Tag: Abortion Policy

By Sofia Resnick
Virginia Mercury

Mylissa McNeill never expected to be a mother. But when she learned she was pregnant in the spring of 2022, at age 41, she and her partner were happy and excited at the prospect of parenting a little girl they planned to name Maeve.

On June 24, 2022, about one month after McNeill discovered she was pregnant, the U.S. Supreme Court overturned Roe v. Wade in its Dobbs ruling, eliminating the constitutional right to an abortion and empowering states to outlaw it. Missouri was the first state to enact a ban; at that time, McNeill was living in Joplin, Missouri.

In August 2022, McNeill miscarried. It was the beginning of a health crisis that plagues her to this day and that she blames, at least in part, on hospitals’ reluctance to provide miscarriage management care that might run afoul of state abortion bans.

Missouri’s law prohibited nearly all abortions, but it allowed abortion providers who were charged or sued under the law to escape punishment by arguing that they acted in a “medical emergency” to prevent the death of the pregnant woman or to avert “a serious risk of substantial and irreversible physical impairment of a major bodily function.”

Missouri’s ban is no longer in effect — it was overturned by voters in 2024 — but such language is typical: All 13 states that currently have abortion bans allow the procedure to protect the life of the pregnant woman. Some, but not all, of the bans also have exceptions to protect the health of the woman.

But patients and providers have argued in lawsuits challenging the bans that such exceptions are too ill defined to give doctors and hospitals enough confidence to provide timely care. McNeill believes that her persistent health problems are the result of delayed care.

In early August 2022, less than two months after Missouri’s ban took effect, McNeill’s water broke at about 18 weeks. She says her OB-GYN told her the pregnancy was no longer viable, and she sought an abortion and miscarriage management procedure known as dilation and curettage, or D&C, in hospitals in both Missouri and Kansas (where abortion was legal). However, doctors declined to provide miscarriage care while they were able to detect fetal cardiac activity.

After three days of bleeding and aching, McNeill finally received treatment at a hospital in Illinois. When she had a subsequent tubal ligation to prevent future pregnancies, McNeill said medical staff told her she had scar tissue resulting from an infection she developed after her water broke.

“While they were in there, they saw what happened,” McNeill said. “The infection went outside of my uterus. It went to my liver, and my liver is permanently attached in multiple places. It’s attached to my uterus; it’s attached to my stomach lining.”

McNeill says the lingering effects of that infection include severe bouts of vomiting and significant financial hardship as she has struggled to pay for care without steady health care coverage.

“I literally break all the blood vessels in my skin. … This kind of pain is — there’s no word for it,” said McNeill, who shared with Stateline pictures of her face covered in red splotches, her nose magenta. “The delay is what really upset me, because women have died with less time than I had, and that delay and the infection that I did get from this by waiting three days, it destroyed my life.”

Last year, states including Texas, Kentucky and Tennessee enacted laws designed to provide additional clarity on medical exceptions to their bans, but confusion persists in those states and others. Stories of denied miscarriage care continue to emerge, including in a brand-new lawsuit in Texas, and several deaths have been attributed in part to abortion restrictions, including in Georgia and Texas. Research has linked abortion restrictions to higher rates of maternal death and injury.

“The four years since the Dobbs (v. Jackson Women’s Health Organization) decision have unfortunately proven what OB-GYNs already knew: abortion care is inextricable from reproductive health care,” Molly Meegan, chief legal officer and general counsel for the American College of Obstetricians and Gynecologists, wrote in a statement.

“Bans and restrictions on abortion care have resulted in patients across the country being denied care, even in instances of pregnancy loss and miscarriage.”

A new study published last month by the Journal of the American Medical Association found that since the Dobbs decision, in states where abortion bans took effect, miscarriage management has shifted away from medical intervention toward more of a “wait-and-see” approach.

But anti-abortion groups blame doctors and abortion-rights advocates for creating confusion around the medical exceptions in abortion bans, insisting it is clear what is a medically indicated abortion and what is purely elective.

“As architects of the majority of the nation’s pro-life laws, Americans United for Life has been very clear that none prevent women from receiving life-saving miscarriage care. Efforts to suggest otherwise are made in bad faith” said Gavin Oxley, a spokesperson for the group.

“Doctors who delay or altogether deny medical treatment must be held accountable for the harm they inflict upon women. If doctors are not clear on this four years after Dobbs, they clearly have not been listening.”

Dr. Susan Bane, an OB-GYN in Greenville, North Carolina, who is on the board of directors for the American Association of Pro-Life Obstetricians and Gynecologists, told Stateline that doctors — especially the American College of Obstetricians and Gynecologists — have unfairly blamed abortion bans for the denial of medical care to pregnant or miscarrying women.

“There’s nothing, I mean zero, about any of these laws that say you have to have her dying or septic,” Bane said. “I’ve done this hundreds of times in the last 30 years, where the baby was alive, and I sat at the bedside and had an excruciating conversation with a woman to say, ‘I am so sorry, but if we don’t move towards delivery, I’m worried both of you will die.’”

She said her organization supports state laws, like one signed in South Dakota earlier this year, that redefine “abortion” as the intentional ending of the life of the “unborn child.” Supporters say such laws will allow doctors to manage miscarriages, ectopic pregnancies and other pregnancy-related emergencies.

“It’s sad that more clarification isn’t happening, but the blame really started right in my profession.” Bane said.

But Meegan said attempts to legislate health exceptions fall short of protecting all patients.

“There is no law or exception that can account for the immense variety of medical situations that can present in pregnancy,” she wrote. “And there is no additional legislation that can undo the harm created by abortion bans short of repealing the bans themselves.”

McNeill said that following her miscarriage, she lost her job and the health insurance that came with it. She sued and then reached a settlement with the Missouri hospital that she believes denied her prompt care. But she continues to search for relief from her health problems, and says she has racked up substantial medical debt.

She and her husband moved to Arkansas and then Kansas in search of the financial stability that has eluded them since her miscarriage almost four years ago.

“My debt is in the millions with all of this illness without coverage for long periods,” McNeill said. “Now that my credit is destroyed, I’ll never be able to buy a house again while in this health.”

Stateline reporter Sofia Resnick can be reached at [email protected].

By Sofia Resnick
Virginia Mercury

A federal poverty-fighting program focused on reducing unintended pregnancies is about to undergo a major overhaul.

Reproductive health clinics use Title X federal grant money to provide birth control, cancer screenings and testing and treatment for sexually transmitted infections to people with little or no health insurance. Title X money cannot be used for abortions.

The Guttmacher Institute estimates that Title X, which was signed into law by Republican President Richard Nixon in 1970, has prevented almost 20 million unintended pregnancies and 9 million abortions. It has also helped reduce child poverty, according to the group, which supports abortion rights.

But President Donald Trump has taken aim at the program, which has long been a target for abortion opponents. Since regaining the White House, Trump has temporarily blocked and then restored grants to certain reproductive health clinics, and proposed a U.S. Department of Health and Human Services budget with no funding for the program.

The department’s recently issued funding guidelines for Title X grants represent a significant mission shift.

Instead of expanding access to contraception, the focus of Title X will be “to strengthen family formation and assist clients in achieving healthy pregnancies,” according to the new guidance. That will align the program with the administration’s efforts to increase the U.S. birth rate.

The new rules say Title X will prioritize educating Americans about natural methods to avoid pregnancy and overcome infertility, and will promote “body literacy education” and “informed, preventive, and restorative approaches to reproductive health.” Some conservative groups tout an obscure alternative treatment for infertility called “restorative reproductive medicine,” which is based on the idea that the underlying causes of infertility can be treated through lifestyle changes and improving a person’s overall health.

The guidance directs Title X clinics to promote “fertility-awareness-based methods,” such as period-tracking apps, which the American College of Obstetricians and Gynecologists says can be helpful for getting pregnant but less effective at preventing pregnancy. It also calls on clinics to offer counseling on male fertility issues and to address environmental causes of infertility, including pornography use. And it includes a prohibition on DEI efforts and warns grantees that federal money cannot be used to “facilitate or incentivize illegal immigration.”

Anti-abortion groups support the changes, but many health policy researchers say they will disproportionately harm low-income and minority women, who are more reliant on Title X services and are more likely to have unintended pregnancies. Researchers also say the new guidelines are unlikely to achieve the administration’s “pronatalist” goal of reversing declining birth rates.

Corinne Rocca, an epidemiology professor at the University of California, San Francisco, said the way to do that would be to spend more on childcare subsidies and other social programs to help new parents.

“Policies that help people and families feel supported to meet their childbearing preferences … would actually help people who are open to the prospect of childbearing to do so,” Rocca said.

Rocca co-authored a study published in JAMA Network Open last fall suggesting Black and Hispanic women are less likely than other racial groups to be able to choose if, when and how to start a family.

Clinics must reapply for funding under these new guidelines by Jan. 9, 2027. HHS did not respond to a request for comment.

During his first term, Trump banned Title X clinics from referring patients to other providers for an abortion or even mentioning it as an option. He also prohibited grantees from offering family planning services and abortions in the same building. As a result, many grantees quit the program, including about a dozen state health departments and all participating Planned Parenthood chapters.

The program served about 844,000 fewer patients in 2019 than it did in 2018, when it served 3.9 million patients, according to HHS. About 225,000 fewer patients received oral contraceptives; about 50,000 fewer received hormonal implants; and about 86,000 fewer received IUDs.

The reframing of Title X that is reflected in the new guidelines was a recommendation laid out in the controversial blueprint known as Project 2025, created by the conservative think tank Heritage Foundation as a guide for the second Trump administration.

In line with Project 2025’s recommendations, HHS says Title X grantees will no longer be required to counsel or refer for abortions, and tells applicants that relationship counseling should encourage marriage as a precursor to having children.

“In a time when we are facing a rapidly declining birth rate that falls far short of the replacement fertility rate, we should be doing all we can to encourage and support family formation and fertility,” Dr. Christina Francis, CEO of the American Association of Pro-Life Obstetricians and Gynecologists, told MedPage Today in April.

“Women deserve accurate information about their fertility and their health — and this includes highlighting the many benefits of pregnancy and motherhood.”

Some abortion opponents have criticized Title X for promoting certain forms of contraception, such as IUDs, that they view as abortifacients. A spokesperson for the National Right to Life Committee said the organization does not take a stance on contraception that prevents fertilization, “however, National Right to Life does oppose any device or drug that would destroy a life already created at fertilization.”

“If there is any doubt, we recommend that a woman speak with her doctor to determine if an agent would cause an abortion,” the spokesperson said in an email.

But Leonard Lopoo, a professor at the Maxwell School of Citizenship and Public Affairs at Syracuse University who has studied fertility and family policies for the past three decades, said the federal government could help families achieve their family planning goals by expanding pregnancy prevention and infertility treatments at all income levels.

“When you’re trying to take away the funding for someone who doesn’t want to have a child, that’s not the same as providing funding to support someone who does,” Lopoo said.

As a Black woman and researcher focused on Black maternal health at Ibis Reproductive Health, Terri-Ann Thompson is better informed than most on the ways having children can be disproportionately more dangerous and less affordable for women who look like her.

But she says what she wasn’t expecting to uncover — during research for a study she co-authored in the journal Frontiers in Public Health this spring — is how much the fear of negative medical and criminal justice outcomes makes many Black women in Georgia and North Carolina scared of pregnancy.

“I was very surprised to see that folks were actually thinking about the context within which a Black child is born and raised well before they even contemplated starting a family,” Thompson said. “We had a lot of, just, stories of folks saying, ‘Why would I want to bring a child into this context; how does one prepare Black women to bring a child into this context?’”

Thompson said her team’s findings show how much Black women depend on low-cost access to long-acting reversible contraceptives such as IUDs.

“We have people who drove very, very far just to get a sliding scale to either get an IUD placed, an IUD removed, or to even get on birth control pills,” Thompson said.

“If the administration moves forward with these restrictions, what we are doing is we are removing access to contraceptives for a population that is at higher risk.”

Stateline reporter Sofia Resnick can be reached at [email protected].