What States Can and Can't Do When Banning Abortion

What States Can and Can't Do When Banning Abortion

For more information about your reproductive health rights and related federal resources, you can visit the US government's

Reproductive Rights

site.

Whether someone can get an abortion or related medical procedure mostly hinges on which state they live in after the Supreme Court overturned Roe v. Wade last month and ended the constitutional right to abortion. But the switch from federal protection to state law isn't straightforward and has led to confusion and misinformation on what pregnant patients and physicians can do.

In this still developing landscape, how confident can people be that their treatment is still legal?

"The answer to all your questions is 'Who the heck knows,'" said Dr. Louise Perkins King, a surgeon and bioethicist at Harvard Medical School. "And that's the problem."

The US Department of Health and Human Services issued guidance on July 11 reminding physicians of their responsibilities under the existing Emergency Medical Treatment and Labor Act, or EMTLA, which supports the need to treat and stabilize patients in an emergency, including pregnant patients who may require an abortion. Days later, Texas sued the Biden administration over the law, which allows for medical assistance to save the life of the mother, because, Texas Attorney General Ken Paxton said, it "seeks to transform every emergency room in the country into a walk-in abortion clinic." 

On Tuesday, a judge in Texas blocked the EMTLA guidance, so physicians in that state may no longer be protected by federal law if they perform an abortion when they deem it medically necessary but it falls outside of Texas' interpretation of a life-endangering pregnancy. Physicians nationwide who are members of the American Association of Pro-Life Gynecologists and Obstetricians or the Christian Medical and Dental Association are also exempt -- a total of about 18,000 health care providers, according to the court document.

Texas' new trigger law -- which will be in effect on Aug. 25 -- bans all abortions except when the pregnancy puts the mother "at risk of death or poses a serious risk of substantial impairment of a major bodily function." Physicians who perform an illegal abortion will be committing a felony. It doesn't make exceptions for rape, incest or fetal abnormalities, and it also doesn't make an exception for when the pregnant person's risk of death would come from a "claim or diagnosis" that they'll be hurt or might die in the future. (This could be interpreted to mean a doctor can't provide an abortion if a woman threatens to die by suicide because she has depression.) All abortions are currently banned in Texas after the state's Supreme Court ruled that a law from the 1920s could stand.

Legal battles within some states will continue to shape post-Roe America, with the landscape changing by the day. And lawsuits like the one in Texas clarify the country's stance on whether state law preempts federal rule on abortion or reproductive health care. Basically, can federal regulations trump state law? 

"There's going to be cases that are going to have to determine this question," I. Glenn Cohen, a professor and bioethicist at Harvard Law School, said. 

The argument over medication abortion access -- which is banned or restricted in many states but still available to people if they order it (not without risk) online -- will likely also be one of the first big court cases post-Roe, Cohen said. Questions of whether federal regulations on medication abortion conflict directly enough with state restrictions will continue to be center stage.

Medication abortion, for use in early pregnancy, accounts for more than half of abortions in the US. Restricting the pills is the new frontier of abortion bans.

Robyn Beck/Getty Images

Other federal guidance issued by the Biden administration includes a reminder to pharmacists that they are required to fill medication and birth control prescriptions for patients. Failing to do so is discrimination based on pregnancy status. This was in response to the many reports of women having treatment delayed or prescriptions denied while health care workers try to  navigate around new state laws.

Here's what we know today.

Can states ban abortion pills? Not completely, but some are trying. 

Any state with a current total ban on abortion -- including Texas, Oklahoma, South Dakota, Alabama, Arkansas, Mississippi, Missouri and Wisconsin -- also bans medication abortion. Heavy restrictions in other states, including Tennessee and South Carolina, which ban abortion after about six weeks, also extend to medication abortion. This means providers can't prescribe the medication in those states and patients can't fill prescriptions at pharmacies.  

"If a state law bans abortion broadly, that includes medication abortions," Elisabeth Smith, director of state policy and advocacy at the Center for Reproductive Rights, told MedPage Today.

But abortion bans and state laws seek to punish abortion providers or people who assist them, not the person seeking the abortion (there's reason to believe this might change in the future). For now, people living in the most restrictive states can still order pills from an overseas pharmacy, including Aid Access. However, the pills could take awhile to arrive and potentially put the person past the point of pregnancy for which the medication is safe and effective (about 10 weeks).

Peter Dazeley/Getty Images

The fate of medication abortion pills in Republican-leaning states centers on mifepristone, the first pill given in the two-dose regimen of medication abortion. Because the US Food and Drug Administration approved mifepristone as a safe and effective way to end a pregnancy over 20 years ago, states shouldn't be able to restrict it, the US attorney general's office argued the same day Roe was overturned. (Misoprostol, the second pill, is used off-label for abortion and miscarriage treatment. It's also used to treat health conditions such as stomach ulcers.) 

Whether this federal regulation (and the FDA's stamp of approval) supersedes state laws will need to be decided. Cohen said this is likely to be determined by the Supreme Court as "one of the first post-Dobbs cases."

"It's unclear whether that's going to be a winner of an argument, to be perfectly honest," Cohen said.

Last year, the FDA extended a pandemic-era rule that allowed patients to get medication abortion pills through the mail, instead of requiring them to be prescribed in person. This was seen as a victory for the American College of Obstetricians and Gynecologists and other medical groups, which viewed the in-person requirement as unnecessary for a medication that's safe and effective in early pregnancy.   

But states have their own requirements for medication abortion, and providers licensed in Montana can't prescribe pills to patients who travel over from a restrictive state like South Dakota, NPR reported.

Read more: Worries About Post-Roe Data Privacy Put Spotlight on Period Apps  

Ectopic pregnancies can't result in a delivery and require medical treatment. Symptoms can start with typical pregnancy signs, including a missed period, but can progress to abdominal or pelvic pain, vaginal bleeding, weakness and more. 

Svetlana Gustova/Getty Images

Can states ban treatment for high risk pregnancies? The HHS says no, but doctors say state laws are restricting care.  

Even though the most restrictive states banning abortions leave room for some degree of medical emergency, practicing physicians need to decide where the medical emergency line is – and risk prosecution if a state sees it differently. 

This month, the story of a 10-year-old girl who was raped and pregnant and who traveled to Indiana from Ohio, where abortion is banned around six weeks without exception for rape or incest, made headlines. Not only was the physician publicly questioned by Indiana's attorney general on whether she followed state law, but Ohio Attorney General Dave Yost said in the aftermath that the girl should've been able to legally get an abortion under the state law's medical emergency exemption. Ohio's OB-GYNs disagreed. 

"It states specifically 'medically diagnosed condition,' and as far as I can tell, adolescent pregnancy is not a medically diagnosed condition that's listed," Dr. Jason Sayat, a Columbus OB-GYN, told the Ohio Capital Journal. 

The Department of Health and Human Services reminded physicians and hospitals that if they want to keep their Medicare agreement and avoid "civil penalties," they must treat pregnant patients and provide abortions if necessary as required under the 1986 Emergency Medical Treatment and Labor Act. The EMTLA, now blocked in Texas, outlines certain life-endangering pregnancies that doctors must treat regardless of state law, including ectopic pregnancies, preeclampsia and complications of pregnancy loss.

But that narrow line of abortion exceptions for medical emergencies given by states like Wisconsin is what's troubling Dr. Jennifer McIntosh, a maternal-fetal medicine physician practicing in the state. While Wisconsin's attorney general said he wouldn't enforce a ban, physicians there stopped performing abortions because the state has a pre-Roe criminal statute that prohibits most abortions. The "save the life of the mother" abortion exception language in that law can leave out health conditions which may not be an immediate emergency but can become one down the line. 

"Some of what we do is to prevent emergencies from happening," McIntosh said. "To have to wait for an emergency to actually appear puts your patient's life at risk."

The treatment for an ectopic pregnancy is termination, because terminating the pregnancy is the only safe outcome when an embryo grows outside of the uterus, typically in a fallopian tube. Without treatment, the fallopian tube is likely to rupture, which can lead to internal bleeding and death. But some laws, like one in Texas, specifically restrict medications including methotrexate, which has led to access problems for people who are pregnant as well as people who are taking methotrexate for another health reason. 

Complicating confusion and risk over how abortion bans will affect treatments for ectopic pregnancies is the fact that more rare types of ectopic pregnancies exist, including ones where the pregnancy is growing inside a C-section scar or other area outside the safety of the main cavity of the uterus -- but still technically in the uterus. These rarer kinds of ectopic pregnancies are also life-threatening, and may be more difficult to diagnose and treat as such in a state that bans abortions with an emphasis on the pregnancy being in the uterus.

Saul Loeb/AFP/Getty Images

States are not prosecuting people who have abortions (yet)

Current state laws -- both those in effect and those in limbo in court -- prosecute other people involved in an abortion, not the person who's pregnant. 

But the health impact may be already felt when a doctor is hesitant to treat patients, or pharmacists are reluctant to fill a prescription for mifepristone before interviewing a woman to ascertain whether her pregnancy is already ended and her situation is in line with state law.

"Even in these straightforward cases of basic OB/GYN practice, the laws leave providers questioning and afraid," Dr. Carley Zeal, an OB-GYN in Wisconsin, told The New York Times. "These laws are already hurting my patients."

Aside from hesitancy among health care providers, physicians also fear that worries people have about being prosecuted for having an abortion or miscarriage will stop patients experiencing complications from any kind of pregnancy loss from seeking care. 

That's because it was already happening, before Roe was overturned. According to the National Advocates for Pregnant Women, there were over 1,700 arrests or prosecutions of women from 1973 (when Roe became law) to 2020 where their pregnancies were the focus of the case against them. 

So will doctors report you if they suspect you had an abortion? 

"The vast majority of health care professionals will not do that, because that's not caring for their patients," King said. But, she added, "I'm sure there's a very small, but unfortunately detrimental, minority who might." 

Your current access to birth control shouldn't be impacted by the overturn of Roe v. Wade. However, there's reason to believe that could change in the future.

Carol Yepes/Getty Images

Birth control is still protected under the Affordable Care Act

Right now, IUDs, birth control pills and other birth control methods are legal in all 50 states. And they should also be covered at no out-of-pocket cost for those covered under the Affordable Care Act. The right to birth control is protected under two Supreme Court rulings: Griswold v. Connecticut (1965) and Eisenstadt v. Baird. (Another Supreme Court Case, Burwell v. Hobby Lobby Stores, chipped away a little of that protection, however, finding that some corporations are exempt for religious reasons.) 

Plan B or "morning after pill" brands are also not included in abortion bans, because they will not end an existing pregnancy. Most health plans should also cover them. 

Legislators in Missouri last year voted to block taxpayer funding for IUDs and emergency contraception, casting doubt that all birth control devices will be protected indefinitely, at least in some states. The claims of legislators like Paul Wieland, a Republican state senator in Missouri, are that anything that has the potential to disrupt a fertilized egg's implantation into the uterus is an abortifacient. 

The medical community has been clear that IUDs and emergency contraception do not cause abortions and will not end an existing pregnancy. Copper IUDs work mostly by causing a chemical change in the sperm and egg before they meet, according to the World Health Organization. Hormonal IUDs like Mirena work mostly by thickening cervical mucus so sperm can't reach the egg, and can also prevent ovulation. Plan B and similar pills likely won't work if a person has already ovulated, meaning the chances of it stopping implantation are currently understood to be slim.

Nevertheless, unlikely occurrences or instances where a fertilized egg may be prevented from implanting into a uterus could be called into question in future court cases.

Read more: Could a Post Roe v. Wade World Impact Your Access to Birth Control?   

The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.

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Apple Watch: It's been 5 years since my original review, and it holds up

Apple Watch: It's been 5 years since my original review, and it holds up

I'd love to say that when I first put on the Apple Watch, I'd never seen anything like it before. But of course, that's not true. By late 2014 I'd been surrounded by smartwatches for a few years. So when Apple announced it was making its own watch, my thought (as so often with Apple) was: finally.

The first smartwatch I reviewed at CNET was the Martian Passport, an analog watch that could make phone calls. It sounds so primitive now, but it was cool in early 2013. The Pebble Watch followed, and the Steel version became my favorite: It was like a Casio watch turned into a useful little pager-assistant. It was simple and had long battery life, and it was great.

There were others, too: Samsung's first smartwatches were ambitious (a camera?). Google's first Android Wear watches arrived in 2014. Meanwhile, there were Fitbits and Jawbone trackers galore.

I say this to lay the groundwork for the Apple Watch and what its impact was. Like the iPhone wasn't the first smartphone, the Apple Watch wasn't the first smartwatch... but it made the biggest footprint. It was another step validating that a world of wearables was here to stay. 

I was able to wear the Apple Watch a month before it went on sale. I spent a ton of time with it, getting used to both how it handled phone calls, and the activity tracking rings. I looked at my heart rate measurements. I accidentally ordered an Xbox One with an early Amazon app.

The Watch was, much like the first iPhone, sometimes feature-limited. But it also had some features that already stood out.

My original review was updated a year later, which you can read here. Some parts have changed, clearly, and Apple has updated the OS. But I'll comment on what I wrote then, and how I felt, and how that's evolved. Quotes from the original review are in italics.

The gold Apple Watch, way back when.

James Martin/CNET

An excellent design, with luxury overtones

Apple wants you to think of the Apple Watch as fine jewelry. Maybe that's a stretch, but in terms of craftsmanship, there isn't a more elegantly made piece of wearable tech. Look at the Apple Watch from a distance, and it might appear unremarkable in its rectangular simplicity compared with bolder, circular Android Wear watches. It's clearly a revamped sort of iPod Nano. But get closer, and you can see the seamless, excellent construction.

The first Apple Watch came in aluminum, steel and ramped all the way up to a gold model costing more than $10,000. Compared to other smartwatches, it screamed luxury.

Certain touches felt luxurious, too: the fine-feeling Digital Crown, which spun ever so smoothly like a real watch part, for instance. The OLED display, which was a first for an Apple product, looked crisp and bright.

The most amazing part, maybe, were the watch bands. Apple created a really nice series of specially designed straps, from a steel link to a clever magnetic Milanese mesh that were extremely expensive and impressively engineered. 

Its watch face designs were great, too, and they integrated some information from the iPhone that aimed to add at-a-glance ease of use. There was a Mickey Mouse watch face that danced! The Solar face showing sunrise and sunset, and the astronomy face that showed planetary alignments and moon phases, felt like magic. I wanted more, but Apple's assortment of watch faces was limited, and it didn't allow for third-party watch face design. That's still the case now.

A lot of the Apple Watch reminded me of the strides Apple began with the iPod Nano, which also had watch mode... and a Mickey Mouse watch face.

Sarah Tew

New technologies at first: fantastic haptics, a force-sensitive display

All Apple Watches have a new S1 processor made by Apple, that "taptic" haptic engine and a force-sensitive and very bright OLED display, which is differently sized on the 38mm and 42mm models. The watch has its own accelerometer, gyrometer and heart-rate monitor, but no onboard GPS. It uses Bluetooth 4.0 and 802.11b/g/n 2.4GHz Wi-Fi to connect to your phone or your home network. There's a built-in speaker and microphone, but no headphone jack.

As I wore the watch on the first day, I felt a rippling buzz and a metallic ping: one of my credit card payments showed up as a message. Apple's "Taptic Engine" and a built-in speaker convey both a range of advanced taps and vibrations, plus sounds. Unlike the buzz in a phone or most wearables, these haptics feel sharper: a single tap, or a ripple of them, or thumps.

Sometimes the feelings are too subtle: I don't know if I felt them or imagined them. My wrists might be numbed from too many smart devices. I set my alerts to "prominent" and got sharper nudges on my wrist.

The first watch introduced some ideas that eventually made their way to other iPhones. A "taptic engine" delivered on some amazingly refined vibration effects, ranging from a purr to a ping to a gentle tap. These were way ahead of what anybody else was doing -- and they weren't just a gimmick. The notification types associated with unique vibrations felt distinct. Sometimes, the vibrating taps on the first Watch weren't as powerful as I wanted. But with later updates, the haptics made parts of the interface seem real: virtual wheels, clicking as if moving with invisible gears.

The more advanced haptics made their way to the iPhone next, making us used to them now. Other phones, game consoles like the Nintendo Switch, and VR accessories, have evolved haptics since, but the Apple Watch was the first mainstream device that upped the haptics game.

Force Touch was another wild idea: Apple made its watch display force-sensitive, meaning a deeper press could work like pushing a button. Though this idea was refined further into 3D Touch on the iPhone 6S, 3D Touch was a technology that never became as necessary as expected, and current iPhone models have dropped the pressure-sensitive display tech completely.

The Apple Watch still has Force Touch, though, and I think it always will.

Digital Touch: I never used it much after that.

Sarah Tew

Lots of features. Too many features?

As you can see, this is a lot of stuff. Did I have fun using the watch? Yes, mostly, but there are so many features that I felt a little lost at times. There are so many ways to interact: swiping, touching, pressing harder into the display, a button and a clickable digital crown-wheel. Plus, there's Siri. Do I swipe, or click, or force touch or speak? Sometimes I didn't know where an app menu was. Or, I'd find getting back to an app I just had open would require an annoying series of crown clicks, swiping through apps, then opening the app again.

There's a reason I used the word "complicated" to describe my feelings using that first Apple Watch. Setting up bits of information, called complications, was slow and not always intuitive. Apps took a while to load, and were sometimes so slow that it was easier to check my phone instead. Quick glances and notifications, and phone calls, were fine. Apple Pay on the watch was clever, but would I use it? I wished the watch had more battery life.

I didn't like the overcomplicated feel. The design of the OS, and the card-like swappable mini-view apps that used to be on the Watch like a dock, changed over time. It's gotten better since.

Storing music on the watch, while it took a while to sync, was easier than attempts on Samsung Gear or Android Wear. Of course, I had to hunt for a good pair of Bluetooth headphones to connect with the watch.

Today I still forget to dive into and make the most of the apps on the watch. I just dusted off Walkie Talkie: it's cool. There's noise monitoring. One app lets me remote control my iPhone camera, which has been a huge help for my stay-at-home self-shot videos. The Remote app helps me when I lose the Apple TV remote every other day. 

Third-party apps, and the grid of options? It turns out I don't use them much at all. I don't dig down deep into the layers of functions. I prefer what's on the surface: watch faces, and their readouts. But I've come to appreciate the watch's surprising number of options and settings. It's better than not having them at all.

The rings were the beginning.

Sarah Tew/CNET

Fitness: The ring idea was just the beginning

The Apple Watch doesn't work any fitness miracles that the rest of the wearable world hasn't already invented, and it doesn't ship with any new magical sensors that change the game. But the Apple-made integrated fitness apps, Activity and Workout, are far and away the best fitness apps on any existing smartwatch that isn't a dedicated "fitness watch" (Samsung Gear, Android Wear, Pebble and the like). A clever three-ring method of tracking daily activity, which simultaneously measures and rewards daily calorie burn, active exercise and standing up, feels like a fusion of rewards and metrics seen on the Nike FuelBand, Jawbone Up, Fitbit and others. 

I appreciated Apple's complete-the-ring motivational activity tracker, which felt inspired by wearables like the Nike FuelBand (not surprising, since Apple's head of fitness, Jay Blahnik, arrived from Nike). For the red ring's daily goals, it's great. It felt too easy to complete the blue Stand ring, and it still does.

There are tons of fitness advancements Apple has made on the Watch in the last five years: GPS, resting heart rate, workout controls, social sharing, third-party app integration, swimming, modes for accessibility, activity trends -- and I haven't even discussed Apple's massive health aspirations like adding ECG, checking for falls, monitoring elevated or irregular heart rate or women's health tracking. There is some form of coaching and motivation, too. But I'd still love to see more of that. I hit a wall when trying to be fit, and there's only so much watches seem to help.

The first Apple Watch was more of a Fitbit. Now, it's more of a health companion. Those two worlds still feel like they need to dovetail and grow. There are missing features, too, like sleep tracking, which feels like the inevitable next step.

You still need an iPhone, just like in 2015.

Sarah Tew

It was, and still is, an iPhone accessory

Much like most other smartwatches, the Apple Watch isn't a standalone device -- it's a phone accessory. Android Wear, Samsung Gear, Pebble and others work the same way. But here, you must own an iPhone 5 or later to use the Watch. A few Apple Watch functions work away from the phone, but the watch primarily works alongside the phone as an extension, a second screen and basically another part of your iOS experience. It's a symbiote.

One thing I noted back then was that you needed an iPhone to use the Apple Watch. Unlike other wearables that can pair with Android or iOS, or even sync with a computer, the Apple Watch was always designed to live symbiotically with the iPhone.

That's still the case now. Even with independent cellular options, and an on-watch App Store, you can't use the Watch without pairing to an iPhone. And it still won't work with Android. It's a shame, because a fully standalone watch could be a really helpful tool for many people who don't have iPhones, and it could even be a phone alternative (for kids, maybe).

Apple's AirPods created a gadget trinity where the Watch, the iPhone and AirPods can all work seamlessly together. But that trinity is an expensive one. The entry price of the Apple Watch has dropped, at least. But it feels like an extension of the iPhone more than its own device, even now.

The Apple Watch Series 5: much better, with a few similarities.

Sarah Tew/CNET

Today: the best watch in a war of attrition

You don't need an Apple Watch. In many ways, it's a toy: an amazing little do-it-all, a clever invention, a possibly time-saving companion, a wrist-worn assistant. It's also mostly a phone accessory for now. In the months and years to come, that may change: with Apple's assortment of iPads, Macs, Apple TV and who knows what else to come, the watch could end up being a remote and accessory to many things. Maybe it'll be the key to unlock a world of smart appliances, cars and connected places. In that type of world, a smartwatch could end up feeling utterly essential.

I think back to what the Apple Watch was competing against back then: Jawbone, Pebble, Fitbit, Google's Android Wear, Samsung's watches, the Microsoft Band. A lot of competitors are gone now. Fitbit was acquired by Google. Samsung still has watches. Garmin makes lots of dedicated fitness watches. There are still plenty of more affordable relative newcomers, too.

The original Apple Watch, with the Pebble Steel, Moto 360 and the original iPod Nano with wristband (clockwise from top left).

Sarah Tew

In a field of fewer alternatives, the Apple Watch's consistent addition of new features and ongoing performance improvements has made it the best option. It's Apple's commitment to gradual improvements that has made it a stand-out watch now, especially compared to the struggles of Google's Wear OS.

The Apple Watch is still an iPhone accessory. And it's still not an essential product. But it's become a really fluid and useful device, one with lots of key upgrades that work, and one that's a lot easier to use.

What's the best smartwatch now? The Apple Watch. That doesn't mean I don't want to see improvements: battery life, sleep tracking, a watch face store and most importantly, Android support and true standalone function. If the last five years are any indication, Apple will tackle these problems on its own... time.

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Zepp E smartwatch hands-on: Gorgeous hardware marred by frustrating faults

Zepp E smartwatch hands-on: Gorgeous hardware marred by frustrating faults

Say hello to Zepp, a wearable-tech brand that in 2018 was acquired by Huami, which also owns Amazfit. Amazfit makes wearables as well, including one of my personal favorites, the $80 Bip S. The new Zepp E is the posh ying to that affordable yang, a $250 smartwatch with a gorgeous display and plenty of health and activity features. However, built-in GPS isn't one of them and various software issues mar the experience of using this watch. In its current state it's hard for me to recommend.

That's too bad, because it's a beauty, with a screen to match. 

Read more: The best smartwatches of 2020

Hardware heaven

You know from the get-go the Zepp E is no budget watch: It comes in a long, hefty box reminiscent of Apple's and seems a bit opulent for a smartwatch. I tested the circular model, but there's also an Apple Watch-like square version that's not yet available in the US. 

Zepp built the E into a 42mm stainless steel case that measures just 9mm thick. Its bright, razor-sharp AMOLED display resides under curved glass, a striking design choice that, with some faces, makes it look like the screen goes edge-to-edge. There's some bezel, of course, but it's virtually invisible when looking at a face with a black background. I did notice, however, that the screen was harder to read under bright sun than my Apple Watch.

The Zepp is available in four colors, including Ice Blue, shown here.

Zepp

The Zepp's watch-face library is one of the best I've seen, with a generous mix of whimsical, stylish, traditional and health-minded options. Some of the faces support customization, meaning you can choose between various widgets in different spots. Cooler still, each face has its own unique "always-on" variant as well, which is one of the E's notable features.

Battery life is another one. Zepp promises up to seven days of "typical" usage or 15 days in basic watch mode (without heart-rate tracking and other frills). If you opt for always-on mode, that can easily drop to 2-3 days, which is still an improvement over most premium smartwatches out there like the Apple Watch and Samsung Galaxy Watch 3. Those last anywhere from 18 to 24 hours.

I was less impressed with the proprietary magnetic charger, which works in only one orientation. When you go to connect it there's no way to tell which end is "up," so there's a 50/50 chance it'll be positioned the wrong way. (If it is, the magnets will repel instead of attract.)

Healthy skepticism

In addition to heart-rate monitoring, the Zepp E can measure your blood-oxygen saturation, a capability that Apple touted in the new Apple Watch Series 6. It also promises to alert you if it detects high levels of stress, though it's not immediately clear what would trigger such an alert or what actionable steps you'd be advised to take. It also gives you a stress score, which is equally confusing. I reached a max stress score of 54, but I'm not sure if that's good or bad.  

I'm more enthusiastic about the watch's Personal Activity Intelligence (PAI) tracking, because the app does a good job of explaining how that works and why it's useful. PAI is a combined, cumulative look at activity and heart rate: The more you elevate both, the higher your score. But I did start to question the accuracy of some of these metrics. 

Although the watch seemed to provide accurate resting heart rate numbers, it tended to be way off while I was exercising: either too low or too high, or just inconsistent. I believe the watch was placed properly on my wrist and making good contact with my skin, so I'm don't think it was wearer error. 

Another frustration: During a run, I pressed the side button to dismiss a notification and ended up back at the watch face, with no easy way get back to my run stats. I had to stop in my tracks and navigate back through the workouts menu to get there. After that happened, notifications stopped appearing on the watch (even though I could hear tones for them in my headphones). And to top it all off, a call came in while I was running, causing the E to reboot -- and lose all the current run data.

While some of these issues can be fixed with future firmware updates, the one thing it can't fix is its lack of onboard GPS. The Zepp E offers only connected GPS, meaning you'll have to bring your phone along with you during an outdoor run or bike ride if you want to track your route. Even the $80 Bip S has proper built-in GPS; to me it seems inexcusable that the Zepp didn't include it.

The Zepp app offers some gorgeous watch faces, but other aspects of it are inconsistent and not very intuitive.

Rick Broida/CNET

Zepp's the way the cookie crumbles

During daily wear, I encountered a few annoyances. For example, sometimes call alerts (in the form of "ring-ring" vibration) happened after my phone had stopped ringing. There's a setting that lets you delay call notifications, which I thought might explain this, but it wasn't enabled. I also found it frustrating that I couldn't increase the font size on the screen and that various message sources (such as Slack) were identified simply as "app" rather than their actual name.  

Speaking of notifications, you can't respond to them. There's no way to answer a text, for example, nor can you use the watch for any voice features (like calls or Alexa commands).

I'm also disappointed by the Zepp app, which is the same one used for various Amazfit products (including the Bip). It's divided into three main sections -- Home, Enjoy (huh?) and Profile -- all of which look completely different from one another. To change any Zepp E settings, you venture into the Profile section. It's fairly straightforward, but there are a lot of options to sift through.

It's easy enough to forgive a mediocre app when you're talking about an $80 smartwatch, but it gets harder to ignore when you're talking about a smartwatch that's three times the price. It needs a usability overhaul.

The price is (not) right

For iPhone owners in particular, it's hard to recommend the Zepp E at $249 when you can get the Apple Watch Series 3 for as low as $199. (At this writing, in fact, it's still on sale for $169.) The latter is more tightly integrated with iOS, allowing you to reply to text messages directly and even have phone conversations.

Meanwhile, the Samsung Galaxy Active 2 sells for $249 offers some distinct advantages over the Zepp E, like its touch bezel, LTE option and FDA-cleared electrocardiogram (ECG) feature, all for the same $249 price tag. 

The Zepp E deserves praise for its lovely design, solid battery life and gorgeous selection of watch faces, but I don't feel those are compelling enough to compensate for weak software, questionable health readings and lack of onboard GPS. There are better options available from the Amazfit brand that cost considerably less.

Zepp E specs

Shape	Round
Watch size	42mm
Materials/ Finishes	Stainless steel
Display size, resolution	AMOLED
Dimensions	42.2 x 42.2 x 9.1mm
Weight	32g
Colors	Onyx Black, Ice Blue, Polar Night Black, Moon Grey
Always On	Optional
Interchangable bands	Yes
GPS	Connected GPS
Automatic workout detection	No
Compass	No
Altimeter	No
Water resistance	Yes, up to 5 ATM
Calls	Alerts
Notifications	Yes, but no replies
Microphone	No
Voice assistant	No
Music	Playback control only
Mobile Payments	No
Sleep tracking	Yes
Special features	SpO2 tracking
Emergency features	No
Compatibility	Android and iOS
Power	Proprietary magnetic connector
Battery life	7-15 days
Price (USD)	$250

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Garmin Venu Sq review: A solid fitness tracker without the frills

Garmin Venu Sq review: A solid fitness tracker without the frills

The $200 (£179, AU$300) Garmin Venu Sq has almost every fitness- and health-tracking feature you could want in a smartwatch for less than competitors like the Apple Watch ($349 at eBay) and Fitbit Versa 3 ($170 at Target). It has a bright LCD touchscreen, built-in GPS, SpO2 (blood oxygen) tracking and up to six days of battery life, which makes it a compelling buy, especially if you want a watch that's compatible with both Android and iOS. 

It's not the most premium-looking smartwatch out there and it misses out on features like a voice assistant and altimeter, but it makes up for it in health and fitness features that elevate it from the rest. 

A functional watch without the wow factor

Like the name suggests, the Venu Sq has a square watch face with rounded edges, unlike the original Garmin Venu and almost every other Garmin sports watch with circular designs. Its 1.3-inch color LCD display feels a bit cramped compared to other Garmin watches, but it's clear and easy to read even in bright sunlight and you can keep the screen set to always-on. Having used the larger Garmin Venu for a while, the smaller size of the Venu Sq took a bit of getting used to, especially during workouts when I couldn't see as many stats at a glance and had to scroll to find the right metric like heart rate, which was all the way on the last page.

The overall build quality is sturdy enough thanks to an aluminum bezel, although the plastic case and buttons make it feel like a cheaper watch than it actually is, especially compared to something like the Apple Watch SE ($280 at eBay), Galaxy Watch Active 2 ($200 at Amazon) or Fitbit Versa 3 for example, which all have metal finishes and OLED displays. The Venu Sq has two side buttons: one to start/stop activities and the other to navigate back and forth between menus. Once I figured out which did what, it took me a few days to get completely comfortable using them to navigate the interface. 

My biggest complaint with the Venu Sq's design is the vibration motor, which is not particularly strong. Half the time it was the buzzing noise, not the vibration itself, that clued me in on a notification. 

Blood oxygen monitor and heart health alerts 

Garmin's biggest strength is in health and fitness tracking, with the Venu Sq squarely hitting the mark. It has an SpO2 sensor to identify blood oxygen levels, either as a spot check or automatically throughout the day and night, similar to the $399 Apple Watch Series 6. Although setting it to monitor constantly will reduce battery life a lot faster. It's also hard to find the SpO2 option in the menus and I found that adding it as a widget in the settings is the best way to get it to pop up on your wrist. 

Unfortunately I didn't have a pulse oximeter to compare the readings from the Venu Sq to determine accuracy. Either way, it's important to note that the Venu Sq has not been approved to be used as a medical device and should not be used for diagnostic purposes. Always consult with a physician or other qualified health provider about any health-related issues you may have about a medical condition or health objectives.

Though the Venu Sq doesn't have an ECG, or electrocardiogram, like the Apple Watch Series 6 and Galaxy Watch 3 ($399 at Amazon), it does give you the option to receive high and low heart rate notifications that will let you know if your heart rate spikes above or falls below what it considers to be a healthy threshold. 

The Venu Sq also uses heart rate variability to determine your stress levels, but doesn't really offer much guidance on how to decrease your stress. I found Garmin's Body Battery meter, which takes into account heart rate variability readings, activity levels and sleep, a more accurate representation of how my body was working that day and helped me decide what kind of workout to do and how hard to push myself. It works better than the Stress Management Score in the Fitbit Sense ($240 at Target) that is a bit more difficult to interpret for me.

Garmin also offers breathing rate and estimated VO2 max, the maximum amount of oxygen your body can use during exercise, which can be used to gauge and improve athletic performance. The higher the number, the more fit you are. 

Screenshot by Lexy Savvides/CNET

Sleep tracking is also great on the Venu Sq and clearly identifies your sleep stages of REM, deep and light sleep. You'll also be able to see breathing rate and SpO2 levels in the morning. The downside is that the Garmin Connect app doesn't give you any tips on improving your sleep quality. Menstrual cycle tracking is also available on the Venu Sq and like other Garmin watches, it offers pregnancy tracking to log symptoms and monitor baby movement.

The Venu Sq has a range of workouts preloaded onto the watch, including cardio, strength, Pilates and yoga, so you can follow along with a preset routine on your wrist. There aren't any visual cues on the screen though, just text cues, so if you're doing yoga for example, you'll need to know what "standing forward bend pose" or "low lunge pose" means to get the most out of the routine. You can also build your own workout, such as a circuit of weights, a Pilates routine or a run, within the Garmin Connect app and sync them to the watch. There are also over 50 additional Garmin-created workouts you can load.

On top of these preloaded routines, the Venu Sq can track more than 20 different workout types, from the usual running and walking variants to golf and pool swimming. There's also a personal running coach you can use to help you train for a race or to hit a set goal. It doesn't give you personalized feedback on your form or audio cues like the Galaxy Watches ($295 at Amazon), for example, instead it's more a guide for when you should warm up or how long you should run for, displayed on your wrist.

The Venu Sq has built-in GPS, meaning you don't have to rely on your phone for distance tracking when you're outside. Just be warned that it does take at least 30 seconds to lock on to a GPS signal when you are outside (regardless of whether you have your phone with you or not), which seems like an eternity if you're an impatient runner like me who just wants to get on with it. Once it finally locked though, it tracked my route accurately.

The downside is that there is no gyroscope or altimeter on the Venu Sq, so if you need accurate elevation data you'll likely want to look elsewhere. The Garmin Connect app does a good job of clearly showing you all the details after your workout, but it doesn't dive any deeper into metrics than what similarly priced rivals like the Apple Watch SE or Fitbit Versa 3 offer.

Like other Garmin watches, the Venu Sq has Garmin Live Track which lets you share your location with a safety contact when you are doing an outdoor workout. It does however require a cellular connection, so you will need your phone with you to use this feature. 

You can customize the options on this screen to show only your favorite workout types to track.

Lexy Savvides/CNET

Just enough smarts for most people

While the Venu Sq is geared towards fitness and health tracking, that doesn't necessarily mean you'll miss out on smartwatch features. Like almost every other watch, the Venu Sq displays notifications from your phone and pings your phone to locate it if you lose it within Bluetooth range. You'll be able to see call notifications come through regardless of which phone you have the watch paired with, but only Android users will be able to decline calls and respond to text messages from the watch with prewritten responses. There is no speaker or mic onboard so you can't use voice-to-text responses.

The Venu Sq runs Garmin's own operating system (Garmin OS) which is not as seamless as that of Apple or Samsung's smartwatches, but I found it to be stable and more responsive than the Fitbit OS. It's faster to sync updates and doesn't experience any lag in selecting menu options or opening apps.

The biggest pain point for me when using the Venu Sq paired with an iPhone ($500 at Best Buy) has been notifications. The Garmin Connect app on iOS doesn't let you filter out what notifications come through on your wrist and simply mirrors whatever notifications you have set up on your phone. It might not be a deal breaker for many, but I like to push only the most important notifications such as calls and text messages to my wrist, rather than everything that my phone shows. Android users get more control over which notifications come through.

Lexy Savvides/CNET

If you want onboard music storage, you'll need to opt for the music edition of the Venu Sq that costs $50 more, which is the version I tested in this review. The Venu Sq Music lets you store music for offline listening from apps like Spotify (with a Premium subscription) or songs you already own. It's also the watch to get for faster data transfers as it has Wi-Fi and Bluetooth connectivity, whereas the regular Venu Sq only uses Bluetooth.

Garmin has plenty of watch faces to choose from, including third-party options to help personalize the look, plus a fairly wide selection of apps through the Connect IQ Store (a separate app you need to download on your phone). You can also make contactless payments with Garmin Pay on all versions of the watch. The main Garmin Connect app is where you see all your stats and change settings on the watch, while the Connect IQ Store is for adding apps and watch faces.

The Venu Sq, however, lacks a voice assistant, a feature that by now has become standard for most of its similarly priced competitors. This might not be a deal-breaker for you, but it means you miss out hands-free voice control, which I like.

A week's worth of battery life 

The Venu Sq has great battery life and you can get up to six days worth of use before you'll need to charge it up, though that number may start to whittle down if you're using it for a lot of GPS workouts, listening to music or continuously tracking your blood oxygen levels. Garmin quotes up to eight hours of battery when playing back music, 14 hours if you are using it in GPS mode, or up to six hours with GPS and music playback. 

A great fitness watch without extra bells and whistles

If you're willing to sacrifice a few smart features for better health and fitness tracking, the Garmin Venu Sq is a solid choice that works with Android or iOS. That said, I do wish that Garmin wouldn't charge the extra $50 for the music version, as it does alter the value proposition quite a bit, particularly if you are an iPhone user who might also be considering the Apple Watch SE which, at that point doesn't cost you that much more. 

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Your Next Smartwatch May Have 90 Hours of Battery Life and Maybe a Camera Too

Your Next Smartwatch May Have 90 Hours of Battery Life and Maybe a Camera Too

People often gripe about smartwatch battery life, and for good reason, as even premium watches like the Samsung Galaxy Watch 4 last only two to three days before needing a recharge. But Qualcomm's upcoming W5 chips promise to extend battery life by up to 24 hours thanks to a slew of performance and efficiency advancements.

These new designs, officially called the Snapdragon W5 and W5 Plus, are the successors to the Snapdragon 4100 and 4100 Plus that powered the Samsung Galaxy Watch 4, TicWatch 3 Pro and other wearables that statistically few people actually bought. Qualcomm said its new silicon achieves better battery life by reducing the chip's size to 4nm. That's just a fraction of the 80,000 nanometer size of a human hair, and down from 12nm in the 4100 series.

Qualcomm's W5 Plus has all those benefits, plus an extra feature to eke out even more battery life of up to 24 hours longer than with the prior 4100 Plus chip. The W5 Plus pulls this off with what's called a co-processor, or effectively a separate computer chip designed to do basic tasks, like displaying notifications. 

In the W5 Plus, Qualcomm has also decreased how much of the chip's various parts "wake up" to do something, leaving the rest  dormant to save even more battery. For instance, when going for a run or listening to music, only the satellite GPS location service, Wi-Fi, and audio portions functions would be active. Qualcomm's senior director of Head and Wearables, Pankaj Kedia, compared it to only turning on a few lights to get to the kitchen at night instead of wastefully flipping on every light in the house. "The rest of the SoC is power collapsed so you get longer battery life," Kedia said.

Qualcomm's steady drumbeat of wearable advances are arriving as smartwatches are becoming more common. Smartwatches have already outsold the entire Swiss watch industry. The questions facing tech companies now are whether smartwartwatches will remain a relatively niche product among techies and fitness enthusiasts, or whether new functionality can make them essential to more customers' lives. 

Apple, which is by far the most popular smartwatch maker, is rumored to be making a ruggedized Apple Watch meant for extreme sports and could reveal it later this year. Meanwhile, Google is working on a new smartwatch called the Pixel Watch that's expected to launch in the fall alongside the upcoming Google Pixel 7 to compete with Apple and Samsung's premium watches, though there's no word on Pixel Watch pricing. 

It's also not clear what kind of chipset will power the Pixel Watch, so a lot of its capabilities are unknown -- except that it will run Wear OS 3, Google's wearable operating system that integrates parts of Samsung's Tizen OS. That gives it a similar advantage as the Apple Watch: using their own software for a better integration with hardware. 

"On the watch side, the problem is that the silicon needs to be tightly integrated with the end product," said Avi Greengart, president and lead analyst at research firm Techsponential. "While Qualcomm has had silicon products with the [Snapdragon] 3100 and 4100, it hasn't been able to tie those with software and hardware in a product consumers want to buy anywhere near what Apple has been able to do." 

Despite the competition, Qualcomm's W5 series has features that could pave the way for the next generation of wearables. 

Battery, battery, battery

One key feature of Qualcomm's W5 Plus chip is its battery life. The W5 promises longer wear times, but the W5 Plus, with its extra power-saving features, can get up to 24 hours more battery life than before. Given most Apple Watch models won't last longer than a day, and even the leading Wear OS watches last three days at most, getting more battery life is a big deal.

That focus on battery life is also likely why the Snapdragon W5 series doesn't support 5G. The newer cellular technology promises faster web surfing but is still a battery hog. So, for now, any cellular-connected watches will be able to connect only to older, slower 4G LTE networks for mobile service (but don't worry, your music will still stream just fine). Qualcomm declined to comment on when we'd see a wearable with 5G capabilities.

That 4G LTE ceiling also applies to other devices using the W5 too. Facebook's Ray-Ban Stories photo and video-sharing glasses, for example, used the older Snapdragon 4100 chipset, Qualcomm said. Future augmented reality glasses may use the W5, and though they won't have 5G, they would likely benefit from the rest of the chipset's battery efficiencies. That could help make the glasses easier to design with smaller batteries, which are critical for making them look as normal as possible. 

W5 Series: An actual Dick Tracy watch?

You may not know it, but Qualcomm chips have supported cameras since 2018. Back then, the company's chip powered the Samsung Galaxy Watch 3, which didn't come with a camera. Only a few smartwatches have come out with the ability to take photos and videos, and they've either launched in China or been designed for kids. Mainstream smartwatches haven't implemented cameras, but Qualcomm thinks that might change with the W5, because it has better battery life that would make taking photos less burdensome. 

This includes two-way video calling, a feature that gadget nerds have been dreaming about since the Dick Tracy days, as well as smoother video playback and Memoji-style 3D watch faces, all made possible with cameras on watches. 

Qualcomm said it's notched 25 products that are currently being developed with its W5. The first will be the next-generation Oppo Watch coming in August with the W5 chip. Qualcomm said an unnamed TicWatch will be the first to use its W5 Plus, though the chipmaker didn't have any details to share about it, including if it would have a camera. Qualcomm's Kedia also declined to say whether any of the remaining 23 devices were AR glasses.

"I wish I could share the 25 customers in the pipeline -- they bring a whole new meaning to the next-generation wearables," Kedia said.

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