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

Because the law blocks physicians from intervening until a medical emergency becomes severe, women experiencing pregnancy complications now face higher risks of preventable harm. Studies have linked the law and its ripple effects to:

• Infants dying: A Johns Hopkins study estimated an additional 12.7% increase in infant deaths (216 babies less than 12 months old) from March to December 2002, versus the expected. 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.
• Women getting very sick: 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. There was also a 54% increase in emergency blood transfusions for first-trimester miscarriages.
• Women dying: The rate of maternal deaths in Texas rose 33% between 2019 and 2023, even as the national rate fell by 7.5%.

In short, SB 8 reorganized the state’s entire reproductive health landscape and continues to affect Texans’ safety, outcomes, and autonomy in 2025.

It must be noted that, not surprisingly, the bill also led to an increase in the number of babies who survived. A Johns Hopkins team of researchers observed a 3% increase in live births (from 9,900 to 10,200) 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.

This new legal model of private enforcement paved the way for today’s near-total abortion ban. For Texans, that shift hasn’t just changed access to abortion; it has reshaped maternal health and medical care.

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.

Resources

KXAN Austin - State says 7,000 Texas women got an abortion out of state in 2024; advocates say number is 4x higher
National Partnership for Women and Families - NEWS: After Texas banned abortion, more women nearly bled to death during miscarriage 
Johns Hopkins - A Spike in Births and Other Potential Impacts of Texas’ Abortion Restrictions