In post-Roe Texas, 2 mothers with traumatic pregnancies walk very different paths

The funeral did not go as Samantha Casiano had hoped — she did not get an open casket for the baby she named Halo.

"I was super-heartbroken," Casiano tells NPR. "It's the last time I was going to be able to see my daughter. It would have been the first time that a lot of my family members were able to see her."

Halo had anencephaly — her brain and skull did not fully develop. She lived for four hours. Casiano found out about the condition months earlier in her pregnancy, and she learned it is always fatal. Casiano, who lives outside Houston, wanted an abortion but couldn't afford to leave Texas to get one.

Beyond a very narrow exception when a mother's life is in immediate danger, there is no access to abortion in Texas. And doctors who perform an illegal abortion in the state face the possibility of life in prison, fines and the loss of their medical license. They can also be sued for aiding and abetting an abortion.

And so, in Texas, if you are pregnant and your fetus is diagnosed with a fatal condition, you have two options: travel out of state for an abortion or continue to carry the pregnancy until it ends on its own.

This is the story of two women who walked those different paths. Lauren Miller was able to leave Texas to abort one of the fetuses in her twin pregnancy, safeguarding herself and her healthy twin. Casiano had to carry Halo until she went into labor at 33 weeks gestation.

Both Miller and Casiano shared their stories in real time with NPR this year as they were making wrenching decisions and walking through painful circumstances. They spoke to us again in late June as the U.S. marked the first anniversary of the landmark Dobbs v. Jackson Women's Health ruling. The contrast between their lives highlights how, sometimes, what determines who can terminate a pregnancy for medical reasons is access to thousands of dollars on short notice to be able to "escape the state."

Why Texas?

Texas is the setting for many stories about the impact of abortion bans in the first year since the Supreme Court ended the constitutional right to abortion in the United States. It's the country's second most populous state, with nearly 30 million residents. And it had a head start in limiting access to abortion because a six-week ban went into effect there in September 2021. New research suggests nearly 10,000 more babies were born in the state as a result.

Both Miller and Casiano are also now plaintiffs in a lawsuit against Texas, in which 15 women are challenging the state's abortion restrictions. "It's the world's worst club," Miller tells NPR. "But I hope that this is showing people how many people are impacted by these bans."

In a court filing, the Texas attorney general's office argues that any potential harms suffered by the women were the result of their doctors' actions, not the state's. It says the plaintiffs have participated in "splashy news conferences and media tours." In Casiano's case, it also says that her economic circumstances caused her harm.

Texas Attorney General Ken Paxton and his office did not respond to a request for comment. The office has not responded to any of NPR's requests for comment on the implementation of Texas' abortion laws over the course of our reporting on the state's laws in the past year.

"Punished with time"

When Samantha Casiano's OB-GYN gave her the anencephaly diagnosis right around Christmas, Casiano was devastated. "I asked her, 'Hey, what are my options?'" she told NPR in March. "And she says, 'Well, because of the new law, you don't have any options. You have to go on with your pregnancy.'"

Casiano and her husband, Luis Fernando Villasana, live in a mobile home outside Houston, where they are raising five children, the youngest of whom just turned 1. Louie Villasana's first birthday party at Chuck E. Cheese on June 24, 2023, coincided with the first anniversary of the Dobbs decision.

When she first spoke to NPR, Casiano was scrambling to fundraise for the funeral — her GoFundMe campaign had raised only $20, and she wanted a proper service. A person of faith, Casiano said at that time that she wanted an abortion to be able to let her baby rest sooner: "I should have had that choice — that right over my own body and over my daughter's body to be able to tell my daughter, 'It is time for you to rest,' because she was going to end up having to rest anyways."

Many people were moved by her situation — after NPR aired and published her story in early April, over a thousand people donated a total of $50,000 to her. (This sum is mentioned in Texas' court filing to dismiss the case as part of a list of plaintiffs' activist activities.)

Casiano says she used the money that people donated to buy a car for herself for the first time (although it has had to go back to the dealer to get fixed several times). She also paid to get her husband's truck, which he uses for work, fixed. And she donated some money to another family that lost an infant through First Touch Family, a local organization that had helped her with Halo's funeral.

She is still very upset that she had to carry the pregnancy for many months knowing that her daughter wouldn't survive. It was especially hard to feel Halo kick.

"If you're on life support, your family can take you off of life support," she says. "I feel like it's the same thing, except for my daughter was in my womb — like I'm her life support. I feel like I should have been able to release her into heaven sooner rather than later, and I wasn't given that right."

She has gone back to work full time, and it hasn't been easy. Her kids still have to explain to friends and teachers why they don't have a baby sister.

In Casiano's lawsuit against the state of Texas, attorneys defending the state wrote in its filing in Casiano's case, "the cause of her alleged injuries appears to stem from a lack of resources and the intervening independent actions of her treatment providers who determined that she did not qualify for the medical exception to Texas abortion laws."

The only exception to Texas' abortion laws is if the pregnant patient's life or "major bodily function" is in imminent danger. A hearing in the case is scheduled for mid-July.

Casiano hasn't been able to bring herself to pick up Halo's death certificate. She says when she thinks about it all, she gets angry. She says it feels like she and Halo were sentenced to do time in prison, as she carried the pregnancy for months.

"I felt like I got punished with time. But why? Why did me and Halo get punished with time? What did we do that was so bad that we got punished with time?" she says. "That's how I feel."

"Henry made it"

Lauren Miller wrote to NPR in late September in response to a call for personal stories from people about how state abortion restrictions were affecting their lives.

"I am nearly 13 weeks with a wanted twin pregnancy, but we just found out today that while one of our twins is healthy, the other has Trisomy 18 or Edward's Syndrome, which is one of the chromosomal abnormalities often described as 'incompatible with life,'" Miller's email reads. "I am struggling to get information beyond the poor outlook, and the information that the longer that this twin continues, the higher risk that it becomes for our other baby."

NPR stayed in touch with Miller over the next few months. She and her husband, Jason, struggled to figure out their options from terse physicians, some of whom would not say the word "abortion" aloud. Health professionals were apparently cowed by the provision in Texas law that says anyone aiding and abetting an abortion can be sued. Over the course of several stressful weeks, they made the decision to fly to Colorado for an abortion procedure called a selective reduction, to help safeguard the healthy twin.

"It kind of felt like this secret mission — like, a we've-got-to-escape kind of feeling," Miller told NPR at the time. "I'm from Texas. I'm an eighth-generation Texan. To be feeling like I needed to escape the state was just a bizarre sensation."

A week after NPR published her story, Miller stood near the state Capitol building, visibly pregnant, for a news conference. She had joined the Center for Reproductive Rights' lawsuit against the state of Texas challenging its abortion laws, along with several other women.

Two weeks after that, in late March, she gave birth to the healthy twin — a baby boy she and Jason named Henry. "He's coming up on 3 months now, which is fun. We're just finally starting to do more stuff," she explained recently, bouncing her son on her lap. "You might hear the occasional coo as we're talking — he's very chatty."

It was emotional when she gave birth. When she first received the diagnosis in September, her doctors in Texas had told her that continuing the pregnancy with the twin with the fetal anomaly threatened her health and the health of the other twin. Even though she was able to have the selective reduction procedure out of state, she hadn't really let her guard down.

"I don't know that I'd fully registered until Henry was born how worried I had been," she says. "The first words I said to him were, 'You made it.' Despite the laws in Texas, Henry made it."

An infant-size urn

In a selective reduction procedure, one fetus stops growing but stays in the uterus, and the other continues to grow. So Miller delivered her healthy baby, as well as Henry's twin, whom they named Thomas. She and Jason brought an infant-size urn for Thomas in their bag for the hospital.

Miller says it's strange to be so public now about something so deeply personal. "It's kind of interesting," she says. "It used to be a conversation that was behind closed doors, and instead, people in my mom's Pilates class at the country club are mentioning it to her." She's willing to be so public, including joining the lawsuit against the state, because she's incensed about what Texas' abortion laws put her family through.

In Texas' court response to that lawsuit, Attorney General Ken Paxton says that Miller "contends the source of her injuries was the confusion and frustration she felt after speaking to her medical providers" and so cannot blame the state.

"They were very dismissive of all of our physical and emotional trauma, and to me, what that really showed is that we're disposable," Miller says. "Then I look down at Henry and, as I said, he made it. He's here despite these bans."

Photography by Nitashia Johnson and Danielle Villasana. Additional reporting by Danielle Villasana. Visuals production by Pierre Kattar. Edited by Diane Webber. [Copyright 2023 NPR]