The year is 2021, and Kaitlyn Kash is pregnant with her second child, but she’s been told that the baby won’t survive because of lethal skeletal dysplasia, a genetic mutation affecting bone development.
Texas has just passed a Senate bill banning abortion, a few months ahead of a U.S. Supreme Court decision that would overturn Roe v. Wade. Kash, who grew up in a “conservative, religious” home near Dallas, says she’s always been pro-choice but never expected to have to make difficult decisions regarding the termination of a pregnancy.
Kash panics and asks her doctor for advice. “I was told that my baby was going to die and my doctor could not give me the dignity of explaining all my options,” she recalls. At the time, there was confusion about the new state law and whether people could be charged with aiding and abetting by simply providing the name of an out-of-state clinic — or if a mother could be charged with a crime for getting an abortion outside of Texas.
Kash finds a clinic in Kansas that will do the procedure, and her husband buys a printer so they can complete consent forms at home. They’re too scared to download the information at a public library or print the forms at a UPS store. She’s heard of women who pay cash for their airline tickets to go out of state so there’s no paper trail.
“We didn’t go that far, but we didn’t explain to a lot of people what we were doing until we were back in Texas,” she says. “It was terrifying.” She arrives at the doctor’s office on the last day she’ll ever spend with her dying baby and walks past protesters who shout at her: “Murderer!”
“I said goodbye to my baby in a room alone with a nurse and a doctor I’d just met that morning,” Kash recalls.
Later that year, Kash became pregnant again, and had a miscarriage at eight weeks. When trying to obtain Misoprostol so she could pass the tissue and avoid scarring and infection, she says she was treated by Texas healthcare professionals “like an addict looking for drugs rather than a mother losing her child.” A pharmacist told her he needed more information before he could fill the prescription, so she went home and ordered it online.
She then became pregnant by IVF and had complications with that delivery too, requiring dilation and curettage — a procedure also used in abortions — to remove pregnancy tissue from the uterus.
The IVF baby survived, but doctors waited two hours after birth to start the D&C procedure, while Kash suffered a severe postpartum hemorrhage. “When I woke up I had lost half of my blood and was told that I was lucky I still had my uterus,” she says. “This delay wasn’t chaos. It was policy.”
Since the U.S. Supreme Court overturned Roe v. Wade in June 2022, women haven’t been able to legally obtain an abortion in Texas. The Dobbs v. Jackson Women’s Health Organization decision prompted at least 50 Planned Parenthood centers across the country to shutter and those that remained were defunded and forced to scale back their services.
The Lone Star State’s “near-total” abortion ban shouldn’t have affected a woman’s ability to obtain healthcare when suffering a miscarriage — but it has.
The Mayo Clinic reports that one in four recognized pregnancies ends in miscarriage, and the number may be even higher because some losses occur before someone realizes she is pregnant.
A woman filed a federal complaint last month claiming she was told to take Tylenol and basically left for dead by emergency room doctors at two Austin-area hospitals because doctors refused surgery and abortion-inducing medication while she was miscarrying.
Lynn Callaway, 40, says she visited three medical facilities in four days before she was prescribed Misoprostol and Mifepristone, a standard — and legal — procedure for treating early pregnancy loss. The U.S. Supreme Court is currently reviewing a lawsuit seeking to ban the distribution of Mifepristone by mail and is expected to rule this summer.
Callaway’s complaint alleges that Baylor Scott and White Medical Center in Round Rock and St. David’s Round Rock Medical Center violated the Emergency Medical Treatment and Active Labor Act, a federal statute that requires hospitals to provide stabilizing treatment for miscarriages.
According to court documents, an ER doctor at Baylor Scott and White told Callaway that she was likely having a miscarriage, “but that I only had one option: to go home and pass the pregnancy on my own, then follow up with my OB/GYN in a week. I expressed concern that I could bleed out or that the pain could feel like going into labor. But [the doctor] was dismissive, chuckling as she told me I would be ‘fine,’ to just expect some cramping, and to take over-the-counter Tylenol if I needed.”
The Doctors’ Dilemma
It’s been four years since the Dobbs decision, and the ripple effect is now prompting women in Callaway’s situation to seek medical care out of state even if they are suffering from a miscarriage — that is, if they’re able to get to a state like Kansas, New Mexico or Colorado in time.
The fight over reproductive healthcare is no longer just about abortion. Now the anti-abortion activists are coming for drugs and procedures that provide safe miscarriage care for pregnant women. They’re also coming for in-vitro fertilization, according to the Republican Party of Texas platform and legislative priorities revealed at a mid-June convention in Houston. Notably, Attorney General Ken Paxton, who is running for a hotly contested U.S. Senate seat in November and has been relentless in pursuing criminal charges against medical professionals who provide reproductive care, spoke out in favor of IVF.
Sen. Patty Murray, D-Washington, called a Congressional forum in Washington, D.C., on June 23 titled “Post-Dobbs Chaos: Republicans’ War on Reproductive Healthcare.”
Lawmakers including Chuck Schumer of New York and Elizabeth Warren of Massachusetts listened and empathized with the testimony of Kash and others at the hearing, but no elected representatives from Texas attended. Kash says last month’s hearing was the third time she’s been to D.C. on the anniversary of the Dobbs decision, and no U.S. senator from Texas has ever offered to meet with her.
U.S. Rep. Lloyd Doggett, who represents the Austin area, has, however, been “incredibly supportive” and even joined Kash in hosting a “field hearing” in Austin to “help give women the chance to testify since the Texas lege won’t host hearings on the bans,” Kash says.
Murray said during last month’s forum that since 2022, states have pushed dangerous “fetal personhood bills” that attack abortion, birth control and IVF, and President Donald Trump has told hospitals that they can deny women lifesaving care during medical emergencies. Additionally, Murray said far-right senators and anti-abortion groups have urged the Environmental Protection Agency to deem Mifepristone a water pollutant.
“For the anti-abortion Republicans, overturning Roe was never going to be enough, and they show that every day,” Murray said. “We have Republicans who claim to support abortion and women’s choices, but what are they doing about the unending attacks on women’s rights? Nothing. Republicans are trying to whistle past the graveyard they helped dig as if they had nothing to do with where we are today.”
Republicans who voted to confirm Robert F. Kennedy Jr. as U.S. Secretary of Health and Human Services “don’t get to act surprised that Trump puts politics over healthcare,” she added. “Republicans don’t just want women to stay pregnant. They want them to stay silent. They are hoping the women who were miscarrying and were forced to suffer until they were at death’s door because of Republican policies will just be quiet.”
Rice University’s Baker Institute for Public Policy issued a lengthy report in 2024 pointing out that unclear guidelines following the Dobbs decision “blur the distinction between miscarriage care and abortion.”
“As a result, Texas healthcare providers, pregnant individuals, and lawmakers live in a climate of uncertainty and even fear regarding legal miscarriage treatment, putting the lives of pregnant individuals at risk,” the report states.
Miscarriage is defined as the sudden loss of pregnancy before 20 weeks. Up to 20 percent of confirmed pregnancies end in miscarriage and half of these cases require medical intervention, according to the report. Researchers found that in some miscarriage cases, physicians must decide whether to leave a pregnant patient in critical condition or risk legal repercussions and the loss of their medical license for performing an abortion.
That’s why Callaway and hundreds of Texas women in similar situations aren’t given immediate care even though they may be suffering or even close to death, says Nicolas Kabat, a New York attorney for the Center for Reproductive Rights.
“There is really no medical difference between elective abortion and the same procedure that you’re offering for a miscarriage,” Kabat says. “When the doctor goes into their computer system at the end of the day and enters the procedure they did, it’s going to come up as an abortion. The public needs to understand that, medically speaking, these procedures are the same. So when politicians try to legislate in this area, they are causing havoc for the medical system.”
Texas laws are putting doctors in a position where they have to consider professional ethics, the obligation they have to their patients and their own personal liberty, Kabat adds.
“With severe penalties of up to 99 years in prison and loss of their medical license, it creates a chilling effect where even doctors who understand their professional ethical duties and are concerned about medical malpractice understandably reach a more conservative approach,” he says. “They either want to pass the buck to another doctor who can take that risk or delay care, and delays in care are known to be dangerous.”
Texas lawmakers in 2025 passed a bill aimed at assuring doctors they wouldn’t be punished for treating miscarriages, so why are doctors still confused about the type of care they can provide? Kabat says often they’re not confused; they’re scared.
“Even if they know that a patient is inevitably having a miscarriage, it could be seen the next day or two or three weeks later by someone in the prosecutor’s office or the very aggressive Texas attorney general’s office that they were facilitating an abortion,” he says. “Even if the law tries to carve those things out, which it does, the doctor in the situation doesn’t know in advance if they’re on the right side of the line in the view of a very aggressive anti-abortion office like the attorney general in Texas.”
Kash agrees. Texas doctors are caught between the rock of personal ethics and the hard place of the state and federal government, she says. With a shortage of maternal fetal medicine doctors, they don’t want to take the chance of getting in trouble, even if they’re never found guilty of a crime, because an investigation could put their practices on hold and prevent hundreds of other women from obtaining healthcare. “I don’t blame the doctors,” Kash says. “I can see pain in their eyes. The doctors who have chosen to stay are being tormented daily. They know what they need to do and they can’t do it.”
Medical students preparing to become OB/GYNs are no longer trained in how to perform abortions or provide care after a woman has had one in a state where it’s legal. Alexis McGill Johnson, president and CEO of the Planned Parenthood Federation of America, said at last month’s public hearing that up to 20 percent of OB/GYN students in states where abortion is banned leave to do their residencies elsewhere.
Twenty states ban abortion, and the bans don’t stop it from happening; they only add burdens to those seeking them and those providing them, Johnson said. Abortion bans in Idaho, Tennessee, Mississippi and Alabama are also aggressive and have created repercussions for women seeking miscarriage care, Kabat says.
And yet abortion bans remain unpopular with the public. “Eighty percent of Americans do not want the government involved in abortion, and 69 percent oppose Congress extending their defund of Planned Parenthood,” Johnson said.
Kabat says the OB/GYN shortage has been exacerbated by young medical students who are thinking about planning families and would prefer to start their careers in states where reproductive healthcare is more accessible. That leaves small rural hospitals in a situation where they don’t have enough trained staff to deal with a reproductive healthcare emergency.
“That’s what keeps me up at night,” he says. “The patients who are seeking care in rural areas at hospitals with fewer resources for treating obstetrical emergencies are already in a crisis. They may be having serious bleeding, and there’s no one at the hospital who’s trained properly to treat them. They’re being delayed and transferred. Or you may have emergency physicians who are trained in how to provide necessary abortion care but are worried, under these laws, that they can’t do so.”
As a result, sepsis and maternal morbidity rates are going up in Texas, Kabat says. Some women, who believe they could die if they take their chances on a Texas hospital, choose to miscarry at home, or if they are able, seek care in another state.
“If you put yourself in the shoes of a pregnant woman who is suffering a miscarriage, they see the news about their state’s aggressive efforts to police their healthcare and police their doctors,” Kabat says. “They’re understandably concerned about whether they’re going to get the care they need. That shouldn’t be in doubt. They shouldn’t be thinking about the laws of the state when they’re just seeking out basic, essential healthcare.”
The Survivors
In December 2022. Samantha Casiano was 20 weeks pregnant with her fifth child, and the fetus was diagnosed with anencephaly, a fatal birth defect in which a baby is born without the front part of the brain.
Casiano says she knew that carrying the child she’d already named Halo to term would put her own health at risk and cause severe emotional trauma. Due to the financial burden, the timing of the diagnosis and the fact that she had other small children at home, she couldn’t go out of state for an abortion. Halo died hours after her birth in an East Texas hospital.
Casiano recalled her experience last month before the Congressional panel in Washington. D.C. “She was going to die,” Casiano said of her daughter Halo. “The only question was when, and whether she was going to die inside of my body. I thought for sure I would be granted an exception. I thought my doctors would show Halo and me some compassion. I was wrong.”
“The one person that I trusted with my life, my doctor, had her hands tied by the state,” she added. “Helping me could have sent her to jail.”
The mother planned Halo’s funeral while she was still carrying the baby and tending to her other children.
“I had no rights to my own body,” she said. “Even though I did not get an abortion in Texas or out of state, my family and I lived in fear. We were afraid to say the wrong thing, afraid to ask too many questions. We were worried that even searching for information about options outside of Texas could somehow get us in trouble.”
Casiano said that when Halo was born, her eyes were bleeding and she was like a fish gasping for air. “She changed colors from pink to red to blue to purple. She changed from warm to cold,” Casiano said. “Under Texas’ cruel abortion ban, I was forced to give birth to a baby that every doctor knew would not survive and then walk out of the hospital as if nothing happened. It was like sending my child into a war that I knew she was going to lose. It was inhumane. My womb was Halo’s life support. I was not allowed to make the decision [to remove her from life support]. The state made it for me.”
The remedy to the medical neglect and harm to women caused by abortion bans is to reverse them, Kabat says.
“Let’s be clear, the wide majority of Texas supports getting rid of these abortion bans, and that’s true across the country,” he says. “ In cases like Kaitlyn Kash’s and Samantha Casiano’s, the vast majority of the voting public thinks those people should have easy access to abortion care and the state should get out of the way of doctors. So that’s the first measure. Just stop legislating reproductive healthcare. The second thing is, Congress can act and pass a law that protects women across the country, and it really should do so.”
Both Casiano and Kash were among 20 plaintiffs in the Zurawski v. Texas case in which they sued the state, with Kabat and the Center for Reproductive Rights serving as their attorneys. The Texas Supreme Court ruled in May 2024, rejecting the plaintiffs’ plea to clarify emergency exceptions in abortion bans and finding no constitutional right to abortion.
Undeterred by the ruling, Casiano says she’ll continue to speak out until reproductive healthcare rights are restored.
“What happened to me and Halo will keep happening to other mothers and families until we make a change,” she said at last month’s Congressional hearing. “Right now, as we sit here, there’s a woman out there reliving my nightmare. I want her to know that she is not alone. I see you, I hear you and I stand with you.”
Kash is also committed to telling her story every chance she gets. U.S. Senators Ted Cruz and John Cornyn have repeatedly refused to meet with her, she says, so she books media appearances on conservative talk shows in hopes that the “old, white men” passing laws about women’s rights will hear what she’s been through.
Now a full-time advocate for reproductive healthcare, the 39-year-old has two healthy children, ages 7 and 2, and is hopeful that now the public and the media are catching on that abortion bans are causing severe harm that extends to miscarriages. She says during her pregnancies she felt alone and like a failure, and she wants to ensure that other women don’t have to go through the process by themselves.
“I’ve been called a baby killer and told that I’m going to hell,” Kash says. “If my time comes and I go to the Pearly Gates and God decides that I’m going to hell, I will say thank you and I will go. I ended my baby’s pain, because that’s what mothers do. If I have to go to hell forever because of that, I’ll go.”
