Series: Life of the Mother: How Abortion Bans Lead to Preventable Deaths

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Pregnancy became far more dangerous in Texas after the state banned abortion in 2021, ProPublica found in a first-of-its-kind data analysis.

The rate of sepsis shot up more than 50% for women hospitalized when they lost their pregnancies in the second trimester, ProPublica found.

The surge in this life-threatening condition, caused by infection, was most pronounced for patients whose fetus may still have had a heartbeat when they arrived at the hospital.

ProPublica previously reported on two such cases in which miscarrying women in Texas died of sepsis after doctors delayed evacuating their uteruses. Doing so would have been considered an abortion.

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The new reporting shows that, after the state banned abortion, dozens more pregnant and postpartum women died in Texas hospitals than had in pre-pandemic years, which ProPublica used as a baseline to avoid COVID-19-related distortions. As the maternal mortality rate dropped nationally, ProPublica found, it rose substantially in Texas.

ProPublica’s analysis is the most detailed look yet at a rise in life-threatening complications for women losing a pregnancy after Texas banned abortion. It raises concerns that the same pattern may be occurring in more than a dozen other states with similar bans.

To chart the scope of pregnancy-related infections, ProPublica purchased and analyzed seven years of Texas’ hospital discharge data.

“This is exactly what we predicted would happen and exactly what we were afraid would happen,” said Dr. Lorie Harper, a maternal-fetal medicine specialist in Austin.

She and a dozen other maternal health experts who reviewed ProPublica’s findings say they add to the evidence that the state’s abortion ban is leading to dangerous delays in care. Texas law threatens up to 99 years in prison for providing an abortion. Though the ban includes an exception for a “medical emergency,” the definition of what constitutes an emergency has been subject to confusion and debate.

Many said the ban is the only explanation they could see for the sudden jump in sepsis cases.

"This is exactly what we predicted would happen and exactly what we were afraid would happen."

The new analysis comes as Texas legislators consider amending the abortion ban in the wake of ProPublica’s previous reporting, and as doctors, federal lawmakers and the state’s largest newspaper have urged Texas officials to review pregnancy-related deaths from the first full years after the ban was enacted; the state maternal mortality review committee has, thus far, opted not to examine the death data for 2022 and 2023.

The standard of care for miscarrying patients in the second trimester is to offer to empty the uterus, according to leading medical organizations, which can lower the risk of contracting an infection and developing sepsis. If a patient’s water breaks or her cervix opens, that risk rises with every passing hour.

Sepsis can lead to permanent kidney failure, brain damage and dangerous blood clotting. Nationally, it is one of the leading causes of deaths in hospitals.

While some Texas doctors have told ProPublica they regularly offer to empty the uterus in these cases, others say their hospitals don’t allow them to do so until the fetal heartbeat stops or they can document a life-threatening complication.

Last year, ProPublica reported on the repercussions of these kinds of delays.

Forced to wait 40 hours as her dying fetus pressed against her cervix, Josseli Barnica risked a dangerous infection. Doctors didn’t induce labor until her fetus no longer had a heartbeat.

Physicians waited, too, as Nevaeh Crain’s organs failed. Before rushing the pregnant teenager to the operating room, they ran an extra test to confirm her fetus had expired.

Both women had hoped to carry their pregnancies to term, both suffered miscarriages and both died.

In response to their stories, 111 doctors wrote a letter to the Legislature saying the abortion ban kept them from providing lifesaving care and demanding a change.

“It’s black and white in the law, but it’s very vague when you’re in the........

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