On Monday, Texas Attorney General Ken Paxton announced the arrest of Houston-area midwife Maria Margarita Rojas for allegedly providing abortion care under the state’s extreme ban and “illegally” operating a network of clinics. The 48-year-old was charged with a second-degree felony punishable by up to 20 years in prison, as well as practicing medicine without a license, which could mean up to a decade in prison and fines totaling $10,000. Two of Rojas’s work colleagues, Jose Ley, 29, and Rubildo Labanino Matos, 54, a nurse practitioner, were also arrested in connection with Paxton’s investigation.

The arrests mark the first criminal charges brought under the state’s abortion ban and appear to be the first criminal arrests in a banned state since the conservative bloc of the US Supreme Court overturned Roe v. Wade in 2022.

Despite the fact that Texas has seen a significant increase in pregnancy-related deaths and near-death experiences, as well as an increase in infant mortality, since the implementation of its near-total abortion ban in 2021, Paxton claimed that the state sees “life” as “sacred” in his statement announcing the arrest. “I will always do everything in my power to protect the unborn, defend our state’s pro-life laws, and work to ensure that unlicensed individuals endangering the lives of women by performing illegal abortions are fully prosecuted,” added Paxton. “Texas law protecting life is clear, and we will hold those who violate it accountable.”

Texas enforces one of the strictest abortion laws in the country, which offers no carve-out for rape, incest, or severe fetal abnormality. The state’s vague language on what constitutes a medical emergency has cast fear among doctors who want to avoid hefty fines and jail time and led some to jeopardize care or not intervene in life-threatening situations, wreaking havoc and tragedy on pregnant Texans, whose lives were in danger after being denied abortion care and suffering hemorrhaging and the loss of reproductive organs.

The flood of dire and harrowing consequences due to the state’s extreme abortion ban hasn’t relented: The 2021 law directly led to a rise in infant deaths while a recent analysis from ProPublica found that following the state’s first ban, sepsis rates rose more than 50 percent for patients who experienced a second-trimester pregnancy loss in Texas hospitals. This fall, ProPublica also reported what has long been both feared and expected by healthcare professionals, who have seen maternal mortality rates dramatically rise: Three pregnant women died after doctors waited to treat their miscarriages. Medical experts interviewed concluded that their deaths were preventable.

Midwives, like Rojas, typically offer holistic reproductive health care during pregnancy, labor, delivery, and postpartum. Some patients may require abortion and miscarriage care, but under the state’s bans, midwives have been forced to navigate policies that add greater risk to their patients’ health and well-being. And as the bans push more Texans into forced pregnancy and the potential for added complications, the need for abortion care has anything but dissipated: Despite the restrictions, thousands of people in banned states have continued to order abortion pills online or traveled out of state for care.

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Rojas allegedly “attempted abortion” on a person experiencing a nonviable pregnancy identified as “E.G.” by giving them abortion pills on two separate occasions in March; she was first arrested on March 6 for allegedly practicing medicine without a license and given a $10,000 bond. A friend of Rojas tells the media that when Rojas was arrested earlier this month while driving to one of her clinics, she was “pulled over by the police at gunpoint and handcuffed” and that the police “wouldn’t tell her what was happening.” While the state suggested both Rojas and Ley be held on a staggering $1 million bond, a local judge has set the figure at $500,000 for abortion-related charges and $200,000 for the medical license charges. The case is expected to head to a grand jury next to consider indictment.

The Texas attorney general doesn’t technically have power to enforce criminal law, but he can do so if a local district attorney requests it. In this instance, Paxton coordinated the charges with the help of conservative Waller County District Attorney Sean Whittmore, who said Paxton’s office approached him with the case two months ago, after a complaint was filed with the Texas Health and Human Services Commission; investigators later began to surveil the clinics. Whittmore is a Paxton stalwart, having worked for the attorney general in Houston and appointed by the AG to special prosecutor.

While shocking, the news for those in Texas feels painfully inevitable. The state’s aggressively anti-abortion AG has been steadily escalating his threats toward abortion providers for years. In 2023, when a 31-year-old woman with a nonviable pregnancy needed emergency abortion care, Paxton threatened to prosecute “hospitals, doctors, or anyone else” who would assist in providing the procedure. He sued the Biden administration when it pushed to ensure that the Emergency Medical Treatment and Labor Act—a federal law meant to protect emergency care—would apply to abortions in states that have banned the care. And last year, he led the charge to evade HIPAA laws in order to access out-of-state abortion medical records. Recently, Paxton filed a civil lawsuit against New York–based doctor Margaret Carpenter, for allegedly sending abortion-inducing drugs to a North Texas woman. (A Texas judge fined Carpenter $100,000 in penalties while Louisiana officials indicted her on felony charges. With a shield law in place, New York Governor Kathy Hochul has resisted attempts to extradite the physician. Despite the indictment, doctors in abortion-legal states continue to help those in banned states access pills via telemedicine.)

The arrests could still instill a chilling effect on all health workers in the state and of course, their patients as well, says Dr. Ghazaleh Moayedi, a longtime Dallas-area ob-gyn who offered abortion care to Texans prior to the bans. The latest move is a continuation of Paxton and other state officials’ zealous crusade to punish and elicit fear among anyone offering—or receiving—the full spectrum of reproductive health care support, she says.

“Community healthcare workers—from midwives, to doulas, to nurses—are critical to patients in Texas, especially under these draconian abortion bans, and relied on by thousands and thousands of people to deliver safe reproductive care,” says Moayedi, who also serves as board chair with Physicians for Reproductive Health. “While some of the details of the case remain in question, it is clear that this is an attempt to scare away the people who need abortion and those who provide them.”

Moayedi also believes that the arrests appear to be a targeted attack with possible anti-immigrant sentiment. In a press release, Paxton alleges Ley “entered the U.S. illegally in 2022” and curiously inserts the fact Matos was arrested after returning to the US from Cuba. At her three Clinica Latinoamericana locations, Rojas—who was born in Peru and practiced obstetrics there before immigrating to the United States—offers low-cost healthcare services for largely Spanish-speaking, low-income clients.

Immigrant communities face steep barriers to healthcare, including the increased risk of criminalization based on citizenship status. Traveling out of state for care can mean risking detention, family separation, or deportation.

“It is not surprising to me that the first person to be arrested under these charges is a woman, a midwife, and a person of color who serves immigrant communities,” Moayedi says. “It’s telling that Paxton has targeted someone who is showing up for the Spanish-speaking community amid the intersecting oppressions of the state and national government’s anti-abortion and anti-immigrant extremism.”

Local activist D’Andra Willis, of the Afiya Center, a North Texas reproductive justice group, echoes the point, saying Rojas’s arrest is a strike at the heart of communities of color who have historically relied on midwifery as an alternative to the institutional routes that often perpetuate healthcare inequities. She points out that the United States has a long history of targeting and smearing midwives.

“Midwifery is not just a healthcare practice, it is a cultural and indigenous practice for people of color,” says Willis. “For good reason, the traditional healthcare system has sowed distrust among these communities and midwives continue to be trusted allies for those of us who are marginalized or dismissed in these typical settings.”

Her organization works with several community midwives who help clients through their pregnancies, from offering prenatal visits to assisting with labor. “For them, there is now even more fear of the unknown after these arrests,” says Willis. “But sadly, all of us in the reproductive rights space here in Texas have been living under so much fear for so long. We will continue to do our work, and won’t stop regardless.”

While the case progresses and the potential for more abortion-related arrests in Texas and elsewhere lay on the horizon, as well as a slew of bills filed this legislative session targeting abortion pills, Moayedi urges the public to be critical of the framing—and any information—dispensed directly from the state and law enforcement officials, like Paxton.

“It’s important to remember not to play into or blindly buy the authoritarian and anti-abortion narrative of state officials when it comes to charges like this,” she says. “We have to keep in mind this basic truth for a reason, especially in these terrifying times: Everyone is innocent until proven guilty.”