Abortion bans always kill women

When abortion is illegal, women die. Over 39,000 women die each year from unsafe abortions worldwide, most of them in countries where abortion is illegal.

In the U.S., many thousands of women died before the U.S. Supreme Court legalized abortion in its Roe v. Wade decision in 1973. And women are dying again since the current Court’s Dobbs v. Jackson Women’s Health Organization ruling overturned Roe in June 2022.

The bloody coat hanger was the symbol of pre-1973 abortion deaths, resulting from desperation: women desperate to end an unwanted pregnancy who were forced to resort to dangerous and illegal measures to attempt to do so, fearing the legal consequences if they went to a hospital when facing deadly illness.

Since Dobbs, however, the reported deaths have been from a different source—no less desperate than before Roe, just not the same.

This time around, the horrific image is of pregnant patients seeking treatment for life-threatening illness, bleeding out in their cars in hospital parking lots, at home, or even in the hospital because medical personnel refuse to treat them. In the 21 states that now ban abortion, medical staff work in perpetual fear of being prosecuted for breaking the law if they provide lifesaving abortion care, even for women already in the process of miscarrying. If found guilty, they could end up with sentences as long as life in prison.

The stories of women being turned away from receiving emergency medical care began to circulate even before Dobbs, because Texas had banned abortions at six weeks of gestation a year earlier, providing an early indicator of the deadly future that overturning Roe would bring: Doctors instructing women nearing death to wait in the parking lot or to go home until they were closer to dying before returning, in order to “qualify” for care in states that only allowed abortion to save the patient’s life.

The fatal consequence of recent abortion bans in the U.S.

It was only a matter of time before deaths began to be officially reported, as is now finally happening. But the newly emerging information on the patients who have been dying is already outdated—sometimes two or more years old, compiled by state agencies that are only now reporting the fatal consequences of banning abortion. There is no single national agency keeping track of these deaths, resulting in this time lapse in data.

Moreover, the reliability of this data varies state-by-state, subject to manipulation by anti-abortion state governments. There is reasonable cause to doubt the accuracy of the information now reaching the public—which might very well understate the fatalities that have occurred.

The news outlet ProPublica has compiled information on the first five known women who died because of abortion bans, in a stellar example of the kind of reporting that is urgently needed today:

Josseli Barnica, a 28-year-old mother of one, died soon after Texas’ abortion ban went into effect in 2021. At 17 weeks pregnant, her fetus was already in the process of miscarrying, but doctors were not allowed to treat her until the fetal heartbeat had already stopped. Three days after doctors finally delivered the fetus, Barnica died of “sepsis” involving “products of conception.”
In the summer of 2022, Amber Nicole Thurman, a 28-year-old medical assistant and single mom to her six-year-old son, learned she was pregnant with twins just days after Georgia’s abortion ban went into effect. She made the four-hour drive to North Carolina, which then allowed abortion at her stage of pregnancy, but missed her appointment due to standstill traffic. The clinic gave her abortion pills and taught he how to use them. But in a rare occurrence, Thurman experienced uncontrolled bleeding and cramps and was even vomiting blood. Nearly 20 hours after Thurman arrived at the hospital, and had been diagnosed with sepsis, doctors finally performed surgery. Her heart stopped beating during surgery. Her last words to her mother were, “Promise me you’ll take care of my son.”
In the fall of 2022, Georgia resident Candi Miller—a mother of three with Lupus, diabetes and hypertension—accidentally became pregnant. She acquired abortion pills online. But the fetal tissue did not fully expel, also a rare occurrence. She feared going to the hospital because of Georgia’s ban on abortion, even though a routine dilation and curettage (D&C) procedure could have saved her life. Her husband found her dead in her bed, with her three–year-old daughter lying next to her.
In Texas, 18-year-old Nevaeh Crain was feverish and vomiting the day she visited two different emergency rooms 12 hours apart. The first diagnosed her with strep throat while disregarding her painful abdominal cramps. The second did diagnose her with sepsis but advised her to go home because the fetus had a heartbeat. Upon her third emergency room visit, a doctor insisted on two ultrasounds to “confirm fetal demise.” Hours later, Crain was dead.
Also in Texas, thirty-five-year-old Porsha Ngumezi bled so much after miscarrying her fetus at 11 weeks that she needed two blood transfusions, but was “still passing large clots the size of grapefruit.” Instead of providing a routine D&C, which would have stopped the bleeding, the doctor prescribed the abortion pill misoprostol, which is also sometimes used to stop the bleeding in miscarriages. But three hours later, she was dead. As ProPublica reported, “’Misoprostol at 11 weeks is not going to work fast enough,’ said Dr. Amber Truehart, an OB-GYN at the University of New Mexico Center for Reproductive Health. ‘The patient will continue to bleed and have a higher risk of going into hemorrhagic shock.’ The medical examiner found the cause of death to be hemorrhage.”

It is worth noting that after ProPublica’s reporting about the deaths of Amber Nicole Thurman and Candi Miller, Republicans from the state of Georgia fired all 32 members of its maternal mortality review committee—stating, “confidential information provided to the Maternal Mortality Review Committee was inappropriately shared with outside individuals.”

Maternal mortality rising from abortion bans

The 1973 Supreme Court ruling in Roe v. Wade, studies show, succeeded in reducing the rate of maternal deaths for women of color by up to 40% in its first year. It should be no surprise therefore that maternal deaths have been rising sharply since Roe was overturned.

Years before the Dobbs decision, the National Center for Health Statistics conducted a study that showed a clear relationship between higher maternal deaths and the strictest state anti-abortion laws between 2015 and 2018. For example, states that required a licensed physician to perform abortions “had a 51% higher total maternal mortality and a 35% higher maternal mortality (i.e. a death during pregnancy or within 42 days of being pregnant), and restrictions on state Medicaid funding for abortion was associated with a 29% higher total maternal mortality.”

Maternal deaths (during and shortly after pregnancy) skyrocketed in Texas in the first year after its 2021 abortion ban. While maternal mortality rose 11 percent across the nation between 2019 and 2022 (including the rise in Covid-related deaths), Texas’s rate grew by 56 percent, according to an analysis by the Gender Equity Policy Institute (GEPI). Nancy L. Cohen, president of the GEPI, concluded, “There’s only one explanation for this staggering difference in maternal mortality. All the research points to Texas’ abortion ban as the primary driver of this alarming increase.” She added, “Texas, I fear, is a harbinger of what’s to come in other states.”

As NBC News reported of the study’s findings on the effects of Texas’s 2021 abortion ban:

Within a year, maternal mortality rose in all racial groups studied.

Among Hispanic women, the rate of women dying while pregnant, during childbirth or soon after increased from 14.5 maternal deaths per 100,000 live births in 2019 to 18.9 in 2022. Rates among white women nearly doubled — from 20 per 100,000 to 39.1. And Black women, who historically have higher chances of dying while pregnant, during childbirth or soon after, saw their rates go from 31.6 to 43.6 per 100,000 live births. While maternal mortality spiked overall during the pandemic, women dying while pregnant or during childbirth rose consistently in Texas following the state’s ban on abortion, according to the Gender Equity Policy Institute.

“If you deny women abortions, more women are going to be pregnant, and more women are going to be forced to carry a pregnancy to term,” Cohen said.

Beyond the immediate dangers of pregnancy and childbirth, there is growing evidence that women living in states with strict abortion laws, such as Texas, are far more likely to go without prenatal care and much less likely to find an appointment with an OB-GYN.

The U.S. already has the highest maternal death rate among wealthy nations, and pregnant Black women already die at twice the national rate—and three times more that the rate of white women. Since Dobbs, states with abortion bans have experienced a mass exodus of OB-GYNs, resulting in “maternity care deserts”—with no available prenatal care in one-third of U.S. counties. Roughly 100 hospitals have shut down their maternity care departments.

This crisis will only grow worse. Rachel Hardeman, professor of reproductive health and founding director of the Center for Antiracism Research for Health Equity at the University of Minnesota, told the Guardian, “I expect in the next few years, we’re going to start to see the infant mortality, pre-term birth, maternal mortality, and maternal morbidity numbers rise for everyone, and particularly for folks from racially marginalized and low-socioeconomic communities,” said.

Infant mortality has also risen since Dobbs, mainly because more pregnant patients have been forced to carry fetuses with lethal congenital anomalies (which would kill them minutes, hours, days or months after birth) to term in states with abortion restrictions and bans. Banning abortion in these cases only causes more heartbreak for those who already know their pregnancies are doomed.

Medication abortion in the crosshairs

The only thing standing in the way of the return of the bloody coat hanger is medication abortion—mifepristone and misoprostol, a set of pills that can still be accessed through telemedicine online and mail delivery that can safely terminate an unwanted pregnancy even in most states that ban abortion. Nearly two-thirds of abortion patients now end their pregnancies via this method. As ProPublica reported, “A recent study by the Society of Family Planning found that in 2023, nearly 8,000 people every month in states with bans received pills via telehealth from clinicians in states with shield laws.”

In June, the U.S. Supreme Court was left with no choice but to reject a legal challenge to medication abortion that was filed by a spurious group of anti-abortion physicians. But other lawsuits with the intention of outlawing abortion pills are working their way through the legal pipeline, and there is no reason to believe that the current Supreme Court (much less with any additional Trump anti-abortion appointees) will reject them. On the contrary, they would welcome any cases that pass legal muster.

Other legal challenges on the abortion front include those outlawing transporting teenagers across state lines to get abortions; barring doctors in states that allow abortion from prescribing abortion pills to patients from states that ban it; charging doctors and clinics in states with abortion bans from referring pregnant patients to out-of-state abortion resources.

For these reasons, we cannot rule out that we will return to the days when those desperate to end an unwanted pregnancy will be forced to risk their lives to obtain one. Don’t dismiss the possibility of the return of the bloody coat hanger. In the meantime, the death toll continues to rise from pregnant women bleeding out when emergency rooms refuse to treat them.

The last time around, a pro-choice movement emerged and held firm until abortion was made legal. It must happen again, or the consequences will be monumental.