Counting – and cutting – the human cost of abortion bans

Hey there,

A quick note before I get going this week! My newsroom, the Bureau of Investigative Journalism, is still running its annual audience survey. It’s your opportunity to have a say in what we do, including how I run this newsletter. It only takes about five minutes – I’d really appreciate you taking the time.

I’m a big fan of ProPublica and I’ve long admired the reporting they’ve done on child and maternal health. So today, I’m going to focus on two stories from this strand of reporting. That does mean I’ll be talking about stillbirth, miscarriage and maternal deaths – if those are subjects you can’t read about today, I understand, and I’ll see you next week.

To start with, I want to take you back to 2022, when shockwaves rippled around the world as the US Supreme Court overturned Roe v Wade, the landmark case law that had guaranteed women in the US the right to an abortion.

At the time, doctors warned that women would die. Politicians who passed state abortion bans didn’t listen, and didn’t care to track the results. Even the Centers for Disease Control didn’t ask states to record deaths linked to abortion bans.

When those in power look away, it’s the job of journalists to force them to face the realities. So it was that a team of reporters from ProPublica got stuck into uncovering the life-threatening consequences of restrictive abortion laws.

In Texas, the state’s abortion laws were getting in the way of basic miscarriage care. As women waited in hospitals – cramping, fluid running down their legs – doctors told them they couldn’t empty their uterus to guard against deadly complications.

Even pregnancies that were no longer viable could not legally be aborted. Hospitals could be punished and doctors threatened with life imprisonment if they flouted the laws. There was one exception – doctors could intervene in the case of a life-threatening emergency.

Doctors’ instinctive haste to do everything possible to protect the health of their patients was therefore pushed aside for a more macabre practice. On the advice of hospital lawyers, doctors would have to withhold treatment until they had enough evidence to prove the patients were at risk of dying. They sent tests to labs, looking for signs of infection, and watched as women suffered in agony, in some cases losing so much blood that they needed transfusions.

To chart the scope of pregnancy-related infections, ProPublica purchased and analysed seven years of Texas’ hospital discharge data. The team sifted through information about millions of pregnancy hospitalisations, comparing outcomes before and after the ban.

The findings were stark. ProPublica’s analysis revealed that the rate of sepsis shot up more than 50% for women hospitalised when they lost their pregnancies in the second trimester.

They revealed the heart-breaking consequences for women like Josseli Barnica. And the team continued to pick over the data. They uncovered a seismic split in how hospitals in two of the state’s largest cities treated miscarrying patients. 

At major hospitals in Dallas, bosses had empowered doctors to intervene before patients’ conditions worsened, allowing them to induce deliveries or perform procedures to empty the uterus. But this didn’t happen at many hospitals in Houston.

Rates of sepsis in Houston spiked, and it was 70% more common than in Dallas.

With such variation in how the same law was applied across the state, it’s no wonder that women experiencing pregnancy loss didn’t know what they were entitled to. The ProPublica team responded by creating a handy guide for anyone in the same situation.

I’m very happy to say legislators have been taking notice of all of the ProPublica team’s efforts.

In May, the Texas Senate unanimously passed legislation that aims to prevent maternal deaths under the state’s strict abortion ban. Written in response to ProPublica’s reporting, The Life of the Mother Act represents a remarkable turnaround from the Republican lawmakers who first backed the ban. For the first time in four years, they acknowledged that women were being denied care because of confusion about the law and took action to clarify its terms.

The impact of ProPublica’s reporting spreads beyond Texas. Lawmakers are filing more than a dozen bills to expand abortion access in at least seven states. In Florida, Kentucky and North Dakota the bills have been filed in direct response to ProPublica’s reporting on the fatal consequences of restrictive abortion laws.

That’s a really incredible outcome for some truly inspiring reporting!

“My daughter Reese was stillborn in 2014. There isn't a day that goes by that I don’t wonder about her and miss her deeply.

Having this bill pass means that the government is finally recognising that my daughter's life matters enough to invest in preventing stillbirth happening to another family. It means the world to me.

Oftentimes, when a baby is stillborn, [they] are quick to be forgotten by society. The state doesn't recognise them as having personhood because they didn't take a breath, and for many of us whose babies were born at or near term, they very well could have survived outside of the womb had the stillbirth been prevented.

Many loss parents visited Washington DC throughout the last couple of years advocating for this bill to pass. We shared our stories with congressmen and women; we talked about how this shouldn't have happened to us – and how it doesn't need to keep happening. There are prevention measures that can be taken.

When I was there in September advocating with representatives from my state [Minnesota], I heard: “Your story is so powerful. We promise to support this bill.” I was guarded but hopeful that their promises weren’t like the hollow attempts at support after Reese died. That there would be follow through and that the onus wouldn’t be placed back onto grieving families to advocate again next year.

I was in shock when it finally happened. I’m still in shock – and I’m optimistic that this is just the beginning.

The significance of the bill passing was huge from a grieving mother’s perspective. The fact that the bill passed unanimously tells me that our stories matter, that our babies matter.

With the passing of the bill, we will start to see states recognise that stillbirth prevention is an important topic to invest in. With the passing of this bill, we will start to see more research being done as to causes, support resources for grieving families and an investment in educating expectant people on the risks of stillbirth. And I hope that with the passing of this bill comes the vanishing of the stigma around talking about stillbirth and the fear of scaring pregnant people by bringing up its risk factors.

With every state that invests in stillbirth prevention, more people will benefit. Stillbirth can happen to anyone and is more common in people of colour who are already navigating a broken healthcare system. Investing in stillbirth prevention efforts will also lower the maternal mortality rates, too. This bill will impact prenatal care for all expectant people.

I don’t believe that without ProPublica’s reporting, any of this would have happened. Since Reese died, my husband and I have said “we need a national news organisation to see the importance of stillbirth prevention before anything will change”.

The way that Duaa [Eldeib] and ProPublica painstakingly researched, graciously interviewed and did their due diligence leaves little question that stillbirth is a public health crisis that needs to be addressed. There was not one hole in the stillbirth series. No one could read those articles and think, “You missed this” or, “This isn’t fact checked”. The proof was in the pudding.

I am so honoured to be able to tell Reese’s story. One of the many difficult things of living without Reese is worrying about her being forgotten. I don’t get to watch her grow up, she doesn't get to make friends, make memories, so to be able to tell her story in a way that leverages the importance of prevention efforts is everything. Her death was preventable, sharing her with the world is a bandaid that aids in my healing as her mom.

She did not die in vain, she is saving lives.”

It’s been a little while since Amanda spoke to me for the piece above, but when I got in touch with her just recently she had more news. A new stillbirth prevention programme had been launched in Minnesota, showing that impact from the bill she championed continues to roll in. 

Propublica does fantastic work in the US, and here in the UK, we’re also reporting on the erosion of reproductive rights and freedoms. Just last year we exposed secretive deals struck between ex-Trump official Valerie Huber and the Ugandan government to roll out public health initiatives that could include anti-abortion and pro-abstinence policies. We also reported on forced pregnancy tests at schools in east Africa.

Reproductive rights are only as strong as the pillars that safeguard them – a free press, a strong civil society and sympathetic decision-makers. The Bureau is committed to ensuring these rights are upheld, and we need your help to do it.

That’s it for this week but I’ll be back next time with more stories that force the world to stand up and take notice.

Take care,