Ectopic Pregnancy Deaths Have Nearly Doubled. It’s Worse in States With Abortion Bans.

The analysis by ProPublica uncovered a stark and baffling increase in fatalities from ectopic pregnancies, a condition where a fertilized egg implants outside the uterus, most commonly in a fallopian tube. Such pregnancies are almost never viable and, if left untreated, will rupture, causing catastrophic internal bleeding and posing a severe threat to the mother’s life. While historically rare, these deaths have surged, with nearly 200 women dying from the condition between 2020 and 2025, a dramatic doubling compared to approximately 100 deaths in the preceding six years. This alarming rise has occurred with surprisingly little public scrutiny or official response from federal health agencies like the Centers for Disease Control and Prevention (CDC).

"A death related to ectopic pregnancy should really be a never event," emphasized Dr. Alice Abernathy, an OB-GYN based in Philadelphia, highlighting the medical community’s consensus that such fatalities are almost entirely preventable with prompt and appropriate medical care. The current trend, therefore, signals a profound failure in the healthcare system.

The Alarming Surge in Ectopic Pregnancy Deaths

Ectopic pregnancies, while impacting a relatively small proportion of pregnancies—up to 2% in the U.S.—have long been recognized as the leading cause of maternal mortality during the first trimester. The standard treatment involves terminating the non-viable pregnancy, either through medication (methotrexate) or surgery, to prevent rupture and save the mother’s life. The procedure is medically distinct from elective abortion but falls under the legal definition of abortion in many jurisdictions, creating a complex and dangerous dilemma for healthcare providers in states with restrictive laws.

ProPublica’s deep dive into CDC WONDER multiple cause of death and natality data revealed the troubling trajectory. The initial uptick in ectopic deaths coincided with the onset of the COVID-19 pandemic, a period characterized by widespread chaos, overwhelmed hospitals, and significant access issues within the healthcare system. Many experts theorized that these disruptions could account for a temporary increase in adverse outcomes. However, the analysis demonstrates that the surge in ectopic pregnancy deaths has not only persisted but intensified even as hospital systems stabilized. This persistence has prompted serious questions regarding the role of the most significant recent disruption to maternal healthcare: the proliferation of state-level abortion restrictions following the Supreme Court’s overturning of Roe v. Wade in June 2022.

The data further reveals a growing divide in outcomes for women, specifically a much steeper climb in ectopic deaths in states that implemented strict abortion bans after the Dobbs v. Jackson Women’s Health Organization decision. While a nationwide increase was observed, the rate of increase was significantly higher in states with bans commencing at six weeks of pregnancy or earlier. This geographical disparity underscores the potential causal link between policy changes and maternal health outcomes.

A Crisis Unfolding: Patient Testimonies and Medical Delays

The abstract statistics translate into harrowing personal experiences for women caught in the crosshairs of medical necessity and legal uncertainty. Lawsuits and federal complaints have brought to light instances where medical providers, fearing criminal penalties, have hesitated or outright refused to provide timely treatment for ectopic pregnancies in states with abortion bans. Patients describe profound terror and fear for their lives.

Kyleigh Thurman’s ordeal in Texas in 2023 serves as a stark example. Despite clear indications of an ectopic pregnancy, two emergency departments reportedly sent her home without resolving the life-threatening complication. Her right fallopian tube subsequently ruptured, necessitating its surgical removal. Regulators in 2025 investigated one of the hospitals, Ascension Seton Williamson, and found it failed to properly screen Thurman for a suspected ectopic pregnancy and did not consult an OB-GYN, a clear violation of both hospital policies and the federal Emergency Medical Treatment and Labor Act (EMTALA), which mandates emergency departments to stabilize patients before discharge. Thurman has filed an ongoing medical malpractice lawsuit against both Ascension Seton Williamson and Ascension Seton Highland Lakes.

"I genuinely thought I was going to die," Thurman recounted to ProPublica, likening her condition to "a time bomb you can’t control." She added, "I’ve never been in a situation where I didn’t get healthcare when I needed it."

Similarly, Leitaea Lowrimore of Oklahoma experienced terrifying delays in February, seeking care at multiple hospitals in both Oklahoma and Arkansas after experiencing severe abdominal pain and bleeding. Despite the fact that both states’ abortion bans include exceptions for ectopic pregnancies, Lowrimore was denied timely treatment. One doctor reportedly told her that intervening in her pregnancy could lead to "10 years in the poky," explicitly citing fear of legal repercussions. "I felt like my life was a risk he couldn’t afford," Lowrimore stated in her lawsuit. She ultimately had to drive to Kansas, where abortion is legal, to receive a methotrexate injection within hours of arrival. Lowrimore’s lawsuit, which aims to block Arkansas’s abortion ban, is ongoing, and federal regulators have cited Mercy Hospital in Fort Smith, Arkansas, for failing to provide care during her eight-hour wait.

The Shadow of Abortion Bans: Policy and Practice

The core issue lies in the interpretation and implementation of state abortion bans, even those with explicit exceptions for ectopic pregnancies. Maternal health experts have consistently warned that these laws create a "chilling effect" on medical professionals. Doctors, fearing legal prosecution, often delay treatment until an "ironclad diagnosis" is obtained, typically via ultrasound confirmation of an extrauterine mass. This delay can be perilous.

Ectopic pregnancy symptoms often begin with non-specific abdominal pain and bleeding, prompting emergency room visits. Early in pregnancy, however, an embryo may not be visible on an ultrasound, making definitive diagnosis challenging. While blood tests tracking pregnancy hormone levels over several days can indicate an ectopic pregnancy, waiting for such confirmation can consume critical time. In states without bans, a patient can choose to terminate a suspected ectopic pregnancy based on clinical suspicion, mitigating risk. In states with bans, however, doctors may feel compelled to wait for irrefutable visual evidence, prolonging the risk of rupture.

Dr. Rebecca Nerenberg, an emergency medicine doctor in New York and clinical director at Access Bridge, which educates ER doctors on reproductive healthcare, states, "Seeing a mass is not the only reason to have high suspicion for an ectopic pregnancy." She emphasizes that doctors should be able to offer treatment based on other symptoms like plateauing hormone levels, bleeding, and abdominal pain. However, this is precisely where the legal ambiguity of abortion bans interferes.

To quantify the broader impact of these delays, ProPublica analyzed hospital data from Texas, a populous state with an early and strict abortion ban. The findings are sobering: 310 more patients in Texas experienced substantial blood loss after an ectopic pregnancy in 2023 and 2024 compared to 2018 and 2019, representing an increase of approximately 29%. This surge in severe complications also began during the pandemic but remained elevated after hospital systems stabilized and the state’s restrictive law took full effect.

In response to previous ProPublica reporting on other deadly impacts of its abortion ban, Texas passed the "Life of the Mother Act" in 2025, explicitly adding ectopic pregnancies to the list of allowed abortions. However, subsequent guidance from the Texas Medical Board only included a case study with an ectopic pregnancy visible via ultrasound, omitting scenarios where early detection is difficult. This omission leaves a dangerous gray area, potentially still exposing doctors to prosecution, with penalties up to 99 years in prison for illegal abortions. Michelle Maloney, an attorney representing Thurman and other Texas women denied care, including seven with ectopic pregnancies, noted that she continues to receive frequent calls, underscoring that "specific exemptions don’t address the massive gray areas that arise in pregnancy."

Unraveling the ‘Why’: Competing Theories and Unanswered Questions

While the link to abortion bans is increasingly evident, maternal health experts caution that these laws alone cannot explain the national rise in ectopic deaths. The complexity of maternal health outcomes means multiple factors often intertwine.

The COVID-19 pandemic undoubtedly played a role in initial increases across all pregnancy-related deaths, though most other categories have since subsided. Experts are still grappling with why ectopic deaths have continued to rise uniquely. For instance, while ectopic pregnancies are more common in older women, the increase in deaths has been disproportionately stark among younger women, according to the analysis.

Anti-abortion groups have suggested that the increased use of abortion pills prescribed online without an initial ultrasound could lead to undiagnosed ectopic pregnancies. However, research, including studies published in Nature and Wiley Online Library, has shown that ectopic rates are significantly lower in individuals seeking medication abortions than in the general population. Telehealth clinics typically employ rigorous screening questions and follow-up protocols to identify patients at higher risk of ectopic pregnancy.

Other potential factors remain under-researched. There is no comprehensive national tracking of whether women experiencing ectopic pregnancies also have common risk factors such as a history of ectopic pregnancies, infertility, or use of hormonal intrauterine devices. Furthermore, the connection between rising ectopic deaths and untreated sexually transmitted infections (STIs) like gonorrhea and chlamydia — which saw a substantial increase during the early pandemic years — is also unclear. These infections can lead to pelvic inflammatory disease, causing fallopian tube scarring and increasing the long-term risk of ectopic pregnancy.

Eugene Declercq, a public health researcher at Boston University, highlights the challenge: "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." Many states with strict abortion bans also tend to provide less Medicaid funding and coverage to low-income women, contributing to generally poorer maternal outcomes.

A System in Decline: Gaps in Research, Funding, and Training

A significant impediment to addressing the rise in ectopic pregnancy deaths is the alarming lack of awareness, research, and data at the federal level. Despite having access to the same CDC data analyzed by ProPublica, the CDC and other federal agencies across two administrations have failed to publicly acknowledge or respond to the increase.

The capacity of the U.S. public health infrastructure to tackle such issues has been severely eroded. Under the Trump administration, substantial cuts were made to staff and funding for healthcare research. The CDC’s Division of Reproductive Health, for instance, reportedly lost most of its 100 employees, as detailed in a lawsuit filed by state attorneys general. The entire team responsible for the Pregnancy Risk Assessment Monitoring System (PRAMS), a vital source of data for maternal health researchers, is on paid administrative leave, including those who would typically investigate trends like the rise in ectopic pregnancy deaths.

"You’re losing the capacity to know what’s going on with pregnant women," warned Lee Warner, former chief of the Women’s Health and Fertility Branch at the CDC, adding that "it’s going to take decades to build this capacity back."

Funding cuts have also impacted critical training initiatives. Ectopic pregnancies often cause complications before standard prenatal care begins, meaning patients frequently present to emergency departments. However, ER doctors typically lack specialized training in high-risk early pregnancy conditions. In 2025, the CDC ceased funding a partnership with the American College of Obstetricians and Gynecologists (ACOG) for "Obstetric Emergencies in Nonobstetric Settings," an initiative providing resources for emergency departments on caring for pregnant patients. While ACOG’s foundation now funds the project and is developing guidelines for managing tubal ectopic pregnancies in the ER, the lapse in federal support underscores a broader systemic weakness.

A spokesperson for the Department of Health and Human Services (HHS) stated that the agency continues to track maternal mortality trends, investigate causes, and provide funding for research, asserting that "this important work is being accelerated across the Department to support healthy mothers, healthy babies, and strong families." However, the lack of a specific public response to the ectopic pregnancy death spike raises questions about the efficacy of these efforts.

International Contrast: Lessons from the United Kingdom

The United Kingdom’s proactive response to a similar, albeit smaller, spike in ectopic deaths during the pandemic offers a stark contrast to the U.S. approach. Researchers and officials in the U.K. and Ireland identified a surge in 2021 and 2022, with 12 women dying from ectopic pregnancies – a near doubling of their previous death rate.

Crucially, they investigated the causes. Marian Knight, a professor at the University of Oxford who leads the U.K.’s maternal mortality reporting, found culprits ranging from overstretched emergency services to inadequate early pregnancy screenings. In 2024, Knight co-authored a maternal mortality report focusing on these deaths and offered concrete policy recommendations. She collaborated with policymakers and a U.K. charity to raise awareness among both doctors and the public about ectopic pregnancy symptoms. Officials even modified how patients with suspected ectopic pregnancies are prioritized when calling for an ambulance, leading to faster response times.

"If we’re not tracking and not just understanding the numbers, but understanding the why behind the numbers, we have no ability to respond," Knight emphasized, highlighting the fundamental importance of systematic investigation.

The U.S. lacks a national maternal mortality review system. Instead, the CDC primarily compiles national totals from death and birth records, while state and local committees conduct in-depth reviews of individual cases. While Declercq’s committee in Massachusetts has not seen a significant increase in ectopic deaths, these fatalities are often sporadic enough at the state level that trends become visible only through comprehensive national aggregation.

The Path Forward: Calls for Investigation and Policy Clarity

The ProPublica analysis, coupled with compelling patient narratives, underscores an urgent need for concerted action. Maternal health experts are unanimous in their call for thorough investigation into the driving forces behind these preventable deaths.

Dr. Courtney Schreiber, a professor of obstetrics and gynecology, warns, "Reproductive health is unusual across medicine when we consider how swiftly policy changes affect the care patients can receive." She added that ProPublica’s analysis "raises concern that young women are dying from a preventable cause at an increasing rate. That is not what we should be seeing in the United States of America."

Caitlin Myers, an economist at Dartmouth College who studies abortion policy, echoed these sentiments, stating, "This is a potentially profound consequence of the regulation."

Without a robust, national commitment to tracking, researching, and responding to these trends, the U.S. risks not only continuing to lose more women to a preventable condition but also further eroding trust in its healthcare system. The findings serve as a critical alarm, demanding that policymakers, medical professionals, and public health agencies address the complex interplay of legal restrictions, systemic failures, and diminished public health capacity that is tragically costing women their lives.