Ohioans United for Reproductive Rights field staff member Carlos Ortiz delivered boxes of petitions to the secretary of state’s office in Columbus on July 5, 2023. Advocates behind abortion initiatives often look to votes in Kansas and Ohio as harbingers of success. (Graham Stokes/Ohio Capital Journal)

After abortion rights were upended federally in June 2022, Kansas voters got a chance to weigh in on a ballot measure that was something of a test balloon just a couple of months later. Defying expectations, nearly 60% of voters rejected an anti-abortion constitutional amendment.

Since then, voters in states with both conservative- and liberal-leaning electorates have either rejected abortion restrictions or secured the right to an abortion. The majority of these successful campaigns were spearheaded by coalitions of doctors, advocates and everyday people who disagreed with the Supreme Court’s decision to upend federal abortion rights.

The issue was on the ballot in five states in November 2022. Americans in California, Michigan and Vermont enshrined the right to a host of reproductive health care services into their state constitutions during the midterms, while voters in Montana defeated a measure containing anti-abortion rhetoric and Kentucky voters soundly rejected an amendment seeking to declare that nothing in the state constitution guaranteed abortion rights.

Then, last year, faced with a Republican trifecta in state government where many lawmakers harbored anti-abortion positions, Ohio reproductive rights advocates took matters in their own hands and launched an effort to codify the right to abortion, contraception, fertility treatments, miscarriage management and pregnancy care.

Despite roadblocks thrown up by GOP officials who tried to increase the threshold for an amendment to be added to the Ohio Constitution, Issue 1 succeeded in November. Nearly 57% of Buckeye State voters cast ballots in favor of reproductive rights.

Elected officials elsewhere are playing a role in thwarting abortion ballot petitions, too. Missouri’s attorney general tried to push the state auditor to inflate the estimated cost of an initiative, and the secretary of state offered up ballot summaries that judges dismissed as partisan last year. (Abortion-rights proponents are suing again over the same issue, Missouri Independent reported.)

In Arkansas, Republican Secretary of State John Thurston refused to count all of the signatures for an abortion-rights ballot petition, citing technical paperwork errors, according to Arkansas Advocate. After a five-week legal battle — on the day of the deadline for Thurston to distribute certified ballots to counties — the state Supreme Court affirmed his position. Arkansans for Limited Government, the group behind the ballot measure, said the justices’ recent 4-3 ruling silenced more than 102,000 people who signed on to the effort, the Advocate reported.

Another strategy being deployed by opponents: “decline-to-sign” campaigns popped up in Arkansas, Arizona, Missouri and South Dakota.

Democrats have pledged to restore the right to an abortion nationally if they retain the White House and gain seats in Congress in the coming election, and Republican leaders have said they don’t support a national ban.

Still, as things stand today, 10 states have confirmed abortion-rights questions for Nov. 5 ballots. Lawsuits to invalidate them are pending across the nation.

Arizona?

Abortion is illegal after 15 weeks in Arizona, unless the patient’s life is at risk. There are no exceptions for rape, incest or genetic abnormalities.

Proposition 139 will ask voters if they want to allow abortion up to fetal viability with exceptions later in pregnancy for the patient’s life, or physical or mental health. The amendment would also prevent any penalties for someone who helps a person get an abortion. Arizona for Abortion Access is behind the initiative.

Colorado

Abortion is legal throughout pregnancy in Colorado, but the state enacted a ban on public funds being used for abortions in 1984. Government employees’ insurance does not cover abortion care.

Initiative 89, titled “Right to Abortion,” could effectively repeal that 40-year-old coverage ban if 55% of voters approve the amendment. Coloradans for Protecting Reproductive Freedom is leading the effort.

Florida?

Abortion is illegal after six weeks in Florida with exceptions for rape, incest and to save the patient’s life.

Amendment 4 would bar government interference in abortion access before fetal viability or when a provider deems the procedure necessary to save a person’s health. Sixty percent of voters have to approve the measure, which wouldn’t remove the parental notification requirement for minors seeking abortions. Floridians Protecting Freedom is behind the campaign.

Maryland?

In March 2023, the Democratic-controlled Legislature voted in favor of a referendum that put the “Right to Reproductive Freedom Act” before voters this fall. Abortion is broadly legal in Maryland.

Question 1 would reify the right to “reproductive freedom,” including the right to make “decisions to prevent, continue, or end” a pregnancy. The proposed amendment would also prevent the state from interfering in the right for the most part.

Missouri?

Abortion is only permitted in Missouri for medical emergencies. Restrictions on clinics and providers hindered access in the state before the Dobbs decision, Missouri Independent reported.

Amendment 3, if approved by a simple majority, would legalize abortion up to fetal viability with exceptions later in pregnancy to protect the life or physical or mental health of a pregnant person. It also states patients and providers cannot be prosecuted for abortion. Missourians for Constitutional Freedom is the political action committee behind the initiative.

Montana?

A 1999 Montana Supreme Court ruling solidified abortion access based on the state’s constitutional right to privacy, and a 2023 decision reaffirmed the precedent, while also ruling that advanced practice nurses can provide abortions. Still, the Republican-controlled legislature advanced abortion restrictions, which are largely blocked by the courts, Daily Montanan reported.

CI-128 asks voters to further enshrine into the state’s constitution the right to make decisions about one’s pregnancy, including abortion up to fetal viability, without government regulation. The amendment would include exceptions later in pregnancy to protect the life or health of the patients, as determined by providers. Montanans Securing Reproductive Rights headed the ballot effort.

Nebraska?

A 12-week abortion ban was enacted last year. Protect Our Rights launched a campaign in November for an amendment that would expand access up to viability, as determined by a provider, with later exceptions for a mother’s health.

Protect Women and Children announced a counter-effort in the spring for a competing constitutional amendment that would ban abortions after the first trimester (12-14 weeks), with later exceptions for rape, incest or the life of a mother. It would allow the legislature to pass stricter bans in the future.

If both questions make it to the ballot and both are approved by voters, the one with the most votes wins, Nebraska Examiner reported.

Nevada?

In 1990, Nevada voters secured the right to an abortion through 24 weeks of pregnancy, or later if the mother’s life is at risk. Question 6 will ask voters to ensure similar rights constitutionally — making them harder for lawmakers to modify. If passed, this amendment would protect abortion access up to fetal viability, or later to protect the life or health of the patient, Nevada Current reported.

The coalition Nevadans for Reproductive Freedom is behind the proposal, which will have to be approved twice — once this year and again in 2026.

New York

Abortion is legal in New York up to 24 weeks of pregnancy, and abortions after that point must be approved by providers who decide whether a fetus is viable, or if a patient’s life or health is at risk.

Proposal 1, a legislatively referred referendum, asks voters if they want to add an equal rights amendment to the constitution. If approved, it would bar discrimination based on sex, including “pregnancy, pregnancy outcomes and reproductive health care and autonomy.” Supporters say this would add protection for the right to an abortion.

South Dakota?

Abortion is banned in South Dakota unless it’s necessary to save a patient’s life. Dakotans for Health led an effort to expand access.

Amendment G asks voters whether to ban legislators from regulating abortion until the end of the first trimester, allow regulations during the second trimester “in ways that are reasonably related to the physical health of the pregnant woman” and let the state prohibit abortion in the third trimester unless the procedure is necessary to save the life or health of a pregnant patient.

Vice presidential candidate Minnesota Gov. Tim Walz celebrates with his daughter Hope, son Gus and wife Gwen at Democratic National Convention on Wednesday, Aug. 21, in Chicago. The Walzes clarified this week that they didn’t use IVF but another kind of fertility treatment to grow their family. (Justin Sullivan/Getty Images)

The broader scope of fertility treatments entered the spotlight this week after Minnesota Gov. Tim Walz and his wife Gwen shared that they had children through a less commonly known procedure.

Since Vice President Kamala Harris selected Gov. Walz as her running mate, he has discussed his family’s fertility journey during speeches in Pennsylvania, Nebraska and mostly recently at the Democratic National Convention in Chicago, Illinois.

“It took Gwen and I years,” Walz said on Wednesday night. “But we had access to fertility treatments. And when our daughter was born, we named her Hope.”

This week, the Walzes clarified that they conceived via intrauterine insemination, not in vitro fertilization.

IUI involves injecting sperm into the uterus during or just before ovulation to increase the chances of fertilization and pregnancy.

“Our fertility journey was an incredibly personal and difficult experience. Like so many who have experienced these challenges, we kept it largely to ourselves at the time — not even sharing the details with our wonderful and close family,” Gwen Walz said in a statement provided to States Newsroom. “The only person who knew in detail what we were going through was our next door neighbor. She was a nurse and helped me with the shots I needed as part of the IUI process.”

During IVF, eggs and sperm are combined in a lab and an embryo is inserted into the uterus. IVF has been drawn into national reproductive rights debates for much of this year, and Walz has been talking about it on the campaign trail while discussing his family’s fertility journey.

U.S. Ohio Sen. J.D. Vance, the Republican vice presidential candidate, accused his opponent of lying about how he and his wife had children. In an Aug. 20 social media post, Vance said, “Today it came out that Tim Walz had lied about having a family via IVF. Who lies about something like that?” He also shared a clip of Walz talking about fertility care and families on Aug. 9.

In a statement, Harris-Walz campaign spokesperson Mia Ehrenberg said, “Governor Walz talks how normal people talk. He was using commonly understood shorthand for fertility treatments.”

Experts said that patients commonly get IUI and IVF confused or refer to them interchangeably, given that in vitro fertilization is more popular.

“There’s such a huge sort of alphabet soup that comes along with assisted reproduction,” said Kimberly Mutcherson, a professor at Rutgers University-Camden who specializes in reproductive justice, bioethics, and family and health law.

Dr. Kelly Acharya, a fertility physician and assistant professor of obstetrics and gynecology at Duke University, said patients’ partners are more likely to mix up the two treatments or rope related procedures into IVF.

“A lot of times in my line of work, I see people that are referring to other things, like egg freezing, they call that IVF, even though technically it’s not,” she said.

Both Acharya and Mutcherson said the main differences between IUI and IVF are where fertilization occurs, the price and effectiveness.

“Intrauterine insemination or IUI is basically less invasive. It’s typically less expensive, and it is often what is recommended as the first thing that somebody tries,” Acharya said. “When somebody has mild forms of infertility, like if there are mild differences in the semen analysis, or if somebody is young and they’re not quite sure why they’re not getting pregnant, then often a provider will recommend that they do IUI as a first step to help things along.”

IUI is performed during or near ovulation, and it typically takes 10 minutes and is a minor procedure, according to Acharya. The price of IUI varies, depending on insurance coverage, from a few hundred dollars to several thousand dollars.

Mutcherson noted that some people also confuse IUI with intracervical insemination, or ICI. During this method, the sperm is inserted into the cervix — the passageway to the uterus, according to the Carolina Fertility Institute.

Doctors often recommend ICI or IUI as a precursor to IVF, which Mutcherson said can cost $12,000 to $15,000 per cycle — or more with grading and genetic testing. During IVF, “fertilization happens outside of the body,” Acharya said.

IUI, the treatment the Walz family used to have children, is not under the same scrutiny as IVF, which has faced opposition from anti-abortion hardliners. “It sometimes is listed as being less controversial than IVF, because it’s just helping along the natural process of getting the sperm inside the uterus and then expecting fertilization to happen inside the body,” Acharya said.

But Mutcherson said that could also be attributed to the fact that it’s a less well-known procedure.

“I think the really big issue when it comes to something like artificial insemination is that it allows people to create families that a lot of these folks — unfortunately, in the Republican Party and folks who are evangelicals — don’t approve of: families with two moms, families with two dads, single women who are having children,” she said.

Price is a significant barrier to fertility care. Only 21 states require insurers to cover fertility procedures, Stateline reported. A successful birth via IVF can cost more than $60,000, according to a 2022 study published in Reproductive Biology and Endocrinology.

“It requires a lot more physically, emotionally and economically to be able to do IVF,” Mutcherson, who conceived via IUI, said.

IVF became a national reproductive rights issue in February after the Alabama Supreme Court likened frozen embryos to “unborn children” in a ruling. The plaintiffs were couples who sued for damages under an 1872 wrongful death of children law after their embryos were accidentally destroyed in a clinic four years ago, Alabama Reflector reported. Alabama’s fertility clinics temporarily closed after the ruling until Republican Gov. Kay Ivey signed legislation in March shielding providers from criminal and civil liabilities, the Reflector reported.

But there’s still uncertainty over whether embryos and fetuses in the state have legal “personhood” rights. Despite the new law, two fertility clinics in Alabama announced plans to close by the end of the year, though one denied the decision was related to the? ruling.

Since the Alabama ruling, polls have shown most Americans back IVF. A survey conducted by Pew in April found that 70% said IVF is a good thing, while 22% said they’re not sure, and 8% said it’s a bad thing. Awareness is growing, too: 42% of Americans said they or someone they know have had fertility treatments, according to a 2023 Pew poll.

Nationally, Republicans and Democrats condemned the Alabama Supreme Court’s ruling and filed bills seeking to protect IVF this spring, though all of them stalled in Congress. The Republican Party’s platform featured support for both IVF and the equal protections clause of the 14th Amendment, which conservative legal scholars argue can be used to solidify “fetal personhood” along with effectively banning abortion. And in June, the Southern Baptist Convention — the largest Protestant denomination in the U.S. — voted to condemn IVF, particularly the destruction or donation of embryos that are not implanted in the uterus.

“People who believe that life begins at conception, people who believe that an embryo is no different than a 5-year-old sitting in a kindergarten classroom, those are people who have really deep and abiding principles related to procedures like in vitro fertilization,” Mutcherson said.

The number of babies born in the U.S. using assisted reproductive technology has increased in recent years: 2.5% of newborns were conceived using fertility treatments in 2022, according to the American Society of Reproductive Medicine. That’s up from 2.3% in 2021, per federal data.

Hadley Duvall, a sexual assault survivor, speaks onstage during the first day of the Democratic National Convention at the United Center on Monday, Aug. 19, in Chicago. She appeared alongside reproductive rights advocates from states with post-Roe abortion restrictions. (Joe Raedle/Getty Images)

Most major party leaders who took the stage at the Democratic National Convention in Chicago, Illinois, mentioned that Vice President Kamala Harris would work to restore federal abortion rights if elected president.

But the most poignant remarks about the issue on the DNC’s first day came from Southern women who had traumatic pregnancies and spoke about the erosion of abortion rights since the U.S. Supreme Court overturned Roe v. Wade more than two years ago.

Kaitlyn Joshua of Louisiana, Amanda Zurawski of Texas and Hadley Duvall of Kentucky spoke at the convention on Monday night. Joshua and Zurawski were denied care for pregnancy complications in 2022. Duvall, a 22-year-old who became pregnant as a child after she was raped by her stepfather, has called for exceptions to Kentucky’s abortion ban for sexual assault survivors.

Woman in Beshear’s abortion ad says she wants to give voice to victims

“At age 12, I took my first pregnancy test, and it was positive,” Duvall told the DNC crowd. “That was the first time I was ever told, ‘You have options.’ I can’t imagine not having a choice, but today, that’s the reality for many women and girls across the country because of Donald Trump’s abortion bans.”

Trump, the Republican presidential candidate, nominated three of the Supreme Court justices who voted to overturn Roe v. Wade during his first term as president.

Joshua spoke about being denied miscarriage treatment when she was pregnant with her second child. “Two emergency rooms sent me away. Because of Louisiana’s abortion ban, no one would confirm that I was miscarrying,” she said.

Appearing alongside her husband, Zurawski said delayed pregnancy care threatened her life. “Every time I share our story, my heart breaks for the baby girl we wanted so desperately, for the doctors and nurses who couldn’t help me deliver safely, for Josh who feared he’d lose me too,” she said.

All three women have campaigned in battleground states such as Florida, Michigan and Wisconsin this year for Harris, the Democratic Party’s presidential nominee, and President Joe Biden before he suspended his reelection bid. Like Biden, Harris has pledged to sign legislation codifying the federal right to an abortion if she’s elected and if Congress passes such a bill.

“Our daughters deserve better. America deserves better,” Joshua said.

During a campaign stop in Florida last week, she told the story of how she was 11 weeks pregnant when she drove herself to an emergency room in Baton Rouge after experiencing heavy bleeding, Florida Phoenix reported. Providers said her fetus stopped growing but sent her home and said they would pray for her. Joshua went to a different hospital after her bleeding worsened, but she was told to go home again until her pregnancy passed.

“I no longer feel safe being pregnant in Louisiana,” Joshua wrote in an opinion piece for Louisiana Illuminator this spring. “Not as a Black woman who received inadequate and delayed medical care while enduring a painful miscarriage because of my home state’s abortion ban.”

When Zurawski learned her state enacted its trigger law after the Dobbs v. Jackson Women’s Health Organization ruling in June 2022, she was in the intensive care unit of a hospital dealing with septic shock, according to Texas Tribune. Days earlier, she found out she had premature prelabor rupture of the membranes at 18 weeks of pregnancy. Zurawski was initially denied an abortion — her fetus had cardiac activity — until she went into sepsis.

“What I went through was nothing short of barbaric, and it did not need to happen,” Zurawski said in May while campaigning for Biden in Madison, Wisconsin. “It was completely avoidable. It was preventable.”

Zurawski is one of the plaintiffs who sued Texas last year asking for clarity on what type of medical emergency warrants abortion under the state’s bans. The state Supreme Court rejected the challenge in May, ruling that medical exceptions in the law were broad enough, the Tribune reported.

While Joshua and Zurawski have often traveled together in swing states to share their stories of denied care in a post-Roe United States, Duvall rose to prominence after she appeared in an ad for Kentucky Democratic Gov. Andy Beshear’s reelection campaign last year.

Duvall, who miscarried a pregnancy resulting from assault, criticized Beshear’s opponent and former Republican Attorney General Daniel Cameron for his lack of support for adding rape and incest exceptions to the state’s ban, Kentucky Lantern reported. “To tell a 12-year-old girl she must have the baby of her stepfather who raped her is unthinkable,” she said.

She has since become a reproductive rights advocate and hit the campaign trail for national Democrats, appearing alongside Harris on MSNBC in June and in an ad for Biden last month.

“There are other survivors out there who have no options,” Duvall said Monday before introducing Beshear’s DNC speech. “And I want you to know that we see you. We hear you.”

Supporters respond as U.S. Vice President Kamala Harris delivers remarks on reproductive rights at Ritchie Coliseum at the University of Maryland on June 24, 2024. Harris spoke on the two year anniversary of the Dobbs decision, the Supreme Court ruling that overturned Roe v. Wade and struck down federal abortion protections. (Photo by Kevin Dietsch/Getty Images)

The Democratic Party kicked off its virtual roll call on Thursday to formally nominate Vice President Kamala Harris as its pick for the next commander-in-chief. Harris is expected to announce her running mate soon.

Speculation over her vice presidential nominee has run rampant. States Newsroom’s Washington, D.C.,?bureau?recently spoke with political experts who suspect Harris is looking for someone outside the Beltway to connect with voters.

According to media reports, she has narrowed her choices to four male governors and a U.S. senator — all white — who represent a mix of competitive and solidly, left-leaning states:?Govs. Andy Beshear of Kentucky, J.B. Pritzker of Illinois, Josh Shapiro of Pennsylvania, Tim Walz of Minnesota and Sen. Mark Kelly of Arizona.

All five men have criticized the U.S. Supreme Court’s decision to overturn the federal right to abortion, and they’ve backed policy to secure or expand reproductive rights in the two years since the Dobbs v. Jackson Women’s Health Organization ruling. (The governors are also members of the?Reproductive Freedom Alliance, a nonpartisan coalition of leaders dedicated to preserving the right to abortion and reproductive health post-Dobbs.)

Here’s a look at what Harris’ possible vice president picks has said — and done — on reproductive rights:

Kentucky Gov. Andy Beshear?

As a Democratic governor in a conservative-leaning state, Beshear has pushed for lawmakers to add rape and incest exceptions to abortion laws. The commonwealth enacted a trigger law and a near-total abortion ban after Roe v. Wade fell in June 2022. During his reelection campaign last year, Beshear?ran ads featuring Hadley Duvall, underscoring the lack of reprieve for sexual assault survivors?under bans,?Kentucky Lantern?reported. Duvall was raped and impregnated by her stepfather when she was 12. The?pressure?from the ads led Beshear’s opponent, former Republican Attorney General?Daniel Cameron, to say he would sign legislation adding rape and incest exceptions to Kentucky’s ban if elected governor.

Beshear?won?52% of the vote in November 2022, and he thanked Duvall in his victory speech, according to the?Lantern. “What a brave, courageous young woman that she is,” Beshear said. “We believe she and everyone else should have options, and the legislature should make that change as quickly as they come in.” In April, the?Senate GOP blocked a vote?on legislation that would have addressed the issue.

Arizona Sen. Mark Kelly?

A former astronaut and Navy captain, Kelly has been in office since 2020 and was reelected in 2022. He voted in favor of the?Women’s Health Protection Act?in May 2022, legislation that would codify the federal right to an abortion. “We’ve got to codify Roe at the federal level,” Kelly said in May, according to?Arizona Mirror. “I think that is truly the path forward.” Ahead of the second anniversary of the Dobbs decision, Kelly?highlighted?how?abortion bans?have affected the full scope of reproductive health care and?led some doctors to flee Arizona, which has a 15-week ban.

Kelly has also?backed protective IVF measures?in Congress. In June, he and his wife?Gabby Giffords, a former congresswoman who survived an assassination attempt in 2011, wrote in? an essay for?People?magazine about their?struggles with fertility. Two days after Giffords was shot the couple was supposed to have an appointment for embryo implantation. They wrote: “Our dream of having a child together was taken away by a gunman. The dreams of Americans to have a child together could be taken away by politicians.”

Illinois Gov. J.B. Pritzker

Pritzker leads a state that has become an abortion access point in the Midwest. Illinois borders Indiana, Kentucky and Missouri — all have abortion bans — and Iowa, which enacted a six-week ban this week. He recently signed legislation that will require insurers to cover postpartum care — doulas, midwives, lactation consultants — up to a year after birth,?Capitol News Illinois?reported. The?law?also ended abortion copays and deductibles.

He?signed?a budget in June that allocates more than?$23 million for a slew of maternal health care programs that will invest in community-based providers, home nurse programs and free diapers. “There is no freedom of choice without access to a full spectrum of reproductive healthcare for women and new mothers,” Pritzker?said?in February when announcing the initiative.

Pennsylvania Gov. Josh Shapiro?

Formerly the state’s attorney general, Shapiro was elected governor in November 2022. Last month,?Pennsylvania Capital-Star?reported that?he would not defend the state’s ban on the use of Medicaid funds for abortion. “Pennsylvania’s Constitution prohibits discrimination on the basis of sex — and as our State Supreme Court ruled earlier this year, the state ban on Medicaid coverage for abortion services is sex-based discrimination,” Shapiro said in a statement.

He?ended?the state’s contract with Real Alternatives, a group that funds?anti-abortion pregnancy centers, in December 2023, Capital Star reported. The organization received more than $30 million in state funding between?2012 and 2017. Shapiro also signed legislation last year to?improve tracking of pregnancy-related deaths. He is facing?criticism?because his office paid $295,000 to settle a female employee’s sexual harassment complaint against his former cabinet secretary.

Minnesota Gov. Tim Walz

Even though a 1995 state Supreme Court ruling guaranteed the right to abortion in Minnesota, Walz has signed legislation that widened access in the state. Last?year, lawmakers?removed the 24-hour waiting period for abortions,?ended extensive abortion reporting, and?removed the requirement that abortions be performed in hospitals.

He signed the?Protect Reproductive Options Act?in January 2023, which?codified the right to reproductive health care and abortion with no limits or exceptions,?Minnesota Reformer?reported. “The message that we’re sending Minnesota today is very clear. Your rights are protected in the state. You have the right to make your own decisions about your health, your family and your life,” Walz said during a ceremonial bill signing.

New parents share stories of tense encounters with airport security over breast milk and formula. A bill from U.S. Rep. Katie Porter, a California Democrat, would strengthen guidelines for U.S. Transportation Security Administration officers. (Getty Images)

As the summer travel season approaches, new parents may be navigating airports with their babies — and the complexities of keeping them fed. Despite federal guidelines for airport agents laying out how to treat nursing moms, stories about problem encounters with security sometimes go viral.

In 2023, actress and singer Keke Palmer said she was at Houston airport when she faced threats to throw out her 16 ounces of breast milk. A year earlier, engineer and science TV host Emily Calandrelli said U.S. Transportation Security Administration officers escorted her out of line and made her check her partially thawed ice packs, which are used to keep breast milk cool.

“It was a very traumatizing experience, and it also didn’t align with what the TSA policies were, which state that you’re allowed to have them for medically necessary purposes,” Calandrelli told States Newsroom.

In May 2022, she went on her first work trip away from her 10-week-old baby and was traveling from Los Angeles to Washington, D.C. Calandrelli planned on pumping after going through security at LAX, but TSA officers drilled her with questions about what the ice packs were for and said it wouldn’t have been an issue if her breast milk was already pumped.

“I spoke to three different males who worked at TSA, and I requested to speak to a woman but wasn’t able to,” she said.

Like Palmer, she shared the experience with her legions of social media followers. Calandrelli said the agency later apologized. TSA issued a statement shortly after the incident: “Our employees go through regular training to effectively engage and screen diverse traveler populations, including those who are breastfeeding and/or traveling with breast milk.”

Both women’s experiences violate TSA guidelines: formula, breast milk, toddler drinks and baby food are allowed on planes and carry-ons in quantities greater than 3.4 ounces. Breast milk, formula and ice packs — along with other cooling accessories — are considered medically necessary. Passengers are advised to let TSA officers know they’re carrying these items when arriving at airport security.

Even though these protections exist, many lactating parents still encounter problems during air travel, and these issues carry physical and emotional side effects, according to Tina Sherman, a doula and interim executive director at the U.S. Breastfeeding Committee.

“Lactating parents have to pump on a fairly regular basis to be able to continue to keep up their supply,” Sherman said.

When they can’t express milk or that cycle is interrupted, mothers experience pain or breast leaks, she said. In some cases, long delays in pumping can lead to mastitis — an infection that causes swelling in the breasts and cracked nipples. Emotionally, being prevented or delayed from expressing milk can make parents feel anxious, embarrassed and stressed, Sherman said.

Calandrelli’s plight two years ago led her to reach out to her local California congresswoman. U.S. Democratic Rep. Katie Porter first introduced legislation to strengthen existing protections for breastfeeding parents in August 2022.

“You have to have clear instructions and clear rules, and have people follow them in order for moms to be able to meet the standards,” Porter said. “There’s a lot of obstacles to breastfeeding. There’s a lot of challenges to feeding a baby and traveling with a baby.”

The Bottles and Breastfeeding Equipment Screening (BABES) Enhancement Act would require “hygienic handling of breast milk and baby formula” by TSA officers and private security companies. Porter’s bill would direct airport officials to “minimize the risk for contamination” of breast milk, formula and infant drinks, along with ice or freezer packs and related cooling accessories.

Under the proposal, the agency must consult with maternal health organizations — March of Dimes, Association of Maternal and Child Health Programs, American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine — to determine what policies and regulations need to be updated as pumping technology and best practices for breast milk storage evolve, she said.

BABES Act is an update to a 2016 law that required TSA training on special screening procedures for nursing parents. The original law also made it legal to carry larger amounts of breast milk, formula and infant drink — juice or purified water — in airports and on planes.

Reps. Maria Elvira Salazar, a Florida Republican, and Eric Swalwell, a California Democrat, are the lead co-sponsors in the House. Democratic Sens. Tammy Duckworth of Illinois and Mazie Hirono of Hawaii, along with GOP Sens. Steve Daines of Montana and Ted Cruz of Texas sponsored the bill in the upper chamber.

The bipartisan bill didn’t go anywhere last session, but Porter reintroduced the proposal. She said the bill is set to be heard in the Senate Commerce, Science and Transportation Committee soon.

As a mother of three, Porter is acutely familiar with the problems that come with traveling with infants. Her children are adolescents and teens now, but when they were babies, lactation stations in airports were uncommon. She said a flight attendant once told her to stop nursing her baby while the plane was still on the ground. Porter said she was angry and scared, but mostly “worried about my baby, who was hungry.”

As for her bill, she recognizes that TSA agents have a hard job. But the BABES Act will help them “have clear rules and better training so that they’re not put in challenging situations when they’re dealing with frustrated parents,” she said.

Making travel for lactating parents easier could chip away at larger stigma about breastfeeding, advocates said. More than 80% of babies are breastfed in infancy, and 58% are still getting some breast milk by the time they’re 6-months-old, according to the U.S. Centers for Disease Control and Prevention.

Still, earlier this month, an ad for lactation cookies featuring a cooking star’s covered breasts and pregnant belly was temporarily removed from a Times Square billboard, according to The New York Times.

“Normalizing breastfeeding and lactation is really critical to families being able to meet their breastfeeding goals,” Sherman said.

Demonstrators at the Jewish Rally for Abortion Justice at Union Square near the U.S. Capitol on May 17, 2022, in Washington, D.C. (Anna Moneymaker/Getty Images)

Lawmakers who oppose abortion often invoke their faith — many identify as Christian — while debating policy.

The anti-abortion movement’s use of Christianity in arguments might create the impression that broad swaths of religious Americans don’t support abortion rights. But a recent report shows that Americans of various faiths and denominations believe abortion should be legal in all or most cases.

Jewish women cite Kentucky’s Religious Freedom law in contesting state abortion ban

According to a Public Religion Research Institute survey of some 22,000 U.S. adults released last week, 93% of Unitarian Universalists, 81% of Jews, 79% of Buddhists and 60% of Muslims also hold that view.

Researchers also found that most people who adhere to the two major branches of Christianity — Catholicism and Protestantism — also believe abortion should be mostly legal, save for three groups: white evangelical Protestants, Latter-day Saints and Jehovah’s Witnesses.

Historically, the Catholic Church has opposed abortion. But the poll found that 73% of Catholics of color — PRRI defines this group as Black, Asian, Native American and multiracial Americans — support the right to have an abortion, followed by 62% of white Catholics and 57% of Hispanic Catholics.

The findings show that interfaith views on abortion may not be as simple as they appear during political debate, where the voices of white evangelical legislators and advocates can be the loudest.

States Newsroom spoke with Abrahamic religious scholars — specifically, experts in Catholicism, Islam and Judaism — and reproductive rights advocates about varying perspectives on abortion and their history.

Abortion views in America before Roe v. Wade

The Moral Majority — a voting bloc of white, conservative evangelicals who rose to prominence after the U.S. Supreme Court Roe v. Wade ruling in 1973 — is often associated with spearheading legislation to restrict abortion.

Gillian Frank is a historian specializing in religion, gender and sexuality who teaches at the Stevens Institute of Technology in New Jersey. Frank said evangelical views on abortion were actually more ambivalent before the early ’70s Roe decision established the federal right to terminate a pregnancy. (The Supreme Court upended that precedent about two years ago.)

“What we have to understand is that evangelicals, alongside mainline Protestants and Jews of various denominations, supported what was called therapeutic abortion, which is to say abortion for certain exceptional causes,” Frank said, including saving the life or health of the mother, fetal abnormalities, rape, incest and the pregnancy of a minor. Religious bodies like the Southern Baptist Convention and the National Association of Evangelicals said abortion was OK in certain circumstances, he added.

Evangelical Protestants before Roe did not endorse “elective abortions,” Frank said, or what they called “abortion on demand,” a phrase invoked by abortion-rights opponents today that he said entered the American lexicon around 1962.

The 1973 ruling was seismic and led organizations opposing abortion, such as the National Right to Life Committee — formed by the Conference of Catholic Bishops — to sprout across the country, according to an article published four years later in Southern Exposure. Catholic leaders often lobbied other religious groups — evangelicals, Mormons, orthodox Jews — to join their movement and likened abortion to murder in their newspapers.

After Roe, “abortion is increasingly associated with women’s liberation in popular rhetoric in popular culture, because of the activism of the women’s movement but also because of the ways in which the anti-abortion movement is associating abortion with familial decline,” Frank said. Those sentiments, he said, were spread by conservative figures like Phyllis Schlafly, a Catholic opposed to feminism and abortion, who campaigned against and managed to block the Equal Rights Amendment in the 1970s.

Polls suggest the views of Catholic clergy and laypeople diverge

Catholicism is generally synonymous with opposition to abortion. According to the United States Conference of Catholic Bishops, the church has stood against abortion since the first century. The conference points to Jeremiah 1:5 in the Bible to back up arguments that pregnancy termination is “contrary to the moral law.”

But nearly 6 in 10 American Catholics believe abortion should be mostly legal, according to a Pew Research Center report released last month.

Catholics for Choice spokesperson Ashley Wilson said that there’s a disconnect between the church as an institution and its laity. “We recognize that part of the problem is that the Catholic clergy, and the people who write the official teaching of the church, are all or mostly white male — my boss likes to say ostensibly celibate men — who don’t have wives,” Wilson said. “They don’t have daughters. They have no inroads into the lives of laypeople.”

Her group plans on going to Vatican City in Rome this fall to lift up stories of Catholics who’ve had abortions. The organization is also actively involved in efforts to restore abortion access — 14 states have near-total bans — through direct ballot measures in Colorado, Florida and Missouri this year.

Catholic dioceses and fraternities are often behind counter-efforts to proposed ballot questions. They poured millions into campaigns in Kansas and Kentucky in 2022 to push anti-abortion amendments, and also in Ohio last year to defeat a reproductive rights ballot measure but they failed in each state.

Ensoulment and mercy in Islam

Tenets of Islam — the second largest faith in the world — often make references to how far along a person’s pregnancy is and whether there are complications. University of Colorado Law professor Rabea Benhalim, an expert on Islamic and Judaic law, said there’s a common belief that at 40 days’ gestation, the embryo is akin to a drop of fluid. After 120 days, the fetus gains a soul, she said.

While the Quran doesn’t specifically speak to abortion, Benhalim said Chapter 23: 12-14 is considered a description of a fetus in a womb. The verses are deeply “important in the development of abortion jurisprudence within Islamic law, because there’s an understanding that life is something that is emerging over a period of stages.”

In some restrictive interpretations of Islam, there’s a limit on abortion after 40 days, or seven weeks after implantation, Benhalim said. In other interpretations, because ensoulment doesn’t occur until 120 days of gestation, abortion is generally permitted in some Muslim communities for various reasons, she said. After ensoulment, abortion is allowed if the mother’s life is in danger, according to religious doctrine.

Sahar Pirzada, the director of movement building at HEART, a reproductive justice organization focused on sexual health and education in Muslim American communities, confirmed that some Muslims believe in the 40-day mark, while others adhere to the 120-day mark when weighing abortion.

“How can you make a black-and-white ruling on something that is going to be applied across the board when everyone’s situation is different?” she asked. “There’s a lot of compassion and mercy with how we’re supposed to approach matters of the womb.”

The issue is personal for Pirzada, who had an abortion in 2018 after her fetus received a fatal diagnosis of trisomy 18 when she was 12 weeks pregnant. “I wanted to terminate within the 120-day mark, which gave me a few more weeks,” she said.

She consulted scholars and Islamic teachings before making the decision to end her pregnancy, she said, and mentioned the importance of rahma — mercy — in Islam. “I tried to embody that spirit of compassion for myself,” she said.

Pirzada, who is now a mother of two, had the procedure at exactly 14 weeks on a day six years ago that was both Ash Wednesday and Valentine’s Day. She said she felt loved and surrounded by people of faith at the hospital, where some health care workers had crosses marked in ash on their foreheads. “I felt very appreciative that they were offering me care on a day that was spiritual for them,” she said.

Seeing the stories of people with pregnancy complications in the period since the Supreme Court overturned the federal right to an abortion has left her grief stricken. For instance, Kate Cox, a Texas woman whose fetus had the same diagnosis as Pirzada’s, was denied an abortion by the state Supreme Court in December. Cox had to travel elsewhere for care, Texas Tribune reported.

Benhalim, the University of Colorado expert, said teachings in Islam and Judaism offer solace to followers who are considering abortion, as they can provide guidance during difficult decisions.

No fetal personhood in Judaism?

In Jewish texts, the embryo is referred to as water before 40 days of gestation, according to the National Council of Jewish Women. Exodus: 21:22-23 in the Torah mentions a hypothetical situation where two men are fighting and injure a pregnant woman. If she has a miscarriage, the men are only fined. But if she is seriously injured and dies, “the penalty shall be a life for a life.”

Is IVF protected in Kentucky? Depends on whom you ask.

This part of the Torah is interpreted to mean that a fetus does not have personhood, and the men didn’t commit murder, according to the council. But this may not be a catchall belief — Benhalim noted that denominations of Judaism have different opinions on abortion.

Today, Jewish Americans have been at the forefront of legal challenges to abortion bans based on religious freedom in Florida, Indiana and Kentucky. Many of the lawsuits have interfaith groups of plaintiffs and argue that restrictions on termination infringe on their religion.

The legal challenge in Indiana has been the most successful. Hoosier Jews for Choice and five anonymous plaintiffs sued members of the state medical licensing board in summer 2022, when Indiana’s near-total abortion ban initially took effect.

Plaintiffs argued that the ban violated the state’s Religious Freedom Restoration Act, and the court later let the claim receive class-action status. Several Jewish Hoosiers said they believe life begins after a baby’s first breath, and that abortion is required to protect the mother’s health and life, according to court documents.

Last month, the Indiana Court of Appeals ruled that the plaintiffs have the right to sue the state but sent the request for a temporary halt on the ban back to a lower court.

While the decision was unanimous, Judge Mark Bailey issued a separate concurring opinion explaining his reasoning and criticizing lawmakers — “an overwhelming majority of whom have not experienced childbirth” — who assert they are protectors of life from the point of conception.

“In my view, this is an adoption of a religious viewpoint held by some, but certainly not all, Hoosiers,” he wrote. “The least that can be expected is that remaining Hoosiers of child bearing ability will be given the opportunity to act in accordance with their own consciences and religious creeds.”

The U.S. Food and Drug Administration approved a key abortion pill mifepristone for use in 2000. The U.S. Supreme Court will take up a case Tuesday, March 26, 2024, challenging that approval. (Getty Images)

Self-managed abortions rose by more than 26,000 in the six months after the U.S. Supreme Court overturned Roe v. Wade nearly two years ago, according to a?peer-reviewed study?published Monday in JAMA, the American Medical Association’s journal.

Researchers determined that an increase of approximately 27,838 online orders of abortion pills between July and December 2022 corresponded to the findings of an additional 26,055 medication abortions reported outside the formal health care system, the study found.

The Dobbs v. Jackson Women’s Health Organization ruling in June 2022 overturned the federal right to abortion, returning the decision to the states and leading to?14 with near-total abortion bans.

The study was published a day before the nation’s highest court is set to hear arguments in a case over the federal approval of?mifepristone, one of two drugs used for medication abortions. A decision in favor of an anti-abortion group could limit access to mifepristone, even in states with protective abortion laws.

Alliance for Hippocratic Medicine, an anti-abortion group of physicians, is asking the court to rule that the U.S. Food and Drug Administration should revert to pre-2016 mifepristone regulations. The change would reduce mifepristone’s use from 10 weeks gestation to seven, alter the dosage, require three in-person visits, and only allow doctors to provide medication abortions, among other restrictions.

Lawyers for the Biden administration are?urging?the court to keep the current regulations on the drug.?Hundreds of studies point to the pill’s safety. Since the FDA approved mifepristone in?2000, 32 deaths have been associated with the drug’s use as of December 2022.

Regardless of the outcome, the JAMA research suggests that some people in states with strict abortion bans have found ways to terminate their pregnancies outside of a clinician setting.

“Given the increases we’ve seen and reductions in access, we could make a good guess that a lot of these pills are going to states with those bans,” said?Abigail Aiken, a University of Texas at Austin public affairs professor and the study’s lead author.

Researchers analyzed data provided by telemedicine organizations — such as Aid Access, an international abortion pill provider, community networks and online vendors. Community networks — organizations run by volunteers that sometimes work offline or through hotlines and provide pills at no-cost to recipients? — accounted for more than half of all abortion pill orders. Online vendors are websites that give various price options for buying abortion medications.

Post-Dobbs, there was an estimated monthly average of 5,931 provisions — orders — of abortion pills from those main sources. That’s a 322% increase from a pre-Dobbs average of 1,407 provisions per month, according to the study.

Despite the availability of abortion pills, Aiken said some people may not want to terminate a pregnancy without clinician support. She noted from her previous 2016 research in?Ireland, before the country legalized abortion in 2018, feelings associated with self-managed abortion, including isolation.

“They oftentimes wanted to connect with the formal health care setting,” Aiken said.? “They were experiencing prolonged symptoms and wanted to make sure they didn’t need help.”

Aiken’s latest study broadens the scope of research on medication abortions since the end of Roe.

Abortions through telehealth?increased?post-Dobbs, according to a Society of Family Planning #WeCount?report?published last month. They made up 16% of all reported abortions as of September 2023. Before Dobbs, just 4% of all abortions were telehealth abortions.

“Telehealth abortion has really had a huge impact,” Ushma Upadhyay, a professor at the University of California, San Francisco’s Advancing New Standards in Reproductive Health, told States Newsroom in February. “We’re addressing unmet need that existed in those states, even before Dobbs. I think that a lot of the unmet need in the blue states is being met, as well as people traveling from states with abortion bans.”

A report released last week by the Guttmacher Institute showed that?63% of all clinician-provided abortions in the U.S. last year were medication abortions.

There were more than 1 million abortions provided in the formal health care system in 2023, the largest number since 2012. In 2020, medication abortions made up 53% of all abortions, according to the institute.

The data “helps paint the picture of the extreme need that we are experiencing around reproductive health in this country,” said Monica Simpson, the executive director of?SisterSong, a Georgia-based reproductive justice organization.

Simpson said a Supreme Court decision restricting medication abortion access would create a scenario similar to the aftermath of the Alabama Supreme Court?ruling?that said frozen embryos are “unborn children.” That ruling brought fertility services in the state to a standstill until the governor signed legislation providing?criminal and civil immunity?to IVF providers and patients.

“Our opposition — these anti-abortion extremists — this is what they want. They want to intentionally create chaos around us,” she said.

Of the more than 1 million Americans who had abortions last year, 63% terminated their pregnancies using medication, according to new data analysis. The U.S. also saw the most abortions since 2012. (Anna Moneymaker/Getty Images)

Researchers found that 63% of all abortions provided in the U.S. last year were medication abortions.

There were an estimated 1,026,690 abortions — the most in over a decade — performed in the formal health care system in 2023, according to a report released Tuesday by the Guttmacher Institute, a reproductive health research organization.

The data provides a quantitative look at abortion care the first full year after the U.S. Supreme Court’s Dobbs v. Jackson Women’s Health Organization ruling in June 2022.

Medication abortions increased by 10% from 2020 to 2023. About 642,700 medication abortions were provided in the country last year, the data shows.

“Improved access to medication abortion is a positive development, but it is not a panacea,” said Rachel Jones, Guttmacher principal research scientist, in a news release. “As abortion restrictions proliferate post-Dobbs, medication abortion may be the most viable option — or the only option — for some people, even if they would have preferred in-person procedural care.”

The findings were published one week before the U.S. Supreme Court is set to hear arguments in a pivotal lawsuit that could severely limit access to medication abortion.

Alliance for Hippocratic Medicine, an anti-abortion rights group, and other doctors who oppose abortion are asking the court to restrict access to mifepristone, one of two drugs used to terminate pregnancies. The Biden administration is urging the justices to maintain the U.S. Food and Drug Administration’s current regulations on mifepristone.

“As our latest data emphasize, more than three out of five abortion patients in the United States use medication abortion,” said Amy Friedrich-Karnik, Guttmacher’s director of federal policy.

“Reinstating outdated and medically unnecessary restrictions on the provision of mifepristone would negatively impact people’s lives and decrease abortion access across the country,” Friedrich-Karnik said.

Most states without near-total bans saw upticks in abortions.

Despite the patchwork of abortion laws in the nation — 14 states, including Kentucky, have near-total bans, while Arizona, Florida, Georgia, Nebraska, the Carolinas and Utah restrict abortion after 18 weeks’ gestation or earlier — Americans terminated pregnancies at the highest number and rate seen in a decade, according to a policy analysis by Isaac Maddow-Zimet, a data scientist, and Candace Gibson, director of state policy at Guttmacher.

The rate was 15.7 abortions per 1,000 women of reproductive age last year. Over 160,000 people traveled out of state in 2023 to seek abortion care, the report stated.

According to Maddow-Zimet and Gibson, several factors likely contributed to the increase in abortions last year, including the rise of telehealth, financial support from abortion funds and shield laws in 22 states and Washington, D.C., that protect providers and patients from out-of-state investigations or prosecutions concerning reproductive health.

“This increase in abortions does not diminish the impact of Dobbs on people’s lives,”? Maddow-Zimet and Gibson wrote. “Instead, the data provide important evidence that people will continue to seek abortion care in spite of the policy barriers that anti-abortion policymakers impose.”

States that share borders with states that enacted bans post-Dobbs saw a 37% increase in abortions between 2020 and 2023. Illinois had the highest total surge with 38,010 more abortions than in 2020, a 72% increase over three years. New Mexico (15,090 more abortions, 257% increase) Virginia (14,190 more abortions, 76% increase) and North Carolina (12,970 more abortions, 41% increase) followed suit.

The Guttmacher Institute classified the following states as border states in the current abortion policy landscape: Colorado, Florida, Georgia, Iowa, Illinois, Kansas, Michigan, Minnesota, North Carolina, New Mexico, Ohio, South Carolina and Virginia.

Almost every state without a near-total ban saw increases in abortion. But Arizona, Georgia, Indiana and Wisconsin all saw declines. Arizona has a 15-week ban, Georgia has a six-week ban, while near-total bans were in effect in Indiana and Wisconsin at certain periods in 2023.

Several New Mexico towns are using an 1873 federal law to push back against a new state law to protect abortion access. (Getty Images)

When officials in a small New Mexico city sued the governor and attorney general over their ordinance placing restrictions on abortion clinics earlier this month, they argued that a late 19th century federal anti-obscenity law superseded state law. In March, Gov. Michelle Lujan Grisham signed into law a measure prohibiting public entities from interfering with reproductive and gender-affirming care access.

It was the latest legal challenge to abortion access to lean on the Comstock Act of 1873, federal statutes that ban the mailing of anything “obscene, lewd, lascivious” or considered morally impure, including abortifacients or abortion-related materials. The plaintiffs in the high-profile Alliance for Hippocratic Medicine v. U.S. Food and Drug Administration, challenging the U.S. Food and Drug Administration’s decades-old approval of the key abortion pill mifepristone, cited the act in legal arguments, asking the court to find the 150-year-old law makes it illegal to send abortion pills through the mail.?

But in December, the U.S. Department of Justice Office of Legal Counsel issued an opinion for the U.S. Postal Service stating that federal law does “not prohibit the mailing of certain drugs that can be used to perform abortions where the sender lacks the intent that the recipient of the drugs will use them unlawfully. Because there are manifold ways in which recipients in every state may lawfully use such drugs, including to produce an abortion, the mere mailing of such drugs to a particular jurisdiction is an insufficient basis for concluding that the sender intends them to be used unlawfully.’’

The campaign launched by abortion opponents to revive the Comstock Act is working: Recent court rulings in the abortion pill case suggest the dormant law can be applied today.??

U.S. District Judge Matthew Kacsmaryk referenced the act earlier this month in revoking FDA approval of mifepristone, a decision immediately appealed to the U.S. Fifth Circuit Court of Appeals. “Defendants rely heavily on the OLC (Office of Legal Counsel) Memo that purports to establish this ‘consensus.’ But none of the cases cited in the OLC Memo support the view that the Comstock Act bars the mailing of abortion drugs only when the sender has the specific intent that the drugs be used unlawfully,” Kacsmaryk wrote. He found that the FDA’s decision to allow abortion pills to be mailed violated the act.?

The conservative-leaning appellate court in Louisiana also appeared skeptical of the federal government’s argument that the Gilded Age law is irrelevant. “The plain text does not require that a user of the mails or common interstate carriage intend that an abortion actually occur. Rather, a user of those shipping channels violates the plain text merely by knowingly making use of the mail for a prohibited abortion item,” the Fifth Circuit wrote. (The U.S. Supreme Court issued a stay on lower courts’ rulings last week while the appeals process plays out in court, leaving the ability to access the pill in place.)

Legal and historical experts told States Newsroom the statutes — named after the moral purist Anthony Comstock — could be the next major legal argument used by the anti-abortion movement in the courts to restrict abortion and reproductive health care. “No court has really determined what is the enforceability and scope of the Comstock Act,” said Rachel Rebouché, Temple University Beasley School of Law dean.?

“We’re going to see this head right back to the Supreme Court,” Rebouché said.?

Who was Anthony Comstock?

Anthony Comstock was a Connecticut native affiliated with Congregationalists, a devout sect of Christianity descended from the Puritans, according to Amy Werbel, a cultural historian and professor at the Fashion Institute of Technology who wrote the 2018 book Lust on Trial: Censorship and the Rise of American Obscenity in the Age of Anthony Comstock.?

“They were true believers in the sense that if one wasn’t saved properly as they thought, they would burn in hell. And I think that’s really important to understand — that the root of all of these laws is even Christianity, the desire to save the souls of Americans through the lens of their own religious framework. And that also then will be motivated by this idea of Christian nationalism,” Werbel said.

Comstock spent his life spreading his view of moral superiority. Congregationalists believed that sex was a sin and people should only have intercourse for procreation, Werbel said. After serving in the Civil War — many Northern fundamentalists were abolitionists —? Comstock and others turned to other tactics to sanctify the nation. “An abortion also wasn’t seen as a sin because it was the death of a person. It was seen as taking away the punishment for sex” because procreation was the sole purpose of intercourse, Werbel explained.

His crusade eventually influenced Congress, who named the 1873 anti-obscenity laws after him, she said. President Ulysses S. Grant signed the act into law in March 1873. First-time violators faced up to five years in prison. The federal government soon hired Comstock to serve as a Post Office special agent.???

“After 1873, Comstock goes all over the country,” Werbel said. “He goes to state capitals. He’s always bringing suitcases of contraceptives, abortifacients, sex toys, pornographic photographs. And [he] spread them out for people to look at, then they pass the legislation, express their horror.”?

The act was weakened in the 20th century after a pivotal U.S. Supreme Court ruling, 1965’s Griswold v. Connecticut, which found the state law banning contraception was unconstitutional and violated the right to privacy, according to legal experts. Six years later, Congress removed restrictions on contraception and birth-control information from the act, wrote Joanna L. Grossman, a Southern Methodist University law professor, and Lawrence M. Friedman, a Stanford Law School professor.?

But a version of the law is still on the books — Congress never repealed it.?

Culturally, the newfound interest in the late-19th century anti-obscenity codes revives a stunted view of sexual morality, said Priscilla Smith, a Yale Law School professor and director of the Information Society Project’s study of reproductive justice program. “They’re rooted in archaic views of women’s sexual expression and their subservient role in the family. They really were designed to control women’s sexual activity.”?

“All of these things go together,” Werbel said. “The suppression of teaching about LGBTQ history, the suppression of access to abortifacients. All of these things go to this belief that is also woven into this particular Christian evangelical idea: God creates Adam, woman is born from man, and I’m just going flat out say it —? a white man has dominion over all else in the world, including women.”

New Mexico ordinance cases cite Comstock?

The New Mexico lawsuit, filed on April 17 in the Fifth Judicial District Court County of Lea, stems from the city of Eunice’s recently enacted ordinance requiring abortion clinics to comply with Comstock.?

The ordinance is part of the so-called Sanctuary Cities for the Unborn campaign, started by Texas anti-abortion activist Mark Lee Dickson, whose mission has been to ban abortion across the nation city by city. The initiative started in Texas and has spread to other states.?

The New Mexico Supreme Court recently suspended similar ordinances in Hobbs and Clovis, Source NM reported. And the town of Edgewood just passed a parallel ordinance, according to the Albuquerque Journal.

“The problem that the New Mexico attorney general has really isn’t with these ordinances; it’s with these laws that were passed by Congress in 1873,” Dickson told States Newsroom. “Even if the New Mexico Supreme Court were to rule against us, that would actually be a great opportunity to take this before the Supreme Court of the United States. And I do not believe the Supreme Court of the United States would hold the same opinion as the Office of Legal Counsel opinion that the Biden administration put forth.”

Attorneys for Eunice – two local lawyers and former Texas solicitor general Jonathan Mitchell, the architect of a bounty-style six-week abortion ban –? argued that city ordinances and the Comstock Act take precedence over state laws, according to the complaint. “Federal law imposes criminal liability on every person who ships or receives abortion pills or abortion-related paraphernalia through the mail, an express service, a common carrier, or an interactive computer service,” they said.?

They also claim distributing abortion pills is a violation under the Racketeer Influenced and Corrupt Organizations (RICO) Act. Therefore, abortion providers such as Planned Parenthood, employees, volunteers and donors face civil and criminal penalties, the suit said.?

“I think the argument is that RICO provides a civil cause of action against people who are violating civil law,” Rebouché said. “RICO is a hook to prosecuting people under civil litigation for their conspiracy to violate federal law. It’s just another way to try to breathe life into Comstock.”?

Last week, New Mexico Attorney General Torrez argued that the local government ordinances exceed their authority and are unconstitutional, according to a brief filed to the state Supreme Court.??

“Our brief demonstrates that the counties and cities violated the state constitution and state law when they passed their ordinances to restrict abortion care and undermine women’s reproductive rights,” Torrez said in a statement. “Further, our briefing provides analysis into House Bill 7 which reinforces our argument that local governments cannot regulate abortion clinics and reproductive healthcare.”?

Eunice officials want a judgment that the act is fully enforceable, after the Dobbs decision? overturned the federal right to abortion. They urged the court to ban abortion pills and abortion-related paraphernalia through the mail.

Arguments referencing Comstock target early abortions, according to Smith, the Yale professor. Medication abortion is approved by the FDA for up to 10 weeks of pregnancy. Besides abortion pills, devices called tenaculums and vacuum aspiration equipment are needed in surgical abortions. Even though 14 states ban most abortions, there are still exceptions in some states to save the life of the mother or terminate an ectopic pregnancy, for example.

“It’s ridiculous to say that abortion remains legal in many states around the country, and yet you can’t deliver equipment and medications used to perform abortions through mail carriers,” Smith said. “How else are you going to get the equipment there? That’s like saying it’s legal to take Viagra, but nobody can send it to pharmacies or doctors around the country.”?

Sofia Resnick contributed to this report.

VOA’s Freedom House, a program for pregnant and parenting women who have substance use disorders, wants to improve completion rates for Black women.(Getty Images)

Arkansas has the highest maternal mortality rate in the United States: 43.5 deaths from 2018 to 2021 for every 100,000 live births, according to the latest federal data. But the state only extends postpartum Medicaid to 60 days after childbirth.?

A bill by Arkansas Rep. Aaron Pilkington, R-Knoxville, aims to change that and would seek to continue Medicaid coverage postpartum for a full year. The House Public Health, Welfare and Labor Committee heard the measure Tuesday, but Pilkington told States Newsroom he is optimistic the bill will become law.

Extending health care benefits for low-income people with infants could reduce maternal mortality rates in the U.S., several reproductive health experts told States Newsroom. But researchers also said it’s too soon to determine if those extensions will lessen maternal deaths in a nation where 13 states ban abortions with few exceptions, and the laws are so vaguely written in some cases that medical professionals are wary of providing life-saving health care.?

What’s clear is that U.S. maternal mortality rates keep growing, an anomaly compared to other economically similar countries. In 2021, the nation’s rate was 32.9 deaths per 100,000 live births, up from 23.8 deaths per 100,000 live births in 2019, according to data released this month from the Centers for Disease Control and Prevention’s National Center for Health Statistics. In other words, 1,205 women died of maternal causes in the U.S. during the second year of the COVID-19 pandemic, up from 861 maternal deaths in 2020 and 754 maternal deaths in 2019. The CDC categorizes a death as maternal if it occurs during pregnancy, childbirth or up to 42 days postpartum.

The CDC data also illuminates racial disparities: The maternal mortality rate for Black women was 69.9 per 100,000 live births, 2.6 times the rate for non-Hispanic white women, which was? 26.6 in 2021. The maternal mortality rate for Hispanic women that year was 28.?

“These are sad and unfortunate, but not surprising,” said Dr. Maeve Wallace, a reproductive epidemiologist at Tulane University’s Mary Amelia Center for Women’s Health Equity Research in Louisiana.?

“From what we know about the coronavirus pandemic, we probably could’ve seen that maternal health would’ve been impacted negatively, both directly by the virus and indirectly by all of the social and economic disruptions that it caused, and especially how uneven the economic impact was across the population, really exacerbating what already was long-standing and entrenched racial inequities in maternal health,” Wallace said.?

Kentucky has implemented expansion while some states still weigh decision

Under the federal coronavirus pandemic emergency plan that President Joe Biden signed into law in March 2021, states were allowed to apply for 12-month postpartum Medicaid coverage. As of March 23, the Centers for Medicare and Medicaid Services has approved expansions for 30 states and Washington, D.C.?

Kentucky is one of the 30 states. The Beshear administration received approval in May 2022 to expand ?postpartum Medicaid coverage from 60 days to 12 months. The expansion allowed 10,000 new moms and their babies to remain covered by Medicaid or KCHIP (Kentucky Children’s Health Insurance Program), according to state Medicaid Commissioner Lisa Lee.

More than half of Kentucky’s children are covered by Medicaid or KCHIP; Medicaid covers half of all Kentucky births.

Maternal health is a challenge in Kentucky, one of just nine states plus Puerto Rico to receive an F on March of Dimes’ annual report card, which ?presents the state of maternal and infant health. One measure, Kentucky’s preterm birth rate, rose from 11% in 2020 to 12% in 2021. Half of Kentucky’s 120 counties are classified by March of Dimes as maternal-care deserts.

Kentucky is also one of the 13 states where abortion is banned. The Kentucky law makes an exception for the life of the mother.

Nine states are waiting on approval from the federal agency: Arizona, Delaware, Mississippi, New York, Rhode Island, South Dakota, Vermont, Utah and Wyoming.??

Mississippi is the latest state to expand Medicaid from the federally mandated 60 days to 12 months postpartum, according to Mississippi Today.? Republican Gov. Tate Reeves signed a bill into law this month after overcoming his own skepticism of the proposal. For years, the state Senate has supported postpartum Medicaid expansion, only for the initiative to stall in the state House, as Mississippi Today has chronicled.??

Of the 11 states that have yet to expand Medicaid coverage — Alaska, Arkansas, Idaho, Iowa, Missouri, Montana, Nebraska, Nevada, New Hampshire, Texas and Wisconsin — to a year for new mothers, eight have pending legislation that would extend coverage from 60 days to 12 months, according to a States Newsroom analysis.?

The Missouri Senate cleared postpartum Medicaid expansion earlier this month. In Montana, the House recently voted to extend postpartum Medicaid coverage from 60 days to a year as an amendment tucked in the state budget bill; the proposal is pending in the upper chamber. Three states that have relatively wide abortion access, Alaska, Nevada and New Hampshire, have also introduced related bills this year.?

In Texas, Democratic Rep. Toni Rose has sponsored a bill to extend postpartum coverage to a year, the Texas Tribune reports. The House Health Care Reform Select Committee heard the bill this month. In February, House Speaker Dade Phelan, a Republican, indicated support for the extension, along with repealing taxes on diapers and menstrual products. (The Texas House approved the latter proposal Tuesday.)??

As of mid-March, new mothers in Wisconsin would be eligible for Medicaid for three months postpartum upon federal approval; a 12-month expansion bill is pending in the Legislature. The states with near-total abortion bans typically have higher maternal mortality rates, but Wisconsin is an outlier: In 2021, its rate was 11.6 maternal deaths, one of the lowest rates in the country, according to CDC data. But the 2021 data predates the bans enacted after the U.S. Supreme Court overturned the constitutional right to an abortion last year.??

Expansion bills in Idaho, Iowa and Nebraska have either faltered or appear unlikely to pass.?

Why postpartum Medicaid matters post-Dobbs?

People in states with abortion bans are up to three times more likely to die during pregnancy, childbirth or postpartum, according to a Gender Equity Policy Institute report released in January.?

<div class=”flourish-embed flourish-chart” data-src=”visualisation/13189688″><script src=”https://public.flourish.studio/resources/embed.js“></script></div>

Postpartum Medicaid expansion for new mothers is a first step to maternal health equity, not a catch-all solution, said Maggie Clark, program director at the Georgetown University Center for Women and Families in Washington, D.C.?

“While promising, a longer coverage period does not itself lead to improved outcomes,” Clark wrote in a brief released last week. “States should take a closer look at the benefit and payment levers available in Medicaid to ensure that the longer coverage period translates to better access to needed care for mothers and infants in the postpartum year.”?

Maternal health care needs an overhaul, Clark said in an interview. Childbirth can lead to? myriad health conditions, including diabetes, hypertension, substance abuse and mental health issues: think depression, anxiety or psychosis, Clark said. Short-term Medicaid coverage can exacerbate health problems for new mothers, she said.?

“When someone loses their health coverage when they’re dealing with all of that, that means they lose access to prescriptions, they lose access to the doctor that’s supporting them through that time,” Clark said.?

Lawmakers in Congress have taken steps to address the maternal death crisis. North Carolina Rep. Alma Adams and Illinois Rep. Lauren Underwood, both Democrats, will reintroduce the Black Maternal Health Momnibus Act this session, according to Sam Spencer, a spokesperson for Adams.?

“Demographics should not determine your destiny, but it’s going to take addressing social determinants of health – from poverty to education to transportation and environmental factors – to save lives,” Adams said in a statement to States Newsroom. She added that the bill is nonpartisan.?

The collection of bills aim to overhaul the perinatal workforce, improve data collection related to maternal health and provide funding to reproductive health community-based organizations, among other proposals. In 2021, President Joe Biden signed a “momnibus” bill into law that gave $15 million to the U.S. Department of Veteran Affairs to support maternal health, The 19th reported.???

U.S. Sens. Tim Kaine, D-Va., and Lisa Murkowski, R-Alaska, reintroduced the Mothers and Newborns Success Act, a related bill that aims to increase data collection of maternal and infant health issues, last week.?

Reproductive health experts across the country, especially those in the South, a region with high maternal mortality rates and the most abortion bans, agreed that the full spectrum of maternal health care needs improvement.?

“Increasing the number of perinatal health care workers who can look like the people they’re serving is definitely a solution so that they can improve maternal health outcomes because they can improve culturally congruent care,” said Laneceya Russ, the Louisiana-based executive director of March for Moms, a national maternal health advocacy group.?

For Wallace, the Tulane epidemiologist, “it’s been disturbing to watch the closure of birthing centers and other maternity care opportunities in rural places across the country.” Repealing collaborative practice agreements between physicians and assisting health care providers, such as nurse practitioners, could help expand midwifery care and address staff shortages in maternity care, Wallace said.

Dr. Natalie Hernandez, executive director of the Morehouse School for Medicine’s Center for Maternal Health Equity in Georgia, recently examined the effects of COVID-19 on maternal health outcomes. Like Russ, she agreed diversifying the perinatal workforce, along with increasing doula care in communities of color – for example, some states are moving to create doula Medicaid reimbursement programs – could also help improve birth outcomes.?

“A lot of solutions have been focused on the clinical aspects, but we need to ensure we’re adjusting those nonclinical causes – the majority of what contributes to our health status is not just access to care, but it’s really the social determinants of health,” she said. “Then we’ll get better care.”?

Kelcie Moseley-Morris contributed reporting.?