Texas Won't Report on Maternal Deaths
11.26.24
Click to skip ahead: Post-Dobbs Deaths looks at Porsha Ngumezi’s last hours. In War on Data, Texas’ maternal mortality committee won’t report on 2022 and 2023. In Anti-Abortion Strategy, conservatives have a plan to shirk blame for the deadly consequences of bans. In the States, news from North Dakota, Texas, New York and more. In Ballot Measures, updates on Arizona, Ohio and Missouri. In the Nation, some quick hits. Finally, Listen Up with a podcast on the lawsuit against mifepristone.
Post-Dobbs Deaths
ProPublica has reported on yet another woman’s death in Texas. Thirty-five year old Porsha Ngumezi miscarried her 11 week pregnancy and needed a D&C. But instead of giving her this standard abortion procedure, doctors waited as Porsha passed “large clots the size of grapefruit.”
When Porsha and her husband, Hope, asked about a D&C, the OBGYN at Houston Methodist Sugar Land said he’d give her misoprostol instead. Porsha died three hours later.
ProPublica spoke to more than a dozen doctors who called her death preventable and were unequivocal about the standard of care: a D&C, not misoprostol—which wouldn’t work quickly enough. But thanks to Texas’ abortion ban, doctors are increasingly too afraid to give women D&Cs. Even when a patient has miscarried and there’s no fetal heartbeat, as was the case for Porsha. From Houston Dr. Alison Goulding:
“Stigma and fear are there for D&Cs in a way that they are not for misoprostol. Doctors assume that a D&C is not standard in Texas anymore, even in cases where it should be recommended. People are afraid: They see D&C as abortion and abortion as illegal.”
This is precisely what I wrote about yesterday, in my piece about the move towards eradicating abortion ban exceptions for women’s lives: Anti-abortion activists and lawmakers want doctors too afraid to perform standard abortion procedures, even when women’s lives are at risk.
War on Data
Just one day after news broke of Porsha’s death, the Washington Post reports that Texas’ maternal mortality committee will skip over analyzing deaths from 2022 and 2023. Those just so happen to be the first two years after the state passed a total abortion ban. And last week, we learned that Georgia Republicans fired every single person on their maternal death committee; they were angry about ProPublica’s reporting on two women killed by the state’s ban.
Texas’ excuse for why they won’t be reporting on perhaps the most important two years for maternal health? They say they want their analysis to “be more contemporary” by skipping over a backlog of cases and looking at more recent deaths. But several members of the committee spoke anonymously to WaPo, expressing concern over their decision.
“If women are dying because of delays, and we have this huge new policy in Texas that affects their lives, why would we skip over those years? I’m worried.”
It also wasn’t so long ago that Texas Republicans put anti-abortion extremist Ingrid Skop to the committee—a woman who doesn’t believe abortion bans ever endanger women and that abortion isn’t ever medically necessary.
We know why the state is so eager to cover up maternal death data: it’s rising, rapidly. Remember, an independent analysis found that Texas’ maternal mortality rate skyrocketed by 56% after the state passed its abortion ban. I’m sure the GOP doesn’t want to dig into that.
What’s important to know is that this is part of a much broader anti-abortion strategy attacking data—something I’ve been warning about for nearly two years! In addition to targeting maternal mortality committees, anti-abortion activists and legislators have been sowing distrust in credible maternal death numbers and fabricating abortion ‘complication’ reports. (An attempt to make it appear that abortion is hurting women rather than the lack of access to it.) Read more below:
Anti-Abortion Strategy
We’re going to stick with anti-abortion bullshit for a moment, because conservatives’ plan to shirk responsibility doesn’t end with covering up maternal death data. Back in February, I warned about ‘Med Ed’ bills, legislation designed to let Republicans pretend they care about women’s health while actually further embedding dangerous anti-abortion policies. At the time, I predicted we’d be seeing more of the bills—especially as more women suffered and died.
Right on cue, Susan B. Anthony Pro-Life America has released a memo urging states to pass Med Ed bills. They claim that pro-choice misinformation is scaring doctors out of providing life-saving care, and that the bills will clarify bans for doctors. Check out the kind of language they use in the memo:
“Protecting pregnant women should not be a contentious issue. Republican or Democrat, pro-life or pro-choice—we should all agree that putting women in danger for political purposes is wrong and should be put to an end.”
Shameless. Because here’s the reality: these bills have nothing to do with helping women and doctors. First and foremost, they’re a PR tool—legislation meant to create the illusion that Republicans are working hard to protect women and ensure doctors know they can provide life-saving care. More than that, these bills are a vehicle for codifying anti-abortion misinformation.
Take the first bill passed in South Dakota, for example. It required the state health department to publish an informational video and other materials offering ‘guidance’ to doctors about the state’s abortion ban. What it really did, though, was give anti-abortion groups the power to define what constitutes life-threatening conditions and life-saving care. (Can you imagine anything more terrifying?)
So when South Dakota released their video, we found out that it was created by the American Association of Pro-Life OBGYNs (AAPLOG)—a radical anti-abortion group that doesn’t believe abortion is ever necessary to save someone’s life or health. That’s who they got to tell doctors when and how to provide care.
In the video, South Dakota’s Secretary of Health Melissa Magstadt redefines abortion as an intention and says doctors can treat patients with life-threatening pregnancies through “maternal fetal separations.” Remember: that’s not an abortion, it’s a c-section or vaginal birth! (Sound familiar?)
In other words, they codified guidance to doctors that recommends they not give dying women abortions. It’s just another step toward eradicating exceptions for women’s lives, yet anti-abortion groups are using the legislative trend to pretend they’re protecting women. Everything these people do is incredibly fucked up, but this might take the cake.
In the States
North Dakota’s Supreme Court may bring back the state’s abortion ban, one of the strictest in the nation. The ban was struck down back in September by a judge who said the law “takes away a woman’s liberty and her right to pursue and obtain safety and happiness.” Judge Bruce Romanick’s ruling got straight to the point:
“The reality is that ‘individuals’ did not draft and enact the North Dakota Constitution. Men did. And many, if not all, of the men who enacted the North Dakota Constitution, and who wrote the state laws of the time, did not view women as equal citizens with equal liberty interests.”
But last week, solicitor general Phil Axt asked the state Supreme Court to put Romanick’s ruling on hold while the broader case is heard. In other words, they want to ban abortion while they’re fighting it out over whether to ban abortion.
This comes at the same time that a new poll shows that North Dakota voters decidedly do not want abortion banned in the state. A poll from the North Dakota News Cooperative found that the state’s ban only has 38% support, and that support among Republicans declined from 71% to 54% in just a year.
This is too bad: The San Antonio City Council in Texas may have approved a long-contested Reproductive Justice Fund, but the city’s $500,000 won’t actually go towards helping people leave the state for abortions. Instead, the money will go to less ‘controversial’ issues like sex education, birth control access, and STI testing.
Councilwoman Melissa Cabello Havrda said, “I know that it’s not enough for all of the need, but it’s a step in the right direction.”
The city council has been dealing with non-stop anti-abortion hate, with Republicans claiming the fund would violate Texas’ abortion ban—even though the money wouldn’t go towards abortion procedures, just the travel and logistics.
You may recall that Austin, Texas also recently approved a reproductive health fund: $100,00 to support out-of-state abortions. As expected, Attorney General Ken Paxton is suing over the money, calling it unlawful use of taxpayer dollars.
I’m following local efforts like this for two reasons: 1) We need our good news where we can get it, and I really appreciate the way that pro-choice city councils in anti-abortion states are trying to help. 2) There is so much anti-abortion activism happening on a local level, it’s vital to be paying attention.
Meanwhile, The City has a big piece on how Florida’s abortion ban has impacted New York, where patients from the Southern state are coming to get abortion care. Chelsea Williams-Diggs, executive director of the New York Abortion Access Fund (NYAAF), says that after Florida enacted its 6-week ban, her group “immediately saw a spike—a huge increase in Floridians traveling to New York to access abortion care.”
That’s why abortion rights organizations in the state are pushing for bills to strengthen the state’s shield laws, patient privacy, and more funding in the state’s budget.
Ballot Measures
The Missouri Independent has done a deep dive into some of the frustrations of Missouri reproductive justice activists around Amendment 3. As you know, the pro-choice measure passed earlier this month, and will protect abortion rights in the state until ‘viability.’ But as Abortion, Every Day has reported previously, not every reproductive rights organizer in the state was thrilled with the measure—largely because of that viability language.
The feeling (and it’s not wrong!) is that ballot measures that stop protections at ‘viability’ end up enshrining restrictions in the state constitution that impact the most marginalized groups. And that as difficult as our post-Dobbs reality is, we have the opportunity to build something bigger and better that Roe.
As reproductive justice activist Sandra Thornhill put it: “We have to shoot beyond the moon. We gotta shoot for the next galaxy.”
In response to Amendment 3’s passage, some activists have released an accountability plan, What’s Next, that calls for the measure’s legal strategy to “close all gaps that put Missourians who face the most barriers to abortion at risk.”
In case you need another reminder that Republicans don’t care about the will of voters, check out what’s happening in Ohio. Republican Attorney General Dave Yost wants to bring back parts of the state’s abortion ban—like waiting periods and ultrasound mandates.
Yost—best know around these parts as the guy who called the story of a 10 year-old rape victim a fabrication—campaigned against Issue 1, which voters passed to protect abortion rights in the state constitution. (He claimed, among other lies, that the amendment would allow children to get gender affirming surgery without parental consent, for example.)
The AG has also tried to roll back HIPAA protections in an attempt to be able to access patients’ out-of-state abortion records. So yeah, all around terrible person. I’ll keep you updated as the case moves forward.
Meanwhile, Arizona Gov. Katie Hobbs certified the Arizona for Abortion Access Act yesterday. Ballot measure organizer Chris Love said, “It’s a lovely day.”
The new amendment means that Arizona’s 15-week abortion ban is unconstitutional, though that law won’t be repealed right away. Activists have to bring lawsuits to overturn a whole slew of restrictions, from the ban to things like an ultrasound mandate. All of that will take some time.
That said, Arizona Attorney General Kris Mayes made clear, “The position of the state of Arizona will be that we agree that abortion is legal in our state.” That means abortion providers could theoretically give care after that 15-week cut-off without fear of prosecution—though some might not want to do so until the ink is dry on a legal repeal.
Something noteworthy: Gov. Hobbs was working to protect abortion rights even before the amendment passed. You may remember that last year, the governor granted AG Mayes with the authority to prosecute abortion cases, taking that ability away from district attorneys. It was essentially a way to ensure that no one was prosecuted for abortion ‘crimes’.
Republicans were furious and demanded that Gov. Hobbs rescind the order. She refused. Arizona’s abortion laws were also in the spotlight this year after the state Supreme Court ruled in favor of an 1864 abortion ban, sparking a national backlash.
Now that abortion is protected in the state constitution, you can be sure that anti-abortion activists will gear up to propose their own ballot measure to reverse the amendment.
For Abortion, Every Day’s coverage of the abortion rights ballot measure results on election night, click here.
In the Nation
States Newsroom has a good piece that breaks down how different federal agencies could attack abortion rights under a Trump administration. In addition to some of the attacks Abortion, Every Day has warned about before (like the Comstock Act), the Department of Justice could revoke or refuse to enforce the federal Freedom of Access to Clinic Entrances (FACE) Act, the federal law protecting clinics from violence; the Department of Health and Human Services could reverse EMTALA guidelines around emergency abortions; and the U.S. Departments of Defense and Veterans Affairs could reverse policies expanding abortion access for service-members.
NOTUS also looks at what’s likely to happen to abortion rights under Trump, namely the defunding of Planned Parenthood. Already, fuckboy extraordinares Elon Musk and Vivek Ramaswamy—who will both lead a new Department of Government Efficiency (DOGE) wrote an Wall Street Journal op-ed saying that they’ll target the “nearly $300 million to progressive groups like Planned Parenthood.”
Planned Parenthood president Alexis McGill Johnson responded by saying, “We’ve been here before—we are not new to shutdown and ‘defund’ fights.”
We can expect Trump’s administration to claim that they’re simply trying to stop the funding of abortions (which doesn’t happen). That’s why it’s vital that we’re repeating the truth again and again: defunding Planned Parenthood would be an attack on contraception, STI and cancer screenings.
Quick hits:
CNN reports taht the Trump team is trying to allay anti-abortion fears about RFK Jr.;
The 19th has recommendations for what President Joe Biden could do to protect abortion rights from the incoming Trump administration;
Salon reports on how TikTok is being inundated with misinformation about birth control;
And thank you to the inimitable Moira Donegan, who writes at The Guardian that we have to defend all abortions—not just the politically palatable ones.
Listen Up
Remember the mifepristone lawsuit brought by three Republican Attorneys General that Abortion, Every Day was the first to report on last month? This week, Slate’s “What’s Next” podcast does a deep dive into attack with The New York Times’ Linda Greenhouse:
Everyone should read Pro Publica’s investigation into the entirely preventable death of Porsha Ngumezi. Warning- you will be infuriated by what you read. Here are some of the points that left me feeling incredibly angry about Porsha’s care.
First- she was treated in the ER for over 6 hours. During that time her nurses documented that she was passing blood clots the size of grapefruits. Porsha had a clotting disorder so from the start she should have been identified as high risk. During her time in the ER she lost 20% of her total blood supply and had 2 blood transfusions. Yet the on call OB did nothing. At a later point he ordered misoprostal, which every expert who spoke to Pro Publica said is not the standard of care for a miscarriage and cannot work fast enough to control this level of bleeding.
Second- despite the fact that Porsha was in an unstable condition and was still bleeding profusely, the OB wrote an order for her to be transferred to a regular bed in the hospital. The ER nurse objected to this move saying she was concerned that Porsha would not receive the close monitoring she required. Once Porsha was transfered out of the ER, there was no further documentation of her continued blood loss. Additionally, Porsha complained of chest pain and shortness of breath yet no diagnostic tests were ordered. She died shortly thereafter.
Third- After Porsha’s death, the OB wrote a post-mortem note that directly contradicted the already documented notes from the ER nurse(s) stating that Porsha experienced heavy bleeding and was passing clots the size of a grapefruit. In his post-mortem note the OB wrote that Porsha’s bleeding was minimal.
I am writing as a former nurse practitioner who is enraged about the manner in which Porsha was treated and her ultimate death. It seems clear to me that the OB was trying to obscure some of his treatment errors by writing in his post-mortem note that Porsha was bleeding minimally when the chart already documented the severity of Porsha’s bleeding. I recognize that the Texas abortion ban has put physicians and other health professionals in a bind since they can be criminally prosecuted and, if found guilty, sentenced to up to 99 years in prison. Nearly every day we are learning of yet another preventable death of a woman who would still be alive today if they had received an abortion. I have reached the point where I am no longer willing to say…They (doctors) had no choice. Their hands are tied. Many OB’s have demonstrated they do have a choice. It’s not an easy or desirable choice- but there are choices. Many OB’s have left states like Texas because they were no longer willing to endanger their patients. Some have retired and others have stopped practicing obstetrics. None of this is optimal. But neither is withholding standard care and allowing patients like Porsha to die painful and preventable deaths.
These decisions make me hurt mentally and physically. They don’t even care about women when we die.