May 24, 2019 (National Right to Life) — Perhaps no state is as big a source of frustration to the advocates of abortion as Texas. Second only to California in population, it was for years home to some of the nation's busiest abortion clinics, performing some 100,000 abortions a year in the 1980s.
Like everywhere else, these numbers began to fall in Texas in the 1990s. But what really provoked the ire of abortion advocates was when Texas began passing laws to limit abortion and the funding of abortion-performing groups in the 2010s.
Though clinics were closing and numbers were falling for years, abortion advocates were especially alarmed when Texas first passed a law in 2011 cutting funds to family planning clinics and then HB2 in 2013, a law imposing basic safety regulations on clinics. Wildly unsubstantiated claims were made that these laws were responsible for the closure of some twenty Texas abortion clinics, leaving large areas of the state without any abortion provider.
While many of the details and characterizations of these claims had to be corrected or refuted (see NRL News 3/8/16), abortion advocates offered this as “evidence” of a looming crisis in Texas women's health.
All this is to readily explain why abortion advocates and their allies in the media, in politics, and the medical establishment latched onto a report that appeared in the journal of Obstetrics & Gynecology in September of 2016. The report asserted that maternal mortality had skyrocketed in Texas between 2010 and 2012 — more than doubling from 72 mothers dying from pregnancy-related complications to 148 in just two years time!
Relying on Unreliable Maternal Mortality Data
Even researchers admitted that an actual doubling within a two-year period seemed unlikely in the absence of “war, natural disaster, or severe economic upheaval.” But they nonetheless hung their hat on the notion that “There were some changes in the provision of women's health services in Texas from 2011-2015, including the closing of several women's health clinics.”
The results were quickly picked up in the popular media. The Houston Chronicle reported “Texas pregnancy-related deaths double” (8/18/16). The Guardian reported “Texas has highest maternal mortality rate in developed world, study finds.” They added, “As the Republican-led state legislature has slashed funding to reproductive healthcare clinics, the maternal mortality rate doubled over just a two-year period” (8/20/16)
The Washington Post reported the increase, although acknowledging that “Pregnancy-related deaths started climbing before the latest cuts to Texas's Title X family planning services.” Their fallback position was to claim “the budget cuts are making it worse” (9/26/16). The Texas Tribune accepted the results but said only “More New Mothers in Texas are Dying; Experts Can't Explain Why” (9/5/16).
In a Sept 3, 2016 editorial, the New York Times noted the huge increase in Texas, and while cautious about placing the whole blame on the new abortion laws, nevertheless assumed they were a factor.
The surge in maternal mortality in Texas defies easy explanation. Such increases typically happen during war, natural disasters and severe economic distress. State Republican lawmakers sharply reduced spending on women's health care in 2011 in an effort to eliminate government funding of Planned Parenthood. The cuts, which took effect at the end of that year, don't account for all of the increase, but they certainly don't aid maternal health.
As noted by the Times and other sources, there was some question at the time as to the accuracy of the findings. The jump was too high, too fast. The timing wasn't precise in relation to history of the Texas legislature's activities. A multi-disciplinary task force set up by the Texas legislature looked into the data from the 2016 Obstetrics & Gynecology study and found a number of problems.
Correcting the Record
After examining and cross referencing the medical records of the 147 women the original study said had died of pregnancy-related complications, the task force noted that many of those cases had been erroneously counted.
In a response published in Obstetrics & Gynecology in May of 2018, the task force said that only about a third (56) of those deaths actually met the standard criteria for maternal mortality.
With this correction, the maternal mortality rate for Texas for 2012 dropped from the 38.4 deaths per 100,000 live births reported in the 2016 Obstetrics & Gynecology study to just 14.6 deaths per 100,000 live births.
This means instead of a figure nearly twice the national maternal mortality rate of 19.9 reported for 2012, the real figure was actually less than the national average.
And if the original number of 72 maternal deaths given for Texas for 2010 holds up (the task force did not reexamine the 2010 data), it would actually mean that maternal deaths declined following the Texas state legislature's redirection of family planning funds in 2011.
This was decidedly not the pro-abortion narrative.
There was some coverage of the revised mortality figures. The Dallas Morning News (4/16/18) published commentary from a doctor claiming “Texas is more concerned with counting maternal mortality deaths than saving lives.”
The Washington Post (3/11/18) was more straightforward — “Texas's maternal mortality rate was unbelievably high. Now we know why.”
But there were apparently some top political and medical figures who didn't get the message or, perhaps, chose to ignore it.
Congressional Testimony Repeats Faulty Data
This week Washington Post fact checker Glenn Kessler recounted remarks made by Rep. Don Beyer (D-VA) at a House and Ways Committee hearing on May 16, 2019. Beyer asserted:
Anti-abortion bills increase maternal mortality and infant mortality. Texas is the best case. The reported rate of maternal deaths in Texas doubled when the state closed their abortion clinics and cut funding for Planned Parenthood. The fact is that if Texas was a country it would have the highest maternal mortality rate of any developed country in the world.
Unfortunately for Beyer, Lisa Hollier, one of the members of the Texas task force that debunked the original findings, was a witness at that hearing. She corrected Beyer, a reliable abortion defender.
“When we analyzed the data, we identified there was significant over-reporting of deaths based on the death certificate data,” she told the committee, telling them because of the errors, the maternal mortality rate was “not as high as previously reported” (Washington Post, 5/21/19).
A staffer from Beyer's office later owned up to the error. This allowed Beyer to avoid the Washington Post fact-checker's dreaded “Four Pinocchios” rating for “Whoppers” that go beyond “significant factual error and/or obvious contradictions” (“Three Pinocchios”). Kessler expressed concern that Beyer's staff had missed the newer information.
As bad as that was, another witness on the same Congressional panel, Patrice Harris, president-elect of the American Medical Association (AMA) Board of Trustees made the same erroneous claim in her prepared testimony.
Dr. Harris said that Texas maternal mortality rates had been stable from 2006 to 2010, but (incorrectly) claimed that the passage of HB2 (the clinic safety bill passed in 2013) led to the defunding and closure of half of the family planning clinics relied upon by the poor and minorities.
“Following this,” Harris's prepared testimony said, “the rate of maternal death in Texas doubled, with other states' rates increasing more slowly and California's rates diminishing.” She cited a paper hypothesizing connections between the two events.
Someone for the AMA told Kessler that they had relied on a CNN report on the original study for their data. But the staff failed to notice a note on the top of the article saying a later study had found those numbers inflated by two-thirds. They promised to contact the Ways and Means Committee and correct the record.
Agenda Trumps Accuracy in Testimony
This mea culpa is troubling on many levels. Even if Harris had only read the faulty original 2016 Obstetrics & Gynecology study, she would have seen that the data claiming the doubled maternal mortality figures was supposed to have occurred from 2000 to 2012, before the clinic safety bill (HB2) she cites was even passed (2013).
Obviously, it is problematic that the incoming head of the AMA's board of trustees was testifying as a medical expert about a subject where she had not even read the latest literature — in this case a critical correction to an erroneous claim she was boldly and broadly asserting.
That she and her staff would rely upon a news report (from CNN, no less) rather than access the latest medical literature is an indication that it is not a medical, but a political agenda driving the AMA's participation in this public debate.
By the same token, Rep. Beyer's reliance on an outdated, inaccurate study shows how reflexive acceptance of abortion industry's claim that abortion laws endanger women's lives may lead to one miss evidence to the contrary.
The abortion lobby and industry has for too long gotten away with conducting shoddy research and making false claims about abortion's safety, its impact on women's physical and psychological health, and the humanity of each life abortion destroys.
For once, someone has called them on it. Hopefully, the next time they publish a study or make an outrageous claim, they'll be scrutinized more carefully.
Published with permission from National Right to Life.