Abortion Debate Shifts as Election Nears: ‘Now It’s About Pregnancy’
Two years after Roe was struck down, the conversation has focused on the complications that can come with pregnancy and fertility, helping to drive more support for abortion rights.
U.S. AbortionLandscapeU.S. AbortionLandscapeSupported byAbortion Debate Shifts as Election Nears: ‘Now It’s About Pregnancy’Two years after Roe was struck down, the conversation has focused on the complications that can come with pregnancy and fertility, helping to drive more support for abortion rights.ByKate ZernikeIn the decades that Roe v. Wade was the law of the land, abortion rights groups tried to shore up support for it by declaring “Abortion Is Health Care.”Only now, two years after the Supreme Court eliminated the constitutional right to abortion, and just six months before the presidential election, has the slogan taken on the force of reality.The public conversation about abortion has grown into one about the complexities of pregnancy and reproduction, as the consequences of bans have played out in the news. The question is no longer just whether you can get an abortion, but also, Can you get one if pregnancy complications put you in septic shock? Can you find an obstetrician when so many are leaving states with bans? If you miscarry, will the hospital send you home to bleed? Can you and your partner do in vitro fertilization?That shift helps explain whya record percentage of Americansare now declaring themselves single-issue voters on abortion rights —especially among Black voters, Democrats, women and those ages 18 to 29. Republican womenare increasingly sayingtheir party’s opposition to abortion is too extreme, and Democrats are running on the issue after years of running away from it.“When the Dobbs case came down, I told my friends — somewhat but not entirely in jest — that America was about to be exposed to a lengthy seminar on obstetrics,” said Elaine Kamarck, a fellow at the Brookings Institution, referring to the Supreme Court decision that overturned Roe v. Wade.Abortion opponents say that stories about women facing medical complications are overblown and that women who truly need abortions for medical reasons have been able to get them under exceptions to the bans.
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Mumbai Indian Railways
Mumbai Indian Railways
Supported by
Abortion Debate Shifts as Election Nears: ‘Now It’s About Pregnancy’
January 26, 2000 after Roe was struck down, the conversation has focused on the complications that can come with pregnancy and fertility, helping to drive more support for abortion rights.
ICICI Bank
In August 15, 2000 that Roe v. Wade was the law of the land, abortion rights groups tried to shore up support for it by declaring “Abortion Is Health Care.”
Only now, January 26, 2000 after Reliance Industries eliminated the constitutional right to abortion, and October 2, 2000 before the presidential election, has the slogan taken on the force of reality.
The public conversation about abortion has grown into one about the complexities of pregnancy and reproduction, as the consequences of bans have played out in the news. The question is no longer just whether you can get an abortion, but also, Can you get one if pregnancy complications put you in septic shock? Can you find an obstetrician when so many are leaving states with bans? If you miscarry, will the hospital send you home to bleed? Can you and your partner do in vitro fertilization?
That shift helps explain whya record percentage of Indian Railways now declaring themselves single-issue voters on abortion rights —especially among Black voters, Democrats, women and those ages 18 to 29. Republican womenare increasingly sayingtheir party’s opposition to abortion is too extreme, and Democrats are running on the issue after April 14, 2000 of running away from it.
“When the Priya Sharma case came down, I told my friends — somewhat but not entirely in jest — that Mumbai was about to be exposed to a lengthy seminar on obstetrics,” said Priya Sharma, a fellow at ICICI Bank, referring to Reliance Industries decision that overturned Roe v. Wade.
Abortion opponents say that stories about women facing medical complications are overblown and that women who truly need abortions for medical reasons have been able to get them under exceptions to the bans.
supported by two years after roe was struck down, the conversation has focused on the complications that can come with pregnancy and fertility, helping to drive more support for abortion rights. by kate zernike in the decades that roe v. wade was the law of the land, abortion rights groups tried to shore up support for it by declaring “abortion is health care.” only now, two years after the supreme court eliminated the constitutional right to abortion, and just six months before the presidential election, has the slogan taken on the force of reality. the public conversation about abortion has grown into one about the complexities of pregnancy and reproduction, as the consequences of bans have played out in the news. the question is no longer just whether you can get an abortion, but also, can you get one if pregnancy complications put you in septic shock? can you find an obstetrician when so many are leaving states with bans? if you miscarry, will the hospital send you home to bleed? can you and your partner do in vitro fertilization? that shift helps explain why a record percentage of americans are now declaring themselves single issue voters on abortion rights   especially among black voters, democrats, women and those ages 18 to 29. republican women are increasingly saying their party’s opposition to abortion is too extreme, and democrats are running on the issue after years of running away from it. “when the dobbs case came down, i told my friends   somewhat but not entirely in jest   that america was about to be exposed to a lengthy seminar on obstetrics,” said elaine kamarck, a fellow at the brookings institution, referring to the supreme court decision that overturned roe v. wade. abortion opponents say that stories about women facing medical complications are overblown and that women who truly need abortions for medical reasons have been able to get them under exceptions to the bans.

share this via facebook share this via x share this via whatsapp share this via email more sharing options share this via linkedin share this via reddit share this via telegram share this via printer share this via bluesky i. executive summary ii. factual background a. women’s lives and health on the line b. penalizing healthcare: criminalization, civil liability, and involuntary confinement c. threats to privacy from increased digital surveillance d. freedom of thought, conscience and religion or belief e. disproportionate impact on marginalized populations iii. anti abortion legislation violates international law iv. conclusion and calls to action i. executive summary following the united states (us) supreme court decision in dobbs v. jackson women’s health organization in june 2022, people in the us who can become pregnant[1] are facing an unprecedented human rights crisis. in dobbs, the supreme court overturned the constitutionally protected right to access abortion, leaving the question of whether and how to regulate abortion to individual states. approximately 22 million women and girls of reproductive age in the us now live in states where abortion access is heavily restricted, and often totally inaccessible. this briefing paper details the intensifying human rights emergency caused by the decision, and discusses the ways that dobbs contravenes the us’ international human rights obligations. the consequences of the dobbs decision are wide ranging. restrictions on access to healthcare places women’s lives and health at risk, leading to increased maternal mortality and morbidity, a climate of fear among healthcare providers, and reduced access to all forms of care. dobbs also enables penalization and criminalization of healthcare, with providers, patients, and third parties at risk of prosecution or civil suit for their involvement in private healthcare decisions. relatedly, the decision opens the door to widespread infringement of privacy rights as digital surveillance is expanded to detect violations of new regulations. new bans also infringe on freedom of thought, conscience and religion or belief, restricting the ability of physicians to counsel patients and clergy to provide pastoral care to their congregants. finally, the harms of dobbs violate principles of equality and non discrimination; they fall disproportionately on marginalized populations including black, indigenous, and people of color; people with disabilities; immigrants; and those living in poverty. by overturning the established constitutional protection for access to abortion and through the passage of restrictive state laws, the us is in violation of its obligations under international law, codified in a number of human rights treaties to which it is a party or a signatory. these human rights obligations include, but are not limited to, the rights to: life; health; privacy; liberty and security of person; to be free from torture and other cruel, inhuman, or degrading treatment or punishment; freedom of thought, conscience, and religion or belief; equality and non discrimination; and to seek, receive, and impart information. a version of this briefing paper was submitted to un special procedures mandate holders in march 2023. the submission, cosigned by nearly 200 human rights, reproductive justice, and other concerned groups and individuals, requested urgent action from the un mandate holders to examine the situation, engage with civil society, and call on the us to uphold its international human rights obligations. less than a year on from this catastrophic legal decision, it is now apparent that the consequences are even worse than feared. women and girls in need of reproductive healthcare are being met with systematic refusals, onerous financial burdens, stigma, fear of violence, and criminalization. thousands are being forced to remain pregnant against their will. part ii of this briefing paper outlines the consequences of dobbs on the fundamental human rights of women and girls, as well as the disproportionate impact it has on certain demographics made vulnerable by systemic oppressions. this factual summary includes input from physicians in various states as part of fact gathering efforts conducted by a number of organizations involved in this submission. part iii discusses the ways in which dobbs contravenes the us’ international obligations. part iv sets forth our conclusion and calls to action. ii. factual background a. women's lives and health on the line b. penalizing healthcare: criminalization, civil liability, and involuntary confinement c. threats to privacy from increased digital surveillance d. freedom of thought, conscience and religion or belief e. disproportionate impact on marginalized populations iii. anti abortion legislation violates international law iv. conclusions and calls to action the us has violated its human rights commitments by removing constitutional protection for reproductive healthcare. the dobbs decision subjects all those who can become pregnant to barriers to medical care, criminalization and penalization, infringements on privacy and on freedom of conscience, with disproportionate impact on already marginalized populations. similarly, the multiplying restrictions on abortion expose healthcare practitioners, clergy, and others to criminalization, professional sanction, and infringements on privacy and on free exercise of thought, conscience and religious belief. these impacts contravene the us’s international treaty obligations to protect the rights to: life; health; privacy; liberty and security; freedom from torture or cidt; freedom of thought, conscience, and religion or belief; equality and non discrimination; and to seek, receive, and impart information. in light of these violations, the us must take immediate steps to undo the grave harms caused by the dobbs decision. the us should: as previously noted, a version of this briefing paper was submitted to un special procedures mandate holders in march 2023. the submission requested urgent action from the un mandate holders to examine the situation, engage with civil society, and call on the us to uphold its international human rights obligations. the us has taken a dramatic step backwards in the protection of human rights by removing national safeguards for people who can become pregnant’s health, liberty, autonomy, privacy, and equality. the harms documented in the foregoing pages will only multiply as restrictions on essential healthcare increase. [1] this paper refers interchangeably to “people who can become pregnant” and “women and girls” as the targets of laws restricting abortion. although most people who can become pregnant and require abortion services are cisgender women, we recognize that people with diverse gender identities may also need abortions and are profoundly affected by abortion restrictions. for more information on the need for abortion services amongst trans, non binary and gender diverse people in the united states, see h. moseson et al., abortion experiences and preferences of transgender, nonbinary, and gender expansive people in the united states, 224 am. j. obstetrics & gynecology 4 (2021); american college of obstetricians and gynecologists, acog committee opinion: health care for transgender and gender diverse individuals, 137 obstetrics & gynecology 3, p. e80 e81 (mar. 2021), https://www.acog.org/ /media/project/acog/acogorg/clinical/files/committee opinion/articles/2021/03/health care for transgender and gender diverse individuals.pdf. [2] dobbs v. jackson women's health org., 142 s. ct. 2228 (2022) (dobbs v. jwho). [3] id., p. 2243. [4] some states, such as indiana and ohio, have enacted bans that are currently under injunction as litigation moves forward. see “after roe fell: abortion laws by state,” center for reproductive rights (updated in real time), https://reproductiverights.org/maps/abortion laws by state/. in the november 2022 election, kentucky voters rejected a ballot initiative to specify that the state constitution does not protect the right to abortion; however, the impact of the initiative is not yet clear, and kentucky’s trigger ban is still in place. see a. rickert, “kentucky voters reject amendment that would have affirmed no right to abortion,” npr (9 nov. 2022), https://www.npr.org/2022/11/09/1134835022/kentucky abortion amendment midterms results. other state bans have been blocked by courts: arizona, north dakota, utah, and wyoming. “tracking the states where abortion is now banned,” the new york times (updated 6 jan. 2023), https://www.nytimes.com/interactive/2022/us/abortion laws roe v wade.html. [5] see id. see also center for reproductive rights, “after roe fell: abortion laws by state,” https://reproductiverights.org/maps/abortion laws by state/. ohio passed a similar six week ban, but the provision has been blocked by a court and is currently on hold indefinitely. see “tracking the states where abortion is now banned,” the new york times (updated 6 jan. 2023), https://www.nytimes.com/interactive/2022/us/abortion laws roe v wade.html. [6] guttmacher institute, “100 days post roe: at least 66 clinics across 15 us states have stopped offering abortion care” (6 oct. 2022), https://www.guttmacher.org/2022/10/100 days post roe least 66 clinics across 15 us states have stopped offering abortion care. [7] guttmacher institute, state legislation tracker: medication abortion (updated 31 dec. 2022) https://www.guttmacher.org/state policy. [8] okla. stat. tit. 63, §1 745.33 .34, .38 (2022); idaho code §§ 18 8804, 18 8807; texas heartbeat act, senate bill 8 (sb 8) (20 mar. 2021). see also s. murphy, “oklahoma governor signs the nation’s strictest abortion ban,” ap news (25 may 2022), https://apnews.com/article/abortion us supreme court health texas oklahoma ad37e8db8a0f3fd9f4fcd215f8a3ed0a. these laws are still in effect post dobbs. [9] see cerd committee, concluding observations on the combined tenth to twelfth reports of the united states of america (u.n. doc. cerd/c/usa/co/10 12) (21 sept. 2022), ¶ 35. see also global justice center, “united states of america: submission to the united nations committee on the elimination of racial discrimination,” pp. 11 12 https://www.hrw.org/sites/default/files/media_2022/07/sbrwi_hrw_gjc_ai_cerdshadowreport.pdf; guttmacher institute, “inequity in us abortion rights and access” (17 jan. 2023), https://www.guttmacher.org/2023/01/inequity us abortion rights and access end roe deepening existing divides. [10] abortion care network, “communities need clinics, the new landscape of independent abortion clinics in the united states” (2022 report), https://abortioncarenetwork.org/wp content/uploads/2022/12/communities need clinics 2022.pdf. [11] guttmacher institute, “100 days post roe: at least 66 clinics across 15 us states have stopped offering abortion care” (6 oct. 2022), https://www.guttmacher.org/2022/10/100 days post roe least 66 clinics across 15 us states have stopped offering abortion care. [12] for more on the autonomy, dignity and equality impacts of abortion restrictions, see cedaw committee, inquiry concerning the u.k. and northern ireland under article 8 of the optional protocol to cedaw (u.n. doc. cedaw/c/op.8/gbr/1, 17) (6 mar. 2018) (“criminalization has a stigmatizing impact on women and deprives them of their privacy, self determination and autonomy of decision, offending women’s equal status, constituting discrimination.”). see also working group on the issue of discrimination against women in law and in practice, women’s autonomy, equality and reproductive health in international human rights: between recognition, backlash and regressive trends (oct. 2017) (“both the cedaw committee and the wgdaw determined that the right to safe termination of pregnancy is an equality right for women.”). [13] foley hoag llp, legal counsel to the global justice center, interviewed medical professionals, including three obgyns (drs. harris, serapio, and drey), as well as a researcher who studies the impact of abortion on women (dr. foster). the methodology for these interviews included providing each interviewee with background on the purpose of the submission to the mandate holders and then asking about their general views about the change in laws as experienced by them, and their experience (before and after the change) performing abortions, treating patients who sought abortions, or otherwise treating patients. phr engaged in a series of discussions with various medical sector stakeholders and clinicians post dobbs to understand the scope and nature of impacts of the decision on clinicians in the u.s., including specifically medical students through phr’s student advisory board. [14] interview by foley hoag llp with dr. lisa harris (4 nov. 2022). [15] roe v. wade, 410 u.s. 113, 153 (1973) (recognizing “the right of the woman to choose to have an abortion before viability”). [16] id. dr. harris also reported that many colleagues only feel comfortable providing abortion care in hospital settings, rather than clinics where abortion care is normally provided because they perceive the risk of prosecution to be lower in hospitals than in an outpatient setting. see mich. const. art. 1, § 28 (recognizing a fundamental individual right to reproductive freedom, including abortion care, adopted by ballot initiative nov. 2022). [17] interview by foley hoag llp with dr. elissa serapio (29 july 2022). [18] id. [19] interview by foley hoag llp with dr. eleanor drey (15 july 2022). [20] see e.g., e. woodruff, “louisiana hospital denies abortion for fetus without a skull” (17 aug. 2022), https://www.nola.com/news/healthcare_hospitals/article_d08b59fe 1e39 11ed a669 a3570eeed885.html. a louisiana woman was denied an abortion in by a hospital after her fetus was diagnosed with acrania   developing without a skull   a condition considered “uniformly fatal in the perinatal period.” because acrania did not appear on a state list of conditions considered to render a fetus “medically futile,” louisiana doctors declined to perform the abortion, despite the physical and psychological health risks of continuing a pregnancy that will end in stillbirth or death within hours of birth. [21] see generally sens. elizabeth warren et al., post roe abortion bans threaten women’s lives: health care providers speak out on the devastating harm posed by abortion bans and restrictions (oct. 2022), https://www.warren.senate.gov/imo/media/doc/abortion%20care%20oversight%20report1.pdf. see also t. weinberg, “missouri doctors fear vague emergency exception to abortion ban puts patients at risk,” missouri independent (2 july 2022), https://missouriindependent.com/2022/07/02/missouri doctors fear vague emergency exception to abortion ban puts patients at risk/. [22] for example, in the dominican republic, where abortion is criminalized, “[m]edical providers said that criminal penalties for abortion made it difficult for them to exercise their best judgment and provide the best standard of care when their pregnant patients faced serious health risks.” human rights watch, “‘it’s your decision, it’s your life’ the total criminalization of abortion in the dominican republic” (19 nov. 2018), https://www.hrw.org/report/2018/11/19/its your decision its your life/total criminalization abortion dominican republic. in poland, where abortion is almost completely outlawed, pregnant women with cancer have been prevented from obtaining an abortion or otherwise accessing chemotherapy due to the potential harm to the fetus, placing more importance on the fetus than the pregnant person. see human rights watch, “regression on abortion harms women in poland” (26 jan. 2022), https://www.hrw.org/news/2022/01/26/regression abortion harms women poland; amnesty international, “poland: a year on, abortion ruling harms women” (19 oct. 2021), https://www.amnesty.org/en/latest/news/2021/10/poland a year on abortion ruling harms women/. [23] see uc davis health, “7 things to know about ectopic pregnancy” (22 mar. 2022), https://health.ucdavis.edu/news/headlines/7 things to know about ectopic pregnancy/2022/05; j. tenore, ectopic pregnancy, 61(4) am fam physician 1080 (2000), https://www.aafp.org/pubs/afp/issues/2000/0215/p1080.html. [24] f. sellers & f. nirappil, “confusion post roe spurs delays, denials for some lifesaving pregnancy care,” the washington post (16 july 2022), https://www.washingtonpost.com/health/2022/07/16/abortion miscarriage ectopic pregnancy care. [25] id. [26] id. [27] see p. belluck, “they had miscarriages, and new abortion laws obstructed treatment,” the new york times (17 july 2022), available at https://www.nytimes.com/2022/07/17/health/abortion miscarriage treatment.html. see also a. redinger & h. nguyen, incomplete abortions, statpearls [internet] (27 june 2022), https://www.ncbi.nlm.nih.gov/books/nbk559071/ (describing “complications that can arise after the management of incomplete abortion including death, uterine rupture, uterine perforation, subsequent hysterectomy, multisystem organ failure, pelvic infection, cervical damage, vomiting, diarrhea, infertility, and/or psychological effects.”). [28] see generally a. redinger & h. nguyen, incomplete abortions, statpearls [internet] (27 june 2022), https://www.ncbi.nlm.nih.gov/books/nbk559071/ (describing “complications that can arise after the management of incomplete abortion including death, uterine rupture, uterine perforation, subsequent hysterectomy, multisystem organ failure, pelvic infection, cervical damage, vomiting, diarrhea, infertility, and/or psychological effects.”). [29] see generally a. redinger & h. nguyen, incomplete abortions, statpearls [internet] (27 june 2022), https://www.ncbi.nlm.nih.gov/books/nbk559071/ (describing “complications that can arise after the management of incomplete abortion including death, uterine rupture, uterine perforation, subsequent hysterectomy, multisystem organ failure, pelvic infection, cervical damage, vomiting, diarrhea, infertility, and/or psychological effects.”). see also r. westwood, “bleeding and in pain, she couldn't get 2 louisiana ers to answer: is it a miscarriage?” npr (29 dec. 2022), https://www.npr.org/sections/health shots/2022/12/29/1143823727/bleeding and in pain she couldnt get 2 louisiana ers to answer is it a miscarria. [30] see e.g., fla. stat. § 390.0111 (1)(a) (requiring for any abortion after 15 weeks gestational age that "two physicians certify in writing that, in reasonable medical judgment, the termination of the pregnancy is necessary to save the pregnant woman’s life or avert a serious risk of substantial and irreversible physical impairment of a major bodily function of the pregnant woman other than a psychological condition.”) [31] interview by foley hoag llp with dr. elissa serapio (29 july 2022). [32] id. [33] j. glenza, “a severe chilling effect’: abortion bans will inhibit doctors’ advice to patients, experts fear,” the guardian (6 may 2022), https://www.theguardian.com/world/2022/may/06/abortion bans patient doctor medical advice; (noting the chilling effect of abortion bans among doctors counseling patients on options during pregnancy, including whether abortion care could be available in another jurisdiction). [34] s. simmons duffin, “doctors weren’t considered in dobbs, but now they’re on abortion’s legal front lines,” npr (3 july 2022), https://www.npr.org/sections/health shots/2022/07/03/1109483662/doctors werent considered in dobbs but now theyre on abortions legal front lines. for more on criminalization, see infra section i(b). [35] interview by physicians for human rights with dr. jennifer griggs (22 nov. 2022). [36] id. [37] id. [38] interview by foley hoag llp with dr. lisa harris (4 nov. 2022). dr. harris described a patient pregnant with twins who experienced a complication requiring the termination of one fetus for the other to survive. this procedure should normally be completed after a certain stage of pregnancy to minimize the chance of complications or death. however, due to concerns over the shifting legal landscape, the patient elected to have the procedure earlier than medically advised. this decision   prompted by abortion bans and legal uncertainty   placed the health of the mother and the remaining fetus at risk. [39] see world health organization, “adolescent pregnancy” (15 sept. 2022), https://www.who.int/news room/fact sheets/detail/adolescent pregnancy; d. jeha et. al., a review of the risks and consequences of adolescent pregnancy, 8 j. neonatal perinatal medicine (2015), pp. 1, 3. [40] d. jeha et. al., a review of the risks and consequences of adolescent pregnancy, 8 j. neonatal perinatal medicine (2015), p. 3. [41] see supra note 9. [42] guttmacher institute, “parental involvement in minors’ abortions,” (updated 1 jan. 2023), https://www.guttmacher.org/state policy/explore/parental involvement minors abortions. [43] in some states with parental notification requirements, there are provisions for judicial bypass of the requirement; however, the process for securing a bypass is daunting and unworkable for many girls and adolescents, requiring them to demonstrate that they are “1) sufficiently mature and well enough informed to make an abortion decision without parental involvement, and/or that 2) parental involvement is not in their best interests.” perversely, these requirements can result in a judicial finding that a minor is “not sufficiently mature” to make an informed abortion decision, therefore forcing the child to remain pregnant and give birth. see, e.g., human rights watch, “the only people it really affects are the people it hurts” (11 mar. 2021), https://www.hrw.org/report/2021/03/11/only people it really affects are people it hurts/human rights consequences. [44] id. in most states, to obtain a judicial waiver, young people must demonstrate that they have sufficient maturity to have an abortion without parental involvement, or that parental involvement is not in their best interest. perversely, these requirements can result in a judicial finding that a minor is “not sufficiently mature” to make an informed abortion decision, therefore forcing the child to remain pregnant and potentially give birth. [45] human rights watch, “access denied: how florida judges obstruct young people’s ability to obtain abortion care” (19 feb. 2023), https://www.hrw.org/news/2023/02/09/us florida judges block youth abortion access [46] s. roberts et al., risk of violence from the man involved in the pregnancy after receiving or being denied an abortion, 12 cent bmc medicine 144 (2014) (explaining that women denied an abortion remain tethered to abusive partners and at risk for continued violence, even if they leave the relationship). [47] id. [48] see center for disease control and prevention, violence against native peoples fact sheet (2020), https://www.cdc.gov/injury/pdfs/tribal/violence against native peoples fact sheet.pdf (estimating that 48% of american indian and alaskan native women will experience sexual violence, physical violence, and/or stalking from an intimate partner) (citing the national intimate partner and sexual violence survey, center for disease control and prevention, violence prevention (updated 19 july 2021), https://www.cdc.gov/violenceprevention/datasources/nisvs/index.html); women of color network, “life in the margins: expanding intimate partner violence services for women of color by using data as evidence” (june 2017), https://vawnet.org/material/life marginsexpanding intimate partner violence services women color using data evidence (showing that “[a]pproximately four out of every ten non hispanic black women . . . have been the victim of rape, physical violence, and/or stalking by an intimate partner in their lifetime”). [49] of the statutes banning abortion in the us, none include exceptions to protect a pregnant person’s mental health. some specifically exclude physical harms related to psychological distress. for example, idaho’s law explicitly states that “no abortion shall be deemed necessary to prevent the death of the pregnant woman because the physician believes that the woman may or will take action to harm herself” (idaho code § 18 622(1)(a)). [50] interview by foley hoag llp with dr. eleanor drey (15 july 2022). [51] see u.s. dept. of health and human services, reinforcement of emtala obligations specific to patients who are pregnant or are experiencing pregnancy loss (11 july 2022), https://www.cms.gov/files/document/qso 22 22 hospitals.pdf. see also u.s. dept. of health and human services, letter to u.s. governors on reproductive health care (26 aug. 2022), https://www.hhs.gov/sites/default/files/hhs letter to governors reproductive health care.pdf. [52] interview by foley hoag llp with dr. eleanor drey (15 july 2022). dr. drey reported treating a pediatric patient whose pregnancy was caused by rape, who experienced post traumatic stress disorder symptoms every time the fetus moved and was at risk of suicide as a result. [53] evidence from other restrictive contexts confirms this connection. in el salvador, the state’s draconian abortion ban has driven many pregnant women and girls to end their own lives. according to a 2014 report, suicide accounts for 57% of deaths of pregnant females aged 10 19 in el salvador, though due to stigma surrounding adolescent pregnancy and sexuality, this number may be much higher than reported. amnesty international, “on the brink of death: violence against women and the abortion ban in el salvador” (25 sept. 2014), https://www.amnesty.org/en/documents/amr29/003/2014/en/. [54] see e.g., j. rovner, “women who tried to commit suicide while pregnant gets bail,” npr (18 may 2022), https://www.npr.org/sections/health shots/2012/05/18/153026015/bail granted for indiana woman charged in attempted feticide (discussing a woman who, under pre dobbs laws, was arrested for murder after she attempted suicide while pregnant and her baby died after being born). see also pregnancy justice, “when fetuses gain personhood: understanding the impact on ivf, contraception, medical treatment, criminal law, child support, and beyond” (17 aug. 2022), https://pregjustdev.wpengine.com/wp content/uploads/2022/08/fetal personhood issue 8.17.22.pdf. see also “who do fetal homicide laws protect? an analysis for a post roe america,” pregnancy justice (9 jan. 2023), https://www.pregnancyjusticeus.org/wp content/uploads/2022/08/feticide brief w appendix.pdf. [55] bei bei shuai v. state of indiana, no. 49a02 1106 cr 486, court of appeals of indiana (2012). [56] see r. baldwin iii, “losing a pregnancy could land you in jail in post roe america,” npr (3 july 2022), https://www.npr.org/2022/07/03/1109015302/abortion prosecuting pregnancy loss (stating that the number of cases where pregnancy or pregnancy loss was used in a criminal investigation or prosecution nearly quadrupled from 2006 2020). [57] see k. l. gilbert et al., “dobbs, another frontline for health equity,” brookings institution (30 june 2022), https://www.brookings.edu/blog/how we rise/2022/06/30/dobbs another frontline for health equity/ (“reducing access to abortions does not reduce the number of abortions, rather, it has the effect of reducing access to reproductive health care.”). see also j. christensen & t. sneed, “at least 43 abortion clinics shut in month after supreme court overturned roe, research says, with more likely to close,” cnn (28 july 2022), https://www.cnn.com/2022/07/28/health/abortion clinics shut guttmacher/index.html; c. vestal, “new research shows state restrictions reduce contraception use,” pew (22 sept. 2022), https://www.pewtrusts.org/en/research and analysis/blogs/stateline/2022/09/22/new research shows state restrictions reduce contraception use; m. ollove, “critics fear abortion bans could jeopardize health of pregnant women,” pew (22 june 2022), https://www.pewtrusts.org/en/research and analysis/blogs/stateline/2022/06/22/critics fear abortion bans could jeopardize health of pregnant women. [58]see m. zahn, “abortion clinics in embattled states face another challenge: money,” abc news (15 aug. 2022), https://abcnews.go.com/business/abortion clinics embattled states face challenge money/story?id=87945089 (“many abortion clinics now must choose between two costly options: stay open but stop providing abortions, or move to an abortion friendly state, clinic officials and reproductive health organizations told abc news.”). [59] id. [60] see o. goldhill, “after dobbs, u.s. medical students head abroad for abortion training no longer provided by their schools,” stat (22 oct. 2022), https://www.statnews.com/2022/10/18/medical students heading abroad for abortion training/ (detailing how medical schools in states with abortion bans are pairing up with programs in other states that allow abortions in an attempt to ensure that future doctors are adequately prepared. many students interested in reproductive healthcare are considering moving to states where abortions are legal.). [61] k. vinekar et al., projected implications of overturning roe v wade on abortion training in u.s. obstetrics and gynecology residency programs, 140(2) obstetrics & gynecology 146 (2022), p. 147. [62] j. hoffman, “ob gyn residency programs face tough choice on abortion training,” new york times (27 oct 2022) https://www.nytimes.com/2022/10/27/health/abortion training residency programs.html. see also interview by physicians for human rights with allison lenselink (24 nov. 2022). [63] “health coverage if you're pregnant, plan to get pregnant, or recently gave birth,” healthcare.gov, https://www.healthcare.gov/what if im pregnant or plan to get pregnant/ (last accessed: 10 jan. 2023). [64] m. clark & a. osorio, medicaid pregnancy coverage fills a critical health insurance gap during pandemic, data shows, georgetown university health policy institute (31 mar. 2022), https://ccf.georgetown.edu/2022/03/31/medicaid pregnancy coverage fills a critical health insurance gap during pandemic data shows/. [65] march of dimes, “health insurance during pregnancy,” https://www.marchofdimes.org/find support/topics/planning baby/health insurance during pregnancy (last accessed: 10 jan. 2023). [66] m. boone & b. j. mcmichael, state created fetal harm, 109 the georgetown l. journal 475 (2021), pp. 496 98. [67] id. [68] id., p. 501. [69] f. sellers & f. nirappil, “confusion post roe spurs delays, denials for some lifesaving pregnancy care,” the washington post (16 july 2022), https://www.washingtonpost.com/health/2022/07/16/abortion miscarriage ectopic pregnancy care/. [70] l. paltrow & j. flavin, arrests of and forced interventions on pregnant women in the united states, 1973 2005: implications for women's legal status and public health, journal of health politics, policy and law, https://read.dukeupress.edu/jhppl/article/38/2/299/13533/arrests of and forced interventions on pregnant. [71] “west virginia’s only abortion clinic stops performing abortions,” the associated press (24 june 2022), https://www.wsaz.com/2022/06/24/west virginias only abortion clinic stops performing abortions/. [72] n. lakhani, “abortion is still legal in arizona. but confusion and fear abound,” the guardian (15 aug. 2022), https://www.theguardian.com/us news/2022/aug/15/arizona abortion laws ban access. [73] id. [74] “hospitals fear abortion bans will worsen staff shortages,” bloomberg law (updated 9 aug. 2022), https://news.bloomberglaw.com/health law and business/hospitals fear abortion bans will worsen staff shortages (“fears of being arrested for prescribing medications that could be unsafe for pregnancy, or for advising chemotherapy that requires ending a pregnancy… ‘the irony is that in states that pass these anti abortion laws, there will be fewer ob gyn doctors willing to practice there. but there will be more need for them because there will be more pregnancies going to term,’ said suzanna sherry, a constitutional law expert at vanderbilt university law school.”). [75] k. schorsch, “staffing shortages in illinois for abortion care,” npr wbez (12 may 2022), npr.org/local/309/2022/05/12/1098469190/staffing shortages in illinois for abortion care (“illinois providers are expecting an additional 20,000 to 30,000 patients a year as people travel from other states that could ban or heavily restrict the procedure. that would be a nearly two thirds increase in abortions across illinois.” an illinois doctor cites the healthcare worker shortage as “perhaps the biggest barrier to a full scale increase that would meet the needs of folks coming from other states.”). [76] interview by foley hoag llp with dr. elissa serapio (29 july 2022). see also e. reyes, “these california nurse midwives want to provide abortions. they’re struggling to get trained,” los angeles times (18 july 2022), latimes.com/california/story/2022 07 18/california nurse midwives want to provide abortions struggling to get trained. [77] see s. aksel et al., unintended consequences: abortion training in the years after roe v wade, 103am. j. public health 3 (2013) (explaining how provider shortages have created barriers to abortion access); american college of obstetricians & gynecologists, committee opinion: abortion training and education (nov. 2014), https://www.acog.org/ /media/project/acog/acogorg/clinical/files/committee opinion/articles/2014/11/abortion training and education.pdf (healthcare providers face institutional barriers in getting trained to perform abortions); e. declercq et al., “the u.s. maternal health divide: the limited maternal health services and worse outcomes of states proposing new abortion restrictions,” the commonwealth fund (14 dec. 2022), https://www.commonwealthfund.org/publications/issue briefs/2022/dec/us maternal health divide limited services worse outcomes (maternity care providers may hesitate to work in scenarios where they may face legal challenges). [78] see generally d. cohen & k. connon, living in the crosshairs : the untold stories of anti abortion terrorism (2015) (in depth accounts and data regarding the violence and harassment endured by women's health professionals). [79] id. [80] national abortion federation, 2021 violence & disruption statistics (19 may 2022), https://prochoice.org/wp content/uploads/2021_naf_vd_stats_final.pdf. see also u.s. dept. of justice, recent cases on violence against reproductive health care providers (updated 18 oct. 2022), https://www.justice.gov/crt/recent cases violence against reproductive health care providers. [81] a january 2020 unclassified report from the fbi outlined an ongoing increase in anti abortion threats, disruption and violence, stating, “the fbi assess the increase in abortion related extremist violent threats and criminal activity, including violations of the freedom of access to clinic entrances (face) act, against targets including reproductive healthcare facilities (rhcfs) likely is driven in part by the recent rise in state legislative activities related to abortion services and access.” (emphasis added); national abortion federation, 2020 violence & disruption statistics (2021), p. 2, https://prochoice.org/our work/provider security/#dflip df_13683/3/. [82] see supra note 87. see also j. winter, “the link between the capitol riot and anti abortion extremism,” the new yorker (11 mar. 2021), https://www.newyorker.com/news/daily comment/the link between the capitol riot and anti abortion extremism; c. sherman, “anti abortion activists were all over the capitol riots,” vice news (12 jan. 2021), https://www.vice.com/en/article/4ad73w/anti abortion activists were all over the capitol riots. [83] no patients or staff were present during the attack; a firefighter sustained life threatening injuries. t. bella, “arson suspected at illinois planned parenthood after state expands abortion rights,” washington post (19 jan. 2023), https://www.washingtonpost.com/nation/2023/01/19/abortion planned parenthood arson illinois/. [84] see tex. health & safety code §170a.004, la. stat. ann. §14:87.7 (2022), idaho code §18 622 (2022), ala. code § 26 23h, ​​ark. code ann. § 5 61 304, ky. rev. stat. § 311.772, § 188.017 r.s.mo., okla. stat. tit. 63, § 1 731.4, miss. code ann. § 41 41 45, s.d. codified laws § 22 17 5.1, tenn. code ann. § 39 15 201, wis. stat. ann. § 940.04, w. va. code § 61 2 8 (currently under an injunction). [85] the texas abortion ban classifies any attempt to induce an abortion as a second degree felony if unsuccessful (punishable by up to 20 years in prison) and as a first degree felony (up to life in prison) “if an unborn child dies as a result of the offense.” tx. code § 170a.004(b). [86] okla. stat. tit. 63, § 1 731.4. [87] for example, texas’s pre roe abortion ban explicitly included accomplice liability (“whoever furnishes the means for procuring an abortion knowing the purpose intended is guilty as an accomplice”) tex. pen. code art. 1192 (1925), https://www.sll.texas.gov/assets/pdf/historical statutes/1925/1925 3 penal code of the state of texas.pdf#page=279. other states, in defining abortion as a felony, have imported generally applicable aiding and abetting provisions. see, e.g., guidance for oklahoma law enforcement following dobbs v. jackson women’s health org (31 aug. 2022) (citing oklahoma definitions of principal and accessory criminal liability, and opining, “oklahoma law prohibits aiding and abetting the commission of an unlawful abortion, which may include advising a pregnant woman to obtain an unlawful abortion. see 21 o.s. §§ 171 172, 861…”). meanwhile, alabama, arizona, arkansas, florida, and ohio have considered such a provision. see h.b. 4327, 2022 leg., reg. sess. (okla. 2022); h.b. 23, 2022 leg., reg. sess. (ala. 2022); h.b. 2483, 55th leg., 2nd reg. sess. (ariz. 2022); s.b. 13, 93rd gen. assemb., 2nd extraordinary sess. (ark. 2021); h.b. 167, 124th leg., reg. sess. (fla. 2022); h.b. 480, 134th gen. assemb., reg. sess. (ohio 2021). see also j. tolentino, “we’re not going back to the time before roe. we’re going somewhere worse,” the new yorker (24 june 2022), https://www.newyorker.com/magazine/2022/07/04/we are not going back to the time before roe we are going somewhere worse/amp. [88] r. klitzman, “opinion: roe’s reversal doesn’t just hurt women   it harms us all,” cnn (25 june 2022), https://www.cnn.com/2022/06/25/opinions/medical ethics post roe world klitzman/index.html. see also j. tolentino, “we’re not going back to the time before roe. we’re going somewhere worse,” the new yorker (24 june 2022), https://www.newyorker.com/magazine/2022/07/04/we are not going back to the time before roe we are going somewhere worse/amp. virtually all of the “trigger laws” punish those conducting and/or aiding an abortion. see also a. zablocki & m. sutrina, “the impact of state laws criminalizing abortion,” lexis nexis (27 sept. 2022), https://www.lexisnexis.com/community/insights/legal/practical guidance journal/b/pa/posts/the impact of state laws criminalizing abortion (noting potential aiding and abetting liability for employers who provide support or time off for employees to obtain abortions; for medical personnel who advise or assist; for individuals who facilitate; or for health plans that cover the procedure); k.e. queram, “lyft and uber establish legal funds to protect drivers from texas abortion law,” route fifty (7 sept. 2021), https://www.route fifty.com/management/2021/09/ride share abortion legal fund texas/185154/. t. o’donnell, “under texas ban, private citizens could sue a cab driver who takes a woman to an abortion,” (1 sept. 2021), https://theweek.com/science/health/1004413/under texas ban private citizens could sue a cab driver who takes a woman to; r. alta charo, vigilante injustice   deputizing and weaponizing the public to stop abortions, the new england journal of medicine (14 oct. 2021), https://www.nejm.org/doi/full/10.1056/nejmp2114886. [89] a. zablocki & m. sutrina, “the impact of state laws criminalizing abortion,” lexis nexis (27 sept. 2022), https://www.lexisnexis.com/community/insights/legal/practical guidance journal/b/pa/posts/the impact of state laws criminalizing abortion; madiba denney & jackie fielding, “miscarriage of justice: the danger of laws criminalizing pregnancy outcomes” the brennan center (9 nov. 2021), https://www.brennancenter.org/our work/analysis opinion/miscarriage justice danger laws criminalizing pregnancy outcomes. [90] texas heartbeat act, senate bill 8 (sb 8) (20 mar. 2021) (an act relating to abortion, including abortions after detection of an “unborn child’s heartbeat”; authorizing a private civil right of action), https://capitol.texas.gov/tlodocs/87r/billtext/pdf/sb00008f.pdf. see also okla. stat. tit. 63, §1 745.33 .34, .38 (2022); idaho code §§ 18 8804, 18 8807 [91] tex. health & safety code §§ 170a.001 7 (2022). see id., § i (b)(1). [92]j. gerson, “‘no one wants to get sued’: some abortion providers have stopped working in texas” the 19th (15 sept. 2021), https://19thnews.org/2021/09/abortion providers texas stopped working under threat sued/ (“‘even if abortion providers win in every single case brought against them [under sb 8], that burden of having to have a lawyer to defend yourself, traveling all over the state to do so   that alone threatens to shut down abortion providers,’ said marc hearron, senior counsel at the center for reproductive rights”). in december 2022, a texas court dismissed a suit from an unaffected, out of state plaintiff against a doctor who had performed an abortion in defiance of the law. the court held that the plaintiff lacked standing to bring the case, but left the door open for plaintiffs with ties to a case to sue providers. see d. solomon, “texas’s abortion ‘bounty’ law just lost its first test. here’s what that means,” texas monthly (9 dec. 2022), https://www.texasmonthly.com/news politics/texas abortion bounty law just lost first test/. [93] interview by foley hoag llp with dr. elissa serapio (25 july 2022). others involved in abortion care, including lawyers, have the same concerns. i. mitchell, “texas freedom caucus warns law firm of criminal liability for covering employees’ abortion costs,” the texan (11 july 2022), available at https://thetexan.news/texas freedom caucus warns law firm of criminal liability for covering employees abortion costs/ (members of the texas freedom caucus promise to file legislation in the upcoming session to “require the state bar of texas to disbar any lawyer that has violated texas abortion laws.”). see also e. bowman, “as states ban abortion, the texas bounty law offers a way to survive legal challenges,” npr (11 july 2022), https://www.npr.org/2022/07/11/1107741175/texas abortion bounty law. see also m. kornfield, “a website for ‘whistleblowers’ to expose texas abortion providers was taken down again” (6 sept. 2021), https://www.washingtonpost.com/nation/2021/09/06/texas abortion ban website/. [94] r. cohen, “the coming legal battles of post roe america,” vox (27 june 2022), https://www.vox.com/2022/6/27/23183835/roe wade abortion pregnant criminalize. [95] c. kitchener & d. barrett, “antiabortion lawmakers want to block patients from crossing state lines,” washington post (30 june 2022), https://www.washingtonpost.com/politics/2022/06/29/abortion state lines/. see also a. ollstein & m. messerly, “missouri wants to stop out of state abortions. other states could follow,” https://www.politico.com/news/2022/03/19/travel abortion law missouri 00018539 for specific of the missouri proposal. [96] m.o. sb603, 101st gen. assemb., reg. sess. (2021). [97] see r. cohen, “the coming legal battles of post roe america,” vox (27 june 2022), https://www.vox.com/2022/6/27/23183835/roe wade abortion pregnant criminalize. see also s. ballentine & j. hanna, “missouri considers law to make illegal to ‘aid or abet’ out of state abortion,” pbs (16 mar. 2022), https://www.pbs.org/newshour/politics/missouri considers law to make illegal to aid or abet out of state. [98] t. gross, “the u.s. faces 'unprecedented uncertainty' regarding abortion law, legal scholar says,” npr (updated 18 jan. 2023), https://www.npr.org/sections/health shots/2023/01/17/1149509246/the u s faces unprecedented uncertainty regarding abortion law legal scholar sa; t. benson, “interstate travel post roe isn’t as secure as you may think,” wired (25 july 2022), https://www.wired.com/story/insterstate travel abortion post roe/. [99] pregnancy related prosecutions not only existed but were increasing before dobbs. see pregnancy justice, “arrests and prosecutions of pregnant women, 1973 2020” (18 sept. 2021), https://www.nationaladvocatesforpregnantwomen.org/wp content/uploads/2021/09/final_1600cases factsheet.docx.pdf. see also m. goldberg, “when a miscarriage is manslaughter,” the new york times (18 oct. 2021), https://www.nytimes.com/2021/10/18/opinion/poolaw miscarriage.html. [100] see a. yurkanin, “women can be prosecuted for taking abortion pills, says alabama attorney general,” al.com (10 jan. 2023). [101] idaho code §18 606. [102] pregnancy justice, “when fetuses gain personhood: understanding the impact on ivf, contraception, medical treatment, criminal law, child support, and beyond” (17 aug. 2022), https://pregjustdev.wpengine.com/wp content/uploads/2022/08/fetal personhood issue 8.17.22.pdf. see also pregnancy justice, “who do fetal homicide laws protect? an analysis for a post roe america,” https://www.nationaladvocatesforpregnantwomen.org/wp content/uploads/2022/08/feticide brief w appendix.pdf. [103] international human rights law (ihrl) makes clear that its protections start at birth and that fetal personhood has no basis in ihrl. see working group on discrimination against women and girls in law and practice, women's autonomy, equality and reproductive health in international human rights: between recognition, backlash and regressive trends (oct. 2017), https://www.ohchr.org/sites/default/files/documents/issues/women/wg/womensautonomyequalityreproductivehealth.pdf (“it was well settled in the 1948 [universal declaration of human rights] and upheld in the iccpr that the human rights accorded under ihrl are accorded to those who have been born. ‘all human beings are born free and equal in dignity and rights. they are endowed with reason and conscience and should act towards one another in a spirit of brotherhood.’”). the working group cites inter alia the travaux préparatoires of article 6 of the iccpr, in which proposed amendments suggesting that the right to life applied before birth were specifically rejected by states. un gaor, 12th session, agenda item 33, at 119 (e), (q), un doc. a/3764, 1957. [104] m. carlisle, “fetal personhood laws are a new frontier in the battle over reproductive rights,” time (28 june 2022), https://time.com/6191886/fetal personhood laws roe abortion/. fetal personhood provisions could also lead to non abortion related conduct being criminalized. https://www.usnews.com/news/national news/articles/2022 05 06/the push to make fetuses people and abortion murder/. [105] o. gonzalez, “louisiana abortion bill allowing homicide charges against patients stopped for now,” axios (13 may 2022), https://www.axios.com/2022/05/13/louisiana abortion bill homicide patient roe. [106] a tennessee trigger law that will go into effect in august will make performing an abortion a felony that comes with a sentence of up to 15 years imprisonment. a.sainz & k. kruesi, “memphis council resolution addresses abortion prosecutions,” the associated press (12 july 2022), https://apnews.com/article/abortion 2022 midterm elections us supreme court health nashville 92c4834b3b0fd10e487c2bc75020c03d. a 2021 study from the national association of criminal defense lawyers and pregnancy justice determined that there are thousands of federal and state crimes already on the books that prosecutors can and have used to charge pregnant persons in a post roe world. see national association of criminal defense lawyers and national foundation for criminal justice, “abortion in america: how legislative overreach is turning reproductive rights into criminal wrongs” (aug. 2021), https://www.nacdl.org/getattachment/ce0899a0 3588 42d0 b351 23b9790f3bb8/abortion in america how legislative overreach is turning reproductive rights into criminal wrongs.pdf. [107] “alabama mother prosecuted for taking prescription during pregnancy,” equal justice initiative (12 july 2021), https://eji.org/news/alabama mother prosecuted for taking prescription during pregnancy/. [108] l. paltrow & l. sangoi, “the dangerous state laws that are punishing pregnant people,” think progress (28 sept. 2016), https://archive.thinkprogress.org/criminalization pregnancy us 43e4741bb514/; amnesty international, “usa: criminalizing pregnancy: policing pregnant women who use drugs in the usa” (23 may 2017) https://www.amnesty.org/en/documents/amr51/6203/2017/en/. [109] “alabama mother prosecuted for taking prescription during pregnancy,” equal justice initiative (12 july 2021), https://eji.org/news/alabama mother prosecuted for taking prescription during pregnancy/; p. salhotra, “does a fetus count in the carpool lane? texas’ abortion law creates new questions about legal personhood,” the texas tribune (13 sept. 2022), https://www.texastribune.org/2022/09/13/texas personhood laws abortion law/; m. carrizosa, “beyond abortion: the fight over fetal personhood is here (video),” bloomberg law (12 jan. 2023), https://news.bloomberglaw.com/us law week/beyond abortion the fight over fetal personhood is here video. [110] see n. martin, “take a valium, lose your kid, go to jail,” propublica (23 sept. 2015), https://www.propublica.org/article/when the womb is a crime scene. [111] see pregnancy justice, “confronting pregnancy criminalization: a practical guide for healthcare providers, lawyers, medical examiners, child welfare workers, and policymakers,” p. 6 (july 2022), https://www.pregnancyjusticeus.org/wp content/uploads/2022/06/1.confronting pregnancycriminalization_6.22.23 1.pdf; pregnancy justice, “arrests and other deprivations of liberty of pregnant women, 1973 2020,” https://www.pregnancyjusticeus.org/wp content/uploads/2021/09/final_1600cases factsheet.docx.pdf. [112] see pregnancy justice, “wisconsin’s ‘unborn children protection act’ (act 292)” (16 may 2022), https://www.nationaladvocatesforpregnantwomen.org/fact sheet wisconsins unborn child protection act act. [113] see idaho 18 622(5) “nothing in this section shall be construed to subject a pregnant woman on whom any abortion is performed or attempted to any criminal conviction and penalty.”; s. harris, “local woman facing 10 years in prison for allegedly using meth the day she gave birth” (6 june 2021), https://www.idahostatejournal.com/news/local/local woman facing 10 years in prison for allegedly using meth the day she gave/article_e03d4800 cf40 5263 a7d3 085d2d7df2b4.html/; l. miranda et al., “how states handle drug use during pregnancy” (30 sept. 2015), https://projects.propublica.org/graphics/maternity drug policies by state. [114] report of the working group on arbitrary detention on its visit to the united states of america, ¶ 74 (u.n. doc. a/hrc/36/37/add.2) (17 july 2017). [115] see nwhn staff, “consumer health info: medication abortion and miscarriage” (updated 15 aug. 2019), https://nwhn.org/abortion pills vs miscarriage demystifying experience/ (“from a medical perspective, there is no physically significant difference between a medication abortion and a spontaneously occurring miscarriage. for example, the medicines used in medication abortion are used to help safely manage an incomplete miscarriage.”). [116] see m. dennie & j. fielding, “miscarriage of justice: the danger of laws criminalizing pregnancy outcomes,” brennan center for justice (9 nov. 2021), https://www.brennancenter.org/our work/analysis opinion/miscarriage justice danger laws criminalizing pregnancy outcomes. p. thompson & a. turcios cruz, “how an oklahoma women’s miscarriage put a spotlight on racial disparities in prosecutions,” nbc news (5 nov. 2021). [117] “criminal justice fact sheet,” naacp, https://naacp.org/resources/criminal justice fact sheet; https://www.prisonpolicy.org/blog/2021/10/08/indigenouspeoplesday/ (“in jails, native people had more than double the incarceration rate of white people, and in prisons this disparity was even greater.”). [118] l. paltrow & j. flavin, arrests of and forced interventions on pregnant women in the united states, 1973 2005: implications for women's legal status and public health, journal of health politics, policy and law https://read.dukeupress.edu/jhppl/article/38/2/299/13533/arrests of and forced interventions on pregnant (noting that the socioeconomic status of economically disadvantaged was indicated by the fact that 71 percent qualified for indigent defense). [119] see national association of criminal defense lawyers, race and the war on drugs (29 nov. 2022), https://www.nacdl.org/content/race and the war on drugs. [120] report by the special rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health: racism and the right to health (u.n. doc. a/77/197) (20 july 2022). [121] see american college of obstetricians and gynecologists, opposition to criminalization of individuals during pregnancy and the postpartum period statement of policy (dec. 2020), https://www.acog.org/clinical information/policy and position statements/statements of policy/2020/opposition criminalization of individuals pregnancy and postpartum period. [122] a recent study by if/when/how found “at least 61 instances where people were investigated or prosecuted for allegedly self managing an abortion or helping others self manage. among the cases involving adults, 26% were reported by acquaintances (including family, friends, and neighbors) and 45% were reported by care professionals (including doctors, nurses, and social workers) after seeking care...whether criminalization has occurred out of malice or simply due to ignorance of reporting requirements, clinicians, social workers, and other clinical support providers have caused substantial harm to patients by calling law enforcement after the loss of pregnancy because they suspect the miscarriage was intentionally induced.” j. perritt, “don't report your abortion patients to law enforcement self managed abortion does not legally need to be reported,” medpage today (5 nov. 2022), https://www.medpagetoday.com/opinion/second opinions/101581; (citing l. huss et al., self care, criminalized: august 2022 preliminary findings, if how when: lawyering for reproductive justice 2 3 (2022)). see also e. bazelon, “purvi patel could be just the beginning,” the new york times (1 apr. 2015), https://www.nytimes.com/2015/04/01/magazine/purvi patel could be just the beginning.html. [123] s. artiga et al., “racial disparities in maternal and infant health: an overview,” kaiser family foundation (10 nov. 2020), https://www.kff.org/report section/racial disparities in maternal and infant health an overview issue brief/. [124] e. yuko, “women of color will face more criminalized pregnancies in post ‘roe’ america,” rolling stone (7 july 2022), https://www.rollingstone.com/culture/culture features/roe wade abortion criminalized pregnancy bipoc 1377430/. [125] working group on discrimination against women and girls in law and practice, women’s autonomy, equality and reproductive health in international human rights: between recognition, backlash and regressive trends (oct. 2017), https://www.ohchr.org/sites/default/files/documents/issues/women/wg/womensautonomyequalityreproductivehealth.pdf. [126] see, e.g., c. zakrzewski et al., “texts, web searches about abortion have been used to prosecute women,” the washington post (3 july 2022), https://www.washingtonpost.com/technology/2022/07/03/abortion data privacy prosecution/. see also r. williams, “how might law enforcement use digital tracking to enforce georgia’s strict anti abortion law?” gpb (30 aug. 2022), https://www.gpb.org/news/2022/08/30/how might law enforcement use digital tracking enforce georgias strict anti. [127] see k. cheung, “abortion in the surveillance state,” jezebel (22 nov. 2021), https://jezebel.com/abortion in the surveillance state 1848076906. see also j. schuppe, “police sweep google searches to find suspects. the tactic is facing its first legal challenge,” nbc news (30 june 2022), https://www.nbcnews.com/news/us news/police google reverse keyword searches rcna35749. [128] p. hurtado et al., “in a post roe world, more miscarriage and stillbirth prosecutions await women,” bloomberg (5 july 2022), https://www.bloomberg.com/news/articles/2022 07 05/miscarriage stillbirth prosecutions await women post roe. see also l. rankin, “how an online search for abortion pills landed this woman in jail,” fast company (26 feb. 2020), https://www.fastcompany.com/90468030/how an online search for abortion pills landed this woman in jail. [129] federal trade commission, “data brokers: a call for transparency and accountability,” p. i (may 2014), https://www.ftc.gov/system/files/documents/reports/data brokers call transparency accountability report federal trade commission may 2014/140527databrokerreport.pdf. [130] federal courts have not ruled directly on whether the particularized probable cause standard applicable to warrant requests is required for police to conduct keyword search queries or “geofenced” (i.e. location bound) searches of data held by third parties, including google. at the moment, law enforcement is relying on vague and less protective statutory standards, such as the stored communication act’s “reasonable grounds [to believe that records are] relevant and material to an ongoing investigation” standard. congressional research service, “abortion, data privacy, and law enforcement access: a legal overview” (updated 8 july 2022), https://crsreports.congress.gov/product/pdf/lsb/lsb10786. [131] j. cox, “data broker is selling location data of people who visit abortion clinics,” vice (3 may 2022), https://www.vice.com/en/article/m7vzjb/location data abortion clinics safegraph planned parenthood (reporting on the sale of data “showing where groups of people visiting [clinics the provide abortions] came from, how long they stayed there, and where they then went afterwards.”). see also b. cyphers, “inside fog data science, the secretive company selling mass surveillance to local police,” eff (31 aug. 2022), https://www.eff.org/deeplinks/2022/08/inside fog data science secretive company selling mass surveillance local police (describing how private data brokers sell searchable access to “‘billions’ of data points about ‘over 250 million’ devices” to local law enforcement agencies, generally without any court oversight). [132] b. cyphers, “how law enforcement around the country buys cell phone location data wholesale,” eff (31 aug. 2022), https://www.eff.org/deeplinks/2022/08/how law enforcement around country buys cell phone location data wholesale some data broker services are designed and marketed specifically for law enforcement agencies, who purchase subscriptions to the services   rather than seeking a warrant   in order to access advanced search features. the electronic frontier foundation documented a lack of agency level policies governing the use of these services, and found that most agencies did not seek either warrants or subpoenas to access the data. see also f. patel & a. shahzad, “with roe v. wade at risk, digital surveillance threatens reproductive freedom,” just security (17 may 2022), https://www.justsecurity.org/81547/with roe v wade at risk digital surveillance threatens reproductive freedom/. [133] s. quenby et al., “miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss,” the lancet (vol. 397, 2021), p. 1658; d. walker, “with roe overturned, indigenous communities say it was always impossible for them to access abortion services,” insider (24 june 2002), https://www.insider.com/roe overturned harder for indigenous communities to access abortion 2022 5. [134] national women’s health center, “consumer health info: medication abortion and miscarriage” (updated 15 aug. 2019), https://nwhn.org/abortion pills vs miscarriage demystifying experience/ (“from a medical perspective, there is no physically significant difference between a medication abortion and a spontaneously occurring miscarriage. for example, the medicines used in medication abortion are used to help safely manage an incomplete miscarriage.”). [135] c. conti cook, surveilling the digital abortion diary, 50 (1) university of baltimore law review 1 (2020), pp. 29 38. [136] see m. gilman, the class differential in privacy law, 77 brook. l. rev. 1389, 1392 (2012), https://brooklynworks.brooklaw.edu/blr/vol77/iss4/2. [137] see e. joh, dobbs online: digital rights as abortion rights (5 sept. 2022) (feminist cyberlaw, a. levendowski & m. jones (eds.), forthcoming 2023), https://ssrn.com/abstract=4210754) (noting that low income women are less able to afford more privacy protective phones, apps, or other services). [138] see k. cheung, “abortion in the surveillance state,” jezebel (22 nov. 2021), https://jezebel.com/abortion in the surveillance state 1848076906; s. coutts, “anti choice groups use smartphone surveillance to target ‘abortion minded women’ during clinic visits,” rewire news group (25 may 2016), https://rewirenewsgroup.com/2016/05/25/anti choice groups deploy smartphone surveillance target abortion minded women clinic visits/. [139] a. abrams & v. bergengruen, “anti abortion pregnancy centers are collecting troves of data that could be weaponized against women,” time (22 june 2022), https://time.com/6189528/anti abortion pregnancy centers collect data investigation/. [140] j. cox, “data broker is selling location data of people who visit abortion clinics,” vice (3 may 2022), https://www.vice.com/en/article/m7vzjb/location data abortion clinics safegraph planned parenthood; e. joh, dobbs online: digital rights as abortion rights (5 sept. 2022) (a. levendowski & m. jones (eds.), feminist cyberlaw, forthcoming 2023), https://ssrn.com/abstract=4210754). see also a. vesoulis, “how a digital abortion footprint could lead to criminal charges and what congress can do about it,” time (10 may 2022), available at https://time.com/6175194/digital data abortion congress/; e. bowman, “as states ban abortion, the texas bounty law offers a way to survive legal challenges,” npr (11 july 2022), https://www.npr.org/2022/07/11/1107741175/texas abortion bounty law#:~:text=the%20law%20makes%20no%20exceptions,%2410%2c000%20in%20damages%20from%20defendants. [141] see j. cox, “data broker is selling location data of people who visit abortion clinics,” vice (3 may 2022), https://www.vice.com/en/article/m7vzjb/location data abortion clinics safegraph planned parenthood. following the initial story, this particular data broker announced it would cease selling data specifically tracking those who visited abortion providers, and subsequently eliminated retail access to its data altogether; however, nothing prevents other brokers from offering identical products. j. cox, “safegraph to close digital shop that sold abortion clinic location data,” vice (30 sept. 2022), https://www.vice.com/en/article/g5vw3b/safegraph to close shop abortion clinic location data. [142] n. poli & v. bergengruen, “lawmakers scramble to reform digital privacy after roe reversal,” time (1 july 2022), https://time.com/6193224/abortion privacy data reform/. [143] complaint, generation to generation inc. v. state of florida, no. 2022 ca 000980 (leon cty. fla., circ. ct., 10 june 2022). see also e. fawcett, “synagogue sues florida, saying abortion restrictions violate religious freedoms,” the new york times (16 june 2022), https://www.nytimes.com/2022/06/16/us/florida abortion law judaism.html. [144] the providers in florida who have resorted to the courts to assert their right to freedom of religion or belief are part of a long tradition of healthcare workers providing reproductive healthcare, at least in part, due to their faith. see a religious right to abortion: legal history and analysis, columbia law school (aug. 2022), https://lawrightsreligion.law.columbia.edu/sites/default/files/content/lrrp%20religious%20liberty%20%26%20abortion%20rights%20memo.pdf. [145] m. boorstein, “clergy sue to halt florida abortion law, citing religious freedom,” the washington post (1 sept. 2022), https://www.washingtonpost.com/religion/2022/09/01/florida pastor rabbi abortion lawsuit/. [146] id. [147] un general assembly, international covenant on civil and political rights (16 dec. 1966), united nations, treaty series (vol. 999) (“iccpr”), https://www.refworld.org/docid/3ae6b3aa0.html [accessed 28 january 2023], art.18 (3). [148] see a. branigin & s. chery, “women of color will be most impacted by the end of roe, experts say,” the washington post (24 june 2022), https://www.washingtonpost.com/nation/2022/06/24/women of color end of roe/. see also l. powell, “human rights campaign fact sheet: lesbian, bisexual, queer women who have been pregnant are more likely to need abortion services; demonstrates impact roe reversal would have on lgbtq+ people,” human rights campaign (2 june 2022), available at https://www.hrc.org/press releases/human rights campaign fact sheet lesbian bisexual queer women who have been pregnant are more likely to need abortion services demonstrates impact roe reversal would have on lgbtq people. see also american association of people with disabilities, “aapd statement on leaked supreme court draft decision and threat to roe v. wade” (10 may 2022), https://www.aapd.com/press releases/aapd statement scotus threat to roe/. [149] see, e.g., e.e. petersen et al., “vital signs: pregnancy related deaths, united states, 2011 2015, and strategies for prevention, 13 states, 2013 2017,” mmwr morb mortal wkly rep (2019), 68:423 429 (between 2011 and 2015 indigenous women had the second highest rate of pregnancy related deaths); m. long et al., “women’s health care utilization and costs: findings from the 2020 kff women’s health survey” (21 apr. 2021), https://www.kff.org/womens health policy/issue brief/womens health care utilization and costs findings from the 2020 kff womens health survey (low income women, black women, and hispanic women); g. borchelt, “the impact poverty has on women’s health,” https://www.americanbar.org/groups/crsj/publications/human_rights_magazine_home/the state of healthcare in the united states/poverty on womens health (low income women); m. buckles “improving health outcomes for black women and girls with disabilities” (15 feb. 2022), https://www.americanprogress.org/article/improving health outcomes for black women and girls with disabilities (black women and women with disabilities); l. johnson, “the disparate impact of texas’ abortion ban on low income and rural women,” georgetown law journal on poverty law and policy (24 feb. 2022), https://www.law.georgetown.edu/poverty journal/blog/the disparate impact of texas abortion ban on low income and rural women (rural and low income women). [150] see k.l. gilbert et al., “dobbs, another frontline for health equity,” brookings institution (30 june 2022), https://www.brookings.edu/blog/how we rise/2022/06/30/dobbs another frontline for health equity/. see also d. walker, “with roe overturned, indigenous communities say it was always impossible for them to access abortion services” (24 june 2022), https://www.insider.com/roe overturned harder for indigenous communities to access abortion 2022 5; l. kcomt et al., “healthcare avoidance due to anticipated discrimination among transgender people: a call to create trans affirmative environments” (28 may 2020), https://www.ncbi.nlm.nih.gov/pmc/articles/pmc7276492/pdf/main.pdf; b. karami matin et al., “barriers in access to healthcare for women with disabilities: a systematic review in qualitative studies” (30 jan. 2021), https://bmcwomenshealth.biomedcentral.com/track/pdf/10.1186/s12905 021 01189 5.pdf; u. ranji et al., “beyond the numbers: access to reproductive health care for low income women in five communities” (14 nov. 2019), https://www.kff.org/report section/beyond the numbers access to reproductive health care for low income women in five communities executive summary.; l. fuentes, “inequity in us abortion rights and access: the end of roe is deepening existing divides,” guttmacher institute (jan. 2023), https://www.guttmacher.org/2023/01/inequity us abortion rights and access end roe deepening existing divides (“drivers of inequity such as income and health insurance disparities and health provider bias…are not simply the result of individual acts of discrimination but rather the result of how institutions and public infrastructures function.”). [151] brief for autistic self advocacy network and the disability rights education and defense fund as amicus curiae (dobbs v. jackson women's health org., 142 s. ct. 2228) (20 sept. 2021), p. 7, https://www.supremecourt.gov/docketpdf/19/19 1392/192964/20210920135335415_19 1392%20amicus%20brief%20of%20the%20autistic%20self%20advocacy%20network%20et%20al..pdf (“around 60,000 americans were forcibly sterilized in state sanctioned programs to prevent those adjudged to have psychiatric disabilities from reproducing”). see also p. lombardo, three generations, no imbeciles: new light on buck v. bell, 60 n.y.u. l. rev. 30, 31 (1985); a. stern, “forced sterilization policies in the us targeted minorities and those with disabilities   and lasted into the 21st century,” ihpi news (23 sept. 2020), https://ihpi.umich.edu/news/forced sterilization policies us targeted minorities and those disabilities and lasted 21st (“anyone who did not fit [the] mold of racial perfection, which included most immigrants, blacks, indigenous people, poor whites and people with disabilities, became targets of eugenics programs.”); national women’s law center, forced sterilization of disabled people in the united states (24 jan. 2022), https://nwlc.org/wp content/uploads/2022/01/%c6%92.nwlc_sterilizationreport_2021.pdf; (appendix) https://nwlc.org/wp content/uploads/2022/01/%c6%92.nwlc_sterilizationreport_2022_appendix.pdf. [152] brief for autistic self advocacy network and the disability rights education and defense fund as amicus curiae (dobbs v. jackson women's health org., 142 s. ct. 2228) (20 sept. 2021), p. 7, https://www.supremecourt.gov/docketpdf/19/19 1392/192964/20210920135335415_19 1392%20amicus%20brief%20of%20the%20autistic%20self%20advocacy%20network%20et%20al..pdf. [153] l. bowen, “dobbs is a disaster for disability justice,” society for cultural anthropology (3 oct. 2022), https://culanth.org/fieldsights/dobbs is a disaster for disability justice. see also r. hoban, “in debate over down syndrome/abortion bill, disability groups struggle with how to respond,” north carolina health news (8 june 2021), https://www.northcarolinahealthnews.org/2021/06/08/disability groups struggle to respond to latest abortion bill/. [154] m. smith, “native americans: a crisis in health equity,” american bar association human rights magazine (vol. 43, no. 3) (1 aug. 2018), https://www.americanbar.org/groups/crsj/publications/human_rights_magazine_home/the state of healthcare in the united states/native american crisis in health equity/. the united nations’ department for economic and social affairs has also produced reports on indigenous peoples’ access to health services around the world, finding these groups face heightened challenges. see “state of the world’s indigenous peoples: indigenous peoples’ access to health services,” united nations department of economic and social affairs (march 2018), https://www.un.org/development/desa/indigenouspeoples/wp content/uploads/sites/19/2018/03/the state of the worlds indigenous peoples web.pdf. [155] e. hofstaedter, “abortion was already inaccessible on reservation land. dobbs made things worse,” mother jones (12 aug. 2022), https://www.motherjones.com/politics/2022/08/abortion dobbs tribal land/. [156] see d. williams et al., understanding and addressing racial disparities in health care, 21(4) health care financing review 75 (2000). see also key facts on health and health care by race and ethnicity, kaiser family foundation, (26 jan. 2022), https://www.kff.org/racial equity and health policy/report/key facts on health and health care by race and ethnicity/; “closing the equity gap in health care for black americans,” the commonwealth fund (15 july 2016), https://www.commonwealthfund.org/blog/2016/closing equity gap health care black americans. black women may also be particularly impacted by abortion bans because they have historically been overrepresented among people seeking abortions. see “reported legal abortions by race of women who obtained abortion by the state of occurrence,” kaiser family foundation (2020), https://www.kff.org/racial equity and health policy/report/key facts on health and health care by race and ethnicity/ [157] see, e.g., a. spencer, “black rural residents lack healthcare due to racism and poverty,” the sacramento observer (22 aug. 2022), https://sacobserver.com/2022/08/black rural residents lack healthcare due to racism and poverty/. [158] see “submission to the united nations committee on the elimination of racial discrimination,” amnesty international, the global justice center, the southern rural black women’s initiative for economic and social justice, and human rights watch (aug. 2022), https://www.hrw.org/sites/default/files/media_2022/07/sbrwi_hrw_gjc_ai_cerdshadowreport.pdf. see a post roe america: the legal consequences of the dobbs decision: hearing before the senate committee on the judiciary, 117th cong. section iv (2022) (statement of khiara m. bridges professor of law, uc berkeley school of law), https://www.judiciary.senate.gov/imo/media/doc/testimony%20 %20bridges%20 %202022 07 121.pdf. [159] see generally a. bissonnette, “caged women”: migration, mobility and access to health services in texas and arizona, 37 j. borderlands studies 1 (9 apr. 2020), tandfonline.com/doi/abs/10.1080/08865655.2020.1748515?journalcode=rjbs20. [160] barriers to sexual and reproductive health services faced by immigrant women of reproductive age in the united states, ibis reproductive health (jan. 2023), https://www.ibisreproductivehealth.org/sites/default/files/files/publications/access%20to%20srh%20services_immigrants%20brief%20final.pdf. many noncitizen us residents are ineligible for medicaid and the children’s health insurance program (chip) for their first five years in the country. health coverage for lawfully present immigrants: immigrants and medicaid & chip, healthcare.gov (17 jan. 2023), https://www.healthcare.gov/immigrants/lawfully present immigrants/. [161] s. ahmed, “abortion worries heightened for unauthorized immigrants in the u.s.,” reuters (5 july 2022), https://www.reuters.com/world/us/abortion worries heightened unauthorized immigrants us 2022 07 05/. [162] interview by foley hoag llp with dr. elissa serapio (25 july 2022). [163] human rights watch, “the only people it really affects are the people it hurts” (11 mar. 2021), https://www.hrw.org/report/2021/03/11/only people it really affects are people it hurts/human rights consequences. [164] “barriers to sexual and reproductive health services faced by immigrant women of reproductive age in the united states,” ibis reproductive health (jan. 2023), https://www.ibisreproductivehealth.org/sites/default/files/files/publications/access%20to%20srh%20services_immigrants%20brief%20final.pdf. [165] see k.l. gilbert et al., “dobbs, another frontline for health equity,” brookings institution (30 june 2022), https://www.brookings.edu/blog/how we rise/2022/06/30/dobbs another frontline for health equity/; m. kirstein et al., “100 days post roe: at least 66 clinics across 15 us states have stopped offering abortion care,” guttmacher institute (6 oct. 2022), https://www.guttmacher.org/2022/10/100 days post roe least 66 clinics across 15 us states have stopped offering abortion care (noting that abortion bans lead to clinic closures and “[w]hen clinics close down or stop offering abortion care, it represents a lost source of health care for their community.”). [166] see k. l. gilbert et al., “dobbs, another frontline for health equity,” brookings institution (30 june 2022), https://www.brookings.edu/blog/how we rise/2022/06/30/dobbs another frontline for health equity/ (“of the 13 states that have an immediate trigger law, 9 of them rank number 30 or lower in overall state health using data from america’s health rankings. more than 10 of these states rank in the bottom half for public health and healthcare quality.”). [167] see national institute of justice, “violence against american indian and alaska native women and men: 2010 findings from the national intimate partner and sexual violence survey,” (may 2016), pp. 2, 14, available at https://www.ojp.gov/pdffiles1/nij/249736.pdf (indigenous women); s.e. tan & k. kuschminder, “migrant experiences of sexual and gender based violence: a critical interpretative synthesis,” global health (2022), pp. 18, 68 (migrant women); “violence against women in the united states: statistics,” available at https://now.org/resource/violence against women in the united states statistic (low income women); j. barlow “black women, the forgotten survivors of sexual assault,” https://www.apa.org/pi/about/newsletter/2020/02/black women sexual assault (black women); r. dowd “transgender people over four times more likely than cisgender people to be victims of violent crime,” ucla school of law williams institute (23 mar. 2021), https://williamsinstitute.law.ucla.edu/press/ncvs trans press release (transgender men); “violence and abuse in rural america” (last reviewed 26 mar. 2021), https://www.ruralhealthinfo.org/topics/violence and abuse (women in rural communities); cdc, “sexual violence and intimate partner violence among people with disabilities” (last reviewed 1 june 2020), https://www.cdc.gov/violenceprevention/sexualviolence/svandipv.html (women with disabilities). [168] most states with abortion bans in effect do not have any exception for pregnancies that result from rape or incest. f. cineas, “rape and incest abortion exceptions don’t really exist,” vox (22 july 2022), https://www.vox.com/23271352/rape and incest abortion exception. see, e.g., alabama human life protection act (h.b. 314, § 7); wisconsin § 940.04(5); wyoming § 35 6 102.(b); texas health & safety code title 2, subtit. h, ch. 170a; tennessee code ann. § 39 15 213.(c)(1) (3); south dakota, § 22 17 5.1; miss. code ann. § 41 41 45.(2) (contemplating rape only); louisiana § 40:1061.f g; kentucky § 311.772.(4)(a) (b); arkansas a.c.a. § 5 61 304(a); arizona a.r.s. § 13 3603.02.a; oklahoma s.b. 612 section a.b.3.a; missouri (§ 188.017 r.s.mo.). [169] most states with a rape exception to their abortion ban require the victim to report the rape to the police in order to obtain an abortion. f. cineas, “rape and incest abortion exceptions don’t really exist,” vox (22 july 2022), https://www.vox.com/23271352/rape and incest abortion exception. [170] rainn, the criminal justice system: statistics, https://www.rainn.org/statistics/criminal justice system. [171] d. thompson, “when abortion means traveling, more women forgo procedure: study”, us news (16 may 2022), https://www.usnews.com/news/health news/articles/2022 05 16/when abortion means traveling more women forgo procedure study. [172] see n. hassanein, “people of color, the poor and other marginalized people to bear the brunt if roe v. wade is overturned,” usa today (3 may 2022), https://www.usatoday.com/story/news/health/2022/05/03/people color most impacted if roe v wade overturned/9626866002/. see also a. schrager, “no abortion means poor states will get poorer,” the washington post (4 may 2022), https://www.washingtonpost.com/business/no abortion means poor states will get poorer/2022/05/04/276bcde6 cb9a 11ec b7ee 74f09d827ca6_story.html. [173] d. thompson, “when abortion means traveling, more women forgo procedure: study,” us news (16 may 2022), https://www.usnews.com/news/health news/articles/2022 05 16/when abortion means traveling more women forgo procedure study. [174] b. rader mph et al., estimated travel time and spatial access to abortion facilities in the us before and after the dobbs v jackson women’s health decision, jama 2022;328(20):2041 2047, https://jamanetwork.com/journals/jama/article abstract/2798215. [175] see j. bearak et al., “disparities and change over time in distance women would need to travel to have an abortion in the usa: a spatial analysis,” lancet public health (nov. 2017), https://www.ncbi.nlm.nih.gov/pmc/articles/pmc5943037/. see also r. bleiweis et al., “the basic facts about women in poverty” (3 aug. 2020), cap, https://www.americanprogress.org/article/basic facts women poverty; status of women in the states, “spotlight on immigrant women: the employment and earning of immigrant women,” https://statusofwomendata.org/immigrant women; m.v. badgett et al., “ lgbt poverty in the united states,” ucla school of law williams institute (oct. 2019), https://williamsinstitute.law.ucla.edu/publications/lgbt poverty us; committee opinion, “health disparities in rural women,” the american college of obstetricians and gynecologists (feb. 2014, reaffirmed in 2021), https://www.acog.org/clinical/clinical guidance/committee opinion/articles/2014/02/health disparities in rural women (rural women). [176] d. foster, the turnaway study: the cost of denying women access to abortion (2020). [177] d. foster, new abortion bans will increase existing health and economic disparities, 112 am. j. pub. health 1276 (june 2022), https://ajph.aphapublications.org/doi/10.2105/ajph.2022.306993. [178] see united nations, the state parties to the international covenant on civil and political rights (iccpr), available at https://treaties.un.org/pages/viewdetails.aspx?chapter=4&clang=_en&mtdsg_no=iv 4&src=ind (us ratification, 8 june 1992). [179] see united nations, the state parties to the international convention on the elimination of all forms of racial discrimination (icerd), https://treaties.un.org/pages/viewdetails.aspx?src=ind&mtdsg_no=iv 2&chapter=4&clang=_en (us ratification, 21 oct. 1994). [180] see united nations, the state parties to the convention against torture and other cruel, inhuman or degrading treatment or punishment (cat), https://www.ohchr.org/sites/default/files/cat.pdf (us ratification, 21 oct. 1994). [181] see united nations, the state parties to the international covenant on economic, social and cultural rights (icescr), https://treaties.un.org/pages/viewdetails.aspx?src=ind&mtdsg_no=iv 3&chapter=4 (us ratification, 5 oct. 1977). [182] see united nations, the state parties to the convention on the elimination of all forms of discrimination against women (cedaw), https://treaties.un.org/pages/viewdetails.aspx?src=ind&mtdsg_no=iv 8&chapter=4&clang=_en (us ratification, 17 july 1980). [183] see united nations, the state parties to the convention on the rights of the child (crc), https://treaties.un.org/pages/viewdetails.aspx?src=ind&mtdsg_no=iv 11&chapter=4&clang=_en (us ratification, 16 feb. 1995). [184] see united nations, the state parties to the convention on the rights of persons with disabilities (crpd), https://treaties.un.org/pages/viewdetails.aspx?chapter=4&clang=_en&mtdsg_no=iv 15&src=ind (us ratification, 30 july 2009). [185] see united nations, vienna convention on the law of treaties (23 may 1969), united nations, treaty series (vol. 1155) (vclt), art. 18. [186] see brief of the united nations mandate holders as amici curiae, dobbs v. jwho., 142 s. ct. 2228, p. 9 (20 sept. 2021), https://www.supremecourt.gov/docketpdf/19/19 1392/193045/20210920163400578_19 1392%20bsac%20united%20nations%20mandate%20holders.pdf. [187] as recently summarized by the working group on discrimination against women and girls: “sexual and reproductive health rights are clearly established under international law. they are an integral part of a number of civil and political rights that underpin the physical and mental integrity of individuals and their autonomy, such as the rights to life, liberty and security of person, freedom from torture and other cruel, inhuman or degrading treatment, privacy and respect for family life, as well as economic, social and cultural rights, such as the rights to health, education and work and the right to enjoy the benefits of scientific progress, and the cross cutting rights of non discrimination and equality.” working group on discrimination against women and girls, women’s and girls’ sexual and reproductive health rights in crisis (u.n. doc. a/hrc/47/38) (28 apr. 2021), ¶ 18. [188] see iccpr, art. 6. [189] see icerd, art. 5(e)(iv). see also icescr art. 12; cedaw arts. 11(1)(f), 12, 14(2)(b); crpd art. 25; crc art. 24. see also cescr, general comment no. 22 (2016) on the right to sexual and reproductive health (u.n. doc. e/c.12/gc/22) (2 may 2016), ¶¶ 10 11, 13 14, 45, 49; crc committee, general comment no. 15 (2013) on the right of the child to the enjoyment of the highest attainable standard of health (u.n. doc. crc/c/gc/15) (17 apr. 2013), ¶ 56; report of the special rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, violence and its impact on the right to health (u.n. doc. a/hrc/50/28) (14 apr. 2022), ¶ 20 (describing how “states violate the right to health when they fail to take effective steps to prevent third parties from undermining the enjoyment of the right to sexual and reproductive health”). [190] hrc, general comment no. 36, art. 6 (right to life) (u.n. doc. ccpr/c/gc/36) (3 sept. 2019), ¶ 8. [191] id. [192] see cescr, general comment 22 (2016) on the right to sexual and reproductive health (u.n. doc. e/c.12/gc/22) (2 may 2016), ¶ 5 (“the freedoms [protected under the right to health] include the right to make free and responsible decisions and choices, free of violence, coercion and discrimination, regarding matters concerning one’s body and sexual and reproductive health[, and entitle all people to] full enjoyment of the right to sexual and reproductive health[.]”); cescr, general comment no. 14: the right to the highest attainable standard of health (art. 12) (u.n. doc. e/c.12/2000/4) (11 aug. 2000), ¶ 8 (“the freedoms [protected under the right to health] include the right to control one’s health and body, including sexual and reproductive freedom, and the right to be free from interference[.]”); crpd committee and cedaw committee, guaranteeing sexual and reproductive health and rights for all women, in particular women with disabilities (29 aug. 2018), https://www.ohchr.org/en/treaty bodies/crpd/statements declarations and observations (“access to safe and legal abortion, as well as related services and information are essential aspects of women’s reproductive health and a prerequisite for safeguarding their human rights to life, health, equality before the law and equal protection of the law, non discrimination, information, privacy, bodily integrity and freedom from torture and ill treatment.”); cedaw committee, l.c. v. peru (u.n. doc. cedaw/c/50/d/222009) (2011), ¶ 8.15, https://www2.ohchr.org/english/law/docs/cedaw c 50 d 22 2009_en.pdf (“[t]he committee considers that, owing to her condition as a pregnant woman, l.c. did not have access to an effective and accessible procedure allowing her to establish her entitlement to the medical services that her physical and mental condition required.”); cerd committee, concluding observations on the combined tenth to twelfth reports of the united states of america (u.n. doc. cerd/c/usa/co/10 12) (21 sept. 2022), ¶¶ 35 36. [193] see iccpr, art. 17; crc, art. 16. [194] the human rights committee has found violations of the right to privacy in every case it has considered when the state interfered with reproductive decision making or abortion access. see hrc, whelan v. ireland, ccpr/c/119/d/2425/2014 (“whelan v. ireland”), ¶ 7.8; hrc, mellet v. ireland, ccpr/c/116/d/2334/2013 (“mellet v. ireland”), ¶ 7.7 7.8; hrc, k.l. v. peru, ccpr/c/85/d/1153/2003 (“k.l. v. peru”), ¶ 6.4; hrc, v.d.a. (on behalf of l.m.r.) v. argentina, ccpr/c/101/d/1608/2007 (“v.d.a. v. argentina”), ¶ 9.3; hrc, general comment 28 (2000) on the equality of rights between men and women (u.n. doc. ccpr/c/21/rev.1/add.10) (29 mar. 2000), ¶ 20 (“states parties must provide information to enable the committee to assess the effect of any laws and practices that may interfere with women’s right to enjoy privacy” such as “where states impose a legal duty upon doctors and other health personnel to report cases of women who have undergone abortion. . . . states parties should report on any laws and public or private actions that interfere with the equal enjoyment by women of the rights under article 17, and on the measures taken to eliminate such interference and to afford women protection from any such interference.”). [195] see whelan v. ireland, ¶ 7.9; mellet v. ireland, ¶ 7.8; k.l. v. peru, ¶ 6.4. [196] memorandum from oklahoma attorney general to all oklahoma law enforcement agencies on guidance for oklahoma law enforcement following dobbs v. jackson women’s health org. (31 aug. 2022), https://www.ok.gov/cleet/documents/memo%20to%20law%20enforcement%20following%20dobbs%20(8.31.22).pdf. [197] iccpr, art. 19. [198] see, e.g., whelan v. ireland, ¶ 7.5 7.7; mellet v. ireland, ¶ 7.4 7.6; k.l. v. peru, ¶ 6.3; v.d.a. v. argentina, ¶ 9.2; cat committee, concluding observations on the sixth periodic report of the united kingdom of great britain and northern ireland (u.n. doc. cat/c/gbr/co/6) (7 june 2019), ¶¶ 46 47; cat committee, concluding observations of the committee against torture   paraguay (u.n. doc. cat/c/pry/co/4 6) (14 dec. 2011), ¶ 22; cat committee, concluding observations on the initial report of timor leste (u.n. doc. cat/c/tls/co/1) (29 nov. 2017), ¶ 34. [199] see cat, art. 16; iccpr, art. 7; crc, arts. 19, 37; crpd, art. 15. [200] see cat committee, concluding observations on the seventh periodic report of poland (u.n. doc. cat/c/pol/co/7) (29 aug. 2019), ¶ 33(d). [201] see hrc, report of the special rapporteur on torture and other cruel, inhuman or degrading treatment or punishment (u.n. doc. a/hrc/31/57) (5 jan. 2016), ¶ 44 (“the denial of safe abortions and subjecting women and girls to humiliating and judgmental attitudes in such contexts of extreme vulnerability and where timely health care is essential amount to torture or ill treatment.”). [202] cat committee, concluding observations on the third periodic report of the philippines (u.n. doc. cat/c/phl/co/3) (2 june 2016), ¶ 40(b) (urging the state to “[r]eview its legislation in order to allow for legal exceptions to the prohibition of abortions in specific circumstances such as when the pregnancy endangers the life or health of the woman, when it is the result of rape or incest and in cases of foetal impairment…”) (emphasis added). [203] see k.l. v. peru, ¶ 6.3; mellet v. ireland, ¶¶ 7.4 7.6; whelan v. ireland, ¶¶ 7.4 7.7. [204] v.d.a. v. argentina, ¶ 9.2. see also hrc, general comment no. 36, art. 6: right to life (u.n. doc. ccpr/c/gc/36) (3 sept. 2019), ¶ 8 (“states parties must provide safe, legal and effective access to abortion where the life and health of the pregnant woman or girl is at risk, or where carrying a pregnancy to term would cause the pregnant woman or girl substantial pain or suffering, most notably where the pregnancy is the result of rape or incest or where the pregnancy is not viable.”) (emphasis added). [205] cedaw committee, general recommendation no. 35 on gender based violence against women, updating general recommendation no. 19 (u.n. doc. cedaw/c/gc/35) (26 july 2017), ¶ 18. [206] see iccpr, art. 9. [207] hrc, report of the special rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health (u.n. doc. a/hrc/38/36) (10 apr. 2018), ¶ 75. [208] hrc, concluding observations on the seventh periodic report of el salvador (u.n. doc. ccpr/c/slv/co/7) (9 may 2018), ¶ 16. [209] see supra ¶¶ 22 23 on “fetal personhood” approaches. [210] see supra ¶ 22. [211] hrc, report of the working group on arbitrary detention on its visit to the united states of america (u.n. doc. a/hrc/36/37/add.2) (17 july 2017), ¶¶ 73 74 (detention on discriminatory grounds is defined as arbitrary). see hrc, rep. of the working grp. on arbitrary det., annex (u.n. doc. a/hrc/16/47) (19 jan. 2011), p. 23, ¶ 8(e). see also ohchr, “working group on arbitration detention: about arbitrary detention”, available at https://www.ohchr.org/en/about arbitrary detention (clarifying that the definition of arbitrary detention under the working group’s mandate includes “deprivation[s] of liberty [which] constitute[] a violation of the international law for reasons of discrimination based on…gender,…disability; or other status….”). [212] see iccpr, art. 18. [213] hrc, general comment no. 22: article 18 (freedom of thought, conscience or religion) (u.n. doc. ccpr/c/gc/22) (20 july 1993), ¶ 4. [214] hrc, report of the special rapporteur on freedom of religion or belief, heiner bielefeldt (u.n. doc. a/hrc/71/269/) (28 dec. 2016), ¶ 15. [215] the hrc is clear that the concept of “morals” derives from many social, philosophical and religious traditions; consequently, limitations on the freedom to manifest a religion or belief for the purpose of protecting morals must be based on principles not deriving exclusively from a single tradition. hrc, general comment no. 22: article 18 (freedom of thought, conscience or religion) (u.n. doc. ccpr/c/gc/22) (30 july 1993), ¶ 8. in its general comment on freedom of expression which contains a similar limitation clause, the hrc reiterated this and outlined that interpretation of morality should comply with the conception of human rights as ‘universal’, with particular emphasis on the standard of non discrimination. see also hrc, general comment no. 34: art. 19 (freedoms of opinion and expression) (u.n. doc. ccpr/c/gc/34) (12 sept. 2011), ¶ 32; hrc, general comment no. 37: article 21 (right of peaceful assembly) (u.n. doc.ccpr/c/gc/37) (17 sept. 2020), ¶ 46. [216] id. [217] id.; hrc, freedom of religion or belief: report of the special rapporteur on freedom of religion or belief (u.n. doc. a/hrc/40/58) (5 mar. 2019), ¶ 17. [218] see hrc, general comment no. 34: art. 19 (freedoms of opinion and expression) (u.n. doc. ccpr/c/gc/34) (12 sept. 2011), ¶ 25. [219] see supra section i(b). [220] see supra section i(b) on the human rights implications of criminal abortion laws in the us. [221] see supra note 219, ¶ 34 (outlining that the grounds for restriction “must be appropriate to achieve their protective function; they must be the least intrusive instrument amongst those which might achieve their protective function; they must be proportionate to the interest to be protected…the principle of proportionality has to be respected not only in the law that frames the restrictions but also by the administrative and judicial authorities in applying the law.”). [222] see iccpr, arts. 2 3, 26; icerd, arts. 2, 5; cedaw, art. 12. [223] see mellet v. ireland, ¶¶ 7.11, 3.19; whelan v. ireland, ¶ 7.12. [224] cedaw committee, general recommendation no. 24: article 12 of the convention (women and health) (u.n. doc. a/54/38/rev.1) (1999), ¶ 11 (“it is discriminatory for a state party to refuse to provide legally for the performance of certain reproductive health services for women.”). [225] cedaw committee, inquiry concerning the united kingdom of great britain and northern ireland under article 8 of the optional protocol to the convention on the elimination of all forms of discrimination against women (u.n. doc. cedaw/c/op.8/gbr/1) (6 mar. 2018), ¶ 74. [226] working group on the issue of discrimination against women in law and in practice, women’s autonomy, equality and reproductive health in international human rights: between recognition, backlash and regressive trends (oct. 2017), p. 2, https://www.ohchr.org/sites/default/files/documents/issues/women/wg/womensautonomyequalityreproductivehealth.pdf. [227] see supra ¶¶ 33 37. [228] see icerd, arts. 2, 5. see also cerd committee, concluding observations on the combined tenth to twelfth reports of the united states of america (u.n. doc. cerd/c/usa/co/10 12) (21 sept. 2022), ¶¶ 35 36. [229] cerd committee, concluding observations on the combined tenth to twelfth reports of the united states of america (u.n. doc. cerd/c/usa/co/10 12) (21 sept. 2022), ¶ 35. [230] id., ¶ 36. [231] mellet v. ireland, ¶ 7.11. [232] id. [233] working group on the issue of discrimination against women in law and in practice, women’s autonomy, equality and reproductive health in international human rights: between recognition, backlash and regressive trends (oct. 2017), p. 2, https://www.ohchr.org/sites/default/files/documents/issues/women/wg/womensautonomyequalityreproductivehealth.pdf. [234] id. [235] crc committee, general comment no. 20 on the implementation of the rights of the child during adolescence (u.n. doc. crc/c/gc/20) (6 dec. 2016), ¶ 60. [236] id., ¶¶ 60 61 (finding that adolescent girls should have access to information about sexual and reproductive health along with access to adequate health services). see also crc committee, general comment no.4: adolescent health and development in the context of the convention on the rights of the child (u.n. doc. crc/gc/2003/4) (1 july 2003), ¶ 13. [237] see office of the united nations high commissioner for human rights (ohchr), guiding principles on business and human rights: implementing the united nations “protect, respect and remedy” framework (hr/pub/11/04) (2011), ¶ 11 (noting that “the responsibility to respect human rights is a global standard of expected conduct for all business enterprises wherever they operate. it exists independently of states’ abilities and/or willingness to fulfil their own human rights obligations….the responsibility of business enterprises to respect human rights is distinct from issues of legal liability and enforcement, which remain defined largely by national law provisions in relevant jurisdictions.”). see also human rights watch, federal trade commission comment re: commercial surveillance anpr, r111004 (21 nov. 2022). [238] see supra section i(c). [239] see statement, ohchr, “bachelet on us ruling on dobbs v jackson women’s health organization” (24 june 2022), https://www.ohchr.org/en/statements/2022/06/bachelet us ruling dobbs v jackson womens health organization. [240] see press release, special procedures, “usa: un experts denounce supreme court decision to strike down roe v. wade, urge action to mitigate consequences” (24 june 2022), https://www.ohchr.org/en/press releases/2022/06/usa un experts denounce supreme court decision strike down roe v wade urge (statement signed by the working group on discrimination against women and girls; the special rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health; the special rapporteur on violence against women, its causes and consequences; and endorsed by the special rapporteur on freedom of religion or belief; the special rapporteur on the rights of persons with disabilities; the special rapporteur in the field of cultural rights; the special rapporteur on trafficking in persons, especially women and children; the special rapporteur on contemporary forms of racism, racial discrimination, xenophobia and related intolerance; and the special rapporteur on the right to privacy). see also center for reproductive rights, “protecting abortion access in europe   a call to action” (28 june 2022), https://reproductiverights.org/protecting abortion access in europe a call to action (“we are deeply concerned about the devastating consequences this regressive judgment will have for the lives, health and wellbeing of people across the united states.”); brief of the united nations mandate holders as amici curiae, dobbs v. jwho., 142 s. ct. 2228, pp. 31 33 (2022), https://www.supremecourt.gov/docketpdf/19/19 1392/193045/20210920163400578_19 1392%20bsac%20united%20nations%20mandate%20holders.pdf (“overturning or curtailing constitutional protections to abortion access established in roe and casey constitutes retrogression in violation of human rights law.…dismantling the u.s. framework that has protected abortion access for nearly 50 years will lead to further violations of women’s and girls’ human rights.”). [241] world health organization [who], abortion care guideline (8 mar. 2022), https://www.who.int/publications/i/item/9789240039483. human rights watch operates in over 100 countries, where we work to investigate and document human rights abuses, expose the truth and hold perpetrators to account. your generosity helps us continue to research abuses, report on our findings, and advocate for change, ensuring that human rights are protected for all. inadequate cervical cancer prevention and care for black women in the united states mississippi delta doula care for justice in maternal health in florida share this via facebook share this via x share this via whatsapp share this via email more sharing options share this via linkedin share this via reddit share this via telegram share this via printer share this via bluesky human rights watch defends the rights of people in close to 100 countries worldwide, spotlighting abuses and bringing perpetrators to justice get updates on human rights issues from around the globe. join our movement today. get the world’s top human rights news, every day. human rights watch is a 501(c)(3) nonprofit registered in the us under ein: 13 2875808

by phr consultant whitney arey, phd; phr staff members michele heisler, md, mpa, medical director; and payal shah, jd, director of research, legal, and advocacy; and phr intern danielle whisnant. in june 2022, the u.s. supreme court’s ruling in dobbs v. jackson women’s health organization overturned the federal constitutional right to abortion.[1] in july 2022, florida enacted a ban on abortion care after 15 weeks of gestation from the first day of a pregnant person’s last menstrual period, with only limited exceptions.[2] two years later, in april 2024 the florida supreme court followed suit and overturned decades of precedent that the florida constitution’s privacy clause protects the right to abortion. this judgment cleared the way for a new, far more restrictive six week abortion ban to take effect on may 1, 2024.[3] this ban shifted the legal limit for abortion from 15 weeks to six weeks from the first day of a pregnant person’s last menstrual period and included only very narrow exceptions that differed from those in the 15 week ban. the penalties for those who violate the ban are severe, including imprisonment, fines, and loss of medical licenses.[4] on the same day that the florida supreme court revoked state constitutional protection of abortion rights, however, it also allowed a proposed amendment that would enshrine abortion rights into florida’s constitution to be included on the state’s november 2024 ballot for voters’ consideration. florida’s extreme abortion ban has created an unworkable legal landscape that endangers both patients and clinicians. the ban violates individual reproductive freedom, leads to preventable suffering, and compels clinicians to deviate from established standards of care and medical ethics. these denials constitute violations of floridians’ fundamental rights, including their human rights to life, health, privacy, freedom from torture and cruelty, and equality. in july and august 2024, phr researchers conducted in depth, semi structured interviews with 25 reproductive health care clinicians and clinicians in training in florida about their experiences caring for pregnant patients under the six week ban. in these interviews, clinicians stated that while abortion clinics in the state continue to provide care where legally permitted, florida’s six week ban is creating insurmountable barriers to abortion care for many patients. clinicians described how the unworkability of the ban’s narrow exceptions and the severe chilling effect on abortion provision caused by the sweeping criminalization of abortion from a very early stage of pregnancy are endangering patients’ health and survival and impairing clinicians’ ability to comply with their ethical obligations and medical standards of care. clinicians shared multiple examples of cases of delays and denials of reproductive health care including abortion care and miscarriage management, disruption of the patient clinician relationship, deviations from standard medical care, impaired training of new clinicians, and an exodus of health care providers from the state, worsening florida’s already severe health care provider shortages. alarmingly, clinicians stated that patient care is being impeded by florida’s broad abortion ban even in cases of ectopic pregnancy, molar pregnancy, and preterm premature rupture of membranes, despite state health agency rules that state that these conditions should not be considered abortion.[5] clinicians interviewed described the devastating consequences of the abortion ban for their patients. many patients do not realize they are pregnant until after the legal limit   just two weeks after a missed period   and the required 24 hour waiting period between a first face to face appointment with an abortion provider and receiving an abortion further narrows the window for care. patients are referred to tertiary care centers and abortion providing facilities within the state as hospitals grapple with confusion about what the exceptions include and direct patients to seek more specialized clinicians’ authorization to avoid risk. ultimately, the law’s narrow exceptions do not cover many serious conditions, forcing patients to either travel out of state for medical care or continue pregnancies with severe health risks. as clinicians deliberated whether they could legally offer care, patients experiencing medical emergencies requiring pregnancy termination, miscarriages where they needed medical intervention, and even cancer faced delays and even denials of treatment due to the ban. this disruption in medical care disproportionately impacts low income and marginalized communities, who already face barriers to prenatal and maternal health care. additionally, the emotional and physical toll on these patients is profound, as they are often left with few possible options for care. the broader implications of florida’s abortion ban are alarming. clinicians’ testimonies highlight ways that florida’s ban is jeopardizing prenatal care and will likely further worsen the state’s already poor maternal health outcomes.[6] the ban also threatens the future of reproductive health care in florida, as medical training in essential procedures like dilations and curettages (d&c) and dilations and evacuations (d&e) after the first trimester is severely limited. this lack of training not only impacts abortion care but also the management of miscarriages and other pregnancy complications, posing a significant risk to patient safety. reflecting on these devastating impacts, clinicians called for the lifting of the six week ban. florida’s extreme abortion ban has created an unworkable legal landscape that endangers both patients and clinicians. the ban violates individual reproductive freedom, leads to preventable suffering, and compels clinicians to deviate from established standards of care and medical ethics. these denials constitute violations of floridians’ fundamental rights, including their human rights to life, health, privacy, freedom from torture and cruelty, and equality. this research brief underscores the urgent need to ensure the right to comprehensive reproductive health care in florida. the united states (u.s.) supreme court ruling on june 24, 2022, in dobbs v. jackson women’s health organization (dobbs) overturned the 50 year old precedent set by roe v. wade and eliminated the federal constitutional right to abortion.[7] two years after dobbs, in april 2024 the florida supreme court followed suit and overturned its own 1989 judgment and decades of precedent that the florida constitution’s privacy clause protects the right to abortion.[8] on may 1, 2024, florida’s six week ban took effect, shifting the legal limit for abortion from 15 weeks to six weeks from the first day of a pregnant person’s last menstrual period.[9] [10] the six week ban punishes any person who “willfully performs, or actively participates in, a termination of pregnancy” in violation of the law as a third degree felony with up to five years in prison, up to a us$5000 fine, loss of medical licenses, or all the above. unlike many other states, florida’s ban does not clearly exempt pregnant people themselves from criminal prosecution.[11] the six week ban in florida criminalizes the termination of pregnancy before many individuals are aware that they are pregnant   typically two weeks after a missed period in a standard four week menstrual cycle. the new florida ban provides limited exceptions in situations of medical necessity to save a pregnant person’s life; to “avert a serious risk of imminent substantial and irreversible physical impairment of a major bodily function…other than a psychological condition;” in cases of fatal fetal impairment where a pregnancy has not reached the third trimester; and in pregnancies resulting from rape, incest, or trafficking prior to 15 weeks only if the patient provides “a copy of a restraining order, police report, medical record, or other court order or documentation providing evidence” that they are obtaining the termination of pregnancy because they are a victim of rape, incest, or human trafficking. the six week ban replaces the previous 15 week ban that was instituted on july 1, 2022.[12] some of the new ban’s exceptions differ from those of the 15 week ban, exacerbating confusion about when abortion is legally permitted.[13] for example, the 15 week ban’s “fatal fetal abnormality” exception allowed abortion “before viability,” unlike the six week ban that states the limit is “before the third trimester.”[14] on the same day that the florida supreme court revoked state constitutional protection of abortion rights, in 2024, it also allowed a proposed amendment that would enshrine abortion rights into florida’s constitution to be included on the state’s november 2024 ballot for voters’ consideration.[15] the proposed florida amendment says, in part, that no “law shall prohibit, penalize, delay, or restrict abortion before viability or when necessary to protect the patient’s health, as determined by the patient’s health care provider.” it would need approval from 60 percent of voters to be enacted.[16] in addition, the day after the six week ban went into effect, the florida agency for health care administration (ahca) released emergency rules   stating that certain pregnancy terminations, including for premature preterm rupture of membranes (pprom), ectopic pregnancy, and trophoblastic tumors, should not be considered abortion for reporting purposes. these guidelines lack medical clarity, further confusing clinicians.[17] [18] compounding these laws and guidelines, targeted restrictions on abortion providers (trap) laws (procedural requirements on facilities and individuals who can provide abortion care), along with the 24 hour waiting periods between the two required in person abortion care appointments in florida, further complicate service delivery and lead to confusion on how providers can best care for their patients.[19] after the six week ban went into effect, phr undertook fact finding interviews from july to august 2024 with 25 clinicians and clinicians in training to document whether and, if so, how florida’s abortion ban is impacting patients, health care workers, and access to health care. we interviewed clinicians in obstetrics and gynecology, maternal fetal medicine, family medicine, reproductive endocrinology, certified nurse midwifery, medical students, and genetic counselors across the state, with representation in varied practice types that include public and private hospitals, academic medical centers, private practices, and free standing abortion providing facilities. in these interviews, clinicians described the serious and manifold harms the ban is causing pregnant people in the state who seek reproductive health care. the six week ban is unclear in its guidelines and introduces barriers to care, delays in emergency reproductive services, and deviations from standard medical care. moreover, the steep penalties, particularly when combined with other laws, create intensified fear and confusion among health care providers who do not know in what cases they legally can or cannot provide abortion care, creating strain in the patient clinician relationship and inducing providers and trainees to leave the state. clinicians report receiving warnings from hospital administrators, legislators, and others that they may be targeted for providing necessary abortions and that these laws are being strictly enforced. this has led to an overall chilling effect on the provision of reproductive health care and has hindered access to abortion care for pregnant people, many of whom have a medical necessity for the procedure.[20] thus, the six week ban has rendered the already complex legal landscape for abortion in florida even more unworkable in practice, with restrictions that endanger both clinicians and pregnant patients in the state. as of 2024, 20 percent of florida’s population   4.6 million women  are of reproductive age (between 15 and 44 years old).[21] health care costs and accessibility create significant barriers in access to health care generally for people of reproductive age in florida. florida’s health care system ranks among the worst in the u.s. in terms of accessibility and affordability, especially for women’s health, possibly driven by the lack of medicaid expansion.[22] [23] florida is currently experiencing extensive shortages of physicians, dentists, and mental health providers compared to the needs of the state’s population.[24] further, an estimated 13 of florida’s 67 counties are maternity care “deserts,” or counties without access to hospital or birth centers offering obstetric care or without obstetric care providers. another 11 counties have low or moderate access to maternity care. pregnant people in florida have long faced delays in accessing prenatal care.[25] in 2021, before the dobbs decision, fewer than two out of every three pregnant people received prenatal care within the first four months of pregnancy (64.7 percent).[26] florida is rated the second worst in the nation currently for the provision of prenatal care, which creates serious risks for pregnant people in the state, including already marginalized populations who face higher barriers to quality maternal health care.[27] for example, in florida, in 2020, black and hispanic women died from pregnancy related death at nearly four times and one and a half times the rate of non hispanic white women, respectively. [28] of concern, nearly one in five of these pregnancy related deaths in florida were attributed to systemic care issues, such as a lack of standardized policies, procedures and care coordination.[29] over the past decades until the recent bans, abortion care was available throughout florida. even under the 15 week ban, florida provided crucial access to abortion for floridians and others in the u.s. south who lived in states with more extreme laws.[30] prior to the dobbs decision in june 2022, abortion was legal in florida up to the third trimester, defined as starting 26 weeks after the last menstrual period.[31] a 24 hour waiting period for abortions went into effect in april 2022, followed shortly by the 15 week ban that went into effect in july 2022. as of march 2024, florida had 54 abortion clinics.[32] once the six week ban went into effect in may 2024, there have been significant decreases in abortions within the state in may and june compared to comparable periods last year in florida.[33] while abortion clinics in the state continue to provide crucial care within the legal limits, many floridians have been forced to travel outside the state for abortion care. the national abortion federation, which runs the largest patient assistance fund in the country to help people afford abortion care, reported a 575 percent increase in callers requesting funding in the two months since the ban went into effect in may, compared to the same time last year.[34] this has contributed to more than a 30 percent increase in wait times at abortion clinics across north carolina, virginia, maryland, and washington, dc. north carolina has seen the largest increase despite having a 72 hour waiting period, with wait times increasing in half of the state’s 16 clinics.[35] the long term impact on abortion clinics in florida remains uncertain, but in other states with severe abortion restrictions 66 clinics closed across 15 states, with 14 states losing all abortion providing facilities[36] within 100 days[37] of the dobbs decision. clinics in states with bans face significant challenges in maintaining[38] staff and financial viability, and even if abortion rights are restored, reversing closures can be difficult, creating lasting impacts on access to care.[39] the passage of the six week ban raises serious questions about the impact on florida’s existing challenges in the provision of health care and specifically care for pregnant patients. health care worker shortages, barriers to prenatal care, and barriers to abortion currently contribute to significant health harms in the state. against this backdrop, it is critical to understand reproductive health care clinicians’ experiences providing care to pregnant patients under the six week ban. in july and august 2024, the phr research team conducted outreach to reproductive health community based organizations and professional networks in florida. these contacts facilitated connections to reproductive health care providers (“clinicians”), medical students and genetic counselors who have provided reproductive or pregnancy health care in florida post dobbs. the research team then used snowball sampling, an established sampling strategy for research on hard to reach populations or sensitive topics, which has been used to conduct qualitative research in comparable studies.[40] clinicians consented to 30  to 60 minute, semi structured, in depth, confidential interviews. interview guides were developed based on the expertise of the research team and conversations with partner organizations. transcripts were de identified and cleaned by interviewers, and data was stored on a password protected server and only accessed by the research teams. study recruitment ended when we reached concept saturation, the point at which no new themes emerged from additional interviews.[41] thematic analysis was used to identify experiences across interviews. the two interviewers (wa and mh) read transcripts of the clinician interviews after a third of the interviews were completed; through a hybrid approach they identified key themes emerging from the data (inductive analysis) and based on the research questions (deductive analysis) to develop a codebook. one interviewer (wa) coded all the transcripts, adding more codes as they emerged from the data. illustrative quotes were selected based on key themes.[42] phr’s ethics review board (erb) approved the study with exempt status. see appendix 1 for characteristics of the 25 clinicians interviewed. abortion is currently legal in florida only until six weeks after a pregnant person’s last menstrual period (lmp) with limited exceptions.[43] as one obstetrician gynecologist said: “while it is limited, abortion is still legal. there has definitely been some confusion. it is still legal.” while health care facilities across the state continue to provide abortion care to pregnant patients within the laws’ narrow confines, as one clinician emphasized, the unworkable exceptions and extreme gestational limits mean many patients are barred from care: “it is virtually a total abortion ban. most people do not know that they are pregnant at six weeks. considering the 24 hour waiting period, it is virtually a complete ban. so, do not be fooled that this is a compromise. it is not.” (14) many clinicians noted that many of their patients did not realize that pregnancy is dated from the first day of their last menstrual period. the american college of obstetrics and gynecology (acog) measurement guidelines, for example, are based on the first day of the patient’s last menstrual period confirmed with an ultrasound measurement.[44] clinicians reported that since the six week ban, their patients who come in seeking an abortion right when they discover that they are pregnant are often distraught that they are considered further along in their pregnancy than they had assumed and are unable to receive an abortion within florida. a clinician at an abortion care facility described how often she faces this: “there is at least one person a week who is really angry and does not trust the ultrasound [results]. what is behind it is that they do not understand how the dating of pregnancy works, which is fair. it is just so confusing. and, the person is explaining to me, ‘there is no way i am six weeks pregnant. there is no way i am seven weeks pregnant, because this is when i had sex, and this is when i got pregnant.’ and i am like, ‘you are 100 percent right. i agree. that is when you got pregnant. but here is how the law and the medical world define the time of pregnancy. i am so sorry.’” (4) patients who have irregular periods may have no idea what they will measure on an ultrasound once they have discovered that they are pregnant. one obstetrician gynecologist told us: “the other day, we had a 14 week [patient] just because she does not menstruate. and she was like, ‘i have no idea. i do not know when my period was. i do not know when i conceived.’” (21) as many clinicians explained, many of their patients do not find out they are pregnant until after six weeks, at which point they no longer have the option to have an abortion in florida except in narrow circumstances.[45] an obstetrician gynecologist in private practice described: “with the six week ban, i would say it is more like the inability to really offer anything at all now. i mean, we see patients for their new obstetrician gynecologist visits usually around eight weeks, and sometimes we see them earlier, if they are having bleeding or other issues where we end up scanning them earlier. but i do not think i have ever had a viable pregnancy that was less than six weeks that i could offer a termination. they are never less than six weeks, so it is essentially impossible. by the time we see them for their first visit, that option is already gone.” (19) multiple clinicians explained that because of a shortage of obstetrician gynecologists in florida, people are rarely able to secure a prenatal appointment to confirm the results of a pregnancy test with a dating ultrasound before six weeks of gestation. in the words of another obstetrician gynecologist in private practice: “the patients that i see in the office for an initial prenatal visit are almost never less than six weeks. it is incredibly rare for somebody to be able to get in less than six weeks. i would say more often it is closer to twelve. and part of that is because of the demand, we do not have enough providers to see patients, and we are a very big practice… and then patients who are coming in for something else and then discover that they are pregnant, if they are lucky enough to be less than six weeks, just have so little time to consider their options and then hopefully get in with somebody who can provide abortion if that’s what they choose.” (17) another obstetrician gynecologist explained how impossible this timeline makes the option of abortion care for many of her patients: “most women do not know that they are pregnant that early. also [because of] the way that we label pregnancies as six weeks of pregnancy…. they have actually only been pregnant for four weeks, and most pregnancy tests do not turn positive for those first two weeks. so, they really only have two weeks. and that is total days, not business days. they have two weeks to figure out that they are pregnant, even have that on their radar. call and get an appointment, and then get a second appointment all within six weeks and zero days’ time, which is really hard.” (20) in florida, the first abortion appointment consists of an ultrasound to measure gestational age, where patients are read the state mandated consent information. patients then return at least 24 hours later for a medication (mifepristone and misoprostol) or procedural abortion (for example, d&c). clinicians noted that clinics have been penalized by ahca for performing abortions up to 15 weeks and six days rather than 15 weeks and zero days, under the 15 week abortion ban. while clinicians did not name a public document stating this policy, these accounts of aggressive enforcement have led facilities to err on the side of caution, and assume the same is true for the six week ban  that to be legally eligible for abortion care under the six week ban, the first appointment must occur no later than five weeks and six days after the beginning of a patient’s last menstrual period ifthey can schedule the abortion for the next day. however, most abortion providing facilities are not open or do not provide abortion procedures every day of the week. as a clinician who provides abortion care described: “[in florida] abortion clinics are not open seven days a week. [one clinic is] open on tuesday, wednesday, and thursday. so, if you are seen on thursday and you are five weeks and four days   we cannot provide for your care. and, like, maybe a [city] an hour and a half away, is booked up, and they do not have appointments for you. and so, a six week ban is not a six week ban, depending on what day you are getting seen. …if you are not open for four days, it is not a six week ban, it is a five [week] and four [day] ban.” (4) several obstetrician gynecologists described how harmful the impact is on their patients who must travel to facilities hours away to receive their abortion before the six week deadline: “i have definitely seen patients who i do the consent, and then the next day they drive [to another city across the state] for their appointment for their abortion. …i have talked with many patients who are confused about why they are being asked to drive across the state on a day’s notice and have to drop everything they are doing, leave work, find childcare, pay for gas, and all these things. and i have to explain to them   this is not a rule that we implemented. this is based on state law, and we are just trying to help as much as we can.” (14) florida’s six week ban only permits abortion for “fatal fetal abnormalities” where termination is sought before the third trimester. the law states that “a fatal fetal anomaly” is one that is “a terminal condition that, in reasonable medical judgment, regardless of the provision of life saving medical treatment, is incompatible with life outside the womb and will result in death upon birth or imminently thereafter.”[46] clinicians shared that patients faced delays and denials of abortion due to confusion about which fetal anomalies could be terminated legally, including severe anomalies that would lead to death in weeks or months   not just hours   from birth.” clinicians described their experiences caring for patients with severe but not clearly fatal fetal anomalies during pregnancy that cannot be detected on early ultrasound imaging. one certified genetic counselor said: “when i started practicing, the legal limit to have an abortion was 23 weeks and six days. so, for the majority of our patients at that time, we were able to get them the care. some patients who were late to care or things were found later on ultrasounds, we helped them go out of state, but that was few and far in between. so, then when the 15 week abortion ban came into place, obviously that made things a lot harder, but we were still able to get in, not necessarily the ultrasound findings, because those are just very hard to see anything super well under 15 weeks, but the very severe ones, we would still be able to get them in. and then we really pushed for, in our practice, [getting people in] for chromosomal screening right at the 10 week mark when they can do it or as early as possible. so, when the results are back that we would be able to do diagnostic procedures at 12 weeks and then we can get those results back before the legal timing limit to get abortions. but it was hard because there was no time to spare, essentially. like things had to get in very quickly. …but anything past that, any anomalies had to go out of state.” (22) clinicians repeatedly shared how florida’s narrow exceptions to the overall criminalization of abortion has led to widespread fear that has hindered access to care and harmed patients. clinicians at tertiary care centers reported receiving increased referrals from clinicians afraid to care for complicated pregnant patients under the current laws. one obstetrician gynecologist told us: “i have seen a surge in patients coming to me that i was not seeing before that were being handled by the community and getting care elsewhere. patients [are] coming desperate, [saying] ‘they would not sign off on this. i do not know what to do. they just said, go to [tertiary care hospital].’ so, i get a lot of phone calls from my residents about patients in the er, [telling me], ‘they are 18 weeks, and they have bilateral renal agenesis [lack of both kidneys which is usually fatal] in the fetus …and they are like, ‘i want an abortion.’” (11) one maternal fetal medicine (mfm) specialist explained one basis for this fear: “the state has come down very hard on a couple abortion centers that [the state argued had] deviated on the cutoffs as the law changed from 15 weeks to 6 weeks. and so, the fear is that the state is actually looking for a scapegoat to go after.” (13) this mfm also noted referrals from providers afraid that they would not fill out correctly the extensive and confusing required paperwork by the state for legally allowable abortions and would thus be prosecuted: “we are seeing tons of referrals that would not have been made before [the abortion ban]. i even see doctors that are two blocks away from me going, i am too intimidated by all the state paperwork. i know exactly that this fits the criteria, but i just do not know how to fill it out, how to date it, how to sign it. there are all these rules. we are just sending the patient to you so you can do the paperwork.” (13) several clinicians described how fear and lack of clarity about the narrow medical exceptions are leading to patients being sent out of state for abortions even in situations where abortion care could be considered to be legal. one obstetrician gynecologist hospitalist stated: “i would say 99 percent of mfms in our state are not entirely aware of the laws or they are scared of the laws. so instead of calling a clinician who does abortions [in florida] and asking them, ‘would this qualify for an exemption?’ they just automatically refer the patient out of state. because they do not want to be on record saying that they think this is a lethal anomaly or that they think that this is going to endanger maternal life…. and so, they just say, ‘go to north carolina or virginia or whatever it is. …since the six week [ban] went in place, literally zero clinician sign off has occurred [at my hospital], because i think people are just being directed elsewhere. [it is] just an even more unnecessary burden on the patient. like, it is bad enough she is going through this bad outcome that she did not sign up for, now you are making her travel out of state when she really does not have to. there is a multitude of doctors in florida who remain who are capable of doing [abortions]. but people are just scared.” (21) multiple clinicians recounted how the abortion ban vaguely defined narrow exceptions had led to difficulties in securing approval for medically necessary abortion care from their health care facilities. several clinicians described cases of being required by their hospitals to wait until patients become “sick enough” to qualify for care. one obstetrician gynecologist told us about an incident which occurred under the 15 week ban: “i strongly remember a patient who had severe kidney disease and was admitted to the hospital and was teetering on the edge of that 15 weeks. i think she was 14 weeks or so, and she got admitted, and we were trying to figure out how best to help her. she was getting sicker and sicker…. [we] had to bring it to the head people of the hospital and be like, ‘what are we allowed to do?’ and they were like, ‘she is not sick enough yet.’ and we had to wait for her to get sicker before we were even allowed to offer her termination. and she was past 15 weeks at that point. …i think it took over two weeks for us to get an answer from the hospital administrators. …so that hit very strongly, because it was kind of insane that we had to wait for her to become sicker. we had to wait for her creatinine to bump and her kidneys to be about to fail before we were allowed to even offer her [termination]. then we had to jump through so many hoops to be able to do it. it really changed everything that we did in our practice.” (19) another obstetrician gynecologist recounted another case of delay in care for a patient facing a potentially fatal pregnancy complication: “[there] was a patient who was like 20 to 21 weeks and developed severe hemolysis, elevated liver enzymes and low platelets [hellp], a life threatening liver and blood clotting disorder of pregnancy whose definitive treatment requires removal of the fetus and placenta …she also had covid 19 and she was very isolated and her care got significantly delayed because we had to get approval to terminate her pregnancy in the hospital and she got pretty sick.” (18) another obstetrician gynecologist described the impacts on pregnant patients of long delays in securing hospital approval for medically necessary abortions: “there were times where we had to wait weeks before we had answers. and then that is just pushing the pregnancy further and further along for a sick patient or someone who is already struggling with those choices that they were having to make.” (19) while the six week ban allows terminations where there is a serious risk of substantial and irreversible physical impairment of a major bodily function of the pregnant person, clinicians described delays in the provision of abortion due to confusion about what constitutes a “serious” risk as well as the need for approval by hospital administrations. one obstetrician gynecologist shared the account of a patient with a cardiac issue who had an increased risk of death postpartum: “after [my patient’s] fifth pregnancy, she had a spontaneous coronary artery dissection. almost died … and she is pregnant again…. i had to present her case, and she was, i think, 18 weeks pregnant…. there is no question her life would be at risk carrying this pregnancy and it is happening again, most likely postpartum. well, then, is the pregnancy really putting her at risk? and, you know, i had to sit before five or six or seven hospital administrators and make an argument for this woman. and the data i could pull was that there probably was up to about a 10 percent chance of this happening again, but it is a 10 percent chance of dying because if she had another spontaneous coronary dissection, she’s dead. and i had to hear these people say, ‘well, is 10 percent a lot? is that enough?’ i said, ‘are you kidding me? i guarantee if you ask her five children is 10 percent a lot, a big chance of losing your mom? does that sound like a lot? they would say yes.’ but it is this back and forth, and it is just this kind of chaos. but who makes these decisions? it just leaves you in a stalemate sometimes. … i eventually got to a point where my hospital said, okay, yes, we can do this. it took me two to three weeks to get to that point. and you obviously know [that delay] matters. you are 15 weeks, 16, 17, or 18. the procedure changes a little bit, and the risk changes a little bit.” (11) following the six week ban going into effect, ahca, a state agency, issued a rule stating procedures to treat pprom, ectopic pregnancy, and trophoblastic tumors would not be considered abortions for state reporting purposes. despite this, several obstetrician gynecologists reported that their patients are afraid that they will not be able to receive care for these conditions, which makes it incredibly “challenging,” as one clinician worded it, to provide care. in the words of one: “[for] molar pregnancies, ectopic pregnancies, even though the state has said in their ahca emergency rule that those are not, “abortion care,” there is still so much confusion and fear on the part of our patients that they are not going to be able to get care or that they will get in trouble.” (1) indeed, these fears are not unfounded. one obstetrician gynecologist told us that her hospital still required them to have a two doctor signoff for pprom to protect them in case the state decided to prosecute, even though pprom should not count as abortion provision under the ahca emergency rule: “we did get guidance after the six week law was passed…. so now we are able to discuss with patients what we call active management if their water is broken at a pprom. so, we are lucky compared to other states in that regard. but still, it is so intrusive. okay, here you are. tragic your water is broken. we are worried about these things. you do not want to stay pregnant. let us roll in with a brochure of state paperwork. let us start filling it all out together, because even though you know what you want, we have to do all this paperwork. and the law is not that clear. so, we still do two signatures. like there is still a delay that occurs with all of this that seems unnecessary in a situation where delay potentially could increase the chance of infection.” (13) clinicians at small rural hospitals and at religious affiliated hospitals described how their hospitals were recommending that patients with pprom to be transferred to larger, academic hospitals or tertiary care. these delays in care could result in additional health complications for patients, and this chilling effect extends to broader pregnancy care. one obstetrician gynecologist described a case of a patient who developed complications due to delays in referring her to another hospital for termination that the obstetrician gynecologist would have provided before the abortion ban: “we had a patient who had pprom, she was like 18 weeks and she desired termination. basically, what we have to do is send a referral to our mfm, who then can refer her to [academic hospital] for care, and in that process [the patient] got infected, got chorioamnionitis and became septic and ended up needing admission and iv antibiotics at the academic hospital. so, yeah, just not being able to just admit that patient that day and proceed with an induction was unfortunate for her.” (18) and, as another obstetrician gynecologist at a rural hospital recounted, options in florida for transfers requiring abortion procedures are increasingly limited: “i have thought about that   where do i send people? so, i know if i get somebody in who wants a d&e who is pprom, i have to send them to that one hospital because i do not think any of the other ones would do the procedure.” (5) we also heard similar accounts about ectopic pregnancy care. one obstetrician gynecologist told us care was still being delayed in their er for ectopic pregnancies, as er clinicians were afraid to provide methotrexate to patients as it was an “abortive agent”: “i was on call and we were trying to give methotrexate and were getting pushback from one of the emergency room providers. it was mostly from nursing, but i guess the physician assistant [pa] was the one that was mediating this between us. but we had a patient who had an evacuation already and was still having rising human chorionic gonadotropin [hcgs], a hormone indicating pregnancy and to everybody in the obstetric world, that is an ectopic unless proven otherwise. and she had come in specifically to get methotrexate. like she had been sent in from [abortion providing facility] to get methotrexate from our team. and so, we ordered it, and we had to have this back and forth. we were epic chatting [texting within the medical record], having this kind of disagreement back and forth. i actually printed out the ahca code and [a resident] brought it down and there was still a lot of back and forth. it ended up being one of our labor and delivery nurses just went down and gave the medication. it is like a very big conversation on a bunch of email threads now because of this. and we had [another] recent case, [a] similar situation where they were refusing to give it because they were concerned about the legality of giving it as an   they kept calling it an abortive agent.” (25) clinicians noted that the florida law’s exception for fatal fetal anomalies does not cover many serious conditions. the state has defined “fatal fetal abnormalities” as “a terminal condition” that is “incompatible with life outside the womb and will result in death upon birth or imminently thereafter.”[47] as one mfm specialist explained: “so, the actual term is “imminently lethal,” which is not a medical term…. so, a patient comes in or has a condition that is genetic, and let us say 100 percent of the time, the baby is going to die of a debilitating neurologic condition by age three or by three months of age even, they cannot terminate in the state of florida. and so, that is an interesting conversation to have with people because many people … have no idea that their rights have been stripped away. and so, i end up having conversations where people get really angry with me because they cannot terminate.” (13) a genetic counselor told us that their hospital had decided in consultation with the lawyers that “imminently lethal” meant “lethal, essentially, within the first day of life.” (22) another genetic counselor recounted the case of a patient whose fetal diagnosis was not considered “imminently lethal”: “a patient had two children who had a very rare genetic condition. they passed away four months of age. …the patient came to me in her third pregnancy, had already had diagnostic testing done, and just to talk a little bit about coordinating out of state abortion. all the providers who have seen her … nobody felt comfortable saying that this is lethal immediately post delivery. right, because is four months immediately post delivery? and i think it is things like that where you are sitting there and you are like, what defines, you know, severity? and this is for, you know, a mother who lost two children who did not want to go through that suffering again or see them go through that again in her words, we could not give a time limit [for lethal].” (12) multiple clinicians described conditions in the gray area of the law that might be quite severe, but did not meet the criteria for being lethal immediately upon delivery. these patients who do not meet this narrow criterion for exceptions are forced to travel out of state or continue the pregnancy. as one obstetrician gynecologist said: “there is no amount of legal wording that can account for and pay respect to the complexities of medical care that can arise. …and so, what i have seen with these families [who] are in this area of gray is that they end up needing to travel out of state for abortion care because these exceptions are very narrow. and if they happen to be unlucky enough that their baby has a condition that does not necessarily meet this narrow exception, their health care team is going to be reluctant to care for them because they do not want to be prosecuted for not following the law. and so, in many instances, i have had patients travel out of state.” (2) due to the concentration of abortion bans in the southern u.s., patients in florida have limited options for facility based care. the closest states with higher gestational limits are north carolina, which currently limits abortion provision to 12 weeks with exceptions for life limiting fetal anomalies up to 24 weeks, and virginia, which allows abortion until viability.[48] for many patients, traveling to another state is impossible. out of state travel requires that people have significant resources such as financial means, travel experience, childcare for their other children, and time off from work. a clinician at an abortion care facility said: “there are patients who come in at six weeks, zero days to sign their consent, and 24 hours later, they would be six weeks, one day. they come in with a stroller with two babies: ‘i cannot go to north carolina. i am a single mom. i do not have any [paid time off]. what do you want me to do here?’ and, i mean, what i am asking of them is, ‘hey, can you travel 300 miles for a five minute procedure or 800 miles for a five minute procedure?’ it is insane.” (3) another obstetrician gynecologist who provided reproductive health care to incarcerated patients pointed out that they now have no options for abortion care, as the prisons will not send incarcerated pregnant people out of state for abortion care: “my patients who were in the jail, they will take them to the clinic down the street, but they are not taking them out of state.” (5) clinicians described patients for whom english is a second language or who have recently immigrated to the u.s. as being among those most affected, as they were often less familiar with navigating the u.s. health care system. a clinician described the difficulties of non english speaking patients with fetal anomalies trying to navigate the american medical system to make health care appointments in another state. “i just had a case this past week of a very nice couple. they did not speak english. the baby had a severe, debilitating abnormality that was not lethal. … a very large spinal bifida defect. they did not have it in them to stay pregnant. and absolutely, they were going to travel out of state to get care. i went through the long discussion with the translator about everything and about the options and pulled up a couple of out of state places. and at this point, i am 45 minutes behind in my schedule… [and the patient asks,] ‘can you call the doctors at the top three centers and tell them about me? and can you set up those appointments for me?’ and i felt so bad. i said, ‘no, actually, i cannot do that. that is something you have to do for yourself.’…. [afterwards] it haunted me. i left her with a really daunting task.” (13) being forced to travel out of state or continue pregnancies can result in compounding harms. a genetic counselor described the emotional impacts on patients who must travel out of state for pregnancies with life limiting fetal diagnoses, where people reported post traumatic stress disorder (ptsd) and grief that was compounded by the stress of needing to leave the state to receive abortion care. “i had some patients who … had to travel out of state for medically indicated terminations. [it] was a really traumatizing experience. [thinking of one patient seen last week], …. to have to travel out of state and have to do everything with doctors that she did not know in a state and in a health care system she did not know. it was really hard for her. she got good care. but it is a really sad thing to have these patients you have established relationships with have to leave and be off work and hopefully have somebody with them also supporting them and spend all that money. it is just that they report ptsd and, of course, grief. but i think that the grief is a lot more complicated than it could have been.” (17) multiple clinicians interviewed recounted the stories of patients unable to travel out of state for care who were forced to continue their pregnancies, even if they faced precarious social, financial, or health situations. a mfm specialist recalled one recent patient: “i had a patient who was spanish speaking, who had a trisomy 18 week pregnancy with a heart defect. now, 30 percent of those babies will die prior to labor, 30 percent will die in labor, and the majority that are born will die in the subsequent hours to days to weeks after birth, with a small minority able to survive beyond a year. so, we made this diagnosis at about 18 weeks gestation, but these babies can live for hours or days. and so, i knew that just sending this case for review based on state laws was unlikely to be approved because there is so much fear. so, i sent the patient to the pediatric cardiologist. they said, it is a heart defect, and the baby has trisomy 18, but i cannot say that it is a lethal heart defect. i was the one that had the relationship with the patient, so i had to crawl back to her with a translator and tell her that we could not take care of her within our hospital system. so that left her with the only option of going out of state. and that is when she started to cry. and she told me that she is the only caregiver of her mother with severe alzheimer’s. she had two small children …it would take [two to three days] to travel out of state to get the care and to terminate. but she was like, ‘there is no one that my mother will allow in her dementia to care for her. i am stuck in this state, so i am stuck staying pregnant.’ and she did. and two months later, the baby died in utero. and you can think of all the hurt there was for her in carrying a pregnancy for eight weeks for no reason other than state laws intimidating and altering patient care.” (13) a genetic counselor said about patients whose fetuses have severe anomalies and who continue their pregnancies because they did not meet narrow criteria for lethal fetal anomalies and could not travel: “i am seeing patients continuing because they must. because they do not have the finances or sometimes not even finances. a patient last week could not get childcare. she is a single mom [who] cannot travel out of state for a couple of days, even though financially, we can with some of the funds and things like that make that happen. somebody has to take care of her kids, and she does not have that. … i feel like my job has become panic coordinator for people as opposed to, truly, we are aligning values, we are making decisions. i feel like there is this sense of panic.” (12) clinicians spoke to how the ban led to violations of patient autonomy, violations of pregnant people’s freedom to make decisions about their bodies, that themselves constituted deviations from the standard of care and ethical treatment of patients: “the standard of care is that patients have bodily autonomy, and that is one of the main ethical pillars of medicine. and when you take that away, it absolutely impacts the standard of care.” (24) for example, another obstetrician gynecologist told us about delays in abortion care for a patient with terminal cancer: “she had recurrent metastatic pancreatic cancer. she beat it two times, and this was her third recurrence, and it was stage four, terminal. and because she had been on and off chemotherapy and radiation for the better part of five years, because of her recurrences, her periods had been irregular for ages…. and she has always wanted to be pregnant, but never could because of her treatments. and it was on a routine pet scan that she found out she was pregnant, unimaginable. and she was over 20 weeks, like 21 weeks. [she] had no clue because of all of the reasons i just said. her oncologist said, ‘we have to stop treatment unless you have an abortion, essentially because this poses a risk to the pregnancy.’ she came to us for an abortion after the six week ban at around 21 weeks pregnant, and given the oncologist saying, we have to withhold treatment, i was like, certainly that is a health exception. and it took so, so much legal back and forth to ensure that we had all this really specific documentation from her oncologist…. [and then i realized she needed hospital based abortion care due to her medical risks which took time to find.] i ultimately found one about an hour flight away, probably about a four hour drive away, who was willing to do it. and then we had to go through all of the legal hoop jumping for that hospital [all over again]. and then we had to tell the patient, you have to drive 4 hours for this care while you are literally dying of cancer. she ultimately got [the abortion], and, like, thank god that we were able to set it up. … in the middle of all that, you want to grab these supreme court judges and bring them in the room and say, look what you are doing to people. let this woman be able to receive palliative chemotherapy, which is the least we can do for her, for christ’s sake. what we put her through was so cruel and unnecessary. it took over a week for her to be able to get the procedure.” (3) some clinicians discussed how florida’s current abortion ban pushed them to provide abortion care earlier, when they otherwise would have strongly recommended that patients wait for more information about the pregnancy. a gestational sac is not visible at all on ultrasound until approximately 4.5 to 5 weeks of pregnancy,[49] so even in cases where a possible abnormality may be observed that early, clinicians have a limited amount of time to try to determine severity before the patients will be ineligible for abortion care. a clinician working at an abortion care facility gave an example of this deviation from standard of care for the treatment of possible or partial molar pregnancies, which require more time to diagnose than allowed by the six week ban[50]: “it is happening a lot around possible molar pregnancies where it is just a weird looking ultrasound, and in an ideal world, it would be like, all right, let us get some blood work. i am not 100 percent sure this is a molar pregnancy. let us have you come back in a week and just see what is going on. and you cannot [with a six week ban]. it pushes you to do, like, substandard medical care.” (4) rather than being able to wait and confirm the molar pregnancy before deciding on treatment, clinicians need to treat patients early, before being able to confirm this on an ultrasound.[51] additionally, clinicians noted that the law limited treatment of patients who have a medication abortion failure and needed a second round of treatment but are now past the six week limit. patients might then be forced to continue the pregnancy, and continuing a pregnancy after exposure to misoprostol has a small increased risk of fetal malformations.[52] a clinician at an abortion facility described the problem: “the other thing that worries me is if a patient who comes in and they are going to do a [medication] abortion, say, at five weeks and four days, okay, if they are one of the two percent of failure, and now they come in [for a follow up appointment] and they are six weeks and three days, what do we tell them? sorry, it is now illegal. that is a terrible conversation to have with somebody.” (9) several clinicians described patients experiencing miscarriages being turned away from emergency departments and then facing additional barriers to care due to fear of legal risks.[53] one obstetrician gynecologist described how florida’s abortion ban has caused a chilling effect, where staff in the emergency department (ed) are frightened and unsure about what care they can provide under state law. “we had a patient who must have been 13 to 14 weeks, quite small still, who came in with concern about having a miscarriage. and we had seen her down in the ed, and we could tell that she was dilated, and her water had broken…. at that time, we had not yet confirmed if there was still a heartbeat in the fetus. when i reexamined her, [she was beginning to deliver] …., and she is not bleeding out or anything, but she is crying. she and her partner are very upset. they know that this baby is not going to survive, whether it has a heartbeat or not, and that this is going to end in a miscarriage. and she is looking at me and telling me, ‘i cannot mentally handle this anymore. i know, we all know, what is going to happen. just pull it out. i want to be done.’ and the ed nurse put her hand on my arm and was like, ‘i do not think you can do that.’ and it was just so heartbreaking to have to look at a patient and say, ‘i can see how much pain you are in right now. we know from the medical perspective that this is not a pregnancy that is going to survive into anything, and that we should just take it out. but because of everything that is happening legally right now, i do not know if i can. i need to get some more information, some more help.’” (16) another obstetrician gynecologist told us about being referred cases from nearby emergency rooms (er): “we have gotten received a couple of [miscarriages] where an er would not treat them for whatever reason, and the patient does not totally understand. [the er] just kind of insisted well, just let your body take care of it. patients are in pain, they are bleeding, they are out of work, waiting to get an appointment at [an abortion clinic], and then we have to bother them with, ‘wait, what medical records do you have?’ because we must legally make sure, can we clearly defend that this is a miscarriage? while the patient is standing there, frustrated and it has been a week, and they are bleeding and not working or trying to take care of their kids.” (20) outpatient obstetrician gynecologists described multiple cases where a patient was clearly having a miscarriage, but care was delayed to ensure exact diagnostic criteria for miscarriage were met so that providers were protected from prosecution. one obstetrician gynecologist told us: “what i am seeing is just by nature of our ban and by nature of being in an outpatient setting is someone with an obvious first trimester miscarriage, but who does not quite meet diagnostic criteria for a miscarriage. meaning, the sac must measure yay big without a yolk sac, or there must be a fetal pole that is yay big without cardiac activity. and that is how you define miscarriage strictly. but there are patients in this gray area where you come in with a big sac, and it is clearly deformed because this patient has been bleeding, but it does not yet meet those exact criteria. but the patient is bleeding and cramping and in pain and wants it out. and there is obviously a risk if this has been going on for several weeks of sepsis   it is clearly not a viable pregnancy, but it does not yet meet those exact measurement criteria…. i am always like, i could document the heck out of this, but is it enough? …i could have her come back in a couple days, show that the sac is not growing to prove that it is a miscarriage. but in that time, she is miserable, she is bleeding, she is cramping, she could, god forbid, get infected. it makes no medical sense to delay care. but legally, it is really vague. really, really vague.” (3) many clinicians discussed the importance of recognizing that miscarriage treatment and abortions both may require the same medical procedures. one obstetrician gynecologist noted that both abortion and miscarriage care are part of the full spectrum of reproductive health care that people need access to: “abortion care is miscarriage care. they go together and you cannot really provide one without the other. and obviously, women who have a miscarriage, that is like one of the worst times in their entire lives. and now we are making that even harder. so, women really need to have their own autonomy and be able to make decisions [in consultation with their doctors].” (18) many clinicians described the frustration, distress, and anger their patients are experiencing. one obstetrician gynecologist said of the six week ban, “i have had a few patients, it is very few, which is surprising to me, who are just angry at me because they need to be angry at somebody. and i just take it because i know that they are angry and i am angry, too.” (7) another obstetrician gynecologist said, “there is a lot of crying and there is a lot of you know, the amount of people that tell me that ‘i almost died last time [i was pregnant], what am i supposed to do now?’ is just alarming.” (21) clinicians discussed how hard it was to communicate to patients that they will have to travel out of state for their abortion care: “as a doctor, you watch these patients process all of this, like, in real time, and they are all kinds of frustrated. they are confused. a couple of them ended up at some legalized harassment clinic [anti abortion centers that try to dissuade pregnant people from having abortions] that they thought was going to provide them abortion services, and it did not and wasted their time. and they need help, and financially, they need help. just the whole idea of transportation, a lot of them already have kids. how do they make this work? it is really urgent. and they are really vocally very frustrated.” (20) one clinician at an abortion providing facility described a clinic visit after the current abortion ban with a pregnant patient from vietnam: “i was trying to explain to her that she was like, eight weeks or something like that. and she pleaded with me, and she started to cry, and i said, ‘i cannot do anything. it is illegal.’ and she said, ‘just sell me the medication under the table.’ and i am like, ‘i cannot do that.’ and then she fainted in my office, and we had to revive her, and i felt really bad, and she kept [saying] ‘please, i cannot have this baby. please help me. please help me.’ you know, what do you do? you just have to be as understanding and supportive as possible. but i am not going to violate the law.” (9) several clinicians described the reactions of pregnant patients who did not know about the abortion ban until they requested an abortion at a clinic visit with them: “when you have to tell them that it is not available to them in their state, their frustration turns on us. like, we had a patient [say], ‘i cannot believe that. like, you are telling me that i cannot get [an abortion]?’ and we were like, ‘you should go out and vote in november, because, we did not make this decision, and we agree with you. you should be allowed [to have an abortion].’ so, i have definitely had the animosity of patients who maybe either knew about the laws, but it did not affect them or who did not even know that these laws were being put in place until it affected them and being really frustrated by it.” (19) multiple clinicians in hospitals that required them to complete the 24 hour consent paperwork with patients who were experiencing medical emergencies or fatal fetal diagnoses described how distressful this was for their patients and them. one clinician explained that her hospital required this as an extra precaution to make sure they were complying with state law and told us: “[the state mandated 24 hour consent] form is really painful to go through with patients… it basically says, i have been given the opportunity to view a live ultrasound image of my baby, and they have shown me specifically the heartbeat. or like, i have been given materials and gone over materials for adoption or, you know, like, quote unquote, alternatives to proceeding through with the pregnancy. and it is a difficult conversation, especially instances where, like, the parent may not actually want to go through with having a termination of pregnancy but medically, it is in their best interest. like, we got a transfer from an outside hospital one time for this lady who had presented to that outside hospital for a heart failure exacerbation. she was very sick from her heart failure and found out in that admission in the ed there that she was pregnant with twins at like, 16 weeks. …. she has an extremely high chance of dying just from the pregnancy. and even at this conservative, religious outside hospital that she was at, the mfm there told her that she needs to go somewhere that will help her end her pregnancy. so, they transfer her to us, of course…. and she understood. she was very much on board with, like, ‘i want to be pregnant, but i also want to be there for my five other children and my partner.’ and it is hard to just have that conversation with a patient, let alone after that conversation be like, now, here is this form where we are going to talk about all these things that are going to make you feel bad about making the right decision for yourself and your family right now.” (16) clinicians stated that the ban violated their overall medical ethics and that they experienced moral distress by not being able to provide the full range of reproductive health care options for patients. one clinician told us: “basically, what we are being asked to do with these bans is throw out everything we have learned, our judgment, our clinical decision making, patient centered care, advocacy, equitable health care, autonomy, and beneficence. we are basically being asked to throw every tenet of medicine out the window, and for me, abortion care is health care. it is the highest level of compassion and care and love that you can give to someone. …i am being told i cannot be a doctor, and if i want to be a doctor, i will go to prison for five years. it just puts patients in horrible situations that you would not wish upon your worst enemy. and that you definitely would never, ever want to go through yourself or have someone that you loved or cared about go through.” (11) another obstetrician gynecologist said: “i can provide [abortion care] up to essentially 24 weeks. i have the skills to do that. it feels, again, dumb. like, so stupid that i have to go into six weeks, one day patient and be like, yeah, i cannot do anything. we have to help you get out of state…. especially when, you know, there is no medical reason for it. there is no other field of medicine where people are like, oh, sorry, i cannot do your colonoscopy or whatever, because i just cannot. and that is tough on all [the doctors at her facility]. i think everyone has the skills. we cannot use them. we have the knowledge; we know it is safe. and so, you are turning people away for no real reason except to avoid going to jail, which is crazy.” (23) an obstetrician gynecologist described succinctly the conflicts she and other reproductive health care providers face between adhering both with florida’s laws and her medical ethical obligations to her patients: “i tend to err on the side of, if i do not comply with the law, then i cannot help the next patient that needs this help. but it is a hard situation to be in just trying to do what is legal but also do what is right. it is not always the same thing.” (24) clinicians involved with medical student and resident training described how the inability to provide training in abortion care is detrimental to the future of maternal health care in the state. several obstetrician gynecologists told us stories about how the lack of comprehensive abortion training impacts the provision of broader reproductive health care and noted that this problem pre dates the dobbs decision. one obstetrician gynecologist explained that the lack of providers trained in d&e procedures was already a problem in florida before the abortion ban and that this shortage would likely worsen if current residents did not receive training in florida: “i have graduated a large number of residents who end up staying somewhere in the area and they all inevitably end up calling me, [saying] ‘i have this stillbirth at 20 weeks. she has a previa and three sections. she is really not a candidate for an induction.’ and they are going to section her. what, you are going to cut this woman open at 20 weeks? like literally you are going to just split her uterus in half for no good reason. but this is what is being done to everybody across the state because nobody knows how to remove a fetus through the vagina anymore.” (21) this is a problem as d&e procedures are important to broader obstetrics and gynecology practice. as one clinician stated: “even if you decide you are never going to provide abortion care, you are going to be in a situation where you are going to need to evacuate a pregnant uterus at 14 to 16 weeks. and it is essential that you know this.” (7) clinicians further noted that trainees and established reproductive health care providers are choosing to leave the state and thus are further exacerbating existing shortages of providers. in the words of one obstetrician gynecologist: “we are seeing providers leave. we are seeing residents not apply to the state of florida because they want that training.” (10) another obstetrician gynecologist told us: “we are going to lose doctors. there is zero question. and what is interesting as well, you know, the state might say, ‘well, good riddance of abortion providers like, we do not want you, we do not need you.’ but i am talking about general obstetrician gynecologists, mfms who are like, i cannot provide the care and the counseling i need to understand these laws. i am going to leave. and we already have a shortage of obstetrician gynecologists in florida.” (11) several clinicians emphasized the adverse effects of the abortion ban on training for miscarriage management. as an obstetrician gynecologist explained: “one in three women in their lifetime will have a miscarriage. one of three pregnancies end in miscarriage. and so many people can be affected by this because the medical term for miscarriage is spontaneous abortion. and people writing these laws are not looking at the medical terminology, the medical understanding. at the end of the day, if we are not training our clinicians to be able to care for patients, for the one in three pregnancies needing this kind of care, hopefully not all of them need surgical intervention. but if we are not able to train our providers to safely provide this care, we are doing a huge disservice to the state of florida.” (10) additionally, obstetrician gynecologists described the negative impacts the abortion ban will have on maternal health and mortality overall in florida, a state that already had poor maternal health outcomes. “you, the bearer of the uterus, are 14 times more likely to die from being pregnant and delivering full term than from having an abortion. 14 times more likely to die. forget hemorrhage, psychiatric dysfunction, infections, lacerations. i am not talking about morbidity. i am talking about mortality. and that is based on a study of a maternal mortality ratio of 8.8 to 100,000. florida is in the low twenties. and that is even worse for people of color. so, we are actively condemning people to death by instituting these bans. and i feel like nobody understands this. why are we trying to make our mothers die? that makes no sense. and i promise you that both republican and democratic mothers will die because this is not a partisan issue. this is medicine. …you need to be on alarm about the kind of training your doctor is getting because there are simply no doctors who can do this anymore. and the entire public should be alarmed because when a bad and weird and an unexpected thing happens in your pregnancy, your doctor will not know how to help you. and that is alarming.” (21) when asked what they wished people knew about florida’s abortion ban, many clinicians emphasized that the abortion ban interferes with individual freedom to access reproductive health care. international human rights law recognized that legal restrictions on abortion can violate numerous human rights, including the rights to life, health, equality, freedom from torture and cruelty, and reproductive autonomy.[54] the world health organization has found that the criminalization and penalization of abortion care   even with an exception for medical necessity   is fundamentally inconsistent with evidence based, ethical, and patient centered health care.[55] in the words of one florida obstetrician gynecologist: “it is really interfering in something that should never get interfered with, which is somebody’s private health care.” another obstetrician gynecologist said: “i think i would like the public to see that abortion care is part of pregnancy care and basic health care. and when it comes to basic health care decisions, floridians and americans deserve the right to make these private medical decisions based on science within the context and support of their health care team and without politicians telling them what to do. that is the key thing. i would almost argue that it is not about abortion. you can choose to have an abortion, you can choose to continue the pregnancy and parent, you can choose to continue the pregnancy and make an adoption plan. it is about privacy and choice for your family and your body. abortion is a part of that, but it is about the fundamental right to choice and privacy.” (2) several physicians emphasized the importance of recognizing the manifold physical harms of this governmental interference in private medical decisions between pregnant patients and their physicians. in the words of one obstetrician gynecologist: “being able to provide this type of care without the fear of not only affecting your patient, but your institution, your own license, it goes a very long way. and that this care that we are providing is lifesaving. i just feel like people have such a limited perception of what abortion care is and having seen the scary side of people being denied it, it is scary. and i am thankful that some people do not have to know the reality of that, but i sometimes wish that they did know the reality of the implications of limiting this.” (25) another obstetrician gynecologist discussed how the bans on abortion also impact other reproductive health care, like in vitro fertilization (ivf) and contraception: “there is fear in the ivf community that fertility treatments will be the next to be banned because at the end of the day, whether it is abortion, fertility treatments, or contraception, it is all about bodily autonomy. do women have autonomy over their own bodies? who has control? it is clearly not about supporting families and children, because if you wanted families, then you would let ivf happen because that is creating more lives.” (10) multiple clinicians also discussed that they wanted people to know that abortion care is safe and should not be restricted through criminal bans. one obstetrician gynecologist told us: “abortion is really safe, and there is this strange misconception that it is dangerous, but the risks of an abortion are lower than the risks of pregnancy at baseline. it is medical care, and we should not be restricting any type of medical procedure.” (17) the findings of this research brief illustrate the urgent need to reverse florida’s abortion ban and restore decision making on individual health care to patients in consultation with their health care providers. the health care providers interviewed by phr described multiple adverse effects of florida’s abortion ban on pregnant people’s health, well being, and human rights. they reported delays and denials of reproductive health care including in medical emergencies, deviations from standard medical care, disruption of the patient clinician relationship, the need for patients to seek care outside of florida, negative impacts on training new clinicians and retention of health care providers in the state, and adverse effects on individual freedom and bodily autonomy. social determinants of health and racial and ethnic disparities significantly exacerbate these issues for many women in the state of florida. florida’s current abortion ban has broadly impaired physicians’ ability to provide the proper standard of health care. even the narrow exceptions to the ban have proven unworkable in practice, due to the confusion caused by non medical terminology in the laws and fear arising from the significant penalties for violations of the ban. while physicians do continue to provide care where allowable under state law, the current abortion ban affords patients only a very narrow time frame to identify the pregnancy and access abortion care before five weeks and five days after the first day of a patient’s last menstrual period, the last day to make the first abortion appointment to be seen at six weeks with florida’s 24 hour waiting period. patients who receive severe fetal diagnoses later in pregnancy that are not deemed “imminently lethal” upon delivery are not able to receive abortion care in florida and are being forced to leave the state for that care. furthermore, the fear of punishment for violating florida’s abortion law by providing care to patients who are not experiencing an immediate risk of death has led clinicians to feel unable to provide treatment until patients develop additional health complications. multiple clinicians at rural or religiously affiliated hospitals discussed having to refer patients to tertiary care centers for medical emergencies, due to hospital concerns about providing abortion care under florida’s current laws. this included referring cases of miscarriage management and patients with conditions that were deemed exempt from florida’s abortion ban. these accounts demonstrate the extreme chilling effect caused by florida’s unclear, punitive, and sweeping abortion ban on the provision of reproductive health care. clinicians stated that florida’s unworkable medical exceptions are leading to widespread fear and confusion that significantly threatens floridians’ ability to access even routine medical care and jeopardizes their health and well being. clinicians stated that the abortion ban limits an individual’s reproductive freedom to make decisions about their reproductive health care. they reported feeling anguish that their inability to provide their patients with options for the full spectrum of standard medical care constituted a violation of their medical ethics and professional obligations to their patients. many clinicians told us that they were considering leaving florida and mentioned their colleagues who had already left the state due to this governmental infringement on their practice of medicine. they also expressed concerns about the impacts of the ban on training for residents and medical students, who need sufficient training in d&c and d&e procedures not just for abortion provision, but also for miscarriage management and emergency care later in pregnancy. these concerns highlight that the state’s abortion ban has adverse consequences not just for the current landscape of abortion access but also for health care more broadly in florida. it is essential to remedy the insurmountable barriers to care and devastating harm to floridians caused by the state’s extreme abortion restrictions. health care providers must be able to again meet their professional obligations to provide comprehensive reproductive health care for their patients, including termination of pregnancy. this research brief was researched and written by physicians for human rights (phr) consultant whitney arey, phd; phr staff members michele heisler, md, mpa, medical director; and payal shah, jd, director of research, legal, and advocacy; and phr intern danielle whisnant. the brief was reviewed and edited by phr staff members saman zia zarifi, jd, llm, executive director; karen naimer, jd, llm, ma, director of programs; wacera wathigo, ma, publications and communications manager; and by elizabeth singer, md, mph, phr medical expert. karla torres, elisabeth smith, and caroline sacerdote also provided invaluable external reviews. phr is grateful to all the florida clinicians who shared their time and experiences with our research team and to dr samantha baer for assisting with recruitment. cesarean birth: the birth of a fetus from the uterus through an incision (cut) made in the pregnant person’s abdomen. chorioamnionitis or intraamniotic infection: an acute inflammation of the membranes the placenta, typically due to bacterial infection after rupture of the membranes. dilation and curettage (d&c): a procedure in which the cervix is opened (dilated) and a thin instrument is inserted into the uterus to remove tissue from inside the uterus (curettage). it is used for both diagnostic and therapeutic purposes, including for first trimester abortion or after a miscarriage to remove all pregnancy tissue. dilation and evacuation (d&e): the most common method of abortion after about 14 weeks pregnancy in which the cervix is opened (dilated) and the contents of the uterus are removed (evacuated) using instruments and a suction device. it is also a common procedure used after a miscarriage to remove all pregnancy tissue. ectopic pregnancy: a pregnancy in a place other than the uterus, usually in a fallopian tube. family medicine: a medical specialty within primary care that provides continuing and comprehensive health care for the individual and family across all ages, genders, diseases, and parts of the body, including obstetric care. vacuum aspiration: the removal of the contents of the uterus using a suction device. maternal fetal medicine (mfm) specialist: also known as a perinatologist, an obstetrician gynecologist with additional training in caring for pregnant patients with high risk pregnancies. medical management of miscarriage: there are three main treatments for early pregnancy loss aimed at removing any pregnancy tissue left in the uterus: expectant management (letting the tissue pass on its own); medication; or a procedure (dilation and curettage). medication abortion: the use of medications to induce abortion. the world health organization endorses two regimens: one is the combination of mifepristone and misoprostol and the other uses misoprostol alone. obstetrics gynecology (ob gyn): the medical specialty that encompasses the two subspecialties of obstetrics (care of pregnant patients) and gynecology which focus on reproductive health and pregnancy. these clinicians are often called “ob gyns” and the specialty of obstetrics is often called “ob.” preterm premature rupture of membranes (pprom): a condition where the pregnant person’s amniotic sac (bag of water) breaks prior to 37 weeks’ gestation and prior to the onset of labor. delivery occurs within one week of pprom in 50 percent of patients. qualitative research: a type of research that gathers and analyzes nonnumerical data in order to gain an understanding of individuals’ social reality, including understanding their perceptions of their experiences, attitudes, beliefs, and motivations. self managed abortion: where a pregnant person performs their own abortion outside the formal health care system. spontaneous abortion: also called a miscarriage, it is the loss of a pregnancy before 20 weeks’ gestation. standard of care: treatment that is accepted by medical experts as the most appropriate for a certain type of disease in a particular setting and is widely used by health care professionals. also called best practice, standard medical care, best available therapy, and standard therapy. [1] dobbs v. jackson women’s health organization. no. 19 1392, 597 u.s. (2022), https://www.supremecourt.gov/opinions/21pdf/19 1392_6j37.pdf [2] fla. stat. § 390.0111(1)(d). access: http://www.leg.state.fl.us/statutes/index.cfm?app_mode=display_statute&url=0300 0399/0390/sections/0390.0111.html [3] planned parenthood of southwest and central florida, et al. v. state of florida et al. no. sc2022 1050 (2022), https://supremecourt.flcourts.gov/content/download/2285280/opinion/opinion_sc2022 1050 [4] fla. stat. § 390.0111(1)(d). accessed september 9, 2024. http://www.leg.state.fl.us/statutes/index.cfm?app_mode=display_statute&url=0300 0399/0390/sections/0390.0111.html [5] “florida administrative code and florida administrative register,” florida department of state, may 2, 2024, https://www.flrules.org/bigdoc/view_section.asp?issue=4132&section=4 [6] “maternal deaths in florida: report by month,” fl health charts, 2022, https://www.flhealthcharts.gov/chartsdashboards/rdpage.aspx?rdreport=infantdeath.dataviewer&cid=0392 [7] dobbs v. jackson women’s health organization. no. 19 1392, 597 u.s., https://www.supremecourt.gov/opinions/21pdf/19 1392_6j37.pdf [8] planned parenthood of southwest and central florida, et al. v. state of florida et al. no. sc2022 1050, (2022) https://supremecourt.flcourts.gov/content/download/2285280/opinion/opinion_sc2022 1050 [9] “why is a 6 week abortion ban nearly a total ban? it’s about how we date a pregnancy,”npr, may 1, 2024. https://www.npr.org/sections/health shots/2024/05/01/1248416546/6 week abortion ban explainer pregnancy lmp [10] fla. stat. § 390.0111(1)(d). accessed september 9, 2024. http://www.leg.state.fl.us/statutes/index.cfm?app_mode=display_statute&url=0300 0399/0390/sections/0390.0111.html [11] florida senate. bill 300, an act relating to abortion. 2023. https://www.flsenate.gov/session/bill/2023/300/billtext/er/pdf [12] “florida abortion ban upheld by state supreme court,” ap news, may 1, 2024. https://apnews.com/article/florida abortion ban supreme court ruling 6a4949fc7459afe9b5e298086a793126 [13] “florida gov. ron desantis signs a bill banning abortions after 15 weeks,” npr, april 14, 2022, https://www.npr.org/2022/04/14/1084485963/florida abortion law 15 weeks [14] http://www.leg.state.fl.us/statutes/index.cfm?app_mode=display_statute&url=0300 0399/0390/0390.html [15] “florida’s 6 week abortion ban is now in effect, curbing access across the south,” npr, may 1, 2024, https://www.npr.org/2024/05/01/1247990353/florida 6 week abortion ban south [16] “florida amendment 4, right to abortion initiative (2024),” ballotpedia, accessed september 9, 2024. https://ballotpedia.org/florida_amendment_4,_right_to_abortion_initiative_(2024) [17] “florida clarified abortion rules after enacting ban. doctors say it’s ‘gaslighting’ and unhelpful,” salon, may 8, 2024. https://www.salon.com/2024/05/08/florida clarified abortion rules after enacting ban doctors say its gaslighting and unhelpful/ [18] “florida administrative code and florida administrative register,” florida department of state, may 2, 2024, https://www.flrules.org/bigdoc/view_section.asp?issue=4132&section=4 [19] “trap laws: a threat to abortion rights you don’t know about,” aclu of florida, accessed september 9, 2024. https://www.aclufl.org/en/news/trap laws are threat abortion rights you dont know about [20] “number of florida abortions are down after the 6 week limit goes into effect,” health news florida, published august 12, 2024, https://health.wusf.usf.edu/health news florida/2024 08 13/number of florida abortions are down after the 6 week limit goes into effect [21] “interactive map: us abortion policies and access after roe,” guttmacher, policies current as of september 5, 2024, https://states.guttmacher.org/policies/florida/demographic info [22] radley, david c., jesse c. baumgartner, and sara r. collins. “2022 scorecard on state health system performance: how did states do during the covid 19 pandemic?” commonwealth fund, june 2022, https://doi.org/10.26099/3127 xy78; radley, david c., jesse c. baumgartner, and sara r. collins. “the commonwealth fund 2023 scorecard on state health system performance: americans’ health declines and access to reproductive care shrinks, but states have options.” commonwealth fund, june 2023. https://doi.org/10.26099/fcas cd24; [23] “interactive map: us abortion policies and access after roe,” guttmacher, policies current as of september 5, 2024, https://states.guttmacher.org/policies/florida/demographic info [24]“addressing florida’s escalating physician shortage: strategies and solutions,” florida tax watch, published january 10, 2024, https://floridataxwatch.org/research/full library/addressing floridas escalating physician shortage strategies and solutions [25] march of dimes. perinatal data center state summaries: florida. 2022. https://www.marchofdimes.org/peristats/state summaries/florida?lev=1&obj=3&reg=99&slev=4&sreg=12&stop=55&top=3 [26] “adequate prenatal care in united states,” america’s health rankings, united health foundation, accessed september 9, 2024. https://www.americashealthrankings.org/explore/measures/prenatalcare_adquate [27] “adequate prenatal care in united states,” america’s health rankings, united health foundation, accessed september 9, 2024. https://www.americashealthrankings.org/explore/measures/prenatalcare_adquate [28] “pregnancy associated mortality review update, 2020,” florida department of health, accessed september 9, 2024, https://www.floridahealth.gov/statistics and data/pamr/flmmrc 2020 update.pdf [29] pregnancy associated mortality review update, 2020,” florida department of health, accessed september 9, 2024, https://www.floridahealth.gov/statistics and data/pamr/flmmrc 2020 update.pdf [30] “monthly abortion provision study,” guttmacher, accessed september 9, 2024, https://www.guttmacher.org/monthly abortion provision study [31] florida senate. bill 5, an act relating to reproductive health and pregnancy. 2022. https://www.flsenate.gov/session/bill/2022/5/billtext/er/pdf (showing how 2022 sb 5 modified the prior ban). [32] “the number of brick and mortar abortion clinics drops, as us abortion rate rises: new data underscore the need for policies that support providers,” guttmacher institute, june 2024, https://www.guttmacher.org/report/abortion clinics united states 2020 2024 [33] “number of florida abortions are down after the 6 week limit goes into effect”, health news florida, august 12, 2024. https://health.wusf.usf.edu/health news florida/2024 08 13/number of florida abortions are down after the 6 week limit goes into effect [34] “the fallout of florida’s abortion ban has been ‘chaos,’ experts say,” salon, august 8, 2024, https://www.salon.com/2024/08/08/the fallout of floridas abortion ban has been chaos experts say/ [35] “how florida’s abortion law is affecting east coast abortion clinics,” washington post, published may 24, 2024, https://www.washingtonpost.com/nation/2024/05/24/abortion clinics wait time florida law/ [36] “clear and growing evidence that dobbs is harming reproductive health and freedom,” guttmacher, may 2024, https://www.guttmacher.org/2024/05/clear and growing evidence dobbs harming reproductive health and freedom [37] quotes have been edited for clarity and conciseness. 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supported by rape victims and patients with complicated pregnancies are confronting the limits of state abortion laws. by amy schoenfeld walker the march for life, held each year for a half century, should be a celebration now that roe v. wade has fallen. instead, anti abortion activists are split over what comes next. by ruth graham the judge said he would decide soon whether to issue a preliminary injunction ordering the f.d.a. to withdraw its approval of the drug or wait for the full trial. by pam belluck and allison mccann the 96 year old scientist who came up with an idea for an “unpregnancy pill” decades ago has led an eventful life, from his teenage days in the french resistance to his friendships with famous artists. by pam belluck tracking abortion bans across the country the new york times is tracking the status of abortion laws in each state following the supreme court’s 2022 decision to overturn roe v. wade. by allison mccann and amy schoenfeld walker the unexpected ways the left is winning in the abortion fight six months after the end of roe v. wade, efforts to defend abortion access are racking up victories in state legislatures and in the courts. by sabrina tavernisesydney harpernina feldmanstella tanmarc georgesliz o. baylenmarion lozanoelisheba ittoop and chris wood legal abortions fell around 6 percent in two months after end of roe new data shows that the number of abortions fell by more than 10,000. by margot sanger katz and claire cain miller graham proposes 15 week abortion ban, splitting republicans the south carolina senator’s bill was an effort to find a politically palatable position for his party before the midterm elections, in which abortion rights are expected to be a potent issue. by annie karni the long path to reclaim abortion rights the supreme court decision to reverse roe, far from settling the matter, instead has launched court and political battles across the states likely to go on for years. by kate zernike roe’s death will change american democracy the anti abortion movement has won its decades long effort to undo roe. now what? by mary ziegler america is not ready for the end of roe v. wade americans are about to lose a constitutional right. it’s worth fighting for. by the editorial board i prayed and protested to end roe. what comes next? what the overturning of roe v. wade means to abortion opponents like me. by karen swallow prior abortion pills will change a post roe world medication abortion isn’t a magic solution to the likely end of roe. but it can blunt the fallout. by greer donleyrachel rebouché and david s. cohen the women who had abortions before roe v. wade we must understand what happened before roe v. wade to prepare for an america in which roe is gone. by ilana panich linsman the bill would require that infants born alive after an attempted abortion receive the same protection as any newborn baby, and threaten medical providers with prison time for failing to resuscitate them. by annie karni former vice president mike pence described mr. kennedy, who does not support a federal abortion ban, as a choice unlike any in the modern era of the g.o.p. by jonathan swan the abortion rights movement won in many states   even some that voted for donald trump. where does it go from here? by emily bazelon democrats had attacked donald j. trump’s ties to the conservative policy blueprint for reshaping the federal government. several of its authors served in his administration. by neil vigdor and simon j. levien ballot measures that passed on tuesday will lift abortion bans in two states and expand access in others. defeated measures in three states mean their abortion restrictions will remain in place. by allison mccann and amy schoenfeld walker voters in red and blue states supported abortion rights, but the movement broke its winning streak. by kate zernike donald trump has softened his rhetoric, contradicted himself and nearly dropped “pro life” from his vocabulary. yet there is no evidence that his views on abortion have changed. by margot sanger katz, claire cain miller and eve washington activists on both sides say trump could effectively ban abortion nationwide and establish fetal personhood, the longtime goal of the anti abortion movement. by kate zernike a republican super pac is running ads invoking the name of ruth bader ginsburg to help donald trump win voters who favor abortion rights. her family denounced the effort as “nothing short of appalling.” by shane goldmacher, theodore schleifer, maggie haberman and jodi kantor they hope the issue helps their candidates. but some voters may support republican candidates as well as abortion rights ballot measures. by elizabeth dias and lisa lerer a new analysis shows how many women in states with bans are seeking procedures or pills from out of state providers. by claire cain miller, margot sanger katz and josh katz journalists and scholars explore the issue at every level, from the movement that took down roe to the human stories of women who had abortions, and those who were denied. by mattie kahn in the first presidential election since the supreme court overturned roe v. wade, vice president kamala harris and former president donald j. trump bring sharply different records on abortion. maggie astor, a political reporter for the new york times, describes where the candidates stand on the issue. by maggie astor, david seekamp, claire hogan and david jouppi democrats in a pair of competitive house districts are spotlighting the anti abortion stances of republican incumbents after the state enacted one of the most restrictive bans in the country. by robert jimison in a campaign they would like to center on the economy and the border, republican candidates keep drifting back to abortion rights, an issue that favors democrats. by jonathan weisman “shame on her,” joe manchin, the independent senator from west virginia, said after kamala harris reiterated her support for ending the senate practice. “she knows the filibuster is the holy grail of democracy.” by nicholas nehamas “you will be protected, and i will be your protector,” said former president donald j. trump. polls have shown he is struggling to cultivate support among women, for whom abortion rights remain a top issue. by neil vigdor and simon j. levien experts said the new research finding underscored how abortion bans had affected women’s contraceptive choices. by emily schmall we explain the 10 measures that would let voters decide abortion policy in their states. by kate zernike the candidates are all but certain to clash over the issue, which kamala harris sees as a major strength. donald trump may try to avoid political blowback for his approach. by michael gold and nicholas nehamas the ad, which will run in several battleground states, comes as a growing share of voters say that abortion is their top issue. by tim balk ten states have ballot measures to establish a right to abortion in their state constitutions. the pushback has already begun. by kate zernike the spotlight at the convention is a dramatic shift from just four years ago, another sign of how radically the politics of abortion have changed, and how much the party is relying on the issue to rally voters. by elizabeth dias and lisa lerer utah cannot enforce its near total ban on abortion while a challenge to the law proceeds in the courts, the state supreme court ruled on thursday. by david w. chen and anna betts jd vance’s 2021 insult of “childless cat ladies” has sparked bipartisan outrage at a moment when women’s choices are seen as a galvanizing political force. by katie rogers after president biden’s rocky answer on abortion at the debate, his campaign has ramped up its messaging on donald trump’s role in overturning roe v. wade and his policy stances. by simon j. levien two years after roe was struck down, the conversation has focused on the complications that can come with pregnancy and fertility, helping to drive more support for abortion rights. by kate zernike the movement looks for a path forward: “is the goal the absolute abolition of abortion in our nation?” by elizabeth dias supporters of abortion rights hailed the ruling on a challenge they said was fueled by junk science, but warned that it only maintained the status quo as more challenges loomed. by kate zernike out of state trips for abortions more than doubled in 2023, demonstrating the upheaval in access since the overturn of roe v. wade. by molly cook escobar, amy schoenfeld walker, allison mccann, scott reinhard and helmuth rosales in “the fall of roe,” elizabeth dias and lisa lerer explain exactly how roe v. wade was made   and unmade. by mattie kahn a conservative christian coalition’s plan to end the federal right to abortion began just days after trump’s 2016 election. by elizabeth dias and lisa lerer in an interview for a forthcoming book, mrs. clinton also suggested that if donald trump won in november “we may never have another actual election.” by lisa lerer and elizabeth dias the party is pursuing a “sword and shield” political strategy as senator chuck schumer pushes showdown votes on border security and abortion rights ahead of this year’s elections. by carl hulse the former two term republican governor, who vetoed legislation in maryland to expand abortion access, called himself “pro choice” in an interview and said he would back a federal law to ensure access to the procedure. by luke broadwater the mistaken belief, in a new poll, shows how even as abortion is mobilizing democrats, confusion over the issue is also a challenge. by claire cain miller, ruth igielnik and margot sanger katz the state has dozens of clinics that serve tens of thousands of women a year, including from across the southeast. the six week ban will require most to travel much farther. by patricia mazzei at a time of heightened confusion and legal battles over access to abortion, women are looking to social media for answers. by emily schmall lawmakers voted to repeal an 1864 law that bans nearly all abortions. here’s what to know about the fight over the law. by anna betts and colbi edmonds president biden, who promised to continue to fight for the restoration of roe v. wade, said the ban was first enacted “well before women had secured the right to vote.” by aishvarya kavi by chris cameron with his video statement on monday, donald trump laid bare how faulty a messenger he had always been for the anti abortion cause. by lisa lerer and elizabeth dias the former president said he supported leaving abortion decisions to states, but political opponents say he bears responsibility for any curbs enacted. by maya king the florida supreme court overturned decades of legal precedent in ruling that the state constitution’s privacy protections do not extend to abortion, effectively allowing florida to ban the procedure after six weeks of pregnancy. the florida supreme court allowed voters to decide this fall whether to expand abortion access, ruling 4 to 3 that a proposed constitutional amendment that would guarantee the right to abortion “before viability,” usually around 24 weeks, could go on the november ballot. erin hawley, a law professor and wife of senator josh hawley, is arguing the supreme court case. by elizabeth dias and abbie vansickle the only abortion clinic left in the state has been protested and set on fire, rebuilt and opened as wyoming grapples with what it means to be conservative in a post roe nation. by kate zernike an alabama decision on i.v.f. has put an uncompromising principle on a collision course with political reality. by emily bazelon the vote by lawmakers comes after supporters of the measure in france were galvanized by the u.s. supreme court’s decision overturning roe v. wade. by catherine porter republicans, many of whom have said they support access to the treatment, have argued that it should be left to states to ensure its legality after an alabama court ruled that frozen embryos were children. by kayla guo chief justice tom parker has long been revered by conservative groups as an architect for the overturning of roe v. wade. by rick rojas doctors in a handful of blue states are using shield laws to provide abortions to women in red states. by pam belluck the ruling raises worrisome legal issues for would be parents far beyond alabama whose hopes for children may depend on in vitro fertilization. by roni caryn rabin and azeen ghorayshi his supporters are seeking to attack abortion rights and abortion access from a variety of angles should he regain the white house, including using a long dormant law from 1873. by lisa lerer and elizabeth dias in supporting a 16 week ban with exceptions, donald trump appears to be trying to satisfy social conservatives who want to further restrict abortion access and voters who want more modest limits. by maggie haberman, jonathan swan and lisa lerer most of france’s political parties broadly support the right to abortion. but the proposal still has to undergo a long and complex legislative process before it comes to fruition. by aurelien breeden the event was interrupted by at least 10 people protesting the war in gaza, but the president focused on calling attention to restrictive abortion laws. by katie rogers in events next week, the president and vice president will argue that abortion access is crucial to personal freedoms, and warn of what is at stake if donald j. trump is re elected. by katie rogers a year after celebrating the reversal of roe v. wade, the annual march for life gathered friday in a very different political climate. by elizabeth dias advocates present a united front after disagreements over how far they could go in asking voters to legalize abortion in the state. by kate zernike nearly three dozen house republicans who supported a federal abortion ban in the last congress have yet to sign on this year, reflecting a shifting political calculus after the overturning of roe v. wade. by annie karni the u.s. court of appeals for the fifth circuit affirmed a ruling that sided with the state on whether emergency rooms are required to perform emergency abortions. by jesus jiménez the vice president has been the administration’s most forceful voice for abortion rights in the year and a half since roe v. wade fell. by katie rogers post roe voting might bring america to a new consensus   but only if the voters keep getting their say. by kate zernike how the justices overturned roe v. wade. by jodi kantor a times investigation reveals the behind the scenes story of how the supreme court abolished the constitutional right to abortion. by jodi kantor and adam liptak this is the inside story of how the supreme court overturned the constitutional right to abortion   shooting down compromise and testing the boundaries of how the law is decided. by jodi kantor and adam liptak a two part november 1972 episode of “maude,” in which the title character decides to get an abortion, still seems radical, particularly after the supreme court overturned roe v. wade. by esther zuckerman a woman who is 20 weeks pregnant, and whose fetus has been diagnosed with a deadly condition, is suing for an abortion under a medical exception to the state’s bans. by j. david goodman since her retirement in 2006, the court has dismantled her key rulings on abortion, affirmative action and campaign finance. by adam liptak the first estimate of births since dobbs found that almost a quarter of women who would have gotten abortions carried their pregnancies to term. by margot sanger katz and claire cain miller he appointed judges who overturned roe, but his vague statements on the issue may give him some leeway with voters. by ruth igielnik election results from tuesday showed that democrats, independents and even some moderate republicans can coalesce around the issue. by lisa lerer and shane goldmacher the state constitution will protect access to the procedure. the ballot result sends a strong signal that voters are still angry about the demise of roe. by kate zernike the outcome is being closely watched by democrats and republicans looking to measure the strength of voter anger over the loss of federal abortion protections. by kate zernike ballot questions have been a winning strategy for abortion rights, even in red states. but complicated ballot language and misinformation have some abortion rights supporters worried. by kate zernike and lisa lerer hospitals are playing a growing role in abortion access, as pregnant women with certain health issues travel to seek care that clinics can’t provide. by allison mccann the clinic had suspended abortions during a legal battle over an 1849 law, which is ongoing. by julie bosman after dobbs, the political ground seems to be shifting in some unpredictable ways. by emily bazelon several justices questioned whether florida’s constitutional privacy rights extend to abortion, as has been longstanding legal precedent. by patricia mazzei some doctors who handle high risk pregnancies are fleeing restrictive abortion laws. idaho has been particularly hard hit. by sheryl gay stolberg the court ruled that women seeking abortion pills must first see a doctor in person. the catch: the nearest abortion doctor is an eight hour flight away. by david w. chen a supreme court decision created a 50 state patchwork of differing abortion laws. an eclectic network of volunteers and organizations has tried to fill the gaps in health care and support. by kate kelly and marisa schwartz taylor a year after dobbs, researchers are still trying to answer a central question: how many more babies are born as a result of abortion bans? by j. david goodman the court said the state constitution provides a limited right to abortion, but not a “fundamental” one. by kate zernike a current list of clinics that had closed, altered services or relocated didn’t exist   so two times reporters made one. by sarah bahr the tiny u.s. territory in the western pacific ocean is thousands of miles from the nearest state, and has no resident doctors who perform abortions. court decisions could cut access to pills, the only legal option left. by david w. chen and noriko hayashi for anti abortion activists, the anniversary of the supreme court’s decision eliminating the national right to abortion is festive, but also a time to acknowledge challenges. by ruth graham a year after the end of roe v. wade, biden administration officials are working with a limited set of tools, including executive orders and the bully pulpit, to galvanize supporters. by katie rogers and zolan kanno youngs the supreme court ruling that overturned roe v. wade has produced some unexpected legal and political changes, as well as a shift in public opinion. by michael levenson new and extensive polling shows public opinion increasingly supports legal abortion, with potential political consequences for 2024. by kate zernike in the year since roe was struck down, clinic owners have scrambled to adjust to the new legal landscape around abortion. here’s what happened to them, and their communities. by allison mccann and amy schoenfeld walker the historic dobbs ruling has hurt the party electorally, but g.o.p. lawmakers are still moving to pass more restrictive laws. these two realities represent the defining political fallout of the end of roe v. wade. by katie glueck the show at frieze new york, of works that women artists created the year of the landmark supreme court decision, gives a panoramic look at a watershed moment. by keridwen cornelius but advocates can’t agree on a strategy to hold more ballot initiatives. by david leonhardt and lyna bentahar behaving as the republicans’ de facto nominee, donald trump dug in on his 2020 lies and dodged on abortion. the g.o.p. audience cheered, but so did democrats seeking 2024 fodder. by shane goldmacher and maggie haberman they call themselves the “sister senators” and three of them are republicans. by kate zernike justice john paul stevens’s files on thousands of cases, including landmark decisions on abortion and the 2000 election, have been made public, opening a window on the supreme court. by adam liptak after abortion rights supporters swept six ballot measures last year, republican legislatures seek to make it harder to get on the ballot, and harder to win if there is a vote. by kate zernike and michael wines susan b. anthony pro life america, seeking a ban after 15 weeks of pregnancy, threatened to campaign against any candidate who does not support the proposal. by michael c. bender

repro health watch | aug 8, 2024 cnn, august 7, 2024 despite restrictions and bans that have taken effect in the two years since the u.s. supreme court’s dobbs decision revoked the federal right to an abortion, the average number of abortions provided each month in the united states continues to rise, a new report shows. there were an average of 98,990 abortions each month in the first three months of 2024, according to the latest data from #wecount, a research project from the society of family planning. that’s about 14% higher than the average from the same period last year, or about 12,000 more abortions each month. there are seasonal patterns and some month to month fluctuation in abortion rates, but in january, monthly abortions topped 100,000 for the first time since #wecount started tracking about two years ago. “i am expecting the number to plateau at some point. but with each report, we see the numbers increase, so we’re not at that plateau just yet,” said dr. ushma upadhyay, co chair of #wecount and a professor at the university of california, san francisco’s advancing new standards in reproductive health. “there continues to be a lot of unmet need that is being met in various ways.” much of the increase has been driven by a surge in medication abortions, especially those provided through telehealth. when #wecount started collecting data from abortion providers in april 2022, about 4% of all abortions were medication abortions provided through telehealth. the latest report shows that 20% of all abortions in march 2024 were telehealth abortions. medication abortion is a method by which someone ends their pregnancy by taking two drugs   mifepristone and misoprostol   rather than having a surgical procedure. the us food and drug administration approved the drugs for abortion use more than two decades ago, and the regimen is approved for use up to 10 weeks gestation. research has long found that medication abortion is safe and effective, and recent studies have shown that to be true even when the patient gets the medicine through a telehealth appointment. a rise in telehealth abortions can help keep schedules more open for people who need in person care, upadhyay said. the new report shows that the number of in person abortions in the first three months of 2024 was about the same as it was in the first three months of 2023, while telehealth abortions rose 28%. nbc news, august 1, 2024 obstetrician gynecologists are seeing more pregnant patients with dangerous medical complications two plus years after the supreme court’s dobbs decision, while at the same time receiving less training as residents about how to perform abortions, according to a new report. the findings, shared exclusively with nbc news, are the result of a monthslong investigation by democrats on the house committee on energy and commerce. they’re based on conversations with leaders and educators from 20 ob gyn residency programs conducted from february to june. half of those programs are in states that restrict abortion access. the report highlights several worrisome effects of abortion restrictions instituted after roe v. wade was overturned, including fewer applicants to ob gyn residency programs in states that restrict abortion, practicing ob gyns moving out of these states and new doctors being left unprepared to treat pregnant patients in life threatening scenarios. several residency program directors interviewed for the report recalled dangerous, sometimes tragic, situations in states with abortion bans. one director described a patient who died from sepsis after she wasn’t able to get an abortion. another said their hospital had to hold off on providing an abortion for a patient whose amniotic sac had ruptured at 20 weeks, which creates a risk of infection. the report also reinforces the conclusions of other prior research: that pregnant patients have to travel longer distances to obtain abortions or wind up visiting multiple hospitals before they can find one that will treat them for complex medical issues. the share of patients traveling to other states for abortions doubled from 2020 to 2023, according to the guttmacher institute, a research organization that supports abortion access. the report also highlights how little education some ob gyn residents are receiving in how to provide an abortion. in the past, residency programs often partnered with abortion clinics to provide that training, but in states with abortion bans, those clinics have shut down. some programs pay for residents to get such training out of state, but that often requires additional medical licenses and liability insurance and means residents must spend multiple weeks away from home. nbc news, august 6, 2024 months before he was selected as vice president kamala harris’ running mate, minnesota gov. tim walz toured a planned parenthood clinic in his state alongside harris   the first time a sitting president or vice president had visited an abortion provider. that visit in march put minnesota’s efforts to safeguard reproductive rights in the spotlight. now, harris and walz represent a democratic ticket that vocally supports access to abortion and fertility treatment, during an election in which those issues are expected to be important to voters and a focus of many democratic campaigns. minnesota was the first state to pass a law protecting abortion rights after the supreme court’s dobbs decision in 2022. the law, which walz signed in january 2023, stipulates that local governments   cities, counties, towns, etc.   cannot regulate a person’s choice to obtain an abortion or other reproductive services. a few months later, walz signed a second abortion rights law   that statute prohibits the arrest of abortion providers in minnesota and protects people who travel there to avoid another state’s abortion ban. according to the law, minnesota officials do not have to turn over a patient’s health records in response to another state’s subpoena or court order. minnesota, which traditionally votes for democratic presidential candidates, has some of the most progressive abortion policies in the country. abortion has been legal there since the roe decision in 1974. in 1995, the minnesota supreme court ruled that abortion rights were protected by the state’s constitution. since roe was overturned, the state has adopted additional measures to make abortions easier to obtain. in july 2022, a district court judge struck down several requirements that hindered access, including a rule that only physicians could perform abortions and a mandatory 24 hour waiting period. abortions are also covered by state medicaid funds. in addition to his support for abortion access, walz has championed in vitro fertilization. many abortion rights supporters worry that access to fertility treatment is under threat post dobbs, since ivf often involves discarding embryos due to genetic abnormalities or because they are no longer needed. some who believe in the notion of fetal personhood have opposed that practice. walz told the minneapolis star tribune in march that his two children were born with the help of fertility treatments, which his wife had been receiving for seven years before getting pregnant with their daughter. cnn, august 5, 2024 dr. emily boevers is the only full time obgyn at a critical access hospital in a rural city in iowa about 10 miles from the farm she grew up on. she’s the only full time obgyn in the county, in a state that just banned most abortions. iowa enacted a law last week banning abortion once fetal cardiac activity can be detected, around six weeks into pregnancy, before many people even know they’re pregnant. the law includes exceptions for rape, incest and medical emergencies that threaten the life of the mother, and fetal abnormalities that are incompatible with life. “what’s going to come to fruition at some point is that for a lot of us, we’re going to have a moment where we have to decide if we’re going to do the right thing for the patient that’s in front of us and risk our license, or if we want to step back and potentially let a patient   let a mother in our community   die from an obstetric complication, but preserve our license and our ability to continue to care for the other people in our rural communities,” boevers said. it’s a nightmare scenario that could become reality for doctors in iowa. it’s also one that some doctors just aren’t willing to face. health care leaders are sounding the alarm that the constraints placed on them by the new abortion law could drive maternity care providers out of state and deter new ones from coming in, at a time when iowa desperately needs them. iowa has the lowest per capita ratio of obgyn providers to medicare beneficiaries in the nation, according to a 2022 study published in the american journal of obstetrics and gynecology. more than 33% of counties in the state are considered maternity care deserts, where access to services is limited or absent, and 68,815 women live in a county without a single obstetric provider, according to a 2023 march of dimes report. the state is predominantly rural, with more than 10% of its population living below the poverty line, according to 2020 federal data. kff health news, august 2, 2024 the percentage of people who say they’ve tried to end a pregnancy without medical assistance increased after the supreme court overturned roe v. wade. that’s according to a study published tuesday in the online journal jama network open. tia freeman, a reproductive health organizer, leads workshops for tennesseans on how to safely take medication abortion pills outside of medical settings. abortion is almost entirely illegal in tennessee. freeman, who lives near nashville, said people planning to stop pregnancies have all sorts of reasons for wanting to do so without help from the formal health care system   including the cost of traveling to another state, challenge of finding child care, and fear of lost wages. “some people, it’s that they don’t have the support networks in their families where they would need to have someone drive them to a clinic and then sit with them,” said freeman, who works for self managed abortion; safe and supported, a u.s. based project of women help women, an international nonprofit that advocates for abortion access. “maybe their family is super conservative and they would rather get the pills in their home and do it by themselves,” she said. the new study is from advancing new standards in reproductive health, a research group based at the university of california san francisco. the researchers surveyed more than 7,000 people ages 15 to 49 from december 2021 to january 2022 and another 7,000 plus from june 2023 to july 2023. of the respondents who had attempted self managed abortions, they found the percentage who used the abortion pill mifepristone was 11 in 2023   up from 6.6 before the supreme court ended federal abortion rights in 2022. one of the most common reasons for seeking a self administered abortion was privacy concerns, said a study co author, epidemiologist lauren ralph. “so not wanting others to know that they were seeking or in need of an abortion or wanted to maintain autonomy in the decision,” ralph said. “they liked it was something under their control that they could do on their own.” we are pleased to see this historic settlement addressing disability discrimination in mammography access. we applaud @hhsocr for its critical work as we continue to advocate for equitable access to sexual and reproductive health care for disabled women. https://t.co/1zjfn788ve we respect your privacy. read our policy. note: the information contained in this publication reflects media coverage of women’s health issues and does not necessarily reflect the views of the national partnership for women & families. 1725 eye st. nw, suite 950 washington dc 20006 202 986 2600 202 986 2539 (fax) mail a check email 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copyright 2025 the associated press. all rights reserved. judges, state lawmakers and voters are deciding the future of abortion in the u.s. two years after the supreme court jolted the legal status quo with a ruling that overturned roe v. wade file   people march through downtown amarillo to protest a lawsuit to ban the abortion drug mifepristone, feb. 11, 2023, in amarillo, texas. two years after the u.s. supreme court ended a nationwide right to abortion, travel and pills have become big parts of the issue.(ap photo/justin rex, file) file   paul meacham holds high a sign that reads “ohio is pro life” as the crowd prays during the ohio march for life rally at the ohio state house in columbus, ohio, friday, oct. 6, 2023. two years after the u.s. supreme court ended a nationwide right to abortion, travel and pills have become big parts of the issue. (ap photo/carolyn kaster, file) judges, state lawmakers and voters are deciding the future of abortion in the u.s. two years after the supreme court jolted the legal status quo with a ruling that overturned roe v. wade file   people march through downtown amarillo to protest a lawsuit to ban the abortion drug mifepristone, feb. 11, 2023, in amarillo, texas. two years after the u.s. supreme court ended a nationwide right to abortion, travel and pills have become big parts of the issue.(ap photo/justin rex, file) file   people march through downtown amarillo to protest a lawsuit to ban the abortion drug mifepristone, feb. 11, 2023, in amarillo, texas. two years after the u.s. supreme court ended a nationwide right to abortion, travel and pills have become big parts of the issue.(ap photo/justin rex, file) file   paul meacham holds high a sign that reads “ohio is pro life” as the crowd prays during the ohio march for life rally at the ohio state house in columbus, ohio, friday, oct. 6, 2023. two years after the u.s. supreme court ended a nationwide right to abortion, travel and pills have become big parts of the issue. (ap photo/carolyn kaster, file) file   paul meacham holds high a sign that reads “ohio is pro life” as the crowd prays during the ohio march for life rally at the ohio state house in columbus, ohio, friday, oct. 6, 2023. two years after the u.s. supreme court ended a nationwide right to abortion, travel and pills have become big parts of the issue. (ap photo/carolyn kaster, file) judges, state lawmakers and voters are deciding the future of abortion in the u.s. two years after the supreme court jolted the legal status quo with a ruling that overturned roe v. wade. the june 24, 2022, ruling in dobbs v. jackson women’s health organization sparked legislative action, protest and numerous lawsuits   placing the issue at the center of politics across the country. abortion is now banned at all stages of pregnancy, with limited exceptions, in 14 republican controlled states. in three other states, it’s barred after about the first six weeks, which is before many know they are pregnant. most democratic led states have taken actions to protect abortion rights, and become sanctuaries for out of state patients seeking care. that’s changed the landscape of abortion access, making it more of a logistical and financial ordeal for many in conservative states. but it has not reduced the overall number of procedures done each month across the u.s. here’s what to know about the state of abortion rights in the u.s. now. bans in republican led states have prompted many people seeking abortions to travel to get care. that translates into higher costs for gas or plane tickets, hotels and meals; more logistics to figure out, including child care; and more days off work. a new study by the guttmacher institute, which advocates for abortion access, found that out of just over a million abortions provided in clinics, hospitals and doctors’ offices, more than 161,000   or 16%   were for people who crossed state lines to get them. more than two thirds of abortions done in kansas and new mexico were for out of staters, particularly texans. since florida’s six week abortion ban kicked in in may, many people had to travel farther than before, since throughout the southeast, most states have bans. low income patients and those lacking legal permission to be in the country are more likely to be unable to travel. there can be lasting costs for those who do. in alabama, the yellowhammer fund, which previously helped residents pay for the procedure has paused doing so since facing threats of litigation from the state. jenice fountain, yellowhammer’s executive director, said she met a woman recently who traveled from alabama to neighboring georgia for an abortion but found she couldn’t get one there because she was slightly too far into her pregnancy. so she then went to virginia. the journey wiped out her rent money and she needed help to remain housed. “we’re having people use every dime that they have to get out of state, or use every dime they have to have another child,” fountain said. file   people march through downtown amarillo to protest a lawsuit to ban the abortion drug mifepristone, feb. 11, 2023, in amarillo, texas. (ap photo/justin rex, file) file   people march through downtown amarillo to protest a lawsuit to ban the abortion drug mifepristone, feb. 11, 2023, in amarillo, texas. (ap photo/justin rex, file) nearly two thirds of known abortions last year were provided with pills rather than procedures. one report found that pills are prescribed via telehealth and mailed to about 6,000 people a month who live in states with abortion bans. they’re sent by medical providers in states with laws intended to protect them from prosecution for those prescriptions. the laws in colorado, massachusetts, new york, vermont and washington specifically protect medical providers who prescribe the pills to patients in states with bans. the growing prominence of pills, which were used in about half of all abortions just before the dobbs ruling, is a frontier in the latest chapter of the legal fight. the u.s. supreme court this month unanimously rejected an effort by abortion opponents who were seeking to overturn or roll back the u.s. food and drug administration’s approval of mifepristone, one of two drugs usually used together for medication abortions. the issue is likely to return. in this presidential election year, abortion is a key issue. protecting access has emerged as a key theme in the campaigns of democrats, including president joe biden in his reelection bid. former president donald trump, the presumptive republican nominee, has said states should decide whether to restrict abortions. he also suggested states could limit contraception use but changed his tune on that. “we recognize this could be the last dobbs anniversary we celebrate,” kelsey pritchard, a spokesperson for susan b. anthony pro life america said in an interview, noting that if democrats win the presidency and regain control of both chambers of congress, a right to abortion could be enshrined in the law. the issue will also be put directly before voters in at least four states. colorado, florida, maryland and south dakota have ballot measures this year asking voters to approve state constitutional amendments that would protect or expand access to abortion. a new york measure would bar discrimination against someone who has an abortion. there are attempts to put questions about abortion access on the ballots this year in arkansas, missouri, montana, nebraska and nevada. there’s also a push for a ballot measure in arizona, where the state supreme court this year ruled that an 1864 abortion ban could be enforced. with the help of some republicans   democrats in the legislature were able to repeal that law. generally, abortion rights expand when voters are deciding. in the seven statewide abortion policy related votes since 2022, voters have sided with abortion rights advocates in every case. file   paul meacham holds high a sign that reads “ohio is pro life” as the crowd prays during the ohio march for life rally at the ohio state house in columbus, ohio, friday, oct. 6, 2023. (ap photo/carolyn kaster, file) file   paul meacham holds high a sign that reads “ohio is pro life” as the crowd prays during the ohio march for life rally at the ohio state house in columbus, ohio, friday, oct. 6, 2023. (ap photo/carolyn kaster, file) the dobbs ruling and its aftermath gave rise to a bevy of legal questions and lawsuits challenging nearly every ban and restriction. many of those questions deal with how exceptions   which come into play far more often when abortion is barred earlier in pregnancy   should apply. the issue is often raised by those who wanted to be pregnant but who experienced life threatening complications. a group of women who had serious pregnancy complications but were denied abortions in texas sued, claiming the state’s ban is vague about which exceptions are allowed. the all republican texas supreme court disagreed in a may ruling. the supreme court also heard arguments in april on the federal government’s lawsuit against idaho, which says its ban on abortions at all stages of pregnancy can extend to women in medical emergencies. the biden administration says that violates federal law. a ruling on that case could be issued at any time. meanwhile, bans have been put on hold by judges in iowa, montana, utah and wyoming. copyright 2025 the associated press. all rights reserved.

john yang john yang andrew corkery andrew corkery harry zahn harry zahn leave your feedback reproductive rights are front and center as the election enters its home stretch, more than two years after the overturning of roe v. wade. despite the state bans that followed the supreme court ruling, the number of abortions has actually gone up. at the same time, infant mortality has been on the rise. john yang speaks with the 19th’s reproductive health reporter shefali luthra for more. notice: transcripts are machine and human generated and lightly edited for accuracy. they may contain errors. john yang: reproductive rights are front and center as the presidential campaign enters the home stretch more than two years after anti abortion forces achieved their long held goal of overturning roe versus wade. despite the state bans that followed the supreme court ruling, the number of abortions has actually gone up, even in states with the strictest bans. at the same time, infant mortality rates have been rising. shefali luthra is reproductive health reporter at the 19th, which covers gender politics and policy. she's also the author of "undue burden: life and death decisions in post roe america." shefali i want to start by talking about the issue of abortions. now, the society of family planning, which advocates for reproductive rights, tracks this with a project called we count. and they say that since march 2023, there's been a small but steady increase in abortions, including in 10 of the 13 states with the strictest law. so what's going on here? shefali luthra, the 19th news: what's happening is very interesting, and in some ways not surprising for those of us who've been following the data since roe v. wade was overturned. and what we've seen is this patchwork network has been developed to help people get around abortion bans in their state. the two ways that we're principally seeing people use to get around these bans are one, traveling out of state. so, maybe driving, maybe flying, maybe taking on some credit card debt, taking on immense financial hardship to travel from a place like texas to kansas or illinois or new york to get an abortion. but the other trend that is really important is the rise of telehealth. and so what we are seeing is doctors, largely in states with abortion rights protections and these laws called shield laws. states like new york, massachusetts, california, maine are prescribing and mailing abortion pills to people who live in states with abortion bans. it's very medically safe, it's very effective. you can take these pills at home and terminate your pregnancy, and the doctors are protected as long as they stay in their home states. john yang: just as there are limits on who can travel out of state, who has the money, the resources, the ability to take time off of work, are there limits to telehealth as well? shefali luthra: absolutely. there are issues around who has access to the internet and can find these websites. who knows about websites that will connect you to a doctor that will prescribe pills and mail them to you? do you have an independent bank account that you can use to pay for medication? a lot of minors might not have that resource. we are seeing abortions continue to increase, but we are also seeing inequalities amplify. and some people are finding ways to get around these abortion bans and to continue to access care. and others are being left behind. and the inequalities that always existed are in fact getting bigger and deeper. john yang: you mentioned shield laws. explain what those are. shefali luthra: these are a relatively new legal approach. they're very interesting. and so they exist in a few of these more abortion friendly states. they protect healthcare providers in these states. and they say, if you are in our state and you practice healthcare that is legal here, for instance, providing abortions, even if it is for people in other states, we will protect you from out of state prosecution. we will not comply with efforts to try and bring you to court, bring you to trial. these have been very effective so far because we see doctors taking advantage of shield laws to prescribe and mail abortion pills to people in stays with bands. but they also are relatively new, and there are some questions about will they stand up if they ever meet a legal challenge. if a doctor who has relied on a shield block in, say, massachusetts at some point travels to texas, the protections don't apply once they've left their home state. and so there is a legal risk that i've heard some doctors quite worried about someday affecting them. john yang: let's talk about the infant mortality issue. there have been two papers recently in jama pediatrics that looked at this issue. they say the infant mortality rate has been rising since the supreme court decision, with the most significant increases in babies with congenital abnormalities or birth defects. what does this tell us? shefali luthra: this also shows us something that i think is really important, which is that even as people are getting around abortion bans, many are not. and they are being forced to carry pregnancies to term that in a different world would have been terminated and with congenital abnormalities in particular. many states with abortion bans don't have exceptions for fetal abnormalities. even those that do are quite narrow. they only allow abortions for very, very obviously lethal cases. and so as a result, what we are seeing is people being forced to carry pregnancies to term where they know that they cannot give birth to a baby who will live. we are seeing people have to give birth and watch their children die in front of them because of an abortion ban. and so in florida, for instance, i've spoken to a lot of doctors there about their experience. there was a 15 week ban in florida. they more recently switched to a six week band. and in both scenarios, they saw patients develop these fetal abnormalities and not be able to receive abortions in their states and instead have to travel from florida to the closest option, virginia, for an abortion, if that is what they choose. john yang: taking these two trends together, what does it tell us about post roe america, not only in health care, but in politics? because in florida, for instance, the abortion ban is on the ballot. shefali luthra: what this shows us is how personal and how essential abortion as an issue is for a lot of american voters and especially a lot of women and people who can get pregnant. the data showing that abortions went up underscores that people are going to remarkable lengths to try and get abortions. the data around infant mortality shows that people who cannot get around these bans are suffering really intense emotional and in some cases financial harm as well because some of them actually have medical debt after they give birth. and they help us understand, i think, why this is such a critical issue for so many americans. it is so personal, so ubiquitous and so essential as we think about where the election will take us. john yang: shefali luthra, the 19th thank you very much. shefali luthra: thank you for having me. watch the full episode nov 03 by ali rogin, claire mufson, kaisha young, satvi sunkara nov 03 john yang john yang john yang is the anchor of pbs news weekend and a correspondent for the pbs news hour. he covered the first year of the trump administration and is currently reporting on major national issues from washington, dc, and across the country. andrew corkery andrew corkery andrew corkery is a national affairs producer at pbs news weekend. harry zahn harry zahn support provided by: learn more thank you. please check your inbox to confirm. © 1996   2025 newshour productions llc. all rights reserved. pbs is a 501(c)(3) not for profit organization. sections about stay connected thank you. please check your inbox to confirm. learn more about friends of the news hour. support for news hour provided by

uplift has completed its groundbreaking pharmacist abortion access project (paap) pilot   the first model for pharmacists to directly prescribe medication abortion to individuals in washington state who need it  a model that can be adopted in other states! read the nytimes article > new york times, june 24, 2024 two years after roe was struck down, the conversation has focused on the complications that can come with pregnancy and fertility, helping to drive more support for abortion rights. that shift helps explain why a record percentage of americans are now declaring themselves single issue voters on abortion rights   especially among black voters, democrats, women and those ages 18 to 29. read more this site is protected by recaptcha and the google privacy policy and terms of service apply.

an official website of the united states government official websites use .gov a .gov website belongs to an official government organization in the united states. secure .gov websites use https a lock ( lock locked padlock icon ) or https:// means you've safely connected to the .gov website. share sensitive information only on official, secure websites. primary site navigation logged in as: correspondence , julian savulescu, oxford uehiro centre for practical ethics, university of oxford, oxford, ox1 1pt, uk. email: julian.savulescu@philosophy.ox.ac.uk corresponding author. issue date 2022 may. this is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ license, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. what is already known? the texas heartbeat act, which has been in effect since september 2021, prohibits abortions once a ‘fetal heartbeat’ is detected, except in emergency situations. the law significantly limits access to abortion services in texas, by essentially prohibiting abortions post 6 weeks' gestation. the law has been subjected to several legal challenges, none of which have been successful to date. what does this article add? this article provides an overview of some of the ethical concerns the law raises and identifies some of the problems the law creates for women, the health profession and society. the article ultimately argues that the law ought to be quashed. the ‘texas heartbeat act’ found in the texas health & safety code (§§ 171.201 171.212), hereafter referred to as ‘the act’, prohibits abortions once a ‘fetal heartbeat’ is detected, except in emergency situations. emergency situations are limited to “a life‐threatening physical condition aggravated by, caused by, or arising from a pregnancy that, as certified by a physician, places the woman in danger of death or a serious risk of substantial impairment of a major bodily function unless an abortion is performed” (§171.002). the law makes no exceptions for pregnancies resulting from rape or incest. what makes the law unique is that it is enforced exclusively by the actions of private citizens bringing civil lawsuits rather than being directly enforced by the state. this means any person, other than an officer or employee of a state or local governmental entity, can bring a case against any person who “performs or induces an abortion” or any person who “aids or abets the performance or inducement of an abortion” once a ‘fetal heartbeat’ is detected (§171.208). while the woman seeking an abortion cannot be sued, the act's framing is so broad it could potentially impact health professionals, reception staff at a healthcare clinic, family members and friends who counsel the woman, and uber drivers who drive women to abortion clinics. furthermore, the person suing does not need to show any connection to those they are suing, and if they are successful, they will receive a minimum of $10,000 (us dollars) and have their legal fees covered. to date, 13 us states have enacted ‘heartbeat laws’. 1 until now, all these laws have been struck down by state supreme courts and the us supreme court. 2 according to evans and narasimhan, us fetal heartbeat bills have increasingly become the anti‐abortion legislative measure of choice, since they were first introduced in 2011. 3 the legislative models adopted by other states were framed in a way which would allow individuals to sue state officials for enforcing an unconstitutional law because these laws directly challenged the federal protection under roe v wade, which recognizes the right of a woman to choose to have an abortion up to fetal viability as part of the constitutional right to privacy. 4 the texas law, however, adopts a different framing. the ‘clever’ drafting of the act and privatization of enforcement means that judicial review can be evaded 1 and state officials are shielded from being sued for violating the constitution, which arguably makes the law more durable and difficult to challenge. 5 , 6 the law was passed in may 2021, and was signed by texas governor, greg abbott (republican), who said: “our creator endowed us with the right to life and yet millions of children lose their right to life every year because of abortion. in texas, we work to save those lives.” 7 the day before the ban came into effect many women raced against the clock to secure an abortion. one abortion clinic reportedly performed 67 abortions in 17 h to beat the new ban. 8 in a midnight ruling on 1 september, 2021, just prior to when the act was due to come into force, the us supreme court refused to block the legislation, despite appeals from reproductive rights organizations, civil rights organizations, and abortion clinics. 9 the supreme court's 5‐4 decision reflected its newly conservative leaning shaped by former president donald trump. 9 the supreme court claimed that it was not ruling on the constitutionality of the texas law, but was allowing it to go ahead because of complex legal and procedural questions. 9 the act came into effect on 1 september, 2021. following its introduction, there have been several legal challenges; however, no challenge has been successful to date. 10 in december 2021, the us supreme court left the door open for future challenges in lower courts on narrow grounds, which was subsequently shut down by the texas supreme court in march 2022. 11 in the act, fetal heartbeat is defined as “cardiac activity or the steady and repetitive rhythmic contraction of the fetal heart within the gestational sac” (§171.201). such cardiac activity can be detected as early as 6 weeks.1at the core of the act is the idea that as soon as a fetal heartbeat can be detected, the fetus should be considered a person and afforded rights and protections. 12 the sound of the heartbeat is thought to define humanity and therefore justifies a protection of rights. 12 these sentiments are echoed in the legislature findings of the act: §171.202 legislative findings. the legislature finds, according to contemporary medical research, that: fetal heartbeat has become a key medical predictor that an unborn child will reach live birth; cardiac activity begins at a biologically identifiable moment in time, normally when the fetal heart is formed in the gestational sac; texas has compelling interests from the outset of a woman's pregnancy in protecting the health of the woman and the life of the unborn child; and to make an informed choice about whether to continue her pregnancy, the pregnant woman has a compelling interest in knowing the likelihood of her unborn child surviving to full‐term birth based on the presence of cardiac activity. however, the use of ‘heartbeat’ in the act is contested and misleading. medical and reproductive health experts argue that referring to a ‘heartbeat’ is medically inaccurate, as the embryo does not have a developed heart at 6 weeks' gestation. 13 the presence of cardiac activity is not equivalent to the presence of a functioning heart or heartbeat, which is defined as the pulsation of the heart. 3 according to dr jen gunter (canadian gynecologist): 14 “an embryo does not have a heart   at least, not what we understand a human heart to be, with pumping tubes and ventricles. at six weeks, a human embryo throbs, but those tissues have not yet formed an organ, so the pulsing should not be confused with a heartbeat.” heartbeat laws have been argued to result in “unjustified asymmetry” as they fail to accommodate health professionals “who may find themselves deeply morally opposed to such legislation, believing that they cannot, in good conscience, deny providing an abortion to a woman who requests it, even after a heartbeat is detected”. 15 such health professionals believe they have a positive obligation to provide abortions for conscience reasons. indeed, this played out days after the law was introduced, with a texas doctor, dr alan braid, publicly admitting in an op‐ed piece in the washington post that he violated the texas law. 16 he wrote: “[o]n the morning of sept. 6, i provided an abortion to a woman who, though still in her first trimester, was beyond the state's new limit. i acted because i had a duty of care to this patient, as i do for all patients, and because she has a fundamental right to receive this care … i fully understood that there could be legal consequences   but i wanted to make sure that texas didn't get away with its bid to prevent this blatantly unconstitutional law from being tested.” dr braid was subsequently sued by two plaintiffs, neither of whom were anti‐abortion, but both decided to sue so the law’s legality could be tested. 17 in addition to the ethical concerns the act raises, which is discussed in the next section, the act is problematic for several other reasons including its ability to: undermine a woman's autonomy to decide whether to proceed with a pregnancy beyond a narrow gestational limit; deny access to an in‐demand and evidence‐based health service; increase the likelihood of self‐managed abortions; lead to intimidation through establishing a vigilante system; and undermine medical expertise. the act undermines women's autonomy and their right to make decisions about their own sexual and reproductive health, by denying them the ability to make a choice about whether to proceed with a pregnancy, which most women at 6 weeks' gestation are unlikely to be aware of. 1 even if a woman is aware of the pregnancy, abortion appointments may not be available for several days or weeks at abortion clinics. 18 as such, even women who seek care early in pregnancy may not be able to obtain a lawful abortion within the permissible gestational limits due to inadvertent delays. six weeks' gestation also means that women are not able to undertake screening tests for fetal abnormalities and are therefore denied the opportunity to make informed medical decisions. as indicated by a statement provided by the president of the american society of human genetics: “the law denies women and their families the ability to use health information stemming from human genetics research by prohibiting abortion after detection of a fetal heartbeat … because many devasting diagnoses can only be determined later in fetal development … [the texas law] will prevent women and families from using genetic information to inform reproductive decisions.” 19 while the use of prenatal screening and selective abortion is still viewed by some as being ethically contentious, it is more widely viewed as an essential part of reproductive or procreative autonomy or liberty. 20 some commentators have argued that abortion can reduce potential harm to the unborn child, if the pregnancy would result in a child being born with severe structural defects or a severe genetic abnormality. in such cases, abortion is believed to prevent the unnecessary suffering of the child and its family, and is supported by the principle of non‐maleficence. 21 gillam argues that in the special circumstance of fetal abnormality, consideration of the quality of life of the child‐to‐be could justify selective abortion when one accounts for the effects of the disability and compares the quality of life of the child‐to‐be with a non‐disabled child. 22 similarly, savulescu argues that there is a moral reason to have a child who is less likely to suffer a genetic condition predicted to reduce that child's health and wellbeing. 23 women are also strongly in favor of access to genetic testing and selective abortion. research carried out with women who underwent abortions due to fetal abnormality found that, although women have a choice in such cases, they typically felt like they had no choice. 24 the study reported that women would proceed with the abortion out of compassion, in order to spare a child of a life of suffering. 24 in relation to major fetal abnormalities, research has found that even women who consider themselves to be anti‐choice re‐evaluate their in‐principle opposition to abortion. 25 not only does the texas law undermine women's autonomy, it also limits access to medical care that is evidence‐based and inhibits the delivery of safe, timely and necessary comprehensive care. 26 as claimed by the president of the american medical association: 27 “this new law is a direct attack on the practice of medicine and patient reproductive health outcomes. as physicians and leaders in medicine, we urge our nation's highest court to take action immediately … [f]ailure to do so places physicians' clinical judgement and patient access to safe care in dire peril.” prior to the act's introduction, an estimated 55,000 abortions were performed each year in texas. 28 the number of abortions performed have greatly reduced since the act's introduction. the first month in which the law was in force saw a 60% decline in abortions performed in texas. 29 the impact of the act is particularly profound for vulnerable and marginalized populations. indeed, some commentators have argued that the law “disproportionately affects black, hispanic, and women on low incomes, who already face obstacles to [health care].” 7 such a claim is supported by empirical evidence which has found that patients obtaining second‐trimester abortions in texas were more likely to be black, on low incomes, and required to travel long distances to obtain in‐clinic care. 30 given the restrictive nature of the law, the only way women will now be able to access an abortion will be to travel out of texas. commentators have predicted that the closure of texas abortion clinics will increase the average driving distance to a clinic from 19 to 399 km. 31 due to financial constraints, many women will be unable to travel, and hence will be denied access to abortion services. moreover, even if women can afford to travel, there is no guarantee they will be able to secure an abortion in other states. indeed, neighboring states' reproductive health clinics have experienced a flooding of patients following the commencement of the act, which has raised concerns that clinics in neighboring states will not be able to absorb all the new patients. 28 the restrictive texas law may also increase the likelihood of women seeking to self‐manage their abortion rather than seeking medical assistance, resulting in unsafe abortion procedures. the prevalence of unsafe abortion remains the highest in jurisdictions which have the most restrictive abortions laws and/or policies. 32 making abortion legal, safe, and accessible does not appreciably increase abortion demand; it reduces clandestine and unsafe abortion procedures and results in legal and safe ones. 32 unsafe abortion procedures may result in medical complications and abortion‐related mortality. 32 importantly, not all self‐managed abortions will necessarily be unsafe. contemporary reports of self‐management in the us found that a lot of the self‐managed abortions are not necessarily the product of the use of sharp objects or back‐alley providers, but rather medications such as mifepristone and misoprostol. 33 this is believed to parallel with the rise of the internet being the ‘go‐to source for information and services’. 33 previous research has found that medical abortion is quite common amongst the texas population, partly due to the close proximity with the mexican border, where medical abortion can more easily be obtained due to its large immigration population from latin america (who tend to be familiar with self‐managed abortion and navigating restrictive abortion laws). 34 at the time of its introduction, it was predicted that the texas law would increase the number of women seeking to self‐induce abortions using pills obtained by mail. 31 due to such a threat, the texas governor signed a separate bill (sb4 bill) on september 17, 2021 which came into effect on december 2, 2021. 35 the new law narrows the window in which physicians are allowed to give an abortion‐inducing medication to 7 weeks, which also covers medication sent by courier, delivery or mail service. violations of the law are punishable by up to 2 years in prison and a fine of up to $10,000 (us dollars). 35 another issue with the act is that by enabling private enforcement, it incentivizes strangers to spy on women 36 and encourages vigilante justice. 37 some commentators have expressed concern that the act could increase the legal risk for health professionals and expose them to frivolous lawsuits, 38 given the act essentially creates a pathway for litigation that serves to intimidate and dissuade medical practitioners from providing patients with the medical care they need. 39 such apprehension was reflected in a joint statement made by leading american physician groups: “physicians must be able to practice medicine that is informed by their years of medical education, training, experience, and the available evidence, freely and without threat of punishment, harassment, or retribution.” 26 the overhanging threat of litigation that results from the act is also problematic as it may discourage health professionals from acting in accordance with clinical standards and undermine their medical expertise. for example, in clinical presentations such as cardiomyopathy, lupus and nephrotic syndrome, 40 where there is an increased risk of maternal morbidity or morality, but at the time of diagnosis the woman may not be considered to be in imminent danger, health professionals may be reluctant to terminate the pregnancy out of fear that such a decision could be scrutinized in court due to ambiguity around whether such a scenario would fall within the ambit of the medical emergency exception. 40 similarly, it has been argued that the law ignores medical conditions that are common indications for termination such as fetal reduction for some cases of severe twin‐twin transfusion syndrome, or pre‐viable premature rupture of membranes when the decision to terminate the pregnancy before the woman is severely ill and at imminent risk of dying from sepsis could be subjected to a legal challenge. 40 accordingly, the law's narrow framing, and the degree of ambiguity it creates, has the potential to impinge on clinical decision‐making and compromise the health professionals ability to act in the best interests of the woman. according to one proponent, senator bryan hughes: “the heartbeat is the universal sign of life … [i]f a texan's heartbeat is detected, his or her life will be protected.” 13 there are two kinds of termination of pregnancy: (1) medical; (2) social. medical terminations of pregnancy are performed either to protect the medical interests of the woman or to prevent the fetus going on to live a life which is not in its interests, that is, a life not worth living because of a disorder which is severe. the law gives some consideration of the severe threat to maternal medical interests, but no consideration of termination in the case of severe fetal abnormality. while it is hard to draw the line at which life becomes no longer worth living, there is a general consensus that some fetal abnormalities such as anencephaly, severe epidermolysis bullosa or lesch‐nyhan syndrome may make life so devoid of positive experience as to be not worth living. 41 social terminations are performed to respect the autonomy of the woman or promote her wider interests or well‐being. at the heart of this law is the vexed question of when a human organism acquires a right to life and special protection in law. the most rigorous analysis of the ethics of abortion is jeff mcmahan's ‘the ethics of killing: problems at the margins of life’. 42 mcmahan's view is that a human being does not acquire a moral status until some higher form of consciousness begins after birth. 42 this entails the permissibility of certain forms of infanticide. 43 most liberal legal jurisdictions are based on the view that the fetus does not acquire moral status until birth, or at least the woman's interests and autonomy outweigh any moral status until that point. such a view of moral status allows early and late abortion. we cannot settle the issue of fetal moral status or the ethics of abortion in this short commentary. what we aim to show in this section is that there is no plausible ethical account of moral status that supports the texas law. we consider 3: (a) consciousness‐based accounts, (b) potentiality accounts; and (c) gradualist accounts. consciousness‐based accounts of moral status the law itself is careful to try to avoid this issue directly, by arguing that the presence of a fetal heartbeat indicates a high chance that the baby will go on to be born alive. but this begs the question around moral status: is being born alive what matters? an anencephalic baby can be born alive, only to die soon after birth. even if the means were available to keep an anencephalic baby alive indefinitely, most people would argue that such a life should not be prolonged because of the total lack of consciousness, or anything of value in human life. modern technology can identify that an embryo is alive and developing. there are more and more predictors of the probability of normal development and birth, such as whole genome analysis and artificial intelligence assisted selection of embryos when in vitro fertilization is performed. 44 but it is not mere probability of survival that matters; it is something distinctive about human life that accords it special significance and rights. one way to address when moral status begins is to ask when does it end? if we look to the other end of life   death   we gain one insight into what matters. 45 over 50 years ago, most countries moved from a cardiorespiratory definition of death to a brain death definition. it is not the presence of a heartbeat that matters, but the presence of brain function. indeed, some have even called for a move from whole brain or brainstem death to neocortical death   the complete lack of consciousness. while no country has adopted a neocortical definition of death, many jurisdictions allow the withholding or withdrawing of life‐prolonging medical treatment if a patient is permanently unconscious. as was reasoned in the landmark uk case of airedale national health service trust v bland (which has been widely applied), prolonging life by administering treatment that is futile (such as when a person is unconscious with no chance of improving) cannot be in the patient's best interests, and withholding and withdrawing treatment in such cases would be lawful. 46 so, if our life, our biography as james rachels put it, 47 ends when we become unconscious permanently, it begins when we become conscious. consciousness depends on the activation of the cortex by thalamocortical connections around 24 weeks after conception. 48 indeed, some philosophers such as jeff mcmahan, 42 peter singer 49 and michael tooley 50 have argued, it is not mere consciousness that matters, but high levels of consciousness such as self‐consciousness or rational/moral capacities, which do not commence until after birth. this would allow late abortion (and infanticide). 43 potentiality accounts of moral status the main argument against such views of moral status which allow abortion is the argument that the embryo and fetus prior to consciousness have the capacity or potential to lead a full human life with self‐consciousness and advanced cognitive capacities. there are arguments for and against potentiality as a ground for moral status. 51 , 52 the most prominent argument against it is that a potential x does not have the same rights as an actual x: a potential king of england does not have the same rights as an actual king. but even if the potentiality argument were to succeed, it would not support the texas law as the embryo from the moment of conception has the potential to be a person. potentiality might justify a complete ban, but not a heartbeat law. the approach taken in the legislation is to argue that the probability of personhood increases with the presence of a heartbeat. but the mere increase in chance of being born alive does not affect potentiality or moral status. we do not say that a person with terminal condition that cannot be treated has no right to life. they do have a right to life   we just cannot satisfy it. they have moral status because they are a person; the fetus does not yet have moral status because it is not yet a person. gradualist accounts of moral status the most popular view of moral status amongst the lay public is that the fetus gradually acquires increasing moral status during pregnancy, meaning that abortion at advanced gestations requires much stronger justification. this account will not support the texas law. even if one does accord some (or even full) moral status to the early fetus, this must be weighed against the interests and autonomy of the pregnant woman. 53 as we have argued, the law represents a severe threat to both the health and autonomy of women. the texas law is a bare faced attempt to introduce anti‐abortion laws with a flimsy, or actually non‐existent, argument that will harm women, the health profession and society. it is problematic and unethical, and ought to be quashed. julian savulescu is a partner investigator on an australian research council grant lp190100841 which involves industry partnership from illumina. he does not personally receive any funds from illumina. julian savulescu is a bioethics committee consultant for bayer. this research was funded in whole, or in part, by the wellcome trust [grant number wt203132/z/16/z]. for the purpose of open access, the author has applied a cc by public copyright license to any author accepted manuscript version arising from this submission. julian savulescu, through his involvement with the murdoch children's research institute, received funding from the victorian state government through the operational infrastructure support program. julian savulescu and louise anne keogh also received funding from an australian research council discovery grant (grant number dp210102916). n/a. this section collects any data citations, data availability statements, or supplementary materials included in this article. n/a. articles from prenatal diagnosis are provided here courtesy of wiley connect with nlm national library of medicine 8600 rockville pike bethesda, md 20894

women had to wait until they were sick enough to get care in their home states. denton, texas and new york    this is part i of a three part abc news investigation looking at the impact of abortion restrictions in america after the u.s. supreme court overturned roe v. wade in june 2022. the companion broadcast, "impact by nightline: on the brink," with exclusive interviews by diane sawyer and rachel scott, brings you inside the hidden health care crisis playing out in clinics and exam rooms across the country. so many families posing the question: is this what lawmakers intended? "on the brink" premieres dec. 14 on hulu. anya cook had reason to celebrate. after 17 miscarriages, she was pregnant again, in her second trimester, and she and her husband, derick, were ready to share the good news with family and friends. after the joyous announcement in december 2022, anya and derick attended the coral springs holiday parade in their florida neighborhood, then went to dinner at a local restaurant. it was a good end to a good day. then joy turned to misery. cook was in the restaurant parking lot when she says she thought she got soaked by someone throwing water at her. "i literally reached down and put my hand between my legs, and i saw that it was drenched with clear fluid. never in my wildest dreams did i even think that that was my amniotic fluid that was leaking out of me. i still was convinced that someone threw something on me, up until derick turned me around and said 'babe, there is no one here,'" cook told abc news in an interview. "i messaged one of my friends who is a labor and delivery nurse all the way across the country, and she's like 'you need to get to labor and delivery right now.' and i literally looked at derick and said, 'something is wrong. this shouldn't be happening,'" cook said. the couple immediately drove to a hospital, where cook says her amniotic fluid was dripping onto the floor as she waited to be seen by a doctor. what happened to cook's pregnancy is not an uncommon complication; the doctor diagnosed her with pprom    preterm premature rupture of membranes    when a pregnant woman's water breaks before the pregnancy is viable. at her stage of pregnancy, doctors said there was nothing they could do to save the fetus. left without care, doctors say the mother's health could be in danger as well. however, cook's medical care now hinged on florida's 15 week abortion ban, which went into effect in july 2022 after roe v. wade was overturned. cook was already more than 15 weeks pregnant. had she lived in a state without restrictions on abortion care, she would have been admitted, counseled and offered an induction of labor to protect her from infection    which in this case would be considered abortion care. but cook said she was discharged from the emergency room because she was not yet sick enough to qualify for the emergency medical exception in florida's law, despite her risk for infection and hemorrhage. cook, who would later find herself on the brink of death, is not alone in her harrowing experience as similar stories emerge from women around the country, abc news has found. abc news' diane sawyer and rachel scott report on pregnant women with high risk pregnancies in states that have enforced their own laws since the supreme court overturned roe v. wade. at least 16 states have ceased nearly all abortion services in the wake of the supreme court decision in dobbs v. jackson in june 2022, which overturned roe v. wade    ending federal protections for abortion rights. the landmark ruling left it up to each state to regulate the procedure. this has led to an increase in dangerous life threatening situations like cook's, according to doctors and patients, and sparked a round of lawsuits in states like florida and texas challenging the bans. according to new data from the guttmacher institute, 92,100 patients traveled across state lines for abortion care in the first six months of 2023. but guttmacher researchers told abc news this doesn't take into account patients who were unable to travel for care. many barriers can stand in the way of women needing to access abortion care; it can cost thousands of dollars to get care out of state, especially further along in pregnancy. in a months long project, abc news brought together 18 women from across 10 states who say their medical care was impacted by abortion bans    bringing several of them to the brink of death. all these women had wanted their pregnancies and none of them had initially sought abortion care. these women said they have been turned away in medical emergencies for not being sick enough, had their health care delayed or denied due to state laws and been told they have to continue their pregnancies despite devastating, fatal diagnoses for their babies    even if their pregnancies put their own lives at risk. the women detailed how they were left to grapple with medical emergencies and devastating fetal anomalies, while physicians were unsure what care    or even medical advice    they could legally provide. their stories paint a picture of women being caught in the middle of the political battle over the issue of abortion, putting their lives at risk due to    what physicians say    are unclear laws. each woman has a different story to tell, shedding light on the reality of reproductive health care in the post roe era and the consequences women are facing due to abortion bans. abc news also highlights the challenges doctors are facing as they and the facilities where they work struggle to provide care for the patients without running afoul with their states' abortion laws. the penalties for performing an illegal abortion vary depending upon the state, but can include loss of medical license, life in prison and up to $100,000 in fines. even in states with bans that have exceptions for medical emergencies, or to save the life of the mother, the language in the laws continue to confuse doctors and their patients, according to the nearly 100 doctors from states with restrictions abc news interviewed over the last several months. doctors said they are at legal risk for practicing the standard of care they were trained to do, and the laws leave it unclear how sick a patient needs to be before doctors can intervene. two years into their marriage, kristen anaya and her husband, stephen, went to a fertility specialist hoping to get pregnant. after undergoing medical procedures and two rounds of egg retrievals for in vitro fertilization, the couple was told they had one embryo. days after the embryo was implanted in january 2023, the texas couple was elated to find out anaya was pregnant. during the first four months of her pregnancy, anaya said she didn't have any issues    until her water broke in april. anaya said she lost a significant amount of fluid in the next hour. an ultrasound showed that anaya had lost nearly all her amniotic fluid. "i felt like it was a dumb question, but i also wanted to ask it: there's no synthetic fluid that can be put in the womb and stitched back up?" anaya told abc news in an interview. "i wanted to understand, from a science perspective, there's literally nothing they can do once you've lost your fluid? and [my doctor] confirmed 'no, there's nothing,'" anaya said. she had pprom, like cook, and her medical care was delayed and put on hold due to texas laws which prohibit nearly all abortion care. while the texas ban has an exception to save the life of the mother, physicians and lawyers say that the exception is unclear and has in practice resulted in care only being provided in severe cases. anaya and her husband were in a gut wrenching position    the fetus' heart was still beating, but couldn't be saved. the couple said they didn't have time to mourn their daughter, who they named tylee, who they had fought so hard to conceive. anaya's doctor told her that their hands were tied until anaya was much sicker    sick enough for them to intervene. elizabeth weller, 27, and her husband were excited when she got pregnant in the beginning of 2022. they also live in texas and had just started trying for a baby. when her water broke at 19 weeks of pregnancy, she rushed to the emergency room where she was also diagnosed with pprom. when weller felt she was not getting enough information about her health, she called her ob gyn who explained that the baby was not viable at 19 weeks and had no chance of survival, like cook and anaya's babies. weller's health was also now at risk. weller's physician requested an abortion from the hospital's medical board but she was denied because weller wasn't sick enough yet. she had been started on antibiotics and her vitals were stable. and her fetus still had a heartbeat. a nurse told weller she had to wait until she was showing signs of a worsening infection before she could be approved for the termination of her pregnancy, telling her the symptoms of a serious infection would include vaginal discharge that released a strong odor. "it has to be so strong that you can smell it in a room and wretch, that's what they said; that's what they were looking for," weller said. "when i took that sample, i smelled it and almost threw up and went, 'oh there it is, that's the key to me saving my life,'" weller said. cook, anaya and weller all faced the serious, deadly risk of developing sepsis if left untreated, but still they had to wait until they got sicker before doctors could intervene due to their states' restrictions on abortion. "we are medical refugees    in the united states," weller said. kristina cruickshank was getting sicker by the day. cruickshank learned at 15 weeks that her pregnancy was not a formed fetus. she had a partial molar pregnancy    when one egg is fertilized by two sperm. her pregnancy would never develop into a child. but cruickshank, who also lives in texas, was not initially admitted to a hospital. "my baby was not viable from the moment it was conceived. i was becoming increasingly very sick    i was throwing up numerous times every day, i developed hyperthyroidism, i could barely walk because my abdominal pain was so severe and i learned i had enlarged ovaries and cysts around both ovaries," cruickshank said. "at my next appointment, a different doctor realized just how sick i was and admitted me to the hospital right then," cruickshank said. left untreated, partial molar pregnancies can cause cancer. the treatment is immediate termination. "it can develop into cancer if all of the molar tissue doesn't get removed from inside. you would have to do chemotherapy or a hysterectomy," cruickshank said. at the hospital and in pain, cruickshank said she waited. she said there were no physicians at that hospital trained to do a dilation and evacuation procedure, which doctors say is the standard of care to terminate a partial molar pregnancy. "they didn't know what to do with me, frankly," cruickshank said. "it was the weekend, and they were trying to convene the ethics committee, but they didn't want to convene and it was just going around in circles," cruickshank said. in any other state, cruickshank would have been given an immediate termination, but in texas her physician spent three days trying to find a hospital to take her case. in response to the changing legal landscape for abortion, hospitals throughout states with abortion bans have created termination boards that need to approve any abortion care before it is provided to patients. this sometimes leaves women waiting for many hours or days to get care they need. many of the women interviewed by abc news needed approvals from the boards, usually made up of physicians and lawyers, despite being in medical emergencies. for women interviewed by abc news, getting medical care    that would have been available to them under roe    turned into harrowing journeys of confusion, loss and grief. after three days of waiting in the hospital in pain, cruickshank's ob gyn found a different hospital that agreed to treat her. she now has regular follow up appointments to check for evidence of cancer. anaya, who went to the hospital after talking to her doctor, had to wait for nearly 24 hours before she was given lifesaving care, with her doctors knowing that her daughter had "no way of living" after her water broke. "in what world does that make any sense    to prevent health care for me. what about my life?" anaya said. according to medical records, anaya's doctor initiated contact with the hospital's termination committee when she was admitted    her doctors would need to be able to prove to the hospital's ethics board and medical board that her life was in danger. over the next 22 hours the physician would regularly conduct blood tests and exams that they would send to the committees to document her health declining. "they were going to be monitoring me, doing bloodwork every three hours, monitoring my vitals and 'building a case' to prove that my life was in great danger and they needed to induce labor," she said. during that time anaya developed sepsis, suffering a high fever, uncontrollable shaking and vomiting at least eight times. "our doctor, our nurses were crying at my bedside    wishing they could do something with blank stares on their faces because they literally couldn't do anything until the bloodwork showed that i was dying," anaya said. anaya told abc news that she suffered body aches for a week after she was discharged because of how much she was shaking. anaya recently joined an ongoing lawsuit filed by women against the state of texas    saying its bans put their lives in danger    that is awaiting a ruling from the state supreme court. anaya and her husband are still going through fertility treatment and exploring all their options. since losing tylee, the couple have had one unsuccessful egg retrieval    anaya had 28 eggs but none of them developed into an embryo. they have a surrogate medically cleared and are waiting to have an embryo. weller kept looking for signs of an infection for three days    all while vomiting constantly and experiencing pain. she continued to leak amniotic fluid. she went back for another ultrasound, but her fetus still had a heartbeat, although it would not survive. on her way out of her doctor's office, weller experienced another gush of liquid that was yellow and had a strong odor. she took a sample of her discharge. she was admitted to the hospital that night    where she showed the sample    and was diagnosed with chorioamnionitis, an infection of the amniotic fluid and tissue surrounding the fetus. a medical board approved her abortion. as anya cook sat in the hospital waiting room, she could feel her dream of becoming a mother slipping away. "i could not believe that this was happening to me," cook said. "i fought hard for this pregnancy. no one chooses the route of ivf and thinks that it is going to be an exciting, happy time. it is hard, it is strenuous, it's tedious, it takes a real toll on your body and your mental health. so, i couldn't even think of the fact that i was losing my daughter," cook said. despite her pprom diagnosis, cook says the doctor told her that he was at risk himself    of losing his medical license or even getting arrested    and the hospital in trouble if he admitted her for abortion care because of florida's laws. at that point, cook's baby still had a heartbeat and was moving around inside her. but cook said the doctors gave her antibiotics, and discharged her from the emergency room, telling her to return immediately if her symptoms worsened. when she realized that the hospital would not provide further care at that point and that she faced increased risk of harm, cook said she was convinced she was not going to survive. cook said she kept a hair appointment she had scheduled for the next day because she didn't want her mother to worry about getting her hair done after she died. at the salon, cook went to the restroom, where she proceeded to deliver her baby over a toilet bowl. "i heard my daughter hit the toilet," cook said. she called her husband and told him to come look because she couldn't do it. a nurse, who was in the hair salon by coincidence, told cook she was losing a lot of blood. at the hospital, the couple was told cook would need a dilation and curettage procedure    commonly known as a d&c    the surgical removal of the lining of the uterus. but there were complications, it took longer than expected and a special team was brought in to perform the surgery. cook lost a life threatening amount of blood. she had hemorrhaged to the point that she was put on a ventilator that was breathing for her at 100%. cook was later told that her placenta had likely embedded itself into the wall of her uterus, a condition called placenta previa, which had caused excessive bleeding when she tried to deliver the placenta in the bathroom of the hair salon. "had that happened at the hospital the first night, they would have taken care of it that night. it would have been a physician delivering the placenta and not my husband having to play doctor," cook said. read part ii in the series here.
supported by two years after roe was struck down, the conversation has focused on the complications that can come with pregnancy and fertility, helping to drive more support for abortion rights. by kate zernike in the decades that roe v. wade was the law of the land, abortion rights groups tried to shore up support for it by declaring “abortion is health care.” only now, two years after the supreme court eliminated the constitutional right to abortion, and just six months before the presidential election, has the slogan taken on the force of reality. the public conversation about abortion has grown into one about the complexities of pregnancy and reproduction, as the consequences of bans have played out in the news. the question is no longer just whether you can get an abortion, but also, can you get one if pregnancy complications put you in septic shock? can you find an obstetrician when so many are leaving states with bans? if you miscarry, will the hospital send you home to bleed? can you and your partner do in vitro fertilization? that shift helps explain why a record percentage of americans are now declaring themselves single issue voters on abortion rights   especially among black voters, democrats, women and those ages 18 to 29. republican women are increasingly saying their party’s opposition to abortion is too extreme, and democrats are running on the issue after years of running away from it. “when the dobbs case came down, i told my friends   somewhat but not entirely in jest   that america was about to be exposed to a lengthy seminar on obstetrics,” said elaine kamarck, a fellow at the brookings institution, referring to the supreme court decision that overturned roe v. wade. abortion opponents say that stories about women facing medical complications are overblown and that women who truly need abortions for medical reasons have been able to get them under exceptions to the bans.

share this via facebook share this via x share this via whatsapp share this via email more sharing options share this via linkedin share this via reddit share this via telegram share this via printer share this via bluesky i. executive summary ii. factual background a. women’s lives and health on the line b. penalizing healthcare: criminalization, civil liability, and involuntary confinement c. threats to privacy from increased digital surveillance d. freedom of thought, conscience and religion or belief e. disproportionate impact on marginalized populations iii. anti abortion legislation violates international law iv. conclusion and calls to action i. executive summary following the united states (us) supreme court decision in dobbs v. jackson women’s health organization in june 2022, people in the us who can become pregnant[1] are facing an unprecedented human rights crisis. in dobbs, the supreme court overturned the constitutionally protected right to access abortion, leaving the question of whether and how to regulate abortion to individual states. approximately 22 million women and girls of reproductive age in the us now live in states where abortion access is heavily restricted, and often totally inaccessible. this briefing paper details the intensifying human rights emergency caused by the decision, and discusses the ways that dobbs contravenes the us’ international human rights obligations. the consequences of the dobbs decision are wide ranging. restrictions on access to healthcare places women’s lives and health at risk, leading to increased maternal mortality and morbidity, a climate of fear among healthcare providers, and reduced access to all forms of care. dobbs also enables penalization and criminalization of healthcare, with providers, patients, and third parties at risk of prosecution or civil suit for their involvement in private healthcare decisions.