The Trump admin's quiet (but deadly) attack on repro rights
They're doctoring science and changing policy to make pregnancy more dangerous.
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For the first few months of 2025, the Trump administration and Republicans in Congress were pretty thoroughly occupied with tearing the federal government down to the studs and selling the pieces for scrap. That’s really the only reason that the predictable spate of attacks on abortion didn’t start in earnest until a few weeks ago.
But now, with a majority in both houses of Congress, an extremely pliable right-wing majority on the Supreme Court, and a shattered administrative state, conservatives are targeting abortion at the national level. Guess we’ve given up on that whole “we don’t want to ban abortion, we just want to return it to the states” thing that anti-choicers pretended at for so long.
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First up, Sen. Josh Hawley. Hawley has always been forthright about his hardline anti-choice views. But somehow, as the 2024 election drew nearer, Hawley started saying he wouldn’t support a national ban. It was a laughably transparent attempt to align himself with Donald Trump’s laughably transparent attempt at pretending he was opposed to a nationwide ban.
Now, Hawley is savvy enough not to get out ahead of the White House on this, as right now, Trump doesn’t seem to have an appetite for muscling a ban through. Trump’s vagueness about abortion is deliberate. He is fully aware that the majority of people, even in red states, support abortion rights, support that has only increased since the Supreme Court overturned Roe. He’s equally aware, though, that he owes much of his political success to hardline anti-choice activists, many of whom are now unhappy he isn’t ending abortion nationwide.
But just because Trump senses that keeping mum on a national ban is best at the moment doesn’t mean he won’t let people like Hawley propose things that radically restrict access to abortion.
So, Hawley is going after mifepristone. In 2023, medication abortions made up 63 percent of all abortions in the country. Making mifepristone unavailable nationwide would radically decrease the availability of abortion. It would ensure, even in blue states, that abortions become much harder to obtain.
The problem for Hawley and his fellow anti-choicers is that mifepristone is extremely safe. From 2000, when mifepristone was first approved for medication abortions by the Food and Drug Administration, through 2022, there were 32 deaths from taking mifepristone for a medication abortion. Not 32 per year — 32 total in 22 years, during which there were 5.9 million medication abortions. During that same period, there were 4,218 adverse events of any kind, including 1,049 hospitalizations, 604 incidents of blood loss requiring a transfusion, and 418 infections, 75 of which were severe.
Again, that’s out of 5.9 million cases, meaning about .07 percent of all medication abortions resulted in an adverse medical event as defined by the FDA. But Hawley lucked out when Trump tapped the feckless Robert F. Kennedy Jr. to run the Department of Health and Human Services. Kennedy’s anti-science bent is easily exploited, so Hawley had a bogus medical study all teed up to dangle in front of Kennedy like a shiny object in front of a toddler to try to force the FDA to reconsider its approval of a safe drug with decades of research behind it.
This purported study found that a staggering one in 10 people experienced a serious adverse event. Jezebel has a thorough explanation of how what Hawley is pushing bears little resemblance to actual medical research. In brief, real scientific studies appear in real journals, not on the website for the Ethics and Public Policy Center (EPPC), a sort of all-purpose conservative grievance website. Real scientific studies name all authors and researchers, rather than vaguely mentioning an anonymous multidisciplinary team. Real scientific studies are peer-reviewed by other experts in the field. Real scientific studies have clear criteria to show who was included in the study and why.
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Hawley knows full well that this is not an actual study. It’s a polemic with political conclusions, not scientific ones. The same day it came out, Hawley sent a letter to Marty Makary, Trump’s pick to lead the FDA, breathlessly declaring that it is time to “revisit and restore the FDA’s longstanding safety measures” about mifepristone. And though this isn’t really the point, you can apparently only find Makary’s letter to Hawley announcing the FDA’s review on Hawley’s X account, rather than a more normal place like the FDA Newsroom on the official FDA website.
Unlike many Trump appointees, Makary actually has a lengthy background that qualifies him for the job. But unfortunately, he didn’t get the gig because he’s qualified. He got it because he’s a vaccine skeptic just like RFK Jr., happy to go on the Sunday shows and say things like “we don't want to see kids kicked out of school because a 12-year-old girl is not getting her fifth covid booster shot” and that he does not trust data from the Centers for Disease Control because “we know the CDC data is contaminated with a lot of false positives from incidental positive covid tests with routine testing of every kid that walks in the hospital.”
Makary is even more aware than Hawley that EPPC’s report is not an actual study because Makary has authored or coauthored over 300 legitimate scientific publications. That’s why his decision to review the safety of mifepristone based on a lone report on a conservative website where the “related publications” include such totally relevant scholastic bangers like “What, to a Conservative, is Academic Freedom?” and “To Restore all Things in Christ” is so ridiculous.
Cruel and unusual new policy
While Hawley is trying to get the FDA to ban the safest method for an abortion, the Centers for Medicare and Medicaid Services, now run by Dr. Oz because everything is terrible, just reversed Biden-era guidance about the Emergency Medical Treatment and Labor Act (EMTALA). That guidance required all hospitals to perform emergency abortions to stabilize a patient presenting with life-threatening concerns, even if located in a state that bans abortion.
CMS devoted exactly one paragraph to this reversal, providing no reason, medical or otherwise, for the change. The only explanation is that the previous guidance “[does] not reflect the policy of this Administration.” So, ensuring pregnant people don’t die or suffer catastrophic health consequences is not the policy of the Trump administration. Got it.
This non-explanation is much like Hawley’s fake study in that it doesn’t look like anything resembling actual guidance. The Biden administration’s EMTALA guidance was several pages long, called attention to specific provisions and definitions in the law, linked out to a lengthy operations manual, defined obligations for both hospitals and physicians, and described enforcement mechanisms. Put another way, it contained both a legal justification based on the EMTALA and related regulations and a medical justification based on, well, actual medicine.
It’s not just that the CMS announcement is comically brief and without support. It’s that it further muddies the waters as to what, exactly, doctors can do when faced with a patient who might die if they don’t get an abortion. It provides no details about how the administration would interpret or enforce EMLATA and no clarification about when, if ever, an abortion must be performed to save someone’s life. Dr. Oz’s brief statement, also apparently only available by going to his X account rather than the CMS website, is that the Biden administration created confusion, but the law hasn’t changed, and “women will receive care for miscarriage, ectopic pregnancy, and medical emergencies in all fifty states.”
Sure, except for the part where doctors in states with abortion bans aren’t providing care for those things. In Texas, ProPublica found a huge spike in sepsis rates after abortion was banned. With the threat of 99 years in prison for performing an abortion except in cases of “medical emergency” — a phrase left undefined in the law — doctors began refusing to perform procedures to empty the uterus when a patient was miscarrying, delaying until there was no fetal heartbeat. But the longer that goes on, the greater risk of fatal infection.
Multiple patients in multiple states with abortion bans have died preventable deaths after being refused an abortion when critically ill. Most of these occurred because the patient was miscarrying, and doctors delayed treatment too long. Two deaths occurred in patients with ectopic pregnancies where abortion care wasn’t timely provided.
So, Dr. Oz’s breezy assurances notwithstanding, people in states with bans are already not receiving care for miscarriages, ectopic pregnancies, or undefined “medical emergencies.” Simply declaring otherwise doesn’t change that, and it certainly doesn’t help hospitals determine when an abortion can legally be provided in an emergency setting in states with bans.
That lack of clarity is deliberate. It means doctors will continue to be uncertain as to whether performing an abortion could subject them to civil or criminal penalties. Hence, the safest course, legally, is never to perform one.
The problem is that being pregnant and giving birth is dangerous — much more so than a medication abortion. Just before Roe v. Wade was overturned, the rate of maternal mortality nationwide was 17.3 deaths per 100,000 live births and was catastrophically higher for Black pregnant people, at 41 deaths per 100,000 live births. In 2022, the first full year of Texas’s abortion ban, the state saw a 56 percent jump in the maternal mortality rate versus an 11 percent increase nationwide.
That lack of clarity also likely means that there will no longer be any meaningful federal inquiries about a failure to provide emergency abortion care. In an investigation begun during the Biden administration, CMS determined that a Texas hospital violated EMLATA by discharging a bleeding patient multiple times while she was suffering an ectopic pregnancy. The patient survived, but lost part of her reproductive system.
Even in the incredibly unlikely event that the Trump administration undertook such an investigation, its refusal to define the scope of EMLATA and clarify which conditions warrant emergency abortion care makes it difficult, if not impossible, to say that a hospital broke the law. The administration can’t point to any guidance that would have put a hospital on notice about what it was required to do under the law, as Dr. Oz’s post over at Elon’s Nazi Bar doesn’t really count.
Conservatives spent decades laying the groundwork for the Supreme Court to reverse Roe and return abortion to the states. Now that they’ve captured the presidency, the Congress, and the federal courts, they have no intention of stopping there.
That’s it for today
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It is just plain murder to refuse necessary care for an ectopic pregnancy. The embryo could never be viable.
And here we are once again- and the red states have free reign to put the lives of women at extreme risk while they push their lies and misinformation about a drug that has been proven to be safe and effective, the deliberate confusion regarding what is considered an emergency which allows a hospital to provide a life saving abortion. I am thankful for the fact that I live in Washington state where our governor is determined to protect the rights of women.