Maternal mortality, or death from pregnancy-related issues, nearly doubled in the U.S. between 2018 and 2021 - and a person who is Black is three times more likely to die from these issues than one who is white. Nebraska ranked 17th
for maternal mortality, with a higher rate than the national average during those years.

Ashlei Spivey, executive director of the organization "I Be Black Girl," which works in Nebraska for reproductive justice, said data show some practitioners take Black patients' complaints of pain less seriously, with some erroneously believing Black people have a higher pain tolerance.

"How can we make sure medical practitioners - no matter if they're the OB or the phlebotomists - are getting cultural awareness training, that they're being in tune to the experiences of all the different types of patients that they're seeing, especially their Black patients,?" she said.

Awareness-raising events during this Black Maternal Health Month will culminate with a Reproductive Justice Summit on October 27th. Spivey said the speakers and breakout sessions will cover a number of issues that affect "reproductive well-being," including housing, transportation and wages. The keynote speaker will be renowned activist, author and professor Angela Davis. Registration closes after today.

Spivey said one of the steps they're taking is working with partner agencies to increase the number of doula-friendly
hospitals in the state.

"They're a trained companion that can help, and know that pregnant person more intimately," she explained. "And so they know this is this person's birth plan, how can we make sure that it's honored, and help that person have power and choice when working with their medical team - to address some of the things around not being heard."

Research shows doulas have a positive impact for both mothers and babies, and several states now include Medicaid coverage for doula care.

Spivey sees the "transactional" nature of U.S. healthcare - factors like insurance billing, what's covered and what isn't, and how many patients a practitioner is expected to see in a day - as contributing to the risks for patients.

"I think we need to remove that as transactional and really spend time with people, understanding what they're needing, and also making sure people feel empowered to hold doctors accountable. You know, people feel like they're the experts - they don't want to question," she continued.

It is now up to Wisconsin Supreme Court justices to decide the fate of an abortion law from the mid-1800s.

A circuit court determined last year an 1849 law does not apply to "medically consented" abortions in Wisconsin. The high court heard arguments Monday about whether a 1985 state law overrides the older one, allowing abortions before the point at which a fetus could survive outside the womb.

Jenny Higgins, professor of obstetrics and gynecology at the University of Wisconsin-Madison, said while the impact of this case is critically important, even if the 1849 law is determined to be unenforceable, returning to the status quo would mean a dire landscape for abortion access.

"Even though abortion is technically available at clinics in Wisconsin right now, it's heavily restricted," Higgins explained. "Because of insurance and Medicaid prohibitions, people have to pay out-of-pocket for a service that should be covered by insurance."

The 1849 law, which was brought to light after Roe v. Wade was overturned by the U.S. Supreme Court, prompted a statewide freeze on abortion services for more than a year. Higgins noted if Wisconsin's high court rules the law still applies today, the state would be looking at another abortion freeze.

Abortion access disproportionately affects those who are already the most marginalized, Higgins pointed out. She noted while people from all walks of life may find themselves needing abortion care, factors like poverty and racism make it much harder for some to achieve reproductive autonomy, compared to those with more economic and social resources.

"Those effects make it much harder for folks to be able to access contraceptive care, be in relationships that are stable and healthy and communicative, to be able to see past the end of the day into one's future if you are, again, mostly focused on your own economic scarcity or figuring out how to feed your kids, or figuring out how not to get evicted," Higgins outlined.

The 1976 Hyde Amendment, established three years after Roe v. Wade, prohibits the use of federal funds for abortion. Higgins hopes federal lawmakers will focus more on this amendment when considering the barriers to abortion care.


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Strong reactions are pouring in from both sides as Missouri voters made history by adding abortion rights to the state constitution.

The decision to pass Amendment 3, the "Right to Reproductive Freedom Initiative," makes Missouri the first state to overturn a near-total statewide abortion ban. Advocates and opponents are now gearing up for future battles.

Jamie Morris, executive director and general counsel of the Missouri Catholic Conference in Jefferson City, said he is disappointed with the passage of the amendment but emphasized his organization's pride in the conference's efforts, despite limited resources, and vowed the fight is not over.

"From the church's perspective, win or lose, we were going to continue to advocate for policy to help address the needs of women to help them choose life to begin with," Morris explained. "So that not only you're dealing with, necessarily, the supply of abortion, but also the demand."

In addition to abortion rights, Amendment 3 protects access to contraception and reproductive health services.

Meanwhile, pro-choice advocates in Missouri including Planned Parenthood and the ACLU are celebrating the passage of the amendment, while filing a lawsuit to block some restrictions, including parental consent for minors and continued regulatory oversight of abortion services.

Maggie Olivia, senior policy manager for the advocacy group Abortion Action Missouri, applauded the vote.

"I could not be more proud of the first steps that we are taking together as Missourians to dismantle the decades of political infringements on our access to abortion and, frankly, all reproductive care," Olivia stressed.

Missouri was among nine states with abortion rights measures on the 2024 general election ballot. Amendment 3 takes effect Dec. 5.


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By Lauren Rankin for Yes! Media.
Broadcast version by Farah Siddiqi for Ohio News Connection reporting for the Yes! Media-Public News Service Collaboration

Donald Trump didn't deliver on many of his campaign promises as president, but he did achieve one of his administration's stated goals: overturning Roe v. Wade. After appointing three of the five justices who ended the constitutional right to an abortion and unleashed a growing tragedy, Trump has bragged about his role in undoing nearly 50 years of reproductive health care precedent.

But as we face the prospect of another potential Trump presidency, the architects of Project 2025 have made it clear that overturning Roe was just the first in a multistep plan to eradicate access to safe abortion. Though the Republican Party removed a federal abortion ban from its official party platform, there's something more sinister that's been hiding in plain sight for 150 years.

The Comstock Act, signed into law in 1873, made it a federal offense to disseminate contraceptives, abortifacients, and information about either across state lines or through the mail. Named after Anthony Comstock, an anti-obscenity crusader who inspired the title of the biographical book The Man Who Hated Women, the Comstock Law had far-reaching tentacles. Even married couples who used contraception could be sentenced to up to one year in prison.

Over time, various challenges to the Comstock Act, including United States v. One Package in 1936, which made it possible for physicians to distribute contraception across state lines; Griswold v. Connecticut in 1964, which established the constitutional right to contraception; and, of course, Roe v. Wade in 1973, essentially made it unenforceable. However, the law was never repealed and has instead become a "zombie law," a term used to describe laws still on the books that have been overruled by other legal cases. Take, for instance, Arizona's 1864 abortion ban, a zombie law that became legally viable after the Supreme Court struck down Roe v. Wade. Though Arizona's law was repealed in September, it still remained on the books long enough to instill fear in those seeking and providing abortions in the state.

Now, after the fall of Roe, Project 2025 plans to revive the zombie Comstock Act and make it workable. Since it's already on the books, Congress isn't required to pass the Comstock Act. Instead, a president and appointed judges can choose whether to enforce it. Project 2025 architects hope that, if given another term, Trump will do just that.

A Significant Threat to Abortion

Abortion bans are deeply unpopular in the U.S. Since Roe fell in June 2022, voters have supported abortion rights every single time the issue has been on the ballot, even in traditionally conservative states like Kansas, Montana, and Ohio. While a national abortion ban could threaten congressional seats for Republicans, it would also require control of both houses of Congress and the executive branch, a higher threshold than simply winning the presidency. So, it seems, the architects of Project 2025 have developed a workaround to meet their aims.

After Roe was overturned, President Joe Biden's Department of Justice issued guidance about whether the Comstock Act could be used to criminalize someone who receives mifepristone and misoprostol through the United States Postal Service. "We conclude that section 1461 does not prohibit the mailing, or the delivery or receipt by mail, of mifepristone or misoprostol where the sender lacks the intent that the recipient of the drugs will use them unlawfully," the memorandum opinion states. "Federal law does not prohibit the use of mifepristone and misoprostol," the memorandum continues. "Indeed, the U.S. Food and Drug Administration ('FDA') has determined the use of mifepristone in a regimen with misoprostol to be safe and effective for the medical termination of early pregnancy."

But under a Trump presidency, the DOJ would likely have a different view, especially since Project 2025 explicitly calls for the enforcement of the Comstock Act "against providers and distributors of [abortion] pills."

Additionally, the spate of radical, far-right judges Trump appointed during his first term have already proven their willingness to ignore existing case law to curb access to abortion. In 2023, U.S. District Judge Matthew Kacsmaryk, who has deep ties to the anti-abortion movement, defied court precedent to suspend the approval of mifepristone. "The Court does not second-guess FDA's decision-making lightly," he wrote in his decision. "But here, FDA acquiesced on its legitimate safety concerns-in violation of its statutory duty-based on plainly unsound reasoning and studies that did not support its conclusions."

If Trump is able to appoint even more partisan judges like Kacsmaryk to the federal bench, it's possible they would use the Comstock Act to criminalize folks sending or receiving mifepristone and misoprostol (or even information about it) through the mail. "If the Comstock [Act] were enforced, it would seriously impact the work we do," says Sneha S. Nair, partnerships coordinator at Women First Digital, a collection of online platforms that provides abortion and contraception information and services. "We rely on digital platforms to share [sexual and reproductive health] content worldwide, and restrictions like the Comstock [Act] could lead to significant censorship and suppression of vital information."

But even the threat of Comstock being enforced is concerning for abortion advocates and providers. "What people believe the law to be is just as important, if not more so, than what the law actually is," says Farah Diaz-Tello, senior counsel and legal director at If/When/How, a legal organization that aims to transform the policy landscape to make reproductive justice a reality. "When people have to second-guess what their options are and they just know that there's a sort of vague and looming fear of criminalization ... that is not a risk that everybody has the privilege to tolerate."

For Black and Brown people, who have already borne the brunt of criminalization for pregnancy outcomes, even the threat of an enforceable Comstock Law could be enough of a deterrent to prevent them from seeking necessary care.

Refusing to Be Silent

While Project 2025's architects may be banking on the Comstock Act, they will have to contend with a network of providers and advocates refusing to put the genie back in the draconian bottle. For example, Shout Your Abortion's post-Dobbs campaign, "Fuck SCOTUS, We're Doing It Anyway," promotes information about and access to medication abortion online.

Similarly, the Four Thieves Vinegar Collective, a DIY medical collective, has literally turned an information card about medication abortion into medication abortion. Embedded in the cards are three doses of misoprostol, which can be used on its own to induce an abortion, and since it's a paper card, the pills are harder to detect.

Others believe the best way to combat Project 2025's insidious ploy to use the Comstock Act as a backdoor abortion ban is to refuse to be cowed into silence about the revolutionary power of being able to terminate a pregnancy in your own home.

Today, the majority of abortions in the U.S. are induced through medication, most often a combination of the drugs mifepristone and misoprostol. Telehealth for abortion care, in which a provider virtually prescribes these drugs to patients, has become increasingly popular, even in states with abortion bans.

"The number of people served through telehealth has just grown exponentially since the pandemic," says Elisa Wells, co-founder and co-director of Plan C, which promotes access to medication abortion online. "[When people find out] that you can get an abortion by the mail, which is a really new idea ... they think, 'Wow, that's amazing!'"

Research from the Society for Family Planning's WeCount project revealed that in the second half of 2023, more than 40,000 people in states that restrict telehealth or ban abortion were able to receive medication abortion from providers in states that have "shield" laws that protect providers from being criminalized. Plan C's website traffic has surged since Dobbs; Wells says they now receive approximately 2 million visitors annually.

There's also the option of self-managing abortion with abortion pills. For people in states with severe restrictions or bans, self-managed medical abortion with pills has become an option for many who otherwise wouldn't have access to abortion care. Plan C, for example, showcases many sites that prescribe and mail medication abortion to folks directly, including Aid Access and Hey Jane.

There is a vast digital ecosystem of medication abortion information and services that abortion seekers can have mailed right to their door-unless Project 2025 goes into effect.

"What we are most concerned about is that people have access to accurate information about how to get the pills, how to use the pills, and the fact that in some states there might be legal risks associated with using the pills," says Wells. "Every day is a risk assessment, and people can make good decisions about their lives. It's not for me to say about somebody else's life. What's the best choice for you?"


Lauren Rankin wrote this article for Yes! Media.


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