The Women Killed by the <em>Dobbs</em> Decision

Some tragedies are impossible to prevent, or even to predict. The death of Amber Nicole Thurman was not. She was perhaps the first woman killed by the overturning of Roe v. Wade.

In June 2022, the Supreme Court ruling in Dobbs v. Jackson Women’s Health Organization removed the constitutional right to an abortion guaranteed by Roe. As a result, individual states reverted to their own laws. In Georgia, where Thurman lived, abortions became illegal from the time when a “detectable human heartbeat” was present—around six weeks into pregnancy. The law came into effect in late July of that year, at the same time that Thurman, a 28-year-old medical assistant, discovered that she was six weeks pregnant with twins.

Thanks to ProPublica, which obtained Thurman’s medical records with her family’s permission, we can see what happened next. She already had a 6-year-old son, and decided that she could not raise two more children. But she couldn’t get a termination in her home state. And so she scheduled a surgical abortion in North Carolina, took a day off work, hired a babysitter, borrowed a relative’s car on a false pretext, and got up at 4 a.m. to drive four hours with a friend to the clinic. But they hit traffic, and Thurman missed her appointment. The clinic could not give her another time slot, because so many women from out of state, also facing tough new laws, were booked on that day.

So Thurman was prescribed abortion pills instead. These are widely used and overwhelmingly safe and effective for early pregnancies. In less than 5 percent of cases, though, women need another dose, or a procedure called a dilation and curettage (D&C), to empty the uterus completely. In countries and states where abortion is legal, this is a simple and routine procedure that carries little risk.

But not in Georgia. Back home, Thurman’s bleeding would not stop. She went to the hospital at 6:51 p.m. on August 18, and medical examinations showed all the classic signs that her abortion was incomplete, and that the tissue remaining inside her was poisoning her blood. But doctors did not give her a D&C. Nor did they do so the next morning, as her condition continued to worsen. When she was finally taken to the operating theater, at 2 p.m., her condition was so bad that doctors started to remove her bowel and uterus.

But it was too late. Thurman’s heart stopped on the operating table.

Her mother was waiting outside. She had no idea, ProPublica reported, that her daughter’s condition had been life-threatening. She hadn’t understood why Amber had said to her, on the way into surgery, “Promise me you’ll take care of my son.”

Two years after Thurman’s death, Georgia’s official maternal-mortality review committee has concluded that it was preventable, and that she would have had a “good chance” of surviving if she’d been given a D&C earlier. Former President Donald Trump, who appointed half of the six-justice majority in Dobbs, keeps claiming that “everybody wanted” Roe to be overturned. But it isn’t true. “This young mother should be alive, raising her son, and pursuing her dream of attending nursing school,” the Democratic presidential nominee, Kamala Harris, noted in a statement responding to the ProPublica investigation.

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Thurman’s story plays out in every country where abortion is banned. Women still seek abortions, but now they do so in dangerous or unsafe conditions, or with inadequate medical supervision. They lie to their friends and family about where they are going, drive or fly for hours to seek care, and then return home, possibly bleeding heavily. Having to travel for an abortion raises the risks of the procedure enormously. Until abortion was legalized in Ireland and Northern Ireland in 2018, women went covertly to England. (Many still do because access remains limited.) Polish women travel to the Netherlands. In El Salvador, where anti-abortion laws are so strict that women have been jailed for natural miscarriages and premature births, the rich fly to Miami for terminations. Around the world, women denied access to abortion care seek do-it-yourself solutions. ProPublica reported today on a Georgia woman in this situation, Candi Miller, who died after procuring abortion pills online. The mother of three had an autoimmune disease and other medical conditions that substantially increased the health risks of pregnancy.

Add to those women the ones whose pregnancies fail naturally—as so many do. Laws threatening criminal penalties for abortion providers have made doctors and hospitals hesitant to perform procedures urgently needed by many women suffering miscarriages. In Poland, where abortion is illegal in almost all circumstances, the 33-year-old pharmacist Dorota Lalik died in 2023 after a Catholic hospital refused to offer her a D&C when her water broke at five months. Instead, she was advised to lie down with her legs up. She died of sepsis three days later—the same condition that killed Amber Thurman, and the same condition that killed 31-year-old Savita Halappanavar, the woman whose death from sepsis galvanized the campaign to legalize abortion in Ireland. For every death, there are dozens of near misses. On the first night of the Democratic National Convention, delegates heard from Amanda Zurawski, who started to miscarry at 18 weeks, after she had already begun to buy baby clothes. Because of the new laws in Texas, doctors waited until her temperature began to spike—an urgent sign of infection—before giving her the necessary drugs. “Women are bleeding out in parking lots, turned away from emergency rooms, losing their ability to ever have children again,” Harris noted in her statement. “Women are dying.”

Unfortunately, just as the contours of Thurman’s story are familiar, so will the response be. First comes denial: Before the law in Georgia passed, state lawyers referred to the idea that it would cause deaths as “hyperbolic fear-mongering.” Despite the state commission’s ruling that Thurman’s death was preventable, the Trump campaign has already argued that nothing in Georgia’s law stopped the D&C from happening earlier. “President Trump has always supported exceptions for rape, incest, and the life of the mother, which Georgia’s law provides,” a spokesperson said. “With those exceptions in place, it’s unclear why doctors did not swiftly act to protect Amber Thurman’s life.”

Arguments like these are at best naive but more typically disingenuous. In Poland, a patients’-rights ombudsman concluded that Lalik should have been told that her life could have been saved by an abortion—but she wasn’t. In Ireland, Sabaratnam Arulkumaran, a medical professor who led the investigation into Halappanavar’s death, held the law responsible. He ruled that without the (now overturned) Irish amendment giving equal weight to the life of the mother and the fetus, doctors would have given Halappanavar the necessary drugs. “We would never have heard of her, and she would be alive today,” he added. The same is true for Thurman’s death—and that of another Georgia woman, yet to be publicly identified, whom ProPublica discovered had died in similar circumstances.

America is a litigious country, and some of the most extreme anti-abortion legislation, such as Texas’s so-called bounty law, explicitly offers monetary rewards to private citizens if they successfully sue people who help a woman terminate a pregnancy. In this climate, doctors are naturally scared of legal action. My colleague Sarah Zhang recently reported from Idaho, which has strict abortion laws. She found that some ob-gyns are leaving the state because of the impossible choice they are asked to make—leave a woman to die, or risk their entire career to treat her. “I could not live with myself if something bad happened to somebody,” one doctor told Zhang. “But I also couldn’t live with myself if I went to prison and left my family and my small children behind.”

Once denial is no longer effective, then comes misdirection: Abortion drugs must be the real problem. The Heritage Foundation’s Project 2025, a governing blueprint for a second Trump term, calls for extra inspections and regulations of these drugs—far beyond what is normal for similar medications that are unrelated to abortion. As a stretch goal, Project 2025 would like the FDA to revoke its approval of these medications altogether. (Perhaps sensing its unpopularity, Trump has disowned Project 2025, but its contributors include many people in his previous administration and wider orbit.) But Thurman’s story is not about the danger of abortion pills. Her story is about the danger of women not receiving simple, routine follow-up care after taking these pills, because of political decisions made by the state.

It is not good enough, as Trump seems to think, to leave abortion laws to individual states. America cannot put itself in a situation where women have fewer rights to life, liberty, and the pursuit of happiness in Georgia than they do in North Carolina. I was raised Catholic and understand the deep religious opposition that some people have to abortion. But none of these fetuses—not Amber Thurman’s, not Dorota Lalik’s, not Savita Halappanavar’s—could have been saved at the point the women sought emergency care. The three women could have been, however.

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Activists keep saying that abortion is on the ballot in November. In some places, this is literally true: Advocates and lawmakers in nearly a dozen states have proposed constitutional amendments or other measures to protect or restore abortion rights. Trump knows that draconian red-state laws are heavily unpopular, hence his tortured attempts to find a coherent position on an abortion-rights measure proposed in Florida, his adopted home state. His vice-presidential candidate, Senator J. D. Vance of Ohio, has also reversed his former zeal for abortion restrictions since the true effects—and unpopularity—of the Dobbs decision became apparent. In January 2022, before Roe was overturned, Vance said he “certainly would like abortion to be illegal nationally” and also suggested that a “federal response” would be necessary in a hypothetical situation where “George Soros sends a 747 to Columbus to load up disproportionately black women to get them to go have abortions in California.” Now Vance says he is content to follow Trump’s position—although that does rather hinge on Vance, unlike the rest of us, knowing what it is.

I read the story of Amber Nicole Thurman’s death with a kind of cold rage. This did not need to happen. Without Dobbs, it would not have happened. And it will keep happening. Something has gone terribly wrong in America when people who define themselves as pro-life have sentenced a small boy to go to bed tonight, and every night, without his mother.