In a first-of-its-kind analysis of Texas hospital data, we found a rise in life-threatening complications for women hospitalized with second-trimester pregnancy loss after the state banned abortion, as well as an increase in hospital deaths of pregnant women.
Our work built on the series of Pulitzer-winning stories that in 2024 identified five pregnant women, three in Texas, who died because they couldn’t access timely care under state abortion bans. Doctors in Texas told us that when women came to the hospital with miscarriages, they were being forced to wait as life-threatening conditions, like sepsis, developed before doctors could intervene.
But researchers told us that there was no existing methodology to assess pregnancy loss outcomes, and that it would be years before academics published analyses of maternal complication rates before and after abortion bans.
So we decided to do that analysis ourselves.
Texas had the earliest abortion ban in the U.S., implementing a six-week ban in September 2021. It is also the largest state with an abortion ban, and collects data from hospitals that is available by application. At the time, data through 2023 was available, meaning we would be able to examine a full two years of data after the ban. We applied to the state for access to seven years of anonymized hospital inpatient data, from 2017 through 2023, paying $19,500 and signing a data privacy agreement. We agreed to limit access to the raw hospital data to our data reporters, refrain from uploading it to cloud services, and to share only summary data from the files, as specifics could potentially lead to identifying a patient or provider.
To examine maternal outcomes, we used a methodology broadly employed by states and the federal government to assess severe complications in birth events. In consultation with dozens of researchers and clinicians, we adapted that methodology to focus instead on hospitalizations where a pregnancy ended in the second trimester, but prior to fetal viability.
We found that the rate of sepsis, a life-threatening reaction to an infection, for women hospitalized in this period of pregnancy shot up more than 50% after the state banned abortion in 2021. When we zoomed into the specifics of these hospitalizations, we found that those without a diagnosis of fetal death on admission to the hospital were far more likely to develop sepsis.
Additionally, we used the Texas hospital data to count how many women died while hospitalized who were pregnant or recently postpartum. Our analysis compared pre-pandemic years as a baseline to avoid COVID-19-related distortions. It found there were 79 such hospital deaths in 2018 and 2019. For 2022 and 2023, we found that 120 pregnant or postpartum women died in the hospital. Notably, the state’s maternal mortality review committee has said it will not review cases from 2022 and 2023.
A separate analysis we conducted of CDC mortality data echoed this trend. We found that the rate of maternal deaths in Texas rose 33% between 2019 and 2023, even as the national rate fell by 7.5%.
