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.
[…]
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.
When SB8, the vigilante bounty hunter law, passed in 2021, I said it was just a matter of time before some nice white suburban lady who already had kids died as a result of this. Josseli Barnica isn’t white, but she fits otherwise. And as far as that part goes, we saw what happened with Kate Cox and Amanda Zurawski, and we see Ken Paxton twirling his mustache as he fought off EMTALA on the grounds that requiring hospitals to save these women’s lives would be a crime in Texas.
I don’t know what more to tell you, so I’ll turn it over to Jessica Valenti.
I am heartbroken, but more than that I am just so angry. I am angry that this young beautiful woman is dead. I am angry that her now-4 year-old daughter will grow up without a mother. I am angry that we have to live in a country where our lives are treated as disposable. And I am really, truly furious about what I know will come next.
Anti-abortion groups will rush to send out tweets and press releases with phony condolences, insisting that Texas’ law allows life-saving care. They will blame doctors for not acting quickly enough, the hospital for not giving providers clear enough guidance—even pro-choicers for ‘scaring’ doctors out of treating patients. Anything to shirk blame and to wash the blood off their hands.
We cannot let that happen.
When Susan B. Anthony Pro-Life America comes out with a statement promising that abortion bans protect women, I want you to remember that they lobbied against exceptions for women’s lives. When the American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG) claims that Josseli should have been given care, remember that the ‘care’ they’re referring to isn’t an abortion—but a forced c-section or vaginal labor. That’s because these groups believe abortion is never necessary to save a person’s life. They use language and push for laws accordingly.
Most of all, I want us to remember—and for all Americans to know—that these organizations and legislators knew this would happen. They knew women would suffer and die as a result of their laws and decided to pass them anyway. There is no press release or talking point that can paper over that truth: they decided our deaths were an acceptable trade-off for a political win.
When I say that the anti-abortion movement planned for deaths like Josseli’s, I mean it literally. In October 2022, I warned that conservatives had launched a preemptive messaging campaign to blame doctors and abortion rights activists for women’s deaths. Today, two full years later, we’re watching Republicans insist that it’s not bans endangering women, but pro-choice “misinformation” about the laws.
They didn’t just plan to avoid responsibility for our deaths, though—they planned to cover them up.
There is a reason that Republicans are disbanding maternal mortality review committees, or stacking them with anti-abortion activists. In Texas, where Josseli was killed, Republicans put a well-known extremist on the state’s maternal death board just a few months ago: Ingrid Skop has made a career out of arguing that maternal mortality statistics can’t be trusted and that abortion bans won’t lead to maternal deaths.
This comes at the same time that well-funded anti-abortion groups are sowing distrust in maternal mortality statistics across the country, laying the groundwork to argue that the inevitable spike in post-Roe maternal deaths is just bad data.
There’s more, both of the original story and of Jessica’s post, so read them both. I wish I had something simple and effective to say here, but it’s the same thing I’ve been saying all along: Nothing will change until we start winning more elections, and in particular till some of the people imposing this on us start losing them as a result of this. We’re working on it for this year, and we’ll have much more to do in 2026. The Conversation has a longer look at how these laws affect doctors around the country, and The Slacktivist has more.