AUSTIN, Texas — Across the 18 states that have banned or tightly restricted abortion since the U.S. Supreme Court overturned Roe v. Wade, questions have persisted over when doctors can perform abortions in medical emergencies.

State lawmakers out of Texas say a newly passed law called the Life of the Mother Act should clarify for doctors in the state where to draw the line. Reproductive rights advocates and medical groups are watching to see if it saves lives.

In Texas, abortion is only permitted when a woman’s life or one of her major bodily functions is at risk, but doctors have said it’s unclear what qualifies under such emergency medical exceptions. The penalties are steep if they get it wrong: In Texas, doctors face a sentence of up to 99 years in prison, fines and the loss of their medical license.

Dr. Emily Briggs is a family physician in Central Texas who says she fields a lot of questions about the ban from young doctors who train at her practice.

“We have physicians in training — medical students and residents — who are choosing not to go through their training in Texas for a multitude of reasons,” she says.

Many new doctors are worried they can’t get a full education in Texas because they can’t train in abortion care under the ban, Briggs says. Some are concerned about the impact of the ban on their own health as they consider starting families. That’s part of why Briggs supported the new law in Texas.

“I think this is a great step in the right direction,” she says.

A rare bipartisan abortion effort 

The new law came after years of activism by doctors and patients, as well as reporting from ProPublica that showed at least three Texas women have died after delays in care. An investigation from the outlet also found that rates of sepsis have risen among pregnant women under the state’s abortion ban.

A diverse coalition contributed to the writing of the bill, including medical associations and anti-abortion groups.

The new clarifications:

• Specify that a pregnant woman’s death or impairment does not have to be “imminent” for the exception to apply 
• Clarify that doctors can talk about abortion with patients or colleagues while determining if it’s the best treatment option 
• Confirm that the burden of proof is on the state if a doctor is accused of violating the law.

The bill was filed by Republican state Sen. Bryan Hughes, the same lawmaker who authored the Texas Heartbeat Act, a six-week abortion ban that went into effect in 2021, prior to the repeal of Roe v. Wade.

“Most hospitals, most doctors, are getting this right. But this bill is to remove any excuse, remove any question, and also to make sure that doctors are trained,” Hughes said in March.

How other states compare

Several states have tried to clarify their emergency exceptions in the past, both through legislative actions and rules released by state medical boards. Some, like Florida, have released lists of medical conditions that would make an abortion lawful. Kentucky passed a law this spring that listed examples of qualifying conditions, including ectopic pregnancy and excessive bleeding.

But Briggs says this tactic can be limiting.

“The laundry list approach is not appropriate, because there could be a nuance,” she says. “What if her nuanced care is slightly different from what has been deemed appropriate by the legislation?”

Texas’ new law does strengthen protections for when a doctor performs an abortion to treat a couple of specific conditions, including ectopic pregnancy and premature rupture of membranes. That’s in addition to the provisions about immediacy, burden of proof and discussions among doctors and patients.

What the law does not do is add any new exceptions for rape, incest or fatal fetal anomalies — a sticking point for some medical groups and reproductive rights advocates. Some, including the American College of Obstetricians and Gynecologists, said they would oppose any bill that kept Texas’ abortion ban in place.

Will it come to interpretation?

Mary Ziegler, a law professor and abortion law expert at the University of California-Davis, says the impact of the new law may depend on how individual doctors read it.

“I think some physicians will take these clarification bills as a kind of reassurance that the state is not just kind of going to go hog wild in prosecuting physicians in emergency cases,” she says.

But Ziegler also predicts that more risk-averse doctors will feel the law doesn’t offer enough clarity to offset the steep penalties that still exist. The Life of the Mother Act also requires doctors to receive medical education on the state’s abortion laws. While this could be a valuable resource, Ziegler says it could also make doctors feel they are being held to an even higher standard.

“You could see physicians reading this bill and saying, I have to be even more sure this patient is in dire straits to intervene,” she says.

Women who have been affected by Texas’ abortion ban are also weighing whether the law can lead to meaningful change, including Amanda Zurawski, who lost part of her reproductive system and nearly died of sepsis when she was denied prompt abortion care. She became the lead plaintiff in the high-profile Zurawski v. Texas lawsuit, which asked the courts the clarify the state’s abortion ban. The court ultimately ruled it’s not its role to clarify state laws.

Zurawski says she sees Texas’ new law as “a very, very, very tiny step forward,” but that the legislation ultimately does not make her feel safer.

“I can’t get pregnant again, because of what the state of Texas made me go through. If I could, I would not remain in Texas for a pregnancy. There’s no way,” she says.

Ziegler says it will take time to determine whether the law will prevent more cases like Zurawski’s, as doctors and hospital administrators learn about the legislation and are faced with real-time medical emergencies.

“There’s a kind of rubber meets the road question about whether these actually prevent tragedies or not,” Ziegler says, “and I think it’s too early to say.”