In the race for New Hampshire governor, the candidates' positions on reproductive rights could be a deciding factor.
Pollsters have said it is a dead heat between Democrat and former Manchester Mayor Joyce Craig and Republican former U.S. Sen. Kelly Ayotte, and both claim to champion women's health.
Kayla Montgomery, vice president of public affairs for the Planned Parenthood New Hampshire Action Fund, said Ayotte voted for a national abortion ban while in the Senate and supported the Supreme Court overturning Roe v. Wade.
"We can't put our trust in someone who has been against abortion rights and against reproductive freedom her entire career," Montgomery contended.
Ayotte said if elected, she would not change the state's current law, which allows for abortions up to 24 weeks of pregnancy, or back new restrictions.
Craig said she would work to codify abortion rights into the state constitution. New Hampshire is the only New England state without an explicit legal right to abortion care.
Ayotte said her opponents are "politicizing abortion to win votes" but her previous board position with the right-leaning nonprofit Winning For Women is raising questions about her pivot to a more moderate approach. The group has spent millions backing anti-choice candidates for office and Ayotte herself backed bills to remove insurance coverage for birth control.
Sen. Debra Altschiller, D-Stratham, said Ayotte has grown out of step with New Hampshire voters.
"She instead decided to get on board with an extreme right-wing agenda on limiting reproductive health care for the people of her own state," Altschiller asserted. "We remember."
Altschiller added reproductive freedoms are under attack at the State Capitol, despite a majority of voters backing abortion rights, and thinks Craig would serve as a firewall in the governor's office to ensure protections. She noted Craig has also committed to nominating pro-choice justices to the state Supreme Court, where there is a retirement coming up in 2026.
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A new bill before Arkansas lawmakers is designed to improve maternal care for low-income families.
If passed the Healthy Moms, Healthy Babies Act would invest more than $45 million annually into programs for mothers and babies statewide.
Arkansas Surgeon General Dr. Kay Chandler said the legislation would make prenatal care available to everyone.
"As soon as somebody knows they're pregnant, we want them to go to the doctor, make an appointment right away," said Chandler. "If they have a doctor - go to the doctor, OB-GYN, family doctor, wherever you go for prenatal care. But if you don't, you can go to the health department, your local health unit, and get free prenatal care and they can help you get established."
Proposals in the legislation were recommended by members of the Strategic Committee on Maternal Health that was formed by Gov. Sarah Huckabee-Sanders.
Arkansas has one of the highest maternal mortality rates in the nation and the third highest infant mortality rate.
Other parts of the legislation include paying for up to 14 prenatal and post-natal care visits and expanding access to telemedicine.
Chandler said both doctors and patients would benefit from the changes.
"I hear doctors saying, 'We're having a hard time. We're struggling to be able to take care of women with the current way that the reimbursement in,'" said Chandler. "So, this reform -- the changes in the Medicaid payments, the increase, the unbundling, presumptive eligibility, even covering ultrasounds and blood sugar monitoring -- these are new and innovative things."
Medicaid covers about half of all births in Arkansas. Huckabee-Sanders has said she's confident the state will be able to receive federal funds to help support the changes.
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Next week, Kentucky lawmakers are expected to consider a bill that would lift legal red tape that backers say makes it difficult to open up freestanding birth centers.
The Commonwealth is among 10 states with no independent nurse midwife-run facilities that provide prenatal and birth services and postpartum care. So, many people travel to Indiana or Tennessee to give birth, said Trimble County resident Paige Thompson, who went out of state to give birth in 2021. She said her friends have made similar trips, but she worries about those in other rural counties who have no options for a natural birth in a home-like environment.
"They offer the freedom to move around during labor," she said. "They offer the option to eat and drink whenever you're hungry or thirsty. And there's also the option to birth in the water."
Senate Bill 17 would exempt freestanding birth centers from the state's certificate-of-need requirements, rules that regulate health-care facilities. The Kentucky Hospital Association opposes freestanding birth centers, arguing that hospitals are better equipped to handle unpredictable medical complications.
The bill's sponsor, state Sen. Shelley Funke Frommeyer, R-Alexandria, said people should have access to the prenatal and delivery care they feel is best for them, noting there are around 800 home births in Kentucky each year.
"I want to recognize that we are not trying to do anything so complicated, other than remove barriers to wellness," she said, "and we believe that this is a very important barrier to remove."
Thompson said more than one in three Kentuckians give birth by cesarean-section, a rate among the highest in the nation.
"I think that people are waking up to the truth that midwives and midwifery care are safer, and produce better outcomes for low-risk pregnancy, in women who want a natural vaginal delivery," she said.
Data show access to birth centers is linked to fewer medical interventions and lower cesarean rates than in hospitals, and can reduce racial disparities, including fewer low birthweight babies for Black women.
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Gov. Gretchen Whitmer recently signed landmark legislation to expand access to essential OB/GYN services across Michigan.
Between 2018 and 2022, about 19 mothers per 100,000 live births in Michigan died from pregnancy-related issues, mostly in marginalized communities. The new legislation aims to expand maternal and prenatal care.
Rep. Julie Rogers, D-Kalamazoo, a former health policy chair, sponsored several bills in the package, including one to reduce government red tape for breast milk donors.
"That required HIV testing for breast milk donors every 90 days, and to contrast that with the rest of the United States, we're the only state that requires that," Rogers pointed out. "Forty-nine other states do a one-and-done test at the onset of donations."
Data from 2022 showed white mothers having the highest number of maternal transfusions, followed by Black mothers.
A new report from the American College of Obstetricians and Gynecologists revealed a startling statistic: More than 60% of pregnancy-related deaths could have been prevented with improved quality and safety in the maternal care system.
Rogers noted the new law mandates insurance companies to provide support for people without health coverage or access to care.
"Often times people that are not able to access primary care or obstetrics care," Rogers observed. "This would require insurance coverage for blood pressure monitors, so mothers can check their blood pressure at home."
Rogers stressed the legislation expands access to postpartum mental health screenings. She added most bills in the package received strong bipartisan support in the Legislature.
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