The Health Divide: Tierra Walker’s death points to a growing pregnancy danger

The death of Tierra Walker in Texas is a glaring illustration of what happens when an abortion ban collides with one of the most dangerous complications of pregnancy: preeclampsia. 

Much of the press coverage of Walker’s death has focused, rightly, on harsh abortion restrictions that purport to sanctify the right to life of a fetus, even if it means denying that right to the pregnant person. 

But this is also a story about a condition that affects 2% to 8% of pregnancies in this country — as many as 434,000 women annually, Black women disproportionately. It’s a leading cause of preterm birth and maternal and fetal deaths, yet preeclampsia doesn’t get nearly the attention it should.

Walker, a 37-year-old mother in San Antonio, died in December 2024 in the 20th week of pregnancy. She had repeatedly asked to end the pregnancy because it was making her really sick. She had seizures, a blood clot, wild blood pressure swings, and intense pain shooting from her head through her chest to the bottom of her left foot. These are hallmarks of preeclampsia.

A ProPublica investigation in 2025 brought national attention to her death and those of other pregnant women who had serious health problems and were unable to get abortions. Walker’s story was back in the news in September, when her family filed a wrongful death suit against Texas Attorney General Ken Paxton and others. It claims the state’s abortion ban led to her death.

As that allegation is tested in court, journalists can investigate another question: What is happening to women who have preeclampsia or are at risk of developing it?

In the consumer-friendly language of popular health websites, preeclampsia is often described as high blood pressure with signs of organ damage. In fact, it’s way more complex than that. Preeclampsia can cause vascular dysfunction, inflammation and placental impairments, which can interfere with fetal growth.

The risks are especially grave for Black women like Walker, who develop preeclampsia at a 60% higher rate than white women and are more likely to suffer worse outcomes, including kidney damage and death. Walker previously had preeclampsia during a twin pregnancy in 2021; both fetuses died in utero at 25 weeks.

The condition typically begins after 20 weeks of pregnancy, though it can start earlier and escalate quickly. If it becomes severe, the standard recommendation is to end the pregnancy either by giving birth early or having an abortion.

The cause of preeclampsia is unknown, and there’s no surefire treatment. Given the prevalence and danger of the condition, that’s an indictment of our research priorities, which give short shrift to women’s health.

Well-known risk factors include obesity, previous pregnancy complications, age (pregnancy in one’s teens or after age 35), and hypertension. In July, the Centers for Disease Control and Prevention reported that one in 10 birthing mothers had gestational hypertension in 2024, a 73% increase since 2016. We shouldn’t expect preeclampsia rates to decline anytime soon.

While these risk factors affect Black women disproportionately, a study published in April points to another driver of preeclampsia disparities: racism. The study of more than 5,000 Black women found that those reporting the highest levels of racism in their everyday encounters had 50% greater odds of developing preeclampsia than women reporting the lowest levels. 

And Black women who said they experienced institutional racism — for example in employment or interactions with police — were also much more likely to develop the condition than those who reported no such experiences.

The study is not the first to show that systemic racism and the stress it causes are associated with pregnancy and birth complications. But while most research in this area compares Black women and white women, this study sheds light on the diversity of experiences among Black women themselves.

“When you only look at Black women versus white women, you tend to obscure the fact that Black women aren’t monoliths,” said Dr. S. Michelle Ogunwole, the study’s lead author and an assistant professor of medicine at Johns Hopkins University School of Medicine. “Within this group of women there are a variety of experiences.”

Preeclampsia can develop days or weeks after giving birth, and it significantly increases the risk of chronic hypertension and cardiovascular disease down the road. “People often think that once the baby is delivered, the risk of preeclampsia is gone,” Ogunwole said. “That’s a false narrative that we really have to correct.”

All this means that preeclampsia should not be viewed solely as a pregnancy problem. It’s a marker of a woman’s lifelong health, one influenced profoundly by sweeping policy changes of the last few years and a rapidly shifting health care landscape that’s making it harder for women to get the care and support they need.

When you only look at Black women versus white women, you tend to obscure the fact that Black women aren’t monoliths.”— Dr. S. Michelle Ogunwole, Johns Hopkins University School of Medicine

For example, the best way to prevent the devastating effects of preeclampsia is to ensure that women enter pregnancy healthy and receive good prenatal and postpartum care, including diligent blood pressure monitoring. As the largest single payer of maternity care in the U.S., Medicaid is essential for protecting the wellbeing of pregnant women and their newborns. The program financed 41% of births nationally — 1.47 million — and 47% in rural areas in 2023. What will happen to the health of low-income women of reproductive age and to rates of serious birth complications as the country feels the full force of drastic Medicaid cuts under the Republican megabill?

What will happen as millions of people drop Affordable Care Act health plans after Republicans refused to extend enhanced subsidies and the costs of premiums have skyrocketed?

And what will happen as pregnant people, along with millions of other Americans, lose SNAP benefits and can’t afford ample healthy food?

Cuts in the safety net, of course, aren’t happening in isolation. They intersect with the growing crisis in maternity care. One in three U.S. counties, primarily rural and low-income ones, lack a single obstetric provider or birthing facility. By 2035, 44 states are projected to have an inadequate supply of OB-GYNs.

These changes also intersect with abortion restrictions, including total bans in 13 states, following the Supreme Court decision overturning Roe v. Wade.

The lawsuit filed by Tierra Walker’s family should force the country to reckon honestly with the impact of harsh abortion laws when a pregnancy becomes dangerous. It should also spur us to do much more to understand, prevent and treat the condition that killed her and harms so many women.