Texas’ abortion restrictions – the strictest in the country – could lead to a sudden increase in infant mortality as women are forced to carry non-viable pregnancies to term.
Nearly 2,200 infants are expected to die in Texas in 2022, according to preliminary infant death data CNN obtained through a public records request — an increase of 227 deaths, or 11.5%, from the previous year. Infant deaths due to severe genetic and birth defects increased by 21.6%. That boom reversed a nearly decade-long decline. Infant deaths have declined by about 15% between 2014 and 2021.
In 2021, Texas abortion banned more than six weeks of pregnancy. When the Supreme Court overturned federal abortion rights the following summer, a trigger law in the state banned all abortions other than those performed for the purpose of protecting the life of the mother.
The increase in deaths can be partly explained by the fact that more babies are being born in Texas. A recent report found that in the last nine months of 2022, the state saw nearly 10,000 more births than before the abortion ban — an estimated 3% increase.
But several obstetrician-gynecologists who focus on high-risk pregnancies told CNN that Texas’s strict abortion laws likely contributed to the increase in infant mortality.
“We all knew that infant mortality would increase, because many of these abortions were for pregnancies that did not turn into healthy normal babies,” said Dr. Erika Werner, chair of obstetrics and gynecology at Tufts Medical Center. “This is exactly what we were all worried about.”
The issue of coercing women into terminal and often high-risk pregnancies is at the core of a lawsuit filed by the Center for Reproductive Rights, in which several women — who suffered difficult pregnancies or infant deaths soon after giving birth — are testifying in Travis County court this week.
Prior to the most recent abortion restrictions, Texas had banned the procedure after 20 weeks. The law gave parents more time to learn important information about fetal brain formation and organ development, which doctors begin testing at about 15 weeks.
Samantha Cassiano, the plaintiff in the lawsuit filed against Texas, wanted more time to decide.
“If I would have been able to have an abortion at that point, I think it would have meant a lot to me because my daughter wouldn’t have been harmed,” Cassiano told CNN after testifying Wednesday.
When Cassiano was 20 weeks pregnant, a routine scan brought devastating news: her baby would be born dead or die soon after birth.
The fetus had anencephaly, a rare birth defect that prevents the brain and skull from developing during pregnancy. Babies with this condition are often born dead, although sometimes they live for a few hours or days. Two obstetrician-gynecologists told CNN that many women across the country who face this prospect choose abortion.
But Cassiano lived in Texas, where state legislators recently banned most abortions after six weeks of pregnancy. She could not afford to travel out of state for the procedure.
“you have no choice. You have to get over your pregnancy,'” Cassiano’s doctor told her, she claimed in the lawsuit.
Cassiano gave birth to their daughter, Halo, in March. The baby died after having stopped breathing for four hours, Cassiano said during his testimony on Wednesday.
“She could just be struggling to get air. I wanted to see my daughter turn from pink to red to purple. From hot to cold,” Cassiano said. “I just kept telling myself and my baby that I’m so sorry this happened to you.”
Cassiano and 14 others — including two doctors — are plaintiffs in the lawsuit. They allege that the abortion ban has denied them or their patients access to essential obstetric care. Plaintiffs are asking the courts to clarify when doctors can grant medical exemptions to the state’s ban.
Cassiano and two other plaintiffs testified Wednesday about having expected to give birth to healthy babies, but instead learned that their lives or pregnancies were in danger.
“It was supposed to be just one scan day,” Cassiano told the court. “I am deeply saddened to learn that my daughter is about to die.”
Lawyers representing the state argued Wednesday that the plaintiffs’ doctors were to blame, saying they misinterpreted the law and failed to provide adequate care for such high-risk pregnancies.
An attorney said during the state’s opening statement, “Plaintiffs will not and cannot provide any evidence that any medical provider has been prosecuted or punished for performing an abortion using an emergency medical exemption in the State of Texas.”
Another plaintiff, Kylie Beaton, also had to watch her child die. According to the suit, Beaton, who did not testify this week, learned during a 20-week scan that something was wrong with her baby’s brain.
The doctor diagnosed the fetus as suffering from alobar holoprosencephaly, a condition where the two hemispheres of the brain do not separate properly. Babies with this condition are often stillborn or die soon after birth.
Beaton’s doctor told her that he could not perform an abortion unless she was gravely ill, or the fetal heart had stopped. Beaton and her husband sought out-of-state abortions. However, the fetal head was enlarged due to her position, and the only clinic that performed the abortion charged up to $15,000. Beaton and her husband could not afford it.
Instead, Beaton gave birth to a son whom she named Grant. According to the suit, the baby cried constantly, would not eat and could not be lifted upright for fear that it would put too much pressure on his head. Four days later, Grant died.
Experts say that abortion restrictions in states like Texas increase the risk to both babies and mothers.
Maternal mortality has long been a top concern for doctors and health-rights activists. One study found that even before the Supreme Court decision, the United States had the highest maternal mortality rate among wealthy nations.
Amanda Zurawski, the lead plaintiff in the lawsuit, testified Wednesday that her water broke at 18 weeks pregnant, putting her at increased risk of a life-threatening infection. Zurawski’s child will likely not survive.
But the fetal heartbeat was still going on, and so doctors said they were unable to terminate the pregnancy. It was only after her condition worsened and she went into septic shock that she underwent an emergency abortion.
Zurawski told Wednesday’s hearing how his family flocked to the hospital, fearing it would be the last time they would see him. Zurawski has argued that if she had been able to have an abortion, her life would not have been endangered in this way.
Zurawski said, “I blame those who support these sanctions.”
Zurawski previously said that the language of Texas’ abortion laws is “incredibly vague, and it leaves doctors grappling with what they can and cannot do, what health care they can and cannot provide.”
Pregnancy is dangerous, and it is unnecessarily risky to force a woman to keep a non-viable pregnancy for long when it is clear that the baby will not survive, argued Dr. Mae-Lan Winchester, Ohio Maternal-Fetal Medicine Specialist.
“Pregnancy is one of the most dangerous things a person can ever go through,” Winchester said. “To put yourself at that risk without any benefit of finally taking the baby home, it is … to risk maternal morbidity and mortality for nothing.”