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Yahoo
13-02-2025
- Health
- Yahoo
Republican states claim zero abortions. A red-state doctor calls that ‘ludicrous.'
(Oona Zenda/KFF Health News) This article first appeared on KFF Health News. In Arkansas, state health officials announced a stunning statistic for 2023: The total number of abortions in the state, where some 1.5 million women live, was zero. In South Dakota, too, official records show zero abortions that year. And in Idaho, home to abortion battles that have recently made their way to the U.S. Supreme Court, the official number of recorded abortions was just five. In nearly a dozen states with total or near-total abortion bans, government officials claimed that zero or very few abortions occurred in 2023, the first full year after the Supreme Court eliminated federal abortion rights. Those statistics, the most recent available and published in government records, have been celebrated by anti-abortion activists. Medical professionals say such accounts are not only untrue but also fundamentally dishonest. 'To say there are no abortions going on in South Dakota is ludicrous,' said Amy Kelley, an OB-GYN in Sioux Falls, South Dakota, citing female patients who have come to her hospital after taking abortion pills or to have medical procedures meant to prevent death or end nonviable pregnancies. 'I can think of five off the top of my head that I dealt with,' she said, 'and I have 15 partners.' For some data scientists, these statistics also suggest a troubling trend: the potential politicization of vital statistics. 'It's so clinically dishonest,' said Ushma Upadhyay, a public health scientist at the University of California, San Francisco, who co-chairs WeCount, an academic research effort that has kept a tally of the number of abortions nationwide since April 2022. The zeroing out is statistically unlikely, Upadhyay said, and also runs counter to the reality that pregnancy 'comes with many risks and in many cases emergency abortion care will be needed.' 'We know they are sometimes necessary to save the pregnant person's life,' she said, 'so I do hope there are abortions occurring in South Dakota.' State officials reported a sharp decline in the official number of abortions after the Supreme Court overturned Roe v. Wade in June 2022. Arkansas reported zero abortions in 2023, compared with 1,621 in 2022. Texas reported 60 in 2023, after reporting 50,783 abortions in the state in 2021. Idaho reported five in 2023 compared with 1,553 in 2021. South Dakota, which had severely restricted abortions years ahead of the Dobbs ruling, reported zero in 2023 compared with 192 abortions in 2021. Anti-abortion politicians and activists have cited these statistics to bolster their claims that their decades-long crusade to end abortion is a success. 'Undoubtedly, many Arkansas pregnant mothers were spared from the lifelong regrets and physical complications abortion can cause and babies are alive today in Arkansas,' Rose Mimms, executive director of Arkansas Right to Life, said in a press statement. 'That's a win-win for them and our state.' A spokesperson for the Arkansas Department of Health, Ashley Whitlow, said in an email that the department 'is not able to track abortions that take place out of the state or outside of a healthcare facility.' State officials, she said, collect data from 'in-state providers and facilities for the Induced Abortion data reports as required by Arkansas law.' WeCount's tallies of observed telehealth abortions do not appear in the official state numbers. For instance, from April to June 2024 it counted an average of 240 telehealth abortions a month in Arkansas. Abortion bans could reverse decline in teen births, experts warn Groups that oppose abortion rights acknowledge that state surveillance reports do not tell the full story of abortion care occurring in their states. Mimms, of Arkansas Right to Life, said she would not expect abortions to be reported in the state, since the procedure is illegal except to prevent a patient's death. 'Women are still seeking out abortions in Arkansas, whether it's illegally or going out of state for illegal abortion,' Mimms told KFF Health News. 'We're not naive.' The South Dakota Department of Health 'compiles information it receives from health care organizations around the state and reports it accordingly,' Tia Kafka, its marketing and outreach director, said in an email responding to questions about the statistics. Kafka declined to comment on specific questions about abortions being performed in the state or characterizations that South Dakota's report is flawed. Kim Floren, who serves as director of the Justice Empowerment Network, which provides funds and practical support to help South Dakota patients receive abortion care, expressed disbelief in the state's official figures. 'In 2023, we served over 500 patients,' she said. 'Most of them were from South Dakota.' 'For better or worse, government data is the official record,' said Ishan Mehta, director for media and democracy at Common Cause, the nonpartisan public interest group. 'You are not just reporting data. You are feeding into an ecosystem that is going to have much larger ramifications.' When there is a mismatch in the data reported by state governments and credible researchers, including WeCount and the Guttmacher Institute, a reproductive health research group that supports abortion rights, state researchers need to dig deeper, Mehta said. 'This is going to create a historical record for archivists and researchers and people who are going to look at the decades-long trend and try to understand how big public policy changes affected maternal health care,' Mehta said. And now, the recordkeepers 'don't seem to be fully thinking through the ramifications of their actions.' Abortion rights supporters agree that there has been a steep drop in the number of abortions in every state that enacted laws criminalizing abortion. In states with total bans, 63 clinics have stopped providing abortions. And doctors and medical providers face criminal charges for providing or assisting in abortion care in at least a dozen states. Practitioners find themselves working in a culture of confusion and fear, which could contribute to a hesitancy to report abortions — despite some state efforts to make clear when abortion is allowed. For instance, South Dakota Department of Health Secretary Melissa Magstadt released a video to clarify when an abortion is legal under the state's strict ban. The procedure is legal in South Dakota only when a pregnant woman is facing death. Magstadt said doctors should use 'reasonable medical judgment' and 'document their thought process.' Any doctor convicted of performing an unlawful abortion faces up to two years in prison. In the place of reliable statistics, academic researchers at WeCount use symbols like dashes to indicate they can't accurately capture the reality on the ground. 'We try to make an effort to make clear that it's not zero. That's the approach these departments of health should take,' said WeCount's Upadhyay, adding that health departments 'should acknowledge that abortions are happening in their states but they can't count them because they have created a culture of fear, a fear of lawsuits, having licenses revoked.' 'Maybe that's what they should say,' she said, 'instead of putting a zero in their reports.' For decades, dozens of states have required abortion providers to collect detailed demographic information on the women who have abortions, including race, age, city and county — and, in some cases, marital status and the reason for ending the pregnancy. Researchers who compile data on abortion say there can be sound public health reasons for monitoring the statistics surrounding medical care, namely to evaluate the impact of policy changes. That has become particularly important in the wake of the Supreme Court's 2022 Dobbs decision, which ended the federal right to an abortion and opened the door to laws in Republican-led states restricting and sometimes outlawing abortion care. Maryland is training more health workers to offer abortion care Isaac Maddow-Zimet, a Guttmacher data scientist, said data collection has been used by abortion opponents to overburden clinics with paperwork and force patients to answer intrusive questions. 'It's part of a pretty long history of those tools being used to stigmatize abortion,' he said. In South Dakota, clinic staff members were required to report the weight of the contents of the uterus, including the woman's blood, a requirement that had no medical purpose and had the effect of exaggerating the weight of pregnancy tissue, said Floren, who worked at a clinic that provided abortion care before the state's ban. 'If it was a procedural abortion, you had to weigh everything that came out and write that down on the report,' Floren said. The Centers for Disease Control and Prevention does not mandate abortion reporting, and some Democratic-led states, including California, do not require clinics or health care providers to collect data. Each year, the CDC requests abortion data from the central health agencies for every state, the District of Columbia and New York City, and these states and jurisdictions voluntarily report aggregated data for inclusion in the CDC's annual 'Abortion Surveillance' report. In states that mandate public abortion tracking, hospitals, clinics and physicians report the number of abortions to state health departments in what are typically called 'induced termination of pregnancy' reports, or ITOPs. Before Dobbs, such reports recorded procedural and medication abortions. But following the elimination of federal abortion rights, clinics shuttered in states with criminal abortion bans. More patients began accessing abortion medication through online organizations, including Aid Access, that do not fall under mandatory state reporting laws. At least six states have enacted what are called 'shield laws' to protect providers who send pills to patients in states with abortion bans. That includes New York, where Linda Prine, a family physician employed by Aid Access, prescribes and sends abortion pills to patients across the country. Asked about states reporting zero or very few abortions in 2023, Prine said she was certain those statistics were wrong. Texas, for example, reported 50,783 abortions in the state in 2021. Now the state reports on average five a month. WeCount reported an average of 2,800 telehealth abortions a month in Texas from April to June 2024. 'In 2023, Aid Access absolutely mailed pills to all three states in question — South Dakota, Arkansas and Texas,' Prine said. Texas Attorney General Ken Paxton filed a lawsuit in January against a New York-based physician, Maggie Carpenter, co-founder of the Abortion Coalition for Telemedicine, for prescribing abortion pills to a Texas patient in violation of Texas' near-total abortion ban. It's the first legal challenge to New York's shield law and threatens to derail access to medication abortion. Still, some state officials in states with abortion bans have sought to choke off the supply of medication that induces abortion. In May, Arkansas Attorney General Tim Griffin wrote cease and desist letters to Aid Access in the Netherlands and Choices Women's Medical Center in New York City, stating that 'abortion pills may not legally be shipped to Arkansas' and accusing the medical organizations of potentially 'false, deceptive, and unconscionable trade practices' that carry up to $10,000 per violation. Good-government groups like Common Cause say that the dangers of officials relying on misleading statistics are myriad, including a disintegration of public trust as well as ill-informed legislation. These concerns have been heightened by misinformation surrounding health care, including an entrenched and vocal anti-vaccine movement and the objections of some conservative politicians to mandates related to covid-19, including masks, physical distancing, and school and business closures. 'If the state is not going to put in a little more than the bare minimum to just find out if their data is accurate or not,' Mehta said, 'we are in a very dangerous place.' KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — an independent source of health policy research, polling and journalism. Learn more about KFF.
Yahoo
09-02-2025
- Health
- Yahoo
Some incarcerated youths will get health care after release under new law
A new federal law aims to better connect incarcerated children and young adults who are eligible for Medicaid or the Children's Health Insurance Program to services before their release. (Oona Zenda/KFF Health News) This article first appeared on KFF Health News and is republished here under a Creative Commons license. Valentino Valdez was given his birth certificate, his Social Security card, a T-shirt, and khaki pants when he was released from a Texas prison in 2019 at age 21. But he didn't have health insurance, mental health medications, or access to a doctor, he said. Three years later, he landed in an inpatient hospital after expressing suicidal thoughts. After more than a decade cycling through juvenile detention, foster care placements, and state prisons, Valdez realizes now that treatment for his mental health conditions would have made life on his own much easier. 'It's not until you're put in, like, everyday situations and you respond adversely and maladaptive,' he said, 'you kind of realize that what you went through had an effect on you.' 'I was struggling with a lot of mental stuff,' said Valdez, now 27. For years, people like Valdez have often been left to fend for themselves when seeking health care services after their release from jail, prison, or other carceral facilities. Despite this population's high rate of mental health problems and substance use disorders, they often return to their communities with no coverage, which increases their chances of dying or suffering a lapse that sends them back behind bars. A new federal law aims to better connect incarcerated children and young adults who are eligible for Medicaid or the Children's Health Insurance Program to services before their release. The goal is to help prevent them from developing a health crisis or reoffending as they work to reestablish themselves. 'This could change the trajectory of their lives,' said Alycia Castillo, associate director of policy for the Texas Civil Rights Project. Without that treatment, she said, many young people leaving custody struggle to reintegrate into schools or jobs, become dysregulated, and end up cycling in and out of detention facilities. Medicaid has historically been prohibited from paying for health services for incarcerated people. So jails, prisons, and detention centers across the country have their own systems for providing health care, often funded by state and local budgets and not integrated with a public or private health system. The new law is the first change to that prohibition since the Medicare and Medicaid Act's inception in 1965, and it came in a spending bill signed by President Joe Biden in 2022. It took effect Jan. 1 this year, and requires all states to provide medical and dental screenings to Medicaid- and CHIP-eligible youths 30 days before or immediately after they leave a correctional facility. Youths must continue to receive case management services for 30 days after their release. More than 60% of young people who are incarcerated are eligible for Medicaid or CHIP, according to a September 2024 report from the Center for Health Care Strategies. The new law applies to children and young adults up to age 21, or 26 for those who, like Valdez, were in foster care. Putting the law into practice, however, will require significant changes to how the country's thousands of correctional facilities provide health care to people returning to communities, and it could take months or even years for the facilities to be fully in compliance. 'It's not going to be flipping a switch,' said Vikki Wachino, founder and executive director of the Health and Reentry Project, which has been helping states implement the law. 'These connection points have never been made before,' said Wachino, a former deputy administrator of the Centers for Medicare & Medicaid Services. The federal CMS under the Biden administration did not respond to a question about how the agency planned to enforce the law. It's also unclear whether the Trump administration will force states to comply. In 2018, President Donald Trump signed legislation requiring states to enroll eligible youths in Medicaid when they leave incarceration, so they don't experience a gap in health coverage. The law Biden signed built on that change by requiring facilities to provide health screenings and services to those youths, as well as ones eligible for CHIP. Even though the number of juveniles incarcerated in the U.S. has dropped significantly over the past two decades, more than 64,000 children and young adults 20 and younger are incarcerated in state prisons, local and tribal jails, and juvenile facilities, according to estimates provided to KFF Health News by the Prison Policy Initiative, a nonprofit research organization that studies the harm of mass incarceration. The federal Bureau of Justice Statistics estimates that about a fifth of the country's prison population spent time in foster care. Black youths are nearly five times as likely as white youths to be placed in juvenile facilities, according to the Sentencing Project, a nonprofit that advocates for reducing prison and jail populations. Studies show that children who receive treatment for their health needs after release are less likely to reenter the juvenile justice system. 'Oftentimes what pulls kids and families into these systems is unmet needs,' said Joseph Ribsam, director of child welfare and juvenile justice policy at the Annie E. Casey Foundation and a former state youth services official. 'It makes more sense for kids to have their health care tied to a health care system, not a carceral system.' Yet many state and local facilities and state health agencies nationwide will have to make a lot of changes before incarcerated people can receive the services required in the law. The facilities and agencies must first create systems to identify eligible youths, find health care providers who accept Medicaid, bill the federal government, and share records and data, according to state Medicaid and corrections officials, as well as researchers following the changes. In January, the federal government began handing out around $100 million in grants to help states implement the law, including to update technology. Some state officials are flagging potential complications. In Georgia, for example, the state juvenile justice system doesn't have a way to bill Medicaid, said Michelle Staples-Horne, medical director for the Georgia Department of Juvenile Justice. In South Dakota, suspending someone's Medicaid or CHIP coverage while they are incarcerated instead of just ending it is a challenge, Kellie Wasko, the state's secretary of corrections, said in a November webinar on the new law. That's a technical change that's difficult to operationalize, she said. State Medicaid officials also acknowledged that they can't force local officials to comply. 'We can build a ball field, but we can't make people come and play ball,' said Patrick Beatty, deputy director and chief policy officer for the Ohio Department of Medicaid. States should see the law as a way to address a 'neglected part of the health system,' said Wachino, the former CMS official. By improving care for people transitioning out of incarceration, states may spend less money on emergency care and on corrections, she said. 'Any state that is dragging its feet is missing an opportunity here,' she said. The Texas Department of Family Services took custody of Valdez when he was 8 because his mother's history of seizures made her unable to care for him, according to records. Valdez said he ran away from foster care placements because of abuse or neglect. A few years later, he entered the Texas juvenile justice system for the first time. Officials there would not comment on his case. But Valdez said that while he was shuffled between facilities, his antidepressant and antipsychotic medications would be abruptly stopped and his records rarely transferred. He never received therapy or other support to cope with his childhood experiences, which included sexual abuse, according to his medical records. Valdez said his mental health deteriorated while he was in custody, from being put in isolation for long periods of time, the rough treatment of officials, fears of violence from other children, and the lack of adequate health care. 'I felt like an animal,' Valdez said. In August, the U.S. Department of Justice released a report that claims the state exposes children in custody to excessive force and prolonged isolation, fails to protect them from sexual abuse, and fails to provide adequate mental health services. The Texas Juvenile Justice Department has said it is taking steps to improve safety at its facilities. In 2024, 100% of children in Texas Juvenile Justice Department facilities needed specialized treatment, including for problems with mental health, substance use, or violent behavior, according to the department. Too often, 'our system is making people worse and failing to provide them with the continuity of care they need,' said Elizabeth Henneke, founder and CEO of the Lone Star Justice Alliance, a nonprofit law firm in Texas. Valdez said trauma from state custody shadowed his life after release. He was quick to anger and violence and often felt hopeless. He was incarcerated again before he had a breakdown that led to his hospitalization in 2022. He was diagnosed with post-traumatic stress disorder and put on medication, according to his medical records. 'It helped me understand that I wasn't going crazy and that there was a reason,' he said. 'Ever since then, I'm not going to say it's been easy, but it's definitely been a bit more manageable.' KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF. 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