The Texas Supreme Court has unanimously rejected a challenge from 20 women who said they were denied medically necessary abortions under the state’s near-total abortion ban.
The plaintiffs, who were joined in the suit by two doctors, had sued Texas for clarity on the ban’s sole exception – medical emergencies – arguing it was too vague, leaving patients in danger and doctors in fear of punishment.
But the nine justices on the state’s top court disagreed.
“Texas law permits a life-saving abortion,” wrote Justice Jane Bland on behalf of the all-Republican court.
“The law permits a physician to intervene to address a woman’s life-threatening physical condition before death or serious physical impairment are imminent,” Justice Bland said, as long as a doctor uses “reasonable medical judgment”.
Abortions are not permitted for foetuses diagnosed with a “life-limiting” conditions, the court wrote, unless the mother’s life is also under threat.
Doctors found in violation of the law face up to 99 years in prison, $100,000 fines and the loss of their medical licenses.
Amanda Zurawski, the named plaintiff in the suit, said the decision felt “like a gut punch”.
“Unfortunately the Texas Supreme Court has showed us today that they don’t wish to help pregnant Texans access health care and they don’t want to help doctors practice medicine,” she said in a press call on Friday.
Ms Zurawski was 18 weeks into a much-wanted pregnancy when she experienced preterm prelabour rupture of membranes (PPROM). Doctors told her that her unborn daughter, named Willow, would not survive but refused to perform an abortion as long as there was a foetal heartbeat.
Ms Zurawski developed sepsis and spent days in the intensive care unit.
The other 19 plaintiffs shared similar stories of being denied abortions in Texas despite carrying risky or nonviable pregnancies. Some travelled out of state to obtain the procedure while others said they waited to become “sick enough” that doctors could perform an abortion.
Speaking on Friday, Samantha Casiano, whose foetus did not develop a skull, said she had to watch her baby suffer before dying hours after birth.
“I gave birth to my daughter and I watched my daughter suffocate,” she said. “It’s just not something that anyone should have to see.”
Texas Attorney General Ken Paxton, an outspoken opponent of abortion, said in a statement that he would continue to defend Texas’s laws and do “everything in my power to protect mothers and babies”.
Marjorie Dannenfelser, head of the national anti-abortion group Susan B Anthony Pro-Life America also welcomed the ruling, saying that under “all pro-life laws, doctors can provide pregnant women who experience an emergency with proper care”.
But Ms Dannenfelser said “what happened to Amanda Zurawski was completely wrong. No woman should suffer and almost lose her life when the law is clear”.
The plaintiffs were represented by the pro-choice advocacy group, the Center for Reproductive Rights.
The group said this was the first time pregnant women themselves had taken action against anti-abortion laws since the the US Supreme Court overturned the nationwide right to an abortion in June 2022. Lawsuits filed by women in other states with strict bans, including Idaho and Tennessee, have followed.
“The opinion lays bare the cruel consequences of the Supreme Court’s reversal of Roe v Wade,” said the Center’s president, Nancy Northup.
In December, the Texas Supreme Court ruled against another woman, Kate Cox, also seeking an abortion for her high-risk pregnancy. Ms Cox ultimately obtained an abortion in another state.
