As many conservatives hail the fall of Roe for saving unborn lives, high-risk pregnancy becomes even more perilous.

Yeniifer Alvarez arrived in central Texas from San Luis Potosí, Mexico, in 1998. At three, she was just old enough to have a sense of a world left behind: the fire that warmed the house in the evening, the meat hung to dry outside the door, and la bisabuela, her adored great-grandmother, who had died shortly before Yeni and her mom went north. In Luling, Yeni, her parents, aunts, and grandmother settled into a cramped house with a tin roof that was down the street from her great-uncles, the first members of the family to discover the town’s decent jobs, in the oil fields.

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The autopsy capped more than three thousand pages of medical records chronicling the short life of Yeniifer Alvarez-Estrada Glick. None of the records from when Yeni was alive acknowledge that, given her multiple underlying conditions, an abortion would have increased her chances of survival. Only the autopsy put it plainly. “Pregnancy creates stress on the heart and can exacerbate underlying heart disease and cause hypertensive crises,” the medical examiner wrote, in naming pregnancy as a factor in Yeni’s death.

Yeni’s passing came as a shock to her family. “We were scheduled to do her baby shower that weekend,” Andrew’s sister Lisa Bozeman told me. “But we weren’t having a baby shower. We were having a funeral.” Ever since Yeni’s death, some of the medical professionals involved in and briefed about her care have been haunted by the question of whether sins of omission were committed. They have asked themselves if responsibility for her death resided in part with the new laws that suppress free discussion—both among doctors and with patients—about therapeutic abortion. Had fear of legal repercussions trumped compassionate care?

Yeni’s death occurred two weeks after the overturning of Roe, which triggered abortion restrictions in states across the country. In Idaho, Texas, and Missouri, for instance, performing an abortion in almost all circumstances became classified as a felony for which a doctor could face years in prison and the loss of a medical license. Even before the Supreme Court ruling, the U.S. (the rare wealthy nation without universal health care) was one of the few countries where maternal deaths had increased significantly in the past two decades. A study by the University of Colorado Boulder predicted a surge in maternal deaths after Roe fell, disproportionately among women of color; analysts at The Lancet and Harvard Medical School voiced similar worries.