ACLU Comment on Fifth Circuit Decision on Mifepristone

MONTGOMERY, Ala. — An Alabama trial court issued a ruling yesterday permanently blocking the Alabama Department of Public Health (ADPH) from regulating freestanding birth centers like hospitals and imposing onerous licensing rules that would have made it effectively impossible for these centers to provide evidence-based midwifery care in the state. The ruling ensures that plaintiffs Oasis Family Birthing Center in Birmingham and Alabama Birth Center in Huntsville, which have been safely operating for the past year, may continue providing midwifery care to pregnant Alabamians. The decision from the Fifteenth Judicial Circuit Court that the Alabama Legislature never authorized ADPH to regulate midwifery care in birth centers, leaving that responsibility to the Board of Midwifery and other professional licensing boards in the state. Under the terms of a preliminary injunction issued in 2023, two birth centers — Oasis Family Birthing Center and Alabama Birth Center — are now open and providing much-needed care in their communities, in accordance with evidence-based standards set by the American Association of Birth Centers. Birth centers play a critical role in providing care for low-risk pregnant Alabamians. Expanding access to this care is especially important in light of Alabama’s ongoing maternal and infant health crisis, which disproportionately harms Black women and families, low-income communities, Today’s decision will allow even more Alabamians to access this essential care, and the way for more birth centers to open in the state. Statement from Whitney White, staff attorney with the ACLU Reproductive Freedom Project: “We are elated that the dedicated midwives at Alabama’s birth centers can continue to provide crucial care to pregnant Alabamians across the state without undue interference. Midwifery care in birth centers is safe, can improve patient outcomes, and can play a critical role in expanding access to equitable pregnancy care in Alabama. This ruling ensures that these essential health care providers will be able to continue serving their communities.” Statement from JaTaune Bosby Gilchrist, executive director of the ACLU of Alabama: "This ruling is a powerful affirmation of what birth workers, families, and communities across Alabama have long known: midwife-led care is essential. As hospitals and obstetric services close across the state—particularly in rural areas—birth centers and midwives are stepping in to fill a dangerous gap in access. In a state facing a maternal health crisis, we need more options, not fewer. This decision brings us one step closer to ensuring that safe, accessible, and community-based birthing care is available to everyone who needs it." The birth centers’ lawsuit was filed after ADPH created significant uncertainty around the legal status of birth centers that provide midwife-led care by asserting that all such birth centers require a “hospital” license, even though they exclusively provide midwifery care to low-risk patients using a model of care that is safely provided in out-of-hospital settings across the country. ADPH’s actions abruptly shut down operations for the one birth center then-operating in Alabama, despite a perfect safety record. The de facto ban on this essential care was especially harmful in Alabama, which has some of the highest maternal and infant health rates in the country, with Black women and infants making up a disproportionate share of deaths. One factor playing into this concerning trend is inadequate access to pregnancy-related care, including the growing number of maternal health deserts in the state and closures of hospital labor and delivery units. The lawsuit, Oasis Family Birthing Center et. al. v. Alabama Department of Public Health, was filed in the Fifteenth Judicial Circuit Court in Montgomery in August 2023. The plaintiffs – Oasis Family Birthing Center in Birmingham, Heather Skanes, M.D., Alabama Birth Center in Huntsville, Yashica Robinson, M.D., the Alabama affiliate of the American College of Nurse-Midwives, Jo Crawford, CPM, and Tracie Stone, CPM – are represented by the American Civil Liberties Union, the ACLU of Alabama, Covington & Burling LLP, and Bobby Segall of Copeland Franco. A copy of the ruling can be found here. An overview of the case can be found here.

The National Family Planning and Reproductive Health Association (NFPRHA), the lead national advocacy organization for the Title X family planning program, and the American Civil Liberties Union and the ACLU of the District of Columbia sued the Trump administration over its unlawful withholding of $65.8 million in Title X federal family planning grants. Title X is the country’s only dedicated federally funded family planning program that provides access to preventive care like birth control, cancer screening, and STI screening and treatment, with priority given to patients with low incomes. As a result of the Trump administration’s unlawful actions, at least seven states — California, Hawaii, Maine, Mississippi, Missouri, Montana, and Utah — have been left without any Title X-funded family planning services, and approximately 842,000 people have lost access to Title X-funded care.

MONTGOMERY, Ala. — A federal judge has issued a ruling making it clear that Alabama Attorney General Steve Marshall and district attorneys across the state cannot prosecute individuals, including health care providers and reproductive justice organizations, for helping pregnant Alabamians travel across state lines to access abortion care in states where abortion is legal. A group of health care providers filed this lawsuit in 2023 after Attorney General Marshall explicitly threatened that anyone who assists a pregnant Alabamian in accessing legal, out-of-state abortion care could face felony charges. As the federal court held today, the attorney general’s threats blatantly violate the constitutional rights to free speech and to travel freely across state lines. In the ruling, Judge Myron Thompson said, “At its core, this case is simply about whether a State may prevent people within its borders from going to another State, and from assisting others in going to another State, to engage in lawful conduct there. . . . The court now answers no, a State cannot.” Due to Attorney General Marshall’s threats, Alabama health care providers were forced to stop providing crucial information, counseling, and practical support to Alabamians seeking to exercise their constitutional right to travel and obtain legal abortion care outside Alabama. Abortion was outlawed in Alabama in 2022 after the Supreme Court overturned Roe v. Wade, so the ability to safely access out-of-state abortion is critical for patients in Alabama seeking that care. As a result of today’s decision, local health care providers are once again able to share information about and recommendations for specific, trusted out-of-state abortion providers, as well as financial and practical support resources, and can directly assist pregnant people in traveling across state lines, without the threat of criminal prosecution. Statement from Robin Marty, executive director, West Alabama Women’s Center: “We are thrilled that, with the court’s decision today, we are once again able to inform our patients and other pregnant Alabamians about where and how to safely obtain legal, time-sensitive abortion care outside of Alabama, and to point them towards resources that can help them in traveling across state lines to access that care. Health care providers should be able to support their patients in accessing all of their legally available medical care options without undue political interference, and certainly without the threat of criminal prosecution. While there’s still a long way to go in making that a reality in Alabama, today’s ruling is a step in the right direction.” Statement from Dr. Yashica Robinson, medical director, Alabama Women’s Center: “As medical professionals, we have an obligation to ensure that our patients have the information and support they need in order to make and effectuate their own decisions about their health, their bodies and their pregnancies, including the decision to have an abortion. The notion of criminalizing us for providing this vital information and support to our patients is not just ludicrous but counter to everything a patient expects from their health care provider. We are relieved that, with today’s ruling, we will once again be able to provide our patients and the communities we serve with the assistance that we feel ethically obligated to provide, without the threat of being thrown in jail for doing so.” Statement from Meagan Burrows, senior staff attorney with the ACLU Reproductive Freedom Project: “We are pleased that the court has put a stop to Attorney General Marshall’s attempt to prevent pregnant Alabamians from accessing the legal, out-of-state abortion care they need. The court’s decision today should send a strong message to any and all anti-abortion politicians who are considering similar efforts to muzzle health care providers or penalize those who assist others in crossing state lines to obtain legal abortion: such attacks on free speech and the fundamental right to travel fly in the face of the Constitution and cannot stand.” Statement from Alison Mollman, legal director, ACLU of Alabama: “The court’s decision today allows health care providers and others to resume providing vital information and assistance to those seeking to travel across state lines to access legal abortion care. This decision is certainly a win, but the fact of the matter is that abortion remains out of reach for Alabamians who are often unable to jump through the logistical hoops necessary to take time away from their jobs and families and make the often lengthy and expensive trip out of state for abortion. In a state like Alabama, which has one of the highest maternal mortality rates in the nation, the inability to access this often life-saving care can have grave consequences. While we breathe a sigh of relief today, we won’t stop fighting until true reproductive freedom for every Alabamian is secured.” This information and direct support are essential for those who need to travel to access abortion care. Indeed, without such assistance, pregnant people living in states that have banned abortion, like Alabama, will be significantly delayed in finding and accessing safe out-of-state abortion care, and potentially even forced to give birth against their will. This could have deadly consequences for Alabamians as a state that has one of the highest maternal mortality rates in the nation. The lawsuit, West Alabama Women’s Center, et al. v. Marshall, et al., was filed in the U.S. District Court for the Middle District of Alabama in Montgomery by the American Civil Liberties Union and the ACLU of Alabama on behalf of West Alabama Women’s Center, Dr. Yashica Robinson, and Alabama Women’s Center. A similar case was filed in federal court by the Lawyering Project on behalf of the Yellowhammer Fund. The cases were consolidated and decided together.

PHOENIX — Today, a Maricopa County Superior Court judge permanently blocked the state’s ban on abortion after 15 weeks of pregnancy. The case, filed in Maricopa County Superior Court, asserts that the ban is unconstitutional because it denies Arizonans’ access to abortion care in violation of the state’s 2024 constitutional amendment protecting the fundamental right to abortion. The ruling permanently blocks this ban, which Attorney General Kris Mayes agreed not to enforce under a December stipulation in which both the State and abortion providers agreed that the ban is unconstitutional. The stipulation allowed doctors across the state to begin providing care after 15 weeks of pregnancy shortly after Proposition 139, the Arizona Abortion Access Act, was certified and added to the state constitution. The Arizona Abortion Access Act (Proposition 139) restored Arizonans’ right to control their own bodies and medical decisions, enshrining the right to abortion into the state constitution. It was overwhelmingly approved by voters, who declared that politicians have no place in Arizonans’ reproductive health decisions. The case was brought by Dr. Eric M. Reuss, M.D., M.P.H., Dr. Paul A. Isaacson, M.D., and Planned Parenthood Arizona, Inc., represented by the American Civil Liberties Union, the ACLU of Arizona, Planned Parenthood Federation of America, the Center for Reproductive Rights, and Perkins Coie LLP. Statement from Dr. Eric M. Reuss, M.D., M.P.H., obstetrician and gynecologist, Scottsdale Obstetrics & Gynecology, P.C.: “We’re relieved that Arizona’s harmful abortion ban has been permanently blocked. For two years, I’ve seen firsthand how our state’s abortion ban has harmed my patients, with countless lives and futures changed because politicians thought their views of the right health care was more important than pregnant people and their medical providers. What we owe Arizonans is top-quality health care, full stop – not forcing them to wait for severe pregnancy complications to get worse before they can get care. Today’s decision will help pave the way for a future in which all Arizonans have access to the fundamental care they need.” Statement from Dr. Paul Isaacson, M.D., obstetrician and gynecologist, Family Planning Associates Medical Group: “For nearly three years, my hands were tied because of this cruel ban. It is a relief to no longer have to turn away patients from essential health care. All Arizonans deserve to make their own health care decisions with their doctors, without political interference. I will continue to provide the full spectrum of reproductive health care my patients need for their health and their futures – including abortion.” Statement from Dr. Misha Pangasa, physician, Planned Parenthood Arizona: “This is a huge moment for Arizonans, who voted to enshrine abortion access in the state constitution by passing Proposition 139 to stop the government from interfering in people’s health decisions. As an OBGYN who provides comprehensive reproductive healthcare, including abortion care, I firmly believe that people should be able to get care in their own communities, in a manner that is best for them, with the people they trust. This is why we at Planned Parenthood Arizona have been fighting tirelessly for the health and rights of our patients and we are proud to now be serving our community by providing abortion care beyond 15 weeks of pregnancy. Statement from Rebecca Chan, staff attorney, ACLU Reproductive Freedom Project: “Arizonans made it crystal clear that reproductive freedom is a core value in their state by passing Prop 139 in November, establishing a fundamental constitutional right to abortion. While this was a monumental win for the health and rights of people across the state, it was just the first step. While we celebrate today’s court order blocking Arizona’s abortion ban, we know that Arizonans will still need to navigate barriers to care that are medically unnecessary and undermine the will of the people.” Statement from Lauren Beall, staff attorney, ACLU of Arizona: “Today’s ruling to permanently block Arizona’s 15-week ban is an important milestone to protect access to abortion in Arizona. Arizonans made it clear that politicians have no business interfering with private medical decisions related to pregnancy and abortion care when they voted to enshrine the right to abortion in the state constitution. We are committed to working with providers and partners to ensure that all of Arizona’s laws fall in line with the will of the people.” Statement from Alexis McGill Johnson, president and CEO, Planned Parenthood Federation of America: “Today’s ruling demonstrates the power of direct democracy to create real, lasting changes for abortion access. With their vote on Proposition 139, Arizonans rejected the state’s abortion ban, saying decisively that the only people qualified to make pregnancy decisions are patients and their health care providers, not politicians. By permanently voiding the state’s 15-week abortion ban, this court brought Arizonans closer to achieving reproductive freedom for every person. Planned Parenthood Federation of America and our partners will continue our work to ensure that the promise of Proposition 139 is fulfilled.” Statement from Nancy Northup, president and CEO, Center for Reproductive Rights: “Today’s ruling is a people’s victory. Arizona voters made clear in November that they want their fundamental reproductive rights protected, including abortion access. This is democracy at work. Patients and providers can finally move forward without the lingering threat of this unjust ban. But barriers to abortion access in Arizona remain. Burdensome and pointless requirements leveled at abortion providers and mandatory waiting periods for patients continue to undermine the voters’ will. We will keep fighting to ensure that Arizonans get all the freedoms they voted for and rightfully expect.”