In rural Appalachia, abortion pill offers reproductive choice and privacy − but police may see a crime
- Written by Gretchen E. Ely, Professor of Social Welfare, Stony Brook University (The State University of New York)
A 35-year-old Kentucky woman was arrested[1] in late 2025, accused of taking abortion pills that she ordered online.
The gestational age and status of the pregnancy is unknown[2]. But Kentucky, like the majority of Southern states that contain Appalachian counties, has a complete abortion[3] ban.
Mifepristone is a medication approved by the Food and Drug Administration for self-administered abortion care through 10 weeks’ gestation, and research suggests it is safe and effective up to 16 weeks[4]. Mifepristone can still be ordered[5] into states with abortion bans after the Supreme Court weighed in on the matter[6] on May 4, 2026.
Abortion is illegal in Kentucky, however, and the police viewed the woman’s actions as criminal. A grand jury supported bringing charges, including fetal homicide, “abuse of a corpse[7]” and tampering with physical evidence[8]. Her distressed mugshot was plastered all over regional news sites.
As a social work researcher who studies access to reproductive healthcare in underserved Appalachian communities[9], I have worked with clients in similar circumstances. I have observed that many decisions to end pregnancies are motivated by intense barriers to accessing healthcare – not by criminal intent.
It can be extremely difficult for women in this region to get healthcare, and these access burdens affect quality of life in the region. For example, research suggests that Appalachian women are more likely to die at younger ages[10] when compared to women living in other regions of the United States.
Here are six factors I consider when a case like this appears in the news.
1. Abortion bans do not stop abortion
Data clearly shows that outlawing abortion care does not stop abortions from happening[11].
According to data from the Society of Family Planning’s #WeCount[12] project, U.S. abortion rates have actually increased since the Supreme Court overturned Roe v. Wade[13] in 2022, ending federal abortion protections.
What state abortion bans do is change how people try to get care[14].
2. Abortion bans isolate patients from doctors
For people living in most of rural Appalachia, brick-and-mortar abortion facilities are currently only available in another state, often a great distance away.
The only way many people can get care, then, is to order pills and self-manage their own abortion[15].
When someone orders abortion pills without medical consultation, however, there is more room for error in assessing relevant medical information, such as how far along their pregnancy is. When abortion care is legal and accessible, like other forms of healthcare, such estimates are made in consultation with a health provider.
Multiple clinics, community groups and pharmacies will send abortion pills to Kentucky for self-managing abortions up to about 13 weeks into pregnancy, according to the abortion access resource Plan C[16]. These places may offer medical support, peer support or no additional support at all.
Patients who do involve a telehealth provider report satisfaction with that experience[18].
Yet patients in abortion-ban states may avoid using sites that are connected to support services because they fear being discovered[19] and prosecuted. Abortion bans may therefore compel patients to make critical reproductive health decisions without consulting an expert.
This may have occurred in the Kentucky case, according to what the law enforcement officers reported to the Lexington Herald-Leader[20] newspaper.
3. Ending Roe worsened healthcare deserts
Another factor to consider is how abortion bans contribute to existing healthcare deserts in rural Appalachian communities[21].
Even before the repeal of Roe, people living in Appalachian communities were not getting adequate healthcare[22]. Communities in central and southern Appalachia face significant health disparities[23]: These regions have higher illness and death rates[24] and increased risk of cancer and diabetes[25] compared to non-Appalachian areas of the United States.
In part, that has to do with inadequate healthcare infrastructure endemic in rural parts of the country. Geographic isolation[26], limited financial incentives and lack of infrastructure decrease the number of available health providers, meaning that only about 9% of U.S. physicians practice in rural areas.
Appalachia has lost regional obstetric services[27] in recent years and seen numerous hospital closures[28], further discouraging providers from working there. One study found that of 53 rural hospitals that closed between 2005 and 2016[29], 66% of them were in Southern states, 21% in Appalachia.
This has reduced access to specialty care[30], including reproductive healthcare.
Abortion bans have compounded all these problems. They make it difficult, if not impossible, for providers to practice within established standards of care[31] when treating conditions such as miscarriage, which can discourage ER physicians and OB-GYNs from remaining in red states[32].
The shortage of medical professionals makes it increasingly challenging to obtain reproductive healthcare in the region – except by mail.
4. Poverty influences reproductive decisions
Money is another important factor in people’s reproductive choices.
Research indicates that financial distress[33] is a main reason that people seek abortions. Those who are denied abortion access are more likely to be in poverty[34] four years after they give birth than those who were able to access it.
Appalachia’s history of resource extraction[35] has left it impoverished[36]. In Central Appalachia – in Kentucky – up to 21% of residents live in poverty[37].
The median household income in adjusted 2023 dollars[38] in Wolfe County, Kentucky, where the woman was arrested, is just over US$29,000, compared to about $79,000 in the rest of the country. It costs approximately $232,000[39] to raise a child in Kentucky from birth to age 18, the mortgage broker LendingTree calculated in April 2026.
Facing the daunting cost of another mouth to feed, families confronting an unintended pregnancy may see abortion as a financial necessity. Appalachian residents in these circumstances are figuring out how to get the abortion care they need against steep odds.
5. In rural Appalachia, abortion can carry stigma
In rural Appalachian communities where most residents know each other, abortion and reproductive health stigma[41] – some of which, research suggests, is rooted in religiosity[42] – can present a significant barrier to care.
My own research has found that stigma may dissuade Appalachians from seeking healthcare[43] and discussing sexual health topics with providers due to fear of judgment. Many Appalachians have reported to me their negative reproductive health visits with regional medical providers, including attempts to coerce patients into using or not using contraception[44].
Because abortion is stigmatized[45] in Appalachian communities, healthcare workers may be inclined to inform police on their patients.
One news report indicates that in cases where abortions were reported to police[46], 39% of reports were made by health professionals and another 6% by social workers. In 412 cases of pregnancy criminalization[47] analyzed by the advocacy group Pregnancy Justice, 264 involved information that had been disclosed in a medical setting.
That is what happened in the Kentucky case: People working in a clinic[48] allegedly told the police that the woman had disclosed her abortion.
Abortion medication shipped directly to one’s home[49], by contrast, offers privacy.
The prosecutor eventually dismissed the homicide charge, because Kentucky law exempts pregnant people from being prosecuted[50] for getting abortion care. But other charges were added, including concealing the birth of an infant. The woman may still be facing legal consequences.
6. Sex education is important – and lacking
One final factor I consider relevant in understanding this case is sex education – or rather, the lack of it in most Appalachian states[51].
Kentucky requires some sexual health education[52] in public schools, but each county can dictate much of the content. Sex education in the state is not required to be comprehensive, and it must promote abstinence.
As NPR reported in 2023[53], there are parts of rural Appalachia without comprehensive sex education, where contraception is unaffordable and abortion is also banned. Those trying to provide better sex education have faced harassment and threats of violence.
When people do not receive the sexual health education needed to know their bodies and how they function[54], they are more vulnerable to negative health outcomes such as unintended pregnancy[55]. And they may not know their bodies well enough to know how long they’ve been pregnant when they make reproductive health choices.
Bad policies, impossible situations
All of the factors listed above could potentially affect people in any community. But rural Appalachian communities are disproportionately affected by a confluence of these factors.
In my analysis, the Kentucky case elucidates how poor health infrastructure and bad health policies – such as abortion bans – place one barrier after another in front of people who are just trying to do the best they can to cope with an unintended pregnancy.
This story was produced in collaboration with Rewire News Group[56], an independent newsroom dedicated to covering reproductive health in the United States. Read their version here[57].
References
- ^ was arrested (www.theguardian.com)
- ^ status of the pregnancy is unknown (www.kentucky.com)
- ^ complete abortion (www.guttmacher.org)
- ^ safe and effective up to 16 weeks (doi.org)
- ^ Mifepristone can still be ordered (theconversation.com)
- ^ Supreme Court weighed in on the matter (www.nytimes.com)
- ^ abuse of a corpse (www.theguardian.com)
- ^ tampering with physical evidence (kentuckylantern.com)
- ^ studies access to reproductive healthcare in underserved Appalachian communities (scholar.google.com)
- ^ die at younger ages (doi.org)
- ^ does not stop abortions from happening (rewirenewsgroup.com)
- ^ #WeCount (societyfp.org)
- ^ Supreme Court overturned Roe v. Wade (www.npr.org)
- ^ change how people try to get care (theconversation.com)
- ^ self-manage their own abortion (rewirenewsgroup.com)
- ^ Plan C (www.plancpills.org)
- ^ Carl Lokko/iStock via Getty Images (www.gettyimages.com)
- ^ satisfaction with that experience (doi.org)
- ^ fear being discovered (www.washingtonpost.com)
- ^ the Lexington Herald-Leader (www.kentucky.com)
- ^ healthcare deserts in rural Appalachian communities (doi.org)
- ^ not getting adequate healthcare (doi.org)
- ^ significant health disparities (doi.org)
- ^ higher illness and death rates (doi.org)
- ^ increased risk of cancer and diabetes (doi.org)
- ^ Geographic isolation (www.ruralhealth.us)
- ^ lost regional obstetric services (doi.org)
- ^ hospital closures (pmc.ncbi.nlm.nih.gov)
- ^ 53 rural hospitals that closed between 2005 and 2016 (ncats.nih.gov)
- ^ reduced access to specialty care (doi.org)
- ^ providers to practice within established standards of care (rewirenewsgroup.com)
- ^ remaining in red states (www.npr.org)
- ^ financial distress (doi.org)
- ^ more likely to be in poverty (doi.org)
- ^ history of resource extraction (doi.org)
- ^ left it impoverished (journalistsresource.org)
- ^ 21% of residents live in poverty (www.arc.gov)
- ^ median household income in adjusted 2023 dollars (www.arc.gov)
- ^ costs approximately $232,000 (www.cbsnews.com)
- ^ thianchai sitthikongsak/Getty Images (www.gettyimages.com)
- ^ abortion and reproductive health stigma (doi.org)
- ^ religiosity (doi.org)
- ^ dissuade Appalachians from seeking healthcare (doi.org)
- ^ using or not using contraception (doi.org)
- ^ Because abortion is stigmatized (doi.org)
- ^ cases where abortions were reported to police (www.jezebel.com)
- ^ 412 cases of pregnancy criminalization (www.pregnancyjusticeus.org)
- ^ People working in a clinic (www.wdrb.com)
- ^ Abortion medication shipped directly to one’s home (doi.org)
- ^ exempts pregnant people from being prosecuted (www.courier-journal.com)
- ^ the lack of it in most Appalachian states (siecus.org)
- ^ sexual health education (siecus.org)
- ^ NPR reported in 2023 (www.npr.org)
- ^ know their bodies and how they function (theconversation.com)
- ^ unintended pregnancy (pmc.ncbi.nlm.nih.gov)
- ^ Rewire News Group (www.rewirenewsgroup.com)
- ^ Read their version here (rewirenewsgroup.com)
Authors: Gretchen E. Ely, Professor of Social Welfare, Stony Brook University (The State University of New York)