Are Pro-life Laws Harming Women and Children? An Examination of Claims Against Texas
This is Issue 8 of the On Women’s Health Series.
Introduction
Texas, the second largest U.S. state in both area and population, is often the subject of interest and criticism.[1],[2] Notably, the Texas Heartbeat Act was the first strong protection of unborn life (implemented September 1, 2021) allowed while Roe v. Wade was in effect,[3] and an even stronger protection, the Texas Human Life Protection Act (implemented August 25, 2022), was enforced following the overturn of Roe.[4] Much media attention has been focused on potential adverse events these laws might cause.
Yet even before these protections were enacted, Texas was criticized over minor limits implemented under Roe, which encompassed regulations such as facility and provider standards, restrictions after viability, mandatory waiting periods and ultrasounds, informed consent requirements, and parental consent for minors.[5]
Immediately after Texas enacted stronger gestational age limitations, pro-abortion media advocates began a campaign of accusations. In what follows, the most notable of these objections will be addressed.[6]
False Claim #1: Texas’ pro-life protections will cause an increase in deaths of pregnant women from self-managed abortion
Drug-induced abortion, especially without medical supervision, is dangerous and comes with substantial risks.[7] Pro-abortion researchers published two articles in the Journal of the American Medical Association in 2022, warning about increased requests for drug-induced Self-Managed Abortion (SMA) in both Texas and other pro-life states in the wake of the Texas Heartbeat Law’s implementation and the Dobbs decision.[8] Articles published prior to these limitations estimated that 1.7% of Texas women ages 15-49[9] and 7% of all U.S. women have attempted to self-manage an abortion.[10]
Arguably, however, any increase in dangerous self-managed abortions or deaths related to SMA has less to do with pro-life protections themselves and more to do with (1) the abortion industry and even professional medical organizations’ promotion of SMA with mifepristone and misoprostol without medical supervision,[11] and (2) the misinformation about pro-life laws spread by the media and pro-abortion advocates, which may lead some women to avoid the medical care they need when suffering complications after turning to SMA.
Other deceptive tactics have been employed in the effort to create fear, such as falsely implying that women will be prosecuted if they seek care for abortion complications,[12] which is dispelled by reviewing the language of pro-life state laws that exempt women from prosecution.[13] Another suggests that the government may begin to monitor women’s period tracking apps to document pregnancies and identify abortions.[14] After inciting these fears, some abortion advocates then tell women it is not necessary to report the preceding abortion if they should need to seek medical care for post-abortion complications.[15] Fears and confusion engendered by this misinformation arguably contributed to the death of Candi Miller in Georgia by causing her to delay seeking treatment.[16]
False Claim #2: Texas’ pro-life protections will not allow physicians to intervene in pregnancy emergencies
Post-Dobbs, many pro-abortion media sources and medical organizations have implied exceptions in pro-life laws are too confusing for doctors to understand and will not allow quality treatment for medical emergencies.[17] Recent examples from ProPublica describe the truly heartbreaking deaths of three Texas women which they attempted to blame on Texas’ law.
Nevaeh Crain, an 18-year-old woman, died after receiving substandard medical care when she presented to two Texas hospitals suffering an obstetric emergency in 2023. She was discharged from the first hospital without an obstetric evaluation, despite complaining of abdominal pain at six months’ gestation, a gestational age when her child could have survived delivery. She was discharged from a second hospital despite showing signs of sepsis. When she presented again to the second hospital, she was severely ill, and she and her unborn child died within hours.[18],[19]
Another ProPublica article highlighted the similarly tragic and preventable death of Josseli Barnica in 2021, who presented to a Houston area hospital with an inevitable and incomplete miscarriage at 17 weeks’ gestation. Her physicians failed to intervene for over 40 hours, waiting until her child died before inducing her labor. She returned a few days later suffering from hemorrhage and sepsis and died shortly after readmission.[20]
Finally, ProPublica highlighted the death of 35-year-old Porsha Ngumezi in 2023, also following complications of a miscarriage at 11 weeks’ gestation. Despite heavy bleeding requiring blood transfusions, her physician did not perform a D&C, the minor surgical procedure that would have most quickly ended her obstetric emergency, but instead gave her misoprostol. She was moved to a room with less nursing supervision, despite complaining of chest pain, where she subsequently died.[21]
The reality is that every state with pro-life protections, including Texas, allows physicians to provide any intervention believed necessary to protect the life of a mother in a pregnancy emergency.[22] Josseli’s inevitable miscarriage could have been completed with D&C or induction and Nevaeh’s child could have been delivered by induction or cesarean section, if these women’s physicians recognized that their emergencies could lead to their deaths. Porsha could have received a D&C since her child had already died, an exception to the law. Yet, media misinformation such as these ProPublica articles have resulted in unnecessary confusion and fear, which may lead some physicians to fail to intervene in emergencies. So, what does Texas law say?
The Texas Human Life Protection Act (HLPA) states that a “person may not knowingly perform, induce, or attempt an abortion,” but states an exception is allowed if a medical emergency is present: “[if] in the exercise of reasonable medical judgment, the pregnant female … has a life-threatening physical condition aggravated by, caused by, or arising from a pregnancy that places the female at risk of death or poses a serious risk of substantial impairment of a major bodily function unless the abortion is performed or induced” (emphases added).[23]
Nowhere in this law is a requirement that the threat be imminent, nor that a doctor be certain that the complication will cause her death, or even that a consensus of physicians exist, critical facts that the Texas Supreme Court affirmed in December 2023.[24] The Texas Medical Board also reiterated the point about imminence in guidance provided to physicians in July 2024.[25] When an obstetrician diagnoses a complication that can lead to severe illness or death, he does not know for sure if a woman will die, or how quickly her condition may worsen, but he is given deference by Texas law to use his clinical judgment to determine if intervention, including abortion, is indicated. He can document that his medical judgment is reasonable by referencing the obstetric literature and recommendations from professional societies, such as the American College of Obstetricians and Gynecologists (ACOG) or the Society for Maternal Fetal Medicine (SMFM).
It should be noted that similar wording regarding medical emergencies could be found in the earlier Texas Heartbeat Act, which states that the prohibitions “do not apply if a physician believes a medical emergency exists,”[26] and in HB 2 (a 20-week pain-capable limit), implemented in 2013, which “does not apply to abortions that are necessary to avert the death or substantial and irreversible physical impairment of a major bodily function of the pregnant woman.”[27] In fact, a 1925 Texas law prohibiting abortion similarly states, “Nothing in this chapter applies to an abortion procured or attempted by medical advice for the purpose of saving the life of the mother.”[28] Moreover, the federal Hyde Amendment prohibits federal Medicaid payment for elective abortions but allows payment for abortions performed for the “life of the mother,” and this requirement has been followed largely since the 1970s.[29] For nearly 100 years, doctors have known when to intervene under abortion laws in cases of medical emergency. Why, then, the sudden confusion?
Additionally, the Texas Human Life Protection Act defines abortion as “the act of using or prescribing an instrument, a drug, a medicine, or any other substance, device, or means with the intent to cause the death of an unborn child of a woman known to be pregnant. The term does not include birth control devices or oral contraceptives” (emphasis added). The term “abortion” in Texas law does not apply when these acts are done to “(A) save the life or preserve the health of an unborn child; (B) remove a dead, unborn child whose death was caused by spontaneous abortion [miscarriage]; or (C) remove an ectopic pregnancy” (emphases added).[30]
In light of the plain text of all of these statutes, is this physician fear warranted? As legal scholars Maura Quinlan and Paul Linton document through an extensive review of Texas and other U.S. courts’ decisions, not a single physician has been prosecuted for performing an abortion that fell within the scope of the “life of the mother” exception in the years since the overturn of Roe. In fact, exceptions allowing abortion to prevent a mother’s death have existed in the law of every state for over a century, and during that time, only two physicians were prosecuted for performing abortions in cases where there was purported evidence for their being performed due to a threat to the mother’s life (one occurred 60 and the other more than 100 years ago), and both were overturned on appeal.[31]
Texas state data documents that many physicians do understand the law and have performed abortions on the rare occasions they are required to prevent a mother’s death since the HLPA began to be enforced in August 2022.[32] From August 2022 to the latest reported data (September 2024), 134 abortions were reported to protect the life of the mother and preserve her physical health. All were performed in hospitals. Categorized by gestational age (based on last menstrual period – “LMP”), 16 were performed in the first trimester (12 weeks or earlier), 109 were performed in the second trimester before fetal viability (13 to 20 weeks), and six were performed in the second trimester after potential fetal viability (21 weeks and after). By procedure, 16 were performed by D&C (dilation & suction or sharp curettage), only 13 (10%) were performed by D&E (dilation & evacuation), and 96 were performed using medications. Drug-induced abortion is FDA-approved before 10 weeks of gestation with mifepristone and misoprostol, but can also be done with various protocols using mife/miso, misoprostol alone, and sometimes other prostaglandins or Pitocin if the abortion is provided later in pregnancy. The state did not provide information on the regimen used, or the diagnosis, but since most of these abortions were provided in the second trimester, it is likely that they occurred due to previable rupture of membranes. Nine of the abortions were performed via other procedures (including hysterotomy/hysterectomy).
False Claim #3: Texas’ pro-life protections will cause overall maternal mortality to worsen
While it is sometimes assumed that maternal mortality refers only to deaths in childbirth from catastrophic complications of labor, it should be noted the definition also includes deaths occurring during pregnancy or until a year after the end of pregnancy, caused or exacerbated by the pregnancy or its complications.[33] Only about one quarter of maternal deaths occur on the day or within a week of delivery, and the medical industry is getting much better at preventing those deaths due to increased focus on training and protocols addressing emergencies. Approximately half of maternal mortality occurs beyond one week to a year after the end of the pregnancy, often caused by substance abuse or mental health disorders (suicide, homicide, drug overdoses and accidents) and deaths from cardiac or other chronic illnesses, as American women are often unhealthy or of advanced maternal age when they become pregnant.[34] Extensive data deficiencies, however, cause extreme difficulty in the detection of deaths related to early pregnancy events such as induced abortion, contributing to the unproven narrative that abortion is safer than childbirth (a narrative contradicted by better-quality data from other countries).[35] Abortion is associated with many risk factors for maternal mortality, and there are many reasons to suspect that limiting the abortion exposure of American women may improve, rather than worsen, maternal mortality.[36]
In 2022, the Commonwealth Fund released an issue brief, cited by pro-abortion journalists, arguing that maternal and infant death rates are higher in states with pro-life protections than in states without such protections, concluding that “[m]aking abortion illegal makes pregnancy and childbirth more dangerous.” The report compared maternal mortality ratios from 2018-2020 (before Dobbs, because CDC maternal mortality reports lag for several years) in the 26 states that had “Targeted Regulation of Abortion Providers” (TRAP) restrictions on abortion to the twenty-four states and the District of Columbia that had few or no restrictions. These pre-Dobbs restrictions were minimal, usually encompassing informed consent counseling or improved safety standards, so it’s implausible these laws would have a significant impact on maternal deaths. The authors reported that the states with restrictions cumulatively had maternal death rates 62% higher than those without restrictions. Although they acknowledged that many independent factors could contribute to this disparity, they then claimed that more restrictive abortion laws in the future may make these disparities worse.[37]
Another widely promoted report conducted by the Gender Equity Policy Institute alleged that Texas maternal mortality increased by 56% from 2019 to 2022, laying the blame on the Texas Heartbeat law.[38] However, maternal mortality rose dramatically in 2020 and 2021, prior to the Heartbeat Act, likely due to the Covid-19 pandemic.[39] Furthermore, maternal mortality dropped from 2021 to 2022, at the time when one would expect a rise if it was due to the law.[40]
Texas had been known to have high maternal mortality ratios long before Dobbs due to many risk factors unrelated to abortion access. Texas has higher poverty,[41] higher uninsured[42] and undocumented populations,[43] higher chronic illness,[44] and more rural “maternity care deserts” where obstetric care is not readily available,[45] compared to many other states. These factors are often interrelated and do contribute to maternal mortality, but none are related to abortion laws.
Fortunately, recently released data from the CDC documents dramatic improvement in U.S. maternal mortality in recent years, from 32.9/100,000 live births in 2021, to 22.3 in 2022 to 18.6 in 2023.[46] Although this data has not yet been broken down by state, it is encouraging to see that overall, the dire predictions about worsening maternal mortality in the U.S. have not been proven.
False Claim #4: Texas’ pro-life protections have or will cause increased mental health symptoms, possibly leading to suicides in reproductive-aged women
The American Medical Association (AMA)’s psychiatric journal published a peer-reviewed article claiming that “the enforcement of laws restricting access to abortion and reproductive care from 1974 to 2016 was associated with suicide rates among reproductive-aged women but not women of postreproductive age,” leading them to conclude that “[r]estrictions to reproductive care represent a macro-level risk factor for suicide among reproductive-aged women.”[47] Once again, due to the lack of mortality data since Dobbs, their study compared suicides in states enforcing at least one “TRAP” law to states without. They found a 5.81% higher suicide rate in reproductive-aged women living in the abortion-restrictive states and implied that even minimal regulations surrounding abortion could lead to suicidal behavior.
It stretches credibility to imply that so-called TRAP laws that may cause a slight delay in obtaining an abortion would cause a non-pregnant woman to resort to suicide. There certainly may be small spikes in anxiety among women in pro-life states because media disinformation may be stoking unnecessary fears about pro-life laws and maternal mortality, but these fears are not an effect of pro-life laws themselves, because understood correctly, abortion limits safeguard women. Numerous studies have documented improved mental health outcomes when women give birth to their children instead of choosing abortion.[48]
False Claim #5: Texas’ pro-life protections have or will cause increased rape-related pregnancies
A 2023 peer-reviewed article in the American Medical Association’s Internal Medicine journal claimed there were likely over 64,000 rape-related pregnancies (RRP) in 14 pro-life states since Dobbs, including 26,000 in Texas alone.[49] How were these shocking numbers generated? As Charlotte Lozier Institute (CLI) scholar Michael New has noted,[50] the authors made this calculation by estimating that there were 519,981 rape survivors in these states based on results of the National Intimate Partner and Sexual Violence Survey, a 2016/2017 telephone survey of 15,000 American women, extrapolating that 1.4 million women had been victims of rape in a twelve month period.[51] They reported this number uncritically despite it being four times higher than the number of rapes documented in the Department of Justice’s National Crime Victimization Survey[52] and over ten times higher than FBI data on the number of rapes reported to law enforcement.[53] Even in the setting of war, the incidence of RRP is 8%.[54] Healthy reproductive-aged women are only fertile for about six days of a reproductive cycle,[55] and approximately two-thirds of women use hormonal or surgical contraception, thus limiting the likely number of potential pregnancies further.[56] Emergency contraception is readily available over the counter or in emergency rooms,[57] so the true number of pregnancies that occur after rape is likely significantly lower.
False Claim #6: Texas’ pro-life protections have or will cause increased infant mortality
Recent articles from the American Medical Association’s Pediatrics journal reported that infant deaths have increased by 12.9% in Texas following the implementation of the Heartbeat Act[58] as well as increasing nationally, laying the blame on pro-life laws.[59] An accompanying editorial whose lead author is a prominent abortion advocate,[60] “Abortion Bans Harm Not Just Pregnant People—They Harm Newborns and Infants Too,” makes similar claims.[61]
Infant mortality, defined as death in the first year of birth, has been high in the U.S. for decades, with the U.S. consistently ranking near the bottom of developed countries. Although absolute numbers of infant deaths did increase in Texas, these deaths were somewhat offset by increases in births because over 16,000 more children were born in 2022 than 2021 following implementation of the Heartbeat Law.[62] The infant mortality rate in 2022 of 5.6 deaths per 1,000 live births was similar to the rates from 2012 to 2020 (prior to a rise related to the Covid-19 pandemic) and was only a minimal increase (7.7%) from 5.2 in 2021.[63] Additionally, the CDC reported more than half of the states (28) had higher infant mortality rates than Texas in 2022 and many of these are states which had minimal or no abortion restrictions. For example, from 2021 to 2022, Hawaii experienced a 24% increase and New Mexico a 23% increase.[64]
Much of the increase in Texas’ infant mortality can be attributed to more infants being born with life-limiting conditions who died from the severity of their illnesses after birth,[65] which account for about one in five infant deaths. Pro-life laws will not cause a baby to develop a genetic or congenital disorder but may protect him from being targeted by abortion after prenatal diagnosis. The CDC maintains statistics on infant mortality after birth but does not mandate reporting of mortality before birth caused by abortion, although a death occurs in both circumstances. Sadly, prior to the implementation of laws protecting these children, obstetricians often offered abortion as the only or preferred option to grieving families,[66] and many families report feeling pressured to abort.[67]
Killing babies with life-limiting fetal conditions before they have a chance to be born and counted in the statistics is hardly a compelling, or ethical, way to address the issue of prenatally diagnosed severe anomalies and infant mortality.[68]
False Claim #7: Texas pro-life protections have not saved unborn children’s lives
Sometimes, pro-abortion media will imply that no lives have been saved because all women who want an abortion will travel out of state to obtain the procedure or will order abortion pills online.[69] Certainly, pro-abortion states have held themselves out as destinations for women from pro-life states, and so-called “shield laws”[70] aim to protect abortionists from prosecution when abortion drugs are mailed into Texas. Overall abortions have been rising post-Dobbs in the United States, and especially in states without pro-life protections, demonstrating the need for federal protections to continue to make progress in protecting unborn American lives. Yet, there is no doubt that Texas law is protecting women from abortion and saving unborn lives.
The pro-abortion Texas Policy Evaluation Project documented that almost immediately, abortion numbers dropped by 50% with 2,164 abortions in September 2021 compared to 4,313 in September 2020.[71] Both Johns Hopkins-affiliated epidemiologists[72] and pro-life researchers[73] have documented more births after the Heartbeat Act was implemented, reaching similar conclusions. Bell et al state, “Although there was an increase in abortions provided to Texans out of state and requests for medication abortion pills obtained outside the formal health care system, results suggest not everyone who might have received an abortion in the absence of SB8 was able to obtain one.”[74] In 2022, the Texas birthrate rose even as births declined in other states, a change that researchers associated at least in part with the Heartbeat Act. Perhaps most compellingly, some Texas women have shared their own stories of how Texas law led them to keep their babies.[75]
False Claim #8: Texas pro-life protections are causing doctors to consider leaving the state, worsening maternity care deserts
A recent survey by Manatt Health found that Texas obstetricians are concerned about how the pro-life laws may impact their practice.[76] Sponsored by organizations such as Collaborative for Gender + Reproductive Equity and The Reproductive Rights and Justice Fund of Texas, this study surveyed 447 obstetricians in Texas,[77] reporting that 76% believed they cannot practice medicine according to best practices, 60% fear legal repercussions for practicing according to evidence-based medicine, and 44% have thought about or have already changed how or where they practice as a direct result of the state’s new abortion restrictions. About one-fifth of ob/gyn physicians and resident physicians indicated they thought about or planned to leave the state at least in part due to the abortion laws.[78] Similarly, the Commonwealth Fund, in their 2024 State Scorecard on Women’s Health and Reproductive Care, expressed concern that Texas and other states with abortion restrictions tend to have the fewest number of maternity care providers, leading to “maternity care deserts,” counties with few or no obstetric providers or labor and delivery units, implying this was likely to worsen.[79]
A close look at the data reassures those with concerns that pro-life laws will discourage doctors from studying, training, or practicing in these states. Enrollment in allopathic (MD-granting) medical schools rose nearly 7% in pro-life states over the past four years, and enrollment in osteopathic (DO-granting) medical schools rose even higher.[80] In the past five years, 13 new ob/gyn residency programs have been accredited in pro-life states. In 2023, 86.8% of total residency applicants applied in pro-life states, and virtually all residency slots were filled. Obstetrics & gynecology remains a competitive specialty, with 2,143 applicants for 1,539 available positions. While maternity care deserts are a long-standing and serious problem, there is no evidence that the problem is worsening due to pro-life laws. Hospital labor and delivery closures are usually due to financial problems and lack of deliveries, problems that more babies being born may improve, not worsen.[81] As noted earlier, physician education to help them understand and not fear the laws should provide reassurance and encourage doctors to remain in their current practice.
Truth: Pro-Life Safety Net Alternatives to Abortion exist to help women
The attacks against Texas have not been limited to the ways that abortion limits might harm pregnant women and their families. Some imply that the resulting harm is the point of pro-life laws. An author for the Texas Observer writes, “This country hates women; Texas hates women; and Republicans have made it perfectly clear that they don’t care if we die. They don’t care if we die at the hands of abusers or from poverty or from poor healthcare, and certainly not from dangerous pregnancies, childbirth, and unsafe abortions. In fact, they want women to die from unsafe abortions to build a culture of fear around abortion. They need women to die to further their agenda. We aren’t simply collateral damage—we are the target” (emphases added).[82]
Yet, a closer look beyond the hyperbole and drama demonstrates that Texas legislators did not stop after limiting abortion, considering their job done. For decades, they have advanced legislation and funding with the intent of supporting women who face crisis pregnancies. In fact, this dedication to providing care is not unique to Texas, as 18 states authorized some form of alternatives to abortion funding to support life-affirming pregnancy help organizations in 2023.[83]
Texas’ Alternatives to Abortion (A2A) Program, renamed “Thriving Texas Families,” is a “statewide support network that promotes healthy pregnancy and childbirth,” child development, and family formation as an alternative to abortion.[84] The program was created with an allocation of $2.5 million in the 2005 budget, and in the first year of operation, it provided 22,522 services to almost 4,000 clients.[85] Over time, the legislature expanded the program, so that by 2023 the program served 125,416 clients who received 2,215,152 services and 203,123 referrals to government assistance programs.[86] In 2023, Texas awarded $62 million to four large service providers, who then awarded subcontracts to individual organizations, providing services at 190 physical locations, two virtual clinics, and 12 mobile units.[87]
The original program and its continuation were and are committed to promoting childbirth and adoption over abortion, and providing pregnant women and families with the support they need. Services provided to women and their families include material items (car seats, diapers, formula, maternity clothes), pregnancy confirmation, sexually transmitted infection testing, ultrasound, prenatal care, housing, nutritional support, counseling, adoption support, parenting classes, mentorship programs, childcare assistance, education, and job training. In addition to these direct services, referrals are also made for governmental social support services such as financial assistance, healthcare, food benefits, and housing.[88]
Conclusion
Texas’ pro-life laws have been unfairly mischaracterized and maligned. Pro-abortion motivations have prompted allegations which have been proven false or imply outcomes which cannot yet be determined. When the evidence is closely examined, it is too soon to tell how exactly Texas abortion limits will impact maternal mortality, but it seems plausible that rather than worsening these problems, there will be improvements in the future. Fearmongering and misrepresentation surrounding pro-life laws are unlikely to impact the physician workforce if Texas medical organizations take care to make sure physicians understand how the laws should be interpreted in their practice, ensuring that Texas physicians continue to provide quality medical care as allowed by state laws.
Ingrid Skop, M.D., F.A.C.O.G., is Vice President and Director of Medical Affairs for the Charlotte Lozier Institute.
[1] US Census Bureau, “State Population Totals and Components of Change: 2020-2024,” Census.gov, accessed January 27, 2025, https://www.census.gov/data/tables/time-series/demo/popest/2020s-state-total.html.
[2] “All States within United States, … – Census Bureau Search – Profiles,” United States Census Bureau, accessed January 27, 2025, https://data.census.gov/all/profiles?q=All%20States%20within%20United%20States,%20Puerto%20Rico,%20and%20the%20Island%20Areas%20South%20American%20Indian&g=010XX00US.
[3] Texas Heartbeat Act, “SB 8.” 2021, https://capitol.texas.gov/tlodocs/87R/billtext/html/SB00008F.htm.
[4] Texas Human Life Protection Act, Sec. 170A. 002, 2021, https://statutes.capitol.texas.gov/Docs/HS/htm/HS.170A.htm#170A.002.
[5] “State Laws and Policies: Targeted Regulation of Abortion Providers,” Guttmacher Institute, August 31, 2023, https://www.guttmacher.org/state-policy/explore/targeted-regulation-abortion-providers; Texas Policy Evaluation Project, https://sites.utexas.edu/txpep/; “About,” Resound Research for Reproductive Health, https://resoundrh.org/about/.
[6] Texas is an important bellwether state in analyzing health outcomes of women and infants because approximately 10% (350,000) of all deliveries in the United States occur in Texas each year. See: Texas Health Data: Live Births, https://healthdata.dshs.texas.gov/dashboard/births-and-deaths/live-births.
[7] Charlotte Lozier Institute, “Fact Sheet: Risks and Complications of Chemical Abortion,” Charlotte Lozier Institute, August 23, 2023, https://lozierinstitute.org/fact-sheet-risks-and-complications-of-chemical-abortion/.
[8] Abigail Aiken, Jennifer Starling, James Scott, et al, “Association of Texas Senate Bill 8 with Requests for Self-managed Medication Abortion,” JAMA Netw Open. 5, no. 2 (2022): e221122. doi:10.1001/jamanetworkopen.2022.1122, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2789428; Abigail Aiken, Jennifer Starling, James Scott, et al, “Requests for Self-managed Medication Abortion Provided Using Online Telemedicine in 30 US States Before and After the Dobbs v Jackson Women’s Health Organization Decision,” JAMA. 328, no. 17 (2022): 1768-1770. doi:10.1001/jama.2022.18865, https://jamanetwork.com/journals/jama/fullarticle/2797883.
[9] Liza Fuentes, Sarah Baum, Brianna Keefe-Oates, et al. “Texas Women’s Decisions and Experiences Regarding Self-managed Abortion.” BMC Women’s Health 20, 6 (2020). https://doi.org/10.1186/s12905-019-0877-0, https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-019-0877-0.
[10] Lauren Ralph, Diana Foster, Sarah Raifman, et al. “Prevalence of Self-Managed Abortion Among Women of Reproductive Age in the United States,” JAMA Network Open. 3 no. 12 (2020):e2029245. doi:10.1001/jamanetworkopen.2020.29245.
[11] Nisha Verma, Vinita Goyal, Daniel Grossman, Jamila Perrit, Grace Shih, “Society of Family Planning Interim Clinical Recommendations: Self-managed Abortion,” https://societyfp.org/wp-content/uploads/2022/06/SFP-Interim-Recommendation-Self-managed-abortion-09.08.22.pdf.
[12] The Texas Tribune. Eleanor Klibanoff. Lawyers preparing for abortion prosecutions warn about health care, data privacy. July 25, 2022. https://www.texastribune.org/2022/07/25/abortion-prosecution-data-health-care/.
[13]Amanda Mansfield, “Pro-Life Laws Exempt Women from Prosecution: An Analysis of Abortion Statutes in 27 States,” Charlotte Lozier Institute, January 10, 2024, https://lozierinstitute.org/pro-life-laws-exempt-women-from-prosecution-an-analysis-of-abortion-statutes-in-27-states/.
[14]Rina Torchinsky, “How Period Tracking Apps and Data Privacy Fit into a Post-Roe v. Wade Climate,” NPR, June 24, 2022. https://www.npr.org/2022/05/10/1097482967/roe-v-wade-supreme-court-abortion-period-apps.
[15] “Will Medical Staff be Able to Notice That I am Having an Abortion?”, Safe2Choose, https://safe2choose.org/faq/medical-abortion-faq/during-abortion-with-pills/will-medical-staff-be-able-to-notice-that-i-am-having-an-abortion.
[16] Kavitha Surana, “Afraid to Seek Care Amid Georgia’s Abortion Ban, She Stayed at Home and Died,” ProPublica, September 18, 2024, https://www.propublica.org/article/candi-miller-abortion-ban-death-georgia.
[17] American College of Obstetricians & Gynecologists (ACOG): “Abortion Bans Are to Blame, Not Doctors,” October 3, 2024. https://www.acog.org/news/news-releases/2024/10/acog-abortion-bans-are-to-blame-not-doctors.
[18] Sydney Ferguson, “Family Alleges Medical Negligence in Death of Vidor Teen and her Unborn Child.” Fox4Beaumont. November 5, 2024. https://fox4beaumont.com/news/family-alleges-medical-negligence-in-death-of-vidor-teen-and-her-unborn-child.
[19]Lizzie Presser and Kavitha Surana. “A Pregnant Teenager Died After Trying to Get Care in Three Visits to Texas Emergency Rooms,” ProPublica, November 1, 2024, https://www.propublica.org/article/nevaeh-crain-death-texas-abortion-ban-emtala.
[20] Cassandra Jaramillo and Kavith Surana, “A Texas Woman Died After the Hospital Said It Would be a ‘Crime’ to Intervene in Her Miscarriage,” ProPublica. October 30, 2024. Available at https://www.propublica.org/article/josseli-barnica-death-miscarriage-texas-abortion-ban.
[21] Lizzie Presser and Kavitha Surana, “A Third Woman Died Under Texas’ Abortion Ban. Doctors Are Avoiding D&Cs and Reaching for Riskier Miscarriage Treatments,” ProPublica. November 25, 2024. https://www.propublica.org/article/porsha-ngumezi-miscarriage-death-texas-abortion-ban.
[22] Mary Harned and Ingrid Skop. “Pro-life laws protect mom and baby: Pregnant women’s lives are protected in all states.” Charlotte Lozier Institute, September 11, 2023, https://lozierinstitute.org/pro-life-laws-protect-mom-and-baby-pregnant-womens-lives-are-protected-in-all-states/; Ingrid Skop. “Abortion policy allows physicians to intervene to protect a mother’s life.” Charlotte Lozier Institute, May 16, 2023. https://lozierinstitute.org/abortion-policy-allows-physicians-to-intervene-to-protect-a-mothers-life/; and Tessa Cox, Ingrid Skop, Mary Harned. “Fact Sheet: Are Pro-Life State Laws Preventing Pregnant Women from Receiving Emergency Care?” Charlotte Lozier Institute, September 13, 2024. https://lozierinstitute.org/fact-sheet-are-pro-life-state-laws-preventing-pregnant-women-from-receiving-emergency-care/.
[23] Human Life Protection Act, Sec. 170A. 002, 2021, https://statutes.capitol.texas.gov/Docs/HS/htm/HS.170A.htm#170A.002.
[24] In re State, 682 S.W.3d 890, 894 (Tex. 2023), available at: https://casetext.com/case/in-re-state-322203.
[25] Texas Medical Board rules, June 2024, https://www.tmb.state.tx.us/dl/81E2D29C-4DB3-F8B0-5F79-DB6EFA8E1799.
[26] “SB 8.” 2021, https://capitol.texas.gov/tlodocs/87R/billtext/html/SB00008F.htm.
[27] “HB 2,” 2013, https://capitol.texas.gov/tlodocs/832/billtext/html/HB00002F.htm.
[28] “1925 Penal Code of the State of Texas,” https://www.sll.texas.gov/assets/pdf/historical-statutes/1925/1925-3-penal-code-of-the-state-of-texas.pdf#page=278.
[29] S. 142, “Hyde Amendment Codification Act,” 2013. https://www.congress.gov/113/bills/s142/BILLS-113s142is.pdf; See also Michael New, “Hyde @ 40: Analyzing the Impact of the Hyde Amendment with July 2020 and June 2023 Addenda,” Charlotte Lozier Institute, On Point 95, June 27, 2023. https://lozierinstitute.org/hyde-40-analyzing-the-impact-of-the-hyde-amendment-with-july-2020-and-june-2023-addenda/.
[30] The definition of an abortion according to the Texas “Human Life Protection Act” can be found in Title 4 Section 245.002 of the Texas Health and Safety Code at: https://statutes.capitol.texas.gov/Docs/HS/htm/HS.245.htm#245.002.
[31] Maura Quinlan and Paul Linton, “Medically Necessary Abortions After Dobbs: What, if Anything, Has Changed?”, 39 Notre Dame J. L., Ethics & Pub. Pol’y, https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4909792.
[32] ITOP Statistics: Induced Terminations of Pregnancy. Texas Health and Human Services. https://www.hhs.texas.gov/about/records-statistics/data-statistics/itop-statistics. (Gestational ages have been converted from “weeks post-fertilization” as reported by the state to “weeks post-last menstrual period (LMP),” which is the standard way gestational age is reported in the obstetric literature.
[33] Ingrid Skop, “Handbook of Maternal Mortality: Addressing the U.S. Maternal Mortality Crisis, Looking Beyond Ideology,” Charlotte Lozier Institute, January 6, 2023, https://lozierinstitute.org/handbook-of-maternal-mortality-addressing-the-u-s-maternal-mortality-crisis-looking-beyond-ideology/.
[34]“Pregnancy-Related Deaths: Data From Maternal Mortality Review Committees in 36 U.S. States, 2017–2019.” Centers for Disease Control and Prevention, US Department of Health and Human Services. May 28, 2024. https://www.cdc.gov/maternal-mortality/php/data-research/mmrc-2017-2019.html.
[35] Ingrid Skop, “Fact Check: ‘Abortion is 14 Times Safer than Childbirth’,” Charlotte Lozier Institute, April 25, 2024, https://lozierinstitute.org/fact-check-abortion-is-14-times-safer-than-childbirth/.
[36] Ingrid Skop, “Twelve reasons women’s health and maternal mortality will not worsen, and may improve, in states with abortion limits.” Charlotte Lozier Institute, September 22, 2023, https://lozierinstitute.org/twelve-reasons-womens-health-and-maternal-mortality-will-not-worsen-and-may-improve-in-states-with-abortion-limitations/.
[37] Eugene Declercq et al., “The U.S. Maternal Health Divide: The Limited Maternal Health Services and Worse Outcomes of States Proposing New Abortion Restrictions.” The Commonwealth Fund, https://www.commonwealthfund.org/publications/issue-briefs/2022/dec/us-maternal-health-divide-limited-services-worse-outcomes.
[38] Erika Edwards, Zinhle Essamuah, Jason Kane, “A Dramatic Rise in Pregnant Women Dying in Texas After Abortion Ban,” NBC News, September 20, 2024.
[39] TX MMMRC DSHS Joint Biennial Report 2022. https://www.dshs.texas.gov/sites/default/files/legislative/2022-Reports/2022-MMMRC-DSHS-Joint-Biennial-Report.pdf.
[40] “Texas Health Data: Maternal Health,” Texas Department of State Health Services. Accessed February 11, 2025. https://healthdata.dshs.texas.gov/dashboard/maternal-and-child-health/maternal-health/maternal-health.
[41] Steven Ross Johnson, “The 10 States With the Highest Poverty Rates: 10. Texas,” US News & World Report, May 7, 2024, https://www.usnews.com/news/best-states/slideshows/us-states-with-the-highest-poverty-rates.
[42] Texas Medical Association, “The Uninsured in Texas,” https://www.texmed.org/uninsured_in_texas/.
[43] Migration Policy Institute, “Profile of the Unauthorized Population: Texas,” https://www.migrationpolicy.org/data/unauthorized-immigrant-population/state/tx.
[44] “Texas Health Data: Chronic Disease,” Texas Department of State Health Services, https://healthdata.dshs.texas.gov/dashboard/surveys-and-profiles/health-facts-profiles/chronic-disease.
[45]“Maternity Care Deserts,” March of Dimes PeriStats,https://www.marchofdimes.org/peristats/data?top=23&lev=1&stop=641®=99&sreg=48&obj=9&slev=4.
[46] Hoyert DL. Maternal mortality rates in the United States, 2023. NCHS Health E-Stats. 2025.
DOI: https://dx.doi.org/10.15620/cdc/174577.
[47] Jonathan Zandberg, Rebecca Waller, Elina Visoki, et al. “Association Between State-Level Access to Reproductive Care and Suicide Rates Among Women of Reproductive Age in the United States,” JAMA Psychiatry. 80, no. 2 (2023): 127-134. doi:10.1001/jamapsychiatry.2022.4394, https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2799597.
[48] Priscilla Coleman, “Abortion and Mental Health: Quantitative Synthesis and Analysis of Research Published 1995-2009,” Br J Psychiatry, 199, no. 3 (2011): 180-186; David Reardon, “The Abortion and Mental Health Controversy: A Comprehensive Literature Review of Common Ground Agreements, Disagreements, Actionable Recommendations, and Research Opportunities,” SAGE Open Medicine, 29, no. 6 (2018): 2050312118807624, https://doi.org/10.1177/2050312118807624; “Fact Sheet: Abortion and Mental Health.” Charlotte Lozier Institute. September 13, 2023. https://lozierinstitute.org/fact-sheet-abortion-and-mental-health/.
[49] Dickman S, White K, Himmelstein DU et al. “Rape-Related Pregnancies in the 14 US States with Total Abortion Bans.” JAMA Intern Med. 2024;184, no. 3 (2024): 330-332, doi:10.1001/jamainternmed.2024.0014, https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2814274.
[50] Michael New. “No, 64,000 Children Have Not Been Conceived in Rape in States with Pro-Life Laws,” National Review, January 25, 2024. https://www.nationalreview.com/corner/no-64000-children-have-not-been-conceived-in-rape-in-states-with-pro-life-laws/.
[51] “The National Intimate Partner and Sexual Violence Survey: 2016/2017 Report on Sexual Violence,” https://stacks.cdc.gov/view/cdc/124646 ; Denise D’Angelo, Yang Liu, Kathleen Basile, et al. “Rape and Sexual Coercion Related Pregnancy in the United States.” Am J Prev Med. 2023 Nov 5:S0749-3797(23)00442-7. doi: 10.1016/j.amepre.2023.11.001.
[52] Rachel Morgan, Jennifer Truman, “Criminal Victimization, 2017,” December 2018. https://bjs.ojp.gov/content/pub/pdf/cv17.pdf.
[53] “2017 Crime in the United States,” Federal Bureau of Investigation: Uniform Crime Reporting. https://ucr.fbi.gov/crime-in-the-u.s/2017/crime-in-the-u.s.-2017/topic-pages/rape.
[54]Ndziessi Gilbert, Bintsene Gickelle, Aloumba Axel, Bileckot Richard. “Rape and Medical Consequences among Girls and Women Victims during the Post-Armed Conflict Context in Congo.” Open Journal of Epidemiology. 9, no. 1 (2019): 1-10, https://www.scirp.org/journal/paperinformation?paperid=90616.
[55] Wilcox AJ, Dunson D, Baird DD. “The Timing of the ‘Fertile Window’ in the Menstrual Cycle: Day Specific Estimates From a Prospective Study.” BMJ 2000 Nov 18;321(7271):1259–1262, https://pmc.ncbi.nlm.nih.gov/articles/PMC27529/.
[56] Kimberly Daniels, Joyce Abma, “Current Contraceptive Status Among Women Aged 15–49: United States, 2017–2019.” NCHS Data Brief, no 388. Hyattsville, MD: National Center for Health Statistics. 2020. Available at https://www.cdc.gov/nchs/products/databriefs/db388.htm#:~:text=Summary-,In%202017%E2%80%932019%2C%20approximately%2065%25%20of%20women%20aged%2015,and%20non%2DHispanic%20black%20women.
[57] Guttmacher Institute. “Emergency Contraception,” September 1, 2023. https://www.guttmacher.org/state-policy/explore/emergency-contraception.
[58] Alison Gemmill, Claire Margerison, Elizabeth Stuart, Suzanne Bell, “Infant Deaths after Texas’ 2021 Ban on Abortion in Early Pregnancy,” JAMA Pediatrics, Published online June 24, 2024, https://jamanetwork.com/journals/jamapediatrics/article-abstract/2819785.
[59] Parvati Singh and Maria Gallo, “National Trends in Infant Mortality in the US After Dobbs,” JAMA Pediatrics Published online October 21, 2024, https://jamanetwork.com/journals/jamapediatrics/article-abstract/2825201.
[60] “Dr. Ghazaleh Moayedi is PRH’s New Board Chair,” Physicians for Reproductive Health, January 24, 2024. https://prh.org/press-releases/dr-ghazaleh-moayedi-board-chair/.
[61] Ghazaleh Moayedi, Aketch Osamba, Atsuko Koyama, “Abortion Bans Harm Not Just Pregnant People—They Harm Newborns and Infants Too,” JAMA Pediatrics, 178, no. 8 (2024): 748-750. https://jamanetwork.com/journals/jamapediatrics/article-abstract/2819789.
[62] “Texas & Harris County Reproductive Health Update: 2022 Fertility Rates, post 2021 Six-Week Abortion Ban,” The University of Houston Institute for Research on Women, Gender & Sexuality, Briefing 2401. January 2024. https://www.uh.edu/class/ws/irwgs/_docs/2024/56999-ws-abortion-ban-report-v5.pdf
[63] Texas Health Data: “Infant Mortality and Morbidity,” Texas Department of State Health Services. Accessed February 11, 2025. https://healthdata.dshs.texas.gov/dashboard/births-and-deaths/infant-mortality-and-morbidity.
[64] For 2021 data, see Ely DM, Driscoll AK. Infant mortality in the United States, 2021: Data from the period linked birth/infant death file. National Vital Statistics Reports; vol 72 no 11. Hyattsville, MD: National Center for Health Statistics. 2023. DOI: https://dx.doi.org/10.15620/cdc:131356. For 2022 data, see “Infant Mortality Rates by State,” National Center for Health Statistics, Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/pressroom/sosmap/infant_mortality_rates/infant_mortality.htm.
[65] Ingrid Skop, “Pro-Life Laws Aren’t to Blame for Increased Infant Mortality,” National Review, November 8, 2024, https://www.nationalreview.com/2024/11/pro-life-laws-arent-to-blame-for-increased-infant-mortality/.
[66] Dominic Wilkinson, Lachlan de Crespigny, Vicki Xafis, “Ethical Language and Decision-making for Prenatally Diagnosed Lethal Malformations,” Seminars in Fetal & Neonatal Medicine.19, no. 5 (2014): 306-311.
[67] Jennifer Guon, Benjamin Wilfond, Barbara Farlow, Tracy Brazg, Annie Janvier, “Our Children are not a Diagnosis: The Experience of Parents who Continue Their Pregnancy After a Prenatal Diagnosis of Trisomy 13 or 18,” Am J Med Genet 2013.
[68] Ingrid Skop. “Pro-Life Laws Aren’t to Blame for Increased Infant Mortality,” National Review, November 8, 2024, https://www.nationalreview.com/2024/11/pro-life-laws-arent-to-blame-for-increased-infant-mortality/.
[69] “#WeCount Report,” October 22, 2024, Society of Family Planning, DOI: 10.46621/728122kflzwf, https://societyfp.org/wp-content/uploads/2024/10/WeCount-Report-8-June-2024-data.pdf.
[70] See generally Mary E. Harned, “Abortion ‘Shield Laws’: Pro-Abortion States Seek to Force Abortion on Life-Affirming States,” Charlotte Lozier Institute, August 24, 2023. https://lozierinstitute.org/abortion-shield-laws-pro-abortion-states-seek-to-force-abortion-on-life-affirming-states/
[71] Kari White, Elsa Vizcarra, Lina Palomares, et al. “Initial Impacts of Texas’ Senate Bill 8 on Abortions in Texas and at Out-of-State Facilities,” Texas Policy Evaluation Project. October 2021. http://sites.utexas.edu/txpep/files/2021/11/TxPEP-brief-SB8-inital-impact.pdf.
[72] Suzanne Bell, Elizabeth Stuart, Allison Gemmill, “Texas’ 2021 Ban on Abortion in Early Pregnancy and Changes in Live Births,” JAMA. 330, no. 3 (2023): 281-282. doi:10.1001/jama.2023.12034, https://jamanetwork.com/journals/jama/fullarticle/2806878.
[73] Michael New, “A New JAMA Study Shows That the Texas Heartbeat Act Has Saved Thousands of Lives,” National Review, June 29, 2023. https://www.nationalreview.com/corner/a-new-jama-study-shows-that-the-texas-heartbeat-act-has-saved-thousands-of-lives/, Michael New, “The Lifesaving Impact of the Texas Heartbeat Act,” Charlotte Lozier Institute, November 7, 2022. https://lozierinstitute.org/texas-gain-the-lifesaving-impact-of-the-texas-heartbeat-act/, https://lozierinstitute.org/abortion-reporting-texas-2022/.
[74] Suzanne Bell et al.
[75] Elizabeth Williamson, “’I’m Not Ready’: A Mother Denied an Abortion in Texas Faces an Uncertain Future,” New York Times, December 18, 2022. https://www.nytimes.com/2022/12/18/us/politics/abortion-texas-mother.html.
[76] Texas OBGYN Physician Workforce Study,” Manatt Health, October 8, 2024. https://www.manatt.com/insights/white-papers/2024/texas-obgyn-physician-workforce-study.
[77] Noting for context that in 2019, there were 2,723 ob/gyns in Texas according to the Texas Department of State Health Services, “Women’s Health Providers,” https://www.dshs.texas.gov/sites/default/files/chs/hprc/publications/WomensHealthProviders.pdf.
[78] “Texas OBGYN Physician Workforce Study” Manatt Health. https://www.manatt.com/insights/white-papers/2024/texas-obgyn-physician-workforce-study
[79] “2024 State Scorecard on Women’s Health and Reproductive Care,” The Commonwealth Fund, July 18, 2024. https://www.commonwealthfund.org/publications/scorecard/2024/jul/2024-state-scorecard-womens-health-and-reproductive-care.
[80] Tessa Cox and Ingrid Skop, “Will Pro-life Laws Drive Away Doctors and Lead to Hospital Closures?”, Charlotte Lozier Institute, August 27, 2024. https://lozierinstitute.org/dobbs-and-medical-deserts-will-pro-life-laws-drive-away-doctors-and-lead-to-hospital-closures/.
[81] Id.
[82] Shawna Hodgson, “More People Will Die If Texans Don’t Speak Up for Women’s Bodies,” Texas Observer, June 24, 2022. https://www.texasobserver.org/more-women-will-die-if-texans-dont-speak-up-for-womens-bodies/.
[83] Jeanneane Maxon, “Fact Sheet: State Alternatives to Abortion Funding,” Charlotte Lozier Institute, October 13, 2023. https://lozierinstitute.org/fact-sheet-state-alternatives-to-abortion-funding/.
[84] “Thriving Texas Families.” Texas Health and Human Services. https://www.hhs.texas.gov/services/health/women-children/thriving-texas-families#:~:text=The%20Thriving%20Texas%20Families%20program,as%20an%20alternative%20to%20abortion.
[85] Amanda Mansfield, “Alternatives to Abortion Programs: Support for Mothers and Families,” Charlotte Lozier Institute, On Point Series 74, April 20, 2022. https://lozierinstitute.org/alternatives-to-abortion-programs-support-for-mothers-and-families/; “Special Provisions Relating to All Health and Human Services Agencies.” https://lrl.texas.gov/scanned/79ccrs/sb0001.pdf#page=213.
[86] https://www.hhs.texas.gov/sites/default/files/documents/alternatives-abortion-fy2023-rider68.pdf.
[87] Id.
[88] Amanda Mansfield, “Alternatives to Abortion Programs: Support for Mothers and Families,” Charlotte Lozier Institute, Updated April 20, 2022, https://lozierinstitute.org/alternatives-to-abortion-programs-support-for-mothers-and-families/.
