More than two years since the overturn of Roe v Wade, legal battles over abortion laws are as chaotic as ever. But occasionally, the challenges playing out state by state result in a string of good news for abortion rights. That was the case this week, with a cluster of court decisions that will expand abortion access in Nevada and North Dakota, and allow Missouri and Nebraska voters to weigh in on the issue in November.

On Thursday, District Court Judge Bruce Romanick in Bismarck, North Dakota, issued a powerful opinion siding with abortion providers who challenged a state law that had deemed their practice a felony.

In his order, which takes effect in two weeks, Rominick ruled that the North Dakota constitution’s protections for life, liberty, and the right to pursue happiness include the right to choose abortion. “A woman’s choice of whether or not to carry a pregnancy to term shapes the very nature and future course of her life, on nearly every possible level,” he wrote. “The Court finds that such a choice, at least pre-viability, must belong to the individual woman and not to the government.” He also struck down the ban for its vagueness, concluding that, at present, North Dakota doctors could be prosecuted if other physicians second-guessed their decision to provide an emergency abortion.

Virtually all abortions have been illegal in North Dakota since April 2023, when Republican Gov. Doug Burgum signed a ban with exceptions only to save the life of the pregnant person, or for rape and incest survivors within the first six weeks of pregnancy. North Dakota’s only abortion clinic moved across the state line to Minnesota in 2022, soon after the Supreme Court overturned Roe v. Wade, meaning most people seeking to end a pregnancy will have to leave the state.

But Romnick’s decision should make it easier for doctors to provide emergency abortions to patients with severe pregnancy complications—care that that is often withheld in abortion-ban states, with dire consequences. “It is now much safer to be pregnant in North Dakota,” Center for Reproductive Rights lawyer Meetra Mehdizadeh said in a statement on Friday.

Also on Thursday, a Nevada court order requiring the state Medicaid program to cover abortion became final after the state government declined to appeal an earlier ruling. Nevada will become the 18th state to allow Medicaid funds to cover abortion, the Associated Press reported.

That ruling is the result of a challenge brought under Nevada’s Equal Rights Amendment, which added language banning sex discrimination, along with many other types of discrimination, to the state constitution. Voters there supported the ERA by a nearly 18-point margin in 2022.

In their lawsuit, a Nevada abortion fund and the ACLU argued that the ban on Medicaid coverage amounted to sex discrimination because it denied low-income Nevadans who can become pregnant the ability to make decisions about their future. Back in March, a Clark County District Judge Erika Ballou had agreed—though her decision didn’t become final until this week.

”There was a time when we got it wrong and when women did not have a voice,” one judge wrote. “This does not need to continue for all time.”

“The court made clear that the state cannot withhold coverage for essential, sex-linked health care from low-income Nevadans,” ACLU Reproductive Freedom Project staff attorney Rebecca Chan explained in a statement. “As a result of this decision, Nevadans who have Medicaid as their health insurance will no longer need to fear that they will be forced to carry a pregnancy against their will.”

In November, voters in New York will decide whether to enshrine an ERA of their own—one of 10 states with abortion-related initiatives slated for the 2024 ballot. Yet initiatives in two of those states were in jeopardy until courts came to their rescue this week. On Tuesday, the Missouri Supreme Court threw out a last-minute claim arguing that the text of an abortion-rights initiative petition had omitted details required by state law; it ordered the anti-abortion secretary of state to certify the initiative for the ballot.

On Friday, the Nebraska Supreme Court ruled that dueling initiatives can appear on the ballot in that state, where current law bans abortion after 12 weeks. One of the initiatives, titled “Protect the Right to Abortion,” would create a state constitutional right for Nebraskans to get an abortion prior to “viability” (the hard-to-pinpoint moment in pregnancy when a fetus is able to survive outside the uterus). The other, titled “Protect Women and Children” would enshrine the current 12-week abortion ban in the state constitution.

If both pass, the one with the most votes prevails. But anti-abortion advocates had tried to kill the pro-abortion rights measure altogether by arguing that by regulating abortion before and after viability differently, it dealt with more than one subject, according to the Nebraska Examiner. Friday’s state Supreme Court ruling tossed that challenge, and ensures the vote on both questions will proceed.

Now, with 52 days left before voters will decide whether to add abortion protections to their state constitutions, the opinion from North Dakota’s Judge Rominick could offer some guidance.

“If we can learn anything from examining the history and prior traditions surrounding women’s rights, women’s health, and abortion in North Dakota, the Court hopes that we would learn this: that there was a time when we got it wrong and when women did not have a voice,” Rominick wrote. “This does not need to continue for all time, and the sentiments of the past, alone, need not rule the present for all time.”

More than two years since the overturn of Roe v Wade, legal battles over abortion laws are as chaotic as ever. But occasionally, the challenges playing out state by state result in a string of good news for abortion rights. That was the case this week, with a cluster of court decisions that will expand abortion access in Nevada and North Dakota, and allow Missouri and Nebraska voters to weigh in on the issue in November.

On Thursday, District Court Judge Bruce Romanick in Bismarck, North Dakota, issued a powerful opinion siding with abortion providers who challenged a state law that had deemed their practice a felony.

In his order, which takes effect in two weeks, Rominick ruled that the North Dakota constitution’s protections for life, liberty, and the right to pursue happiness include the right to choose abortion. “A woman’s choice of whether or not to carry a pregnancy to term shapes the very nature and future course of her life, on nearly every possible level,” he wrote. “The Court finds that such a choice, at least pre-viability, must belong to the individual woman and not to the government.” He also struck down the ban for its vagueness, concluding that, at present, North Dakota doctors could be prosecuted if other physicians second-guessed their decision to provide an emergency abortion.

Virtually all abortions have been illegal in North Dakota since April 2023, when Republican Gov. Doug Burgum signed a ban with exceptions only to save the life of the pregnant person, or for rape and incest survivors within the first six weeks of pregnancy. North Dakota’s only abortion clinic moved across the state line to Minnesota in 2022, soon after the Supreme Court overturned Roe v. Wade, meaning most people seeking to end a pregnancy will have to leave the state.

But Romnick’s decision should make it easier for doctors to provide emergency abortions to patients with severe pregnancy complications—care that that is often withheld in abortion-ban states, with dire consequences. “It is now much safer to be pregnant in North Dakota,” Center for Reproductive Rights lawyer Meetra Mehdizadeh said in a statement on Friday.

Also on Thursday, a Nevada court order requiring the state Medicaid program to cover abortion became final after the state government declined to appeal an earlier ruling. Nevada will become the 18th state to allow Medicaid funds to cover abortion, the Associated Press reported.

That ruling is the result of a challenge brought under Nevada’s Equal Rights Amendment, which added language banning sex discrimination, along with many other types of discrimination, to the state constitution. Voters there supported the ERA by a nearly 18-point margin in 2022.

In their lawsuit, a Nevada abortion fund and the ACLU argued that the ban on Medicaid coverage amounted to sex discrimination because it denied low-income Nevadans who can become pregnant the ability to make decisions about their future. Back in March, a Clark County District Judge Erika Ballou had agreed—though her decision didn’t become final until this week.

”There was a time when we got it wrong and when women did not have a voice,” one judge wrote. “This does not need to continue for all time.”

“The court made clear that the state cannot withhold coverage for essential, sex-linked health care from low-income Nevadans,” ACLU Reproductive Freedom Project staff attorney Rebecca Chan explained in a statement. “As a result of this decision, Nevadans who have Medicaid as their health insurance will no longer need to fear that they will be forced to carry a pregnancy against their will.”

In November, voters in New York will decide whether to enshrine an ERA of their own—one of 10 states with abortion-related initiatives slated for the 2024 ballot. Yet initiatives in two of those states were in jeopardy until courts came to their rescue this week. On Tuesday, the Missouri Supreme Court threw out a last-minute claim arguing that the text of an abortion-rights initiative petition had omitted details required by state law; it ordered the anti-abortion secretary of state to certify the initiative for the ballot.

On Friday, the Nebraska Supreme Court ruled that dueling initiatives can appear on the ballot in that state, where current law bans abortion after 12 weeks. One of the initiatives, titled “Protect the Right to Abortion,” would create a state constitutional right for Nebraskans to get an abortion prior to “viability” (the hard-to-pinpoint moment in pregnancy when a fetus is able to survive outside the uterus). The other, titled “Protect Women and Children” would enshrine the current 12-week abortion ban in the state constitution.

If both pass, the one with the most votes prevails. But anti-abortion advocates had tried to kill the pro-abortion rights measure altogether by arguing that by regulating abortion before and after viability differently, it dealt with more than one subject, according to the Nebraska Examiner. Friday’s state Supreme Court ruling tossed that challenge, and ensures the vote on both questions will proceed.

Now, with 52 days left before voters will decide whether to add abortion protections to their state constitutions, the opinion from North Dakota’s Judge Rominick could offer some guidance.

“If we can learn anything from examining the history and prior traditions surrounding women’s rights, women’s health, and abortion in North Dakota, the Court hopes that we would learn this: that there was a time when we got it wrong and when women did not have a voice,” Rominick wrote. “This does not need to continue for all time, and the sentiments of the past, alone, need not rule the present for all time.”

Reproductive rights advocates in Missouri have beaten back a last-ditch effort by Republican officials to stop voters from having their say on abortion in November. On Tuesday afternoon, the Missouri Supreme Court ordered that a proposed amendment to enshrine abortion rights in the state constitution will remain on this year’s ballot.

The ruling ensures that Missourians will have the opportunity to vote on Amendment 3, which would establish a right to “reproductive freedom”—defined as the ability to make and carry out one’s own decisions about contraception, abortion, and healthcare during pregnancy. If approved, the amendment will set a high legal bar for how the state can regulate abortion prior to “viability”—the difficult-to-pinpoint moment when a fetus becomes likely to survive outside the uterus. After viability, the measure would let the state ban abortion, with exceptions to protect the life and health of the pregnant patient.

The decision caps a roller-coaster of a year for Missouri reproductive-rights advocates, who faced hurdle after hurdle to get the measure on the November ballot. Supporters gathered more than 380,000 signatures this spring, circumventing a legislature dominated by hard-line abortion foes who passed the state’s current, near-total abortion ban. A St. Louis University/YouGov poll of 900 likely voters in mid-August found that 52 percent supported Amendment 3 and 34 percent opposed it.

“Today’s decision is a victory for both direct democracy and reproductive freedom in Missouri,” Rachel Sweet, campaign manager for Missourians for Constitutional Freedom, the group behind the amendment, said in a statement. “This fight was not just about this amendment—it was about defending the integrity of the initiative petition process and ensuring that Missourians can shape their future directly.”

Ballot initiatives have become a central part of the strategy to restore and expand abortion rights in the post-Roe v. Wade era. They’re also key to Democrats’ efforts to turn out voters in battleground states in this year’s tight presidential election. Abortion rights are popular, even in solidly red states; the pro-choice side has won all seven abortion-related measures on state ballots since 2022.

That’s led Republican officials in GOP-dominated states including Arkansas, Florida, and Nebraska to pull out all the stops this year to prevent abortion-rights measures from getting to the ballot in the first place—filing lawsuits, delaying or invalidating petitions, and spreading misinformation.

In Missouri, Tuesday’s ruling comes in response to a last-minute lawsuit by two Republican state lawmakers, Rep. Hannah Kelly and Sen. Mary Elizabeth Coleman, working with anti-abortion activists and lawyers from the Thomas More Society, a law firm aligned with conservative Catholics. They argued that Missouri Secretary of State Jay Ashcroft should never have certified Amendment 3 because it did not specify which state laws it would repeal. (Missouri law requires initiative petitions to “include all sections of existing law or of the constitution which would be repealed by the measure.”) In a court filing, they claimed that the Amendment 3 campaign “defrauded potential signers” and that the measure “would have far-reaching effects,” including on Missouri’s rules on human cloning and single-sex bathrooms.

Amendment supporters responded that no state laws would be automatically repealed. Instead, advocates would have to file lawsuits challenging anti-abortion laws, with judges making the final decisions about which ones violate the new constitutional amendment. “This is another example of someone flailing, trying to gum the works of a campaign that has serious momentum,” said Mallory Schwartz, executive director of Abortion Action Missouri, part of the pro-Amendment 3 coalition. “What they’re really doing is trying to deny people access to direct democracy.” 

The Missouri Supreme Court’s decision overturns a surprise ruling by Cole County Circuit Judge Christopher Limbaugh last Friday evening declaring that the vote on the amendment should be canceled—though he left time for an appeal. Judge Limbaugh, a cousin of the late conservative talk radio host Rush Limbaugh, was appointed to the bench by his former boss, Republican Gov. Mike Parson, barely five weeks ago.

Ashcroft defended his certification in a hearing before Limbaugh. But following the Friday ruling, Ashcroft sent the abortion-rights campaign a letter announcing that he was decertifying Amendment 3 himself. “On further review in light of the circuit court’s judgment, I have determined the amendment is deficient,” he wrote.

In its Tuesday ruling, the Missouri Supreme Court ordered Ashcroft to recertify Amendment 3 for the ballot, ruling that the deadline for him to issue a certification decision had passed.

For Ashcroft and other Missouri Republicans, the decision is yet another rebuke in a long and exhausting campaign to keep the amendment off the ballot. In at least four previous lawsuits, Missouri courts have slapped down state officials’ attempts to interfere with the amendment.

First, state Attorney General Andrew Bailey, who is running for reelection, held up the initiative for months by pushing a baseless theory that the initiative could cost the state billions in federal Medicaid funding and declining to rubber-stamp a cost estimate prepared by the state’s auditor. After a legal battle, the Missouri Supreme Court ordered Bailey to stop stonewalling.

Then last fall, Kelly and Coleman—the same legislators behind the latest lawsuit—seized on Bailey’s phony theory about Medicaid funding and sued the state auditor over his cost estimate. They too were slapped down by the courts, which found the cost estimate “fair and sufficient.”

Meanwhile, Ashcroft—an outspoken abortion opponent whose job requires him to craft neutral summaries of ballot initiatives—issued summaries claiming the measure would permit “dangerous, unregulated, and unrestricted abortion.” Last October, an appeals court ruled those summaries were “replete with politically partisan language.” A circuit court judge completely rewrote them.

But Ashcroft didn’t learn his lesson. Last month, on the same day he certified the amendment for the ballot, he issued “fair ballot language” to be posted at polling places that made a slew of false claims, including that the measure would prohibit legal recourse against “anyone who performs an abortion and hurts or kills the pregnant women.” Last Thursday, Cole County Circuit Judge Cotton Walker threw out Ashcroft’s description, calling it “unfair, insufficient, inaccurate and misleading.”

Tuesday’s Supreme Court ruling is a crucial win for the fight to expand abortion rights in Missouri, which has some of the most restrictive laws in the country. Even before the Supreme Court overturned Roe v. Wade, only one clinic remained open in the state, providing fewer than 100 abortions annually. Hours after the fall of Roe, state officials invoked a dormant law making it a felony to provide abortion in virtually all cases.

Missouri isn’t the only place where state officials have been making last-ditch efforts to block or blunt voter referendums on abortion. On Monday, the Nebraska Supreme Court heard arguments in a trio of lawsuits over dueling amendments—one to protect abortion until viability and another to ban abortion after the first trimester. Arguments focused on whether the protective amendment violates a state rule requiring ballot measures to only cover a single subject, according to the Nebraska Examiner.

Last month in Arkansas, the state Supreme Court threw out thousands of signatures in favor of an abortion-rights measure, ruling that organizers had failed to file training certifications for their paid canvassers in the proper format, the Associated Press reported. The decision affirmed state officials’ move to disqualify the measure from the ballot.

In Florida, the state Attorney General lost a lawsuit arguing that an amendment to protect abortion rights until viability was “too complicated” for voters to understand. But last month, the state Supreme Court approved a fiscal impact statement for Amendment 4 written with the help of the Heritage Foundation, the conservative group behind Project 2025. Meanwhile, the state’s Agency for Health Care Administration unveiled a website on Thursday full of false claims about the initiative, as my colleague Julianne McShane reported. And the Florida Department of State is reportedly investigating 36,000 voter signatures submitted by amendment organizers.

As it stands on Tuesday, ten states will vote on abortion-related measures on the ballot come November. Missouri is one of two where voters could overturn a near-total abortion ban.

Sophie Hurwitz contributed reporting.

This article was published in partnership with The Marshall Project, a nonprofit news organization covering the US criminal justice system, Reveal, and USA Today. Sign up for The Marshall Project’s newsletters, and follow them on Instagram,  TikTok, Reddit, and Facebook.

Susan Horton had been a stay-at-home mom for almost 20 years, and now—pregnant with her fifth child—she felt a hard-won confidence in herself as a mother.

Then she ate a salad from Costco. 

It was her final meal before going to Kaiser Permanente hospital in Santa Rosa, in Northern California, to give birth in August 2022. It had been an exhausting pregnancy. Her family had just moved houses, and Horton was still breastfeeding her toddler. Because of her teenage son’s heart condition, she remained wary of Covid-19 and avoided crowded places, even doctor’s offices. Now, already experiencing the clawing pangs of contractions, she pulled out a frozen pizza and a salad with creamy everything dressing, savoring the hush that fell over the house, the satisfying crunch of the poppy seeds as she ate. 

Horton didn’t realize that she would be drug-tested before her child’s birth. Or that the poppy seeds in her salad could trigger a positive result on a urine drug screen, the quick test that hospitals often use to check pregnant patients for illicit drugs. Many common foods and medications—from antacids to blood pressure and cold medicines—can prompt erroneous results.

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The morning after Horton delivered her daughter, a nurse told her she had tested positive for opiates. Horton was shocked. She hadn’t requested an epidural or any narcotic pain medication during labor—she didn’t even like taking Advil. “You’re sure it was mine?” she asked the nurse.

If Horton had been tested under different circumstances—for example, if she was a government employee and required to be tested as part of her job—she would have been entitled to a more advanced test and to a review from a specially trained doctor to confirm the initial result. 

But as a mother giving birth, Horton had no such protections. The hospital quickly reported her to child welfare, and the next day, a social worker arrived to take baby Halle into protective custody.  

Kaiser Permanente declined to comment on Horton’s care. A spokesperson said the Santa Rosa hospital typically gets consent to drug-test patients for medical reasons, and as a mandated reporter under state law, it refers potential exposures of newborns to illicit drugs to child welfare authorities. 

The Sonoma County Human Services Department said, in a statement, that it evaluates all referrals using “evidence- and research-based” methods, and if a report is deemed valid, it has a duty under state law to investigate.

Horton said the experience made her feel powerless and terrified.

“They had a singular piece of evidence that I had taken something,” she said, “and it was wrong.” 

For decades, state and federal laws have required hospitals across the country to identify newborns affected by drugs in the womb and to refer such cases to child protective services for possible investigation. To comply, hospitals often use urine drug screens that are inexpensive (as little as $10 per test), simple to administer (the patient pees in a cup), and provide results within minutes. 

But urine drug screens are easily misinterpreted and often wrong, with false positive rates as high as 50 percent, according to some studies. Without confirmation testing and additional review, false positive results can lead hospitals to wrongly accuse parents of illicit drug use and report babies to child welfare agencies—which may separate newborns from their families, an investigation by The Marshall Project and Reveal has found.

It’s unclear how many of the nation’s 3.6 million births every year involve drug testing, but health care experts said urine screening is ubiquitous. Tens of thousands of infants are reported annually to authorities for in utero drug exposure, with no guarantee that the underlying tests are accurate, our analysis of federal data shows.

“They had a singular piece of evidence that I had taken something, and it was wrong.”

To report this story, The Marshall Project interviewed dozens of patients, medical providers, toxicologists, and other experts, and collected information on more than 50 mothers in 22 states who faced reports and investigations over positive drug tests that were likely wrong. We also pored over thousands of pages of policy documents from every state child welfare agency in the country. 

Problems with drug screens are well known, especially in workplace testing. But there’s been little investigation of how easily false positives can occur inside labor and delivery units, and how quickly families can get trapped inside a system of surveillance and punishment.

Hospitals reported women for positive drug tests after they ate everything bagels and lemon poppy seed muffins, or used medications including the acid reducer Zantac, the antidepressant Zoloft, and labetalol, one of the most commonly prescribed blood pressure treatments for pregnant women. 

After a California mother had a false positive for meth and PCP, authorities took her newborn, then dispatched two sheriff’s deputies to also remove her toddler from her custody, court records show. In New York, hospital administrators refused to retract a child welfare report based on a false positive result, and instead offered the mother counseling for her trauma, according to a recording of the conversation. And when a Pennsylvania woman tested positive for opioids after eating pasta salad, the hearing officer in her case yelled at her to “buck up, get a backbone, and stop crying,” court records show. It took three months to get her newborn back from foster care. 

Federal officials have known for decades that urine screens are not reliable. Poppy seeds—which come from the same plant used to make heroin—are so notorious for causing positives for opiates that last year the Department of Defense directed service members to stop eating them. At hospitals, test results often come with warnings about false positives and direct clinicians to confirm the findings with more definitive tests. 

Yet state policies and many hospitals tend to treat drug screens as unassailable evidence of illicit use, The Marshall Project found. Hospitals across the country routinely report cases to authorities without ordering confirmation tests or waiting to receive the results. 

At least 27 states explicitly require hospitals to alert child welfare agencies after a positive screen or potential exposure, according to a review of state laws and policies by The Marshall Project. But, not a single state requires hospitals to confirm test results before reporting them. At least 25 states do not require child welfare workers to confirm positive test results, either. 

While parents often lack protections, most of the caseworkers who investigate them are entitled to confirmation testing and a review if they test positive for drugs on the job, our analysis found. 

Health care providers say there are medical reasons to test labor and delivery patients for drugs, including alerting doctors to watch a newborn for withdrawal symptoms. They also cite concerns about criminal and legal liability if they fail to report positive test results. 

Even when a doctor refutes a positive result and vouches for their patient, hospitals may report the incorrect data anyway to child welfare agencies.

“It’s almost like a gut punch. You come to the hospital and you see a social work note on your patient’s chart,” said Dr. Yashica Robinson, an OB/GYN in Huntsville, Alabama, who has tried and failed several times to halt child welfare reports and investigations of patients with false positive results. “Once that ball is rolling, it’s hard to stop it,” Robinson said.

No government agency collects comprehensive data on false positive results or on how many pregnant patients are tested. And confidentiality laws that shield medical and child welfare records make it difficult for the public to understand how many families are affected. 

In 2016, Congress mandated states to submit the number of “substance-affected” infants to the U.S. Department of Health and Human Services. Not all states track every case, but from fiscal years 2018 through 2022, medical professionals reported at least 170,000 infants to child welfare agencies for exposure to substances, according to an analysis by The Marshall Project. In 2022 alone, more than 35,000 such cases were reported, and authorities removed more than 6,000 infants from their families, our analysis found. 

The harms of drug testing fall disproportionately on low-income, Black, Hispanic, and Native American women, who studies have found are more likely to be tested when they give birth, more likely to be investigated, and less likely to reunite with their children after they’ve been removed. 

But the false positive cases The Marshall Project identified include parents of all socioeconomic classes and occupations—from a lawyer to a school librarian to a nurse who drug-tests other people for a living. 

“People should be concerned,” said Dr. Stephen Patrick, a leading neonatal researcher who chairs the Department of Health Policy and Management at the Rollins School of Public Health in Atlanta. “This could happen to any one of us.”

“People should be concerned. This could happen to any one of us.”

Drug screens are more guesswork than exact science. Chemicals in the tests quickly cross-react with urine, flagging anything that looks like it could be an illicit substance. The tests are like fishing nets that are cast wide and pick up anything and everything that fits, said Dr. Gwen McMillin, a professor at the University of Utah School of Medicine and medical director of a drug-testing lab. The problem is that nets also ensnare fish that aren’t being targeted: compounds that are closely related to illicit substances or merely look similar. 

“Drug testing results need to be confirmed before they go to CPS,” McMillin said. “Actions should not be taken based on a single drug testing result. Period.” 

But sometimes, even confirmation tests can be misinterpreted, as Susan Horton found. At first, Horton was puzzled by her positive test result. She wondered if her urine might have been mixed up with another patient’s. Then—“ding ding ding!”—her last meal popped into her head. She told a nurse about the poppy seeds in her salad, sure that this would resolve her doctors’ concerns. 

Horton’s records show Kaiser ran her urine sample through a second test, and this time it came back positive for one opiate in particular: codeine. That shouldn’t have been surprising—poppy seeds, like the ones in Horton’s salad, are derived from the opium poppy plant and contain codeine. 

To differentiate between salad dressing or bagels and illicit drugs, toxicologists have long recommended testing urine for the presence of a compound called thebaine, which is found in poppy seeds but not in heroin. There’s no indication that the hospital performed or even knew about the thebaine test, leaving providers with no way to prove or disprove Horton’s claims.

“Mom and dad insistent that a Costco salad with poppyseed dressing is responsible,” a doctor wrote in her notes. Another doctor wrote: “We are unable to verify whether this could result in a positive test.”

Soon, multiple doctors and nurses filed into Horton’s room. They said hospital policy dictated that Halle remain there for five days to be monitored for possible drug withdrawal symptoms—“for baby’s safety,” a doctor told Horton.

Unlike most other states that require hospitals to report positive drug tests, California law says a positive test alone “is not in and of itself a sufficient basis for reporting child abuse or neglect.” But because of Covid-19 and her son’s heart condition, Horton had also missed some prenatal appointments, which many providers see as a red flag for drug use. A hospital social worker noted the missed appointments and decided to file a report.

In a statement about its practices in general, Kaiser said it always conducts a “multi-faceted assessment” prior to filing a report to CPS, which is responsible for reviewing the information and investigating. 

Horton insisted that keeping her baby at the hospital was unnecessary. “I’m not a drug addict,” she said she pleaded. Desperate for help, her husband called the police, who declined to oppose hospital directives, records show. 

When the caseworker arrived, the couple refused to sign a safety plan or allow the person to interview their children and inspect their home. So the caseworker immediately obtained a judge’s order and placed baby Halle into temporary custody in the hospital, before discharging her to her grandparents, who were ordered to supervise Horton with her child. 

A few days later, Horton stood silently in court, dressed in pants that clung uncomfortably to her still-healing body, feeling as if her motherhood was on trial. A caseworker told the judge it would be dangerous to release Halle to her parents, and Horton agreed to another drug test. A worker followed her to the bathroom and watched her urinate in a cup.

By then, caseworkers and doctors had privately acknowledged that poppy seeds could have caused Horton’s positive test result. But in court the caseworker didn’t mention that. Instead, she argued that Horton’s purported drug use had “caused serious physical harm” to her child. 

The agency said under state law it can’t comment on individual cases. Speaking generally, it said a single positive drug test, false or otherwise, doesn’t warrant an investigation, and that there needs to be “a reported observation of impact to the child.”

When workplace drug testing was introduced in the 1980s, unions and civil rights groups decried the error rates of drug screens and how companies were firing workers over false positive results. In response, federal authorities mandated safeguards for employees, including requiring confirmation tests and a review from a specially trained doctor to determine whether a food or medication could have caused a positive result. 

A federal medical advisory committee in 1993 urged health care providers who drug-test pregnant patients to adopt the same rigorous standards. But amid the “crack baby” panic, the idea of protecting mothers did not catch on. 

Hospital drug testing policies vary widely. Many facilities, such as Kaiser in Santa Rosa, test every labor-and-delivery patient. Other hospitals flag only certain people, such as those with limited prenatal care, high blood pressure, even bad teeth, experts say. At many hospitals, the decision is up to doctors and nurses, who may view a mother’s tattoos, disheveled clothing, or stressed demeanor with suspicion. Studies have found that the decision to test is rife with class and race bias.

“Those who look like they have less resources, people might say, ‘Well, they look more likely to use drugs,’” said Dr. Cresta Jones, an associate professor and maternal-fetal medicine specialist at the University of Minnesota Medical School.

Hospitals often have full discretion over whether to screen for drugs, but once a positive result is in hand, the decision to report becomes more complicated. Laws and policies in at least 12 states explicitly require hospitals to send screen results to child welfare agencies, even if they are not confirmed, according to The Marshall Project’s review. 

For hospitals, cost is also an issue. While urine screens are cheap, the equipment needed to run a confirmation test costs hundreds of thousands of dollars, in addition to the cost of expert personnel and lab certification. Some hospitals contract out confirmation testing—a lower-cost alternative—but getting results can take days, long after many families are ready to go home.

Doctors, nurses, and hospital social workers face an uncomfortable predicament: Do they send the baby home to what they believe could be an unsafe environment, or do they call authorities?

“God forbid the baby goes home, withdraws and dies, we’re going to be held liable for that,” said Dr. Adi Davidov, an obstetrician at Staten Island University Hospital, which drug-tests every birthing patient.

State mandatory reporting laws add to the pressure on doctors and nurses. These laws impose criminal liability on providers who fail to report, while also protecting physicians who report “in good faith”—insulating hospitals from lawsuits if test results are wrong. 

Even when doctors have the ability to order a confirmation test, they don’t always do so. Many misinterpret positive screens as definitive evidence of drug use.

“We were guilty until proven innocent.”

When Grace Smith had her fourth child in 2021 at St. Luke’s University Hospital, an hour north of Philadelphia, she was taking prescribed marijuana and Vyvanse, a medication for attention deficit hyperactivity disorder. The medicine contains amphetamine, but the hospital’s drug screen results did not differentiate between meth and amphetamine, according to medical records. The day after Smith delivered her son, a doctor told her that she and her baby had tested positive for meth and that the hospital had notified child protective services.

Smith’s husband, Michael, asked the doctor to review his wife’s medical records to confirm her prescription, according to the doctor’s notes. The doctor argued that wasn’t her role. “I explained that our responsibility as healthcare workers was to report the case” to child welfare authorities, she wrote, adding that the agency “would conduct any investigation that was necessary.”

When Michael Smith told the doctor they were leaving with their baby, the hospital called the police. An officer escorted the parents out, without their newborn, a police report shows. The Smiths said the police told them they would be arrested if they returned.

A spokesperson for St. Luke’s University Health Network declined to answer questions from The Marshall Project, saying in an email that the hospital “complies with all rules and regulations regarding drug testing and reporting” and that the newborn’s welfare “is always our primary concern.”

Four days after the Smiths’ son was born, Monroe County Children and Youth Services told the hospital it was okay to release the baby to his parents. But the investigation remained open. It wasn’t until the Smiths paid more than $3,500 for a lawyer—and nearly $300 for a confirmation drug test that came back negative—that the agency closed their case. The agency declined to comment.

The Smiths filed a lawsuit in 2022 against St. Luke’s. In its response, the hospital acknowledged that it had not given Grace a confirmation test, but denied violating the Smiths’ privacy or civil rights. A judge dismissed the suit in 2023, saying in part that the Smiths did not sufficiently argue their claims.

Many providers erroneously assume that child welfare agencies verify a parent’s drug use. But government caseworkers typically lack the expertise to accurately interpret drug test results. State policy manuals seldom mention the possibility of false positives. It often falls on parents to prove their own innocence.

As a nurse in South Carolina, Ashley Riley said she regularly drug-tested patients in an addiction treatment program, flagged faulty tests, and sent out positive screens for confirmation. But when she herself screened positive for opiates after delivering her son in 2023, Riley said the hospital declined to order a confirmation test, then reported her to authorities.

Riley and her husband, Jeffrey, insisted the positive result was from lemon poppy seed muffins that she had eaten throughout her pregnancy. As proof, Jeffrey Riley texted the investigator a receipt for the muffins, studies on false positives caused by poppy seeds, and the 2023 memo from the Department of Defense urging service members to avoid poppy seeds.

“At no point in time was there anybody in there that was even trying to advocate for my wife, except for me,” he recalled.

At first, he thought his efforts were working. The caseworker acknowledged in his notes having seen the poppy seeds and noted that the report “could be falsified.” 

But the caseworker still insisted the couple sign a safety plan, advising them that their two children would be placed in foster care unless they assigned a “protector”—a responsible adult who would supervise them with their children at all times. This continued for 45 days before the case was closed as unfounded. 

“We were guilty until proven innocent,” Ashley Riley said. 

The hospital even charged $424 for the problematic urine test. Hospital officials did not respond to multiple interview requests.

Will Batchelor, a spokesperson for the South Carolina Department of Social Services, wrote in a statement that the agency has a duty to investigate once a hospital has filed a report and that it “exercised appropriate restraint” by not removing the child from the home.

“Because the safety of a child is at stake, DSS has to continue its investigation beyond seeing a receipt for poppy seed muffins,” Batchelor wrote.

Even when a parent has a confirmation test and her own doctor’s word attesting to a false positive result, authorities may keep investigating.

When Melissa Robinson, an elementary school librarian in Huntsville, Alabama, screened pos​​itive for cocaine in early 2024, the news shocked her and her doctors. Robinson had avoided anything during her pregnancy that could be risky, even cold cuts—which may carry bacteria—and had no history of drug use. Because of the positive test, staff told Robinson she was not allowed to breastfeed her daughter, hospital records show, and they reported her to Alabama’s child welfare agency, the Department of Human Resources. Robinson said a caseworker told her that she probably wouldn’t be allowed to be alone with her baby—her husband would have to supervise.

A few days later, a confirmation test came back negative for any substances. With proof that she had not used cocaine, Robinson assumed the case would be closed. Instead, the agency continued to investigate, inspecting her home and even requiring her husband to take a drug test, she said.

A spokesperson for Alabama’s child welfare agency said they are required to respond immediately to a hospital report and “make safety decisions relying on current and most accessible information.”

When the baby was two weeks old, the agency closed the case, citing insufficient evidence. But the allegations will remain on Robinson’s record for at least five years.

“To have such a beautiful experience tainted by something like that, it’s difficult,” Robinson recalled. “Truthfully, it’s turned me into somebody different.” 

“To have such a beautiful experience tainted by something like that, it’s difficult. Truthfully, it’s turned me into somebody different.” 

Some medical groups and providers have taken steps to reduce unnecessary child welfare reports. The American College of Obstetricians and Gynecologists advises hospitals to use a screening questionnaire rather than drug tests to identify people who may have substance abuse problems. The organization also recommends that hospitals obtain consent from patients, explaining the potential consequences of a positive result—including if the hospital is required to report it to authorities. A number of large hospitals have adopted some version of those recommendations. 

After a study at Staten Island University Hospital in New York found a high rate of false positives, administrators brought the confirmation testing in-house. They said results come back within a day or two, rather than the week that is typical for outside tests, which allows providers to wait before contacting child welfare.

“Any time you act on a test that’s not 100 percent, you run the risk of causing more harm than good,” said the hospital’s Dr. Davidov. “If you are going to get CPS involved with a mother who did nothing wrong and is a good citizen, that’s harming her. It’s harming her experience, it’s harming her ability to take care of her newborn.”

In recent years, advocacy groups have filed lawsuits against hospitals for testing without explicit consent, which has led some state officials and lawmakers to speak out against the testing. But in most of the United States, it remains common practice to report families based on unconfirmed positive screens. Most of the women interviewed by The Marshall Project signed general consent forms at the hospital but said they were never informed explicitly they would be drug-tested, nor that a positive result could be reported to authorities.

For Susan Horton, her family’s ordeal has created an undercurrent of fear that courses through her daily life. 

After the court hearing in August 2022, child welfare workers took the baby to Horton’s elderly in-laws and barred Horton and her husband from being alone with their newborn while the agency investigated. Finally, almost two weeks after their daughter was born, the agency withdrew its petition and a judge dismissed the case, allowing the Hortons to bring baby Halle home.

One afternoon last spring, Horton took her daughter, now a toddler, outside. Halle giggled as her mother chased her around the front yard, her little feet splashing in a small mud hole. This was the life Horton had envisioned years ago—a quiet place in the California countryside where her children could delight in the world around them. And yet, Horton couldn’t help but remember the investigation that destroyed her family’s peace of mind—and her self-esteem.

“I had a lot of confidence in how I mother and how I parent,” she said. “Now in my head, I’m always questioning my choices.” She wondered aloud what neighbors would say if they saw her daughter playing in the mud, if someone might accuse her of being a bad parent.

“I just always have that looming feeling that at any moment CPS could come knocking and take my children away.” 

Marshall Project reporters Weihua Li, Andrew Rodriguez Calderón, Nakylah Carter, and Catherine Odom contributed to this story.

On Friday night, a Missouri judge handed down a ruling that could threaten voters’ abilities to enshrine reproductive rights in the state’s constitution this November. It is a massive setback for one of most consequential abortion ballot measures this year.

After the Supreme Court overruled Roe in its June 2022 decision in Dobbs v. Jackson Women’s Health Organization, Missouri began enforcing its near-total abortion ban that had been dormant until Dobbs. Soon after, activists began pushing for a ballot measure, Amendment 3, to bring back abortion to the state. In May, organizers in Missouri turned in more than 380,000 signatures in their bid to get the proposed amendment on the ballot, compared to the 172,000 required.

The proposed amendment stipulates that the government cannot “deny or infringe upon a person’s fundamental right to reproductive freedom” and that abortion cannot be restricted in the state before fetal viability. It also says that life and health exceptions must be respected and that people cannot be prosecuted for helping someone obtain an abortion or for their own pregnancy outcomes.

On Friday, Cole County Circuit Judge Christopher Limbaugh ruled that the proposed Amendment 3 should be removed from the November ballot because it does not specify which specific anti-abortion laws it would repeal. (Advocates say that exact laws for repeal would be determined by future lawsuits.)

In his ruling, Limbaugh wrote that he “recognizes the gravity of the unique issues involved in this case” and would stay his ruling until Tuesday, “so that further guidance or rulings can be provided by a reviewing court.”

In a statement, Rachel Sweet, campaign manager for Missourians for Constitutional Freedom, the group behind the ballot measure initiative, called the judge’s decision a “profound injustice,” adding that the group plans to appeal. “Our fight to ensure that voters—not politicians—have the final say is far from over,” Sweet said.

Limbaugh’s ruling represents just the latest roadblock that Missouri reproductive rights advocates have encountered. As my colleague Madison Pauly reported, anti-abortion officials in the state stymied advocates’ attempts to bring a ballot measure to voters in 2019. As Madison chronicled, advocates also fought amongst themselves about whether the proposed ballot measure should seek to restore Roe or go beyond it:

In the months following the 2022 election, the group—a mix of advocates including the state ACLU and Planned Parenthood affiliates and the local activist group Abortion Action Missouri—splintered. Some members, including [Executive Director of Medical Students for Choice Pamela] Merritt, wanted to go with language that would enshrine a broad right to abortion. Others wanted to consider an amendment with baked-in compromises in the hopes of winning over more voters. They proposed letting the state impose or preserve restrictions that the larger abortion-rights movement often condemns, including a ban on procedures after so-called fetal viability—the hard-to-pin-down point in pregnancy at which a fetus has a decent chance of surviving outside the uterus. (Viability limits often include an exception for abortions needed to protect a pregnant patient’s life or health.)

Now, based on Limbaugh’s order, it seems they may not get anything they were hoping for.

I’m no legal expert, but I’ve got a sneaky suspicion that if you’ve just asked a judge to reconsider the verdict in your defamation case, you probably shouldn’t repeat similarly defamatory statements during a press conference later that same day.

But, of course, that’s precisely what Donald Trump did.

After appearing in a federal appeals court to fight his verdict in the E. Jean Carroll defamation case, Donald Trump proceeded to bash Carroll and several other women who’ve accused him of sexual assault for nearly an hour during a press conference on Friday.

Last year, the ex-president was ordered to pay Carroll $5 million after a civil court found him liable for sexually assaulting her in the mid-1990s and then subsequently defaming her once she told the public her story.

Earlier this year, Trump was found liable yet again in a separate civil lawsuit for additional remarks he’d made in 2019 when she first came forward, including the assertion that she “wasn’t his type”—a venomous insult that made a reappearance during today’s press conference.

“She would not have been the chosen one,” said Trump, referencing an unnamed woman who he allegedly assaulted in the ’70s on an airplane—one of many sexual assault allegations that Trump dredged up during this conference.

But this wasn’t the only such remark Trump made that afternoon. He also took aim at Carroll directly, claiming again that he didn’t know who she was and accusing her of stealing her story from a Law & Order episode.

He also claimed to have never met her, called a picture of them together potentially “AI-generated,” and then later admitted that they did meet but claimed that meeting didn’t count.

He also, for whatever reason, insulted his own lawyers, who were standing right behind him, saying, “I’m disappointed in my legal talent, to be honest with you.”

The entire rant was chaotic, even by Trump’s standards. It will be interesting to see how it impacts the GOP presidential nominee’s chances at an appeal in the coming weeks—according to a report before his rambling speech today, the judge was already “skeptical.”

The judge in Donald Trump’s New York criminal trial ruled on Friday that he won’t sentence the former president until November 26. Juan Merchan, who Trump has relentlessly accused of bias against him, wrote in his decision that the delay was “to avoid any appearance—however unwarranted—that the proceeding has been affected by or seeks to affect the approaching Presidential election in which the Defendant is a candidate.”

Merchan went on to add that he hopes the decision ends any concern about the impartiality of the court—Trump has repeatedly insisted that the entire prosecution, judge, and jury were rigged by the Biden administration, despite the case being heard in a New York court, not under federal jurisdiction.

“The Court is a fair, impartial and apolitical institution,” Merchan wrote.

The sentencing is for 34 felony convictions of falsifying business records for Trump’s hush money scandal involving adult film star Stormy Daniels, and was led by Manhattan District Attorney Alvin Bragg. Each charge carries up to a four-year prison sentence, but it was highly unlikely that Trump would receive a significant sentence—as a first time non-violent offender, probation was far likelier. However, any chance of a major presidential candidate—or president-elect—being required to serve jail time is completely unprecedented.

Trump has yet to respond to Merchan’s ruling, but the delay was at his own request. He has also submitted filings asking for the conviction to be tossed based on July’s Supreme Court decision on presidential immunity—according to Trump’s attorneys, testimony that was used against him that referred to events that occurred while he was president shouldn’t have been used. Merchan has yet to rule on that.

Prosecutors did not oppose Trump’s request to delay the sentencing, but throughout the trial—and the years-long legal process running up to it—Bragg’s attorneys argued that Trump was improperly trying to delay legal consequences against him.

Correction, September 6: This post has been updated to accurately reflect the number of Donald Trump’s felony convictions. There are 34.

This article was published in partnership with The Marshall Project, a nonprofit news organization covering the US criminal justice system, Reveal, and USA Today. Sign up for The Marshall Project’s newsletters, and follow them on Instagram,  TikTok, Reddit, and Facebook.

Susan Horton had been a stay-at-home mom for almost 20 years, and now—pregnant with her fifth child—she felt a hard-won confidence in herself as a mother.

Then she ate a salad from Costco. 

It was her final meal before going to Kaiser Permanente hospital in Santa Rosa, in Northern California, to give birth in August 2022. It had been an exhausting pregnancy. Her family had just moved houses, and Horton was still breastfeeding her toddler. Because of her teenage son’s heart condition, she remained wary of Covid-19 and avoided crowded places, even doctor’s offices. Now, already experiencing the clawing pangs of contractions, she pulled out a frozen pizza and a salad with creamy everything dressing, savoring the hush that fell over the house, the satisfying crunch of the poppy seeds as she ate. 

Horton didn’t realize that she would be drug-tested before her child’s birth. Or that the poppy seeds in her salad could trigger a positive result on a urine drug screen, the quick test that hospitals often use to check pregnant patients for illicit drugs. Many common foods and medications—from antacids to blood pressure and cold medicines—can prompt erroneous results.

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The morning after Horton delivered her daughter, a nurse told her she had tested positive for opiates. Horton was shocked. She hadn’t requested an epidural or any narcotic pain medication during labor—she didn’t even like taking Advil. “You’re sure it was mine?” she asked the nurse.

If Horton had been tested under different circumstances—for example, if she was a government employee and required to be tested as part of her job—she would have been entitled to a more advanced test and to a review from a specially trained doctor to confirm the initial result. 

But as a mother giving birth, Horton had no such protections. The hospital quickly reported her to child welfare, and the next day, a social worker arrived to take baby Halle into protective custody.  

Kaiser Permanente declined to comment on Horton’s care. A spokesperson said the Santa Rosa hospital typically gets consent to drug-test patients for medical reasons, and as a mandated reporter under state law, it refers potential exposures of newborns to illicit drugs to child welfare authorities. 

The Sonoma County Human Services Department said, in a statement, that it evaluates all referrals using “evidence- and research-based” methods, and if a report is deemed valid, it has a duty under state law to investigate.

Horton said the experience made her feel powerless and terrified.

“They had a singular piece of evidence that I had taken something,” she said, “and it was wrong.” 

For decades, state and federal laws have required hospitals across the country to identify newborns affected by drugs in the womb and to refer such cases to child protective services for possible investigation. To comply, hospitals often use urine drug screens that are inexpensive (as little as $10 per test), simple to administer (the patient pees in a cup), and provide results within minutes. 

But urine drug screens are easily misinterpreted and often wrong, with false positive rates as high as 50 percent, according to some studies. Without confirmation testing and additional review, false positive results can lead hospitals to wrongly accuse parents of illicit drug use and report babies to child welfare agencies—which may separate newborns from their families, an investigation by The Marshall Project and Reveal has found.

It’s unclear how many of the nation’s 3.6 million births every year involve drug testing, but health care experts said urine screening is ubiquitous. Tens of thousands of infants are reported annually to authorities for in utero drug exposure, with no guarantee that the underlying tests are accurate, our analysis of federal data shows.

“They had a singular piece of evidence that I had taken something, and it was wrong.”

To report this story, The Marshall Project interviewed dozens of patients, medical providers, toxicologists, and other experts, and collected information on more than 50 mothers in 22 states who faced reports and investigations over positive drug tests that were likely wrong. We also pored over thousands of pages of policy documents from every state child welfare agency in the country. 

Problems with drug screens are well known, especially in workplace testing. But there’s been little investigation of how easily false positives can occur inside labor and delivery units, and how quickly families can get trapped inside a system of surveillance and punishment.

Hospitals reported women for positive drug tests after they ate everything bagels and lemon poppy seed muffins, or used medications including the acid reducer Zantac, the antidepressant Zoloft, and labetalol, one of the most commonly prescribed blood pressure treatments for pregnant women. 

After a California mother had a false positive for meth and PCP, authorities took her newborn, then dispatched two sheriff’s deputies to also remove her toddler from her custody, court records show. In New York, hospital administrators refused to retract a child welfare report based on a false positive result, and instead offered the mother counseling for her trauma, according to a recording of the conversation. And when a Pennsylvania woman tested positive for opioids after eating pasta salad, the hearing officer in her case yelled at her to “buck up, get a backbone, and stop crying,” court records show. It took three months to get her newborn back from foster care. 

Federal officials have known for decades that urine screens are not reliable. Poppy seeds—which come from the same plant used to make heroin—are so notorious for causing positives for opiates that last year the Department of Defense directed service members to stop eating them. At hospitals, test results often come with warnings about false positives and direct clinicians to confirm the findings with more definitive tests. 

Yet state policies and many hospitals tend to treat drug screens as unassailable evidence of illicit use, The Marshall Project found. Hospitals across the country routinely report cases to authorities without ordering confirmation tests or waiting to receive the results. 

At least 27 states explicitly require hospitals to alert child welfare agencies after a positive screen or potential exposure, according to a review of state laws and policies by The Marshall Project. But, not a single state requires hospitals to confirm test results before reporting them. At least 25 states do not require child welfare workers to confirm positive test results, either. 

While parents often lack protections, most of the caseworkers who investigate them are entitled to confirmation testing and a review if they test positive for drugs on the job, our analysis found. 

Health care providers say there are medical reasons to test labor and delivery patients for drugs, including alerting doctors to watch a newborn for withdrawal symptoms. They also cite concerns about criminal and legal liability if they fail to report positive test results. 

Even when a doctor refutes a positive result and vouches for their patient, hospitals may report the incorrect data anyway to child welfare agencies.

“It’s almost like a gut punch. You come to the hospital and you see a social work note on your patient’s chart,” said Dr. Yashica Robinson, an OB/GYN in Huntsville, Alabama, who has tried and failed several times to halt child welfare reports and investigations of patients with false positive results. “Once that ball is rolling, it’s hard to stop it,” Robinson said.

No government agency collects comprehensive data on false positive results or on how many pregnant patients are tested. And confidentiality laws that shield medical and child welfare records make it difficult for the public to understand how many families are affected. 

In 2016, Congress mandated states to submit the number of “substance-affected” infants to the U.S. Department of Health and Human Services. Not all states track every case, but from fiscal years 2018 through 2022, medical professionals reported at least 170,000 infants to child welfare agencies for exposure to substances, according to an analysis by The Marshall Project. In 2022 alone, more than 35,000 such cases were reported, and authorities removed more than 6,000 infants from their families, our analysis found. 

The harms of drug testing fall disproportionately on low-income, Black, Hispanic, and Native American women, who studies have found are more likely to be tested when they give birth, more likely to be investigated, and less likely to reunite with their children after they’ve been removed. 

But the false positive cases The Marshall Project identified include parents of all socioeconomic classes and occupations—from a lawyer to a school librarian to a nurse who drug-tests other people for a living. 

“People should be concerned,” said Dr. Stephen Patrick, a leading neonatal researcher who chairs the Department of Health Policy and Management at the Rollins School of Public Health in Atlanta. “This could happen to any one of us.”

“People should be concerned. This could happen to any one of us.”

Drug screens are more guesswork than exact science. Chemicals in the tests quickly cross-react with urine, flagging anything that looks like it could be an illicit substance. The tests are like fishing nets that are cast wide and pick up anything and everything that fits, said Dr. Gwen McMillin, a professor at the University of Utah School of Medicine and medical director of a drug-testing lab. The problem is that nets also ensnare fish that aren’t being targeted: compounds that are closely related to illicit substances or merely look similar. 

“Drug testing results need to be confirmed before they go to CPS,” McMillin said. “Actions should not be taken based on a single drug testing result. Period.” 

But sometimes, even confirmation tests can be misinterpreted, as Susan Horton found. At first, Horton was puzzled by her positive test result. She wondered if her urine might have been mixed up with another patient’s. Then—“ding ding ding!”—her last meal popped into her head. She told a nurse about the poppy seeds in her salad, sure that this would resolve her doctors’ concerns. 

Horton’s records show Kaiser ran her urine sample through a second test, and this time it came back positive for one opiate in particular: codeine. That shouldn’t have been surprising—poppy seeds, like the ones in Horton’s salad, are derived from the opium poppy plant and contain codeine. 

To differentiate between salad dressing or bagels and illicit drugs, toxicologists have long recommended testing urine for the presence of a compound called thebaine, which is found in poppy seeds but not in heroin. There’s no indication that the hospital performed or even knew about the thebaine test, leaving providers with no way to prove or disprove Horton’s claims.

“Mom and dad insistent that a Costco salad with poppyseed dressing is responsible,” a doctor wrote in her notes. Another doctor wrote: “We are unable to verify whether this could result in a positive test.”

Soon, multiple doctors and nurses filed into Horton’s room. They said hospital policy dictated that Halle remain there for five days to be monitored for possible drug withdrawal symptoms—“for baby’s safety,” a doctor told Horton.

Unlike most other states that require hospitals to report positive drug tests, California law says a positive test alone “is not in and of itself a sufficient basis for reporting child abuse or neglect.” But because of Covid-19 and her son’s heart condition, Horton had also missed some prenatal appointments, which many providers see as a red flag for drug use. A hospital social worker noted the missed appointments and decided to file a report.

In a statement about its practices in general, Kaiser said it always conducts a “multi-faceted assessment” prior to filing a report to CPS, which is responsible for reviewing the information and investigating. 

Horton insisted that keeping her baby at the hospital was unnecessary. “I’m not a drug addict,” she said she pleaded. Desperate for help, her husband called the police, who declined to oppose hospital directives, records show. 

When the caseworker arrived, the couple refused to sign a safety plan or allow the person to interview their children and inspect their home. So the caseworker immediately obtained a judge’s order and placed baby Halle into temporary custody in the hospital, before discharging her to her grandparents, who were ordered to supervise Horton with her child. 

A few days later, Horton stood silently in court, dressed in pants that clung uncomfortably to her still-healing body, feeling as if her motherhood was on trial. A caseworker told the judge it would be dangerous to release Halle to her parents, and Horton agreed to another drug test. A worker followed her to the bathroom and watched her urinate in a cup.

By then, caseworkers and doctors had privately acknowledged that poppy seeds could have caused Horton’s positive test result. But in court the caseworker didn’t mention that. Instead, she argued that Horton’s purported drug use had “caused serious physical harm” to her child. 

The agency said under state law it can’t comment on individual cases. Speaking generally, it said a single positive drug test, false or otherwise, doesn’t warrant an investigation, and that there needs to be “a reported observation of impact to the child.”

When workplace drug testing was introduced in the 1980s, unions and civil rights groups decried the error rates of drug screens and how companies were firing workers over false positive results. In response, federal authorities mandated safeguards for employees, including requiring confirmation tests and a review from a specially trained doctor to determine whether a food or medication could have caused a positive result. 

A federal medical advisory committee in 1993 urged health care providers who drug-test pregnant patients to adopt the same rigorous standards. But amid the “crack baby” panic, the idea of protecting mothers did not catch on. 

Hospital drug testing policies vary widely. Many facilities, such as Kaiser in Santa Rosa, test every labor-and-delivery patient. Other hospitals flag only certain people, such as those with limited prenatal care, high blood pressure, even bad teeth, experts say. At many hospitals, the decision is up to doctors and nurses, who may view a mother’s tattoos, disheveled clothing, or stressed demeanor with suspicion. Studies have found that the decision to test is rife with class and race bias.

“Those who look like they have less resources, people might say, ‘Well, they look more likely to use drugs,’” said Dr. Cresta Jones, an associate professor and maternal-fetal medicine specialist at the University of Minnesota Medical School.

Hospitals often have full discretion over whether to screen for drugs, but once a positive result is in hand, the decision to report becomes more complicated. Laws and policies in at least 12 states explicitly require hospitals to send screen results to child welfare agencies, even if they are not confirmed, according to The Marshall Project’s review. 

For hospitals, cost is also an issue. While urine screens are cheap, the equipment needed to run a confirmation test costs hundreds of thousands of dollars, in addition to the cost of expert personnel and lab certification. Some hospitals contract out confirmation testing—a lower-cost alternative—but getting results can take days, long after many families are ready to go home.

Doctors, nurses, and hospital social workers face an uncomfortable predicament: Do they send the baby home to what they believe could be an unsafe environment, or do they call authorities?

“God forbid the baby goes home, withdraws and dies, we’re going to be held liable for that,” said Dr. Adi Davidov, an obstetrician at Staten Island University Hospital, which drug-tests every birthing patient.

State mandatory reporting laws add to the pressure on doctors and nurses. These laws impose criminal liability on providers who fail to report, while also protecting physicians who report “in good faith”—insulating hospitals from lawsuits if test results are wrong. 

Even when doctors have the ability to order a confirmation test, they don’t always do so. Many misinterpret positive screens as definitive evidence of drug use.

“We were guilty until proven innocent.”

When Grace Smith had her fourth child in 2021 at St. Luke’s University Hospital, an hour north of Philadelphia, she was taking prescribed marijuana and Vyvanse, a medication for attention deficit hyperactivity disorder. The medicine contains amphetamine, but the hospital’s drug screen results did not differentiate between meth and amphetamine, according to medical records. The day after Smith delivered her son, a doctor told her that she and her baby had tested positive for meth and that the hospital had notified child protective services.

Smith’s husband, Michael, asked the doctor to review his wife’s medical records to confirm her prescription, according to the doctor’s notes. The doctor argued that wasn’t her role. “I explained that our responsibility as healthcare workers was to report the case” to child welfare authorities, she wrote, adding that the agency “would conduct any investigation that was necessary.”

When Michael Smith told the doctor they were leaving with their baby, the hospital called the police. An officer escorted the parents out, without their newborn, a police report shows. The Smiths said the police told them they would be arrested if they returned.

A spokesperson for St. Luke’s University Health Network declined to answer questions from The Marshall Project, saying in an email that the hospital “complies with all rules and regulations regarding drug testing and reporting” and that the newborn’s welfare “is always our primary concern.”

Four days after the Smiths’ son was born, Monroe County Children and Youth Services told the hospital it was okay to release the baby to his parents. But the investigation remained open. It wasn’t until the Smiths paid more than $3,500 for a lawyer—and nearly $300 for a confirmation drug test that came back negative—that the agency closed their case. The agency declined to comment.

The Smiths filed a lawsuit in 2022 against St. Luke’s. In its response, the hospital acknowledged that it had not given Grace a confirmation test, but denied violating the Smiths’ privacy or civil rights. A judge dismissed the suit in 2023, saying in part that the Smiths did not sufficiently argue their claims.

Many providers erroneously assume that child welfare agencies verify a parent’s drug use. But government caseworkers typically lack the expertise to accurately interpret drug test results. State policy manuals seldom mention the possibility of false positives. It often falls on parents to prove their own innocence.

As a nurse in South Carolina, Ashley Riley said she regularly drug-tested patients in an addiction treatment program, flagged faulty tests, and sent out positive screens for confirmation. But when she herself screened positive for opiates after delivering her son in 2023, Riley said the hospital declined to order a confirmation test, then reported her to authorities.

Riley and her husband, Jeffrey, insisted the positive result was from lemon poppy seed muffins that she had eaten throughout her pregnancy. As proof, Jeffrey Riley texted the investigator a receipt for the muffins, studies on false positives caused by poppy seeds, and the 2023 memo from the Department of Defense urging service members to avoid poppy seeds.

“At no point in time was there anybody in there that was even trying to advocate for my wife, except for me,” he recalled.

At first, he thought his efforts were working. The caseworker acknowledged in his notes having seen the poppy seeds and noted that the report “could be falsified.” 

But the caseworker still insisted the couple sign a safety plan, advising them that their two children would be placed in foster care unless they assigned a “protector”—a responsible adult who would supervise them with their children at all times. This continued for 45 days before the case was closed as unfounded. 

“We were guilty until proven innocent,” Ashley Riley said. 

The hospital even charged $424 for the problematic urine test. Hospital officials did not respond to multiple interview requests.

Will Batchelor, a spokesperson for the South Carolina Department of Social Services, wrote in a statement that the agency has a duty to investigate once a hospital has filed a report and that it “exercised appropriate restraint” by not removing the child from the home.

“Because the safety of a child is at stake, DSS has to continue its investigation beyond seeing a receipt for poppy seed muffins,” Batchelor wrote.

Even when a parent has a confirmation test and her own doctor’s word attesting to a false positive result, authorities may keep investigating.

When Melissa Robinson, an elementary school librarian in Huntsville, Alabama, screened pos​​itive for cocaine in early 2024, the news shocked her and her doctors. Robinson had avoided anything during her pregnancy that could be risky, even cold cuts—which may carry bacteria—and had no history of drug use. Because of the positive test, staff told Robinson she was not allowed to breastfeed her daughter, hospital records show, and they reported her to Alabama’s child welfare agency, the Department of Human Resources. Robinson said a caseworker told her that she probably wouldn’t be allowed to be alone with her baby—her husband would have to supervise.

A few days later, a confirmation test came back negative for any substances. With proof that she had not used cocaine, Robinson assumed the case would be closed. Instead, the agency continued to investigate, inspecting her home and even requiring her husband to take a drug test, she said.

A spokesperson for Alabama’s child welfare agency said they are required to respond immediately to a hospital report and “make safety decisions relying on current and most accessible information.”

When the baby was two weeks old, the agency closed the case, citing insufficient evidence. But the allegations will remain on Robinson’s record for at least five years.

“To have such a beautiful experience tainted by something like that, it’s difficult,” Robinson recalled. “Truthfully, it’s turned me into somebody different.” 

“To have such a beautiful experience tainted by something like that, it’s difficult. Truthfully, it’s turned me into somebody different.” 

Some medical groups and providers have taken steps to reduce unnecessary child welfare reports. The American College of Obstetricians and Gynecologists advises hospitals to use a screening questionnaire rather than drug tests to identify people who may have substance abuse problems. The organization also recommends that hospitals obtain consent from patients, explaining the potential consequences of a positive result—including if the hospital is required to report it to authorities. A number of large hospitals have adopted some version of those recommendations. 

After a study at Staten Island University Hospital in New York found a high rate of false positives, administrators brought the confirmation testing in-house. They said results come back within a day or two, rather than the week that is typical for outside tests, which allows providers to wait before contacting child welfare.

“Any time you act on a test that’s not 100 percent, you run the risk of causing more harm than good,” said the hospital’s Dr. Davidov. “If you are going to get CPS involved with a mother who did nothing wrong and is a good citizen, that’s harming her. It’s harming her experience, it’s harming her ability to take care of her newborn.”

In recent years, advocacy groups have filed lawsuits against hospitals for testing without explicit consent, which has led some state officials and lawmakers to speak out against the testing. But in most of the United States, it remains common practice to report families based on unconfirmed positive screens. Most of the women interviewed by The Marshall Project signed general consent forms at the hospital but said they were never informed explicitly they would be drug-tested, nor that a positive result could be reported to authorities.

For Susan Horton, her family’s ordeal has created an undercurrent of fear that courses through her daily life. 

After the court hearing in August 2022, child welfare workers took the baby to Horton’s elderly in-laws and barred Horton and her husband from being alone with their newborn while the agency investigated. Finally, almost two weeks after their daughter was born, the agency withdrew its petition and a judge dismissed the case, allowing the Hortons to bring baby Halle home.

One afternoon last spring, Horton took her daughter, now a toddler, outside. Halle giggled as her mother chased her around the front yard, her little feet splashing in a small mud hole. This was the life Horton had envisioned years ago—a quiet place in the California countryside where her children could delight in the world around them. And yet, Horton couldn’t help but remember the investigation that destroyed her family’s peace of mind—and her self-esteem.

“I had a lot of confidence in how I mother and how I parent,” she said. “Now in my head, I’m always questioning my choices.” She wondered aloud what neighbors would say if they saw her daughter playing in the mud, if someone might accuse her of being a bad parent.

“I just always have that looming feeling that at any moment CPS could come knocking and take my children away.” 

Marshall Project reporters Weihua Li, Andrew Rodriguez Calderón, Nakylah Carter, and Catherine Odom contributed to this story.

On Friday night, a Missouri judge handed down a ruling that could threaten voters’ abilities to enshrine reproductive rights in the state’s constitution this November. It is a massive setback for one of most consequential abortion ballot measures this year.

After the Supreme Court overruled Roe in its June 2022 decision in Dobbs v. Jackson Women’s Health Organization, Missouri began enforcing its near-total abortion ban that had been dormant until Dobbs. Soon after, activists began pushing for a ballot measure, Amendment 3, to bring back abortion to the state. In May, organizers in Missouri turned in more than 380,000 signatures in their bid to get the proposed amendment on the ballot, compared to the 172,000 required.

The proposed amendment stipulates that the government cannot “deny or infringe upon a person’s fundamental right to reproductive freedom” and that abortion cannot be restricted in the state before fetal viability. It also says that life and health exceptions must be respected and that people cannot be prosecuted for helping someone obtain an abortion or for their own pregnancy outcomes.

On Friday, Cole County Circuit Judge Christopher Limbaugh ruled that the proposed Amendment 3 should be removed from the November ballot because it does not specify which specific anti-abortion laws it would repeal. (Advocates say that exact laws for repeal would be determined by future lawsuits.)

In his ruling, Limbaugh wrote that he “recognizes the gravity of the unique issues involved in this case” and would stay his ruling until Tuesday, “so that further guidance or rulings can be provided by a reviewing court.”

In a statement, Rachel Sweet, campaign manager for Missourians for Constitutional Freedom, the group behind the ballot measure initiative, called the judge’s decision a “profound injustice,” adding that the group plans to appeal. “Our fight to ensure that voters—not politicians—have the final say is far from over,” Sweet said.

Limbaugh’s ruling represents just the latest roadblock that Missouri reproductive rights advocates have encountered. As my colleague Madison Pauly reported, anti-abortion officials in the state stymied advocates’ attempts to bring a ballot measure to voters in 2019. As Madison chronicled, advocates also fought amongst themselves about whether the proposed ballot measure should seek to restore Roe or go beyond it:

In the months following the 2022 election, the group—a mix of advocates including the state ACLU and Planned Parenthood affiliates and the local activist group Abortion Action Missouri—splintered. Some members, including [Executive Director of Medical Students for Choice Pamela] Merritt, wanted to go with language that would enshrine a broad right to abortion. Others wanted to consider an amendment with baked-in compromises in the hopes of winning over more voters. They proposed letting the state impose or preserve restrictions that the larger abortion-rights movement often condemns, including a ban on procedures after so-called fetal viability—the hard-to-pin-down point in pregnancy at which a fetus has a decent chance of surviving outside the uterus. (Viability limits often include an exception for abortions needed to protect a pregnant patient’s life or health.)

Now, based on Limbaugh’s order, it seems they may not get anything they were hoping for.

I’m no legal expert, but I’ve got a sneaky suspicion that if you’ve just asked a judge to reconsider the verdict in your defamation case, you probably shouldn’t repeat similarly defamatory statements during a press conference later that same day.

But, of course, that’s precisely what Donald Trump did.

After appearing in a federal appeals court to fight his verdict in the E. Jean Carroll defamation case, Donald Trump proceeded to bash Carroll and several other women who’ve accused him of sexual assault for nearly an hour during a press conference on Friday.

Last year, the ex-president was ordered to pay Carroll $5 million after a civil court found him liable for sexually assaulting her in the mid-1990s and then subsequently defaming her once she told the public her story.

Earlier this year, Trump was found liable yet again in a separate civil lawsuit for additional remarks he’d made in 2019 when she first came forward, including the assertion that she “wasn’t his type”—a venomous insult that made a reappearance during today’s press conference.

“She would not have been the chosen one,” said Trump, referencing an unnamed woman who he allegedly assaulted in the ’70s on an airplane—one of many sexual assault allegations that Trump dredged up during this conference.

But this wasn’t the only such remark Trump made that afternoon. He also took aim at Carroll directly, claiming again that he didn’t know who she was and accusing her of stealing her story from a Law & Order episode.

He also claimed to have never met her, called a picture of them together potentially “AI-generated,” and then later admitted that they did meet but claimed that meeting didn’t count.

He also, for whatever reason, insulted his own lawyers, who were standing right behind him, saying, “I’m disappointed in my legal talent, to be honest with you.”

The entire rant was chaotic, even by Trump’s standards. It will be interesting to see how it impacts the GOP presidential nominee’s chances at an appeal in the coming weeks—according to a report before his rambling speech today, the judge was already “skeptical.”

The judge in Donald Trump’s New York criminal trial ruled on Friday that he won’t sentence the former president until November 26. Juan Merchan, who Trump has relentlessly accused of bias against him, wrote in his decision that the delay was “to avoid any appearance—however unwarranted—that the proceeding has been affected by or seeks to affect the approaching Presidential election in which the Defendant is a candidate.”

Merchan went on to add that he hopes the decision ends any concern about the impartiality of the court—Trump has repeatedly insisted that the entire prosecution, judge, and jury were rigged by the Biden administration, despite the case being heard in a New York court, not under federal jurisdiction.

“The Court is a fair, impartial and apolitical institution,” Merchan wrote.

The sentencing is for 34 felony convictions of falsifying business records for Trump’s hush money scandal involving adult film star Stormy Daniels, and was led by Manhattan District Attorney Alvin Bragg. Each charge carries up to a four-year prison sentence, but it was highly unlikely that Trump would receive a significant sentence—as a first time non-violent offender, probation was far likelier. However, any chance of a major presidential candidate—or president-elect—being required to serve jail time is completely unprecedented.

Trump has yet to respond to Merchan’s ruling, but the delay was at his own request. He has also submitted filings asking for the conviction to be tossed based on July’s Supreme Court decision on presidential immunity—according to Trump’s attorneys, testimony that was used against him that referred to events that occurred while he was president shouldn’t have been used. Merchan has yet to rule on that.

Prosecutors did not oppose Trump’s request to delay the sentencing, but throughout the trial—and the years-long legal process running up to it—Bragg’s attorneys argued that Trump was improperly trying to delay legal consequences against him.

Correction, September 6: This post has been updated to accurately reflect the number of Donald Trump’s felony convictions. There are 34.

Jade Dass was taking medication to treat her addiction to opioids before she became pregnant—which scientific studies and the Centers for Disease Control and Prevention recommend. But after Dass delivered a healthy daughter, the hospital reported her to the Arizona Department of Child Safety.

Subscribe to Mother Jones podcasts on Apple Podcasts or your favorite podcast app.

Even as medications like Suboxone help pregnant women safely treat addiction, taking them can trigger investigations by child welfare agencies that separate parents from their newborns. Why are women like Dass being investigated for using addiction-treatment medications during pregnancy?

To understand the scope of the dragnet, the Center for Investigative Reporting’s Shoshana Walter and Melissa Lewis, with a team of researchers and lawyers, filed 100 public records requests, putting together the first-ever tally of how often women are reported to child welfare agencies for taking prescription drugs during pregnancy. 

This week on Reveal, in an episode first aired in July 2023, follow Dass as she grapples with losing custody of her baby—and makes one last desperate attempt to keep her family together.

For more about Dass and other mothers facing investigation for taking medication-assisted treatment, read Shoshana Walter’s investigation in collaboration with the New York Times Magazine.

Lawyers representing Elon Musk and X, previously known as Twitter, have quietly begun sending subpoenas to a host of public interest groups, Mother Jones has learned. Most of the targeted organizations have signed open letters to X’s advertisers expressing concerns about the platform’s direction under Musk’s leadership.

The groups include the Center for Countering Digital Hate, the Union of Concerned Scientists, the digital rights organization Access Now, and Fairness and Accuracy in Reporting (FAIR). The subpoenas represent a new chapter in the legal war Musk launched after advertisers fled X, and are part of a lawsuit Musk and X first filed about a year ago against Media Matters over a report it published documenting that ads appeared alongside extremist content. The subpoenas demand any correspondence the organizations have had with that progressive media watchdog group. Several targets told Mother Jones they’ve had no or limited interaction with Media Matters, and that the subpoenas feel, in the words of more than one person, like “a fishing expedition.”

“It’s really cynical, actually: Mr. Free Speech going after anyone who’s criticized him.”

“We were sent a subpoena,” confirms Jim Naureckas, the editor of FAIR, which has been documenting corporate media bias since 1986. In his 34 years there, Naureckas adds, this is their first subpoena.

While “it was very exciting,” he jokes, he says it is not something for which they can provide any responsive materials. “It’s a long convoluted subpoena looking for a bunch of stuff we don’t have. If we were enthusiastic Elon Musk fans who wanted to help him with his lawsuit against Media Matters, I don’t know what we’d give him.”

Representatives for the Union of Concerned Scientists and the Center for Countering Digital Hate also confirmed they had received subpoenas; other signatories on the open letters did not respond to requests for comment.

One of the letters was sent in May 2022 to express concern about Musk’s plan to take over Twitter, and was spearheaded by Media Matters alongside the big tech watchdog group Accountable Tech and the women’s rights nonprofit Ultraviolet. The other, from a coalition calling itself Stop Toxic Twitter, was sent to the platform’s top ad-buyers in November 2022; Media Matters was one of its lead signatories. Media Matters and their legal counsel declined to comment. Twitter, which no longer responds to requests for comment, could not be reached.

FAIR, for the record, had not signed either letter, but had written about X’s lawsuit targeting Media Matters, calling it an attack on free speech. “If a blog post is evidence of collaboration, that’s a stance that’s somewhat hostile to the First Amendment,” Naureckas dryly says.

With advertisers marching away from his site, Musk, a self-proclaimed “free speech absolutist,” launched what he called a “thermonuclear” lawsuit against Media Matters in November 2023 over its report warning that paid content from major companies like Apple and Oracle was being placed along bigoted material on X. Musk and X contend that Media Matters “manipulated” the algorithm to make the ads appear alongside such content.

The company filed in the Northern District of Texas, where it will appear before Judge Reed O’Connor, who holds $15,000 of stock in Tesla, Musk’s other company. (Earlier this week, Media Matters lost its bid to have O’Connor recuse himself.) Media Matters has also filed to dismiss the case, which O’Connor has not yet ruled on; in the meantime, he has ordered that Media Matters must comply with an expansive discovery request from X’s lawyers. Musk is also taking legal action against ad industry trade groups, accusing the organizations of engaging in an illegal group boycott against X. Seemingly in response to the suit, one of the groups, the Global Alliance for Responsible Media, said it would discontinue its work. 

Similarly, the new subpoenas from X’s lawyers will have “a chilling effect on advocacy and on freedom of expression,” says Jessica González, a co-CEO of the media policy organization Free Press. “It’s really cynical, actually: Mr. Free Speech going after anyone who’s criticized him.”

While Free Press, despite being an original convenor of Stop Toxic Twitter, has not received a subpoena, González worries about the effects on organizations that have. Advocacy groups coming together to speak up for the rights of their communities, she says, “are what free speech is all about.”

“By going on a lawsuit spree and issuing subpoenas to a number of organizations who signed a letter,” she explains, “folks have to think twice about whether they’re going to speak up on behalf of their communities. It’s threatening to smaller organizations with smaller budgets.”

“There’s a grim rationality to his legal activities,” says Imran Ahmed, the Center for Countering Digital Hate’s founder and CEO, of Musk. “They’re the desperate actions of a man trying to avoid accountability for what he knows is atrocious behavior.” Ahmed believes Musk knows the behavior is bad, he added, because he himself said in 2022 that Twitter could not be allowed to become “a free-for-all hellscape,” which critics argue it has.

In February, Musk lost a lawsuit that targeted the Center for Countering Digital Hate, when a federal judge in California ruled that the suit represented a clear effort to “punish” the group for criticizing Twitter. “He’s officially someone who’s tried to use strategic litigation to silence an organization, for all his First Amendment purity,” explains Ahmed.

Ahmed says his group’s lawyers have already raised that loss in pushing back against X’s latest subpoena, objecting that it is not only “vague, ambiguous and unintelligible,” but that it “clearly seeks information that X had sought to obtain in another, completely separate case that X brought against CCDH that has been dismissed with prejudice.”

“He’s revealing the extent to which this has never been about free speech,” says Ahmed. “It’s always been about protecting revenue.”

On March 19, Staci Lindberg, the elected clerk of Nevada’s Lyon County, was hit with some unsettling news: She was being sued for the first time in her life. The plaintiff? Her own political party. 

The Republican National Committee had filed a lawsuit against Lindberg and five other Nevada election officials, alleging they had failed to follow a 1993 federal law requiring they maintain accurate voter registration rolls. As evidence, the RNC pointed to three counties it claimed had more people on their rolls than voting-age residents. 

Lindberg, who in 2022 campaigned for the clerk position as a “patriotic, hardworking, conservative Christian,” says she was “shocked” by the accusation. The RNC hadn’t even inquired about her voter roll maintenance processes before wielding such a serious allegation. “It hurt my feelings,” Lindberg, a soft-spoken grandmother of nine, told me. And she notes: “I truly feel we’re one of the most secure and safest counties when it comes to election integrity.” 

Lindberg shouldn’t take the lawsuit too personally. Three of the other election officials sued alongside her were also Republicans. One, Jim Hindle, was such a Donald Trump diehard in 2020 that he was indicted last December for serving as one of Nevada’s fake Trump electors. (The case was dismissed; Hindle declined to comment.) Lindberg and her fellow Republican clerks are just collateral damage in an aggressive and far-flung RNC strategy to contest the 2024 election before a single vote has been cast. 

In Lyon County—which is located in western Nevada and has not favored a Democrat for president since FDR—the RNC initially asserted that 105 percent of voting-eligible residents were registered, an “impossibly high” percentage, suggesting “an ongoing, systemic problem with its voter list maintenance efforts.” The RNC made similar claims for nearby Douglas (104 percent) and Storey (113 percent) counties. 

More curious than these alarming numbers—and the implications of voter fraud—was how the party came up with them. To estimate registration rates in each county, the RNC compared voter data from the secretary of state to a US census dataset that averaged populations over five years. The census data does not account for the tens of thousands of people who migrated to Nevada during the pandemic. More crucially, it often misses people who are lawfully registered to vote but temporarily residing elsewhere—such as college students and military service members. The RNC’s lawyers also, at one point, projected what they thought Nevada’s voting registration should be by extrapolating from a census survey of 54,000 Americans nationwide, not Nevadans specifically. 

“They take one measure of one thing in one place, purport to compare it with another measure of another thing in a different place, and arrive at a conclusion that does not follow,” says Justin Levitt, a Loyola Law School professor and former adviser in the Biden administration. “It’s a little bit like saying, ‘My clock doesn’t match my thermometer, so that means I need to fill up my car.’” Or as Laena St-Jules, Nevada’s senior deputy attorney general, put it in a letter responding to the RNC’s allegations: “This is comparing apples to orangutans.” 

However math-challenged, the RNC’s organized and well-financed legal approach is a sea change from 2020, when the party’s effort to hijack the Oval Office was frenzied and reactionary. The previous attempt was marked by a bevy of postelection lawsuits brimming with outlandish claims, and surreal press conferences headlined by the party’s legal frontman, Rudy Giuliani, who once famously addressed reporters outside a Philadelphia landscaping business next to a porn shop; in another briefing, black hair dye oozed from the former New York City mayor’s scalp as he stammered on about widespread fraud that he could never prove. (Giuliani was disbarred in July by a state appeals court that said he “baselessly attacked and undermined the integrity of this country’s electoral process.”) 

Even those incoherent efforts had a notable effect. Just before the 2020 election, 55 percent of Republican voters expressed confidence in the electoral process, according to a Monmouth University poll. Two weeks after the election, as Giuliani, Trump, and other Republicans flooded the courts and the airwaves with baseless allegations of fraud, only 22 percent did. 

The party’s recent maneuvering suggests a far more sophisticated—and more dangerous—strategy. Co-led by Trump’s daughter-in-law Lara Trump, the RNC is mobilizing what it has called the “most extensive and monumental election integrity program in the nation’s history,” which will involve “100,000 dedicated volunteers and attorneys.” Spearheading this effort is Christina Bobb, the former One America News personality and Trump lawyer who has been indicted in Arizona for her alleged involvement in Trump’s fake elector scheme.

“This is comparing apples to orangutans.”

The RNC says it is already involved in at least 78 election-related lawsuits in 23 states, often working with white-shoe law firms—including Consovoy McCarthy, which employs multiple former clerks to Supreme Court Justice Clarence Thomas, who may eventually be called upon to hear the merits of some of the cases. Several of them focus on longtime GOP bugaboos, like signature verification laws and absentee voting protocols. Others are dressed-up versions of Trump’s wilder conspiracies, including his claim that a “tremendous number of dead people” cast ballots in 2020. Importantly, the buckshot legal onslaught is preemptive, not defensive, and appears intended to cast doubt on the legitimacy of the 2024 election results. (After Biden dropped out of the race and endorsed Vice President Kamala Harris to lead the ticket, Republicans expanded their aim to question the legality of Harris becoming the presumed Democratic nominee. Republicans provided no basis for their argument; the RNC did not respond to broader questions about the legal strategy.) 

“These claims are designed not to change policy between now and November, or to change administrative procedure in elections between now and November,” says David Becker, executive director of the nonpartisan Center for Election Innovation and Research, “but to seed the ground or claims that an election was stolen.”

Multiple times a month, Ingham County clerk Barb Byrum sits down at her desk in a stone-clad government building southeast of Lansing, Michigan, and compares the recent death certificates her office has received against the county’s Qualified Voter File. Each death gets her condolences—and a distinct marking on the QVF: “CHALLENGED. DECEASED.” 

This same process plays out in all 83 of the state’s counties and is just one of many ways the state maintains its voter rolls. After this county-level review, city and township clerks verify and finalize the county clerk’s markings. In Michigan, Nevada, and almost every other state, secretaries of state and county clerks share the responsibility of keeping their master rolls accurate. In addition to checking the lists against death certificates and Social Security data to cull deceased voters, state election officials cross-check with DMV data to identify changes of address. Further, election mail returned as “undeliverable” allows clerks to mark a voter “inactive” and—if that person doesn’t respond to mailings or vote for two more election cycles—remove them from the rolls. 

Despite these safeguards, Byrum has received multiple emails from so-called election integrity activists urging her to purge batches of purportedly dead voters. Two of the lists she’s received in the last four months contained the same names, which the office investigated, but it found that the voters in question did not have death certificates. 

Activists have besieged clerks around the state with similar lists, prompting Secretary of State Jocelyn Benson to twice write to clerks to reiterate the proper rules and procedures for updating the QVF. The lists people send in “do not constitute permissible challenges and clerks should not reject or challenge ballots on the basis of these emails,” she wrote in one missive. 

Such tactics extend beyond Michigan. In March, the New York Times reported that a “network of right-wing activists and allies of Donald J. Trump” was “quietly challenging thousands of voter registrations in critical presidential battleground states.” In some cases, this cabal “pressed local officials,” even cautioning that clerks may be breaking the law if they did not remove the flagged names. In Michigan, these self-appointed fraud watchdogs nicknamed their efforts “soles to the rolls,” a riff on the “souls to the polls” events some Black churches hold to encourage parishioners to vote. 

The attempts may seem bush league, but the underlying allegation that state rolls are teeming with dead people is buttressed by a much more official effort, an RNC lawsuit against Benson this past spring alleging that “impossibly high” registration rates throughout Michigan “indicate an ongoing, systemic problem with its voter list maintenance efforts.” 

If that language sounds familiar, it should: It’s the same phrasing the RNC’s lawyers from Consovoy McCarthy used in their lawsuit against the Nevada clerks. The RNC claims that the fraud it alleges in Nevada is even more pervasive in Michigan—that at least 53 Michigan counties have “more active registered voters than they have adult citizens who are over the age of 18,” and that an additional 23 have registration rates exceeding 90 percent of their adult populations. By this accounting, the rolls in all but seven of the state’s 83 counties would be crowded with voters who have died or moved away. 

“These claims are designed not to change policy 
between now and November…but to seed the ground  for claims that an election was stolen.”

Both RNC lawsuits rest on disingenuous interpretations of the National Voter Registration Act, says historian Alex Keyssar, a professor at Harvard’s Kennedy School. The bipartisan 1993 law was intended to increase public participation in elections. The Voting Rights Act, passed in 1965, had previously outlawed explicitly racist hurdles such as literacy tests, but until the NVRA was enacted, registering to vote remained challenging. “You had to go down to a voter registration office,” Keyssar says. “You had to figure out, depending on the state and sometimes even the city or county, where the office was, what hours it was open, and what identification materials they would need.” 

Also known as the Motor Voter Act, the NVRA made the process more accessible by requiring state governments to offer voter registration to people applying for driver’s licenses. It stipulated that states must make a “reasonable effort to remove the names of ineligible voters,” but officials also must protect voters from arbitrary or partisan purges by waiting two full federal election cycles before removing anyone they have flagged as inactive. 

The claim of inflated voter rolls in Michigan, according to the secretary of state’s motion to dismiss the RNC lawsuit, is based on a figure that includes inactive voters who cannot yet be removed legally, per the NVRA. The motion also counters that the RNC doesn’t “identify a single voter in any Michigan county that is ineligible to be registered but nonetheless appears as an active voter.” 

Becker, of the Center for Election Innovation and Research, says the RNC is “misunderstanding the difference between active voter records and inactive voter records, and often conflating the two, possibly intentionally, to create the impression that there’s some massive fraud on the horizon when that’s of course not the case at all.” 

What’s more, Michigan and Nevada each backstop their voter roll maintenance with help from the Electronic Registration Information Center (ERIC), a nonpartisan information-sharing nonprofit whose 24 member states (plus DC) compare voter registrations against DMV data to identify people who are registered in multiple states, who have duplicate registrations within a state, who have died, or who, in extremely rare cases, have cast ballots in more than one state. In 2020, ERIC flagged the registrations of 1.5 million voters who may have moved between states, 1.2 million who may have moved within a state, 135,000 potential duplicate registrations, and 73,000 possibly deceased voters. Many had already been flagged, but ERIC is helpful as a fail-safe to ensure necessary fixes get made. 

Yet in a wildly ironic twist, ERIC has itself become a right-wing target. Since 2022, nine GOP-led states have withdrawn from the compact based on unfounded claims that ERIC is a “left-wing voter registration drive” designed to boost Democratic candidates. This conspiracy theory was promulgated by the Gateway Pundit blog, which also claimed that survivors of the Parkland high school shooting were crisis actors and that Dr. Anthony Fauci planned an avian flu outbreak to promote vaccines. Never mind that ERIC’s mission is to improve the accuracy of the rolls and make elections more secure—or that the top election officials in four of the seven states that founded ERIC in 2012 were Republicans. The withdrawal of those nine states leaves ERIC with less data to cross-check. 

Right-wing fantasies of voter rolls packed with dead and ineligible voters are nothing new, especially in Michigan. In September 2020, a conservative group calling itself the Public Interest Legal Foundation (PILF) and chaired by Cleta Mitchell, an Oklahoma lawyer at the forefront of efforts to overturn the 2020 election results, began claiming that Michigan’s rolls may have contained more than 27,000 dead people. According to court records, PILF never produced the crossmatching information it supposedly used in its determination. The group couldn’t even prove all of the names it cited belonged to registered Michigan voters. It finally filed a lawsuit in November 2021. The case was dismissed this past spring, and the RNC filed a similar action two weeks later. 

The federal judge who tossed the PILF case pointed to US Election Assistance Commission data indicating that Michigan election officials are actually quite good at keeping their rolls up to date: For the 2018 cycle, Michigan ranked fourth out of 50 states for purging the largest number of dead voters from its rolls; in 2020, it ranked fifth, removing 187,608 deceased people. 

Michigan’s Senate, then controlled by Republicans, debunked similar 2020 claims that the dead were voting en masse. In June 2021, after hearing 28 hours of testimony from almost 90 people and reviewing thousands of pages of subpoenaed government documents, three Trump-supporting GOP lawmakers and one Democrat released a 55-page report proclaiming they’d found “no evidence of widespread or systematic fraud in Michigan’s prosecution of the 2020 election,” in which Joe Biden beat Trump by more than 154,000 votes. 

“Is the drive to discredit the election process part of the plan? Absolutely.”

Court cases and investigations often drag on for months or years as fabricated allegations harm voter confidence and even incite violence, like Michigan experienced after Election Day 2020. Court records detail how staffers at the Bureau of Elections began receiving an onslaught of emails and calls, many threatening violence. Over the next few weeks, the bureau shut down its phone lines and closed its offices due to bomb threats. Officials had to hold meetings at undisclosed locations and even be provided with police protection. Dozens of gun-toting protesters showed up at the home of Benson, the secretary of state, as she was putting up Christmas decorations with her 4-year-old son. 

In Maryland and Pennsylvania, the United Sovereign Americans, a far-right group that has claimed to measure “the effect of millions of instances of apparent election fraud,” is pursuing voter roll lawsuits similar to the PILF case. But experts say the Michigan and Nevada lawsuits, with their RNC imprimatur, could prove more dangerous. “We now have a major political party bringing these lawsuits, and what that does is strengthens this narrative that there’s something wrong,” says Caren Short, director of legal and research for the League of Women Voters, which has filed motions to intervene in several suits initiated by the RNC, including the Michigan case. “Regardless of whether they win, whether the case is dismissed, as they usually are, it still has the impact of creating mistrust.” 

Democrats and Republicans alike have long engaged in legal battles over election rules. Some cases challenging new voting procedures are “legitimate efforts by partisans,” says Becker. 

Days before Wisconsin’s April 2020 primary elections, for example, a federal judge extended the state’s absentee ballot receipt deadline by a week at the request of the Democratic National Committee and other groups. Citing an unprecedented surge in absentee ballot demand and postal delays during the pandemic, the judge ruled that ballots postmarked after Election Day must be counted as long as they were received by the extended deadline. The RNC appealed the decision to the US Supreme Court, arguing the change was ordered too close to Election Day. The Supreme Court agreed. Fair enough. 

More recently, voting rights groups sued to block a new North Carolina law that would have permitted officials to discard the ballots of same-day registrants if a single notice sent to their mailing address had been returned as “undeliverable.” Following a January court injunction striking down part of the law, the state elections board issued a memo requiring that election officials reach out to the registrants by mail, email, and phone to allow them an opportunity to “cure” their ballot and have it counted if they could provide proof of address. Makes sense. 

But another category of lawsuits—the sinister type—is abounding this cycle. These lawsuits, Becker says, are “not designed to win” but are regurgitating previously rejected arguments or challenging years-old election laws in hopes of gaining an edge, if only by manufacturing distrust. “They are premised on a view of the world that does not comport with reality,” says Loyola’s Levitt. 

In addition to the voter roll cases in Michigan and Nevada, the RNC is recycling allegations over absentee ballot receipt deadlines that have been rejected repeatedly by the courts. This serves two purposes: Regardless of the outcome, the legal claims will inspire doubt in every state where they are filed. And the RNC may eventually find a conservative court willing to accept its argument. 

That’s the approach that appears to be playing out in deep red Mississippi, where the RNC asked a federal court to strike down a state deadline on absentee ballots. A 2020 law passed nearly unanimously in the Republican-controlled state legislature allows the counting of absentee ballots that arrive up to five days after the election, as long as they are postmarked by Election Day. (This differs from the Wisconsin case, which involved ballots postmarked after Election Day.) In its complaint, filed in a conservative division, the RNC argues the Mississippi law “extends the election” in violation of federal law and dilutes “honest votes” in a way that “specifically and disproportionately harms Republican candidates and voters.” (Trump’s baseless attacks on absentee voting have alienated some Republicans from that voting method.)

More than a dozen states have similar deadlines for mail-in ballots. It’s an important policy that safeguards the rights of voters whose ballots arrive late through no fault of their own, said Greta Martin, the litigation director of Disability Rights Mississippi, which filed an amicus brief in the case. These voters include overseas service members casting ballots from their deployments. As with the lawsuits challenging voter roll maintenance, the RNC’s claims in the Mississippi lawsuit have been previously debunked. Federal judges in Illinois and North Dakota—both Trump nominees—dismissed challenges to the post-election receipt deadlines, with the judge in Illinois writing: “Plaintiffs’ votes here are not diluted by other valid, lawfully cast votes.” (An appeal is pending.) 

A federal judge also dismissed, in 2020, an RNC lawsuit challenging a New Jersey provision that allows clerks to accept nonpostmarked ballots up to 48 hours after polls close. (To arrive within that window, they would have likely been mailed before Election Day.) Here the claims of vote dilution were deemed “too speculative.” But this past spring, the RNC challenged Nevada’s similar policy on nonpostmarked ballots received no later than three days after Election Day. (The case is ongoing.) The Trump campaign is a plaintiff in both cases. 

“Is the drive to discredit the election process part of the plan? Absolutely,” says Levitt. 

Back in Nevada, Lindberg, the Lyon County clerk, is a little less cynical. She came to see the RNC’s lawsuit against her and the other clerks as an opportunity for election officials to build some trust and “share information” in a court setting. “I have an open-book policy,” she says. If any local voter wants to come watch her do voter roll maintenance, she says she’ll “get him a chair and a cold water.” 

A judge dismissed the Nevada case on June 18, but some locals are still riled up. “We get a lot of people yelling at us, calling us names, saying that we’re trying to cheat them,” Lindberg told me after the court ruled in her favor. (On July 2, the RNC filed a last-ditch effort to revive its claims.) 

Byrum, the Ingham County clerk, thinks the RNC’s Michigan case, too, will eventually be dismissed, but she doesn’t believe winning was the group’s primary objective. “The court cases,” she says, “are an attempt to divert attention and resources away from election management and election administration, with the added bonus of sowing additional seeds of doubt in the integrity of our election.” 

Additional reporting by Sarah Szilagy

The fate of gender-affirming care for transgender youth in Ohio will soon rest in one person’s hands. For the past week, Franklin County Judge Michael Holbrook has heard a case challenging a recent state law that includes a ban on the use of puberty blockers and hormones for trans youth. Now, it’s up to him to decide whether to turn a temporary block on the law into a permanent one—which would make Ohio just the third state to do so as a growing body of anti-trans laws moves through the courts.

From his chambers on the fifth floor of a downtown Columbus courthouse, the judge has heard pleas from the parents of trans children whose lives have been saved by gender-affirming care, physicians from the state’s children’s hospitals, and national experts in trans care. He’s also heard the state’s sharp defense of its law, featuring what is being framed as the “expert” testimony of nationally prominent anti-trans activists who made dubious claims about the efficacy and risks of puberty blockers, hormones, and other gender-affirming medical treatment.

Ohio’s sweeping law, dubbed the “Saving Adolescents from Experimentation” or “SAFE” Act, doesn’t just block the use of puberty blockers and hormones in trans youth (while allowing such medical interventions for cisgender children who may need them for precocious puberty or polycystic ovary syndrome). Passed by a GOP supermajority in January over Republican Gov. Mike DeWine’s veto, it also prohibits trans girls and women from playing women’s sports, including college athletics. The ACLU of Ohio is challenging the entire law as a violation of the state’s single-subject rule for legislation, which requires that bills must pertain to one topic. The state says that topic is “addressing gender transition in children,” but the trial mainly focused on what the families of two trans girls have argued is the discriminatory, life-threatening impact of the ban on gender-affirming care.

“She laid down and wept in my bed. She is carrying looming anxiety and deep sadness surrounding this law.”

Ohio is among the 25 states with laws on the books restricting gender-affirming care, according to the Kaiser Family Foundation, and 39 percent of trans youth live in states with such policies. While most bans have been challenged—and several temporarily blocked, like Ohio’s—the vast majority remain in effect. Only policies in Florida and Arkansas have been permanently enjoined, while the US Supreme Court has agreed to hear a case this coming term about the constitutionality of trans care bans.

On Monday, the mother of a 12-year-old trans girl testified that when her daughter began publicly identifying as a girl, her anxiety “melted away.” The daughter, going by the alias “Grace Goe,” has received gender-affirming mental health care for seven years and hopes to medically suppress puberty at its onset. The prospect of not being able to access that medical care has caused immense distress for Goe and her family. “She laid down and wept in my bed,” her mother said of Goe learning of the ban. “She is carrying looming anxiety and deep sadness surrounding this law.”

The state of Ohio showcased its line of experts, including Jamie Reed, a self-identified “whistleblower,” whose claims about a Missouri gender clinic have been widely disputed by families of the clinic’s current and former patients. Another Ohio witness was James Cantor, a Canadian sex researcher who has testified in support of gender-affirming care bans in trials across the country.

Cantor, a PhD who has never diagnosed a child with gender dysphoria or served on a child’s gender-affirming care team, claimed US studies on gender-affirming care are “sloppy” and that such care causes “sterility in children.” While hormones are known to cause temporary infertility, the long-term effects are unknown—which is why the World Professional Association for Transgender Health (WPATH), the leading professional organization for gender-affirming care providers, recommends providers and patients extensively discuss fertility impacts and options before initiating such treatments. (Some forms of gender-affirming surgery do cause permanent infertility, but for years the Ohio Children’s Hospital Association has assured lawmakers it is not being offered to trans youth in Ohio.)

And as my colleague Madison Pauly revealed last year, it’s not medical professionals or swaths of people who have stopped gender-affirming care proposing these bans to state legislators; many are conservative Christian organizations that believe transness is something to be “cured.”

As the trial wraps up on Friday, it bears repeating what actual experts testified: Dr. Sarah Corathers, an endocrinologist at Cincinnati Children’s Hospital who has served on care teams for about 300 trans youth over the past decade, said she’s seen patients’ quality of life improve under her care. “When medically indicated, gender-affirming medical treatment is safe, effective, and well-established,” she said. Dr. Jack Turban, the director of the University of California, San Francisco’s Gender Psychiatry program, explained the widely accepted protocols clinicians in Ohio and elsewhere use for offering such care to trans youth, including using a multidisciplinary team of providers, offering comprehensive mental health support, and making every decision in concert with the trans child and their parents. He noted that every major medical organization opposes bans on gender-affirming care.

The International Court of Justice, the body that rules on whether or not a state is committing war crimes, just released a groundbreaking advisory opinion saying Israel’s settlements in the West Bank and East Jerusalem violate international law. The advisory opinion is not binding, but carries “authority and legal weight,” according to the New York Times.  

Judge Nawaf Salam, reading out the Court’s opinion, said that Israel’s occupation of the West Bank and East Jerusalem constitutes “de facto annexation,” and that it infringes on the rights of the Palestinian people for self-determination. Therefore, Salam said, Israel should fully end their occupation of those territories outside its 1967 borders, provide reparations to Palestinians harmed by occupation, cease the construction of new settlements, and dismantle settlements that currently exist.  

Of the 15-member court, 11 members agreed on every provision of the opinion. Several members of the court also argued what most human rights organizations have said for decades: that Israel’s policies in the West Bank constitute “racial segregation or apartheid.” 

The United Nations General Assembly had requested the opinion on the legal consequences of Israel’s occupation in Gaza, the West Bank, and East Jerusalem in January 2023, prior to the October 7th Hamas attack on Israel and Israel’s military incursion into Gaza. This opinion is separate from the ongoing deliberations over South Africa’s case regarding genocide in Gaza. 

In the opinion, the ICJ focused entirely on the West Bank and East Jerusalem and excluded “conduct by Israel in the Gaza Strip” since October 7th, 2023. Still, the court noted that Israel’s 2005 withdrawal from Gaza “has not entirely released it of its obligations under the law of occupation” to those living in the strip. 

In the West Bank the court stated that Israel is in violation of several articles of the Geneva Conventions, due to their seizure of Palestinian land; maintenance of separate settler infrastructure such as roads and water systems which Palestinians are forbidden to use; and diversion of territory’s natural resources towards settlers which “constitute annexation.”

This annexation, the court added, is bolstered by Israel’s system of incentives encouraging its citizens to live in the occupied territories. This includes subsidies for new housing construction, and education benefits for Israeli students living in settlements over the Green Line, the border separating Israel from the territories it captured in the 1967 Six-Day War. 

“Israel must cease all settlement activity,” the opinion concluded, “repeal all legislation or measures creating or maintaining the unlawful situation” and repeal “all measures aimed at modifying the demographic composition of any parts of the territory.” 

The court also said Israel must help settlers living in the West Bank find somewhere else to go, and quickly, calling for the “evacuation of all settlers from the settlements,” so that Israel might “bring an end to its presence in the Occupied Palestinian Territory as rapidly as possible.” Then, Palestinian land and property might be returned. In cases where restitution is “materially impossible,” the Court told Israel to provide compensation to all persons who “suffered any form of material damage as a result of Israel’s wrongful acts under the occupation.” 

Within Israel, this opinion isn’t likely to sway much. On July 18th, the day before the court issued its opinion, Israel’s legislature voted overwhelmingly against the possibility of establishing a Palestinian state. And Israeli Prime Minister Benjamin Netanyahu has already derided the ICJ’s opinion as a “decision of lies.” But Israel is not the only country whose obligations are laid out under the ruling. 

The court also spoke to the obligations of other states and international bodies towards Israel and Palestine: All states, they said, are obligated not to recognize Israel’s ongoing presence in the West Bank as legal and “not to render aid or assistance in maintaining the situation created by Israel’s illegal presence in the Occupied Palestinian Territory.” 

That means US tax breaks for nonprofits funding West Bank settler organizations could be in violation of this clause. (The US makes a habit of ignoring ICC and ICJ rulings, and has recently threatened to sanction the court for going against its interests.) In February, US State Department representatives told the ICJ that they should not rule in support of an Israeli withdrawal from the occupied territories—which is exactly what the ICJ just did.

The fate of gender-affirming care for transgender youth in Ohio will soon rest in one person’s hands. For the past week, Franklin County Judge Michael Holbrook has heard a case challenging a recent state law that includes a ban on the use of puberty blockers and hormones for trans youth. Now, it’s up to him to decide whether to turn a temporary block on the law into a permanent one—which would make Ohio just the third state to do so as a growing body of anti-trans laws moves through the courts.

From his chambers on the fifth floor of a downtown Columbus courthouse, the judge has heard pleas from the parents of trans children whose lives have been saved by gender-affirming care, physicians from the state’s children’s hospitals, and national experts in trans care. He’s also heard the state’s sharp defense of its law, featuring what is being framed as the “expert” testimony of nationally prominent anti-trans activists who made dubious claims about the efficacy and risks of puberty blockers, hormones, and other gender-affirming medical treatment.

Ohio’s sweeping law, dubbed the “Saving Adolescents from Experimentation” or “SAFE” Act, doesn’t just block the use of puberty blockers and hormones in trans youth (while allowing such medical interventions for cisgender children who may need them for precocious puberty or polycystic ovary syndrome). Passed by a GOP supermajority in January over Republican Gov. Mike DeWine’s veto, it also prohibits trans girls and women from playing women’s sports, including college athletics. The ACLU of Ohio is challenging the entire law as a violation of the state’s single-subject rule for legislation, which requires that bills must pertain to one topic. The state says that topic is “addressing gender transition in children,” but the trial mainly focused on what the families of two trans girls have argued is the discriminatory, life-threatening impact of the ban on gender-affirming care.

“She laid down and wept in my bed. She is carrying looming anxiety and deep sadness surrounding this law.”

Ohio is among the 25 states with laws on the books restricting gender-affirming care, according to the Kaiser Family Foundation, and 39 percent of trans youth live in states with such policies. While most bans have been challenged—and several temporarily blocked, like Ohio’s—the vast majority remain in effect. Only policies in Florida and Arkansas have been permanently enjoined, while the US Supreme Court has agreed to hear a case this coming term about the constitutionality of trans care bans.

On Monday, the mother of a 12-year-old trans girl testified that when her daughter began publicly identifying as a girl, her anxiety “melted away.” The daughter, going by the alias “Grace Goe,” has received gender-affirming mental health care for seven years and hopes to medically suppress puberty at its onset. The prospect of not being able to access that medical care has caused immense distress for Goe and her family. “She laid down and wept in my bed,” her mother said of Goe learning of the ban. “She is carrying looming anxiety and deep sadness surrounding this law.”

The state of Ohio showcased its line of experts, including Jamie Reed, a self-identified “whistleblower,” whose claims about a Missouri gender clinic have been widely disputed by families of the clinic’s current and former patients. Another Ohio witness was James Cantor, a Canadian sex researcher who has testified in support of gender-affirming care bans in trials across the country.

Cantor, a PhD who has never diagnosed a child with gender dysphoria or served on a child’s gender-affirming care team, claimed US studies on gender-affirming care are “sloppy” and that such care causes “sterility in children.” While hormones are known to cause temporary infertility, the long-term effects are unknown—which is why the World Professional Association for Transgender Health (WPATH), the leading professional organization for gender-affirming care providers, recommends providers and patients extensively discuss fertility impacts and options before initiating such treatments. (Some forms of gender-affirming surgery do cause permanent infertility, but for years the Ohio Children’s Hospital Association has assured lawmakers it is not being offered to trans youth in Ohio.)

And as my colleague Madison Pauly revealed last year, it’s not medical professionals or swaths of people who have stopped gender-affirming care proposing these bans to state legislators; many are conservative Christian organizations that believe transness is something to be “cured.”

As the trial wraps up on Friday, it bears repeating what actual experts testified: Dr. Sarah Corathers, an endocrinologist at Cincinnati Children’s Hospital who has served on care teams for about 300 trans youth over the past decade, said she’s seen patients’ quality of life improve under her care. “When medically indicated, gender-affirming medical treatment is safe, effective, and well-established,” she said. Dr. Jack Turban, the director of the University of California, San Francisco’s Gender Psychiatry program, explained the widely accepted protocols clinicians in Ohio and elsewhere use for offering such care to trans youth, including using a multidisciplinary team of providers, offering comprehensive mental health support, and making every decision in concert with the trans child and their parents. He noted that every major medical organization opposes bans on gender-affirming care.

The International Court of Justice, the body that rules on whether or not a state is committing war crimes, just released a groundbreaking advisory opinion saying Israel’s settlements in the West Bank and East Jerusalem violate international law. The advisory opinion is not binding, but carries “authority and legal weight,” according to the New York Times.  

Judge Nawaf Salam, reading out the Court’s opinion, said that Israel’s occupation of the West Bank and East Jerusalem constitutes “de facto annexation,” and that it infringes on the rights of the Palestinian people for self-determination. Therefore, Salam said, Israel should fully end their occupation of those territories outside its 1967 borders, provide reparations to Palestinians harmed by occupation, cease the construction of new settlements, and dismantle settlements that currently exist.  

Of the 15-member court, 11 members agreed on every provision of the opinion. Several members of the court also argued what most human rights organizations have said for decades: that Israel’s policies in the West Bank constitute “racial segregation or apartheid.” 

The United Nations General Assembly had requested the opinion on the legal consequences of Israel’s occupation in Gaza, the West Bank, and East Jerusalem in January 2023, prior to the October 7th Hamas attack on Israel and Israel’s military incursion into Gaza. This opinion is separate from the ongoing deliberations over South Africa’s case regarding genocide in Gaza. 

In the opinion, the ICJ focused entirely on the West Bank and East Jerusalem and excluded “conduct by Israel in the Gaza Strip” since October 7th, 2023. Still, the court noted that Israel’s 2005 withdrawal from Gaza “has not entirely released it of its obligations under the law of occupation” to those living in the strip. 

In the West Bank the court stated that Israel is in violation of several articles of the Geneva Conventions, due to their seizure of Palestinian land; maintenance of separate settler infrastructure such as roads and water systems which Palestinians are forbidden to use; and diversion of territory’s natural resources towards settlers which “constitute annexation.”

This annexation, the court added, is bolstered by Israel’s system of incentives encouraging its citizens to live in the occupied territories. This includes subsidies for new housing construction, and education benefits for Israeli students living in settlements over the Green Line, the border separating Israel from the territories it captured in the 1967 Six-Day War. 

“Israel must cease all settlement activity,” the opinion concluded, “repeal all legislation or measures creating or maintaining the unlawful situation” and repeal “all measures aimed at modifying the demographic composition of any parts of the territory.” 

The court also said Israel must help settlers living in the West Bank find somewhere else to go, and quickly, calling for the “evacuation of all settlers from the settlements,” so that Israel might “bring an end to its presence in the Occupied Palestinian Territory as rapidly as possible.” Then, Palestinian land and property might be returned. In cases where restitution is “materially impossible,” the Court told Israel to provide compensation to all persons who “suffered any form of material damage as a result of Israel’s wrongful acts under the occupation.” 

Within Israel, this opinion isn’t likely to sway much. On July 18th, the day before the court issued its opinion, Israel’s legislature voted overwhelmingly against the possibility of establishing a Palestinian state. And Israeli Prime Minister Benjamin Netanyahu has already derided the ICJ’s opinion as a “decision of lies.” But Israel is not the only country whose obligations are laid out under the ruling. 

The court also spoke to the obligations of other states and international bodies towards Israel and Palestine: All states, they said, are obligated not to recognize Israel’s ongoing presence in the West Bank as legal and “not to render aid or assistance in maintaining the situation created by Israel’s illegal presence in the Occupied Palestinian Territory.” 

That means US tax breaks for nonprofits funding West Bank settler organizations could be in violation of this clause. (The US makes a habit of ignoring ICC and ICJ rulings, and has recently threatened to sanction the court for going against its interests.) In February, US State Department representatives told the ICJ that they should not rule in support of an Israeli withdrawal from the occupied territories—which is exactly what the ICJ just did.

When the Iowa Supreme Court ruled in 2018 that abortion was a fundamental right to be protected under the most stringent level of judicial review, reproductive justice advocates cheered. Even in a state where Republicans dominated every level of government, it seemed that abortion rights could still prevail—as long as the courts went along.

That didn’t sit well with Iowa’s first woman governor, Kim Reynolds, or her allies in the legislature, who set about rewriting the rules for how justices are picked. Last month, a much-altered Iowa Supreme Court reversed course. In a 4–3 vote, the court effectively upheld the state’s six-week abortion ban by overturning a block on that ban previously imposed by a lower court, thus handing Reynolds a significant, if unsurprising, victory. When the new ban takes effect, likely this week, Iowa will join North Dakota, Indiana, and other Midwestern states facing a drastic curtailment of abortion rights post-Dobbs—and will become the latest example of how conservatives have gamed state supreme courts to restrict reproductive rights and achieve other policy goals.

Reynolds, whose office didn’t respond to Mother Jones’ questions or request for comment, said in a statement after the ruling, “Iowa voters have spoken clearly through their elected representatives,” a sentiment echoed by other Republican lawmakers in support of the six-week ban. But Iowans’ support for the ban has not changed; in fact, multiple polls show a majority believe abortion should be legal in most cases. What has changed since the Iowa Supreme Court established a constitutional right to abortion in 2018 is who sits on the court and how they got there.

“There’s a lot of fear right now,” Alison Dreith, director of strategic partnerships of the Midwest Access Coalition, told Mother Jones shortly after the decision. “It’s already making an impact, and the details of the ruling haven’t even been established.”

State court politicization has been happening for years, of course. But Michael Milov-Cordoba, an attorney in the Judiciary Program at the Brennan Center for Justice at New York University School of Law, says there’s been a “big uptick” in legislative attempts to politicize courts dating back to the 2019 US Supreme Court decision in Rucho v. Common Cause, which closed the door to federal challenges to partisan gerrymandering. By punting the gerrymandering issue to the states, the US Supreme Court incentivized state lawmakers to try to gain political influence over state courts, he says. 

Then came the Dobbs decision in 2022, which was “a real watershed moment for state judicial politics,” Milov-Cordoba says. “The public as a whole came to see that state supreme courts would be deciding the extent to which folks in the state would have access to abortion and the contours of that access.” Naturally, what matters most is who is on those courts.

The story of how Iowa’s highest court was transformed dates to 2017, when Reynolds succeeded longtime Gov. Terry Branstad to become Iowa’s chief executive. The election that ushered Donald Trump into the White House also gave Iowa its first Republican trifecta—control of the governorship and both houses of Legislature—in nearly two decades. Reynolds made it her mission to use the GOP’s new power to drastically restrict access to abortion, which was then legal until 20 weeks of pregnancy.  

Within a year, the legislature passed, and Reynolds signed, what was then the country’s most restrictive abortion law, banning the procedure after fetal cardiac activity can be detected, or around six weeks after a woman’s last menstrual period. In a May 2018 statement, Reynolds acknowledged the bill would almost certainly be challenged—but she promised that she wouldn’t back down until abortion was banned in Iowa.

By that point, the state’s highest court was already weighing the constitutionality of a different, less onerous law mandating a 72-hour waiting period before patients could terminate a pregnancy. The court eventually struck down the waiting-period requirement, ruling that the state constitution protected a fundamental right to abortion and that any restriction must overcome strict scrutiny, or be “narrowly tailored” to further a “compelling government interest.” That 5–2 decision also doomed Reynolds’ six-week ban. Undeterred, Reynolds said she wouldn’t continue the legal fight. Rather, she would focus on “other ways to advance the cause of protecting the unborn.” 

What Reynolds didn’t spell out: Republicans in the state legislature had already devised their own plan to achieve her goal, which involved overhauling the process of who gets appointed to the courts. Within months, Reynolds signed a law giving her majority control over deciding who sits on the commission that nominates justices and appellate judges. 

For nearly 60 years, Iowa judges were selected under their bipartisan version of the Missouri Plan, which authorized the governor to select appointees from lists provided by a nominating commission. Judges at all court levels face retention elections after a year on the bench. But in a last-minute addition to a budget bill in April 2019, Republican lawmakers pushed through legislation that removed the chief justice from the commission, instead giving the governor another opportunity to appoint a seat—and shifting majority control to those commission members chosen by the governor.

“We read in scripture that the author of life wants to give ‘a future and a hope’ to all his children. Who are we to stand in his way?”

“This is not a power grab,” Holt insisted on the House floor. “This is a majority party in this chamber exercising our authority when we recognize that changes are needed.”

By the time she signed the bill into law in 2019, Reynolds had already appointed two justices to the Supreme Court. At an annual gathering of the Family Leader—an evangelical Christian dark-money group that, according to its website, seeks to advance “God-honoring, righteous policy” in Iowa—she minced no words. “Elections matter, and fortunately the tide is turning in Iowa’s Supreme Court,” she said. “In two short years, we’ve moved the needle from left to right.”

After the change, Reynolds appointed two more justices. Three years later, a week before the Dobbs decision, the Iowa court handed down a ruling that significantly weakened their 2018 decision, holding that abortion restrictions need not satisfy strict scrutiny to be constitutional. But the splintered opinion didn’t establish what standard of judicial review needed to be employed. The next month, Reynolds named her fifth appointee to the Supreme Court.

But Reynolds still didn’t get the outcome she wanted. In a tie vote in June 2023, after one of Reynolds’ appointees recused herself, the court declined to resurrect the 2018 abortion ban. Incensed, Reynolds convened a special legislative session last July to pass another six-week abortion ban. “We read in scripture that the author of life wants to give ‘a future and a hope’ to all his children,” Reynolds told that year’s Family Leader convention, where she signed the ban into law. “Who are we to stand in his way?” 

The state’s abortion providers, Planned Parenthood and the Emma Goldman Clinic, challenged the ban, and a district court quickly blocked it. But this time around, the high court changed course. The majority noted nothing in the “history and tradition” of Iowa’s laws and customs supported a fundamental right to abortion, and that the lower court should employ the rational basis test, which would greenlight abortion restrictions that are “rationally” related to a “legitimate government interest.”

The six-week ban prohibits abortions before as many as a third of women know they’re pregnant. While the law outlines exceptions for reported rape and incest, risk to the patient’s health, and fatal fetal abnormalities, the stories of rape survivors who were denied abortions and women who were forced to leave states like Idaho and Texas to access lifesaving care suggest such exceptions are only theoretical.

Of Reynolds’ five appointees to the high court, only her first, Chief Justice Susan Christensen, voted to reject the six-week ban. In a passionate dissent joined by the two justices who predate Reynolds, Christensen accused the majority of ignoring the sexism underlying the state’s historic abortion bans—and other laws that rendered women “second-class citizens.”

“The only female lives that this statute treats with any meaningful regard and dignity are the unborn lives of female fetuses.”

“The only female lives that this statute treats with any meaningful regard and dignity are the unborn lives of female fetuses,” Christensen wrote. “After that, this statute forces pregnant women (and young girls) to endure and suffer through life-altering health complications that range from severe sepsis requiring limb amputation to a hysterectomy so long as those women are not at death’s door. All in the name of promoting unborn life—or, more accurately, birth.”

It’s not just Iowa lawmakers who are changing the rules of the game. 

For years, politicians across the country have set their legislative sights on state judiciaries, looking to manipulate the courts to benefit their policy goals, the Brennan Center’s Milov-Cordoba says. The Brennan Center annually tracks proposed legislation that, in many cases, can weaken judicial independence or aggrandize a majority party’s power. While legislators principally seek to influence the courts through changing judicial selection procedures, Milov-Cordoba says lawmakers have also sought to change judicial ethics commissions or limit courts’ ability to hear certain cases.

In Ohio, for instance, Republican lawmakers threatened to strip state courts of their jurisdiction to hear abortion law challenges after voters constitutionally protected access to the procedure last November. In 2023 alone, the Brennan Center identified 124 bills undermining judicial independence introduced in 29 states, with legislation passing in Utah, Idaho, and Mississippi. Both parties have sought greater political influence over the courts—in 2021, Illinois Democrats pushed through a first-in-decades redistricting plan for Supreme Court races after a Democratic justice lost a retention election. But Milov-Cordoba says efforts in Republican-controlled legislatures dominate overall tallies. “There’s an asymmetry here,” he says.

A lobbyist for the Family Leader has already called for Iowa lawmakers to enact a total abortion ban, according to the Des Moines Register, and GOP lawmakers haven’t ruled out the idea. Meanwhile, the Emma Goldman Clinic—founded the same year Roe was decided and the last independent abortion clinic in Iowa—will continue performing abortions, including as many as possible under the six-week ban, said its executive director, Francine Thompson.

“We’re going to work as hard as we possibly can to help folks get the care that they need between now and when the ban takes effect,” Thompson said at a news conference, adding that the clinic would refer patients out of state when necessary.

Only four Midwestern states have stricter abortion laws than Iowa’s impending six-week ban: Indiana, Missouri, North Dakota, and South Dakota ban it completely. Shortly after the ruling, the Iowa Abortion Access Fund began routing patients needing support to the Chicago Abortion Fund, announcing the two funds had partnered to help Iowans travel east to Illinois, where abortion is legal until fetal viability.

Iowans were already traveling to Illinois and Minnesota for abortions, says Dreith of the Midwest Access Coalition, which provides practical support, including transportation coordination and money for lodging and childcare. But patients were also traveling to Iowa for care—especially from neighboring Missouri, and Nebraska, which has a 12-week ban. In fact, as many as 10 percent of abortions performed in Iowa in 2023 were for out-of-state patients, according to data from the Guttmacher Institute. 

Abortion costs have risen exponentially in the past several years, in no small part due to state bans forcing women to travel hundreds of miles to obtain abortions. Those costs will certainly increase as more Iowans will need to go out of state for care. Dreith says before Dobbs, the average support the Midwest Access Coalition provided was about $350 per patient. Now, it’s closer to $1,200. And funneling patients out of states with total or near-total bans racks up a different type of cost, too.

“You have the case of just not enough appointments available to go around post-Dobbs,” Dreith said. “You used to be able to get an appointment within 24 hours, and now, some people are scheduling out weeks—still, two years later—because they can’t meet the demand.”