Developments in Abortion, Autonomy, and Access:
Welcome back to the Reproductive Health Digest, and thank you for bearing with us while we took a week off. We are jumping right back in with important developments in federal and state litigation, legislative changes and challenges across the country, and policy updates that continue to shape American public health. As always, please read on to the end for the news that you need to know.
Want access to a detailed analysis of the abortion law in every U.S. state and territory? Please view our free Policy Resource Hub for Reproductive Health, an exclusive legal database where we update the state of the law every single day - so you’re always up to speed.
This Week’s Must Read:
This week’s must-read comes from Jezebel. The piece discusses how restrictions on reproductive care increase the dangers faced by victims of domestic abuse and make the jobs of advocates and supporters more difficult and legally uncertain. As Sara Ainsworth, senior legal and policy director at If/When/How, explained, homicide is the leading cause of death for pregnant people in America and abuse often escalates during pregnancy, but now “between fears for their own safety, or confusion about how these very new, untested laws are going to be enforced,” the work of supporting victims has become a minefield.
Legislation & Litigation:
Overview:
The Department of Justice has dropped a challenge to Idaho’s total abortion ban under EMTALA; however, St. Luke’s has stepped in as a new plaintiff;
On April 2nd, the Supreme Court will hear oral arguments in a case about whether states can deny Medicaid Funding for Planned Parenthood;
Kentucky Governor Andy Beshear has vetoed a bill purporting to clarify the state’s abortion ban;
A Federal Court has blocked the Trump Administration’s attempt to strip funding for all gender-affirming care for minors;
The South Dakota Legislature, alongside several other states legislatures, is attempting to restrict access to citizen-led ballot measures;
Texas has arrested a midwife and her colleagues on charges of allegedly providing unlawful abortions;
An Arizona court has permanently blocked the state’s 15-week abortion ban, further clearing the way for full implementation of the new constitutional amendment protecting pre-viability access;
Wyoming is taking actions to further restrict access to abortion; and
Ohio’s ban on gender-affirming care for minors has been blocked by an appeals court.
The Department of Justice Drops EMTALA Challenge to Idaho’s Abortion Ban:
The Department of Justice under the Trump Administration has dropped a Biden-era lawsuit challenging Idaho’s right to restrict emergency abortion care under its abortion ban. For a recap of the history of the case, read here. In anticipation of the Administration’s move, St. Luke’s Health System filed its own lawsuit, preserving the challenge. On Thursday, March 20th, a federal judge issued a preliminary order shielding St Luke's-affiliated clinicians from liability for providing emergency abortions under EMTALA during the pendency of the litigation.
Medicaid Funding for Planned Parenthood To Go Before the Supreme Court:
The Supreme Court is set to hear oral arguments on April 2nd over Medicaid funding for Planned Parenthood patients. Although federal law requires states to allow Medicaid recipients to obtain care from any qualified provider, South Carolina Governor Henry McMaster has sought to block Medicaid funding for Planned Parenthood, labeling it an abortion clinic. The state concedes that Planned Parenthood providers are competent to provide care. Planned Parenthood provides a broad spectrum of non-abortion related reproductive healthcare including pregnancy and STI testing, prenatal care and preventative care.
Although the case plainly arises out of abortion policy, the specific legal issue before the Supreme Court turns on a technical question about whether individual patients can bring suit to enforce the implicated Medicaid provisions. The Court’s ruling in this case will have broad implications outside of the abortion context, impacting access to care for Medicaid patients nationwide.
Kentucky Governor Vetoes Abortion ‘Clarification’ Bill:
Kentucky Governor Andy Beshear has vetoed a Republican-supported bill that purported to clarify the state’s total abortion ban. The bill set forth a list of emergency conditions wherein a doctor may take action “separating a woman from her unborn child.” However, opponents of the bill argue that no list can adequately account for the complicated medical realities of pregnancy and that bills like HB 90 undermine providers’ independent medical judgment, replacing it with that of non-expert legislators. The Republican supermajority may override Governor Beshear’s veto.
A Federal Court has Blocked the Trump Administration’s Executive Order Targeting Gender-Affirming Care:
A federal judge has extended a block on the Trump Administration’s Executive Order purporting to pull federal funding for medical institutions that provide gender-affirming care to individuals under the age of 19. Judge Lauren King found that the orders improperly encroach upon Congressional authority over federal funding and violate the Equal Protection Clause by discriminating on the basis of sex and transgender status. The Administration’s aggressively implemented anti-trans agenda has faced significant setbacks in courts across the country.
South Dakota Legislature Attempts to Restrict Ballot Measures:
Lawmakers in South Dakota have introduced several measures to restrict the state’s citizen-led ballot initiative process. Governor Larry Rhoden vetoed one of the proposed changes, which would have required signatures to be gathered from every legislative district, effectively giving any one district veto power over an initiative. A second proposal would move the deadline to submit signatures from May to February of the election year, narrowing the window for activists to gather the necessary number of signatures. This is before the Governor for his signature. A third proposal will go before voters in November, 2026; if passed, it would raise the threshold to pass a ballot measure from a simple majority to 60%.
Other states, including Florida, are similarly attempting to tighten access to the ballot initiative process. The Fairness Project warns that over 100 anti-ballot initiative bills have been introduced across 15 different states. This wave of restrictions follows the use of the citizen-led ballot measure process to protect abortion rights in seven states in the 2024 elections.
Texas Arrests Midwife and Colleagues for Alleged Provision of Unlawful Abortions:
Texas has made its first arrests under its total abortion ban. Houston-area midwife Maria Margarita Rojas and two of her colleagues were arrested for allegedly providing unlawful abortions at three clinics. The clinics have been temporarily shut down, and Rojas’s midwifery license has been suspended. If charged, Rojas could face up to twenty years in prison.
These arrests mark an escalation in Texas’s vigorous efforts to enforce its anti-abortion laws. Texas has also brought a lawsuit against New York Doctor Maggie Carpenter, attempting to hold her liable for providing medication abortions to Texans. New York has refused to enforce the judgment against Dr. Carpenter–citing the state’s shield laws. Attorney General Ken Paxton has vowed to prosecute individuals who perform illegal abortions “to the full extent of the law.”
Arizona Permanently Blocks 15-week Ban:
An Arizona court has permanently blocked the state’s previously enforced 15-week abortion ban. Maricopa County Judge Frank Moskowitz held that the 15-week ban was rendered unconstitutional by the passage of a 2024 abortion rights ballot initiative.
Abortion Care in Wyoming Further Restricted:
Wyoming has instituted new requirements for abortion clinics and providers. Governor Mark Gordon recently signed a bill mandating that facilities that provide abortions be licensed as surgical centers, leading the state’s only remaining abortion clinic to pause care. Although Gordon vetoed a bill requiring pregnant people to have an ultrasound 48-hours prior to receiving a medication abortion, the legislature overrode his veto. Although abortion remains legal until viability in Wyoming, it is functionally extremely difficult to access, with many patients forced to leave the state to obtain care.
Ohio’s Ban on Gender-Affirming Care Blocked by Appeals Court:
An Ohio appeals court has permanently blocked the state’s ban on gender-affirming care for minors, holding that it is unconstitutional. In a majority opinion authored by Judge Carly Edelstein, the court noted that the state’s ban does not outlaw the use of identical drugs for other purposes–it only does so in the context of gender-affirming care. Judge Edelstein also referred to parents’ rights to make care decisions about their children’s health without excessive interference from the state. The state will pursue an appeal of the decision.
Trend & Policy Watch:
Texas’ Abortion Ban Has Adverse Impacts on Colorado Patients:
Highlighting the ripple effects of abortion bans, a new study from JAMA finds that Texas’s ban has caused delays and disruptions in care for Coloradans. According to the study, Texas’s 2021 ban taking effect caused a surge in demand in Colorado, resulting in Coloradans being 83% more likely to have second-trimester abortions as appointments bottlenecked and care was delayed.
States without abortion bans have taken action to try and address the shortage of providers. In New York, for example, Senator Liz Krueger and Assembly Member Harvey Epstein have introduced a bill to create a state-funded training program. Maryland has similarly started training advanced practice clinicians, including nurse practitioners, to administer abortion care.
How State Abortion Policies are Shaping Decision-Making:
New data from the Institute for Women’s Policy Research shows how state-level abortion bans and restrictions are impacting individual decision making–particularly for people who plan to have children. In one striking finding, the data showed that one in ten adults have or know someone who has relocated or applied to a job in another state because of a state’s abortion ban. This number doubles for individuals who plan to have children. The research also shows that employees heavily prioritize how their employer handles reproductive health care coverage, meaning that they are less likely to move for or stay in a job where care is not prioritized.
Trans Healthcare Preemptively Curtailed In Light of Administration’s Orders:
Some hospitals and health care providers are preemptively complying with the slew of anti-trans executive orders handed down by the Trump Administration. In response to the Administration’s January Order entitled “Protecting Children From Chemical and Surgical Mutilation,” which seeks to defund gender-affirming care for people under 19, several hospitals across the country have paused or ceased providing such care. Despite the sweeping language of the Administration’s executive order, it does not actually change existing law or supplant state regulations, and it is currently blocked by litigation. Preemptive over-compliance by health care institutions creates unnecessary patient harm and may result in institutions violating state anti-discrimination laws.
Appointment of FDA Commissioner Raises Questions About Mifepristone:
The appointment of Dr. Marty Makary as commissioner for the FDA is raising concerns about the future of mifepristone. During his confirmation hearings, he refused to commit to any action regarding the pill, including preserving access to it. Advocates worry that the Trump Administration will direct the FDA to reassess mifepristone’s availability, despite its exemplary safety and efficacy records.