Almost a year to the day after Rep. Lindsey Burke gave birth to twins — one dead, the other alive — she walked out of a legislative committee meeting in Frankfort. Burke, one of three Kentucky Democrats who walked out that day, was protesting a bill she said shamed the choice to abort a nonviable pregnancy. Burke herself made that choice in October 2022 when she and her husband ended a pregnancy they’d planned for and wanted in order to protect the life of their second child. For her family, Burke was exacting what control she had over an otherwise impossible situation. The decision to walk out of the committee meeting March 7 in response to Republican Rep. Nancy Tate’s House Bill 467, the “Love Them Both Part II Act,” was one she saw similarly: Exacting a sense of control over a situation in which she had little. Republicans hold a veto-proof majority in both legislative chambers, rendering Democrats virtually powerless. Burke knew that this committee — made up of four Democrats and 15 Republicans — was going to advance the bill regardless of her act of protest or the will of her Lexington constituents. In the hallway outside the committee room, Burke told a gaggle of reporters the bill was “an insult to grieving parents everywhere.” Burke underwent her first IVF egg retrieval in late 2021, right around the time she put her name in to run for public office. But it ended eight weeks later in a miscarriage. The medical landscape for her second egg retrieval — and the full range of care she could need should something go wrong — looked very different than the first a few months earlier. It was July 2022. Just a few weeks earlier, Roe v. Wade, which for 50 years prevented states from banning abortion entirely, had been overturned by the U.S. Supreme Court. This historic ruling gave states free regulatory rein over abortion laws. In Kentucky, two abortion bans simultaneously took effect: a trigger law banning abortion except in medical emergencies, and six-week ban, or fetal heartbeat law, outlawing abortion after the first flickers of fetal cardiac activity. Burke got pregnant with twins, but early ultrasounds showed a size disparity between the two. Twin A, whom Burke had already named Ezra, had a series of birth defects and diseases, including a condition called a cystic hygroma. It’s a bulge at the base of the head and neck that often portends other serious conditions. “But then the doctor says, ‘And that’s the problem for Twin B,’” whom Burke and her husband had named Ewan. Allowing her pregnancy with Twin A, which was near 13 weeks, to continue progressing toward its inevitable end was a fine choice. But when her body miscarries, it will likely also try to expel her healthy twin, too, before the pregnancy has reached full term, forcing her into early delivery and potentially jeopardizing his health, too.

When it became clear that the only way to keep their four Northern Kentucky independent pharmacies afloat was to siphon money from their personal retirement funds, Jennifer and Erik Grove made a painful decision. It was finally time to call it quits. It was 2021, and after years of tossing solicitation letters in the trash from CVS Pharmacy and Walgreens offering to buy them out, the Groves, who owned pharmacies in Warsaw, Carrollton, Campbellsburg and Bedford, begrudgingly agreed to call a corporate chain. Like dozens of other independently-owned pharmacists across Kentucky, the Groves could not manage to consistently turn enough of a profit. It wasn’t that their stores, two of which were the only pharmacies in their counties, weren’t high-performing. Each time an independent pharmacist fills a patient’s prescription, how that pharmacy is reimbursed by insurance companies — and what amount in fees are levied for filling it — is decided by a somewhat arbitrary and complex tangle of decisions by entities outside a hometown pharmacy’s control. This lack of control and contractual obligation to pay every fee levied has paved the way for independents to be financially gouged from multiple angles: Low or break-even reimbursement rates set by insurance companies often blunts a pharmacy’s ability to make a profit on every prescription they fill. This reality is made harder to bear when factoring in the fees collected by Pharmacy Benefit Managers (PBMs), who act as a middle man between providers like Grove and insurance and drug wholesalers, and Direct and Indirect Remuneration (DIR) fees. DIR fees are collected by PBMs and governed by the Centers for Medicare and Medicaid Services. Until Jan. 1, those fees were retroactively clawed back as many as six months after a prescription was filled. Withstanding the mandate to fork over hundreds of thousands of dollars in fees, alone, borders on financially unsustainable for many independent pharmacies. That financial burden, coupled with the unpredictable timeline by which that money is collected, is what eventually drowned the Grove’s businesses, Jennifer said. Stories like this are a dime a dozen across Kentucky, according to seven independent pharmacists who spoke with the Herald-Leader and dozens more who’ve shared stories through the Kentucky Independent Pharmacists Alliance, or KIPA. In the past year, at least 67 independent pharmacies have shuttered across the commonwealth – nine in Pulaski County, alone – driven to the brink by a combination of the factors that forced the Groves to close, according to pharmacy alliance co-founder Rosemary Smith. “No one can withstand this onslaught,” said Smith, who owns six pharmacies across Eastern Kentucky with her husband, Luther.

The first pursuit by a pregnant woman in Kentucky to legally challenge the state’s near-total abortion bans — historic not just in the Bluegrass State, but nationwide — has ended less than two weeks after it began. On Dec. 8, “Jane Doe,” who was eight weeks pregnant at the time, filed a class-action lawsuit, asking a Jefferson County circuit judge to intervene on her behalf and allow her to terminate her pregnancy and permanently block Kentucky’s trigger law and six-week abortion bans from enforcement. On Monday, about a week after she learned her embryo no longer had cardiac activity, she asked the judge to dismiss her case. While the request to dismiss ends her particular case, more are predicted to follow, as attorneys with the American Civil Liberties Union of Kentucky and reproductive rights advocates mobilize to mount another legal challenge. But the short-lived nature of this case portends the unique difficulty plaintiffs face in Kentucky in trying to overturn these bans, say legal experts who spoke to the Herald-Leader. In effect, “Kentucky has made it harder than in every other state to challenge its abortion laws,” said David S. Cohen, a law professor at Drexel University who specializes in abortion policy. In February, four justices on Kentucky’s highest court agreed that health care clinics that provide abortions did not have legal standing to sue on behalf of their patients, who were and continue to be barred from accessing the medical procedure. This historic ruling meant that all future challenges to Kentucky’s restrictive abortion laws, which don’t include exceptions for rape, incest or fatal conditions that make survivable after birth impossible, would fall to the population most impacted by them: Pregnant women. The 4-3 decision last February upended longstanding precedent that had previously allowed health care providers to sue on behalf of their patients, as two dissenting justices in that ruling pointed out. But even more notably, it solidified Kentucky as an outlier, raising the bar higher than any other state for effectively contesting the state’s trigger law and six-week ban. “The Kentucky Supreme Court is the only highest court in the land that has said abortion providers cannot bring cases on behalf of their patients,” Cohen said. Instead, it has “put that burden on individual pregnant women.” Though justices said no major “hindrance” existed for pregnant women wishing to sue the state over these laws, experts said the sheer amount of time it took for a plaintiff to step forward — almost a year and a half after the bans took effect — is proof of that hindrance.

In a post-Roe v. Wade world, the GOP’s new social issue of choice is trans rights. Kentucky was one of at least 17 states during their most recent legislative sessions to enact restrictions on health care for trans people. Gov. Andy Beshear, Cameron’s opponent, vetoed the bill, but the Republican supermajority overrode him. These positions from Beshear will “alienate swing voters,” according to Cameron. “Kentuckians are fed up with left-wing nonsense. I’ll bring back commonsense values.” Though he is defending policies passed by members of his party — and appointed a champion of those laws, Henderson Republican Sen. Robby Mills, as his running mate — Cameron’s rhetoric on the campaign trail has aligned more with the party’s ideological extreme. And in a state whose Democratic governor continues to boast high approval ratings across political parties, some within the Republican party are questioning whether Cameron’s emphasis on socially divisive issues is a winning strategy for swing voters, whose support he needs. “What I think he’s attempting to do is connect himself to (the legislature’s) efforts. Whether or not that’s going to be something that moves the dial in his direction remains to be seen,” Senate Bill 150 proponent Rep. Savannah Maddox, R-Dry Ridge said. Each of the lawmakers interviewed for this story said they supported at least a portion of SB 150, even if they ultimately voted against it. But most agreed: The current political characterizations of trans-rights issues, generally, leaves little room for the nuance they believe exists for many of their constituents. Many worry what the continued othering of a marginalized group will do to their party, long-term. “I’m concerned for my party, because I worry this doesn’t portray us as compassionately as I know we are,” said Rep. Kim Moser, R-Taylor Mill. She was one of three Republicans in the House, all women, who voted against the final version of SB 150. Moser is one of 10 Republicans who spoke to the Herald-Leader for this story. Rep. Stephanie Dietz of Edgewood, a second Northern Kentucky Republican who cast a “no” vote, said of Cameron’s messaging on trans issues, “there is an audience that wants to hear that message. “But I think the majority in my district want to hear: What’s the plan to get our kids back on track with their education, what we’re going to do to increase our workforce, what are we going to do about affordable daycare?” When asked whether Dietz thinks her party will continue in its pursuit of legislating trans issues, she said, “I’m hoping this was a one-time thing.”

In a windowless room at the back of a strip-mall restaurant in Hazard, Daniel Cameron said school teachings on gender and allowing transgender girls to play girls’ sports threatened Kentucky’s true values. “We need to make sure our schools are about reading, writing and math, and they’re not incubators for liberal and progressive ideas,” the Kentucky GOP nominee hoping to unseat Gov. Andy Beshear said on a humid morning in late July. “You’ve also had a governor who has said that he’s OK with biological males playing in women’s sports,” Cameron told the crowd. “Your values are at stake in this race for governor.” Cameron, 37, repeated this message to more supporters later that day in Whitesburg. Then again in Harlan. For months, that message was ratcheted up, piped into thousands of homes via cable and YouTube campaign advertisements, paid for by political action committees supporting but not affiliated with Cameron. One such commercial begins with a person dressed in drag reading a children’s book. “The radical transgender agenda,” a narrator begins in a voiceover, conflating people in drag with being trans. “It’s bombarding our children everywhere we turn. Child sex changes with permanent consequences. That’s Andy Beshear’s Kentucky.” On the coattails of a legislative session defined by the passage of anti-trans policies, Cameron’s bid for governor has tacked far-right in hopes that leaning heavily into charged culture war issues will play well with swing voters, his campaign told the Herald-Leader. Though he has defended the same trans-targeting policies passed by his party — and appointed a champion of those laws as his running mate — Cameron’s rhetoric on the campaign trail has aligned more with the GOP’s ideological extreme. Republicans who portray being trans as sinful and biblically immoral have found refuge in his candidacy. This is leaving some in the GOP questioning whether Cameron’s choice to veer from the political middle in an attempt to unseat a relatively well-liked moderate Democratic incumbent is a winning strategy. “Do I think this is the issue that’s going to be a motivating reason to not vote for Beshear?” asked Sen. Amanda Mays Bledsoe, R-Fayette, who voted in favor of SB 150 despite having reservations about it. “It will be for some. But the economy, inflation and public safety are bigger motivators for most voters I hear from.”

From January to July of this year, reported abortions in Kentucky dropped by almost 100% compared with 2021, according to state data. Thirteen abortions were reported to the Cabinet for Health and Family Services between January and July of 2023, compared to 2,591 reported in 2021 during the same time frame — a reduction of 99.5%. The marked cliff is a direct result of Kentucky’s trigger law and six-week ban, both of which took effect after federal abortion protections were overturned in June 2022. The trigger law bans all abortions except when a pregnant person’s life is immediately threatened, and the six-week ban, or fetal heartbeat law, outlaws abortions after fetal cardiac activity develops, which is usually around six weeks gestation. The impact has been a near-total elimination of abortion, even in circumstances where the procedure is medically recommended, as the Herald-Leader has reported, including when a fetus is nonviable. That trend is mirrored across the country in more than a dozen states that have enacted similar abortion bans, according to new estimates released this week from the Guttmacher Institute, a pro-abortion rights research policy center. Though the full scope of Kentuckians traveling across state lines for reproductive health care isn’t known, organizations that help women to this end say demand is not letting up. Kentucky Health Justice Network, which offers assistance to people who need help paying for their abortion, fielded more than 500 calls from January to July of this year (421 received donations from KHJN to pay for their abortions). That breaks down to 15-20 calls a week, said Savannah Trebuna, KHJN’s abortion support fund co-director. “Before the ban, a large barrier to people seeking care at clinics was just the cost of the appointment,” Trebuna said, which can range anywhere from $600 to $1,000. In the more than year since the trigger law, donations spent on travel — what KHJN calls “direct assistance” — has increased 127%. Increasingly, “we’re seeing a large need for practical support, things like gas money or a flight, hotels and childcare expenses,” she said.

Jessica Blackburn didn’t know she was addicted to opioids until her body’s first withdrawal. It was 2004, and she was 18. For the last year, she’d swallowed oxycontin recreationally at high school parties in Betsy Lane, her Eastern Kentucky hometown. The first time her body responded to a deficit of pills, Blackburn thought she’d caught a bad case of the flu. It was her high school boyfriend who explained that her body had become dependent. “It all just kind of clicked,” Blackburn, 36, said recently by phone. After years of trying to stop, to no end, her dad told her about ibogaine, a psychedelic drug he’d read about. An alkaloid derived from the root bark of an iboga shrub native to West Central Africa, ibogaine had a burgeoning international following among war veterans who’d taken it to treat post-traumatic stress disorder. Her dad learned the drug had also long been used in some countries to treat substance use disorders. In 2008, with roughly $6,000 in cash, Blackburn traveled alone to Jalisco, Mexico. There, in a house in a small village, she took two doses of ibogaine under the watch of strangers. The only medical device present was a battery-operated blood pressure cuff. For the next 24 hours, Blackburn lay in a bed, largely immobile with ataxia, a side effect of the drug. She sweated, her heart rate slowed and accelerated, and she hallucinated vividly. “It was not a fun trip,” she said. “It was violent, like being choke-slammed by God.” She’d last taken oxycontin the day before she flew to Mexico and expected to wake up the following morning in cold sweats from withdrawal. But she didn’t. When her hallucinations stopped, she was dead-tired, but her craving for oxycontin had diminished entirely. So, too, had her withdrawals. Surreal, it felt like her brain had reverted to a pre-addiction state.

From an overflow room in the Kentucky Capitol Annex, Henry Svec, 13, listened to adults explain why kids like him needed to be protected from themselves. As lawmakers on the House Judiciary Committee heard testimony in favor of a bill to ban gender-affirming health care, Henry, who's trans, watched the meeting unfold on a projector screen from a room down the hall. Dr. Roger Hiatt, Jr., an Arkansas child and adolescent psychiatry specialist who has publicly supported bills outlawing this type of health care in other states, called transgenderism a “psychiatric disorder.” He had been invited to speak by lead bill sponsor, Waddy Republican Rep. Jennifer Decker. State law prevents parents from giving their underage children alcohol and cigarettes, she told committee members. Gender-affirming care is just as harmful, and trans kids need to be protected from adults who endorse their identity. Taught to respect his elders, Henry quietly considered what Decker, near the age of his grandmother, was saying. If adult lawmakers believed that health care affirming the gender that feels most authentic to him was wrong and harmful, it must mean his trans identity was also somehow wrong and harmful. Otherwise, why would his doctor’s care be so damaging that it warranted a law banning it? But it didn’t feel wrong or harmful to Henry, or any of the 13 families across Kentucky with a trans child the Herald-Leader has interviewed in the months since, each of whom will be directly impacted by some aspect of the new law, which goes into full effect June 29. Parents described a sense of powerlessness and fury at lawmakers for dictating to them how to parent their individual children. Many are territorial about the progress their family has made on a journey of acceptance that, for several, wasn’t an easy or linear one. Now that enforcement of the law is imminent, each is grappling with what to do to ensure their children feel supported in a state they believe is hostile to their well-being.

House Bill 470 from Rep. Jennifer Decker, R-Shelbyville is a sweeping proposal that would wholly restrict how health care providers across specialties, including mental health therapists, school counselors, psychologists, and primary care doctors, treat their underage trans patients by outlawing gender-affirming care. “What we are seeing is medical misinformation with these legislative efforts,” said Dr. Anthony Carney, a family medicine nurse practitioner for UK HealthCare. It’s a “denial and erasure” of this population’s lived experience, he said. Gender-affirming health care is “anything that helps a person live in the gender with which they identify and feel comfortable,” Dr. Amanda Fallin-Bennett said. It can be as simple as referring to a patient by their preferred name, or as involved as prescribing hormone therapy, which, for minors, is done only with informed parental consent; it’s a family decision, providers interviewed for this story said. “You can’t separate someone’s gender, or dysphoria about it, from their depression or from their joint pain or from anything else,” she said. “They all go together in what’s going to make them thrive as a human being.” The underpinnings of lawmakers’ debate over GOP-backed bills like House Bill 470 the validity of the trans identity, providers said. It’s not that more people are “deciding to be trans,” but rather, incrementally, “our culture is more accepting of trans people,” Carney said. “The decision is not to be trans — they are trans. The decision is to disclose that information to their parents, friends, their support network and me as their provider,” he said. Legislative proposals like these not only feel like a “regression,” Carney said, “it feels like retribution for being more visible and existing.”

Sitting in a fluorescent-lit room inside Baptist Health Louisville, Amy English looked for familiar shapes on the screen as an ultrasound tech probed her abdomen. Familiar with radiology in her career as a physical therapist, she has a baseline understanding of how to read ultrasounds: gray shapes usually indicate fluid, and bone shows up as white. Amy remembers seeing her baby’s arms, legs and the curve of its back. But there was no recognizable outline where the skull should be. “I couldn’t see the top of my baby’s head,” Amy said in an interview with the Herald-Leader. “I kept waiting for the tech to move the probe in a way where we could see what we should be seeing. I could tell she was searching for it, too.” Over the next few minutes, Amy remembers the room blurring as she heard her doctor use the word “acrania,” which is when a fetus matures through pregnancy without ever developing parts of its skull. It can spur anencephaly, when the brain, too, is underdeveloped and partially missing. Pregnancies with either of these conditions are nonviable. Amy’s baby, which they learned was a boy, had both. He would not survive into childhood, likely not beyond a few minutes after birth. This, alone, was devastating news. Her dismay was compounded the next day when she learned that terminating her nonviable pregnancy, even by way of an early induction — a commonplace and provider-recommended method of treatment for such a diagnosis — couldn’t happen. Even though Amy’s baby would never survive outside her womb, the pregnancy still had a fetal heartbeat — a technicality, considering the diagnosis. Coupled with the lack of immediate threat to her health, her doctors explained they couldn’t induce labor, much less give her an abortion. Kentucky laws forbade it, they said.

For nine days in late July, abortion was temporarily legal and accessible in Kentucky. The state’s two outpatient abortion providers had filed a lawsuit a month earlier in an effort to overturn the trigger law and a six-week ban, both of which took effect after federal constitutional abortion protections were dropped in late June. Both laws are still intact today. The trigger law bans abortions in all circumstances except in limited emergencies to preserve a pregnant person’s life. The six-week ban criminalizes abortion after a fetal heartbeat is detected, typically around the sixth week of pregnancy. Together, the pair of laws has nearly rid the state of legal abortions. But from July 22 to August 1, enforcement of these laws was briefly halted by an injunction handed down by Jefferson Circuit Judge Mitch Perry. It was the last stretch of time abortion was legal in Kentucky before both bans were reinstated by the Kentucky Court of Appeals, granting a request for emergency relief from Republican Attorney General Daniel Cameron. Perry’s basis for issuing a temporary injunction may foreshadow what’s to come for abortion access in Kentucky, now that voters have rejected Amendment 2, a proposal to revise the constitution to prohibit a protected right to abortion. That rejection leaves the door open for the Kentucky Supreme Court to interpret abortion as a constitutionally-protected right in Kentucky.

On a recent Saturday afternoon, on the steps of the Kentucky Capitol, Bishop John Iffert wanted to make something clear: Christians have a duty to publicly advocate on behalf of unborn fetuses ahead of the November election. “This is the one opportunity in our lifetime for the citizens of Kentucky to register your opinion on abortion and on life,” he told the few hundred people gathered for the Yes For Life rally in early October. They rallied in support of Constitutional Amendment 2 — a yes or no question on the November 8 ballot that seeks to change the wording of Kentucky’s constitution to clearly state there’s no protected right to, or state funding of, abortion. Bishop Iffert, of the Diocese of Covington, walked rally goers step by step how to access sample ballots on their phones. He then directed them to return home to their respective churches and encourage their church leaders to preach a “yes” vote to their congregations. This allowance has opened the door for Yes For Life to lean on faith leaders across Kentucky — a devoutly religious state, with 76% of residents identifying as evangelical Christian — to wade into the political fray this election cycle and preach politics from the pulpit And in such a hyper-religious state, where local priests and pastors are often as influential as local elected leaders, Yes For Life has not only tailored its message to resonate with evangelicals (vote “yes” to “protect the unborn” and to preserve the “sanctity of life”) but the campaign’s voter outreach relies heavily on the proselytizing of Christian leaders.

Less than two months after federal abortion protections ended and Kentucky’s near-total abortion ban became law, the state’s largest medical association was poised to take an unambiguous stance on abortion access for the first time in its history. In Kentucky, the termination of a pregnancy is illegal except when the life of a pregnant person is threatened. But that caveat, vaguely defined in the trigger law, has caused confusion in the medical community, as the Herald-Leader reported in August. It’s a friction playing out for many physicians in states across the country, where largely GOP-backed abortion laws disregard not only evidence-based health care, but physicians’ ethical duty to care and advocate for the wellbeing of their patients. In a state like Kentucky, where broad support of those laws is often buttressed by Christian doctrine rather than peer-reviewed research, many doctors are pinned between their ethical obligation to publicly advocate for patients, and a need to compromise and avoid alienating the political party in power that passes those laws. But the opportunity to proclaim abortion access as an essential part of health care, exclusive to the relationship between patient and medical provider, was largely sidestepped in late August during the Kentucky Medical Association’s annual meeting. When presented with multiple evidence-based proposals, KMA’s governing body chose not to adopt most of the policy changes that would’ve provided medical clarity from experts on the importance of abortion access in a state that has all but eliminated it.

A news conference called by the General Assembly’s Pro-life caucus to “dispel misinformation” about an abortion amendment on the ballot in November contributed to the spread of more misinformation. Standing in front of roughly 25 members of the General Assembly’s Pro-Life caucus in Frankfort, Brandenburg Republican Rep. Nancy Tate, caucus chair and abortion ban supporter, said a “massive misinformation campaign” run by opponents of Constitutional Amendment No. 2 is “scaring Kentucky’s women.” Tate defended the medical exceptions in Kentucky’s trigger law, saying she has “confidence, as a woman with three miscarriages, that there is no concern, from my perspective, about the language that we as lawmakers have enacted. There are provisions specifically stating in the current laws that the woman’s life will always be taken into consideration for physical health issues.” The reality that those exceptions don’t in all cases protect the health of a pregnant person is “absolutely a scare tactic by donors from out of state in order to influence women in Kentucky,” Tate said. But that statement is misleading. The vaguely worded exceptions in the trigger law are creating problems and confusion for physicians providing routine obstetric and gynecologic care, as the Herald-Leader has reported. Those concerns have been communicated to lawmakers a recently as last month, according to Dr. Jeffrey Goldberg, an gynecological oncologist in Louisville who serves as legislative advocacy chair for Kentucky’s section of the American College of Obstetricians and Gynecologists.

For the first time in recent memory, Kentucky voters have a chance to weigh in on the future of abortion access in the state this November. If the amendment is passed and the constitution changed, it would not equal an abortion ban. But if Kentucky’s laws restricting abortion are legally challenged, courts could not interpret a right to abortion as existing within the constitution, because the amendment plainly states it is not a protected right. The General Assembly, then, would become the sole arbiter of state laws and regulations impacting abortion access. In other words, if the “yes” side wins and the constitution is changed, there is “no legal recourse, no legal path to challenge the constitution,” said Western Kentucky University political science professor Saundra Ardrey said. It is coincidental that the question of whether to revoke any right inherent in the constitution comes before voters now, when tensions over abortion access in Kentucky have reached a fever pitch, and as the Kentucky Supreme Court is scheduled to decide whether abortion is an inherent right protected by the state constitution.

Four days after the U.S. Supreme Court did away with federal protections for abortion access, triggering Kentucky’s near-total abortion ban to take effect, Destinee Ott knew it was time. The 25-year-old Beattyville teacher had long considered surgical sterilization, but this was the tipping point. Roe was overturned on a Friday. The following Tuesday, she phoned Lexington Women’s Health to make an appointment to get her tubes tied, a procedure called a tubal ligation that’s a permanent, often irreversible form of birth control. The overturning of Roe v. Wade by the U.S. Supreme Court in June immediately activated a a state law banning abortion in Kentucky, along with a ban on abortions after six weeks of pregnancy. The complete removal of that access — except if it must be done to prevent the death or serious impairment of a life-sustaining organ of the pregnant person — propelled Ott to exert control over her body. And control, for her, was eliminating the risk of pregnancy all together.

In a seventh-floor courtroom in Louisville earlier this month, Kentucky Deputy Attorney General Victor Maddox asked a question of a local OB-GYN. “Would you agree with me that abortion is a procedure that ends pregnancy?” Maddox asked. From the witness stand, Dr. Ashlee Bergin, a board-certified OBGYN at the University of Louisville and abortion provider at a Louisville clinic said yes, abortion ends a pregnancy. “Would you agree in every case that abortion actually stops a beating heart?” asked Maddox, who works for Republican Attorney General Daniel Cameron. “You don’t consider (a) human fetus an unborn child?” Bergin said her role as an OB-GYN was to rely on best medical practices as defined by the American College of Obstetrics and Gynecology, and tailor her care to meet the needs of her patients, often pregnant women. That care could include abortion, but it’s not for her to decide what’s best for any single individual, she said. These binary perspectives on what abortion is and isn’t typify the tension between Kentucky Republicans and Democrats in the General Assembly. It’s a division that has come to dominate dialogue and one that leaves little room for common ground.

On a recent June morning, in a stuffy, second-story room in downtown Louisville, Ashley Jacobs scanned a spreadsheet of women’s names on her computer screen. Each had called the Kentucky Health Justice Network in the last month in need of money to pay for their abortions. Jacobs, operations director for the nonprofit, readied the list of questions she poses when she returns hotline calls, and played the first message, left by a woman who’d called that morning on her drive to work. “I was just hoping to get a call back,” the woman said into her phone, audibly sighing. Clearly stressed, her voice shaky, she wouldn’t be free to talk again until the end of the work day. Her abortion was scheduled for the following week, she said, and “I won’t have my paycheck in time, and I just need some help so I can…” She trailed off. “I’ll just explain on the phone,” she said, sounding embarrassed. “I’m sorry, I’m just nervous.” In any given week, Jacobs and other KHJN staff hear from roughly 40 people needing help paying for an abortion. It was mid-June, and so far the ages of callers that month ranged from 17 to 41. Many already had children.

As the tornado ate through the Dawson Springs trailer, dislodging and gnarling the steel frame, crushing the walls, lifting the floor off its bed and tilting it, Skyler and Geneva, clutching one another, started to fall. “I see the walls start collapsing in, and my thought process is like, goodness, I hope this is it. I hope maybe just a wall falls on us,” Skyler said. But just as the walls begin to collapse, “we get shot up through the roof of our trailer.” Both are sucked out into the open sky. It’s black, like outer space. He can’t maintain his grip on his 67-year-old grandmother, and she tumbles away, mid air. The tornado sucks his shoes off. While he was airborne, “I was just praying to God: if I die, please make it quick. And as soon as that thought process went, I hit the ground. That’s when I thought I was dead, and then I looked up in the air and I see the lightning, and I feel the rain.” Today, nearly three months later, as aid organizations shift their efforts from short-term response to long-term recovery, many are bracing for what it will look like when trauma’s impact settles across whole communities — a byproduct of living through severe natural disasters that’s typically delayed but can last a lifetime.

By the time Leranda Hayton noticed her yard in Smith Bottom Loop was flooding, water was already lapping onto the third step leading up to her trailer. It was close to 7:30 a.m. on New Year’s Day. Hayton, peering out her window in the dark with a flashlight that reflected off the still-rising water, had been woken by her German Shepherd Luna’s barks. Floods and flash floods have long been a way of life in Eastern Kentucky, where communities are often planted in narrow valleys between steep ridgelines – terrain that functions like a clay bowl when it rains, filling up from the bottom and softening hillsides that increasingly slough off, creating landslides and mudslides. But the severity and frequency of flooding is unequivocally projected to worsen in the coming years as the climate continues warming, ultimately bringing more precipitation to vulnerable, unsupported terrain. There’s no comprehensive flooding protection road map for communities facing severe flood risks in Kentucky. As a result, much of the response to flooding is reactive and slapdash, with individual communities left scrambling to clean up devastation from storms, but with too few resources to preemptively plan for the next one.