Are abortion bans doubling ectopic pregnancy deaths?
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On September 9, 2026, ProPublica published Ectopic Pregnancy Deaths Have Nearly Doubled. It’s Worse in States With Abortion Bans. The headline is getting play across social media, with commenters interpreting this as yet more evidence of the harms caused by abortion restrictions.
News headlines often imply, but don’t explicitly claim, causation.
Headlines like ProPublica’s are common in journalism. Name a correlation, and leave readers to infer causation. Research finds that even psychology PhDs read ambiguous wording as implying cause and effect; we can expect the average social media user is more likely to make the same mistake.
And if a few people do question how the two factors in a headline are causally linked, the outlet has plausible deniabilty: “We didn’t say they were.”
Are abortion restrictions causing increases in ectopic pregnancy deaths?
ProPublica’s headline (the only part of the article most people read) implies cause and effect, but the text of the article itself is much more cautious. Examples (emphasis added):
- “ProPublica’s analysis found a stark and baffling increase”
- “[Maternal health experts] cautioned that abortion bans alone can’t explain the national rise”
- “Experts aren’t sure why ectopic deaths have continued to rise.”
- “Experts told ProPublica that more research is required to determine the role of the abortion bans in the rise of ectopic-related deaths.”
Essentially ProPublica has documented a national increase in ectopic pregnancy deaths, noted a correlation between sharper increases and states with abortion restrictions, and speculated as to why abortion restrictions might be a contributing factor to a larger problem.
Here we are in familiar territory. Our country has plenty of reproductive healthcare problems. When the problems happen in states with abortion restrictions, abortion advocates will hurry to argue the restrictions were the reason. (When the problems happen in states without abortion restrictions, there’s less interest.)
[Read more – Are doctors afraid to manage miscarriages because of abortion bans?]
When the problems happen nationally, abortion advocates will argue the situation is worse in states with abortion restrictions, because of those abortion restrictions. These narratives rarely account for other state and regional variables (e.g. disparities in health insurance coverage, prevalence of chronic conditions, rural vs urban healthcare settings, etc.).
ProPublica is again more cautious. In this article the authors call out the problem of confounding variables explicitly (emphasis added):
Many states with bans, which generally provide less Medicaid funding and coverage to low-income women, have long had poorer maternal outcomes. “It’s a real challenge to try and tease out one thing out of the array of factors that undermine women’s health in these states,” said Eugene Declercq, a public health researcher at Boston University.
Ectopic Pregnancy Deaths Have Nearly Doubled. It’s Worse in States With Abortion Bans. ProPublica, 9/9/26
Specifically, many states with abortion restrictions have had poorer maternal outcomes since well before they enacted those restrictions. It gets more difficult, then, to argue that poorer outcomes are because of abortion restrictions.
[Read more – Maternal mortality rates in pro-life vs pro-choice states]
A beginner’s guide to denial-of-care stories
Credit where it’s due, ProPublica repeatedly acknowledges that we don’t actually know why ectopic pregnancy deaths have increased (see above). The article is careful to only speculate, rather than outright claim, that abortion restrictions are to blame. Here the authors engage in the same framings that, at this point, we’ve seen many times over.
Fail to disclose the abortion industry affiliations of quoted experts.
Dr. Ushma Upadhyay (ANSIRH)
ProPublica quotes Ushma Upadhyay, describing her simply as “a researcher at the University of California, San Francisco, who studies telehealth abortion administration.”
Anytime an abortion advocacy piece quotes someone from the University of California, San Francisco, it’s a safe bet they are actually referencing someone who works for ANSIRH (Advancing New Standards in Reproductive Health). ANSIRH is one of the most vociferous abortion advocacy organizations in the country, and possibly in the world.
Upadhyay herself is a self-described “abortion safety expert” who has repeated the long-debunked claim that mifepristone is safer than Tylenol. She leads research on missed period pills, which are abortion pills for people who don’t confirm pregnancy before taking them, so they don’t have to know if they’ve had an abortion or if their period was simply late. In particular, Upadhyay has previously described her decades-long hope to see abortion pills available via telehealth as a way to expand abortion access.
This staunch advocate for mail-order mifepristone is the expert ProPublica turns to when considering whether deregulated abortion pills could have negative impacts on ectopic pregnancy care.
Dr. Rebecca Nerenberg (Access Bridge)
ProPublica describes Rebecca Nerenberg as “an emergency medicine doctor in New York and the clinical director at Access Bridge, which educates ER doctors on reproductive healthcare.”
Access Bridge is an abortion advocacy organization. It frames its purpose around abortion bans, rather than reproductive health generally: “In light of the alarming restrictions on reproductive rights … we can make a critical difference in ensuring access to care in states with abortion bans.” It’s a subset of The Bridge Center, which focuses on “reform in historically stigmatized care … including abortion.”
ProPublica has a history of omitting these kinds of affiliations when quoting experts.
Describe standard medical practice as abnormal.
ProPublica describes a pattern of doctors discharging women with possible ectopic pregnancies, instructing them to return and get repeat hCG levels or ultrasounds later. ProPublica suggests the “discharge and recheck” response is the result of legal caution:
Experts have worried that doctors are hesitating to offer treatment without an ironclad diagnosis, which clinicians say can take time and increase risks to the mother.
Ectopic Pregnancy Deaths Have Nearly Doubled. It’s Worse in States With Abortion Bans. ProPublica, 9/9/26
But the “discharge and recheck” response is a routine medical approach to potential ectopic pregnancy. The ProPublica article itself contains evidence of this; it cites what the authors describe as “evidence-based guidelines” from Access Bridge (an abortion advocacy group). These guidelines explictly recommend the “discharge and recheck” approach: if a patient with a pregnancy of unknown location has no symptoms of a ruptured ectopic pregnancy, and has hCG levels below 3,500 mIU/mL (the “discriminatory zone”), Access Bridge recommends waiting and reassessing hCG in 48 hours.
In fact, Access Bridge offers a Pregnancy of Unknown Location protocol for “settings limiting abortion care/referrals” and a Suspected Ectopic Pregnancy protocol for “settings allowing abortion care/referrals,” but in both protcols, the recommendation remains the same. When a woman’s hCG level is below the discriminatory zone, and ultrasound doesn’t indicate if her pregnancy is in her uterus or elsewhere, both protocols recommend measuring her hCG levels again in 48 hours.
In other words, when a woman has a possible ectopic pregnancy and no signs of emergency, ProPublica’s own quoted experts consider “discharge and recheck” standard medical practice.
Attribute common malpractice issues as results of abortion laws.
Leitaea Lowrimore
ProPublica describes the case of Leitaea Lowrimore, who visited three different ERs (Mercy Hospital and Baptist Health Hospital in Arkansas, and University of Oklahoma) repeatedly over a week until traveling to Kasnas and getting the medical treatment she needed.
Lowrimore’s case is a reasonable example of the cause and effect ProPublica is suggesting, especially because one of the Arkansas OBGYNs claimed treating her could mean he’d go to jail. A doctor citing fear of the law as a reason to not provide necessary medical treatment is enough to make the point that, in at least some cases, patients aren’t getting the care they need because of hospital interpretations of abortion restrictions. We argue these interpretations are, frankly, absurd, and, interestingly, more abortion advocates are starting to argue the same. (See some examples in our previous article: ProPublica is right about Emily Waldorf. Arkansas in particular seems to continue to have this problem.)
That said, even in the Lowrimore case, many details don’t fit the “fear of prosecution” theory. Lowrimore first presented to Mercy with hCG well below the discriminatory zone, and they responded with the “discharge and recheck” protocol ProPublica’s experts have described as standard practice. Her visit the next day to Baptist Health fell within the same guidelines.
Her subsequent visits did not fall within “discharge and recheck” – she showed signs of abnormal hCG level changes, and increasing evidence of probable ectopic pregnancy without getting the treatment she should have. But the failures to get that treatment still aren’t always well explained by fear of prosecution.
The OBGYN who related his medical decisions to fear of jail time was at Baptist Health. Mercy Hospital appeared to have other issues; ProPublica links this summary of deficiencies from the Department of Health and Human Services (DHHS). It describes Mercy Hospital’s deficient response to Lowrimore and two other patients: one at high suicide risk and another with multiple acute rib fractures. All three patients presented with serious conditions, waited for hours, got frustrated, and left before a physician examined them, and in all three cases there’s no documentation that hospital staff explained the risks of leaving. These are failures, but not ones driven by abortion laws.
Kyleigh Thurman
The ProPublica article also describes the case of Kyleigh Thurman, who is suing Texas hospital Ascension Seton Williamson for malpractice. In 2023, Thurman had gone to their ER for suspected ectopic pregnancy only to have the hospital send her home. A week and a half later her fallopian tube ruptured and she needed emergency surgery. ProPublica notes (emphasis added):
Regulators in 2025 found that one of the hospitals, Ascension Seton Williamson, failed to properly screen Thurman for a suspected ectopic pregnancy and did not call in an OB-GYN, in violation of the hospital’s own policies and federal law…
Ectopic Pregnancy Deaths Have Nearly Doubled. It’s Worse in States With Abortion Bans. ProPublica, 9/9/26
The ProPublica article links to another DHHS summary of deficiencies, this one finding that Ascension Seton failed to follow its own standard processes for checking patients with Thurman’s symptoms, including failing to have the on-call OBGYN examine her in person. Instead, the OBGYN consulted only by phone with the ER doctor, and from that alone concluded that Thurman was stable enough to be discharged.
The theory that abortion restrictions are contributing to ectopic pregnancy deaths is based on the idea that hospital staff are afraid of (1) overzealous prosecutors enforcing (2) overly punitive laws against providers who (3) intervene in pregnancy in ways that lead to embryonic or fetal death. In Thurman’s case this theory makes no sense for multiple reasons:
- As we’ve pointed out before, in the years since Dobbs overturned Roe v. Wade, no one in Texas (or in the entire United States) has been prosecuted for providing medically necessary abortions (here I specifically mean interventions in pregnancy that result in embryonic or fetal death). In Texas alone, there are at least 26,000 pregnancies each year that would typically require medical intervention,* or an estimated 104,000 cases in four years since Dobbs. And there has not been a single prosecution related to those interventions.
- Texas abortion law is explicit that ectopic pregnancy intervention is allowed and danger doesn’t have to be imminent before providers can intervene.
- Ascension Seton’s failure was to properly assess for ectopic pregnancy, not failure to intervene once ectopic pregnancy was established. ProPublica’s argument is that doctors are being overly cautious about confirming ectopic pregnancy before intervening, but Ascension Seton’s problem was the exact opposite: they were decidedly incautious about confirming ectopic pregnancy in the first place.
Ascension Seton’s own hospital policies outline how to assess and intervene in cases of ectopic pregnancy, suggesting the hospital is aware that it is legal (in fact expected) for their staff to do both. Nothing about the hospital staff’s behavior suggests they were operating out of concern for abortion laws. Instead this reads as the far more common problem of medical errors due to distraction, poor communication, and shortcuts.
*My back-of-the-envelope calculation to get this number: I conservatively estimated 1% of pregnancies that are ectopic, 1% that are missed miscarriages, and 2.5% PPROM, so 4.5% total. There are other conditions that may require intervention, but to be conservative I picked only these three common ones. I used a ratio of 1.5 pregnancies per live birth (Guttmacher says about 67% of pregnancies end in live birth). Texas had 391,000 in 2024, implying 586,500 pregnancies. 4.5% of those pregnancies would be 26,392 cases.
Describe a problem without proper control group
According to their methodology, ProPublica included 18 states (Alabama, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Carolina, South Dakota, Tennessee, Texas and West Virginia) in their “strict abortion bans” group. They compared these to 27 states plus DC as their “no bans” group. They excluded states that had bans starting later than six weeks, or those that were struck down or never took effect.
It would have been interesting to track each state’s own mortality trend before and after it enacted its restriction. While many of the 18 states began restrictions with Dobbs (2022), others started later. For example, North Dakota’s abortion law was blocked for years until it was ultimately upheld in late 2025. Additionally, some have since removed their restrictions. For example, Missouri voters overturned the state’s ban in 2024.
As we’ve discussed, there are plenty of factors besides abortion laws that could contribute to a state’s better or worse maternal health outcomes. If we had the data to compare each state before and after its changes in abortion laws, such a comparison would account for that state’s confounding factors that existed both before and after the change in law. In other words, a given state’s control group is that same state at an earlier time.
Finally, ProPublica compared national numbers from 2020-2026 to those from the six years prior, but this means it included two years prior to Dobbs (2020 and 2021) when speculating on the effect of abortion restrictions that almost all happened 2022 or later.
When there’s less than meets the eye
ProPublica’s headline suggests a lot more than the actual reporting shows. The outlets experts caution that more research is needed and emphasize they can’t say why the rise in ectopic pregnancy deaths is happening. But the piece still engages in what are now familiar tactics we’ve talked about repeatedly. The authors quote experts with significant ties to abortion advocacy without disclosing those affiliations. They frame “discharge and recheck” as a fear-driven approach, when their own citations outline this response as a standard medical practice. The cases they used to try to demonstrate doctors fear abortion laws tend to have more plausible explanations around common clinical failures. And the piece compares ban and non-ban states without controlling for confounding factors.
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