National

State abortion bans enacted in the months after the Supreme Court overturned Roe v. Wade led to life-threatening health complications for dozens of patients and forced providers to find workarounds, according to a new report.

Driving the news: Researchers at the University of California, San Francisco and University of Texas at Austin compiled 50 clinical anecdotes that took place between September 2022 and March 2023 in 14 states with bans, detailing "cases of care that deviated from the usual standard due to new laws restricting abortion." 

At least 19 states have enacted abortion bans or restrictions since last June's Dobbs decision. The Guttmacher Institute expects 24 states to ban or heavily restrict abortion access.

Lawmakers Nebraska, North Carolina and South Carolina will vote on abortion bans on Tuesday.

The big picture: While state abortion bans usually contain medical exceptions for life-threatening situations, health and legal experts have warned it may be difficult to establish what's permissible during an emergency and be able to consult with a lawyer in real time.

Anti-abortion groups have argued that abortion bans clearly state what exceptions are allowed and that the confusion is created by abortion rights activists' "misinformation."

State of play: Health providers shared anecdotes "anonymously and confidentially, at a time when they are being forbidden by their employers or hospital leadership from speaking with the press about these cases," the report authors wrote.

The patients were from Alabama, Arizona, Florida, Georgia, Idaho, Kentucky, Missouri, North Carolina, Ohio, South Carolina, Tennessee, Texas, West Virginia and Wisconsin.

The two research groups that did the report — UCSF’s Advancing New Standards in Reproductive Health and the Texas Policy Evaluation Project at the University of Texas at Austin — support abortion rights.

Details: In many cases, patients were sent home after their water broke in the second trimester and were told to return when labor started or when they experienced signs of infection. Patients who experienced severe infection had to be brought to the ICU.

Health providers spoke about several cases of ectopic pregnancies, which can be fatal, that required consultation with multiple providers about whether care could be provided under an abortion ban. In one case, the patient was referred out-of-state and had to get surgery to remove her fallopian tube.

In cases of fetal anomalies, several patients could not get an abortion because their lives were not threatened. Care was delayed weeks while they sought alternatives in states where abortion is legal.

Zoom in: In one case, a patient's water broke at around 16 to 18 weeks and the patient contracted sepsis. The fetus was delivered, but the physician had to perform a D&C, a common abortion method.

The patient bled "from everywhere" but survived, the doctor who attended her said. The patient then asked her if they'd both go to jail for the procedure: "[D]id this count as life threatening yet?"

One doctor mentioned a patient with an ectopic pregnancy who could not afford to travel and whose doctor was afraid of breaking the law, so the patient had to continue her pregnancy. 

At 17 to 19 weeks, doctors saw she was developing percreta — a condition where the placenta grows into surrounding organs and can lead to life-threatening bleeding and requires a hysterectomy.

It's unclear what happened to this patient.

A doctor recounted an instance in which a patient became pregnant from rape and tried to commit suicide the day before she was supposed to meet with doctors. She decided to not get an abortion the day after because she was "too emotionally unstable" and wanted to get treated for suicide ideation first.

"I fear for her life," the doctor wrote. "I fear she could kill herself" before the abortion.

The report does not say what happened to this patient.

What they're saying: "The report paints a stark picture of how the fall of Roe is impacting health care in states that restrict abortion," said Daniel Grossman, lead report author.

"Abortion bans that block providers from offering standard medical care have the greatest impact in states like Texas that have some of the poorest indicators of maternal health," said Kari White, lead investigator.

"Pregnant people should be able to rely on their health care provider to provide the best possible care, regardless of where they live," White added.

Go deeper: Listen to the Axios Today podcast, where host Niala Boodhoo talks about the report that says abortion bans leading to life-threatening complications.

Defining "life-threatening" can be tricky in abortion law exceptions

Texas abortion lawsuit puts medical exceptions under spotlight

Red state providers' new abortion dilemma

At least 19 states have enacted abortion bans or restrictions

Report: Abortion bans led to life-threatening health complications

Health providers recounted stories where their patients faced life-threatening health complications due to abortion bans.

Picture of an abortion rights protest with a person holding a sign that says "abortion saves lives"

A person holds a sign reading "Abortion Saves Lives" as abortion rights activists gather outside the a U.S. courthouse in Los Angeles, California on May 3, 2022. Photo: FREDERIC J. BROWN/AFP via Getty Images

Abortion

The U.S. faces a range of health care flashpoints — unaffordable drugs, opioids, vaping — as we debate whether to adopt universal care. For now, the Affordable Care Act is the law of the land, but Republicans want to issue it a final death blow.

Health

Nikki Haley, the former South Carolina governor who's running for the GOP presidential nomination in 2024, said Sunday it's "not realistic" for candidates to pledge a federal abortion ban.

Driving the news: CBS News' Margaret Brennan noted to Haley during their interview that Republican 2024 rival Sen. Tim Scott (R-S.C.) supports a 20-week federal abortion ban and would sign such a bill into law if elected.

"I'm not gonna lie to the American people. Nothing's gonna happen if we don't get 60 votes in the Senate," Haley replied during the interview on CBS' "Face the Nation." "We're not even close to that on the Republican or the Democrat side. Why try and divide people further?"

The Trump administration U.S. ambassador to the United Nations added that she thinks the media has tried to create division "by saying we have to decide certain weeks" for abortion bans. "In states, yes. At the federal level, it's not realistic. It's not being honest with the American people."

Zoom out: Republican National Committee Chair Ronna McDaniel has said GOP 2024 presidential election candidates must directly address the issue of abortion.

The issue emerged as a key matter at November's Midterm Elections following the conservative-dominated Supreme Court's overturning of Roe v. Wade last year.

Of note: During the CBS interview, Haley built on comments she made at the headquarters of SBA Pro-Life America, an influential anti-abortion group, about building a path to a "national consensus" on abortion.

Zoom in: "In order to do a national standard, you'd have to have a majority of the House, 60 Senate votes and a president. We haven’t had 60 pro-life senators in 100 years," Haley told Brennan.

"So the idea that a Republican president could ban all abortions is not being honest with the American people, any more than a Democrat president could ban these pro-life laws in the states," Haley added.

"So let's be honest with the American people and say: Let's find national consensus. Let’s agree on getting rid of late-term abortions."

What they're saying: "As he has previously stated, Senator Scott supports 15 weeks," a representative from Scott's campaign said in an emailed statement Monday in response to an invitation to comment on Haley's remarks.

Go deeper: Trump: "We'll get something done" on abortion

Editor's note: This story has been updated with a statement from Republican presidential candidate Sen. Tim Scott's campaign.

Trump: "We'll get something done" on abortion

Nikki Haley says it's not "honest" to pledge a federal abortion ban

"I'm not gonna lie to the American people," she told CBS News today.

Republican presidential candidate and former South Carolina governor Nikki Haley holds a rally in Greer, South Carolina, United States on May 4, 2023 

Republican presidential candidate and former South Carolina governor Nikki Haley holds a rally in Greer, S.C., on May 4. Photo: Peter Zay/Anadolu Agency via Getty Images

Nikki Haley

2024 Elections

President Biden has made the COVID-19 crisis and a post-Trump return to national unity and traditional democratic ideals his top priorities. From vaccinations to stimulus to schools, Biden is seeking bipartisan compromise while showing a willingness to use executive authority and bare Democratic majorities in the U.S. House and Senate to implement his policies. Republican leaders are navigating deep party divisions over if and how to move beyond former President Trump.

Politics & Policy

Abortion rights advocates are trying to force the Food and Drug Administration to expand access to medication abortion — even if that winds up undercutting the agency's rulemaking discretion. 

The big picture: The FDA's regulatory powers over drugs that terminate pregnancies are being challenged by both abortion rights and anti-abortion groups in a way that creates a "dangerous path" for the agency to make independent scientific decisions, legal experts say.

Catch up fast: A federal court ruling in Texas ordering the FDA to suspend its approval of the widely-used abortion pill mifepristone was temporarily blocked by the Supreme Court.

Meanwhile, a different federal judge in Washington state barred the FDA from curtailing access to the drug in 17 states and the District of Columbia.

Now, abortion clinics are asking a third federal court in Virginia to do away with FDA regulations that limit who can dispense mifepristone in Kansas, Montana and Virginia.

The clinics say that their states have become destinations for  abortions due to bans in surrounding states and should therefore be protected from potential court rulings that could cut access to the most common abortion method in the U.S.

What we're hearing: "I think we're on a dangerous path as a nation when partisans on both sides are using the courts to challenge FDA scientific determination," said Lawrence Gostin, a law professor at Georgetown University.

"One group is saying that ... 'the science tells us that there needs to be more restrictions.' You have another group suing to say, 'the science tells us that there needs to be less restrictions.' But shouldn't the final call [come from] career scientists at the FDA?," Gostin told Axios.

He added that "once we embark on endless lawsuits against the agency questioning its scientific validity, we're on a slippery slope, not just with abortion medications, but with other decisions the FDA makes."

Details: The Center for Reproductive Rights on Monday sued the FDA on behalf of abortion clinics in Kansas, Montana and Virginia to maintain and expand access to medication abortion in those states.

The lawsuit argues that the FDA must "follow the science" and get rid of mifepristone's "burdensome" dispensing restrictions limiting prescribing to those certified by the FDA to to expand access to a drug that has been deemed "safe and effective."

This challenge resembles an action Democratic attorneys general took in Washington state that resulted in a federal judge ruling the agency cannot roll back access to mifepristone in some jurisdictions.

The Center wants a federal district court in Virginia to make a similar ruling and issue a preliminary injunction barring the FDA from "deviating from the status quo" and keeping access to mifepristone intact while the legal challenge plays out.

What they're saying: The Center for Reproductive Rights asserts that undermining the FDA is "far from what we ... have sought," said Rabia Muqaddam, a senior staff attorney for the Center.

The issue "is not that the FDA has made a mistake in its scientific judgment, it has clearly made the correct judgments that [mifepristone] is safe and effective, it's that the regulation that is applicable for mifepristone has had an unintended perhaps, but unfortunate effect of stigmatizing mifepristone," Muqaddam told Axios.

Don’t forget: Since 2016, the FDA has loosened mifepristone’s dispensing restrictions, including making the pill accessible by mail and allowing pharmacies to become certified to provide them.

Between the lines: Judges are not scientists and "typically, what the [courts have] done over the last almost 50 years" is "defer decisions that have been made and keep them intact by those agencies unless there is a clear abuse of discretion," said Andrew Twinamatsiko, associate director of the O’Neill Institute at Georgetown Law School.

The question right now is "which of these parties is presenting a clear abuse of discretion" that would warrant a court to intervene with the FDA's regulatory authority, even as the judicial branch does not have the agency's scientific expertise, Twinamatsiko added.

What we're watching: The Center for Reproductive Rights' lawsuit comes ahead of an upcoming hearing in the U.S. 5th Circuit Court of Appeals next week that will focus on whether to uphold the Texas federal court ruling.

a different federal judge in Washington state

FDA's new abortion catch-22

Experts say that abortion rights and anti-abortion groups are challenging the FDA's regulatory authority.

Illustration of a gavel hitting the top of a prescription pill bottle

Republican National Committee Chair Ronna McDaniel said Sunday GOP 2024 presidential election candidates must directly address the issue of abortion.

Driving the news: Abortion emerged as a key issue at the Midterm Elections following the conservative-dominated Supreme Court's overturning of Roe v. Wade last year, as Democrats won key seats on abortion rights platforms and voters in three states approved protections for the procedure.

After the disappointing midterms results, Republicans who'd stayed largely silent on the issue despite talking points from major GOP committees recommending they speak out on it drew fierce criticism from anti-abortion groups.

What they're saying: "Abortion was a big issue in key states like Michigan and Pennsylvania," said McDaniel during her appearance on "Fox News Sunday."

"So the guidance we're going to give to our candidates is you have to address this head on," she added.

"The Democrats spent $360 million on this and many of our candidates across the board refused to talk about it, thinking, oh, we can just talk about the economy and ignore this big issue, and they can't."

McDaniel told anchor Shannon Bream Republican candidates should put Democrats "on the defensive and articulate where you stand."

Meanwhile, Republican presidential candidate Asa Hutchinson told CNN’s "State of the Union" on Sunday he would sign a federal abortion ban if elected, but he'd "advocate for the exceptions of the life of the mother" and in cases of rape or incest.

"I believe that’s where the American public is," the former Arkansas governor added. "I don't think anything will come out of Congress without those exceptions. And I certainly would sign a pro-life bill, but I would expect those exceptions to be in place."

Of note: Two bills severely restricting abortion in South Carolina and Nebraska's Republican-dominated legislatures both failed to pass last Thursday.

State Sen. Merv Riepe (R) of Nebraska, who was seeking an amendment to extend the proposed six-week abortion ban to 12 weeks, which also failed, warned colleagues "they should heed signs that abortion will galvanize women to vote them out of office," per AP.

Democrats squeeze vulnerable Republicans over abortion pill ruling

 2024 Republicans eye new abortion battle lines

Editor's note: This article has been updated with comment from Republican presidential candidate Asa Hutchinson and further context.

2024 Republicans eye new abortion battle lines

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RNC chair says GOP 2024 candidates must address abortion issue "head on"

"The Democrats spent $360 million on this and many of our candidates across the board refused to talk about it," she told Fox News.

RNC Chairwoman Ronna McDaniel speaks at the Ronald Reagan Presidential Foundation & Institute's 'A Time for Choosing Speaker Series' at the Ronald Reagan Presidential Library on April 20, 2023 in Simi Valley, California. 

Republican National Committee Chair Ronna McDaniel at an April event in Simi Valley, California. Photo: David McNew/Getty Images

Republican National Committee (RNC)

Two bills severely restricting abortion in South Carolina and Nebraska's Republican-dominated legislatures both failed to pass on Thursday.

Driving the news: A near-total abortion ban failed to pass in South Carolina's Senate by 22 votes to 21 — marking the third time such a measure hasn't passed in a GOP-led chamber since the Supreme Court overturned Roe v. Wade last year, AP notes.

A screenshot of a Planned Parenthood of South Carolina tweet stating: "NEWS: After a 2-day filibuster led by the 5 women in the SC State Senate, Senators FAILED to pass a bill that would have banned abortion in nearly all circumstances. The bill is effectively dead for the rest of the year. "

Photo: Planned Parenthood South Atlantic S.C./Twitter 

Meanwile, in the Nebraska Legislature, a bill proposing to ban abortions at six weeks of pregnancy fell one vote short of the required 33 votes to break a filibuster.

The results mean abortions remain legal in the two states until 22 weeks of pregnancy.

Zoom in: In South Carolina, the Republican-led state Senate's five women gave impassioned speeches as they filibustered the bill that had passed in the House.

State Sen. Penry Gustafson said she was "pro-life," but AP reports that she added there was "no room for empathy, reality or graciousness" in the bill.

Fellow Republican state Sen. Sandy Senn compared the measure to the dystopian book "The Handmaid's Tale" as she said abortion laws "have always been, each and every one of them, about control — plain and simple," according to the Washington Post. "And in the Senate, the males have all the control," she added.

Of note: Nebraska's anti-abortion bill failed to pass because of the abstention of state Sen. Merv Riepe, who co-signed the measure, due to concerns that women may not know they're pregnant at six weeks, per AP.

He introduced an amendment to ban abortions at 12 weeks, but this was rejected in the chamber due to concerns it had not been given enough debate time, according to the Omaha World-Herald.

Why it matters: The defeat of bills in the South Carolina and Nebraska legislatures underscores that "even in red states winning is still possible," Planned Parenthood Action Fund's Ianthe Metzger told the Washington Post. "We do know that banning abortion is unpopular," he added.

After his amendment was rejected, "Riepe took to the mic to warn his conservative colleagues that they should heed signs that abortion will galvanize women to vote them out of office," AP reports.

The big picture: The GOP faced backlash after several conservative states swiftly imposed restrictions following the Supreme Court's overturning of Roe v. Wade last year — notably in the Midterm Elections, when Democrats won key seats on abortion rights platforms and voters in three states approved protections for the procedure.

Kentucky voters in November rejected a proposed amendment that said a constitutional right to an abortion didn't exist in the state, months after an anti-abortion measure failed at the ballot box in fellow conservative state Kansas.

Go deeper: 2024 Republicans eye new abortion battle lines

Abortion bans fail to pass in 2 conservative states

Bills severely restricting abortion in South Carolina and Nebraska's GOP-dominated legislatures failed to pass.

South Carolina state Sen. Penry Gustafson, a Republican, becomes emotional while speaking during a debate on the abortion ban on Wednesday April 26, 2023, in the South Carolina State House.

South Carolina state Sen. Penry Gustafson, a Republican, becomes emotional while speaking during a debate on the proposed abortion ban in the South Carolina Legislature on Wednesday. Photo: Tracy Glantz/The State/Tribune News Service via Getty Images

North Dakota Gov. Doug Burgum (R) signed a bill Monday that bans abortion at six weeks of pregnancy.

The big picture: The bill that officials said takes effect immediately only allows for exceptions in cases of rape or incest up until six weeks' gestation is one of the strictest abortion bans in the U.S. 

At least 14 states have mostly banned abortion services since the Supreme Court overturned Roe v. Wade and ended all federal protections for abortion.

The measure that Burgum signed into law comes days after Florida Gov. Ron DeSantis (R) signed a six-week abortion ban bill.

Of note: The North Dakota Supreme Court ruled last month that a state abortion ban on abortions except in cases in which one is needed to prevent the pregnant person's death remain temporarily blocked while a lawsuit challenges its constitutionality.

What they're saying: "This bill clarifies and refines existing state law which was triggered into effect by the (U.S. Supreme Court) Dobbs decision and reaffirms North Dakota as a pro-life state," Burgum said in a statement, per the Bismarck Tribune.

The Red River Women's Clinic, which filed the North Dakota lawsuit and which was the last remaining abortion provider in the state before it moved to Minnesota, said in a statement: "We are watching and are disappointed that Governor Burgum Signed this egregious infringement on bodily autonomy."

North Dakota governor signs 6-week abortion ban

At least 14 states have mostly banned abortion services since the Supreme Court overturned Roe v. Wade.

North Dakota Gov. Doug Burgum. Photo: Stephen Yang/Getty Images

The high-stakes legal battle over a widely used abortion pill has left some blue states busily stockpiling the medication, in anticipation of a time when it could no longer be easily accessible.

The big picture: At least two states say they are creating reserves of mifepristone to continue enabling access to the two-pill regimen for medication abortion that's at the center of the legal battle. Two others are focusing on the other pill, whose availability isn't threatened, to offer an alternative. 

Medication abortion accounts for 54% of abortions in the U.S., and 98% of those used mifepristone, an abortion drug normally used alongside a second pill, misoprostol.

Misoprostol can be used on its own to terminate a pregnancy, but the method is slightly less effective. The combination regimen is considered the gold standard by health providers. 

Driving the news: Last week, the Supreme Court temporarily blocked lower court rulings that put restrictions on the use of mifepristone that the Food and Drug Administration had lifted over the years, including a ban on teleprescribing. 

Mifepristone is still available without those limitations until at least Wednesday while anti-abortion groups respond.

But courts have yet to settle anti-abortion groups challenge to the FDA's overall authorization, and the case could well wind up at the high court again.

What's happening: The states that have said are stockpiling abortion pills have laws protecting abortion access. 

In California, Gov. Gavin Newsom (D) said the state "secured an emergency stockpile" of up to 2 million doses of misoprostol.

Massachusetts Gov. Maura Healey (D) requested the University of Massachusetts purchase around 15,000 doses of mifepristone and has directed individual health providers to do so as well, which the state says will "ensure sufficient coverage ... for more than a year."

The state will financially support any provider by paying for the doses.

New York Gov. Kathy Hochul (D) stockpiled 150,000 doses of misoprostol, a projected five-year supply, "to meet anticipated needs."

In Washington state, Gov. Jay Inslee (D) purchased a three-year supply of mifepristone through the state's Department of Corrections, which has a pharmacy license.

Dispensing mifepristone in Washington at the moment is also protected by a separate federal ruling that prohibits the FDA from rolling back access to the drug.

State of play: The Supreme Court could reinstate the restrictions or even scrap the FDA's approval of the drug, which could cut off access in Massachusetts and Washington state. 

If the FDA's authorization is revoked, it's possible that providing mifepristone would violate the Food, Drug and Cosmetic Act "because that would cause the introduction of an unapproved drug into interstate commerce," said Delia Deschaine, an attorney at Epstein Becker Green specializing in FDA regulatory matters.

However, the Justice Department is responsible for enforcing federal law and has argued that mifepristone is safe and effective. That makes it unlikely that the federal government would enforce the law against providers or pharmacies that are prescribing or dispensing mifepristone, even if it's technically unapproved, Deschaine added. 

Yes, but: States would still be subject to the restrictions if they take effect after Wednesday, particularly the in-person prescribing and dispensing requirement.

There's also the possibility that some providers would hold off providing a drug whose legality is uncertain, fearing possible prosecution.

Zoom in: The availability of mifepristone also depends on which manufacturer provides the drug.

The 5th Circuit Court of Appeals last week ruled that FDA's 2000 approval of the brand name version from Danco Laboratories still stands, but revoked the 2019 approval of the generic version, produced by GenBioPro, which supplies two-thirds of the mifepristone used in the U.S.

It remains unclear where Massachusetts and Washington state acquired their stockpiled mifepristone.

What they're saying: Once the drugs are in the hands of the states, officials there in consultation with state boards of medicine and pharmacy have discretion to find ways to lawfully distribute and allow prescribing, said Susan Lee, an attorney at Goodwin who specializes in the FDA's regulation of drugs and biologics. 

Meanwhile, California and New York took a different route and stockpiled misoprostol, which is not targeted in the legal challenge.

"Misoprostol is not the central focus of the ongoing litigation and therefore it's less subject to potentially being enjoined," said Julia Spiegel, Newsom's deputy legal affairs secretary.

Aja Worthy-Davis, a spokesperson for the New York governor's office, said that state officials are "continuing to explore all options" as the situation around mifepristone evolves.

For some health providers "it might be safer for them to resort to [misoprostol] only," Lee told Axios.

Zoom out: The states stockpiling pills are part of the Reproductive Freedom Alliance, whose members respond to measures looking to curtail abortion access.

Newsom's office shared its misoprostol purchase agreement with the members of the coalition, so it's possible that other blue states could follow suit and stockpile abortion pills.

Go deeper: All eyes on SCOTUS for abortion pill ruling

which supplies two-thirds of the mifepristone used in the U.S.

All eyes on SCOTUS for abortion pill ruling

Blue states stockpile abortion pills amid legal uncertainty

Blue states are stockpiling abortion pills amid legal uncertainty around mifepristone.

Illustration of a pattern of pills on a blue background.

The fight over abortion pills has been escalating since before Roe v. Wade was overturned, but the pills' availability is in danger now more than ever.

Why it matters: With pills now accounting for the majority of abortions, opponents of the procedure are focusing on legislatures and courts to erect barriers. But that's triggering thorny legal questions, foremost of which is playing out in federal courts in Texas and Washington state over whether the FDA has the final say on whether the pills are safe.

Abortion pills have been available in the U.S. for decades, and while the FDA says that medical evidence shows they are safe and effective, the drugs have been subject of fights over manufacturing, distribution, insurance coverage and who can provide them.

Confusion around the drugs continues in the U.S., where nearly half of adults say they are not sure whether medication abortion is legal in the state they live in, according to a recent KFF survey.

Over half of abortions in the U.S. occur via abortion pills, according to the Guttmacher Institute, a research organization that supports abortion rights. 

Abortion pills are often accessed online and mailed to patients, effectively working to circumvent state bans and restrictions that took effect after the Supreme Court overturned Roe v. Wade.

Medication abortion normally consists of two pills: mifepristone and misoprostol.    

Mifepristone is approved by the FDA to be used alongside misoprostol to end a pregnancy during the first 10 weeks — this includes elective abortions and miscarriages. 

A patient first takes 200 milligrams of mifepristone orally to stop the pregnancy from growing. This is followed 1-2 days later by 800 milligrams of misoprostol taken buccally — placed between the gums and cheek — which causes cramping and bleeding to empty the uterus.

How abortion pills work and why they're in the spotlight

Demand for abortion pills has soared since the Supreme Court decided to overturn Roe v. Wade.

All Abortion stories