We Have the Technology. Why Are People Still Dying? Part 1: Ectopic Pregnancies

I saw a headline

I saw a ProPublica headline: “Ectopic Pregnancy Deaths Have Nearly Doubled. It’s Worse in States With Abortion Bans.” Before I believed it at face value, I wanted to know what the evidence actually showed. What doubled? Over what period? And how much of the explanation was established, versus something I was filling in myself?

I live in Florida, and I have friends and family who have survived ectopic pregnancies. This is something that has happened to people I care about. But knowing someone who survived a medical emergency doesn’t tell me why other people are dying from it, or whether more people are dying now.

So I went looking. I thought I was checking a headline. I ended up with a much bigger question about what it means to have medical technology if people can’t reliably benefit from it.

What actually happens in an ectopic pregnancy?

Normally, a fertilized egg travels through a fallopian tube and implants in the lining of the uterus. An ectopic pregnancy implants somewhere else, most often in the tube itself. A pregnancy growing in a fallopian tube cannot develop into a baby and survive to birth. If it keeps growing, it can rupture the tube and cause life-threatening internal bleeding. The Royal College of Obstetricians and Gynaecologists explains the condition and treatment options here.

That doesn’t mean every ectopic pregnancy ruptures. Some stop developing and are reabsorbed by the body. This can happen before someone knows they are pregnant. In selected cases, doctors can monitor a diagnosed ectopic pregnancy as it resolves, using blood tests and reassessment rather than immediately giving medication or operating. The Ectopic Pregnancy Trust describes this process, and NHS guidance explains when monitoring may be appropriate.

It also isn’t necessarily a matter of the body “flushing it out.” Vaginal bleeding can come from the uterine lining shedding while the pregnancy is located elsewhere. Bleeding alone doesn’t establish that the ectopic pregnancy has gone away.

Other cases require medication, commonly methotrexate, or surgery. The pregnant person can survive and recover even though the pregnancy cannot continue. There are extraordinarily rare reports of live births from ectopic pregnancies elsewhere in the abdomen, but these are dangerous exceptions, not what happens with a pregnancy growing in a fallopian tube. One published case report illustrates the difference.

When we talk about ectopic-pregnancy deaths in this article, we are talking about the deaths of the pregnant people.

The increase checks out.

I checked the counts in CDC WONDER’s mortality databases, selecting females ages 10–54 whose death certificates listed ectopic pregnancy among the causes of death. There were 106 deaths during 2014–2019 and 196 during 2020–2025. That is an increase of about 85% between two six-year periods.

The 2025 records are still provisional, meaning they can change as processing continues. Death certificates also have limitations, and CDC cautions about changes in maternal-death coding. Reproducing the count confirms the calculation; it doesn’t independently confirm every diagnosis or explain every death.

I also had to separate two questions that sound similar in a headline. Are more people dying with an ectopic pregnancy? And has an individual person’s chance of dying after developing one increased? We can count the deaths without having a reliable count of every ectopic pregnancy. Without that second number, we can’t calculate the individual risk directly.

A ratio measured against live births is useful for comparing periods or populations, but it answers a different question. More deaths could reflect more ectopic pregnancies, worse outcomes among people who have them, or both.

Then there is the comparison between states. In an NPR interview about the investigation, reporter Andrea Suozzo described a steeper rise in states with abortion bans, while also noting that those states had longstanding differences in maternal outcomes and healthcare resources.

Those differences complicate any attempt to isolate the effect of the laws. So does the timing: the recent six-year period begins in 2020, before Dobbs v. Jackson Women’s Health Organization, the June 2022 Supreme Court decision that overturned Roe v. Wade and the federal constitutional protection for abortion.

The increase is there but the explanation is complicated.

We already know how to treat this

Medicine has made substantial progress against ectopic-pregnancy deaths. A study covering the United States from 1980 through 2007 found that the mortality ratio fell from 1.15 deaths per 100,000 live births in 1980–1984 to 0.50 in 2003–2007, a decline of about 57%.

The tools involved are familiar: pregnancy tests, ultrasound, medication, and surgery. We aren’t waiting for someone to invent the first way of finding an ectopic pregnancy or stopping the bleeding it can cause.

But those tools come with requirements. Medication is appropriate only in certain circumstances and requires follow-up. Surgery needs trained people, equipment and a facility capable of providing it. Diagnosis requires someone to consider the possibility, order the appropriate tests and interpret the results. NICE’s treatment guidance makes those dependencies clear.

This brought William Gibson to mind: “The future is already here—it’s just not very evenly distributed.” Usually I encounter that quote in conversations about computers or whatever expensive new thing has just appeared. Here I was reading about blood tests and emergency surgery.

Having the equipment and getting someone treated in time were turning out to be very different accomplishments.

Florida had already seen this happen

Then I found a CDC investigation of ectopic-pregnancy deaths in Florida during 2009–2010. There were 11 deaths in those two years, compared with 13 during the entire preceding decade. The mortality ratio rose from 0.6 to 2.5 deaths per 100,000 live births.

This happened before COVID and more than a decade before Dobbs. Whatever was going wrong in these cases couldn’t be explained by either of them.

Investigators reviewed the records. Eight women had collapsed before seeking care. Seven of the 11 had no insurance or health plan. Among the three who sought care before collapse, two experienced diagnostic delays.

Substance use appeared in the investigation too: six of the eight women who collapsed tested positive for illicit drugs, including four for cocaine. But testing had been less common in the earlier period, preventing a reliable comparison of drug use between the two periods.

I kept thinking about the people I know who survived. The medical capability existed for them, and it existed during the period covered by this report. Yet there were problems reaching care, paying for it and getting a timely diagnosis.

There isn’t just one weak link. The whole dang chain is busted. Different people were encountering different failures, and fixing one would not necessarily have fixed the others.

What happens when people are afraid to seek help?

The substance-use finding sent me down another path. If someone already has trouble accessing healthcare, what happens when seeking help also creates fear of punishment?

ACOG’s position on substance-use disorder in pregnancy emphasizes treatment and maintaining a connection to healthcare. It identifies punitive testing, reporting and prosecution as problems, and points to the benefits of receiving care and being able to speak openly with a clinician.

That gives us a reason to investigate whether policy discourages people from getting help. The Florida records don’t tell us that a particular law caused those deaths, though. They also don’t establish that a specific treatment program would have prevented them.

I couldn’t turn a positive toxicology result into a complete explanation of someone’s death. It was one part of the circumstances investigators needed to understand.

Was it COVID, or what happened to healthcare during COVID?

Once I got to the pandemic, I had to ask two questions separately. Did infection itself make ectopic pregnancy more dangerous? And did the disruption of healthcare make it harder to diagnose and treat?

A study comparing pandemic years with earlier years doesn’t automatically separate those possibilities. A patient treated during the pandemic might never have had COVID, while still experiencing a closed service, a delayed appointment or an overwhelmed emergency department.

One systematic review examined 12 studies involving 3,122 patients. It compared ectopic-pregnancy management before and during the pandemic, including differences between services with dedicated Early Pregnancy Units and those without them.

In settings without those units, the pooled results showed increased odds of rupture and complications during the pandemic. In the Early Pregnancy Unit group, the researchers did not find a statistically significant change in rupture.

These were observational studies, and the services differed in ways beyond whether they had a particular unit. Still, the results suggested that maintaining a dedicated route into early-pregnancy care could help during a disruption. They gave me more direct evidence about how care was organized than about a biological effect of the virus itself.

I did not find evidence establishing that SARS-CoV-2 infection caused the national increase in ectopic-pregnancy deaths. I found evidence that the pandemic affected care, and that some arrangements appeared to hold up better than others.

Pandemic preparedness is healthcare technology too

This stretched my thinking about what belongs under “technology.” An ultrasound machine is easy to recognize as medical technology. A staffing plan, a referral system or a way to keep urgent services operating during a pandemic is less likely to get that label.

But the machine needs all of those things around it. Someone has to be available to use it. Patients need a way to reach that person. The result needs to lead to treatment, including when the normal arrangements stop working.

I’m using technology here in the broader sense of an organized human capability. Pandemic preparedness preserves the ability to deliver care when conditions change. It belongs in the same conversation as the equipment whose usefulness depends on it.

That also changes how I think about apparently unused capacity. A service can look excessive during an ordinary week and become necessary during a crisis. Whether a particular investment is worthwhile requires evidence, but “we aren’t using it right now” doesn’t tell us what would happen without it.

Having insurance doesn’t mean you can afford care

I have paid roughly 20% of my income for health insurance while still paying copays and prescription costs. I think that is ridiculous. But my bills don’t establish how often other people delay care because of money, much less explain a national mortality increase.

The Commonwealth Fund’s 2024 survey found that 23% of working-age adults were insured throughout the year but underinsured, using a definition based on out-of-pocket expenses and deductibles relative to income.

Among underinsured respondents, 57% reported forgoing needed care because of cost. Among respondents who delayed or skipped care because of cost, 41% said a health problem had worsened as a result.

This was a survey about healthcare broadly, not ectopic pregnancy. It doesn’t tell us how many ectopic deaths resulted from cost barriers. It does show why counting insured people cannot, by itself, tell us how many people can afford to use their coverage.

Repeated blood tests, follow-up visits and another trip to the hospital can all be medically appropriate. Whether someone can actually make those visits is part of whether the treatment plan works.

Can you reach someone who can treat you?

Even affordable care has to exist somewhere you can reach. The March of Dimes’ 2024 report classified 35.1% of U.S. counties as maternity-care deserts: places with neither a birthing facility nor an obstetric clinician. Those counties were home to more than 2.3 million women of reproductive age.

That is not an exact map of access to ectopic-pregnancy treatment. A county without a maternity unit may still have an emergency department, and early-pregnancy emergencies require different services from routine childbirth. But it documents gaps in the surrounding workforce and facilities.

“Access” was becoming a frustratingly broad word. One person might have insurance and no nearby specialist. Another might live near a hospital but be unable to afford follow-up. Someone else might get through the door promptly and still receive the wrong diagnosis.

Putting all of that into one category makes it easy to announce that we have improved access without establishing which obstacle we actually removed.

So capitalism is the problem, right?

My instinct is to look at a system organized around money and ask whether the financial incentives are working against the people who need care. I wanted to test that instinct rather than let it write the conclusion for me.

The progressive criticism is straightforward: a person’s need for healthcare doesn’t depend on their ability to pay, and a community can need a service that isn’t financially attractive to provide. Rural obstetric care gives us a concrete example to examine.

A study of rural hospitals that closed their obstetric units identified low birth volumes, staffing difficulties, reimbursement and other financial pressures among the reasons administrators gave. Keeping trained staff and facilities available for unpredictable needs costs money even when few patients arrive.

A service can therefore be useful to a community while difficult for a hospital to sustain. That supports a criticism of how we finance readiness. It also complicates the idea that every closure can be explained by a greedy owner choosing profit over patients. Staffing shortages and public reimbursement decisions are part of the financial problem too.

The American system combines private markets, public programs and regulation. I couldn’t isolate “capitalism” as though the other parts weren’t there. I could identify specific places where what pays and what people need may diverge.

Paying for care and providing it are different problems

The strongest objection to treating universal coverage as the whole answer is that paying for care doesn’t instantly create the capacity to provide it. Doctors, nurses, laboratories and operating rooms remain finite. People can have coverage and still wait too long.

Some countries with universal coverage have substantial waiting-time problems. But the experience varies enough that “universal healthcare” doesn’t predict one result.

OECD’s 2025 report, using a 2023 international survey, found that 18% of respondents in both the United States and United Kingdom reported waiting more than a week for a GP or nurse appointment. The figure was 7% in the Netherlands and 32% in Canada.

Those figures exclude emergency-department visits, so they cannot tell us how quickly someone with internal bleeding would receive surgery. They do show why comparing actual services is more useful than treating every country with broad coverage as the same system.

Americans also experience delays through cost, geography and unavailable appointments. A comparison that counts another country’s waiting list while overlooking people here who never seek care because of the bill is incomplete.

Government can restrict the supply too

The libertarian argument deserved a closer look as well. Some regulations can make it harder to open or expand healthcare services. Certificate-of-need laws are one example: they can require providers to obtain permission before adding certain facilities or services.

In a joint statement examining Virginia’s system, the Federal Trade Commission and Justice Department argued that these requirements can delay entry and protect existing providers from competition.

That is a real mechanism to investigate. It isn’t evidence that those laws caused the rise in ectopic-pregnancy deaths, and repealing a requirement doesn’t guarantee that someone will finance and staff an otherwise unviable service.

By this point, I had evidence for several criticisms that people often present as competing explanations. Financial incentives can leave needs unmet. Public systems can have inadequate capacity. Regulation can restrict supply. None of those observations eliminates the others.

Now, back to abortion restrictions

Florida’s deaths and the pandemic research had already established reasons to look beyond abortion restrictions. That doesn’t make the restrictions irrelevant. It means their effects need to be investigated alongside problems that existed before them.

A 2026 study in JAMA Network Open interviewed 40 physicians across nine states with total abortion bans. They described additional testing, delays and institutional approval processes affecting several kinds of pregnancy-related care, including ectopic pregnancy. Their accounts described decisions increasingly shaped by perceived legal risk.

The physicians weren’t a random national sample, and an interview study cannot calculate how many deaths a law caused. What it provides is evidence about how some clinicians experienced the restrictions and how those experiences affected care.

Early diagnosis can already involve uncertainty. A positive pregnancy test with nothing visible on ultrasound might mean a pregnancy in the uterus is too early to see, a pregnancy has miscarried, or the pregnancy is ectopic. RCOG describes this as a pregnancy of unknown location. Further testing can be necessary to find out which.

That means we can’t look at every repeat test and conclude that a doctor was stalling because of an abortion law. We also can’t assume that every delay was medically necessary when physicians themselves describe waiting for legal or institutional approval.

I wanted to understand the incentives. What happens when a clinician believes intervening could expose them to prosecution, license loss or a major financial penalty? Texas law contains protections for ectopic-pregnancy treatment alongside severe penalties for prohibited abortions, including civil penalties of at least $100,000 per violation.

Failing to provide appropriate care can carry liability too. It would be inaccurate to say there are consequences only for acting. The concern is whether clinicians perceive intervention as the greater legal risk and respond by waiting longer under uncertainty.

The interviews provide evidence consistent with that concern. They do not establish that the laws required every reported delay or caused the entire national mortality increase.

What about Planned Parenthood?

I also wondered where reproductive-health clinics fit into this. Planned Parenthood lists pregnancy testing and pregnancy-dating ultrasound among its services, with availability varying by location, and provides information about ectopic symptoms and seeking care.

That makes these clinics potential early points of contact: somewhere a person might learn they are pregnant, discuss symptoms, receive an assessment or get connected to further care. It doesn’t mean every location can diagnose an ectopic pregnancy or provide emergency treatment.

I didn’t find evidence sufficient to calculate how much changes in clinic availability contributed to the mortality increase. Their potential role belongs in the investigation, but I couldn’t turn it into a demonstrated national explanation.

They found the problem and changed things

The UK and Ireland had deaths to investigate too. The 2024 MBRRACE-UK report examined 12 early-pregnancy deaths during 2021–2022, all involving ectopic pregnancy. Concern about the deaths prompted an accelerated review, with recommendations addressing assessment and ambulance-call handling.

The earlier research about Early Pregnancy Units hadn’t established that everyone in Britain could reliably reach one, or that the country had eliminated deaths. It examined particular services, periods and outcomes. A system can have something worth learning from and still have serious failures elsewhere.

Following the review, the Ectopic Pregnancy Trust developed its Think Ectopic campaign, providing resources for clinicians who might be a patient’s first contact. Ambulance organizations supported and circulated the materials, and the Royal College of Emergency Medicine collaborated on emergency-department content.

They found the problem and changed things. That stood out to me. People examined what had happened and used it to change the information reaching frontline services.

I can verify that those actions occurred. Establishing how much they improved outcomes requires another measurement. A recommendation, a training resource and a reduction in deaths are three different stages of the work.

Count the deaths. Then find out what happened.

The United States has people doing this work too. State and local maternal mortality review committees investigate deaths in depth, with CDC support. They can examine medical records and other information that never fits on a death certificate. Florida’s investigation shows what those reviews can reveal.

National-scale health data and local case review serve different purposes. A rare event scattered across many places can be difficult to recognize as a trend until the records are considered together. Once a pattern appears, someone still has to investigate the individual cases to understand it.

How long did someone have symptoms? Did they recognize them? Where did they seek help? What happened when they arrived? Those questions can lead to very different changes depending on the answers.

The process I found was: Measure → detect → investigate → understand → change → measure again. The last step prevents us from confusing activity with improvement. Something can sound sensible, receive funding and be implemented without producing the outcome we wanted.

Technology in service of human beings

I started with a headline that seemed to invite a quick political conclusion. Instead, I found documented problems involving cost, geography, diagnosis, pandemic disruption and legal risk. I could verify the increase in recorded deaths. I could not honestly assign a percentage of it to each explanation.

That uncertainty doesn’t erase what medicine has accomplished. My friends and family who survived ectopic pregnancies are part of that accomplishment. So are the decades of historical improvement. But neither guarantees that the next person receives the same care in time.

Gibson’s line stayed with me because the unevenly distributed future here includes tools we’ve had for years. Their usefulness depends on someone knowing they need help, being able to reach it, receiving the right diagnosis and getting treatment.

“Technology in service of human beings” is a theme I want to build my life around. This investigation gave me a more specific way to think about it. The equipment, the people, the arrangements for delivering care and the work of finding and correcting failures all contribute to the result.

I’m still interested in what we might invent next. I also want to know what it would take for more people to benefit from what we already know how to do.