Reproductive Health Archives - 51ÊÓƵ Health News /tag/reproductive-health/ 51ÊÓƵ Health News produces in-depth journalism on health issues and is a core operating program of 51ÊÓƵ. Mon, 28 Sep 2026 15:48:56 +0000 en-US hourly 1 https://wordpress.org/?v=6.8.10 /wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=32 Reproductive Health Archives - 51ÊÓƵ Health News /tag/reproductive-health/ 32 32 257378068 Abortion Is on the Ballot Again as Post-Roe Policies Continue To Evolve /elections/abortion-state-referenda-2026-november-midterms-roe-dobbs-missouri-nevada/ Fri, 25 Sep 2026 09:00:00 +0000 /?p=2281000 MAPLEWOOD, Mo. — After Missouri voters added abortion protections to the state constitution in 2024, Kelly McCoomb decided to keep her yard sign supporting the measure in the basement of her suburban St. Louis home.

Abortion access is important to McCoomb. She wants her daughter to grow up in a state where the option is available if needed, and the sign was a keepsake from the day Missourians voted to reverse the state’s near-total ban. McCoomb also couldn’t shake the feeling that she’d need to display the sign in her yard again soon.

“I have little faith in our Missouri government,” McCoomb said, sitting on her front porch.

Sure enough, just two years later, the state’s Republican-dominated legislature is asking Missouri voters to overturn the abortion protections they recently supported. The conflicting measures even have the same title: Amendment 3. But while a “yes” vote in 2024 supported adding protections to the state constitution, a “no” vote in 2026 would keep them. McCoomb covered the “YES” on her yard sign with a “NO” made from black duct tape before placing the sign back in her yard.

Voters will weigh in on abortion in Missouri, and three other states, in the November general election. Missouri is also one of two states voting on it for the second time since 2024. Nevada will vote again, too.

The spate of referendums comes after the U.S. Supreme Court overturned federal abortion protections with its 2022 decision in Dobbs v. Jackson Women’s Health Organization, leaving each state to make its own abortion policy. The result has been a patchwork of state rules of bans or limitations, and even a series of “shield laws” in states where abortion remains legal that aim to protect providers from prosecution in states where it’s not.

“I just think there’s a constitutional crisis that’s coming,” said , vice president of media and policy for the anti-abortion organization Students for Life Action.

“Can you have 50 state standards on whether or not a human being is a human being? Can you have 50 state standards on whether human beings have legal protection?” Hamrick said.

Advocacy Groups Work To Clarify Ballot Measures

That patchwork of abortion protections is the reason Nevadans for Reproductive Freedom introduced the 2024 ballot measure to enshrine the state’s law allowing abortions up to 24 weeks after conception into the state constitution, said , president of the coalition.

The measure received strong support two years ago, with 64% of voters in favor. Nevada law requires two majority votes to enshrine constitutional amendments, so voters will need to support the expanded protection again in November for it to be enacted.

The Nevada ballot measure wouldn’t change the state’s existing law allowing abortions up to 24 weeks after conception. But the proposal would make it more difficult to overturn abortion access, requiring voter approval of any new ban in two elections.

Lopez said Nevadans for Reproductive Freedom has been campaigning to ensure voters are still mobilized.

“Folks care about it,” she said. “They’re seeing what’s happening at the national level, and they want to make sure that whatever’s happening in our neighboring states, like Idaho and Utah, doesn’t happen here in Nevada.”

Idaho, where a ballot measure establishing abortion rights to go before voters in November, has one of the strictest abortion bans in the country. Voters will decide whether state statute should allow abortion through fetal viability, the point when a fetus can survive after birth, which is generally considered to be around 24 weeks.

In Utah, abortion is allowed up to 18 weeks while legal challenges to the state’s ban continue.

In Virginia, where abortion is already allowed through two trimesters of pregnancy, until 28 weeks, voters will decide whether to amend their state constitution to codify those rights.

Missouri is the only state voting this year on removing abortion protections already on the books. The the 2024 amendment that guaranteed abortion access through fetal viability in the state and replace it with a ban on abortions with exceptions for medical emergencies, fetal anomalies, and pregnancies resulting from rape or incest. Abortions for rape and incest would have to occur before 12 weeks of pregnancy.

Missouri was the first state to ban abortion after the Dobbs decision in 2022. At that time, abortions had already mostly ceased in the state after three decades of state regulations targeting the practice, including a , minimum dimensions for procedure rooms and hallways in clinics that provide abortions, and a mandate that the clinicians have at nearby hospitals, among others. Only were performed in Missouri in 2021, down from , state records show.

Even though Missouri voters backed the abortion amendment in 2024, it took nearly two years for medication abortions to resume in the state.

A Second Vote Causes Confusion

, CEO of St. Louis-based Planned Parenthood Great Rivers, said the whiplash of a second statewide vote on abortion mirrors the confusion that patients have experienced about whether abortion is available in the state.

“Chaos is kind of the point here,” Riphagen-Dunn said, “and it is absolutely a tactic that gets in the way of being able to provide.”

The confusion has presented problems for abortion opponents in the state as well.

“I think it’s unfortunate,” said Reagan Barklage, who is a vice president of Students for Life of America and the treasurer of the Missouri Students for Life Ballot Committee. “People need to be very clear on what they’re voting for.”

Barklage said she has had to correct anti-abortion voters while out canvassing to remind them that they are voting “yes” on Amendment 3 this year even though they voted “no” on Amendment 3 last time.

“It is crazy that it ended up being even the same number. I do not think that was intentional, but we’ve got to deal with what we’ve got,” Barklage said, adding, “I hope the pro-choicers kept their yard signs from last time.”

In Maplewood, Missouri, McCoomb said she was happy that her repurposed sign supporting abortion access had been noticed.

“I hope lots of people see and remember to revote,” McCoomb said.

51ÊÓƵ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 51ÊÓƵ—an independent source of health policy research, polling, and journalism. Learn more about .

This article first appeared on 51ÊÓƵ Health News and is republished here under a .

]]> 2281000 A NY Hospital Tried To Close Its Birthing Center. This City United To Fight Back. /courts/troy-new-york-hospital-birthing-center-bipartisan-fight/ Wed, 09 Sep 2026 09:00:00 +0000 /?p=2281344 TROY, N.Y. — Like many residents of this aging industrial city on the Hudson River, Starletta Washington was stunned when she heard Troy’s last remaining hospital planned to close its birthing center.

“It was devastating,” said Washington, who heads the local YWCA. Washington was born at the hospital and had her children there. She couldn’t believe families would now have to get to a hospital half an hour away or face the prospect of an emergency delivery.

“Nobody else was going to be born in the city of Troy unless they were born on a city bus, in the back of a cab, or, disgustingly, on the side of the street?” Washington said. “Blew my mind.”

Troy wasn’t the first community to face this prospect. Since 2010, hospitals have as cities and towns shrink and hospitals consolidate into larger systems.

Troy found a more hopeful ending.

A group of women and one man stand holding signs that say "Save Burdett Birth Center" with a yellow "SAVED" sticker added to the front.
State Assembly member John T. McDonald III (center), a Democrat, worked to secure $5 million in state funding to help keep the Burdett Birth Center open in Troy, New York. (Katherine Bruno/Upper Hudson Planned Parenthood)
A woman in business formal attire sits at a desk with two American flags behind her.
Carmella Mantello, the Republican mayor of Troy, New York, says even nonprofit hospitals seem to have become more corporate. “The whole hospital scene has changed,” she says. (Hannah Norman/51ÊÓƵ Health News)
A woman wearing a black T-shirt looks towards the camera. She wears a necklace with a tiny star on it, with earrings to match.
Starletta Washington, who heads the YWCA in Troy, was born at the hospital where Burdett Birth Center is located. Like many in the community, she says she was blindsided by Trinity Health’s plan to close the center. (Hannah Norman/51ÊÓƵ Health News)

Elected officials from both major parties joined patient advocates, mothers, midwives, doulas, and community leaders like Washington to challenge Trinity Health, the large Catholic health system that owns Troy’s hospital and birthing center. The campaign even united Planned Parenthood and the .

“Whether you were Republican or Democrat, or if you didn’t vote, it literally brought everyone together,” said Carmella Mantello, the city’s Republican mayor. “Everyone just said, ‘We can’t let this happen.’”

Throughout the country, healthcare remains a flash point as politicians square off ahead of November’s elections. But in many places, Americans are also quietly finding common ground.

In this small city, residents were brought together by frustration over large, corporate health systems that can seem to put profits over patients. And they resolved to work together to keep critical medical services in their community.

A Community Institution

Babies have been delivered at Samaritan Hospital on a hill above Troy since this city’s once bustling factories produced most of America’s shirt collars a century ago.

More recently, Samaritan’s Burdett Birth Center had become a model for patient-focused care. Midwives and doulas work alongside OB-GYNs and support mothers who want to avoid a delivery by cesarean section unless necessary.

Patient safety advocates have pushed for years to reduce surgical deliveries, which can lead to complications. At Burdett, only about a quarter of newborns are delivered by C-section, compared with about a third statewide, according to 2025 hospital data. Burdett also had fewer preterm births and fewer babies with low birth weights.

“I wouldn’t go anywhere else,” said Lidia Zambrano-Madera, who gave birth to both her children at Burdett with the help of a midwife.

A woman who just gave birth holds her infant while lying in a hospital bed. Three adult family members and one child stand around her.
Lidia Zambrano-Madera, a Troy resident, gave birth to both her children at the Burdett Birth Center with the help of a midwife. “I wouldn’t go anywhere else,” she says. (Jayana Espinoza)

For Zambrano-Madera, who recently opened a children’s play center in Troy, Burdett offered another advantage: It was just five minutes from home.

But three years ago, Trinity Health, a multibillion-dollar Michigan-based hospital system, said the birth center was losing money and would close. Families from Troy and surrounding Rensselaer County would have to deliver at another Trinity hospital in Albany, up to a half-hour’s drive away. The hospitals are branded under St. Peter’s Health Partners in the Albany region.

“We’ve been frantic about trying not to cut the care at the bedside,” said Steven Hanks, a physician who oversees Trinity hospitals in New York and New England. “But, you know, you get to a point where you can only consolidate so much. You can only spread people so thin, and then you have to start taking harder looks at your actual services.”

Corporate Backlash

Trinity’s plans — news of which — came without warning, surprising the obstetrical staff and community leaders. They set off a firestorm.

Within days, midwives, mothers, community leaders, and politicians held a rally at the YWCA in downtown Troy. Others would follow. Volunteers led by doulas and midwives made T-shirts and handed out pink “Save Burdett” signs at the local farmers market.

Activists were outraged that the hospital hadn’t adequately assessed the impact of the closure, particularly on low-income families. They conducted a community survey that found 1 in 4 Troy residents didn’t have access to a car and would have trouble getting to Albany.

The campaign drew on deep connections that many residents had to Burdett. “They realized what a gem Burdett is, and what a great community service they provide,” said Jessica Hayek, a doula and birth educator who helped lead the campaign.

A woman stands beside a bed with a quilt looks away from the camera with a subtle smile.
Jessica Hayek, a doula and birth educator, helped lead the campaign to stop Trinity Health from closing the Burdett Birth Center. She says Michigan-based Trinity didn’t appreciate how important the center was to the Troy community. (Hannah Norman/51ÊÓƵ Health News)

Hayek and others also tapped into deep-seated frustration with Trinity, a healthcare behemoth that and last year recorded more than $25 billion in revenue and a healthy operating margin that topped 5%.

“Trinity Health is in the Midwest, and they are not in the community,” Hayek said. “So when you’re looking at just the numbers from an office in the Midwest somewhere, they’re not looking at the benefit that this place has on the community.”

Hayek describes herself as a liberal Democrat. But Trinity’s focus on its bottom line also irked many Republicans, including Mantello, who was the City Council president at the time.

“The whole hospital scene has changed,” Mantello said. “It was very personable. You had nurses and doctors who were able to give more care and spend more time with patients.” Now, by contrast, many hospitals have what she described as a “more corporate type of atmosphere.”

Even the Catholic bishop decried the planned closure of the birthing center as out of step with the values of his faith and the hospital system’s.

“Nothing is more central to the Catholic healthcare mission than supporting life and all those who bring it into the world,” Bishop Edward Scharfenberger said after Trinity announced the closure plan. Scharfenberger has since retired.

A Bipartisan Solution

Despite the backlash, Trinity Health executives for months insisted they had no choice. The system even sued the state to push through the closure.

Ultimately, though, powerful state officials, including New York Attorney General Letitia James, a Democrat, joined the fight to save the birthing center, launching an investigation into the proposed closure and hosting a daylong hearing in Troy.

State Assembly member John T. McDonald III, a Democrat who represents Troy, worked with Republican elected officials, including the county executive and the state senator representing Troy, to secure $5 million in state funding to help keep Burdett open.

 “You had a Democrat and a bunch of Republicans all working together on the same issue,” McDonald said, “because, at the end of the day, our job is to listen to what the public has to say.”

A crowd of people of various genders, ethnicities, and ages stand with signs that say "Save Burdett Birth Center."
Community leaders, politicians, midwives, doulas, and families from Troy rallied for months to stop the Burdett Birth Center from closing, including at the state Capitol in Albany. (Katherine Bruno/Upper Hudson Planned Parenthood)
A plastic lawn sign with white text and a bright pink background reads, "Midwives Save Lives / Save Burdett Birth Center / SAVED!"
Community volunteers in Troy celebrated the success of their campaign to save the Burdett Birth Center by adding a yellow tag to the pink protest signs. (Hannah Norman/51ÊÓƵ Health News)

Nearly a year after announcing the closure, Trinity reversed itself and said Burdett would remain open.

Lois Uttley, a New York City-based researcher and activist who has worked with communities facing hospital consolidation, said Troy’s success reflects a growing bipartisan suspicion of corporate healthcare organizations.

“The executives of these health systems will tell the community that joining a big health system will be good, that the quality of care will improve, that efficiencies will mean they can keep the costs low,” Uttley said. “But what I have seen over the last 30 years of work is that those promises often are broken.”

As hospitals close or downsize, she said, communities are catching on. “They’re becoming more skeptical.”

There’s another, more hopeful lesson in Troy’s success, said McDonald, the state lawmaker.

“If we take down our swords,” he said, “and put out our arms, maybe we can get something done.”

51ÊÓƵ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 51ÊÓƵ—an independent source of health policy research, polling, and journalism. Learn more about .

This article first appeared on 51ÊÓƵ Health News and is republished here under a .

]]> 2281344 High Fertility Costs Push Americans Abroad for IVF Treatment /health-care-costs/ivf-tourism-fertility-in-vitro-fertilization-high-costs-pregnancy-parenthood-greece/ Fri, 28 Aug 2026 09:00:00 +0000 /?p=2272088 In the summer of 2024, Emilie and Justin Solomon found themselves on a top-secret mission in Greece.

Their family and friends thought the adventure-loving couple was on another jet-setting vacation, but they were keeping something else under wraps: They had turned off their phone locations to hide visits to a Greek clinic where they were trying to get pregnant.

The Solomons are among the growing numbers of Americans looking abroad, particularly to Greece and Spain, to escape the high cost of fertility treatments in the U.S., where such procedures are often not covered by insurance. The treatments include , which involves ovulation stimulation, retrieving the eggs, fertilizing them in a lab, and transferring the embryos into the uterus. Other less intensive medical therapies also address infertility.

A man and woman pose for a selfie on sunny day in a rocky landscape in Greece.
Emilie and Justin Solomon visited Greece for IVF treatment in 2024 after they were quoted $40,000 for one round of treatment in Florida. (Emilie Solomon)

President Donald Trump has made fertility, and IVF in particular, a focus of his administration’s agenda after he for women during his 2024 campaign. His administration intended to make it easier for employers to offer fertility coverage, although it has yet to be finalized. So far, the most concrete result has been lower costs for some IVF medications through TrumpRx, a site where cash-paying patients can find some discounted medicines through participating pharmacies. The White House projected that patients could save .

While significant, those savings are up against a since 2014, according to GoodRx, a prescription discount service. A released in July by Axene Health Partners and the Women’s Reproductive Health Foundation found that the overall cost for a cycle of IVF was over $29,000 — or 35% of the median annual household income in the U.S. Genetic testing, embryo storage, pregnancy care, and delivery costs can push the total over $54,000 per IVF-conceived birth, according to the study. An average patient needs two to three cycles to successfully have a child, so the costs for many patients would be even higher.

Infertility affects people in the U.S., but only an estimated 24% of treatment needs are met, because of those high costs and limited insurance coverage, according to the American Society for Reproductive Medicine. The condition is believed to be of people having children later, as well as such as pollution.

Still, were born via IVF in the U.S. in 2024 — a record, according to the Society for Assisted Reproductive Technology. An increasing share of people hoping to be parents are seeking help in Europe: The number of Americans choosing European clinics grew by more than 37% last year, according to , the chair of the European Fertility Society, a group that tracks data on fertility treatment in Europe.

The Solomons knew IVF was their only chance to have children together biologically, because Justin had testicular cancer in his late teens. What the college sweethearts had not expected was the cost — and they learned early in their IVF journey that their insurance would not cover their treatment. While some states have passed laws to require insurers to pay for some fertility care, the coverage .

When the couple first explored IVF in Florida, where they live, they were quoted $40,000 for one round of treatment. The price shocked them, and Emilie said the clinic’s offer of a spring discount for an embryo transfer felt “off-putting.”

“They just kind of prey upon your hopes and dreams to be parents,” Emilie said.

Treatment Plus Island-Hopping Tours

The price of IVF and uncertainty around in Florida, which the Solomons feared their control over their embryos, sent them to the Pelargos IVF Medical Group in Athens. There, in the first of two trips, Emilie underwent ovulation stimulation and egg retrieval.

Including medication, fertilization, storage, and the ultimate embryo insertion, the total treatment cost about $12,000, not including travel, according to the Solomons, a fraction of what they might have spent in America. That affordability drew the couple abroad, but so did the allure of sightseeing and experiencing a new country.

On that first trip, they spent a weekend between doctor appointments exploring the Greek island of Milos. Between Emilie’s hormonal injections, they rented a boat to explore the island. Their video from the trip shows them climbing the island’s striking white volcanic cliffs, and Emilie floating in the turquoise water of the Aegean Sea. Despite the emotional and physical toll of the IVF process, the couple remembers being in a little bubble, away from everyone, exploring a beautiful place.

“It was one of the best summers that we’ve had,” Emilie said.

A selfie of Emilie Solomon with her husband, Justin.
In Greece, the Solomons were able to get a round of the IVF treatment for about $12,000, not including their travel expenses. (Emilie Solomon)

When they traveled back to Greece for their embryo transfer in October 2025, they spent two days in Croatia.

IVF in Greece using a patient’s own eggs typically costs around $3,000 to $4,000, not including medication, so even with travel, it is often a fraction of what patients pay in the U.S.

“Americans choose Greece because they can access treatment that is more affordable, faster to begin, and well supported for international patients,” Dejewski said.

A professional headshot of Jakub Dejewski.
Jakub Dejewski, the chair of the European Fertility Society, which tracks data on fertility treatment in Europe, says the number of Americans choosing European IVF clinics grew by more than 37% in 2025 from the year before. (Dawid Linkowski)

Patients in Greece do face some legal restrictions: Embryo storage is time-limited, donor anonymity is standard, sex selection and embryo-transfer numbers are restricted, surrogacy access is limited for nonresidents, and patients must carefully consider documentation requirements if they plan to move embryos between Greece and the U.S.

Penny Ampatzi said she is clear about these legal differences when Americans consult with her clinic in Athens. Serum IVF offers to schedule airport pickup for patients, as well as island-hopping tours. Ampatzi, the co-founder and clinic director at Serum IVF, said the main draw for the dozen or so American patients her clinic sees each month is the personalized fertility treatment plans. Affordability is close behind. A cycle at her clinic costs just under $6,000, not including embryo freezing. Almost all of Serum’s patients are foreigners, according to Ampatzi.

“You consider that you have a good possibility of success, plus you don’t pay that high amount of money, and you also have combined the treatment with holidays — so it’s a ‘Why not?’” she said.

Not Without Risks

IVF costs in the U.S. have been driven up by a mix of inflation, a shortage of embryologists, a surge in demand after pandemic backlogs, and private equity ownership, Dejewski said.

William Kiltz, vice president of marketing and business development at U.S.-based , said that the costs are becoming too far out of reach. “IVF is almost a treatment that only the top 1% can afford reasonably,” he said.

Kiltz said CNY’s model — offering IVF for around $8,000, not including embryo storage, at its 18 locations across the country — brings just enough profit to “keep the lights on” and open new locations while keeping its costs lower. “We’re trying to deliver this care at the absolute bare-minimum cost,” he said.

More than half of CNY’s patients travel from out of state in search of those lower-cost options, Kiltz said.

He said he hopes the IVF market will eventually settle out, as happens with many new technologies. But nearly five decades in, that normalization hasn’t come. Kiltz believes that’s because the market is so emotionally driven.

“People will do just about anything,” Kiltz said. “There’s certainly some risk in something like that, where the demand and the desire from a single individual is so strong that they could be taken advantage of.”

, the head fertility doctor at the CNY location in Norfolk, Virginia, pointed to the difficulties of trying to vet a clinic overseas when one doesn’t speak the language or understand the local IVF regulations. It also can be challenging to transport temperature-sensitive medication back home.

“It’s almost like a full-time job trying to play regulatory expert and inspector all at the same time, while you’re a patient,” Pakrashi said.

She said she also has had patients who sought treatment abroad return to her clinic struggling to transfer records or understand a diagnosis they received overseas. They often have to repeat tests.

And going abroad for IVF is still out of reach financially for many Americans.

The Solomons said seeking treatment overseas takes a certain type of adventurous spirit, too. But for them, all the logistics and travel were worth it. Their one cycle of IVF and two trips to Greece allowed them to welcome a healthy baby boy this summer.

A photo of Emilie Solomon in a hospital bed. She holds her newborn son in her arms. Her husband, Justin, is by the bed.
After undergoing one round of IVF treatment in Greece, Emilie Solomon gave birth to a son this summer in Florida. (Susie Urff)
51ÊÓƵ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 51ÊÓƵ—an independent source of health policy research, polling, and journalism. Learn more about .

This article first appeared on 51ÊÓƵ Health News and is republished here under a .

]]> 2272088 Watch: Why Abortions Are on the Rise Since ‘Roe’ Was Overturned /courts/video-five-things-abortions-increase-since-roe-overturned/ Fri, 07 Aug 2026 09:00:00 +0000 /?p=2264199 Say you live in deep-red Louisiana, a state that has effectively banned abortion. It may be easier for you to get abortion pills now than before the Supreme Court overturned Roe v. Wade. Here’s why — and what it means for future battles over abortion access.

And as a federal court mulls a case that could result in significant restrictions on a pill used in most abortions, healthcare providers say they have alternatives to preserve access even in states with bans in place. Read more here.

51ÊÓƵ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 51ÊÓƵ—an independent source of health policy research, polling, and journalism. Learn more about .

This article first appeared on 51ÊÓƵ Health News and is republished here under a .

]]> 2264199 Abortion Drug Law in Louisiana Heightens Hemorrhage Risk for Pregnant Patients /courts/abortion-drug-access-misoprostol-louisiana-law-pregnancy-hemorrhage-risk/ Thu, 30 Jul 2026 09:00:00 +0000 /?p=2262962 Over the past decade, Louisiana hospitals began stocking specialized carts designed to treat hemorrhages, one of the in the state. The plug-in cart can be wheeled from room to room and holds surgical tools and lifesaving medications to stem blood loss.

A passed in 2024 forced hospitals to remove a key drug — misoprostol — from the medical cart and keep it locked in a secure room designated for controlled substances.

For physicians like New Orleans obstetrician-gynecologist Nicole Freehill, misoprostol is the go-to medication to treat hemorrhages. The drug is uniquely cheap, safe, and shelf-stable, she said.

But it’s also the second in a two-pill procedure that millions of people have used to have medical abortions. Because of that use, Louisiana lawmakers reclassified misoprostol as a controlled substance, a category typically reserved for addictive drugs.

Now, physicians like her have gone from reaching over to the cart to grab misoprostol to waiting at least two minutes while a nurse sprints to retrieve the medication, Freehill said.

“ You could literally have someone lose, like, a liter of blood or more in that time frame,” Freehill said. “You could have a significantly worse hemorrhage for literally someone running to this medicine and running back because it can’t be on that cart 2 feet from you while you’re treating the hemorrhage.”

She said the reclassification of misoprostol as a controlled substance has set back progress to decrease the frequency of postpartum hemorrhage and blood transfusions. Under the law, her preliminary research found, hemorrhage rates have worsened statewide, she said.

Although the cart includes alternative drugs to treat hemorrhages, they can’t be used if a patient has certain preexisting conditions like asthma or high blood pressure. They’re also more costly.

“ There’s unfortunately a lot of patients nowadays that have these conditions that we might be forced to go straight to misoprostol first without any other real good option because of their medical history,” Freehill said.

Misoprostol has other uses in reproductive healthcare. It prepares women’s cervixes ahead of common, sometimes painful procedures such as inserting an IUD. It also plays a critical role in inducing labor and managing failed pregnancies.

In medication abortions, misoprostol is combined with a medication called mifepristone, which Louisiana also reclassified as a controlled substance. Both mifepristone and misoprostol have uses outside reproductive healthcare, including treating Cushing’s syndrome and preventing stomach ulcers caused by anti-inflammatory drugs.

When Louisiana passed a near-total ban on abortions after Roe v. Wade was overturned in 2022, the number of abortion procedures performed in the state dropped from 7,444 in 2021 to . Similar trends occurred in other states that largely banned abortions that year.

However, in the years since, the number of abortions has largely remained the same in Louisiana and nationally as people receive medication abortions through telemedicine and pills sent across state lines. More than 7,500 Louisianans received medication abortions in 2024, the year the law passed, according to the .

Since then, states with abortion bans have tried to to medication abortions prescribed in telehealth appointments and shipped by mail, looking to close what they saw as a loophole through legislation and lawsuits.

Kimya Forouzan, the state policy adviser for the Guttmacher Institute, a nonprofit reproductive rights advocacy group, said the assault on medication abortions comes as more states that have maintained abortion rights pass laws to shield prescribing providers from prosecution.

“This has been a really important lifeline for a lot of people in states with total bans who are looking to access abortion,” Forouzan said. “However, I think a lot of the restrictive states know that this is happening, and they have wanted to increase the threat and the threat of liability to providers who are doing this.”

Louisiana’s controlled-substance law became one way to do so, though it was originally passed to ensure strict penalties for coerced abortions. Republican state Sen. Thomas Pressly of Shreveport, who introduced the bill, said he did so after his brother-in-law fed his sister the pills to cause an abortion . She gave birth to the baby, and the husband was sentenced to six months in prison after the failed attempt.

The bill was later amended in the legislature to add more restrictions and monitoring of mifepristone and misoprostol by classifying them as controlled substances.

Last October, Louisiana also tried to halt medication abortions by telehealth with a against the FDA. The case is pending before the U.S. Supreme Court.

The New Orleans Health Department called for the repeal of the law in a last September, based on surveys of patients, doctors, and pharmacists. Patients reported delays in treatment while hemorrhaging after birth. Fewer pharmacies filled prescriptions for misoprostol, frustrating doctors.

“ There’s no evidence that it is reducing elective abortions in Louisiana. There’s no evidence that it is helping anybody. There’s only evidence of harm,” said Dara Kass, an emergency physician and a professor at Brown University.

Since Louisiana’s law passed, similar legislation has been introduced in at least nine states, despite established abortion bans.

But so far, no other states have reclassified the medications. Pushback from the medical community and reproductive health advocates over implementation has surprisingly stifled any other attempts, said Alina Salganicoff, director of the women’s health policy program at 51ÊÓƵ, a health information nonprofit that includes 51ÊÓƵ Health News.

“This puts a risk  inside the healthcare system and potentially could delay really extremely time-sensitive lifesaving care,” Salganicoff said. “Especially where we have situations where we have really an unacceptably high maternal mortality situation in the United States.”

Instead of being a model for other states, Louisiana’s law has served as a cautionary tale. Freehill, the New Orleans OB-GYN, said her colleagues have also had patients struggle to fill their misoprostol prescriptions ahead of uterus examinations intended to help with their fertility.

“ So it’s having the complete opposite effect of what it’s been intended,” she said.

According to the New Orleans Health Department’s report, some pharmacists said they were too afraid to release the medication to the patient, confused about what’s required under the law. Others refused to fill prescriptions and stock the medication because they preferred to “stay away from any abortion pills.”

Tehmi Chassion, a pharmacist and a Democratic state representative in Lafayette, is pushing the state to study the law’s impact, given the loss of access to the medications.

Louisiana allows pharmacists to choose not to dispense medication if they are uncomfortable doing so, but Chassion said some pharmacists may be crossing a line by blocking access to medication based on their personal beliefs.

“ Those medications have helped save thousands of lives, and we just need to get to a safe space where prescribers and patients don’t have any worries,” Chassion said.

51ÊÓƵ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 51ÊÓƵ—an independent source of health policy research, polling, and journalism. Learn more about .

This article first appeared on 51ÊÓƵ Health News and is republished here under a .

]]> 2262962 Lawmakers Look To Make Abortion Shield Laws Less Dependent on Who’s Governor /courts/shield-laws-abortion-pills-extradition-doctors-governor-california-newsom-hilton-becerra/ Tue, 14 Jul 2026 09:00:00 +0000 /?p=2257779 Your browser does not support the audio element.

Can’t see the audio player? Visit kffhealthnews.org to listen.

When Gov. Gavin Newsom, using his , refused to extradite a physician accused of prescribing and mailing abortion pills to a Louisiana woman, he said California would “not ever” allow “extremist politicians” to punish its doctors.

Newsom, who is considering a run for president, has long championed reproductive rights, but state lawmakers in the Democratically controlled California legislature know future governors might not have the same political beliefs.

Republican gubernatorial candidate Steve Hilton, a former Fox News host endorsed by President Donald Trump, has vowed to honor these types of extradition requests from other states if he’s elected, Louisiana “is trying to uphold what its people voted for, and California is undermining it.” His opponent, Democrat Xavier Becerra, has said he would deny the requests.

Legislation advancing in Sacramento is the latest chapter in a tit for tat that’s been happening between conservative and liberal states since 2022, when the U.S. Supreme Court overturned Roe v. Wade, ending federal legal protections for abortion.

by state Assembly member Rebecca Bauer-Kahan, which is being heard in committee, would take some decisions out of the governor’s hands, requiring governors to deny extradition requests for healthcare providers who prescribe abortion medication or administer gender-affirming care. It would also shield anyone in California who helped patients travel to California or another state to receive legal care. While opponents cast “shield laws” as an incursion on other states’ authority, supporters of the bill view it as insurance — even with Becerra leading Hilton 52% to 31%, according to by the University of California-Berkeley Institute of Government Studies.

Newsom spokesperson Marissa Saldivar said the governor doesn’t comment on pending legislation. Hilton and Becerra didn’t return calls for comment.

“Protecting providers from prosecution should not rely on shifting political winds or a single person’s decision,” said Alyssa Sherer, a nurse practitioner who spoke in support of the bill at a Senate committee hearing in June. Sherer is also the medical director at Hey Jane, a telehealth medication abortion provider. 

Thirteen states have banned abortion outright, and 28 other states ban abortion somewhere between six weeks and viability. At the same time, other states that allow abortion have enacted shield laws to protect doctors and nurses from liability when they prescribe across state lines.

People living in states with total abortion bans are increasingly getting abortion pills prescribed via telehealth, from 74,000 abortions in 2024 to 92,000 abortions in 2025, according to the Guttmacher Institute, citing numbers from its Monthly Abortion Provision Study.

Critics of shield laws say that states have a legitimate interest in enforcing their own statutes and that such laws represent an attempt by some states, like California, to nullify the legal decisions of others.

“If California says, ‘We’re not going to honor any other state’s laws. We’re going to ship abortion pills into your states. You can’t have a law that says abortion is illegal,’ I don’t know — that doesn’t seem like a workable situation,” said Greg Burt, who is vice president of the California Family Council and has spoken in opposition to shield laws at the State Capitol.

Twenty-one other states and Washington, D.C., have similar shield laws, but Arizona, California, Michigan, North Carolina, and Pennsylvania’s rely on an executive order, which could be reversed by a successor, according to the Guttmacher Institute.

Amanda Barrow, a senior staff attorney at the Center on Reproductive Health, Law, and Policy at UCLA Law, said passing extradition protections would put California on firmer footing, because an executive order “could be revoked by a governor who is anti-abortion or anti-gender-affirming-care.”

Hilton has said he would do just that if elected.

“Just as I wouldn’t want to see Louisiana coming in and undermining something that we voted for here in California,” the GOP candidate told KQED in January. 

During a , Becerra said he was strident about protecting reproductive rights as the state’s attorney general. “Absolutely no,” Becerra said of allowing California physicians to be extradited. 

This year, Hawai‘i to its existing shield laws. And Oregon , including banning law enforcement from cooperating with out-of-state or federal investigations into care that’s legal in the state.

But Republican legislators in conservative states have cast telehealth visits as an end run around their laws. And some have moved to restrict abortion pill access.

The governors of , , and have signed bills this year that criminalize the sale, purchase, or distribution of medication that induces an abortion. Those states make it a felony to provide medication abortion drugs to people who are seeking to end a pregnancy. The laws impose up to 10 years in prison with potentially tens of thousands of dollars in fines.

Mississippi amended the state’s controlled substances code to add abortion pills as a criminal category. Although the state already prohibits abortion broadly, the measure specifically addresses distribution, which could subject out-of-state providers to prosecution.

In January, Louisiana a California doctor, Remy Coeytaux, mailing abortion pills to a patient. Newsom denied the request. Likewise, New York Gov. Kathy Hochul denied Louisiana’s February 2025 extradition request for a .

Texas has taken a slightly different legal tact. Attorney General Ken Paxton, a Republican running for the U.S. Senate, obtained a default judgment of more than $100,000 against the New York doctor targeted by Louisiana, but a , citing New York’s shield law. Neither Paxton nor Louisiana Attorney General Liz Murrill responded to requests for comment. 

Fear of being charged with a crime for providing quality medical care is contributing to physicians leaving medicine, said Sacramento emergency room doctor Kamara Graham, who is vice president of the California chapter of the American College of Emergency Physicians, which is supporting the bill.

“It’s really conflicting and hard for us to weigh that concern of: Will I get extradited and charged and potentially be taken away from my family? Or do I do the right thing for my patient?” Graham said.

The availability of medication used in most abortions could soon change nationwide. Under the leadership of Health and Human Services Secretary Robert F. Kennedy Jr., the Food and Drug Administration it is conducting a safety review of mifepristone, one of two medications in pill form that is used in most U.S. abortions. The FDA maintains the drug is safe and effective.

If the FDA were to decide that mifepristone is not safe, such a ruling would supersede state laws, even in states where abortion is legal. If mifepristone is restricted, many telehealth groups have said they would switch to using only the other medication, misoprostol.

“The elephant in the room is whether the Trump administration, particularly after the midterms, makes some kind of move to put national limits on access to abortions,” said Mary Ziegler, a law professor at UC-Davis who has written several books on reproductive health law.

“Not everything is something that the legislature can solve for,” Ziegler said, “because there’s some uncertainty about how the federal courts are going to react to all of this.”

51ÊÓƵ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 51ÊÓƵ—an independent source of health policy research, polling, and journalism. Learn more about .

This article first appeared on 51ÊÓƵ Health News and is republished here under a .

]]> 2257779 Religious Anti-Abortion Center Finds Opportunity in Town Without OB-GYNs /rural-health/anti-abortion-crisis-pregnancy-center-sandpoint-idaho-obgyn-maternity-care-desert/ Wed, 20 May 2026 09:00:00 +0000 SANDPOINT, Idaho — An anti-abortion pregnancy center on the outskirts of this Idaho Panhandle town greets visitors with an abridged Bible verse painted on the wall of its waiting area: “Come to me & I will give you rest.”

7B Care Clinic has been operating in Sandpoint since 2001 and was previously called Life Choices Pregnancy Center and Sandpoint Crisis Pregnancy Center. It is of a nationwide network of Christian evangelical centers called Care Net. 7B, one of about 1,200 pregnancy centers affiliated with Care Net, offers pregnancy tests, limited ultrasounds, parenting and life skills classes, community support groups, and other free resources, such as children’s clothing. Donations from people, businesses, and more than 40 churches keep 7B’s operations running, Executive Director Janine Shepard said.

Such centers are known as crisis pregnancy centers or pregnancy resource centers. They offer limited resources and medical services to pregnant women and aim to dissuade them from having abortions. Healthcare groups including the have said many crisis pregnancy centers use unethical and deceptive practices to bring women into their organizations.

Traffic at 7B has picked up since the local hospital and its OB-GYNs moved out of state three years ago. The closure left a hole in reproductive health services in this town of more than 10,000 on the shores of Lake Pend Oreille and surrounding rural areas.

“We are seeing a lot more people,” Shepard said.

An exam table lined with paper is next to an ultrasound machine and computer monitor.
7B Care Clinic provides limited ultrasounds in the Sandpoint, Idaho, area. Shepard says the majority of women who see their ultrasounds go through with their pregnancies. (Jazmin Orozco Rodriguez/51ÊÓƵ Health News)
A variety of baby clothes in various colors are hung on display racks.
The crisis pregnancy center also provides gently used children’s clothing and other items at no cost. (Jazmin Orozco Rodriguez/51ÊÓƵ Health News)

By December 2024, more than two years after the U.S. Supreme Court overturned nationwide abortion rights in its Dobbs decision, Idaho had of its OB-GYNs. 7B is expanding, with the goal of bringing obstetric care back to Sandpoint. The organization plans to add to its current building once it’s paid off, Shepard said, and it’s in talks with a hospital about 30 miles away in Washington state to bring in an OB-GYN once a week to provide prenatal care.

If obstetric care existed now in Sandpoint, Shepard said, “we wouldn’t even be considering” the expanded services. “But there’s such a need. And our community suffers because of it.”

As rural communities face the and , crisis pregnancy centers are growing in influence. Some states have approved legislation granting the organizations greater protections from oversight and regulation, and clinics have seen a massive and in recent years.

In a town with limited maternity care, 7B has been providing important resources to struggling low-income women. But critics say the religious nonprofit, which is not medically licensed and isn’t required to meet regulatory standards for medical facilities, has an agenda that makes it an inappropriate place for pregnant patients to seek medical care.

The words, "Come to me & I will give you rest" are displayed on a wall. A TV monitor mounted on the wall shows a slide that reads, "Tell them about God. They will measure the reality of your life against how they hear things are supposed to be."
A message from Christian Scripture is displayed in 7B Care Clinic’s lobby. (Jazmin Orozco Rodriguez/51ÊÓƵ Health News)

Jen Jackson Quintano, a Sandpoint resident and the founder of the Pro-Voice Project, a nonprofit that advocates for abortion rights in Idaho, said crisis pregnancy centers mislead patients by drawing them in with the offer of free pregnancy-related services before delivering their anti-abortion pitch.

“We all need clarity on what those services are: ministry-first, rather than comprehensive medicine,” Quintano said.

Shepard said there are misconceptions about the organization, and she invites people to take a tour of 7B to learn what it does. She said her staff talk to pregnant women about abortion, adoption, and parenting as options and hope they feel supported enough to make a “life-affirming” decision.

7B reflects a trend of crisis pregnancy centers seeking to expand their operations in maternal care deserts and regions with gaps in women’s healthcare, said Andrea Swartzendruber, an associate professor of epidemiology and biostatistics at the University of Georgia College of Public Health. Swartzendruber has studied crisis pregnancy centers in the U.S. since 2018.

“Crisis pregnancy centers have, for years and years, capitalized on gaps in access to healthcare,” she said. “In no way, shape, or form do crisis pregnancy centers have the infrastructure or ability or training to bridge those gaps.”

According to Swartzendruber’s research, more than 2,600 crisis pregnancy centers operated in the U.S. as of 2024, more than three times the number of . Many centers have been found to engage in with clients, including putting misleading information on their websites making them appear to be legitimate medical clinics with the goal of attracting women who are seeking abortions.

An exterior shot of 7B Care Clinic.
7B Care Clinic, a few miles from downtown Sandpoint, Idaho, is an affiliate of Care Net, a national evangelical network of about 1,200 crisis pregnancy centers. (Jazmin Orozco Rodriguez/51ÊÓƵ Health News)

The organizations are also seeing support from the Trump administration. On May 10 — Mother’s Day — the Department of Health and Human Services sharing resources and information for new and expectant mothers. It includes a map to find pregnancy centers and cites services the centers provide, such as pregnancy tests, ultrasounds, and medical referrals.

‘The Perfect Place for This’

Sandpoint is a small mountain town in a deeply conservative and Christian part of a state with a strict abortion law put into place after the Supreme Court overturned Roe v. Wade.

Amelia Huntsberger, one of the OB-GYNs who left Sandpoint three years ago, said the town is “the perfect place for this,” referring to the expansion of the 7B Care Clinic.

In underresourced areas, the benefits that crisis pregnancy centers may bring are welcome.

Lori Sabin, a licensed midwife in Bonners Ferry, about 30 miles north of Sandpoint, said that 7B is a helpful resource to the community, especially for people who struggle to get healthcare because of a lack of health insurance or who face challenges in traveling for care.

“The nicest thing about 7B is all their services are free,” Sabin said, adding that the classes and free baby items are particularly helpful for young first-time mothers. “They can point them in the right direction. They tell them where the midwives are; they tell them where the OBs are.”

Huntsberger, who practiced in Sandpoint for more than a decade and now lives in Oregon, also acknowledged the benefits she saw 7B bring for patients, including the parenting classes and support groups. But she has concerns about its resemblance to a medical facility that provides healthcare.

Lisa Battisfore, founder of Reproductive Transparency Now, a Chicago-based organization that provides education and outreach about crisis pregnancy centers, acknowledged that the limited services they provide can be helpful but said the bad outweighs the good.

“If someone needs diapers or someone needs 51ÊÓƵ and a crisis pregnancy center is willing to give that to them, it’s difficult to say that that in isolation is a bad thing, but you have to look at the bigger picture,” Battisfore said.

Crisis pregnancy centers are largely unregulated and are protected by First Amendment rights to free speech and religious exercise. The Supreme Court crisis pregnancy centers to go to court to block a state attorney general’s subpoena for donor funding information. Critics say lack of oversight allows centers to spread misinformation about abortion and abortion pill “reversal,” a procedure the American College of Obstetricians and Gynecologists has called “.”

Crisis pregnancy centers have against states trying to increase regulation and oversight. Those protections have allowed some of the organizations to blur the line between anti-abortion activism and medical care.

A photo of anti-abortion protesters in front of the Supreme Court. They hold signs reading, "I am the pro-life generation," and "We don't need Planned Parenthood."
Anti-abortion advocates hold signs in front of the Supreme Court on June 25, 2018. (Zach Gibson/Getty Images)

“They seem to be really good at walking on both sides of that line when it suits them best, and that does not suit pregnant people best,” Battisfore said.

She referenced a recent case in Texas in which a woman was hospitalized for an ectopic pregnancy days after she received an ultrasound and a clean bill of health from a crisis pregnancy center. An OB-GYN who works with the Abundant Life Pregnancy Resource Center “there is nothing to fix” when asked about the error. There have been at crisis pregnancy centers.

What’s Next for Sandpoint

A man and a woman stand next to each other.
Bonner General Health CEO John Hennessy and Chief Medical Officer Stacey Good say the Sandpoint, Idaho, hospital is working to rebuild trust in the community after its labor and delivery unit closed three years ago. (Jazmin Orozco Rodriguez/51ÊÓƵ Health News)

angered a lot of locals when it closed its labor and delivery unit three years ago. Residents lamented that women needed to travel farther to give birth and mourned the loss of the OB-GYNs. Since then, the hospital has been working to rebuild trust with the community.

This year, the hospital created a women’s health committee that includes hospital board members, staff, and others. Hospital CEO John Hennessy and Chief Medical Officer Stacey Good, a physician, said their priority is to hear from the community and increase awareness about the women’s healthcare that’s still available.

Women can still receive a range of services, including prenatal care from a nurse practitioner who travels to Bonner General from Coeur d’Alene once a week and other clinicians who can provide more basic gynecological care. A position for a gynecologist at the hospital has been open since May 2023, and Hennessy said filling it remains a priority.

Sandpoint resident Makayla Sundquist, a licensed counselor, grew up in town. She got married last year and has been thinking about starting a family with her husband. She wondered if she would feel safe knowing she’d need to travel at least an hour to the nearest hospital with labor and delivery services.

But she also has doubts about 7B as a potential option for local care. She was skeptical that an anti-abortion, faith-based organization would provide accurate information on the options available to her.

“It is something that I do think about and do have fear about,” Sundquist said. “I wish that wasn’t my reality.”

51ÊÓƵ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 51ÊÓƵ—an independent source of health policy research, polling, and journalism. Learn more about .

This article first appeared on 51ÊÓƵ Health News and is republished here under a .

]]> 2236411 License To Deliver: Some Midwives Break the Law To Assist With Home Births /health-industry/certified-professional-midwives-home-births-state-licensure-lack-georgia/ Thu, 14 May 2026 09:00:00 +0000 GWINNETT COUNTY, Ga. — In a midwife’s suburban Atlanta home with a playground and chicken coop outside, Madie Collins lay on an examination table while the midwife measured her pregnant belly. Unlike at many a doctor’s office, no crinkly paper sheet covered the table and no antiseptic chill lingered in the air. The room next door, where Collins’ appointment began, was filled with children’s toys and scented candles and warmed by a wood-burning stove.

The certified professional midwife pressed the button on a handheld Doppler ultrasound machine she placed on Collins’ belly. “That’s her heartbeat,” she said to Collins’ 3-year-old daughter, who sat beside her mom as a whooshing sound filled the room. “I think Mommy’s baby’s right here.”

The midwife is not licensed as a nurse. In Georgia, that makes what she’s doing illegal. 51ÊÓƵ Health News agreed not to identify her by name.

Georgia is one of seven states where delivering babies can earn non-nurse midwives, at minimum, a cease-and-desist letter requiring them to end their careers. In North Carolina, it’s a . In New York, .

Meanwhile, demand for their services is increasing. Intended home births rose by 42% nationally from 2020 to 2024, according to the National Center for Health Statistics, and those births are often overseen by certified professional midwives. In Georgia, they rose by 72%. Midwives who assist with home births typically see clients from prenatal appointments through after childbirth, providing more postpartum checkups than most new mothers receive.

Home births make up nationwide. In the eight states where they were most common in 2024 — Hawai‘i, Idaho, Montana, Pennsylvania, Utah, Vermont, Wisconsin, and Wyoming— they made up 3-5% of births.

As that number rises, midwifery advocates said, regulating the practice with licenses would allow home births to be safer. Free birth — without the help of a skilled professional before or after labor — can be .

“People are going to keep having their babies at home, and they deserve a trained provider,” said Missi Burgess, president of the Georgia chapter of the National Association of Certified Professional Midwives.

For decades, professional midwives have been advocating for laws to legalize and regulate their profession. More lawmakers have supported those efforts in the past 15 years, with 36 states and Washington, D.C., allowing them to get licensed to deliver babies. Last year, a wave of state lawmakers — in Georgia, Mississippi, Nebraska, New York, North Carolina, Ohio, and West Virginia — tried to add their states to the list, although none of their bills has become law.

Certified professional midwives deliver babies in homes or birth centers. Rather than attend nursing school — which many can’t afford — they earn a nationally recognized certificate by attending at least 55 births and demonstrating their knowledge. Nurse-midwives more often deliver babies in hospitals or clinics than in patients’ homes.

Some hospitals and doctors oppose midwife licensing proposals without certain guardrails. The American College of Obstetricians and Gynecologists showing that infants are twice as likely to die during planned births at home or in birth centers as in hospitals, while acknowledging that the data remains limited. It doesn’t account for several factors, including who assisted in the birth.

Still, prominent stories of home births with midwives gone wrong contribute to the skepticism around licensing laws. In 2023, The Washington Post of a licensed midwife who pleaded guilty to felonies in Virginia after an infant death and assisted with home births in Maryland in which two more babies died.

In Mississippi, a bill that would have regulated and licensed professional midwives died after a state senator blocked a vote in the committee he chaired. Democratic Sen. Hob Bryan he didn’t “wish to encourage that activity.”

But midwives said they have a sympathetic ear now in the Trump administration, with its Make America Healthy Again movement. Cassaundra Jah, executive director of the , said she has been on calls with midwifery groups pushing for the Department of Health and Human Services to provide legal protections for them, and some midwives have been in contact with the agency.

HHS spokesperson Emily Hilliard declined to comment on policy proposals but told 51ÊÓƵ Health News that the administration “regularly meets with a wide range of stakeholders to hear input from the American public.”

Hospitals Want Guardrails

Advocates for the license say allowing certified professional midwives to provide care would help address a shortage of maternity care providers.

“Some midwives are leaving our state,” Rep. , a chiropractor who sponsored the Georgia bill, said during a hearing on the measure last year. “They’re being forced to quit. And now we have a shortage of these providers to take care of our pregnant moms.”

A by the March of Dimes found that 35% of counties in the U.S. have no birthing facility or obstetric provider. Georgia has the 13th-highest maternal mortality rate in the nation, according to the .

After the U.S. Supreme Court’s reversal of Roe v. Wade in 2022 eliminated federal protection for abortion, six-week abortion bans prompted more providers to leave states such as Georgia and Texas. Idaho lost by December 2024, two years after its abortion ban took effect. Doctors who left states with such laws cited fear of prosecution and an inability to provide the standard of care.

Of the 13 states with the fewest maternity care providers per capita, nine had a full or six-week abortion ban as of 2024, .

Licensing midwives won’t solve the larger maternity care shortage, but it’s a first step, said , a professor of midwifery and the principal investigator at the Birth Place Lab at the University of British Columbia. Certified professional midwives currently attend only about 1.4% of births in the U.S., according to federal data.

The would have granted certified professional midwives licenses through a state board, allowed them to administer lifesaving medications, and required their services to be covered by private insurance and Medicaid. They would not have needed a physician to supervise them. Without that mandate, giving birth outside of a hospital could be an option for more people.

But the Georgia Department of Public Health and the Georgia Hospital Association opposed the licensing bill, primarily because they wanted more regulations than the midwives were willing to accept — including physician supervision.

Anna Adams, a spokesperson for the hospital association, suggested establishing transfer agreements that required all women planning to have a home birth to register at the hospital first. When a laboring woman is transferred to a hospital, which happens in about , “we have no prior knowledge of this patient,” Adams said. “It’s a tricky situation to inherit when you’re trying to save the mother and the baby without any background.”

Georgia midwives said they planned to bring the licensing proposal back next year.

In early April, three midwives for restricting their ability to practice, arguing that the rules violate the state constitution.

“Every pregnant person should be able to choose where they give birth and with whom,” said Jamarah Amani, a plaintiff in the lawsuit and co-founder of the .

Black women are three times as likely to die during or after childbirth as white pregnant patients. In January, a prominent Black nurse-midwife in South Carolina died after unexpected complications from childbirth.

Today, midwives and their clients are predominantly white, but the home birth rate among Black women rose 42% nationally from 2019 to 2024, according to the Centers for Disease Control and Prevention.

“Ultimately the system has failed us as a people,” said Tina Braimah, a Black nurse-midwife who attended home births for a decade. She then opened a in North Carolina, allowing her to see more clients from a variety of backgrounds. “When the system consistently fails you, you look for other options.”

Becoming Part of the System

Many maternal health researchers say mothers fare better when midwives are a key part of the health system. In 2018, researchers at the Birth Place Lab published a study of all 50 states showing that integrating midwives was associated with better outcomes for moms and babies, including lower rates of infant deaths. Integration involves collaboration among all kinds of midwives and doctors so that patients can easily transfer to or from a hospital. It also involves giving all midwives the authority to practice the full range of their skills, including prescribing lifesaving medication.

A by the National Academies of Sciences, Engineering, and Medicine states that data from other countries suggests home births can be as safe as hospital births for low-risk women who are part of an integrated, regulated system.

Washington state has one of the highest rates of in the U.S., according to the . Its home birth rate is consistently higher than the national rate, while its remains lower than the national average.

One in 5 women report being mistreated during maternity care, according to a . Pregnant patients tend to be more satisfied when midwives lead their care, whether at a hospital, a birth center, or home.

Hannah Haynes gave birth to her first three children in a hospital near her home in Jefferson, Georgia. During the third labor, which was induced, she received a catheter that led to a urinary tract infection and then sepsis, a life-threatening condition. She was separated from her newborn for four days while receiving treatment.

“Something has to change,” Haynes said.

Haynes regrets electing to get induced when it wasn’t medically necessary. She gave birth to her fourth child at home, with the help of a certified professional midwife she trusted. She’s pregnant with her fifth and plans to use the same midwife. She said she won’t deliver at a hospital again.

“I was a little nervous,” Haynes said, because she had heard rumors that midwives didn’t know what they were doing. But after meeting the midwife, “I just felt so confident in her.”

51ÊÓƵ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 51ÊÓƵ—an independent source of health policy research, polling, and journalism. Learn more about .

This article first appeared on 51ÊÓƵ Health News and is republished here under a .

]]> 2233483 Montana Moves Ahead With Doula Pay but Warns Medicaid Cuts Still May Come /medicaid/doula-care-pregnancy-medicaid-montana-budget-cuts/ Wed, 22 Apr 2026 09:00:00 +0000 Montana officials said they are moving forward with plans to allow Medicaid to pay doulas, reversing a previous statement that budget problems had prompted them to pause the effort to reimburse the birth workers.

But officials warned that all optional Medicaid services are still under review as the state health department looks for cuts to offset a shortfall driven by higher-than-expected Medicaid costs.

Jon Ebelt, a spokesperson with the Montana Department of Public Health and Human Services, said the agency is preparing a request to the federal government to add doula care to the state’s Medicaid program. It would cost the state about $118,000 in its first year to provide doula Medicaid reimbursements, according to .

His April 15 comments came three weeks after department officials told 51ÊÓƵ Health News that the state budget deficit had put those plans on hold. Ebelt denied that a final decision had been made in March to scrap the doula Medicaid payments, which state lawmakers approved in a bill last year. The coverage is “now proceeding as planned,” he said.

“At the time of your initial inquiry, we were still in the process of analyzing the appropriation,” Ebelt said.

Federal health officials must approve any amendments to the state’s Medicaid program before payments can begin. reimburse doulas through Medicaid.

Doulas are trained, nonmedical workers who support people through pregnancy and after they give birth. The care they provide is in health complications, which has prompted more states to cover doula services in recent years.

Montana lawmakers who supported expanding Medicaid to cover doula care in 2025 cited scarce maternity services, especially in rural and Indigenous communities. But this year, the state has a Medicaid budget deficit of more than and is expecting a similar shortfall next year. Plus, federal policy changes slated to take effect later this year are expected to increase costs.

“ There’s a need and a desire for doula services, but a lot of people can’t afford it,” said Sheri Walker, a Helena-based doula and president of the . “So that means many of us have other jobs that we have to juggle.”

Walker is a part-time labor and delivery nurse outside of her doula work.

On March 25, health department spokesperson Holly Matkin said in an email to 51ÊÓƵ Health News that the agency “will not be moving forward with the implementation of doula services in the Montana Medicaid benefit package at this time.” She had added that it was unclear whether state law gives the department the authority to authorize coverage during the budget shortfall.

State Sen. , a Democrat who sponsored last year’s bipartisan doula reimbursement bill, said she didn’t know about the department’s plans until she saw 51ÊÓƵ Health News’ reporting. Neumann said she and groups that had backed the legislation began calling health officials, making the case for doula services as a low-cost way to provide critical care.

After about a week, Neumann said, state officials told her the agency was moving ahead with doula services after all.

“They were on the chopping block,” Neumann said. “This is a story of how important it is for all Montanans to pay attention and stay connected to what’s happening.”

Ebelt did not clarify what led the department to change its position. However, he warned that optional Medicaid services, such as doula services, may still be cut.

“All optional services, including this service, are being reviewed,” Ebelt said, referring to doula care. He did not respond to a follow-up query as to whether the department might still decide to postpone the program following federal approval.

are types of care that states choose to cover through their Medicaid programs but aren’t required by federal law. That can include covering eyeglasses, prescription drugs, and prosthetics, and more specialized care such as physical therapy, or inpatient psychiatric services for people under 21.

Those services may not sound optional, said , who studies Medicaid financing at 51ÊÓƵ, a health information nonprofit that includes 51ÊÓƵ Health News. But she said they’re one of the few avenues states have to make adjustments when budgets get tight.

Congressional Republicans’ One Big Beautiful Bill Act, the spending measure President Donald Trump signed into law last July, is expected to put more states in a budget crunch as its provisions start to take effect by the end of the year. The federal government has estimated that the law will reduce federal Medicaid spending by nearly $1 trillion over 10 years. The law also left states with a higher share of the costs to provide food assistance.

Williams said many states expanded services in recent years by boosting optional Medicaid benefits and provider pay.

“We could see them walk those back,” Williams said.

Montana’s financial problems preceded federal changes. Last year, state lawmakers cut some of the health department’s funding and underestimated Medicaid use. The state also overestimated what the federal government would pay toward Montana’s Medicaid costs.

Health officials must outline a plan to cut costs before the state’s 2027 budget year begins on July 1. Simultaneously, the agency is trying to hire more staffers to begin vetting whether Medicaid enrollees meet or are exempt from new work requirements that also go in place July 1. The new rules, mandated through long-delayed state legislation and the federal spending law, will have a three-month grace period.

Stephanie Morton, executive director of , said she’s grateful the state is back on track to pay for doula services through Medicaid. But she said she’s worried about potential health care cuts to come.

“We know that doulas are a critical piece of that infrastructure, but standing alone and losing other sources of care really isn’t optimal,” Morton said. “These are not robust systems as it stands.”

51ÊÓƵ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 51ÊÓƵ—an independent source of health policy research, polling, and journalism. Learn more about .

This article first appeared on 51ÊÓƵ Health News and is republished here under a .

]]> 2229052 As US Birth Rate Falls, Feds’ Response May Make Pregnancy More Dangerous /public-health/us-birth-rate-decline-title-x-family-planning-grants-contraception-pronatalist/ Thu, 16 Apr 2026 09:00:00 +0000 /?p=2228147 The number of babies born in the United States fell again last year.

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According to new data from the Centers for Disease Control and Prevention, there were 3.6 million births in 2025, a from 2024. The fertility rate dropped to 53.1 births per 1,000 women ages 15 to 44, down 23% since 2007.

The Trump administration has said it wants to reverse this trend. President Donald Trump has called for “a new baby boom,” and aides have solicited proposals from outside advocates and policy groups ranging from baby bonuses to expanded fertility planning. The administration is also the federal government’s only dedicated family planning program: Title X.

For more than five decades, Title X has been geared — with bipartisan support — toward giving low-income women access to contraception, screening for sexually transmitted infections, and reproductive health care regardless of ability to pay. At its peak, the served more than 5 million patients a year. Title X clients have reported the program as their sole source of health care in a given year.

In early April, the Department of Health and Human Services for Title X grants for fiscal year 2027, which begins in October. The 67-page Notice of Funding Opportunity included only one mention of contraception — describing it as overprescribed, associated with negative side effects, and part of a broader “overreliance on pharmaceutical and surgical treatments.”

The grant notification reshapes the program from its traditional public health intervention efforts to focus on fertility, family formation, and reproductive health conditions such as polycystic ovary syndrome, endometriosis, low testosterone, and erectile dysfunction.

While Title X will continue to help women “achieve healthy pregnancies,” the grant document does not explicitly reference preventing unintended pregnancies — a long-standing goal of the program.

Jessica Marcella, who oversaw the Title X program as a senior official in the Biden administration, said the new funding notice amounts to a wholesale redefinition of family planning.

“What we’re seeing is trying to use our nation’s family planning as a Trojan horse for an entirely different agenda,” Marcella said, noting that Trump eliminating Title X altogether.

Birth Rates and Fertility Trends

The administration is overhauling Title X in the context of declining birth rates. But researchers who study fertility trends say the decline is driven by forces that have little to do with contraception access and that restricting it is unlikely to produce more births.

The most important factors, according to demographer Alison Gemmill of UCLA, are timing-related. “Childbearing is increasingly delayed as part of a broader shift toward later adult milestones, including stable employment, leaving the parental home, and marriage,” she said.

Most American women, she said, still complete their childbearing years with an average of two children, suggesting a shift toward smaller families rather than an increase in childlessness.

“Having children has become more contingent and more planned,” she said.

Much of the decline since 2007 reflects women postponing births rather than forgoing them.

“The average number of babies women are having in their whole lives has not fallen. It’s still more than 2.0 for women aged 45,” said Philip Cohen, a professor of sociology at the University of Maryland.

Phillip Levine, an economist at Wellesley College, said the birth rate has declined due to shifts in how women approach work, leisure, and parenting. “Efforts to reverse those patterns would be more successful if they can make childbearing more desirable, not make it harder to prevent a pregnancy,” he said.

Asked about the role of contraception in reducing maternal mortality and how the new funding notice advances that goal, HHS press secretary Emily Hilliard said in a statement: “Applicants for the 2027 Title X funding cycle will be expected to align with the administration’s stated priorities in the released Notice of Funding Opportunity. HHS, under the leadership of Secretary Kennedy and President Trump, will continue to support policies that support life, family well-being, maternal health, and address the chronic disease epidemic. HHS remains focused on improving maternal outcomes and ensuring programs are administered consistent with applicable law.”

Marcella said the new funding notice is the product of two converging forces: the Make America Healthy Again movement, with its skepticism of conventional medicine and emphasis on lifestyle and behavioral interventions, and a pronatalist agenda that seeks to boost birth rates by steering policy toward family formation.

The document’s language reflects both: It repeatedly invokes “optimal health” and “chronic disease” while sidelining the contraceptive services that have defined Title X for .

Clare Coleman, president and CEO of the National Family Planning & Reproductive Health Association, which represents health professionals focused on family planning, said tying Title X to birth-rate goals replaces individual decision-making with a government objective. The program “is designed to facilitate access to family planning services, including services to achieve and prevent pregnancy,” she said.

Title X’s New Focus

The administration’s changes have been welcomed on the right.

Emma Waters, a senior policy analyst at the conservative Heritage Foundation, who has advocated for what she calls “restorative reproductive medicine,” said the new funding notice reflects overdue attention to neglected aspects of women’s health.

“I was particularly encouraged to see language that spoke to the delays in diagnosis for conditions like endometriosis, the need for women to practically understand how their cycle and fertility works, and to ensure that real root-cause was promoted through Title X,” Waters said.

She described the notice as an expansion, not a narrowing, of the program’s mission: “I see this iteration of Title X as the fulfillment of its purpose. The goal was never just ‘more contraception’ but a wholesale empowerment of women to govern their own fertility.”

Waters also argued that untreated reproductive health problems may contribute to lower birth rates.

“One of the interesting aspects of this debate, and one that is often overlooked, is the degree to which painful and unaddressed reproductive health problems may suppress or create ambivalence around a woman’s desire to have kids,” she said, pointing to endometriosis.

An estimated of reproductive age have endometriosis, and of those, . Scientifically speaking, the relationship is an association, not a proven cause. Women aren’t screened for endometriosis if they don’t have symptoms, and the condition may be more prevalent than is recognized. Researchers still do not fully understand why some women with endometriosis struggle to conceive while others do not, and treating the disease does not reliably restore fertility.

Infertility rates in the U.S., meanwhile, have not risen. An found them essentially flat between 1995 and 2019, even as the national birth rate fell sharply — a divergence that points away from untreated reproductive disease as an explanation.

Meanwhile, in February, the American College of Obstetricians and Gynecologists enabling earlier diagnosis of endometriosis without surgery, a step toward addressing the delays Waters described. But the first-line treatment ACOG recommends is hormonal therapy, part of the same category of care the funding notice dismisses as part of an “overreliance on pharmaceutical and surgical treatments.” The effect, reproductive health experts say, is a contradiction: Title X is now prioritizing diagnosis of endometriosis while deemphasizing the drugs clinicians use to treat it.

Treatments that have been shown to improve fertility in women with endometriosis, such as laparoscopic surgery and in vitro fertilization, are . When President Richard Nixon signed Title X into law in 1970, as a way to expand access to family planning services — helping women determine the number and spacing of their children by making contraception and related preventive care more widely available, particularly for those who could not afford it. , not Title X, is the primary government health insurance program covering health care for low-income women, but, like many commercial insurance plans, it .

Many of the conditions prioritized in the funding notice deserve attention, said Liz Romer, a former chief clinical adviser for the HHS Office of Population Affairs who helped write updated guidelines for the family planning program. But they fall outside the scope of what Title X can realistically provide.

“There’s not even enough funding to support the core premise of contraception,” Romer said. “And so, if you want to expand Title X funding, you can expand the scope, but you can’t move away from the foundation.”

The emergence of an anticontraception ideology within federal health policy is striking, she said, given how broadly the public supports access to birth control. Eight in 10 women of childbearing age surveyed by 51ÊÓƵ in 2024 reported having in the previous 12 months.

Laura Lindberg, director of the Concentration in Sexual and Reproductive Health, Rights and Justice at Rutgers School of Public Health, said, “If contraception is sidelined in Title X, it won’t just change language on paper but will show up as fewer options and more barriers for patients.” Funding could move away from providers who offer a full range of contraceptive care, she added, “toward organizations that are ideologically opposed to contraception and don’t deliver the same standard of health care services.”

The Stakes Are High

The United States already has one of the highest maternal mortality rates among wealthy nations — as of 2024. According to the CDC, in the U.S. may be preventable. Medical research shows that pregnancy carries substantially higher risks of blood clots, stroke, and cardiovascular complications than hormonal contraception.

And since the Supreme Court’s Dobbs decision in 2022, which overturned the constitutional right to abortion established by Roe v. Wade, access to abortion has been significantly curtailed across much of the country. While national abortion numbers have risen, driven largely by telehealth and interstate access, research shows births have increased in states with bans, with an estimated , disproportionately among young women and women of color.

Dr. Christine Dehlendorf, who directs the Person-Centered Reproductive Health Program at the University of California-San Francisco, said “there is absolutely no evidence for any positive outcome of restricting access to contraception.” Restrictions would instead increase demand for abortion care and make it harder for women to prevent high-risk pregnancies.

Since Trump returned to office, more than a dozen Title X grantees have had their grants frozen, forcing some health centers to stop delivering services, lay off staff, or close. During the first Trump administration, regulatory changes led to a decline in Title X participation from more than . The program grew slowly under the Biden administration, reaching about 3 million clients, before the current round of disruptions began.

The second Trump administration’s overhaul of the program, Marcella said, “directly undermines the public health intent of our nation’s family planning program and will potentially exclude millions of individuals from getting the care they have relied on for decades. It’s bad policy.”

51ÊÓƵ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 51ÊÓƵ—an independent source of health policy research, polling, and journalism. Learn more about .

This article first appeared on 51ÊÓƵ Health News and is republished here under a .

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