Hiltzik: The death toll from abortion bans is rising

California Attorney General Rob Bonta stands next to Anna Nusslock

By Michael HiltzikBusiness Columnist

Oct. 2, 2024 3 AM PT

This election day, voters will have a direct voice in deciding whether to preserve or enhance abortion rights in 10 states, including six in which abortion is outlawed or seriously restricted.

As it happens, new data points arrive almost weekly to inform voters what’s at stake in these ballot campaigns. To put it bluntly, the health of pregnant women and those of childbearing age hangs in the balance.

With the election now less than five weeks away, let’s take an up-to-date look at this increasingly dismal landscape.

We expect that if Donald Trump is elected he will find a way to impose a nationwide abortion ban. Then we will start seeing these tragedies and near-tragedies in every state.

— Nancy L. Cohen, president, Gender Equity Policy Institute

There can no longer be any doubt that the abortion bans enacted in more than 20 states threaten women’s health.

The bellwether state is Texas, the only state to impose its abortion ban as early as September 2021, even before the Supreme Court’s June 2022 ruling in Dobbs vs. Jackson Women’s Health Organization overturned the nationwide abortion right guaranteed by Roe vs. Wade in 1973.

That timing has allowed analysts to generate statistics on maternal mortality in 2022 (for other antiabortion states, those statistics won’t be available until early next year). The Texas statistics are horrific.

As compiled by the Los Angeles-based Gender Equity Policy Institute initially at the request of NBC News, they show that maternal deaths rose in Texas to 28.5 per 100,000 live births in 2022, exceeding the national rate of 22.3.

“The data are telling us that Texas is a harbinger of what is to come in states that ban abortion,” says GEPI President Nancy L. Cohen.

The maternal mortality rate rose by 56% in Texas from 2019 through 2022, the figures show, well exceeding the national increase of 11%. The rate for Black women rose by 38% and for Hispanic women by 30%.

What was especially striking, Cohen told me, was that the maternal mortality rate for white women in Texas nearly doubled in 2019-22, while rising by only 6% nationwide.

“To see middle-class women with health insurance and all the privileges in the world experiencing this causes real alarm about what we might see coming down the road,” Cohen says. “We expect to see significant increases in maternal mortality in all the ban states.”

New antiabortion initiatives are surfacing all the time.

Most recently, as of Tuesday, Louisiana’s classification of two drugs used for medication abortions — mifepristone and misoprostol — as controlled substances went into effect, making possession without a prescription punishable by up to five years in prison. Since Louisiana already bans all abortions except to protect the life or physical health of the mother, that effectively rules out the use of the drugs to terminate a pregnancy.

Another noxious new wrinkle is efforts to prevent pregnant women from leaving antiabortion states to obtain abortions where they’re legal. On Monday, the goonishly malevolent Texas Atty. Gen. Ken Paxton sued the city of Austin to block its spending of public funds to pay for residents to travel outside the state for abortions. The city appropriated $400,000 for the purpose in its current fiscal year budget. City officials decried Paxton’s lawsuit as an attempt to “score a few political points.”

Antiabortion Republicans have also objected to Biden administration rules extending the federal medical privacy law, HIPAA, to cover requests from authorities in antiabortion states for medical information about residents who have sought abortions in states where they’re legal. Among the 30 GOP lawmakers who sent a letter to Health and Human Services Secretary Xavier Becerra last year, demanding that he rescind the rule, was Sen. JD Vance (R-Ohio), currently the GOP candidate for vice president. The rule remains in place.

Antiabortion statutes in many states have been cynically drafted with purported exemptions that afford physicians some leeway to perform abortions for women in extreme cases — say, for women in imminent danger of death or severe medical complications. They don’t work.

“The so-called ‘life’ or ‘health’ exceptions are so vague that doctors fear jail time or fear for their licenses, so they cannot provide the standard of care,” Cohen says. “None of the states that have banned abortions have meaningful exceptions.”

That may be what caused the death of a 28-year-old Georgia woman who perished while physicians debated whether her pregnancy-related infection was severe enough to warrant operating. The doctors, according to a report by ProPublica, were so worried that acting might expose them to felony charges under Georgia’s abortion ban that they waited 20 hours before performing surgery. It was too late, and she died.

It’s important to understand that even explicit laws protecting abortion rights cannot always safeguard those rights in the face of determined interference. That’s illustrated by the lawsuit that California Atty. Gen. Rob Bonta filed Monday over the refusal of St. Joseph Hospital, a Catholic hospital in Eureka, for its alleged denial of an emergency abortion to a patient, Anna Nusslock, who suffered a major pregnancy crisis in February.

Doctors at St. Joseph understood that the patient’s health was threatened and the twins she was carrying were not viable, the lawsuit states. But they couldn’t perform the operation because Catholic Church rules that govern healthcare at the institution forbade it. Instead, they recommended that Nusslock be helicoptered to UC San Francisco for an abortion.

Nusslock said at a news conference Monday that she was concerned about the $40,000 cost of the trip. She was advised against driving the 300 miles to UCSF — “If you try to drive, you will hemorrhage and die before you get to a place that can help you,” her physician at St. Joseph warned her, the lawsuit says. Instead, she was told to drive 12 miles to Mad River Community Hospital for treatment. A nurse gave her a bucket and towels in case she continued bleeding in the car.

Bonta alleges that the hospital’s discharge of Nusslock while she was experiencing a pregnancy-related crisis violated at least four provisions of California law. It may also have violated the federal Emergency Medical Treatment and Labor Act, or EMTALA, which mandates that hospitals with emergency rooms stabilize any arriving patients before discharging them.

A spokesman for Providence, the Washington-based Catholic chain that owns the Eureka hospital, told me that “while elective abortions are not performed in Providence facilities, we do not deny emergency care. When it comes to complex pregnancies or situations in which a woman’s life is at risk, we provide all necessary interventions to protect and save the life of the mother.”

The hospital chain said it is “immediately re-visiting our training, education and escalation processes in emergency medical situations to ensure that this does not happen again.”

It should be clear that if even some of Bonta’s and Nusslock’s allegations hold water, Providence’s right to continue running the Eureka hospital should come under question.

“Elective abortion” is not a medical term but one favored by the Catholic Church to signify abortions that cannot be performed in its hospitals, according to the Ethical and Religious Directives for Catholic Health Care Services, which is promulgated by the U.S. Conference of Catholic Bishops.

I asked Providence who, if anyone, provided an interpretation of the directives to the doctors on hand when Nusslock was at the hospital that prevented them from providing her with necessary care, and why licensed physicians need to retrained and reeducated about how to respond to an emergency in the emergency room at Eureka, but haven’t received a reply.

Providence’s alleged actions suggest that state laws protecting abortion rights are not impervious — and that would especially be so if Republicans regain the White House and control of Congress in the coming election.

“We expect that if Donald Trump is elected he will find a way to impose a nationwide abortion ban,” Cohen says. “Then we will start seeing these tragedies and near-tragedies in every state. Under a national ban, state protections will be meaningless.”

Trump has given equivocal indications about his abortion policies in a second term. But he also has bragged about appointing the Supreme Court justices who cemented the majority that overturned Roe vs. Wade.

Moreover, Project 2025, the manifesto for a second Trump term drafted by the Heritage Foundation, several of whose authors have close ties to Trump, calls for stringent limits on reproductive healthcare rights.

Among other provisions, Project 2025 calls for revoking the Food and Drug Administration’s approval of mifepristone, which would mean taking the abortion drug off the market, or barring that, reinstating restrictions on mifepristone, including requiring in-person dispensing and eliminating prescribing via telehealth.

It would exempt abortion from EMTALA, so that even treatments in the most dire emergencies could not include abortion. It would eliminate all federal funding for Planned Parenthood and “all other abortion providers,” and allow states to ban Planned Parenthood from their Medicaid programs.

Project 2025 also advocates removing Medicaid funding for states that require health insurance plans to cover abortion, as is the law for many health plans in California.

There are reasons to fear a second term for Trump. But few have such immediate life-or-death consequences as his policies on healthcare.