A 35-year-old Kentucky woman was arrested in late 2025, accused of taking abortion pills that she ordered online.
The gestational age and status of the pregnancy is unknown. But Kentucky, like the majority of Southern states that contain Appalachian counties, has a complete abortion ban.
Mifepristone is a medication approved by the Food and Drug Administration for self-administered abortion care through ten weeks’ gestation, and research suggests it is safe and effective up to 16 weeks. The abortion pill can still be ordered into states with abortion bans after the Supreme Court weighed in on the matter on May 4, 2026.
But abortion is illegal in Kentucky, and the police viewed the woman’s actions as criminal. A grand jury supported bringing charges against her, including fetal homicide, “abuse of a corpse,” and tampering with physical evidence. Her distressed mugshot was plastered all over regional news sites.
The prosecutor eventually dismissed the homicide charge because Kentucky law exempts pregnant people from being prosecuted for getting abortion care. But other charges, including concealing the birth of an infant were added.
As a social work researcher who studies access to reproductive health care in underserved Appalachian communities, I have worked with clients in similar circumstances. I have observed that many decisions to end pregnancies are motivated by intense barriers to accessing health care—not by criminal intent.
It can be extremely difficult for women in this region to get health care, and these health-care access burdens impact quality of life in the region. For example, research suggests that Appalachian women are more likely to die at younger ages when compared to women living in other regions of the U.S.
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 people from getting abortions.
According to data from the Society of Family Planning’s We Count project, U.S. abortion rates have actually increased since the Supreme Court overturned Roe v. Wade in 2022, ending federal abortion protections.
What state abortion bans do is change how people try to get care.
2. Abortion bans isolate patients from doctors
For people living in most of rural Appalachia, brick-and-mortar abortion clinics are currently only available in another state, often a great distance over rugged terrain.
The only way many people can get care is to order pills and self-manage their own abortion, with or without the involvement of health-care professionals.
When someone orders abortion pills without medical consultation, however, there is more room for error in assessing relevant medical information, like how far along their pregnancy is. When abortion care is legal and accessible, like other forms of health care, 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 around 13 weeks into pregnancy, according to the abortion care resource Plan C. 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.
Yet patients in abortion-ban states may avoid using sites that are connected to support services, because they fear being discovered 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.
3. Ending Roe worsened health-care deserts
Another factor to consider is how abortion bans contribute to existing health-care deserts in rural Appalachian communities.
Even before the overturn of Roe, people living in Appalachian communities were not getting adequate health care. Communities in central and southern Appalachia face significant health disparities: They have higher illness and death rates and increased risk of diseases like cancer and diabetes compared to non-Appalachian areas of the United States.
In part, that has to do with inadequate health-care infrastructure endemic in rural parts of the country. Geographic isolation, limited financial incentives, lack of infrastructure, and educational limitations decrease the available pipeline of health providers, meaning that only about 9 percent of U.S. physicians practice in rural areas.
Appalachia has lost regional obstetric services in recent years and seen numerous hospital closures, further discouraging providers from working there. One study found that of 53 rural hospitals that closed between 2005 and 2016, 66 percent of them were in Southern states, and 21 percent in Appalachia.
This has reduced access to specialty care, including reproductive health care.
Abortion bans have compounded all these problems. They make it difficult, if not impossible, for providers to practice within established standards of care when treating conditions like miscarriage, which can discourage ER physicians, OB-GYNs, and other providers from remaining in red states.
In the absence of an adequate number of medical professionals, it becomes increasingly challenging to obtain reproductive health care in the region—except by mail.
4. Poverty influences reproductive decisions
Another important factor in people’s reproductive choices is money.
Research indicates that financial distress is a main reason that people seek abortions. Those who are denied abortion care are more likely to be in poverty four years after they give birth than those who were able to access it.
Appalachia’s history of resource extraction has left it impoverished. In Central Appalachia, where Kentucky is located, up to 21 percent of residents live in poverty.
The median household income in adjusted 2023 dollars in Wolfe County, Kentucky—where the woman was arrested—is just over $29,000, compared to about $79,000 in the rest of the U.S. It costs approximately $232,000 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—some of which, research suggests, is rooted in religiosity—can present a significant barrier to care.
My own research has found that stigma may dissuade Appalachians from seeking health care 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.
Because abortion is stigmatized in Appalachian communities, health-care workers may be prompted to inform police on their patients.
One news report indicates that, in cases where abortions were reported to police, 39 percent of reports were made by health professionals, and another 6 percent by social workers. In 412 cases of pregnancy criminalization 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 allegedly told the police that the woman had disclosed her abortion.
Abortion medication shipped directly to one’s home, by contrast, offers privacy.
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.
Kentucky requires some sexual health education in public schools, but each county can dictate much of the content. Sex education is not required to be comprehensive, and it must promote abstinence.
As NPR reported in 2023, there are parts of rural Appalachia without comprehensive sexual education, where contraception is unaffordable and abortion is also banned. Those trying to provide better sex ed 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, they are more vulnerable to negative health outcomes like unintended pregnancy. 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 impacted by a confluence of these factors.
In my analysis, the Kentucky case elucidates how poor health infrastructure and bad health policies—like abortion bans—place one barrier after another onto people who are just trying to do the best they can to cope with an unintended pregnancy.
This story was produced in collaboration with The Conversation U.S., a nonprofit, independent news organization dedicated to unlocking the knowledge of experts for the public good.
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