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Pregnancy became far more dangerous in Texas after the state banned abortion in 2021, ProPublica found in a first-of-its-kind data analysis.
The rate of sepsis shot up more than 50% for women hospitalized when they lost their pregnancies in the second trimester, ProPublica found.
The surge in this life-threatening condition, caused by infection, was most pronounced for patients whose fetus may still have had a heartbeat when they arrived at the hospital.
ProPublica previously reported on two such cases in which miscarrying women in Texas died of sepsis after doctors delayed evacuating their uteruses. Doing so would have been considered an abortion.
The new reporting shows that, after the state banned abortion, dozens more pregnant and postpartum women died in Texas hospitals than had in pre-pandemic years, which ProPublica used as a baseline to avoid COVID-19-related distortions. As the maternal mortality rate dropped nationally, ProPublica found, it rose substantially in Texas.
ProPublica’s analysis is the most detailed look yet at a rise in life-threatening complications for women losing a pregnancy after Texas banned abortion. It raises concerns that the same pattern may be occurring in more than a dozen other states with similar bans.
To chart the scope of pregnancy-related infections, ProPublica purchased and analyzed seven years of Texas’ hospital discharge data.
When abortion was legal in Texas, the rate of sepsis for women hospitalized during second-trimester pregnancy loss was relatively steady. Then the state’s first abortion ban went into effect and the rate of sepsis spiked.
Note: For hospitalizations involving a pregnancy loss between 13 weeks’ gestation and the end of the 21st week. Rates are annual. (Lucas Waldron/ProPublica)“This is exactly what we predicted would happen and exactly what we were afraid would happen,” said Dr. Lorie Harper, a maternal-fetal medicine specialist in Austin.
She and a dozen other maternal health experts who reviewed ProPublica’s findings say they add to the evidence that the state’s abortion ban is leading to dangerous delays in care. Texas law threatens up to 99 years in prison for providing an abortion. Though the ban includes an exception for a “medical emergency,” the definition of what constitutes an emergency has been subject to confusion and debate.
Many said the ban is the only explanation they could see for the sudden jump in sepsis cases.
The new analysis comes as Texas legislators consider amending the abortion ban in the wake of ProPublica’s previous reporting, and as doctors, federal lawmakers and the state’s largest newspaper have urged Texas officials to review pregnancy-related deaths from the first full years after the ban was enacted; the state maternal mortality review committee has, thus far, opted not to examine the death data for 2022 and 2023.
The standard of care for miscarrying patients in the second trimester is to offer to empty the uterus, according to leading medical organizations, which can lower the risk of contracting an infection and developing sepsis. If a patient’s water breaks or her cervix opens, that risk rises with every passing hour.
Sepsis can lead to permanent kidney failure, brain damage and dangerous blood clotting. Nationally, it is one of the leading causes of deaths in hospitals.
While some Texas doctors have told ProPublica they regularly offer to empty the uterus in these cases, others say their hospitals don’t allow them to do so until the fetal heartbeat stops or they can document a life-threatening complication.
Last year, ProPublica reported on the repercussions of these kinds of delays.
Forced to wait 40 hours as her dying fetus pressed against her cervix, Josseli Barnica risked a dangerous infection. Doctors didn’t induce labor until her fetus no longer had a heartbeat.
Physicians waited, too, as Nevaeh Crain’s organs failed. Before rushing the pregnant teenager to the operating room, they ran an extra test to confirm her fetus had expired.
Both women had hoped to carry their pregnancies to term, both suffered miscarriages and both died.
In response to their stories, 111 doctors wrote a letter to the Legislature saying the abortion ban kept them from providing lifesaving care and demanding a change.
“It’s black and white in the law, but it’s very vague when you’re in the moment,” said Dr. Tony Ogburn, an OB-GYN in San Antonio. When the fetus has a heartbeat, doctors can’t simply follow the usual evidence-based guidelines, he said. Instead, there is a legal obligation to assess whether a woman’s condition is dire enough to merit an abortion under a prosecutor’s interpretation of the law.
Some prominent Texas Republicans who helped write and pass Texas’ strict abortion bans have recently said that the law should be changed to protect women’s lives — though it’s unclear if proposed amendments will receive a public hearing during the current legislative session.
ProPublica’s findings indicate that the law is getting in the way of providing abortions that can protect against life-threatening infections, said Dr. Sarah Prager, a professor of obstetrics and gynecology at the University of Washington.
“We have the ability to intervene before these patients get sick,” she said. “This is evidence that we aren’t doing that.”
A New ViewHealth experts, specially equipped to study maternal deaths, sit on federal agencies and state-appointed review panels. But, as ProPublica previously reported, none of these bodies have systematically assessed the consequences of abortion bans.
So ProPublica set out to do so, first by investigating preventable deaths, and now by using data to take a broader view, looking at what happened in Texas hospitals after the state banned abortion, in particular as women faced miscarriages.
“It is kind of mindblowing that even before the bans researchers barely looked into complications of pregnancy loss in hospitals,” said perinatal epidemiologist Alison Gemmill, an expert on miscarriage at Johns Hopkins Bloomberg School of Public Health.
In consultation with Gemmill and more than a dozen other maternal health researchers and obstetricians, ProPublica built a framework for analyzing Texas hospital discharge data from 2017 to 2023, the most recent full year available. This billing data, kept by hospitals and collected by the state, catalogues what happens in every hospitalization. It is anonymized but remarkable in its granularity, including details such as gestational age, complications and procedures.
To study infections during pregnancy loss, ProPublica identified all hospitalizations that included miscarriages, terminations and births from the beginning of the second trimester up to 22 weeks’ gestation, before fetal viability. Since first-trimester miscarriage is often managed in an outpatient setting, ProPublica did not include those cases in this analysis.
When looking at stays for second-trimester pregnancy loss, ProPublica found a relatively steady rate of sepsis before Texas made abortion a crime. In late 2021, the state made it a civil offense to end a pregnancy after a fetus developed cardiac activity, and in the summer of 2022, the state made it a felony to terminate any pregnancy, with few exceptions.
In 2021, 67 patients who lost a pregnancy in the second trimester were diagnosed with sepsis — as in the previous years, they accounted for about 3% of the hospitalizations.
In 2022, that number jumped to 90.
The following year, it climbed to 99.
ProPublica’s analysis was conservative and likely missed some cases. It doesn’t capture what happened to miscarrying patients who were turned away from emergency rooms or those like Barnica who were made to wait, then discharged home before they returned with sepsis.
Our analysis showed that patients who were admitted while their fetus was still believed to have a heartbeat were far more likely to develop sepsis.
Sepsis Rates Spiked for Patients Whose Initial Diagnosis Didn’t Include Fetal DeathFor patients in Texas hospitals who lost a pregnancy, about half were not diagnosed with fetal demise when they were admitted, meaning that their fetus may still have had a heartbeat at that time. Those patients saw a dramatic increase in sepsis after the state banned abortion.
Note: For hospitalizations involving a pregnancy loss between 13 weeks’ gestation and the end of the 21st week. We identified patients whose fetus had no heartbeat when they were admitted by looking for a diagnosis of “intrauterine death” or “missed abortion.” Rates are annual. (Lucas Waldron/ProPublica)“What this says to me is that once a fetal death is diagnosed, doctors can appropriately take care of someone to prevent sepsis, but if the fetus still has a heartbeat, then they aren’t able to act and the risk for maternal sepsis goes way up,” said Dr. Kristina Adams Waldorf, professor of obstetrics and gynecology at UW Medicine and an expert in pregnancy complications. “This is needlessly putting a woman’s life in danger.”
Studies indicate that waiting to evacuate the uterus increases rates of sepsis for patients whose water breaks before the fetus can survive outside the womb, a condition called previable premature rupture of membranes or PPROM. Because of the risk of infection, major medical organizations like the Society for Maternal-Fetal Medicine and the American College of Obstetricians and Gynecologists advise doctors to always offer abortions.
Researchers in Dallas and Houston examined cases of previable pregnancy complications at their local hospitals after the state ban. Both studies found that when women weren’t able to end their pregnancies right away, they were significantly more likely to develop dangerous conditions than before the ban. The study of the University of Texas Health Science Center in Houston, not yet published, found that the rate of sepsis tripled after the ban.
Dr. Emily Fahl, a co-author of that study, recently urged professional societies and state medical boards to “explicitly clarify” that doctors need to recommend evacuating the uterus for patients with a PPROM diagnosis, even with no sign of infection, according to MedPage Today.
UTHealth Houston did not respond to several requests for comment.
ProPublica zoomed out beyond the second trimester to look at deaths of all women hospitalized in Texas while pregnant or up to six weeks postpartum. Deaths peaked amid the COVID-19 pandemic, and most patients who died then were diagnosed with the virus. But looking at the two years before the pandemic, 2018 and 2019, and the two most recent years of data, 2022 and 2023, there is a clear shift:
In the two earlier years, there were 79 maternal hospital deaths.
In the two most recent, there were 120.
Caitlin Myers, an economist at Middlebury College, said it’s crucial to examine these deaths from different angles, as ProPublica has done. Data analyses help illuminate trends but can’t reveal a patient’s history or wishes, as a detailed medical chart might. Diving deep into individual cases can reveal the timeline of treatment and how doctors behave. “When you see them together, it tells a really compelling story that people are dying as a result of the abortion restrictions.”
Texas has no plans to scrutinize those deaths. The chair of the maternal mortality review committee said the group is skipping data from 2022 and 2023 and picking up its analysis with 2024 to get a more “contemporary” view of deaths. She added that the decision had “absolutely no nefarious intent.”
“The fact that Texas is not reviewing those years does a disservice to the 120 individuals you identified who died inpatient and were pregnant,” said Dr. Jonas Swartz, an assistant professor of obstetrics and gynecology at Duke University. “And that is an underestimation of the number of people who died.”
The committee is also prohibited by law from reviewing cases that include an abortion medication or procedure, which can also be used during miscarriages. In response to ProPublica’s reporting, a Democratic state representative filed a bill to overturn that prohibition and order those cases to be examined.
Because not all maternal deaths take place in hospitals and the Texas hospital data did not include cause of death, ProPublica also looked at data compiled from death certificates by the Centers for Disease Control and Prevention.
It shows that the rate of maternal deaths in Texas rose 33% between 2019 and 2023 even as the national rate fell by 7.5%.
A New ImperativeTexas’ abortion law is under review this legislative session. Even the party that championed it and the senator who authored it say they would consider a change.
On a local television program last month, Republican Lt. Gov. Dan Patrick said the law should be amended.
“I do think we need to clarify any language,” Patrick said, “so that doctors are not in fear of being penalized if they think the life of the mother is at risk.”
State Sen. Bryan Hughes, who once argued that the abortion ban he wrote was “plenty clear,” has since reversed course, saying he is working to propose language to amend the ban. Texas Gov. Greg Abbott told ProPublica, through a spokesperson, that he would “look forward to seeing any clarifying language in any proposed legislation from the Legislature.”
Patrick, Hughes and Attorney General Ken Paxton did not respond to ProPublica’s questions about what changes they would like to see made this session and did not comment on findings ProPublica shared.
In response to ProPublica’s analysis, Abbott’s office said in a statement that Texas law is clear and pointed to Texas health department data that shows 135 abortions have been performed since Roe was overturned without resulting in prosecution. The vast majority of the abortions were categorized as responses to an emergency but the data did not specify what kind. Only five were solely to “preserve [the] health of [the] woman.”
At least seven bills related to repealing or creating new exceptions to the abortion laws have been introduced in Texas.
Doctors told ProPublica they would most like to see the bans overturned so all patients could receive standard care, including the option to terminate pregnancies for health considerations, regardless of whether it’s an emergency. No list of exceptions can encompass every situation and risk a patient might face, obstetricians said.
“A list of exceptions is always going to exclude people,” said Dallas OB-GYN Dr. Allison Gilbert.
It seems unlikely a Republican-controlled Legislature would overturn the ban. Gilbert and others are advocating to at least end criminal and civil penalties for doctors. Though no doctor has been prosecuted for violating the ban, the mere threat of criminal charges continues to obstruct care, she said.
In 2023, an amendment was passed that permitted physicians to intervene when patients are diagnosed with PPROM. But it is written in such a way that still exposes physicians to prosecution; it allows them to offer an “affirmative defense,” like arguing self-defense when charged with murder.
“Anything that can reduce those severe penalties that have really chilled physicians in Texas would be helpful,” Gilbert said. “I think it will mean that we save patients’ lives.”
Rep. Mihaela Plesa, a Democrat from outside Dallas who filed a bill to create new health exceptions, said that ProPublica’s latest findings were “infuriating.”
She is urging Republicans to bring the bills to a hearing for debate and discussion.
Last session, there were no public hearings, even as women have sued the state after being denied treatment for their pregnancy complications. This year, though some Republicans appeared open to change, others have gone a different direction.
One recently filed a bill that would allow the state to charge women who get an abortion with homicide, for which they could face the death penalty.
Do you live in a state that has passed laws affecting abortion in the last few years? In the time since, have you or a loved one experienced delayed health care while pregnant or experiencing a miscarriage?
ProPublica would like to hear from you to better understand the unintended impact of abortion bans across the country. Email our reporters at reproductivehealth@propublica.org to share your story.
We understand this may be difficult to talk about, and we have detailed how we report on maternal health to let you know what you can expect from us.
Lucas Waldron contributed graphics. Mariam Elba contributed research.
ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published.
A first-of-its-kind analysis by ProPublica found that the sepsis rate in second-trimester pregnancy loss hospitalizations increased by more than 50% after Texas’ near-total abortion ban went into effect in September 2021. The analysis also identified at least 120 in-hospital deaths of pregnant or postpartum women in 2022 and 2023 — an increase of dozens of deaths from a comparable period before the COVID-19 pandemic.
Neither the CDC nor states are investigating deaths or severe maternal complications related to abortion bans. And although the federal government and many states track severe complications in birth events using a federally established methodology, far less is known about complications that arise during a pregnancy loss. There is no federal methodology for doing this, so we consulted with experts to craft one.
We acquired Texas hospitalization data from 2017 through 2023, giving us more than two years of data after the implementation of the state’s six-week abortion ban in September 2021, and more than a year of data following its full abortion ban, which went into effect in August 2022.
We spoke with dozens of researchers and clinicians to adapt the federal algorithm for birth complications to focus on severe complications in early pregnancy, before fetal viability.
This methodology lays out the steps we took to complete this analysis, to help experts and interested readers understand our approach and its limitations.
Identifying Second-Trimester HospitalizationsWe purchased seven years of inpatient discharge records for all hospitals from the Texas Department of State Health Services. These records contain de-identified data for all hospital stays longer than a day, with information about the stay, including diagnoses recorded and procedures performed during the stay, as well as some patient demographic information and billing data.
Within this dataset, we opted to focus on second-trimester pregnancy loss, because first-trimester miscarriage management often occurs in an outpatient setting. In the future, we plan to look at outpatient data as well.
To examine outcomes in the second trimester, we first identified hospitalizations where a pregnancy ended. We used a methodology to identify severe complications in birth events developed by the Health Resources and Services Administration, the Centers for Disease Control and Prevention, the Agency for Healthcare Research and Quality, and the Alliance for Innovation on Maternal Health, an initiative of the American College of Obstetricians and Gynecologists. The method is outlined in statistical code published by HRSA, and it first identifies every hospitalization with a live birth, stillbirth or an “abortive outcome” (which refers to an intended or unintended pregnancy loss before 20 weeks). Rather than excluding those abortive outcomes to focus on birth, as the HRSA code directs, we included them to look at all hospitalizations where a pregnancy ended. This narrowed our list of hospitalizations to an average of 370,000 per year.
The HRSA methodology further filters hospitalizations to only patients who are female and between the ages of 12 and 54. Our dataset had five-year age ranges, so we filtered to ages between 10 and 54. This brought our hospitalization list to 364,000 each year, on average.
For each hospitalization where a pregnancy ended, we looked for a diagnosis code recording the gestational age of the fetus. In cases where a long hospitalization had multiple gestational week codes recorded over the course of the stay, we took the latest one.
We excluded pregnancy-end hospitalizations without a gestational week code from our analysis — removing about 49,500 hospitalizations, or 1.9% of our dataset. More than two-thirds had coding that indicated a birth, likely to have occurred after 20 weeks.
Based on conversations with doctors and researchers, we narrowed our focus to hospitalizations where a pregnancy ended in the second trimester before fetal viability, from the start of the 13th week through 21 weeks and six days. While pregnancies that end at 20 and 21 weeks are often coded as births, rather than abortive outcomes, we included those weeks in our definition of pregnancy loss because experts told us it’s extremely unlikely that a baby born at 21 weeks could survive. This brought our list of hospitalizations to 15,188.
The number of second trimester hospitalizations, and characteristics of the women hospitalized, was largely stable from 2017 through 2023, the years of our analysis. In 2023, however, as the number of births in the state increased, the number of hospitalizations in our window declined to 2,036, below the yearly average of 2,169.
The race and ethnicity of patients each year, as well as the proportion of these hospitalizations in which the patients were covered by Medicaid or uninsured, did not change significantly after the state’s 2021 abortion ban, known as SB 8, went into effect.
Determining Sepsis RatesWithin these hospitalizations, we looked for diagnoses of sepsis, a life-threatening complication that can follow delays in emptying the uterus. The CDC defines a list of sepsis codes associated with severe maternal complications, which formed the basis of our definition. However, that list of codes is developed to look at sepsis in birth events, the vast majority of which occur much later in a pregnancy than our hospitalizations. We identified five sepsis codes associated with early pregnancy events like ectopic pregnancy and miscarriage, adding them to the existing list of sepsis codes to develop a definition that more fully captured early pregnancy complications.
To compare rates before and after the implementation of SB 8, we grouped the nine quarters of data we had after the implementation of the ban (October 2021 through December 2023) and compared it with the nine quarters immediately before (July 2019 through September 2021). Our dataset gives us the quarter in which a patient was discharged from the hospital but not the exact date, so the “before” group contains one month of data from after SB 8 went into effect on Sept. 1, 2021.
Identifying Fetal DemiseThe standard of care for second-trimester miscarriage or rupture of membranes prior to fetal viability is to offer patients a dilation and evacuation or an induction to end the pregnancy — even if there is still a fetal heartbeat. In our reporting, we’d heard that because of the language of Texas’ abortion law, some hospitals and doctors were waiting for the fetal heartbeat to stop or the mother to develop a life-threatening illness, whichever occurred first. To look into this, we wanted to separate hospitalizations in which doctors would have theoretically been able to offer a termination immediately under the law — ones where the patient had a diagnosis indicating that there was no fetal heartbeat at the time of admission to the hospital — from ones where doctors may have waited to provide care.
We determined that about half of our second-trimester hospitalizations did not have a fetal heartbeat on admission. We identified these cases by focusing on two sets of diagnosis codes: Prior to 20 weeks gestation, a diagnosis of “missed abortion” refers to a miscarriage where the fetus has stopped developing, but the body has not yet expelled the tissue. After 20 weeks, a diagnosis of “intrauterine death” indicates that the fetus has died. For both diagnoses, we included only those that were marked as “present on admission.”
Sepsis Rate FindingsOur analysis found that the sepsis rate in second-trimester pregnancy loss hospitalizations increased after the state’s ban went into effect, and the surge was most pronounced in cases in which the fetus may still have had a heartbeat when the patient arrived at the hospital.
In the nine quarters before SB 8 went into effect, the sepsis rate in second-trimester pregnancy loss hospitalizations was 2.9%. In the nine quarters after SB 8 went into effect, the sepsis rate was 4.5%, an increase of 55%.
Since our total number of sepsis cases was relatively small, we measured whether the two groups of data were significantly different using a t-test. We calculated sepsis rates for second-trimester hospitalizations in the nine quarters after SB 8 went into effect and compared that with sepsis rates during the nine quarters immediately prior. We found that increase to be statistically significant (p-value < 0.05).
Sepsis Rate Increased Over 50% for Second-Trimester Pregnancy Loss Hospitalizations After SB 8We compared the nine quarters after SB 8 went into effect — from October 2021 through December 2023 — to the nine quarters before the ban went into effect — July 2019 to September 2021.
Note: For hospitalizations involving a pregnancy loss between 13 weeks’ gestation and the end of the 21st week.Sepsis is a reaction to an infection, and the most common additional infection diagnosis in sepsis hospitalizations was chorioamnionitis, an infection of the amniotic fluid that can also cause early rupture of membranes. Rates of chorioamnionitis in sepsis cases remained stable before and after SB 8.
Our analysis also showed that patients admitted while their fetus was still believed to have a heartbeat were far more likely to contract sepsis.
Sepsis Rates Spiked for Patients Whose Initial Diagnosis Didn’t Include Fetal DeathFor patients in Texas hospitals who lost a pregnancy, about half were not diagnosed with fetal demise when they were admitted, meaning that their fetus may still have had a heartbeat at that time. Those patients saw a dramatic increase in sepsis after the state banned abortion.
Note: For hospitalizations involving a pregnancy loss between 13 weeks’ gestation and the end of the 21st week. We identified patients whose fetus had no heartbeat when they were admitted by looking for a diagnosis of “intrauterine death” or “missed abortion.” Rates are annual. (Lucas Waldron/ProPublica)In the nine quarters prior to the implementation of SB 8, the rate of sepsis was nearly twice as high for those with no fetal demise diagnosis on admission compared with those with a fetal demise diagnosis on admission. After SB 8, the rate increased in both groups, and the gap between them widened.
Again, since the number of total sepsis cases was relatively small, we used a t-test to see if there was a statistically significant difference before and after SB 8 in both groups. We found the increase in rates to be significant on both counts (p < 0.05).
Sepsis Rates for Hospitalizations With Fetal Demise on Admission Sepsis Rates for Hospitalizations Without Fetal Demise on Admission Notes: For hospitalizations involving a pregnancy loss between 13 weeks’ gestation and the end of the 21st week. We compared the nine quarters after SB 8 went into effect to the nine quarters before the ban went into effect. Sepsis Rate Analysis LimitationsMaternal health experts noted that discharge data offers a limited window into the details of patient care. Changes in the frequency of a diagnosis code can signal a change in patient health but also a change in coding practices. Our analysis can’t isolate changes in outcomes from changes in sepsis coding practices over time or doctors taking additional documentation steps to show they’ve complied with the law. And billing records offer no detail into a patient’s history and medical wishes or the decisions that medical staff make in the course of care.
Our analysis also does not account for changes in health care outside of hospitals. Though births typically take place in a hospital, other early pregnancy care often occurs in an outpatient setting and does not require a hospitalization, so we can only see a small subset of this type of care — specifically, the most severe cases. We also can’t account for how closures of reproductive health care clinics in the wake of Texas’ abortion ban changed the role hospitals play in miscarriage care.
We cannot see when hospitals turn patients away rather than admitting them. And if a patient who is miscarrying has an inpatient stay at one hospital and is then transferred to another hospital for another inpatient stay, that patient would be double-counted in our analysis, since we can’t connect patients across visits. This could potentially inflate the number of hospitalizations in our dataset, artificially pushing the sepsis rate down.
Our dataset is missing a handful of records from the fourth quarter of 2023; in a small number of cases — about 300 per quarter, or 0.04% of records — providers submit data on a hospitalization late, and that record is released in the dataset for the following quarter.
Billing data is widely used by researchers to study maternal health. While it will never tell the whole story, in aggregate, particularly in a state with a large population, it can paint a picture of changing health outcomes. Our analysis gives us a broad view of care at Texas hospitals before and after a major policy change.
More than a dozen maternal health experts reviewed ProPublica’s findings and said our analysis adds to mounting evidence that the state’s abortion ban is likely leading to dangerous delays in care. Many said the ban is the only explanation they could see for the sudden jump in sepsis cases.
Pregnancy-Associated Hospital DeathsWe found 120 women who died while hospitalized during pregnancy or up to six weeks postpartum in 2022 and 2023 in the inpatient billing data. The Texas Maternal Mortality and Morbidity Review Committee will not review deaths from these years, stating that they will skip to 2024 in an effort to get a more “contemporary” view of deaths, a choice that faced widespread criticism. (The committee chair said there was “absolutely no nefarious intent” behind the decision.)
To identify inpatient deaths in the Texas hospital discharge data, we included all records with a “patient status” of “expired” and with a diagnosis or procedure code indicating that the patient was pregnant or up to six weeks postpartum, with a specific postpartum complication based on the “Identifying Pregnant and Postpartum Medicaid and CHIP Beneficiaries” code list by the Centers for Medicare & Medicaid Services. The CDC looks at deaths up to within one year of a pregnancy’s end, but our dataset doesn’t explicitly identify pregnant or recently pregnant patients, so we were limited in the hospitalizations we could identify through codes.
Our tally does not include those who died in a hospitalization that took place separately from the end of a pregnancy, unless the patient was diagnosed with a specific postpartum complication. We did not filter for age and gender for our death records, as that data was less reliably filled out than the diagnosis and procedure codes.
Our count of inpatient deaths does not attempt to determine what role a person’s pregnancy or the state’s abortion ban played in their death. That type of analysis would require access to medical records. Our tally would include, for example, a person who was hospitalized after a car crash but who was also pregnant. Experts advised us to leave these cases in, because without investigation by the maternal mortality committee, it’s impossible to know, for example, if there was any relationship between the patient’s pregnancy and the cause of the accident, or if there were any delays in maternal care after the accident.
We found that deaths increased sharply during the height of the COVID-19 pandemic and peaked in 2021, and that many cases in 2020 and afterward included COVID-19 diagnostic codes. More than 60% of the deaths that we analyzed had a diagnosis of COVID-19 in 2021, and 27% had a COVID-19 diagnosis in 2022. The COVID-19 diagnostic code was not introduced until October 2020, several months after the pandemic began, and was updated in January 2021. The coding changes, combined with changes in hospital protocols around identifying COVID-19 cases, make it impossible to filter out all COVID-19 related deaths during this time period.
Texas and National Rates of Maternal MortalityThe hospital billing data only includes information about Texas, so to compare with national rates, we used data from the CDC’s WONDER portal, which is based on birth and death certificates. For this analysis, we used a definition of maternal death recommended by CDC research guidelines for this data source. Our denominator includes all live births. For statewide rates, we use the state of residence of the mother in both the numerator and denominator. Rates are reported per 100,000 births.
Between 2019 and 2023, we found a 33% increase in maternal mortality rates in Texas, compared with a decrease of 7.5% nationally during the same time.
While both nationally and in Texas rates of maternal mortality peaked in 2021 during the COVID-19 pandemic and have dropped since, rates in Texas remain higher than before the pandemic.
Missing DocumentsThe federal methodology we used as a basis for our analysis of severe complications in pregnancy hospitalizations was outlined in a document available for download from HRSA’s Maternal and Child Health Bureau. The instructions included statistical code that we adapted to do our own analysis, and they were accompanied by a spreadsheet of maternal and child outcome measures over time for all 50 states and nationally.
As of early February, both the instructions and the spreadsheet had been replaced by documents noting that the files were “currently under construction and not available.”
Lucas Waldron contributed graphics.
FOR IMMEDIATE RELEASE:
A judge yesterday granted the City of Clarksdale, Mississippi’s request to order a newspaper, The Clarksdale Press Register, to delete an editorial criticizing city officials. The order blatantly disregards the constitutional prohibition on “prior restraints” censoring the press.
The following statement can be attributed to Seth Stern, director of advocacy at Freedom of the Press Foundation (FPF):
It's hard to imagine a more unconstitutional order than one compelling a newspaper to take down an editorial critical of the government. And it's particularly ironic when the editorial in question is about government secrecy undermining the public trust. If anyone previously trusted the secretive officials involved in this censorship campaign, they shouldn't now.
“The underlying lawsuit here appears frivolous for any number of reasons. But even in constitutionally permissible defamation lawsuits, it's been well-established law for decades that the remedy for plaintiffs is monetary damages, not censorship orders.
“This case should not be viewed in isolation — it's part of a nationwide increase in baseless censorship orders, known as ‘prior restraints.’ But this one is uniquely egregious. City Attorney Melvin D. Miller II and all other lawyers involved in asking a court to silence the press should face real consequences, as should Judge Crystal Wise Martin, who rubber-stamped their request. Judge Martin shouldn’t be adjudicating parking tickets, let alone First Amendment cases.
Please contact us if you would like further comment.
stLouIST
