On June 24, 2022, the Supreme Court's decision in Dobbs dissolved a fifty-year federal constitutional framework for abortion access and converted a national clinical standard into fifty-one regulatory regimes.1 The clinical, economic, and administrative consequences propagated quickly: trigger bans took effect within weeks, interstate travel for care multiplied more than tenfold over two years, obstetric workforces in restrictive jurisdictions began to thin, and the legal status of in vitro fertilization was thrown into question by state court reasoning premised on embryonic personhood.2,4,14 What began as a dispute over one procedure became a reorganization of reproductive medicine's geography, financing, and documentation practices — and therefore a first-order problem of health economics.
This report, prepared by the Havellum Institute as Volume II of its Reproductive Health & Access Series, analyzes that reorganization across three coupled layers. The clinical layer comprises the conditions through which legal delay and workforce loss translate into morbidity: ectopic pregnancy and miscarriage management, perinatal insomnia and sleep disruption, obstetric trauma and trauma-spectrum illness, migraine disorders intertwined with contraceptive selection, and post-surgical recovery after cesarean delivery or delayed intervention. The economic layer comprises the new cost structure of reproductive care: travel, lodging, lost wages, legal navigation, IVF risk premiums, and the employer-benefit machinery now enlisted to absorb them. The administrative layer comprises the documentation, review, and privacy apparatus — exception reviews, ethics-committee clearances, HIPAA reproductive-privacy compliance, and roster management — that sits between clinical judgment and delivered care.
The analytical instrument is the Havellum Reproductive Access Module (HSBC-RAM), a microsimulation of 14,220 beneficiaries of reproductive potential nested within the HSBC-2025 cohort. It assigns each synthetic beneficiary a jurisdiction, benefit design, and clinical trajectory, then prices the legal, travel, and administrative frictions they encounter. Section 2 situates the four Havellum condition families inside reproductive care; Section 3 maps the post-Dobbs socio-legal frameworks; Section 4 presents the empirical results in six visualizations; Section 5 addresses privacy and conflict resolution under the 2024 HIPAA reproductive-privacy rule; Section 6 issues ten strategic recommendations; and Section 7 concludes with AMA-formatted references.
Jurisdiction is now a clinical variable. The same diagnosis — a failing first-trimester pregnancy with maternal sepsis risk, a migraine-with-aura patient seeking contraception, an embryo cryopreservation dispute — produces different medicine, different bills, and different privacy risks depending on which side of a state line the patient stands. Institutions that fail to encode jurisdiction into clinical workflows will continue to discover it in their adverse-event reviews.
Havellum's standard four-condition architecture — insomnia, trauma, migraine, post-surgical recovery — maps with unusual precision onto reproductive care, because pregnancy and its complications touch all four. This section recasts each family in its post-Dobbs clinical context, and documents where legal delay changes outcomes rather than merely access.
2.1Perinatal Insomnia and the Anxiety Multiplier
Insomnia symptoms affect an estimated 50% to 78% of pregnant individuals, with chronic insomnia disorder present in roughly one in five, driven by hormonal shifts, physical discomfort, and perinatal mood disturbance.14 Pharmacologic options in pregnancy are constrained — doxylamine-based regimens and cognitive behavioral therapy for insomnia (CBT-I) carry the strongest evidence base, while most sedative-hypnotics and the dual orexin receptor antagonist class lack adequate pregnancy safety data — which elevates the value of behavioral treatment and environmental sleep hygiene interventions. The post-Dobbs climate adds a measurable situational exacerbation: in the HSBC-RAM cohort, beneficiaries residing in ban states reported insomnia symptom scores 11% higher than matched beneficiaries in protective states, an effect concentrated in the second and third trimesters, when legal ambiguity around complication management is most psychologically salient. Clinically, this matters because untreated perinatal insomnia is independently associated with gestational hypertension, preterm birth, and postpartum depression — precisely the morbidity lines that workforce attrition is already straining.
2.2Obstetric Trauma and the Surveillance Shadow
Birth-related post-traumatic stress disorder affects an estimated 3% to 6% of postpartum individuals, with sharply elevated rates after emergency cesarean, severe maternal morbidity, or perceived loss of autonomy during care.18 The post-Dobbs environment introduces a novel trauma vector: the criminalization-adjacent surveillance of pregnancy loss. Documented cases of individuals being investigated or detained following miscarriage — medically indistinguishable from early spontaneous abortion in most presentations — create what the cohort models as a surveillance shadow: a measurable reduction in early-pregnancy care-seeking among beneficiaries who fear that seeking help for bleeding or pain could expose them to legal scrutiny. HSBC-RAM estimated a 9% reduction in first-trimester evaluation visits among ban-state beneficiaries presenting bleeding symptoms, with downstream increases in emergency-department presentation severity. Trauma-informed clinical waivers — institutional instruments that modify examination protocols, chaperone rules, and documentation disclosure for patients with obstetric trauma histories — emerge in this environment as clinical necessities rather than courtesies, and Section 5 specifies their privacy design.
2.3Migraine, Contraception, and the Estrogen Boundary
Migraine affects roughly one in four women of reproductive age, and the intersection with contraception is clinically hard-edged: migraine with aura is a category-4 contraindication to combined estrogen-containing contraception because of elevated ischemic stroke risk, making reliable access to progestin-only and long-acting reversible contraceptive (LARC) methods a neurological safety issue as much as a reproductive one.16,19 Post-Dobbs uncertainty chilled contraceptive provision in multiple ways modeled by the cohort: pharmacy-level hesitancy in restrictive jurisdictions, confusion between abortion statutes and contraceptive statutes, and self-censorship by clinicians counseling on sterilization and IUD candidacy. The HSBC-RAM cohort showed a 7.2% decline in new LARC insertions in ban states over the first twenty-four months post-Dobbs, against flat trends in protective states. For migraine patients specifically, that decline compounds stroke risk: the modeled excess is small in absolute terms (roughly 18 avoidable ischemic events per 100,000 migraine-with-aura patients over five years) but entirely preventable, and invisible to any registry that does not link contraceptive access to neurological outcomes.
2.4Post-Surgical Recovery and the Delay Penalty
The most acute clinical consequence of restrictive regimes is delay in time-critical surgical care: ectopic pregnancy, septic or inevitable miscarriage, preterm premature rupture of membranes (PPROM), and lethal fetal anomalies. National guidance is unambiguous that these conditions require prompt uterine evacuation or surgical management;8 the ambiguity is legal, not medical, and it operates through clinician fear. Published Texas data associate restrictive regimes with measurable increases in maternal deaths, including ectopic-pregnancy-related mortality.6 In the HSBC-RAM cohort, median decision-to-intervention time for ban-state beneficiaries with diagnosed nonviable pregnancy was 8.9 days versus 1.3 days in protective states — and every day of delay increased the modeled probability of septic complications, hemorrhage, and consequently more invasive surgery with longer postoperative recovery. The downstream economics are stark: a delayed miscarriage managed expectantly under legal uncertainty converts, in roughly one of six modeled cases, into an admission with sepsis, extending post-surgical recovery by weeks and multiplying episode cost severalfold.
| Condition family | Reproductive intersection | Post-Dobbs risk vector | Modeled outcome signal |
|---|---|---|---|
| Perinatal insomnia | 50–78% symptomatic prevalence in pregnancy14 | Legal-climate anxiety; situational exacerbation; constrained pharmacopeia | +11% symptom score, ban states |
| Obstetric trauma / PTSD | 3–6% postpartum prevalence18 | Surveillance of pregnancy loss; loss of care autonomy | −9% first-trimester care-seeking for bleeding |
| Migraine | ≈25% of reproductive-age women; aura contraindicates estrogen19 | Contraceptive provision chill; LARC access decline | −7.2% new LARC insertions, ban states |
| Post-surgical recovery | Ectopic, miscarriage, cesarean, PPROM management6,8 | Decision-to-intervention delay under legal ambiguity | 8.9 d vs 1.3 d median delay; sepsis risk ↑ |
Emergency clinicians in restrictive jurisdictions should adopt a documentation standard that makes the medical indication legible to non-clinical reviewers: vital signs, gestational assessment, and a plain-language statement of the standard-of-care rationale. The cohort shows that standardized emergency documentation reduces legal-review escalation by 38% without delaying care — and it protects the clinician. Ambiguity in the chart is the clinician's adversary; precision is their shield.
The post-Dobbs environment is governed not by one law but by a collision of them: state criminal and civil statutes, federal emergency and privacy law, employment and leave statutes, and institutional rules from athletic associations to benefits committees. Understanding the collision — rather than any single statute — is the precondition for safe practice.
3.1The State Regime Map: Bans, Restrictions, Protections, Shields
As of Q1 2025, the Havellum classification counts fourteen states enforcing near-total bans (most without rape or incest exceptions; all with narrow life-of-mother language rarely defined clinically), seven with gestational-age restrictions, sixteen with statutory protections, and thirteen with shield laws that extend legal protection to in-state clinicians treating out-of-state patients, including by telehealth and mail-order medication.1-3 Two structural features dominate. First, the exceptions problem: "life of the mother" language in ban statutes is drafted in legal, not clinical, terms, and the cohort's clinician survey module found 74% of ban-state obstetric clinicians reporting uncertainty about when their own judgment would satisfy the exception — uncertainty that converts directly into the decision-to-intervention delays of Section 2.4. Second, the extraterritoriality frontier: several restrictive jurisdictions have entertained civil actions against helpers of out-of-state travel, while shield states have enacted non-cooperation provisions; no appellate court has yet resolved the conflict, making interstate care a live constitutional question rather than a settled practice.3
3.2EMTALA, Travel, and the Federal Counterweight
The Emergency Medical Treatment and Labor Act obligates Medicare-participating hospitals to stabilize emergency conditions, and federal guidance has asserted that this includes termination of pregnancy where necessary to prevent serious jeopardy to health — guidance immediately contested in federal litigation and effectively narrowed by subsequent rulings.20 For health systems, the practical position remains: EMTALA is a floor, not a clearance letter. Interstate travel for care is itself lawful — the Supreme Court has long protected the right to travel — but the logistics layer (funding, navigation, follow-up) is where employers, funds, and charities now operate, and where state laws diverge on whether helping travel constitutes an offense.3,17 The cohort prices this uncertainty as a measurable legal-navigation cost component in every modeled interstate episode (Figure 1).
3.3ADA, the Pregnant Workers Fairness Act, and FMLA
Pregnancy itself is not an ADA disability, but pregnancy-related impairments — severe nausea, gestational diabetes, postpartum depression, post-cesarean non-permanent functional impairment — qualify, engaging the ADA's interactive process and reasonable-accommodation obligations under Title I, with Titles II and III governing clinical settings' accessibility obligations.12 The Pregnant Workers Fairness Act of 2023 substantially broadened this terrain by requiring accommodations for known limitations related to pregnancy, childbirth, or related medical conditions without the ADA's "disability" threshold, and by enumerating accommodations that presumptively qualify.10 FMLA interacts at two points: leave for serious health conditions of pregnancy, and parental bonding leave — the latter unpaid, which means that low-wage beneficiaries returning from cesarean delivery simultaneously face wage loss and newborn care costs, an affordability collision documented in the cohort's post-surgical recovery module.11 Reasonable accommodations under ADA Title II/III in clinical settings — appointment flexibility for patients traveling from restrictive jurisdictions, private consultation spaces, environmental sleep hygiene adjustments in postpartum units — are inexpensive and under-deployed.
3.4NCAA, Title IX, and the Student-Athlete Pregnancy Gap
Title IX prohibits pregnancy discrimination in education, including athletics; NCAA guidance requires member institutions to provide pregnancy and parenting accommodations and protects scholarship continuity.13 Practice lags policy. The cohort modeled 412 student-athlete pregnancy or parenting cases across 58 institutions: 31% encountered a roster decision (non-renewal, positional reassignment, or redshirt pressure) inconsistent with written policy, and 44% reported that pregnancy-related medical information was visible to coaching staff beyond what the waiver standard required. In ban states, student-athletes additionally face the travel problem: team insurance rarely covers out-of-state reproductive care, and scholarship-dependent students cannot self-fund interstate episodes. Trauma-informed clinical waivers for athletes with obstetric trauma histories, and confidentiality walls between treatment records and roster decisions, are the two highest-yield reforms identified (Section 6).
3.5IVF, Personhood, and Contraceptive Fragility
The February 2024 Alabama Supreme Court decision applying wrongful-death law to cryopreserved embryos suspended IVF operations statewide until emergency legislation restored provider immunity — a sequence that demonstrated how personhood reasoning propagates from abortion statutes into fertility medicine.14 The cohort modeled an IVF legal-uncertainty premium: in states with active personhood proposals, modeled clinic-level compliance costs rose 9–14%, utilization dipped 6–11% during peak uncertainty months, and cycle cancellation due to disposition disputes appeared as a novel administrative category. With a median cycle cost near $21,600 and only a minority of states mandating coverage, IVF affordability was already precarious; legal uncertainty compounds it.15 Medication abortion's 63% share of provision places mifepristone litigation at the system's center: the Alliance for Hippocratic Medicine litigation preserved access through standing doctrine, but the underlying approval remains politically contested.2,16
| Regime | States (n) | Legal architecture | Clinician exposure | Modeled clinical consequence |
|---|---|---|---|---|
| Near-total ban | 14 | Criminal/civil prohibition; narrow life exceptions, rarely defined | Felony exposure; licensure action | 8.9 d median intervention delay; workforce −15.4% |
| Gestational restriction | 7 | Gestational limits 6–15 wks; enforcement variability | Civil liability dominant | Referral friction; partial outmigration |
| Statutory protection | 16 | Access codified; some funding protections | Standard-of-care baseline | Travel destination load; capacity strain |
| Shield law | 13 | Telehealth/mail protection; non-cooperation statutes | Protected for out-of-state care3 | Telehealth corridor growth; legal-frontier risk |
The single most consequential near-term regulatory development is the April 2024 HIPAA Privacy Rule amendment prohibiting use or disclosure of reproductive health information for investigation or liability purposes, with compliance required by December 23, 2024.9 Every institution in this report's scope — hospitals, campus health centers, athletics departments, employers administering travel benefits — has obligations under it. Compliance is not optional, and the enforcement posture is adversarial in both directions: shield states will protect, restrictive states will test the rule's limits in court.
All figures derive from the HSBC-RAM microsimulation and are synthetic estimates calibrated to public benchmarks; they are modeled results, not claims data. Six visualizations price the interstate episode, map the service-line risk space, track the exception pipeline, profile regime-level burden, trace travel and workforce trends, and lay out the legal roadmap through 2028.
Methods (4.0)
The module assigns each of 14,220 beneficiaries a home jurisdiction (regime category), benefit design (KFF distributions), and stochastic clinical trajectory across the Section 2 condition families.2,4,5 Travel costs use published distance distributions for ban-state residents to nearest provider;17 legal exposure uses a 0–10 composite index (statute severity, enforcement history, extraterritorial posture); administrative events are costed at fully loaded staff time. Figures are FY2024 dollars. Charts render client-side and are interactive on hover.
The waterfall makes the hidden economics of geography explicit. Travel, lodging, childcare, and lost wages collectively exceed the procedure cost itself — the clinical service is rarely the most expensive line item in an interstate episode. Lost wages are the largest single component and the least visible to policymakers: they fall disproportionately on hourly workers without paid leave, intersecting FMLA's coverage gaps. The cohort also finds that legal-navigation consultation ($240 median) is a genuinely new cost category in American medicine — expenditure that produces no health, only risk reduction — and it should be understood as a direct deadweight loss of legal fragmentation.
The funnel is the paper's central administrative finding. Exception provisions in ban statutes are not functioning clearance mechanisms; they are adjudication processes embedded inside emergencies. Each stage — clinical identification, documentation, legal or ethics-committee review, approval, delivery — consumes hours to days, and the conversion at the legal-review stage (69.9%) reflects counsel conservatism rather than clinical disagreement: chart-review sampling found clinicians and reviewers aligned on medical necessity in 91% of cases. The policy implication is structural: medically indicated exemptions cannot be managed as individual waivers; they require standing protocols that pre-authorize defined clinical scenarios, an approach modeled to raise conversion above 80%.
| Pipeline stage | n | Stage conversion | Median elapsed | Dominant attrition driver |
|---|---|---|---|---|
| Clinically identified exception basis | 8,640 | — | Day 0 | — |
| Documentation complete | 7,210 | 83.4% | Day 1.4 | Documentation under time pressure; chart ambiguity |
| Legal / ethics-committee review initiated | 5,890 | 81.7% | Day 3.1 | Reviewer availability; weekend gap |
| Exception approval granted | 4,120 | 69.9% | Day 5.6 | Counsel conservatism despite clinical agreement |
| Care delivered before clinical deterioration | 2,955 | 71.7% | Day 8.9 | Deterioration outrunning review |
| Service | Median cost | Coverage posture | Legal-uncertainty effect | Modeled utilization shift |
|---|---|---|---|---|
| IVF, single fresh cycle | $21,600 | Mandated in minority of states | Compliance +9–14% in personhood-active states | −6% to −11% peak uncertainty |
| Embryo cryopreservation, annual | $820 | Typically self-pay | Disposition disputes; consent-redrafting costs | +19% storage renewals (precautionary) |
| LARC insertion (IUD/implant) | $0 – $1,100 | ACA preventive coverage; waiver carve-outs | Pharmacy/clinician chill in restrictive regimes | −7.2% insertions, ban states |
| Medication abortion (telehealth) | $150 – $420 | Shield-state protected3 | Mifepristone litigation overhang2 | +61% volume, 2022 → 2024 |
HSBC-RAM is synthetic; no individual patient, clinician, or institution is represented. Travel estimates anchor to published Guttmacher monthly provision data; maternal mortality anchors to NCHS; desert classification to March of Dimes.2,5,7 Sensitivity analysis (±20% on legal-exposure weights, ±10 points on LARC elasticity) leaves directional findings invariant. Havellum publishes parameter tables for academic replication.
Reproductive data is now legally hazardous material. The same records that support continuity of care — pregnancy tests, ultrasounds, medication histories, period-tracking exports — are the records that investigative processes in restrictive jurisdictions seek. Privacy governance therefore moves from compliance function to clinical safety function.
5.1The 2024 HIPAA Reproductive Privacy Rule
The April 2024 amendment to the HIPAA Privacy Rule creates a targeted prohibition: covered entities and business associates may not use or disclose reproductive health care information for the purpose of investigating or imposing liability on any person for seeking, obtaining, providing, or facilitating lawful reproductive care.9 Three implementation obligations follow. First, attestation: disclosures potentially related to reproductive health to certain requesters now require a signed attestation that the request is not for a prohibited purpose. Second, notice of privacy practices updates. Third — and most operationally difficult — segmentation: institutions must be able to identify reproductive-health records within the chart for traveling patients whose home jurisdiction may subpoena. The cohort found only 34% of modeled hospital systems had functional segmentation capability at the December 2024 compliance date; the remainder rely on manual review, which fails precisely under litigation pressure.
5.2Period Data, Apps, and the Surveillance Shadow
Consumer period-tracking applications sit outside HIPAA for most users, and their data stores have already appeared in at least one documented criminal proceeding. The surveillance shadow of Section 2.2 is substantially fueled by this exposure: beneficiaries reasonably infer that a tracked missed period could become evidence. Health systems cannot regulate consumer apps, but the cohort supports three mitigations within their control: documenting reproductive-history inquiries in ways that minimize unnecessary specificity; offering patients privacy counseling as part of intake in restrictive jurisdictions; and refusing voluntary disclosure absent valid, attested process. For athletics departments, the intersection is sharper: athlete wellness-monitoring data — sleep trackers, cycle monitoring marketed as performance tools — is simultaneously roster-relevant and subpoena-attractive, and should be governed under the highest privacy tier the institution operates.
5.3Roster Privacy, Conscientious Objection, and Structured Resolution
Three institutional conflicts recur in the cohort. First, roster conflicts: pregnancy-related treatment records visible to coaching staff beyond the waiver standard violate both Title IX expectations and, where HIPAA-covered, the minimum-necessary rule;12,13 the remediation is a hard confidentiality wall with access logging. Second, conscientious objection: individual clinicians' objection rights are real but institutionally bounded — the institution's duty is continuity, and modeled systems with objection registries plus guaranteed referral pathways show zero patient-abandonment events versus 2.1% in unmanaged systems. Third, interstate record conflicts: when a traveling patient's home-jurisdiction provider requests records, the 2024 rule's attestation requirements apply, and blanket release policies fail it. The report's resolution ladder — internal review, ethics consultation, external legal review at institution expense, published aggregate outcomes — mirrors Havellum's Volume I framework, with one addition: in reproductive care, every rung must run through privacy counsel before clinical records move.
The deepest ethical finding is again suppression — but this time of whole episodes of care. An estimated 9% of bleeding first-trimester presentations in ban states never reach evaluation because patients fear what the encounter could trigger. No denial statistic captures a visit that never happened. Institutions should treat care-seeking suppression as a measurable safety signal, and policymakers should recognize that the surveillance shadow costs lives quietly, in the prehospital space where no chart is ever written.
Ten recommendations follow, sequenced to deliver protection inside the current legal regime while the 2025–2028 litigation windows mapped in Figure 6 resolve. Each traces to a specific Section 4 finding.
Stand up standing exception protocols, not case-by-case waivers
Pre-authorize defined clinical scenarios (ectopic, septic miscarriage, PPROM with infection) through legal counsel in advance; the model raises exception-pipeline conversion from 34% toward 80% and shortens median intervention delay by days.
Implement record segmentation before the next subpoena
Functional reproductive-health segmentation, attestation workflows, and traveling-patient privacy counseling are the operative core of the 2024 HIPAA rule;9 manual review processes fail under litigation load.
Negotiate interstate corridor contracts with destination providers
Pre-negotiated referral, warm-handoff, and return-of-record protocols between restrictive- and protective-state systems convert Figure 2's northeast quadrant from improvisation into infrastructure.
Fund OB workforce retention in desert counties
Loan repayment, locum subsidies, and tele-maternal-fetal-medicine coverage target the modeled 15.4% attrition; March of Dimes desert designations should set eligibility.7
Offer travel benefits through self-funded ERISA designs in shield-state structures
Only 31% of modeled beneficiaries had any travel benefit; self-funded ERISA vehicles plus shield-state administration protect both employer and employee, and capture the $800 reimbursement effect shown in Figure 1.
Pair FMLA with paid-leave bridges around childbirth episodes
Unpaid bonding leave collides with newborn costs and cesarean recovery; bridge benefits targeted at the first twelve weeks materially improve post-surgical recovery adherence and return-to-work stability.11
Enforce Title IX / NCAA pregnancy accommodations with written scholarship guarantees
Written continuity guarantees, pregnancy/parenting accommodations, and appeal rights eliminate the 31% inconsistent-roster-decision rate modeled in student-athlete cases.13
Build confidentiality walls between athlete treatment records and roster decisions
Access logging, minimum-necessary gating, and trauma-informed clinical waivers for athletes with obstetric trauma histories address both the Title IX exposure and the surveillance-shadow dynamic.
Codify clinically legible exception standards and fund MMRC expansion
Exception language should be drafted with clinical societies to define "life" and "serious health risk" in obstetric terms; maternal mortality review committees need funding and authority to attribute deaths to care delay, including legal-delay pathways.5,6
Measure suppression, delay, and desert exposure as quality metrics
First-trimester care-seeking rates, decision-to-intervention times, and county-level desert status should sit in the same dashboard as infection rates — because in the post-Dobbs environment, they are quality metrics.
Three years after Dobbs, the evidence permits a plain statement: the fragmentation of reproductive law has produced measurable clinical harm, a new geography of care, a thinning obstetric workforce in precisely the regions with the worst baseline outcomes, and a privacy regime under active stress. Interstate travel absorbs some demand but exports cost onto the least insulated patients. Shield laws and the HIPAA reproductive rule are real protections, but they are contested fronts, not settled ground. IVF remains one appellate decision away from renewed disruption.
What institutions control, they should exercise now: standing exception protocols, record segmentation, corridor contracts, travel benefits, athlete privacy walls, and paid-leave bridges. Each recommendation in Section 6 operates inside existing authority and each returns measurable value in the cohort — fewer delayed interventions, fewer privacy breaches, fewer roster violations, fewer catastrophic episodes born of ordinary legal uncertainty. The institutions that treat jurisdiction as a clinical variable will be the ones whose adverse-event reviews stay short.
As always with Havellum modeling: these are synthetic estimates, calibrated and disclosed, offered to structure decisions rather than replace them. The patients are real. The clinicians working under felony exposure are real. The 2.2 million people living in maternity care deserts are real, and they were there before 2022 — the post-Dobbs economy has made their situation worse, and made it visible. The question this report poses to health systems, employers, and academic institutions is whether visibility will be followed by infrastructure. The recommendations above are that infrastructure, ready to build.
References (AMA Style)
- Dobbs v Jackson Women's Health Organization, 597 US 747 (2022).
- Guttmacher Institute. Monthly Abortion Provision Study: updated estimates of abortion incidence and interstate travel. Guttmacher Institute; 2024.
- Center for Reproductive Rights; Guttmacher Institute. State shield laws and telehealth protections: comparative statutory analysis. 2024.
- Jones RK, Witwer E, Maddow-Zimmers I, et al. Abortion provision and travel following Dobbs: quarterly estimates. Perspect Sex Reprod Health. 2024. Guttmacher Institute data series.
- Hoyert DL. Maternal mortality rates in the United States, 2021. National Center for Health Statistics Health E-Stat. CDC; 2023.
- Gemmill A, et al. Association of restrictive abortion legislation with maternal mortality in Texas. JAMA. 2024;332(21):1-9.
- March of Dimes. Nowhere to Go: Maternity Care Deserts Across the United States. March of Dimes; 2023.
- American College of Obstetricians and Gynecologists. Ectopic pregnancy and miscarriage management: clinical guidance and legal FAQ resource. ACOG; 2023-2024.
- HIPAA Privacy Rule to Support Reproductive Health Care Privacy, 89 Fed Reg 32976 (April 26, 2024) (codified at 45 CFR pts 160, 164).
- Pregnant Workers Fairness Act of 2022, 42 USC §2000gg et seq (effective June 27, 2023); EEOC implementing regulations, 29 CFR pt 1636 (2024).
- Family and Medical Leave Act of 1993, 29 USC §2601 et seq.
- Americans with Disabilities Act of 1990, as amended, 42 USC §12101 et seq.
- US Department of Education. Title IX and pregnancy/parenting accommodations, 20 USC §1681; National Collegiate Athletic Association. Pregnancy and parenting guidance for student-athletes. NCAA; 2023.
- LePage v Center for Reproductive Medicine, ___ So 3d ___ (Ala 2024); Ala Act No 2024-209 (provider immunity restoration).
- Centers for Disease Control and Prevention; Society for Assisted Reproductive Technology. 2021 Assisted Reproductive Technology Fertility Clinic and National Summary Report. CDC; 2023.
- Biggs MA, Upadhyay UD. Prescription and self-managed medication abortion: evolving provision shares. Perspect Sex Reprod Health. 2024.
- Upadhyay UD, Desai S, Zlidar V, et al. Distance to abortion facilities and travel burden after Dobbs. Am J Public Health. 2023;113(suppl).
- Dekel S, Ein-Dor T, Goldschmidt P, et al. Birth-related PTSD: prevalence and risk architecture in the postpartum period. J Affect Disord. 2021;283:122-131.
- American College of Obstetricians and Gynecologists. U.S. Medical Eligibility Criteria for Contraceptive Use adaptations: migraine and combined hormonal contraception. ACOG; 2023.
- Emergency Medical Treatment and Labor Act, 42 USC §1395dd; US Dept of Health & Human Services. Letter to health care providers re: EMTALA obligations (July 11, 2022); Idaho v United States, litigation series 2022-2024.
- KFF. Employer-provided travel benefits for reproductive care: findings from the Employer Health Benefits Survey. KFF; 2023.
- Roberts SCM, Biggs MA, Foster DG, et al. Turnaway Study: mental health and socioeconomic outcomes following denied abortion care. JAMA Psychiatry. 2022 series.
- Wallace M, Dyer L, Felker-Kantor E, et al. Maternity care workforce and desert formation: a longitudinal analysis. Health Aff (Millwood). 2022;41(10).
- Commonwealth Fund. The US maternal mortality crisis: international comparisons and policy options. Commonwealth Fund; 2023.