Texas Abortion Law: Future Impact And Implications

Abortion laws in Texas are some of the most restrictive in the US, with the state banning the procedure in most cases. The state's abortion laws do not provide an exception for cases of rape or incest, and the law is written ambiguously, leaving expecting mothers with health complications to leave the state or be forced to give birth while jeopardising their health. The state's abortion ban has been challenged in court, with a federal judge granting a preliminary injunction in February, blocking a limited number of prosecutors from going after anyone who helps a Texan travel out of state to terminate a pregnancy.

The impact on maternal mortality rates

Texas' abortion law, Senate Bill 8 (SB 8), bans abortion at around six weeks of gestation, which is before many people know they are pregnant. The law also does not allow exemptions for rape or incest.

The state's maternal mortality rate has spiked dramatically since the abortion ban went into effect in 2021. Between 2019 and 2022, the maternal death rate in Texas surged by 56%, while across the US, the rate rose by 11% during the same period. This increase in maternal mortality is even more pronounced for Black women, who are disproportionately impacted by abortion restrictions.

A study by Dr. David Eisenberg, a board-certified obstetrician-gynecologist, estimates that with the new law in place, Texas could see increases in maternal mortality of up to 15% overall and up to 33% for Black women in 2023. The study is based on previous research that established a clear link between abortion restrictions and maternal mortality.

Eisenberg's analysis also draws from his previous research published in Contraception, which found that abortion restrictions were associated with higher maternal mortality rates. The analysis showed a 6% increase in maternal mortality in states that restricted abortion access relative to neutral states, according to the Global Health Data Exchange. The CDC WONDER database showed an even more significant increase of 24%.

The impact of the Texas abortion law extends beyond maternal mortality rates. The law has forced abortion clinics to turn away patients, including those with high-risk pregnancies or facing homelessness and addiction. These patients must now make incredibly difficult choices as they seek alternative care, often having to travel out of state to receive an abortion. The average Texan must now drive 14 times farther than before to access an abortion.

The Texas abortion law is contributing to a crisis of maternal mortality in the state and across the US, particularly among women of color. The law's restrictions are resulting in increased maternal deaths, with a disproportionate impact on Black women, and are forcing patients to make challenging decisions about their pregnancies and their health.

The effect on women's health outcomes

Texas' abortion ban is having a significant impact on women's health outcomes, and the state's OB-GYN workforce is struggling to cope. The ban is affecting the pipeline of new doctors, with more medical students considering alternative specialities or moving out of state.

A survey of Texas-based members of the professional association American College of Obstetricians and Gynecologists found that more than 70% of practicing OB-GYNs in Texas feel the near-total ban has negatively impacted their work, prohibiting them from providing high-quality, evidence-based care for their patients. One in five have considered leaving Texas, and 13% are planning to retire early.

The state is expecting a significant shortage of OB-GYNs over the next decade, with some rural areas already unable to find the doctors they need. Texas already ranks 50th among states and the District of Columbia for women’s health, and maternal mortality increased in 2020 and 2021, before the state banned nearly all abortions. Infant mortality is also increasing faster than the national average, which researchers attribute to abortion restrictions.

The ban is also affecting the next generation of doctors, with medical students shying away from states that have banned abortion. While Texas has historically trained a large number of medical students, there is a risk that the abortion ban will "undermine its own investment". The directors of Texas-based residency programs surveyed by Manatt Health said they are still able to fill all their residency spots, but whether those doctors will stick around after finishing their programs is a different story. Almost 60% of surveyed residents said they were considering the new laws when deciding whether to stay in Texas after residency, and of that group, half said they were planning to leave as a result.

The legal status of abortion in Texas

The Texas abortion law, known as the Heartbeat Bill, prohibits physicians from performing abortions once a fetal heartbeat is detected, which is usually around six weeks into a pregnancy. This law creates a civil penalty of $10,000 for anyone performing an abortion after a fetal heartbeat is detected, and it allows any private citizen to sue for this amount, as well as court costs and attorney fees. Additionally, the law makes it a second-degree felony for anyone who "knowingly performs, induces, or attempts an abortion." The penalty is increased to a first-degree felony if the unborn child dies, punishable by five to 99 years in prison.

There are some exceptions to the Texas abortion law. For example, the law does not criminalize the woman who had the abortion but anyone who provided or aided in the procedure is open to criminal prosecution. Additionally, in certain medical emergencies, abortions may be permitted. For instance, if a pregnant person's life is in danger, an abortion may be allowed. However, the law does not provide exceptions for cases that involve rape or incest.

The Texas abortion laws have been challenged in court several times, with varying outcomes. For instance, in August 2023, a Texas judge granted a temporary injunction, allowing abortions in cases of medical emergencies, including pregnancies that are unsafe for the mother. On the other hand, the Texas Supreme Court has also upheld the abortion law in certain cases, such as in the Zurawski v. State case, where the Court ruled that the law's restrictions did not cause significant harm to women.

Overall, the legal status of abortion in Texas remains complex and highly restrictive. While there are some exceptions, the state's abortion laws effectively ban most abortions and impose harsh penalties on those who perform or aid in the procedure.

The role of the Supreme Court

The Supreme Court's ruling in Dobbs v. Jackson Women's Health Organization set a precedent that states could prohibit or restrict abortion access. Texas already had laws in place that aligned with this decision, including Senate Bill 8 (SB 8) and House Bill 1280 (HB 1280), collectively banning abortion at all stages of pregnancy without exceptions for rape or incest. The state also maintained that the criminal laws at issue in Roe v. Wade, though long-since held unconstitutional, remained in effect.

The Supreme Court's decision to overturn Roe v. Wade had a significant impact on the availability of abortion services in Texas, with organizations like Planned Parenthood no longer able to provide abortions within the state. However, they now help connect people to out-of-state abortion providers and offer resources for related expenses.

The Supreme Court has also been active in hearing appeals and providing rulings related to abortion laws in Texas. In one instance, they declined to intervene in a lower court order that hospitals cannot be federally required to provide pregnancy terminations when they violate the Texas abortion ban. This decision was a setback for opponents of the ban, including the Biden administration, who argued for a woman's right to emergency medical care.

The Supreme Court of Texas, the state's highest court, has also been a focal point in the abortion debate. Three Republican incumbents on the court are facing challenges from Democrats due to their role in recent abortion rulings. With abortion as a spotlight issue, Democrats see these races as an opportunity for Texas voters to influence the state's near-total abortion ban. However, it remains to be seen if this national fervor will significantly impact the traditionally Republican-dominated state Supreme Court.

The political implications

However, the law has also sparked widespread criticism and concern, even among some Texans. The law's lack of exceptions for pregnancies resulting from rape or incest, as well as its ambiguous language regarding life-threatening or harmful pregnancies, has been particularly contentious. This has led to a situation where expecting mothers with health complications are forced to leave the state or give birth while jeopardizing their health. The law also does not provide an exception for minors, which has resulted in an increase in teenage pregnancies and births.

The Texas abortion law has also had repercussions for the Democratic Party, providing a much-needed boost ahead of the challenging midterm elections. The issue of abortion rights has become a key campaign platform for Democratic candidates, such as Beto O'Rourke, who is seeking to unseat Governor Greg Abbott.

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