Key Takeaways

• Before the 1973 Roe v. Wade decision, many state abortion laws banned or indirectly regulated fetal research.
• On Friday, July 1, 2022, Michigan GOP senators quickly passed two bills that would prohibit research on cells obtained from an abortion.
• On Monday, June 27, 2022, Pennsylvania House Republicans amended the state's appropriation bill for state-related universities. The amendment, which passed in a 108-92 vote, seeks to ensure that state-related universities cease to engage in fetal tissue research or experimentation using fetal tissue from an elective abortion. Based on the amendment, the University of Pittsburgh will not receive its $151 million state appropriation unless it stops such research.

Introduction

Historical Background

• Although fetal tissue research has been a key area of focus in discussions about abortion laws, fetal research, rather than fetal tissue research, was historically the target of much of the regulatory and legislative quagmire.
• Fetal research drew more criticism, having emerged before the contentious use of fetal tissue for transplantation. It involved older technologies and had a wide range of applications, including improving fetal survival and fertility of couples who experience conception issues. By its nature, fetal research encompasses “the complete spectrum of ethical, legal, and social issues that attend to experiments on living fetuses in utero, embryos produced by in vitro methods, and even the very ownership of those embryos.”
• However, before the 1973 Roe v. Wade decision, many state abortion laws banned or indirectly regulated fetal research.

Regulation of Fetal Tissue Research

• Specifically, regulation for fetal tissue research came in 1973 following the ratification of the Uniform Anatomical Gift Act (UAGA), which “regulated the use of human organs and tissues after death, prohibiting their sale for-profit and their use for any” reasons, with an exception for research or therapy. Roe v. Wade most likely triggered federal regulation for fetal tissue research as the legalization of abortion, with its potential for increasing the supply of fetal tissue and cells, put the spotlight on the debate.
• Versions of the UAGA regulate fetal tissue donation at the state level. A policy review by the Guttmacher Institute in 2016 showed that UAGA laws in 38 states and the District of Columbia explicitly treat fetal tissue like other human tissue, permitting women to donate it for research, therapy, or education. The other 12 states remained silent on the donation of fetal tissue.
  Source
   

• Specific statutes (which often incorporate federal standards) in some states also regulate fetal tissue donation and research. For example, profiting from the donation or transfer of fetal tissue for research purposes is prohibited in 12 states, and the woman's consent is required for research in eight states. Meanwhile, state laws in five states, such as Indiana, ban the use of fetal tissue obtained from abortions for research.
• While federal policies include limitations on funding for human embryo and embryoid research, state laws often deal with aspects such as fetal tissue research, abortion, and others.
• While 29 states have laws that impact human embryo research, only 11 states, including Arkansas, New Mexico, Pennsylvania, North Dakota, South Dakota, Kentucky, Minnesota, Nebraska, Oklahoma, Louisiana, and Rhode Island, prohibit it.
•  Five states, with a broad range of definitions of a fetus, ban fetal research. These include Pennsylvania, Minnesota, North Dakota, New Mexico, and Rhode Island.
• In a paper published in the Journal of Law and the Biosciences, Kirstin Matthews and Daniel Moralí concluded that “the patchwork of policies between US states is morally inconsistent, with some research banned in one state but publicly funded in another. As a result of our current decentralized approach to the human embryo and embryoid research, we find a highly pluralist approach to regulation, which reflects geographic differences in perceptions and opinions about the research.”

States Already Announcing Measures to Limit Fetal Tissue Research

Pennsylvania

• Following the overturning of Roe v. Wade, on Monday, June 27, 2022, Pennsylvania House Republicans amended the state's appropriation bill for state-related universities. The amendment, which passed in a 108-92 vote, seeks to ensure that state-related universities cease to engage in fetal tissue research or experimentation using fetal tissue from an elective abortion. Based on the amendment, the University of Pittsburgh will not receive its $151 million state appropriation unless it stops such research.
• State Rep. Jerry Knowles (R., Schuylkill), who focused on tissue research when he addressed the floor, said, “My goal is not to stop the funding. As a matter of fact, I want to help Pitt get themselves out of a problem they have created for themselves.”

Michigan

• On Friday, July 1, 2022, Michigan GOP senators quickly passed two bills that would prohibit research on cells obtained from an abortion.
• House Bill 5558, bans research conducted on an “organ, tissue or cell taken from a dead embryo, fetus or neonate obtained from an abortion.” The second bill, House Bill 5559, proposes a prison sentence of up to five years for violators.
• The bills, which passed in a 21-16 vote at 2:30 am following no discussion or debate, are expected to be vetoed by Gov. Gretchen Whitmer.
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• During a congressional hearing on fetal tissue research in 2016, Dr. Lawrence Goldstein, "now an emeritus professor of cellular and molecular medicine at the University of California San Diego” said, “My message is simple: Fetal tissue and cells that would otherwise be discarded play a vital role in modern cutting edge medical research.”

Research Strategy

Key Takeaways

• According to Asia Eaton, PhD, associate professor of psychology at Florida International University and director of the Power, Women, and Relationships Lab, “An abortion ban will increase college dropout rates for women, especially women of color.
• According to Bayliss Fiddiman, director of educational equity at the National Women's Law Center: “Colleges should be prepared for a larger population of pregnant students and parenting. But we don’t even have a system to support the ones we currently have.”
• Following the repeal of Roe v. Wade, Pennsylvania House Republicans amended the state's appropriation bill meant to block public funding for the four state-related universities in Pennsylvania unless they stop engaging in fetal tissue research. They include the University of Pittsburgh, Penn State University, Lincoln University, and Temple University. The schools would be required to swear under oath to that effect.

Introduction

Medical Training

• The US Supreme Court's decision to repeal Roe v. Wade will make it more difficult for medical trainees to learn abortion-related procedures, including patient counselling, miscarriage management, and emergency care. Although the fallout of the decision will have to be assessed over time, medical educators expect the impact on medical training to be immense.
• Scott Sullivan, MD, the American College of Obstetricians and Gynecologists spokesperson, said: “The widespread criminalization of an aspect of health care and the effect we expect on medical education is unprecedented.”
• Similarly, Margaret Boozer, MD, a professor of obstetrics and gynaecology at the University of Alabama at Birmingham Heersink School of Medicine, said: “I worry that limited opportunities to train mean that future patients may be cared for by providers who don’t have the skills necessary in such situations.”
• Following the repeal, medical educators are considering their options in navigating the new legal environment with regard to meeting the related professional recommendations and requirements. For instance, obstetrics and gynaecology residents unable to receive their required medical training in their states might have to look for out-of-state medical schools and health care programs that provide a complete reproductive health care education that includes abortion.

 

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• Michael Drake, president of the University of California, stated thus: “Despite this decision by the Court, we will continue to provide the full range of health care options possible in California. We will also continue to offer comprehensive education and training to the next generation of health care providers and to conduct life-saving research to the fullest extent possible.”

Funding for State-Related Universities

• Following the repeal of Roe v. Wade, Pennsylvania House Republicans amended the state's appropriation bill meant to block public funding for the four state-related universities in Pennsylvania unless they stop engaging in fetal tissue research. They include the University of Pittsburgh, Penn State University, Lincoln University, and Temple University. The schools would be required to swear under oath to that effect.

 

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• The state appropriation to these four institutions, most of which subsidizes the tuition of in-state Pennsylvanian college students and their families, amounted to almost $600 million last year.
• The move came after years of pressure from those who oppose abortion access, arguing since 2019 against funding Pitt due to fetal tissue research conducted using aborted fetuses. Blocking the funding is quite easy as the legislative rules require that two-thirds of lawmakers agree to fund educational institutions that are not entirely state-controlled, such as Pitt and Penn State.
• An independent review of Pitt's research practices in all 31 fetal tissue studies since 2001 concluded that they had been “conducted in compliance with federal and state laws.” The report was released in December 2021 and cited by Democrats.
• Meanwhile, in countering claims by Democrats, House Republicans specified that the funding restrictions would only apply to fetal tissue derived from abortions and not other circumstances such as miscarriage or stillbirth.

Pregnant and Parenting Students in Colleges

• Repealing Roe v. Wade, which now allows for broad abortion restrictions in at least 20 US states, will likely increase the number of pregnant students in colleges. The Court's decision is expected to cause a spike in the number of college students who would have to choose between raising children on college campuses or foregoing dreams of graduating from college.
• Raising children on campus would be challenging, considering the decades-long struggles that institutions have undergone to provide pregnant students with things like private rooms, housing, and flexible schedules.

 

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• According to Bayliss Fiddiman, director of educational equity at the National Women's Law Center: “Colleges should be prepared for a larger population of students who are pregnant and parenting. But we don’t even have a system in place to support the ones that we currently have.”
• Consequently, college graduation rates might be affected, as the chances of graduating from college on time are ten times less for student-parents than those without children.
• “Asia Eaton, PhD, associate professor of psychology at Florida International University and director of the Power, Women, and Relationships Lab,” said that abortion restrictions will impact people of color and other marginalized groups the most. These include students and employees of colleges and universities. According to her, “An abortion ban will increase college dropout rates for women, especially women of color. Caring for a child you haven’t planned for is at odds with attending college, and you might have health complications that make it impossible to continue in school.”

Research Strategy

Key Takeaways

• Legal experts say that the Supreme Court's decision to overturn Roe v. Wade can make states restrict access to some contraceptives. 

• The Supreme Court's overturning does not directly affect access to contraception. However, experts predict that the countries, states, and individual prosecutors that want to ban Plan B may believe they have the Supreme Court's support.

• Several direct-to-consumer brands such as Nurx and Wisk are now trying to make it easier to access emergency pills that do not require prescriptions. On 21st June, Stix debuted its $38 emergency contraceptive pill called Restart and launched a fund that will make pills free for women in need.

Introduction

1. Possible Upcoming Legal Restrictions

• Legal experts say that the Supreme Court's decision to overturn Roe v. Wade can make states restrict access to some contraceptives. 
• According to Wendy Parmet, the director of the Center for Health Policy and Law at Northeastern University, the states that have or are attempting to limit abortion from contraception could also challenge emergency contraception and Plan B. These states are Kentucky, Arkansas, Missouri, Louisiana, Oklahoma, South Dakota, Wyoming, Utah, North Dakota, Mississippi, Idaho, Texas, and Tennessee.

 

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• These birth control forms could become bigger targets for restrictions than conventional birth control pills since they stop implantation and fertilization. There are people who already deem them as abortion-inducing medications because of this.
• The Supreme Court's overturning does not directly affect access to contraception. However, experts predict that the countries, states, and individual prosecutors that want to ban Plan B may believe they have the Supreme Court's support.
• Justin Clarence Thomas' concurring opinion suggested that the Supreme Court should rethink the other past rulings. This included Griswold v. Connecticut, a case that gave married couples the right to purchase and use contraceptives.
• Khiara M. Bridges, a law professor at the University of California, said that some states could label Plan B as an abortifacient as they interpret old anti-abortion laws that could be effective.
• There were already attempts to ban emergency contraception by anti-abortion groups and lawmakers before the overturning, and now, this is likely to be the next step.
• The Supreme Court's decision makes clear that other rights founded on the same principle of privacy, such as the freedom to use contraception, are also called into question. 

2. The Initial Growth of the Industry Plus Increase in Demand for Emergency Contraceptives

• Walgreens' spokeswoman said that the company saw a jump in demand for the ship-to-home business of emergency contraception pills. Wisk, an online reproductive and sexual health producer that sells two types of morning-after pills said it saw a historic 3,000% increase in sales of emergency contraceptives after the Supreme Court's decision. This increase in demand for emergency contraceptives is expected to continue increasing as abortion gets banned in more states.
• Several direct-to-consumer brands such as Nurx and Wisk are now trying to make it easier to access emergency pills that do not require prescriptions. Predicting the court's decision, on 21st June, Stix debuted its $38 emergency contraceptive pill called Restart and launched a fund to make pills free for women in need.
• Expanding access to emergency contraception at local pharmacies will be prioritized. All pharmacies will be required to have and dispense birth control to those requesting it with or without a prescription.
• The removal of abortion rights will be a “boon for Plan B's manufacturer, Foundation Consumer Healthcare,” since it has the largest market share among emergency contraceptives.
• Pharmacies around the country intend to be prepared to supply emergency contraception for their communities. Tara Carpenter, a pharmacy manager in Columbia, said that as a local health center, it is important that they try to provide such resources.
• The Fitchburg Family Pharmacy is preparing for an inevitable increase in the need for emergency contraceptives.
• Fear that abortion could be banned in many states has made retail investors turn to the stocks of some contraceptive producers like Evofem Biosciences, Femasys Inc., and Agile Therapeutics.
• On June 24th, Evofem, Agile, and Femasys jumped by 189%, 90%, and 31%, respectively.

Research Strategy

Key Takeaways

• According to Laurie Sobel, associate director for women’s health policy at the Kaiser Family Foundation, access to virtual abortions will be illegal in states that seek to make abortion illegal.
• States are trying to ban access to abortion pills by introducing legislation that would outrightly prohibit the use of mifepristone. This is the case in over a half-dozen states.
• According to Alina Salganicoff, director of women’s health policy at the Kaiser Family Foundation, in the beginning, it will be difficult for states to track, follow, and enforce laws against in-mail abortion pills because people can't just access other people's mailboxes. She also noted that black markets are bound to arise when things are made illegal or banned.

Introduction

Expert Opinion

• Abortion through the telemedicine route is subject to state laws-it was already banned in 19 states before Roe was upturned. Greer Donley, a law professor at the University of Pittsburgh, said that states that more states could ban abortions altogether following the repeal of Roe, including telemedicine abortion.
• According to Laurie Sobel, associate director for women’s health policy at the Kaiser Family Foundation, access to virtual abortions will be illegal in states that seek to make abortion illegal.
• In December 2021, the Food and Drug Administration announced its decision to permanently allow the abortion pills—mifepristone and misoprostol—to be prescribed via telehealth and mailed to patients in states that permit it. However, opponents in anti-abortion states with trigger laws fear that the FDA's decision would subvert state abortion laws that restrict or ban mifepristone.

 

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• Kirsten Moore, director of the Expanding Medication Abortion Access Project, said, “It’s crazy that states are trying to ban access to an FDA-approved drug.”
• According to Mary Ziegler, a law professor at Florida State University, “Getting abortion medication in the mail, or just expanding access to abortion medication period, could potentially be a game-changer in the United States, where abortion is illegal in some places and inaccessible in lots of places.”

Enforcement Challenges

• Experts say that although virtual abortions may become more cumbersome and risky, people won't stop getting them. People could travel across state borders to states where telehealth services are legal, book virtual appointments in a car, and have the pills mailed to addresses near the state border.

 

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• They could also rely on internationally-based groups that provide online consultations and mail pills to all states in the US. According to legal experts, anti-abortion states will find it hard to enforce their laws against these groups, one of which is Austria-based Aid Access. Rebecca Gomperts, a Dutch doctor who funds Aid Access, insists that the organization will not stop assisting women in the US.
• Laurie Sobel said: “The idea of being able to have any repercussions for groups that are abroad, it’s a lot harder to imagine.”
• According to Alina Salganicoff, director of women’s health policy at the Kaiser Family Foundation, in the beginning, it will be difficult for states to track, follow, and enforce laws against in-mail abortion pills because people can't just access other people's mailboxes. She also noted that black markets are bound to arise when things are made illegal or banned.

Moves by States with Trigger Laws to Curb the Use of In-Mail Abortion Pills

• States are trying to ban access to abortion pills by introducing legislation that would outrightly prohibit the use of mifepristone. This is the case in over a half-dozen states.

 

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• One of these states is Louisiana, whose governor signed, into law, a bill that bars pregnant people from accessing abortion pills via mail. In opposition to federal guidance, the bill criminalizes the delivery, dispensing, distribution, or provision of abortion-inducing medication.
• Although abortion pills were required to be taken in a doctor's office, the bill now explicitly adds mailing or supplying abortion pills to its definition of criminal abortion. In the absence of Roe, the bill, which takes effect from August 1, strengthens Louisiana's trigger laws that attract up to a ten-year prison sentence and up to a $100,000 fine for those who provide abortions.
• Other states like Arizona, Arkansas, and Texas have banned the mailing of abortion pills.

Research Strategy

Key Findings

• There was limited health insurance coverage even when Roe v. Wade was in effect and is now expected to get even rarer in states where abortion has been banned.

• Employers that fund their health insurance policy may maintain abortion coverage.

• "State-regulated insurers in states where abortion is banned will have to drop coverage of abortions to stay in compliance with state criminal law."

Introduction

Insurance coverage for Abortion Is Expected to Get Even Rarer in States Where the Practice is Banned.

• Health insurance coverage for abortion was rare even when Roe v. Wade was in effect. Many states have restrictions on what plans can cover. The national law also prohibits using federal funds for abortions, meaning Medicaid and Medicare didn't often cover abortion.
• With the Roe v. Wade ruling expected to be effected in at least half of the US states, experts have opined that abortion coverage will become rarer. "State-regulated insurers in states where abortion is banned will have to drop coverage of abortions to stay in compliance with state criminal law," said Caitlin Donovan, National Patient Advocate Foundation spokesman.
• In states like South Dakota and Louisiana, which have banned abortion, insurance coverage on the act has now been limited to grievous cases like a threat to a mother's life, rape, or incest. However, according to Caitlin Donovan, some states have banned the act completely without exceptions.
• "State-level variations were already the norm for health insurance coverage of abortion, particularly for health plans purchased by individuals and small groups. States that will now ban abortions were generally the same states that already prohibited abortion coverage on health plans purchased in the exchange or even on all private state-regulated health plans." said Louise Norris, an analyst with healthinsurance.org.
• According to Norris, there is "a limited likelihood of a major change in abortion coverage under health plans sold in the Affordable Care Acts marketplaces."

Employers that Fund their Health Insurance Policy May Maintain Abortion Coverage

• According to Joelle Abramowitz, an assistant research scientist at the University of Michigan, US employers that fund their health insurance policy may maintain their coverage on abortion in the current landscape. This is because "such plans tend to be subject to less regulation, giving the company more flexibility on benefits offered."
• However, employers are required to have a comprehensive review of the legal implications of Roe v. Wade. According to legal experts at Morgan Lewis, employers should consider doing the following using legal counsel;rrrr
• Review what is covered under the Employee Retirement Income Security Act (ERISA). Particularly section 514 (a), which "creates exclusive federal control over employee benefit plans by preempting all state laws that relate to any employee benefit plan."
• Review the scope of their state regulations to determine what they can or cannot pay via their health benefits.
• Find out if their state regulations apply to services offered out-of-state. States that have banned abortion "might also have laws stopping employers from conspiring to violate criminal laws or aiding and abetting the commission of a crime. There might be laws that prohibit employers."

How Some Employers are Responding to the Abortion Law in Terms of Insurance Coverage

• Apple announced that its health insurance plan would cover the cost of abortion, including travel related to it.
• Citigroup has also announced that its health plan will cover travel and accommodation costs for employees who must travel to procure an abortion.
• Match Group has created a fund that supports its employees and their dependents in getting reproductive care outside the state of Texas.
• While Yelp's health insurance plan covers abortion, the company recently announced that it would also cover travel costs for their US employees and dependents who have to travel to access such services.
• Amazon also announced a health benefit covering $4,000 annually in travel expenses for employees who travel out-of-state to get medical treatments, including abortion.

There Will be No Changes in Insurance Coverage in States that will Continue to Offer Access to Abortive Care.

•   Regulators in Connecticut and some other states have confirmed that the decision by SCOTUS would not limit access to abortion services in their states.
• "We will continue to ensure every Connecticut citizen has access to safe and appropriate health care. This decision does not affect your insurance coverage and does not change Connecticut law that allows for an abortion. Abortions are still legal in the state of Connecticut." Andrew N. Mais, Connecticut Insurance Commissioner, said in a statement.
• "Even with the Supreme Court decision overturning Roe, abortion remains legal in New York, and all those who come here seeking care — have my word that New York state has been and will continue to be a haven for abortion access. I will never stop fighting to protect the freedom to make our own decisions about our lives and futures." Said Letitia James, New York Attorney General.
• Other states that have or are planning to ensure access to abortion services are California, Colorado, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Nevada, New Jersey, Oregon, Rhode Island, Vermont, Washington, and the District of Colombia.
• In New York, for instance, health insurance, including Medicaid, covers the termination of pregnancy. Insurers have been prohibited from excluding abortions that are considered to be medically necessary. "Insurers may also not charge co-pays, coinsurance, or deductibles unless the plan is a high deductible plan."

Out-of Network Coverage Could Also Be an Option for Women Considering Moving Out-of State to Conduct Abortion

• Individuals with insurance cover on abortion may also consider having an 'out-of-network' coverage in their health plans. Experts say that out-of-network would help women plan to see a medical specialist in another state.
• Joelle Abramowitz has suggested that individuals should " inquire from their providers if their insurance cover has out-of-network benefits and how they work."
• However, out-of-network is less robust and is not offered in most health plans, including Health Maintenance Organization (HMO) plans.

Research Strategy

Key Takeaways

• The first law that made abortion a criminal offense was passed in the mid-1850s in Massachusetts.
• In 1910, abortion was prohibited in all states in the United States. However, these bans allowed abortions in instances where the mother's life or health was in danger, as judged by a physician.
• According to Jennifer Holland, “by the mid-1990s to the early 2000s, the pressure really escalates from socially conservative leaders on the Republican party."

Introduction

1847 to 1910: Abortion Bans and Vilification

• In 1847, the American Medical Association (AMA) was founded by a group of doctors. The association was male-dominated and investigated reproductive health care personnel such as midwives, and phased out the obstetric services they offered. Additionally, members of the association began a criminalization campaign against abortion.
• The first law that made abortion a criminal offense was passed in the mid-1850s in Massachusetts.
• Restrictions on abortion access became the norm during this period. By 1880, all states had laws that restricted abortion. However, several states allowed abortions in instances where the mother's life or health was in danger, as judged by a physician.
• By 1910, abortion was prohibited in all states in the United States. However, these bans allowed abortions in instances where the mother's life or health was in danger, as judged by a physician.
• According to Planned Parenthood, America had been seeing considerable immigration for several decades at this point. Concerned about losing control of the country, "white men in power supported abortion bans as a way to get upper-class white women to have more children."

1930: Unsafe Abortions

• The criminalization of abortion drove the procedure underground, resulting in a high mortality toll.
• According to Guttmacher Institute, abortion was cited as the cause of death for approximately 2,700 women. Abortion accounted for 18 percent of all maternal fatalities in 1930.

The 1960s and early 1970s: Abortion Reform

• Thalidomide, a drug that was used to ease pregnancy symptoms was discovered to cause serious birth abnormalities. In 1962, a pregnant TV personality who had taken thalidomide was unable to seek a legal abortion. The media followed her travel to Sweden, where she got an abortion. About 52 percent of Americans backed her.
• In 1966, nine doctors were sued for conducting abortions on pregnant women exposed to rubella, a condition that causes birth deformities. Doctors from all throughout the country rallied in support of the nine doctors. This resulted in abortion law reforms in California, hospital committees were allowed to approve abortion requests.
• In 1969, the National Association for the Repeal of Abortion Laws (NARAL) was established. The group was "the first national group created solely to campaign for the legalization of abortion, marking the start of direct action to repeal abortion bans."
• Colorado was the first state to legalize abortion for a variety of reasons, including rape and threat to the mother's life, in 1967. It was followed by North Carolina and Oregon.
• Hawaii repealed abortion restrictions entirely in 1970. It was followed by New York and Washington.

1973: Roe v. Wade

• Norma McCorvey (Jane Roe) filed a lawsuit against Henry Wade, Dallas County DA who tried to enforce a Texas statute prohibiting abortion. McCorvey was unable to seek an abortion lawfully in Texas.
• The lawsuit was filed "with the U.S. District Court for the Northern District of Texas, which challenged the state’s ban on abortions." The court unanimously decided in McCorvey's favor, ruling Texas' legislation unconstitutional. Texas appealed this ruling to the Supreme Court.
• On January 22, 1973, the Supreme Court issued a 7-2 decision that established that women had a basic right to choose abortion without intervention from the government.

The 1970s to 2000s: Anti-Abortion Movement

• According to Jennifer Holland, Assistant Professor of U.S. history at the University of Oklahoma, the anti-abortion movement was a small movement in the 1970s, mostly consisting of white Catholics. Members of the movement argued that "the fetus is a life" and equated legal abortion to Holocaust-style extermination.
• Evangelical Christians also joined the movement in the 1970s and 1980s in large numbers, which increased the movement's size and clout. 
• Recognizing the movement's enormous vote potential, the Republican Party adopted an anti-abortion viewpoint to its platform in 1976.
• According to Jennifer Holland, “by the mid-1990s to the early 2000s, the pressure really escalates from socially conservative leaders on the Republican party."
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• With its decision in Planned Parenthood v. Casey in 1992, the Supreme Court reaffirmed the right to abortion while also making it easier for American states to implement more restrictive abortion legislation. State legislators then enacted a slew of medically unjustified abortion restrictions that judges said did not constitute an undue burden. 
• In 2005, Elizabeth Nash, a public policy associate at the Alan Guttmacher Institute, said, "Every year, we see a lot of legislation introduced. This year, we have seen a lot more action than in recent years. The level of bills enacted has been much higher."
• In the same year, the first abortion trigger law was introduced in South Dakota. Trigger law, i.e., one that wasn't enforceable when it passed, would allow to immediately ban abortion if Roe v. Wade was overturned.
• In 2007, in Gonzales v. Carhart and Gonzales v. Planned Parenthood, the "Supreme Court upheld the first federal legislation to criminalize abortion, allowing Congress to ban certain second-trimester abortion procedures."

Research Strategy

Key Takeaways

• The state of Louisiana introduced a trigger law to prohibit abortions in 2006. The original law did not allow abortions under any circumstances. However, in June 2022, Louisiana's Democratic governor signed a bill allowing abortions in the state in cases of ectopic pregnancies, where two doctors confirmed that the fetus would not survive after birth.
• The state of North Dakota introduced its abortion trigger law on January 3rd, 2007. North Dakota's trigger law bans abortions, except in cases of rape, incest, or when the pregnancy threatens the mother's life. The law would make performing abortions a felony.
• In 2020, the state of Tennessee introduced a second law. The “Heartbeat Bill" bans abortions from being performed after a heartbeat can be detected, normally around six weeks.

Introduction

South Dakota - 2005

• South Dakota's abortion trigger law has been in place under 22-17-5.1, since 2005. The trigger law was set up in case Roe v Wade was overturned and only allows abortions in case of life-threatening medical emergencies. 
• The state's ban on abortions became effective as soon as Roe v Wade was overturned, stating, "This Act is effective on the date states are recognized by the United States Supreme Court to have the authority to prohibit abortion at all stages of pregnancy."

Louisiana - 2006

• The state of Louisiana introduced a trigger law to prohibit abortions in 2006. The original law did not allow abortions under any circumstances. However, in June 2022, Louisiana's Democratic governor signed a bill allowing abortions in the state in cases of ectopic pregnancies, where two doctors confirmed that the fetus would not survive after birth.
• In Louisiana, the punishment for performing an illegal abortion starts at 10 years in prison, and a fine of $100,000. There are currently no provisions in cases of incest or rape.
•  In June 2022, a judge temporarily blocked the enforcement of the state's trigger law. A hearing has been set for July 8th, 2022. 

North Dakota - January 3rd 2007

• The state of North Dakota introduced its abortion trigger law on January 3rd, 2007. North Dakota's trigger law bans abortions, except in rape, incest, or when the pregnancy threatens the mother's life. The law would make performing abortions a felony.
• North Dakota has two abortion trigger laws. The second was introduced in 2019, and bans the "dismembering of a living unborn child".
• Both bans state they will be put in place thirty days after the overturning of Roe v Wade. Attorney General Drew Wrigley confirmed in writing that abortions would be illegal in North Dakota from July 28th 2022.  

Mississippi - 2015

•  Code 41-41-45, introduced in 2015 in Mississippi, would ban abortions in the state. There are some exceptions to the law in the state, when the procedure is needed to save the mother's life, in cases of rape, but only if they have been reported to law enforcement, and for minors with parental consent or with a court-ordered waive of parental consent.
• The law stated that abortions would be prohibited ten days after the overturning of Roe v Wade. On June 28th, 2022, Mississippi Attorney General Lynn Fitch certified that the law would come into effect on July 7th, 2022.

Missouri - February 2019

• Missouri's abortion trigger law passed in 2019. Bill 126 was passed in February 2019. The law makes performing abortions a felony in the state, except in medical emergencies.
• As soon as Roe v Wade was overturned in June 2022, Gov. Mike Parson announced that the trigger law was now in place, and doctors risk five to fifteen years in jail.

Tennessee - May 2019

• Tennessee's trigger abortion law was introduced in May 2019. It will be introduced 30 days after Roe v Wade is overturned. The law only allows abortions when the mother's life is threatened or if not doing so would cause serious risk, or permanent impairment to the mother.
• In 2020, the state of Tennessee introduced a second law. The “Heartbeat Bill," bans abortions from being performed after a heartbeat can be detected, normally around six weeks. The bill was blocked; however, in June 2022, the federal 6th Circuit Court of Appeals vacated the injunction. Currently, abortions are not allowed in Tennessee after six weeks.

Kentucky - 2019

• In 2019, Kentucky introduced an abortion trigger law that would ban abortions and make performing one a felony. Under the bill, abortions are only permitted in life-threatening situations or if the doctor determines that the mother will suffer permanent impairments.
• The law came into effect as soon as Roe v Wade was overturned. However, on June 30th, a Kentucky state court halted enforcement of the trigger law in the state.

Arkansas - 2019

• In 2019, Arkansas introduced Act 180, an abortion trigger law that would come into effect if Roe v Wade was overturned. The bill currently only allows abortions to be performed in life threatening situations. 
• On June 24th 2022, Attorney General Leslie Rutledge enacted the law when Roe v Wade was overturned. Anyone who performs an abortion can be charged with an unclassified felony, and faces a fine of $100,000 and 10 years in prison.

Utah - May 2020

• In May 2020, Utah introduced an abortion trigger law. The law makes exceptions for ectopic pregnancies, in cases of rape or incest, and if severe birth defects are found.
• When Roe v Wade was overturned, this trigger law was ineffective as a state judge blocked it for two weeks. While the full ban did not come into effect, a different bill, bill HB136 did, which bans abortions after 18 weeks.

Idaho - 2020

•   Idaho code 18-622 was introduced in 2020; the bill makes performing an abortion a felony. The trigger law exceptions are rape, incest, and life-threatening situations.
• In March 2022, the state introduced a second bill that bans abortions after six weeks and once a fetal heartbeat can be detected. This bill allows family members of the fetus to bring legal action against a medical provider who performs the procedure.
• On June 27th 2022, Planned Parenthood brought a lawsuit against the state, and the two bills are currently blocked in Idaho. A hearing has been scheduled for August 3rd to hear arguments on the matter.

Texas - June 2021

• Texas' abortion trigger law was signed in June 2021, which would go into effect thirty days after Roe v Wade was overturned. The bill only allows abortions in cases of medical emergencies to the mother. The trigger law bans abortions from the moment of fertilization.
• On July 1st 2022, the state Supreme Court ruled that a 1925 abortion law could go into effect before the thirty days. The law means that medical professionals face fines and lawsuits if they perform abortions.

Wyoming - March 2022

• In March 2022, Wyoming introduced House Bill 92, an abortion trigger law. The law bans all abortions in the state, with exceptions for rape, incest, or when continuing the pregnancy would endanger the mother's life.
• The Wyoming trigger law requires the attorney general to review the supreme court ruling and provide a report to the governor within 30 days. Five days after the governor certifies the bill, the law would come into effect.

Oklahoma - April 2022

•  Oklahoma Republican Gov. Kevin Stitt signed the states' abortion trigger law in April 2022. Senate Bill 612 only allows abortions when the mother's life is in immediate danger.
• The bill came into effect as soon as Wade v Roe was overturned and banned abortions from conception.

Research Strategy

Key Takeaways

•   Mitchell v. Helms in 2000 was the first case decided by the Supreme Court that seemed to directly oppose what was decided in the 1971 Lemon case, which was long used as a precedent for deciding cases involving the separation of church and state.
• Examples of cases that further allowed the use of taxpayer funds for religious education are Trinity Lutheran Church v. Comer (2017) which allowed a church-based preschool was eligible to receive state funds for a playground, and Espinoza v. Montana Department of Revenue (2017) the Court ruled that a Montana tax program that helps private religious schools is constitutional.
• In February 2016 the ideological makeup of the Supreme Court was pretty evenly split with experts stating that Roberts, Thomas, and Alito were consistently conservative, while Ginsburg, Breyer, Sotomayer, and Kagan were consistently liberal. Kennedy leaned conservative, but also voted with liberals about 1/3 of the time, and Scalia was a moderate conservative who did not consistently vote conservative.
• The final shift of the Court occurred in September 2020, when Ruth Bader Ginsburg, one of the consistently liberal justices on the Court, died, opening up another slot for Trump to fill. This was filled just weeks before the 2020 presidential election by Amy Conan Barrett, a justice that was considered by many to be very conservative. This gave the Court its current ideological makeup with three liberals and six conservatives.

Introduction

Background

• The US Constitution does not specifically call for the "separation of church and state." Rather, the idea of such a separation comes from the First Amendment (establishment clause) which states, "Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances."
• The specific terminology, "separation of church and state," actually came from a letter written by Thomas Jefferson in 1802. In the letter, Jefferson stated, "the whole American people which declared that their legislature should ‘make no law respecting an establishment of religion, or prohibiting the free exercise thereof,’ thus building a wall between church and State.”
• The Supreme Court was first asked to rule on the concept of the "separation of church and state" in Reynolds v. the United States in 1878. In their opinion, they state that "The word "religion" is not defined in the Constitution. We must go elsewhere, therefore, to ascertain its meaning, and nowhere more appropriately, we think, than to the history of the times in the midst of which the provision was adopted." The court concluded that the best source of information was from the people involved in drafting the Amendment, including Jefferson. This was the first time that there was a precedent for the "separation of church and state."

Mitchell v. Helms

What Happened

• There have been many cases heard by the Supreme Court through the years when the justices had to rule on the idea of the separation of religion and education. One critical case from 1971 was Lemon v. Kurtzman. In this case, the court set out a three-prong test for determining whether a statute was constitutional:
• (1) it has a primarily secular purpose  
• (2) its principal effect neither aids nor inhibits religion 
• (3) government and religion are not excessively entangled  
• The third prong came from a 1970 case, Walz v. Tax Commission, where the court ruled that churches could continue to be tax-exempt. The Lemon case further clarified the idea of "excessively entangled," and cases heard after 1971 were generally subject to the Lemon test. When the third prong was imposed in the Lemon case, it was widely seen as a way to further ensure that government and religion stayed separate.
• In the Lemon case, the Court ruled that programs that provided public funds to religious schools for the purpose of salaries and textbooks violated the establishment clause because “[a] comprehensive, discriminating, and continuing state surveillance will inevitably be required” in order to ensure that funds are not being used to promote education.
• In 2000, Mitchell v. Helms again had the Court examining the idea of providing funds to religious schools. In this case, the Court ruled that there was no excessive entanglement between government and religion, which appeared to be directly opposed to what was decided in Lemon. Zelman v. Simmons-Harris in 2002 also ruled in favor of government-provided tuition vouchers being used for religious education. These cases could be seen as a turning point in using government funds for religious education.
• Examples of cases that further allowed the use of taxpayer funds for religious education are Trinity Lutheran Church v. Comer (2017) which allowed a church-based preschool was eligible to receive state funds for a playground, and Espinoza v. Montana Department of Revenue (2017) in which the Court ruled that a Montana tax program that helps private religious schools is constitutional.

Why it is a Main Factor

• The importance of Mitchell v. Helms can be seen in the opinion written by Sandra Day O'Connor. In her concurring opinion, she discussed major concerns with the main opinion, even though she agreed with the outcome. She stated, "The plurality also rejects the distinction between direct and indirect aid, and holds that the actual diversion of secular aid by a religious school to the advancement of its religious mission is permissible. Although the expansive scope of the plurality’s rule is troubling, two specific aspects of the opinion compel me to write separately. First, the plurality’s treatment of neutrality comes close to assigning that factor singular importance in the future adjudication of Establishment Clause challenges to government school-aid programs. Second, the plurality’s approval of actual diversion of government aid to religious indoctrination is in tension with our precedents and, in any event, unnecessary to decide the instant case."
• Although not directly related to the Mitchell Case, there has been a noticeable shift in the Court's stance toward religious freedom since Roberts became Chief Justice in 2005. Since that time, "the Supreme Court has ruled in favor of religious claimants 81% of the time. This compares with a rate of about 50% for the 20th century." The point is being made since both events occurred in the 2000s.

Supreme Court Moves Ideologically to the Right

What Happened

• In February 2016 the ideological makeup of the Supreme Court was pretty evenly split with experts stating that Roberts, Thomas, and Alito were consistently conservative, while Ginsburg, Breyer, Sotomayer, and Kagan were consistently liberal. Kennedy leaned conservative, but also voted with liberals about 1/3 of the time, and Scalia was a moderate conservative who did not consistently vote conservative.
• When Justice Scalia died in February 2016, then-President Obama nominated Merrick Garland to fill the seat. However, Senate Majority Leader Mitch McConnell quickly stated that the Senate would not consider the nominee and would instead wait until the new president took office in January of the following year, 11 months later.
• When Donald Trump won the election later that year, partially due to his focus on the Supreme Court during the election season, he became the person who would fill the vacancy, possibly ensuring that the Court would move ideologically to the right. Neil Gorsuch, who eventually filled Scalia's slot, was seen as being very similar to Scalia after his first season on the court, which means there was not a large apparent shift in ideology.
  Source
   

• In 2018, Justice Kennedy retired. Eventually, this slot was filled by Brett Kavanaugh. This change gave conservatives an assumed 5-4 majority on the Court. However, in reality, there were eight cases where one conservative justice voted with the liberals to decide a case.
• The final shift of the Court occurred in September 2020, when Ruth Bader Ginsburg, one of the consistently liberal justices on the Court, died, opening up another slot for Trump to fill. This was filled just weeks before the 2020 presidential election by Amy Conan Barrett, a justice that was considered by many to be very conservative. This gave the Court its current ideological makeup with three liberals and six conservatives.
  Source
   

Why it is Important

• Since the Court was established in its current form in 2020, there have been several cases decided in favor of religious institutions. Three from 2022 include:
• The Court voted 6-3 that a Christian football coach could lead prayers with players after games and that the school suspending him for this was unconstitutional. This ruling seemed to undo the precedent of the Lemon case.
• The Court also stated that public money in Maine could be used to pay for students attending religious schools.
• A May decision by the Court decided that it was unconstitutional for the Boston city hall to refuse to allow a Christian group to fly its flag there since other groups were allowed to do so.
• These rulings may be empowering people to push for more. As an example, congresswoman Lauren Boebert gave a speech at a church where she stated, "I’m tired of this separation of church and state junk that’s not in the constitution. It was in a stinking letter, and it means nothing like what they say it does.”
• There are many articles discussing how these recent moves by the Supreme Court are weakening, if not destroying, the establishment clause in respect to the separation of church and state. Examples can be seen here, here, and here.

Research Strategy

Key Takeaways

• During the run-up to the most recent presidential election in 2020, a Pew survey found that 63% of US adults said it was very or somewhat important to have a president who "personally lives a moral, ethical life," and 52% said it was very or somewhat important that the president "has strong religious beliefs."
• About half of US adults stated that they believed the bible should have a great deal or some influence on US laws, even if that was not what the people wanted. For Christians, white evangelicals, and black protestants the numbers were even higher.
• When looking at State documents, Pew conducted an analysis in 2017 and found that every state except Colorado, Iowa, Hawaii, and Washington mentions God at least once in their state constitutions. For the states that don't mention God, they do mention some type of Divine or Supreme being. However, this was not the case prior to about 1840.
• This paper from 2013 purports to show the potential importance of God being in state constitutions when it states, "Advocates of religious liberty might do better to focus their attention on state constitutions rather than their national counterpart. State constitutions avoid the agnostic and neutral language found in the U.S. Bill of Rights and typically offer stronger protection for religious liberty as well." (page 226)

Introduction

Expectation That US Presidents are Religious

What Happened

• Bruce Schulman is a William E. Huntington Professor of History at Boston University’s College of Arts & Sciences (CAS). He is an expert in the area of politics and religion, partially due to a book he co-edited in 2015 titled 'Faithful Republic: Religion and Politics in Modern America.' According to Schulman, “it’s almost impossible to win the presidency without some show of serious religious commitment.”
• Schulman states that it was around the mid-1970s when candidates started talking about their personal faith. An example of this is how Jimmy Carter openly discussed his Christian beliefs in his 1976 presidential campaign. Many pundits credited the evangelical vote for giving Carter the win over Gerald Ford, although that has been widely debated.
• More recently, it was reported that in 2008, Mitt Romney's affiliation with the Mormon faith hurt his bid for president. According to John Green, director of the Ray C. Bliss Institute of Applied Politics at the University of Akron, Romney's problem "is that his Mormon faith, in particular, makes many people uneasy. And that unease has political consequences.”
• During the run-up to the most recent presidential election in 2020, a Pew survey found that 63% of US adults said it was very or somewhat important to have a president who "personally lives a moral, ethical life," and 52% said it was very or somewhat important that the president "has strong religious beliefs."
  Source
   

• Also of note, a growing number of Christians believe they have been winning politically, which could encourage more voting and more involvement of religion in politics.
  Source

Why it is a Main Factor

• About half of US adults stated that they believed the bible should have a great deal or some influence on US laws, even if that was not what the people wanted. For Christians, white evangelicals, and black protestants the numbers were even higher.
  Source
   

• With President Trump running on a platform of installing conservative justices to the Supreme Court, he sent the message that having a Supreme Court that would overturn Roe v. Wade was a priority, even as the majority of Americans opposed the move (from 2013 data).
  Source
   

• Ultimately, Trump won the election in 2016 at least partially due to his appeal to religious voters. This ultimately gave him the power to reshape the Supreme Court which has been friendly to religious institutions. 

Addition of God to State Constitutions

What Happened

• Starting at the Federal level, there are several important government documents that mention God or some type of supreme being. These include the Declaration of Independence, The Pledge of Allegiance, and US currency.
• It is important to note that President Eisenhower was responsible for the addition of God to both the Pledge (1954) and to currency (1955). Therefore, the Declaration of Independence stands as the only document of the three that mentioned God at the time it was created. Eisenhower's move to have God included could be seen as a move towards lessening the separation of church and state.
• When looking at State documents, Pew conducted an analysis in 2017 and found that every state except Colorado, Iowa, Hawaii, and Washington mentions God at least once in their state constitutions. For the states that don't mention God, they do mention some type of Divine or Supreme being. However, this was not the case prior to about 1840.
• The following graphic shows the number of mentions of God in each state's constitution as of the 2017 analysis.
  Source
   

• A research paper published by Marquette Law Review discusses the Second Great Awakening, and its impact on the preambles of state constitutions (page 760). The Second Great Awakening was a Protestant religious revival that occurred from 1795 to 1835. The movement played a role in stimulating temperance, the emancipation of women, and the founding of mission societies and seminaries in the US.
• Importantly to this discussion, the Second Great Awakening attempted "to create, rather than to continue or restore, a tradition of collective acknowledgment of God in state constitutions." (page 760) What is meant by this is that the movement wasn't trying to spread something that was already prevalent, but instead, was attempting to insert God where it previously was rarely seen. With God or some type of supreme being currently being mentioned in all 50 state constitutions, it seems the movement was successful in this goal.

Why it is a Main Factor

• This paper from 2013 purports to show the potential importance of God being in state constitutions when it states, "Advocates of religious liberty might do better to focus their attention on state constitutions rather than their national counterpart. State constitutions avoid the agnostic and neutral language found in the U.S. Bill of Rights and typically offer stronger protection for religious liberty as well." (page 226)
•  Another paper from 2017 goes in-depth discussing how the uniform mentioning of God in state preambles complicates the issue for those who want to claim that God is not inherent in our government. But the paper also argues the other side, since these mentions were not in place in most of the original documents, and only came about as the result of modifications. (page 757)
• Finally, although no specific examples are given, this paper in the Penn State Law Review mentions how state preambles that mention God "have been used to justify practices – the placement of religious monuments in government space, the censorship of films, sectarian religious instruction in public schools, and the denial of tax preferences to disfavored religious groups – that have been held to violate the Establishment Clause."

Research Strategy

Key Takeaways

• District of Columbia, New York, New Jersey, Illinois, and Florida are five states with the highest abortion rates.
•  49% of women who have abortions in the US earn less than 100% of the federal poverty threshold.
•  29.3% of US women who have abortions are 25-29, while 27.6% are 20-24.

Introduction

Demographic Profile of Women Who Have Abortions in the US

1. Age Group

• According to data published in 2019 by the Center for Disease Control, the percentage breakdown of US abortions by age is as follows:
• Less than 15 years: 0.2%
• 15-19: 8.7% (However, the 18-19 age group accounts for 70.2% of adolescent abortions.)
• 20-24: 27.6%  
• 25-29: 29.3%  
• 30-34: 19.4%  
• 35-39: 10.8%  
• Above 40 years: 3.7%  
  Source
   

2. Ethnicity

• According to 2019 data:
• Black Women: 38.4%  
• White Women: 33.4%  
• Hispanic Women: 21.0%  
• Other Race Category: 7.2%  

3. Income

• As per 2020 data:
•  49% earn less than 100% of the federal poverty threshold, i.e., $21,720 or less for a family of 3.
•   26% have incomes of between 100–199% of the federal poverty level, i.e., between $21,720 and $43,223.
•   25% earn 200% or more of the poverty threshold, i.e., ≥ $43,440. 

4. State

I. Five States with the Highest Abortion Rates (2020)

• District of Columbia: 51.5% 
• New York: 34.5%
• New Jersey: 33.6%  
• Illinois: 28.4%  
• Florida: 27.0% 

II. Five States with the Lowest Abortion Rates (2020)

• Missouri: 0.2%  
• South Dakota: 1.2%  
• Wyoming: 1.6%  
• West Virginia: 5.5%  
• Utah: 6.4%  

5. By Weeks of Gestation/Pregnancy Stage

• According to 2019 data:
• ≤6 weeks: 42.9%  
• 7-9: 36.4%  
• 10-13: 13.4%  
• 10-15: 2.9%  
• 16-17: 1.7%  
• 18-20: 1.6% 
• ≥21 weeks: 1.0%  
  Source
   

Research Strategy

Key Takeaways

• There were an estimated 55.3 deaths for every 100,000 live births for non-Hispanic African American women in the United States in 2020, the highest for any group.

• There were 29.7 deaths per 100,000 live births for American Indian/Alaska Native women in the United States in 2015-2016.

• In 2020, there were 19.1 deaths for every 100,000 live births for non-Hispanic White women in the United States.

Introduction

Highest Maternal Mortality Rates in the U.S.

1. African American Women

• According to statistics disclosed by the Centers for Disease Control & Prevention's National Center for Health Statistics in February 2022, the demographic group in the United States with the highest maternal mortality rates is non-Hispanic African American women. In 2020, there were approximately 55.3 deaths for every 100,000 live births for this specific group, which is overwhelmingly the highest rate in the country by race. This figure represents an alarming increase over the 37.3 and 44.0 deaths per 100,000 live births reported in 2018 and 2019, respectively.

 

Source

 

• The maternal mortality rate for non-Hispanic African American women is twice as high as the national rate of 23.8. Broken by age cohort, non-Hispanic African American women aged 40 and older experienced a maternal mortality rate of 263.1 deaths per 100,000 live births, which remains the highest among any group.
• African American women in the United States encounter systemic discrimination and racism, including implicit bias from health care specialists, residential segregation, and income inequality. This has contributed to their being faced with higher risk during and after pregnancy and childbirth. This has resulted in African American women having a maternal mortality rate that is three times higher than White women in the country. African American women are also beset by social determinants of health, which prevent many of them from obtaining fair opportunities for emotional, economic, and physical health.
• Another reason for the high maternal mortality rate is the prevalence of chronic diseases (e.g., haemorrhaging, infection, thrombotic pulmonary, cardiomyopathy, etc.), which are "less well controlled in black women" due to inadequate access to quality care.
• To decrease maternal mortality rates for this group, the Centers for Disease Control & Prevention (CDC) has issued guidance for healthcare providers, hospitals, healthcare systems, states, and communities. Among the guidelines, the CDC states that healthcare providers should acknowledge any unconscious bias within themselves, along with their offices. The organization also states that hospitals and healthcare systems should identify and properly address all forms of unconscious bias within healthcare.
• The CDC also recommends that states and communities identify and properly address the various social factors that help to influence maternal health among African American women, including transportation access, substance use, economic inequality, racial inequality, food insecurity, unstable housing, and violence.

2. American Indian/Alaska Native Women

• From 2015-2016, American Indian/Alaska Native Women (AIAN) had a maternal mortality rate of around 29.7 deaths per 100,000 live births, which is higher than non-Hispanic White mothers in the United States. Meanwhile, from 2013 to 2017, the maternal mortality rate for the AIAN group amounted to 31.3 deaths per 100,000 live births, which was about 64% higher than non-Hispanic White women.

 

Source

 

• Those residing in small rural areas suffered a much larger maternal mortality rate (55.1 deaths per 100,000 live births) than those in urban ares. Moreover, the maternal mortality rate for AIAN mothers aged 35 to 39 is around 104.2 deaths per 100,000 live births.
• Similar to non-Hispanic African American women in the United States, women in the AIAN group are socially disadvantaged (e.g., racial discrimination, implicit bias, cultural misunderstandings, etc.), although very little attention has been dedicated to their pregnancy-related struggles. AIAN mothers are impacted by a discouraging lack of access to care and quality care, and a high prevalence of chronic diseases. While millions of AIAN individuals acquire care via the government-funded Indian Health Services, the agency maintains an inadequate number of providers while struggling to replace ageing health facilities.
• The group has encountered severe cases of hypertensive, hemorrhage, and cardiomyopathy disorders during their pregnancies, leading to high volumes of pregnancy-related deaths.
• In some states, health departments are attempting to diminish maternal mortality for AIAN women by addressing health provider bias via training and bolstering urban and tribal Indian representation on review panels.

3. Non-Hispanic White Women

• As reported by the National Center for Health Statistics, non-Hispanic White women have the third highest maternal mortality rate in the United States. The group experienced around 19.1 deaths for every 100,000 live births in the year 2020, which is slightly higher than Hispanic mothers (18.2 deaths per 100,000 live births). Reflecting an overall trend, the rate has been steadily increasing over the past few years (14.9 in 2018, 17.9 in 2019).
• Among the group, those aged 40 and older have the highest maternal mortality rate, with at least 96.8 deaths for every 100,000 live births, as of 2020.
• One of the primary reasons behind the maternal mortality rate is that non-Hispanic White women suffer from high prevalence rates of infections, thrombotic pulmonary or other embolisms, cardiomyopathy, and other cardiovascular conditions during pregnancy. The percentage of pregnancy-related moralities due to infection is actually among the highest of all racial groups (15.2%), second only to Hispanic women (16.7%). Meanwhile, the percentage of pregnancy-related moralities due to "other cardiovascular conditions" is the highest among all racial groups (16.9%).
• Information on measures and actions specific to non-Hispanic White women to address the maternal mortality rate appears to be unavailable in the public domain. Most of the measures and actions that have been introduced concern ways to address maternal mortality rates for other racial/ethnic groups or general maternal mortality.

Additional Findings

• Various forms of legislation to help the nation address maternal mortality rates for different groups have been introduced by members of the U.S. Congress. Senator Cory A. Booker introduced the "Black Maternal Health Momnibus Act of 2021" to the U.S. Senate, but it has yet to obtain a vote in the chamber, as of February 22, 2021. Senator Tina Smith introduced the "Data to Save Moms Act", but it too has yet to receive a vote in the U.S. Senate as of February 22, 2021.
• African American and AIAN women that have attained a college degree are at least five times as likely to die during pregnancy than white women that have gained a similar education.
• The maternal mortality rate for all groups in the United States is 23.8 deaths per 100,000 live births as of 2020. Data from the CDC's National Center for Health Statistics indicates that, in general, women aged 40 and older are at a much greater risk of mortality than others, with 107.9 deaths for every 100,000 live births.

Research Strategy

Key Takeaways

• Findings from a recent study that investigated the impact zero abortions have on maternal mortality rates revealed that an abortion ban in the United States would result in an estimated increase of 210 maternal deaths annually, which translates to a 24% increase from 861 to 1,071.
• According to the Turnaway Study, individuals who wish to terminate their pregnancies but are not able to do so are "more likely to face negative health outcomes." The study found that individuals who do not have access to abortion and instead gave birth reported more life-threatening conditions such as postpartum hemorrhaging and eclampsia.
• Quantitative data found that Black women are more likely to be negatively affected by the overturning of Roe.

Introduction

The latest estimates of maternal mortality rates in the United States are 23.8 deaths per 100,000 births whereas abortion-related deaths per 100,000 abortions are at 0.41. As U.S. states respond to the overturning of Roe v. Wade, individuals who would have otherwise chosen abortion due to its relatively lower mortality risk are now exposed to the much "higher risk of carrying pregnancies to term."

Source

 

Impacts Of Abortion Bans On Maternal Mortality Rates

• Findings from a recent study that investigated the impact zero abortions have on maternal mortality rates revealed that an abortion ban in the United States would result in an estimated increase of 210 maternal deaths annually, which translates to a 24% increase from 861 to 1,071.
• The study found that the increase in maternal deaths would be greatest among non-Hispanic Black people (39% increase).
• Abortion rates are higher among black women, partly because of "lower contraceptive access" and partly because there is a greater risk of complications in their pregnancies.
• Amanda Stevenson, an assistant professor of sociology and author commented — "The takeaway here is that if you deny people abortion, pregnancy-related deaths will increase because staying pregnant is more dangerous to a woman than having an abortion."

Consequences Stemming From Lack Of Access

• Over the past couple of decades, the rate of abortion-related deaths has remained stable. According to the Centers for Disease Control and Prevention (CDC), in the United States, the death rate from 2013 to 2018 was 0.41 deaths per 100,000 abortions.
• According to the Turnaway Study, individuals who wish to terminate their pregnancies but are not able to do so are "more likely to face negative health outcomes."
• The study found that women who do not have access to abortion and instead gave birth reported more life-threatening conditions such as postpartum hemorrhaging and eclampsia compared to individuals who had access to an abortion.
• According to the CDC, pregnancy-related deaths are three times higher in black people than in Hispanic and non-Hispanic White people. 
  Source
   

• Experts have warned that maternal mortality rates in the nation will likely continue to rise if pregnant individuals are not given access to abortion care.
• Lauren Ralph, an epidemiologist, commented — "I think we can say with certainty that those deaths could have been avoided had these people had access to the abortion care that they had sought."

Long-Term Consequences

• This study concluded that it is "mathematically inevitable" that the full impact of abortion bans on maternal mortality will not be observed during the first year. In reality, the delay in the full impact could take over a year since individuals who require abortions in states with a ban in place may receive a considerable amount of support in the period immediately after the ban.
• Researchers from the Institute of Behavioral Science estimate that a nationwide abortion ban would result in a 13% increase in maternal deaths in the first year. In the following years, maternal deaths would rise 210 over baseline (a 24% increase).

• For Black individuals, the expected increase in maternal deaths if abortion is banned nationwide jumped by 18% to 39%.
  Source
   

 Research Strategy

Key Findings

• A pro-life group in Wisconsin is pushing for the removal of all exceptions in the state's abortion law that allows abortion when the pregnant patient's life is in danger.

• State abortion bans will lead to “over-policing and surveillance of reproductive health services” that will eliminate access to abortion even in life-threatening circumstances.

•   Regulations allowing litigation of physicians for providing abortion will generate fear among physicians, which will curb their will to provide abortion even in life-threatening circumstances.

Introduction

Legal Removal of Abortion Exception for Life-Threatening Pregnancies

• Across the United States, 26 states are certain or likely to enforce abortion bans after the overturning of Roe V. Wade. Among these select states, about 13 of them had already passed trigger laws, which automatically enforced state abortion bans as long as Roe V. Wade was banned.

 

Source

 

•  All the 13 states with trigger laws had exceptions that allowed abortion if a pregnancy was life-threatening. Other states that are likely to pass abortion bans are likely to follow this precedent. After states were allowed to pass their abortion legislation in the face of the Supreme Court decision overturning Roe V. Wade, pro-life advocates began pushing for the withdrawal of the exception allowing pregnant women to access abortion in case of a life-threatening scenario.
• In one of the trigger law states -Wisconsin, an anti-abortion group is seeking to remove the exception that allows abortion in the life of a pregnant person in danger. According to the legislative director leading these pro-life advocates, Matt Sande, "many Wisconsin lawmakers would support the total abortion ban." The pro-life advocates seek to eliminate abortion law safeguards that can even allow abortion in case of ectopic pregnancy or the removal of cancerous uterus tumors.
• According to Dr. Noelle LoConte, a chemotherapy cancer specialist at UW Health in Wisconsin, “Before the new court ruling, a patient who chose to have an abortion would be connected with appropriate medical care in the Ob/Gyn department or with a clinic such as Planned Parenthood. ‘Right now we are being told that that situation does not qualify’ under the 1849 abortion ban’s exception, LoConte says.”

Difficulty in Physicians' Evaluation of Life-Threatening Pregnancy in compliance with anti-abortion regulations

• The American Medical Association identified that overturning Roe V. Wade accompanied by state abortion bans will result in “over-policing and surveillance of reproductive health services.” Health practitioners will be afraid of policing and persecution when they determine abortion is necessary in life-threatening pregnancy. Already, it is estimated that the Supreme Court decision will lead to over 200 abortion clinics closing down.
• Texas's law allows private citizens to sue abortion providers if they undertake an abortion after six weeks. Texas and states with similar regulations will build fear of multiple lawsuits among physicians providing abortion services. It will lead to a decline in the provision of abortion services to pregnant patients, even in life-threatening circumstances.
• Dr. Jessica Rubino, a physician at an abortion clinic at Austin Women’s Health Center in Texas, noted that she would decline to take in abortion patients even with life-threatening circumstances. According to the physician, to avoid being prosecuted for providing abortion, the patient should not only be in a life-threatening condition but has to be near death. She notes that "My lawyer told me, 'Unless they are on that table dying in front of you, you cannot do an abortion on them, or you are breaking the law,'" she said, adding, "How am I supposed to help people from jail?"

Research Strategy

Key Takeaways

• A few days after the Supreme Court ruled that states can outlaw abortion, Alabama argued that the state should also be allowed to ban gender-affirming medical treatments for transgender youth.
• According to Rewire News Group, trans people will find it more challenging to afford increased travel costs to states that allow abortion because they are more likely to live in poverty due to employment discrimination.
• Alexander (a trans man) says he worries about getting pregnant and “it would be a literal nightmare, and I couldn’t imagine anyone who would want to continue life being forced in that predicament."

Introduction

1. It May Lead to Change in Other Laws Affecting Transgender Men

• According to CBS News, the reversal of Roe v. Wade and the legal reasoning behind the high court ruling could lead to states rolling back other laws, including those affecting non-women with a uterus, like birth control and gender-affirming medical treatments for transgender youth.
• A few days after the Supreme Court ruled that states can outlaw abortion, Alabama argued that the state should also be allowed to ban gender-affirming medical treatments for transgender youth.
• As per Cathryn Oakley, senior counsel at the Human Rights Campaign, "The court is opening the door to having things like contraception be put at risk."
• According to Bay News 9, gender-affirming care for transgender children and teens has been under attack in Texas for months, as doctors and families have been targeted for providing the care. The ban on abortion has heightened the fears transgender people had that their rights would be rolled back.

 

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2. The Ban Is Impacting People's Mental Health

• The reversal of Roe v. Wade affects transgender and nonbinary communities, as they also lose access to abortion rights. For non-women with a uterus, before the ruling, getting pregnant did not concern them greatly as they knew in the unlikely event it happened, they could get an abortion. The Supreme Court's decision could severely affect their mental health, and some in the transgender and nonbinary community are concerned about their access to abortion rights.
• The reversal of Roe v. Wade has increased stress and could have severe consequences for the mental health of transgender and nonbinary communities. Additionally, since birth control conflicts with hormone treatments for trans men, getting pregnant is traumatizing, and being forced to give birth would reverse the treatment entirely and trigger gender dysmorphia.
•   Dr. Michelle Forcier, a sex, gender, and reproductive rights specialist and a clinical consultant for FOLX, serving LGBTQ clients, says without abortion access, some people might decide to take more drastic measures. She states that "reversing Roe v. Wade eliminates everyone's body autonomy and privacy rights. We know the suicidality, as well as suicide attempts, as well as completed suicide rates, are so higher in the trans community, you know, clearing this is not going to help.”
• Alexander (a trans man) says he worries about getting pregnant and “it would be a literal nightmare, and I couldn’t imagine anyone who would want to continue life being forced in that predicament."

 

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3. Abortion Will Be Out of Reach for Many Low-Income Trans People

• In addition to banning, some states like Texas are trying to criminalize abortion and gender-affirming care. For example, the Texas SB 8 law allows private citizens to sue someone for aiding in an abortion. Texas' attorney general has also directed courts to prosecute parents for child abuse if they help their children access gender-affirming care.
• These directives disproportionately impact low-income communities, including trans people who cannot afford to cross state lines to access medical services. A first-trimester abortion costs around $750 out-of-pocket where one has no insurance and travel and lodging expenses.
• According to Rewire News Group, trans people will find it more challenging to afford increased travel costs to states that allow abortion because they are more likely to live in poverty due to employment discrimination.
• A 2015 U.S. Transgender Survey found that 29% of trans respondents lived in poverty, while the national poverty rate was 13.5%. The figures are even higher for Black, Latinx, and Indigenous trans individuals, meaning that for most trans people, abortion is already out of reach and will become even more challenging to access.

Research Strategy

Key Takeaways

• Three methods of state surveillance or control to prevent circumvention of abortion laws include digital surveillance, corporate accountability, and abortion travel bans.

• Nathan Wessler, the deputy project director of the Speech, Privacy and Technology Project at the American Civil Liberties Union, comments on the potential implications of digital surveillance in the wake of the Roe v. Wade reversal, "The depth of information about us that the police can try to access in investigations is unprecedented in human history... We live in a digital age when our activities, our movements, our transactions and our communications leave a digital trail. And it is extraordinarily hard to eliminate all of the digital trails that might be of interest to law enforcement."

• University of Pennsylvania's Wharton School professor, Maurice Schweitzer, predicts an upcoming clash between companies offering employee abortion travel support and states with abortion bans: "It could lead to a big mess in the best of cases. And I don’t think it’s going to turn out to be the best of cases. I think what we are going to see is Republican legislators, either out of principle or out of personal interest, go after companies. And I think a recent example, (Gov. Ron) DeSantis and Disney, is a template for why we should be concerned about this mix between business and politics."

• While there are currently no attempts to prosecute abortion-seekers who travel across state lines, Drexel University’s Thomas R. Kline School of Law professor, David S. Cohen says, "There is no guarantee that an aggressive prosecutor might try to stretch the law as much as they can." Cohen views legislation surrounding travel bans as "the next frontier in anti-abortion legislation" with "no real clear precedent."

Introduction

Digital Surveillance

Description

• Digital surveillance involves the use of "personal data to punish people who look for information about or access to abortion services online."
• Data such as call histories, email, text messages, social media activity, location data, fertility apps, Google (and other search engines) searches, online payment histories and any other data that leaves a "digital trail" may potentially be used for prosecution.
• Some experts have expressed concern over possible future digital privacy risks, including facial recognition and petitioning health apps for data.
• Retrieving data directly from a mobile device currently requires a search warrant and "probable cause" to justify a search. However, evading the need for a warrant is frequently accomplished via data brokers willing to sell personal data for a fee or by issuing a subpoena directly to a tech company (requiring only "reasonable suspicion" for a search).
• Following the leak of the Roe vs. Wade reversal decision in May 2022, 40 members of Congress pressed Google to limit location-sharing data collection (currently collected via its Android system and apps and regularly provided to law enforcement) in an effort to curtail its potential use for prosecution in abortion-related cases. In response, Google recently agreed to delete the location history of a person who has visited a medical facility, including abortion providers, noting that if their systems identify a visit to a medical location it will "delete these entries from Location History soon after they visit."
• Still, most large tech companies have not yet articulated a stance regarding user data protection post-Roe.

Expert Insight

• Nathan Wessler, the deputy project director of the Speech, Privacy and Technology Project at the American Civil Liberties Union, comments on the potential implications of digital surveillance in the wake of the Roe v. Wade reversal, "The depth of information about us that the police can try to access in investigations is unprecedented in human history... We live in a digital age when our activities, our movements, our transactions and our communications leave a digital trail. And it is extraordinarily hard to eliminate all of the digital trails that might be of interest to law enforcement."
• Electronic Frontier Foundation Executive Director Cindy Cohn says the best protection against digital surveillance "will come in the form of new laws": "[Abortion] is not the only place where people really do deserve privacy. We need to change course from the way our digital technologies work now where they track us all the time, they keep that information forever, they sell it, and they use it in ways that we do not understand, we can’t control and we can’t do anything about.”
• In a recent report, Albert Fox Cahn and Eleni Manis of the Surveillance Technology Oversight Project (S.T.O.P.) commented on the vast array of digital tools that could potentially be used to prosecute abortion seekers and their supporters: "When purchasers pay with a credit card, an online account, or with an in-store loyalty card, everyday purchases — medication, pregnancy tests, prenatal vitamins, menstrual products — can become circumstantial evidence."
• Cahn and Morris further highlight the risk of lesser-know technology in law enforcement efforts post-Roe: "Law enforcement can use "keyword warrants" that would "cast digital dragnets, identifying large numbers of potential abortion seekers" by requiring technology companies to turn over information about anyone in a geographic area who has searched online for particular terms. They can also obtain "geofence warrants" that require those same companies to give information about all people who were in a particular place at a particular time.

Past Cases and Related Possibilities

• In 2017, a Mississippi woman, Latice Fisher, was indicted for second-degree murder based on her internet search history. After arriving at a Mississippi hospital with a stillborn fetus, Fisher was interviewed and placed under suspicion of committing a crime.
• Prosecutors successfully proved "criminal intent" to the first Grand Jury by presenting Fisher's cell phone history, including a description of her internet searches in the third trimester that revealed she researched methods to induce abortion such as "buy Misoprostol abortion pill online."
• The indictment was eventually dismissed based on expert testimony casting doubt on the state medical examiner's conclusions.
• In 2015, Indiana resident Purvi Patel was sentenced to 20 years in prison for allegedly "inducing her own abortion." Text messages between Patel and a friend involving an abortion pill order were used as evidence in the conviction.
• In May 2022, Motherboard reported two instances of abortion clinic visitation location data being sold. The information included where the visitors came from, the duration of the visit, and where they went after the visit.

Corporate Accountability

Description

• In the wake of the Roe decision, many companies such as Apple, Disney, Nike, Dick's Sporting Goods, and Meta, have confirmed they will support employees seeking out-of-state abortions, either via an expansion of their health coverage or travel reimbursement.
• In response, some Republican lawmakers have introduced legislation that would penalize companies who "pay for abortions in other states."
• At the moment, efforts to hold corporations accountable for providing support for employees seeking out-of-state abortions are limited, with the most publicized action being driven by a group of Texas lawmakers. The Texas Tribune has reported that 14 state lawmakers have pledged to "bar corporations from doing business in Texas if they pay for abortions in states where the procedure is legal."
• In May 2022, Florida Senator Mario Rubio introduced a piece of legislation that would also potentially impact corporations that financially support their employees who require travel to seek an abortion. The "No Tax Breaks for Radical Corporate Activism Act" (S. 4131, currently referred to the Senate finance committee) would disallow employer expense deductions related to employee travel for abortions (as well as other expenses, such as gender-affirming care). In a statement about his proposed legislation, Rubio says, "Our tax code should be pro-family and promote a culture of life. Instead, too often our corporations find loopholes to subsidize the murder of unborn babies or horrific 'medical' treatments on kids. My bill would make sure this does not happen."

Expert Commentary

• University of Illinois' law professor, Robin Fretwell Wilson, believes corporate lawsuits against companies paying for abortion travel expenses are inevitable-either from states or anti-abortion activists: "If you can sue me as a person for carrying your daughter across state lines, you can sue Amazon for paying for it."
• University of Pennsylvania's Wharton School professor, Maurice Schweitzer, predicts an upcoming clash between companies offering employee abortion travel support and states with abortion bans: "It could lead to a big mess in the best of cases. And I don’t think it’s going to turn out to be the best of cases. I think what we are going to see is Republican legislators, either out of principle or out of personal interest, go after companies. And I think a recent example, (Gov. Ron) DeSantis and Disney, is a template for why we should be concerned about this mix between business and politics."
• Robert Field, a professor of health management and policy at Drexel University, comments further on the potential "backlash" corporations (particularly smaller corporations) that support travel costs for employees seeking abortions may face from either states or even employees opposed to abortion: "That's going to be a real tough one for employers. We've already seen the flood of litigation from the Dobbs decision starting to flow in, and that's one of the major issues that's going to arise. It is a legal risk for companies. A larger company has the advantage of having the resources for legal costs. A smaller company is going to find that more difficult."

Past Cases and Related Possibilities

• There is limited direct precedent for banning companies from paying for abortion travel, with legal lawyer Jennifer B. Rubin noting that "this is all very new. Nothing like this has been tested yet in the context of ERISA preemption." [ERISA prevents states from regulating group health plans].
• However, strategies such as banning companies supporting abortion travel, empowering shareholders to hold executives financially accountable, and allowing shareholders to sue executives for breach of fiduciary duty have also been proposed as avenues for states to punish companies who support employee abortion travel.
• Disney vs. Desantis was noted by Schweitzer as a "template" for the ability for government to intervene in corporate policies. In April, Desantis signed into law a bill revoking Disney's "special tax status" after Disney expressed its opinion on the sexual identity and gender education bill. Desantis said Disney was free to express its opinion on the bill, but "are not free to force all of us to subsidize their activism, and that's what they were doing."

Abortion Travel Bans

Description

• Abortion travel bans would restrict abortion seekers from traveling out of state to seek an abortion, effectively attempting to enforce its own state laws out of state.
• David S. Cohen, a professor at Drexel University’s Thomas R. Kline School of Law considers legislation surrounding travel bans "the next frontier in anti-abortion legislation" with "no real clear precedent."
• Currently, there are no attempts to prosecute abortion-seekers who travel across state lines, though Cohen notes "There is no guarantee that an aggressive prosecutor might try to stretch the law as much as they can."
• Notably, Justice Kavanaugh recently suggested that "women who travel to neighboring states to receive an abortion would be protected by the constitutional right to interstate travel."
• While at the moment, those seeking an abortion are not being penalized for interstate travel, those who support someone seeking an abortion may be more at risk. Texas and Oklahoma recently passed laws that give private citizens permission to sue someone who assists someone in getting an abortion.
• President Biden expressed concern that some states would attempt to prosecute abortion-seekers who travel across state lines: "people are gonna be shocked when the first state ... tries to arrest a woman for crossing a state line to get health services. And I don't think people believe that's gonna happen. But it's gonna happen, and it's gonna telegraph to the whole country that this is a gigantic deal that goes beyond; I mean, it affects all your basic rights".
• There is also evidence from states in which abortion remains legal suggesting preparation for a legal landscape in which abortion travel bans exist. Connecticut (where abortion is legal) recently passed legislation prohibiting Connecticut authorities from cooperating with out-of-state investigators or responding to extradition requests from the patient's home state to protect both patients and providers.

 

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 Additional Expert Commentary

• Experts strongly caution individuals on social media from offering support to those seeking to travel for abortions. University of Illinois' Wilson comments on the risk: "hosting a person seeking an abortion out of state, even with the best intentions, could put both parties in the legal crosshairs of anti-abortion states or individuals. Missouri, for example, is considering two separate bills that would make it illegal for residents to go out of state for abortions, as well as allow individuals to sue those who aid and abet those seeking an abortion. The combination would be similar to Texas".
• Cohen and law professors Greer Donley, and Rachel Robouché wrote in a Columbia Law School draft article that states "could use already existing tools to try to limit or completely prohibit people in their state from going elsewhere to obtain legal abortion," additionally writing that "Georgia’s conspiracy laws could apply to people who help patients travel to other states to get an abortion."

Past Cases and Related Possibilities

• Mark D. Rosen, professor at the Chicago-Kent College of Law, suggests there is little past precedent suggesting a state would attempt to impose its laws beyond its borders: "There is not a huge amount of case law" on such matters because, "by and large, states have not tried to" regulate what other states do. It reflects a certain ethic of interstate comity."

Research Strategy

Key Takeaways

• Experts feel that the Supreme Court's decision to overturn Roe v. Wade may pave the way for limited access to birth control. 

•  68% of U.S. adults who participated in an April Morning Consult poll want and expect states to give free access to birth control after the overturning of Roe v. Wade.

•   65% expect that there will be an increase in public funding for birth control and family planning services, and will support it, while 62% perceive and favor requirements for employer health insurance plans covering birth control.

Introduction

1. Insights on The Reduced Access to Birth Control

• Experts feel that the Supreme Court's decision to overturn Roe v. Wade may pave the way for limited access to birth control. 

• This is expected because there are already attempts to reduce the access to contraceptives across the country in states like Missouri and Idaho and after the court's reversal, the proponents could feel that they have the Supreme Court's support.

• Since the issue surrounds complete reproductive control, reducing access to emergency contraception, hormonal birth control, and IUDs seems like the next logical step.

• Anne Cavett, a Clinical Services' coordinator at Planned Parenthood of Metropolitan Washington, thinks that this expectation is founded, saying, “I don’t think it’s alarmist to worry it may get worse.”

• This expectation can also be seen through requests for long-acting contraceptives, with patients expressing anxiety surrounding how much longer they will be available. Some patients are even replacing their IUD before expiration, worrying that it will be their final chance.

2. Insights on Public Expectations Related to The Reduced Cost of Birth Control

•  68% of U.S. adults who participated in an April Morning Consult poll want and expect states to give free access to birth control after the overturning of Roe v. Wade.

•   65% expect that there will be an increase in public funding for birth control and family planning services, and will support it, while 62% perceive and favor requirements for employer health insurance plans covering birth control.

• In a survey conducted on April 19-21, 2022, when asked about their response to states' expected support of birth control:
•  Seven in ten adults said that they would support any initiatives by states to offer free birth control, including 54% of Republicans.
•  Over half of adults said that they would back an increase in funding for family planning services and affordable contraception.

 

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• The Centers for Medicare and Medicaid Services (CMS) is expected to encourage states to use Medicaid to ensure women and men have access to birth control.
• Even though compliance with the legal requirement for insurers to cover contraception at no cost has been historically inconsistent, the stakes for women's health are now higher after the Supreme Court's decision. Therefore, payers are expected to fulfil their obligation to cover contraception in the U.S. states more effectively.

Research Strategy