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Before states banned abortion, one of the gravest outcomes of early miscarriage could easily be avoided: Doctors could offer a dilation and curettage procedure, which quickly empties the uterus and allows it to close, protecting against a life-threatening hemorrhage.

But because the procedures, known as D&Cs, are also used to end pregnancies, they have gotten tangled up in state legislation that restricts abortion. Reports now abound of doctors hesitating to provide them and women who are bleeding heavily being discharged from emergency rooms without care, only to return in such dire condition that they need blood transfusions to survive. As ProPublica reported last year, one woman died of hemorrhage after 10 hours in a Houston hospital that didn’t perform the procedure.

Now, a new ProPublica data analysis adds empirical weight to the mounting evidence that abortion bans have made the common experience of miscarriage — which occurs in up to 30% of pregnancies — far more dangerous. It is based on hospital discharge data from Texas, the largest state to ban abortion, and captures emergency department visits from 2017 to 2023, the most recent year available.

After Texas made performing abortions a felony in August 2022, ProPublica found, the number of blood transfusions during emergency room visits for first-trimester miscarriage shot up by 54%.

The number of emergency room visits for early miscarriage also rose, by 25%, compared with the three years before the COVID-19 pandemic — a sign that women who didn’t receive D&Cs initially may be returning to hospitals in worse condition, more than a dozen experts told ProPublica.

While that phenomenon can’t be confirmed by the discharge data, which tracks visits rather than individuals, doctors and researchers who reviewed ProPublica’s findings say these spikes, along with the stories patients have shared, paint a troubling picture of the harm that results from unnecessary delays in care.

“This is striking,” said Dr. Elliott Main, a hemorrhage expert and former medical director for the California Maternal Quality Care Collaborative. “The trend is very clear.”

After the state’s first abortion ban went into effect in September 2021, blood transfusions increased. After abortion became a felony in August 2022, they increased more.

The data mirrors a sharp rise in cases of sepsis — a life-threatening reaction to infection — ProPublica previously identified during second-trimester miscarriage in Texas.

Blood loss is expected during early miscarriage, which usually ends without complication. Some cases, however, can turn deadly very quickly. Main said ProPublica’s analysis suggested to him that “physicians are sitting on nonviable pregnancies longer and longer before they’re doing a D&C — until patients are really bleeding.”

That’s what happened to Sarah De Pablos Velez in Austin last summer. As she was miscarrying and bleeding profusely, she said physicians didn’t explain that she had options for care. Sent home from the emergency room without a D&C two times, she ultimately needed blood transfusions so that she wouldn’t die, according to medical records. “What happened to me was just so wrong,” she told ProPublica. "Doctors need to be providing care to pregnant women — that needs to be a baseline.”

After ProPublica exposed preventable deaths following delays in care, the Texas Legislature passed a bill this year to clarify that doctors can provide abortions when a patient is facing a life-threatening emergency, even if it is not imminent.

But many Texas doctors say the reform does not address the difficulty of treating women experiencing early miscarriages, which almost always involve blood loss; they say it’s hard to know when the expected bleeding might evolve into a life-threatening emergency — one that could have been prevented with a D&C. Women can bleed and remain stable for a long time, until they crash.

Texas forbids abortion at all stages of pregnancy — even before there is cardiac activity or a visible embryo. And while the law allows doctors to “remove a dead, unborn child,” it can be difficult to determine what that means during early miscarriage, when an array of factors can signal that a pregnancy is not progressing.

An embryo might fail to develop. Cardiac activity may not emerge when it should. Hormone levels might dip or bleeding might increase. Even if a doctor strongly suspects a miscarriage is underway, it can take weeks to conclusively document that a pregnancy has ended, and all the while, a patient might be losing blood.

Some OB-GYNs and emergency room physicians have long been advising patients to complete their miscarriage at home, especially at Catholic hospitals, even if that is not the standard of care. But now, physicians across the state are faced with a law that threatens up to 99 years in prison, and more are making a new calculus around whether to intervene or even tell patients they are likely miscarrying, said Dr. Anitra Beasley, an OB-GYN in Houston. “What ends up happening is patients have to present multiple times before a diagnosis can be made,” she added, and some of those patients wind up needing blood transfusions.

While they can be lifesaving, transfusions do not stop the bleeding, experts told ProPublica, and they can introduce complications, such as severe allergic reactions, autoimmune disorders or, in rare events, blood cancer. The dangers of hemorrhage are far greater, from organ failure to kidney damage to loss of sensation in the fingers and toes. “There’s a finite amount of blood,” said Dr. Sarah Prager, a professor of obstetrics and gynecology at the University of Washington. “And when it all comes out, you’re dead.”

ProPublica’s findings about the rise in blood transfusions make clear that women who experience early miscarriages in abortion ban states are living in a more dangerous medical climate than many believe, said Amanda Nagle, a doctoral student investigating the same blood transfusion data for a forthcoming paper in the American Journal of Public Health.

“If people are seeking care at an emergency department,” Nagle said, “there are serious health risks to delaying that care.”

In some clinics and hospitals across Texas, the pressure to definitively diagnose a miscarriage has led to delays in offering D&Cs.

Considering the chance of criminal prosecution, some doctors now default to what many pregnancy loss experts view as an overly cautious method for diagnosing miscarriage: ultrasound images alone, using criteria from the Society of Radiologists in Ultrasound. Relying only on images to diagnose — and discounting other factors, like lab results or clinical symptoms — can take days or even weeks.

Dr. Gabrielle Taper was a resident at a Catholic hospital in Austin when the ban was enacted, and a culture of fear took hold among her colleagues, she told ProPublica. “We started asking, ‘Are we certain that we can document that we’ve met the radiology guidelines?’ as opposed to just treating the patient in front of us,” she said.

If they couldn’t show that the likely miscarriage met the criteria, they often felt they had to discharge patients without offering a D&C. “People are already in distress, and you are giving them confusion, a false sense of hope,” she told ProPublica. “Having to send a patient home knowing they may bleed so much they would need a blood transfusion — when I know there are procedures I could do or medicine I could offer — is just excruciating.”

The hospital where she worked did not respond to ProPublica’s request for comment.

The American College of Obstetricians and Gynecologists does not recommend this approach, advising doctors instead to review the ultrasound as one piece of information among many and counsel patients on all their options.

The Society of Radiologists in Ultrasound said that the guidelines “are not meant to apply in the setting of a life-threatening situation, such as heavy bleeding,” but did not respond to a question about whether it agreed with ACOG that doctors should use a combination of ultrasound images and clinical judgment to assess a pregnancy loss.

Dr. Courtney A. Schreiber, an obstetrics and gynecology professor and expert in early pregnancy care, said that even if a patient wants to let a likely miscarriage complete at home, the medical team should still explain different management options, including medication to speed up the process or a D&C, should symptoms like bleeding get worse.

“It’s our obligation to share information, help manage expectations and keep women safe,” she said.

What happened to Porsha Ngumezi shows how dangerous it can be to delay care, according to more than a dozen doctors who previously reviewed a detailed summary of her case for ProPublica.

When the mother of two showed up bleeding at Houston Methodist Sugar Land in June 2023, at 11 weeks pregnant, her sonogram suggested an “ongoing miscarriage” was “likely,” her doctor noted. She had no previous ultrasounds to compare it with, and the radiologist did not locate an embryo or fetus — which Ngumezi said she thought she had passed in a toilet; her doctors did not make a definitive diagnosis, calling it a pregnancy of “unknown location.” After hours bleeding, passing “clots the size of grapefruit,” according to a nurse’s notes, she received two blood transfusions — a short-term remedy. But she did not get a procedure to empty her uterus, which medical experts agree is the most effective way to stop the bleeding. Hours later, she died of hemorrhage, leaving behind her husband and young sons.

Doctors and nurses involved in Ngumezi’s care did not respond to multiple requests for comment for ProPublica’s story last fall, and the hospital did not answer questions about her care when asked about it again for this story. A spokesperson from Methodist Hospital said its OB-GYNs follow ACOG’s miscarriage diagnosis guidelines, which recommend considering clinical factors in addition to ultrasounds.

Even in circumstances in which the abortion ban allows a doctor to intervene — to treat a life-threatening emergency, for example, or to “remove a dead, unborn baby” — there’s plenty of evidence, detailed in lawsuits and federal investigations, that doctors in Texas still aren’t offering procedures.

As soon as Sarah De Pablos Velez, a 30-year-old media director, learned she was pregnant last summer, she began attending regular checkups at St. David’s Women’s Care, in Austin. During her third appointment at about nine weeks, a resident, Dr. Carla Vilardo, and her supervisor, Dr. Cynthia Mingea, reviewed the ultrasound, according to medical records, which indicated her pregnancy wasn’t viable. Instead of being offered treatment for a miscarriage, De Pablos Velez says she was advised to hold out hope and come back for the next checkup.

Five maternal health experts and practicing OB-GYNs who reviewed the records for ProPublica said by that ultrasound visit, doctors would have had enough information to determine that the pregnancy wasn’t viable, even under the most conservative guidelines. If they wanted to be extra sure, they could have done blood work or one more ultrasound during that visit.

Instead, De Pablos Velez was told to come back in two weeks, according to medical records. During a visit when she should have been nearly 11 weeks pregnant, Mingea wrote in her chart she was “not optimistic” about the pregnancy's viability. Still, De Pablos Velez was advised to return in another week to be sure.

Within a few days, when the cramping got so bad she could barely walk, De Pablos Velez went to the emergency room at St. David’s Medical Center, unaware that a D&C could stop the pain and the bleeding. “I’ve never researched what it looks like for women who have a miscarriage,” she told ProPublica. “I always thought you go to the bathroom and have a little bit of blood.”

Over two visits to the emergency room, doctors told her that she could complete the miscarriage at home, even as she reported filling up three toilet bowls with blood and a nurse remarked that they needed a janitor to clean the floor, De Pablos Velez and her husband recalled. No obstetrician ever came to assess her condition, according to medical records, and while her hospital chart says “all management options have been discussed with the patient and her husband,” De Pablos Velez and her husband both told ProPublica no one offered her a D&C.

She was told to follow up with her OB at her next appointment in three days. Six hours after discharge, though, she was trying to ride out the pain at home when her husband heard her muttering “lightheaded” in the bathroom and ran to her in time to catch her as she collapsed. “She was pale as a ghost, sweating, convulsing,” said her husband, Sergio De Pablos Velez. “There was blood on the toilet, the trash can — like a scene out of a horror movie.”

An ambulance rushed her to the hospital, where doctors realized she no longer had enough blood flowing to her organs. She received two blood transfusions. Without them, several doctors who reviewed her records told ProPublica, she would have soon lost her life.

Vilardo and the doctors who saw De Pablos Velez in the emergency room did not respond to requests to speak with ProPublica or declined to be interviewed. St. David’s Medical Center, which is owned by HCA, the largest for-profit hospital chain in America, said it could not discuss her case unless she signed privacy waivers. The hospital did not respond to ProPublica’s questions even after she submitted them. The De Pablos Velezes say that a hospital patient liaison told them after the ordeal that the hospital would conduct an internal investigation, educate the emergency department on best practices and share the results. It never shared anything. When ProPublica asked about the status of the investigation, neither the liaison nor the hospital responded.

Mingea, who supervised Vilardo’s care during checkups, reviewed the clinic’s records with ProPublica and agreed that De Pablos Velez should have been counseled about miscarriage management options at the clinic, weeks before she ended up in the ER. She said she did not know why she wasn’t but pointed ProPublica to the Society of Radiologists in Ultrasound criteria, which is hanging on the clinic’s wall and is used to teach residents.

She was adamant that her clinic, which she described as “very pro-choice — about as much as we can be in Texas,” regularly provides D&Cs for miscarrying patients. “I feel badly that Sarah had this experience, I really do,” she said. “Everybody deserves to be counseled about all their options.”

Doctors had five opportunities to counsel De Pablos Velez about her options and offer her a D&C, said Dr. Jodi Abbott, an associate professor of obstetrics and gynecology at Boston University School of Medicine, who reviewed case records. If they had, the life-or-death risks could have been avoided.

De Pablos Velez “basically received the same care Porsha Ngumezi did, only Porsha died and she survived,” said Abbott. “She was lucky.”

Sophie Chou contributed data reporting, and Mariam Elba contributed research.

This content originally appeared on ProPublica and was authored by by Kavitha Surana, Lizzie Presser and Andrea Suozzo.

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published.

Even though about a million women a year experience a miscarriage, there is little research on complications related to pregnancy loss in the first trimester, when most miscarriages happen. The need to explore this phase is urgent, experts told ProPublica, given the way state abortion bans have disrupted maternal health care.

Although most early miscarriages resolve without complications, patients with heavy bleeding can hemorrhage if they don’t get appropriate treatment — which includes a procedure called dilation and curettage, or D&C, that is now tangled up in legislation that bans abortion. As women recounted being left to lose dangerous amounts of blood, and ProPublica told the story of a mother who died in a Houston hospital while seeking miscarriage care, reporters searched for a way to gain a broader understanding of what was happening in the state.

We consulted dozens of researchers and clinicians to develop our methodology and understand how to look at early miscarriage outcomes in the emergency department.

Our latest analysis, of hospital discharge data from Texas, found that after the state made performing abortions a felony in August 2022, the number of blood transfusions during emergency room visits for first-trimester miscarriage shot up by 54%.

The number of emergency room visits during first-trimester miscarriage also rose by 25%, a sign that women may be returning to hospitals in worse condition after being sent home, more than a dozen experts told ProPublica.

Experts say the spike is a troubling indicator of delays in care.

The most effective way to prevent severe blood loss during miscarriages, experts said, is a D&C, which uses suction to remove remaining tissue, allowing the uterus to close. The procedure is also used to terminate pregnancies.

Dr. Elliott Main, an expert on maternal hemorrhage and the former medical director for the California Maternal Quality Care Collaborative, said the increase in transfusions suggested to him that doctors working under abortion bans are now delaying those interventions for miscarrying patients for longer — “until they’re really bleeding.”

These findings add to ProPublica’s growing body of reporting revealing that maternal outcomes have gotten worse after the state’s abortion bans. In February, we published an analysis of second-trimester pregnancy loss hospitalizations, which found that the rate of sepsis climbed by more than 50% after the state banned abortion. That study focused only on inpatient stays in Texas hospitals. However, many of the clinicians and researchers we spoke with told us that that focus would limit what we could say about miscarriage care earlier in pregnancy; most people experiencing first-trimester pregnancy complications would likely be seen in a shorter emergency department visit, rather than an inpatient stay.

This methodology lays out the steps we took to examine early miscarriage outcomes in the emergency department, to help experts and interested readers understand our approach and its limitations.

We purchased seven years of discharge records for inpatient and outpatient encounters at hospitals and ambulatory surgery centers from the Texas Department of State Health Services. These records contain deidentified data for visits, with information about the encounter, including diagnoses recorded and procedures performed, as well as some patient demographic information and billing data.

We limited our analysis to visits with a diagnosed pregnancy loss across both the inpatient and outpatient datasets. We followed a methodology that maternal health researchers have used for many years to identify “abortive outcomes” — instances of pregnancy loss at less than 20 weeks, which includes diagnoses like ectopic pregnancy and miscarriage. Researchers have typically identified these cases in order to exclude them from metrics assessing complications in childbirth. In contrast, we focused our analysis only on those encounters with a pregnancy loss diagnosis. Medical experts suggested that it's possible more women are self-managing abortions at home; since a self-managed medication abortion would present like a spontaneous miscarriage, however, we can’t differentiate those patients in our data.

We also limited our analysis to either emergency department visits or inpatient stays that began in the emergency department. The state’s outpatient data also includes encounters for outpatient procedures and data for ambulatory surgery centers, which we excluded to focus on emergent hospital care. Ultimately, our analysis focused on 35,500 first-trimester visits per year that came into hospitals through the emergency department, excluding a small number (about 1,400 per year) of inpatient stays that did not begin in the emergency room.

To limit our analysis to pregnancy loss in the first trimester, we looked for a diagnosis code indicating gestational weeks. In cases where a long hospitalization had multiple gestational week codes recorded over the course of the stay, we took the latest one. We excluded any row that had a gestational week code of 13 weeks or more, which marks the start of the second trimester. The vast majority — 78% — of emergency department visits for pregnancy loss had a code indicating unknown gestational week or no gestational week diagnosis code at all. We included those visits in the first-trimester category. Clinicians told us that a pregnant patient coming to the emergency department in her first trimester is less likely to have had a doctor’s appointment establishing gestational age. Since pregnancy loss in the second or third trimester is more serious, and because it is easier to establish gestational age in a pregnancy that is further along, an emergency department doctor would likely be able to establish a gestational age over the course of treatment in those cases.

We then filtered our list of visits to ones where the patient was female and between the ages of 10 and 54, to exclude rows with potential errors. This removed 2,692 visits, or 1.1% of all visits we’d identified.

The number of emergency department first-trimester hospitalizations were relatively stable prior to COVID-19. In 2022, the first full year after the state passed its six-week abortion ban, the number of encounters jumped by 11%. And in 2023, the year after the state criminalized abortion, they rose again, increasing by 25% from pre-COVID levels.

While we could identify an increase in visits, we could not identify patients across visits, which means we can’t say how many of these visits represent the same person returning to the emergency department multiple times for the same pregnancy loss. Texas has seen an increase in live births since the state banned abortion — about 2.7% in 2022, compared with the pre-COVID average, and declining slightly in 2023. But this increase in births — and, by extension, pregnancies — does not explain the rate of change in emergency visits, which far surpasses it.

Clinicians also told us that the threshold for diagnosing pregnancy loss increased after the state banned abortion. To assess how many relevant visits our analysis might be leaving out, and whether we were missing more visits after hospital policy changes, we looked for visits without a pregnancy loss code but with a diagnosis of “threatened abortion” or “early pregnancy hemorrhage,” indicating uterine cramping or bleeding in early pregnancy. Since clinicians told us that these diagnoses might range from light spotting to significant bleeding, and since bleeding in pregnancy is common and does not always indicate a miscarriage in progress, we did not include these visits in our main analysis. However, we also identified a 23% increase in visits with those codes — from an annual average of 70,936 prior to COVID to 87,431 in 2023.

Next, we identified pregnancy loss visits with a transfusion, which typically indicates that there has been a dangerous loss of blood.

For our inpatient dataset, where procedures performed during a hospitalization were recorded as ICD-10-PCS codes, we identified visits with a blood transfusion using a list of codes defined by the Centers for Disease Control and Prevention. The outpatient dataset, which uses Current Procedural Terminology codes, has just one code — 36430 — for blood transfusions.

Prior to COVID-19, there were 840 first-trimester pregnancy loss emergency department visits each year, on average, with a blood transfusion. In 2022, the first full year after the state passed its first abortion ban, transfusions climbed to 1,076 — an increase of 28% from pre-COVID years. By 2023, the first full year after abortion was criminalized, that number climbed to 1,290 — an increase of 54% compared to pre-COVID. That’s 450 more visits with a blood transfusion in 2023 than the pre-COVID average.

After the state’s first abortion ban went into effect in September 2021, blood transfusions increased. After abortion became a felony in August 2022, they increased more.

Even as the number of visits to the emergency department increased, the proportion of those visits with a transfusion also went up, from 2.5% in pre-COVID years to 2.8% in 2022 and 3% in 2023 — suggesting that the increase in transfusions may not be explained by an increase in encounters alone.

Experts who reviewed ProPublica’s data wondered if the increase in transfusions might be driven by more women experiencing complications of ectopic or molar pregnancies, rare nonviable pregnancies in which the likelihood of a blood transfusion is much higher than for a spontaneous miscarriage. The data did not bear this out. When we excluded visits with ectopic and molar pregnancy diagnoses, the increase in the number of pregnancy loss transfusions was even higher — it rose by 61% by 2023.

To understand whether there were increases in the numbers of transfusions in other maternal visits over the same time period, we also looked at blood transfusions in delivery events, using the federal methodology to identify birth complications. In hospital births, the number of transfusions increased by 6.7% in 2022 and 9.9% in 2023 compared with the pre-COVID average — an increase, but smaller in magnitude than the increase in first-trimester pregnancy loss hospitalizations.

Sophie Chou contributed data reporting.

This content originally appeared on ProPublica and was authored by by Andrea Suozzo, Kavitha Surana and Lizzie Presser.

Note: This article contains a graphic description that some readers may find upsetting.

An 88-year-old mother whose son died in the 1989 Tiananmen massacre has trouble even walking to a Beijing cemetery to commemorate his passing every June 4, but authorities still keep her under surveillance. “Am I that scary?” she asks.

Zhang Xianling is one of the founding members of the Tiananmen Mothers group that represents the families of victims of the crackdown on pro-democracy protesters that left hundreds if not thousands dead. The incident is expunged from the public record in China.

(Courtesy of the Tiananmen Mothers)

Each year, the mothers submit a letter to Chinese leaders, calling on the ruling communist party to publicize records about the June 4, 1989, incident, award compensation and to hold accountable those responsible for the killings.

Zhang told Radio Free Asia that although she is old, has difficulty getting about and needs a wheelchair, as long as her physical condition allows, she will definitely go to Beijing’s Wan’an Cemetery on June 4 to pay tribute to her son Wang Nan who died in the crackdown - as a group of mothers does each year.

Last year, on the eve of June 4, her phone line was cut and she lost contact with the outside world. This year, starting from April, she said she has been under close surveillance.

(Andy Wong/AP)

“They (the authorities) keep a close eye on me,” Zhang told RFA Mandarin, recounting how on a recent trip outside Beijing she got home around midnight and state security agents called her to say they would post someone outside her door.

“At 6:00 the next morning, they sent someone to guard my door. I don’t know why they are so afraid of me. I am 88 years old and I have to use a wheelchair if I have to walk 200 meters. Am I that scary?” she said.

Fallen silent

The annual gathering of the Tiananmen Mothers at the cemetery is a defiant act. Public commemoration of the massacre is banned in China. An annual candlelight vigil that for three decades marked the anniversary in Hong Kong’s Victoria Park has also fallen silent for the past five years amid a crackdown on pro-democracy activists there since Beijing tightened its grip over the once semi-autonomous territory.

While China has never made public the numbers who died or were injured on June 4, the Tiananmen Mothers published a detailed map in 2009 showing where some of the victims died. Estimates of the death toll have ranged from a few hundred to several thousand. June 4 is also a forbidden search term on the internet in China.

(AP)

Zhang’s son Wang Nan was a 19-year-old student at Beijing’s Yuetan High School when he was shot dead by martial law troops in the wee hours of June 4 at an intersection north of the Great Hall of the People, according to a record of victims curated by the non-government group, Human Rights in China. The bullet entered the left side of his forehead and came out behind his left ear, leaving a bullet hole at the back of the motorcycle helmet he was wearing.

Troops buried Wang Nan’s body with others in a shallow grave west of Tiananmen Gate but heavy rains washed the soil away a few days later. His body was taken to a hospital morgue and was initially mistaken as that of a soldier as he’d recently returned from military training and was wearing an old military uniform. His family was only able to recover his body on June 14, and his cremated remains were interred at Wan’an Cemetery.

Promise not to see reporters

Thirty-six years on, and the anniversary of Wang Nan’s passing still looms large in Zhang’s life and remains politically sensitive.

Zhang said that she had protested against the authorities’ frequent deployment of guards at her gate. She said a policeman she had contacted about this had urged her against seeing journalists.

“They asked me to promise not to see reporters and not to say anything, I said, ‘I can’t do that.’ I said that if I spread rumors and you arrest me, I have no objection. I said everything I said is true. You (the Chinese government) don’t tell the truth, and if people come to ask me, won’t I tell it? If people come to me, whether they are reporters or not, I will tell them about June 4,” Zhang told RFA.

Zhang said she feels very sad every year when the anniversary of her son’s death approaches, and that the pain of losing him will not be diluted or erased by the years.

“Between April and June, if the current government didn’t say it was a sensitive period, I would (still) be sad,” she said. “As a mother, it is impossible for me to forget, especially such a sudden death.”

“The pain is deeply engraved in my heart. This is different from the original grief. It is a kind of pain. One is the pain of missing (him), and the other is the pain of not having resolved this matter.”

‘I will not stop fighting’

Zhang said that the members of Tiananmen Mothers are scattered and cannot meet often, but judging from the number of people who sign the open letter every year demanding answers, many of the victims’ families are as committed as she is, which has strengthened her belief and determination.

(Tiananmen Mothers)

“I will not stop fighting,” she said. “We want to seek justice for those who died in the June 4 incident. We have this firm belief, so we have persisted up to now. I just want to tell my children that Mom is still persisting, and also to tell the authorities that we are still persisting.”

Zhang added that no matter how powerful the regime is, it cannot completely erase what has happened.

“The (June 4) massacre took place in full view of the public, so it is not something that will be easily forgotten. Although the candles in Victoria Park (Hong Kong) were blown out by the strong wind, the spark of justice is still burning in the hearts of every person with a conscience,” she said.

“As long as there is a spark, and one person commemorating, it is meaningful to our family … No matter how many people there are, it is a kind of comfort and support to us, and it also gives us spiritual strength."

Edited by Mat Pennington.

This content originally appeared on Radio Free Asia and was authored by Chen Zifei for RFA Mandarin.

Ahead of the Mother’s Day holiday in the Untied States, we speak to Duha Latif, a mother of two children in Gaza, about life for mothers living under Israeli occupation and assault. Democracy Now! last spoke to Latif over a year ago, when she was attempting to evacuate Rafah with her family. She now resides in a tent in Khan Younis and struggles to feed her family as Israel’s blockade has created widespread famine throughout the Gaza Strip. “We are not living. We are enduring,” says Latif. Her children, 8-year-old Amir and 3-year-old Karim, are suffering the effects of hunger and malnutrition. “The loss they are living is more than just the absence of food — it’s the absence of life as they knew it.”

This content originally appeared on Democracy Now! and was authored by Democracy Now!.

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Nearly four years ago in Texas, the state’s new abortion law started getting in the way of basic miscarriage care: As women waited in hospitals cramping, fluid running down their legs, doctors told them they couldn’t empty their uterus to guard against deadly complications.

The state banned most abortions, even in pregnancies that were no longer viable; then, it added criminal penalties, threatening to imprison doctors for life and punish hospitals. The law had one exception, for a life-threatening emergency.

Heeding the advice of hospital lawyers, many doctors withheld treatment until they could document patients were in peril. They sent tests to labs, praying for signs of infection, and watched as women lost so much blood that they needed transfusions.“You would see the pain in peoples’ eyes,” one doctor said of her patients.

Not every hospital tolerated this new normal, ProPublica found. A seismic split emerged in how medical institutions in the state’s two largest metro areas treated miscarrying patients — and in how these women fared.

Leaders of influential hospitals in Dallas empowered doctors to intervene before patients’ conditions worsened, allowing them to induce deliveries or perform procedures to empty the uterus.

In Houston, most did not.

The result, according to a first-of-its-kind ProPublica analysis of state hospital discharge data, is that while the rates of dangerous infections spiked across Texas after it banned abortion in 2021, women in Houston were far more likely to get gravely ill than those in Dallas.

As ProPublica reported earlier this year, the statewide rate of sepsis — a life-threatening reaction to infection — shot up more than 50% for women hospitalized when they lost a second-trimester pregnancy.

A new analysis zooms in: In the region surrounding Dallas-Fort Worth, it rose 29%. In the Houston area, it surged 63%.

ProPublica has documented widespread differences in how hospitals across the country have translated abortion bans into policy. Some have supported doctors in treating active miscarriages and high-risk cases with procedures technically considered abortions; others have forbidden physicians from doing so, or left them on their own to decide, with no legal backing in case of arrest.

This marks the first analysis in the wake of abortion bans that connects disparities in hospital policies to patient outcomes. It shows that when a state law is unclear and punitive, how an institution interprets it can make all the difference for patients.

Yet the public has no way to know which hospitals or doctors will offer options during miscarriages. Hospitals in states where abortion is banned have been largely unwilling to disclose their protocols for handling common complications. When ProPublica asked, most in Texas declined to say.

ProPublica’s Texas reporting is based on interviews with 22 doctors in both the Houston and Dallas-Fort Worth metro areas who had insight into policies at 10 institutions covering more than 75% of the births and pregnancy-loss hospitalizations in those areas.

The findings come as evidence of the fatal consequences of abortion bans continue to mount, with a new report just last month showing that the risk of maternal mortality is nearly twice as high for women living in states that ban abortion. Last year, ProPublica documented five preventable maternal deaths, including three in Texas.

One second-trimester pregnancy complication that threatens patients’ lives is previable premature rupture of membranes, called PPROM, when a woman’s water breaks before the fetus can live on its own. Without amniotic fluid, the likelihood of the fetus surviving is low. But with every passing hour that a patient waits for treatment or for labor to start, the risk of sepsis increases.

The Texas Supreme Court has said that doctors can legally provide abortions in PPROM cases, even when an emergency is not imminent.

Yet legal departments at many major Houston hospitals still advise physicians not to perform abortions in these cases, doctors there told ProPublica, until they can document serious infection.

Dr. John Thoppil, the immediate past president of the Texas Association of Obstetricians and Gynecologists, said he was “blown away” by this finding. He said it’s time for hospitals to stop worrying about hypothetical legal consequences of the ban and start worrying more about the real threats to patients’ lives.

“I think you’re risking legal harm the opposite way for not intervening,” he said, “and putting somebody at risk.”

In the summer of 2021, Dr. Robyn Horsager-Boehrer, a Dallas specialist in high-risk pregnancy, listened as hospital lawyers explained to a group of UT Southwestern Medical Center doctors that they would no longer be able to act on their clinical judgment.

For decades, these UT Southwestern physicians had followed the guidance of major medical organizations: They offered patients with PPROM the option to end the pregnancy to protect against serious infection. But under the state’s new abortion ban, they would no longer be allowed to do so while practicing at the county’s safety net hospital, Parkland Memorial, which delivers more babies than almost any other in the country. Nor would they be permitted at UT Southwestern’s William P. Clements Jr. University Hospital.

Lawyers from the two hospitals explained in a meeting that the law’s only exception was for a “medical emergency” — but it wasn’t clear how the courts would define that. With no precedent or guidance from the state, they advised the doctors that they should offer to intervene only if they could document severe infection or bleeding — signs of a life-threatening condition, Horsager-Boehrer recalled. They would need to notify the state every time they terminated a pregnancy. ProPublica also spoke with six of Horsager-Boehrer’s colleagues who described similar meetings.

As the new policy kicked in, the doctors worried the lawyers didn’t understand how fast sepsis could develop and how difficult it could be to control. Many patients with PPROM can appear stable even while an infection is taking hold. During excruciating waits, Dr. Austin Dennard said she would tell patients at Clements, “We need something to be abnormal so that we can offer you all of the options that someone in New York would have.” Then she would return to the physicians’ lounge, lay down her head and cry.

Their only hope, the doctors felt, was to collect data and build a case that the hospital’s policy needed to change.

Within eight months, 28 women with severe pregnancy complications before fetal viability had come through the doors of Parkland and Clements. Twenty-six of them were cases in which the patients’ water broke early. Analyzing the medical charts, a group of researchers led by Dr. Anjali Nambiar, a UT Southwestern OB-GYN, found that a dozen women experienced complications including hemorrhage and infection. Only one baby survived.

The research team compared the results with another study in which patients were offered pregnancy terminations. They found that of patients who followed the “watch and wait” protocol, more than half experienced serious complications, compared with 33% who immediately terminated their pregnancies.

Armed with the research, the doctors, including Horsager-Boehrer, returned to the lawyers for the two hospitals. Everyone agreed the data demanded action. Alongside physicians, the lawyers helped develop language that doctors could include in medical charts to explain why they terminated a pregnancy due to a PPROM diagnosis, Dennard said.

At Parkland, the new protocol required doctors to get signoff from one additional physician, attach the study as proof of the risk of serious bodily harm — part of the “medical emergency” definition in the law — and notify hospital leaders. At Clements, doctors also needed to get CEO approval to end a pregnancy, which could create delays if patients came in on a weekend, doctors said. But it was vastly better than the alternative, Dennard said. The message from the lawyers, she said, was: “We have your back. We are going to take care of you.”

A spokesperson for UT Southwestern said “no internal protocols delay care or otherwise compromise patient safety.” A spokesperson for Parkland said that “physicians are empowered to document care as they deem appropriate” and that hospital attorneys had “helped review and translate the doctors’ proposed language to make sure it followed the law.”

Parkland and UT Southwestern are not the only ones providing this care in Dallas. ProPublica spoke with doctors who have privileges at hospitals that oversee 60% of births and pregnancy loss hospitalizations in the Dallas-Fort Worth region, including Baylor Scott & White and Texas Health Resources. They said that their institutions support offering terminations to patients with high-risk second-trimester pregnancy complications like PPROM.

At Baylor Scott & White, doctors said, the leadership always stood by this interpretation of the law. (When asked, a spokesperson said miscarrying patients are counseled on surgical options, and that its hospitals follow state and federal laws. “Our policies are developed to comply with those laws, and we educate our teams on those policies.”)

Texas Health and other hospitals in the region did not respond to requests for comment.

While efforts to be proactive have meant more patients are able to receive the standard of care in Dallas, that is still not the case at every medical campus in the region. Doctors at Parkland said they have seen patients come to them after they were turned away from hospitals nearby.

In other parts of the state, however, it’s been impossible to know where to turn.

In Houston, one of America’s most prestigious medical hubs, Dr. Judy Levison mounted her own campaign.

The veteran OB-GYN at Baylor College of Medicine wanted hospital leaders to support intervening in high-risk complications in line with widely accepted medical standards. In 2022, she emailed her department chair, Dr. Michael Belfort, who is also the OB-GYN-in-chief at Texas Children’s. She told him colleagues had shared “feelings of helplessness, moral distress and increasing concerns about the safety of our patients.”

They needed training on how to protect patients within the bounds of the law, she said, and language they could include in charts to justify medically necessary abortions. But in a meeting, Belfort told her he couldn’t make these changes, Levison recalled.

He said that if he supported abortions in medically complicated cases like PPROM, the hospital could lose tens of millions of dollars from the state, she told ProPublica. “I came to realize that he was in a really difficult place because he risked losing funding for our residency program if Baylor and Texas Children’s didn't interpret the law the way they thought the governor did.” She wondered if he was deferring to hospital lawyers.

Belfort did not respond to requests for comment about his stance. Nor did Baylor or Texas Children’s.

Although Texas Attorney General Ken Paxton has threatened hospitals with civil action if they allow a doctor to perform what he views as an “unlawful” abortion, he hasn’t filed any such actions. And in the years since the ban, there have been no reports of the state pulling funding from a hospital on account of its abortion policy.

A spokesperson at only one major Houston hospital chain, Houston Methodist, said that it considered PPROM a medical emergency and supported terminations for “the health and safety of the patient.”

Five other major hospital groups that, together, provide the vast majority of maternal care in the Houston region either continue to advise doctors not to offer pregnancy terminations for PPROM cases or leave it up to the physicians to decide, with no promise of legal support if they’re charged with a crime. This is according to interviews with a dozen doctors about the policies at HCA, Texas Children’s, Memorial Hermann, Harris Health and The University of Texas Medical Branch. Together, they account for about 8 in 10 hospitalizations in the region for births or pregnancy loss.

Most of the doctors spoke with ProPublica on the condition of anonymity, as they feared retaliation for violating what some described as a hospital “gag order” against discussing abortion. In a sign of how secretive this decision-making has become, most said their hospitals had not written down these new policies, only communicated them orally.

Several doctors told ProPublica that Dr. Sean Blackwell, chair of the obstetrics and gynecology department at Houston’s University of Texas Health Science Center, which staffs Harris Health Lyndon B. Johnson Hospital and Memorial Hermann hospitals, had conveyed a message similar to Belfort’s: He wasn’t sure he would be able to defend providers if they intervened in these cases. He did not respond to multiple requests for comment, and his institution, UTHealth Houston, declined to comment.

ProPublica reached out to officials at all five hospital groups, asking if they offer terminations at the point of a PPROM diagnosis. Only one responded. Bryan McLeod at Harris Health pointed to the hospital system’s written policy, which ProPublica reviewed, stating that an emergency doesn’t need to be imminent for a doctor to intervene. But McLeod did not respond to follow-up questions asking if patients with PPROM are offered pregnancy terminations if they show no signs of infection — and several doctors familiar with the chain’s practices said they are not.

The state Senate unanimously passed a bill last week to clarify that doctors can terminate pregnancies if a woman faces a risk of death that is not imminent. ProPublica asked the hospitals if they would change their policies on PPROM if this is signed into law. They did not respond.

Last fall, ProPublica reported that Josseli Barnica died in Houston after her doctors did not evacuate her uterus for 40 hours during an “inevitable” miscarriage, waiting until the fetal heartbeat stopped. Two days later, sepsis killed her.

Barnica was treated at HCA, the nation’s largest for-profit hospital chain, which did not respond to a detailed list of questions about her care. With 70% of its campuses in states where abortion is restricted, the company leaves the decision of whether to take the legal risk up to the physicians, without the explicit legal support provided in Dallas, according to a written policy viewed by ProPublica and interviews with doctors. A spokesperson for the chain said doctors with privileges at its hospitals are expected to exercise their independent medical judgment “within applicable laws and regulations.” As a result, patients with potentially life-threatening conditions have no way of knowing which HCA doctors will treat them and which won’t.

Brooklyn Leonard, a 29-year-old esthetician eager for her first child, learned this in February. She was 14 weeks pregnant when her water broke. At HCA Houston Healthcare Kingwood, her doctor Arielle Lofton wrote in her chart, “No interventions can be performed at this time legally because her fetus has a heartbeat.” The doctor added that she could only intervene when there was “concern for maternal mortality.” Leonard and her husband had trouble getting answers about whether she was miscarrying, she said. “I could feel that they were not going to do anything for me there.” Lofton and HCA did not respond to a request for comment.

It was only after visits to three Houston hospitals over five days that Leonard was able to get a dilation and evacuation to empty her uterus. A doctor at Texas Children’s referred her to Dr. Damla Karsan, who works in private practice and is known for her part in an unsuccessful lawsuit against the state seeking permission to allow an abortion for a woman whose fetus was diagnosed with a fatal anomaly. Karsan felt there was no question PPROM cases fell under the law’s exception. She performed the procedure at The Woman’s Hospital of Texas, another HCA hospital. “She’s lucky she didn’t get sick,” Karsan said of Leonard.

Many Houston doctors said they have continued to call on their leadership to change their stance to proactively support patients with PPROM, pointing to data analyses from Dallas hospitals and ProPublica and referring to the Texas Supreme Court ruling. It hasn’t worked.

Houston hospitals haven’t taken action even in light of alarming research in their own city. Earlier this year, UTHealth Houston medical staff, including department chair Blackwell, revealed early findings from a study very similar to the one out of Dallas.

It showed what happened after patients at three partner hospitals stopped being offered terminations for PPROM under the ban: The rate of sepsis tripled.

Still, nothing changed.

To examine second-trimester pregnancy loss outcomes in Houston and Dallas, we used a methodology we developed to determine sepsis rates in inpatient hospitalizations where a pregnancy ended between 13 weeks’ gestation and the end of the 21st week. To assess regional differences, we grouped hospitals by perinatal care region and focused on the two regions with the highest population: Houston and Dallas-Fort Worth.

We grouped hospitalizations in the nine quarters after the implementation of the state’s six-week abortion ban (October 2021 through December 2023) and compared them with hospitalizations in the nine quarters immediately before. Each region had about 2,700 second-trimester pregnancy loss hospitalizations over the course of the time span we examined.

Sophie Chou contributed data reporting, and Mariam Elba contributed research.

This content originally appeared on ProPublica and was authored by by Kavitha Surana, Lizzie Presser and Andrea Suozzo.

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The Texas Senate has unanimously passed legislation that aims to prevent maternal deaths under the state’s strict abortion ban.

Written in response to a ProPublica investigation last year, Senate Bill 31, called The Life of the Mother Act, represents a remarkable turn among the Republican lawmakers who were the original supporters of the ban. For the first time in four years, they acknowledged that women were being denied care because of confusion about the law and took action to clarify its terms.

“We don’t want to have any reason for hesitation,” said Republican state Sen. Bryan Hughes, who authored the state’s original abortion ban and sponsored this reform with bipartisan input and support. Just last fall, he had said the law he wrote was “plenty clear.”

The bill stops short of removing what doctors say are the ban’s biggest impediments to care, including its major criminal penalties, and doesn’t expand abortion access to cases of fetal anomalies, rape or incest. Sen. Carol Alvarado, the Democratic lawmaker who co-authored the bill, said that its limits were a “real hard pill to swallow” but that it could still make a difference. “I believe this bill will save lives,” she said.

ProPublica’s reporting showed how doctors in states that ban abortion have waited to intervene in cases where women ultimately died of high-risk complications.

To address that problem, Senate Bill 31 states that a life-threatening medical emergency doesn’t need to be “imminent.” It also says doctors can terminate ectopic pregnancies, which occur when the fertilized egg implants outside of the uterine cavity. It would allow for a pregnant patient to receive cancer treatment, Hughes said, even if doing so threatened the viability of a fetus.

The bill also clarifies that medical staff or hospital officials can discuss termination with patients without violating a provision of the law that criminalizes “aiding and abetting” an abortion. It had been unclear to doctors whether simply discussing the option could lead to steep criminal penalties; patients have reported not being able to get straight answers from their providers about their prognosis and options for treatment.

It remains to be seen how the bill, if made law, would be interpreted by doctors and hospitals, and whether risk-averse institutions would still delay care during pregnancy complications.

Many reproductive rights advocates are skeptical given that the bill does not explicitly address many high-risk pregnancy complications. The most common one in the second trimester, previable premature rupture of membranes, or PPROM, occurs when someone’s water breaks early. In these cases, the chance of the fetus surviving is low, but delaying a pregnancy termination leaves the patient at risk of infection, which can lead to sepsis, a potentially deadly condition. Since the state banned abortion, lawyers at many hospitals across Texas have advised physicians not to empty the uterus until they can document signs of infection — an indication of a life-threatening emergency.

The death of Josseli Barnica, which ProPublica reported last year, reveals the dangers of forcing miscarrying patients to wait for care. Diagnosed with an “inevitable” miscarriage at 17 weeks, she showed symptoms similar to PPROM without an official diagnosis — her water had not yet broken. While stable, she was made to wait 40 hours until the fetal heartbeat ended before doctors induced delivery. She later died of sepsis, which medical experts say she likely developed because of the wait.

In addition to documenting cases in which women died of sepsis, ProPublica has shown how rates of the potentially deadly complication spiked by more than 50% statewide in second-trimester pregnancy-loss hospitalizations after Texas banned abortion.

Officials with the Texas Medical Association, the Texas Hospital Association and major anti-abortion groups — Texas Right to Life, Texas Alliance for Life and the American Association of Pro-Life OB-GYNs — told ProPublica they believed that this bill would now allow doctors to offer a termination at the point of a PPROM diagnosis, before infection set in.

Dr. Zeke Silva, chair of the Texas Medical Association’s Council on Legislation, included PPROM on a list of potentially life-threatening conditions he believed may fall under the bill’s clarified exception. The list, which is not exhaustive, includes preeclampsia, renal failure, liver failure, cardiac disease, pulmonary hypertension and neurological conditions. He added that decisions to intervene because a medical condition could be life-threatening “are, by definition, subjective, based on multiple clinical considerations” and must be based on “sound medical judgment.”

However, ProPublica spoke with six legal experts who said they were unsure whether hospitals, wary of litigation or penalties, would interpret the bill to mean that doctors can offer a termination to patients with PPROM.

Some PPROM patients can remain pregnant for weeks and not develop infections, while others can contract an infection and deteriorate very quickly, noted Molly Duane, a senior staff attorney at the Center for Reproductive Rights. “I could see some doctors saying this means, ‘I have more leeway to intervene in all PPROM cases,’ and others saying, ‘I still don’t know, so I’ll wait until signs of infection.’”

The largest association of OB-GYNs, the American College of Obstetricians and Gynecologists, said in an emailed statement that it did not support the bill: “This bill would keep Texas’ abortion ban in place and we strongly oppose the abortion ban and will continue to do so.”

Yesterday, the Texas Senate also passed Bill 2880, which would authorize civil lawsuits against anyone in or outside of Texas who distributes or provides abortion medication to someone in the state. It is expected to face pushback in the state House.

The Life of the Mother Act now goes to the House, where it must be voted out of committee before it heads to the House floor. Both chambers would need to agree on a final version before the governor could sign it into law.

This content originally appeared on ProPublica and was authored by by Cassandra Jaramillo and Lizzie Presser.

We speak with New York Immigration Coalition President Murad Awawdeh about a mother and three children who were swept up in an ICE raid not far from the home of Trump’s “border czar” Tom Homan in Sackets Harbor, New York, handcuffed and taken to a family detention center in Texas despite having no order of deportation. A protest calling for the family’s return is planned for this Saturday, and the mayor has called a state of emergency. Awawdeh also responds to what appears to be a pattern of collaboration with the Trump administration’s mass deportation plan among local leaders and institutions in New York, from Eric Adams’s mayoral administration to Columbia University. Adams had federal corruption charges against him dropped after agreeing to support increased immigration enforcement, while Columbia had federal funding restored after allowing ICE officers to carry out arrests and searches on campus and in university-owned housing.

This content originally appeared on Democracy Now! and was authored by Democracy Now!.

Police found the heavily bruised and naked body of 18-year-old Heng Seavly in a shallow grave near a lake in Phnom Penh’s Dangkor district on March 1.

On Monday, investigators announced the arrests of her boyfriend, 30-year-old Chen Cong, and 34-year-old Li Haohao.

Police said the suspects confessed to the killing, adding that they believed she was about to leak information about a cyberscam operation in Phnom Penh.

Relatives held a funeral for Heng Seavly in her hometown in southern Kampot province on Tuesday.

“When I saw her brought into the temple, my energy and soul flew out of my body,” said her mother, Tim Sophy.

“My daughter was naked when they killed her,” she told RFA. “This is so brutal. As a mother, I am shocked and speechless.”

As the eldest daughter, Heng Seavly left home to work as a goods vendor in Sihanoukville to help her parents support her two younger siblings, Tim Sophy said.

She was later persuaded by her boyfriend to move to Phnom Penh, the mother said.

(RFA)

“She was my fabulous daughter,” she said. “She never missed sending US$250 to $300 each month.”

Police have said the two suspects acted on the orders of another Chinese national, 26-year-old Yang Kaixin, who remains at large.

Translated by Sok Ry Sum. Edited by Matt Reed.

This content originally appeared on Radio Free Asia and was authored by RFA Khmer.

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Georgia recently relaunched its maternal mortality review committee after dismissing all 32 of its members last year. But state officials won’t say who the current members are.

The dismissals were in response to ProPublica obtaining internal reports in which the committee detailed the “preventable” deaths of two women who were unable to obtain legal abortions or timely care after Georgia banned abortion.

In September, ProPublica published stories on the deaths of Amber Thurman and Candi Miller. They were the first reported cases of women who died without access to care restricted by a state abortion ban. Before those stories, the state Department of Public Health had released the names of committee members to ProPublica. Now it’s saying that releasing the names would be a violation of state law.

The law states that the work of the committee is confidential and that some records and reports obtained and created by the committee are not covered by public records laws. The law does not state that committee members’ identities are confidential. However, Department of Public Health spokesperson Nancy Nydam said the department’s review of the law “determined that the broad confidentiality protections directed toward the committee should be extended to the identities of the committee members.” She did not respond to questions about why the department could share committee members’ names in August but not now.

The newly appointed committee, which reviews maternal deaths and makes recommendations to improve care for pregnant women, held its first meeting Feb. 21.

If the public doesn’t know who is on a committee, it could create mistrust of its findings, said Elizabeth Dawes, director of maternal and reproductive health at the Century Foundation, a public-policy nonprofit. She has been an advocate for Black mothers, who die from causes related to pregnancy or birth at higher rates than other groups.

“If everything is confidential, there’s no way to really be able to trust what comes out of it,” Dawes said. “They could completely ignore abortion. They could completely ignore race, racism, discrimination, and say what they want to say.”

Dawes said those questions are particularly important in Georgia. The state has one of the nation’s highest rates of maternal death, especially among Black women, who die at twice the rate of white women.

The stories of Thurman and Miller sparked widespread outrage about the effects of abortion bans; Georgia law bans the procedure after six weeks.

Thurman, who traveled to North Carolina and obtained abortion pills, died from sepsis after doctors in Georgia delayed the removal of infected tissue that remained in her uterus. Her case, and others identified in Georgia and Texas, show the dangers women face in states that force hospitals and doctors to weigh criminal laws against abortion before providing care.

Less than two months after ProPublica published the stories, the commissioner of the Georgia Department of Public Health, Dr. Kathleen Toomey, sent a Nov. 8 letter to all members of the committee stating that information had been inappropriately shared with an outside source.

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

That application process ended earlier this year. The Department of Public Health denied ProPublica’s Open Records Act request for the names of new members on Feb. 27, three weeks after the request was made. In a response, a staff member said 30 people had been appointed to the board and attached language from a letter inviting new members to the committee’s first meeting on Feb. 21.

All 50 states, as well as other localities, have maternal mortality review committees. They examine the deaths of pregnant women and new mothers to identify gaps in care and provide recommendations to improve treatment. ProPublica recently found that the names of committee members in 18 states with abortion restrictions were publicly available, or accessible through a public records request.

Recently, some states have come under fire for allegedly politicizing the work of these committees.

The maternal mortality review committee in Idaho was allowed to go dormant in 2023 after conservative groups attacked its recommendation to expand Medicaid for postpartum women. The state has since revived the committee as an advisory body to the State Board of Medicine.

Also in 2023, Texas lawmakers changed the composition of the state’s committee more than a year after a member spoke out about a delay in releasing a report. She lost her seat. Officials later appointed an anti-abortion obstetrician, Dr. Ingrid Skop, to the group. The Texas MMRC is also not reviewing deaths from 2022 or 2023, a period covering the first year and a half after Roe v. Wade was overturned.

In the letter last year dismissing the members of Georgia’s committee, Toomey wrote that the shake-up of the board would not delay its work. Nydam said in February that Department of Public Health staff members have continued their work while the committee has been inactive.

“The work of the MMRC has not stopped,” Nydam wrote in an email. “It has continued with our staff doing case abstractions, which they do regardless, before the cases go to the MMRC.”

However, a person familiar with the committee’s work, who because of her continuing work with the Department of Public Health asked not to be named, said the full committee usually met every other month. Subcommittees met even more frequently to review cases.

“There’s no way there’s not going to be a delay unless they are going to meet every week,” she said.

The Georgia MMRC was beginning to identify deaths from 2023 when all members were dismissed.

Kavitha Surana and Cassandra Jamarillo contributed reporting. Mariam Elba contributed research.

This content originally appeared on ProPublica and was authored by by Amy Yurkanin.

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Less than a week after deporting Venezuelans detained at Guantanamo Bay, the Trump administration has again flown about two dozen migrants to the U.S. naval base in Cuba. This time, however, the migrants are from countries across the world, including from places that are willing to take them back, which has raised additional questions about whom the government is choosing to send there and why.

ProPublica and The Texas Tribune interviewed Angela Sequera, the mother of one of the first migrants sent to Guantanamo. She described her fear and desperation upon learning that her son, Yoiker Sequera, had been transferred to the facility, which she knew only as a place where terrorists were held and tortured after the 9/11 attacks.

On Feb. 9, Sequera was waiting for her daily phone call from Yoiker, who had been in an El Paso immigration detention facility since he was charged with entering the U.S. illegally late last year. When the phone finally rang, it wasn’t her son but another detainee who told her that Yoiker had been taken to Guantanamo.

“It hit me like a bucket of cold water. I asked the man: ‘Why? Why? Why?’” Sequera recalled. She said the detainee told her that the federal government was trying to link Yoiker to Tren de Aragua, a notorious Venezuelan gang known for migrant smuggling and other crimes in Latin America.

She panicked. She couldn't understand why this was happening. She and some of the relatives of 178 Venezuelans who were among the first migrants transferred to Guantanamo by the U.S. government scrambled to try to establish contact with their loved ones, scoured the internet and exchanged messages on an impromptu WhatsApp group.

ProPublica and The Texas Tribune obtained records about Yoiker and two other Venezuelans taken to Guantanamo. A search of U.S. federal court records found that Yoiker and another man had no crimes except for illegal entry, while a third had been convicted for assaulting a federal officer during a riot while in detention. “My son is not a criminal. He has no record. He has nothing to do with gangs. He does not belong to any Tren de Aragua,” said Sequera, who shared documentation from Venezuelan authorities that stated he did not have a criminal history.

On Feb. 21, after 13 days without hearing from her son, Sequera got a call from Yoiker. He had been released and was back in Venezuela, but he refused to discuss the time he spent detained at the naval base. “I think he does it to not make me worry,” said Sequera, who is among the plaintiffs named in a lawsuit filed by immigrants’ rights advocates seeking legal access to the migrants in Guantanamo.

A spokesperson for the U.S. Department of Homeland Security said this week that nearly half of the Venezuelans originally detained at Guantanamo were members of the Tren de Aragua gang and that many had serious criminal records. DHS did not provide evidence to support that assertion.

DHS also said in court filings this month that Guantanamo will continue to “temporarily house” migrants before they are “removed to their home country or a safe third country.”

Migrants on recent flights to Guantanamo have come from El Salvador, Nicaragua, Egypt, Ecuador, Guatemala, Honduras, Guinea, Vietnam, Cambodia and Senegal, according to government data shared with ProPublica and the Tribune. DHS did not respond to multiple requests for comment about the most recent transfers.

“We continue to know very little about the conditions there, who the government is sending there and why this is happening,” said Zoe Bowman, an attorney with the El Paso-based Las Americas Immigrant Advocacy Center, which is also a plaintiff in the lawsuit.

Watch the video: Mother Speaks Out Against Trump’s Detention of Her Son at Guantanamo

Mauricio Rodríguez Pons contributed to the production.

This content originally appeared on ProPublica and was authored by by Gerardo del Valle, Perla Trevizo and Mica Rosenberg.

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published.

Pregnancy became far more dangerous in Texas after the state banned abortion in 2021, ProPublica found in a first-of-its-kind data analysis.

The rate of sepsis shot up more than 50% for women hospitalized when they lost their pregnancies in the second trimester, ProPublica found.

The surge in this life-threatening condition, caused by infection, was most pronounced for patients whose fetus may still have had a heartbeat when they arrived at the hospital.

ProPublica previously reported on two such cases in which miscarrying women in Texas died of sepsis after doctors delayed evacuating their uteruses. Doing so would have been considered an abortion.

The new reporting shows that, after the state banned abortion, dozens more pregnant and postpartum women died in Texas hospitals than had in pre-pandemic years, which ProPublica used as a baseline to avoid COVID-19-related distortions. As the maternal mortality rate dropped nationally, ProPublica found, it rose substantially in Texas.

ProPublica’s analysis is the most detailed look yet at a rise in life-threatening complications for women losing a pregnancy after Texas banned abortion. It raises concerns that the same pattern may be occurring in more than a dozen other states with similar bans.

To chart the scope of pregnancy-related infections, ProPublica purchased and analyzed seven years of Texas’ hospital discharge data.

When abortion was legal in Texas, the rate of sepsis for women hospitalized during second-trimester pregnancy loss was relatively steady. Then the state’s first abortion ban went into effect and the rate of sepsis spiked.

“This is exactly what we predicted would happen and exactly what we were afraid would happen,” said Dr. Lorie Harper, a maternal-fetal medicine specialist in Austin.

She and a dozen other maternal health experts who reviewed ProPublica’s findings say they add to the evidence that the state’s abortion ban is leading to dangerous delays in care. Texas law threatens up to 99 years in prison for providing an abortion. Though the ban includes an exception for a “medical emergency,” the definition of what constitutes an emergency has been subject to confusion and debate.

Many said the ban is the only explanation they could see for the sudden jump in sepsis cases.

The new analysis comes as Texas legislators consider amending the abortion ban in the wake of ProPublica’s previous reporting, and as doctors, federal lawmakers and the state’s largest newspaper have urged Texas officials to review pregnancy-related deaths from the first full years after the ban was enacted; the state maternal mortality review committee has, thus far, opted not to examine the death data for 2022 and 2023.

The standard of care for miscarrying patients in the second trimester is to offer to empty the uterus, according to leading medical organizations, which can lower the risk of contracting an infection and developing sepsis. If a patient’s water breaks or her cervix opens, that risk rises with every passing hour.

Sepsis can lead to permanent kidney failure, brain damage and dangerous blood clotting. Nationally, it is one of the leading causes of deaths in hospitals.

While some Texas doctors have told ProPublica they regularly offer to empty the uterus in these cases, others say their hospitals don’t allow them to do so until the fetal heartbeat stops or they can document a life-threatening complication.

Last year, ProPublica reported on the repercussions of these kinds of delays.

Forced to wait 40 hours as her dying fetus pressed against her cervix, Josseli Barnica risked a dangerous infection. Doctors didn’t induce labor until her fetus no longer had a heartbeat.

Physicians waited, too, as Nevaeh Crain’s organs failed. Before rushing the pregnant teenager to the operating room, they ran an extra test to confirm her fetus had expired.

Both women had hoped to carry their pregnancies to term, both suffered miscarriages and both died.

In response to their stories, 111 doctors wrote a letter to the Legislature saying the abortion ban kept them from providing lifesaving care and demanding a change.

“It’s black and white in the law, but it’s very vague when you’re in the moment,” said Dr. Tony Ogburn, an OB-GYN in San Antonio. When the fetus has a heartbeat, doctors can’t simply follow the usual evidence-based guidelines, he said. Instead, there is a legal obligation to assess whether a woman’s condition is dire enough to merit an abortion under a prosecutor’s interpretation of the law.

Some prominent Texas Republicans who helped write and pass Texas’ strict abortion bans have recently said that the law should be changed to protect women’s lives — though it’s unclear if proposed amendments will receive a public hearing during the current legislative session.

ProPublica’s findings indicate that the law is getting in the way of providing abortions that can protect against life-threatening infections, said Dr. Sarah Prager, a professor of obstetrics and gynecology at the University of Washington.

“We have the ability to intervene before these patients get sick,” she said. “This is evidence that we aren’t doing that.”

Health experts, specially equipped to study maternal deaths, sit on federal agencies and state-appointed review panels. But, as ProPublica previously reported, none of these bodies have systematically assessed the consequences of abortion bans.

So ProPublica set out to do so, first by investigating preventable deaths, and now by using data to take a broader view, looking at what happened in Texas hospitals after the state banned abortion, in particular as women faced miscarriages.

“It is kind of mindblowing that even before the bans researchers barely looked into complications of pregnancy loss in hospitals,” said perinatal epidemiologist Alison Gemmill, an expert on miscarriage at Johns Hopkins Bloomberg School of Public Health.

In consultation with Gemmill and more than a dozen other maternal health researchers and obstetricians, ProPublica built a framework for analyzing Texas hospital discharge data from 2017 to 2023, the most recent full year available. This billing data, kept by hospitals and collected by the state, catalogues what happens in every hospitalization. It is anonymized but remarkable in its granularity, including details such as gestational age, complications and procedures.

To study infections during pregnancy loss, ProPublica identified all hospitalizations that included miscarriages, terminations and births from the beginning of the second trimester up to 22 weeks’ gestation, before fetal viability. Since first-trimester miscarriage is often managed in an outpatient setting, ProPublica did not include those cases in this analysis.

When looking at stays for second-trimester pregnancy loss, ProPublica found a relatively steady rate of sepsis before Texas made abortion a crime. In late 2021, the state made it a civil offense to end a pregnancy after a fetus developed cardiac activity, and in the summer of 2022, the state made it a felony to terminate any pregnancy, with few exceptions.

In 2021, 67 patients who lost a pregnancy in the second trimester were diagnosed with sepsis — as in the previous years, they accounted for about 3% of the hospitalizations.

In 2022, that number jumped to 90.

The following year, it climbed to 99.

ProPublica’s analysis was conservative and likely missed some cases. It doesn’t capture what happened to miscarrying patients who were turned away from emergency rooms or those like Barnica who were made to wait, then discharged home before they returned with sepsis.

Our analysis showed that patients who were admitted while their fetus was still believed to have a heartbeat were far more likely to develop sepsis.

For patients in Texas hospitals who lost a pregnancy, about half were not diagnosed with fetal demise when they were admitted, meaning that their fetus may still have had a heartbeat at that time. Those patients saw a dramatic increase in sepsis after the state banned abortion.

“What this says to me is that once a fetal death is diagnosed, doctors can appropriately take care of someone to prevent sepsis, but if the fetus still has a heartbeat, then they aren’t able to act and the risk for maternal sepsis goes way up,” said Dr. Kristina Adams Waldorf, professor of obstetrics and gynecology at UW Medicine and an expert in pregnancy complications. “This is needlessly putting a woman’s life in danger.”

Studies indicate that waiting to evacuate the uterus increases rates of sepsis for patients whose water breaks before the fetus can survive outside the womb, a condition called previable premature rupture of membranes or PPROM. Because of the risk of infection, major medical organizations like the Society for Maternal-Fetal Medicine and the American College of Obstetricians and Gynecologists advise doctors to always offer abortions.

Researchers in Dallas and Houston examined cases of previable pregnancy complications at their local hospitals after the state ban. Both studies found that when women weren’t able to end their pregnancies right away, they were significantly more likely to develop dangerous conditions than before the ban. The study of the University of Texas Health Science Center in Houston, not yet published, found that the rate of sepsis tripled after the ban.

Dr. Emily Fahl, a co-author of that study, recently urged professional societies and state medical boards to “explicitly clarify” that doctors need to recommend evacuating the uterus for patients with a PPROM diagnosis, even with no sign of infection, according to MedPage Today.

UTHealth Houston did not respond to several requests for comment.

ProPublica zoomed out beyond the second trimester to look at deaths of all women hospitalized in Texas while pregnant or up to six weeks postpartum. Deaths peaked amid the COVID-19 pandemic, and most patients who died then were diagnosed with the virus. But looking at the two years before the pandemic, 2018 and 2019, and the two most recent years of data, 2022 and 2023, there is a clear shift:

In the two earlier years, there were 79 maternal hospital deaths.

In the two most recent, there were 120.

Caitlin Myers, an economist at Middlebury College, said it’s crucial to examine these deaths from different angles, as ProPublica has done. Data analyses help illuminate trends but can’t reveal a patient’s history or wishes, as a detailed medical chart might. Diving deep into individual cases can reveal the timeline of treatment and how doctors behave. “When you see them together, it tells a really compelling story that people are dying as a result of the abortion restrictions.”

Texas has no plans to scrutinize those deaths. The chair of the maternal mortality review committee said the group is skipping data from 2022 and 2023 and picking up its analysis with 2024 to get a more “contemporary” view of deaths. She added that the decision had “absolutely no nefarious intent.”

“The fact that Texas is not reviewing those years does a disservice to the 120 individuals you identified who died inpatient and were pregnant,” said Dr. Jonas Swartz, an assistant professor of obstetrics and gynecology at Duke University. “And that is an underestimation of the number of people who died.”

The committee is also prohibited by law from reviewing cases that include an abortion medication or procedure, which can also be used during miscarriages. In response to ProPublica’s reporting, a Democratic state representative filed a bill to overturn that prohibition and order those cases to be examined.

Because not all maternal deaths take place in hospitals and the Texas hospital data did not include cause of death, ProPublica also looked at data compiled from death certificates by the Centers for Disease Control and Prevention.

It shows that the rate of maternal deaths in Texas rose 33% between 2019 and 2023 even as the national rate fell by 7.5%.

Texas’ abortion law is under review this legislative session. Even the party that championed it and the senator who authored it say they would consider a change.

On a local television program last month, Republican Lt. Gov. Dan Patrick said the law should be amended.

“I do think we need to clarify any language,” Patrick said, “so that doctors are not in fear of being penalized if they think the life of the mother is at risk.”

State Sen. Bryan Hughes, who once argued that the abortion ban he wrote was “plenty clear,” has since reversed course, saying he is working to propose language to amend the ban. Texas Gov. Greg Abbott told ProPublica, through a spokesperson, that he would “look forward to seeing any clarifying language in any proposed legislation from the Legislature.”

Patrick, Hughes and Attorney General Ken Paxton did not respond to ProPublica’s questions about what changes they would like to see made this session and did not comment on findings ProPublica shared.

In response to ProPublica’s analysis, Abbott’s office said in a statement that Texas law is clear and pointed to Texas health department data that shows 135 abortions have been performed since Roe was overturned without resulting in prosecution. The vast majority of the abortions were categorized as responses to an emergency but the data did not specify what kind. Only five were solely to “preserve [the] health of [the] woman.”

At least seven bills related to repealing or creating new exceptions to the abortion laws have been introduced in Texas.

Doctors told ProPublica they would most like to see the bans overturned so all patients could receive standard care, including the option to terminate pregnancies for health considerations, regardless of whether it’s an emergency. No list of exceptions can encompass every situation and risk a patient might face, obstetricians said.

“A list of exceptions is always going to exclude people,” said Dallas OB-GYN Dr. Allison Gilbert.

It seems unlikely a Republican-controlled Legislature would overturn the ban. Gilbert and others are advocating to at least end criminal and civil penalties for doctors. Though no doctor has been prosecuted for violating the ban, the mere threat of criminal charges continues to obstruct care, she said.

In 2023, an amendment was passed that permitted physicians to intervene when patients are diagnosed with PPROM. But it is written in such a way that still exposes physicians to prosecution; it allows them to offer an “affirmative defense,” like arguing self-defense when charged with murder.

“Anything that can reduce those severe penalties that have really chilled physicians in Texas would be helpful,” Gilbert said. “I think it will mean that we save patients’ lives.”

Rep. Mihaela Plesa, a Democrat from outside Dallas who filed a bill to create new health exceptions, said that ProPublica’s latest findings were “infuriating.”

She is urging Republicans to bring the bills to a hearing for debate and discussion.

Last session, there were no public hearings, even as women have sued the state after being denied treatment for their pregnancy complications. This year, though some Republicans appeared open to change, others have gone a different direction.

One recently filed a bill that would allow the state to charge women who get an abortion with homicide, for which they could face the death penalty.

Do you live in a state that has passed laws affecting abortion in the last few years? In the time since, have you or a loved one experienced delayed health care while pregnant or experiencing a miscarriage?

ProPublica would like to hear from you to better understand the unintended impact of abortion bans across the country. Email our reporters at reproductivehealth@propublica.org to share your story.

We understand this may be difficult to talk about, and we have detailed how we report on maternal health to let you know what you can expect from us.

Lucas Waldron contributed graphics. Mariam Elba contributed research.

This content originally appeared on ProPublica and was authored by by Lizzie Presser, Andrea Suozzo, Sophie Chou and Kavitha Surana.

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published.

A first-of-its-kind analysis by ProPublica found that the sepsis rate in second-trimester pregnancy loss hospitalizations increased by more than 50% after Texas’ near-total abortion ban went into effect in September 2021. The analysis also identified at least 120 in-hospital deaths of pregnant or postpartum women in 2022 and 2023 — an increase of dozens of deaths from a comparable period before the COVID-19 pandemic.

Neither the CDC nor states are investigating deaths or severe maternal complications related to abortion bans. And although the federal government and many states track severe complications in birth events using a federally established methodology, far less is known about complications that arise during a pregnancy loss. There is no federal methodology for doing this, so we consulted with experts to craft one.

We acquired Texas hospitalization data from 2017 through 2023, giving us more than two years of data after the implementation of the state’s six-week abortion ban in September 2021, and more than a year of data following its full abortion ban, which went into effect in August 2022.

We spoke with dozens of researchers and clinicians to adapt the federal algorithm for birth complications to focus on severe complications in early pregnancy, before fetal viability.

This methodology lays out the steps we took to complete this analysis, to help experts and interested readers understand our approach and its limitations.

We purchased seven years of inpatient discharge records for all hospitals from the Texas Department of State Health Services. These records contain de-identified data for all hospital stays longer than a day, with information about the stay, including diagnoses recorded and procedures performed during the stay, as well as some patient demographic information and billing data.

Within this dataset, we opted to focus on second-trimester pregnancy loss, because first-trimester miscarriage management often occurs in an outpatient setting. In the future, we plan to look at outpatient data as well.

To examine outcomes in the second trimester, we first identified hospitalizations where a pregnancy ended. We used a methodology to identify severe complications in birth events developed by the Health Resources and Services Administration, the Centers for Disease Control and Prevention, the Agency for Healthcare Research and Quality, and the Alliance for Innovation on Maternal Health, an initiative of the American College of Obstetricians and Gynecologists. The method is outlined in statistical code published by HRSA, and it first identifies every hospitalization with a live birth, stillbirth or an “abortive outcome” (which refers to an intended or unintended pregnancy loss before 20 weeks). Rather than excluding those abortive outcomes to focus on birth, as the HRSA code directs, we included them to look at all hospitalizations where a pregnancy ended. This narrowed our list of hospitalizations to an average of 370,000 per year.

The HRSA methodology further filters hospitalizations to only patients who are female and between the ages of 12 and 54. Our dataset had five-year age ranges, so we filtered to ages between 10 and 54. This brought our hospitalization list to 364,000 each year, on average.

For each hospitalization where a pregnancy ended, we looked for a diagnosis code recording the gestational age of the fetus. In cases where a long hospitalization had multiple gestational week codes recorded over the course of the stay, we took the latest one.

We excluded pregnancy-end hospitalizations without a gestational week code from our analysis — removing about 49,500 hospitalizations, or 1.9% of our dataset. More than two-thirds had coding that indicated a birth, likely to have occurred after 20 weeks.

Based on conversations with doctors and researchers, we narrowed our focus to hospitalizations where a pregnancy ended in the second trimester before fetal viability, from the start of the 13th week through 21 weeks and six days. While pregnancies that end at 20 and 21 weeks are often coded as births, rather than abortive outcomes, we included those weeks in our definition of pregnancy loss because experts told us it’s extremely unlikely that a baby born at 21 weeks could survive. This brought our list of hospitalizations to 15,188.

The number of second trimester hospitalizations, and characteristics of the women hospitalized, was largely stable from 2017 through 2023, the years of our analysis. In 2023, however, as the number of births in the state increased, the number of hospitalizations in our window declined to 2,036, below the yearly average of 2,169.

The race and ethnicity of patients each year, as well as the proportion of these hospitalizations in which the patients were covered by Medicaid or uninsured, did not change significantly after the state’s 2021 abortion ban, known as SB 8, went into effect.

Within these hospitalizations, we looked for diagnoses of sepsis, a life-threatening complication that can follow delays in emptying the uterus. The CDC defines a list of sepsis codes associated with severe maternal complications, which formed the basis of our definition. However, that list of codes is developed to look at sepsis in birth events, the vast majority of which occur much later in a pregnancy than our hospitalizations. We identified five sepsis codes associated with early pregnancy events like ectopic pregnancy and miscarriage, adding them to the existing list of sepsis codes to develop a definition that more fully captured early pregnancy complications.

To compare rates before and after the implementation of SB 8, we grouped the nine quarters of data we had after the implementation of the ban (October 2021 through December 2023) and compared it with the nine quarters immediately before (July 2019 through September 2021). Our dataset gives us the quarter in which a patient was discharged from the hospital but not the exact date, so the “before” group contains one month of data from after SB 8 went into effect on Sept. 1, 2021.

The standard of care for second-trimester miscarriage or rupture of membranes prior to fetal viability is to offer patients a dilation and evacuation or an induction to end the pregnancy — even if there is still a fetal heartbeat. In our reporting, we’d heard that because of the language of Texas’ abortion law, some hospitals and doctors were waiting for the fetal heartbeat to stop or the mother to develop a life-threatening illness, whichever occurred first. To look into this, we wanted to separate hospitalizations in which doctors would have theoretically been able to offer a termination immediately under the law — ones where the patient had a diagnosis indicating that there was no fetal heartbeat at the time of admission to the hospital — from ones where doctors may have waited to provide care.

We determined that about half of our second-trimester hospitalizations did not have a fetal heartbeat on admission. We identified these cases by focusing on two sets of diagnosis codes: Prior to 20 weeks gestation, a diagnosis of “missed abortion” refers to a miscarriage where the fetus has stopped developing, but the body has not yet expelled the tissue. After 20 weeks, a diagnosis of “intrauterine death” indicates that the fetus has died. For both diagnoses, we included only those that were marked as “present on admission.”

Our analysis found that the sepsis rate in second-trimester pregnancy loss hospitalizations increased after the state’s ban went into effect, and the surge was most pronounced in cases in which the fetus may still have had a heartbeat when the patient arrived at the hospital.

In the nine quarters before SB 8 went into effect, the sepsis rate in second-trimester pregnancy loss hospitalizations was 2.9%. In the nine quarters after SB 8 went into effect, the sepsis rate was 4.5%, an increase of 55%.

Since our total number of sepsis cases was relatively small, we measured whether the two groups of data were significantly different using a t-test. We calculated sepsis rates for second-trimester hospitalizations in the nine quarters after SB 8 went into effect and compared that with sepsis rates during the nine quarters immediately prior. We found that increase to be statistically significant (p-value < 0.05).

We compared the nine quarters after SB 8 went into effect — from October 2021 through December 2023 — to the nine quarters before the ban went into effect — July 2019 to September 2021.

Sepsis is a reaction to an infection, and the most common additional infection diagnosis in sepsis hospitalizations was chorioamnionitis, an infection of the amniotic fluid that can also cause early rupture of membranes. Rates of chorioamnionitis in sepsis cases remained stable before and after SB 8.

Our analysis also showed that patients admitted while their fetus was still believed to have a heartbeat were far more likely to contract sepsis.

For patients in Texas hospitals who lost a pregnancy, about half were not diagnosed with fetal demise when they were admitted, meaning that their fetus may still have had a heartbeat at that time. Those patients saw a dramatic increase in sepsis after the state banned abortion.

In the nine quarters prior to the implementation of SB 8, the rate of sepsis was nearly twice as high for those with no fetal demise diagnosis on admission compared with those with a fetal demise diagnosis on admission. After SB 8, the rate increased in both groups, and the gap between them widened.

Again, since the number of total sepsis cases was relatively small, we used a t-test to see if there was a statistically significant difference before and after SB 8 in both groups. We found the increase in rates to be significant on both counts (p < 0.05).

Maternal health experts noted that discharge data offers a limited window into the details of patient care. Changes in the frequency of a diagnosis code can signal a change in patient health but also a change in coding practices. Our analysis can’t isolate changes in outcomes from changes in sepsis coding practices over time or doctors taking additional documentation steps to show they’ve complied with the law. And billing records offer no detail into a patient’s history and medical wishes or the decisions that medical staff make in the course of care.

Our analysis also does not account for changes in health care outside of hospitals. Though births typically take place in a hospital, other early pregnancy care often occurs in an outpatient setting and does not require a hospitalization, so we can only see a small subset of this type of care — specifically, the most severe cases. We also can’t account for how closures of reproductive health care clinics in the wake of Texas’ abortion ban changed the role hospitals play in miscarriage care.

We cannot see when hospitals turn patients away rather than admitting them. And if a patient who is miscarrying has an inpatient stay at one hospital and is then transferred to another hospital for another inpatient stay, that patient would be double-counted in our analysis, since we can’t connect patients across visits. This could potentially inflate the number of hospitalizations in our dataset, artificially pushing the sepsis rate down.

Our dataset is missing a handful of records from the fourth quarter of 2023; in a small number of cases — about 300 per quarter, or 0.04% of records — providers submit data on a hospitalization late, and that record is released in the dataset for the following quarter.

Billing data is widely used by researchers to study maternal health. While it will never tell the whole story, in aggregate, particularly in a state with a large population, it can paint a picture of changing health outcomes. Our analysis gives us a broad view of care at Texas hospitals before and after a major policy change.

More than a dozen maternal health experts reviewed ProPublica’s findings and said our analysis adds to mounting evidence that the state’s abortion ban is likely leading to dangerous delays in care. Many said the ban is the only explanation they could see for the sudden jump in sepsis cases.

We found 120 women who died while hospitalized during pregnancy or up to six weeks postpartum in 2022 and 2023 in the inpatient billing data. The Texas Maternal Mortality and Morbidity Review Committee will not review deaths from these years, stating that they will skip to 2024 in an effort to get a more “contemporary” view of deaths, a choice that faced widespread criticism. (The committee chair said there was “absolutely no nefarious intent” behind the decision.)

To identify inpatient deaths in the Texas hospital discharge data, we included all records with a “patient status” of “expired” and with a diagnosis or procedure code indicating that the patient was pregnant or up to six weeks postpartum, with a specific postpartum complication based on the “Identifying Pregnant and Postpartum Medicaid and CHIP Beneficiaries” code list by the Centers for Medicare & Medicaid Services. The CDC looks at deaths up to within one year of a pregnancy’s end, but our dataset doesn’t explicitly identify pregnant or recently pregnant patients, so we were limited in the hospitalizations we could identify through codes.

Our tally does not include those who died in a hospitalization that took place separately from the end of a pregnancy, unless the patient was diagnosed with a specific postpartum complication. We did not filter for age and gender for our death records, as that data was less reliably filled out than the diagnosis and procedure codes.

Our count of inpatient deaths does not attempt to determine what role a person’s pregnancy or the state’s abortion ban played in their death. That type of analysis would require access to medical records. Our tally would include, for example, a person who was hospitalized after a car crash but who was also pregnant. Experts advised us to leave these cases in, because without investigation by the maternal mortality committee, it’s impossible to know, for example, if there was any relationship between the patient’s pregnancy and the cause of the accident, or if there were any delays in maternal care after the accident.

We found that deaths increased sharply during the height of the COVID-19 pandemic and peaked in 2021, and that many cases in 2020 and afterward included COVID-19 diagnostic codes. More than 60% of the deaths that we analyzed had a diagnosis of COVID-19 in 2021, and 27% had a COVID-19 diagnosis in 2022. The COVID-19 diagnostic code was not introduced until October 2020, several months after the pandemic began, and was updated in January 2021. The coding changes, combined with changes in hospital protocols around identifying COVID-19 cases, make it impossible to filter out all COVID-19 related deaths during this time period.

The hospital billing data only includes information about Texas, so to compare with national rates, we used data from the CDC’s WONDER portal, which is based on birth and death certificates. For this analysis, we used a definition of maternal death recommended by CDC research guidelines for this data source. Our denominator includes all live births. For statewide rates, we use the state of residence of the mother in both the numerator and denominator. Rates are reported per 100,000 births.

Between 2019 and 2023, we found a 33% increase in maternal mortality rates in Texas, compared with a decrease of 7.5% nationally during the same time.

While both nationally and in Texas rates of maternal mortality peaked in 2021 during the COVID-19 pandemic and have dropped since, rates in Texas remain higher than before the pandemic.

The federal methodology we used as a basis for our analysis of severe complications in pregnancy hospitalizations was outlined in a document available for download from HRSA’s Maternal and Child Health Bureau. The instructions included statistical code that we adapted to do our own analysis, and they were accompanied by a spreadsheet of maternal and child outcome measures over time for all 50 states and nationally.

As of early February, both the instructions and the spreadsheet had been replaced by documents noting that the files were “currently under construction and not available.”

Lucas Waldron contributed graphics.

This content originally appeared on ProPublica and was authored by by Andrea Suozzo, Sophie Chou and Lizzie Presser.

An undocumented Venezuelan mother and two of her children were deported to Mexico earlier this month — just hours after a minor traffic stop, reports John Washington, who has covered the case for the Tucson-based independent outlet Arizona Luminaria. Arizona Public Safety troopers claimed the mother was driving under the speed limit. The mother, whom Democracy Now! is not identifying at the request of the family, described being handcuffed in front of her children, aged 6 and 9. The troopers called Border Patrol agents, who apprehended the woman and her two children and later turned them over to Mexican immigration officials in the border city of Nogales before they were put on a bus and driven about 2,000 miles away to the southern Mexican state of Tabasco. The woman suffered a “night of interrogation,” says Washington. The woman’s family was unable to reach the mother for days, until she was finally able to call her family letting them know of her whereabouts. Her two other children, who are 8 and 14 years old, are still in Tucson. We also speak with immigrant rights activist Greisa Martínez Rosas, executive director of United We Dream Action, who says Democrats share the blame for harmful immigration policies now reaching new heights under the Trump administration. “We need a true opposition power and party,” she says.

This content originally appeared on Democracy Now! and was authored by Democracy Now!.

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published.

In advance of this year’s state legislative sessions, lawmakers are filing more than a dozen bills to expand abortion access in at least seven states, and a separate bill introduced in Texas seeks to examine the impact that the state’s abortion ban has had on maternal outcomes.

Some were filed in direct response to ProPublica’s reporting on the fatal consequences of such laws. Others were submitted for a second or third year in a row, but with new optimism that they will gain traction this time.

The difference now is the unavoidable reality: Multiple women, in multiple states with abortion bans, have died after they couldn’t get lifesaving care.

They all needed a procedure used to empty the uterus, either dilation and curettage or its second-trimester equivalent. Both are used for abortions, but they are also standard medical care for miscarriages, helping patients avoid complications like hemorrhage and sepsis. But ProPublica found that doctors, facing prison time if they violate state abortion restrictions, are hesitating to provide the procedures.

Three miscarrying Texas women, mourning the loss of their pregnancies, died without getting a procedure; one was a teenager. Two women in Georgia suffered complications after at-home abortions; one was afraid to seek care and the other died of sepsis after doctors did not provide a D&C for 20 hours.

Florida state Sen. Tina Polsky said the bill she filed Thursday was “100%” inspired by ProPublica’s reporting. It expands exceptions to the state’s abortion ban to make it easier for doctors and hospitals to treat patients having complications. “We’ve had lives lost in Texas and Georgia, and we don’t need to follow suit,” the Democrat said. “It’s a matter of time before it happens in Florida.”

Texas state Rep. Donna Howard, who is pushing to expand the list of medical conditions that would fall under her state’s exceptions, said she’s had encouraging conversations with her Republican colleagues about her bill. The revelations that women died after they did not receive critical care has "moved the needle here in Texas," Howard said, leading to more bipartisan support for change.

Republican lawmakers in other states told ProPublica they are similarly motivated.

Among them is Kentucky state Rep. Jim Gooch Jr., a Baptist great-grandfather who is trying for the second time to expand circumstances in which doctors can perform abortions, including for incomplete miscarriages and fatal fetal anomalies. He thinks the bill might get a better reception now that his colleagues know that women have lost their lives. “We don’t want that in Kentucky,” he said. “I would hope that my colleagues would agree.”

He said doctors need more clearly defined exceptions to allow them to do their jobs without fear. “They need to have some clarity and not be worried about being charged with some type of crime or malpractice.”

After a judge in North Dakota overturned the state’s total abortion ban, Republican state Rep. Eric James Murphy acted quickly to stave off any similar bans, drafting a bill that would allow abortions for any reason up to the 16th week and then up through about 26 weeks if doctors deem them medically necessary.

“We need other states to understand that there’s an approach that doesn’t have to be so controversial,” said Murphy, who is also an associate professor of pharmacology at the University of North Dakota School of Medicine and Health Sciences. “What if we get the discussion going and we get people to know that there are rational Republicans out there? Maybe others will come along.”

Under state rules, North Dakota lawmakers are required to give his bill a full hearing, he said, and he plans to introduce ProPublica’s stories as evidence. “Will it make it easier? I sure hope so,” he said. “The Lord willing and the creeks don’t rise, I sure hope so.”

So far, efforts to expand abortion access in more than a dozen states where bans were in effect have faced stiff opposition, and lawmakers introducing the bills said they don’t expect that to change. And some lawmakers, advocates and medical experts argue that even if exceptions are in place, doctors and hospitals will remain skittish about intervening.

As ProPublica reported, women died even in states whose bans allowed abortions to save the “life of the mother.” Doctors told ProPublica that because the laws’ language is often vague and not rooted in real-life medical scenarios, their colleagues are hesitating to act until patients are on the brink of death.

Experts also say it is essential to examine maternal deaths in states with bans to understand exactly how the laws are interfering with critical care. Yet Texas law forbids its state maternal mortality review committee from looking into the deaths of patients who received an abortive procedure or medication, even in cases of miscarriage. Under these restrictions, the circumstances surrounding two of the Texas deaths ProPublica documented will never be reviewed.

“I think that creates a problem for us if we don’t know what the hell is happening,” said Texas state Sen. José Menéndez.

In response to ProPublica’s reporting, the Democrat filed a bill that lifts the restrictions and directs the state committee to study deaths related to abortion access, including miscarriages. “Some of my colleagues have said that the only reason these women died was because of poor practice of medicine or medical malpractice,” he said. “Then what’s the harm in doing the research … into what actually happened?”

U.S. Rep. Jasmine Crockett agreed. The Texas Democrat and three other members of the House Committee on Oversight and Accountability on Dec. 19 sent a letter to Texas state officials demanding a briefing on the decision not to review deaths that occurred in 2022 and 2023.

Crockett said the state has not responded to the letter, sent to Texas Public Health Commissioner Jennifer Shuford.

“If you feel that your policies are right on the money, then show us the money, show us the goods,” she said. “This should be a wakeup call to Texans, and Texans should demand more. If you believe that these policies are good, then you should want to see the numbers too.”

Doctors are starting to hear about heightened concerns in conversations at their hospitals.

Dr. Austin Dennard, a Dallas OB-GYN, said her hospital recently convened a meeting with lawyers, administrators and various specialists that focused on “how to keep our pregnant patients safe in our hospital system and how to keep our doctors safe.” They discussed creating additional guidance for doctors.

Dennard, who noted she is speaking on her own behalf, said she is getting more in-depth questions from her patients. “We used to talk about vitamins and certain medications to get off of and vaccines to get,” she said. “Now we do all that and there’s a whole additional conversation about pregnancy in Texas, and we just talk about, ‘What’s the safest way we can do this?’”

In addition to being a doctor, Dennard was one of 20 women who joined a lawsuit against the state after they were denied abortions for miscarriages and high-risk pregnancy complications. When she learned her fetus had anencephaly — a condition in which the brain and skull do not fully develop — she had to travel out of state for an abortion. (The lawsuit asked state courts to clarify the law’s exceptions, but the state Supreme Court refused.)

Dennard said stories like ProPublica’s have crystallized a new level of awareness for patients there: “If you have the capacity to be pregnant, then you could easily be one of these women.”

Mariam Elba contributed research and Kavitha Surana contributed reporting.

This content originally appeared on ProPublica and was authored by by Ziva Branstetter and Cassandra Jaramillo.

Times Algebra shared the video on its X handle, calling the news shocking and added, “In Pakistan, a son married his mother, who raised him for 18 years. The news is viral all over the world. Your opinion? Pakistan media called it a ‘heartwarming gesture.’ Abdul Ahad shared his story on social media.” (Archived link)

This tweet was viewed by more than 30 Lakh users.

Right-wing influencers @MeghUpdates and @Kreatelymedia, who have often been found sharing communal misinformation, also shared the video with similar claims. (Archived link 1, link 2)

Verified X handle The Jaipur Dialogues wrote, ‘These people will never change, anything can happen in Islam’. Alt News has previously exposed several false claims amplified by The Jaipur Dialogues.

Right wing X handles Rajesh Singh, Avkush Singh, and Raju Valmiki also shared photos and videos with the same claim. (Archived link 1, Link 2, Link 3)

Many other social media users amplified these photos and videos with similar claims.

Fact Check

On performing a reverse image search with one of the photos in the viral post, we found an article published on the Pakistani website Reviewit.pk on December 27, 2024 and a news report published by India Today on December 30, 2024. Both of these reports state that Abdul Ahad, a young man from Pakistan, arranged his mother’s second marriage.

The India Today report further stated that Ahad shared an emotional video on Instagram which featured touching scenes of precious moments spent with his mother, symbolizing their strong bond. Finally, there were scenes from his mother’s nikah (marriage).

Abdul Ahad uploaded the video on his Instagram account on December 18, 2024, stating, “In the last 18 years, I tried my best to give her a special life to the best of my ability, because she sacrificed her whole life for us. But ultimately, she deserved a peaceful life. So as a son, I think I did the right thing by helping my mother get a second chance at love and life after 18 years.”

 

View this post on Instagram

 

A post shared by Abdul Ahad | عبدالاحد (@muserft.ahad)

In a follow-up post from December 20, 2024, he shared a picture of the ceremony and posted a note along with it. It said he hesitated for several days before sharing the news of his mother’s marriage. However, he told his mother how much appreciation and respect their decision had received and the love and support they got from social media users. He expressed his and his mother’s gratitude for the same. 

 

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A post shared by Abdul Ahad | عبدالاحد (@muserft.ahad)

To sum it up, Abdul Ahad, a young man from Pakistan, arranged a second marriage for his mother. This news was being shared with false claims that he himself married his mother. We have come across multiple instances in which Islam was targeted through false claims about fathers marrying their daughters, or as in this case, a son marrying his own mother.

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This content originally appeared on Alt News and was authored by Pawan Kumar.

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After the Supreme Court overturned the constitutional right to abortion in 2022, President Joe Biden issued an executive order tasking the federal government with assessing the “devastating implications for women’s health“ of new state abortion bans.

Experts were warning that these bans would interfere with critical medical care and lead to preventable deaths. And the states that passed the laws had little incentive to track their consequences.

Biden directed the secretary of Health and Human Services to make sure federal agencies were “​​accurately measuring the effect of access to reproductive healthcare on maternal health outcomes.” He called on the National Institutes of Health and the Centers for Disease Control and Prevention to drive targeted research and data-collection efforts.

But the Biden administration has missed a critical opportunity to illuminate how abortion bans are interfering with maternal health care, leading to deaths and irreversible injuries: The CDC has not pushed state committees that review maternal deaths to examine the role these new laws have played.

The CDC leads the nation’s work to track and reduce maternal mortality, spending nearly $90 million over the last five years to fund state panels made up of health experts who analyze fatalities to spot trends and recommend reforms. While it cannot require states to collect or report certain data, the CDC gives committees detailed guidance for assessing whether deaths were preventable and which factors contributed to them.

Following this guidance, committees consider factors including obesity, mental health issues, substance use, homicide and suicide. In 2020, the CDC added a checkbox to its model case review form for committees to indicate whether discrimination played a role.

Yet the agency has issued no guidance to address the recent rollback of reproductive rights or to direct committees to consider how abortion bans factor into deaths. Some state officials point to this silence as a reason their committees haven’t made any changes to their process. “The committee must follow national guidelines in maternal mortality review committee death investigations,” said a spokesperson for Oklahoma’s health department, which oversees the committee in the state.

Researchers say that this can obscure the impact of abortion bans.

“It’s pushing it under the rug in a way — like we don’t want to count it, we don’t want to know what’s happening,” said Maeve Wallace, an epidemiologist at the University of Arizona who has published studies on the intersection of intimate partner violence and maternal deaths, including one that found a rise in maternal homicides in places with increased abortion restrictions.

When asked about this, the CDC said the information submitted by states is sufficient to understand any effects from abortion bans.

“Maternal mortality review committees already comprehensively review all deaths that occur during pregnancy and through the year after the end of pregnancy, including abortion-related deaths,” said David Goodman, lead health scientist with the CDC’s Maternal Mortality Prevention Team. “The current process includes documenting and understanding contributing factors.”

But experts said that the CDC’s current guidance gives committees no standard way to consider the role abortion bans played in maternal deaths, which makes it harder to study deaths related to the restrictions and create an evidence base to inform recommendations.

Georgia’s maternal mortality review committee blamed the state’s abortion ban as a factor in one of the deaths examined by ProPublica, that of Candi Miller. The 41-year-old mother of three ordered abortion medication online and suffered complications, but did not visit a doctor “due to the current legislation,” her family told the coroner, who documented the statement. Committee members told ProPublica that the explicit mention in the records indicated the law created a barrier to care.

The case of Amber Thurman wasn’t as clear-cut; she had taken abortion medication at home and she sought care in a Georgia hospital for complications similar to Miller’s. Records showed doctors discussed, but did not provide, a dilation and curettage procedure to clear her uterus of infected tissue as she suffered for 20 hours with sepsis. Any impact the law may have had on the doctors’ decisionmaking was not noted in records the committee reviewed.

The committee concluded that one of the factors in her preventable death was the delay in care. And while members were able to check a “discrimination” box for Thurman’s case, they did not have any method to flag that she experienced a delay in receiving a procedure that is commonly used in both abortions and miscarriages and that had recently been criminalized.

If such a category were created by the CDC, it would allow researchers to see if there have been increased delays in care after abortion was banned, maternal health researchers said.

Experts told ProPublica this categorization would likely have covered the three other deaths ProPublica reported on, of Texas women who had not considered ending their pregnancies but who needed the same kind of procedure to manage their miscarriages. In those cases and that of Thurman, doctors diverged from the standard of care in ways that raise serious questions about how criminal abortion bans are affecting care for pregnancy loss, ProPublica’s reporting found.

“CDC public data shows an alarming increase in maternal mortality in states that ban abortion,” said Nancy L. Cohen, president of Gender Equity Policy Institute, a nonpartisan research organization. “Our analysis of the evidence and other factors strongly indicates that the bans are driving this increase, but there is no way currently to determine from publicly available data if abortion restrictions contributed to a particular death.”

The CDC “has the power to correct this,” she said, by asking states to collect information about whether abortion restrictions contributed to a death.

Inas Mahdi, a maternal health researcher who previously worked at the CDC for 15 years, said officials at her former agency know the power that investigating the impacts of policy can have. “The CDC is well aware that without data, there’s no action,” she said. But she added that officials likely experienced “trepidation” over wading into a “polarizing” topic without more direct support from the administration.

In Republican-led states, there’s little appetite to study the harmful effects of laws that their leaders avidly support, and any backlash could hamper efforts to improve maternal health that are seen as bipartisan, she said.

Her fellow CDC alum, Dr. Zsakeba Henderson, agrees. “If CDC were to request that of maternal mortality review committees, I know there would be pushback at the state level,” said Henderson, who previously worked in the agency’s reproductive health division supporting state-based perinatal quality collaboratives. The maternal mortality program is voluntary, and states could simply opt out. In the past year, for example, Texas decided to forgo federal funding and not share maternal death data with the CDC. Officials at the CDC declined to comment on the reason for the change. A spokesperson for the Texas Department of State Health Services said the Legislature directed the agency to do this.

A spokesperson for the Biden administration responded to ProPublica’s questions about whether his order had been fulfilled with a list of efforts to gather and make available data on contraception access and maternal health care outcomes. They said the administration had also “amplified” data from other sources on the impact of abortion bans in a memo.

When asked why the CDC has not created a checkbox to track deaths related to abortion access, a spokesperson for HHS, the CDC’s parent agency, said that the CDC “receives feedback from states on data fields.” The spokesperson noted that the discrimination checkbox was “added based on state requests” after a work group went through a multiyear process.

The spokesperson also said the lack of a checkbox does not mean HHS failed to meet the goals of Biden’s order. The spokesperson forwarded a 73-page update on the maternal mortality crisis that had been sent to Congress this past July. The report is packed with information on progress combating major maternal health risks: task forces to support mental health, initiatives to respond to the opioid crisis, research on intimate partner violence.

It doesn’t include a single reference to abortion access.

Ushma Upadhyay, a public health scientist at the University of California, San Francisco, said collecting data is crucial for understanding how the new abortion bans are impacting maternal health. Her research through WeCount, a project from the Society of Family Planning, has helped establish that the number of abortions has increased nationally since Roe v. Wade was overturned.

Though she has participated in roundtables with HHS officials about how it could better support reproductive health research related to abortion access, she never saw the agency take action based on these talks, she said. (When asked about what these conversations had led to, the agency shared a readout on an expert roundtable about contraception and said its work on studying how abortion restrictions impact maternal health care is ongoing.)

Upadhyay said sending a congressional update on maternal mortality with no mention of abortion access as evidence of fulfilling the order “kind of says it all.” When it comes to measuring the impact of abortion restrictions, “HHS is not doing much.”

The federal government’s largest contribution to this effort comes in the form of millions of dollars of NIH funding to research projects by academics looking into the impact of abortion restrictions, Upadhyay said. But more than two years after the Dobbs v. Jackson Women’s Health Organization decision allowed abortion bans to go into effect, none of those studies have been published and it’s unclear whether the incoming administration will continue funding them.

Researchers who track reproductive health lament the failure to think creatively and act urgently to monitor the fallout of abortion bans while the department had a chance.

“The Biden administration’s lost opportunity is that it viewed Dobbs as a political moment to gain advances for the Democratic Party,” said Tracy Weitz, the director of the Center on Health, Risk, and Society at American University. “It did not take this seriously as a public health crisis.”

The window is closing as President-elect Donald Trump prepares to take office. There is little chance a Republican administration will try to collect data that helps shed light on the impact of abortion bans, which were uniformly passed by Republican-majority state houses.

Last week, Trump named Ed Martin, a prominent anti-abortion activist, to be the chief of staff for his Office of Management and Budget, which oversees how the federal budget is administered. Martin has opposed abortion exceptions, supported a national ban and discussed the idea that women and doctors should be prosecuted for abortions.

If Project 2025 is any guide to how the Trump administration will approach abortion, the CDC may soon start a very different project: launching a mandatory, nationwide surveillance program aimed at portraying abortion care as dangerous.

The conservative blueprint for reshaping the federal government recommends that the agency require all states to report detailed data on abortions, miscarriages and stillbirths or risk losing federal funding.

It states that the CDC “should ensure that it is not promoting abortion as health care.” Instead, “It should fund studies into the risks and complications of abortion.”

Mariam Elba contributed research.

This content originally appeared on ProPublica and was authored by by Kavitha Surana, Robin Fields and Ziva Branstetter.

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published.

As doctors navigate risks of criminal prosecution in states with abortion bans, hospital leaders and lawyers have left them to fend for themselves with minimal guidance and, at times, have remained “conspicuously and deliberately silent,” according to a 29-page report released Thursday by Senate Finance Committee Chair Ron Wyden. The poor direction is leading to delays in emergency care for patients facing pregnancy complications, the report concluded.

The Oregon Democrat launched a probe in September in response to ProPublica’s reporting on preventable maternal deaths in states with abortion bans. Wyden requested documentation from eight hospitals to see whether they were complying with a federal law that requires them to stabilize or transfer emergency patients; his committee has authority over the regulatory agency that enforces the law. The report also draws on roundtable discussions with doctors from states with abortion restrictions.

The resulting committee staff report provides a new layer of insight into the chaotic and dysfunctional hospital landscape in states with abortion bans, as well as a fresh opportunity for hospitals to consider reforms and provide proactive and transparent guidance to patients and doctors.

Physicians, whose accounts were anonymized, described hospital lawyers who “refused to meet” with them for months, were "pretty much impossible" to reach during "life or death" scenarios and offered little help beyond “regurgitating” the law, according to the report. Doctors described how other doctors gave out wrong and potentially harmful information, saying that patients could not legally choose their own course of treatment and that doctors could not legally treat ectopic pregnancies, potentially fatal complications in which an embryo develops outside the uterine cavity.

“Doctors are playing lawyer, and lawyers are playing doctor,” Wyden said in an interview. As a result, “women are getting hurt, they’re suffering, they can die, and we want to deliver this wake-up call so that they’re better protected and they understand what their rights are.”

The Biden administration has told hospital officials that they have a responsibility under the federal Emergency Medical Treatment and Labor Act, known as EMTALA, to stabilize any patients who show up to their emergency rooms, even if that means doing so with an abortion procedure that conflicts with state abortion law. If they can’t, according to the administration’s guidance, they must transfer the patient to a hospital that can. Some states have fought this. In Texas, a court ruled that the administration’s guidance can’t supersede the state abortion ban and the Supreme Court turned down an appeal.

Information on how to handle the legal conflicts between the bans and federal law is usually not written down at hospitals and, in some cases, is only provided on a “need-to-know” basis, the investigation found. Nurses not included on the same emails as doctors did not trust that they could treat patients, according to an Idaho physician, who added that doctors are left on their own to “figure out the second or third best option.” An emergency medicine doctor who once worked in Texas said they’d encountered OB-GYNs who were too afraid to help deliver care. Another said that colleagues “just want to get these patients out of the hospital” because they worried about the professional and personal risks of treating them.

The report described each of the five preventable deaths ProPublica reported as examples of the fatal consequences of abortion bans. It also added to the mounting accounts of patients in crisis being denied care. Physicians shared examples such as:

• A patient in Idaho whose placenta had “sheared off” the side of the uterus, leading to a massive hemorrhage; the bleeding patient was sent home from the emergency room four or five times. Only at the moment they were “going to bleed out” did the hospital believe they were legally allowed to stabilize the patient, the doctor said.
• Another Idaho patient who was 19 weeks pregnant and cramping and spotting but was sent home at the direction of maternal-fetal medicine specialists until she could “be brought into an emergency situation.”
• A patient whose water broke at 21 weeks and whose fetus wasn’t viable. Doctors refused to remove the fetus until the heartbeat stopped, first sending her home and then, upon her return, requiring her to wait over six hours before they agreed to induce labor. ProPublica wrote about a similar case in Texas in which a woman died of a fatal infection after being made to wait for 40 hours for the fetal heartbeat to stop.

Wyden was able to obtain documentation and answers from hospitals that are rarely provided to the public. In December, ProPublica requested miscarriage treatment protocols from the 50 hospitals in Texas that account for roughly half of the births in the state, according to state hospital discharge data. Almost all declined to provide them. Researchers who attempted a similar survey in Oklahoma last year were met with comparable resistance after they tried to get hospitals to share their policies for treating pregnancy complications under the state’s ban, according to a study by Physicians for Human Rights.

The senator requested documentation from eight hospitals across the country that had been the subject of reports of delayed or denied emergency care for pregnancy complications. He asked for their “policies, processes and procedures related to state abortion laws and emergency reproductive health care.” All eight responded, sharing hundreds of pages of documentation and answers, which the committee published along with the report. The documents provide a rare, detailed view into the operations of private medical systems that may give doctors and ethics committees at hospitals new insight into what others are doing to respond to the laws.

The response revealed that many of the hospitals were relying on guidance created before the existence of abortion bans, the report said. In most cases, physicians were given basic EMTALA guidance that didn’t discuss how to handle new abortion restrictions and were told to contact legal or ethics counsel for questions. Only a few hospitals had created proactive guidance to help their providers navigate the new landscape, and only two of those explicitly discussed conflicts that exist between abortion bans and EMTALA and how to handle them. It was not always clear if these directives were created before media reports of denied care.

Freeman Health System in Missouri was found by federal investigators to have violated EMTALA after doctors told a patient whose water broke nearly 18 weeks into her pregnancy that they could not induce labor because of the state’s new abortion law. It submitted robust protocols to the committee that include a flowchart of its intake for pregnant patients and informed consent paperwork advising patients of high-risk pregnancy complications that constitute an “emergency medical condition” under EMTALA. The Missouri hospital system was the only one out of the eight that said it offered full civil and criminal defense of any providers sued under state abortion laws, according to the report.

Also surveyed was the Georgia hospital system that treated Amber Thurman, a 28-year-old single mother who faced a deadly infection from a rare complication after taking abortion medication. Doctors at Piedmont Henry Hospital discussed, but did not provide, a procedure to clear her uterus in time, according to a report by the state maternal mortality review committee, which concluded that her death was preventable.

Piedmont told Wyden it had assembled a task force after the state’s abortion ban went into effect. The hospital said it gave providers educational material on conflicts the abortion ban could create, including a “decision tree,” a statement from the American College of Obstetricians and Gynecologists on navigating exceptions to abortion bans and guidance for complying with the law’s documentation requirements. (ProPublica reported in September that the task force provided education in the months after Thurman’s death.)

Piedmont, Freeman and five of the other hospitals mentioned in the report did not respond to requests for comment. Dr. R. Cliff Moore, the chief medical officer and maternal-fetal medicine physician for Woman’s Hospital in Louisiana, said that when an early pregnancy-loss diagnosis is unclear, physicians “wait for additional information as long as the patient is stable.”

“The policies, evaluation, treatment and care for early pregnancy loss at Woman’s Hospital have not changed,” he said.

To safeguard emergency reproductive care, the report called for abortion access to be reestablished across America and for the federal government to enforce EMTALA “to the fullest extent of the law.”

But with Republicans in control of all branches of government next session, Wyden recognizes this is an unlikely scenario.

“It is all the more important that hospitals and provider groups step up and do all that they can to make sure patients get the health care they need,” he said. “That means making it crystal clear that patients have a federal legal right to emergency care, no matter where they live, and shouldn’t have to be on the brink of death to get it.”

The report issued four recommendations:

• It called on hospitals and hospital associations to work together to provide training, guidance and resources to doctors to ensure they provide emergency pregnancy care in abortion ban states.
• It said professional medical organizations “should issue guidance and publish standards that clearly define appropriate clinical care in obstetric emergencies.”
• It encouraged hospitals to support the full spectrum of doctors, from OB-GYNs to family medicine physicians, in becoming certified to prescribe mifepristone, part of the two-pill abortion medication regimen.
• It said doctors should counsel patients about their rights under EMTALA and how to report violations.

Mariam Elba, Cassandra Jaramillo, Lizzie Presser and Ziva Branstetter contributed reporting.

This content originally appeared on ProPublica and was authored by by Kavitha Surana.

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published.

We heard the same story again and again this year:

The women were having miscarriages. They were bleeding and in pain.

They needed a medical procedure to clear their uterus, but their doctors delayed it or didn’t even counsel them about it. Our yearlong investigation found that abortion laws are affecting how physicians treat pregnancy loss and other complications because the procedures used in these cases are also used for abortions.

We spoke to women who survived terrifying experiences, and we interviewed family members of those who died without care. They all felt unprepared as they entered emergency rooms, unaware of how abortion laws were reaching into pregnancy care.

They wished they had known what to expect and how to advocate for themselves and their loved ones.

We created this guide for them and anyone who finds themselves in the same position.

We wrote it in consultation with dozens of doctors, including those who hold positions at leading medical organizations and those who regularly treat patients who are miscarrying.

This guide does not provide medical or legal advice. We encourage you to seek out other reliable resources and consult with experts you trust.

When a pregnancy has stopped developing before 20 weeks, that is considered a miscarriage.

This is common — it happens in up to 1 out of every 4 known pregnancies. The medical term for miscarriage is “spontaneous abortion.”

During a pregnancy loss, someone might experience symptoms like bleeding and cramping and pass pregnancy tissue. Or an ultrasound might show that there’s no fetal cardiac activity even if the patient had no miscarriage symptoms.

While most miscarriages resolve on their own, some lead to dangerous complications, including hemorrhage and infection.

Eight in 10 miscarriages occur in the first trimester. A pregnancy that ends after 20 weeks is considered a stillbirth, but sometimes it is still referred to as a miscarriage.

Other rare complications, like premature rupture of membranes (when the water breaks too early) or preeclampsia (life-threatening high blood pressure), can develop in the second trimester of pregnancy and endanger both the pregnant patient and the fetus. Choosing not to intervene may mean there is some chance the fetus could survive, but it also may put the patient at risk of developing life-threatening complications.

Each situation is unique. In these circumstances, doctors should talk to patients about the risks and benefits of continuing the pregnancy and the option of ending it to protect their health, experts said. Sometimes these cases are referred to as a miscarriage.

When a patient is having a miscarriage or is at high risk for one, they should be offered three choices, according to major medical organizations like the American College of Obstetricians and Gynecologists:

1. Expectant management: Waiting to see if the body will pass the pregnancy on its own.
2. Medication: Taking medicine to help the body clear the tissue. This can include misoprostol or mifepristone with misoprostol, which causes the uterus to contract and can speed up the process
3. Procedure: Getting a dilation and curettage (D&C) in the first trimester or a dilation and evacuation (D&E) in the second trimester to empty the uterus.

All of these can be safe choices for an uncomplicated miscarriage, and a first trimester-miscarriage is rarely an emergency. The standard of care is for doctors to explain all options along with their risks and benefits, and then let their patients choose what they prefer. All major medical societies say that patients should be given that choice.

If a patient is bleeding heavily or showing signs of infection, doctors should recommend a procedure (D&C or D&E) to protect their health, medical experts say.

A D&C is a procedure to empty the uterus and is one of several safe ways to navigate pregnancy loss.

The term D&C stands for dilation and curettage and the procedure is often called “surgical” — but that’s a bit of a misnomer. It is more accurately called “uterine aspiration.” Doctors don’t need to make incisions or use sharp tools. They insert a straw-like tube into the uterus and use suction to gently draw out pregnancy tissue. The patient can be awake, sedated or asleep. It only takes a few minutes and typically ends the bleeding quickly.

When this suction procedure was popularized in the 1970s, after abortion became legal nationwide, “it was a real awakening” in maternal health care, said Dr. Philip Darney, a reproductive health care expert at the University of California, San Francisco. It made emptying the uterus faster, safer and more accessible, he said, saving countless lives.

Today, the simple procedure is usually used for pregnancies up to 12 weeks. Some prefer it as a quick and thorough way to complete a miscarriage and minimize ongoing pain and bleeding, as well as infection risks. For patients with heavy bleeding or infections in the first trimester, a D&C could be lifesaving, doctors told us.

A D&E, or dilation and evacuation, is a procedure used in the second trimester to empty the uterus. The doctor uses suction and tools like forceps. The patient is sedated or asleep in an operating room. It takes less time than an induction, allows the patient to avoid a labor experience and generally is associated with less blood loss and infection risk than other options. For patients with heavy bleeding or infections in the second trimester, a D&E could be lifesaving, doctors told us.

The same procedures are used for both abortions and miscarriages; whether they’re used to remove pregnancy tissue because of a complication or because the patient has decided to end the pregnancy for another reason, there’s no difference in how the procedures are carried out, and most state abortion bans aren’t clear about when physicians are legally allowed to perform them. The American College of Obstetricians and Gynecologists, the leading organization representing OB-GYNs, calls the language these laws use to describe exceptions “unclear” and “inherently vague.”

This can create confusion and fear around the procedures. For example, a patient can be in the process of miscarrying, but there might still be fetal cardiac activity. Some doctors consider intervening to be a risk because managing the miscarriage in that situation could be defined as an abortion.

The laws attach criminal penalties to a violation — in Texas, for example, doctors can face up to 99 years in prison for performing an abortion. State laws usually include exceptions for “medical emergencies.” (Patients can check their state law and discuss it with their doctors.)

Many physicians have told us, however, that the exceptions do not account for how quickly emergencies can develop or how medical decisions are made. While many miscarriages resolve on their own, infections and other complications like heavy bleeding can rapidly become life-threatening, leaving doctors little time to intervene.

While some OB-GYNs who work in abortion-ban states interpret these laws as allowing them to offer all options for a miscarriage, sticking to longstanding medical best practices, our reporting has found that confusion around the grey areas in the laws and the need for extra documentation have caused some doctors to change their approach to counseling and treating miscarriages, even in cases where there is no fetal cardiac activity.

We have found that sometimes doctors didn’t talk about any procedures or medication management options with patients and only told them about the “watch and wait” approach. We’ve heard from doctors who say that it can be difficult to get these procedures approved by their hospitals and that sometimes other medical staff such as OB-GYNs, anesthesiologists or nurses don’t feel comfortable participating. In still other cases, we have reported on doctors delaying care while they take extra steps to document that there is no fetal heartbeat.

At least five women — Amber Thurman, Candi Miller, Josseli Barnica, Nevaeh Crain and Porsha Ngumezi — died after they didn’t receive these procedures in time, we found.

Talk to people and organizations you trust for recommendations. This can include local doulas, midwives, nurses who work on labor and delivery wards, and reproductive health organizations.

Medical experts suggested asking physicians direct questions like: I’ve seen stories about patients who were unable to get care for miscarriage or pregnancy complications because of state abortion laws. Can you explain to me how the law in our state could affect my care?

They suggested following up with questions like:

• Considering the law in our state, are there options you would not be able to offer?
• If I were having a miscarriage, would you do a D&C if I wanted one? Would you do a D&C if I needed one for medical safety?
• If I were having a miscarriage in the second trimester, would you perform a D&E?
• Are you allowed to tell me my options or give me information in the event of a miscarriage?
• If you can’t provide these services, where should I go?

Experts told us patients can talk to their doctors early about what to do if something goes wrong.

Here are some questions they recommend asking:

• If I think I’m miscarrying, can I receive care at your office, or do I need to go to the ER?
• Do you do D&Cs and D&Es? How often and where?
• If my water breaks in the second trimester, do you offer the option of abortion care or do you wait until there are signs of infection?
• Which hospital do you recommend if I need emergency care?

Here are some things doctors and patients told us you can do:

• Ask to see the hospital’s miscarriage management guidelines.
• Ask whether doctors are expected to counsel patients on all three treatment options and provide whichever the patient chooses.
• Ask if the hospital has any physicians who have expertise in D&Es. One sign that a doctor may be well-qualified to perform this procedure is if they have done a Complex Family Planning fellowship.
• Check what organizations a hospital is affiliated with. Hospitals with religious affiliations sometimes don’t perform procedures to empty the uterus. Hospitals affiliated with universities tend to provide more comprehensive care and are more likely to have doctors with extra training in D&Es.
• Don’t delay seeking emergency care, even if it’s difficult to find an ideal hospital.

Cramping and bleeding can be signs of miscarriage, but not always. Call your doctor or midwife to discuss symptoms first.

• You may be advised to wait and monitor your symptoms. Most miscarriages resolve without intervention within two weeks.
• If a doctor says to go to a hospital or a clinic, experts suggest asking for:
  • An ultrasound to guide your care
  • An OB-GYN to be involved in your care
  • Information about all three treatment options
  • The treatment option you prefer to get
• Be on the lookout for symptoms like high pulse and feeling faint, which could mean you have a serious complication. Bleeding heavily, such as soaking a pad in 30 minutes or less, is a reason to ask doctors if it’s necessary to empty the uterus, experts told us.

Medical experts recommend the following:

• Documenting the care.
• Asking directly for the desired treatment.
• Asking why care is being denied.
• Asking to see another doctor if the one assigned to the case is not providing the desired care.
• Requesting a transfer to another hospital if the one you’re at will not provide the care. Patients can cite EMTALA, the Emergency Medical Treatment and Labor Act, and remind physicians that federal law requires hospitals to stabilize anyone experiencing an emergency. If they can’t, they must transfer the patient to another hospital that will.
• Showing doctors evidence-based standards of care from professional medical organizations to explain that you should be offered these options. Here are guidelines from the American College of Obstetricians and Gynecologists.
• Asking to speak with patient advocates, who work at hospitals to help patients understand their rights and answer questions about their care. Or asking to speak to the hospital’s legal team. Hospitals have processes for escalating concerns.
• Asking for an ethics consult if you still aren’t getting straight answers or are being denied a procedure. Another option is an interdisciplinary meeting with your doctors and nurses, nursing leaders and hospital administrators.
• Reminding doctors that you are being denied the standard of care, which could mean the providers are committing malpractice.
• Filing complaints with the state survey agency, if you think EMTALA was violated, and with the state medical board.
• Calling your state representatives or contacting legal advocacy groups that can advocate for patients’ rights, including the Repro Legal Helpline at If/When/How (844-868-2812), the Center for Reproductive Rights (917-637-3600), the American Civil Liberties Union or the National Women’s Law Center.
• You can also reach out to journalists at ProPublica at reproductivehealth@propublica.org. We are continuing to investigate cases of denied care.

This content originally appeared on ProPublica and was authored by by Kavitha Surana and Lizzie Presser.

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published.

In states with abortion bans, ProPublica has found, pregnant women have bled to death, succumbed to fatal infections and wound up in morgues with what medical examiners recorded were “products of conception” still in their bodies.

These are the very kinds of cases state maternal mortality review committees are supposed to delve into, determining why they happened and how to stop them from happening again.

But panels in states that have recently imposed strict bans on abortion have done little to uncover whether the laws are contributing to maternal deaths, including tracking delays in care for pregnancy complications and making these problems known, a ProPublica investigation shows.

In fact, we found that in a few states, political leaders who backed the bans have stood in the way of measuring their consequences.

They have dismissed committees, slowing down their work. They have weeded out members openly critical of abortion bans and supportive of transparency.

Texas has gone as far as to legally prohibit its committee from reviewing deaths that are considered abortion-related. This could include some miscarriage care, health officials told ProPublica.

In two deaths of Texas women that ProPublica investigated, Porsha Ngumezi and Josseli Barnica had already miscarried when they were given misoprostol to help complete the process. The committee does not review cases that involve that drug because it’s also used for abortions, said committee chair Dr. Carla Ortique: “If they received medication, if they received any procedure, we will not get those records.” Chris Van Deusen, the spokesperson at the Texas Department of State Health Services, would not say whether Ngumezi’s and Barnica’s deaths would be reviewed.

Other state committees have not made changes to systematically examine the role abortion bans are playing in maternal deaths, officials acknowledged, though some said they might note it as a contributing factor if it appears in the records. “If the committee discovers a trend that raises a particular concern, it could decide to include that information in its reports,” South Carolina officials said.

Some noted that they follow guidelines from the Centers for Disease Control and Prevention, and that those recommendations don’t direct committees to consider abortion access or delays in abortion care. Indiana’s law directs committee members to determine whether the person who died had an abortion and whether that contributed to their death; it does not focus on delays in access to abortion care.

States can direct their committees to look at any important health issue; Texas’ panel added new questions to its process to help capture the role of the coronavirus pandemic in deaths, for example.

ProPublica asked governors in 15 states with strict abortion bans whether committees should examine the impact of the laws on maternal deaths; most did not respond. None directly answered the question or advocated for specific changes. (Read their responses here.)

“We’re not acting like we want to know the answer to this question. And that concerns me,” said Caitlin Myers, an economics researcher at Middlebury College who is studying the impact of abortion access on maternal health. “However you feel about the ethics of abortion, we should want to understand how these policies are affecting women’s health.”

Experts interviewed by ProPublica say state maternal mortality review committees are uniquely well-positioned to examine the impacts of abortion bans on maternal health. The panels are often made up of practicing OB-GYNs, cardiologists and nurses, and they can also include doulas, medical examiners and experts in mental health, substance abuse and domestic violence. They review summaries of medical records to determine whether deaths were preventable and to identify contributing factors. This allows researchers and government officials to see patterns and come up with ways to improve the country’s poor maternal health outcomes.

Committees are not systematically tracking an issue that came up throughout ProPublica’s reporting on deaths in states with abortion bans: delays and denials of procedures, like dilation and curettage, which are used to empty the uterus during miscarriages to avoid hemorrhage and infection. The procedures are also used for abortions, and doctors face prison time for violating restrictions. Women have died after they could not access these procedures, ProPublica found.

Nevaeh Crain, a teenager whose organs were failing, was made to wait 90 minutes for a second ultrasound to confirm fetal demise. Amber Thurman suffered for 20 hours while sepsis spread. And Barnica was subjected to serious infection risks for 40 hours while doctors monitored the fetal heartbeat until it stopped.

Studying such delays “needs to be a part of these kinds of reviews,” said Dr. Daniel Grossman, a leading reproductive health care researcher and professor of obstetrics and gynecology at the University of California San Francisco.

Grossman has collected dozens of accounts from health care providers detailing substandard treatment and poor outcomes in states that banned abortion. But he and others recognize who is ultimately in charge of state maternal mortality review committees.

“I can’t imagine the states that passed restrictions saying, ‘Now we want to know if that caused any deaths,’” said Eugene Declercq, a professor at Boston University’s School of Public Health who serves on Massachusetts’ maternal mortality review committee. “The clinicians and the public health people might want to know, but the political leaders would be aghast.”

Even if they start to pursue such answers, states are years behind in reviewing deaths, ProPublica found in a survey of 18 states with the most restrictive abortion laws. Most have not finished reviewing deaths from 2022, the year most bans became effective after the Supreme Court overturned the constitutional right to abortion. Two states are still reviewing 2021 deaths. Three states — Florida, North Dakota and South Dakota — did not respond.

Reviews typically lag years behind deaths because of the time it takes state health department employees to learn of cases, track down records and wrestle them free from hospitals and doctors before they summarize and redact them for review. “We have one person in the entire state that has to collect all that data. Literally one,” said Dr. Stacie Geller, a founding member of Illinois’ committee. “I live in fear of her retiring.”

The CDC, which has pumped tens of millions of dollars into helping states establish these committees and standardizing their work, has tried to reduce the backlog by setting a goal for committees that receive funding to review cases within two years. However, there’s no way to compel states to do so, and not all have caught up.

Such lags matter more in places where there has been a seismic shift in abortion access, experts told ProPublica, because there isn’t a full understanding yet of the laws’ effect on maternal health care.

Marian Knight leads the United Kingdom’s maternal mortality review program, widely seen as the world’s best. She said if there were a major legal shift like this in her country, she and her colleagues would adapt to track the impact in close to real time. “I would be monitoring that in the same way as I did during COVID, where we were analyzing data weekly and feeding it in,” Knight said.

As of last month, only five states — Iowa, West Virginia, Indiana, Georgia and Tennessee — had finished reviewing cases from 2022, ProPublica found. None had yet published a report on its findings for that year.

Seven other states were still examining 2022 cases: Alabama, Oklahoma, South Carolina, Mississippi, Missouri, Arkansas and Louisiana.

Idaho, Texas and Kentucky had not yet started looking at cases from that year.

Even though North Dakota did not respond to ProPublica’s survey, reporters found that its committee, formed by state legislation in 2021, has never met to review cases, according to two members.

In some instances, state officials are responsible for delays.

Idaho disbanded its committee in summer 2023 after a conservative group argued it was unnecessary and attacked members for recommending that the state expand Medicaid for postpartum patients. The move froze the group’s work until last month, when a reconstituted, smaller committee met for the first time. Two members who had spoken out against the ban’s impacts on maternal health, and are suing the state over it, were not brought back onto the committee. The state is defending its anti-abortion laws; the Idaho Attorney General has said he “will not stop protecting life in Idaho.”

It is unclear how long Georgia’s reviews will be stalled after state officials dismissed its committee last month, citing a violation of confidentiality rules after ProPublica reported on internal documents in stories about two preventable deaths examined by the group. The Georgia Department of Public Health said in a letter about the dismissal that this would not result in any delays to the committee’s responsibilities.

In a move that confused maternal research experts, Texas’ committee said it would not review data from 2022 and 2023 and begin with reports from 2024 to get a more “contemporary” view of deaths. The committee has skipped years in the past to address gaps, and at its recent meeting, Ortique, the chair, said that the decision had “absolutely no nefarious intent.” The period it plans to skip includes two of the preventable deaths ProPublica reported.

Dr. Romy Ghosh, an OB-GYN in Austin, Texas, pleaded with the maternal mortality review committee at a public meeting this month to reconsider its decision to skip those years.

“There’s been a lot of fear in my patients. They wonder, can I save their life if something goes wrong?” she said. “I think that this information will tell us there’s either nothing to worry about or it will be damning.”

Between the decision to skip years and the legal prohibition against examining cases involving abortion-related care, it appears Texas will not review any of the three preventable deaths ProPublica identified.

There is a limit to how much committee members can push back against state leaders.

When Texas delayed publishing its maternal mortality report in 2022, an election year, then-committee member Nakeenya Wilson, a community advocate, spoke out, saying “withholding data that does not make us look good is dishonorably burying those women.”

The next session, Texas lawmakers passed a bill changing the requirements for the position that Wilson held, effectively removing her from the committee. State officials appointed Dr. Ingrid Skop, a Texas OB-GYN who is the vice president of a prominent anti-abortion organization.

Wilson said maternal mortality review committees must be free to speak candidly about patterns they see in maternal deaths and to release information in a timely fashion.

“If it’s not the committee, then who is it?” she said. “There has to be increased accountability.”

Audrey Dutton, Anna Maria Barry-Jester, Lizzie Presser and Amy Yurkanin contributed reporting.

This content originally appeared on ProPublica and was authored by .

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published.

In states with abortion bans, ProPublica has found, pregnant women have bled to death, succumbed to fatal infections and wound up in morgues with what medical examiners recorded were “products of conception” still in their bodies.

These are the very kinds of cases state maternal mortality review committees are supposed to delve into, determining why they happened and how to stop them from happening again.

But panels in states that have recently imposed strict bans on abortion have done little to uncover whether the laws are contributing to maternal deaths, including tracking delays in care for pregnancy complications and making these problems known, a ProPublica investigation shows.

In fact, we found that in a few states, political leaders who backed the bans have stood in the way of measuring their consequences.

They have dismissed committees, slowing down their work. They have weeded out members openly critical of abortion bans and supportive of transparency.

Texas has gone as far as to legally prohibit its committee from reviewing deaths that are considered abortion-related. This could include some miscarriage care, health officials told ProPublica.

In two deaths of Texas women that ProPublica investigated, Porsha Ngumezi and Josseli Barnica had already miscarried when they were given misoprostol to help complete the process. The committee does not review cases that involve that drug because it’s also used for abortions, said committee chair Dr. Carla Ortique: “If they received medication, if they received any procedure, we will not get those records.” Chris Van Deusen, the spokesperson at the Texas Department of State Health Services, would not say whether Ngumezi’s and Barnica’s deaths would be reviewed.

Other state committees have not made changes to systematically examine the role abortion bans are playing in maternal deaths, officials acknowledged, though some said they might note it as a contributing factor if it appears in the records. “If the committee discovers a trend that raises a particular concern, it could decide to include that information in its reports,” South Carolina officials said.

Some noted that they follow guidelines from the Centers for Disease Control and Prevention, and that those recommendations don’t direct committees to consider abortion access or delays in abortion care. Indiana’s law directs committee members to determine whether the person who died had an abortion and whether that contributed to their death; it does not focus on delays in access to abortion care.

States can direct their committees to look at any important health issue; Texas’ panel added new questions to its process to help capture the role of the coronavirus pandemic in deaths, for example.

ProPublica asked governors in 15 states with strict abortion bans whether committees should examine the impact of the laws on maternal deaths; most did not respond. None directly answered the question or advocated for specific changes. (Read their responses here.)

“We’re not acting like we want to know the answer to this question. And that concerns me,” said Caitlin Myers, an economics researcher at Middlebury College who is studying the impact of abortion access on maternal health. “However you feel about the ethics of abortion, we should want to understand how these policies are affecting women’s health.”

Experts interviewed by ProPublica say state maternal mortality review committees are uniquely well-positioned to examine the impacts of abortion bans on maternal health. The panels are often made up of practicing OB-GYNs, cardiologists and nurses, and they can also include doulas, medical examiners and experts in mental health, substance abuse and domestic violence. They review summaries of medical records to determine whether deaths were preventable and to identify contributing factors. This allows researchers and government officials to see patterns and come up with ways to improve the country’s poor maternal health outcomes.

Committees are not systematically tracking an issue that came up throughout ProPublica’s reporting on deaths in states with abortion bans: delays and denials of procedures, like dilation and curettage, which are used to empty the uterus during miscarriages to avoid hemorrhage and infection. The procedures are also used for abortions, and doctors face prison time for violating restrictions. Women have died after they could not access these procedures, ProPublica found.

Nevaeh Crain, a teenager whose organs were failing, was made to wait 90 minutes for a second ultrasound to confirm fetal demise. Amber Thurman suffered for 20 hours while sepsis spread. And Barnica was subjected to serious infection risks for 40 hours while doctors monitored the fetal heartbeat until it stopped.

Studying such delays “needs to be a part of these kinds of reviews,” said Dr. Daniel Grossman, a leading reproductive health care researcher and professor of obstetrics and gynecology at the University of California San Francisco.

Grossman has collected dozens of accounts from health care providers detailing substandard treatment and poor outcomes in states that banned abortion. But he and others recognize who is ultimately in charge of state maternal mortality review committees.

“I can’t imagine the states that passed restrictions saying, ‘Now we want to know if that caused any deaths,’” said Eugene Declercq, a professor at Boston University’s School of Public Health who serves on Massachusetts’ maternal mortality review committee. “The clinicians and the public health people might want to know, but the political leaders would be aghast.”

Even if they start to pursue such answers, states are years behind in reviewing deaths, ProPublica found in a survey of 18 states with the most restrictive abortion laws. Most have not finished reviewing deaths from 2022, the year most bans became effective after the Supreme Court overturned the constitutional right to abortion. Two states are still reviewing 2021 deaths. Three states — Florida, North Dakota and South Dakota — did not respond.

Reviews typically lag years behind deaths because of the time it takes state health department employees to learn of cases, track down records and wrestle them free from hospitals and doctors before they summarize and redact them for review. “We have one person in the entire state that has to collect all that data. Literally one,” said Dr. Stacie Geller, a founding member of Illinois’ committee. “I live in fear of her retiring.”

The CDC, which has pumped tens of millions of dollars into helping states establish these committees and standardizing their work, has tried to reduce the backlog by setting a goal for committees that receive funding to review cases within two years. However, there’s no way to compel states to do so, and not all have caught up.

Such lags matter more in places where there has been a seismic shift in abortion access, experts told ProPublica, because there isn’t a full understanding yet of the laws’ effect on maternal health care.

Marian Knight leads the United Kingdom’s maternal mortality review program, widely seen as the world’s best. She said if there were a major legal shift like this in her country, she and her colleagues would adapt to track the impact in close to real time. “I would be monitoring that in the same way as I did during COVID, where we were analyzing data weekly and feeding it in,” Knight said.

As of last month, only five states — Iowa, West Virginia, Indiana, Georgia and Tennessee — had finished reviewing cases from 2022, ProPublica found. None had yet published a report on its findings for that year.

Seven other states were still examining 2022 cases: Alabama, Oklahoma, South Carolina, Mississippi, Missouri, Arkansas and Louisiana.

Idaho, Texas and Kentucky had not yet started looking at cases from that year.

Even though North Dakota did not respond to ProPublica’s survey, reporters found that its committee, formed by state legislation in 2021, has never met to review cases, according to two members.

In some instances, state officials are responsible for delays.

Idaho disbanded its committee in summer 2023 after a conservative group argued it was unnecessary and attacked members for recommending that the state expand Medicaid for postpartum patients. The move froze the group’s work until last month, when a reconstituted, smaller committee met for the first time. Two members who had spoken out against the ban’s impacts on maternal health, and are suing the state over it, were not brought back onto the committee. The state is defending its anti-abortion laws; the Idaho Attorney General has said he “will not stop protecting life in Idaho.”

It is unclear how long Georgia’s reviews will be stalled after state officials dismissed its committee last month, citing a violation of confidentiality rules after ProPublica reported on internal documents in stories about two preventable deaths examined by the group. The Georgia Department of Public Health said in a letter about the dismissal that this would not result in any delays to the committee’s responsibilities.

In a move that confused maternal research experts, Texas’ committee said it would not review data from 2022 and 2023 and begin with reports from 2024 to get a more “contemporary” view of deaths. The committee has skipped years in the past to address gaps, and at its recent meeting, Ortique, the chair, said that the decision had “absolutely no nefarious intent.” The period it plans to skip includes two of the preventable deaths ProPublica reported.

Dr. Romy Ghosh, an OB-GYN in Austin, Texas, pleaded with the maternal mortality review committee at a public meeting this month to reconsider its decision to skip those years.

“There’s been a lot of fear in my patients. They wonder, can I save their life if something goes wrong?” she said. “I think that this information will tell us there’s either nothing to worry about or it will be damning.”

Between the decision to skip years and the legal prohibition against examining cases involving abortion-related care, it appears Texas will not review any of the three preventable deaths ProPublica identified.

There is a limit to how much committee members can push back against state leaders.

When Texas delayed publishing its maternal mortality report in 2022, an election year, then-committee member Nakeenya Wilson, a community advocate, spoke out, saying “withholding data that does not make us look good is dishonorably burying those women.”

The next session, Texas lawmakers passed a bill changing the requirements for the position that Wilson held, effectively removing her from the committee. State officials appointed Dr. Ingrid Skop, a Texas OB-GYN who is the vice president of a prominent anti-abortion organization.

Wilson said maternal mortality review committees must be free to speak candidly about patterns they see in maternal deaths and to release information in a timely fashion.

“If it’s not the committee, then who is it?” she said. “There has to be increased accountability.”

Audrey Dutton, Anna Maria Barry-Jester, Lizzie Presser and Amy Yurkanin contributed reporting.

This content originally appeared on ProPublica and was authored by .

President Joe Biden’s decision to grant clemency to a corrupt former judge has sparked widespread outrage, including from members of his own party. Biden announced nearly 1,500 commutations and pardons last week in what the White House described as the largest single-day act of clemency from a president, but among those whose sentences were reduced is former Pennsylvania Judge Michael Conahan — one of two judges in the notorious “kids for cash” scandal. In 2011, Conahan was sentenced to 17.5 years for accepting nearly $3 million in kickbacks for sending 2,300 children, some as young as 8 years old, to for-profit prisons on false charges. His co-conspirator, former Judge Mark Ciavarella, remains in prison. We speak with filmmaker Robert May, director of the Kids for Cash documentary, and Sandy Fonzo, mother of Edward Kenzakoski, who was incarcerated as a teenager as part of the kickback scheme and later died by suicide. “It’s just reopening wounds that have never healed,” Fonzo says of the commutation. She describes her son as “strong” and “proud” before his time in detention, but says “he came out broken” and never fully recovered. “It stole his youth, his childhood.”

This content originally appeared on Democracy Now! and was authored by Democracy Now!.

My heart is overwhelmed with joy, relief and renewed hope this holiday season. After more than 20 years of separation, I am finally reunited with my beloved mother here in America. The most precious moment was seeing her embrace her grandchildren for the first time — a long-deferred dream finally realized. For much of my life, holidays like Thanksgiving felt hollow because of our family’s fractured reality.

I have always been close to my mother. Our family often joked that I was an only child, although I have three younger brothers. My mother relied on me when she felt stressed or sad. This deep bond traces back to my birth during China’s notorious Cultural Revolution in a Communist reeducation camp.

Chinese authorities used this bond to torment me, despite my having lived in America as a free Uyghur for nearly three decades. I had not seen my mother since 2004 and had spent only 11 months with my parents since leaving China 29 years ago.

My mother, Ayshem, suffered immensely, beginning with her arrest while pregnant with me. Her “offense” was being her father’s favorite child and answering the door to his visitors, who were under the watchful eyes of the authorities in the late 1960s.

During that era of repression, her father, once an official in the short-lived Second East Turkistan Republic, became a target. Red Guards sent him to a camp and accused him of being “intoxicated with separatist ideology.”

Similarly, my father, Ablikim, an educator and public intellectual, spent three years in labor camps for having relatives across the Soviet border. His “crime” was to have been “infected with Soviet ideology.”

These family affiliations marked my parents as enemies of the state. Both were locked up in separate camps located in and around Kashgar and accused of ideological crimes.

This practice of “guilt by association” persists today, targeting those who are critical of Chinese actions and policies, serving as a harsh reminder of the enduring legacy of repression.

I was born in 1970 in the midst of unspeakable horrors. My mother had already spent over six months in the camp before my birth.

Severely malnourished and suffering from a fractured hip and ankle, she gave birth to me while in a cast from the chest down.

We lived under dire conditions, marked by scarce food and constant surveillance. I was malnourished and frail, a living testament to my mother’s suffering. The first several months of my life were spent in detention alongside her. We were starved, isolated and stripped of our dignity.

Yet, through it all, her resilience and unwavering strength sustained me through the darkest times.

In the summer of 1995, driven by a long-standing admiration for freedom in America and inspired by the end of the Cold War, I arrived in the United States as a student and was later granted asylum.

Witnessing the collapse of former Soviet blocs, including Central Asia regions with deep cultural, historical and geographical ties to the Uyghur people, reinforced my desire for freedom and higher education.

Despite my life as a free American and four years as a U.S. official, the past continued to haunt me.

I endured years of sanctioned isolation, unable to be there when my father passed away in 2022. The Chinese government’s retaliation intensified, barring my mother from traveling and isolating her socially.

My mother, facing severe health issues, remained under constant surveillance and travel restrictions. These are common sufferings and struggles for countless Uyghurs around the world.

I have been sanctioned by both China and Russia for what appears to be retaliation against my service in the U.S. government and decades-long human rights advocacy work.

Every attempt to reunite us was blocked, and my mother’s deteriorating health intensified the urgency. Yet, our determination to be together never wavered.

On the eve of Thanksgiving, a miracle unfolded.

Three days before her arrival in America, security officials in Urumqi notified my mother that she would need to get ready to go to Beijing at 4 a.m. the next day. She had about 20 hours to prepare for this trip. It was a journey she had longed for with hope and prayer for over two decades.

In her final hours in China, she visited my father’s grave to say goodbye one last time, honoring their shared history and fulfilling a deeply personal need for closure before embarking on her long-awaited journey.

They had been married for 53 years, sharing countless memories, from raising a family to weathering life’s challenges with unwavering love and commitment.

On the night of Nov. 24, around the same time Chinese security informed my mother about the trip to Beijing, I received a call from the White House notifying me about developments I would learn more about the next day at a pre-planned meeting with a senior National Security Council official. I woke up my wife and children and shared the news.

I felt relieved, excited and deeply grateful. Early on Thanksgiving morning, while driving to Dulles Airport for my flight to Texas where I was to meet my mother, I received a call from a U.S. official who put her on the phone.

“Son, I am on a U.S. government plane and free,” she said. “I don’t know what to say. So happy beyond words.”

For so long, I lived with the constant fear that one day I might receive the unthinkable news of my mother’s imprisonment — or worse — just as I lost my father over two years ago.

But when I heard my mother’s voice, hope prevailed, and the long-held darkness lifted. That fear and the unthinkable are no longer part of my life.

At the U.S. Joint Base in San Antonio, Texas, I watched my mother descend the plane’s stairs, supported by a U.S. diplomat and greeted by a military commander in uniform.

A wave of emotions washed over me, and I ran toward my mother. We embraced, tears streaming down our faces, overwhelmed by the reality of our long-awaited reunion.

Her first words — “Thank God I’m here with you, and I won’t be alone when I die” — shattered and mended my heart all at once.

This has been more than a reunion. It’s the restoration of a piece of my soul. Words cannot fully express my gratitude.

On Thanksgiving morning, my brother, who had flown with me to Texas, and I brought our mother to Washington. Watching her embrace her grandchildren for the first time was a moment of incredible joy and healing. Though my father didn’t live to see this day, I felt his presence, his spirit guiding us toward this long-awaited reunion.

The privilege of my children knowing their grandmother is a gift that begins to heal the wounds of our family’s long separation. It bridges a gap that has weighed on my heart for two decades. I am forever grateful to my country.

America has given me everything — my freedom, my livelihood and now the joy of seeing my children play with their grandmother.

I am deeply grateful for the tireless efforts of Secretary of State Antony Blinken, Ambassador Nick Burns, National Security Adviser Jake Sullivan, Senior Director for China Sarah Beran, and countless U.S. national security officials who championed our cause across four presidential administrations.

Our family reunion should serve as a beacon of hope for thousands of Uyghurs around the world, including members of Radio Free Asia’s Uyghur Service, whose loved ones were forcibly taken to camps in China — seemingly in retaliation for their service to the American people.

May this moment inspire renewed efforts to reunite all separated families and restore the dignity and freedom they deserve.

Nury Turkel is a lawyer and the award-winning author of “No Escape: The True Story of China’s Genocide of the Uyghurs.” He serves as a senior fellow at the Hudson Institute and is an advisory board member of the Krach Institute for Tech Diplomacy.

Edited by Jim Snyder and Boer Deng.

This content originally appeared on Radio Free Asia and was authored by Nury Turkel.

Laila Soueif is on the 75th day of a hunger strike calling for the U.K. government to push for the release of her son, jailed Egyptian British author and activist Alaa Abd El-Fattah. Charged with spreading false news, Alaa remains imprisoned in Egypt despite having completed his sentence in September. Human rights group say he has been subjected to torture, beatings and horrific treatment while in prison. “Since neither government appears to do anything about political prisoners except when there is a crisis, I’m hoping to create a crisis,” says Soueif, who vows to reunite her son and grandchild, 13-year-old Khaled. “Alaa has missed all of his childhood. They need to be together, and until that happens, I’m not going to go back on my word. I’m on hunger strike until either I collapse or that happens.”

This content originally appeared on Democracy Now! and was authored by Democracy Now!.

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published.

The night the EMTs carried Elizabeth Nakagawa from her home, bleeding and in pain, the tarp they’d wrapped her in reminded her of a body bag.

Nakagawa, 39, is a Coast Guard commander: stoic, methodical, an engineer by trade. But as they maneuvered her past her young daughters’ bedroom, down the narrow steps and into the ambulance, she felt a stab of fear. She might never see her girls again.

Then came a blast of anger. She’d been treated for a miscarriage before. She knew her life never should have been in danger.

Earlier that day, April 3, 2023, Nakagawa had been scheduled to have a surgical procedure called a D&C, or dilation and curettage, to remove fetal tissue after losing a very wanted pregnancy. But that morning, she was told the surgery had been canceled because Tricare, the military’s health insurance plan, refused to pay for it.

While her doctor appealed, Nakagawa waited. Then the cramps and bleeding began.

In recent months, ProPublica and other media outlets have told the stories of women who died or nearly died when state abortion restrictions imposed after the Supreme Court’s 2022 Dobbs decision impeded them from getting critical care.

But long before Roe v. Wade was overturned, military service members and their families have faced strict limits on abortion services, which are commonly used to resolve miscarriages.

Under a decades-old federal law, the military is prohibited from paying for abortions except in cases of rape, incest or to save the life of the mother. This applies even to service members based in states where abortion is legal; Nakagawa lives in Sonoma County, California.

There’s also no exception for catastrophic or fatal fetal anomalies. In such cases, service members either have to pay out of pocket for abortions or carry to term fetuses that won’t survive outside the womb.

Tricare does allow abortions in cases like Nakagawa’s, in which the fetus has no heartbeat. But even then, some doctors who treat military service members say that Tricare requires more documentation and takes longer to approve these procedures than other insurers, putting women at risk.

“There definitely have been cases where our Tricare patients have required emergency services, emergency D&C procedures, blood transfusions, things that have been critical to lifesaving care because their procedure had yet to occur,” said Dr. Lauren Robertson, an OB-GYN who has served military members and their spouses in San Diego for more than a decade.

Erin Edwards is a Navy veteran and reporter who has been covering reproductive health care access for military members. She’s spoken with military and civilian doctors, researchers and patients across the country about the challenges service members have long faced in obtaining reproductive health care.

Robin Fields is a longtime ProPublica reporter who has written about maternal deaths and near-deaths, as well as about the reliability of data gathered on maternal mortality.

If you want to get in touch and learn more about how we work, email Edwards at erin@moseyroad.com or Fields at robin.fields@propublica.org. We take your privacy very seriously.

“It just feels very unnecessary.”

Since the Dobbs decision, abortion care for service members seems to be coming under heightened scrutiny, said retired Rear Adm. Dana Thomas, who was until recently the Coast Guard’s chief medical officer and advocated for Nakagawa.

“Trust me, post Roe v. Wade, I’m sure people felt there was much more of a spotlight,” Thomas said. “I think they were more guarded after June of ’22.”

After being rushed to the emergency room, Nakagawa hemorrhaged for four more hours before doctors performed the surgery Tricare had refused to authorize. Later, Tricare and Defense Department officials would all agree that Nakagawa should have been treated as her doctor recommended, and she said they told her they’d taken steps to prevent future mistakes.

But her experience, which doctors say nearly cost Nakagawa her life, laid bare the challenges service members have long faced in obtaining reproductive health care. And it raises questions about whether the Supreme Court’s ruling has created a chilling effect that has further complicated access to these procedures.

Officials at the Defense Health Agency, which runs the military health system, including Tricare, did not respond to specific questions from ProPublica, but they provided a statement saying its policies haven’t budged.

“There have not been any changes to Tricare coverage or documentation requirements for medically necessary care of D&Cs following the Supreme Court’s Dobbs decision,” the statement said. “Medically necessary care was, and continues to be, covered.”

The agency declined to answer questions about Nakagawa, saying that “as a matter of practice” it doesn’t discuss individual beneficiaries’ care. (ProPublica is involved in an unrelated public records lawsuit with the DHA.)

As a senior officer, Nakagawa felt duty-bound to press for answers about what happened to her.

“The abortion policy, in theory, is supposed to protect life, and in my case it did the opposite,” Nakagawa said. “It almost led to my children not having a mother.”

After the Supreme Court upended Roe, the Biden administration took steps to reassure service members that their access to reproductive health care would remain unaffected by a wave of state abortion bans.

An October 2022 memo from Defense Secretary Lloyd Austin pledged to facilitate leave for service members seeking abortions that were not covered by Tricare, and to pay for travel if care wasn’t available nearby. It also emphasized that these procedures would be “consistent with applicable federal law.”

The statute barring the Defense Department from paying for most abortions goes back to 1985 and mirrors language in what’s called the Hyde Amendment. Named for its author, Henry Hyde, a Republican representative from Illinois, Congress has attached the amendment to spending bills since the late 1970s to prohibit the use of federal funds on abortion.

With Congress in control of military spending, abortion care is highly politicized, said Kyleanne Hunter, a Marine Corps combat veteran and senior political scientist at RAND Corp. “There’s been a lot of backlash and a lot of scrutiny and a lot of congressional disapproval as to how the DOD has engaged with abortion care, D&C care and the like.”

About 9.5 million people, including active-duty service members and their families as well as military retirees and their dependents, rely on Tricare for health services. Women make up a growing portion of the active-duty force, more than 17%. They also leave the military at higher rates. Research by RAND and others suggests the military’s reproductive health policies may make it harder to recruit and retain them.

Dr. Toni Marengo, a former Navy OB-GYN, said she left the service in part because she felt unable to provide patients with appropriate care. Many of them only discovered how sharply Tricare’s policies curtailed access to procedures like D&Cs when they needed them.

“It was like living in a pre-Roe world,” said Marengo, now chief medical officer at Planned Parenthood of the Pacific Southwest.

The effects have been felt for decades. In 1994, Maureen Griffin and her then-husband, a captain in the Air National Guard, ended her pregnancy after learning their baby had anencephaly, a fatal birth defect. They found out the military considered her induced labor an abortion when she got a phone call from a bill collector for the hospital seeking thousands of dollars in reimbursement for the procedure.

“I said: ‘We have full coverage. My husband’s in the military.’ And they said, ‘They don’t pay for abortions,’” Griffin recalled. “We were completely blindsided. I mean, no one called it an abortion. It was a horrible tragedy.”

Griffin, then known as Maureen Britell, was so outraged that she sued the Defense Department, winning a judgment in federal district court in 2002. Two years later, an appeals court reversed the decision, upholding the Defense Department’s refusal to cover abortions in such circumstances.

Twenty-five years after Griffin’s pregnancy, Samantha Babcock spent the equivalent of seven paychecks to fly home from her husband’s Air Force base in Okinawa, Japan, for an abortion Tricare wouldn’t cover.

She was five months pregnant when doctors told her that her fetus had multiple abnormalities and wasn’t viable.

The grief was crushing. Then she found out that, by law, the military couldn’t perform or pay for a surgery called a D&E, or dilation and evacuation, which her military doctors agreed was the safest option. She and her family paid $14,000 — most of it for plane tickets — with help from a GoFundMe so that she could go home to Portland, Oregon, to get the procedure.

She still can’t believe such a step was necessary.

“I assumed Tricare had my best interest at heart,” she said. “If the condition was fatal, why wouldn’t they help me?”

Babcock said her specialist told her that the military would pay to transfer her temporarily to Hawaii for more testing. They also offered to move her family to a location where they would have access to specialty care for the baby in the unlikely chance she survived outside of the womb.

For Babcock, that was untenable. “I did not want to keep growing a baby that wouldn’t live,” she said.

In August 2022, Thomas, the Coast Guard’s chief medical officer, was galvanized into action when a service member sought help to end her pregnancy after receiving a diagnosis similar to Babcock’s.

Doctors had recommended that, like Babcock, she have a D&E. Because the fetus still had a heartbeat, Tricare would not approve the procedure.

Thomas called Tricare daily trying to find a solution, then elevated the case to leaders at the DHA, which sets policy for the health plan. “We have to do something,” she told them.

Tricare stuck to its denial even after the service member’s doctor appended a note explain­ing that continuing the pregnancy would endanger the patient’s life.

That was the first case Thomas had taken on after Dobbs.

The second was Nakagawa’s.

Nakagawa and her husband, Matt, met a couple years after earning engineering degrees from the Coast Guard Academy in the mid-2000s. Their path to a family was long and bittersweet. In 2015, they suffered a miscarriage. A year later, their first daughter was born. Then came a second miscarriage, followed by the birth of a healthy girl.

For the next three years, they tried for another child. Then Nakagawa got pregnant in 2021, only to learn at 10 weeks there was no fetal heartbeat. She waited, hoping to miscarry naturally, then tried abortion pills.

When a follow-up exam showed she hadn’t passed all the fetal tissue, her OB-GYN scheduled a D&C. The procedure was approved by Tricare, and she had the surgery soon afterward.

By early 2023, Nakagawa had risen to become chief of engineering at the Coast Guard’s training center in Petaluma, California, and her husband had left the service and was supporting her as a stay-at-home dad. They were thrilled to learn she was pregnant, only to have their joy turn to devastation when two ultrasounds showed that once again, her fetus had no heartbeat.

This time, since abortion pills hadn’t worked in 2021, Nakagawa and her OB-GYN agreed the best course would be to schedule a D&C as soon as possible. Her doctor’s office scheduled the procedure for Monday, April 3, and requested approval in advance, or prior authorization, from Tricare.

Then, five hours before the procedure was scheduled to begin, the office told Nakagawa the surgery was canceled — Tricare had refused to cover it.

In its denial letter, Health Net Federal Services, the contractor that administered claims for Tricare’s western region, said the services requested were “not a covered benefit.”

The insurer’s letter also said it had requested additional information from Nakagawa’s doctor, but that the information had not been sent. (Health Net declined to answer questions from ProPublica about Nakagawa even though she waived her right to privacy.)

Her doctor maintains that wasn’t the case. She declined to be identified, citing concerns about safety.

“Tricare has always been difficult to work with for coverage of women’s health care — they require records more than other insurances — this often creates a delay in care,” the doctor said via text.

The office staff appealed the denial, telling Nakagawa they’d provided documentation of the ultrasounds showing no fetal heartbeat. The staff also told her a Tricare medical director wasn’t available to review it that day and that it might take an additional three to five days to get a response.

Nakagawa called Tricare for answers herself, only to be told her options were to wait or pay out of pocket — not only for the surgery but for any follow-up care, including mental health counseling.

“It was surreal. I was angry and shaking,” Nakagawa said. She couldn’t understand why Tricare had approved her D&C in 2021 under similar circumstances, then denied the same care two years later.

Overwhelmed by emotion, she climbed into bed and cried herself to sleep.

At about 5 p.m., her doctor provided a prescription for abortion pills as a backup plan. But before Nakagawa could pick it up, she started to miscarry.

The first signs were mild cramping and spotting. Soon after, the fetus passed. Nakagawa yelled for her husband and sobbed. They consoled themselves with the thought that they’d made it through the hardest part.

“At least this is over,” Nakagawa recalled saying. “At least God’s giving us a break for once.”

Then the hemorrhaging started — fist-sized clots of blood that soaked through sanitary pads in minutes. Nakagawa lay in the fetal position on towels, in so much pain she couldn’t sit up.

Around 9 p.m., her husband called the doctor, who recommended they go to the emergency room.

At the hospital, she was given fluids, a clotting drug and a transfusion, but her bleeding continued.

After four hours, doctors decided her condition was critical and they needed to intervene. They performed a D&C to remove the remaining tissue.

Nakagawa’s recovery took more than a week. Lying on her couch, unable to walk, she was determined to ensure other service women would get the care she was denied. Taking a risk, she banged out a long email to Thomas, who had a reputation for being approachable.

“I feel compelled to report a traumatic experience I went through that will undoubtedly impact more women in the CG and DOD if the TRICARE policy is not changed,” the email began. “The summary is that I nearly lost my life last week due largely to a TRICARE policy regarding miscarriages and abortions.”

Thomas connected Nakagawa to the Defense Health Agency’s chief medical officer, Dr. Paul Cordts, who called her personally a month after her emergency surgery.

Nakagawa said that Cordts seemed apologetic and even angry on her behalf. “This shouldn’t have happened to you,” she recalled him saying, adding that he’d get to the bottom of what went wrong. (Cordts didn’t respond to emails from ProPublica.)

Two days later, a new record appeared in Nakagawa’s Tricare file: a letter approving the scheduled D&C she’d never received and no longer needed. “Please contact the provider to schedule your appointment(s),” it said.

Cordts also arranged for Col. John Verghese, Tricare’s chief of clinical oversight and integration, to look into her case. Nakagawa said she had two calls with Verghese, who looped in a senior official at Health Net, the Tricare contractor that had dealt with the request to cover her D&C.

In one, she said, Verghese acknowledged Tricare had become more conservative in reviewing requests for D&Cs, requiring more documentation to justify approving these procedures. (Verghese, who has retired, declined to answer questions from ProPublica about the case.)

He admitted that until her case, Tricare hadn’t understood that delaying or denying care could put women at risk, she said. This infuriated Nakagawa.

“I just said, ‘Well, maybe you didn’t realize there would be physical negative consequences, but you had to know there would be mental and emotional consequences to making women carry around their [dead] fetuses’” after a miscarriage.

Verghese quickly apologized, she said.

On the final call, Nakagawa said that Verghese and the Health Net official told her that from now on, they would no longer require doctors to submit proof of no fetal heart tones to get approvals for D&Cs and would speed up reviews of appeals.

In its statement to ProPublica, the DHA maintained that Tricare’s coverage and documentation requirements for D&Cs have not changed.

Nakagawa is one of few women in senior leadership within Coast Guard civil engineering. She remains committed to serving in the military. But she worries about the impact the Defense Department’s reproductive health policies could have on service members and their spouses and daughters. Junior members especially might be less able to advocate for themselves, she said.

“At the very least, this policy will likely encourage women, like myself, to work for a company that has insurance that will cover these procedures,” she said, “At the worst, it will lead to service members or their dependents losing their lives.”

This content originally appeared on ProPublica and was authored by by Erin Edwards for ProPublica and Robin Fields.

The story uses only screenshots in view of the graphic nature of the actual video.

A video is viral on the social media showing distressing footage of the lifeless bodies of three children and a woman. Users have claimed that this video is from Bangladesh, and depicts the brutality of ‘radical Islamists’ who apparently attacked the village of Giripur, in Mymensingh. Such claims have been viral against the backdrop of the unrest that has engulfed the country since the abdication of former Prime Minister Sheikh Hasina, continuing to the present day, under the interim leadership of Mohammed Yunus.

X user @Sanatan Voice (@SanatanVoice_in) shared the video, claiming that ‘a mother and her three young children were injured in the attack.’ The tweet was later deleted. (Archive)

The X account Megh Updates (@MeghUpdates) shared the viral video, claiming that ‘radical Islamists’ had attacked the homes of Hindu residents in Mymensingh, committing rape and vandalism. The tweet had managed to accumulate more than 33,000 views and over 750 re-shares, but was eventually deleted by the user. (Archive)

Readers should note that Alt News has previously debunked several false claims by this user, including misinformation related to the Bangladesh situation. 

Another verified X user, Sunanda Roy (@SaffronSunanda) shared the viral video, claiming that Muslim perpetrators had raped a woman and attacked her children, leaving them badly injured. At the time of this article being written, the post has garnered more than 19,000 views, and has been re-shared over 870 times. (Archive) 

Another X user, Amitabh Chaudhary (@MithilaWaala), who has been called out by Alt News for sharing disinformation on social media on several occasions, also shared the viral video with the same claim. (Archive)

Below are a few more instances of the same claim being made along with the viral video.

Fact Check

To verify the claim, we ran a relevant keyword search on Google, which led us to a news report by Times of India, from November 7. In the report, it is mentioned that on November 6, a 32-year-old woman by the name of Babita Devi had killed her three children, Riya, Suraj, and Sujeet, aged 8, 5, and 3, respectively. This had taken place at Kilpara village in Purnea district of Bihar.

After hanging her children from nooses inside their house, she had allegedly killed herself. During preliminary investigation, it was revealed that the woman was mentally unstable, and was on medication.

Taking a cue from this, we checked if any video or footage from this unfortunate event in Bihar could be found on the internet. A keyword search in Hindi led us to this YouTube video uploaded on November 7. We are not embedding the video in view of the graphic content.

Comparing the viral video with footage from the YouTube report, we could ascertain that the footage of the dead woman and her three children showed the woman from Purnea identified as Babita Devi, and her three children, whom she had killed before killing herself.

Further, we came across another YouTube video, uploaded by a news outlet called Khabar Seemanchal, which reported on the same event from Purnea, Bihar.

We were also able to find news reports by India TV News, ETV Bharat News, Aaj Tak, etc, that corroborated the circumstances under which the tragic event had transpired on November 6.

To sum up, the video that is viral on social media showing distressing footage of the dead bodies of a woman and three children are not linked in any way to any incident in Bangladesh. It is from Purnea, Bihar. The claims of the footage showing the aftermath of an attack on Hindus are entirely false.

The post Tragic deaths of mother & children in Purnea, Bihar, falsely viral as attack on Hindu family in Bangladesh appeared first on Alt News.

This content originally appeared on Alt News and was authored by Prantik Ali.

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Wrapping his wife in a blanket as she mourned the loss of her pregnancy at 11 weeks, Hope Ngumezi wondered why no obstetrician was coming to see her.

Over the course of six hours on June 11, 2023, Porsha Ngumezi had bled so much in the emergency department at Houston Methodist Sugar Land that she’d needed two transfusions. She was anxious to get home to her young sons, but, according to a nurse’s notes, she was still “passing large clots the size of grapefruit.”

Hope dialed his mother, a former physician, who was unequivocal. “You need a D&C,” she told them, referring to dilation and curettage, a common procedure for first-trimester miscarriages and abortions. If a doctor could remove the remaining tissue from her uterus, the bleeding would end.

But when Dr. Andrew Ryan Davis, the obstetrician on duty, finally arrived, he said it was the hospital’s “routine” to give a drug called misoprostol to help the body pass the tissue, Hope recalled. Hope trusted the doctor. Porsha took the pills, according to records, and the bleeding continued.

Three hours later, her heart stopped.

The 35-year-old’s death was preventable, according to more than a dozen doctors who reviewed a detailed summary of her case for ProPublica. Some said it raises serious questions about how abortion bans are pressuring doctors to diverge from the standard of care and reach for less-effective options that could expose their patients to more risks. Doctors and patients described similar decisions they’ve witnessed across the state.

It was clear Porsha needed an emergency D&C, the medical experts said. She was hemorrhaging and the doctors knew she had a blood-clotting disorder, which put her at greater danger of excessive and prolonged bleeding. “Misoprostol at 11 weeks is not going to work fast enough,” said Dr. Amber Truehart, an OB-GYN at the University of New Mexico Center for Reproductive Health. “The patient will continue to bleed and have a higher risk of going into hemorrhagic shock.” The medical examiner found the cause of death to be hemorrhage.

D&Cs — a staple of maternal health care — can be lifesaving. Doctors insert a straw-like tube into the uterus and gently suction out any remaining pregnancy tissue. Once the uterus is emptied, it can close, usually stopping the bleeding.

But because D&Cs are also used to end pregnancies, the procedure has become tangled up in state legislation that restricts abortions. In Texas, any doctor who violates the strict law risks up to 99 years in prison. Porsha’s is the fifth case ProPublica has reported in which women died after they did not receive a D&C or its second-trimester equivalent, a dilation and evacuation; three of those deaths were in Texas.

ProPublica condensed 200 pages of medical records into a summary of the case in consultation with two maternal-fetal medicine specialists and then reviewed it with more than a dozen experts around the country, including researchers at prestigious universities, OB-GYNs who regularly handle miscarriages, and experts in maternal health.

Texas doctors told ProPublica the law has changed the way their colleagues see the procedure; some no longer consider it a first-line treatment, fearing legal repercussions or dissuaded by the extra legwork required to document the miscarriage and get hospital approval to carry out a D&C. This has occurred, ProPublica found, even in cases like Porsha’s where there isn’t a fetal heartbeat or the circumstances should fall under an exception in the law. Some doctors are transferring those patients to other hospitals, which delays their care, or they’re defaulting to treatments that aren’t the medical standard.

Misoprostol, the medicine given to Porsha, is an effective method to complete low-risk miscarriages but is not recommended when a patient is unstable. The drug is also part of a two-pill regimen for abortions, yet administering it may draw less scrutiny than a D&C because it requires a smaller medical team and because the drug is commonly used to induce labor and treat postpartum hemorrhage. Since 2022, some Texas women who were bleeding heavily while miscarrying have gone public about only receiving medication when they asked for D&Cs. One later passed out in a pool of her own blood.

“Stigma and fear are there for D&Cs in a way that they are not for misoprostol,” said Dr. Alison Goulding, an OB-GYN in Houston. “Doctors assume that a D&C is not standard in Texas anymore, even in cases where it should be recommended. People are afraid: They see D&C as abortion and abortion as illegal.”

Doctors and nurses involved in Porsha’s care did not respond to multiple requests for comment.

Several physicians who reviewed the summary of her case pointed out that Davis’ post-mortem notes did not reflect nurses’ documented concerns about Porsha’s “heavy bleeding.” After Porsha died, Davis wrote instead that the nurses and other providers described the bleeding as “minimal,” though no nurses wrote this in the records. ProPublica tried to ask Davis about this discrepancy. He did not respond to emails, texts or calls.

Houston Methodist officials declined to answer a detailed list of questions about Porsha’s treatment. They did not comment when asked whether Davis’ approach was the hospital’s “routine.” A spokesperson said that “each patient’s care is unique to that individual.”

“All Houston Methodist hospitals follow all state laws,” the spokesperson added, “including the abortion law in place in Texas.”

Hope marveled at the energy Porsha had for their two sons, ages 5 and 3. Whenever she wasn’t working, she was chasing them through the house or dancing with them in the living room. As a finance manager at a charter school system, she was in charge of the household budget. As an engineer for an airline, Hope took them on flights around the world — to Chile, Bali, Guam, Singapore, Argentina.

The two had met at Lamar University in Beaumont, Texas. “When Porsha and I began dating,” Hope said, “I already knew I was going to love her.” She was magnetic and driven, going on to earn an MBA, but she was also gentle with him, always protecting his feelings. Both were raised in big families and they wanted to build one of their own.

When he learned Porsha was pregnant again in the spring of 2023, Hope wished for a girl. Porsha found a new OB-GYN who said she could see her after 11 weeks. Ten weeks in, though, Porsha noticed she was spotting. Over the phone, the obstetrician told her to go to the emergency room if it got worse.

To celebrate the end of the school year, Porsha and Hope took their boys to a water park in Austin, and as they headed back, on June 11, Porsha told Hope that the bleeding was heavier. They decided Hope would stay with the boys at home until a relative could take over; Porsha would drive to the emergency room at Houston Methodist Sugar Land, one of seven community hospitals that are part of the Houston Methodist system.

At 6:30 p.m, three hours after Porsha arrived at the hospital, she saw huge clots in the toilet. “Significant bleeding,” the emergency physician wrote. “I’m starting to feel a lot of pain,” Porsha texted Hope. Around 7:30 p.m., she wrote: “She said I might need surgery if I don’t stop bleeding,” referring to the nurse. At 7:50 p.m., after a nurse changed her second diaper in an hour: “Come now.”

Still, the doctor didn’t mention a D&C at this point, records show. Medical experts told ProPublica that this wait-and-see approach has become more common under abortion bans. Unless there is “overt information indicating that the patient is at significant risk,” hospital administrators have told physicians to simply monitor them, said Dr. Robert Carpenter, a maternal-fetal medicine specialist who works in several hospital systems in Houston. Methodist declined to share its miscarriage protocols with ProPublica or explain how it is guiding doctors under the abortion ban.

As Porsha waited for Hope, a radiologist completed an ultrasound and noted that she had “a pregnancy of unknown location.” The scan detected a “sac-like structure” but no fetus or cardiac activity. This report, combined with her symptoms, indicated she was miscarrying.

But the ultrasound record alone was less definitive from a legal perspective, several doctors explained to ProPublica. Since Porsha had not had a prenatal visit, there was no documentation to prove she was 11 weeks along. On paper, this “pregnancy of unknown location” diagnosis could also suggest that she was only a few weeks into a normally developing pregnancy, when cardiac activity wouldn’t be detected. Texas outlaws abortion from the moment of fertilization; a record showing there is no cardiac activity isn’t enough to give physicians cover to intervene, experts said.

Dr. Gabrielle Taper, who recently worked as an OB-GYN resident in Austin, said that she regularly witnessed delays after ultrasound reports like these. “If it’s a pregnancy of unknown location, if we do something to manage it, is that considered an abortion or not?” she said, adding that this was one of the key problems she encountered. After the abortion ban went into effect, she said, “there was much more hesitation about: When can we intervene, do we have enough evidence to say this is a miscarriage, how long are we going to wait, what will we use to feel definitive?”

At Methodist, the emergency room doctor reached Davis, the on-call OB-GYN, to discuss the ultrasound, according to records. They agreed on a plan of “observation in the hospital to monitor bleeding.”

Around 8:30 p.m., just after Hope arrived, Porsha passed out. Terrified, he took her head in his hands and tried to bring her back to consciousness. “Babe, look at me,” he told her. “Focus.” Her blood pressure was dipping dangerously low. She had held off on accepting a blood transfusion until he got there. Now, as she came to, she agreed to receive one and then another.

By this point, it was clear that she needed a D&C, more than a dozen OB-GYNs who reviewed her case told ProPublica. She was hemorrhaging, and the standard of care is to vacuum out the residual tissue so the uterus can clamp down, physicians told ProPublica.

“Complete the miscarriage and the bleeding will stop,” said Dr. Lauren Thaxton, an OB-GYN who recently left Texas.

“At every point, it’s kind of shocking,” said Dr. Daniel Grossman, a professor of obstetrics and gynecology at the University of California, San Francisco who reviewed Porsha’s case. “She is having significant blood loss and the physician didn’t move toward aspiration.”

All Porsha talked about was her devastation of losing the pregnancy. She was cold, crying and in extreme pain. She wanted to be at home with her boys. Unsure what to say, Hope leaned his chest over the cot, passing his body heat to her.

At 9:45 p.m., Esmeralda Acosta, a nurse, wrote that Porsha was “continuing to pass large clots the size of grapefruit.” Fifteen minutes later, when the nurse learned Davis planned to send Porsha to a floor with fewer nurses, she “voiced concern” that he wanted to take her out of the emergency room, given her condition, according to medical records.

At 10:20 p.m., seven hours after Porsha arrived, Davis came to see her. Hope remembered what his mother had told him on the phone earlier that night: “She needs a D&C.” The doctor seemed confident about a different approach: misoprostol. If that didn’t work, Hope remembers him saying, they would move on to the procedure.

A pill sounded good to Porsha because the idea of surgery scared her. Davis did not explain that a D&C involved no incisions, just suction, according to Hope, or tell them that it would stop the bleeding faster. The Ngumezis followed his recommendation without question. “I’m thinking, ‘He’s the OB, he’s probably seen this a thousand times, he probably knows what’s right,’” Hope said.

But more than a dozen doctors who reviewed Porsha’s case were concerned by this recommendation. Many said it was dangerous to give misoprostol to a woman who’s bleeding heavily, especially one with a blood clotting disorder. “That’s not what you do,” said Dr. Elliott Main, the former medical director for the California Maternal Quality Care Collaborative and an expert in hemorrhage, after reviewing the case. “She needed to go to the operating room.” Main and others said doctors are obliged to counsel patients on the risks and benefits of all their options, including a D&C.

Performing a D&C, though, attracts more attention from colleagues, creating a higher barrier in a state where abortion is illegal, explained Goulding, the OB-GYN in Houston. Staff are familiar with misoprostol because it’s used for labor, and it only requires a doctor and a nurse to administer it. To do a procedure, on the other hand, a doctor would need to find an operating room, an anesthesiologist and a nursing team. “You have to convince everyone that it is legal and won’t put them at risk,” said Goulding. “Many people may be afraid and misinformed and refuse to participate — even if it’s for a miscarriage.”

Davis moved Porsha to a less-intensive unit, according to records. Hope wondered why they were leaving the emergency room if the nurse seemed so worried. But instead of pushing back, he rubbed Porsha’s arms, trying to comfort her. The hospital was reputable. “Since we were at Methodist, I felt I could trust the doctors.”

On their way to the other ward, Porsha complained of chest pain. She kept remarking on it when they got to the new room. From this point forward, there are no nurse’s notes recording how much she continued to bleed. “My wife says she doesn’t feel right, and last time she said that, she passed out,” Hope told a nurse. Furious, he tried to hold it together so as not to alarm Porsha. “We need to see the doctor,” he insisted.

Her vital signs looked fine. But many physicians told ProPublica that when healthy pregnant patients are hemorrhaging, their bodies can compensate for a long time, until they crash. Any sign of distress, such as chest pain, could be a red flag; the symptom warranted investigation with tests, like an electrocardiogram or X-ray, experts said. To them, Porsha’s case underscored how important it is that doctors be able to intervene before there are signs of a life-threatening emergency.

But Davis didn’t order any tests, according to records.

Around 1:30 a.m., Hope was sitting by Porsha’s bed, his hands on her chest, telling her, “We are going to figure this out.” They were talking about what she might like for breakfast when she began gasping for air.

“Help, I need help!” he shouted to the nurses through the intercom. “She can’t breathe.”

Hours later, Hope returned home in a daze. “Is mommy still at the hospital?” one of his sons asked. Hope nodded; he couldn’t find the words to tell the boys they’d lost their mother. He dressed them and drove them to school, like the previous day had been a bad dream. He reached for his phone to call Porsha, as he did every morning that he dropped the kids off. But then he remembered that he couldn’t.

Friends kept reaching out. Most of his family’s network worked in medicine, and after they said how sorry they were, one after another repeated the same message. All she needed was a D&C, said one. They shouldn’t have given her that medication, said another. It’s a simple procedure, the callers continued. We do this all the time in Nigeria.

Since Porsha died, several families in Texas have spoken publicly about similar circumstances. This May, when Ryan Hamilton’s wife was bleeding while miscarrying at 13 weeks, the first doctor they saw at Surepoint Emergency Center Stephenville noted no fetal cardiac activity and ordered misoprostol, according to medical records. When they returned because the bleeding got worse, an emergency doctor on call, Kyle Demler, said he couldn’t do anything considering “the current stance” in Texas, according to Hamilton, who recorded his recollection of the conversation shortly after speaking with Demler. (Neither Surepoint Emergency Center Stephenville nor Demler responded to several requests for comment.)

They drove an hour to another hospital asking for a D&C to stop the bleeding, but there, too, the physician would only prescribe misoprostol, medical records indicate. Back home, Hamilton’s wife continued bleeding until he found her passed out on the bathroom floor. “You don’t think it can really happen like that,” said Hamilton. “It feels like you’re living in some sort of movie, it’s so unbelievable.”

Across Texas, physicians say they blame the law for interfering with medical care. After ProPublica reported last month on two women who died after delays in miscarriage care, 111 OB-GYNs sent a letter to Texas policymakers, saying that “the law does not allow Texas women to get the lifesaving care they need.”

Dr. Austin Dennard, an OB-GYN in Dallas, told ProPublica that if one person on a medical team doubts the doctor’s choice to proceed with a D&C, the physician might back down. “You constantly feel like you have someone looking over your shoulder in a punitive, vigilante type of way.”

The criminal penalties are so chilling that even women with diagnoses included in the law’s exceptions are facing delays and denials. Last year, for example, legislators added an update to the ban for patients diagnosed with previable premature rupture of membranes, in which a patient’s water breaks before a fetus can survive. Doctors can still face prosecution for providing abortions in those cases, but they are offered the chance to justify themselves with what’s called an “affirmative defense,” not unlike a murder suspect arguing self defense. This modest change has not stopped some doctors from transferring those patients instead of treating them; Dr. Allison Gilbert, an OB-GYN in Dallas, said doctors send them to her from other hospitals. “They didn’t feel like other staff members would be comfortable proceeding with the abortion,” she said. “It’s frustrating that places still feel like they can’t act on some of these cases that are clearly emergencies.” Women denied treatment for ectopic pregnancies, another exception in the law, have filed federal complaints.

In response to ProPublica’s questions about Houston Methodist’s guidance on miscarriage management, a spokesperson, Gale Smith, said that the hospital has an ethics committee, which can usually respond within hours to help physicians and patients make “appropriate decisions” in compliance with state laws.

After Porsha died, Davis described in the medical record a patient who looked stable: He was tracking her vital signs, her bleeding was “mild” and she was “said not to be in distress.” He ordered bloodwork “to ensure patient wasn’t having concerning bleeding.” Medical experts who reviewed Porsha’s case couldn’t understand why Davis noted that a nurse and other providers reported “decreasing bleeding” in the emergency department when the record indicated otherwise. “He doesn’t document the heavy bleeding that the nurse clearly documented, including the significant bleeding that prompted the blood transfusion, which is surprising,” Grossman, the UCSF professor, said.

Patients who are miscarrying still don’t know what to expect from Houston Methodist.

This past May, Marlena Stell, a patient with symptoms nearly identical to Porsha’s, arrived at another hospital in the system, Houston Methodist The Woodlands. According to medical records, she, too, was 11 weeks along and bleeding heavily. An ultrasound confirmed there was no fetal heartbeat and indicated the miscarriage wasn’t complete. “I assumed they would do whatever to get the bleeding to stop,” Stell said.

Instead, she bled for hours at the hospital. She wanted a D&C to clear out the rest of the tissue, but the doctor gave her methergine, a medication that’s typically used after childbirth to stop bleeding but that isn’t standard care in the middle of a miscarriage, doctors told ProPublica. "She had heavy bleeding, and she had an ultrasound that's consistent with retained products of conception." said Dr. Jodi Abbott, an associate professor of obstetrics and gynecology at Boston University School of Medicine, who reviewed the records. "The standard of care would be a D&C."

Stell says that instead, she was sent home and told to “let the miscarriage take its course.” She completed her miscarriage later that night, but doctors who reviewed her case, so similar to Porsha’s, said it showed how much of a gamble physicians take when they don’t follow the standard of care. “She got lucky — she could have died,” Abbott said. (Houston Methodist did not respond to a request for comment on Stell’s care.)

It hadn’t occurred to Hope that the laws governing abortion could have any effect on his wife’s miscarriage. Now it’s the only explanation that makes sense to him. “We all know pregnancies can come out beautifully or horribly,” Hope told ProPublica. “Instead of putting laws in place to make pregnancies safer, we created laws that put them back in danger.”

For months, Hope’s youngest son didn’t understand that his mom was gone. Porsha’s long hair had been braided, and anytime the toddler saw a woman with braids from afar, he would take off after her, shouting, “That’s mommy!”

A couple weeks ago, Hope flew to Amsterdam to quiet his mind. It was his first trip without Porsha, but as he walked the city, he didn’t know how to experience it without her. He kept thinking about how she would love the Christmas lights and want to try all the pastries. How she would have teased him when he fell asleep on a boat tour of the canals. “I thought getting away would help,” he wrote in his journal. “But all I’ve done is imagine her beside me.”

Mariam Elba and Lexi Churchill contributed research.

This content originally appeared on ProPublica and was authored by by Lizzie Presser and Kavitha Surana.

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Georgia officials have dismissed all members of a state committee charged with investigating deaths of pregnant women. The move came in response to ProPublica having obtained internal reports detailing two deaths.

ProPublica reported in September on the deaths of Amber Thurman and Candi Miller, which the state maternal mortality review committee had determined were preventable. They were the first reported cases of women who died without access to care restricted by a state abortion ban, and they unleashed a torrent of outrage over the fatal consequences of such laws. The women’s stories became a central discussion in the presidential campaign and ballot initiatives involving abortion access in 10 states.

“Confidential information provided to the Maternal Mortality Review Committee was inappropriately shared with outside individuals,” Dr. Kathleen Toomey, commissioner of the state Department of Public Health, wrote in a letter dated Nov. 8 and addressed to members of the committee. “Even though this disclosure was investigated, the investigation was unable to uncover which individual(s) disclosed confidential information.

“Therefore, effective immediately the current MMRC is disbanded, and all member seats will be filled through a new application process.”

A health department spokesperson declined to comment on the decision to dismiss the committee, saying that the letter, which the department provided to ProPublica, “speaks for itself.” Georgia Gov. Brian Kemp’s office also declined to comment, referring questions to the health department.

Under Georgia law, the work of the maternal mortality review committee is confidential, and members must sign confidentiality agreements. Those members see only summaries of medical records stripped of personal details, and their findings on individual cases are not supposed to be shared with the public — not even with hospitals or with family members of women who died.

The health department’s letter states that there could be new steps to keep the board’s deliberations from public view. The letter said officials might change “other procedures for on-boarding committee members better ensuring confidentiality, committee oversight and MMRC organizational structure.”

Maternal mortality review committees exist in every state. They are tasked with examining deaths of women during a pregnancy or up to a year after and determining whether they could have been prevented.

Georgia’s had 32 standing members from a variety of backgrounds, including OB-GYNs, cardiologists, mental health care providers, a medical examiner, health policy experts and community advocates. They are volunteer positions that pay a small honorarium.

Their job is to collect data and make recommendations aimed at combatting systemic issues that could help reduce deaths and publish them in reports. The Georgia committee’s most recent report found that of 113 pregnancy-related deaths from 2018 through 2020, 101 had at least some chance of being prevented. Its recommendations have led to changes in hospital care to improve the response to emergencies during labor and delivery and to new programs to increase access to psychiatric treatment.

The health department’s letter states that the “change to the current committee will not result in a delay in the MMRC’s responsibilities.” But at least one other state has experienced a lag as a result of reshaping its committee. Idaho let its maternal mortality review committee legislation expire in July 2023, effectively disbanding the committee after lobbyist groups attacked members for recommending that the state expand Medicaid for postpartum women. Earlier this year, Idaho’s Legislature reestablished the committee, but new members weren’t announced until Nov. 15. There is now more than a yearlong delay in the review process.

Reproductive rights advocates say Georgia’s decision to dismiss and restructure its committee also could have a chilling effect on the committee’s work, potentially dissuading its members from delving as deeply as they have into the circumstances of pregnant women’s deaths if it could be politically sensitive.

“They did what they were supposed to do. This is why we need them,” said Monica Simpson, executive director of SisterSong, one of the groups challenging Georgia’s abortion ban in court. “To have this abrupt disbandment, my concern is what we are going to lose in the process, in terms of time and data?”

One objective of any maternal mortality review committee is to look at the circumstances of a death holistically to identify root causes that may be able to help other women in the future.

In the case of Candi Miller, the most prominent detail in a state medical examiner’s report of her death was that she had a lethal combination of painkillers in her system, including fentanyl. It attributed the cause of death to drug intoxication.

But the Georgia committee looked at the facts of the death with a different objective: to consider the broader context. A summary of Miller’s case prepared for the committee, drawn from hospital records and the medical examiner’s report, included that Miller had multiple health conditions that can be exacerbated by pregnancy, that she had ordered abortion pills from overseas and that she had unexpelled fetal tissue, which showed the abortion had not fully completed. It also stated that her family had told the coroner she didn’t visit a doctor “due to the current legislation on pregnancies and abortions.”

The committee found her death was “preventable” and blamed the state’s abortion ban.

“The fact that she felt that she had to make these decisions, that she didn’t have adequate choices here in Georgia, we felt that definitely influenced her case,” one committee member told ProPublica in September. “She’s absolutely responding to this legislation.”

For Miller’s family, the committee’s findings were painful but wanted. “It seems like that is essential information that you would share with the family,” said Miller’s sister, Turiya Tomlin-Randall, who was not aware of the committee’s work until ProPublica contacted her.

She also said it’s upsetting to hear that the committee’s members were dismissed partly as a result of her sister’s case being disclosed to the public. “I don’t understand how this is even possible,” she said.

The committee also investigated the case of Amber Thurman, who died just one month after Georgia’s six-week abortion law went into effect. The medical examiner’s report stated that Thurman died of “sepsis” and “retained products of conception” and that she had received a dilation and curettage, or D&C, and a hysterectomy after an at-home abortion.

When the committee members received a summary of her hospital stay, they saw a timeline with additional factors: The hospital had delayed providing a D&C — a routine procedure to clear fetal tissue from the uterus — for 20 hours, which Thurman needed for rare complications she’d developed after taking abortion medication. The state had recently attached criminal penalties to performing a D&C, with few exceptions. The summary showed doctors discussed providing the D&C twice, but by the time they performed the procedure it was too late. Committee members found that there was a “good chance” Thurman’s death could have been prevented if she had received the D&C sooner.

Doctors and a nurse involved in Thurman’s care did not answer questions from ProPublica for its September story. The hospital also did not respond to multiple requests for comment.

Thurman’s family also told ProPublica they had wanted the information about her death disclosed.

Some experts say that keeping the reports of maternal mortality review committees confidential is important for a committee to serve its purpose. They are set up not to assign blame but instead to create a space for clinicians to investigate broad causes of maternal health failures. But others say the lack of transparency can serve to obscure the biggest disruption to maternal health care in half a century.

“We know that the reports that have come out of that committee are anonymized and synthesized in order to provide a 50,000-foot view,” said Kwajelyn Jackson, executive director of Feminist Women’s Health Center in Atlanta, which provides abortion care. “But my worry is that in an effort to protect the state, there will be less information that will be available to people who could shift their actions, shift their protocols, shift their strategies, shift their behaviors in order to make a difference in maternal health outcomes.”

Two states did make shifts to their committees — Idaho, after members made a recommendation to expand Medicaid that Republicans opposed, and Texas, after a member publicly criticized the state.

In 2022, Texas committee member Nakeenya Wilson, a community advocate, spoke out against the state’s decision to delay the release of its report during an election year. The following year, the Legislature passed a law that created a second community advocate position on the committee, redefined the position and had Wilson reapply. She was not reappointed. The state instead filled one of the slots with a prominent anti-abortion activist.

Wilson said Georgia’s decision to dismiss its committee could cause greater harm.

“What message is being said to the families who lost their loved ones?” she said. “There’s going to be even less accountability for this to not happen again.”

Ziva Branstetter, Kavitha Surana, Cassandra Jaramillo and Anna Barry-Jester contributed reporting. Doris Burke contributed research.

This content originally appeared on ProPublica and was authored by by Amy Yurkanin.

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Weeks after ProPublica reported on the deaths of two pregnant women whose miscarriages went untreated in Texas, state lawmakers have filed bills that would create new exceptions to the state’s strict abortion laws, broadening doctors’ ability to intervene when their patients face health risks.

The legislation comes after the lawmaker who wrote one of Texas’ recent abortion bans wrote an op-ed in the Houston Chronicle defending the current exceptions as “plenty clear.”

But more than 100 Texas OB-GYNs disagree with his position. In a public letter, written in response to ProPublica’s reporting, they urged changes. “As OB-GYNs in Texas, we know firsthand how much these laws restrict our ability to provide our patients with quality, evidence-based care,” they said.

Texas’ abortion ban threatens up to 99 years in prison, $100,000 in fines and loss of medical license for doctors who provide abortions. The state’s health and safety code currently includes exceptions if a pregnant woman “has a life-threatening physical condition aggravated by, caused by, or arising from a pregnancy that places the female at risk of death or poses a serious risk of substantial impairment of a major bodily function unless the abortion is performed or induced.” A separate exception exists that provides doctors with some legal protections if they perform an abortion for an ectopic pregnancy or in cases when a patient’s water breaks.

The bills, filed in the state House and Senate last week, create new health exceptions. They would allow doctors to induce or perform abortions necessary to preserve the mental or physical health of a patient, including preserving the patient’s fertility. Doctors could also provide abortions in cases where the fetus had an anomaly that would make it unable to survive outside the womb or able to survive only with “extraordinary medical interventions.”

State Rep. Donna Howard, who filed the bill in the Texas House, said ProPublica’s recent reporting adds to evidence that the current legislation is a threat to the safety of pregnant women in Texas and increases the urgency to make changes. “This is my reaction,” she said. “It’s one of extreme sadness and disbelief that we are at a point where we are allowing women to die because we haven’t been able to clarify the law,” she said.

Investigations by ProPublica have found that at least four women, including two in Texas, died after they could not access timely reproductive care in states that ban abortion. There are almost certainly others.

In Houston, Josseli Barnica died in September 2021, just days after the state’s six-week abortion ban went into effect. Barnica, 28, was miscarrying at 17 weeks, but doctors did not offer her the medical standard of care — to speed up labor or empty her uterus — for 40 hours, until after the fetal heartbeat had stopped. Her husband said she was told it would be a “crime” to intervene. This left her seriously exposed to infection, experts told ProPublica. Three days later, she died from an infection, leaving behind a young daughter.

Her death was “preventable,” according to more than a dozen medical experts who reviewed a summary of her hospital and autopsy records at ProPublica’s request; they called her case “horrific,” “astounding” and “egregious.”

The doctors involved in Barnica’s care at HCA Houston Healthcare Northwest did not respond to multiple requests for comment on her case. In a statement, HCA Healthcare said, “Our responsibility is to be in compliance with applicable state and federal laws and regulations,” and that physicians exercise their independent judgment. The company did not respond to detailed questions about its policy.

Nevaeh Crain, 18, made three trips to emergency rooms in rural southeast Texas last year for vomiting and abdominal pain, waiting 20 hours before doctors admitted her. Doctors insisted on two ultrasounds to document “fetal demise” as Crain’s vital signs grew more alarming. By the time they rushed to operate, sepsis had spread throughout her body and her organs failed.

Experts who reviewed a summary of Crain’s medical records for ProPublica said it may have been possible to save both the teenager and her pregnancy if she had been admitted earlier for close monitoring and continuous treatment.

Doctors involved in Crain’s care did not respond to several requests for comment. The two hospitals — Baptist Hospitals of Southeast Texas and Christus Southeast Texas St. Elizabeth — declined to answer questions about her treatment.

The cases highlight how abortion laws can interfere with maternal health care, even for those who want to have a child.

Much of the confusion hinges on the definition of a “medical emergency.” In many cases, women experiencing a miscarriage or a pregnancy complication may be stable. But requiring them to wait for an abortion until signs of sickness are documented or the fetal cardiac activity stops violates the professional standard of care, putting them at higher risk that a life-threatening infection or other complications could develop and be harder to control.

Attaching criminal penalties to abortion procedures has led to a chilling effect, making some physicians more hesitant to care for patients experiencing pregnancy complications in general, doctors told ProPublica.

After ProPublica’s reporting, state Sen. Bryan Hughes, the author of one of the state’s abortion bans, wrote an op-ed in the Houston Chronicle. He said the women were “wrongfully denied care,” but he blamed media outlets including ProPublica for publishing stories that made doctors “afraid to treat the women.”

“When a mother’s life or major bodily function are in jeopardy, doctors are not only allowed to act, but they are legally required to act,” he wrote. “And contrary to what ProPublica would have us believe, Texas law does not prevent them from aiding their patients and saving their lives.”

He argued that the medical emergency exceptions in Texas’ new abortion bans use the same language as abortion laws from the 1800s. “We did not want to risk confusing medical providers by changing the definition,” he said. But that language was written at a time when many more women died in pregnancy and childbirth — before medical innovations such as suction devices to empty the uterus and lower the risk of sepsis helped make maternal care vastly safer.

Hughes is a licensed attorney who lists no medical training on his Senate webpage.

ProPublica repeatedly requested an interview with Hughes to further understand his interpretation of how doctors should apply the law in specific scenarios. He did not respond to a detailed list of questions and requests to comment for this article.

There is no state office that doctors can call to make sure their decisions in miscarriage cases do not violate the law. Yet Texas Attorney General Ken Paxton has made it clear he will not hesitate to prosecute doctors if the abortions they provide do not meet his interpretation of a medical emergency.

Last year, a Dallas woman asked a court for approval to end her pregnancy because her fetus was not viable and she faced health risks if she carried it to term. Paxton fought to keep her pregnant, arguing that her doctor hadn’t proved her situation was an emergency, and threatened to prosecute anyone who helped her. The courts sided with him, and the woman traveled out of state for the abortion.

After reading ProPublica’s stories, 111 Texas OB-GYNs signed a letter placing blame for the deaths squarely on state abortion law that “does not allow us as medical professionals to do our jobs.”

“The law does not allow Texas women to get the lifesaving care they need and threatens physicians with life imprisonment and loss of licensure for doing what is often medically necessary for the patient’s health and future fertility,” they wrote.

Their letter adds to years of warnings from the medical community and from patients themselves: 20 women who were denied abortions for miscarriages and high-risk pregnancy complications joined a lawsuit against the state. They asked the courts to clarify the law’s exceptions, but the Texas Supreme Court refused.

Dr. Austin Dennard, a Dallas OB-GYN, is one of the women represented in the lawsuit. She has seen the consequences of the laws from both sides. As a doctor, she has to call a hospital lawyer any time she wants to provide abortion care to patients facing emergencies. She also was personally affected when she was pregnant and learned her fetus had anencephaly — a condition in which the brain and skull do not fully develop. Texas’ law would have forced her to carry to term, putting her through more health risks and making her wait longer to try again for another pregnancy, so she traveled out of state for an abortion.

She said lawmakers have failed for years to listen to the doctors who have to navigate these laws.

In response to Hughes’s op-ed, she said: “We’re the ones with their boots on the ground. We’re the ones taking care of these patients, and we’re the ones telling you it is very nebulous and confusing, and we’re all terrified,” Dennard said.

State Sen. Carol Alvarado, who filed the Senate version of the bill, said she worked with physicians who represent major medical organizations to draft the exceptions.

“This bill is not about politics — it’s about ensuring that doctors can provide life-saving care without hesitation or fear of prosecution,” Alvarado said. “This bill is about restoring trust in our health care system and ensuring that no one has to endure the heartbreak of wondering whether more timely medical care could have saved their loved one.”

Molly Duane, a lawyer with the Center for Reproductive Rights who represents women who are suing the state, said the bill, if passed, could help save some lives, but cautioned that without removing the threat of criminal penalties, some doctors might still deny care.

“Exceptions don’t work in reality, no matter how clear they are,” Duane said. “We’ve seen hospitals turn away Texans facing life-threatening ectopic pregnancies, even though providing an abortion in these cases is legal under state law. As long as doctors face the threat of jail time and loss of license, they will be terrified to provide care.”

In his op-ed, Hughes said that the Texas Medical Board has issued guidance that an emergency doesn’t need to be “imminent” to keep physicians “from doing what is medically necessary” under the law.

But Dennard, echoing many doctors who spoke to ProPublica, said the board was “incredibly unhelpful.” The guidance instructed doctors on ways they could document why the abortion was necessary and still left open the question of how lawyers and courts might interpret “medically necessary.”

“None of them want to face the reality of the situation, which is that the laws that were put in place are directly harming pregnant people, and it is their fault,” she said.

The board, whose members are appointed by the governor, issued the guidance earlier this year after declining for more than two years to respond to questions about how the law should be interpreted, even as patients facing health risks publicly shared their stories of being denied abortion care and journalists asked the board to respond. The board issued guidance only after the Texas Supreme Court directed it to do so.

The president of the board, Dr. Sherif Zaafran, said in an interview that it would have been “inappropriate” to weigh in without that direction.

“Somebody could easily sue the medical board and say, ‘You shouldn’t have done this,’ and then we’d be in limbo also, and that could have actually dragged things out even longer.”

In the meantime, women’s lives were left in the balance.

Last year, lawmakers created a new exception for two conditions that the original law had not addressed: ectopic pregnancies and previable premature rupture of membranes, when a patient’s water breaks too early, causing a miscarriage.

But the exception is small comfort, some doctors say. It’s written in a way that only allows doctors to make an “affirmative defense” for a legal penalty. An affirmative defense, if found credible by a judge or jury, means the defendant wouldn’t be liable for the alleged acts even if he or she committed them.

“Nobody wants to be that poster child,” said Dr. Robert Carpenter, a Houston OB-GYN who signed the letter.

The Houston Chronicle also published 10 letters to the editor in response to Hughes’ editorial, eight of them arguing against his claim that the Texas abortion ban is clear.

Among them was Trevor M. Bibler, an assistant professor at Baylor College of Medicine’s Center for Medical Ethics and Health Policy.

“If doctors weren’t threatened with jail time and accused of murder just for upholding a basic standard of care, then these tragedies wouldn’t happen,” he wrote. “The possibility that the cause of these tragedies are the doctors who read the writings of the left-wing media rather than the law is absurd, disingenuous and not at all convincing. His law, not the media, is the cause.”

Howard said she’s hopeful the Texas Legislature will listen to the medical community and the public and create health and other exceptions in the abortion laws. She also pointed out that President-elect Donald Trump has said that he supports exceptions in cases of rape and incest, which Texas’ ban does not include. She filed a separate bill to propose such exceptions.

“It’s really just unbelievable, from a state that considers itself to be pro-life, that these obstacles will be put in place that are the antithesis of pro-life,” Howard said.

As other states assess whether to ban or protect abortion rights, Texas is providing an example of what to expect.

In Wisconsin, state Supreme Court Justice Jill Karofsky recently pressed an attorney for the state to explain whether an abortion ban on the books from 1849 would stop doctors from providing abortion care to patients who were experiencing miscarriages if the court allowed it to go into effect.

Describing Barnica’s case, she asked for clarification: “She suffered an infection that killed her because medical providers were unwilling or unable to give her the health care that she needed,” she said. “That’s a scenario that could easily — and perhaps has easily — play out here in Wisconsin under your interpretation of [the law], couldn’t it?”

“I’m not sure, Justice Karofsky,” the attorney responded. “I’m not a doctor.”

This content originally appeared on ProPublica and was authored by by Cassandra Jaramillo, Kavitha Surana, Lizzie Presser and Ziva Branstetter.

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Candace Fails screamed for someone in the Texas hospital to help her pregnant daughter. “Do something,” she pleaded, on the morning of Oct. 29, 2023.

Nevaeh Crain was crying in pain, too weak to walk, blood staining her thighs. Feverish and vomiting the day of her baby shower, the 18-year-old had gone to two different emergency rooms within 12 hours, returning home each time worse than before.

The first hospital diagnosed her with strep throat without investigating her sharp abdominal cramps. At the second, she screened positive for sepsis, a life-threatening and fast-moving reaction to an infection, medical records show. But doctors said her six-month fetus had a heartbeat and that Crain was fine to leave.

Now on Crain’s third hospital visit, an obstetrician insisted on two ultrasounds to “confirm fetal demise,” a nurse wrote, before moving her to intensive care.

By then, more than two hours after her arrival, Crain’s blood pressure had plummeted and a nurse had noted that her lips were “blue and dusky.” Her organs began failing.

Hours later, she was dead.

Fails, who would have seen her daughter turn 20 this Friday, still cannot understand why Crain’s emergency was not treated like an emergency.

But that is what many pregnant women are now facing in states with strict abortion bans, doctors and lawyers have told ProPublica.

“Pregnant women have become essentially untouchables,” said Sara Rosenbaum, a health law and policy professor emerita at George Washington University.

Texas’s abortion ban threatens prison time for interventions that end a fetal heartbeat, whether the pregnancy is wanted or not. It includes exceptions for life-threatening conditions, but still, doctors told ProPublica that confusion and fear about the potential legal repercussions are changing the way their colleagues treat pregnant patients with complications.

In states with abortion bans, such patients are sometimes bounced between hospitals like “hot potatoes,” with health care providers reluctant to participate in treatment that could attract a prosecutor, doctors told ProPublica. In some cases, medical teams are wasting precious time debating legalities and creating documentation, preparing for the possibility that they’ll need to explain their actions to a jury and judge.

Dr. Jodi Abbott, an associate professor of obstetrics and gynecology at Boston University School of Medicine, said patients are left wondering: “Am I being sent home because I really am OK? Or am I being sent home because they’re afraid that the solution to what’s going on with my pregnancy would be ending the pregnancy, and they’re not allowed to do that?”

There is a federal law to prevent emergency room doctors from withholding lifesaving care.

Passed nearly four decades ago, it requires emergency rooms to stabilize patients in medical crises. The Biden administration argues this mandate applies even in cases where an abortion might be necessary.

No state has done more to fight this interpretation than Texas, which has warned doctors that its abortion ban supersedes the administration’s guidance on federal law, and that they can face up to 99 years in prison for violating it.

ProPublica condensed more than 800 pages of Crain’s medical records into a four-page timeline in consultation with two maternal-fetal medicine specialists; reporters reviewed it with nine doctors, including researchers at prestigious universities, OB-GYNs who regularly handle miscarriages, and experts in emergency medicine and maternal health.

Some said the first ER missed warning signs of infection that deserved attention. All said that the doctor at the second hospital should never have sent Crain home when her signs of sepsis hadn’t improved. And when she returned for the third time, all said there was no medical reason to make her wait for two ultrasounds before taking aggressive action to save her.

“This is how these restrictions kill women,” said Dr. Dara Kass, a former regional director at the Department of Health and Human Services and an emergency room physician in New York. “It is never just one decision, it’s never just one doctor, it’s never just one nurse.”

While they were not certain from looking at the records provided that Crain’s death could have been prevented, they said it may have been possible to save both the teenager and her fetus if she had been admitted earlier for close monitoring and continuous treatment.

There was a chance Crain could have remained pregnant, they said. If she had needed an early delivery, the hospital was well-equipped to care for a baby on the edge of viability. In another scenario, if the infection had gone too far, ending the pregnancy might have been necessary to save Crain.

Doctors involved in Crain’s care did not respond to several requests for comment. The two hospitals, Baptist Hospitals of Southeast Texas and Christus Southeast Texas St. Elizabeth, declined to answer detailed lists of questions about her treatment.

Fails and Crain believed abortion was morally wrong. The teen could only support it in the context of rape or life-threatening illness, she used to tell her mother. They didn’t care whether the government banned it, just how their Christian faith guided their own actions.

When they discovered Crain was pregnant with a girl, the two talked endlessly about the little dresses they could buy, what kind of mother she would be. Crain landed on the name Lillian. Fails could not wait to meet her.

But when her daughter got sick, Fails expected that doctors had an obligation to do everything in their power to stave off a potentially deadly emergency, even if that meant losing Lillian. In her view, they were more concerned with checking the fetal heartbeat than attending to Crain.

“I know it sounds selfish, and God knows I would rather have both of them, but if I had to choose,” Fails said, “I would have chosen my daughter.”

Crain had just graduated from high school in her hometown of Vidor, Texas, in May of 2023 when she learned that she was pregnant.

She and her boyfriend of two years, Randall Broussard, were always hip to hip, wrestling over vapes or snuggling on the couch watching vampire movies. Crain was drawn to how gentle he was. He admired how easily she built friendships and how quickly she could make people laugh. Though they were young, they’d already imagined starting a family. Broussard, who has eight siblings, wanted many kids; Crain wanted a daughter and the kind of relationship she had with her mom. Earlier that year, Broussard had given Crain a small diamond ring — “a promise,” he told her, “that I will always love you.”

On the morning of their baby shower, Oct. 28, 2023, Crain woke with a headache. Her mom decorated the house with pink balloons and Crain laid out Halloween-themed platters. Soon, nausea set in. Crain started vomiting and was running a fever. When guests arrived, Broussard opened gifts — onesies and diapers and bows — while Crain kept closing her eyes.

Around 3 p.m., her family told her she needed to go to the hospital.

Broussard drove Crain to Baptist Hospitals of Southeast Texas. They sat in the waiting room for four hours. When Crain started vomiting, staff brought her a plastic pan. When she wasn’t retching, she lay her head in her boyfriend’s lap.

A nurse practitioner ordered a test for strep throat, which came back positive, medical records show. But in a pregnant patient, abdominal pain and vomiting should not be quickly attributed to strep, physicians told ProPublica; a doctor should have also evaluated her pregnancy.

Instead, Baptist Hospitals discharged her with a prescription for antibiotics. She was home at 9 p.m. and quickly dozed off, but within hours, she woke her mother up. “Mom, my stomach is still hurting,” she said into the dark bedroom at 3 a.m. “I’m in a lot of pain.”

Fails drove Broussard and Crain to another hospital in town, Christus Southeast Texas St. Elizabeth. Around 4:20 a.m., OB-GYN William Hawkins saw that Crain had a temperature of 102.8 and an abnormally high pulse, according to records; a nurse noted that Crain rated her abdominal pain as a seven out of 10.

Her vital signs pointed to possible sepsis, records show. It’s standard medical practice to immediately treat patients who show signs of sepsis, which can overtake and kill a person quickly, medical experts told ProPublica. These patients should be watched until their vitals improve. Through tests and scans, the goal is to find the source of the infection. If the infection was in Crain’s uterus, the fetus would likely need to be removed with a surgery.

In a room at the obstetric emergency department, a nurse wrapped a sensor belt around Crain’s belly to check the fetal heart rate. “Baby’s fine,” Broussard told Fails, who was sitting in the hallway.

After two hours of IV fluids, one dose of antibiotics, and some Tylenol, Crain’s fever didn’t go down, her pulse remained high, and the fetal heart rate was abnormally fast, medical records show. Hawkins noted that Crain had strep and a urinary tract infection, wrote up a prescription and discharged her.

Hawkins had missed infections before. Eight years earlier, the Texas Medical Board found that he had failed to diagnose appendicitis in one patient and syphilis in another. In the latter case, the board noted that his error “may have contributed to the fetal demise of one of her twins.” The board issued an order to have Hawkins’ medical practice monitored; the order was lifted two years later. (Hawkins did not respond to several attempts to reach him.)

All of the doctors who reviewed Crain’s vital signs for ProPublica said she should have been admitted. “She should have never left, never left,” said Elise Boos, an OB-GYN in Tennessee.

Kass, the New York emergency physician, put it in starker terms: When they discharged her, they were “pushing her down the path of no return.”

“It’s bullshit,” Fails said as Broussard rolled Crain out in a wheelchair; she was unable to walk on her own. Fails had expected the hospital to keep her overnight. Her daughter was breathing heavily, hunched over in pain, pale in the face. Normally talkative, the teen was quiet.

Back home, around 7 a.m., Fails tried to get her daughter comfortable as she cried and moaned. She told Fails she needed to pee, and her mother helped her into the bathroom. “Mom, come here,” she said from the toilet. Blood stained her underwear.

The blood confirmed Fails’ instinct: This was a miscarriage.

At 9 a.m, a full day after the nausea began, they were back at Christus St. Elizabeth. Crain’s lips were drained of color and she kept saying she was going to pass out. Staff started her on IV antibiotics and performed a bedside ultrasound.

Around 9:30 a.m., the OB on duty, Dr. Marcelo Totorica, couldn’t find a fetal heart rate, according to records; he told the family he was sorry for their loss.

Standard protocol when a critically ill patient experiences a miscarriage is to stabilize her and, in most cases, hurry to the operating room for delivery, medical experts said. This is especially urgent with a spreading infection. But at Christus St. Elizabeth, the OB-GYN just continued antibiotic care. A half-hour later, as nurses placed a catheter, Fails noticed her daughter’s thighs were covered in blood.

At 10 a.m., Melissa McIntosh, a labor and delivery nurse, spoke to Totorica about Crain’s condition. The teen was now having contractions. “Dr. Totorica states to not move patient,” she wrote after talking with him. “Dr. Totorica states there is a slight chance patient may need to go to ICU and he wants the bedside ultrasound to be done stat for sure before admitting to room.”

Though he had already performed an ultrasound, he was asking for a second.

The first hadn’t preserved an image of Crain’s womb in the medical record. “Bedside ultrasounds aren’t always set up to save images permanently,” said Abbott, the Boston OB-GYN.

The state’s laws banning abortion require that doctors record the absence of a fetal heartbeat before intervening with a procedure that could end a pregnancy. Exceptions for medical emergencies demand physicians document their reasoning. “Pretty consistently, people say, ‘Until we can be absolutely certain this isn’t a normal pregnancy, we can’t do anything, because it could be alleged that we were doing an abortion,’” said Dr. Tony Ogburn, an OB-GYN in San Antonio.

At 10:40 a.m, Crain’s blood pressure was dropping. Minutes later, Totorica was paging for an emergency team over the loudspeakers.

Around 11 a.m., two hours after Crain had arrived at the hospital, a second ultrasound was performed. A nurse noted: “Bedside ultrasound at this time to confirm fetal demise per Dr. Totorica’s orders.”

When doctors wheeled Crain into the ICU at 11:20 a.m., Fails stayed by her side, rubbing her head, as her daughter dipped in and out of consciousness. Crain couldn’t sign consent forms for her care because of “extreme pain,” according to the records, so Fails signed a release for “unplanned dilation and curettage” or “unplanned cesarean section.”

But the doctors quickly decided it was now too risky to operate, according to records. They suspected that she had developed a dangerous complication of sepsis known as disseminated intravascular coagulation; she was bleeding internally.

Frantic and crying, Fails locked eyes with her daughter. “You’re strong, Nevaeh,” she said. “God made us strong.”

Crain sat up in the cot. Old, black blood gushed from her nostrils and mouth.

Crain is one of at least two pregnant Texas women who died after doctors delayed treating miscarriages, ProPublica found.

Texas Attorney General Ken Paxton has successfully made his state the only one in the country that isn’t required to follow the Biden administration’s efforts to ensure that emergency departments don’t turn away patients like Crain.

After the U.S. Supreme Court overturned the constitutional right to abortion, the administration issued guidance on how states with bans should follow the Emergency Medical Treatment and Labor Act. The federal law requires hospitals that receive funding through Medicare — which is virtually all of them — to stabilize or transfer anyone who arrives in their emergency rooms. That goes for pregnant patients, the guidance argues, even if that means violating state law and providing an abortion.

Paxton responded by filing a lawsuit in 2022, saying the federal guidance “forces hospitals and doctors to commit crimes,” and was an “attempt to use federal law to transform every emergency room in the country into a walk-in abortion clinic.”

Part of the battle has centered on who is eligible for abortion. The federal EMTALA guidelines apply when the health of the pregnant patient is in “serious jeopardy.” That’s a wider range of circumstances than the Texas abortion restriction, which only makes exceptions for a “risk of death” or “a serious risk of substantial impairment of a major bodily function.”

The lawsuit worked its way through three layers of federal courts, and each time it was met by judges nominated by former President Donald Trump, whose court appointments were pivotal to overturning Roe v. Wade.

After U.S. District Judge James Wesley Hendrix, a Trump appointee, quickly sided with Texas, Paxton celebrated the triumph over “left-wing bureaucrats in Washington.”

“The decision last night proves what we knew all along,” Paxton added. “The law is on our side.”

This year, the U.S. Court of Appeals for the 5th Circuit upheld the order in a ruling authored by Kurt D. Engelhardt, another judge nominated by Trump.

The Biden administration appealed to the U.S. Supreme Court, urging the justices to make it clear that some emergency abortions are allowed.

Even amid news of preventable deaths related to abortion bans, the Supreme Court declined to do so last month.

Paxton called this “a major victory” for the state’s abortion ban.

He has also made clear that he will bring charges against physicians for performing abortions if he decides that the cases don’t fall within Texas’ narrow medical exceptions.

Last year, he sent a letter threatening to prosecute a doctor who had received court approval to provide an emergency abortion for a Dallas woman. He insisted that the doctor and her patient had not proven how, precisely, the patient’s condition threatened her life.

Many doctors say this kind of message has encouraged doctors to “punt” patients instead of treating them.

Since the abortion bans went into effect, an OB-GYN at a major hospital in San Antonio has seen an uptick in pregnant patients being sent to them from across Southern Texas, as they suffer from complications that could easily be treated close to home.

The well-resourced hospital is perceived to have more institutional support to provide abortions and miscarriage management, the doctor said. Other providers “are transferring those patients to our centers because, frankly, they don’t want to deal with them.”

After Crain died, Fails couldn’t stop thinking about how Christus Southeast Hospital had ignored her daughter’s condition. “She was bleeding,” she said. “Why didn’t they do anything to help it along instead of wait for another ultrasound to confirm the baby is dead?”

It was the medical examiner, not the doctors at the hospital, who removed Lillian from Crain’s womb. His autopsy didn’t resolve Fails’ lingering questions about what the hospitals missed and why. He called the death “natural” and attributed it to “complications of pregnancy.” He did note, however, that Crain was “repeatedly seeking medical care for a progressive illness” just before she died.

Last November, Fails reached out to medical malpractice lawyers to see about getting justice through the courts. A different legal barrier now stood in her way.

If Crain had experienced these same delays as an inpatient, Fails would have needed to establish that the hospital violated medical standards. That, she believed, she could do. But because the delays and discharges occurred in an area of the hospital classified as an emergency room, lawyers said that Texas law set a much higher burden of proof: “willful and wanton negligence.”

No lawyer has agreed to take the case.

Mariam Elba contributed research. Cassandra Jaramillo contributed reporting. Andrea Suozzo contributed data reporting.

This content originally appeared on ProPublica and was authored by by Lizzie Presser and Kavitha Surana.

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Josseli Barnica grieved the news as she lay in a Houston hospital bed on Sept. 3, 2021: The sibling she’d dreamt of giving her daughter would not survive this pregnancy.

The fetus was on the verge of coming out, its head pressed against her dilated cervix; she was 17 weeks pregnant and a miscarriage was “in progress,” doctors noted in hospital records. At that point, they should have offered to speed up the delivery or empty her uterus to stave off a deadly infection, more than a dozen medical experts told ProPublica.

But when Barnica’s husband rushed to her side from his job on a construction site, she relayed what she said the medical team had told her: “They had to wait until there was no heartbeat,” he told ProPublica in Spanish. “It would be a crime to give her an abortion.”

For 40 hours, the anguished 28-year-old mother prayed for doctors to help her get home to her daughter; all the while, her uterus remained exposed to bacteria.

Three days after she delivered, Barnica died of an infection.

Barnica is one of at least two Texas women who ProPublica found lost their lives after doctors delayed treating miscarriages, which fall into a gray area under the state’s strict abortion laws that prohibit doctors from ending the heartbeat of a fetus.

Neither had wanted an abortion, but that didn’t matter. Though proponents insist that the laws protect both the life of the fetus and the person carrying it, in practice, doctors have hesitated to provide care under threat of prosecution, prison time and professional ruin.

ProPublica is telling these women’s stories this week, starting with Barnica’s. Her death was “preventable,” according to more than a dozen medical experts who reviewed a summary of her hospital and autopsy records at ProPublica’s request; they called her case “horrific,” “astounding” and “egregious.”

The doctors involved in Barnica’s care at HCA Houston Healthcare Northwest did not respond to multiple requests for comment on her case. In a statement, HCA Healthcare said “our responsibility is to be in compliance with applicable state and federal laws and regulations” and said that physicians exercise their independent judgment. The company did not respond to a detailed list of questions about Barnica’s care.

Like all states, Texas has a committee of maternal health experts who review such deaths to recommend ways to prevent them, but the committee’s reports on individual cases are not public and members said they have not finished examining cases from 2021, the year Barnica died.

ProPublica is working to fill gaps in knowledge about the consequences of abortion bans. Reporters scoured death data, flagging Barnica’s case for its concerning cause of death: “sepsis” involving “products of conception.” We tracked down her family, obtained autopsy and hospital records and enlisted a range of experts to review a summary of her care that ProPublica created in consultation with two doctors.

Among those experts were more than a dozen OB-GYNs and maternal-fetal medicine specialists from across the country, including researchers at prestigious institutions, doctors who regularly handle miscarriages and experts who have served on state maternal mortality review committees or held posts at national professional medical organizations.

After reviewing the four-page summary, which included the timeline of care noted in hospital records, all agreed that requiring Barnica to wait to deliver until after there was no detectable fetal heartbeat violated professional medical standards because it could allow time for an aggressive infection to take hold. They said there was a good chance she would have survived if she was offered an intervention earlier.

“If this was Massachusetts or Ohio, she would have had that delivery within a couple hours,” said Dr. Susan Mann, a national patient safety expert in obstetric care who teaches at Harvard University.

Many noted a striking similarity to the case of Savita Halappavanar, a 31-year-old woman who died of septic shock in 2012 after providers in Ireland refused to empty her uterus while she was miscarrying at 17 weeks. When she begged for care, a midwife told her, “This is a Catholic country.” The resulting investigation and public outcry galvanized the country to change its strict ban on abortion.

But in the wake of deaths related to abortion access in the United States, leaders who support restricting the right have not called for any reforms.

Last month, ProPublica told the stories of two Georgia women, Amber Thurman and Candi Miller, whose deaths were deemed “preventable” by the state’s maternal mortality review committee after they were unable to access legal abortions and timely medical care amid an abortion ban.

Georgia Gov. Brian Kemp called the reporting “fear mongering.” Former President Donald Trump has not weighed in — except to joke that his Fox News town hall on women’s issues would get “better ratings” than a press call where Thurman’s family spoke about their pain.

Leaders in Texas, which has the nation’s oldest abortion ban, have witnessed the consequences of such restrictions longer than those in any other state.

In lawsuits, court petitions and news stories, dozens of women have said they faced dangers when they were denied abortions starting in 2021. One suffered sepsis like Barnica, but survived after three days in intensive care. She lost part of her fallopian tube. Lawmakers have made small concessions to clarify two exceptions for medical emergencies, but even in those cases, doctors risk up to 99 years in prison and fines of $100,000; they can argue in court that their actions were not a crime, much like defendants can claim self-defense after being charged with murder.

Amid the deluge of evidence of the harm, including research suggesting Texas’ legislation has increased infant and maternal deaths, some of the ban’s most prominent supporters have muted their public enthusiasm for it. U.S. Sen. Ted Cruz, who once championed the fall of Roe v. Wade and said, “Pregnancy is not a life-threatening illness,” is now avoiding the topic amid a battle to keep his seat. And Gov. Greg Abbott, who said early last year that “we promised we would protect the life of every child with a heartbeat, and we did,” has not made similar statements since.

Both declined to comment to ProPublica, as did state Attorney General Ken Paxton, whose commitment to the ban remains steadfast as he fights for access to the out-of-state medical records of women who travel for abortions. Earlier this month, as the nation grappled with the first reported, preventable deaths related to abortion access, Paxton celebrated a decision by the U.S. Supreme Court that allowed Texas to ignore federal guidance requiring doctors to provide abortions that are needed to stabilize emergency patients.

“This is a major victory,” Paxton said.

To Barnica, an immigrant from Honduras, the American dream seemed within reach in her corner of Houston, a neighborhood filled with restaurants selling El Salvadoran pupusas and bakeries specializing in Mexican conchas. She found work installing drywall, saved money to support her mother back home and met her husband in 2019 at a community soccer game.

A year later, they welcomed a big-eyed baby girl whose every milestone they celebrated. “God bless my family,” Barnica wrote on social media, alongside a photo of the trio in matching red-and-black plaid. “Our first Christmas with our Princess. I love them.”

Barnica longed for a large family and was thrilled when she conceived again in 2021.

Trouble struck in the second trimester.

On Sept. 2, 2021, at 17 weeks and four days pregnant, she went to the hospital with cramps, according to her records. The next day, when the bleeding worsened, she returned. Within two hours of her arrival on Sept. 3, an ultrasound confirmed “bulging membranes in the vagina with the fetal head in the open cervix,” dilated at 8.9 cm, and that she had low amniotic fluid. The miscarriage was “in progress,” the radiologist wrote.

When Barnica’s husband arrived, she told him doctors couldn’t intervene until there was no heartbeat.

The next day, Dr. Shirley Lima, an OB on duty, diagnosed an “inevitable” miscarriage.

In Barnica’s chart, she noted that the fetal heartbeat was detected and wrote that she was providing Barnica with pain medication and “emotional support.”

In a state that hadn’t banned abortion, Barnica could have immediately been offered the options that major medical organizations, including international ones, say is the standard of evidence-based care: speeding up labor with medication or a dilation and evacuation procedure to empty the uterus.

“We know that the sooner you intervene in these situations, the better outcomes are,” said Dr. Steven Porter, an OB-GYN in Cleveland.

But Texas’ new abortion ban had just gone into effect. It required physicians to confirm the absence of a fetal heartbeat before intervening unless there was a “medical emergency,” which the law did not define. It required doctors to make written notes on the patient’s condition and the reason abortion was necessary.

The law did not account for the possibility of a future emergency, one that could develop in hours or days without intervention, doctors told ProPublica.

Barnica was technically still stable. But lying in the hospital with her cervix open wider than a baseball left her uterus exposed to bacteria and placed her at high risk of developing sepsis, experts told ProPublica. Infections can move fast and be hard to control once they take hold.

The scenario felt all too familiar for Dr. Leilah Zahedi-Spung, a maternal-fetal medicine specialist who used to work in Tennessee and reviewed a summary of Barnica’s records at ProPublica’s request.

Abortion bans put doctors in an impossible position, she said, forcing them to decide whether to risk malpractice or a felony charge. After her state enacted one of the strictest bans in the country, she also waited to offer interventions in cases like Barnica’s until the fetal heartbeat stopped or patients showed signs of infection, praying every time that nothing would go wrong. It’s why she ultimately moved to Colorado.

The doctors treating Barnica “absolutely didn’t do the right thing,” she said. But she understood why they would have felt “totally stuck,” especially if they worked at a hospital that hadn’t promised to defend them.

Even three years after Barnica’s death, HCA Healthcare, the hospital chain that treated Barnica, will not disclose whether it has a policy on how to treat miscarriages.

Some HCA shareholders have asked the company to prepare a report on the risks to the company related to the bans in states that restrict abortion, so patients would understand what services they could expect and doctors would know under what circumstances they would be protected. But the board of directors opposed the proposal, partly because it would create an “unnecessary expense and burdens with limited benefits to our stockholders.” The proposal was supported by 8% of shareholders who voted.

The company’s decision to abstain has repercussions far beyond Texas; the nation’s largest for-profit hospital chain has said it delivers more babies than any other health care provider in America, and 70% of its hospitals are in states where abortion is restricted.

As the hours passed in the Houston hospital, Barnica couldn’t find relief. On the phone with her aunt Rosa Elda Calix Barnica, she complained that doctors kept performing ultrasounds to check the fetal heartbeat but were not helping her end the miscarriage.

Around 4 a.m. on Sept. 5, 40 hours after Barnica had arrived, doctors could no longer detect any heart activity. Soon after, Lima delivered Barnica’s fetus, giving her medication to help speed up the labor.

Dr. Joel Ross, the OB-GYN who oversaw her care, discharged her after about eight more hours.

The bleeding continued, but when Barnica called the hospital, she was told that was expected. Her aunt grew alarmed two days later when the bleeding grew heavier.

Go back, she told her niece.

On the evening of Sept. 7, Barnica’s husband rushed her to the hospital as soon as he got off from work. But COVID-19 protocols meant only one visitor could be in the room with her, and they didn’t have a babysitter for their 1-year-old daughter.

So he left and tried to get some sleep.

“I fully expected her to come home,” he said.

But she never did. Her family planned two funerals, one in Houston and another in Honduras.

Nine days after her death, Barnica’s husband was processing his shock, learning how to be a single dad and struggling to raise funds to bury his wife and the son he had hoped to raise.

Meanwhile, Lima was pulling up Barnica’s medical chart to make an addition to her records.

The notes she added made one point abundantly clear: “When I was called for delivery,” she wrote, “the fetus no longer had detectable heart tones.”

Texas has been on the forefront of fighting abortion access.

At the time of Barnica’s miscarriage in 2021, the Supreme Court had not yet overturned the constitutional right to terminate a pregnancy. But Texas lawmakers, intent on being the first to enact a ban with teeth, had already passed a harsh civil law using a novel legal strategy that circumvented Roe v. Wade: It prohibited doctors from performing an abortion after six weeks by giving members of the public incentives to sue doctors for $10,000 judgments. The bounty also applied to anyone who “aided and abetted” an abortion.

A year later, after the Dobbs v. Jackson ruling was handed down, an even stricter criminal law went into effect, threatening doctors with up to 99 years in prison and $100,000 in fines.

Soon after the ruling, the Biden administration issued federal guidance reminding doctors in hospital emergency rooms they have a duty to treat pregnant patients who need to be stabilized, including by providing abortions for miscarriages.

Texas Attorney General Ken Paxton fought against that, arguing that following the guidance would force doctors to “commit crimes” under state law and make every hospital a “walk-in abortion clinic.” When a Dallas woman asked a court for approval to end her pregnancy because her fetus was not viable and she faced health risks if she carried it to term, Paxton fought to keep her pregnant. He argued her doctor hadn’t proved it was an emergency and threatened to prosecute anyone who helped her. “Nothing can restore the unborn child’s life that will be lost as a result,” he wrote to the court.

No doctor in Texas, or the 20 other states that criminalize abortion, has been prosecuted for violating a state ban. But the possibility looms over their every decision, dozens of doctors in those states told ProPublica, forcing them to consider their own legal risks as they navigate their patient’s health emergencies. The lack of clarity has resulted in many patients being denied care.

In 2023, Texas lawmakers made a small concession to the outcry over the uncertainty the ban was creating in hospitals. They created a new exception for ectopic pregnancies, a potentially fatal condition where the embryo attaches outside the uterine cavity, and for cases where a patient’s membranes rupture prematurely before viability, which introduces a high risk of infection. Doctors can still face prosecution, but are allowed to make the case to a judge or jury that their actions were protected, not unlike self-defense arguments after homicides. Barnica’s condition would not have clearly fit this exception.

This year, after being directed to do so by the state Supreme Court, the Texas Medical Board released new guidance telling doctors that an emergency didn’t need to be “imminent” in order to intervene and advising them to provide extra documentation regarding risks.

But in a recent interview, the board’s president, Dr. Sherif Zaafran, acknowledged that these efforts only go so far and the group has no power over criminal law: “There’s nothing we can do to stop a prosecutor from filing charges against the physicians.”

Asked what he would tell Texas patients who are miscarrying and unable to get treatment, he said they should get a second opinion: “They should vote with their feet and go and seek guidance from somebody else.”

An immigrant from El Salvador who works 12-hour shifts, Barnica’s husband doesn’t follow American politics or the news. He had no inkling of the contentious national debate over how abortion bans are affecting maternal health care when ProPublica contacted him.

Now he is raising a 4-year-old daughter with the help of Barnica’s younger brother; every weekend, they take her to see her grandmother, who knows how to braid her hair in pigtails.

All around their home, he keeps photos of Barnica so that the little girl grows up knowing how much her mother loved her. He sees flashes of his wife when his daughter dances. She radiates the same delight.

When asked about Barnica, he can’t get out many words; his leg is restless, his eyes fixed on the floor. Barnica’s family calls him a model father.

He says he’s just doing his best.

Mariam Elba and Doris Burke contributed research. Lizzie Presser contributed reporting.

This content originally appeared on ProPublica and was authored by by Cassandra Jaramillo and Kavitha Surana.

More than a dozen ProPublica journalists are working across the country to cover reproductive health in the wake of abortion bans. We hope to hear from medical providers, families and policymakers. We asked Deputy Managing Editor Alexandra Zayas to explain our reporting process and the ethics that guide it.

It’s clear by now that state abortion bans are having a seismic impact on health care. They are, as intended, preventing doctors from terminating pregnancies. But they are also introducing a dangerous new dynamic for anyone who happens to conceive.

If you have a story to share or expertise to volunteer, you can get in touch with the whole team, including editors, by:

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Doctors have told us they’ve seen their colleagues hesitate to treat deadly conditions like preeclampsia and cancer, worried their attempts to protect their pregnant patients could be interpreted as a crime against the fetus, punishable by prison time.

Defenders of abortion bans insist that those doctors are being misled or confused, and that so-called “life-of-the-mother” exceptions are clear. But even a Republican lawmaker who voted for his state’s ban, a doctor himself, told ProPublica he thinks the language is too vague.

Indeed, the death of Amber Thurman raises critical questions about the role abortion bans are playing in the decisions of doctors in emergency situations. Suffering from a grave infection, the 28-year-old medical assistant and single mother needed a procedure that had been criminalized in Georgia, with few exceptions. As her condition deteriorated in a suburban Atlanta hospital, doctors discussed performing it, but they did not do so until 20 hours after she had arrived; by then, it was too late. A state committee of maternal health experts, including 10 doctors, deemed her death preventable and blamed a delay in care.

The more cases like these we examine, the more we can do to expose the cracks through which women are falling.

ProPublica has a long, successful track record of exploring the causes of maternal harm. Seven years ago, we dedicated a significant portion of our staff to investigating why so many women in the United States were dying from causes related to pregnancy and childbirth. We dug past academic research and hospital data to explore individual, preventable deaths. What specific, fixable flaws in the system had cost us Lauren Bloomstein, and Shalon Irving, and Dacheca Fleurimond? What had left their babies motherless?

Each loss was a tragedy. But when the people closest to those mothers shared what they knew, they also unearthed lessons for how to save the next life, illuminating the causes and consequences of maternal mortality in a way nothing else had.ProPublica’s reporting on the “Lost Mothers” had a tremendous impact, including a landmark new law funding the study of maternal deaths and how to prevent them.

Our reporting so far suggests state abortion bans are having unintended, lethal consequences. If there are more cases out there, only the people closest to the families know the most critical details. This is why we’ve again devoted a significant portion of our newsroom to examining preventable maternal deaths — and it’s why we need your help to unearth them, so that those with the power to change systems can learn from them.

If you happen to be aware of a case in which you suspect abortion-related laws played a role, we understand why you may be hesitant to tell us about it. This is why we want to tell you more about our reporting process and the ethics that guide it.

We are a nonprofit, independent newsroom and have no partisan agenda in exposing these deaths. While we are bringing necessary scrutiny to the Republican state governments that passed these bans, we are also questioning what more the Biden administration can do to assess and mitigate their consequences.

Ahead of a heated election in which abortion is on the ballot in 10 states — and on the lips of presidential candidates — we want voters to know everything they can about the impact state bans are having on the safety of anyone who can conceive.

Only because of the courage of ProPublica’s anonymous sources does the public know the extent of the horror of child separation at the U.S.-Mexico border, and the intertwined interests of billionaire donors and Supreme Court justices, and the preventable nature of the abortion-related deaths we exposed in Georgia.

We have secure ways to speak to us and send us documents. We honor agreements to not name sources in our stories. We do not rely on any single source for reporting; we independently and carefully confirm and corroborate evidence.

We can help families get medical records and then consult with experts about them. We take our findings and go to hospitals, clinics and doctors and press them for answers. We work hard to check every fact and to keep families updated on our progress.

We want to know not just about the last moments of a person’s life, but the entirety of it, to help the public understand the magnitude of the loss and how to avoid another. We can travel and meet with families face-to-face, at the time, place and pace that feels most comfortable to them. We recognize the loss of control families already feel and work hard to not add to that.

When reporter Kavitha Surana first began talking with Thurman’s family members, their grief was raw and intense, and they did not feel ready to grapple with their loss. It took a year before they were finally ready to discuss her death.

“Hopefully her death won’t be in vain,” her sister Cjuana Williams told ProPublica.

Recognizing that every one of these cases involves a unique set of very complex factors, we seek out independent experts to help us interpret and convey all of the details. We never rely on one source, and we subject our final stories to a rigorous editing process by journalists with decades of experience reporting on health care systems.

If you have a story to share or expertise to volunteer, you can get in touch with the whole team, including editors, at reproductivehealth@propublica.org. You can also leave us a voicemail at 917-512-0242.

If your tip is sensitive, consider sending us a secure message on Signal at 917-512-0242.

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Women in Georgia can once again legally obtain abortions after six weeks of pregnancy, following a judge’s strongly worded order this week tossing the state’s ban. While Gov. Brian Kemp spoke out against the decision and Georgia’s attorney general quickly appealed it, providers told ProPublica they have immediately resumed offering such care.

Planned Parenthood’s four clinics in Georgia are fielding an influx of calls from within the state and those around it where most abortions remain banned, said Jaylen Black, vice president of marketing and communications for the organization’s Southeast region. Workers are also calling patients they have previously had to turn away. “We’ve been able to get them rescheduled,” Black said.

The new, if temporary, access is the latest in a wave of developments in the two weeks since ProPublica told the stories of Amber Nicole Thurman and Candi Miller, Georgia women who died after they couldn’t access legal abortions and timely medical care in their state. A committee of maternal health experts, including 10 doctors, deemed their deaths “preventable,” shifting the discussion about such outcomes from hypothetical to a new American reality.

“This isn’t something that the state will easily be able to sweep under the rug,” said Monica Simpson, executive director of SisterSong, one of the plaintiffs in the lawsuit challenging the ban. “It is now a national issue.”

Watch video ➜

The women’s stories reverberated through the U.S. Senate, the vice presidential debate and a demonstration outside the Georgia Capitol. Vice President Kamala Harris spoke to one of their families alongside Oprah Winfrey, then traveled to Atlanta to give a speech about them. “Now we know that at least two women — and those are only the stories we know — here in the state of Georgia died — died because of a Trump abortion ban,” she told the crowd. Before launching into the details of the first, she led the crowd in a chant to “speak her name: Amber Nicole Thurman, Amber Nicole Thurman, Amber Nicole Thurman.”

Thurman died on Aug. 19, 2022, one month after Georgia’s law went into effect banning abortion before many women know they’re even pregnant. Thurman had traveled to North Carolina, where she obtained abortion medication, and had not fully expelled the fetal tissue.

She sought care for the rare complication at a suburban Atlanta hospital, where she was diagnosed with sepsis, a life-threatening infection. As her condition deteriorated, doctors discussed a procedure to empty the uterus called a dilation and curettage, or D&C; the state had recently attached criminal penalties to performing it, with few exceptions. It took 20 hours after Thurman’s arrival for doctors to do so, according to records reviewed by ProPublica. It came too late.

Miller, who died Nov. 12, 2022, had lupus, diabetes and hypertension, and doctors warned another pregnancy could kill her. She ordered abortion pills online, but she also did not expel all the fetal tissue and needed a D&C. Her family later told a coroner she hadn’t visited a doctor “due to the current legislation on pregnancies and abortions.” Her children watched her suffer in bed for days, moaning in pain. She ultimately took a lethal combination of painkillers.

Georgia’s maternal mortality review committee, tasked with studying deaths of pregnant women and new mothers to recommend improvements in care, directly blamed the state’s abortion ban for Miller’s death, according to members who spoke to ProPublica on the condition of anonymity. The committee found that the hospital’s delay in performing the critical procedure on Thurman had a “large” impact on her “preventable” outcome. The hospital and doctors involved in her care have not explained the delay or commented on her case; an attorney hired by Thurman’s family said the hospital was within its legal rights to perform the procedure.

While defenders of the ban have said it includes an exception to save the life of the mother, doctors have told ProPublica that the language doesn’t account for the fast-moving realities of emergency medicine or the complexities of maternal health.

Though Miller’s underlying conditions would have made her pregnancy riskier as it progressed, that alone did not qualify her for an abortion. And once she and Thurman needed a D&C to clear the fetal tissue, neither of their cases appeared to clearly fit the language of the ban’s exception allowing doctors to perform it.

It allows doctors to remove “a dead unborn child” that resulted from a “spontaneous abortion” defined as “naturally occurring” from a miscarriage or a stillbirth. Thurman had told doctors her miscarriage was not spontaneous but the result of abortion pills. Most bans including Georgia’s also allow abortions “necessary in order to prevent the death of the pregnant woman or the substantial and irreversible physical impairment of a major bodily function.” There is no standard protocol for how providers should interpret such language, doctors have told ProPublica — or how far gone a patient needs to be to qualify.

Forty-one senators introduced a resolution inspired by ProPublica’s reporting that calls on hospitals in all states to provide emergency abortion care when their patients need it. Sen. Ron Wyden, an Oregan Democrat who chairs the powerful Senate Finance Committee, has a pending request for information from the hospital that treated Thurman to determine whether doctors violated a federal law that requires them to provide emergency care. (The hospital has not responded to ProPublica’s requests seeking comment on those questions about its adherence to the law.)

And in Georgia on Monday, Fulton County Superior Judge Robert C. I. McBurney struck down key parts of the state’s ban criminalizing nearly all abortions after about six weeks.

“It is not for a legislator, a judge, or a Commander from ‘The Handmaid’s Tale’ to tell these women what to do with their bodies during this period when the fetus cannot survive outside the womb,” McBurney’s ruling states.

“The Court finds that, until the pregnancy is viable, a woman’s right to make decisions about her body and her health remains private and protected, i.e., remains her business and her business alone. When someone other than the pregnant woman is able to sustain the fetus, then — and only then — should those other voices have a say in the discussion about the decisions the pregnant woman makes concerning her body and what is growing within it.”

In reversing the six-week ban, McBurney reverted to the state’s previous standard, which allowed abortion up until a fetus was deemed viable, at about the 22nd week of pregnancy.

Kemp, a Republican who said he was “overjoyed” when the ban first went into effect, said this week through a spokesperson: “Once again, the will of Georgians and their representatives has been overruled by the personal beliefs of one judge.”

The ruling marks the second time McBurney has blocked the state abortion ban.

In 2022, he issued a ruling that the law was unconstitutional when the state legislature passed it in 2019, frozen in the books until after the U.S. Supreme Court struck down the federal constitutional right to abortion three years later. The state appealed, and its Supreme Court reinstated the ban until it could review McBurney’s ruling.

About a year later, with the ban still in place, the state Supreme Court rejected the argument, sending the case back to McBurney to consider the lawsuit’s underlying question: Whether the Georgia Constitution protects the right to privacy and, if so, if that right includes abortion. McBurney’s ruling Monday emphatically says it does.

While McBurney allowed abortions to resume in Georgia, the Supreme Court could, once again, stay the judge’s ruling until it takes up the case.

The last time it did so, the window of abortion access in Georgia lasted eight days.

The urgency and impermanence of this moment in Georgia was palpable in conversations with providers. “I think this type of moment definitely feels like a demand to provide a lot of care to as many people as possible,” said Kristen Baker, public affairs manager and lobbyist for the Feminist Women’s Health Center, which operates a clinic in Georgia.

Black said that Planned Parenthood staff is doing all it can — “for the time being” — to meet the demand and “getting people in our doors as soon as possible.”

Kavitha Surana contributed reporting. Mariam Elba and Cassandra Jaramillo contributed research.

This content originally appeared on ProPublica and was authored by by Ziva Branstetter.

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published.

The Georgia hospital that failed to save Amber Thurman may have broken a federal law when doctors there waited 20 hours to perform a procedure criminalized by the state’s abortion ban, according to Sen. Ron Wyden, chair of the Senate Finance Committee.

The Emergency Medical Treatment and Labor Act, or EMTALA, requires hospitals to provide emergency care to stabilize patients who need it — or transfer them to a hospital that can. Passed nearly four decades ago, the law applies to any hospital with an emergency department and that accepts Medicare funding, which includes the one Thurman went to, Piedmont Henry in suburban Atlanta. The finance committee has authority over the regulatory agency that enforces the law.

In a letter sent Monday, Wyden, an Oregon Democrat, cites ProPublica’s investigation into Thurman’s death, which was found preventable by a state committee of maternal health experts. The senator’s letter asks Piedmont CEO David Kent whether the hospital has delayed or denied emergency care to pregnant patients since Georgia’s abortion ban went into effect. (Kent did not respond to requests for comment.)

“It is my duty to conduct oversight of potential violations of patients’ rights under these laws,” Wyden wrote. The senator asked for the hospital’s policies covering treatment of patients with emergencies that require abortion care. He also asked for a list of personnel involved in making those decisions. He gave the hospital a deadline of Oct. 24 to provide those and other requested records and answers.

Wyden sent the same letter citing ProPublica’s reporting on Thurman to seven hospitals in North Carolina, Florida, Missouri, Louisiana and Texas. One letter seeks information from a Texas hospital where Yeniifer Alvarez-Estrada Glick died in 2022 from complications of pregnancy including hypertension, as reported by The New Yorker. Other letters seek information from hospitals where women have reportedly been turned away or experienced delayed care.

The hospitals’ answers could lead to proposed legislation or executive actions to strengthen compliance. The federal Centers for Medicare and Medicaid Services investigates complaints and can take actions including levying fines against hospitals that violate EMTALA.

Wyden’s committee plans to hold a hearing on Tuesday, saying in a news release it will “examine how Donald Trump’s successful overturn of Roe v. Wade and subsequent state abortion bans have threatened access to life-saving medical care for women nationwide.”

Piedmont did not respond to multiple requests seeking comment about Wyden’s letter or whether it is aware of an investigation into an EMTALA violation. Doctors who handled Thurman’s care have previously declined to explain their thinking and did not respond to questions from ProPublica.

A spokesperson for the U.S. Department of Health and Human Services, which oversees the regulatory agency that enforces the law, said in an email: “No woman or her family should have to worry that she could be denied life-saving treatment. While we can’t comment on complaints or investigations, we are committed to ensuring that every woman gets the care she needs.”

But some hospitals in abortion-ban states continue to deny or delay emergency care to pregnant women.

A recent Associated Press review of federal investigations found that more than 100 pregnant women in medical distress who sought help from emergency rooms were turned away or treated negligently since 2022, when the Supreme Court overturned Roe v. Wade. Last year, a federal investigation found that hospitals in Missouri and Kansas involved in the care of a patient, Mylissa Farmer, violated the law.

Vice President Kamala Harris has singled out Thurman’s case as evidence that a national law is needed to restore the right to abortion. Harris’ office didn’t respond to ProPublica’s questions about what federal actions she might pursue as president apart from signing a law, which would have to be passed by a divided Congress.

Former President Donald Trump has bragged about appointing three Supreme Court justices who voted to overturn Roe. Project 2025, the controversial playbook and policy agenda for a right-wing presidential administration, calls for doing away with Biden administration guidance that EMTALA requires hospitals to provide abortion care in emergency situations, even in states that ban it, or transfer the patients to a hospital that can provide the needed care.

Trump’s campaign pointed to previous statements by the former president that Project 2025 does not represent his plans for a second term. Leavitt said the former president “has always supported exceptions for rape, incest and the life of the mother, which Georgia’s law provides. With those exceptions in place, it’s unclear why doctors did not swiftly act to protect Amber Thurman’s life.”

Georgia Gov. Brian Kemp, too, has said his state’s six-week ban has clear exceptions to protect the “life of the mother.” In a statement, he blamed “partisan activists and so-called journalists” for spreading “misinformation and propaganda that fostered a culture of fear and confusion.”

But doctors have warned for years that these laws use language not rooted in science and begged for clearer exceptions. The confusion is apparent: In the wake of the bans, some hospitals have refused to even issue written policies informing doctors when and how to provide emergency abortions.

Legal reproductive rights scholars told ProPublica they believe Thurman’s treatment is a clear violation of EMTALA.

“It’s not even a question,” said Sara Rosenbaum, a George Washington University health law and policy professor and former adviser to President Bill Clinton. She helped develop EMTALA while at the Children’s Defense Fund. “I think the hospital, like all hospitals in these situations, is caught between violating EMTALA and state prosecution,” she said.

Thurman was rushed to the hospital on Aug. 18, 2022, in need of immediate care. Days earlier, she had taken abortion medication to end her pregnancy but was facing a rare complication: Some of the tissue remained inside her body, causing a grave infection.

To clear the infected tissue, she needed a dilation and curettage, or D&C, a procedure used to empty the uterus for both abortions and routine miscarriage care. Medically speaking, Thurman’s pregnancy had already ended. But the state’s abortion ban had criminalized performing a D&C and threatened doctors with up to 10 years in prison if prosecutors decided they violated it.

Records obtained by ProPublica show doctors discussed the procedure at least twice as Thurman’s condition deteriorated over 20 hours. Experts on the state maternal mortality review committee agreed there was a “good chance” Thurman would have survived if the D&C was provided sooner.

After the Supreme Court overturned the constitutional right to abortion, the federal government reminded hospitals and doctors they had to follow EMTALA and provide abortion procedures to patients if necessary in emergency situations, regardless of abortion bans. Some Republican officials have aggressively pushed back and said hospitals do not need to follow EMTALA, even for high-risk situations.

In Texas, Attorney General Ken Paxton threatened to prosecute a doctor for providing an emergency abortion to a woman with a high-risk pregnancy, whose fetus had a fatal anomaly and whose pregnancy threatened her health and future ability to have children.

He argued in court that she did not meet the state ban’s criteria. He also filed a lawsuit arguing the federal government cannot force Texas to follow the guidance on providing emergency abortions to patients.

In an opinion written by a Trump-appointed judge, a federal appeals panel agreed. That means enforcement of EMTALA in emergency abortion cases is barred in that state.

The Supreme Court last summer considered a lawsuit brought by the Biden administration challenging Idaho’s abortion ban, which lacks health exceptions and appears to conflict with EMTALA. A lawyer for the state acknowledged that Idaho’s abortion ban was written to prevent doctors from offering abortions even if the woman could suffer a serious medical complication like losing an organ.

Conservative justices in that case raised arguments about the rights of the fetus. The court issued a ruling that meant the case would be returned to a lower court, which upheld EMTALA while the case continues.

Rosenbaum said the federal government is not doing enough to require hospitals to follow EMTALA in states that banned abortion: “The federal government has no resources. It was only recently that the Biden administration has made it clear how to file complaints. The complaints go uninvestigated or poorly investigated.”

Wyden’s letters sum up the perilous landscape for patients and doctors.

“Across the country, there are reports that women are being turned away by emergency departments when they seek emergency reproductive health care, even in instances where medical professionals determine that, without such care, the patient is at risk of serious complications, infection, or even death. These women are caught between dangerous state laws that are in clear conflict with — and preempted by — EMTALA.”

On Tuesday, Thurman’s sister, Cjauna Williams, visited Thurman’s grave near Atlanta. She arrived to find fresh flowers and birthday balloons left there by people she and her family had never met. Thurman would have turned 31 the day before, and the story of her desperate wait for the medical care she needed had reverberated across the country.

“Hopefully her death won’t be in vain and something good can come of it,” Williams said.

Kavitha Surana and Nydia Blas contributed reporting. Cassandra Jaramillo, Mariam Elba, Jeff Ernsthausen and Kirsten Berg contributed research.

This content originally appeared on ProPublica and was authored by by Ziva Branstetter.

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published.

Candi Miller’s health was so fragile, doctors warned having another baby could kill her.

“They said it was going to be more painful and her body may not be able to withstand it,” her sister, Turiya Tomlin-Randall, told ProPublica.

But when the mother of three realized she had unintentionally gotten pregnant in the fall of 2022, Georgia’s new abortion ban gave her no choice. Although it made exceptions for acute, life-threatening emergencies, it didn’t account for chronic conditions, even those known to present lethal risks later in pregnancy.

Why should I trust your reporting? I (Kavitha Surana) am a reporter that has been covering reproductive health care access since Roe v. Wade was overturned. I’ve spoken with doctors, community workers and patients across the country about how abortion bans have made pregnancy more dangerous in America, and I’ve written about the Republican lawmakers who refused to listen.

If you want to get in touch and learn more about how I work, email me. I take your privacy very seriously.

At 41, Miller had lupus, diabetes and hypertension and didn’t want to wait until the situation became dire. So she avoided doctors and navigated an abortion on her own — a path many health experts feared would increase risks when women in America lost the constitutional right to obtain legal, medically supervised abortions.

Miller ordered abortion pills online, but she did not expel all the fetal tissue and would need a dilation and curettage procedure to clear it from her uterus and stave off sepsis, a grave and painful infection. In many states, this care, known as a D&C, is routine for both abortions and miscarriages. In Georgia, performing it had recently been made a felony, with few exceptions.

Her teenage son watched her suffer for days after she took the pills, bedridden and moaning. In the early hours of Nov. 12, 2022, her husband found her unresponsive in bed, her 3-year-old daughter at her side.

An autopsy found unexpelled fetal tissue, confirming that the abortion had not fully completed. It also found a lethal combination of painkillers, including the dangerous opioid fentanyl. Miller had no history of drug use, the medical records state; her family has no idea how she obtained them or what was going through her mind — whether she was trying to quell the pain, complete the abortion or end her life. A medical examiner was unable to determine the manner of death.

Her family later told a coroner she hadn’t visited a doctor “due to the current legislation on pregnancies and abortions.”

When a state committee of experts in maternal health, including 10 doctors, reviewed her case this year at the end of August, they immediately decided it was “preventable” and blamed the state’s abortion ban, according to members who spoke to ProPublica on the condition of anonymity.

They came to that conclusion after weighing the entire chain of events, from Miller’s underlying health conditions, to her decision to manage her abortion alone, to her reticence to seek medical care. “The fact that she felt that she had to make these decisions, that she didn’t have adequate choices here in Georgia, we felt that definitely influenced her case,” one committee member told ProPublica. “She’s absolutely responding to this legislation.”

This is the second preventable death related to abortion bans that ProPublica is reporting this week. Amber Thurman, 28, languished in a suburban Atlanta hospital for 20 hours before doctors performed a D&C to treat sepsis that resulted from an incomplete abortion. It was too late. “This young mother should be alive, raising her son and pursuing her dream of attending nursing school,” Vice President Kamala Harris said of Thurman on Tuesday. “This is exactly what we feared when Roe was struck down.”

There are almost certainly other deaths related to abortion access. Georgia’s committee, tasked with examining pregnancy-related deaths to improve maternal health, has only reviewed cases through fall 2022. Such a lag is common in these committees, which are set up in each state; most others have not even gotten that far.

The details of their reviews are not shared with the public, but ProPublica obtained the Georgia committee’s summary report of Miller’s death. ProPublica also reviewed death records and Miller’s autopsy and spoke to her family.

Her case adds to mounting evidence that exceptions to abortion bans do not, as billed, protect the “life of the mother.” Harrowing stories about denied care have been at the center of the upcoming presidential election, during which the right to abortion is on the ballot in 10 states. ProPublica’s new reporting makes clear, for the first time, that in the wake of bans, women are losing their lives in ways that experts have deemed preventable.

It also underscores the reality that abortion bans have not actually led to a decrease in abortions. But for people like Miller, they have increased the degree of difficulty and risk.

Miller grew up in Alabama and spent most of her adulthood in Atlanta, where she made a living braiding hair and doing nails. She had a soft spot for stray cats, nurtured a garden and was known to break into dance at the sound of old school funk like the Commodores. At 4 foot 9, she was a “firecracker,” her family said — quick to stand up for those she loved. That included her three kids, who range in age from 5 to 16.

But about eight years ago, she was diagnosed with lupus, an autoimmune disease in which the body attacks healthy tissue, her sister said. Symptoms include extreme fatigue; painful, swollen joints; heart complications; and kidney disease.

Miller experienced flare-ups of debilitating pain for which she had to seek radiation treatments. She often wasn’t able to stand for long periods and her hair fell out. It distressed her how often doctors dismissed her pain; she grew to doubt they could give her help when she needed it.

Soon after she was diagnosed, she suffered a major depressive episode, Tomlin-Randall said. For months, she barely left her bed. Tomlin-Randall cared for her sister’s children during that time.

There is no cure for lupus, but patients can manage symptoms with a mixture of drugs and therapies; 90% of those afflicted are women, and the condition is three times more common in Black women than white.

Miller also had diabetes and hypertension. Those conditions, layered on top of her lupus, can be dangerously exacerbated by pregnancy and are highly unpredictable, during both the pregnancy and the aftermath, according to the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine. Patients with those conditions are also more likely to have a pregnancy that ends in miscarriage or premature birth and are more likely to need a cesarean section, a major surgery that is especially hard for patients with diabetes to recover from.

With support, some patients can remain stable and have healthy pregnancies, though the experience can be physically taxing and painful. In the worst cases, pregnancy with lupus can lead to high blood pressure that can quickly progress to seizures, kidney and liver dysfunction and, ultimately, death. Studies have found the maternal death rate for women with lupus is 20-fold higher than for those without lupus. The chance of relapses and flare-ups are also high in the postpartum period.

Each patient’s situation is different and needs careful evaluation of their particular health risks, including discussion of the option to end the pregnancy, said Dr. Sarah Horvath, an OB-GYN representing ACOG.

Politicians who support abortion bans often point to their exceptions, which they say protect “the life of the mother.” During last week’s debate, former President Donald Trump called them “very important.”

But the anti-abortion groups that drafted the bans wrote the exceptions to be as narrow as possible and persuaded lawmakers to impose steep criminal penalties, fearing doctors might stretch definitions to create loopholes.

The exceptions are limited to acute emergencies, usually defined as when “necessary in order to prevent the death of the pregnant woman or the substantial and irreversible physical impairment of a major bodily function.” They also specifically prohibit mental health reasons from counting as health emergencies, even if a pregnant woman says she is thinking about harming herself. In Georgia, violating the law can cost doctors their license and subject them to prison terms of up to 10 years.

The laws typically don’t include any leeway for intervening earlier to treat patients with broader health risks that could make pregnancy more dangerous, such as lupus.

ProPublica surveyed dozens of doctors in nine states with abortion bans. None of their hospitals approve abortions for women with high-risk complications like lupus or diabetes unless the patient is already deteriorating and the issue is urgent.

Horvath regularly sees patients with complications from those conditions in Pennsylvania because they can’t get care in their own state. Often, the delay in figuring out where to go means their pregnancy is further along — and, as a result, their conditions have become more dangerous. They show up to outpatient clinics already displaying signs of trouble, Horvath said, and immediately have to be sent to the hospital where there’s an operating room and a blood bank.

It often takes time for patients and their providers to coordinate care in other states because there is so much confusion about the laws.

“People who are really suffering in these pregnancies really don’t know where to go,” Horvath said. “Or if they even can.”

Miller’s third pregnancy was difficult and she never fully recovered, Tomlin-Randall said.

When Miller learned she was pregnant again in 2022, she ordered abortion pills for about $80 from a website called AidAccess, according to her 16-year-old son, Christian Cardenas.

The organization, based in the Netherlands, is devoted to expanding abortion access to places where it is not legal. Patients contact a doctor in Europe who sends them pills from a supplier in India. According to one researcher, Aid Access serves about 7,000 patients a month in the U.S., nearly 90% of them in states with abortion bans or severe restrictions. Its founder, Dr. Rebecca Gomperts, said it was clear the abortion pill did not cause her death.

The committee also did not believe Miller’s death was caused by the abortion medication. Her autopsy found extremely high doses of diphenhydramine (the main ingredient in Benadryl) and acetaminophen (what’s found in Tylenol) in Miller’s system, along with the fentanyl. Considering the quantity of drugs and the timing of her death, the committee also did not suspect the abortion pills themselves were in any way tainted.

Self-managing abortions at home has skyrocketed since the Supreme Court overturned the constitutional right to abortion, because of access to pills that can be ordered online, researchers say.

Major studies, the Food and Drug Administration and the World Health Organization have found abortion pills to be more than 90% effective when taken correctly and in the first trimester. Deaths due to abortion pills are exceedingly rare. Complications can develop if some fetal tissue remains in the uterus, where it can lead to sepsis, a grave infection. Patients are supposed to follow up with a doctor to make sure the abortion has fully completed and go to the hospital if bleeding heavily or exhibiting other symptoms.

Miller’s family does not know how far along her pregnancy was when she took the abortion pills.

But soon enough, she was in excruciating pain.

And that’s how she remained, for days, until she took the potent drug mixture. Her family doesn’t know what she was thinking when she did it, but can’t fathom that she would want to end her life; she was excited about the future and drawing closer to her church, her sister Tomlin-Randall said.

“She was trying to terminate the pregnancy, not terminate herself,” she said.

It was significant to the state maternal mortality review committee that Miller did not feel she could seek medical care.

Although Georgia courts have said women can’t be prosecuted for getting abortions, the state has sent mixed messages. While some state bans explicitly say women can’t be prosecuted, Georgia’s ban leaves open that possibility. In 2019, a district attorney on the outskirts of metro Atlanta called abortion “murder” and said women “should prepare for the chance that they could be criminally prosecuted for having an abortion.”

That was the understanding in Miller’s family.

“If you get caught trying to do anything to get rid of the baby,” her son Christian told ProPublica, “you get jail time for that.”

Cassandra Jaramillo contributed reporting. Mariam Elba, Jeff Ernsthausen and Kirsten Berg contributed research.

This content originally appeared on ProPublica and was authored by by Kavitha Surana.

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published.

Candi Miller’s health was so fragile, doctors warned having another baby could kill her.

“They said it was going to be more painful and her body may not be able to withstand it,” her sister, Turiya Tomlin-Randall, told ProPublica.

But when the mother of three realized she had unintentionally gotten pregnant in the fall of 2022, Georgia’s new abortion ban gave her no choice. Although it made exceptions for acute, life-threatening emergencies, it didn’t account for chronic conditions, even those known to present lethal risks later in pregnancy.

Why should I trust your reporting? I (Kavitha Surana) am a reporter that has been covering reproductive health care access since Roe v. Wade was overturned. I’ve spoken with doctors, community workers and patients across the country about how abortion bans have made pregnancy more dangerous in America, and I’ve written about the Republican lawmakers who refused to listen.

If you want to get in touch and learn more about how I work, email me. I take your privacy very seriously.

At 41, Miller had lupus, diabetes and hypertension and didn’t want to wait until the situation became dire. So she avoided doctors and navigated an abortion on her own — a path many health experts feared would increase risks when women in America lost the constitutional right to obtain legal, medically supervised abortions.

Miller ordered abortion pills online, but she did not expel all the fetal tissue and would need a dilation and curettage procedure to clear it from her uterus and stave off sepsis, a grave and painful infection. In many states, this care, known as a D&C, is routine for both abortions and miscarriages. In Georgia, performing it had recently been made a felony, with few exceptions.

Her teenage son watched her suffer for days after she took the pills, bedridden and moaning. In the early hours of Nov. 12, 2022, her husband found her unresponsive in bed, her 3-year-old daughter at her side.

An autopsy found unexpelled fetal tissue, confirming that the abortion had not fully completed. It also found a lethal combination of painkillers, including the dangerous opioid fentanyl. Miller had no history of drug use, the medical records state; her family has no idea how she obtained them or what was going through her mind — whether she was trying to quell the pain, complete the abortion or end her life. A medical examiner was unable to determine the manner of death.

Her family later told a coroner she hadn’t visited a doctor “due to the current legislation on pregnancies and abortions.”

When a state committee of experts in maternal health, including 10 doctors, reviewed her case this year at the end of August, they immediately decided it was “preventable” and blamed the state’s abortion ban, according to members who spoke to ProPublica on the condition of anonymity.

They came to that conclusion after weighing the entire chain of events, from Miller’s underlying health conditions, to her decision to manage her abortion alone, to her reticence to seek medical care. “The fact that she felt that she had to make these decisions, that she didn’t have adequate choices here in Georgia, we felt that definitely influenced her case,” one committee member told ProPublica. “She’s absolutely responding to this legislation.”

This is the second preventable death related to abortion bans that ProPublica is reporting this week. Amber Thurman, 28, languished in a suburban Atlanta hospital for 20 hours before doctors performed a D&C to treat sepsis that resulted from an incomplete abortion. It was too late. “This young mother should be alive, raising her son and pursuing her dream of attending nursing school,” Vice President Kamala Harris said of Thurman on Tuesday. “This is exactly what we feared when Roe was struck down.”

There are almost certainly other deaths related to abortion access. Georgia’s committee, tasked with examining pregnancy-related deaths to improve maternal health, has only reviewed cases through fall 2022. Such a lag is common in these committees, which are set up in each state; most others have not even gotten that far.

The details of their reviews are not shared with the public, but ProPublica obtained the Georgia committee’s summary report of Miller’s death. ProPublica also reviewed death records and Miller’s autopsy and spoke to her family.

Her case adds to mounting evidence that exceptions to abortion bans do not, as billed, protect the “life of the mother.” Harrowing stories about denied care have been at the center of the upcoming presidential election, during which the right to abortion is on the ballot in 10 states. ProPublica’s new reporting makes clear, for the first time, that in the wake of bans, women are losing their lives in ways that experts have deemed preventable.

It also underscores the reality that abortion bans have not actually led to a decrease in abortions. But for people like Miller, they have increased the degree of difficulty and risk.

Miller grew up in Alabama and spent most of her adulthood in Atlanta, where she made a living braiding hair and doing nails. She had a soft spot for stray cats, nurtured a garden and was known to break into dance at the sound of old school funk like the Commodores. At 4 foot 9, she was a “firecracker,” her family said — quick to stand up for those she loved. That included her three kids, who range in age from 5 to 16.

But about eight years ago, she was diagnosed with lupus, an autoimmune disease in which the body attacks healthy tissue, her sister said. Symptoms include extreme fatigue; painful, swollen joints; heart complications; and kidney disease.

Miller experienced flare-ups of debilitating pain for which she had to seek radiation treatments. She often wasn’t able to stand for long periods and her hair fell out. It distressed her how often doctors dismissed her pain; she grew to doubt they could give her help when she needed it.

Soon after she was diagnosed, she suffered a major depressive episode, Tomlin-Randall said. For months, she barely left her bed. Tomlin-Randall cared for her sister’s children during that time.

There is no cure for lupus, but patients can manage symptoms with a mixture of drugs and therapies; 90% of those afflicted are women, and the condition is three times more common in Black women than white.

Miller also had diabetes and hypertension. Those conditions, layered on top of her lupus, can be dangerously exacerbated by pregnancy and are highly unpredictable, during both the pregnancy and the aftermath, according to the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine. Patients with those conditions are also more likely to have a pregnancy that ends in miscarriage or premature birth and are more likely to need a cesarean section, a major surgery that is especially hard for patients with diabetes to recover from.

With support, some patients can remain stable and have healthy pregnancies, though the experience can be physically taxing and painful. In the worst cases, pregnancy with lupus can lead to high blood pressure that can quickly progress to seizures, kidney and liver dysfunction and, ultimately, death. Studies have found the maternal death rate for women with lupus is 20-fold higher than for those without lupus. The chance of relapses and flare-ups are also high in the postpartum period.

Each patient’s situation is different and needs careful evaluation of their particular health risks, including discussion of the option to end the pregnancy, said Dr. Sarah Horvath, an OB-GYN representing ACOG.

Politicians who support abortion bans often point to their exceptions, which they say protect “the life of the mother.” During last week’s debate, former President Donald Trump called them “very important.”

But the anti-abortion groups that drafted the bans wrote the exceptions to be as narrow as possible and persuaded lawmakers to impose steep criminal penalties, fearing doctors might stretch definitions to create loopholes.

The exceptions are limited to acute emergencies, usually defined as when “necessary in order to prevent the death of the pregnant woman or the substantial and irreversible physical impairment of a major bodily function.” They also specifically prohibit mental health reasons from counting as health emergencies, even if a pregnant woman says she is thinking about harming herself. In Georgia, violating the law can cost doctors their license and subject them to prison terms of up to 10 years.

The laws typically don’t include any leeway for intervening earlier to treat patients with broader health risks that could make pregnancy more dangerous, such as lupus.

ProPublica surveyed dozens of doctors in nine states with abortion bans. None of their hospitals approve abortions for women with high-risk complications like lupus or diabetes unless the patient is already deteriorating and the issue is urgent.

Horvath regularly sees patients with complications from those conditions in Pennsylvania because they can’t get care in their own state. Often, the delay in figuring out where to go means their pregnancy is further along — and, as a result, their conditions have become more dangerous. They show up to outpatient clinics already displaying signs of trouble, Horvath said, and immediately have to be sent to the hospital where there’s an operating room and a blood bank.

It often takes time for patients and their providers to coordinate care in other states because there is so much confusion about the laws.

“People who are really suffering in these pregnancies really don’t know where to go,” Horvath said. “Or if they even can.”

Miller’s third pregnancy was difficult and she never fully recovered, Tomlin-Randall said.

When Miller learned she was pregnant again in 2022, she ordered abortion pills for about $80 from a website called AidAccess, according to her 16-year-old son, Christian Cardenas.

The organization, based in the Netherlands, is devoted to expanding abortion access to places where it is not legal. Patients contact a doctor in Europe who sends them pills from a supplier in India. According to one researcher, Aid Access serves about 7,000 patients a month in the U.S., nearly 90% of them in states with abortion bans or severe restrictions. Its founder, Dr. Rebecca Gomperts, said it was clear the abortion pill did not cause her death.

The committee also did not believe Miller’s death was caused by the abortion medication. Her autopsy found extremely high doses of diphenhydramine (the main ingredient in Benadryl) and acetaminophen (what’s found in Tylenol) in Miller’s system, along with the fentanyl. Considering the quantity of drugs and the timing of her death, the committee also did not suspect the abortion pills themselves were in any way tainted.

Self-managing abortions at home has skyrocketed since the Supreme Court overturned the constitutional right to abortion, because of access to pills that can be ordered online, researchers say.

Major studies, the Food and Drug Administration and the World Health Organization have found abortion pills to be more than 90% effective when taken correctly and in the first trimester. Deaths due to abortion pills are exceedingly rare. Complications can develop if some fetal tissue remains in the uterus, where it can lead to sepsis, a grave infection. Patients are supposed to follow up with a doctor to make sure the abortion has fully completed and go to the hospital if bleeding heavily or exhibiting other symptoms.

Miller’s family does not know how far along her pregnancy was when she took the abortion pills.

But soon enough, she was in excruciating pain.

And that’s how she remained, for days, until she took the potent drug mixture. Her family doesn’t know what she was thinking when she did it, but can’t fathom that she would want to end her life; she was excited about the future and drawing closer to her church, her sister Tomlin-Randall said.

“She was trying to terminate the pregnancy, not terminate herself,” she said.

It was significant to the state maternal mortality review committee that Miller did not feel she could seek medical care.

Although Georgia courts have said women can’t be prosecuted for getting abortions, the state has sent mixed messages. While some state bans explicitly say women can’t be prosecuted, Georgia’s ban leaves open that possibility. In 2019, a district attorney on the outskirts of metro Atlanta called abortion “murder” and said women “should prepare for the chance that they could be criminally prosecuted for having an abortion.”

That was the understanding in Miller’s family.

“If you get caught trying to do anything to get rid of the baby,” her son Christian told ProPublica, “you get jail time for that.”

Cassandra Jaramillo contributed reporting. Mariam Elba, Jeff Ernsthausen and Kirsten Berg contributed research.

This content originally appeared on ProPublica and was authored by by Kavitha Surana.

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published.

When the Supreme Court overturned Roe v. Wade and the constitutional right to abortion in 2022, strict bans on the procedure kicked in across the country, leaving women in at least 22 states with fewer options to end pregnancies that in some cases endangered their lives.

ProPublica has uncovered at least two cases of women who died after their state banned abortion. In both cases, the women took pills to end their pregnancies and the abortion did not fully complete, causing complications, as can occur in a small number of cases involving abortion medication.

Their stories speak to the challenges women face when abortion is banned, not the safety of abortion pills when taken properly and with appropriate follow-up care.

We reviewed information from the U.S. Food and Drug Administration and from groups that closely track the latest medical advice and scientific evidence to answer the most frequently asked questions about abortion pills.

What some people call the “abortion pill” is actually a combination of two pills — mifepristone and misoprostol — commonly called “abortion medication.”

Mifepristone tablets are also sold under the brand name Mifeprex, which has been approved by the U.S. Food and Drug Administration since 2000 to be used along with misoprostol to end an intrauterine pregnancy through 10 weeks gestation. (That is measured as 70 days or less since the first day of a patient’s last menstrual period.)

Abortion pills are now used in more than 60% of all abortions in the U.S. health care system.

Mifepristone blocks a hormone called progesterone that is needed for a pregnancy to continue. The FDA-approved regimen is to take 200 milligrams of mifepristone on the first day. Patients are directed to take misoprostol within 24 to 48 hours of the mifepristone. The misoprostol works to expel fetal tissue from the uterus.

In some cases, patients take a regime of misoprostol only to end a pregnancy.

Patients are directed to follow up with a health care provider about seven to 14 days after taking mifepristone or earlier if any unusual symptoms are noted. (See below.)

Yes. The FDA first approved Mifeprex 25 years ago, so there’s an extensive record of safety involving this drug.

Out of nearly 6 million women who’ve taken mifepristone since then, only 32 deaths of women who used the drug to terminate pregnancies were reported to the FDA through the end of 2022, regardless of whether the drug played a role in the death.

Of those, 11 involved deaths of women who developed a deadly infection called sepsis. Most of the remaining cases involved intentional and accidental drug overdoses, suicide, homicide and ruptured ectopic pregnancies.

The American College of Obstetricians and Gynecologists has opposed laws and court rulings that limit or ban the availability of abortion pills. “Mifepristone has been used safely and effectively for medication abortion for more than two decades. That safety and efficacy is backed up by robust, evidence-based, clinical data and its observed use by millions of people with support from clinicians, including obstetricians-gynecologists,” the organization states on its website.

Abortion pills are not approved for use in some pregnancies. According to the FDA, people should not use abortion pills if they:

• Have an ectopic pregnancy (a pregnancy outside of the uterus).
• Have problems with the adrenal glands (the glands near the kidneys).
• Are being treated with long-term corticosteroid therapy (medications).
• Have had an allergic reaction to mifepristone, misoprostol or similar drugs.
• Have bleeding problems or are taking anticoagulant (blood-thinning) drug products.
• Have inherited porphyria (a rare disorder that can affect the liver and other organs).
• Have an intrauterine device in place. (It must be removed before taking mifepristone.)

Bleeding and cramping initially are expected. If you have abdominal pain or discomfort, or you are feeling sick — including weakness, nausea, vomiting or diarrhea, with or without fever — more than 24 hours after taking misoprostol, doctors say to contact your health care provider without delay. These symptoms may be a sign of a serious infection or another problem.

In the days after treatment, if you have a fever of 100.4°F or higher that lasts for more than four hours, doctors say you should contact your health care provider or visit the nearest emergency room right away. Fever may be a symptom of a serious infection or another problem.

Contact your health care provider right away if you bleed enough to soak through two thick full-size sanitary pads per hour for two consecutive hours or if you are concerned about heavy bleeding. If you can’t reach your health care provider, go to the emergency room to seek care.

Taken as directed, they are highly effective. In about 1 in 100 women, a procedure will be required to remove remaining tissue. That’s why it’s important to seek follow-up care for any of the symptoms described above.

Doctors say you should seek immediate medical attention if you experience any of the unusual symptoms described above. (This patient agreement form required by the FDA describes what to look for.)

While abortion medication is banned in 14 states, it is not a crime to seek medical attention because you took abortion pills. In fact, the federal government requires hospitals to treat urgent medical conditions like infection. Do not avoid seeking help from your doctor or at the emergency room if you have sustained bleeding, pain and/or fever. An infection of this kind is not likely to go away on its own and could be fatal.

Yes, in some states. In January 2023, the FDA lifted restrictions that prevented patients from obtaining medication abortion pills from a retail pharmacy and allowed them to be dispensed by mail, with certain requirements.

But patients can’t legally order abortion medication in 14 states that ban abortion: Alabama, Arkansas, Idaho, Indiana, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas and West Virginia. In 15 states, there are various restrictions that make it more difficult for patients to obtain abortion medication.

Some pharmacies and organizations that provide abortion medication through the mail are not approved by the FDA. Patients should exercise caution when ordering pills from unregulated pharmacies to determine whether the medication is authentic and safe.

This content originally appeared on ProPublica and was authored by by Ziva Branstetter.

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published.

In her final hours, Amber Nicole Thurman suffered from a grave infection that her suburban Atlanta hospital was well-equipped to treat.

She’d taken abortion pills and encountered a rare complication; she had not expelled all of the fetal tissue from her body. She showed up at Piedmont Henry Hospital in need of a routine procedure to clear it from her uterus, called a dilation and curettage, or D&C.

But just that summer, her state had made performing the procedure a felony, with few exceptions. Any doctor who violated the new Georgia law could be prosecuted and face up to a decade in prison.

Thurman waited in pain in a hospital bed, worried about what would happen to her 6-year-old son, as doctors monitored her infection spreading, her blood pressure sinking and her organs beginning to fail.

It took 20 hours for doctors to finally operate. By then, it was too late.

Why should I trust your reporting? I (Kavitha Surana) am a reporter that has been covering reproductive health care access since Roe v. Wade was overturned. I’ve spoken with doctors, community workers and patients across the country about how abortion bans have made pregnancy more dangerous in America, and I’ve written about the Republican lawmakers who refused to listen.

If you want to get in touch and learn more about how I work, email me. I take your privacy very seriously.

The otherwise healthy 28-year-old medical assistant, who had her sights set on nursing school, should not have died, an official state committee recently concluded.

Tasked with examining pregnancy-related deaths to improve maternal health, the experts, including 10 doctors, deemed hers “preventable” and said the hospital’s delay in performing the critical procedure had a “large” impact on her fatal outcome.

Their reviews of individual patient cases are not made public. But ProPublica obtained reports that confirm that at least two women have already died after they couldn’t access legal abortions and timely medical care in their state.

There are almost certainly others.

Committees like the one in Georgia, set up in each state, often operate with a two-year lag behind the cases they examine, meaning that experts are only now beginning to delve into deaths that took place after the Supreme Court overturned the federal right to abortion.

Thurman’s case marks the first time an abortion-related death, officially deemed “preventable,” is coming to public light. ProPublica will share the story of the second in the coming days. We are also exploring other deaths that have not yet been reviewed but appear to be connected to abortion bans.

Doctors warned state legislators women would die if medical procedures sometimes needed to save lives became illegal.

Though Republican lawmakers who voted for state bans on abortion say the laws have exceptions to protect the “life of the mother,” medical experts cautioned that the language is not rooted in science and ignores the fast-moving realities of medicine.

The most restrictive state laws, experts predicted, would pit doctors’ fears of prosecution against their patients’ health needs, requiring providers to make sure their patient was inarguably on the brink of death or facing “irreversible” harm when they intervened with procedures like a D&C.

“They would feel the need to wait for a higher blood pressure, wait for a higher fever — really got to justify this one — bleed a little bit more,” Dr. Melissa Kottke, an OB-GYN at Emory, warned lawmakers in 2019 during one of the hearings over Georgia’s ban.

Doctors and a nurse involved in Thurman’s care declined to explain their thinking and did not respond to questions from ProPublica. Communications staff from the hospital did not respond to multiple requests for comment. Georgia’s Department of Public Health, which oversees the state maternal mortality review committee, said it cannot comment on ProPublica’s reporting because the committee’s cases are confidential and protected by federal law.

The availability of D&Cs for both abortions and routine miscarriage care helped save lives after the 1973 Supreme Court ruling in Roe v. Wade, studies show, reducing the rate of maternal deaths for women of color by up to 40% the first year after abortion became legal.

But since abortion was banned or restricted in 22 states over the past two years, women in serious danger have been turned away from emergency rooms and told that they needed to be in more peril before doctors could help. Some have been forced to continue high-risk pregnancies that threatened their lives. Those whose pregnancies weren’t even viable have been told they could return when they were “crashing.”

Such stories have been at the center of the upcoming presidential election, during which the right to abortion is on the ballot in 10 states.

But Republican legislators have rejected small efforts to expand and clarify health exceptions — even in Georgia, which has one of the nation’s highest rates of maternal mortality and where Black women are three times more likely to die from pregnancy-related complications than white women.

When its law went into effect in July 2022, Gov. Brian Kemp said he was “overjoyed” and believed the state had found an approach that would keep women “safe, healthy and informed.”

After advocates tried to block the ban in court, arguing the law put women in danger, attorneys for the state of Georgia accused them of “hyperbolic fear mongering.”

Two weeks later, Thurman was dead.

Thurman, who carried the full load of a single parent, loved being a mother. Every chance she got, she took her son to petting zoos, to pop-up museums and on planned trips, like one to a Florida beach. “The talks I have with my son are everything,” she posted on social media.

But when she learned she was pregnant with twins in the summer of 2022, she quickly decided she needed to preserve her newfound stability, her best friend, Ricaria Baker, told ProPublica. Thurman and her son had recently moved out of her family’s home and into a gated apartment complex with a pool, and she was planning to enroll in nursing school.

The timing could not have been worse. On July 20, the day Georgia’s law banning abortion at six weeks went into effect, her pregnancy had just passed that mark, according to records her family shared with ProPublica.

Thurman wanted a surgical abortion close to home and held out hope as advocates tried to get the ban paused in court, Baker said. But as her pregnancy progressed to its ninth week, she couldn’t wait any longer. She scheduled a D&C in North Carolina, where abortion at that stage was still legal, and on Aug. 13 woke up at 4 a.m. to make the journey with her best friend.

On their drive, they hit standstill traffic, Baker said. The clinic couldn’t hold Thurman’s spot longer than 15 minutes — it was inundated with women from other states where bans had taken effect. Instead, a clinic employee offered Thurman a two-pill abortion regimen approved by the U.S. Food and Drug Administration, mifepristone and misoprostol. Her pregnancy was well within the standard of care for that treatment.

Getting to the clinic had required scheduling a day off from work, finding a babysitter, making up an excuse to borrow a relative’s car and walking through a crowd of anti-abortion protesters. Thurman didn’t want to reschedule, Baker said.

At the clinic, Thurman sat through a counseling session in which she was told how to safely take the pills and instructed to go to the emergency room if complications developed. She signed a release saying she understood. She took the first pill there and insisted on driving home before any symptoms started, Baker said. She took the second pill the next day, as directed.

Deaths due to complications from abortion pills are extremely rare. Out of nearly 6 million women who’ve taken mifepristone in the U.S. since 2000, 32 deaths were reported to the FDA through 2022, regardless of whether the drug played a role. Of those, 11 patients developed sepsis. Most of the remaining cases involved intentional and accidental drug overdoses, suicide, homicide and ruptured ectopic pregnancies.

Baker and Thurman spoke every day that week. At first, there was only cramping, which Thurman expected. But days after she took the second pill, the pain increased and blood was soaking through more than one pad per hour. If she had lived nearby, the clinic in North Carolina would have performed a D&C for free as soon as she followed up, the executive director told ProPublica. But Thurman was four hours away.

On the evening of Aug. 18, Thurman vomited blood and passed out at home, according to 911 call logs. Her boyfriend called for an ambulance. Thurman arrived at Piedmont Henry Hospital in Stockbridge at 6:51 p.m.

ProPublica obtained the summary narrative of Thurman’s hospital stay provided to the maternal mortality review committee, as well as the group’s findings. The narrative is based on Thurman’s medical records, with identifying information removed. The committee does not interview doctors involved with the case or ask hospitals to respond to its findings. ProPublica also consulted with medical experts, including members of the committee, about the timeline of events.

Within Thurman’s first hours at the hospital, which says it is staffed at all hours with an OB who specializes in hospital care, it should have been clear that she was in danger, medical experts told ProPublica.

Her lower abdomen was tender, according to the summary. Her white blood cell count was critically high and her blood pressure perilously low — at one point, as Thurman got up to go to the bathroom, she fainted again and hit her head. Doctors noted a foul odor during a pelvic exam, and an ultrasound showed possible tissue in her uterus.

The standard treatment of sepsis is to start antibiotics and immediately seek and remove the source of the infection. For a septic abortion, that would include removing any remaining tissue from the uterus. One of the hospital network’s own practices describes a D&C as a “fairly common, minor surgical procedure” to be used after a miscarriage to remove fetal tissue.

After assessing her at 9:38 p.m., doctors started Thurman on antibiotics and an IV drip, the summary said. The OB-GYN noted the possibility of doing a D&C the next day.

But that didn’t happen the following morning, even when an OB diagnosed “acute severe sepsis.” By 5:14 a.m., Thurman was breathing rapidly and at risk of bleeding out, according to her vital signs. Even five liters of IV fluid had not moved her blood pressure out of the danger zone. Doctors escalated the antibiotics.

Instead of performing the newly criminalized procedure, they continued to gather information and dispense medicine, the summary shows.

Doctors had Thurman tested for sexually transmitted diseases and pneumonia.

They placed her on Levophed, a powerful blood pressure support that could do nothing to treat the infection and posed a new threat: The medication can constrict blood flow so much that patients could need an amputation once stabilized.

At 6:45 a.m., Thurman’s blood pressure continued to dip, and she was taken to the intensive care unit.

At 7:14 a.m., doctors discussed initiating a D&C. But it still didn’t happen. Two hours later, lab work indicated her organs were failing, according to experts who read her vital signs.

At 12:05 p.m., more than 17 hours after Thurman had arrived, a doctor who specializes in intensive care notified the OB-GYN that her condition was deteriorating.

Thurman was finally taken to an operating room at 2 p.m.

By then, the situation was so dire that doctors started with open abdominal surgery. They found that her bowel needed to be removed, but it was too risky to operate because not enough blood was flowing to the area — a possible complication from the blood pressure medication, an expert explained to ProPublica. The OB performed the D&C but immediately continued with a hysterectomy.

During surgery, Thurman’s heart stopped.

Her mother was praying in the waiting room when one of the doctors approached. “Come walk with me,” she said.

Until she got the call from the hospital, her mother had no idea Thurman had been pregnant. She recalled her daughter’s last words before she was wheeled into surgery — they had made no sense coming from a vibrant young woman who seemed to have her whole life ahead of her:

“Promise me you’ll take care of my son.”

There is a “good chance” providing a D&C earlier could have prevented Amber Thurman’s death, the maternal mortality review committee concluded.

Every state has a committee of experts who meet regularly to examine deaths that occurred during or within a year after a pregnancy. Their goal is to collect accurate data and identify the root causes of America’s increasing maternal mortality rate, then translate those lessons into policy changes. Their findings and recommendations are sent to the Centers for Disease Control and Prevention, and their states publish an annual report, but their reviews of individual cases are never public.

Georgia’s committee has 32 regular members from a variety of backgrounds, including OB-GYNs, cardiologists, mental health care providers, a medical examiner, health policy experts, community advocates and others. This summer, the committee reviewed deaths through Fall 2022, but most states have not gotten that far.

After reviewing Thurman’s case, the committee highlighted Piedmont’s “lack of policies/procedures in place to evacuate uterus immediately” and recommended all hospitals implement policies “to treat a septic abortion on an ongoing basis.”

It is not clear from the records available why doctors waited to provide a D&C to Thurman, though the summary report shows they discussed the procedure at least twice in the hours before they finally did.

Piedmont did not have a policy to guide doctors on how to interpret the state abortion ban when Thurman arrived for care, according to two people with knowledge of internal conversations who were not authorized to speak publicly. In the months after she died, an internal task force of providers there created policies to educate staff on how to navigate the law, though they are not able to give legal advice, the sources said.

In interviews with more than three dozen OB-GYNs in states that outlawed abortion, ProPublica learned how difficult it is to interpret the vague and conflicting language in bans’ medical exceptions — especially, the doctors said, when their judgment could be called into question under the threat of prison time.

Take the language in Georgia’s supposed lifesaving exceptions.

It prohibits doctors from using any instrument “with the purpose of terminating a pregnancy.” While removing fetal tissue is not terminating a pregnancy, medically speaking, the law only specifies it’s not considered an abortion to remove “a dead unborn child” that resulted from a “spontaneous abortion” defined as “naturally occurring” from a miscarriage or a stillbirth.

Thurman had told doctors her miscarriage was not spontaneous — it was the result of taking pills to terminate her pregnancy.

There is also an exception, included in most bans, to allow abortions “necessary in order to prevent the death of the pregnant woman or the substantial and irreversible physical impairment of a major bodily function.” There is no standard protocol for how providers should interpret such language, doctors said. How can they be sure a jury with no medical experience would agree that intervening was “necessary”?

ProPublica asked the governor’s office on Friday to respond to cases of denied care, including the two abortion-related deaths, and whether its exceptions were adequate. Spokesperson Garrison Douglas said they were clear and gave doctors the power to act in medical emergencies. He returned to the state’s previous argument, describing ProPublica’s reporting as a “fear-mongering campaign.”

Republican officials across the country have largely rejected calls to provide guidance.

When legislators have tried, anti-abortion groups have blocked them.

In 2023, a group of Tennessee Republicans was unable to push through a small change to the state’s abortion ban, intended to give doctors greater leeway when intervening for patients facing health complications.

“No one wants to tell their spouse, child or loved one that their life is not important in a medical emergency as you watch them die when they could have been saved,” said Republican Rep. Esther Helton-Haynes, a nurse who sponsored the bill.

The state’s main anti-abortion lobbyist, Will Brewer, vigorously opposed the change. Some pregnancy complications “work themselves out,” he told a panel of lawmakers. Doctors should be required to “pause and wait this out and see how it goes.”

At some hospitals, doctors are doing just that. Doctors told ProPublica they have seen colleagues disregard the standard of care when their patients are at risk of infection and wait to see if a miscarriage completes naturally before offering a D&C.

Although no doctor has been prosecuted for violating abortion bans, the possibility looms over every case, they said, particularly outside of well-funded academic institutions that have lawyers promising criminal defense.

Doctors in public hospitals and those outside of major metro areas told ProPublica that they are often left scrambling to figure out on a case-by-case basis when they are allowed to provide D&Cs and other abortion procedures. Many fear they are taking on all of the risk alone and would not be backed up by their hospitals if a prosecutor charged them with a crime. At Catholic hospitals, they typically have to transfer patients elsewhere for care.

When they do try to provide care, it can be a challenge to find other medical staff to participate. A D&C requires an anesthesiologist, nurses, attending physicians and others. Doctors said peers have refused to participate because of their personal views or their fear of being exposed to criminal charges. Georgia law allows medical staff to refuse to participate in abortions.

Thurman’s family members may never learn the exact variables that went into doctors’ calculations. The hospital has not fulfilled their request for her full medical record. There was no autopsy.

For years, all Thurman’s family had was a death certificate that said she died of “septic shock” and “retained products of conception” — a rare description that had previously only appeared once in Georgia death records over the last 15 years, ProPublica found. The family learned Thurman’s case had been reviewed and deemed preventable from ProPublica’s reporting.

The sting of Thurman’s death remains extremely raw to her loved ones, who feel her absence most deeply as they watch her son grow taller and lose teeth and start school years without her.

They focus on surrounding him with love but know nothing can replace his mother.

On Monday, she would have turned 31.

ProPublica reporter Kavitha Surana reviewed death records and medical examiner and coroner reports to identify cases that may be related to abortion access. She first reached out to Amber Thurman’s family and friends a year ago. The family shared her personal documents and signed a release for ProPublica to access her medical information. The maternal mortality review committee reviewed Thurman’s case at the end of July 2024.

Do you have any information about how abortion bans have affected medical care? Reach out to ProPublica reporters covering reproductive health care including Kavitha Surana at kavitha.surana@propublica.org or Cassandra Jaramillo at cassandra.jaramillo@propublica.org.

Cassandra Jaramillo and Mariam Elba contributed research.

This content originally appeared on ProPublica and was authored by by Kavitha Surana.

An “unemployed man in his 50s” was arrested immediately after attacking the mother, her preschooler and a Chinese woman in the city of Suzhou, which is near Shanghai, Reuters reported.

The Chinese woman was the most critically injured in the knife attack, the report said, and had to be hospitalized. The Japanese mother and her child did not receive life-threatening injuries, the report said.

At a press briefing Tuesday, Chinese Foreign Ministry spokesperson Mao Ning called the attack “regrettable” but an “isolated incident.”

“Such isolated incidents could happen in any country in the world,” she said. “China will continue to take effective measures to protect the safety of all foreign nationals in China like protecting our own citizens.”

The attack was the latest in a string of knife attacks in China. 

Earlier this month, four American teachers were stabbed in a park in the northeastern city of Jilin. Last month, a knife attack at a hospital in Yunnan province left two people dead and 21 people injured.

The Japanese Embassy in Beijing warned Japanese nationals living in China to take precautions against stabbing incidents while in public places including schools and parks, the Associated Press reported.

Japanese schools in China had also requested extra security in the wake of Monday’s stabbings, Japanese media outlet NHK said.

This content originally appeared on Radio Free Asia and was authored by By RFA Staff.

“Since her biographical information has never been officially stated, the recall on the film is actually raising suspicions,” a resident of the northeastern province of North Hamgyong told RFA Korean on condition of anonymity for security reasons. 

Most North Koreans don’t know her name – Ko Yong Hui – or that she was born in Osaka, Japan, or that her father, Ko Gyon Taek, managed a military factory in the city prior to the end of World War II. 

The documentary, titled “Mother of Great Songun Korea,” leaves out all those facts, the sources said. In lieu of her name, the film referred to her as “respected mother” and showed many scenes of her at Kim Jong Il’s side during his official appearances. 

It was distributed internally to high-ranking officials, government agencies, and the military on VCD, or video compact disc, in 2011, the same year that Kim Jong Il died.

“Recently, judicial agencies such as the Provincial State Security Department and the Social Security Department have begun rounding up copies of propaganda materials,” the resident said.

“Instructions were given to retrieve and delete documentary films related to the general secretary’s biological mother,” he said, explaining that “Mother of Great Songun Korea” was on the undisclosed list of now-banned materials.

The recall was also confirmed by a resident of the northern province of Ryanggang, who told RFA in the now-banned documentary that “Ko Yong Hui, is touted as having ‘accumulated great achievements that brought about a bright future’” for North Korea.

Made in Japan

Ko was raised in Japan as part of the Korean minority in the country, and in 1962, the family moved to North Korea as part of a repatriation program. 

In the early 1970s, Ko appeared as a dancer in the Mansudae Art Troupe – a popular group of musicians known for propaganda performances that glorify the state and its leaders.

It is not known when she got together with Kim Jong Il, but she is believed to have met him in the early 1970s, and she bore him three children in the 1980s, including Kim Jong Un. Though most sources describe her as having been his mistress, some suggest she may have been his third wife. The government has never acknowledged any marriage between them, however.

According to North Korea’s songbun caste system, Ko would be of the lowest caste because she was born in Japan, her father’s job supported the Japanese war effort, and her occupation as a dancer – which would tarnish Kim Jong Un’s image.

Ko’s background does not neatly fit the nation’s founding myth that its leaders are descended from the so-called Paektu Line, named after the Korean peninsula’s tallest mountain, which is the setting of many of the Korean nation’s founding myths, including the lore of the Kim Dynasty.

Kim’s grandfather, national founder Kim Il Sung is the progenitor of the line, and his first wife Kim Jong Suk – Kim Jong Il’s mother – fought alongside her husband in his guerilla army against Japanese rule prior to and during World War II, giving Kim Jong Il near mythical status as the legitimate son of two popular national heroes.

“In the past, previous leaders inherited power based on the purity of the Paektu bloodline and the legitimacy of revolutionary traditions,” the North Hamgyong resident said. 

“Details about the birth and lives of the leaders as well as their siblings, parents, grandparents and great-grandparents, were made public and promoted as patriotic examples.”

Erasing sensitive information?

In contrast, Kim Jong Un, due to his mother’s background, could be seen not as a third-generation revolutionary leader, but the illegitimate son of Kim Jong Il’s Japan-born mistress whose father supported the imperialist war effort.

If it becomes widely known, that support of imperial Japan could cause problems for Kim Jong Un, Bruce Bennett, a senior researcher at the California-based RAND Corporation, told RFA.

"Kim is trying to wipe out anything that would potentially challenge his control of the country,” said Bennett. “So the issue of his maternal grandfather having supported the Japanese I mean that's something that could really hurt him potentially. 

“And so that's part of the history he wants to get rid of,” he said.

Bennett said erasing facts about his mother might marginally help his case to stay in power, but it would be more helpful were he to improve the economy and his people’s lives.

The lack of available information about Ko is causing residents to question what they have been told about their leader, Kim Jong Un, the Ryanggang resident said.

“As the biography of the leader has not been made public even after him having been in power for 12 years, some are raising doubts about the identity of his mysterious birth mother,” he said. “The argument is that if there is no dishonorable family history in the pure Paektu bloodline, there is no reason not to disclose details about her.”

Kim Jong Il was able to claim that his hereditary succession was legitimate because of the purity of his lineage to the Paektu bloodline, the second resident said. 

Kim Jong Un claims the same lineage, but the secrecy appears to be giving people doubts.

“Given the actions of the authorities, who are ordering the recall and destruction of copies of the already released documentary film about his mother, people are questioning whether his is a half-lineage,” the second resident said.

Translated by Claire S. Lee and Leejin J. Chung. Edited by Eugene Whong and Malcolm Foster.

This content originally appeared on Radio Free Asia and was authored by By Kim Jieun for RFA Korean.

The activists are facing charges that they insulted Cambodia’s king and plotted to overthrow the government.

As they had for a previous hearing, they wore white clothes to protest what they call an unfair Cambodian justice system, and also burned incense in front of the court and later meditated under a heavy rain.

They are among 10 activists charged in a case that covers several instances of activism, including the 2021 filming of sewage draining into the Tonle Sap river in front of Phnom Penh’s Royal Palace. Seven of the 10 activists were a part of Mother Nature.

One of the defendants, Ly Chandaravuth, told reporters outside the court that members of the public should be able to attend and monitor the trial.

“Don’t claim you are independent,” he said of the court. “Don’t claim you are independent if you won’t have a public trial.”

Court officials announced earlier on Tuesday that journalists would need to pre-register with authorities if they wanted to go inside the courtroom. 

Limiting access to the courtroom is part of Deputy Prosecutor Seng Heang’s effort to rush the case toward a verdict, Ly Chandaravuth said.

Ly Chandaravuth and the other four activists who refused to attend Wednesday’s hearing are out on bail in the case. 

The other five defendants in the case are either in hiding or live outside of the country and are being tried in absentia, including the group’s Khmer-speaking founder, Spanish environmentalist Alejandro Gonzalez-Davidson, who was deported from Cambodia in 2015.

Police officer’s testimony

The five activists outside the court building on Wednesday appeared to be trying to disrupt the proceedings with their absence and their behavior, Seng Heang said.

Inside the courtroom, judicial police officer Chin Vannak testified that Gonzalez-Davidson and the Mother Nature movement have used the issue of protecting Cambodia’s forestland as a pretext for inciting people to overthrow the government.

Defendants’ lawyer Sam Chamroeun said the allegations made by the judicial police officer didn’t contain any specific evidence that Mother Nature wanted to overthrow the government.

Yi Soksan, who monitored the hearing for human rights group Adhoc, said a judicial police report was presented as evidence but also didn’t have a specific basis for indicting Mother Nature activists. 

The judicial police officers also didn’t present any concrete evidence in response to questions from defense lawyers, he said.

Presiding Judge Ouk Reth Kunthea scheduled the next hearing for June 11.

Translated by Yun Samean. Edited by Matt Reed and Malcolm Foster.

This content originally appeared on Radio Free Asia and was authored by By RFA Khmer.

The activists are among eight from Mother Nature facing charges in a case that covers several instances of activism by the group, including the 2021 filming of sewage draining into the Tonle Sap river in front of Phnom Penh’s Royal Palace. 

Two of the activists – Thon Ratha and Yim Leang Hy – shaved their heads to convey their devotion to social work and carried lotus flowers to show they don’t carry any hatred or desire for revenge. 

“Mother Nature’s work is to protect the environment. We don’t gather people to topple the government or to hate anyone,” Yim Leang Hy told the court. “Hatred is not on Mother Nature’s agenda.” 

Registered with Cambodian authorities in 2013, Mother Nature has worked over the years to protect the country’s environment, exposing irregularities in development and construction projects and helping villagers organize to protect their land.

The group’s Khmer-speaking founder, Spanish environmentalist Alejandro Gonzalez-Davidson, was deported from Cambodia in 2015 after the government refused to renew his visa. Opposition groups and local NGOs said he was expelled to prevent him from organizing against a planned hydropower dam in southwestern Koh Kong province.

Gonzalez-Davidson is one of the eight facing charges in the current case. He hasn’t been allowed to return to Cambodia since 2015 and wasn’t present in the courtroom on Wednesday.

Bracing for bad news

Mother Nature suspended operations in Cambodia in 2021 amid another round of charges against the activists, which were widely thought to be politically motivated. Wednesday’s hearing was related to those charges. 

The other three activists in court were Long Kunthea, Phuon Keo Raksmey and Ly Chandaravuth, who returned to Cambodia last week after a month-long trip to the United States.

“We know Cambodia’s court system and the verdict might not be good for me,” he said in a video blog published by Radio Free Asia on Tuesday. “I’ve prepared myself to confront what will happen.”

More than a dozen evicted villagers, youth activists and monks came to the court to raise banners that read, “We support Mother Nature” and “Environmental protection is not illegal.”

A university student in Phnom Penh, Ream Srey Pich Ratana, said she came to show her support for the activists because she felt that the court’s charges were contrary to the group’s actual efforts to protect the environment.

RFA couldn’t immediately reach Justice Ministry spokesman Chin Malin for comment.

The hearing was also attended by European Union diplomats to Cambodia and representatives from the United Nations and several NGOs. 

Presiding Judge Ouk Reth Kunthea scheduled the next hearing in the case for June 5. 

Translated by Yun Samean. Edited by Matt Reed and Malcolm Foster.

This content originally appeared on Radio Free Asia and was authored by By RFA Khmer.

Photograph Source: Mайкл Гиммельфарб (Mike Gimelfarb) – Public Domain

The so-called “mother of parliaments” in London is currently in over-drive generating a plethora of responses to widespread dysfunction, ranging from side-splitting guffaws to a weary cynicism to tears and a deep sadness (depending on who you are).

The context for these responses is the total collapse of the Conservative Party as potential winner of the forthcoming general election. Beset by factional infighting, the Tories have for months been around a consistent 20 points behind the opposition Labour Party in the opinion polls.

Every move by the Tory government seems to emerge from a crisis while precipitating another crisis in turn. It is no exaggeration to say that the Tories are a government in name only.

One parliamentary farce centered on the vote for a motion calling for a ceasefire in the Israel-Gaza conflict. The motion was proposed by the Scottish National Party (SNP), with the clear aim of making even more prominent the split between Labour’s pro-Zionist leader Keir Starmer (who had refused steadfastly to call for a ceasefire) and Labour MPs and town and city councilors in areas with significant Muslim electorates overwhelmingly in favor of a ceasefire.

In Walsall, 8 councilors who resigned from Labour over the issue in November are threatening to up their own candidate against Labour at the general election.

Eleven Labour councillors in Burnley resigned from the party in November, 10 resigned in Oxford, and 8 quit in Blackburn. This month two Labour councilors resigned in Kirklees, Yorkshire, and there has been a steady stream of others.

Starmer, a technocratic opportunist with no visible political convictions while entirely reliant on focus groups for his declared (pro tem) positions–  “misspoke” initially when he said Israel had the right to turn off water and electricity for Gazans after the October 7 Hamas attack, and took his time before shifting his position to a call for meaningless “humanitarian pauses” in Israel’s relentless slaughter.

The SNP ceasefire motion created an obvious problem for Starmer, now faced with splits at every level of his party.

Parliamentary procedure decreed that the original motion would be debated, as well as a Tory government motion designed to water down the SNP motion by calling for a “humanitarian pause”.

Starmer, to save his skin, then tabled a Labour motion identical to the SNP motion, which the Speaker Lindsay Hoyle (who is a Labour MP), chose for debate in addition to the other motions, in a clear breach of parliamentary procedure, which required only the SNP motion and the government amendment to be put up for debate. When Hoyle announced his decision chaos ensued as SNP and Tory MPs walked out of the chamber. Hoyle said he allowed Labour’s motion in order to protect MPs (presumably Labour?) from threats to their safety over the vote. Despite his two apologies Hoyle’s breach of parliamentary convention prompted 63 SNP and Tory MPs to sign a motion of no confidence in the Speaker.

The Speaker survived because a sufficient number of MPs gave Hoyle the benefit of the doubt over the question of the threat to MPs— the Labour MP Jo Cox was murdered by a rightwinger in 2016 and the Tory MP David Amess in 2021 by an Islamist.

The SNP announced that it would try to reintroduce the ceasefire motion this week, this time including a call for arms sales to Israel to be frozen. It will be interesting to see how the Speaker and Starmer respond.

Starmer’s troubles extend beyond the chamber of the House of Commons. Also this week is a by-election in Rochdale—with a population that is 30% Muslim– in the north-west of England following the death of its Labour MP Tony Lloyd.

Labour chose a Lancashire county councilor, Azhar Ali, as its candidate. The rightwing tabloid Daily Mail then released a recording in which Ali suggested at a meeting that Israel allowed the October 7 attacks to go ahead, so that it could retaliate by attacking Gaza “in self-defense”. Ali apologized for his comments, but following the disclosure of other similar comments made by Ali, Labour withdrew its support for him, and ceased to campaign on his behalf. Ali can still stand in the election, but will sit as an independent if elected.

Two former Labour MPS are also standing in this election. George Galloway, a strong supporter of the Palestinian people and critic of Starmer, is standing for the Workers Party of Britain. Simon Danczuk was selected as the candidate for the rightwing Reform UK. Danczuk was the Labour MP for Rochdale in 2010-2015, but was suspended from the party after it emerged he had been sexting with a 17-year-old girl. Danczuk said he is standing as an “old Labour” candidate, and would focus on local issues, rather than on what he describes as Starmer’s “woke” politics, or the conflict in Gaza. Starmer would be the loser no matter who got elected.

Meanwhile, the Tories faced a mess of their own.

The Conservative MP and former deputy chair of the party, Lee Anderson, said Islamists had “got control of London” and that its Labour mayor, Sadiq Khan had “given our capital city away to his [Islamist] mates”. Anderson refused to apologize for his comments, and was suspended from the party.

The former Tory home secretary/interior minister, Suella Braverman, then said that “Islamist cranks and leftwing extremists” had taken control of the UK’s streets as part of a leftwing agenda. Starmer sought a respite from his travails by calling on the Tory party to purge its ranks of Islamophobes. Braverman and Anderson belong to their party’s rightwing, which has been putting prime minister Rishi Sunak under pressure after a series of catastrophic by-election defeats. The Tory right is fearful of losing votes to the far-right Reform UK, regardless of the fact that it would be electoral suicide for the Tories to move even further to the right. Sunak though is too weak to bring his rabble-resembling rightwing into line.

The “mother of parliaments”? Do Brits laugh or cry?

The post Chaos in the Mother of Parliaments appeared first on CounterPunch.org.

This content originally appeared on CounterPunch.org and was authored by Kenneth Surin.

A Russian metals tycoon's assets in a company that produces a key component in making steel have reportedly been nationalized days after President Vladimir Putin criticized his management of his company.

Yury Antipov, 69, the owner of Russia’s largest ferroalloy company, was also questioned by investigators in Chelyabinsk, the Urals industrial city where his company is based, and released on February 26, according to local media.

Earlier in the day, the government seized his shares in Kompaniya Etalon, a holding company for three metals plants that reportedly produce as much as 90 percent of Russia’s ferroalloy, a resource critical for steelmaking.

Russia’s Prosecutor-General Office filed a lawsuit on February 5 to seize Etalon, claiming the underlying Soviet-era metals assets were illegally privatized in the 1990s. It also said the strategic company was partially owned by entities in “unfriendly” countries.

While campaigning for a presidential vote next month, Putin criticized Antipov on February 16 without naming him during a visit to Chelyabinsk, whose working-class residents are typical of the president’s electoral base.

Putin told the regional governor that the Chelyabinsk Electrometallurgical Plant, the largest of Etalon’s five metals factories, had failed to reduce dangerous emissions as agreed in 2019 and the asset would be taken over even though the court had yet to hear the case on privatization.

“I think that all the property should be transferred to state ownership and part of the plant -- [where there is ecologically] harmful production -- should be moved outside the city limits,” Putin told Governor Aleksei Teksler.

In a closed hearing, a Chelyabinsk court approved the transfer of Etalon’s assets to the state, a move potentially worth hundreds of millions of dollars.

Antipov ranked 170 on Forbes 2021 list of richest Russians with a net worth of $700 million.

The nationalization of a domestic company owned by a Russian citizen is the latest in a series of about two dozen by the state since Russia invaded Ukraine in 2022.

Prosecutors have based their cases on illegal privatization, foreign ownership, criminal activity, or a combination of the three. A rare-metals producer whose owner had been critical of the war effort was among the other assets seized. l

The seizures contradict Putin’s repeated promises in the nearly quarter century he has been in power that he would not review the controversial 1990s privatizations. In return, businessmen were expected to be loyal to the Kremlin and stay out of politics, experts say.

That unofficial social contract had more or less functioned up until the war. Now businessmen are also expected to contribute to the war effort and support the national economy amid sweeping Western sanctions, experts say.

The current trend of state seizures has spooked Russian entrepreneurs and raised questions about whether that social contract is still valid.

U.S. Ties

Antipov began his business career in the 1990s selling nails, fertilizer, dried meats, and other goods. In 1996 he and his business partner plowed their profits into the purchase of the Chelyabinsk Electrometallurgical Plant and subsequently purchased four more metals plants in the ensuing years.

The plants sold some of their output in the United States, where the firm had a trading company.

Antipov received full control of the metals holding in 2020 when he split with his business partner. That year he put 25 percent of the company each in the names of his wife and two eldest sons, Sergei and Aleksei Antipov, according to Russian business registration records.

In 2022, the metal assets were transferred to the Etalon holding company, whose ownership was hidden. Ferroalloy prices surged in 2022 as the war triggered a spike in commodity prices.

A hit piece published by The Moscow Post in December -- six weeks before prosecutors launched the privatization case -- claimed Antipov paid himself a dividend of more than $300 million from 2021-2023 using a structure that avoids capital gains taxes. RFE/RL could not confirm that claim. The Moscow Post is a Russian-language online tabloid that regularly publishes compromising and scandalous stories.

According to public records, Antipov’s two sons own homes in the United States and may be U.S. citizens. Sergei Antipov founded the trading company around the year 2000 in the U.S. state of Indiana. If he and his brother together still own 50 percent of the company, prosecutors could potentially have grounds for seizure.

Russia has changed some laws regulating the purchase of large stakes in strategic assets since its invasion of Ukraine.

One is a 2008 law that requires foreign entities to receive state permission to buy large stakes in strategic assets. An exception had been made for foreign entities controlled by Russian citizens.

Under the change, a Russian citizen with dual citizenship or a residence permit in another country may be considered a “foreign” owner and must receive permission to own an asset.

Nationalization is among the punishments for failure to do so. Thus, if Antipov’s two sons are U.S. citizens or if they have U.S. residency permits, their combined 50 percent stake in the company could be seized.

This already happened to a Russian businessman from St. Petersburg. His business was determined to be strategic and seized after he received foreign residency.

This content originally appeared on News - Radio Free Europe / Radio Liberty and was authored by News - Radio Free Europe / Radio Liberty.

Photograph by Nathaniel St. Clair

“Am I doing the right thing?” parents ask. They make millions of decisions raising children with little official guidance. But a recent court decision in Michigan gave a resounding answer to Jennifer Crumbley. The court found that she was partially responsible for her 15-year-old son Ethan’s murderous rampage, determining she was guilty of four counts of involuntary manslaughter.

The court judged the mother accountable although she did not pull the trigger on the 9mm semi-automatic pistol the son used to murder four students and wound seven other people at a local high school. As the Gazan death toll approaches 30,000, and Israeli Prime Minister Benjamin Netanyahu prepares to bomb Rafah, we question whether those countries continuing to supply weapons to Israel are like the mother on a larger scale.

What had Mrs. Crumbley done or not done? The parents had bought the weapon for him. They had taken the 15-year-old boy to a firing range. The day of the school shooting the parents had been called to the school after a teacher had found a violent drawing and message on Ethan’s desk. The parents ignored strong signals that their son was potentially dangerous. The involuntary manslaughter charges were based on the mother’s failure to secure the gun Ethan used.

The notion of responsibility is never simple. The International Law Commission (ILC) considered Articles on Responsibility of States for Internationally Wrongful Acts between 1955 and 2001. No binding conventions or treaties resulted from the proposed articles. The Commission was unable to establish obligatory arbitration between states, to agree on penalties for international crimes, or to establish any formal legal structure with which to oversee legal state responsibility.

What makes the Michigan case so intriguing is the relationship between the final act by the son and the parents’ actions prior to the shootings. The German jurist Hans Kelsen examined the relationship between the consequences of an act and what preceded the act by imputation. Kelsen’s argument was that imputation is beyond simple cause and effect. We know the boy caused four deaths and seven injured persons. Imputation seeks to determine the responsibility for how the actor came to commit the act. In this case, the mother did not commit the murders, but she was determined to be partially responsible.

Can we use the idea of indirect parental responsibility for the action of a son to states’ indirect responsibility for providing weapons to Israel’s committing what the International Court of Justice (ICJ) officially ruled was “plausible” genocide? Can we impute responsibility for the 28,000 Gazan deaths to those countries which have supplied military material to Israel? If Mrs. Crumbley was guilty of not securing the gun, what about those countries which have not controlled the use of the weapons they sold to Israel?

Article III of the Geneva Convention on the Prevention and Punishment of the Crime of Genocide states that: “The following acts shall be punishable: (a) Genocide; (b) Conspiracy to commit genocide; (c) Direct and public incitement to commit genocide; (d) Attempt to commit genocide; (e) Complicity in genocide.” The Convention entered into force in 1951. As of January 2024, 153 countries have ratified the Convention, including Israel.

What does complicity mean for the United States? Although the United States signed the Convention in 1948, it was only forty years later, in 1988, that the Senate finally ratified the Convention. In addition to the Senate ratification, it also passed the Proxmire Act. The Act fully committed the U.S. to implementing the Convention.

Three Canadian scholars wrote in The Conversation the implications for Canada of the recent ICJ decision and Article III section (e) of the Convention:

 “In 2022, Canada sent more than $21 million worth of military exports to Israel. The Export and Import Permits Act forbids arms permits to be issued if there’s a “substantial risk” that the goods could be used to commit or facilitate serious violations of international humanitarian or human rights law. Because the ICJ found a serious risk of genocide in Gaza, continuing to export arms to Israel would be illegal. It would also be flagrantly inconsistent with Canada’s obligation to prevent genocide and could expose Canada and Canadian officials to liability for participation in genocide.”

Does the Canadian experience relate to the United States? How has the U.S. implemented the Convention? “The United States has briefed Israel on a new U.S. national security memorandum that reminds countries receiving U.S. weapons to stick to international law, the White House said,” Steve Holland reported for Reuters on February 10. Briefed? Reminded? Washington gives $3.8 billion in annual military assistance to Israel. By continuing to give military aid with full knowledge of Israel’s behavior, isn’t the United States complicit in a “plausible” genocide? The United States certainly cannot plead ignorance as Ethan’s mother did. Israel’s blatant attacks have gone on for four months.

As political science Professor Zachary Karazsia wrote in 2019; “it is clear that the international community has overwhelmingly failed to uphold the Genocide Convention’s prevention mandate” as opposed to “punishing perpetrators posthaste (e.g., the 1940s Nuremburg and Tokyo trials; the 1990s tribunals in the former Yugoslavia and Rwanda; and the International Criminal Court).”

If Jennifer Crumbley was guilty of involuntary manslaughter, can the actions of states be considered involuntary genocide? Is not the mother’s not securing the gun like the obligation of Signatories to the Genocide Convention have to not only not commit genocide, but also to not be complicit in genocide?

It is unusual for a mother to be judged legally responsible for the actions of her child. It is even rarer for a state to be judged responsible for not preventing genocide. Since the court found Mrs. Crumbley guilty of not securing the gun her son used, is there hope for the military suppliers to Israel to face consequences for not securing the use of their significant delivery of weapons?

There is some hope. “Nicaragua has warned Germany, the United Kingdom, the Netherlands, and Canada that it will take the countries to the International Court of Justice over allegations that weapons they are providing Israel are being used in a genocide against Palestinians in Gaza,” Middle East Eye reported. Also, a Dutch appeal court recently ruled that the government must halt all sales of F-35 jet parts to Israel. “It is undeniable that there is a clear risk that the exported F-35 parts are used in serious violations of international humanitarian law,” Judge Bas Boele said of the decision.

States, like people, should be held responsible. Preventing genocide is just as important as punishing genocide. Just ask the 28,000 Gazans and counting.

The post If a Mother Can be Found Complicit in Her Son’s Murders, Shouldn’t States Be Held Complicit in a “Plausible” Genocide?  appeared first on CounterPunch.org.

This content originally appeared on CounterPunch.org and was authored by Daniel Warner.

As Palestinian health officials say overnight Israeli strikes killed dozens in Rafah, where over 1 million Palestinians have sought refuge, we speak with a teacher trying to evacuate Rafah with her young children, who urges the U.S. government to stop the bloodshed. “My message to President Biden: We are innocent civilians, and we have no fault in what is happening,” says Duha Latif. “Our children deserve to live a normal life like the rest of the world’s children.” Latif is fundraising to gather the money she needs to enter Egypt. The latest Israeli bombardment was conducted as part of an operation to free two Israeli hostages and came amid warnings from U.S. President Joe Biden and other world leaders against Israel’s expected ground invasion of Rafah. Aid agencies fear the offensive would cause massive casualties.

This content originally appeared on Democracy Now! and was authored by Democracy Now!.

The mother of Al Jazeera’s award-winning Gaza bureau chief Wael Dahdouh has died at a hospital in Gaza due to illness, reports Al Jazeera.

Dahdouh, who has become a symbol for the perseverance of Palestinian journalists in Gaza, had lost his wife Amna, son Mahmoud, daughter Sham and grandson Adam to an Israeli air raid in October.

Dahdouh was later wounded in an Israeli drone attack that killed his colleague, Al Jazeera cameraman Samer Abudaqa. He is currently being treated for his injuries in a hospital Doha, Qatar.

• READ MORE: Israel’s war on Gaza updates: Officials report ‘massacre’ in Deir el-Balah
• 31 Palestinian journalists currently held in Israeli prisons in record wave of detentions
• The suffering of Wael al-Dahdouh in ‘deadliest conflict for journalists’
• Israel kills journalists, while the West merely censors them

Last month, his eldest son, Hamza — a journalist who worked with Al Jazeera — was also killed in an Israeli attack alongside fellow journalist Mustafa Thuraya, a freelancer.

Last Friday, India’s Kerala Media Academy announced that its Media Person of the Year award has been given to Wael Al-Dahdouh in recognition of his exceptional journalistic courage.

‘Global face of courage’
The academy said in a statement that Al-Dahdouh was “a global face of journalistic courage, who continues to work despite the heavy losses borne by his family”.

Anil Bhaskar, secretary of the academy, told Arab News that Al-Dahdouh was recognised for his fearless reporting that allowed the world see the “true picture of the catastrophe” in Gaza.

“His commitment and bravery are exemplary and set an example for other journalists not only in India but all over the world,” Bhaskar said.

According to UN reports, more than 122 journalists and media workers have been among more than 27,000 people killed in Israel’s nearly four-month offensive in Gaza.

Press freedom watchdog the Committee to Protect Journalists said last month that journalists were being killed in Gaza at a rate with no parallel in modern history and that there was “an apparent pattern of targeting of journalists and their families by the Israeli military.”

‘Struggling to keep alive’
Meanwhile, Ayman Nobani, reporting from Nablus in the occupied West Bank, says Palestinian journalists are “struggling to keep alive”.

He reported that Shorouk al-Assad, a member of the general secretariat of the Palestinian Journalists Syndicate, as saying that journalists in the besieged coastal enclave were living through unprecedented times as they were being targeted by Israeli forces.

“The most important challenge today is the survival of journalists in light of their targeting and bombardment by Israel, in addition to the killing of their families, the destruction of their neighbourhoods, and the death of their colleagues,” she told Al Jazeera.

She also said:

• At least 73 media offices have been bombed since October 7;
• All of Gaza’s radio stations are no longer operating due to bombardment, power outages, or the killing or displacement of staff;
• Only 40 journalists remain in northern Gaza and they are besieged and isolated, with no means to send food or relief items to them; and
• Some 70 journalists have lost close family members

Earlier reports have indicated 78 Palestinian journalists have been killed in the Israeli war on Gaza, many of them targeted.

This content originally appeared on Asia Pacific Report and was authored by Pacific Media Watch.

Duong Van Thai, 41, was living in Thailand when he disappeared on April 13 in what many believe was an abduction. 

Vietnam has neither confirmed nor denied that he was abducted and taken back to Vietnam, but shortly after his disappearance, authorities announced that they had apprehended him for trying to sneak into the country illegally.

On Tuesday afternoon, Thai’s mother Duong Thi Lu, 70, received an unexpected phone call from the police, saying that she would be allowed to see her son the next day at the B14 Detention center in Hanoi’s Thanh Tri district, she told RFA Vietnamese on Friday.

On Wednesday morning, she visited the detention center and talked to her son through a thick glass window – the first time she had seen him in nine months.

“For about half an hour we talked about his health, the family and our village,” she said. “Police had warned me at the gate not to talk about [problematic] issues.”

It’s a rarity that she was allowed to see him while the investigation was ongoing.

Abduction 

Thai had fled to Thailand in late 2018 or early 2019, fearing political persecution for his many posts and videos that criticized the Vietnamese government and leaders of the Communist Party on Facebook and YouTube. 

He had been granted refugee status by the United Nations refugee agency’s office in Bangkok. He was interviewed to resettle in a third country right before his disappearance near his rental home in central Thailand’s Pathum Thani province.  

By mid-2023, the Security Investigation Agency under the Ministry of Public Security announced that Thai was under investigation for anti- State charges under Article 117, a vaguely written law that rights organizations say is used to silence dissent..

Health

The last time Lu saw Thai in person was when she visited her son in Bangkok one year ago around the Tet holiday, Vietnam’s version of the Lunar New Year. She said that he looks different after his time in custody.

”I could not recognize him because his skin is fairer. When he was in Thailand it was dark,” But he looked very healthy and hasn’t lost a lot of weight.”

Duong assured her that in the detention center he was adequately fed and well treated, she said.

Regarding the investigation, she said that police did not give any details about it, but encouraged her in a general way. 

”When I was back at the gate, the detention guard said, ‘Be calm. He does not face any problems here. He will soon be at home with you From now until Feb. 20, if there is not any change, we will send you confirmation.’”

Lu said that they were not allowed to freely talk, so she did not know her son’s thinking about hiring defense lawyers, and that she was also too old to know how to do anything like that.

RFA attempted to contact the Security Investigation Agency under the Ministry of Public Security to inquire about Thai’s case, but the officer in charge refused to respond.

Under the Penal Code of Vietnam, the defendants in National Security cases are only allowed to see their family and lawyers when the investigation is complete.

Translated by An Nguyen. Edited by Eugene Whong and Malcolm Foster.

This content originally appeared on Radio Free Asia and was authored by By RFA Vietnamese.

Live Briefing: Russia's Invasion Of Ukraine

RFE/RL's Live Briefing gives you all of the latest developments on Russia's full-scale invasion, Kyiv's counteroffensive, Western military aid, global reaction, and the plight of civilians. For all of RFE/RL's coverage of the war in Ukraine, click here.

Zelenskiy met with his Lithuanian counterpart Gitanas Nauseda on January 10 to discuss military aid, training, and joint demining efforts during the previously unannounced trip, which will also take him to Estonia and Latvia.

“We have proven that Russia can be stopped, that deterrence is possible,” he said after talks with Nauseda on what is the Ukrainian leader's first foreign trip of 2024.

"Today, Gitanas Nauseda and I focused on frontline developments. Weapons, equipment, personnel training, and Lithuania's leadership in the demining coalition are all sources of strength for us," Zelenskiy later wrote on X, formerly Twitter.

Lithuania has been a staunch ally of Ukraine since the start of Russia's unprovoked full-scale invasion, which will reach the two-year mark in February.

Nauseda said EU and NATO member Lithuania will continue to provide military, political, and economic support to Ukraine, and pointed to the Baltic country's approval last month of a 200-million-euro ($219 million) long-term military aid package for Ukraine.

Russia's invasion has turned Ukraine into one of the most mined countries in the world, generating one of the largest demining challenges since the end of World War II.

"Lithuania is forming a demining coalition to mobilize military support for Ukraine as efficiently and quickly as possible," Nauseda said.

"The Western world must understand that this is not just the struggle of Ukraine, it is the struggle of the whole of Europe and the democratic world for peace and freedom," Nauseda said.

Ukraine has pleaded with its allies to keep supplying it with weapons amid signs of donor fatigue in some countries.

There is continued disagreement between Democrats and Republicans in the U.S. Congress on continuing military aid for Kyiv, while a 50-billion-euro ($55 billion) aid package from the European Union remains blocked due to a Hungarian veto.

But a NATO allies meeting in Brussels on January 10 made it clear that they will continue to provide Ukraine with major military, economic, and humanitarian aid. NATO allies have outlined plans to provide "billions of euros of further capabilities" in 2024 to Ukraine, the alliance said in a statement.

Zelensky warned during the news conference with Nauseda that delays in Western aid to Kyiv would only embolden Moscow.

"He (Russian President Vladimir Putin) is not going to stop. He wants to occupy us completely," Zelenskiy said.

"And sometimes, the insecurity of partners regarding financial and military aid to Ukraine only increases Russia's courage and strength."

Since the start of the year, Ukraine has been subjected to several massive waves of Russian missile and drone strikes that have caused civilian deaths and material damage.

Zelenskiy said on January 10 that Ukraine badly needs advanced air defense systems.

"In recent days, Russia hit Ukraine with a total of 500 devices: we destroyed 70 percent of them," Zelenskiy said. "Air defense systems are the number one item that we lack."

Meanwhile, in Ukraine, an all-out air raid alert was declared on the morning of January 10, with authorities instructing citizens to take shelter due to an elevated danger of Russian missile strikes.

"Missile-strike danger throughout the territory of Ukraine! [Russian] MiG-31Ks taking off from Savasleika airfield [in Russia's Nizhny Novgorod region].

Don't ignore the air raid alert!' the Ukrainian Air Force said in its warning message on Telegram.

With reporting by AFP and Reuters

This content originally appeared on News - Radio Free Europe / Radio Liberty and was authored by News - Radio Free Europe / Radio Liberty.

The Federal Aviation Administration has temporarily grounded scores of Boeing 737 MAX 9 jetliners after a fuselage door plug blew off an Alaska Airlines plane midflight near Portland, Oregon, on Friday. The incident forced the plane to make an emergency landing. The National Transportation Safety Board has revealed Alaska Airlines had concerns about the plane prior to the incident but kept flying it. It’s just the latest safety issue plaguing Boeing’s MAX planes, which had two catastrophic crashes in 2018 and 2019 that killed 346 people when faulty flight control systems put the planes into nosedives. “This is a tip of the iceberg type situation,” says aviation expert Ed Pierson, a former senior manager at Boeing who says he left the company over its “unacceptable” business practices that prioritize production over safety. We also speak with Nadia Milleron, whose daughter Samya Rose Stumo was among those killed in the 2019 crash of Ethiopian Airlines Flight 302. “There are serious, serious problems with these MAX planes,” says Milleron. “A lot of them are manufacturing problems, and Boeing is trying to evade safety regulations.”

This content originally appeared on Democracy Now! and was authored by Democracy Now!.

At Charles de Gaulle airport I had only 15 minutes in which to waste 10 of them waiting for a shuttle bus to carry me on an 8-minute journey followed by a 400-meter walk. It just didn’t compute. Thanks to Brexit, I also had to check out of transit and then go straight back in again, including through security. At least the French were courteous and sympathetic, but when I reached my correct longer-haul terminal, I had to race through the modish architecture and ascend a long set of stairs as if they went on forever. It was like being trapped inside a work by Escher. Even worse, when I reached the top, it was — incomprehensibly — a dead-end. So I had to come straight back down again, until finally — way over in what felt like an unachievable distance — was my gate number. I was so out of breath. I was wheezing like an Atlantic seal. I didn’t know how, but I made it. Several hours later, next to a bearded Frenchman asleep upright in his seat, I monitored the flight path on his screen. We were within the Sahel region and about to turn eastwards.

Having landed on the world’s least industrialized continent, with its under-reported conflicts and incredible personable strengths, my checked-in suitcase was nowhere to be seen. I waited what felt like hours by the carousel. It must have missed the connection. ‘It is very sad,’ noted the manager of the hotel I was staying in. ‘It used to be the pride of Africa,’ she said, referring to the airline, even though I had already said to her it was just as likely to be the fault of the British carrier arriving late into Paris. I had also told no one there were one or two important pieces of film kit in the suitcase, just in case this made it overly attractive to thieves, though I was largely trusting, and these items were of far more practical than financial value.

Suitcase or not, I was heartened by the camaraderie of everyone in a land with over half a million refugees. They knew a thing or two about being there for someone. Some of these refugees were recent influxes; others from over 30 years ago. I kept meeting more and more of the latest influx, which was in part why I was in the region. These were interesting and dignified people. Their resilience was astounding. Their manners and good grace was for me second to none. Nor had I slept for over 36 hours. At least there was a fan in my room whose sound felt as soothing as the air it was trying to generate. It was not for the first time I was reminded of Martin Sheen’s renegade Colonel Willard in Apocalypse Now, though there were no accompanying helicopter sounds, and the closest to explosions were celebratory fireworks outside my window.

One night I was with an expert of the region taking a taxi through a series of narrow back roads. A makeshift street fire was burning to our left. Picked up by rising and dipping headlights, battered road signs were displaying far more character and resilience than the unbattered ones. One man sat in the middle of the road. He looked like an important piece of sculpture. This was until his hand reached for his head and he began to scratch it. I was actually in the middle of being taken to meet two special people staying a few days in the capital in temporary accommodation. Both had left a country torn asunder by conflict and were in fact here from a neighboring haven. This was only for a few days. The room where the four of us sat was small but the hospitality was enormous. Fruit juice. Tea. A chocolate biscuit. Warm smiles. Language-compensatory nods.

Both were political writers who had been dragged by fate from both their one closed and one still open publications. I listened and listened, speaking only to show appreciation. The man was wearing a flowing jalabiya outfit in a traditional light brown color, just like his skull cap. It spoke of deserts past as well as the free press. The woman wore a patterned ankle-length dress and retained the restless composure of a heroine in an ambitious novel. Such brave and special people. They were seated on a tight green sofa by a drenched red and yellow wall, enjoying the shadows while the colors continued to contradict them by beckoning for someone to film them. I knew my protocol. These people were relatively under the radar, and I was like a guest in the house of loss. As for getting to know people generally over the next while, I knew it would take time, months even, and would require further exploratory trips, further establishments of trust, before I could even dare to declare true knowledge or any green light. Hence, if you like, my deliberate obliqueness. Hence my gentle, though unwavering, reports of progress. Meanwhile, traffic sounds competed outside like a metropolis yearning for trains again, in a city first begun as a rail depot.

I knew I would soon be moving to a neighboring country, a place considered the biggest refugee-hosting country in the world, with over one and a half million refugees. It is not just to the north across the Mediterranean that migrants and refugees from the vast continent of Africa are drawn, such as the 61 missing people presumed dead off the Libyan coast at the weekend.

But first I wanted to find out more about the women and youth within this diaspora. As a result, I was privileged enough to meet among many others one young highly creative group of both sexes, all miles from home. In this group, there was a very young musician. He asked tenderly if I could help him quit cigarettes. ‘Gum,’ I said: ‘At first.’ I noticed he had been tearing off the tops of the sugar sachets on the table before pouring the granules into his mouth and crunching them satisfactorily.

The spirit among each young person — around a table in the shade by a series of long and hanging vines — was impressive beyond belief, and the manner in which they were so obviously looking out for one another was impressive to witness. Monsters stalk this earth but they are not like their people. I asked one shy artist, a painter, wearing a really cool bucket hat, how much he wanted people to see his work. This was knowing that he was in exile and divorced therefore from the usual oxygen of exhibition or criticism. ‘Some of it,’ he said, self-protectively. ‘I would like people to see some of my work.’

A young woman meanwhile said she would like to speak about the war. She wore a light-coloured hijab and placed a hand on her heart before attaching all of the blame on men. That day, two of her fellow nationals had been killed and seven badly hurt in an attack on an aid convoy in her country. A few days later, not so far from her own coastline, a western destroyer shot down a suspected attack drone from another conflict altogether. Everyone is at it. ‘Hey, don’t worry about your lost suitcase,’ chipped in the musician from across the table. This was out of the blue, I was thinking. ‘Just because we guys have escaped war,’ he said, ‘it doesn’t mean we don’t have feelings for others.’ I would happily sacrifice my suitcase to meet a person like that every time.

The post Letter from Alkebulan: the Mother of Mankind appeared first on CounterPunch.org.

This content originally appeared on CounterPunch.org and was authored by Peter Bach.

We speak with the mother of Hisham Awartani, one of the three 20-year-old Palestinian college students who were shot last weekend in Burlington, Vermont, in a suspected hate crime. Elizabeth Price traveled from her home in Ramallah in the occupied West Bank to see her son, who is still hospitalized in Burlington. He was shot in the spine and, while in stable condition, now faces an immediate loss of mobility. Price shares how her son’s “resilience” and “brotherhood” with his childhood best friends who are the other survivors of the shooting, Kinnan Abdalhamid and Tahseen Ali Ahmad, have been an integral part of his recovery. She also emphasizes that had Awartani been shot in Palestine, “he would have been dead in prison or thrown somewhere in a medical facility without the support to recover from this.” We also discuss life under occupation in the West Bank, U.S. displays of solidarity with Palestinians, and the media narrative surrounding the shooter’s motives. Of the three young men’s commitment to highlighting the larger picture of Israeli oppression of Palestine, Price says that “the fact that the Israelis have started bombarding again in the Gaza Strip is something that will crush them more than their injuries.”

This content originally appeared on Democracy Now! and was authored by Democracy Now!.

Standing silently, the 8-year-old girl in Papua New Guinea could only watch as her mother was stripped and tortured until she succumbed to her injuries, catching her last breath in front of her daughter last Wednesday.

The woman, identified as Lorna Nico, 39, from Kira LLG in the Sohe district, was married to a man from Mumeng and moved to Bulolo to be with the husband and start a family.

Lorna Nico died after being tortured in front of her daughter after a so-called “prayer warrior” accused her of having satanic powers and being a witch, bringing bad luck into the community.

• READ MORE: PNG Post-Courier: ‘Laughing stock’ sorcery issue way out of control – Editorial
• Other sorgery allegation killings

She was tortured so badly that salt was used to pour into her wounds causing her more pain while her daughter watched her die.

The bishop of the Evangelical Lutheran Church, Reverend Jack Urame, condemned the actions of the community in Mumeng, saying that the mixing of religion and sorcery was “not what the Bible taught”.

He said there was “a shift in people using Christianity to identify suspected sorcerers which was now being used to destroy families and commit murders”.

“Using Christianity as a means to enact killings against those accused of sorcery is an idea condemned by the churches. I as the head of the Lutheran Church do not promote such
acts and I condemn the actions taken against the innocent family,” Reverend Urame said.

‘Prayer warrior’ accused
Morobe Rural police commander Superintendent David Warap said that the use of the “prayer warrior” pushed the community to commit the torture and the killing.

“The prayer warrior, using the name of the Lord, started performing a prayer ritual and was describing and naming people in the village who she claimed had satanic powers and were killing and causing people to get sick, have bad luck and struggle in finding education, finding jobs and doing business,” Superintendent Warap said.

“Upon the woman’s announcement, youths and villagers agreed to kill Lorna and when the village councillors and mediation group tried to stop them, they threatened the group,” he added.

Lorna Nico saw the group coming and told her family to run.

“She had with her, her 8-year-old who she was trying to drag and run,” Superintendent Warap said.

“She looked ahead to her older children and told them to run for their lives. The group of men quickly surrounded Lorna, dragged her and her daughter back to the village and proceeded with the torture.”

Children fled in fear
After Lorna Nico died, the group of men left her out in the sun and then they dug a hole and threw her in, covering her body with a canvas.

The children, in fear of their lives, left the village and walked with several other villagers to the nearest police station.

Police got to the scene and removed the body and took the body to Angau Hospital morgue in Lae where the corpse will be examined.

The family have now petitioned the Bulolo MP Sam Basil Jr to ensure the police investigate the case and arrests are made.

The petition also states that the woman who was brought in as a “prayer warrior” should be identified and dealt with by police for falsely accusing their mother.

They have also demanded that the rule of law must prevail and they would not accept any form of compensation for their loss.

Police are continuing their investigation.

Sorcery accusation-related violence (SARV) in Papua New Guinea is a growing social crisis.

Republished with permission.

This content originally appeared on Asia Pacific Report and was authored by APR editor.

On a recent Monday, the Department of Justice announced the arrest of an 18-year-old man, Davin Daniel Meyer, on charges of attempting to provide material support to a foreign terrorist organization. Meyer had been arrested the previous Friday, July 14, at Denver International Airport as he tried to board a flight to Turkey. Meyer thought he was going to the Turkish city of Ankara for a rendezvous with members of the Islamic State terrorist group.

In a press release announcing the arrest, the Justice Department said that Meyer had been caught after he had “pledged an oath of allegiance to the leader of ISIS and intended to travel to serve as a fighter for ISIS in Iraq.”

Beneath the surface of these serious allegations, however, are troubling details about what really happened between Meyer and the FBI in the months leading up to his arrest. According to the criminal complaint against him, Meyer had first come to the attention of the FBI last year when he was 17 years old, after a person he knew contacted the local sheriff’s office to report “concerning behavior,” including threats of violence against them and the United States by Meyer. The complaint did not mention that the person who reported Meyer to the authorities was his mother.

Concerned over Meyer’s erratic behavior and deteriorating mental health, Deanna Meyer reported her son, then a minor, to the authorities in the hopes that they would help keep him away from trouble. What followed instead was a lengthy government investigation employing two confidential FBI informants. First contacting Meyer the day after his 18th birthday, the informants secretly developed a relationship with him. Rather than help steer him away from wrongdoing, the FBI informants helped Meyer develop the plan to join the Islamic State that eventually led to his arrest.

In a hearing last week to determine whether Meyer would be held in custody while awaiting trial, his mother testified that she had tried to get help from the police to aid her son, who had suffered from mental illness for years and made threats of violence against her since he was 14 years old.

Meyer had previously spent eight months, between 2021 and 2022, in a facility “focused on mental health and behavior treatment,” according to the affidavit. He had been diagnosed with autism, clinical depression, and a range of anxiety and mood disorders — diagnoses of which the government was aware and even referenced in the criminal complaint. All while still a minor, Meyer espoused white supremacist beliefs and, still grappling with a range of diagnosed mental illnesses, then developed an interest in extremist Islam online. The behavior had alarmed his mother.

“It was the wrong place to go for help in going to law enforcement.”

“I had exhausted all private routes,” Deanna Meyer said at the hearing, explaining her original decision to contact the local sheriff’s office for help with her child. “I was more concerned about ideology and where that would go.”

If convicted on the charges, Meyer could face up to 20 years in prison. Yet his family and lawyers say that he had been the victim of an FBI sting operation that groomed him for the very crime for which he was arrested.

“It was the wrong place to go for help in going to law enforcement,” Meyer’s lawyer David Kaplan said at the hearing. “They represented themselves as facilitators and fanned the flames of what they condemn now.”

Davin Daniel Meyer as 16 year old.

Photo: Courtesy of Deanna Meyer

Mental Health Diagnoses

The two paid undercover FBI informants who helped secure his arrest began communicating with Meyer “soon after his 18th birthday,” according to the affidavit in the case — fostering his path to extremist ideology only once he could be legally prosecuted as an adult. One of the informants even traveled to meet with Meyer in person, three times, in his small Colorado hometown. They discussed the idea of going abroad to join a terrorist group — a possibility that Meyer had already been talking over with the other FBI operative online.

The complaint goes into considerable detail about the relationship that developed between Meyer and the undercover informants, whom he believed to be members of the Islamic State who could facilitate his travel abroad.

Court documents also show that the FBI was aware of Meyer’s history of mental illness, including his stay at a residential treatment facility during part of the year in which the investigation started.

While institutionalized, Meyer reportedly refused to take his prescribed psychiatric medication or attend online school programs. He also engaged in racist speech against medical staff before developing an interest in radical Islamist ideology. The FBI reviewed this history, saying in the affidavit that “records show that Meyer has received diagnoses of autism spectrum disorder; attention-deficit hyperactivity disorder; adjustment disorder with mixed anxiety and depressed mood; specific learning disorder with impairment in mathematics; and major depressive disorder, recurrent episode, moderate.”

Sometime after his release from mental health treatment, in the summer of 2022, Meyer was banned from a local mosque he tried to attend after being accused of harassing the imam and congregants.

That November, he found the Islamic State online — in the form of the FBI informant. After developing a relationship with them, Meyer sent the informant videos of himself, face wrapped in scarves, pledging allegiance to the group. The informant later introduced Meyer to the second informant in December 2022, whom he met in person and discussed travel abroad. In their meetings, Meyer shared videos with the informant he had found online of violent acts perpetrated by ISIS abroad.

For a period of several months, Meyer continued discussing with the FBI informants a plan for him to leave the country and join a terrorist group abroad. Many of these discussions included talk about what type of shoes, clothing, and electronic devices would be useful for him while traveling, as well as how he would obtain a passport and accumulate enough money to pay for his ticket. Meyer attempted to work part-time jobs to save the required funds. After running into problems securing the cash, he eventually settled upon using a sum of $3,000 provided by his mother that she had given him to pay for groceries and transportation.

“I am very happy this is happening, but at the time I feel sad because I will most likely never see my parents again.”

The issue of his mother and how she would respond to him potentially leaving the country was a running theme for Meyer in his conversations with the FBI. “One day she’s gonna wake up and her son’s not gonna be there and that’s gonna be difficult for her,” Meyer said, as quoted in the indictment. In the end, he decided upon leaving a note in his apartment, to which she had a spare key, indicating that he had left the country and would not be coming back.

In the days leading up to his final departure, Meyer, while expressing to the FBI informant his continued commitment to the plan for him to leave, continued to bring up his parents. “I am very happy this is happening, but at the time I feel sad because I will most likely never see my parents again, and I’m leaving the place I’ve grown up all my life and become attached to,” he told an FBI informant in a message. “It is a trial but it can be heavy on the heart.”

According to the indictment, Meyer continued to express “anxiety and hesitation,” right up until the hours he was expected to board a flight to Turkey in July, though he reassured the informants that he would still go through with the plan. To his own detriment, he would wind up fulfilling his promise to the FBI — a plan that they themselves had helped him develop. At around 8:00 p.m. on July 14, after showing his boarding pass to a gate agent at Denver International Airport, Meyer was arrested by FBI agents while walking the jet bridge to board his flight.

“Groomed”

Meyer’s case follows a long pattern of FBI sting operations targeting young people with histories of mental illness that make them vulnerable to manipulation — stings that often result in the teens being prosecuted for terrorism and receiving lengthy prison terms. Just last month, a lengthy FBI investigation targeting a 16-year-old with “brain development issues” led to an arrest on terrorism charges shortly after he — like Meyer — became a legal adult.

At Meyer’s hearing last week, it was alleged by prosecutors that Meyer had also communicated online with an Islamic extremist in the United Kingdom who had recently been arrested — likely a reference to a notoriously media-friendly radical activist named Anjem Choudary. The nature of that alleged contact and how extensive it was remains unclear. In the charges against Meyer related to his alleged criminal plot, the only terrorists he is accused of ever actually collaborating with were undercover operatives working for the FBI.

More details could come out as Meyer’s case heads to trial that could shed light on the allegations against him. At his hearing, prosecutors stated that the 18-year-old was given many “off-ramps” during the investigation by the FBI informants, but that he remained committed to carrying out his imagined plan to leave the country with their help and join ISIS.

His mother, however, believes that Meyer — far from being a legitimate threat to herself or to U.S. national security — was “groomed” at a young age while already grappling with mental illness to generate yet another terrorism case for federal prosecutors and the FBI.

In a Facebook post, titled “My Lost Son,” Deanna Meyer lamented what she described as the manipulation of her son by law enforcement officials and the FBI.

“I made the choice to call the police and beg for any kind of mental health options before his 18th birthday to keep him safe and out of the criminal justice system not knowing that their solution would be to wait until he the day he was 18 and send multiple undercover agents to groom him,” she wrote. “I lost him. He is gone behind the walls of steel and indifference.”

This content originally appeared on The Intercept and was authored by Murtaza Hussain.

RFA reported on June 6 that Russian authorities announced that they were searching for Kim Kum Sun, 43, and Park Kwon Ju, 15, who had last been seen on June 4 leaving the North Korean consulate in Vladivostok.

Kim had been working as the acting manager of two North Korean restaurants in the city in place of her husband, considered a diplomat, who traveled to North Korea in 2019 but was unable to return to Russia due to the COVID-19 pandemic.

On July 7, the day after the announcement, Kim and Park were arrested after boarding a  Moscow-bound flight departing from the central Russian city of Krasnoyarsk, a resident of Vladivostok, who requested anonymity for personal safety, told RFA’s Korean Service.

“Their flight to Moscow departed from Yemelyanovo International Airport located on the outskirts of Krasnoyarsk as normal, but to arrest the mother and the son, the Russian public security authorities forced the plane to return to the airport,” he said. “When the plane landed …, the authorities arrested them.”

They would have gotten all the way to Moscow if not for the consulate getting Russian authorities involved, the Vladivostok resident said. 

As of Tuesday, Russian media has made no mention of Kim and Park’s arrest. RFA was not able to confirm with Russian authorities that they grounded the flight to arrest the pair.

Higher priority?

It was also not clear if Kim and Park had been accused of any crimes.

But it is standard procedure for the North Korean consulate to fraudulently accuse missing personnel of crimes so that Russian authorities place a higher priority on the case, a Russian citizen of Korean descent from Krasnoyarsk, who requested anonymity for security reasons, told RFA. 

“North Korea reports missing people by framing them for crimes,” he said. “So the escapees are in danger of being executed without the protection of the local state and the international community.”

But if they were accused criminals, the runaways would not be eligible for international protection, he said. 

The Krasnoyarsk resident confirmed that the authorities ordered the plane to return to the airport to arrest Kim and Park.

“There has been an increasing number of escape attempts among North Korean trade officials and workers in Russia recently,” he said. 

They may have been inspired by other North Koreans who successfully fled, including a computer engineer, a work unit manager, a work site manager, a doctor and a soldier from the General Staff Department of the North Korean military.

“The United Nations and the international community must take an active role in helping those who risk their lives to escape from the dictatorship,” the Krasnoyarsk resident said. 

“Instead of [arresting them] as demanded by the North Korean authorities and sending them to a place where death awaits them, [Russian authorities] should open the way for them to receive refugee status according to the regulations set by the United Nations.”

Translated by Leejin J. Chung. Edited by Eugene Whong and Malcolm Foster.

This content originally appeared on Radio Free Asia and was authored by By Kim Jieun for RFA Korean.

The post The Radical Life of Mother Jones appeared first on CounterPunch.org.

This content originally appeared on CounterPunch.org and was authored by Victor Grossman.

Thol Samnang, a member of the opposition Candlelight Party, was snatched off the streets of Bangkok by men in plainclothes before dawn on Friday as he made his way to the office of the United Nations refugee agency UNHCR, according to an eyewitness and human rights advocacy groups.

The arrest is the latest in a series of incidents where foreign activists fleeing repression in their home countries have been detained on Thai soil.

“I’m afraid officials in Thailand may send him to Cambodian officials to be punished,” Chaet Lak, his mother who lives in Cambodia, told Radio Free Asia (RFA), a news service affiliated with BenarNews. “I want human rights organizations to help prevent his deportation.”

Samnang fled Cambodia on July 4, a day after police and government authorities visited his home to detain him without a warrant.

The 34-year-old had criticized Prime Minister Hun Sen and the governing Cambodian People’s Party (CPP) on Facebook in the weeks leading up to his departure, his mother told RFA Khmer in an interview on Sunday.

Cham Chit, a Cambodian citizen who left the country with Samnang, said the two were seeking asylum in Thailand.

“But on July 7, plainclothes Thai officials arrested him and took him away on a motorcycle as we were leaving our residence near the Victory Monument,” he told RFA, referring to a military memorial at the heart of Bangkok.

Samnang was being held at an immigration detention center in the Thai capital, said Pornpen Khongkachonkiet, director of the Cross Cultural Foundation, a local NGO providing legal aid and advocacy for victims of human rights abuses.

“We received an assurance from the immigration officials that there will not be an immediate deportation,” she told BenarNews on Monday. “Our lawyer is processing him to gain protection through the UNHCR or the Thai government.”

She said Thailand’s recently enacted Prevention and Suppression of Torture and Enforced Disappearance Act  prohibited the deportation of anyone who faces a serious threat to life or freedom – a key principal of the U.N. Refugee Convention known as non-refoulement.

Samnang would face an uncertain fate if forcibly sent back to Cambodia. 

Hun Sen, who has ruled the Southeast Asian nation of 16 million for nearly four decades, has clamped down on democratic freedoms, jailed or exiled political rivals, and shut independent media outlets.

In May, the National Election Committee disqualified the Candlelight Party from competing in Cambodia’s July 23 parliamentary elections, leaving no credible challenger to the CPP.

‘Well-founded fear of persecution’

Human Rights Watch called on Thailand to protect Samnang.

“It is absolutely urgent that UNHCR be granted immediate access to Thol Samnang so he can explain his very serious, well-founded fear of persecution if he is forced to return to Cambodia, and receive refugee protection,” Phil Robertson, HRW’s deputy Asia director, told BenarNews on Monday.

“Quite clearly, the ruling Cambodian People’s Party and key officials are turning up the heat against anyone who dares criticize government policies or questions the upcoming election, which Human Rights Watch believes will be neither free nor fair.

“Thailand should refuse to participate in Phnom Penh’s efforts at transnational repression against opposition political activists.”

A UNHCR spokeswoman said she could not comment on the details or even confirm the existence of individual cases. The Thai Immigration Bureau did not immediately respond to a BenarNews request for comment.

Thailand has hosted thousands of refugees from neighboring countries who fled war, natural disasters and human rights violations.

Still, rights advocates have criticized Thailand’s pro-military government for recent cases where refugees and asylum seekers have been deported to face prosecution and other rights abuses in their home countries. 

Khoukham Keomanivong, a Lao activist living in Thailand as a U.N.-recognized refugee, was arrested by Thai police in Bangkok on Jan. 29, 2022, for overstaying his visa. He was released on bail on Feb. 1 with the help of a human rights lawyer, narrowly avoiding deportation. 

In November 2021, Thai authorities deported to Cambodia two activists from a banned opposition party after Hun Sen ordered one of them arrested for a poem that criticized him on Facebook.

In August 2019, Lao democracy activist Od Sayavong, who was 34, vanished under mysterious circumstances in Thailand after posting a video clip online criticizing the Lao government. Listed as a “person of concern” by the UNHCR because of his advocacy for democracy and human rights in Laos, his whereabouts remain unknown. 

RFA Khmer contributed to this report. BenarNews is an RFA-affiliated news service.

This content originally appeared on Radio Free Asia and was authored by By Nontarat Phaicharoen and Harry Pearl for BenarNews.

Thea Malar Win, 42, and Saung Thazin Oo, 24, were killed in their home in Htantabin township’s Yoe Gyi village on Tuesday, according to neighbors who didn’t want to be named, fearing reprisals.

They are the mother and sister of 23-year-old anti-junta Special Task Force member Kaung Zarni Hein, who was arrested along with 30-year-old Kyaw Thura on June 6, and accused of killing Lily Naing Kyaw.

On Tuesday evening, following the arrests, members of pro-military Ma Ba Tha and Pyu Saw Htee militias went to the women’s home, where they tortured and killed them, residents said.

“They were shot dead after being beaten and interrogated,” said a local who didn’t want to  be named for safety reasons.

“People say the bad guys, Naing Gyi and Ma Ba Tha, extremists from the village shot them … People don’t dare to talk much about this incident as they are afraid. The people who were killed were preschool teachers."

Lily Naing Kyaw, a pro-junta supporter of the Ma Ba Tha militia, was critically injured when she was shot in front of her home In Yangon’s Yankin township on the evening of May 30. She died on June 6, while undergoing treatment at Yangon’s Mingaladon Military Hospital.

As well as singing, she acted in military propaganda films and videos and often attended and performed at pro-junta events.

She was on record as saying there were no Rohingya in Myanmar, referring to the Muslim minority who have been targeted by Myanmar’s military, forcing around 740,000 to flee to Bangladesh, while the remainder live in Internally Displaced Peope’s camps, mainly in Rakhine state.

Lily Naing Kyaw was close to top junta officials, including Deputy Information Minister Major Gen. Zaw Min Tun, and often posted pictures of herself with the military leaders on her Facebook page.

Translated by RFA Burmese. Edited by Mike Firn.

This content originally appeared on Radio Free Asia and was authored by By RFA Burmese.

The specific reason for her death remains unclear, but in a video recorded before she died, the woman, surnamed Yang, said that national security officers had told her to keep quiet about her son’s death. 

Yang also was criticized by netizens who commented on her interviews with Chinese media by blasting her for dressing too well and seeking more compensation for her son’s death. 

Her son was killed on May 23, when a car driven by a teacher surnamed Liu hit him on the grounds of Hongqiao Primary School in Hanyang District in the city of Wuhan. His parents rushed to the scene and were devastated by what had happened.

Two days later, Yang jumped from her apartment building and died. Her husband also wanted to jump off, but he was stopped by family members, a resident surnamed Qin who knew the family, told Radio Free Asia. 

"This is the power of online harassment,” Qin said.

He Peirong, an educator familiar with the situation, told RFA that Yang's suicide was not only caused by cyberbullying, but by Wuhan officials who tried to “maintain stability” and prevent her from speaking out. She said Yang's friends hinted on TikTok that the police had put pressure on her.

‘He didn’t apologize’

In a video that circulated on the Douyin online platform, Yang could be seen standing outside the gate of her son's school that a security officer named Zhou Jun from the Wuhan Municipal Public Security Bureau had scolded her and her family for making trouble and didn't apologize or ask about her son.

“He didn’t apologize to me, didn’t apologize to my child and accused us of causing trouble here,” she says on the video.

Under interviews Yang gave to the media, online readers posted a large number of malicious comments, Cover News reported. The Xiaoxiang Morning Post also reported that the incident had attracted attention from many media outlets and some that there were negative comments about Yang.

He Peirong said that an account called “Hubei Has Positive Energy,” with more than 1 million followers and which attacked Yang, was likely a government account. She said Yang was a victim of “stability maintenance,” and called for truth and justice.

The Hanyang District Education Bureau of Wuhan City issued a statement on May 25, expressing grief and self-blame for the boy’s death and saying that the teacher, Liu, had been detained and the school's principal and vice-principal had been dismissed.

A Wuhan resident who asked only to be identified as Xu said every time a local group or or individual demands rights, the national security officers will suppress online speech. 

"I believe it is true. They want to maintain stability,” he said. “I know that the cost of stability maintenance is higher than military spending."

In addition, 27 Chinese poets wrote poems to express their voice for Yang.

Among them, a poet who goes by the name of “Night Kangqiao” wrote that only a mother grieved when a child died and that since ancient times Chinese have been educated to only sweep the snow from their own front doors.

Translated by Chris Taylor. Edited by Malcolm Foster.

This content originally appeared on Radio Free Asia and was authored by By Gu Ting for RFA Mandarin.

Comprehensive coverage of the day’s news with a focus on war and peace; social, environmental and economic justice.

• Supreme Court justices delay until Friday a decision on the continued use of the abortion drug mifepristone
• Texas man shoots two cheerleaders who mistake his car for their own
• Ukraine’s top prosecutor testifies to House committee on Russian abuses
• Antioch city council plans audit of police after racist text messages scandal

Image: Democracy Now

The post Supreme Court delays until Friday its decision on abortion medication; Antioch City Council orders police department audit after release of racists text messages; Tyre Nichols’ mother sues Memphis over her son’s beating death: The Pacifica Evening News, Weekdays – April 19, 2023 appeared first on KPFA.

This content originally appeared on KPFA - The Pacifica Evening News, Weekdays and was authored by KPFA.

Disability rights advocates were joined by labor leaders, progressive politicians, and other advocates for justice on Monday in mourning the death of influential activist Judy Heumann, who began decades of advocacy work fighting for employment as a teacher and was credited with paving the way for numerous federal laws to protect people with disabilities. She was 75 and died on March 4.

Known as the "mother of the disability rights movement," Heumann's first experience with advocacy work came in 1970 after she was denied employment at a New York City public school, with the school citing her "paralysis of both lower extremities" as the reason and saying she would not be able to evacuate students and herself in case of a fire.

The denial harkened back to her treatment as a young child, when a school principal stopped Heumann's mother from enrolling her in kindergarten and said her wheelchair—which she used as a result of contracting polio at 18 months—rendered her a "fire hazard."

Heumann sued the New York City school district and won her case, becoming the city's first teacher who used a wheelchair and drawing national attention to the issue of discrimination against people with disabilities. One newspaper ran an article about the case titled, "You Can Be President, Not Teacher, with Polio," in which Heumann told the outlet, "We're not going to let a hypocritical society give us a token education and then bury us."

"Disability only becomes a tragedy when society fails to provide the things we need to lead our lives—job opportunities or barrier-free buildings, for example," she told journalist Joseph Shapiro years later. "It is not a tragedy to me that I'm living in a wheelchair."

Seven years later Heumann led more than 100 people in San Francisco in joining nationwide protests to demand that President Jimmy Carter's health, education, and welfare secretary, James Califano, implement a crucial statute within the 1973 Rehabilitation Act.

The law had been signed by President Richard Nixon and included Section 504, which prohibited institutions that receive federal funding from discriminating against disabled people. Califano delayed implementing the provision and failed to meet a deadline—April 4, 1977—set by disability rights advocates. The next day Heumann led a sit-in at a government office which turned into a weekslong occupation, culminating in Califano signing Section 504 on April 28. According toThe New York Times, Heumann's action was the "longest nonviolent occupation of a federal building in American history."

"We will no longer allow the government to oppress disabled individuals," Heumann told a representative for Califano at one meeting. "We want the law enforced. We want no more segregation."

Section 504 paved the way for the Americans With Disabilities Act, which extended protections to the private sector.

"Judy’s impact is vast," said the Disability Rights Education and Defense Fund. "Each action she took built on the one before it. In her early life, she learned perseverance and patience from witnessing her mother's ongoing advocacy to have her go to school with her non-disabled peers... Those years of segregation sparked her thinking about disability and identity."

Becky Pringle, president of the National Education Association, noted that Heumann's work was instrumental in securing the passage of the Individuals with Disabilities Education Act, then known as the Education for All Handicapped Children Act, in 1975.

Organizer Ady Barkan, who has amyotrophic lateral sclerosis (ALS), wrote on social media that Heumann's decades of advocacy made it possible for people with disabilities to take part in numerous aspects of public life.

"We owe so much to Judy Heumann," he said.

Heumann served for eight years in the Clinton administration as assistant secretary of the office of special education and rehabilitation services and for seven years in the Obama administration as the State Department's first special adviser for international disability rights.

"I join the disability community in mourning the passing of Judy Heumann," said Independent Sen. Bernie Sanders of Vermont. "From leading the 504 sit-ins to fighting for the passage of the Americans with Disabilities Act, Judy dedicated her life to advancing the rights of people with disabilities. We must continue her work."

This content originally appeared on Common Dreams and was authored by Julia Conley.

Disability rights advocates were joined by labor leaders, progressive politicians, and other advocates for justice on Monday in mourning the death of influential activist Judy Heumann, who began decades of advocacy work fighting for employment as a teacher and was credited with paving the way for numerous federal laws to protect people with disabilities. She was 75 and died on March 4.

Known as the "mother of the disability rights movement," Heumann's first experience with advocacy work came in 1970 after she was denied employment at a New York City public school, with the school citing her "paralysis of both lower extremities" as the reason and saying she would not be able to evacuate students and herself in case of a fire.

The denial harkened back to her treatment as a young child, when a school principal stopped Heumann's mother from enrolling her in kindergarten and said her wheelchair—which she used as a result of contracting polio at 18 months—rendered her a "fire hazard."

Heumann sued the New York City school district and won her case, becoming the city's first teacher who used a wheelchair and drawing national attention to the issue of discrimination against people with disabilities. One newspaper ran an article about the case titled, "You Can Be President, Not Teacher, with Polio," in which Heumann told the outlet, "We're not going to let a hypocritical society give us a token education and then bury us."

"Disability only becomes a tragedy when society fails to provide the things we need to lead our lives—job opportunities or barrier-free buildings, for example," she told journalist Joseph Shapiro years later. "It is not a tragedy to me that I'm living in a wheelchair."

Seven years later Heumann led more than 100 people in San Francisco in joining nationwide protests to demand that President Jimmy Carter's health, education, and welfare secretary, James Califano, implement a crucial statute within the 1973 Rehabilitation Act.

The law had been signed by President Richard Nixon and included Section 504, which prohibited institutions that receive federal funding from discriminating against disabled people. Califano delayed implementing the provision and failed to meet a deadline—April 4, 1977—set by disability rights advocates. The next day Heumann led a sit-in at a government office which turned into a weekslong occupation, culminating in Califano signing Section 504 on April 28. According toThe New York Times, Heumann's action was the "longest nonviolent occupation of a federal building in American history."

"We will no longer allow the government to oppress disabled individuals," Heumann told a representative for Califano at one meeting. "We want the law enforced. We want no more segregation."

Section 504 paved the way for the Americans With Disabilities Act, which extended protections to the private sector.

"Judy’s impact is vast," said the Disability Rights Education and Defense Fund. "Each action she took built on the one before it. In her early life, she learned perseverance and patience from witnessing her mother's ongoing advocacy to have her go to school with her non-disabled peers... Those years of segregation sparked her thinking about disability and identity."

Becky Pringle, president of the National Education Association, noted that Heumann's work was instrumental in securing the passage of the Individuals with Disabilities Education Act, then known as the Education for All Handicapped Children Act, in 1975.

Organizer Ady Barkan, who has amyotrophic lateral sclerosis (ALS), wrote on social media that Heumann's decades of advocacy made it possible for people with disabilities to take part in numerous aspects of public life.

"We owe so much to Judy Heumann," he said.

Heumann served for eight years in the Clinton administration as assistant secretary of the office of special education and rehabilitation services and for seven years in the Obama administration as the State Department's first special adviser for international disability rights.

"I join the disability community in mourning the passing of Judy Heumann," said Independent Sen. Bernie Sanders of Vermont. "From leading the 504 sit-ins to fighting for the passage of the Americans with Disabilities Act, Judy dedicated her life to advancing the rights of people with disabilities. We must continue her work."

This content originally appeared on Common Dreams and was authored by Julia Conley.

While it is illegal for North Koreans to maintain contact with any family members who have escaped to the South, staying in touch with them through the use of cellular phones on the Chinese network is fairly easy in the areas near the Chinese border. 

If they are caught, in most cases they can bribe the police to look the other way, and if that does not work, then it’s usually only the caller who gets arrested. 

But now it appears that their families will also be considered guilty by association, and residents are nervous that they too could be punished for the actions of others, a resident of the northeastern province of North Hamgyong told RFA on condition of anonymity for security reasons.

“In my neighborhood close to the border, there have been occasional incidents where people have gotten arrested on charges of making telephone connections with South Korea,” said the source. “But this is the first time I’ve witnessed an entire family being taken away.”

According to the source, authorities caught the mother  in the act of calling her child who escaped to the South.

“On the 21st, [she] was arrested on the spot when she was caught making a call far away from her home,” the source said. “The people saw police drag the three other family members out of their home and arrest them, even though they were not present at the scene of the call.”

As news spread of their arrests the residents became increasingly nervous, according to the source.

“They said that authorities have escalated to a new level by arresting the entire family,” said the source. “They are blaming the authorities for being too harsh.”

The source said that the harsh measure may have been to make an example of the family, because this is the first time they caught someone calling South Korea this year.

“This is meant as a warning to the other residents that the entire family will be severely punished if they are caught talking on the phone with South Korea,” the source said.

Impoverished and autocratic North Korea is highly wary of the cultural influence and soft power of the prosperous and democratic South and works hard to keep its people from contacting southerners or consuming South Korean movies, television and music.

News of the North Hamgyong arrests has reached neighboring Ryanggang province, and a source there, who declined to be named, told RFA that authorities have been beefing up surveillance to stop people from calling outside the country.

“To make a phone call on the Chinese network, you have to go out of the city to get to the highlands, which can take two hours,” said the second source. “Inspectors … are frequently monitoring the movements and travels of defectors’ families.”

Though the term “defector” is widely used in colloquial speech to refer to anyone who escapes from North Korea, human rights organizations prefer to use that term only for those who were in the military or government when they escaped. They refer to others as either “refugees” or “escapees.”

The arrest in North Hamgyong was because an inspector had been assigned to track the whereabouts of all of the family members, and tipped off police when the mother left to make the call, the second source said.

“In the past, the [authorities] entrusted the monitoring of the residents' movements to the head of the neighborhood-watch unit,” the second source said. “However, starting this year, people who cooperate with the authorities are selected from among the residents of the same neighborhood. They are now used as the watchdogs.”  

People caught calling the South are to be charged with “leaking internal secrets,” according to the second source.

“The number of neighborhood-watch unit leaders, informants, and security teams who follow the direction of the State Security Department and the Social Security Department to inspect residents’ movements has increased significantly,” the second source said. “Neighbors are suspicious and wary of each other.”

While the exact number of illegal phone users in North Korea is unknown, the Database Center for North Korean Human Rights, which interviewed 414 North Koreans in the South, reported that 47 percent of them were in constant contact with their families in the North in 2018. Of those, about 93 percent said they called their families on the phone.

In the same survey, 62 percent said they had sent money to North Korea. Based on their answers, the center estimated that refugees in the South who send money to North Korea do it about twice per year, sending around 2.7 million South Korean won (U.S. $2,190) each time.

Each time they had to pay an average broker fee of almost 30 percent.

According to South Korea’s Ministry of Unification, around 33,000 North Koreans have settled in South Korea since 1998, but arrivals have decreased significantly since 2020, likely due to border restrictions in North Korea and China during the COVID-19 pandemic.

Translated by Claire Shinyoung Oh Lee. Edited by Eugene Whong and Paul Eckert.

This content originally appeared on Radio Free Asia and was authored by By Myung Chul Lee for RFA Korean.

The post Mother Nature Still Calls the Shots appeared first on CounterPunch.org.

This content originally appeared on CounterPunch.org and was authored by George Ochenski.

Yang Zijing, who uses the social media handle "Dim Sum," was taken away on Dec. 4 by plainclothes police from her home in Guangzhou on suspicion of "picking quarrels and stirring up trouble," a charge frequently used to target critics of the government, the Hubei-based Civil Rights and Livelihood Watch website reported on Dec. 14.

Yang was detained after getting home from a Dec. 4 protest on Guangzhou's Haizhu Square, and her friends warned not to post details of the arrest to social media, the website said.

The Beijing Road police station confirmed on Dec. 7 she was being held under criminal detention, despite the fact that she had neither held up a sheet of paper, nor made any kind of public speech in Haizhu Square.

Yang's mother Gao Xiusheng flew to Guangzhou as soon as she heard the news, she told Radio Free Asia in a recent interview.

"When I arrived in Guangzhou at 10.00 p.m. that evening, I went straight to the police station, who told me the officer in charge of the case wasn't there," Gao said. "They told me she was in criminal detention but didn't tell me why."

"I asked them to explain why they had brought Dim Sum in, but they said I wasn't allowed to have that information, just to know that she had been detained," she said.

"I went back to the police station with my lawyer the next day, but they told me that they couldn't let me meet with her, and the lawyer couldn't either," Gao said.

Makes no sense

She said it made no sense that people who protested for an end to the zero-COVID policy should be locked up now that it had been lifted.

"Dim Sum was just going along with everyone else," Gao said. "Maybe the means weren't right, but her intentions were good."

"Now, everyone else is allowed to move around freely, but Dim Sum is still locked up," she said.

Uncertainties remain over Yang's exact location.

While a police detention notice claimed she was being held in the Yuexiu District Detention Center, the civil rights website said she was still in Beijing Road police station as of Dec. 12.

Gao said she is concerned for Yang's well-being in police detention.

"I'm most worried about her health, because of the [current COVID-19] outbreak," she said. "I tried to deliver some clothes, but the police officer told me they can't take them, because prisoners aren't allowed to wear their own clothes."

'White paper' protests

Gao's lawyer recently tested positive for COVID-19, and is currently in self-isolation, making it impossible to proceed any further with their attempts to get a meeting with Yang, she said.

"She is a good kid who has always been obedient and never did anything illegal," Gao said. "I had no idea it was so serious at first; I just thought it would be a question of bringing her back home."

"I've been here more than 10 days, and I'm not even allowed to see her ... I've never experienced anything like this before," she said. "All I want is for her to get out as soon as possible, even if we're told we can't talk to anyone about it, and go back home."

Three other Guangzhou-based protesters were detained around the same time for their role in "white paper" demonstrations, in which protesters held up blank sheets of paper in a mute protest at the lack of freedom of speech around ruling Chinese Communist Party leader Xi Jinping's zero-COVID policy.

The authorities relaxed most restrictions under the policy within days of the protests, which were sparked by public anger over a fatal lockdown fire in Xinjiang's regional capital Urumqi, and included calls for Xi to step down and call elections.

Chinese human rights lawyers have been scrambling to assist the friends and families of people arrested during a wave of anti-lockdown protests at the end of November, many of whom have little experience being treated as dissidents by Chinese authorities. 

While the legal volunteers have reported large numbers of enquiries in the aftermath of the protests, lawyer Wang Shengsheng said the authorities have been contacting the dozens of attorneys who signed up and putting pressure on them to withdraw their services.

The Communist Party, faced with the biggest challenge to its rule in decades, views the "white paper" protests as the work of "foreign forces" infiltrating China, a notion that has been met with widespread derision among protesters and social media users.

Translated by Luisetta Mudie.

This content originally appeared on Radio Free Asia and was authored by By RFA Cantonese.

The cases are another example of Beijing severely punishing members of the ethnic minority for visiting or contacting relatives abroad.

Capt. Munirdin Jadikar, now a Dutch citizen, has been living in the Netherlands since 2006. His mother came to visit him in 2014 to attend his wedding, he told RFA’s Uyghur Service.

In 2016, the same year he joined the Royal Netherlands Air Force, he lost contact with his mother, Imanem Nesrulla, and his sister-in-law, Ayhan Memet, he said.

In 2018, while he was stationed in the United States, his sister-in-law was able to initiate contact with him for the first time in two years, using the WeChat messaging platform. She told him that Chinese authorities arrested his mother and sent her to a concentration camp, Munirdin said. 

Then in 2019, he heard that his sister-in-law was arrested for telling him about his mother’s arrest. 

Munirdin made several appeals to the Dutch government to find out more information about both cases, but it wasn’t until he returned to the Netherlands in 2020 that his inquiries made any headway. 

The Dutch foreign ministry contacted the Chinese Embassy, and in July 2021 he received news that his mother and sister-in-law had both been sentenced to 15 years in prison, he said.

“[Ayhan] had told me of my mother’s situation, hoping I would get my mother released since I was living in Europe and working in the military,” Munirdin said. “Just for this information, the authorities sentenced her to 15 years in jail.”

‘Enemy force’

According to the written response he received from the ministry, Imanem was charged with “supporting terrorist activities and inciting ethnicity [sic] hatred and discrimination,” and Ayhan for “illegally providing national intelligence to foreign forces.”

In China’s view, Munirdin said that he is considered to be part of an “enemy force.” 

Munirdin said he was very disappointed that the Dutch foreign ministry could do nothing to help him after they were able to reveal his family members’ fates. “It seems this will hurt their big interests,” he said. “I wrote to my prime minister twice but did not receive any response.”

Munirdin said that both his mother and sister-in-law lived and worked in Qumul (in Chinese Hami), about 370 miles east of Urumqi in the Xinjiang Uyghur Autonomous Region.

In an effort to find more details about both case, RFA contacted Imanem’s last place of employment, a veterinary hospital in the town of Gherbitagh inside Qumul. Staff there confirmed she had been arrested but denied knowledge of the sentence or where she was imprisoned.

RFA also contacted the police station in Gherbitagh, and a police officer said he did not know the exact details of Imanem’s case. “I heard from my colleagues that she was arrested because she had traveled abroad,” he said. “I don’t even know which country she visited.”

Another officer confirmed that Ayhan was sentenced to a lengthy prison term along with her mother-in-law, but denied exact knowledge because the city-level police bureau had handled the case. 

“I was not involved with this. I heard the reason for her arrest was that she had written to someone abroad,” the second officer said.

Due to his professional responsibilities, Munirdin has refrained from any involvement with political activities, but he expressed to RFA that he can remain silent no more, and he is now doing as much as he can for his mother and sister-in-law.

“[Previously] I was not willing to speak to the media as a complainer and a victim because of my position,” he said. But now, “I have to do this for my mother and sister-in-law, who are in prison because of me.”

Translated by RFA’s Uyghur Service. Written in English by Eugene Whong.

This content originally appeared on Radio Free Asia and was authored by By Shohret Hoshur for RFA Uyghur.

Relatives of Alaa Abd El Fattah said Monday that they've received proof in the form of a letter that the jailed, hunger-striking Egyptian-British dissident is alive.

"I'm so relieved. We just got a note from prison to my mother, Alaa is alive, he says he's drinking water again."

"How are you, Mama? I'm sure you're really worried about me," El Fattah's letter, which is dated November 12, begins. "From today I'm drinking water again so you can stop worrying until you see me yourself. Vital signs today are OK. I'm measuring regularly and receiving medical attention."

The 40-year-old father—who according to Egyptian authorities received a "medical intervention" last week—promises to write again and asks his mother to bring him an MP3 player and vitamins when she is able to visit.

Sanaa Seif, El Fattah's sister, tweeted: "I'm so relieved. We just got a note from prison to my mother, Alaa is alive, he says he's drinking water again... He says he'll say more as soon as he can. It's definitely his handwriting. Proof of life, at last."

"Today is the first day I've been able to take a proper breath in eight days," Seif told the BBC. "Now we know he's alive. I'd know his handwriting anywhere. But when I read [the letter] again and again it leaves me with more questions. Why have they been refusing his lawyer access to him, even with a permit?  Why did they hold this letter back from us for two days? Is it just cruelty to punish the family for speaking up?"

Khaled Ali, an attorney representing El Fattah's family, said on Facebook Monday that Alaa also wrote in the letter that he was "fine and under medical supervision."

El Fattah has been imprisoned for most of the past decade for his activism. He played a prominent role in the Arab Spring pro-democracy uprisings that swept the Middle East in the early 2010s and is currently serving a five-year sentence for allegedly disseminating "false news undermining national security," a common charge used to silence activists in the Middle Eastern country run by authoritarian President Gen. Abdel Fattah el-Sisi.

Subjected to torture by beating, solitary confinement, and other methods, El Fattah began his hunger strike 206 days ago on April 2. Earlier this month—with his health already dangerously deteriorated—he stopped drinking water as world leaders, activists, and others gathered in Sharm El-Sheikh, Egypt for the United Nations Climate Change Conference, or COP27.

World leaders, human rights groups, Nobel laureates, climate activists, and others have called for the release of El Fattah and the tens of thousands of other political prisoners jailed in Egypt. Demonstrations in Egypt, Britain, the United States, and elsewhere have demanded the dissident's immediate release.

In a Monday interview with Times Radio, U.K. Foreign Secretary James Cleverly said he was keeping "a very, very close eye on this case."

"What we will do," he said, "is we will keep working to secure consular access because he is British dual national and that is what we expect and we'll keep pushing to get resolution on this long standing and very difficult case."

This content originally appeared on Common Dreams - Breaking News &amp; Views for the Progressive Community and was authored by Brett Wilkins.

The bodies of the two children were found immediately on Saturday morning. Their mother’s body was found later that evening, according to locals. Firefighters and locals are still searching for the man. The names and the ages of the deceased are not yet known. 

A Pakokku resident told RFA it rained heavily on Friday night and Saturday morning, filling the creek and causing it to overflow.

“It’s a dry creek that flows strongly from the rain,” the local said. “The two parents and the children were swept away by the flood when the rain was heavy.”

Myanmar’s rainy season normally lasts from May through October but central regions are usually drier than the lower parts of the country. This year, Pakokku residents say the city has seen heavy rains, toppling trees and power poles and causing roadblocks.

Residents told RFA people who do not own homes in the city center are forced to build houses next to creeks, which often overflow during rainstorms. 

There are many creeks in the city and locals said nearly 100 people have been killed by floods there since 2010.

This content originally appeared on Radio Free Asia and was authored by By RFA Burmese.

CNN is one of two major US TV networks that aired President Joe Biden’s speech live from Philadelphia.

Across the Atlantic just over a week later, King Charles III addressed Britain and the world about his 96-year-old mother’s death and his preparations to take over the solely symbolic role of British monarch. ABC, CBS, NBC and Fox all presumably found it more newsworthy than the President’s remarks, because they carried it live (MediaMatters, 9/9/22). (CNN and MSNBC carried both Biden’s and Charles’ speeches.)

Biden’s speech urgently named MAGA Republican ideology as an imminent threat to democracy, rejected violence and extremism, and condemned conspiracy theories. The “political” speech took an explicitly bipartisan tone, with Biden repeatedly claiming that Trumpism doesn’t represent the majority of the Republican party, and appealing to the American public regardless of political affiliation to defend democracy.

“I’m an American president—not the president of Red America or Blue America, but of all America,” he said.

Charles’ speech, on the other hand, was essentially a eulogy. He waxed poetic about Queen Elizabeth II’s public and private lives, praising her “warmth” and “humor” and the “sacrifices” she made to uphold her “duty.” It was appropriately vague and inoffensive for a figurehead whose job is to be apolitical.

Despite the President of the United States’ speech being patently more relevant to the American people than the symbolic figurehead of another country’s address, the latter had not only more networks airing it, but nearly as much analysis and coverage in the 48 hours surrounding it as the former: A Nexis database search of ABC, CNN, NBC, MSNBC, CBS and Fox transcripts the day of and the day after each of the respective speeches turned up 113 mentions of Charles’ speech and 116 of Biden’s.

The networks varied widely in the relative amount of coverage they gave to the two speeches. ABC and NBC had roughly twice as many segments on Charles’ speech compared to Biden; Fox and MSNBC had closer to twice as many segments on Biden’s speech. CBS and CNN had roughly similar numbers of segments on each speech.

‘Politically charged’

However much time they gave it, each of these networks characterized the president’s speech as inflammatory, ignoring much of its content, and “balancing” it with a chorus of Trump-aligned politicians.

Fox characterized Biden’s speech as a “dark and depressing” “diatribe.”

Unsurprisingly, on Fox News’s Hannity (9/2/22), fill-in host Tammy Bruce whined that Biden “bashe[d]” Republicans in his “rage-filled speech” that she later described as a “dark and depressing” “diatribe.” But this same right-wing indignation could be heard across network news, regardless of their presumed political leanings.

ABC’s World News Tonight anchor Mary Bruce (9/2/22) called the remarks “scathing,” saying the speech “slam[med]” MAGA Republicans. The segment quoted Republican former South Carolina Gov. Nikki Haley, who served as UN ambassador for Trump: “It was one of the most unbelievable things I’ve seen in a long time. It’s unthinkable he would be so condescending and criticize half of America.”

Putting aside that Haley’s own history of opinions about Trump are mixed—“He went down a path he shouldn’t have, and we shouldn’t have followed him, and we shouldn’t have listened to him,” she said after January 6—the segment did not bring up Biden’s repeated clarifications:

• “Now, I want to be very clear up front: Not every Republican, not even the majority of Republicans, are MAGA Republicans. Not every Republican embraces their extreme ideology.”
• “There are far more Americans—far more Americans from every background and belief—who reject the extreme MAGA ideology than those that accept it.”
• “Democrats, independents, mainstream Republicans: We must be stronger, more determined, and more committed to saving American democracy than MAGA Republicans are to destroying American democracy.”

Reporter Craig Melvin on NBC’s Today show (9/2/22) described the speech as “politically charged,” and anchor Peter Alexander called it “blistering,” including derisions from Republican California Rep. Kevin McCarthy, without including any voices of those who found Biden’s condemnation of Trumpism necessary. The segment also described the speech being delivered in front of a “military backdrop”—that is, two Marines standing behind Biden. (Marines have been present at other debatably “political” presidential speeches, including Trump’s at the RNC in 2020.)

CBS Morning News’ Bradley Blackburn (9/2/22) chose the word “sharp.” And though CNN opted to air the remarks in primetime, they included the opinion of former Trump White House official Gavin Smith, who posited that threats to democracy are not a priority to discuss in a 25-minute speech, and that Biden should have spoken instead about rising prices (CNN New Day, 9/2/22). (To her credit, anchor Brianna Keilar pushed back against this statement.)

MSNBC’s The Beat (9/2/22) took Biden’s speech more seriously, with anchor Katie Phang calling out the irony of the GOP labeling a speech about the GOP’s divisiveness as divisive. “There’s so many Trump supporters,” she said:

They’re screaming about how Joe Biden now has promoted this divisiveness. But you know, the reality is, they’re not looking in the mirrors, right? There’s this hypocrisy that seems to be the currency that these Republicans are trading in.

Believers in the ‘storm’

Instead of engaging in handwringing over Biden’s tone, these outlets could have investigated the truth of his claims that MAGA ideology—regardless of what percentage of the Republican party subscribes to it—is a threat to democracy. Beyond the deadly January 6 insurrection itself, polling backs up Biden’s assertions that there are  widespread anti-democratic tendencies within the Republican Party.

In February, a PRRI report found that a quarter of Republicans consider themselves believers of the QAnon conspiracy theory. When polled on the three central delusions of QAnon, 16% completely or mostly agreed that  media and economy are run by a Satan-worshiping cabal of child sex-traffickers; 22% completely or mostly agreed that a coming “storm” will wipe away these elites and restore the country to its rightful leaders; and 18% completely or mostly agreed that violence may be necessary to save the country.

Additionally, the Washington Post (9/18/22) recently questioned 19 GOP candidates running in gubernatorial and Senate races about whether they’d accept the results of the upcoming elections. Twelve either refused to commit or declined to respond. All 19 Democratic nominees committed to accepting the results of the elections.

Sowing distrust in legitimate democratic processes—and resorting to violence in an attempt to prevent them—is certainly dangerous to democracy.

‘A very significant event’

Of course, Charles’ address the day after the queen’s death served a much different purpose than Biden’s: celebrating and remembering a figurehead, versus warning against a rising domestic threat to American democracy. While comparing the content of these two addresses would be comparing apples and oranges, networks’ attitudes toward each are telling.

“Breaking News”: CBS had extensive live coverage from London surrounding King Charles III’s speech.

On Chris Jansing Reports (9/9/22), MSNBC’s British historian Andrew Roberts called Charles’ speech “very significant.” CBS Evening News’ Norah O’Donnell and Charlie D’Agatta (9/9/22) called it “historic.” On CNN’s Erin Burnett Outfront (9/9/22), CNN International diplomatic editor Nic Robertson foreshadowed the upcoming ceremony that marked Charles’ official ascension to the throne, also calling it “perhaps a very significant event.”

While the death of the 96-year-old queen and ascension of her son might be significant for royalists—and the pomp, circumstance, anachronism and celebrity of the monarchy might be entertaining and appealing to many Americans—it has almost no political implications for the world. That’s because the British monarch’s role is ceremonial, and, as the constitution dictates, apolitical.

But the British monarch is also inextricably linked to the British Empire and is a living symbol of that imperial legacy, as well as of an extreme elitism based on nothing more than the privilege of birth (Economist, 9/15/22). Elizabeth’s death spurred significant conversations about Britain’s brutal, bloody legacy of colonialism around the world and abolishing the monarchy—all of which was left out of the above segments, and the majority of network news coverage.

US news networks instead largely discussed the queen’s death as if everyone agreed on her legacy. “The world mourns the death of Queen Elizabeth,” said CBS Mornings’ Anne-Marie Green (9/9/22), who described the late monarch as “one of the most beloved women in the world.”

‘We need to examine that history’

The entire world was not, in fact, mourning the death of Britain’s queen. On Democracy Now! (9/13/22), Amy Goodman discussed the possibility that “British Overseas Territory” (read: colony) Antigua and Barbuda might cut ties with the British monarch. When asked to respond to the queen’s death, Dorbrene O’Marde, chair of the Antigua and Barbuda Reparations Commission, said:

I’m under no obligation, I think, to be mourning her death. And that is simply because of, I think, my understanding of history, my understanding of the relationships of the British monarchy to African people and Asian people, but to African people certainly, on the continent and here in the Caribbean. And so that my response is perhaps to recognize the role that the queen, Queen Elizabeth II, has played, how she has managed to cloak the historical brutality of empire in this veneer of grandeur and pomp and pageantry, I guess, and graciousness. But I think that at this point in time, we need to examine that history a lot more closely.

The British Empire committed many atrocities during Elizabeth II’s reign (Liberation News, 9/9/22):

• The “Malayan Emergency” (1948–60) was a guerilla war fought between Britain and the Communist Malayan National Liberation Army (MNLA) after the territory sought independence from British rule. During this 12-year-long war (of which eight years were fought under Elizabeth), British forces set fire to homes and farmland of those suspected to be affiliated with the MNLA, sent 400,000 people to concentration camps and destroyed crops with Agent Orange. 6,700 MNLA fighters and more than 3,000 civilians were killed.
• The Mau Mau rebellion (1952–60) took place in Kenya when the Mau Mau rebels launched an uprising against colonial powers, white settlers and loyalists in the country. The British launched a counterinsurgency campaign, sending more than 100,000 people to detainment camps where they were tortured, interrogated and abused. The Kenyan Human Rights Commission estimated 90,000 Kenyans were killed, maimed or tortured, and 160,000 were detained in camps.
• The Covert War in Yemen (1962–69) cost an estimated 200,000 lives. After the death of Yemeni King Ahmed in 1962, Arab Army nationalists backed by the Egyptian army seized power and declared the country a republic, with popular support. Britain claimed it would not intervene, but supplied fighter jets and weapons to royalist forces.
• Bloody Sunday (January 30, 1972) was just one incident during the Northern Irish Troubles, a 30-year fight for independence from Britain. Marchers in Derry, in British-occupied Ireland, were protesting against British legislation that allowed suspected Irish nationals to be imprisoned without trial; the British military opened fire on them, killing 14.

Even though Elizabeth II had no legislative abilities, this colonial violence was enacted to uphold the empire she helmed (Vox, 9/13/22).

‘They know nothing about colonialism’

Fox specifically scolded those criticizing the monarchy, claiming colonized countries should be grateful for the image of stability Elizabeth upheld, arguing she led the decolonization process. Contributor Douglas Murry claimed on Hannity (9/9/22):

They know nothing about colonialism. They clearly know nothing about the decolonization process. They know nothing about the late queen’s extraordinary work with the commonwealth countries. If the queen would preside over this, was it a genocidal empire? Unbelievable. There’d be nobody alive if it had been a genocidal empire. And they smear her with this total lack of knowledge.

There are a handful of scholarly and international legal definitions of genocide. “Everyone has to be dead” is not one of them.

Other programs may not have engaged in this kind of royalist admonishment, but they still delighted in the royal corgis (ABC’s Nightline, 9/9/22), swooned over Charles’ “emotion” (CNN Newsroom, 9/9/22), admired his handshaking with the crowd (Fox Special Report, 9/9/22) and saluted his promise of a “life of service” (NBC Nightly News, 9/9/22), with little space given to substantive critique of what the monarchy represents.

Outlets aired King Charles III’s speech live and spent the surrounding hours commending his life in service and glossing over Britain’s colonialism.

As noted, none of the aforementioned TV segments that effusively memorialized the queen and relished in the pomp and circumstance of the monarchy addressed colonialism. In fact, of the total 113 segments on network TV that mentioned Charles’ speech, only 29 mentioned—even in passing—Britain’s colonial legacy or calls to abolish the monarchy. Fifteen of those were from CNN, five from MSNBC, four from NBC, three from Fox (all of which condemned criticism of the monarchy), one from ABC and one from CBS.

CBS’s mention denied that there was any movement for change: “There is no current, no modern, serious movement to abolish the monarchy,” journalist and royal-watcher Tina Brown said on CBS Mornings (9/9/22).

That depends on what you define as “serious.” In Australia, thousands marched for abolishment, shutting down streets in Melbourne on the country’s National Day of Mourning for the queen (Australian Broadcasting Corporation, 9/22/22). #AbolishTheMonarchy trended on social media (Forbes, 9/9/22). Pro-republican campaigns in Australia, New Zealand and Canada are expected to gain traction now (Wall Street Journal, 9/11/22).

Many shows repeated the term “colonial past” (e.g., NBC’s Today, 9/9/22; CNN Newsroom, 9/9/22), as if British colonialism is not ongoing. Today, British companies still own $1 trillion of Africa’s gold, diamonds, gas and oil, and an area of land in the continent about four times the size of Britain itself (Guardian, 4/17/18).

Other legacies of colonialism still reverberate: In 2013, Carribbean heads of governments established the Caricom Reparations Commission (CRC) to demand reparations for Britain’s genocide, slave trade and apartheid in the region, citing illiteracy, physical and mental health issues and generational poverty as modern-day effects of British rule and slave trade.

Suffice it to say, worldwide opinion about the British monarchy, the death of Queen Elizabeth and the rise of King Charles is far from unanimous, despite US television news framing Charles’ speech—unlike Biden sounding the alarm over the threat to democracy—as something we all could agree on.

The post King Mourns Mother? Breaking News. Democracy Under Threat? Not So Much. appeared first on FAIR.

This content originally appeared on FAIR and was authored by Olivia Riggio.

Journalist Kavish Aziz tweeted the 10-second video of the Prime Minister’s speech. (Archive link)

जब मैं छोटी चोरी करता था..उस दिन अगर मेरी मां ने रोका होता… तो आज मै इतना बड़ा लुटेरा नहीं बनता.. pic.twitter.com/U0cgc63u97

— Kavish Aziz (@azizkavish) September 6, 2022

Journalist Dinesh Kumar, too, tweeted the clip. (Archive link)

A Facebook user named Mohammad Javed Akhtar shared the 10-second video. It got more than 6 lakh views till the time of the writing of this article.

This video is viral on Facebook and Twitter.

Fact-check

Alt News performed a reverse image search of a frame of the viral video on Google. We found the video of Prime Minister Narendra Modi’s YouTube channel in the search result. On 10 April 2021, the channel uploaded a video of Prime Minister Modi’s speech in Siliguri, West Bengal. The viral video is part of this speech. In the video of PM Modi’s entire speech, the part of the viral video can be seen after 40 minutes 38 seconds.

At the 39.39-minute mark in the original video, Modi broaches the topic. He says “when we were younger, we heard a story. In that story, there was a very big dacoit who was sentenced to death. After the sentence, he was asked what his last wish was. So he said he wanted to meet his mother. Then the government made arrangements so that before going to the gallows, he could meet his mother. When he met his mother, he snapped at her and cut off her nose. Before being hanged to death, he cut off his mother’s nose. So people asked him why did that to his mother. He said if my mother had stopped me from committing small thefts when I was a child, I would not have become such a big looter, and today I would not have been sentenced to death.”

To sum it up, in the viral video, PM Modi was talking about theft and robbery in the context of a story. But the clipped video of Prime Minister Narendra Modi’s speech was shared without context by many journalists and social media users.

The post Did Modi say his mother should’ve stopped him from committing petty thefts? No, it’s a clipped video appeared first on Alt News.

This content originally appeared on Alt News and was authored by Abhishek Kumar.

The move was a safety precaution: After the leak of a draft of a majority Supreme Court opinion in Dobbs v. Jackson Women’s Health Organization to overturn the constitutional right to abortion, reporters at Rewire grew concerned about a possible uptick in online harassment.

“The newsroom has for years kept a repository of harassing messages to track patterns, just in case,” said editor-in-chief Galina Espinoza. The threats range from blowing up Rewire’s Virginia headquarters to suggesting the editors should be shot. 

“I feel very fortunate to say that nothing has ever come of these kinds of threats,” Espinoza said. “But it’s obviously not only scary, it’s mentally taxing and it takes a toll on mental and emotional health.” 

The changing abortion landscape in America has put some reporters who cover the topic on edge. In addition to concerns about online harassment, reporters told CPJ they are wary of real-world violence and of the ways that shifting laws could leave them and their sources vulnerable to legal threats in the wake of the Supreme Court’s decision in June to overturn Roe v. Wade. 

In Kansas, where an anti-abortion activist killed abortion provider George Tiller in 2009, reporters are highly aware of the potential for violence around the issue. 

“I would say that I’m always cautious of that danger, particularly being in a state where we’ve seen a doctor murdered in his church,” Sherman Smith, editor-in-chief of the nonprofit news organization Kansas Reflector, told CPJ. He said he’s not worried about an immediate threat, “but it’s something I think that we have to be cautious about, that when we’re going out to public events we have to think about it, and certainly when we’re talking to sources, we have to be cautious about putting them in harm’s way.” 

Smith said that though the news organization has no stance on abortion, it was accused of taking sides after it published in July leaked audio of a meeting during which an activist group made clear its intent to ban abortion with a proposed amendment to nullify the state Supreme Court’s abortion protections. The group, Value Them Both, had publicly claimed that it didn’t seek to ban the procedure. 

When the amendment failed, Value Them Both sent out an email blast claiming that “the mainstream media propelled the left’s false narrative, contributing to the confusion that misled Kansans about the amendment.” Smith said the newsroom also received vitriolic emails from readers, including one that accused the reporters of having “bloodshed” on their hands by failing to portray abortion as murder. 

“From our perspective, we’re just trying to give people the information they need to make up their mind about this [issue], but if we’re not carrying water for them, [advocates] see us as the enemy and they can direct their rage toward us,” Smith told CPJ. The only other issue around which Smith remembers witnessing so much vitriol toward the media was another dealing with bodily autonomy: COVID-19 vaccine mandates.

Becca Andrews, a reporter at Mother Jones magazine who covers abortion and is based in Nashville, has also noticed a more heated environment, she told CPJ in a phone interview.

When a source who works in abortion rights called to say that anti-abortion activists had damaged her house and car, Andrews, who has a book about abortion rights coming out this fall, began reassessing her own risk profile. 

“Things just feel a little more charged than they have previously,” said Andrews, adding that her identity as a white staff reporter adds a layer of privilege that others do not necessarily enjoy. “I’d like to say it all [the threats to advocates and sources] doesn’t have a chilling effect… but it’s messy.” 

Shifting legal landscape

The Supreme Court decision to overturn the constitutional right to abortion has also ushered in a new era of legal uncertainty for pro-abortion activists, medical providers, and patients, as well as the journalists who cover them. 

Journalist Rosemary Westwood, one of the few reporters in the Deep South on the reproductive health beat, chronicled the closing of Mississippi’s last abortion clinic at the center of Dobbs v. Jackson Women’s Health Organization case in a podcast called Banned. 

She told CPJ in a phone interview that she began to fear that her reporting could be used against her sources after Roe v. Wade fell. 

“I was reporting on things that were completely legal – they were just controversial. And now I’m reporting on stuff that’s going to be illegal, which is a completely different landscape,” Westwood said. 

According to Gabe Rottman, director of the Technology and Press Freedom Project at the Reporters Committee for Freedom of the Press, a non-profit that provides free legal resources for journalists, Westwood is right to be concerned. 

“People need to know what the fallout of the Dobbs decision looks like on the ground, which creates a professional obligation for journalists to tell the story,” he told CPJ in a phone interview. He fears that legislation in states where abortion is newly restricted could compel reporters to compromise their sources. 

He pointed to Branzburg v. Hayes, a 1970s case in which prosecutors forced a reporter to hand over source information, arguing that the source, a drug dealer, was committing a crime. A court could, in theory, attempt to use this same argument to compel reporters to turn over identifying source material from their abortion coverage. 

“There are, of course, First Amendment arguments you could make if that kind of situation arose [around abortion],” Rottman said. “But the fact that this is even in the realm of possibilities is itself cause for concern… [T]he temptation to push the envelope can itself impact newsgathering and reporters’ ability to report on abortion after Dobbs.”

For some news organizations, the possibility of legislation that increasingly could limit speech around abortion has also stoked concerns.