New parents share stories of tense encounters with airport security over breast milk and formula. A bill from U.S. Rep. Katie Porter, a California Democrat, would strengthen guidelines for U.S. Transportation Security Administration officers. (Getty Images)

As the summer travel season approaches, new parents may be navigating airports with their babies — and the complexities of keeping them fed. Despite federal guidelines for airport agents laying out how to treat nursing moms, stories about problem encounters with security sometimes go viral.

In 2023, actress and singer Keke Palmer said she was at Houston airport when she faced threats to throw out her 16 ounces of breast milk. A year earlier, engineer and science TV host Emily Calandrelli said U.S. Transportation Security Administration officers escorted her out of line and made her check her partially thawed ice packs, which are used to keep breast milk cool.

“It was a very traumatizing experience, and it also didn’t align with what the TSA policies were, which state that you’re allowed to have them for medically necessary purposes,” Calandrelli told States Newsroom.

In May 2022, she went on her first work trip away from her 10-week-old baby and was traveling from Los Angeles to Washington, D.C. Calandrelli planned on pumping after going through security at LAX, but TSA officers drilled her with questions about what the ice packs were for and said it wouldn’t have been an issue if her breast milk was already pumped.

“I spoke to three different males who worked at TSA, and I requested to speak to a woman but wasn’t able to,” she said.

Like Palmer, she shared the experience with her legions of social media followers. Calandrelli said the agency later apologized. TSA issued a statement shortly after the incident: “Our employees go through regular training to effectively engage and screen diverse traveler populations, including those who are breastfeeding and/or traveling with breast milk.”

Both women’s experiences violate TSA guidelines: formula, breast milk, toddler drinks and baby food are allowed on planes and carry-ons in quantities greater than 3.4 ounces. Breast milk, formula and ice packs — along with other cooling accessories — are considered medically necessary. Passengers are advised to let TSA officers know they’re carrying these items when arriving at airport security.

Even though these protections exist, many lactating parents still encounter problems during air travel, and these issues carry physical and emotional side effects, according to Tina Sherman, a doula and interim executive director at the U.S. Breastfeeding Committee.

“Lactating parents have to pump on a fairly regular basis to be able to continue to keep up their supply,” Sherman said.

When they can’t express milk or that cycle is interrupted, mothers experience pain or breast leaks, she said. In some cases, long delays in pumping can lead to mastitis — an infection that causes swelling in the breasts and cracked nipples. Emotionally, being prevented or delayed from expressing milk can make parents feel anxious, embarrassed and stressed, Sherman said.

Calandrelli’s plight two years ago led her to reach out to her local California congresswoman. U.S. Democratic Rep. Katie Porter first introduced legislation to strengthen existing protections for breastfeeding parents in August 2022.

“You have to have clear instructions and clear rules, and have people follow them in order for moms to be able to meet the standards,” Porter said. “There’s a lot of obstacles to breastfeeding. There’s a lot of challenges to feeding a baby and traveling with a baby.”

The Bottles and Breastfeeding Equipment Screening (BABES) Enhancement Act would require “hygienic handling of breast milk and baby formula” by TSA officers and private security companies. Porter’s bill would direct airport officials to “minimize the risk for contamination” of breast milk, formula and infant drinks, along with ice or freezer packs and related cooling accessories.

Under the proposal, the agency must consult with maternal health organizations — March of Dimes, Association of Maternal and Child Health Programs, American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine — to determine what policies and regulations need to be updated as pumping technology and best practices for breast milk storage evolve, she said.

BABES Act is an update to a 2016 law that required TSA training on special screening procedures for nursing parents. The original law also made it legal to carry larger amounts of breast milk, formula and infant drink — juice or purified water — in airports and on planes.

Reps. Maria Elvira Salazar, a Florida Republican, and Eric Swalwell, a California Democrat, are the lead co-sponsors in the House. Democratic Sens. Tammy Duckworth of Illinois and Mazie Hirono of Hawaii, along with GOP Sens. Steve Daines of Montana and Ted Cruz of Texas sponsored the bill in the upper chamber.

The bipartisan bill didn’t go anywhere last session, but Porter reintroduced the proposal. She said the bill is set to be heard in the Senate Commerce, Science and Transportation Committee soon.

As a mother of three, Porter is acutely familiar with the problems that come with traveling with infants. Her children are adolescents and teens now, but when they were babies, lactation stations in airports were uncommon. She said a flight attendant once told her to stop nursing her baby while the plane was still on the ground. Porter said she was angry and scared, but mostly “worried about my baby, who was hungry.”

As for her bill, she recognizes that TSA agents have a hard job. But the BABES Act will help them “have clear rules and better training so that they’re not put in challenging situations when they’re dealing with frustrated parents,” she said.

Making travel for lactating parents easier could chip away at larger stigma about breastfeeding, advocates said. More than 80% of babies are breastfed in infancy, and 58% are still getting some breast milk by the time they’re 6-months-old, according to the U.S. Centers for Disease Control and Prevention.

Still, earlier this month, an ad for lactation cookies featuring a cooking star’s covered breasts and pregnant belly was temporarily removed from a Times Square billboard, according to The New York Times.

“Normalizing breastfeeding and lactation is really critical to families being able to meet their breastfeeding goals,” Sherman said.

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WASHINGTON, DC - MAY 17: Protesters cheer as they attend the "Jewish Rally for Abortion Justice" rally at Union Square near the U.S. Capitol on May 17, 2022 in Washington, DC. The rally, hosted by the National Council of Jewish Women, is taking place more than two weeks since the leaked draft of the Supreme Court's potential decision to overturn Roe v. Wade. (Photo by Anna Moneymaker/Getty Images)

Lawmakers who oppose abortion often invoke their faith — many identify as Christian — while debating policy.

The anti-abortion movement’s use of Christianity in arguments might create the impression that broad swaths of religious Americans don’t support abortion rights. But a recent report shows that Americans of various faiths and denominations believe abortion should be legal in all or most cases.

According to a Public Religion Research Institute survey of some 22,000 U.S. adults released last week, 93% of Unitarian Universalists, 81% of Jews, 79% of Buddhists and 60% of Muslims also hold that view.

Researchers also found that most people who adhere to the two major branches of Christianity — Catholicism and Protestantism — also believe abortion should be mostly legal, save for three groups: white evangelical Protestants, Latter-day Saints and Jehovah’s Witnesses.

Historically, the Catholic Church has opposed abortion. But the poll found that 73% of Catholics of color — PRRI defines this group as Black, Asian, Native American and multiracial Americans — support the right to have an abortion, followed by 62% of white Catholics and 57% of Hispanic Catholics.

The findings show that interfaith views on abortion may not be as simple as they appear during political debate, where the voices of white evangelical legislators and advocates can be the loudest.

States Newsroom spoke with Abrahamic religious scholars — specifically, experts in Catholicism, Islam and Judaism — and reproductive rights advocates about varying perspectives on abortion and their history.

Abortion views in America before Roe v. Wade

The Moral Majority — a voting bloc of white, conservative evangelicals who rose to prominence after the U.S. Supreme Court Roe v. Wade ruling in 1973 — is often associated with spearheading legislation to restrict abortion.

Gillian Frank is a historian specializing in religion, gender and sexuality who teaches at the Stevens Institute of Technology in New Jersey. Frank said evangelical views on abortion were actually more ambivalent before the early ’70s Roe decision established the federal right to terminate a pregnancy. (The Supreme Court upended that precedent about two years ago.)

“What we have to understand is that evangelicals, alongside mainline Protestants and Jews of various denominations, supported what was called therapeutic abortion, which is to say abortion for certain exceptional causes,” Frank said, including saving the life or health of the mother, fetal abnormalities, rape, incest and the pregnancy of a minor. Religious bodies like the Southern Baptist Convention and the National Association of Evangelicals said abortion was OK in certain circumstances, he added.

Evangelical protestants before Roe did not endorse “elective abortions,” Frank said, or what they called “abortion on demand,” a phrase invoked by abortion-rights opponents today that he said entered the American lexicon around 1962.

The 1973 ruling was seismic and led organizations opposing abortion, such as the National Right to Life Committee — formed by the Conference of Catholic Bishops — to sprout across the country, according to an article published four years later in Southern Exposure. Catholic leaders often lobbied other religious groups — evangelicals, Mormons, orthodox Jews — to join their movement and likened abortion to murder in their newspapers.

After Roe, “abortion is increasingly associated with women’s liberation in popular rhetoric in popular culture, because of the activism of the women’s movement but also because of the ways in which the anti-abortion movement is associating abortion with familial decline,” Frank said. Those sentiments, he said, were spread by conservative figures like Phyllis Schlafly, a Catholic opposed to feminism and abortion, who campaigned against and managed to block the Equal Rights Amendment in the 1970s.

Polls suggest the views of Catholic clergy and laypeople diverge

Catholicism is generally synonymous with opposition to abortion. According to the United States Conference of Catholic Bishops, the church has stood against abortion since the first century. The conference points to Jeremiah 1:5 in the Bible to back up arguments that pregnancy termination is “contrary to the moral law.”

But nearly 6 in 10 American Catholics believe abortion should be mostly legal, according to a Pew Research Center report released last month.

Catholics for Choice spokesperson Ashley Wilson said that there’s a disconnect between the church as an institution and its laity. “We recognize that part of the problem is that the Catholic clergy, and the people who write the official teaching of the church, are all or mostly white male — my boss likes to say ostensibly celibate men — who don’t have wives,” Wilson said. “They don’t have daughters. They have no inroads into the lives of laypeople.”

Her group plans on going to Vatican City in Rome this fall to lift up stories of Catholics who’ve had abortions. The organization is also actively involved in efforts to restore abortion access — 14 states have near-total bans — through direct ballot measures in Colorado, Florida and Missouri this year.

Catholic dioceses and fraternities are often behind counter-efforts to proposed ballot questions. They poured millions into campaigns in Kansas and Kentucky in 2022 to push anti-abortion amendments, and also in Ohio last year to defeat a reproductive rights ballot measure but they failed in each state.

Ensoulment and mercy in Islam

Tenets of Islam — the second largest faith in the world — often make references to how far along a person’s pregnancy is and whether there are complications. University of Colorado Law professor Rabea Benhalim, an expert of Islamic and Judaic law, said there’s a common belief that at 40 days’ gestation, the embryo is akin to a drop of fluid. After 120 days, the fetus gains a soul, she said.

While the Quran doesn’t specifically speak to abortion, Benhalim said Chapter 23: 12-14 is considered a description of a fetus in a womb. The verses are deeply “important in the development of abortion jurisprudence within Islamic law, because there’s an understanding that life is something that is emerging over a period of stages.”

In some restrictive interpretations of Islam, there’s a limit on abortion after 40 days, or seven weeks after implantation, Benhalim said. In other interpretations, because ensoulment doesn’t occur until 120 days of gestation, abortion is generally permitted in some Muslim communities for various reasons, she said. After ensoulment, abortion is allowed if the mother’s life is in danger, according to religious doctrine.

Sahar Pirzada, the director of movement building at HEART, a reproductive justice organization focused on sexual health and education in Muslim American communities, confirmed that some Muslims believe in the 40-day mark, while others adhere to the 120-day mark when weighing abortion.

“How can you make a black-and-white ruling on something that is going to be applied across the board when everyone’s situation is different?” she asked. “There’s a lot of compassion and mercy with how we’re supposed to approach matters of the womb.”

The issue is personal for Pirzada, who had an abortion in 2018 after her fetus received a fatal diagnosis of trisomy 18 when she was 12 weeks pregnant. “I wanted to terminate within the 120-day mark, which gave me a few more weeks,” she said.

She consulted scholars and Islamic teachings before making the decision to end her pregnancy, she said, and mentioned the importance of rahma — mercy — in Islam. “I tried to embody that spirit of compassion for myself,” she said.

Pirzada, who is now a mother of two, had the procedure at exactly 14 weeks on a day six years ago that was both Ash Wednesday and Valentine’s Day. She said she felt loved and surrounded by people of faith at the hospital, where some health care workers had crosses marked in ash on their foreheads. “I felt very appreciative that they were offering me care on a day that was spiritual for them,” she said.

Seeing the stories of people with pregnancy complications in the period since the Supreme Court overturned the federal right to an abortion has left her grief stricken. For instance, Kate Cox, a Texas woman whose fetus had the same diagnosis as Pirzada’s, was denied an abortion by the state Supreme Court in December. Cox had to travel elsewhere for care, Texas Tribune reported.

Benhalim, the University of Colorado expert, said teachings in Islam and Judaism offer solace to followers who are considering abortion, as they can provide guidance during difficult decisions.

No fetal personhood in Judaism

In Jewish texts, the embryo is referred to as water before 40 days of gestation, according to the National Council of Jewish Women. Exodus: 21:22-23 in the Torah mentions a hypothetical situation where two men are fighting and injure a pregnant woman. If she has a miscarriage, the men are only fined. But if she is seriously injured and dies, “the penalty shall be a life for a life.”

This part of the Torah is interpreted to mean that a fetus does not have personhood, and the men didn’t commit murder, according to the council. But this may not be a catchall belief — Benhalim noted that denominations of Judaism have different opinions on abortion.

Today, Jewish Americans have been at the forefront of legal challenges to abortion bans based on religious freedom in Florida, Indiana and Kentucky. Many of the lawsuits have interfaith groups of plaintiffs and argue that restrictions on termination infringe on their religion.

The legal challenge in Indiana has been the most successful. Hoosier Jews for Choice and five anonymous plaintiffs sued members of the state medical licensing board in summer 2022, when Indiana’s near-total abortion ban initially took effect.

Plaintiffs argued that the ban violated the state’s Religious Freedom Restoration Act, and the court later let the claim receive class-action status. Several Jewish Hoosiers said they believe life begins after a baby’s first breath, and that abortion is required to protect the mother’s health and life, according to court documents.

Last month, the Indiana Court of Appeals ruled that the plaintiffs have the right to sue the state but sent the request for a temporary halt on the ban back to a lower court.

While the decision was unanimous, Judge Mark Bailey issued a separate concurring opinion explaining his reasoning and criticizing lawmakers — “an overwhelming majority of whom have not experienced childbirth” — who assert they are protectors of life from the point of conception.

“In my view, this is an adoption of a religious viewpoint held by some, but certainly not all, Hoosiers,” he wrote. “The least that can be expected is that remaining Hoosiers of child bearing ability will be given the opportunity to act in accordance with their own consciences and religious creeds.”

Editor’s note: This article was updated to specify Evangelical Protestants in particular did not endorse “elective abortions” before Roe.

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Short-term Medicaid coverage can exacerbate health problems for new mothers, adding to the health issues and stress some face, says Maggie Clark, program director at the Georgetown University Center for Women and Families. (Getty Images)

Arkansas has the highest maternal mortality rate in the United States: 43.5 deaths from 2018 to 2021 for every 100,000 live births, according to the latest federal data. But the state only extends postpartum Medicaid to 60 days after childbirth. 

A bill by Arkansas Rep. Aaron Pilkington, R-Knoxville, aims to change that and would seek to continue Medicaid coverage postpartum for a full year. The House Public Health, Welfare and Labor Committee heard the measure Tuesday, but Pilkington told States Newsroom he is optimistic the bill will become law.

Extending health care benefits for low-income people with infants could reduce maternal mortality rates in the U.S., several reproductive health experts told States Newsroom. But researchers also said it’s too soon to determine if those extensions will lessen maternal deaths in a nation where 13 states ban abortions with few exceptions, and the laws are so vaguely written in some cases that medical professionals are wary of providing life-saving health care. 

What’s clear is that U.S. maternal mortality rates keep growing, an anomaly compared to other economically similar countries. In 2021, the nation’s rate was 32.9 deaths per 100,000 live births, up from 23.8 deaths per 100,000 live births in 2019, according to data released this month from the Centers for Disease Control and Prevention’s National Center for Health Statistics. In other words, 1,205 women died of maternal causes in the U.S. during the second year of the COVID-19 pandemic, up from 861 maternal deaths in 2020 and 754 maternal deaths in 2019. The CDC categorizes a death as maternal if it occurs during pregnancy, childbirth or up to 42 days postpartum.

The CDC data also illuminates racial disparities: The maternal mortality rate for Black women was 69.9 per 100,000 live births, 2.6 times the rate for non-Hispanic white women, which was  26.6 in 2021. The maternal mortality rate for Hispanic women that year was 28. 

“These are sad and unfortunate, but not surprising,” said Dr. Maeve Wallace, a reproductive epidemiologist at Tulane University’s Mary Amelia Center for Women’s Health Equity Research in Louisiana. 

“From what we know about the coronavirus pandemic, we probably could’ve seen that maternal health would’ve been impacted negatively, both directly by the virus and indirectly by all of the social and economic disruptions that it caused, and especially how uneven the economic impact was across the population, really exacerbating what already was long-standing and entrenched racial inequities in maternal health,” Wallace said. 

Some states weigh expansion

Under the federal coronavirus pandemic emergency plan that President Joe Biden signed into law in March 2021, states were allowed to apply for 12-month postpartum Medicaid coverage. As of March 23, the Centers for Medicare and Medicaid Services has approved expansions for 30 states and Washington, D.C. 

Nine states are waiting on approval from the federal agency: Arizona, Delaware, Mississippi, New York, Rhode Island, South Dakota, Vermont, Utah and Wyoming.  

Mississippi is the latest state to expand Medicaid from the federally mandated 60 days to 12 months postpartum, according to Mississippi Today.  Republican Gov. Tate Reeves signed a bill into law this month after overcoming his own skepticism of the proposal. For years, the state Senate has supported postpartum Medicaid expansion, only for the initiative to stall in the state House, as Mississippi Today has chronicled.  

Of the 11 states that have yet to expand Medicaid coverage — Alaska, Arkansas, Idaho, Iowa, Missouri, Montana, Nebraska, Nevada, New Hampshire, Texas and Wisconsin — to a year for new mothers, eight have pending legislation that would extend coverage from 60 days to 12 months, according to a States Newsroom analysis. 

The Missouri Senate cleared postpartum Medicaid expansion earlier this month. In Montana, the House recently voted to extend postpartum Medicaid coverage from 60 days to a year as an amendment tucked in the state budget bill; the proposal is pending in the upper chamber. Three states that have relatively wide abortion access, Alaska, Nevada and New Hampshire, have also introduced related bills this year. 

In Texas, Democratic Rep. Toni Rose has sponsored a bill to extend postpartum coverage to a year, the Texas Tribune reports. The House Health Care Reform Select Committee heard the bill this month. In February, House Speaker Dade Phelan, a Republican, indicated support for the extension, along with repealing taxes on diapers and menstrual products. (The Texas House approved the latter proposal Tuesday.)  

As of mid-March, new mothers in Wisconsin would be eligible for Medicaid for three months postpartum upon federal approval; a 12-month expansion bill is pending in the Legislature. The states with near-total abortion bans typically have higher maternal mortality rates, but Wisconsin is an outlier: In 2021, its rate was 11.6 maternal deaths, one of the lowest rates in the country, according to CDC data. But the 2021 data predates the bans enacted after the U.S. Supreme Court overturned the constitutional right to an abortion last year.  

Expansion bills in Idaho, Iowa and Nebraska have either faltered or appear unlikely to pass. 

Why postpartum Medicaid matters post-Dobbs 

People in states with abortion bans are up to three times more likely to die during pregnancy, childbirth or postpartum, according to a Gender Equity Policy Institute report released in January. 

Postpartum Medicaid expansion for new mothers is a first step to maternal health equity, not a catch-all solution, said Maggie Clark, program director at the Georgetown University Center for Women and Families in Washington, D.C. 

“While promising, a longer coverage period does not itself lead to improved outcomes,” Clark wrote in a brief released last week. “States should take a closer look at the benefit and payment levers available in Medicaid to ensure that the longer coverage period translates to better access to needed care for mothers and infants in the postpartum year.” 

Maternal health care needs an overhaul, Clark said in an interview. Childbirth can lead to  myriad health conditions, including diabetes, hypertension, substance abuse and mental health issues: think depression, anxiety or psychosis, Clark said. Short-term Medicaid coverage can exacerbate health problems for new mothers, she said. 

“When someone loses their health coverage when they’re dealing with all of that, that means they lose access to prescriptions, they lose access to the doctor that’s supporting them through that time,” Clark said. 

Lawmakers in Congress have taken steps to address the maternal death crisis. North Carolina Rep. Alma Adams and Illinois Rep. Lauren Underwood, both Democrats, will reintroduce the Black Maternal Health Momnibus Act this session, according to Sam Spencer, a spokesperson for Adams. 

“Demographics should not determine your destiny, but it’s going to take addressing social determinants of health – from poverty to education to transportation and environmental factors – to save lives,” Adams said in a statement to States Newsroom. She added that the bill is nonpartisan. 

The collection of bills aim to overhaul the perinatal workforce, improve data collection related to maternal health and provide funding to reproductive health community-based organizations, among other proposals. In 2021, President Joe Biden signed a “momnibus” bill into law that gave $15 million to the U.S. Department of Veteran Affairs to support maternal health, The 19th reported.   

U.S. Sens. Tim Kaine, D-Va., and Lisa Murkowski, R-Alaska, reintroduced the Mothers and Newborns Success Act, a related bill that aims to increase data collection of maternal and infant health issues, last week. 

Reproductive health experts across the country, especially those in the South, a region with high maternal mortality rates and the most abortion bans, agreed that the full spectrum of maternal health care needs improvement. 

“Increasing the number of perinatal health care workers who can look like the people they’re serving is definitely a solution so that they can improve maternal health outcomes because they can improve culturally congruent care,” said Laneceya Russ, the Louisiana-based executive director of March for Moms, a national maternal health advocacy group. 

For Wallace, the Tulane epidemiologist, “it’s been disturbing to watch the closure of birthing centers and other maternity care opportunities in rural places across the country.” Repealing collaborative practice agreements between physicians and assisting health care providers, such as nurse practitioners, could help expand midwifery care and address staff shortages in maternity care, Wallace said.

Dr. Natalie Hernandez, executive director of the Morehouse School for Medicine’s Center for Maternal Health Equity in Georgia, recently examined the effects of COVID-19 on maternal health outcomes. Like Russ, she agreed diversifying the perinatal workforce, along with increasing doula care in communities of color – for example, some states are moving to create doula Medicaid reimbursement programs – could also help improve birth outcomes. 

“A lot of solutions have been focused on the clinical aspects, but we need to ensure we’re adjusting those nonclinical causes – the majority of what contributes to our health status is not just access to care, but it’s really the social determinants of health,” she said. “Then we’ll get better care.” 

Kelcie Moseley-Morris contributed reporting.

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