Texas committee won’t examine maternal deaths in first years after abortion ban

The Texas committee that examines all pregnancy-related deaths in the state will not review cases from 2022 and 2023, the first two years after Texas’s near-total abortion ban took effect, leaving any potential deaths related to abortion bans during those years uninvestigated by the 23 doctors, medical professionals and other specialists who make up the group.

In a September meeting, leaders of the Texas Maternal Mortality and Morbidity Review Committee said the change was made to “be more contemporary” - allowing them to skip over a backlog of older cases and review deaths closer to the date when they occurred, and therefore offer more relevant recommendations to policymakers.

“In 2024, the committee provided recommendations based on findings from maternal deaths that occurred in 2020,” Jennifer Shuford, the commissioner of the Texas Department of State Health Services, wrote in a September letter about the decision. “I am concerned that this means the committee’s recommendations to policy makers are still not based on the most recent case cohorts available.”

But in interviews with The Washington Post, several members of the committee expressed concern that they would not be reviewing deaths that may have resulted from delays in care caused by Texas’s abortion bans. The first ban took effect in September 2021, outlawing abortion after six weeks of pregnancy. Texas banned all abortions with limited exceptions when Roe v. Wade was overturned the following June.

At least three women have died in Texas because of delays in care related to the abortion bans, according to reporting from ProPublica.

“If women are dying because of delays, and we have this huge new policy in Texas that affects their lives, why would we skip over those years?” one member of the Texas maternal mortality committee said, speaking on the condition of anonymity out of fear of retribution from government officials. “I’m worried.”

The Texas maternal mortality committee by design does not review cases of deaths in which the woman died in the course of trying to get an abortion. But the abortion bans have restricted the ability of doctors and hospitals to provide critical care to women experiencing miscarriages or other pregnancy complications - situations that would trigger a review by the committee if a woman died.

None of the members interviewed from the Texas maternal mortality committee said they had heard anything to suggest that the decision was an attempt to cover up potential deaths related to abortion bans. The committee has skipped years in the past, leaders said at the September meeting - jumping forward a few years after 2013 to review cases closer to the present day.

Chris Van Deusen, director of media relations at the Texas Department of State Health Services, pointed to Shuford’s September letter to explain the decision to skip over 2022 and 2023, adding that the case review process is “not the only tool we have for understanding maternal health.” The department also works with epidemiologists who publish data on maternal mortality, he added.

In the more than two years since Roe v. Wade was overturned, many stories have surfaced in the media of women with high-risk pregnancy complications being denied care because of new abortion laws - situations that have left some in critical condition and resulted in at least five deaths. While all abortion bans include some version of an exception for the life or health of the mother, doctors say those exceptions are overly vague and hard to interpret in a high-stakes emergency-room setting when decisions must be made quickly.

Antiabortion advocates argue that the laws are clear - and that doctors should feel free to provide care in emergency situations. The largest antiabortion group in Texas called the reports of deaths resulting from abortion bans “misleading.”

Maternal mortality committees - groups largely made up of medical professionals that review cases of maternal deaths in every state - will offer the first big-picture look at how often women are dying because of delays in care related to abortion bans. They examine the potential causes of pregnancy-related death, typically interrogating whether each death was preventable. Many operate on a two-year lag, meaning that some committees are just now starting to review cases that could be impacted by abortion laws that took effect when Roe fell in June 2022.

As the first and largest state to implement a strict abortion ban, Texas can offer broader insight into the impact of abortion bans than any other state in the country.

The number of women who died while pregnant, during labor or in the year after giving birth surged in Texas in 2020 and 2021, the most recent years when maternal mortality data is available in state reports - rising from 17 maternal deaths per 100,000 live births in 2019 to 38 deaths per 100,000 live births in 2021, according to the maternal mortality committee’s report published earlier this year. Experts have attributed much of that increase to the covid pandemic, though studies suggest the abortion ban in the second half of 2021 also could have played a role.

Veronica Gillispie-Bell, an OB/GYN and national expert on maternal health, called the Texas committee’s decision not to examine cases from 2022 and 2023 “bewildering.”

“Maternal mortality review committees are hugely important,” said Gillispie-Bell, who has worked with such committees for years. “It’s the difference between just having the numbers and digging down in the data to understand the numbers.”

The idea that the Texas committee would need to skip two years of cases to be more up-to-date in its review “doesn’t sound like an explanation that makes sense,” she said.

The Texas committee has faced other controversies in recent months.

Earlier this year, Shuford appointed Ingrid Skop, an OB/GYN and national antiabortion advocate, to join the committee - a decision that prompted a national outcry from abortion rights advocates. Skop is the vice president and director of medical affairs for the Charlotte Lozier Institute, the research arm of Susan B. Anthony Pro-Life America, one of the country’s largest antiabortion organizations. In a high-profile case that aimed to revoke the decades-old approval of a key abortion drug, Skop made claims about the dangers of abortion pills that have been disputed by leading medical associations.

Shuford, an epidemiologist, was appointed to her position by the head of the Texas Health and Human Services Commission, who was appointed by Republican Gov. Greg Abbott. Abbott signed the first Texas abortion ban into law in 2021.

Skop said her appointment reflected her interest in promoting maternal health. “Preventing maternal mortality should not be a political or ideological issue, and any attempt to do so distracts us from finding real solutions to this serious issue,” she said. “I’m proud to continue advancing quality care for mothers so that no family must face the devastation of maternal death.”

Other maternal mortality committees in states with abortion bans have faced significant turbulence since the fall of Roe. In Idaho - a state with a near-total abortion ban - the Republican-led legislature dissolved the state’s committee in 2023. While the committee was reestablished with a law passed earlier this year, the situation has resulted in significant delays in the review process.

And in Georgia last week, the state’s public health commissioner dismissed all members of the state’s maternal mortality committee after ProPublica obtained confidential information about two deaths that occurred in the state, where abortion is banned after six weeks of pregnancy.

“Even though this disclosure was investigated, the investigation was unable to uncover which individual(s) disclosed confidential information,” Kathleen Toomey, commissioner of the Georgia Department of Public Health, wrote in a November letter to the committee. “Therefore, effective immediately the current MMRC is disbanded, and all member seats will be filled through a new application process.”