Since Texas the Senate bill banning abortion (SB 8) went into effect in September, the three full-spectrum doulas that work with the Dallas-based based Afiya Center have seen a troubling rise in the number of women forced to continue their pregnancies after being blocked from accessing abortion care. Women at 15 and 20 weeks of pregnancy, some of whom are victims of domestic violence, are having parenthood imposed upon them with little choice.
“It’s been very traumatic for these women who are forced to carry a child and eventually bring it into this world knowing for certain that is not what they want or what they can handle—financially, emotionally, or logistically,” Cerita Burrell of the Afiya Center tells The Nation. “Many of these women are struggling to just sustain themselves or their families.”
The most draconian abortion law in the United States, SB 8 bars care after about six weeks of pregnancy with no exception for rape or incest, making the procedure inaccessible to the overwhelming majority of abortion-seeking patients in Texas. (And as of December, in addition to SB 8, Texans have been barred from the use of abortion-inducing pills after seven week of pregnancy, despite US Food and Drug Administration guidelines that state they are safe to use for up to 10 weeks.)
The radical law, designed to evade judicial review, also dangerously shifts enforcement from the state to private citizens empowered to sue anyone who “aids and abets” care. Last month, the US Supreme Court failed to block the law and diluted the power abortion providers have to legally challenge the measure. It now stands at the doorstep of the conservative US Court of Appeals for the Fifth Circuit, where a three-judge panel will decide if the case heads to the Texas Supreme Court—seen as a “delay tactic” by Texas officials aiming to prolong the law—or gets sent to a lower court, where it may have less chance of survival, as requested by abortion providers.
In effect for more than four months, the law has decimated abortion access in the second-largest state in the country, forcing pregnant people who are unable to obtain an abortion in their home state to travel hundreds, if not thousands, of miles for safe medical procedures. And that’s only those who can obtain the resources to afford travel, lodging, child care, and time off work to make the trip. Low-income people and people of color, who comprise nearly 75 percent of abortion-seeking patients in Texas, bear the greatest burden when it comes to access, and are most likely to continue unwanted pregnancies against their will, as the 10-year Turnaway Study found.
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Afiya, the North Texas reproductive justice organization that centers its work on supporting Black women and girls, is “deeply worried” about the impact of forced birth under SB 8 on the lives of the population it serves. The law, it cautions, will create a “wave of death” by further perpetuating the rate of maternal mortality and morbidity, already disproportionately high among Black women and other women of color.
The United States holds the highest maternal death rate among similarly developed countries and stands as the sole industrialized nation where those deaths are increasing. Black and American Indian women are two to three times more likely to die from a pregnancy-related cause than white women, according to the Centers for Disease Control and Prevention.
And in Texas, that dire rate is above the national average, at 18.5 deaths per 100,000 live births. According to the state’s Maternal Mortality and Morbidity Review Committee, Black women in Texas are “disproportionately” affected by this crisis, accounting for 11 percent of live births but 31 percent of maternal deaths. Finding that roughly one-third of pregnancy-related deaths in the state occurred 43 days to a year after the end of pregnancy, the committee has long strongly recommended extending postpartum Medicaid coverage from two months to a full year in order to save lives. They found that nearly 90 percent of these overall deaths could have been prevented. The leading underlying causes of mortality with the highest chance of preventability were infection, hemorrhage, preeclampsia, and cardiovascular conditions; by prolonging vital health coverage for people who’ve recently given birth most of these cases could be averted, maternal health experts stress.
However, in 2021 the Republican-dominated legislature, with little explanation, sliced a Democratic-filed proposal to extend coverage after childbirth from one year to only six months, falling short of what experts point to as the best solution. During the same legislative session, Republicans passed SB 8, effectively barring nearly all abortion care, creating a perfect storm of dire consequences, say advocates.
“If you are a Black woman, giving birth can literally kill you in the state of Texas,” says Burrell. “Now we have a law that is forcing these potentially dangerous births, which could increase this death rate. We are very concerned as an organization.”
New research appears to bolster that anxiety from Texas advocates. An October study published in the academic journal Demography found that abortion bans would lead to a 21 percent rise in the number of overall pregnancy-related deaths—and a 33 percent increase in such deaths among Black women. While much of the focus on abortion-related deaths center on so-called unsafe and unregulated “back-alley” abortion, less attention has been paid to the risks of staying pregnant: Pregnancy is found to be about 14 times deadlier than abortion care.
“While abortion has become even safer over the years, staying pregnant has tragically become more dangerous in the US,” study author and University of Colorado professor of sociology Amanda Stevenson tells The Nation. “So when you deny people the opportunity to have a safe abortion procedure and replace it with the higher risk of continuing pregnancies, more people are going to die.”
While pregnancy-related deaths would increase for all races and ethnicities, non-Hispanic Black people would experience the greatest increase in deaths, Stevenson found. The projections in her study can “absolutely” be applied to the Texas law, she says. “Those who already face the greatest barriers to health care will experience the most elevated risk under an abortion ban.”
Adding to the worry, reproductive health activists point to the myriad ways Texas fails to systemically support its most vulnerable. The state holds the highest rate of uninsured residents in the United States as well as the highest rate of uninsured women of childbearing age. State officials have continually failed to expand Medicaid under the Affordable Care Act for poor adults and have made it a mission to exclude Planned Parenthood patients from the federal program, severing access to basic preventive care like birth control and cancer screenings for thousands of low-income women. Meanwhile, social support programs like WIC, TANF, and SNAP are “overburdened or not fully funded,” say advocates on the ground.
And, as the state braces for an increase in forced births, the Texas foster care system faces a long-standing state of crisis. Some children have been forced to sleep on office and hotel room floors while others have been subject to physical and sexual abuse, groomed for sexual trafficking, or have even gone missing.
Kamyon Conner, executive director of the Texas Equal Access Fund (TEA), a North Texas abortion fund that serves largely Black clients, stresses that even before callers were faced with several barriers to basic health care and social support in the state—SB 8 has only exacerbated those obstacles. Systemic racism and racial bias in medical delivery, which the Texas legislature failed to take action on, compounds the problem for women of color.
TEA is ramping up its funding to help clients obtain abortion care out of state, but, like all Texas abortion funds, it is unable to fully meet the demand: Of the 4,328 helpline calls received in 2021, the organization was able to fund 1,460 people. The majority (70 percent) of TEA clients are low-income women of color and 62 percent are already parents. Conner’s concern for those who cannot access care is twofold: She worries about the dangers of giving birth to an unplanned pregnancy in Texas and the lack of a safety net for new children and parents.
“We are living in a state that is forcing people to have children but at the same time not providing them with the support they need to give birth as safely as possible or live healthy lives as new moms so they can take care of their families,” Conner tells The Nation. “And there isn’t much thought given to what happens after the child is born. This is all just going to create more unnecessary deaths and more cycles of generational poverty down the line.”
