Sofia Resnick, Arizona Mirror

The day before Brittany Watts miscarried at home in Warren, Ohio, medical staff at Mercy Health-St. Joseph Warren Hospital told Watts that her nearly 21-week-old fetus had no chance of survival. And without treatment, neither would she.

On that, Watts’ attorneys and those representing the hospital she is now suing agree.

But Watts still ended up in jail two years ago, after leaving the hospital due to care delays and then returning in need of medical care but without a fetus.

While St. Joseph medical staff were treating Watts, a nurse was on the phone with police, speculating that Watts had birthed and then killed a live baby, according to a federal lawsuit filed earlier this year. The suit claims the hospital and individual staff were negligent and lied to police, and that police allegedly violated her civil rights.

Rachel Brady, an attorney and partner at Chicago law firm Loevy & Loevy, said that though the charges in Watts’ case — “abuse of a corpse,” after she had flushed the remains — were ultimately dropped, she has suffered lasting harms. After inadvertently becoming the public face of pregnancy criminalization in the post-Roe v. Wade era, she is among the first since the Dobbs decision to seek legal recourse for alleged civil rights violations.

“She found herself the unwilling face of this movement, and she has been traumatized by the entire event,” Brady said of Watts, who declined an interview. “This is every expectant mother’s worst nightmare. And rather than being able to grieve her loss, she was taken away in handcuffs. She was interrogated in her hospital bed while she was still tethered to IVs, and so she wants compensation for her own trauma, but most importantly, wants to make sure that this doesn’t happen to anyone else.”

In the three years after the U.S. Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision struck down the federal right to abortion granted by Roe, women around the country have faced criminal charges after their pregnancies ended in miscarriage or stillbirth. Experts believe these cases have risen since states began banning abortion, though most often women are charged not under abortion bans but existing statutes including homicide, abandonment of a body and abuse of a corpse. And they believe these cases will continue to climb, as more prosecutors feel emboldened by state abortion bans; as more states consider laws that would give full legal rights to fetuses and embryos; and as more police investigate miscarriages as potential abortions.

“We are seeing more cases of pregnancy loss resulting in charges, certainly in the four-plus years that I’ve been at the organization,” said Dana Sussman, senior vice president of the legal nonprofit Pregnancy Justice, which researches pregnancy criminalization in the U.S. and helps defend people who have been charged with crimes related to their pregnancies. “Increasingly we are seeing law enforcement view pregnancy loss as a suspicious event — as a potentially criminal event — as opposed to a health concern, a health crisis.”

Women have faced pregnancy criminalization for decades, especially under drug laws and at a higher rate for those who are poor or people of color like Watts, who is Black. Pregnancy Justice has tracked more than 1,800 pregnancy-related arrests and detentions between 1973, when Roe v. Wade was decided, and 2022, when the decision was overturned. But in the first year after Dobbs, Pregnancy Justice documented 210 pregnancy-related prosecutions, the most they’d found in a single year since they started this research. And 22 cases involved pregnancy losses similar to Watts.

“It still remains a very, very, very tiny percentage of all people who experience pregnancy loss or who are pregnant, so I don’t want to create unwarranted fear,” Sussman said. “But one is too many, and 22 is certainly too many. And the more we normalize the idea that abortion is criminalized and your behavior during pregnancy is something that law enforcement can investigate, can make judgments about, can use as evidence against you, we will see more of these cases.”

Reproductive rights legal advocates say police have become increasingly suspicious of miscarriages, in states with bans, like Idaho, but also in states with more liberal abortion policies. The majority of states that allow abortion cut off access at between 22 and 24 weeks of pregnancy, which is an approximate estimate of when fetuses could survive outside of the uterus with medical intervention. An estimated 10% to 20% of known pregnancies end in miscarriage. The American College of Obstetricians and Gynecologists says it is difficult to determine the cause of a miscarriage or stillbirth.

According to Pregnancy Justice’s most recent numbers, Alabama prosecutes more pregnant people than any other state — 104 of 210 prosecutions in 2023. Many are concentrated in Etowah County, which in recent years has cracked down on drug use while pregnant, using a 2006 chemical endangerment law intended to protect children from meth labs, according to a 2023 AL.com analysis. The Etowah County District Attorney’s Office did not respond to a request for comment.

Sussman said evidence of direct harm caused by women in pregnancy-related prosecutions is often thin, and that these cases are often more about emotion than science. Some women who delivered stillbirths have been convicted of murder or manslaughter based on the hydrostatic lung test, also known as the lung float test, a widely discredited idea dating back centuries that involves putting fetal lungs in a container of water: If they float, the baby must have born alive, goes the theory. But medical examiners say these tests are deeply flawed and that air can enter the lungs of a stillbirth in many ways. After being sentenced to 30 years in prison on the basis of the lung float test, Moira Akers, of Columbia, Maryland, was this year ordered a new trial.

Sussman said serious charges are often dropped or reduced in the pregnancy loss cases, upon investigation and with autopsies, but by then, many of the harms of incarceration have already taken hold. She said charges can result in reputationally damaging news headlines, as well as loss of custody of their other children, housing and employment.

Rafa Kidvai is the director of If/When/How’s Repro Legal Defense Fund, which provides financial support for people investigated for pregnancy outcomes, including bail, bond, court fees, transportation and other expenses. They said the fund’s caseload has been rising since they began offering these services in 2022, with about 30 clients and more than $2.7 million paid in bail and bond. Kidvai said steep charges following a pregnancy loss — including manslaughter and murder — allow for high bails many cannot afford.

“The trends that I’ve seen are more cases in volume, higher bails, more intense prosecutions across the board, and the use of pregnancy as a factor, regardless of outcome, being used against someone,” Kidvai said, noting that newer laws around bail in states like Texas have made the Repro Legal Defense Fund’s work more challenging.

When Watts miscarried in September 2023, an Ohio abortion ban had already been blocked and abortion was legal until around 22 weeks’ gestation, right around the time Watts was losing her pregnancy. She was not charged under the abortion law but under a statute typically applied as an enhancement to murder.

“A lot of the cases in Ohio are, you kill somebody and dismember them in order to hide the body, or you kill somebody and set the body on fire in order to conceal it,” Brady said. “When you talk about abuse of a corpse, that’s what we’re talking about. We’re absolutely not, under any circumstances, talking about having the miscarriage and then disposing of the products of conception. That is very clearly not what this law is for or how it has historically been used.”

The city prosecutor who advanced Watts’ case took issue with how Watts disposed of the fetal remains, and how she “went on (with) her day,” though county prosecutors sided with the grand jury’s decision not to indict. But Watts’ personal situation continued in the public eye. She told the Tribune Chronicle she was “swatted” that first Christmas after her pregnancy loss.

Brady said that through discovery, Watts’ legal team is hoping to understand why there were alleged delays in Watts’ care within Mercy Health, which is a Catholic hospital system. Miscarriage care delays and denials have cropped up all over the country in the wake of state abortion bans, but also before Dobbs, especially at Catholic hospitals.

Attorneys representing the hospital and named medical staff, in its response brief, argue that Watts forfeited care when she signed a waiver and left against doctors’ advice. Watts claims she waited for several hours without miscarriage treatment before leaving the hospital two separate times, even after she’d agreed to doctors’ proposed treatment, which was to induce labor rather than give her a common second-trimester abortion procedure. Last year CBS News, after reviewing hundreds of medical records, reported that Watts waited for nearly 20 hours at the hospital over two days, begging to be induced while doctors waited for approval from an ethics team.

“There has to be a shift in the risk analysis here of what is more risky,” Sussman said. “Is it more risky to turn over your patient to law enforcement, or is it more risky to give the patient the care that she needs in the moment and not turn her over to law enforcement?”

More states propose adopting legal personhood for embryos, abortion-homicide laws

Many state abortion bans include an exemption from criminal prosecution for the pregnant person, but women who have had abortions have been prosecuted under other laws. A Nebraska teenager was sentenced to 90 days in jail after taking abortion pills her mother ordered online for burning and burying the fetal remains, under a law related to the removal of human remains.

But for the past three years, an extremist faction of the anti-abortion movement has been trying to apply homicide charges to pregnant people in order to further curb abortion rates that have continued to climb, with the availability of abortion pills. This year, “equal protection” model bills crafted with the help of groups like Abolitionists Rising and the Foundation to Abolish Abortion, were introduced in several states, including: Georgia, Indiana, Kentucky, Missouri, North Dakota, Ohio, Oklahoma, South Carolina, and Texas. Most of these bills died in committee, but activists said they’ve seen more support from state lawmakers than in any other year.

“So far this year, 122 state lawmakers have sponsored equal protection bills, easily eclipsing every other past session,” said Bradley Pierce, a constitutional attorney and president of the Foundation to Abolish Abortion, in an email. He said 16 such bills were introduced in 14 states this year. “We had 21 initial bill sponsors in both Georgia and Texas, as well as 17 in Idaho. We also had 16 lawmakers vote for the bill on the floor of the North Dakota House, which is a new record.”

Pierce noted that recently the Oklahoma Republican Party censured four state lawmakers who voted against one of these bills in committee. He said these laws should not apply to miscarriages but that it would be under states’ criminal justice systems to handle cases of “suspected prenatal homicide.”

T. Russell Hunter, the executive director of Abolitionists Rising, based in Norman, Oklahoma, says induced abortions are indistinguishable from homicide, and he blames the more mainstream anti-abortion movement for opposing bills his organization pushes, which would subject women to homicide charges. A father who says he lost two children to miscarriage, Hunter said spontaneous miscarriages and stillbirths should not be prosecuted like abortions. But he supports investigations depending upon if the pregnant person used drugs, how they disposed of the fetal remains, and perceptions around their emotions.

“I don’t think that all miscarriages need to be investigated,” Hunter said. “One, people who actually have miscarriages are terribly sad. You know immediately; it’s not like you have to investigate this person.”

Students for Life of America CEO Kristian Hawkins calls the abortion abolitionists “pro-prosecutionists” and says they are detrimental to the anti-abortion movement. The organization did not respond to an interview request, but on her podcast, Hawkins said women should not be prosecuted for having abortions — until culture and more laws have changed.

“There’s those who say prosecute women and abortionists now. There’s those who say prosecute the abortionist now and perhaps women later, after culture and laws are changed. And then there’s a third class of folks that’ll say never prosecute women but you can prosecute abortionists now or later,” Hawkins said. “The vast majority of us, including myself, in the pro-life movement are in that mid-category, because that makes the most logical sense. It allows us to move the ball forward in good faith to save as many lives as we can right now while working to change culture, elect actual political leaders who will agree with us.”

More states are passing laws that could potentially lead to investigations at the same time that a federal judge recently struck down a federal health privacy rule for legal abortion care. West Virginia Gov. Patrick Morrisey recently signed into law House Bill 2871, which expands the vehicular homicide offense to include aggravated vehicular homicide and clarifies that victims can include embryos and fetuses. The West Virginia Prosecuting Attorneys Association recently said women who miscarry are not required to notify law enforcement or face potential criminal prosecution, after a prosecutor warned that residents who miscarry could face criminal charges under the state’s strict abortion ban.

At least 38 bills containing personhood language have been introduced across 24 states this year, according to a new report from the State Innovation Exchange and Guttmacher Institute, both of which support abortion rights. Personhood language in some state laws has allowed prosecutors to push for harsher sentences when pregnant women are killed, abused or injured. But the laws have also allowed women to be prosecuted for child endangerment for substance use while pregnant. And experts say these laws could also enable states to force medical interventions against a pregnant person’s will.

Moving in the opposite direction, this year, Washington Gov. Bob Ferguson signed into law the Dignity in Pregnancy Loss Act, to prevent the criminalization of pregnancy outcomes, outside of unlawful or suspicious circumstances, similar to California’s. It also requires jails, prisons, and immigration detention centers to report pregnancy losses to the state annually.

If the budget reconciliation package before the U.S. Senate becomes law in the coming weeks, reproductive health advocates say the provision that would cut federal funding to Planned Parenthood clinics could serve as a backdoor nationwide abortion ban, eliminating access to 1 in 4 abortion providers.

The Republican-led bill, which already passed the House by a slim margin, is more than 1,000 pages and includes sweeping tax cuts that mostly benefit the wealthy coupled with steep spending cuts to social services, including Medicaid.

On page 339 of the bill, Republicans included a provision prohibiting Medicaid funding from going to any sexual and reproductive health clinics that provide abortions and received more than $1 million in federal and state Medicaid funding in fiscal year 2024. While there may be a few independent clinics with operating budgets that high, it effectively singles out Planned Parenthood clinics.

Planned Parenthood clinics rely heavily on Medicaid funding, not to provide abortions, which is not permitted by federal law (except in cases of rape, incest or life-threatening health emergencies), but to provide standard reproductive health care at little to no cost, including treatment for sexually transmitted infections and cancer screenings, as well as contraception. Planned Parenthood provides services for about 2 million patients every year, and 64% of its clinics are in rural areas or places with health care provider shortages.

A Planned Parenthood spokesperson said people who use Medicaid make up half of the total patient volume nationwide for essential health care services provided by their clinics. Even though those patients aren’t seeking abortion care, funding cuts would affect the financial sustainability of those clinics, the spokesperson said.

The organization already identified that 200 of its clinics in 24 states are at risk of closure with the cuts but told States Newsroom on Thursday that further analysis revealed nearly all of those clinics — 90% — are in states where abortion is legal, and in 12 states, approximately 75% of abortion-providing Planned Parenthood health centers could close. The entire organization has about 600 clinics in 48 states.

The “One Big Beautiful Bill” would result in nearly 11 million people losing access to health insurance by 2034, according to the nonpartisan Congressional Budget Office, and add $2.4 trillion to the federal deficit over the next 10 years.

Alexis McGill Johnson, president and CEO of Planned Parenthood Action Fund, told States Newsroom she and other advocates have been meeting with senators to lobby against the bill’s passage, emphasizing that it will have an outsized negative effect on rural clinics and hospitals.

“We are encouraging everyone to reach out to their representatives about this,” McGill Johnson said. “They know that they’re doing this under a watchful eye, and we want to make sure their constituents know about it.”

The defunding effort would be a win for several prominent anti-abortion organizations that have long lobbied for this change and nearly achieved it in 2017 with a similar budget bill. Americans United for Life sent a fundraising email to its supporters Thursday saying this is a “crossroads” for abortion in America.

“So far in 2025 more than a dozen Planned Parenthood clinics have closed, their taxpayer funding is hanging by a thread, and the highest-ranking federal health officials are undertaking a ‘top-to-bottom review’ on the abortion pill,” the email attributed to CEO John Mize said. “It’s possible that very soon, mail-order abortion could be walked back, and more Planned Parenthood locations could be closing their doors for good.”

Susan B. Anthony Pro-Life America, another anti-abortion organization that helped draft the Heritage Foundation’s Project 2025 blueprint for the next Republican president, told States Newsroom in an emailed statement that the budget provision should be no surprise, and there are better uses for the funding, like community health centers.

“Republicans have identified budgetary concerns with funding Big Abortion since 2015, and the bill language to do so has remained substantially the same,” said SBA President Marjorie Dannenfelser.

Planned Parenthood has already closed some clinics around the country, including eight clinics across Iowa and Minnesota at the end of May. Dr. Sarah Traxler, chief medical officer of Planned Parenthood North Central States, which includes Iowa and Minnesota, said the U.S. Health and Human Services’ decision to freeze Title X family planning funding to many reproductive health clinics at the beginning of May contributed to the decision to close those clinics. The North Central States affiliates serve more than 93,000 patients each year, about 20,000 of which use telehealth services.

About 30% of those patients use Medicaid to access care, she said.

“When Planned Parenthood isn’t able to provide services to patients as an essential safety net provider, it has ripple effects across the health care system at large,” Traxler said. “We are already sitting in a time in our country, and have for several decades, where we have patients who can’t access care.”

Clare Coleman, president and CEO of the National Family Planning and Reproductive Health Association, told States Newsroom that 865 Title X clinics in 23 states are impacted by the federal freeze. She said there are no Title X services in eight states: California, Hawaii, Maine, Mississippi, Missouri, Montana, Tennessee and Utah. She said the funding freeze affects one-quarter of all Title X funding grantees, translating to about 842,000 patients who have lost access to care.

“In the two months since HHS withheld federal funding for nearly two dozen Title X family planning grants, affected grantees have been struggling with the unknown of whether they will ever receive the vital funds,” Coleman said in an email. “Some have had to close clinics, lay off staff, and reduce essential contraceptive and sexual health care services. … On top of the Title X funding freeze, proposed Medicaid cuts will be devastating for Title X grantees. Rates of unintended pregnancies and STIs will increase, cancer screenings and diagnoses will be delayed, and decades of public health progress will be reversed.”

After the Iowa Legislature axed Planned Parenthood from its family planning program, Traxler said, the rates of sexually transmitted infections increased considerably across the state — an outcome verified by a 2022 medical study. She expects similar effects from these cuts.

People already travel long distances for abortion care, she said, and that will only get worse if more cuts come to pass. But she also expects to see patients start traveling long distances for routine gynecological care.

Like many independent abortion clinics, the all-trimester Maryland abortion clinic Partners in Abortion Care does not receive Title X funding. But because Maryland is one of 17 states whose Medicaid program covers abortions, they do see a lot of patients who are on Medicaid, at a significant cost to the clinic. Certified nurse-midwife and Partners co-founder Morgan Nuzzo said the clinic did not receive more than $1 million in federal or state Medicaid dollars in fiscal year 2024, and in fact loses about $1 million annually for seeing Medicaid patients.

Nuzzo said Maryland’s Medicaid program reimburses first-trimester abortions at a “decent rate,” but at a very low rate for later abortion cases, which are more medically complex.

“After about 15 to 16 weeks [gestation], we’re losing money on these cases,” Nuzzo said. “We’ve been billing now for almost a year through the state. In second and third-trimester abortion care, we’re losing about 85% of what we would charge for a cash pay fee. So that comes out to about $250,000 a quarter that we are losing just by the under-reimbursement from Maryland Medicaid.”

For that reason, Nuzzo is hopeful about Maryland’s new $25 million Public Health Abortion Grant Program, recently approved by Gov. Wes Moore. The program will be open to clinics like Partners and abortion funds like the Baltimore Abortion Fund, but Nuzzo said it could be a while before that funding is available. Right now she is uncertain and concerned about how the federal reconciliation bill could potentially impact Maryland’s Medicaid program.

Because Partners provides abortions for all trimesters, they see patients from all over the country, and even the world, and the vast majority need financial assistance, Nuzzo said.

“People are traveling further for their procedures, just like they were before,” she said. “The landscape is constantly changing, almost week to week, about where you can access abortion, which is confusing and chaotic to patients. Changes to Medicaid and insurance coverage of abortion only adds to the chaos.”

In the first presidential election since the U.S. Supreme Court allowed state governments to determine if, when and why a woman can end a pregnancy, former President Donald Trump, who touted during the campaign he “was able to kill Roe v. Wade” appeared poised to be reelected early Wednesday. Simultaneously, at least five out of 10 states voted to restore or expand abortion rights, according to early election results.

National anti-abortion groups celebrated Trump’s impending victory over Democratic Vice President Kamala Harris, who campaigned heavily on restoring reproductive rights. They also celebrated the defeat of Florida’s and South Dakota’s abortion-rights amendments, and foreshadowed a full assault on reproductive freedom throughout the country.

“Now the work begins to dismantle the pro-abortion policies of the Biden-Harris administration,” said Susan B Anthony Pro-Life America President Marjorie Dannenfelser in a statement. “President Trump’s first-term pro-life accomplishments are the baseline for his second term. In the long term, GOP pro-life resolve must be strengthened and centered on the unalienable right to life for unborn children that exists under the 14th Amendment.”

Despite their losses, abortion-rights advocates said the ballot question victories signal widespread American support for abortion protections even in red states.

Most significantly, Missourians voted to overturn a total abortion ban. Voters also approved an abortion-rights amendment in Arizona, which will override the current 15-week ban. Voters agreed to expand reproductive-rights protections in Colorado, Maryland and New York. Ballot measure races in Montana and Nevada were too close to call as of early morning Wednesday.

“This is an especially historic win for Missouri,” said Nancy Northup, president and CEO of the national legal advocacy group Center for Reproductive Rights. “In fact, the amendment goes even further, calling for ‘a fundamental right to reproductive freedom, defined to include abortion and all matters relating to reproductive health care.’ By saying yes to this powerful language, voters have demanded the return of the essential human rights and freedoms they lost after Roe was overturned.”

But abortion-rights advocates suffered a major loss in Florida, which barely failed to clear a 60% supermajority threshold, more than any of the other state abortion initiatives. With 58% voting in favor to overturn a strict abortion ban and enshrine protections, Florida is the first state to fail to secure abortion rights since Roe v. Wade was overturned two years ago.

Abortion-rights organizers who spearheaded and funded Florida’s Yes on 4 campaign said the result still shows majority approval for abortion rights among Floridians, and they vow to continue trying to restore abortion rights in the state that six months ago was an abortion-access haven for the Southeast region.

“We’re incredibly proud to have stood with doctors, patients, and advocates impacted by this ban,” said Yes on 4 Florida campaign manager Lauren Brenzel in a statement. “Their stories, along with the countless women who will continue to suffer under Florida’s cruel and extreme abortion ban, remind us that our fight is far from over.”

Attorney and anti-abortion activist Catherine Glenn Foster told States Newsroom she is celebrating the fact that Floridians blocked attempts to enshrine abortion in their state constitution. However, she acknowledged that state abortion bans have created real problems, including women dying of preventable pregnancy-related causes and being denied routine miscarriage care. She said states that ban abortion should increase social supports, something that largely hasn’t happened since states started banning abortion, and should implement a robust training system around treating health emergencies.

“We need to have a real reckoning,” said Foster, who has previously worked for major anti-abortion groups like Americans United for Life and Alliance Defending Freedom. “We’ve created an environment where doctors are scared. They don’t know how to respond and how to treat, and that’s a big problem. We have to address that before we pass anything else.”

Abortion ballot initiative results

Since Roe v. Wade was overturned in June 2022, seven states — California, Kansas, Kentucky, Michigan, Montana, Ohio and Vermont — have approved reproductive-rights state constitutional amendments or rejected anti-abortion constitutional amendments. This year reproductive-rights coalitions put abortion on the ballot in 10 states. Arkansas had collected enough signatures to qualify for the ballot, but this summer the state Supreme Court ruled that Arkansans for Limited Government, the committee behind the initiative, did not submit the correct paperwork. The group opposing abortion, marijuana and education measures in the state was led by a top adviser to Republican Gov. Sarah Huckabee Sanders, Arkansas Advocate reported.

Arizona — Proposition 139, to enshrine abortion rights until fetal viability — APPROVED

YES: 63%

NO: 37%

In this swing state, abortion is currently legal until 15 weeks’ gestation. Earlier this year, a few Republicans crossed party lines to repeal a Civil War-era near-total abortion ban the legislature had revived. This citizen-initiated amendment would also prevent any penalties for someone who helps a person get an abortion. And it would allow for exceptions later in pregnancy for the patient’s life or physical or mental health.

Colorado — Initiative 79, to allow public insurance to cover abortions — APPROVED

YES: 62%

NO: 39%

The citizen-initiated amendment proposes to expand abortion access in a state that currently has no gestational limits but does have a 40-year-old public funding ban. The amendment also proposes to prevent government interference in pregnancy and allow public insurance to cover abortions.

Florida — Amendment 4, to enshrine abortion rights until viability — FAILED

YES: 57%

NO: 43%

This citizen-initiated amendment would have overturned a 6-week abortion ban that has impacted the Southeast. Republican Gov. Ron DeSantis’ administration mounted fierce opposition against the abortion-rights campaign that involved a state-sponsored misinformation campaign. Florida was the only state in this election to require a 60% supermajority for ballot measures.

Maryland — Question 1, to protect reproductive autonomy — APPROVED

YES: 74%

NO: 26%

This legislatively-referred amendment would enshrine an individual’s right to make “decisions to prevent, continue, or end” a pregnancy. Maryland has become a major abortion-access haven for the country; it is legal here until fetal viability and after for reasons related to the health of the fetus or pregnant person.

Missouri — Amendment 3, to enshrine abortion rights until fetal viability — APPROVED

YES: 52%

NO: 48%

This citizen-initiated amendment would overturn a near-total abortion ban that only has exceptions to prevent the death of the pregnant person. The ban’s ambiguous language led at least one Missouri hospital system to stop providing emergency contraception to patients, a move that forced the state attorney general to announce that Plan B and contraception remain legal.

Montana — Constitutional Initiative 128, to enshrine abortion rights until fetal viability — RESULTS NOT FINAL

YES: 58%

NO: 42%

This citizen-initiated amendment would guarantee protections in a state where abortion is currently legal but where Republican lawmakers have attempted to pass restrictions since Roe fell in 2022. Preliminary results show supporters of the measure were leading opponents as of 11 p.m. local time.

Nebraska — Initiative 434, to ban abortion after the first trimester vs. Initiative 439, to enshrine the right to abortion until viability

Initiative 434 — APPROVED

FOR: 55%

AGAINST: 45%

Initiative 439

FOR: 49%

AGAINST: 51%

Nebraska was the only state to have two competing abortion-related initiatives on the ballot.

Nevada — Question 6, to enshrine abortion rights until fetal viability — RESULTS NOT FINAL

YES: 63%

NO: 37%

In this swing state abortion is currently legal up to 24 weeks of pregnancy, but this citizen-initiated measure would enshrine abortion rights into law. The measure will need to be approved by voters again in 2026 to become law.

New York — Proposal 1, to bar discrimination based on pregnancy status — APPROVED

YES: 62%

NO: 39%

This legislatively-referred measure would guarantee abortion rights in a state where abortion is legal up to 24 weeks of pregnancy — later if a provider determines the procedure is necessary to save a patient’s life or health, or if the fetus is nonviable.

South Dakota — Amendment G, to allow abortion through the end of the first trimester — FAILED

YES: 39%

NO: 61%

This citizen-initiated measure would have allowed regulation in the second trimester for maternal health reasons and allow lawmakers in the third trimester unless the procedure is necessary to save the life or health of a pregnant patient.

Races where abortion took center stage

Minnesota Congressional District 3

Democrat Dr. Kelly Morrison: 59%

Republican Tad Jude: 41%

Minnesota State Sen. Kelly Morrison, DFL-Deephaven, won the Minnesota 3rd Congressional District race to replace Democratic U.S. Rep. Dean Phillips in a seat that before 2018 had for decades gone to Republicans, AP reported. Morrison is a practicing OB-GYN who supports abortion rights. Currently, the only OB-GYNs in Congress oppose abortion. Her Republican opponent, Tad Jude, has called every abortion a “tragedy” and supported the overturning of Roe v. Wade.

A special election in Minnesota will determine who takes over Morrison’s state Senate seat, whose term ends in 2026.

Wisconsin Congressional District 8

Republican Tony Wied: 60%

Democrat Dr. Kristin Lyerly: 40%

Of the close races in the swing state of Wisconsin, the 8th Congressional District was the least likely to flip from Republican control. But Dr. Kristin Lyerly launched a fierce campaign emphasizing a commitment to restoring reproductive health access to Americans, something she is uniquely positioned to advocate for as a longtime OB-GYN and abortion provider. Lyerly is also one of the plaintiffs in a lawsuit that successfully blocked an 1849 Wisconsin feticide law that was temporarily enforced as a state abortion ban. Her campaign attracted national campaign cash and support. Her opponent, Republican Tony Wied, a former gas station owner, largely ran on his Trump endorsement.

Tennessee State House District 75

Republican Jeff Burkhart: 55 %

Democrat Allie Phillips: 45 %

Incumbent Republican Rep. Jeff Burkhart defeated former day care operator and political newcomer Allie Phillips, who largely campaigned on reproductive rights. The 29-year-old drew national attention after speaking out about being denied a necessary abortion in Tennessee, where abortion is banned, when her desired pregnancy became nonviable and dangerous at 19 weeks. She ultimately traveled out of state to obtain the abortion. Phillips joined a legal challenge to the state’s strict abortion law. She pledged if elected to immediately push for a policy that would carve out exceptions for fetal anomalies to Tennessee’s abortion ban, which she’s named “Miley’s Law” after the baby she and her husband lost.

In the two years since the U.S. Supreme Court started allowing states — what has become almost half of the country — to ban all or most abortions, doctors continue to report that these laws have detrimentally changed their jobs and the quality of care they can provide pregnant patients.

A research team led by Dr. Daniel Grossman at the University of California San Francisco has been studying the impacts on medical care of the Dobbs v. Jackson Women’s Health Organization decision that overturned the federal right to abortion under Roe v. Wade. On Monday they released their latest Care Post Roe findings. Having grown from 50 to 86 submissions since the preliminary findings were released in May 2023, the survey details medical situations gone wrong because of legal concerns over a state’s abortion ban.

When Grossman — a clinical and public health researcher who specializes in abortion and contraception — talked to States Newsroom last year about the early findings, he emphasized the patient fear palpable in the narratives of their doctors. They told stories about women traveling outside their ban states just to check if they could be pregnant, or during a medical emergency. But as more submissions continue to flow in, Grossman recently said he’s struck by the distress coming from the medical community.

“One thing that was notable in some of these more recent submissions,” Grossman told States Newsroom, “is how moral distress is being incorporated into medical education, like medical students and residents are essentially now learning about the moral distress as part of their medical education, as they’re learning about the care that they can’t provide.”

The Care Post Roe study details 86 submissions received between September 2022 and August 2024 from health professionals recounting cases involving patients from 19 states that, during the study’s time frame, fully or partly banned abortion. Participants described cases that “deviated from the usual standard” of care because of a state abortion ban, some that resulted in preventable complications like severe infections or the placenta growing too deep into the patient’s uterine wall. The participants were directed not to give details that could identify themselves or their patients.

Grossman said the study was designed this way to protect the identity of health providers and patients, many of whom currently fear prosecution for their medical decisions. Researchers also conducted optional in-depth interviews with more than 30 of the participants, but those findings were not included in Monday’s report.

The majority of submissions so far have come from Texas, Grossman said, the largest of the states and where abortion has been illegal the longest. According to the study, the narratives represent a range of different ages, income levels and racial and ethnic backgrounds, though a high proportion are Black and Latinx. Submissions were also reviewed by two physicians and were rejected if they did not contain information about a specific case or did not relate to a change in care since the Dobbs ruling.

Grossman said the study is limited in size and scope and doesn’t say how common these medical situations are or how they will trend over time. But he said the stories are consistent with ongoing news reports and lawsuits wherein doctors and patients describe denying and being denied care because of abortion bans. He said the study, which includes excerpts from health providers’ narratives, serves as a qualitative representation of the types of medical emergencies that doctors all over the country have been reporting.

The submissions were organized into several categories, including:

Second-trimester obstetric complications

The most common type of reported scenario involving second-trimester complications is the preterm prelabor rupture of membranes (PPROM). A doctor described treating a patient who had ruptured membranes at 16-18 weeks’ gestation but instead of being offered an abortion procedure or an induction termination, she had been sent home, where she had developed a severe infection.

“I meet her 2 days later in the ICU. She was admitted from the ER with severe sepsis…and bacteremia. Her fetus delivers; she is able to hold [the fetus]. We try every medical protocol we can find to help her placenta deliver; none are successful,” the physician writes. “The anesthesiologist cries on the phone when discussing the case with me — if the patient needs to be intubated, no one thinks she will make it out of the OR. I do a D&C.”

Ectopic pregnancies

Ectopic pregnancies occur when a fertilized egg implants outside the uterus. They are medical emergencies, but study participants reported cases of ectopic pregnancy requiring extra steps, such as consulting multiple physicians, as well as patients delaying care because they were too scared to be seen in their home states where abortion is banned.

“If [the patient] had seen [a] provider in [her home state] when bleeding started,” one doctor wrote, “she would have had the ectopic diagnosed about 6 weeks earlier, potentially eligible for [methotrexate] and therefore potentially avoided surgery, and even if [she] needed surgery [it] would have been at home with her family and support. Instead [she] had to… recover alone in a hotel room in a random state she had never been to before.”

Underlying medical conditions

Some physicians described cases where patients had underlying medical conditions that complicated their pregnancies. In some cases, patients were delayed or denied treatment, worsening their conditions.

“She was mid-second trimester [16-18 weeks] when she presented. She has [more than 5] children at home and had severe postpartum cardiomyopathy when she gave birth a year

ago, which has persisted,” a doctor wrote. “The risk of her dying from childbirth would have been extremely high — but she was unable to find anyone in her state willing to do the procedure.”

Miscarriage

Respondents also reported challenges with miscarriage management in states with abortion bans.

“The pharmacy refused to fill the medication until they had confirmation of its use but was unable to list what that confirmation needed to include,” one clinician wrote. “The back and forth delayed the care and ultimately the client could no longer face attempting to pick up the medication and decided to utilize expectant management [i.e. waiting for the tissue to pass naturally] due to the trauma of being refused her prescribed treatment.”

Fetal anomalies

Several submitted narratives involved patients whose pregnancies were complicated by fetal anomalies, many of which were described as being incompatible with neonatal life, though termination was not possible in their state.

“Due to the anencephaly, as soon as the umbilical cord was cut, the pink skin of the baby rapidly progressed to navy, only for the baby to be completely dark navy by the time they were wrapped in a blanket and handed to the mom,” a medical student wrote. “The patient was letting out a loud scream throughout the labor due to the sheer pain of giving birth, but the scream and wailing she let out once she saw the baby was soul-crushing.”

Denied other types of medical care

One of the more shocking examples for Grossman involved a patient with a postpartum hemorrhage who needed a common procedure known as dilation and curettage, or D&C, which is used for abortions, miscarriages and sometimes to empty the uterus after the baby has been born. But according to the narrative submitted, a patient had been told by the labor and delivery staff that “D&Cs were now illegal for any reason.”

In another case, an abortion ban allegedly led to the cancellation of a patient’s liver transplant.

“Patient with… [an intrauterine device (IUD)] in place came in for liver transplant after there

was a donor match found,” the physician wrote. “On routine pre-surgical testing she had a positive urine pregnancy test, and her bHCG quant was in the 1000s. Her transplant was cancelled because of her positive pregnancy test despite it being an undesired, very early pregnancy.”

Carceral system

Three submissions highlighted how patients in detention, awaiting trial, or on parole faced additional obstacles obtaining an abortion in states with bans.

“Asked for permission to leave her county (and state) to receive abortion care and was told NO,” a physician wrote. “Patient left the state for abortion care anyway. Given 24-hour waiting period in [state with legal abortion] and need for a 2-day procedure, was away for 3 days (2 separate trips). She also refused any sedation because she needed to be drug tested and couldn’t admit to leaving the state for a procedure.”

Researchers predict more poor-quality care if EMTALA ruled to exclude abortion care

“It is notable that the narratives reported here describing delayed and denied care have occurred with EMTALA still intact and hospitals required to provide emergency abortion care,” the study’s authors write, referring to the federal Emergency Medical Treatment and

Labor Act, which the federal government has stipulated includes emergency abortion care, and which states with abortion bans have sued over. The U.S. Supreme Court this summer declined to rule on Idaho’s lawsuit challenging the federal requirements, allowing doctors to provide emergency abortions while litigation continues.

“Although it is difficult to assess from the narratives, some … may have been EMTALA violations since stabilizing care was not provided,” the researchers write. “Other cases, such as those where the patient was admitted to a hospital for observation or those involving a patient pregnant with a fetus with an anomaly incompatible with life, are likely not EMTALA violations. Regardless, we anticipate these cases of poor-quality care would become even more common if the Supreme Court were to rule that EMTALA does not apply to emergency abortion care.”

Overall, participants reported that their patients suffered emotionally and financially, sometimes even insured patients having to pay out of pocket for medical care because it was in another state. Grossman also noted that affected patients could face long-term physical and mental-health consequences because of the medical care they did or did not receive.

“When we came out with our first report, maybe I was a little bit more optimistic and thought that perhaps this information could be used to help streamline care, reduce these delays, and identify workarounds,” Grossman said. “And perhaps that has happened in some places, but I think it’s really clear now, more than two years out, that those kinds of fixes or Band-Aids on a bad policy just aren’t going to work, and that really it’s not possible to provide evidence-based care in these states. These bans need to be repealed.”

Two of the key studies cited by plaintiffs and judges as evidence that medication abortion should be pulled from the market or heavily restricted have been retracted because of undeclared conflicts of interest and unreliable findings, academic publisher Sage announced Monday.

States Newsroom was the first to report last year that Sage had opened an investigation into some of the research featured prominently in the initial Alliance for Hippocratic Medicine v. U.S. Food and Drug Administration case, whose appeal goes before the U.S. Supreme Court next month. The case is centered on mifepristone, part of a two-drug regimen used to terminate pregnancies and to manage miscarriages.

Sage retracted three studies published in its journal “Health Services Research and Managerial Epidemiology,” which were funded and produced by the Charlotte Lozier Institute, the research arm of the influential Susan B. Anthony Pro-Life America, which works to elect federal and state anti-abortion lawmakers.

“Following Committee on Publication Ethics (COPE) guidelines, we made this decision with the journal’s editor because of undeclared conflicts of interest and after expert reviewers found that the studies demonstrate a lack of scientific rigor that invalidates or renders unreliable the authors’ conclusions,” reads a statement issued by Sage.

The studies are:

“A Longitudinal Cohort Study of Emergency Room Utilization Following Mifepristone Chemical and Surgical Abortions, 1999–2015” (2021)

“A Post Hoc Exploratory Analysis: Induced Abortion Complications Mistaken for Miscarriage in the Emergency Room are a Risk Factor for Hospitalization” (2022)

“Doctors Who Perform Abortions: Their Characteristics and Patterns of Holding and Using Hospital Privileges” (2019)

The lead author for each study was James Studnicki, Charlotte Lozier’s vice president and director of data analytics, who was on the editorial board of “Health Services Research and Managerial Epidemiology” at the time the studies were published.

“Upon submission, the lead author declared no conflicts of interest and all authors declared the same within each article; however, all but one of the article’s authors had an affiliation with one or more of Charlotte Lozier Institute, Elliot Institute, and American Association of Pro-Life Obstetricians and Gynecologists – all pro-life advocacy organizations that explicitly support judicial action to restrict access to mifepristone,” the Sage statement reads. One of those groups, AAPLOG, is a plaintiff in the Alliance v. FDA lawsuit.

Neither Studnicki nor the Charlotte Lozier Institute responded to a request for comment in time for publishing.

Last year, pharmaceutical sciences professor Chris Adkins contacted Sage with his concerns about the 2021 “Longitudinal Cohort Study,” which was cited by U.S. District Judge Matthew Kacsmaryk as evidence that the anti-abortion doctor-plaintiffs had standing to sue because “they allege adverse events from chemical abortion drugs can overwhelm the medical system and place ‘enormous pressure and stress’ on doctors during emergencies and complications.”

That paper looked at Medicaid patients’ visits to the emergency room within 30 days of having an abortion and concluded that medication abortion is excessively risky.

“I can’t prove that there was intent to deceive, but I struggled to find an alternative reason to present your data in such a way that exaggerates the magnitude,” Adkins told States Newsroom at the time. “They’re misrepresenting its conclusions to begin with.”

The epidemiology and public health experts who conducted an independent post-publication peer review of the three studies ultimately agreed with Adkins. Regarding the 2021 and a follow-up 2022 paper using the same dataset, the experts found “fundamental problems with the study design and methodology,” “unjustified or incorrect factual assumptions,” “material errors in the authors’ analysis of the data,” and “misleading presentations of the data.”

The 2019 article, using a different dataset, contained “unsupported assumptions,” “misleading presentations of the findings,” and “demonstrate a lack of scientific rigor and render the authors’ conclusion unreliable,” the experts found.

Experts have cited mifepristone’s safety and efficacy with more than 5.6 million uses over the past two decades. The FDA has recorded 28 deaths but has stated that the drug cannot be identified as the cause of those deaths.

Georgia Recorder is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501c(3) public charity. Georgia Recorder maintains editorial independence. Contact Editor John McCosh for questions: info@georgiarecorder.com. Follow Georgia Recorder on Facebook and Twitter.