Image copyright Getty Images Image caption Texas legislators passed a raft of controversial abortion restrictions
Texas is one of five states – the others are Mississippi, Alabama, Nebraska and South Dakota – whose abortion laws may lead to increased maternal mortality rates, a nationwide study has found.
This is because the rates of preventable maternal deaths in these states are lower than in the rest of the country.
The study’s authors call the four leading pregnancy-related killers – smoking, not breastfeeding, a prior pregnancy and unsafe home births – “race-specific, modifiable, preventable health issues”.
Because of their higher rates of air pollution and less widespread internet access, non-Hispanic black women are three times more likely to die from pregnancy-related causes.
But among the six states that have some restrictions on abortion, Texas is a large exception.
Texas’ self-imposed abortion restriction law – HB2 – was thought to have the potential to take 100,000 or more women off of reproductive-age women’s health services and reduce the number of births in the state by thousands.
The trial of that law was ruled unconstitutional and the judge was only partially able to declare it unconstitutional, saying other aspects of the legislation posed a sufficient obstacle.
Lawmakers then passed a new law that went much further, outlawing abortions even when the woman’s life is not in danger.
The new law is set to go into effect on 5 September, or when a doctor concludes it poses an immediate, serious threat to a woman’s health.
Photo: AFP / Getty Images
Previous research has found that women who undergo abortions in Texas are about as safe as the national average.
If the new law goes into effect, and women in the state have to walk into clinics or have an abortion at home instead, more complications could be reported to hospitals.
What does research tell us?
In a recent National Review Online piece, Texas journalist Joseph Farah argues that even prior to HB2, the state’s abortion rates had been increasing.
In 1990, 4.9% of Texas women between the ages of 15 and 44 had an abortion, versus 3.5% by 2014.
Despite the rate increase, researchers say it is hard to be certain what is caused by the increase in Texas, and that instead of detecting a public health problem, HB2 may be helping it grow.
In his piece, Dr Farah points to recent data from the Centers for Disease Control and Prevention (CDC) which shows that national rates for unintended pregnancies have been decreasing and that the number of unintended pregnancies were recorded in the first trimester fell from 39% in 2009 to 32% in 2014.
Dr Alan Ferber, an assistant professor at the University of Texas MD Anderson Cancer Center and co-author of the study from the Yale School of Public Health, says the researchers calculated the decline in unintended pregnancies through their use of the Census Bureau’s Current Population Survey.
“We wanted to know the women who had abortions before and after the new law. Then we wanted to see if there was any increase in the numbers who do so after the law,” he says.
The study found a small increase of 518 abortions compared to a national average of 58,781 abortions in 2009 to 2013.
But Dr Ferber says the increase may be due to more women finding safe methods of abortion in Texas.
Though many anti-abortion groups continue to say that the new law would reduce the number of abortions, it was never a direct argument in favour of it being imposed on Texas’ women, Dr Ferber says.
“Because women in Texas use other methods than abortion before the law was passed, it’s hard to be certain what changes in the practice are caused by the law.”
From unintended pregnancies to unsafe home deliveries
Another study found that some women continue to go through with a planned home birth after being denied a provider at their local health centre, even if they could not afford the surgery.
More than 6,000 women died in the USA last year from complications following unsafe home deliveries, the study revealed.
According to Dr Ferber, women went through the home delivery method primarily out of desperation as they could not afford healthcare on the NHS, or they couldn’t take time off work or lose their jobs.
“One woman told us that her husband would hear her whining when she was in labour and he would have to address it, but he did not want to and she could never get him to stop listening,” Dr Ferber explains.
The study highlighted a major limitation in maternity care – this limitation did not account for factors such as home birth consulting teams, midwives or physical barriers to giving birth in the home, like separate bathrooms and utility outlets.