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A group of 111 gynecologists in Texas released a letter to elected state leaders on Sunday, urging them to change abortion laws that they say have prevented them from providing life-saving care to pregnant women.

The doctors pointed to recent reporting by ProPublica about two pregnant Texas women who died after medical staff delayed emergency care.

Josseli Barnica, 28, died in 2021 from an infection, three days after she suffered a miscarriage. More than a dozen medical experts said Barnica’s death was preventable. However, state abortion laws prevented doctors from intervening until they could not detect a fetal heartbeat, which did not happen until about 40 hours after the miscarriage began.

Nevaeh Crain, 18, died last year after developing a dangerous complication of sepsis that doctors refused to treat while her six-month-old fetus still had a heartbeat. Two emergency departments failed to treat her and a third delayed care, resulting in Crain being transferred to the intensive care unit only after she suffered organ failure. Medical experts said that if hospital staff had treated her early, they could have helped Crain with an early delivery, or saved her life by terminating the pregnancy if the infection had gone too far.

“Josseli Barnica and Nevaeh Crain should still be alive today,” the doctors wrote in their letter. “As a gynecologist in Texas, we know firsthand how much these laws limit our ability to provide our patients with high-quality, evidence-based care.”

In 2021, Texas lawmakers passed a law banning doctors from performing abortions after six weeks. The law allows citizens to sue doctors or anyone who helps perform an abortion for $10,000.

After the Dobbs v. Jackson ruling overturned Roe v. Wade, Texas banned almost all abortions – including in cases of rape and incest. The law does make an exception for a doctor to perform an abortion if he or she believes it is necessary to save the life of the pregnant patient. Doctors who violate the state’s abortion law risk losing their medical licenses and possibly going to prison for life.

Doctors have said the confusion over what constitutes a life-threatening condition has changed the way they treat pregnant patients with complications. The Texas Medical Board has provided guidance on how to interpret the law’s medical exception, and the Texas Supreme Court has ruled that doctors do not have to wait until there is an immediate risk to the patient to intervene. But some doctors say the guidelines are vague and that hospitals consider each situation on a case-by-case basis.

ProPublica’s reporting on Crain and Barnica comes as U.S. Sen. Ted Cruz and U.S. Rep. Colin Allred of Dallas face off in a heated bid for one of Texas’ two seats in the U.S. Senate. Their differing views on abortion have been at the center of the race, and both candidates have offered their opinions on the deaths of Crain and Barnica.

“Doctors in Texas can’t do their jobs because of Ted Cruz’s cruel abortion ban,” Allred wrote on X, referring to the Crain story. “Cruz even lobbied SCOTUS to allow states to ban life-saving emergency abortions.”

In 2021, Cruz sponsored a 20-week federal abortion ban. He also co-sponsored a bill that would allow states to exclude medical providers who perform abortions from Medicaid funding. After the U.S. Supreme Court overturned Roe v. Wade, Cruz celebrated the decision as a “huge victory.”

Cruz has previously said he thought Texas’ exception to save the pregnant mother’s life worked. This week he reiterated that position. He called the deaths of Crain and Barnica “heartbreaking” in an interview with The Houston Chronicle and said procedures needed to save the pregnant mother’s life are legal in Texas.

Dozens of women have come forward that after the abortion ban went into effect, they were unable to get the health care they needed for their medically complex pregnancies.

Last year, state lawmakers passed a law allowing abortions for people with ectopic pregnancies, a nonviable form of pregnancy in which the embryo implants outside the uterus, and also when a patient’s amniotic fluid breaks before the fetus is viable.

The doctors who signed the letter said they wanted to see a change in state law.

“Texas needs change. A change in the laws. A change in the way we record medical decisions that should be a matter between a patient, their family and their doctor.”