Texas is Fabricating Abortion Data

Doctors are being forced to report fake abortion ‘complications’ under threat of losing their jobs

This article is the first in an ongoing series on the anti-abortion movement’s attack on data and science. If you don’t want to miss the next installment, subscribe here. If you’d like to support more pieces like this one, consider signing up for a paid subscription.

With research by Grace Haley

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Sue sobbed as she entered her patient’s personal information into the state website: Date of birth, county of residence, last menstrual period. The Texas Department of Health and Human Services even wanted to know whether the woman was married, and how many children she had.

“Reporting every detail of that woman’s information, the fact that I was putting any of it in...it was devastating to me as a physician,” she says.

Sue, a pseudonym, is an emergency medicine physician at a major Texas city hospital. Ever since Roe was overturned and the state’s trigger law went into effect, Sue and other Texas doctors have been required to submit patients’ private medical information into a state-run website without their knowledge or consent—adhering to a mandate that forces them to report women as suffering from abortion complications even when they’re not.

This rarely reported on section of Texas law lists 28 medical issues as abortion complications—conditions that reproductive health experts point out often have nothing to do with abortion. Still, doctors are required to tell the state about any woman who develops one of these issues if she happens to have had an abortion at any point in her life. 

Doctors who don’t make these reports can be fined for each ‘violation’; after three violations, they could lose their license. Sue, who got conflicting and often confusing guidance from the large health system that runs her hospital and dozens of others in the state, was terrified not to comply. “For all I knew, I could be one that [Attorney General] Ken Paxton made an example of,” she says. 

This reporting mandate is a central and insidious part of Republicans’ strategy to paint abortion as dangerous despite decades of evidence to the contrary. It’s a policy that forces doctors, under threat of losing their license, to lend their name and medical credibility to the collection of false data—‘research’ that will be used by the state to claim abortion is unsafe.

“They want to force us to report a complication so they can submit and advertise bad data,” Sue says. 

The list of ‘complications’ that Texas doctors are forced to attribute to abortion are vague and nonsensical. Some, like “adverse reactions to anesthesia,” are risks associated with having any medical procedure. (As Sue points out, it’s not as if there’s a state commission on adverse reactions to colonoscopies.) 

Others, like “infection,” could develop in a patient for a reason completely unrelated to abortion or predate the procedure, yet would still be counted as a complication. The law also lists complications like “pelvic inflammatory disease,” which is a type of infection and therefore could be double-counted.

Other ‘complications’ would require reports to the state years after a patient had an abortion. I’ll use myself as an example: My daughter was born three months early after I developed severe preeclampsia. If I delivered her in Texas tomorrow, and happened to mention that I ended a pregnancy a few years previous, my doctor would be required to report my daughter’s early birth as a complication of abortion. Never mind that there’s no link between preeclampsia and abortion; because “preterm delivery in subsequent pregnancies” is on the law’s list of reportable conditions, my physician would have no choice. 

What’s more, it wouldn’t be just one doctor reporting my supposed complication to the state. Texas law requires that every single physician involved in a patient’s care fill out the state’s abortion complication form. Even the hospital itself, as an entity, has to file a report. It’s a policy that encourages double, triple, even quadruple duplicate reports for a single person. (Again, a patient who may not have an abortion complication at all!)

So in this hypothetical where I’ve given birth in Texas, I’d be under the impression that I’m at the hospital to deliver a baby and get treatment for preeclampsia. But something very different is happening behind the scenes: The birth of my daughter is being recorded, reported, and counted three or four times as proof that abortion is dangerous—‘data’ that will be published in Texas’ annual abortion complication report.

And though Texas’ law on abortion reporting says that the annual report “may not include any duplicative data,” Dr. Ushma Upadhyay, professor and public health scientist at the University of California, San Francisco, tells me there’s no real way to prevent such a thing. “There’s no guidance or standards,” she says. 

The state’s abortion complication form doesn’t include a patient’s name, or any unique identifier, for officials to cross reference. Even if the health department managed to match another piece of information, like date of birth, with multiple reports coming in on the same day from the same hospital, there’s another issue: That same patient’s data will be counted again if she sees another doctor down the line, months or even years later.

Duplicate reports are not the only way the state’s policy skews data (which, remember, is medically dubious regardless of how it’s collected). The vague criteria for what constitutes a complication means that a doctor who is against abortion could use the system to report non-attributable conditions as abortion complications. Or, a doctor who isn’t sure about a condition’s connection to abortion could report it anyway out of fear of the law’s steep penalties.

Indeed, Texas’ law, which encourages citizens to turn each other in, has created an atmosphere of terror among health care providers. Doctors have to worry not only about adhering to a deliberately-unscientific and political mandate, but that if they don’t, they’ll be turned in by their colleagues. One medical professional told Abortion, Every Day about a physician who chose not to report a ‘complication’, only to have other staff tell hospital administrators—who then pressured them to fill out the form.

This, of course, is deliberate. The fear, confusion, bad science and vague language—it’s all meant to drive up the number of reportable complications. Planned Parenthood put it plainly in their 2018 lawsuit challenging Idaho’s near-identical abortion complication reporting mandate: “The Idaho legislature cobbled together the new law to poison the data.” 

Dr. Upadhyay, who gave testimony in that case, says, “That’s exactly the point, to create really inflated abortion statistics.” It was never about keeping patients safe, or collecting information to benefit public health.

That’s why some Texas doctors are refusing to comply despite the legal risks. Carrie (a pseudonym), an emergency medicine physician at a large academic training center in the state, has a ‘don’t ask, don’t tell’ policy. “I don’t ask any of my patients if they’ve had an abortion, and I make sure to tell my medical students and residents not to ask,” she says. 

Carrie tells me that abortion is so safe, she has never felt the need to know if a patient had one in order to give proper treatment. “When you look at the legislation, it was clearly not written by a physician or someone in healthcare,” she says.

And she’s right. The list of abortion ‘complications’ in Texas’ law wasn’t created by doctors or experts, but by Americans United for Life, an anti-abortion group that drafts model legislation for Republican politicians. Arguably the most powerful legislative organization in the movement, AUL insists that abortion complications are vastly underreported—so they’ve created laws that churn out false reports to be used as evidence that abortion should be banned.

Most states, even those that protect abortion rights, have some kind of abortion complication reporting law. But the reporting mandate by AUL was deliberately crafted to create bogus data—and it’s gaining traction beyond Texas. Idaho, Indiana, South Carolina and Mississippi all have laws with identical or similar language, as does legislation introduced in Georgia and Tennessee last session. And just yesterday, North Carolina Republicans proposed a bill that uses the AUL complications list—including “psychological complications.”

It’s a brilliant move, really. The anti-abortion movement wants to prove that abortion is harmful, but they don’t have the statistics to back it up. Laws like this allow states to simply make them up.

Most importantly, the policy forces doctors to attach their names and reputations to these supposed complications, giving anti-choice activists and politicians something they’re absolutely desperate for: medical and scientific credibility.

After all, it’s difficult to claim that abortion is harmful to women when all evidence proves otherwise: Decades of research shows that abortion is safe; 1 in 4 women will have one in her lifetime; and you’re more likely to have a serious complication getting a wisdom tooth pulled.

Unable to use legitimate research to argue for the end of abortion, activists have resorted to creating their own science. They’ve opened up anti-abortion centers modeled to look like health clinics, despite having no medical staff on site. They’ve founded organizations posing as independent research groups—like the Charlotte Lozier Institute, which is actually an arm of Susan B. Anthony Pro-Life America. And they’ve cultivated a group of activists pretending to be researchers. These are people who testify in support of anti-choice legislation, publish bad data, and present themselves as experts despite having questionable qualifications. (The man behind much of the movement’s research on abortion complications, for example, David Reardon, has a degree from an unaccredited online university that was shut down as a diploma mill.)

Feigning academic seriousness has inarguably made it easier for anti-choice activists to lobby politicians and influence court decisions, but the anti-abortion movement still hasn’t been able to break through into the medical mainstream: Every time anti-choice organizations spread a new lie about the dangers of abortion, the scientific community shuts them down. 

When activists tried to assert a link between abortion and breast cancer, for example, reputable medical organizations like the National Cancer Institute and the American Cancer Society called it bunk. When the movement created a fake mental health condition, “post-abortion syndrome,” their research was widely discredited and the American Psychological Association convened a task force to report no link between mental health issues and abortion.

Most recently, the Alliance for Hippocratic Medicine falsely argued that mifepristone was unsafe and hurt women in their lawsuit against the FDA. The conservative group only relied on studies from other anti-choice organizations and data from valid sources that was deliberately mischaracterized. One author of a Finnish study that the group cited in their suit called the interpretation of his research “pure nonsense.”

And that’s the rub; while anti-abortion activists have successfully seeded misinformation in conservative legislation and culture, actual experts have never found their ‘science’ credible. (It doesn’t help, of course, that conservatives are in the habit of reminding Americans how little they know about reproductive health via a steady stream of unfortunate gaffes.)

The anti-abortion movement knows that people don’t trust them when it comes to women’s bodies. That’s what makes abortion complication reports so politically valuable. This is data submitted by independent physicians—reports that conservatives will claim were objectively collected. No need to mention that the doctors were pressured to report under threat of losing their jobs!

And while Texas’ reporting mandate is absolutely meant to instill fear, it’s vital that complication reporting laws aren’t seen solely as a harassment tactic. This is data the anti-abortion movement plans to make serious use of.

When the law went into effect, for example, Sue consoled herself with the thought that perhaps no one would really be looking at these women’s private information. But mere minutes after submitting her second-ever report, she got an email back from someone at the Texas Health Department asking about a discrepancy. To get an email back from the government so quickly shocked her; it gave Sue the impression that someone was sitting at their desk waiting for abortion complication reports to roll in. “If only they processed Medicaid applications this quickly,” she said. 

For anti-abortion organizations like the AUL, these reports, the false data they produce and the strategy they represent are all years in the making. When the AUL put out their model Abortion Reporting Act in 2018, for example, they wrote that implementing a state-by-state reporting system, “one that specifically emphasizes reporting on complications” was the only way for them to “unmask the reality of abortion in America.”

Their goal, they said, was to “safeguard maternal health.” But it’s hard to argue that your top concern is women’s health and lives when the laws you create are sending women to the ICU with sepsis. “If they cared about safety,” Sue says, “they wouldn't be forcing women to the brink of death.”

One of the more horrific ironies of Texas’ reporting mandate is that the state’s ban on abortion will likely drive up the number of complications later reported by doctors. Consider the many stories of Texas women who are denied health- and life-saving abortion, and must leave the state for treatment. If they need to visit an emergency room or doctor after coming back home, any health conditions that were caused by that delay in care will now be counted as an abortion complication—rather than what they are, an adverse effect of being denied an abortion.

Essentially, Republican lawmakers are creating the complications that they’ll later claim are proof that abortion is dangerous. 

Just as troubling, the focus on ‘complication’ reporting is happening at the same time that the anti-abortion movement is working to sow distrust in credible data around maternal mortality. They know that those numbers are going to look very bad very soon, so they’re preemptively claiming that the studies can’t be trusted.

Some good news in all of this horror is that because of the confusion and chaos around Texas’ abortion law, some doctors in the state don’t even know that they’re supposed to be reporting ‘complications’ at all. “When I talk to fellow ER docs,” Carrie tells me, “only half of them know about the actual reporting requirements.” It’s a rare benefit of a lack of standardized guidance on the issue.

But Sue worries that if the state doesn’t compile as many abortion ‘complications’ as they’re looking for, the government will decide it’s time to start punishing doctors. We’ve already seen the way that anti-abortion legislators and organizations are blaming physicians, claiming that women who were denied vital care were the victims of bad doctors rather than bad policy. It makes sense that their next step would be to go after doctors who don’t give them the data that they’re so desperate for.

We’ll know more once the state releases their annual complication report. If it has the numbers they were hoping for, they’ll put out press releases and do cable news hits. Americans will see it used by anti-abortion activists everywhere, despite the fact that it’s manufactured data. If the report isn’t quite as hefty as Republicans wanted, we’ll either hear nothing about it at all, or the state will start to make examples out of institutions they think didn’t follow the law correctly.

Still, Sue says she’s decided to stop submitting reports. She just can’t stomach it, even with the potential legal risk. “I won't be forced to be complicit in faulty, inaccurate and misleading data collection and have my over a decade of education and training be subverted,” she says. “It betrays the patient-physician relationship.”

Carrie is leaving the state entirely. You see, she wants to have children and Texas, she says, simply isn’t a safe place to be pregnant. 

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Keep an eye out for the next installment in this series on the anti-abortion movement’s war on data and science. To support more pieces like this, consider signing up for a paid subscription or donating a subscription to someone who couldn’t otherwise afford it:

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