Republicans in Congress are poised to try to force all 50 states to report on abortions and miscarriages in ways never required before.
This article was produced in collaboration with The Fuller Project, a journalism nonprofit that reports on global issues affecting women.
Dr. Nisha Verma wants her patients to know that they don’t have to tell any doctor that they have ever had an abortion. She wants them to know that no doctor can tell the difference between a natural miscarriage and one caused by medication, and she wants her patients to know that they don’t have to report what’s causing their bleeding if, for some reason, they visit an emergency room for care.
Verma, who is senior adviser on reproductive health policy and advocacy for the American College of Obstetricians and Gynecologists, said the Supreme Court’s 2022 decision to overturn Roe v. Wade has made women scared to seek reproductive care. November’s election results could make matters profoundly more serious. So it’s OK for women to protect their medical information from a threat of increased government surveillance, she said in an interview.
“I think there is a lot of fear about things getting much, much worse,” said Verma.
That’s because conservatives in Congress are poised to try to force all 50 states to report on abortions and miscarriages in ways never required before.
Surveillance is currently voluntary and kept carefully anonymous. But pending legislation and a conservative roadmap known as Project 2025 could change that if Republicans win control of the White House and Congress.
“There would be a monitor, monitoring your abortions and miscarriages,” Vice President Kamala Harris, the Democratic nominee for president, said during a debate with former president Donald Trump, the Republican nominee, this month.
Trump has boasted that he is responsible for overturning the constitutional right to abortion because he nominated three Supreme Court justices who made the ruling possible. His pledge to select justices who opposed abortion rights helped him win over evangelicals and other conservatives in 2016.
“Viewed in the context of a profound anti-abortion agenda, there are just many implications, reasons to be concerned about privacy,” said Dr. Joshua Sharfstein, vice dean and professor at the Bloomberg School of Public Health at Johns Hopkins University.
The Project 2025 policy roadmap lays out how, in a second Trump administration, the Department of Health and Human Services (HHS) could use billions of dollars in federal funding to control “liberal” states that try to preserve reproductive rights. One goal of the blueprint, drafted by the conservative Heritage Foundation and other groups with input from former Trump administration officials, is to stop states that protect abortion access from serving women from states that don’t.
“Because liberal states have now become sanctuaries for abortion tourism, HHS should use every available tool, including the cutting of funds, to ensure that every state reports exactly how many abortions take place within its borders, at what gestational age of the child, for what reason, the mother’s state of residence, and by what method,” Project 2025 reads.
The language echoes the Republican-sponsored “Ensuring Accurate and Complete Abortion Data Reporting Act of 2023,” introduced in the Senate by Joni Ernst of Iowa (and whose co-sponsors include vice-presidential nominee JD Vance) and in the House by Ralph Norman of South Carolina.
“Every single life is precious. Yet right now, only a handful of states record abortion data in a comprehensive and verifiably accurate way, including tragic cases where babies are born alive during abortions,” Ernst said in a statement when she introduced the bill. Like other abortion rights opponents, Ernst says she believes that too many abortions occur after a fetus is viable and her bill is a way to demonstrate that.
While the Senate version of the bill was stopped early by the razor-thin Democratic majority, Norman’s version was introduced to the full House, although it has not moved beyond a subcommittee.
Whether the legislation becomes law hinges on the November election, said Alina Salganicoff, senior vice president and director for women’s health policy at KFF, a nonpartisan health policy research organization. “So much is really going to be shaped by what happens in the House and Senate—not only who gets the majority, but how strong of a majority they have,” she said.
“You don’t even need to enforce the policy to make the policy have an impact,” she added, because there is a “very, very potent impact of the chilling effect and fear on individuals and clinicians and the institutions in which they work.”
Salganicoff said the fear already is palpable in states that have passed stricter abortion laws, which also can limit care for women experiencing miscarriages or stillbirths. “You can see what’s happening with clinicians unwilling to do miscarriage management,” Salganicoff said. Even with women whose pregnancies are clearly not viable, “we are seeing that clinicians are afraid, and this is impacting how they are providing care.”
Verma, who until recently was a practicing ob/gyn in Atlanta, said she has seen that happening. Georgia law bans abortion after six weeks of pregnancy. Lawmakers there have made it a felony for medical professionals to perform some procedures used not only in abortions, but in miscarriages. A recent investigation by ProPublica concluded that at least two women have died as a result.
“I think there is a breakdown in the trust between physicians and their patients that we are seeing in this legal environment. Patients are scared. Doctors are scared. Patients don’t feel the healthcare system is keeping them safe,” Verma said.
Already, she said, Republican-led states like Georgia have added reporting requirements for doctors who provide reproductive care. “It is burdensome. It introduces fear. I just dread providing it,” Verma said. Georgia’s new “termination of pregnancy” form asks medically irrelevant questions such as the specific start and end dates of every pregnancy a patient has ever had, she said. The proposed new federal legislation would place similar requirements on all 50 states.
“There’s fear about where this is all going. It’s not information the government needs,” Verma said.
Currently, the information goes into each patient’s medical chart. That, of course, has all the patient’s personal data. The Georgia Department of Public Health says that while doctors are required to report all abortions to the state, names are not used. Currently, data that is voluntarily reported by states to the U.S. Centers for Disease Control and Prevention is stripped of details that would identify a patient.
But that doesn’t mean they never could come out, Verma noted. While the Health Insurance Portability and Accountability Act of 1996—widely known as HIPAA—protects medical privacy, courts can subpoena private medical records for criminal prosecutions. Verma’s organization is working with the American Medical Association to tighten protections of medical records.
“I find myself discussing legal risks with patients more often. There are absolutely legal risks,” she said.
In 2022, prosecutors in Nebraska demanded and obtained Facebook messages between a mother and daughter and used them to convict both in connection with the daughter’s abortion.
That’s why Verma wants patients to know that what they don’t tell their doctors won’t go into their medical records. And what doesn’t go into their medical records cannot be tracked by the government.The discretion might be needed even if Harris wins. The makeup of the Supreme Court won’t change unless a justice retires or dies, and states with abortion bans or tough restrictions will continue to fight for medical records—even across state borders. This month, Texas Attorney General Ken Paxton, a Republican, sued the Biden administration to try to block a new rule protecting the medical records of those crossing state lines for abortions. In 2023 the attorneys general of 18 states joined Texas in opposing the rule.
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