Reproductive rights activists organize around abortion ban anniversary
The Tennessee Freedom Circle, an activist group formed in the wake of the Supreme Court's landmark Dobbs decision, is organizing around the Aug. 25 anniversary by educating voters about the state's abortion ban and IVF policy.
Reproductive rights advocates are using the second anniversary of Tennessee's abortion law taking effect as a rallying cry.
The big picture: The Tennessee Freedom Circle, an activist group formed in the wake of the Supreme Court's landmark Dobbs decision, is organizing around the Aug. 25 anniversary by educating voters about the state's abortion ban and IVF policy.
The Freedom Circle released a 30-second digital ad and new strategic plan, which the organization says is "aimed at maximizing voter engagement and education throughout the 2024 election cycle."
Why it matters: The state's strict abortion ban has recast activism around the issue and created unexpected new policy debates, such as fertility treatments.
The legislature amended the state's abortion law last year to allow narrow exceptions for the life and health of the pregnant woman.
The other side: With the abortion ban in effect, the Tennessee Right to Life organization is focused on working "with legislators to ensure that adequate funding and resources are allocated to help babies and their mothers during pregnancy and into early childhood," the group's attorney and lobbyist Will Brewer tells Axios.
Brewer says Tennessee Right to Life supports Gov. Bill Lee's Strong Families program, which provides aid to needy mothers.
"The second anniversary of the Human Life Protection Act going into effect represents the continuing celebration that women and their children are being protected in Tennessee," Brewer says. "After 50 years of abortion-on-demand, we are proud to live in a state where our elected officials recognize the intrinsic value of every human life."
Zoom out: The aftermath of the Dobbs ruling pushed state laws concerning fertility treatments into the forefront. A court ruling in Alabama briefly banned some fertility treatments, and some religious groups have condemned IVF.
The Tennessee Freedom Circle pushed a bill this past session to clarify that IVF and other fertility treatments are protected under state law. The bill ultimately failed, but the group says it will continue pushing on that front.
The Tennessee attorney general issued a legal opinion this year that says the disposal of fertilized embryos from IVF treatments is not illegal under the state's abortion law.
Brewer says Tennessee Right to Life has no position or comment with regard to IVF treatments. "It is important to note that Tennessee law does not prohibit IVF treatments and there has been no legislation introduced to do so," he says.
Tennessee two years after 'near' abortion ban
This past Sunday marked two years since Tennessee banned abortions, except to prevent serous injury or death in the mother. After the U.S. Supreme Court overturned Roe v. Wade in 2022, states now decide their own abortion laws.
NASHVILLE, Tenn. (WZTV) — This past Sunday marked two years since Tennessee banned abortions, except to prevent serous injury or death in the mother. After the U.S. Supreme Court overturned Roe v. Wade in 2022, states now decide their own abortion laws. Tennessee moved quickly after the ruling. About two months later, state lawmakers passed some of the toughest abortion restrictions in the nation.
"Last year alone, over 10,000 women left state to receive maternal healthcare," said Emily Cupples, director of the Tennessee Freedom Circle, a pro-choice organization. The nonprofit's website said it's "dedicated to advancing reproductive freedom through a comprehensive approach that includes legal expertise, legislative advocacy, and public education." The Tennessee Freedom Circle released an advocacy video this weekend, aiming to share the impact of the decision, now 24 months later.
"Abortions are no longer legal in the state of Tennessee for the first time in 50 years," stated the video's opening narration.
Cupples said it's the first in a series of videos the organization plans to release this election cycle to educate voters on our state's current abortion laws, and their effect on Tennesseans.
Since Tennessee passed what's known as a trigger law or ban after Roe v. Wade was overturned, Cupples said abortion clinics across the state closed. Now, doctors are leaving as well, according to Cupples.
"We've seen a decline, a 5% decline in med school applications in the state of Tennessee because the laws are so restrictive," said Cupples. "People don't want to come here to be trained and practice because they're worried about legal and financial consequences."
But republicans have often remained in support of states controlling the abortion issue.
"I don't think there's a real shot at a national ban or a national approval of abortion," said conservative radio host Steve Gil.
"We now have abortion going onto the ballot in a number of states. We're going to see it increasingly where people will decide in their state, what they think the abortion restrictions should be. Should it be soon after someone gets pregnant? Should it be a moment before or a moment after birth?"
A 2022 Vanderbilt University poll showed 80% of Tennesseans supported abortion under some circumstances. The most widely accepted are rape, incest, fatal fetal issues or preventing serious injury or death to the mother.
Republican vice presidential candidaite JD Vance said former president Donald Trump would not support a federal ban on abortion, and would veto it, if elected. Trump has said states should make the decision.
Kentucky governor decries 'extremism' in exception-less abortion bans at Nashville event
Kentucky Democratic Gov. Andy Beshear decried "extremism" in state abortion bans during a Nashville event on reproductive rights on Friday, pointing to a lack of rape and incest exceptions in Kentucky and Tennessee law as Republicans have effectively banned nearly all abortions in both states.
Kentucky Democratic Gov. Andy Beshear decried "extremism" in state abortion bans during a Nashville event on reproductive rights on Friday, pointing to a lack of rape and incest exceptions in Kentucky and Tennessee law as Republicans have effectively banned nearly all abortions in both states.
"Extremism pushes everybody off. It's not the right way to govern," Beshear said. "It's not the right way to make policies, because our policies aren't about proving how pure you are to this party or that party. They're about human beings."
A 2023 Vanderbilt poll showed the vast majority of Tennesseans, including a majority of Republicans, support increased abortion exceptions for victims of rape and incest. Increasingly, Tennessee women of all stripes have identified as "pro-choice" in the wake of the abortion ban. Meanwhile, the Republican supermajority in the General Assembly has continually resisted efforts to add narrow exceptions to the state's abortion ban.
Hadley Duvall, a Kentucky woman who survived child sexual abuse and has emerged as an outspoken advocate for abortion rights, joined Beshear on Friday to speak to the Tennessee Freedom Circle, a reproductive rights group. Both said abuse survivors urgently need exceptions to the law.
Duvall first shared her story on social media in the wake of the Dobbs ruling overturning Roe v. Wade. Duvall, whose stepfather abused her for most of her childhood, became pregnant at the age of 12.
The pair on Friday acknowledged abortion can be a polarizing political issue, but Beshear encouraged Tennesseans to approach conversations about it on a personal level, as Duvall has done. Duvall said she doesn't describe herself as "pro-choice" or pro-abortion.
"I say all the time, I'm pro mind your own business," Duvall said.
Reproductive rights played a significant role in Beshear's reelection last fall, and the victory in a close race was a major win for Democrats in a state with a Republican legislative supermajority. Duvall fronted an affecting ad directly calling out Beshear's opponent for supporting the Kentucky abortion ban without a rape or incest exception, calling it "unthinkable" to require a 12-year-old to have her stepfather's baby.
Kentucky's abortion ban resembles Tennessee's in requiring women and children who become pregnant via sexual abuse to continue the pregnancy. Tennessee lawmakers last year added a very narrow exception to prevent the death or serious injury of the mother, as the initial version made it a crime for any abortion to be performed in the state.
Tennessee Republican lawmakers have continually blocked efforts to add rape/incest exceptions or exceptions in cases of extreme fetal abnormalities incompatible with life.
"I can't imagine having to hear the news that far too many people who want to be parents do: That your child is not going to make it," Beshear said. "You might have to hear the last gasps of their life the moment that they are born, and you don't have an option. That's wrong. It is just wrong. And again, the vast majority of Americans agree that it's wrong."
Beshear's Nashville stop came just days after the Iowa Democratic Party announced the Kentucky governor will be its keynote speaker at an annual fundraiser dinner next month. The announcement added fuel to ongoing speculation that Beshear is eyeing a 2028 presidential run, as Iowa has historically played an outsize role in presidential primary contests.
He launched a political action committee this year, which has raised more than $300,000 and endorsed candidates across the country, not just in Kentucky.
Beshear denounces ‘extremism’ in abortion policy at Tenn. reproductive health event
“Imagine somebody violated by a person in their family, somebody who is supposed to keep them safe,” Beshear said to a crowd at the Tennessee Justice Center in Nashville Friday evening.
Gov. Andy Beshear reiterated a call for Kentucky and Tennessee to add rape and fatal fetal anomaly exceptions to both state’s near-total abortion bans, saying “extremism pushes everybody off.” “Imagine somebody violated by a person in their family, somebody who is supposed to keep them safe,” Beshear said to a crowd at the Tennessee Justice Center in Nashville Friday evening.
There is no fault with the victim, he said, “there is only a crime committed, and our state legislatures are trying to say they shouldn’t have basic options.” The second-term Democratic governor, alongside abortion rights advocate Hadley Duvall, were the keynote speakers at fundraiser for the restoration of reproductive health care access in Tennessee hosted by the Tennessee Freedom Circle, a group formed after the fall of Roe v. Wade in 2022. Among the audience of roughly 100 donors and supporters were a handful of the Volunteer State’s Democratic lawmakers.
Read more at: https://www.kentucky.com/news/politics-government/article289474480.html#storylink=cpy
Scoop: Kentucky's Gov. Beshear to talk reproductive rights in Nashville
Kentucky Gov. Andy Beshear will visit Nashville next month to speak at an event advocating for reproductive rights in Tennessee. The Tennessee Freedom Circle, which formed after the U.S. Supreme Court's Dobbs ruling, will host the June 21 event.
Kentucky Gov. Andy Beshear will visit Nashville next month to speak at an event advocating for reproductive rights in Tennessee.
Beshear will be joined by Hadley Duvall, a rape survivor turned advocate whose story inspired "Hadley's Law," a legislative effort to reform Kentucky's near-total abortion ban.
Why it matters: Beshear's visit is at a time when reproductive rights groups are gaining momentum in organizing, but still losing legislative battles.
Beshear is seen as a rising star in the Democratic party who won re-election in a conservative state last year after campaigning on abortion access.
State of play: During its most recent session, the Republican-majority Tennessee legislature rejected a proposal to clarify that the state's strict abortion law doesn't ban fertility treatments.
Lawmakers passed a bill making it illegal for non-family members to drive a minor out of state for an abortion without parental consent.
Zoom in: The Tennessee Freedom Circle, which formed after the U.S. Supreme Court's Dobbs ruling, will host the June 21 event.
General admission tickets cost $100.
What she's saying: Tyler Chance Yarbro, co-founder of the Tennessee Freedom Circle, said in a statement she hopes the event with Beshear and Duvall will serve "as a beacon of hope, rallying individuals committed to advocating for compassionate and sensible policies that respect reproductive freedom and support survivors."
Zoom out: Beshear is the political rarity of a Democrat leading a conservative state with an abortion ban. Earlier this year, he backed legislation to add exceptions for rape, incest and nonviable pregnancies to Kentucky's ban. The bill failed to advance in the Kentucky legislature.
Tennessee bill to codify IVF protection fails
A plaintiff in the Center for Reproductive Rights’ case against Tennessee shares how she had to leave the state for an abortion to save her own life.
A bill to protect in vitro fertility treatments from Tennessee's strict abortion ban failed in a House subcommittee last week.
Why it matters: There's a push to protect IVF treatments in the law following a ruling by the Alabama Supreme Court, which found that frozen embryos should be considered children.
In response, Alabama already passed a law protecting the fertility treatments from its abortion ban. Lawmakers in other states are considering similar measures.
State of play: Reproductive rights advocates led by the Tennessee Freedom Circle sought to clarify that fertility treatments are protected under Tennessee law.
The proposed legislation also would have protected contraception approved by the federal Food and Drug Administration.
Zoom in: Gov. Bill Lee said he supports IVF treatments. A 2022 legal opinion by Tennessee Attorney General Jonathan Skrmetti concluded that fertility treatments are not banned under the abortion law.
Despite Lee's support and the AG opinion, advocates worry a legal gray area, similar to what happened in Alabama, could arise here. To avoid that, they said, explicit protections are needed.
Driving the news: In its meeting on Tuesday, the House population health subcommittee rejected the bill from Rep. Harold Love, D-Nashville. Republican lawmakers expressed doubt during the meeting that clarifying language is necessary.
"It is legal here in Tennessee," said Rep. Bryan Terry of Murfreesboro. "And there's not something that anybody's doing to not make that legal here in Tennessee."
The latest: In his State of the Union speech on Thursday, President Biden urged Congress to protect IVF treatments.
By the numbers: 1,025 infants were born in Tennessee in 2021 with the use of assisted reproductive technologies like IVF, according to the most recent CDC data.
That accounts for 1.3% of all births in Tennessee that year.
More than 2,055 embryo transfers were performed in Tennessee to get that number of infants.
What's next: Tyler Chance Yarbro, who chairs the Tennessee Freedom Circle advocacy group, tells Axios her organization will focus on "educating and engaging with lawmakers across the political spectrum."
New bill aims to protect IVF, fertility treatments in Tennessee
Tennessee lawmakers are set to consider legislation this week to clarify that the state's strict abortion law doesn't also ban fertility treatments, including the use of in vitro fertilization.
Why it matters: There's an urgent push for legal protections for fertility treatments after Alabama's Supreme Court ruled last month that frozen embryos can be considered children under its state law.
Tennessee lawmakers are set to consider legislation this week to clarify that the state's strict abortion law doesn't also ban fertility treatments, including the use of in vitro fertilization.
Why it matters: There's an urgent push for legal protections for fertility treatments after Alabama's Supreme Court ruled last month that frozen embryos can be considered children under its state law.
Between the lines: While the Alabama case worked its way through the courts, advocates in Tennessee saw the writing on the wall and began pursuing the clarifying legislation here.
In addition to fertility treatments, the legislation clarifies that Food and Drug Administration-approved contraceptive use does not fall under the abortion ban.
Tennessee's abortion ban is among the strictest in the nation. It only lists ectopic pregnancies and miscarriages as legally allowed exemptions.
The ban doesn't address IVF or other fertility treatments.
Behind the scenes: In the wake of the Dobbs ruling, a prominent group of attorneys formed the Tennessee Freedom Circle to "protect and advance reproductive freedom." The Tennessee Freedom Circle backs the clarifying legislation, which is sponsored by Democratic Rep. Harold Love Jr. and Sen. Raumesh Akbari.
There is some bipartisan support. Republican Rep. Ron Travis signed on as a co-sponsor.
What she's saying: Nashville attorney Tyler Chance Yarbro, co-founder and board chair of the Tennessee Freedom Circle, tells Axios that the legal uncertainty surrounding IVF is a "natural but unintended consequence" of the U.S. Supreme Court's Dobbs ruling in 2022.
Following the Alabama court ruling, some fertility clinics paused treatments for patients out of fear that continuing IVF treatments could provoke legal ramifications. Alabama subsequently passed a clarifying law that protects doctors and health care providers from criminal prosecution.
"Alabama law is different from Tennessee law, but since Dobbs, there are a lot of states that have put into effect abortion bans that lead to the logical conclusion that embryos — even frozen embryos — have as many rights as people who create the embryos," Yarbro says.
Flashback: In 2022, Tennessee Attorney General Jonathan Skrmetti wrote a legal opinion that concluded the state's abortion ban does not apply to unused IVF embryos.
Last month, Gov. Bill Lee said he supported IVF.
What's next: The legislation is on the agenda for the House population health subcommittee Tuesday at 3pm.
Their States Banned Abortion. Doctors Now Say They Can’t Give Women Potentially Lifesaving Care.
In Tennessee and other states that banned abortion, doctors are left to debate high-risk pregnancy cases with their colleagues. ProPublica takes an exclusive look inside those discussions.
Sitting at her computer one day in late December, Dr. Sarah Osmundson mustered her best argument to approve an abortion for a suffering patient.
The woman was 14 weeks pregnant when she learned her fetus was developing without a skull. This increased the likelihood of a severe buildup of amniotic fluid, which could cause her uterus to rupture and possibly kill her. Osmundson, a maternal-fetal medicine specialist at Vanderbilt University Medical Center who helps patients navigate high-risk pregnancies, knew that outcome was uncommon, but she had seen it happen.
She drafted an email to her colleagues on the Nashville hospital’s abortion committee, arguing that the risk was significant enough to meet the slim exception to Tennessee’s strict abortion ban, which allows termination only when “necessary to prevent the death of the pregnant woman or to prevent serious risk of substantial and irreversible impairment of a major bodily function.” She pleaded with her fellow doctors to spare this woman the gamble when her baby wasn’t even viable.
Then came the replies.
One doctor wasn’t “brave enough.”
Another urged her to consider the optics — approving an abortion in this case could be seen as “cavalier” and trying to circumvent the law. “I’m saying this because I care about you and your personal liberties,” the doctor said.
To Osmundson, the responses reflected just how much abortion bans had warped doctors’ decision-making and forced them to violate the ethics of their profession, which require acting in the best interests of their patients.
Most medical exceptions in abortion bans only allow the procedure to “save the life of the mother.” But there is a wide spectrum of health risks patients can face during pregnancy, and even those that are potentially fatal could fall outside of the exceptions, depending on how the law is interpreted and enforced. Without clarification from legislators and prosecutors on how to handle the real-life nuances that have emerged in hospitals across America, doctors in abortion ban states say they are unable to provide care to high-risk pregnant patients that meets medical standards.
Under threat of prison time and professional ruin, they are finding their personal interests pitted against their patients’ and are overriding their expert training for factors that have nothing to do with medicine, like political perceptions and laws they aren’t qualified to interpret. As a result, some patients are forced to endure significant risks or must travel out of state if they want to end a pregnancy. Sometimes, their doctors aren’t even giving them adequate information about the dangers they face.
Osmundson and 30 other doctors across nine states in which abortion is banned or restricted described to ProPublica the impossible landscape they must navigate in the nearly two years since the Supreme Court struck down Roe v. Wade.
It is one in which fetuses — some with no chance of survival — are being prioritized over their at-risk mothers and oncologists are hesitating to give chemotherapy to cancer patients for fear of legal consequences if it disrupts the pregnancies.
Doctors described the position they’ve been put in — denying abortions to high-risk patients who are begging for them — as “distressing,” “untenable” and “insane.” Speaking out about the broken system felt like the only way to not be complicit, Osmundson said. “It’s going to take physicians coming together and saying: ‘We’re not going to participate in this. We’re going to do what we think is right for patients.’”
Osmundson, who has worked at Vanderbilt for the past eight years, decided to share with ProPublica the inner workings of the hospital’s abortion committee to give the public a rare glimpse into the tortured decisions she and her colleagues are being forced to make. It shows how maternal health care could be dramatically altered across America if Republicans gain control of Congress this fall and succeed in passing the nationwide ban that influential anti-abortion activists have long sought.
In a series of interviews, Osmundson detailed the deliberations in a wide variety of cases and described conversations and emails among doctors. She did not disclose the identities of patients or their individual files. ProPublica was able to confirm details with one patient and three colleagues familiar with the committee, some of whom were not willing to speak publicly for fear of professional repercussions. Vanderbilt declined to comment.
What she shared shows how the strictly written bans fail to account for a broad range of dangerous maternal health risks, leaving doctors to deny abortion requests for medical reasons like warning signs of preeclampsia, a potentially fatal blood pressure condition; complications related to Type 1 diabetes, which can cause vision loss, kidney disease and death; and conditions requiring patients to have their uteruses “cracked open” in order to give birth.
She’s come to believe it’s time to take abortion decisions out of doctors’ hands and shift the final say to hospital lawyers and administrators. In her view, that’s the only way to protect the independent judgment of the medical experts, who could make strong arguments in their patients’ interests using research and data.
“I understand pragmatism,” Osmundson told ProPublica. “I also don’t want to have a patient die and be responsible for it.”
She also thinks hospitals should require doctors to obtain informed consent from patients facing dangerous pregnancy complications, so that providers can’t make decisions on their behalf without counseling them about their risk and getting their response. “In this climate, we’ve really diminished women’s autonomy,” she said. “If a patient says, ‘I don’t want to take on that risk,’ we need to honor that.”
A few months ago, she was on call caring for a patient who had developed severe high blood pressure near 24 weeks, a warning sign for preeclampsia, which can rapidly deteriorate and lead to organ damage or death. With her pregnancy at the edge of viability, the patient requested to have a cesarean section, Osmundson said, even though there was a significant chance the baby might not survive.
Osmundson said she scheduled the surgery. This was not considered an abortion, because the intent was still to deliver a live baby. But after her shift ended, Osmundson recalled, a colleague overrode her and kept the patient pregnant.
Osmundson and her colleagues launched the committee in fall 2022 to address a crisis they were seeing unfold in abortion ban states across the country and at Vanderbilt: Patients facing severe and urgent pregnancy complications were being denied care by hospitals where doctors were terrified about the new legal personal and professional risks.
With strength in numbers, the committee members would back one another up and aim to serve the most patients possible while staying within the law.
Since then, the committee has helped Vanderbilt doctors respond to the most severe emergencies. Abortion requests can hit the committee’s inbox at any hour — at least two a month, but sometimes four in a week. When complications are urgently life-threatening — cardiac failure, Stage 3 kidney disease — doctors often coordinate through a few text messages and sign off that an abortion is medically indicated.
The committee has also developed critical protocols. If a patient’s water breaks before a fetus is viable, the administration considers it a medical emergency because the patient has a high chance of developing sepsis, which can lead to death. In those cases, it’s a blanket policy that doctors can offer abortion care, Osmundson said.
Other cases fall outside of the committee’s power. Osmundson said she has seen some doctors avoid the issue entirely, never informing their patients about the option to terminate their risky pregnancies; those cases never make it to the committee’s attention. The law also makes no exception for sexual assault or fetal anomaly cases, even when the pregnancy is not viable. Doctors direct these and other patients who want abortions to leave the state, if they can. In 2023, Osmundson counted 27 cases of nonviable pregnancies that were referred out of state.
It is those cases in the middle — potentially perilous, but not urgently deadly — that can feel like bombs hitting their inboxes, blasting shrapnel into the rest of their days as they turn over the particulars and try to come to a consensus.
The six doctors, five of whom are women, sometimes call one another up to hash it out. Other times, the discussion unfolds over email and can involve specialists from other departments. They respect one another and know they share the same goals, but the conversations can be heated and emotionally draining.
Last October, a challenging case came before the abortion committee, showcasing the murky limits of Tennessee’s exception.
The patient was seven weeks pregnant and stable, but with a medical history that would make delivery very high risk. Surgeons would need to make a vertical incision on her abdomen — a procedure Osmundson described as “fileting” the uterus — that could lead to permanent bladder or bowel damage due to the patient’s existing complications.
When Osmundson read the file, her mind ticked through worst-case scenarios if things didn’t go well: The patient might need to use an ostomy bag attached to her abdomen to dispel waste. She could suffer severe blood loss or develop sepsis. She could die. The patient already had children and, in a letter to her doctors, requested an abortion.
The challenge for the doctors: The patient had no immediate complications; the potential emergency would not occur until the baby was at full term and doctors were performing surgery. Was it enough to predict that a patient might suffer “substantial and irreversible impairment” or death, based on past case studies? Or did the emergency need to have actually begun?
The law doesn’t say. Nor does it give guidance on how doctors should interpret the spectrum of risk. Was a 50% chance of death or “substantial and irreversible impairment” enough to meet the standard of the law? Twenty percent? Ten? The law says only that an abortion must be “necessary” in a doctor’s “reasonable” medical judgment.
Committee members could see how a zealous prosecutor might challenge that judgment. Doctors like Osmundson often help manage risk for patients who choose to go forward with dangerous pregnancies; some make it through with few long-term issues. It wasn’t hard to imagine a scenario in which a prosecutor held up cases of women who had survived similar complications and pointed to one patient’s abortion as a crime. The penalties for violating the ban include up to 10 years in prison and a $15,000 fine. Doctors can also lose their medical licenses if they are criminally charged. Many have expressed that they would not trust jurors without medical training to evaluate their cases and decide their fate.
In that October case, one doctor argued that the patient’s condition did not fit the definition of a medical emergency because continuing the pregnancy itself would not cause direct harm to an organ — all of the risk would emerge at the time of delivery.
“Who are we to say what is too much or not enough risk?” another wrote. “Where is the line and why do we have to decide that?” But the doctor pointed out that if they offered the abortion, “nurses and other staff will be upset.”
A third wrote: “I unfortunately don't think this meets the criteria for the law and my interpretation even though it is the ethical right thing to do.”
A fourth: “If one of our purposes is to protect the physicians involved in the care of these patients, I think this case is too risky.”
Osmundson bit her lips as she read the responses. After work, as she cooked dinner for her family and played with her kids, she couldn’t stop thinking about the patient. It was one thing to choose to continue a high-risk pregnancy — another to be forced to. As a doctor who spent her career working with the most difficult cases, she knew better than anyone that even healthy pregnancies could suddenly turn life-threatening.
“I just watched a woman die from liver failure this weekend after a normal uncomplicated pregnancy,” Osmundson told them. “I’m finding it morally repugnant to force anyone to continue a pregnancy for a potential life when the pregnancy poses a real threat to her life.”
If the patient the committee was considering died, Osmundson felt they would all have blood on their hands.
“I cannot deny abortion care to a patient concerned about their medical safety,” she wrote.
The group punted the decision until the university’s ethics committee could weigh in.
The patient was left waiting on a faceless abortion committee to deliver its verdict as the clock ticked.
Soon after, Osmundson learned, the woman was no longer pregnant. Perhaps it was a miscarriage. Or perhaps, Osmundson thought, she had gotten fed up and taken measures into her own hands.
It saved the committee from making a difficult decision. This time.
The predicament is far worse at many other hospitals.
Plenty of doctors ProPublica interviewed don’t work at a well-resourced institution or have an administration that has promised criminal defense if they are prosecuted. And some hospitals rely on state funding, leaving them subject to the demands of lawmakers who could request their emails and protocols, which are public record. Many doctors requested anonymity to speak about sensitive internal matters, fearful they could land on the radar of state officials looking to target abortion providers.
There were wide variations in how their hospitals have navigated the post-Roe reality. Some had abortion committees, but many relied on informal networks among colleagues to make decisions. A few had developed protocols like Vanderbilt’s, but others still require signs of infection or bleeding in order to act, even in cases when a patient’s water breaks before viability. “We are trying to push the idea that the harm does not have to be immediate,” said Dr. Nisha Verma, an OB-GYN and abortion provider in Georgia. “But institutions want to protect themselves.”
Doctors recounted nurses saying they weren’t allowed to treat patients who needed urgent abortions to survive. One was bleeding out. Another was septic. “That’s part of our risk,” one doctor said. “You don’t know who you are working with, who will decide you need to run this by the district attorney.”
Doctors felt similar hesitation from their specialist colleagues, some of whom have balked at having to sign off on any abortion-related paperwork. One OB-GYN described trying to get a cardiologist to evaluate a pregnant patient with heart failure. “We got a ‘Look, we know what you guys are doing and we don’t agree with abortion, so we aren’t going to say she can have an abortion,’” the doctor said.
In other cases, specialists have been afraid to treat patients for fear of accidentally causing harm to a fetus. One OB-GYN said an oncologist at their hospital was reluctant to provide cancer treatment for a patient who wanted to continue their pregnancy, in case chemotherapy were to be misconstrued as an abortion.
Some doctors feel that instead of offering backup, their hospitals have siloed all responsibility to a few providers who would take the fall if an abortion case were challenged. “Care was dependent on each case and who saw the patient and what their risk tolerance was and their views about abortion,” said Dr. Jessica Tarleton, an OB-GYN and abortion provider in South Carolina who left her institution due to its handling of the ban. “It was like chaos all the time.”
Doctors have no clarity on whether they could face repercussions for offering abortions for life-threatening health risks that aren’t active emergencies.
Lawmakers and prosecutors don’t want to offer it.
In Tennessee, legislators sided with an anti-abortion group last year to defeat an effort to include clear exceptions for fatal fetal anomalies and broader health risks. A lobbyist for the group opposed language that would allow doctors to provide abortions to “prevent” emergencies because, he said, “that would mean that the emergency hasn’t even occurred yet.” And Attorney General Jonathan Skrmetti is fighting a legal effort aimed at getting a judge to clarify the ban’s exception; he argues that the state can’t be held liable for doctors “overcomplying” for fear of violating the law. The case is ongoing.
Anti-abortion groups that support the bans have advocated for the narrowest possible interpretation of exceptions. “We would want a stricter standard,” Blaine Conzatti, the president of Idaho Family Policy Center, told ProPublica in November. “The only appropriate reason for abortion would be treating the mother and the unintended consequence is the death of the preborn child.”
Meanwhile, officials have doubled down on their warnings about the consequences if doctors go too far.
Texas Attorney General Ken Paxton fought back against the Biden administration’s federal guidance to offer abortion care for patients with medical complications and threatened doctors with prosecution if they complied with a court’s order to offer emergency abortion care. And in Indiana, the Attorney General Todd Rokita investigated a doctor for sharing with the media that a 10-year-old rape victim had to go out of state to get an abortion.
“There aren’t many people who want to risk or just rely on the goodwill of the legislature and the attorney general or any politician in our state,” one doctor said. Penalties vary by state — in Texas a doctor could face 99 years behind bars.
No doctor has been prosecuted under their state’s abortion ban. But the few public glimpses into judges’ thinking hasn’t provided reassurance. Recently, a Texas court denied a doctor’s request to serve a woman who wanted an abortion because her fetus had a fatal anomaly. The doctor argued the woman shouldn’t be subject to the risks of carrying to term a baby that would not survive. The court said the doctor hadn’t proved her life was in danger.
Will a judge decide the same if a doctor is charged with a felony? Would a jury, or an appellate court, or ultimately the Supreme Court? “The bottom line,” said Dr. Emily Patel, a maternal-fetal medicine specialist in Nebraska, “we don’t know what [the exception] means and won’t know until it’s tested in a court of law.”
No doctor wants to be the first to stand trial. “I don’t know how you can overinterpret the law when you are looking at jail time,” said Dr. Dawn Bingham, an OB-GYN in South Carolina. “A prudent person would hear that and go, ‘Well I guess I will interpret that to be as safe as possible.’”
A year ago, Osmundson said, she could never have imagined arguing to strip her committee of its decision-making power and turning it into an advisory board. But now she believes it’s the only way to shield doctors from the ethical conflict of denying patients evidence-based care. “I feel like these committees are kind of making physicians become complicit in an unethical and unjust system,” she said.
Dr. Mack Goldberg, her committee colleague, knows the position perhaps better than anyone else. Unlike most of his colleagues, including Osmundson, he actually performs abortions; since clinics shuttered in the wake of the ban, he’s one of the only people in the state with the expertise and institutional support to do so for medical complications.
He knows the hospital submits paperwork to the state after each one. And while he recognizes that his colleagues are putting their names on the decisions, he feels more exposed. He often can’t shake the feeling of being constantly on call, his livelihood perpetually on the line, a burning question in the back of his mind: “When push comes to shove, if I ever got trudged through a court case, how many people will truly have my back?”
Despite all of the anguish it causes him to turn away some patients, Goldberg disagrees with Osmundson. He believes it’s important for doctors to continue walking the tightrope: Do as much as possible with the support of colleagues and their institution, while being honest with patients about their risks and options. He feels the committee has made it possible for him to save some lives by acting quickly, and he doesn’t want to leave the call to hospital administrators and lawyers, who may be even more risk averse.
”We are on the front lines,” he said. “At the end of the day, the patients are staring right in our faces.”
Late last year, he sighed heavily as he counseled the woman whose baby was developing without a skull and gently told her what he tells all of his patients in her position: that he had the training to help her, but because of Tennessee’s laws, he might face prosecution and jail time if he did. He had a baby at home and couldn’t take that risk, he explained. Instead he would refer her to options outside the state.
The patient, Charlotte Miller, told ProPublica she understood and appreciated his thorough counseling. But she was stricken to realize it would have been different had they been in her home state of Colorado.
When the 22-year-old sat across from Goldberg in his office, all she knew was that she didn’t want to spend the next six months putting her body through the hardships of pregnancy to give birth to a baby that would never survive.
Her first pregnancy had been challenging. She struggled with worsened asthma and endometriosis, a painful condition in which tissue grows outside of the uterus. The toll on her mental health alone would be enormous, she believed, and she didn’t want to risk any unexpected complications that could make getting pregnant again more difficult. She desperately desired another child, but in this case, the best option, she was certain, would be to deliver her baby as soon as possible — to have the chance to hold him and say goodbye.
Instead, her family would have to scrape together more than $1,200, a week of her partner’s paycheck as a waiter, so she could travel to a clinic in Illinois. There, her only choice would be a dilation and evacuation procedure while unconscious, not a delivery in which her baby could emerge intact and she could hold him in his last moments. Before it came to that, she lost the pregnancy naturally.
She’d been unaware of the committee’s debate about her health risks. When she learned of it, it only affirmed what she’d come to believe: “It’s just so disheartening to me that doctors can want to provide me care and not be able to because of what a law says, for fear that they would have repercussions.”
Tennessee's abortion law threatened my life. I'm suing on behalf of my deceased daughter.
A plaintiff in the Center for Reproductive Rights’ case against Tennessee shares how she had to leave the state for an abortion to save her own life.
Tennessee’s politicians are passing cruel laws against something they know nothing about − medically essential abortions.
I needed one, and it was traumatizing for me and my family that I had to leave Tennessee to get it. Tennesseans must be able to get the care they need at home.
A lifelong Tennessean, I became a single mom at age 22, working three jobs to support my daughter while earning my degree.
Adalie is 6 now and like me, she’s very social and a little stubborn. About the time she turned 3, I reconnected with a former high school boyfriend and we got married last year.
Bryan is such a great stepfather and we both wanted to grow our family. We were ecstatic to learn we were pregnant last November. Each night, at bedtime, Adalie would lie next to me and sing "Twinkle Twinkle Little Star" while rubbing my belly.
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I could not legally get an abortion in Tennessee
Early on, we learned we were having a girl. We named her Miley Rose, after the song “Flowers” by Miley Cyrus.
At 19 weeks, I brought Adalie along with me to share in what I thought would be a routine anatomy scan. But after the scan, I saw a high-risk maternal fetal medicine specialist who explained that Miley’s kidneys, bladder and stomach had not formed as expected and were not functioning.
Two of the four chambers of her heart were also not working. She had little-to-no amniotic fluid. She had stopped growing. There were no signs of lung development. She also had a rare brain condition. We were told she had no chance at life.
It was definitive.
The doctor suggested there were two options– either terminating the pregnancy, or continuing, knowing she would not survive.
Because of Tennessee’s cruel ban on abortion, an essential medical procedure, I could not legally get an abortion in my home state. I would have to travel out of state, and my doctor told me that Tennessee law prevented her from offering me any resources in that effort.
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Our daughter died, but the risk to me was still great
Although there was no way of knowing how much longer Miley Rose would survive inside my womb, the longer she was there, the more risk there was to my health and safety. I made the decision to have an abortion.
Instead of being able to grieve for her and the future we dreamed of, I had to scramble and start calling clinics in the states that allowed second trimester abortions, book flights, find hotels and arrange transportation. And figure out how to pay for it all.
Thankfully, I found a clinic in New York City that could get me in the following week. After I arrived at the clinic, I learned that Miley Rose’s heart was no longer beating.
Completely broken, I had to call Bryan and tell him over the phone that our daughter was gone. But the risk to me was not over. The doctor told me that my body hadn’t recognized that she had died, and that there was about a 2-week window before I would become severely at risk of blood clots and infections, including sepsis.
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I can honor my daughter Miley Rose through my testimony
Within an hour, I went into surgery alone. I sat in recovery alone. I grieved the loss of my daughter alone, in a city I’d never been to, around doctors I’d never met before, far from my family. I am so grateful for the caring professionals who treated me with such dignity, but I should never have had to leave home for humane health care–abortion care.
I realized that sharing my experience publicly could be a powerful way to honor Miley Rose.
That is why I’m joining the Center for Reproductive Rights’ case against Tennessee; it’s why I documented my heartbreaking experience on TikTok. It’s why I’m going to keep fighting these dangerous laws. The autonomy to make personal medical decisions about our lives and futures and health care must be returned to patients like me and our doctors.
Allyson "Allie" Phillips, a Tennessee mother and plaintiff in the case filed Sept. 11 against the State of Tennessee on behalf of three women who were denied abortions in dire situations.