What have the country’s most restrictive abortion laws meant for the women and babies living under them?
That’s the million-dollar question posed over the last three years by reporters, health care providers, activists, academics, and, of course, the people who’ve had to navigate Texas’ tumultuous reproductive care landscape.
Yet, Texas officials, particularly the politicians who supported the ban, have taken steps to prevent the public from finding out. The state’s maternal mortality committee — which reviews deaths during pregnancy through postpartum, to understand the causes and prevent further death — is legally prohibited from reviewing deaths deemed abortion-related, which ProPublica found could include miscarriages. Last year, the committee announced, to much controversy, that it would skip reviews for 2022 and 2023 — the first two years under the abortion ban.
Despite a lack of transparency from the state, news reports and academic research have emerged. They already paint a bleak picture: Mothers dying. Infants dying and abandoned. STDs surging and doctors fleeing. Here, The Barbed Wire is pulling together available (and reliable) data, studies, lawsuits, patient complaints, and individual stories of women and infants who have been harmed by these laws to show the full scope of damage to real Texans.
How Did We Get Here?
In 1970, Jane Roe filed a lawsuit against Henry Wade, the then-district attorney of Dallas County, over Texas’ abortion ban. Roughly three years later, the U.S. Supreme Court ruled that the state’s law was unconstitutional.
Afterward, Roe v Wade became the law of the land. But, in one form or another, Texas has restricted or banned abortion since 1854. During the bulk of that time, lawmakers argued the laws were necessary to protect women’s health: In 1999, legislators created a parental notification requirement for minors seeking abortion. Four years later came the “Women’s Right To Know” Act and state-mandated misinformation on the risks of abortion. Then came sonogram requirements, and informed consent requirements, and mandatory admitting privileges at hospitals for physicians performing abortions, which all but outlawed abortion clinics.
The reason was always the same: the laws protect women.
But that was a fallacy.
In 2016, the U.S. Supreme Court struck down Texas’ law on admitting privileges, concluding the “state’s evidence did not show how the law advanced its legitimate interest in protecting women’s health.” That was backed up by a landmark 2018 report from the National Academies of Sciences, Engineering, and Medicine, which found abortions are safe medical procedures, and the laws were effectively making them less safe.
Afterwards, right-wing politicians tried a new rationale: fetal personhood and dignity.
First came updated provisions on the handling of embryonic and fetal remains, including a requirement that they be cremated or buried, which was struck down by the federal Fifth Circuit Court of Appeals.
Then, in September 2021, the Texas Legislature passed Senate Bill 8, an extreme measure on multiple fronts. Dubbed the “heartbeat bill,” itself an unscientific misnomer, the law became the most restrictive in the country. It banned physicians from performing abortions if a fetal heartbeat was detected, which is usually around six weeks of pregnancy — and before many people know they are pregnant.
Before Roe v Wade was overturned, enforcement of that law was exclusively through civil action — not by the state, or a district or county attorney. Any citizen could begin suing another citizen for $10,000 for performing or aiding in an abortion. While other states had passed similar bans, they were blocked by courts, as they had been in Roe v Wade. But Texas got around that problem by creating the “vigilante” civil enforcement mechanism.
Then, in 2022, the Supreme Court overturned Roe v Wade in its opinion for another case: Dobbs v Jackson Women’s Health Organization. Texas’ “trigger ban,” House Bill 1280, took effect soon after, making providing an abortion a felony punishable by up to life in prison, license revocation and a $100,000 fine.
Both bills were purportedly passed in the name of preserving life: “Texas has compelling interests from the outset of a woman’s pregnancy in protecting the health of the woman and the life of the unborn child,” Senate Bill 8 reads. But again, research and lawsuits showed that premise was not made in good faith. Experts and activists agree that Texas is more dangerous for pregnant people and their babies than it was before the laws were passed.
In November, following news reports of two women’s deaths, more than a hundred Texas OB-GYNs wrote an open letter to officials and policy makers urging changes. “The law does not allow Texas women to get the lifesaving care they need and threatens physicians with life imprisonment and loss of licensure for doing what is often medically necessary for the patient’s health and future fertility,” they wrote. Later that month, state lawmakers filed bills in the House and Senate to create new exceptions that would allow doctors to provide abortions preserve the mother’s mental or physical health, and in cases of lethal fetal abnormalities.
We will continue to update this page as new information becomes available.
Babies Are Dying
Infants are dying in Texas at a greater rate than anywhere else in the country.
255 more infants died in 2022 than the year prior.
Researchers at Johns Hopkins Bloomberg School of Public Health found infant deaths increased from 1,985 to 2,240 between 2021 and 2022 in Texas. That equates to a 12.9% increase, compared to a 1.8% increase nationally. Congenital abnormalities, the leading cause of infant death, increased 22.9% in the state versus 3.1% in the U.S.
Texas’ abortion laws don’t provide exemptions for fetal abnormalities of any kind, even in cases like Samantha Casiano’s, when doctors conclude a fetus has little or no chance of survival. Casiano is one of the plaintiffs in Zurawski v Texas, a lawsuit on behalf of more than 20 women denied abortions who are now seeking clarity on exemptions within the law. Casiano learned while 20 weeks pregnant that her daughter had anencephaly, a birth defect in which the fetal brain and skull do not fully develop. Her doctor would not perform an abortion, forcing her to carry her daughter, Halo, for another three months. She was born prematurely, and she died within hours.
“This study found that Texas’ 2021 ban on abortion in early pregnancy was associated with unexpected increases in infant and neonatal deaths in Texas between 2021 and 2022,” the authors of the Johns Hopkins study wrote, noting “the results suggest that restrictive abortion policies may have important unintended consequences in terms of trauma to families and medical cost as a result of increases in infant mortality.”
“We’ve found that infant mortality is going up,” said Houston-based OB-GYN Dr. Damla Karsan, who is also Kate Cox’s physician. Cox was pregnant with her third child when she discovered that her fetus had trisomy 18, a genetic condition that doctors said meant her child would likely survive less than one week after birth — at best.
“We know a lot of the trisomy 18 babies don’t survive birth, so I could lose her at any point in the pregnancy,” Cox told CBS News. “There’s risk of infection, risk of uterine rupture. And we want more children as well, so what does that mean for future pregnancies?”
“I talked with our doctors,” Cox continued. “And I didn’t want her to suffer. I felt it was best for her, and I felt it was best for our family as well. We want to be able to have more babies. We want to give siblings to our kids.” Last December, when Cox was 20 weeks pregnant, they sued the state of Texas in hopes that a court order finding she qualified for a medical exception to the state’s ban would shield her doctors from prosecution.
Moms Are Dying
Abortion is the standard of care for a variety of pregnancy complications, including in some miscarriages, to prevent potential infection, hemorrhage, and other life-threatening effects. With severely limited access to abortion care, experts warned that women would have a greater risk of dying from such complications.
And, in fact, mothers in the state are dying at higher rates.
Maternal deaths in Texas rose 33% between 2019 and 2023 while falling nationally by 7.5%.
Reporters at ProPublica reviewed data compiled from death certificates by the Centers for Disease Control and Prevention, as well as hospital discharge and billing data from 2017 through 2023, which catalogues what happens in every hospitalization. While the state Maternal Mortality and Morbidity Review Committee said it will not review deaths from 2022 and 2023, ProPublica found 120 women who died while hospitalized during pregnancy or up to six weeks postpartum in those two years — meaning an increase of dozens of deaths compared to a similar time before the COVID-19 pandemic. While rates rose across the country have fallen — after peaking in 2021 due to COVID-19 — ProPublica found rates in Texas remain higher than pre-pandemic times.
From 2019 to 2022, Texas’ maternal mortality rate rose by 56%.
Maternal mortality rates count the number of women who died while pregnant, during labor, or soon after childbirth, and are calculated per 100,000. According to analysis from the nonprofit research group Gender Equity Policy Institute and NBC News, the corresponding rate nationwide was 11%, based on available reports from the Centers for Disease Control and Prevention.
“There’s only one explanation for this staggering difference in maternal mortality,” Nancy L. Cohen, president of the nonprofit, told NBC. “All the research points to Texas’ abortion ban as the primary driver of this alarming increase.”
Texas had a mortality rate of 34.7 per 100,000 in 2022.
The state’s maternal mortality rate per 100,000 live births for 2022, the last year data is available, was significantly higher than the national average — 26.3%, according to the Commonwealth Fund, a foundation focused on promoting a high-performing, equitable health care system.
At least three Texas women have died after being denied care
A ProPublica investigation found that Josseli Barnica, a 28-year-old mother in Houston, died in 2021 after suffering a miscarriage at 17 weeks pregnant. Doctors reportedly told Josseli “they had to wait until there was no heartbeat” and that “it would be a crime to give her an abortion” — even though her baby was not going to survive. Nevaeh Crain, ProPublica found, also died after being turned away from two hospitals, and made to wait at a third. She’d developed sepsis while six months pregnant. Nevaeh was 18 years old.
Separately, a New Yorker report found that in 2022, Yeniifer Alvarez-Estrada Glick of Luling, Texas, experienced life-threatening complications from her pregnancy, including pulmonary edema and hypertension. Yet, doctors did not provide standard treatment — an abortion — and Glick died of the complications.
About one-third of OB-GYNs in Texas do not have a clear understanding of the law — and 60% are fearful of legal repercussions, according to a recent survey by a medical consulting company.
STDS, Complications & Infertility
Women who survive severe pregnancy complications are often left with permanent damage and impacts on future fertility: Many of the 22 plaintiffs who sued the state in the Zurawski case suffered adverse health effects from delays in treatment.
Amanda Zurawski, the lead plaintiff in the case, experienced preterm pre-labor rupture of membranes (PPROM) while 18 weeks pregnant. She was denied an abortion because doctors could still detect a fetal heartbeat. Days later, she became septic, and she spent three days in the ICU. The infection left one of her fallopian tubes permanently closed.
Sepsis rates in hospitalizations for pregnancy loss have increased.
Using Texas hospitalization data from 2017 through 2023, ProPublica reporters found second-trimester pregnancy loss hospitalizations (just like Zurawski experienced) increased by more than 50% since the state’s abortion ban went into effect. It had previously been relatively stable. What’s more, reporters found that the increase was most notable in patients whose fetuses were still believed to have a heartbeat.
When a pregnant person’s water breaks, and the fetus can’t survive, the standard of care recommended by most major medical associations is to evacuate the womb — also known as an abortion. Delays increase the risk of infections and sepsis.
As doctors told ProPublica reporters: That finding indicates that patients largely aren’t receiving care without a fetal death diagnosis. “This is needlessly putting a woman’s life in danger,” one professor of obstetrics told reporters.
A new, yet-to-be-published study from the University of Texas Health Science Center in Houston found that the rate of sepsis tripled after the state’s abortion ban.
Sepsis is not the only concern.
Cristina Nuñez was advised against pregnancy by doctors because of medical conditions, including diabetes, cardiovascular issues, and end-stage renal disease. When she learned she was six weeks pregnant, Nuñez sought an abortion, which she didn’t receive until her arm turned black due to blood clotting issues, and she feared she was at risk of pulmonary embolism.
Such outcomes have, in part, led nonprofit and research organizations to rank Texas as one of the worst states for women’s healthcare.
In 2024, the Commonwealth Fund, which supports independent health policy research, developed state scorecards to track trends and policy impacts on women’s healthcare. The scores are based on 32 measures including health care access, quality, and health outcomes.
Fiftieth out of 51.
Texas ranked 50 overall, second only to Mississippi. The Lone Star State ranked 38 on health and reproductive care outcomes and 49 on healthcare quality and prevention — based on indicators including preventive care use, prenatal and postpartum care, and mental health screening.
D-
The March of Dimes publishes a similar report card with key indicators on maternal and infant health. It gave Texas a D- in 2023 with 11.2%, compared to a national rate of 10.4%.
“Birthing people in Texas have a very high vulnerability to poor outcomes and are most vulnerable due to reproductive healthcare access,” the report said.
The Commonwealth Fund also found rising rates of syphilis across the country over the last decade, in part due to limited access to care and screenings, including during pregnancy.
The sexually transmitted disease is particularly concerning when left untreated during pregnancy. It can cause severe complications, including risk of miscarriage and stillbirth, as well as infant death.
The Centers for Disease Control and Prevention recommends that all pregnant women be screened for syphilis early in pregnancy and again in the third trimester, as well as at birth for those at high risk. But screening and treatment have been unequal across states.
In Texas, 122 women out of 100,000 women ages 15 to 44 had syphilis in 2022.
Compared to 78 nationally — and the best-ranked state had a rate of one per 100,000. Texas ranked 42nd of 51 states.
The rate of infants born with congenital syphilis was 246.8 per 100,000 live births in 2022.
Compared to 102.5 nationally, and 0 for the best-ranked state. Texas ranked 48th of 51 states.
Abandoned Infants
Houston saw a spate of abandoned infants over the last year, The Washington Post found. According to the Texas Department of Family and Protective Services, at least 18 babies had been abandoned by December – compared to seven a decade earlier.
The Post’s reporting showed the reason for the increase is multifold. Blake Rocap, a lawyer with the Sissy Farenthold Reproductive Justice Defense Project at the University of Texas at Austin, pointed to Texas’ strict abortion bans, limited access to prenatal care, crackdowns on immigration, and high uninsured rates.
“All of these intersectional things could be leading to this,” Rocap told the paper.
Or, as the Post put it: “No matter the circumstances, desperation is a common thread.”
Pregnant Children Forced Out Of State
One hundred Texas children received abortions in other states in 2023 — the first year after Texas’ ban of the procedure took effect — including six children under the age of twelve, the Houston Chronicle reported in January. The numbers came via state data and are a nearly ninefold jump from figures five years earlier, though the newspaper reported that they only covered the first half of 2023 and were likely an undercount, as fears around prosecution have risen in the wake of the ban.
In December, the Houston Landing chronicled the arduous, cross-country journey some teens have made in order to end their pregnancies.
Why is this alarming?
Children and teens under the age of 17 cannot consent to sexual activity, per Texas law, but the state abortion ban makes no exceptions for rape or incest. Despite this, doctors have said that children see more complications in pregnancy than adult women, including serious and high-risk conditions that endanger both their lives and the lives of infants, as well as girls’ ability to conceive later in life.
Health Care Deserts
Texas has fewer OB-GYNs and maternity wards than it did prior to 2021, which limits people’s ability to access obstetric and prenatal care — important indicators in overall women and infant health metrics.
The Commonwealth Fund’s research shows nearly 7 million women in the U.S. live in counties without hospitals or birth centers. Texas is one of 24 states as of June 2024 to ban or limit abortion — 21 of those, including Texas, have the the “fewest number of maternity care providers relative to the number of women who might need them,” according to the Commonwealth’s research.
Texas is 51st for access to abortion clinics per 100,000 women aged 15 to 44.
Eight hospitals serving 26,000 miles.
According to reporting from the Texas Tribune, there were just eight hospitals in the 26,000 square mile Panhandle region as of June 2024. Amarillo, the largest city in the region with a population of 201,000, is a medical hub for the 26-county area — meaning residents in some counties must travel between 26 to 72 miles away for the closest hospital with delivery services.
According to the Texas Organization of Rural and Community Hospitals, 28 rural hospitals have closed since 2010, the most in the country. And of the 158 remaining, only 64 provide obstetrical and delivery services.
The Commonwealth Fund found that in 2023 and 2024, fewer medical school graduates applied to residency programs in states with abortion bans.
Doctors Are Fleeing
Of Texas OB-GYNs surveyed recently by a healthcare consulting firm:
- 44% indicated that they have thought about or have already changed how and/or where they practice as a direct result of the state’s new abortion restrictions.
- 13% are planning to retire early.
- 21% have thought about it or are planning to leave Texas to practice in another state.
- 14% would like to leave Texas to practice in another state but cannot due to personal reasons.
Of resident physicians surveyed, 57% said that Texas abortion laws were relevant to their decision about whether to stay or leave the state after residency; half indicated plans to leave the state in part due to the laws.
(Correction: A previous version of this story stated that, in 2022, Texas had a maternal mortality rate of 34.7% — in fact, Texas had a mortality rate of 34.7 per 100,000 in 2022. The Barbed Wire regrets the error.)