Some U.S. Postal Service facilities failed to properly handle ballots during this year’s primary elections, according to a new audit from the agency’s Office of Inspector General. Election experts say the findings call into question the agency’s ability to meet even greater demands for the November election that are under consideration by the U.S. Supreme Court.

The audit, which is dated Sept. 4 but has not been previously reported, found a lack of training for post office staff on how to properly and expeditiously handle mail ballots, deficiencies in how ballots were tracked and errors leading to delays, all of which risked ballots having incorrect postmarks or otherwise arriving late to election officials, which could lead to their rejection. 

The identified failures increase “the risk that Election and Political Mail is not handled, documented, monitored, and reported in accordance with Postal Service policy,” the audit said, though it noted that “most facilities we visited generally adhered to Postal Service’s election-related policies and procedures” and that nearly 99% of ballots reached election officials in a timely manner.

“While instances of non-compliance were low relative to overall volume, the presence of similar procedural gaps across multiple facilities indicates a need for improved understanding and increased enforcement of Postal Service policies among its employees,” it said.

The findings come as the Supreme Court weighs whether to allow the Postal Service to move ahead with new rules that would allow the agency to regulate mail voting, under a March executive order signed by President Donald Trump. The order requires states to give USPS a list of all voters eligible to receive a ballot in the mail and requires USPS to use those lists to determine which ballots get sent to voters. 

Top Postal Service employees, along with a whistleblower who filed a disclosure with U.S. Sen. Richard Blumenthal, D-Conn., have expressed concern that the new system stands to disenfranchise large swaths of eligible voters, both by its design and lack of testing, ProPublica reported last week.

Election experts told ProPublica the new audit findings should be considered by the Supreme Court, as they make even clearer what election officials already know. 

David Becker, executive director of the Center for Election Innovation and Research and a former Justice Department civil rights lawyer, said the audit confirms that USPS has “a long way to go to meet its core obligations of delivering election mail in a timely manner.”

“The administration and USPS are simply incapable of successfully meeting vast and radical new responsibilities under the president’s executive order,” Becker said.

Postal workers, through the American Postal Workers Union, also said Wednesday in a brief filed with the Supreme Court that it is not practical to implement the rules, which pose a “significant risk of wide swaths of Americans not being able to vote by mail.”

Even if the Supreme Court allows the new rule to move forward, some state election officials say the requirements would be impossible to meet for the November election, with mail ballots starting to go out this month.

Chelsey Wininger, executive director of the Democratic Association of Secretaries of State, said the audit shows the Postal Service “struggles to implement even basic changes to postal process consistently” and reinforces the organization’s opposition to any new rules this close to an election.

In a response included with the findings of the audit, the Postal Service wrote that “while we acknowledge that we can always reinforce and amplify our internal processes and procedures (and will continue to do so between now and November) — overall ballot mail performance is strong.” The agency acknowledged that there are some instances in which employees didn’t follow policies and procedures, but called other errors “isolated incidents,” such as when some New Jersey ballots were delivered to Tennessee before being sent back.

The Postal Service agreed with all recommendations on how to protect against future problems, except for one that suggested promptly notifying customers impacted by new regional transportation plans.

The Postal Service did not immediately respond to a request for further comment Wednesday evening. 

The Postal Service typically goes to great lengths to handle election mail in an expedited and careful manner. And overall, it delivered in this year’s primaries: Completed ballots from voters to election officials were processed “on time” nearly 99% of the time during the primaries, up from about 98% in 2024, for the about 6.3 million ballots that the Postal Service was able to track, according to the report. The definition of “on time” is not provided in the report. It refers to how quickly the ballot was handled by the Postal Service, not whether the ballot reached the election officials on time.

But when observing election mail at 14 processing facilities and 73 delivery units across eight states, the auditors found significant flaws in the handling of mail ballots.

There were no election-related training materials posted at 22 of 73 delivery units, or about 30%. In some locations, local management and employees weren’t familiar with requirements on how to process election mail, the report said.

In 14 states and Washington, D.C., election officials count ballots only when they are postmarked by the Postal Service by Election Day, making the correct postmark crucial for understanding which ballots to count and which to reject.

But the audit found that in 10 of 82 facilities, or about 12%, management wasn’t aware of the proper way to postmark a ballot. Some thought ballots should be postmarked at that time they go out to election offices instead of earlier on when they reach a processing facility or retail counter. 

Also, at five of nine mail processing facilities studied, retail clerks who were postmarking ballots by hand sometimes used stamps with inaccurate dates, according to the report. That included a facility in Pennsylvania on the state’s primary election day, which caused 56 ballots to be postmarked with the wrong date.

In 13 of 82 facilities, Postal Service workers didn’t complete proper procedures to make sure election mail had been sent out from the delivery units each day. In one instance at a Harrisburg, Pennsylvania, processing plant, 108 ballots were grouped with other mail and had to be expedited to Pittsburgh on the morning of the election so they would count.

The post U.S. Postal Service Failed to Properly Handle Some Ballots During This Year’s Primary Elections, Audit Finds appeared first on ProPublica.

The number of women who died after an ectopic pregnancy has spiked in recent years, a ProPublica analysis found. The mounting deaths in Centers for Disease Control and Prevention data have drawn little scrutiny or response.

Such deaths typically occur in the first trimester, after a pregnancy fails to properly implant in the uterus and begins to develop elsewhere, most commonly inside a fallopian tube. The embryo grows until it causes the organ to rupture, triggering catastrophic bleeding. 

With prompt and appropriate medical care, maternal health experts say, women should not die. Yet ProPublica’s analysis found a stark and baffling increase: Almost 200 women with the condition died from 2020 to 2025, compared with about 100 in the previous six years.

“A death related to ectopic pregnancy should really be a never event,” said Dr. Alice Abernathy, an OB-GYN in Philadelphia.

While chaos and access issues at hospitals during the COVID-19 pandemic likely contributed to at least some of the deaths, the surge has persisted, raising serious questions about the role of the most significant disruption to maternal healthcare in the years since: state restrictions on abortion. 

To treat an ectopic pregnancy, which is almost never viable, doctors must terminate it. But lawsuits and federal complaints have alleged that some medical providers are hesitating or flat-out refusing to do that in states where they face criminal penalties for performing an abortion. Patients described their terror. 

“I genuinely thought I was going to die,” said Kyleigh Thurman, whose right fallopian tube ruptured after she struggled to get ectopic care in Texas in 2023.

“There were a few times I asked my husband if I was going to die,” Leitaea Lowrimore of Oklahoma said in a lawsuit after being denied treatment for an ectopic pregnancy at multiple hospitals in February. “I kept thinking about our kids.”

To determine whether these issues go beyond anecdotes, ProPublica analyzed the data collected from every state by the CDC to look for patterns. The analysis shows a growing divide for women in states with strict abortion bans compared with those without.

While the uptick in ectopic deaths occurred nationwide, the climb has been much steeper in states that banned abortion after the Supreme Court overturned Roe v. Wade in 2022. 

ProPublica shared its analysis with more than a dozen maternal health experts, including leaders in the field, who were unaware of the spike; early pregnancy complications are chronically underresearched.

While they cautioned that abortion bans alone can’t explain the national rise, maternal health experts said any examination of the spike should include the documented delays in care caused by the laws, including for ectopic pregnancies. 

In Thurman’s case, despite clear signs of an ectopic pregnancy, two emergency departments sent her home without resolving the complication. Regulators in 2025 found that one of the hospitals, Ascension Seton Williamson, failed to properly screen Thurman for a suspected ectopic pregnancy and did not call in an OB-GYN, in violation of the hospital’s own policies and federal law that requires emergency departments to treat and stabilize patients before discharging them. Thurman has an ongoing lawsuit against Ascension Seton Williamson and the other hospital, Ascension Seton Highland Lakes, for medical malpractice.

Thurman had to have her fallopian tube removed after it ruptured. (Thurman is not related to Amber Thurman, who died in Georgia, which also has an abortion ban, after doctors delayed treating different pregnancy complications in 2022.) 

“I’ve never been in a situation where I didn’t get healthcare when I needed it,” Thurman told ProPublica, comparing the condition to having “a time bomb you can’t control.”

A spokesperson for the Ascension Seton hospitals said in a statement, “When a patient experiences a serious or life-threatening condition during pregnancy, our clinicians provide medically indicated treatment, including treatment for an ectopic pregnancy.” The hospital has denied Thurman’s malpractice allegations in a court filing.

Ectopic pregnancies, while rare, have long been recognized as the leading cause of maternal deaths in the first trimester. The condition impacts up to 2% of pregnancies in the U.S. Because government agencies don’t require hospitals to track or report overall ectopic diagnoses, it is impossible to know whether the condition itself is becoming more common.

While rates for other pregnancy-related deaths also increased during the pandemic, those climbs have largely subsided. 

Experts aren’t sure why ectopic deaths have continued to rise. Ectopic pregnancies are more common among older women, but the increase in deaths has been even more stark among younger women, the analysis showed. 

Anti-abortion groups have suggested that the use of abortion pills prescribed online is leading to more undiagnosed ectopics because telehealth patients don’t receive an ultrasound. But studies have found that ectopic rates are far lower among people who seek medication abortions than in the general population. Telehealth clinics ask questions that filter out patients at higher risk of ectopic pregnancy and follow up with those they treat to screen for symptoms, said Ushma Upadhyay, a researcher at the University of California, San Francisco, who studies telehealth abortion administration.

Experts told ProPublica that more research is required to determine the role of the abortion bans in the rise of ectopic-related deaths. Many states with bans, which generally provide less Medicaid funding and coverage to low-income women, have long had poorer maternal outcomes. “It’s a real challenge to try and tease out one thing out of the array of factors that undermine women’s health in these states,” said Eugene Declercq, a public health researcher at Boston University.

But experts said ProPublica’s data analysis, along with stories about delays in ectopic care, underscores the need to find out what is driving the deaths.

“Reproductive health is unusual across medicine when we consider how swiftly policy changes affect the care patients can receive,” said Dr. Courtney Schreiber, a professor of obstetrics and gynecology. 

Caitlin Myers, an economist at Dartmouth College who studies abortion policy, said the deaths should be investigated: “This is a potentially profound consequence of the regulation,” she said. 

How Abortion Bans Interfere With Ectopic Care

Many state abortion bans include exceptions for ectopic pregnancies. But experts have worried that doctors are hesitating to offer treatment without an ironclad diagnosis, which clinicians say can take time and increase risks to the mother.

Ectopic pregnancy symptoms often begin with abdominal pain and bleeding, which send women to emergency rooms. There, doctors use ultrasounds to locate where the pregnancy has implanted. 

However, embryos are often not visible on an ultrasound early in pregnancy. That could mean the pregnancy is ectopic, but it may also be a miscarriage or normal pregnancy that’s too small to see. Doctors can also assess whether the pregnancy is likely ectopic through blood tests over multiple days.

If the pregnancy is ectopic, the risk of rupture increases the longer treatment is delayed. In a state without a ban, a patient could decide at any point that that risk is not worth taking and opt to terminate the pregnancy.

In a state with a ban, however, that option may not exist. If doctors can confirm the pregnancy is ectopic through an ultrasound, they can protect themselves from having their decision to terminate questioned, perhaps by a zealous prosecutor. But waiting for this can delay treatment by days or even weeks. 

“Seeing a mass is not the only reason to have high suspicion for an ectopic pregnancy,” said Dr. Rebecca Nerenberg, an emergency medicine doctor in New York and the clinical director at Access Bridge, which educates ER doctors on reproductive healthcare and has released evidence-based guidelines for diagnosing possible ectopic pregnancies.

Experts say that doctors should be able to offer treatment when other symptoms are present, such as plateauing pregnancy hormone levels, bleeding and abdominal pain. Patients can be treated with a procedure or a cancer drug that stops cells from growing.

But for women in states with abortion bans, getting that treatment can be difficult.

Lowrimore, who lives near the state border in Oklahoma, sought care at an Arkansas emergency department in February after experiencing abdominal pain and significant bleeding. She was sent home and told to return for more tests after being diagnosed with a “pregnancy of unknown location,” because an ultrasound could not show where her pregnancy had implanted, according to a lawsuit. 

Lowrimore visited three different hospitals across both states over the following week as she began passing blood clots and the pain intensified, radiating up the left side of her body, according to the lawsuit.

The fact that the states’ abortion bans make exceptions for ectopic pregnancies did not help her, even though doctors acknowledged that was a possible diagnosis. In each visit, they didn’t treat her for that condition. One told her that intervening in her pregnancy could land him jail time — “10 years in the poky,” according to the suit. “I felt like my life was a risk he couldn’t afford,” she said in the lawsuit filing.

After consulting a lawyer, Lowrimore finally drove to a hospital in Kansas, where abortion is legal, and got an injection of the cancer drug called methotrexate within hours of arrival. 

Lowrimore’s lawsuit, in which an OB-GYN and six women who were denied care are seeking to block the Arkansas abortion ban, is ongoing. Lowrimore also filed complaints under the same emergency medicine law as Thurman against the three hospitals. Regulators cited Mercy Hospital in Fort Smith, Arkansas, for failing to provide care during the eight hours Lowrimore waited to be seen. The other two hospitals were not found to have violated that law, and they did not respond to requests for comment.

A spokesperson for Mercy Hospital declined to comment on the case, saying that, “in tragic situations when a mother suffers from an urgent, life-threatening condition during pregnancy, Mercy provides all medically indicated treatment to save her life.” 

Many experts predicted that ordeals like the ones Lowrimore and Thurman described would occur when abortion bans took effect. To see if more women with ectopic pregnancies are experiencing severe health outcomes, ProPublica analyzed hospital data from Texas, the most populous state to ban abortion.

In this new analysis, ProPublica found that 310 more patients in Texas experienced substantial blood loss after an ectopic pregnancy in 2023 and 2024 compared with 2018 and 2019, an increase of about 29%. Similar to ectopic deaths, the rise appeared to begin during the COVID pandemic, but the rate of complications remained elevated after hospital systems stabilized and the state passed its restrictive law. ProPublica is working to acquire similar data from states without abortion bans.

In response to ProPublica’s reporting on the deadly impacts of Texas’ abortion ban, the state passed the Life of the Mother Act in 2025, which attempted to clarify what kinds of abortions are allowed by the state’s law, explicitly adding ectopic pregnancies to the list. 

But new guidance from the Texas Medical Board includes only a case study with an ectopic pregnancy that can be seen in an ultrasound, remaining silent on the difficulty of early ultrasounds to detect where a pregnancy has implanted. This leaves open the possibility that a prosecutor could question whether such a case was really ectopic, in a state where doctors face up to 99 years in prison for performing illegal abortions.

A spokesperson for the Texas Medical Board said the course is not intended to cover all scenarios and that it “explains that imminent harm is unnecessary and specifically states that physicians who follow evidence-based medicine, standard emergency protocols, and proper documentation face minimal risk.” Asked whether a conclusive ultrasound image is necessary for an ectopic diagnosis, the spokesperson said, “The Board has consistently stated that providing commentary on every possible situation would be impractical.”

But Michelle Maloney, an attorney who represents Thurman and 13 other Texas women or their families who say they were denied care — including seven with ectopic pregnancies — said she still gets frequent calls from women who say they were denied care for pregnancy complications. “I don’t think specific exemptions address the massive gray areas that arise in pregnancy,” she said. 

Solutions are unlikely to come from the states themselves. A previous ProPublica investigation found that states with strict bans are not studying whether their laws are contributing to maternal deaths. And others have not followed Texas in attempting to amend their bans.

Gaps in Research, Training and Awareness 

One of the biggest challenges to reducing ectopic pregnancy deaths nationwide is the lack of awareness, research and data. 

No one, for example, is tracking whether women who experienced ectopic pregnancies also had one or more common risk factors, like a history of ectopic pregnancies, infertility or use of hormonal intrauterine devices, according to ProPublica’s review of maternal health statistics and interviews with experts. 

Nor has any published research addressed the connection between recent ectopic pregnancy death rates and untreated infections like gonorrhea and chlamydia, which increased substantially during the first years of the pandemic before declining again. Those infections can cause pelvic inflammatory disease, which causes fallopian tube scarring and raises the long-term risk of developing an ectopic pregnancy.

It is unclear why the CDC and other federal agencies across two administrations have failed to publicly respond to the increase in deaths despite having access to the same information ProPublica analyzed. But experts say the country’s capacity to respond to it has been greatly reduced under President Donald Trump.

Robert F. Kennedy Jr., secretary of the Department of Health and Human Services, told Congress in April that improving maternal health outcomes is a priority. But the Trump administration has eliminated much of the staff devoted to researching the topic and cut hundreds of millions of dollars in government funding for healthcare research. 

The CDC’s Division of Reproductive Health, for example, lost most of its 100 employees, according to a lawsuit filed by more than a dozen states’ attorneys general last year. The entire team that ran the Pregnancy Risk Assessment Monitoring System, a significant source of data for state and local governments as well as maternal health researchers, is on paid administrative leave. That includes many researchers who would have been responsible for investigating the rise in ectopic pregnancy deaths, according to current and former CDC employees.

“You’re losing the capacity to know what’s going on with pregnant women,” Lee Warner, the former chief of the Women’s Health and Fertility Branch at the CDC, said of the cuts at the division. “It’s going to take decades to build this capacity back.”

Funding cuts have also impacted efforts to raise awareness about the condition. Because ectopic pregnancies usually cause complications before standard prenatal care begins around 10 weeks, patients often rely on emergency departments, where doctors don’t typically have specialized training in pregnancy care. Experts say more training on high-risk early pregnancy conditions could help combat rising maternal mortality rates.

The CDC in 2025 also stopped funding a partnership with the American College of Obstetricians and Gynecologists to educate emergency medicine doctors about reproductive healthcare. The initiative, “Obstetric Emergencies in Nonobstetric Settings,” offers resources for emergency departments on caring for pregnant patients with cardiovascular disease, hypertension and eclampsia. An ACOG spokesperson said its foundation now funds the project, and that the organization is working on a set of guidelines for diagnosing and managing tubal ectopic pregnancies in the emergency department.

A spokesperson for HHS said the agency continues to track maternal mortality trends, investigate their causes and provide funding for research. “This important work is being accelerated across the Department to support healthy mothers, healthy babies, and strong families,” the spokesperson said.

The United Kingdom’s response to a similar spike in ectopic deaths during the pandemic shows just how much the U.S. is failing to do. 

Researchers and officials there identified a surge in deaths in 2021 and 2022 in the U.K. and Ireland; 12 women died of an ectopic pregnancy during those years, which, as in the U.S. during this period, represented a near doubling of the death rate compared with previous years.

They investigated the causes and found a range of culprits, including overstretched emergency services and inadequate early pregnancy screenings, says Marian Knight, a professor at the University of Oxford who leads the U.K.’s maternal mortality reporting.

In 2024, Knight co-authored a maternal mortality report that focused on those deaths and offered policy recommendations. Knight worked with policymakers and a U.K. charity to raise awareness and help doctors and the general public recognize ectopic pregnancy symptoms. Officials also changed how patients experiencing ectopic pregnancy symptoms are prioritized when they call for an ambulance, leading to faster response times.

But the first step, said Knight, was identifying and investigating the issue. “If we’re not tracking and not just understanding the numbers, but understanding the why behind the numbers, we have no ability to respond,” Knight said.

The U.S. doesn’t do national maternal mortality reviews, said Boston University’s Declercq, who serves on the Massachusetts Maternal Mortality and Morbidity Review Committee. Instead, CDC epidemiologists review death and birth records to establish accurate national totals of pregnancy-related deaths, largely leaving state and local maternal mortality committees to take an in-depth look at individual cases and make recommendations to lawmakers and medical providers.

Declercq said his committee has not identified a notable increase in deaths from ectopic pregnancies in Massachusetts in recent years. In most states, these deaths are sporadic enough that they don’t, in isolation, show a notable trend.

It’s only at the national level that this increase in avoidable deaths becomes visible. 

ProPublica’s analysis “raises concern that young women are dying from a preventable cause at an increasing rate,” Schreiber, the professor of OB-GYN, said. “That is not what we should be seeing in the United States of America.”

The post Ectopic Pregnancy Deaths Have Nearly Doubled. It’s Worse in States With Abortion Bans. appeared first on ProPublica.

I’d like to tell you about Fred Steese, who died in August of cancer at 62. When I first met Fred, he was living hand to mouth in a seedy motel on the outskirts of Las Vegas. He had been released from prison a couple of years earlier and struggled to find stable housing and a job, because — on paper, at least — Fred appeared to be a convicted murderer. 

In 1995, Fred was wrongfully convicted of the murder of Gerard Soules — a former trapeze artist who had a dancing poodle show at a Las Vegas casino — even though prosecutors had evidence that he was hundreds of miles away at the time. He then spent 21 years in prison before a judge declared him innocent. 

I wrote about Fred in a 2017 ProPublica and Vanity Fair story. It was part of a series that investigated how an obscure type of plea deal was shaping innocence cases and giving cover to district attorney offices that didn’t want to admit wrongdoing — or examine prosecutorial misconduct. 

In Fred’s case, he told me he thought his ordeal was finally ending when the judge uttered the words “factually innocent” during a court hearing in 2012. Instead, Las Vegas prosecutors insisted he was guilty, that they had not made a mistake all those years ago and that they would retry him for Soules’ murder. 

But then they dangled a deal: Fred could walk away now, if only he would agree to plead guilty. 

The offer was something I, and a lot of lawyers I talked to, had never heard of. It’s called an “Alford plea,” and it allows someone like Fred to assert for the record that they are innocent but agreed the state might be able to convict them anyway. Experts told me some prosecutors around the country were using the obscure plea as a tool to thwart exonerations. 

Fred took the deal. He felt he couldn’t face the uncertainty of another trial and the additional time it would rob from him.

Fred had only 13 years of freedom before he died.

In June, he went into the hospital for a hernia operation, and when he wasn’t healing like he should, the doctors discovered a large mass on his liver and another on his pancreas. It was stage 4 cancer. By August, he was in hospice, and he died on Aug. 8.  

When I heard, it felt like the universe had dealt Fred yet another injustice. Fred did see a measure of accountability, and I can appreciate as an investigative reporter the rarity of that being the case at all. But I’m sobered that his death means he spent more time fighting to clear his name than he got to enjoy his freedom. He deserved 40 more years.

In late 2017, with the help of a tireless pro bono lawyer who worked his case for years, Fred was fully and unconditionally pardoned by the state of Nevada. His record was finally cleared after 22 years. 

The pardon cleared the way for the state to pay Fred $1.4 million for his wrongful conviction. 

Fred bought a pickup truck, a Mustang and his very own big rig; his lifelong dream was to be a long-haul trucker.

He didn’t manage to keep the money for long, though. Fred, who’d been in and out of foster homes as a child, spent much of his life outside prison without reliable structure, much less a budget. He was a drifter. He also struggled with drug use. At one point, Fred was swindled out of upward of $15,000 when someone pretended to be the owner of a house for sale that Fred wanted to buy. 

Fred’s most marked characteristic was his cheerfulness. He was an easy laugh, and his good-humored resourcefulness quickly endeared him to those he met. 

“He’d give you the shirt off his back, even if he didn’t have another one,” his sister, Lynn Myers, told me. 

Ryan Norwood, the federal public defender who proved Fred’s innocence, told me he wished Fred had had more time. “But he got to live his dream of being a truck driver and to live his life on his own terms for better or worse.”

Myers hadn’t seen Fred since childhood, but the two reunited after he was exonerated, and the relationship was a rare touchpoint in Fred’s otherwise transient life. Fred’s ashes will rest in a handmade wooden box at Myers’ home in California. 

“Maybe now,” she said, “he’s driving big rigs for God.”

The post I Wrote About His Wrongful Conviction. He Got Only 13 Years of Freedom Before Cancer Took His Life. appeared first on ProPublica.