Podcast recap: “ProPublica’s Ectopic Pregnancy reporting” with AAPLOG

Dr. Christina Francis, CEO of the American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG) invited me back onto AAPLOG’s Observations podcast for another “reverse interview,” where I ask her the questions instead of the other way around. This is a recurring format for us. Our most recent round covered Representative Kat Cammack’s ectopic pregnancy. This time, we dug into a new ProPublica article that implies pro-life laws are driving a rise in ectopic pregnancy deaths.

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Key Takeaways

1. Nearly every state abortion restriction explicitly exempts ectopic pregnancy treatment, so the confusion ProPublica describes is not really about what the laws say. It is about hospitals who still have not gotten their guidance right several years after Dobbs.
2. The timeline ProPublica uses lines up better with a 2020 change in mail-order abortion pill access than with the 2022 Dobbs decision, and factors like rising STI rates, IUD use, and IVF also plausibly contribute to more ectopic pregnancies overall.
3. In the years since Dobbs, Texas and Arkansas have prosecuted zero doctors for providing medically necessary abortion care, which undercuts the claim that fear of “overzealous prosecutors” explains delayed treatment.

Summary

Dr. Francis walked me through how doctors actually diagnose ectopic pregnancy: ultrasound findings, hCG hormone trends measured across multiple visits, and a discriminatory zone above which a normal pregnancy should be visible in the uterus. This is patient work, not guesswork, and it often takes more than one data point.

“The vast majority of state abortion laws that are preventing abortion do actually explicitly list out that this doesn’t apply to ectopic pregnancies.”

That’s the part ProPublica’s framing skips past. The confusion doesn’t come from unclear laws. It comes from hospitals and hospital attorneys who still get the law wrong, years after they had time to read it. Dr. Francis described a hospital attorney in her state who wrongly told staff to file abortion paperwork for ectopic pregnancy treatment, guidance the hospital association corrected only after she pushed back with the bill’s actual text. She argued the fix is straightforward: hospital systems and their attorneys need to train physicians accurately when a new law passes, and colleagues need to break medicine’s “culture of silence” and correct each other instead of staying quiet. Four years past Dobbs, she said, hospitals that still haven’t done that work have run out of excuses.

“ProPublica is comparing 2020 to 2025 as the after-abortion-restrictions years, even though Roe wasn’t overturned until 2022.”

ProPublica’s own numbers show about 200 deaths linked to ectopic pregnancy diagnoses from 2020 through 2025, compared to roughly 100 in the six years before that. But most state abortion restrictions did not take effect until the Dobbs decision in 2022, some as late as 2025. What actually changed in 2020 was the removal of the in-person dispensing requirement for mail-order abortion pills. Dr. Francis pointed to that shift, along with rising STI rates, IUD use, and IVF, as more plausible drivers. As for the studies telehealth providers cite to show low ectopic rates among their patients, she noted those patients were screened for risk factors before enrollment. As she put it, that’s “not the real world.”

She would know. Earlier this year, Dr. Francis did an expose on Aid Access, where she posed as a patient with a history of ectopic pregnancy and an IUD, both of which are risk factors for additional ectopic pregnancy. Aid Access still sent her abortion pills.

“Zero. Zero, and not just Texas. Also Arkansas, also everywhere.”

That’s how many doctors have been prosecuted across the country for providing medically necessary care in the four years since Dobbs. Using conservative estimates, I calculated more than 100,000 cases of medically necessary interventions to end pregnancy (missed miscarriage, PPROM, or ectopic pregnancy) in just Texas since Dobbs. Not one has led to a prosecution.

Dr. Francis still recommends medical professionals thoroughly document their process with every patient, not because prosecutors are coming, but because it protects both the patient’s care and the doctor’s judgment on record.

We closed on what should be easy common ground: this rise in ectopic pregnancy deaths is concerning, and better CDC data would help determine root causes.

Interview Chapters

• 00:00 – Introduction and today’s “reverse interview” setup
• 03:46 – Monica frames ProPublica’s ectopic pregnancy article
• 06:07 – Ectopic pregnancy versus “pregnancy of unknown location,” defined
• 09:11 – The “ring of fire” and other ultrasound signs
• 11:15 – Why doctors wait for a second data point
• 13:30 – The “evidence-based guidelines” ProPublica cites
• 16:12 – Reading hCG trends to tell ectopic pregnancy from miscarriage
• 20:50 – The “diagnostic aspiration” argument from abortion rights advocates
• 26:44 – Comparing the death data to the 2020 mail-order pill change
• 32:24 – Other factors behind rising ectopic pregnancy rates
• 38:02 – Maternity care deserts and the OB-GYN “exodus” claim
• 42:18 – Steelmanning the Arkansas case of denied treatment
• 48:40 – Zero prosecutions for medically necessary abortion care
• 52:25 – Why documentation protects doctors and patients
• 55:01 – Where pro-life and pro-choice advocates agree

Additional Resources

• SPL’s detailed breakdown of the ProPublica ectopic pregnancy article: Are abortion bans doubling ectopic pregnancy deaths?
• Registration for AAPLOG’s 2027 conference (where I will be keynoting on reproductive grief resources for secular patients)
• SPL interview of Dr. Francis regarding the Tierra Walker case
• AAPLOG’s medical education videos on obstetric practice in states with abortion restrictions
• Previous AAPLOG episodes where I “reverse interviewed” Dr. Francis:
  • Asking Your Burning Questions for Pro-Life OB-GYNs
  • What Do OB-GYNs Believe About Abortion?
  • Using Medically Accurate Vocabulary When Discussing Abortion
  • What’s it like to be a pro-life physician in a pro-abortion culture?
  • Do Pro-Life Laws STOP Miscarriage & Ectopic Pregnancy Care? (Discussion of Kat Cammack case)

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