‘Women are dying’: Texas Offers a Glimpse Into the Future of U.S. Reproductive Healthcare

As the first in her family to graduate high school, attend college, and secure a corporate job, twenty-eight-year-old Kat believed she had broken her family’s cycle of generational poverty. 

“My mom and aunts were still kids themselves when they became mothers,” she said. “They worked so hard to give us better lives. I promised myself I wouldn’t bring a child into this world unless I was ready to provide them with stability.” 

When she marched at the Texas State Capitol in 2021 to advocate for reproductive rights, the first-generation American, whose family is from Central America, never imagined it would become a personal fight.

In 2023, Kat lost her job in tech for the second time, and she immediately went from making close to six figures to finding herself on food stamps. She made a vow to herself not repeat the patterns that impoverished generations of women in her family. 

But one day, despite taking precautions and Plan B within hours of unprotected sex with her partner, and despite the relief of starting her period days after, she decided to take a pregnancy test. To her shock, it came back positive. Her partner dismissed the severity of the situation. 

“He didn’t think it affected him,” she said. “That’s part of the problem — too many people think this fight isn’t theirs.” 

Kat, whose full name is withheld to protect her identity, believed she had no legal options in her home state of Texas. “I didn’t even feel safe considering Plan C,” she said, referring to a self-managed, at-home abortion medication, which is only legal to obtain in partnership with international nonprofits, such as AidAccess. 

“What if something went wrong? They would call the police before an ambulance,” said Kat.

Texas’ six-week abortion ban, known as The Heartbeat Act, was enacted in September 2021. It criminalizes terminating pregnancy at six weeks gestation —  a stage when healthcare professionals and advocates say many women may not even know they are pregnant. Through this law, physicians in Texas also risk fines of up to $100,000, the loss of their medical license, and a lifetime in prison if they are found to have violated the state’s abortion laws. At the time [the law] passed, it was the most restrictive abortion law in the country.

The state’s restrictions on reproductive healthcare have resulted in the preventable deaths of Porsha Ngumezi, Nevaeh Crain, and Josseli Barnia, to date. Texas OB-GYN Ghazaleh Moayedi notes that these women didn’t die because their conditions were untreatable; they died because doctors were too afraid to act in a system where the law doesn’t support evidence-based care. 

“This bill is 100 percent about putting fear in physicians and putting fear in abortion funds and intimidating us,” Moayedi says, noting that “every single hospital across the state has had to think about, What is near death? What’s our policy around near death? And what risks are we willing to take? Because it’s not clear.” ​

Austin-based OB-GYN Leah Tatum agrees: “The law is written in such an ambiguous way that there are always going to be cases where you're apprehensive about providing that care​, because no one wants to end up in criminal court.” 

Legal experts note “the ambiguity of​ Texas Medical Board’s proposed rules not only complicates potential compliance but also places potential burdens on health care providers who are committed to delivering urgent, life‑saving care.​”

As a second Trump administration approaches in January, advocates warn these shifts in Texas may also threaten access to contraception care and Affordable Care Act subsidies nationally. Influential Pro-Life groups like the Heritage Foundation lobby to “explicitly reject the notion that abortion is healthcare” in a broader push for federal abortion restrictions. 

“If Congress were to adopt a law prohibiting abortions, that would preempt state laws to the contrary,” said Erwin Chemerinsky, Dean of Berkeley Law. A federally codified ban could override state protections. In other words, what’s happening in Texas would no longer be an exception — it would become the rule.

For women like Kat, it’s more than policy; it’s a lived reality. 

“It was the most heartbreaking thing I’ve ever been through,” she said, referring to the weight of her decision and the reality that the only legal way for her to obtain an abortion was to travel out of state. When her partner suggested they explore options closer to home instead of traveling to Colorado, where abortion is legal, she laughed. “There aren’t any,” said Kat. 

Even with the support of family and friends, tools like therapy and meditation, and resources to offset costs, Kat struggled with isolation and hormonal lows for months after her procedure. “I felt like I was drowning."

Many Texas lawmakers frame abortion restriction policies as moral imperatives. Texas Senator Ted Cruz called overturning Roe v. Wade “nothing short of a massive victory for life” and Texas Governor Greg Abbott said the laws “protect innocent lives.” The policies also incentivize citizens to sue anyone who “aids or abets” an abortion, which advocates warn creates a fear-based norm where neighbors effectively act as bounty hunters, with a $10,000 reward. 

Legal scholars like Carol Smart say that the narrative of morality is a smokescreen. As a native Texan with a Christian upbringing in a conservative Texan town, Kat agrees, “it’s about power, not protection.”  Kat said the 2024 election “sent a message to the U.S. and the world that it’s okay to stomp on women. The real sin,” she said, “is bringing a child into the world you can’t care for.” 

When it comes to policy, what happens in Texas does not stay in Texas. Today, the state ranks 50th in the nation for women’s health. Moayedi argues the state is positioned to become a blueprint for federal actions:

“[The heartbeat law] has not only caused a near total abortion ban in Texas, it has also made it extremely dangerous to be pregnant in our state, where maternal morbidity and mortality is already unconscionably high, especially for black women and pregnant women of color.”

According to a recent Texas OBG-YN Physician Workforce survey, treatments that were once routine for the health and safety of a mother and her child, such as prescribing medication for a miscarriage or performing necessary procedures, now put doctors at risk of a felony and a lifetime in prison. 76 percent of physicians believe that they cannot practice medicine according to the best practices of evidence-based medicine. 60 percent fear legal repercussions.

States like Oklahoma, Florida, and Idaho have enacted similar policies. Meanwhile, clinics in states like New Mexico and Colorado, where Kat found support, are overwhelmed by an influx of patients fleeing Texas. 

“We’re seeing women travel 500 miles or more for care,” said Emily Briggs, a former Texas OB-GYN. “But resources are finite. If more states adopt these laws, the system will collapse.” 

The demand not only delays care for local residents, it also exacerbates socioeconomic inequality. Traveling for care means taking on costs for flights, hotels, and childcare. Women who are denied an abortion are four times likelier to fall into poverty, facing higher rates of eviction, financial distress, and bankruptcy.

Without access to prenatal care or procedures, many are now forced to carry dangerous pregnancies to term. A study by the Journal of the American Medical Association revealed a 13 percent increase in infant mortality in Texas since the heartbeat law went into effect.

Rates of maternal mortality and morbidity are rising nationwide, with deaths among women aged 15 to 44 disproportionately concentrated in the southeastern U.S. where abortion laws are more prohibitive. More than 2.3 million women of childbearing age live in areas with no access to birthing facilities or maternity care providers, also referred to as “maternity care deserts.” According to the March of Dimes’ 2024 Maternity Care Deserts Report, up 46.5 percent of counties in the state of Texas limit access for pregnancy-related complications, chronic illnesses, or other treatable issues. 

“Women are dying, but that’s still not enough to move the needle,” Kat said. “If [the policy makers] are fighting this hard to control our bodies, it must be because they are scared,” she said. “The biggest problem of all is a lack of compassion in humanity. Why are they afraid of us making our own decisions?” 

The struggle for reproductive justice isn’t new, but the stakes are rapidly escalating. Since the Supreme Court overturned Roe v. Wade in 2022, the U.S. has become a global outlier on reproductive rights: it is one of only three other countries, including El Salvador, Nicaragua, and Poland, that has repealed abortion rights in recent years.

The tragedies of preventable deaths in Texas mirror those in Poland, whose near-total ban has led to fatal outcomes. The UN Committee on the Elimination of Discrimination Against Women notes that Poland’s “doctors [are] hesitating to perform abortions due to fear of criminal liability or on moral or religious grounds, making it challenging for women to access safe abortion services.”

Committee Vice-Chair Genoveva Tisheva said “the situation in Poland constitutes gender-based violence against women and may rise to the level of torture or cruel, inhuman, or degrading treatment.” She adds that “these factors create a complex, hostile and chilling environment in which access to safe abortion is stigmatised and practically impossible.” During the same time period, 59 other countries have expanded abortion rights. 

“I’ve always wanted to keep the peace,” Kat said. “But then I wondered — whose peace am I keeping? The peace of people who think I’m a criminal for making a choice about my own body?”