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Abortion has become more common despite bans or deep restrictions in most Republican-controlled states, and the legal and political fights over its future are not over yet.

It’s now been two and a half years since the U.S. Supreme Court overturned Roe v. Wade and opened the door for states to implement bans.

The policies and their impact have been in flux ever since the ruling in Dobbs v. Jackson Women’s Health Organization.

Here’s a look at data on where things stand:

Abortions are more common than before Dobbs

Overturning Roe and enforcing abortion bans has changed how woman obtain abortions in the United States.

One thing it hasn’t done is put a dent in the number of abortions being obtained.

There have been slightly more monthly abortions across the country recently than there were in the months leading up to the June 2022 ruling, even as the number in states with bans dropped to near zero.

“Abortion bans don’t actually prevent abortions from happening,” said Ushma Upadhyay, a public health social scientist at the University of California San Francisco.

For women in some states, there are major obstacles to getting abortions — and advocates say that low-income, minority and immigrant women are least likely to be able to get them when they want.

For those living in states with bans, the ways to access abortion are through travel or abortion pills.

Pills become bigger part of equation — and legal questions

As the bans happened, abortion pills became a bigger part of the equation.

They were involved in about half the abortions before Dobbs. More recently, it’s been closer to two-thirds of them, according to research by the Guttmacher Institute.

The uptick of that kind of abortion, usually involving a combination of two drugs, was underway before the ruling.

But now, it’s become more common for pill prescriptions to be made by telehealth. By the summer of 2024, about 1 in 10 abortions were via pills prescribed via telehealth to patients in states where abortion is banned.

As a result, the pills are now at the center of battles over abortion access.

This month, Texas sued a New York doctor for prescribing pills to a Texas woman via telemedicine. There’s also an effort by Idaho, Kansas and Missouri to roll back their federal approvals and treat them as “controlled dangerous substances,” and a push for the federal government to start enforcing a 19th-century federal law to ban mailing them.

Travel for abortion has increased

Clinics have closed or halted abortions in states with bans.

A network of efforts to get women seeking abortions to places where they’re legal has strengthened and travel for abortion is now common.

The Guttmacher Institute found that more than twice as many Texas residents obtained abortions in 2023 in New Mexico as New Mexico residents did. And as many Texans received them in Kansas as Kansans.

Abortion funds, which benefitted from “rage giving” in 2022, helped pay the costs for many abortion-seekers. But some funds have had to cap how much they can give.

The ban that took effect in Florida this year has been a game-changer

Florida, the nation’s third most-populous state, began on May 1 enforcing a ban on abortions after the first six weeks of pregnancy.

That immediately changed the state from one that was a refuge for other Southerners seeking abortions to an exporter of people looking for them.

There were about 30% fewer abortions there in May compared with the average for the first three months of the year. And in June, there were 35% fewer.

While the ban is not unique, the impact is especially large. The average driving time from Florida to a facility in North Carolina where abortion is available for the first 12 weeks of pregnancy is more than nine hours, according to data maintained by Caitlin Myers, a Middlebury College economics professor.

Clinics have opened or expanded in some places

The bans have meant clinics closed or stopped offering abortions in some states.

But some states where abortion remains legal until viability – generally considered to be sometime past 21 weeks of pregnancy — have seen clinics open and expand.

Illinois, Kansas and New Mexico are among the states with new clinics.

There were 799 publicly identifiable abortion providers in the U.S. in May 2022, the month before the Supreme Court reversed Roe v. Wade. And by this November, it was 792, according to a tally by Myers, who is collecting data on abortion providers.

Myers said some hospitals that always provided some abortions have begun advertising it. So, they’re now in the count of clinics – even though they might provide few of them.

Lack of access to abortions during emergencies threatens patients’ lives

How hospitals handle pregnancy complications, especially those that threaten the lives of the women, has emerged as a major issue since Roe was overturned.

President Joe Biden’s administration said hospitals must offer abortions when they’re needed to prevent organ loss, hemorrhage or deadly infections, even in states with bans. Texas is challenging the administration’s policy and the U.S. Supreme Court this year declined to take it up after the Biden administration sued Idaho.

More than 100 pregnant women seeking help in emergency rooms were turned away or left unstable since 2022, The Associated Press found in an analysis of federal hospital investigative records.

Among the complaints were a woman who miscarried in the lobby restroom of Texas emergency room after staff refused to see her and a woman who gave birth in a car after a North Carolina hospital couldn’t offer an ultrasound. The baby later died.

“It is increasingly less safe to be pregnant and seeking emergency care in an emergency department,” Dara Kass, an emergency medicine doctor and former U.S. Health and Human Services official told the AP earlier this year.
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BOGOTA, COLOMBIA — 2024 was a brutal year for the Amazon rainforest, with rampant wildfires and extreme drought ravaging large parts of a biome that’s a critical counterweight to climate change. 

A warming climate fed drought that in turn fed the worst year for fires since 2005. And those fires contributed to deforestation, with authorities suspecting some fires were set to more easily clear land to run cattle. 

The Amazon is twice the size of India and sprawls across eight countries and one territory, storing vast amounts of carbon dioxide that would otherwise warm the planet. It has about 20% of the world’s fresh water and astounding biodiversity, including 16,000 known tree species. But governments have historically viewed it as an area to be exploited, with little regard for sustainability or the rights of its Indigenous peoples, and experts say exploitation by individuals and organized crime is rising at alarming rates. 

“The fires and drought experienced in 2024 across the Amazon rainforest could be ominous indicators that we are reaching the long-feared ecological tipping point,” said Andrew Miller, advocacy director at Amazon Watch, an organization that works to protect the rainforest. “Humanity’s window of opportunity to reverse this trend is shrinking, but still open.” 

There were some bright spots. The level of Amazonian forest loss fell in both Brazil and Colombia. And nations gathered for the annual United Nations conference on biodiversity agreed to give Indigenous peoples more say in nature conservation decisions. 

“If the Amazon rainforest is to avoid the tipping point, Indigenous people will have been a determinant factor,” Miller said. 

Wildfires and extreme drought 

 

Forest loss in Brazil’s Amazon — home to the largest swath of this rainforest — dropped 30.6% compared to the previous year, the lowest level of destruction in nine years. The improvement under leftist President Luiz Inacio Lula da Silva contrasted with deforestation that hit a 15-year high under Lula’s predecessor, far-right leader Jair Bolsonaro, who prioritized agribusiness expansion over forest protection and weakened environmental agencies. 

In July, Colombia reported historic lows in deforestation in 2023, driven by a drop in environmental destruction. The country’s environment minister, Susana Muhamad, warned that 2024’s figures may not be as promising because a significant rise in deforestation had already been recorded by July due to dry weather caused by El Nino, a weather phenomenon that warms the central Pacific. Illegal economies continue to drive deforestation in the Andean nation. 

“It’s impossible to overlook the threat posed by organized crime and the economies they control to Amazon conservation,” said Bram Ebus, a consultant for Crisis Group in Latin America. “Illegal gold mining is expanding rapidly, driven by soaring global prices, and the revenues of illicit economies often surpass state budgets allocated to combat them.” 

In Brazil, large swaths of the rainforest were draped in smoke in August from fires raging across the Amazon, Cerrado savannah, Pantanal wetland and the state of Sao Paulo. Fires are traditionally used for deforestation and for managing pastures, and those man-made blazes were largely responsible for igniting the wildfires. 

For a second year, the Amazon River fell to desperate lows, leading some countries to declare a state of emergency and distribute food and water to struggling residents. The situation was most critical in Brazil, where one of the Amazon River’s main tributaries dropped to its lowest level ever recorded. 

Cesar Ipenza, an environmental lawyer who lives in the heart of the Peruvian Amazon, said he believes people are becoming increasingly aware of the Amazon’s fundamental role “for the survival of society as a whole.” But, like Miller, he worries about a “point of no return of Amazon destruction.” 

It was the worst year for Amazon fires since 2005, according to nonprofit Rainforest Foundation U.S.  Between January and October, an area larger than the state of Iowa — about 15.1 million hectares of Brazil’s Amazon — burned. Bolivia had a record number of fires in the first 10 months of the year. 

“Forest fires have become a constant, especially in the summer months and require particular attention from the authorities who don’t how to deal with or respond to them,” Ipenza said. 

Venezuela, Colombia, Ecuador, and Guyana also saw a surge in fires this year. 

Indigenous voices, rights made headway 

The United Nations conference on biodiversity — this year known as COP16 — was hosted by Colombia. The meetings put the Amazon in the spotlight and a historic agreement was made to give Indigenous groups more of a voice on nature conservation decisions, a development that builds on a growing movement to recognize Indigenous people’s role in protecting land and combating climate change. 

Both Ebus and Miller saw promise in the appointment of Martin von Hildebrand as the new secretary general for the Amazon Treaty Cooperation Organization, announced during COP16. 

“As an expert on Amazon communities, he will need to align governments for joint conservation efforts. If the political will is there, international backers will step forward to finance new strategies to protect the world’s largest tropical rainforest,” Ebus said. 

Ebus said Amazon countries need to cooperate more, whether in law enforcement, deploying joint emergency teams to combat forest fires, or providing health care in remote Amazon borderlands. But they need help from the wider world, he said. 

“The well-being of the Amazon is a shared global responsibility, as consumer demand worldwide fuels the trade in commodities that finance violence and environmental destruction,” he said. 

Next year marks a critical moment for the Amazon, as Belem do Para in northern Brazil hosts the first United Nations COP in the region that will focus on climate. 

“Leaders from Amazon countries have a chance to showcase strategies and demand tangible support,” Ebus said. 
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As Russia’s war against Ukraine enters its third year, centers focused on soldiers’ rehabilitation and mental health are appearing across Ukraine. An active serviceman started one such place in his native village in the Carpathian Mountains. Omelyan Oshchudlyak has the story. Videographer and video editor: Yuriy Dankevych
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A different approach to energy is at the center of President-elect Donald Trump’s promise to bring down the cost of living for Americans. But as VOA’s Congressional Correspondent Katherine Gypson reports, Trump’s plans could be complicated by a complex global interdependence on oil and gas supplies.
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WASHINGTON — Changes are coming to the cold and cough aisle of your local pharmacy: U.S. officials are moving to phase out the leading decongestant found in hundreds of over-the-counter medicines, concluding that it doesn’t actually relieve nasal congestion.

Phenylephrine is used in popular versions of Sudafed, Dayquil and other medications, but experts have long questioned its effectiveness. Last month the Food and Drug Administration formally proposed revoking its use in pills and liquid solutions, kicking off a process that’s likely to force drugmakers to remove or reformulate products.

It’s a win for skeptical academics, including researchers at the University of Florida who petitioned the FDA to revisit the drug’s use in 2007 and again in 2015. For consumers it will likely mean switching to alternatives, including an older decongestant that was moved behind the pharmacy counter nearly 20 years ago.

Doctors say Americans will be better off without phenylephrine, which is often combined with other medicines to treat cold, flu, fever and allergies.

“People walk into the drugstore today and see 55,000 medicines on the shelf and they pick one that is definitely not going to work,” said Dr. Brian Schroer of the Cleveland Clinic. “You take away that option and it will be easier for them to self-direct toward products that really will help them.”

Why is FDA doing this now?

The FDA decision was expected after federal advisers last year voted unanimously that oral phenylephrine medications haven’t been shown to relieve congestion.

Experts reviewed several recent, large studies indicating that phenylephrine was no better than a placebo at clearing nasal passageways. They also revisited studies from the 1960s and 1970s that supported the drug’s initial use, finding numerous flaws and questionable data.

The panel’s opinion only applied to phenylephrine in oral medications, which account for roughly $1.8 billion in annual U.S. sales. The drug is still considered effective in nasal sprays, though those are much less popular.

Phenylephrine wasn’t always the top choice for cold and allergy products. Many were originally formulated with a different drug, pseudoephedrine.

But a 2006 law required pharmacies to move pseudoephedrine products behind the counter, citing their potential to be processed into methamphetamine. Companies such as Johnson & Johnson and Bayer decided to reformulate their products to keep them readily available on store shelves — and labeled many of them as “PE” versions of familiar brand names.

What are some alternatives for congestion?

Consumers who still want to take pills or syrups for relief will probably need to head to the pharmacy counter — where the pseudoephedrine-containing versions of Sudafed, Claritin D and other products remain available without a prescription. Purchasers need to provide a photo ID.

Beyond those products, most of the other options are over-the-counter nasal sprays or solutions.

Saline drops and rinses are a quick way to clear mucus from the nose. For long-term relief from seasonal stuffiness, itching and sneezing, many doctors recommend nasal steroids, sold as Flonase, Nasacort and Rhinocort.

“These medicines are by far the most effective daily treatment for nasal congestion and stuffiness,” Schroer said. “The biggest issue is they’re not great when used on an as-needed basis.”

Nasal steroids generally have to be used daily to be highly effective. For short-term relief, patients can try antihistamine sprays, such as Astepro, which are faster acting.

Phenylephrine-based sprays will also remain on pharmacy shelves.

Why doesn’t phenylephrine work when taken by mouth?

The experts who challenged the drug’s effectiveness say it’s quickly broken down and rendered ineffective when it hits the stomach.

“This is a good drug, but not when it’s swallowed,” said Leslie Hendeles, professor emeritus at the University of Florida’s College of Pharmacy, where he co-authored several papers on the ingredient. “It’s inactivated in the gut and doesn’t get into the bloodstream, so it can’t get to the nose.”

When Hendeles and his colleagues first petitioned the FDA on phenylephrine, they suggested a higher dose might be effective. But subsequent studies showed that even doses 400% higher than those currently recommended don’t treat stuffiness.

The FDA and other researchers concluded that pushing the dosage even higher might carry safety risks.

“If you’re using very high doses, the risk is raising blood pressure so high that it could be hazardous to patients,” said Randy Hatton, a University of Florida professor who co-led the research on phenylephrine.

Because of its cardiovascular effects, the drug is sometimes used to treat dangerously low blood pressure during surgery, Hatton noted.

What happens next?

Oral phenylephrine medicines will still be with us for a while.

Government regulators must follow a public, multistep process to remove the ingredient from FDA’s list of drugs approved for over-the-counter decongestants.

For six months, the FDA must take comments on its proposal, including from consumers and companies. Then, the FDA must review the feedback before writing a final order. Even after that decision is finalized, companies will likely have a year or more to remove or reformulate products.

Drugmakers could further delay the process by requesting additional FDA hearings.

For now, the Consumer Healthcare Products Association — which represents medicine makers — wants the products to stay available, saying Americans deserve “the option to choose the products they prefer for self-care.”

Hatton says he and his colleagues disagree: “Our position is that choosing from something that doesn’t work isn’t really a choice.” 
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A genetic analysis suggests the bird flu virus mutated inside a Louisiana patient who contracted the nation’s first severe case of the illness, the U.S. Centers for Disease Control and Prevention said this week.

Scientists believe the mutations may allow the virus to better bind to receptors in the upper airways of humans — something they say is concerning but not a cause for alarm.

Michael Osterholm, a University of Minnesota infectious-disease researcher, likened this binding interaction to a lock and key. To enter a cell, the virus needs to have a key that turns the lock, and this finding means the virus may be changing to have a key that might work.

“Is this an indication that we may be closer to seeing a readily transmitted virus between people? No,” Osterholm said. “Right now, this is a key that sits in the lock, but it doesn’t open the door.”

The virus has been causing sporadic, mostly mild illnesses in people in the United States; nearly all of those infected worked on dairy or poultry farms.

The patient in the U.S. state of Louisiana was hospitalized in critical condition with severe respiratory symptoms from bird flu after coming in contact with sick and dead birds in a backyard flock. The person, who has not been identified, is older than 65 and has underlying medical problems, officials said earlier this month.

The CDC stressed there has been no known transmission of the virus from the Louisiana patient to anyone else. The agency said its findings about the mutations were “concerning,” but the risk to the general public from the outbreak “has not changed and remains low.”

Still, Osterholm said, scientists should continue to follow what’s happening with mutations carefully.

“There will be additional influenza pandemics, and they could be much worse than we saw with COVID,” he said. “We know that the pandemic clock is ticking. We just don’t know what time it is.”
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Health care organizations may be required to bolster their cybersecurity to better prevent sensitive information from being leaked by cyberattacks like the ones that hit Ascension and UnitedHealth, a senior White House official said Friday.

Anne Neuberger, the U.S. deputy national security adviser for cyber and emerging technology, told reporters that proposed requirements are necessary in light of the massive number of Americans whose data has been affected by large breaches of health care information. The proposals include encrypting data so it cannot be accessed, even if leaked, and requiring compliance checks to ensure networks meet cybersecurity rules.

The full proposed rule was posted to the Federal Register on Friday, and the Department of Health and Human Services posted a more condensed breakdown on its website.

She said that the health care information of more than 167 million people was affected in 2023 as a result of cybersecurity incidents.

The proposed rule from the Office for Civil Rights (OCR) within HHS would update standards under the Health Insurance Portability and Accountability Act and would cost an estimated $9 billion in the first year, and $6 billion in years two through five, Neuberger said.

“We’ve made some significant proposals that we think will improve cybersecurity and ultimately everyone’s health information, if any of these proposals are ultimately finalized,” an OCR spokesperson told Reuters late Friday. The next step in the process is a 60-day public comment period before any final decisions will be made.

Large health care breaches caused by hacking and ransomware have increased by 89% and 102%, respectively, since 2019, Neuberger said.

“In this job, one of the most concerning and really troubling things we deal with is hacking of hospitals, hacking of health care data,” she said.

Hospitals have been forced to operate manually and Americans’ sensitive health care data, mental health information and other information are “being leaked on the dark web with the opportunity to blackmail individuals,” Neuberger said.
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washington — Cosmetics companies would have to take extra steps to ensure that any products containing talc are free of asbestos under a federal rule proposed Thursday.

The proposal from the Food and Drug Administration and mandated by Congress is intended to reassure consumers about the safety of makeup, baby powder and other personal care products.

It follows years of lawsuits against Johnson & Johnson and other companies alleging links between talc-based baby powder and cancer.

Despite the lawsuits, research has found mixed evidence of a potential link between cancer and talc, although the possibility has been recognized for decades because of how it is mined.

Talc is a mineral used to absorb moisture or improve the texture, feel and color of cosmetics. It is mined from underground deposits that are sometimes located near the toxic mineral asbestos. The risk of cross contamination has long been recognized by cosmetic companies.

But recent FDA-sponsored testing hasn’t uncovered any safety issues. Since 2021, laboratory analysis of more than 150 cosmetics samples has come back negative for asbestos, according to the FDA.

Still, concerns about the risk prompted Congress to pass a 2023 law requiring the FDA to release new industry standards for asbestos testing.

Dr. Linda Katz, director of the FDA’s Office of Cosmetics and Colors, said in a statement that the agency has “carefully considered the scientific evidence and complex policy issues related to detecting and identifying asbestos in talc and talc-containing cosmetic products.”

“We believe that the proposed testing techniques are appropriate methods to detect asbestos to help ensure the safety of talc-containing cosmetic products,” Katz said.

The long-running litigation against J&J alleges that the company’s talc baby powder caused women to develop ovarian cancer, when used for feminine hygiene.

A J&J subsidiary has proposed paying roughly $8 billion to settle tens of thousands of lawsuits. As part of the deal, the subsidiary would declare bankruptcy, although that proposal has been challenged in court by the Justice Department.

J&J removed talc from its baby powder in the U.S. market in 2020 and then internationally in 2023. The company says it continues to stand by the safety of its products.

Determining the root cause of cancer is difficult, especially in cases of ovarian cancer, which is a relatively rare form of the disease. Even large studies in thousands of women might not gather enough data to show a clear connection or definitively rule one out. The American Cancer Society says that if there is an increased risk of cancer due to talc, “it is likely to be very small.”
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The U.S. Centers for Disease Control and Prevention said on Thursday its analysis of samples from the first severe case of bird flu in the country last week showed mutations not seen in samples from an infected backyard flock on the patient’s property.

The CDC said the patient’s sample showed mutations in the hemagglutinin (HA) gene, the part of the virus that plays a key role in it attaching to host cells.

The health body said the risk to the public from the outbreak has not changed and remains low.

Last week, the United States reported its first severe case of the virus, in a Louisiana resident above the age of 65, who was suffering from severe respiratory illness.

The patient was infected with the D1.1 genotype of the virus that was recently detected in wild birds and poultry in the United States, and not the B3.13 genotype detected in dairy cows, human cases and some poultry in multiple states.

The mutations seen in the patient are rare but have been reported in some cases in other countries and most often during severe infections. One of the mutations was also seen in another severe case from British Columbia, Canada.

No transmission from the patient in Louisiana to other persons has been identified, the CDC said. 
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London — King Charles thanked the medics who have cared for him and his daughter-in-law Kate, after they both underwent treatment for cancer this year, in a Christmas Day message that touched on global conflicts and the summer’s riots in Britain.

In his third Christmas TV broadcast since becoming king, Charles struck an unusually personal tone for the royal seasonal message, a tradition that dates back to a radio speech by George V in 1932.

The year has been traumatic for the royals after Buckingham Palace said in February the 76-year-old had been diagnosed with an unspecified form of cancer detected in tests after a corrective procedure for an enlarged prostate.

A month later, Kate, the wife of his son and heir Prince William, said she was undergoing preventative chemotherapy for cancer that concluded in September. William has said the year has been brutal for the family.

“All of us go through some form of suffering at some stage in our life, be it mental or physical,” Charles, who became king in 2022 after the death of Queen Elizabeth, said.

His words were accompanied by footage of a visit he made to a cancer treatment center on returning to public duties in April and of one of Kate’s first engagements when she resumed working.

“From a personal point of view, I offer special heartfelt thanks to the selfless doctors and nurses who this year have supported me and other members of my family through the uncertainties and anxieties of illness, and have helped provide the strength, care and comfort we have needed,” Charles said.

“I am deeply grateful too to all those who have offered us their own kind words of sympathy and encouragement,” he said in the pre-recorded broadcast that was filmed at an ornate chapel of a former London hospital.

Last week, a palace source said the king’s treatment was progressing well and would continue into next year.

Earlier on Wednesday, Charles was joined by his family, including Kate, William and their children, for a traditional church service on his Sandringham estate in eastern England.

Charles’ brother Prince Andrew, who was embroiled in another scandal this month when a close business associate was banned from Britain over government suspicions he was a Chinese agent, was a notable absentee from the royal get-together.

Diversity a strength

The king spoke about nationwide riots, which broke out following the murder in July of three girls at a Taylor Swift-themed event in northern England, and mainly targeted mosques and immigrants.

“Diversity of culture, ethnicity and faith provide strength, not weakness”, he said.

“I felt a deep sense of pride here in the United Kingdom when in response to anger and lawlessness in several towns this summer, communities came together not to repeat these behaviors, but to repair, to repair not just buildings, but relationships,” he said.

Charles also referenced ongoing wars.

“On this Christmas Day, we cannot help but think of those for whom the devastating effects of conflict in the Middle East, in central Europe, in Africa and elsewhere, pose a daily threat to so many people’s lives and livelihoods,” he said.
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