Well, this is horrifying: In Texas, ever since the state’s civilly enforced six-week abortion ban took effect in September 2021, the rate of sepsis among people who were hospitalized while losing a pregnancy in the second trimester surged by more than 50%., according to a new ProPublica report published Thursday.
Sepsis is a leading cause of death in hospitals across the U.S., and people with nonviable pregnancies face a higher risk of sepsis the longer fetal tissue remains in their uterus. The life-threatening condition can lead to permanent kidney failure, brain damage, dangerous blood clotting, infertility, and death. Texas’ six-week ban was followed by a total abortion ban threatening doctors with life in prison, which took effect after Dobbs v. Jackson Women’s Health in June 2022. The state’s abortion laws offer a narrow exception for threats to the pregnant person’s life, but doctors say it’s unclear when they can actually act—and, given how rapidly a pregnant person’s health can deteriorate amid complications, sometimes, it’s too late.
The outlet also found that, since Texas banned abortion, dozens more pregnant and postpartum people died in hospitals than before the bans. During that same period, the national maternal mortality rate fell by 7.5% from 2019 to 2023—but in Texas, it rose by 33%.
ProPublica obtained a trove of Texas hospital discharge data related to pregnancy from 2017 to 2023, the most recent full year available, and then analyzed this data with the help of over a dozen maternal health researchers and obstetricians. In 2021, 67 patients who lost a pregnancy in the second trimester were diagnosed with sepsis; in 2022, it was 90 patients; and in 2023, that number climbed to 99. ProPublica further referenced a study by the University of Texas Health Science Center in Houston that hasn’t yet been published, which similarly found the rate of sepsis tripled in Texas after abortion was banned.
The outlet also notes that Texas maternal deaths peaked amid the covid pandemic in 2020, so reporters compared maternal mortality data from 2018 and 2019 with data from 2022 and 2023. In the two earlier years, ProPublica tracked 79 maternal hospital deaths; in the more recent years, there were 120. In September, the Gender Equity Policy Institute reported that maternal deaths in Texas increased by 56% from 2019 to 2022, compared to an 11% increase nationwide during the same time period. The organization’s president attributed this sharp spike directly to Texas’ 2021 abortion ban.
The ProPublica reporters stressed that their “analysis was conservative and likely missed some cases.” For example, their reporting doesn’t include patients experiencing miscarriage who were turned away from emergency rooms or forced to wait for emergency abortions for extended periods of time. In one such case, which ProPublica reported last fall, Texas woman Josseli Barnica died in 2021 after a hospital made her wait 40 hours before treating her, since her nonviable fetus still had a heartbeat. The outlet also reported on the death of 18-year-old Nevaeh Crain, whose organs failed as she waited to receive an emergency abortion for her nonviable pregnancy. Both women contracted sepsis.
Dr. Lorie Harper, a maternal-fetal medicine specialist based in Texas, told ProPublica that “this is exactly what we predicted would happen and exactly what we were afraid would happen” under abortion bans. And Texas is just one state: ProPublica and the maternal health experts the outlet spoke to expressed concern that this is happening in all states where abortion is banned.
In May, the Texas Supreme Court unanimously rejected a landmark lawsuit filed by nearly two dozen women who say the state’s abortion ban endangered their lives due to the ambiguity of its medical emergency exception. The court refused to offer clarification on when hospitals can intervene to provide emergency abortion care to patients experiencing complications. Last January, a federal judge also sided with Texas in its lawsuit against the Biden administration, challenging a guidance from the former president directing hospitals to adhere to federal laws that require hospitals to provide emergency, stabilizing care—including abortion care.
Yet, as the state’s maternal health crisis worsens and preventable deaths surge, the state’s maternal mortality committee announced in November that they will not be analyzing or publishing data from 2022 and 2023, which are obviously the first years after the state’s total abortion ban. This comes as other states with abortion bans have also sabotaged or censored their maternal mortality committees. Georgia dismissed its entire maternal review committee after ProPublica published reports on two maternal deaths directly caused by the state’s abortion ban and in 2023, Idaho allowed its maternal mortality review committee legislation to expire, effectively disbanding the committee. Following public outrage, the state reestablished the committee last year, but only appointed members to fill it in November, causing a severe delay in when data will become publicly available.
Dr. Jonas Swartz, an assistant professor of obstetrics and gynecology at Duke University, told ProPublica that Texas is doing “a disservice to the 120 individuals” who died in Texas hospitals in 2023 from pregnancy-related complications, by neglecting to review the circumstances of their maternal deaths. “And that is an underestimation of the number of people who died.”
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