TX - Impact of the Heartbeat Act

On May 19, 2021, Governor Abbott signed SB 8, also known as the Heartbeat Act, prohibiting doctors from performing abortions once a fetal heartbeat is detected, typically around 6 weeks. Physicians must test for a heartbeat before performing or inducing an abortion for any reason, and cannot proceed if one of two things happens: they fail to test for one, or they detect one. There are no exceptions for congenital anomalies.

In addition, although private citizens cannot sue someone who received an abortion, they can sue someone who either performs an abortion (doctors) or who "aids or abets" someone who is (e.g., a person who pays for the abortion). And they have 4 years to file the lawsuit. If successful, plaintiffs will be awarded a minimum of $10,000, along with the reimbursement of all legal costs. Courts also have the right to issue injunctions to stop a defendant from performing further prohibited abortions.

Why it Matters

At a time when Roe v. Wade still protected a woman's right to an abortion in all 50 states, the Heartbeat Act was considered a backdoor strategy to prevent abortions and deter abortion providers. Moreover, it laid the groundwork for the state's current reproductive landscape, one of the most restrictive in the country in 2025.

Since its enactment, the following increases have been recorded:

Infant mortality: A Johns Hopkins study estimated an additional 12.7% increase in infant deaths from March to December 2002 versus the expected. This means that 216 babies might not have died had this law not been in place. Further, the leading cause of death was attributed to congenital anomalies (not an exception under this law), which increased 21% over that time period, versus 1% in the rest of the US.
Maternal sepsis: The rate of sepsis, a life-threatening condition caused by infection, increased more than 50% for women hospitalized when they lost their pregnancies during the second trimester. Women whose fetus may still have had a heartbeat when they arrived at the hospital were the most likely to become septic due to the required delay in care.
Maternal death: The same ProPublica study showed that the rate of maternal deaths in Texas rose 33% between 2019 and 2023, even as the national rate fell by 7.5%.
Increase in live births: Another Johns Hopkins team of researchers saw a 3% in live births (9900 babies) from April to December 2022. A similar pattern was not detected in other states.

Background

The Heartbeat Act was a change to the Texas Health and Safety Code, Chapter 171 titled "The Woman's Right to Know Act," that has been in effect since September 2003. At the time, it was the strictest state abortion law in the country, and the only one of its kind that survived legal and other court challenges. The reason for its success is rooted in the privatization of enforcement, which gives state officials cover from constitutional challenges and makes the law harder to challenge.

Update - Oct 31, 2025: Based on Texas government data, more than 50,000 residents received abortion care annually from 2008 to 2021. In 2022, after the Heartbeat Act, fewer than 20,000 received such care. In 2023 and 2024, after the Supreme Court decision, no residents received care except when the mother's life was in jeopardy. The Guttmacher Institute estimates that in 2024, roughly 28,000 Texas residents obtained abortions, with the majority traveling to New Mexico, Kansas, and Colorado.