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The Guardian
26-04-2025
- Health
- The Guardian
Volunteers rush to send abortion pills to US women in need as ‘war between the states' looms
Seated around a circular table in a nondescript office building just outside Boston, the volunteers pack the abortion pills into envelopes with practiced efficiency. Each of the volunteers – five women and one man – have a unique role in the assembly line. One volunteer drops slim, orange boxes of mifepristone, the first drug typically used in a medication abortion, into the envelopes, while another volunteer adds green-capped bottles of the second drug, misoprostol. A few volunteers add brochures on topics such as how to use abortion pills or what to do if a woman suspects she has an ectopic pregnancy. Finally, one volunteer drops small purple cards into each envelope. They all bear the same handwritten message: 'We wish you the best.' The cards are signed with a swooping heart and a nondescript name: 'the Map', or the Massachusetts Medication Abortion Access Project. By the end of the day, dozens of these envelopes will have been dropped off at a US Postal Service office – many on their way to people who live in states that have banned abortion. The Map is one of a handful of organizations operating under a controversial legal innovation known as a 'shield law'. Enacted by eight states in the years since the US supreme court overturned Roe v Wade, shield laws are designed to protect abortion providers from red-state prosecutions and legal actions, even if the providers' patients are located in states that ban abortion. Providers in shield law states routinely ship abortion pills across state lines: in spring 2024, they facilitated more than 7,700 monthly abortions in states with total or six-week abortion bans, according to #WeCount, a research project by the Society of Family Planning. But shield laws are now being put to the test. In December, Texas sued Dr Margaret Carpenter, a New York doctor, over allegations that she violated Texas's abortion bans by mailing abortion pills to a Texas woman. Then, in January, a Louisiana grand jury criminally indicted Carpenter. The New York governor, Kathy Hochul, has refused to sign an extradition order for Carpenter. Citing the state's shield law, a New York county clerk has also refused to enforce a $113,000 fine, levied by a Texas court, against her. Now, Texas is expected to sue New York over the shield law – a move that could ultimately land the case in front of the supreme court, dominated 6-3 by conservatives, and tip the balance of power between states that protect abortion rights and those that do not. 'No one wanted this, but it's not unexpected,' said Dr Angel Foster, the Map's co-founder, of the state-on-state fight. 'I think we were prepared for this to happen, and we're waiting for the next shoe to drop.' The legal battle has not slowed down demand at the Map. Before dropping their prices last year, the Map was mailing pills to about 500 patients a month. Now, it provides pills to roughly 2,500 per month. 'Since the election, it's felt even more urgent to have a tangible and literally hands-on impact. A package is going to somebody who needs it, in a place where they are being denied their rights,' one Map volunteer said as she sealed envelopes. She spread her palm out on a package as if she were placing a hand on a Bible. 'It's going to a real person.' To order pills from the Map, a patient must be within their first trimester of pregnancy and at least 16, the age of consent for an abortion under Massachusetts law. After they fill out an online intake form, a licensed clinician reviews their chart; if a patient has questions, someone from Map will take their call. Because the organization operates on a sliding scale, patients can receive pills for as little as $5. On one recent Tuesday morning, Cheryl, a retired OB-GYN, sat in the Map's tiny, dimly lit office and quietly clicked through patients' charts, evaluating the answers to questions about the date of their last period and their past pregnancies. Patients shared why they wanted abortions, but Cheryl rarely lingered over their answers. One, however, struck her: a 25-year-old single mom who felt like another pregnancy would endanger her ability to take care of her child. It reminded Cheryl of the five years she spent providing abortions at Mississippi's last abortion clinic, which shuttered shortly after the supreme court's 2022 decision in Dobbs v Jackson Women's Health Organization paved the way for state abortion bans to unfurl across the US. 'That was a really common refrain: 'I just want to do right by the kids I have,'' Cheryl recalled. About half of the Map's patients, she said, already have children. They are also predominantly under 35 and people of color – similar to abortion patients writ large, at least before Roe fell. After Roe's collapse forced the Mississippi clinic to close, Cheryl started providing abortions in North Carolina – until that state banned the procedure after 12 weeks and the clinic where she worked no longer needed her services. 'I was sitting at home, being sad and useless and doing local advocacy stuff,' Cheryl said. She also grew increasingly angry and frustrated with what she saw as mass complacency with the post-Roe reality. That's when someone told her: 'I have just the group for you.' Working with the Map means assuming a certain level of risk. There is no way to guarantee that a staffer or volunteer won't get drawn into a lawsuit – or worse. To diffuse risk, the Map never mails anything that includes clinicians' names. Foster no longer travels to or through states with abortion bans, and does not drive outside of Massachusetts; she doesn't want to run the risk of getting pulled over for speeding and learning that another state has put out a warrant out for her arrest. This is also, in part, why the Map relies on an assembly line to put its packages together: there is no single person to point a finger at. 'I'm feeling like the people that have the power to protect us really aren't, so we just have to keep moving along and doing what we think is right,' Cheryl said. 'It's terrifying, but the whole world is terrifying. I feel like just walking down the street these days is terrifying. Someone's going to whisk you off and accuse you of writing an op-ed or something.' She asked to be identified only by her first name to protect her ability to travel in the US, although Cheryl has no plans to enter a state with an abortion ban. As Cheryl worked, a US map dotted with silver stars glimmered on the wall above her head. Each star represented the location of a patient served in October 2023, the Map's first month of operation. Although sky-blue areas like the coast of Oregon glinted with stars, most were clustered in the south-eastern US, which is now blanketed in abortion bans. Today, a third of the Map's patients come from Texas, which outlaws virtually all abortions, while another third hail from Florida and Georgia, which both prohibit abortion past six weeks of pregnancy. The map's constellations illuminate a paradox of the post-Roe US: even though 26 million women of reproductive age live under a total or six-week abortion ban, many are still receiving abortion pills in the mail or crossing state lines to visit a brick-and-mortar clinic. In 2023 and 2024, the US saw more than 1m abortions – some of the highest numbers in a decade, according to the Guttmacher Institute. The question is whether this paradox is sustainable. Anti-abortion activists consider this kind of interstate networking an existential threat. While Texas and Louisiana have gone after Carpenter, a number of states have attempted to criminalize people who help others cross state lines for abortions. Courts have frozen many of those efforts, but these legal battles are far from over. With different US states now home to fundamentally contradictory reproductive regimes, both sides – whether they seek to punish out-of-state travel or offer banned healthcare – are scrambling traditional codes of conduct between states, creating new questions about what the constitution allows. These questions are sure to end up before the supreme court. 'There isn't really much of a precedent for anything like shield laws, and the courts are very conservative,' warned Mary Ziegler, a University of California, Davis School of Law professor who studies the legal history of reproduction. The US constitution protects people's right to travel, but also mandates that states honor court rulings from other states – such as the fine that Texas won against Carpenter (because she and her lawyer did not show up to a court date in the state). In addition, the constitution specifies that, if an individual commits a crime in one state and 'shall flee from justice' to another state, that individual must be 'delivered up' – or extradited – back to the scene of the crime. Yet there's no evidence that Carpenter and other shield law providers did 'flee from justice'; rather, they're practicing within and obeying the law of their own home states. 'New York is going to say: 'She's not a fugitive. This is not the kind of scenario where a court should get involved,'' Ziegler said. 'Precedent would say they don't have to extradite her, and the question would become whether Louisiana can find a way around that.' Ziegler also questioned whether Texas could convince a court to force New York to collect its $113,00 fine. The constitution, she said, forces states to recognize fines levied in lawsuits between individuals – not necessarily fines that result from a lawsuit by a state against an individual. But Steven Aden, the chief legal officer and general counsel at the powerful anti-abortion group Americans United for Life, is bullish about Texas's chances. 'You can't go to Reno and incur a gambling debt in a casino and then go back home and raise a defense in court, when the casino comes after you for that gambling debt, by saying: 'We don't have gambling in our state,'' Aden said. Ziegler and Aden did agree on one thing, though: not only is the supreme court all but certain to take up Carpenter's case in one form or another, but the high court will likely see a deluge of similar cases over the next several years. 'These are the first shots fired in what we like to call – what we reluctantly, I guess, call – a coming war between the states,' Aden said. Experts have noted that the closest parallels are the pre-civil war battles over how to treat enslaved people who had escaped southern states (which permitted slavery) and fled to northern states (which did not). When these disputes reached the US supreme court, as in the case of Dred Scott v Sandford, the court repeatedly sided with enslavers and lent power to the federal government to enforce pro-slavery laws. The modern-day dispute between states over abortion is dramatically different from the 19th-century interstate battle over slavery – but Abraham Lincoln's famous warning still seems to resonate: 'A house divided cannot stand.' Other threats to abortion pills could soon imperil shield-law providers, too. The attorneys general of Idaho, Kansas and Missouri are now pursuing a lawsuit that could roll back providers' ability to prescribe the pills through the mail. Anti-abortion activists are also trying to cajole the Trump administration to enforce the Comstock Act, a 19th-century anti-vice law that bans the mailing of abortion-related materials but went dormant under Roe. The Map would close if the law no longer protected its work, Foster said. But that doesn't necessarily mean she would give up. 'We might, as a group of people, decide to pivot and do something that's around civil disobedience, and create a different kind of entity doing different work,' she said. Even if anti-abortion forces prevail in court, there is likely no way to keep abortion pills out of US hands. The US Postal Service already fails, frequently, to detect the illicit drugs that swim through it. In addition to shield law abortion providers, there is a thriving online market for abortion pills that are sent straight from overseas pharmacies, allowing women to end their pregnancies without involving the formal US healthcare system. (Medical experts widely agree that it is safe to end your own pregnancy using pills in the first trimester of pregnancy.) For now, the Map has no shortage of volunteers. As the volunteers stuffed abortion pills into envelopes, a woman working in another part of the office building, who had no connection to the group, walked by the conference room and asked Foster: 'Can I volunteer?' Another bystander told them: 'Thank you guys for what you're doing.' It took less than two hours for the volunteers to package some 200 envelopes. Soon after they departed, another pair of volunteers arrived to add shipping labels and drop off the packages, discretely packed into a bin, at a nearby post office. In January, the Map was mailing roughly 150 packages a day – in part, Map project manager Andrea suspects, due to fears surrounding Donald Trump's inauguration – but that volume has slowed, to about 65 to 85 packages a day. (Andrea asked to be identified by her first name only.) A woman working at the post office once asked Andrea if she was running a jewelry business, given the number of shipments and the rattling sounds each package made. She had mistaken the pills for beads. Andrea smiled. She did not confirm or deny.
Yahoo
14-03-2025
- Health
- Yahoo
Ohio suffers badly from health ‘dead zones,' new report finds
The use of telehealth for abortion care has continued to grow in the U.S., according to the latest #WeCount report, particularly since five states passed laws legally shielding providers who work with patients living in states with bans. () When it comes to health, low-income rural communities in Ohio and elsewhere face a double whammy: residents tend to be sicker and they tend to have fewer health professionals. A report released this week by KFF Health News shows that some of those communities actually face a triple whammy. They also lack sufficient broadband to allow health professionals to remotely diagnose and treat people who otherwise lack access. Ohio — particularly its Appalachian southeast — has more than its share of such 'dead zones,' according to the report. The analysis found that 3 million people in the United States lived in such dead zones. 'Compared with those in other regions, patients across the rural South, Appalachia, and remote West are most often unable to make a video call to their doctor or log into their patient portals,' the report said. 'Both are essential ways to participate in the U.S. medical system.' The analysis used data from the Federal Communications Commission, George Washington University, the Centers for Disease Control and Prevention and the Census Bureau to identify areas where primary care or mental health providers were lacking, and whether they had adequate high-speed internet. It also looked at income and the prevalence of certain chronic diseases, such as diabetes and obesity. SUBSCRIBE: GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX Counties were considered broadband deserts if less than 70% of households had adequate service as defined by the FCC. Primary care deserts were defined as counties that ranked in the bottom third in terms of providers per Medicaid patient. Mental health deserts were counties that ranked in the bottom third in terms of the number of behavioral health providers per resident. In Ohio, six counties met the analysis's definition of a 'dead zone' — they had inadequate broadband service and they were Medicaid primary care as well as behavioral health deserts. Those counties were Carroll, Meigs, Monroe, Pike and Vinton counties. Another five — Adams, Brown, Harrison, Hocking and Holmes counties — lacked adequate broadband and had one care desert. Gallia, Highland and Washington counties didn't have care deserts, but ranked as broadband deserts. Broadband shortages are especially concerning in an era of aging populations and growing provider shortages. The National Institute of Healthcare Management Foundation reports that shortages are growing especially quickly in rural areas, and it estimates that by 2036, the United States will be short more than 85,000 doctors. So, adequate broadband will only become more crucial if states are to fill the gap through virtual visits. More than $42 billion was earmarked to expand broadband this year as part of the 2021 Infrastructure Investment and Jobs Act. But Howard Lutnick, President Donald Trump's secretary for the U.S. Department of Commerce, last week announced a 'rigorous review' of the spending. In his announcement, Lutnick complained of 'woke mandates' the Biden administration built into the program. That is raising fears that the funding could be on the chopping block. Such cuts might be bad for Ohioans' health. According to the KFF Health News analysis, the Buckeye State is slightly better than the national average when it comes to the percentage of homes with adequate broadband access, 93.7% vs. 93.1%. But it has a higher-than-average percentage of residents in rural areas, 23.7% vs. 20%. And Ohio lags significantly when it comes to life expectancy, 75.6 years vs. 77.6, median household income, $69,680 vs. $78,538, and rate of poverty, 13.2% vs. 12.%. Meanwhile, Ohio has higher rates of hypertension, 35.6% vs. 32.7% chronic obstructive pulmonary disease, 9.5% vs. 6.8%, diabetes, 13% vs. 12%, obesity, 38.1% vs. 33.3%, stroke, 4.3% vs. 3.6%, and suicide, 15 per 100,000 vs. 14.4. SUPPORT: YOU MAKE OUR WORK POSSIBLE
Yahoo
10-03-2025
- Health
- Yahoo
Women still access abortion in Texas despite stict laws that prohibit them, per SXSW panel
AUSTIN (KXAN) – State and national abortion rights leaders took to a South By Southwest panel Sunday afternoon to discuss ways women continue to access abortions in Texas despite the state having some of the strictest laws in the country. Among the women on the panel was former Texas State Senator Wendy Davis, now a senior adviser to Planned Parenthood Texas Votes, who said pregnancy can be a dangerous condition when women do not have access to life-saving abortion care. 'We've seen that time and time again since the abortion bans have been in place in Texas,' she told KXAN. 'We know that sepsis rates have increased by 50% in our state and that our maternal mortality rates and our infant mortality rates are skyrocketing.' Even though laws that prohibit nearly all abortions have been on the books in Texas since 2022, thousands of Texans are still able to terminate pregnancies each year. 'The panel today is talking about how, in the face of abortion bans in Texas and elsewhere, people are still able to access care,' Davis said. 'People are leaving the state to get the care that they need in states that do provide it,' she said. '[Others] are able to avail themselves of telehealth medicine and get a prescription for abortion medication if they're in the weeks prior to their 13th week of pregnancy.' #WeCount, a project from the Society of Family Planning, reported that around 2,800 Texas women monthly in the first six months of 2024 acquired abortion medications, like Mifepristone, through telehealth medicine. 'Of course, there's a lawsuit that is trying to do away with abortion medication altogether,' Davis said. In January, a Texas judge ruled that three states could move ahead with another attempt to roll back federal rules and make it more challenging for people to access mifepristone in the U.S. Additionally, one bill filed in the Texas House of Representatives aims to add criminal and civil penalties for providing abortion-inducing drugs in Texas. Despite these efforts, Davis said she believes a majority support more access to abortion procedures than is allowed currently in Texas. She encouraged SXSW attendees Sunday to make their voices heard at election time. 'The only way we can change policies is to change policymakers. It's that simple,' she said. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
Yahoo
08-03-2025
- Health
- Yahoo
US states prepare for battle over abortion pills
The anti-abortion movement in the United States has set its sights on a new target: doctors sending pills across state lines to help women end unwanted pregnancies. Since the US Supreme Court's decision to overturn the federal protection of the right to an abortion, states like Texas and Louisiana have adopted tough anti-abortion laws. Women seeking to end pregnancies, even victims of rape or incest, are now obliged to travel long distances or to seek the delivery of abortion pills from other jurisdictions. And that measure is now under attack. Texas and Louisiana are launching a legal case against a doctor in New York, a state which in turn has passed a "shield law" to protect its physicians from outside prosecutions. "These are the first kind of cross-border fights that we've seen since Roe was overturned," said California legal scholar Mary Ziegler, referring to the 2022 Supreme Court decision. "And those are just, I think in some ways, the tip of the iceberg. We're likely to see a lot more of these cross-border fights. "From Texas or Louisiana's standpoint, they're saying: 'Why is this doctor mailing pills into our state?'" explained Ziegler, a professor at the law school at the University of California, Davis. "And from New York's standpoint, they're saying: 'Our doctor wasn't doing anything wrong. Why are you trying to prosecute her?'" - 'Chilling effect' - In Texas, Attorney General Ken Paxton declared that "out-of-state doctors may not illegally and dangerously prescribe abortion-inducing drugs to Texas residents." Margaret Carpenter, a New York doctor and a co-founder of the Abortion Coalition for Telemedicine, was ordered to stop sending pills to Texas and fined $100,000. In Louisiana, she faces criminal charges and the state has demanded her extradition, to which New York Governor Kathy Hochul responded: "Not now, not ever." Hochul said the state's shield law was designed to "anticipate this very situation." According to #WeCount, an initiative that collates abortion statistics nationwide, 10 percent of abortions in the second quarter of 2024 were conducted under the protection of shield laws. This accounts for approximately 10,000 women each month. In Louisiana, this was the solution chosen by 60 percent of women -- about 2,500 -- to terminate pregnancies in the second half of 2023, #WeCount estimates. Now, abortion rights activists fear that individual doctors will be targeted. "The tactic of going after providers, patients and helpers through the courts is definitely something that we are going to see them try more of," Amy Friedrich-Karnik, of the Guttmacher Institute, told AFP. "And I think the goal is both to, you know, scare those individuals... and there's a chilling effect from that," said Friedrich-Karnik, a policy director at the pro-abortion rights think tank. The legal battles will be long, and the results are far from certain. Some cases may get to the Supreme Court, and it is not clear whether President Donald Trump's administration will attempt to intervene. "This is a long-lasting debate, even if it goes to the Supreme Court," Ziegler said. "Because then what would happen is the next case that comes along will be different enough that whatever the Supreme Court has to say about these cases won't give us the answer necessarily," she said. "There's not... going to be one clean solution that the Supreme Court reaches that resolves this once and for all." - Procedure rejected - Meanwhile, the attorneys general of Idaho, Kansas and Missouri have demanded that the federal Food and Drug Administration (FDA) end prescriptions of the pill via online medical visits -- effectively restricting access nationwide. A similar request was nevertheless rejected by the Supreme Court in 2024. "There's uncertainty about what Trump is going to do. There's uncertainty about what power states have to project power outside of state lines. There's uncertainty about what the FDA is going to do," Ziegler said. "Simply not knowing can impact patients and doctors. But that's the scenario right now -- there's a big question mark around a lot of it." es/dc/sst
Yahoo
13-02-2025
- Health
- Yahoo
Republican states claim zero abortions. A red state doctor calls that 'ludicrous'
This is a . 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. MORE: Fighting for their lives: Women and the impact of abortion restrictions in post-Roe America 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 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 overruled 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. 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." MORE: Abortion ballot initiatives could have helped Harris win, instead Trump overperformed 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. MORE: A state-by-state breakdown of where abortion stands after ballot initiatives pass 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. 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. MORE: What could abortion access look like under Trump? 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." Republican states claim zero abortions. A red state doctor calls that 'ludicrous' originally appeared on
