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Despite state bans, abortions nationwide are up, driven by telehealth

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Despite state bans, abortions nationwide are up, driven by telehealth

Abortion rights activists at the Supreme Court in Washington, D.C. on March 26, the day the case about the abortion drug mifepristone was heard. The number of abortions in the U.S. increased, a study says, surprising researchers.

Drew Angerer/AFP via Getty Images


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Drew Angerer/AFP via Getty Images


Abortion rights activists at the Supreme Court in Washington, D.C. on March 26, the day the case about the abortion drug mifepristone was heard. The number of abortions in the U.S. increased, a study says, surprising researchers.

Drew Angerer/AFP via Getty Images

In the 18 months following the Supreme Court’s decision that ended federal protection for abortion, the number of abortions in the U.S. has continued to grow, according to The Society of Family Planning’s WeCount project.

“We are seeing a slow and small steady increase in the number of abortions per month and this was completely surprising to us,” says Ushma Upadhyay, a professor and public health scientist at the University of California, San Francisco who co-leads the research. According to the report, in 2023 there were, on average, 86,000 abortions per month compared to 2022, where there were about 82,000 abortions per month. “Not huge,” says Upadhyay, “but we were expecting a decline.”

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The slight increase comes despite the fact that 14 states had total abortion bans in place during the time of the research. According to the report, there were about 145,000 fewer abortions in person in those states since the Dobbs decision, which triggered many of the restrictive state laws.

“We know that there are people living in states with bans who are not getting their needed abortions,” says Upadhyay. “The concern we have is that that might be overlooked by these increases.”

Florida, California and Illinois saw the largest surges in abortions, which is especially interesting given Florida’s recent 6-week ban that started on May 1.

Abortion rights opponents demonstrate in New York City, on March 23. Some states’ abortion bans are known as “heartbeat bills,” because they make abortion illegal after cardiac activity starts, usually around six weeks of pregnancy.

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Abortion rights opponents demonstrate in New York City, on March 23. Some states’ abortion bans are known as “heartbeat bills,” because they make abortion illegal after cardiac activity starts, usually around six weeks of pregnancy.

Kena Betancur/AFP via Getty Images

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The latest report also captures for the first time the impact of providers offering telehealth abortions from states with protections for doctors and clinics known as shield laws – statutes that say they can’t be prosecuted or held liable for providing abortion care to people from other states.

Between July and December 2023, more than 40,000 people in states with abortion bans and telehealth restrictions received medication abortion through providers in states protected by shield laws. Abortion pills can be prescribed via telehealth appointments and sent through the mail; the pills can safely end pregnancies in the first trimester.

The report includes abortions happening within the U.S. health care system, and does not include self-managed abortions, when people take pills at home without the oversight of a clinician. For that reason, researchers believe these numbers are still an undercount of abortions happening in the U.S.

Accounting for the increases

A major factor in the uptick in abortions nationwide is the rise of telehealth, made possible in part by regulations first loosened during the coronavirus pandemic.

According to the report, telehealth abortions now make up 19% of all abortions in the U.S. In comparison, the first WeCount report which spanned April 2022 through August 2022 showed telehealth abortions accounted for just 4% of all abortions. Research has shown that telehealth abortions are as safe and effective as in-clinic care.

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“It’s affordable, it’s convenient, and it feels more private,” says Jillian Barovick, a midwife in Brooklyn and one of the co-founders of Juniper Midwifery, which offers medication abortion via telehealth to patients in six states where abortion is legal. The organization saw its first patient in August 2022 and now treats about 300 patients a month.

“Having an in-clinic abortion, even a medication abortion, you could potentially be in the clinic for hours, whereas with us you get to sort of bypass all of that,” she says. Instead, patients can connect with a clinician using text messages or a secure messaging platform. In addition to charging $100 dollars for the consultation and medication – which is well below the average cost of an abortion – Barovick points to the cost savings of not having to take off work or arrange child care to spend multiple hours in a clinic.

She says her patients receive their medication within 1 to 4 business days, “often faster than you can get an appointment in a clinic.”

A study published in JAMA Internal Medicine on Monday followed about 500 women who had medication abortions with the pills distributed via mail order pharmacy after an in-person visit with a doctor. More than 90% of the patients were satisfied with the experience; there were three serious adverse events that required hospitalization.

In addition to expansions in telehealth, there have been new clinics in states like Kansas, Illinois and New Mexico, and there’s been an increase in funding for abortion care – fueled by private donors and abortion funds.

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The impact of shield laws

During the period from October to December 2023, nearly 8,000 people per month in states with bans or severe restrictions accessed medication abortions from clinicians providing telehealth in the 5 states that had shield laws at the time. That’s nearly half of all monthly telehealth abortions.

“It’s telemedicine overall that is meeting the need of people who either want to or need to remain in their banned or restricted state for their care,” says Angel Foster, who founded The MAP, a group practice operating a telehealth model under Massachusetts’ shield laws. “If you want to have your abortion care in your state and you live in Texas or Mississippi or Missouri, right now, the shield law provision is by far the most dominant way that you’d be able to get that care.”

Foster’s group offers medication abortions for about 500 patients a month. About 90% of their patients are in banned or restrictive states; about a third are from Texas, their most common state of origin, followed by Florida.

“Patients are scared that we are a scam,” she says, “they can’t believe that we’re legit.”

Since the WeCount data was collected, additional states including Maine and California have passed shield laws protecting providers who offer care nationwide. The new shield laws circumvent traditional telemedicine laws, which often require out-of-state health providers to be licensed in the states where patients are located. States with abortion bans or restrictions and/or telehealth bans hold the provider at fault, not the patient.

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Existing lawsuits brought by abortion opponents, including the case awaiting a Supreme Court decision, have the potential to disrupt this telehealth surge by restricting the use of the drug mifepristone nationwide. If the Supreme Court upholds an appeals court ruling, providers would be essentially barred from mailing the drug and an in-person doctor visit would be required.

There is also an effort underway in Louisiana to classify abortion pills as a controlled substance.

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Tech reversal pushes US megacaps into correction territory

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Tech reversal pushes US megacaps into correction territory

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Four of the so-called Magnificent Seven technology stocks that have powered the US market rally for the past nine months ended the week in correction territory, having fallen by more than 10 per cent from recent peaks. 

Another two — Microsoft and Amazon — are close to the double-digit falls that define a correction. Investors are looking ahead to further tech earnings updates next week amid worries about punchy valuations and the risks that returns from vast artificial intelligence-related spending may not live up to early hopes.

Nvidia and Tesla are each down 17 per cent from their recent peaks while Meta and Google parent Alphabet have fallen 14 per cent and 12 per cent. Apple is the best performer in the group, having lost just 7 per cent while Microsoft and Amazon have slid about 9 per cent each.

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On Wednesday Alphabet sparked a wider market sell-off when, despite it reporting solid quarterly operating numbers, its shares fell more than 5 per cent on concerns about AI-related investments. Its $13bn quarterly capital expenditure was almost double the levels of a year ago.

“For a long time investors were really sold on the premise that AI investment in and of itself — spending money — is good,” said Max Gokhman, a senior vice-president at Franklin Templeton Investment Solutions. “What we’re seeing now is . . . investors saying, ‘Hold up a sec, what are the productivity gains here, when do you expect to see them?’”

Alphabet’s fall helped drag the tech-heavy Nasdaq Composite to its worst one-day decline in 18 months on Wednesday, down 3.6 per cent. The index ended the week down 2.1 per cent.

Microsoft, Meta, Apple and Amazon earnings next week may set up a fresh test of investor faith in the AI narrative that has been a crucial driver of market gains.

“Expectations are high and valuations for the Mag Seven aren’t cheap. We’re also closer to the point when we see some decelerations in earnings from them as a group — from the beneficiaries of AI in general,” said Josh Nelson, head of US equity at T Rowe Price. 

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Investors this week also showed they were prepared to punish companies that missed expectations, with Tesla losing 12 per cent on Wednesday after slowing sales and its own AI spending shrank profits more than expected. And Ford shares tumbled 18 per cent on Thursday when its profits fell short, hurt by unexpectedly high warranty costs.

On average, companies that missed expectations had seen their shares drop 3.3 per cent in the days surrounding their earnings, according to data from FactSet, more than the five-year average of 2.3 per cent.

Companies that beat expectations saw on average no gains in their share price, FactSet reported.

“The trend of misses getting punished more than beats get rewarded is getting a little bit more significant,” said Liz Ann Sonders, chief investment strategist at Charles Schwab. “There is uncertainty and skittishness with regard to just how fast the market, driven by those names ran, without the commensurate improvement in their forward earnings prospects.”

Sonders also pointed to the fact that the earnings season under way had coincided with a “rotation” among investors taking profits in the biggest tech names in favour of backing smaller companies that were more likely to see big benefits if the Federal Reserve begins to cut interest rates in September.

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This week, the Russell 2000 index of small-cap stocks added 3.5 per cent while the blue-chip S&P 500 fell 0.8 per cent.

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Boar's Head recalls 200,000 pounds of deli meat linked to a Listeria outbreak

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Boar's Head recalls 200,000 pounds of deli meat linked to a Listeria outbreak

An electron microscope image of a Listeria monocytogenes bacterium, which has been linked to an outbreak spread through deli meat. Boar’s Head recalled meat on Friday, after two deaths and 33 hospitalizations linked to Listeria.

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Elizabeth White/AP/Centers for Disease Control and Prevention

Boar’s Head is recalling more than 200,000 pounds of deli meat that could be contaminated with listeria, the Food Safety and Inspection Service announced Friday.

The recall includes all Liverwurst products, as well as a variety of other meats listed in the FSIS announcement. The CDC has identified 34 cases of Listeria from deli meat across 13 states, including two people who died as of Thursday. The statement also said there had been 33 hospitalizations.

The CDC warns that the number of infections is likely higher, since some people may not be tested. It can also take three to four weeks for a sick individual to be linked to an outbreak.

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Listeria is a foodborne bacterial illness, which affects about 1,600 people in the U.S. each year, including 260 deaths. While it can lead to serious complications for at-risk individuals, most recover with antibiotics. Its symptoms typically include fever, muscle aches and drowsiness,

The CDC says people who are pregnant, aged 65 or older, or have weakened immune systems are most at risk. It suggests that at-risk individuals heat any sliced deli meat to an internal temperature of 165°F.

The investigation from the CDC and FSIS is ongoing. This is not the first listeria outbreak of the summer, as more than 60 ice cream products were previously recalled during an outbreak in June.

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US charges short seller Andrew Left with fraud

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US charges short seller Andrew Left with fraud

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A federal grand jury in Los Angeles has charged prominent short seller Andrew Left with more than a dozen counts of fraud, alleging that he made profits of at least $16mn from “a long-running market manipulation scheme”, according to a statement from the Department of Justice.

The DoJ added: “Left knowingly exploited his ability to move stock prices by targeting stocks popular with retail investors and posting recommendations on social media to manipulate the market and make fast, easy money.”

The grand jury indictment charged him with 17 counts of securities fraud, one count of engaging in a securities fraud scheme and one count of making false statements to federal investigators.

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The indictment alleged that Left, who has a high profile on social media, publicly claimed that companies’ share prices were too high or low, often with a recommended target price and “an explicit or implicit representation about Citron’s trading position”. This, the DoJ said, “created the false pretence that Left’s economic incentives aligned with his public recommendation”.

Left prepared to quickly close positions after publishing his comments, taking profits on price moves he had caused, according to the indictment.

It also accused Left of presenting himself as independent and concealing Citron’s links with a hedge fund by fabricating invoices and wiring payments through a third party.

If convicted, Left could face decades in prison. Each securities fraud count carries a maximum penalty of 20 years in prison, while the securities fraud scheme and false statements counts each carry a maximum prison term of 25 years and five years, respectively.

The US Securities and Exchange Commission has also filed a separate civil fraud case against Left and his firm Citron Research, claiming the founder made $20mn from a “multi-year scheme to defraud followers.” Left declined to comment on the DoJ and SEC charges.

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“Andrew Left took advantage of his readers. He built their trust and induced them to trade on false pretences so that he could quickly reverse direction and profit from the price moves following his reports,” said Kate Zoladz, regional director of the SEC’s Los Angeles office. “We uncovered these alleged bait-and-switch tactics, which netted Left and his firm $20mn in ill-gotten profits, and we intend to hold Left and his firm accountable for their actions.”   

The practice of betting that a company’s share price will go down has long been controversial — opponents say it gives traders incentives to spread misinformation, while supporters argue that it improves price discovery and holds management accountable. Last year the SEC adopted new rules that require investors to disclose short positions more quickly and fully.

Left has been most vocal recently in his scepticism over GameStop, the ailing video games retailer. In May it raised $3bn selling new shares following a surge in its price driven by the reappearance of Roaring Kitty — whose real name is Keith Gill — who was instrumental in the 2021 meme stock mania that had sent its value rocketing.

Left told followers in mid-June that Citron had closed its short position on the stock not because he had changed his views but because of GameStop’s newly-strengthened balance sheet.

In 2016, Left received a five-year “cold shoulder” ban from regulators in Hong Kong — a landmark ruling for the city — temporarily barring him from its markets after he was found culpable of misconduct related to a research report he published on Chinese property developer China Evergrande.

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Additional reporting by Stefania Palma in Washington and Brooke Masters in New York

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