators in some healthcare systems have come together to reach informal agreements about what they are comfortable doing within the confines of an abortion ban.

“You have some defense if everyone has agreed to do the same thing,” he said.

When laws are unclear, he said, people will most often lean toward over-complying, which can create worse outcomes for the patient. 

“Even outside of abortion, medical care tends to work better when you have consensus and you have common best practices, even if it’s on a regional level,” he said. 

‘When they need me, they call me’

Many specialists’ cases aren’t emergencies, but rather pregnancies that put a patient at risk because of underlying health conditions, whether they existed before a pregnancy or developed during pregnancy, or late-term diagnoses of fetal anomalies that upend a wanted pregnancy. 

In those cases, the maternal-fetal organization says, patients should be told that their options include termination, even if that can’t happen in their home state.

Dr. Leilah Zahedi-Spung, a maternal-fetal medicine specialist who co-authored the special statement, moved to Colorado from Tennessee in 2023 after that state enacted a near-total abortion ban.

She said she saw firsthand how difficult it was in Tennessee to try to take care of patients without clarity around the law and without leadership that was willing or able to try to provide support. One goal of the statement is to help provide that kind of support to physicians, she said.

“We know you’re in a tough situation, we’re not blind to that. No one is blaming you for what you can and cannot do,” Zahedi-Spung said.

The society’s statement suggests that providers establish relationships with leaders within their clinical settings as well as in the community, region and state to agree on legal interpretations of abortion restrictions, particularly those who might hold leadership positions themselves. It also encourages doctors to establish referral networks locally and between states to ensure patient access.

“I have lots of people from Texas who have my phone number, and when they need me, they call me,” Zahedi-Spung said. “That is a system that works. And then those patients go back to safe providers who can take care of them.”  

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