The state of Texas on Monday published an online pamphlet filled with medically dubious claims about abortion care, including discredited information linking abortion to cancer and a section exaggerating the medical dangers associated with the procedure. 

The Texas Department of State Health Services (DSHS) quietly published the final version of the pamphlet, “A Woman’s Right to Know,” which doctors are required to provide to all pregnant people seeking abortion care.

After a draft of the pamphlet was published in June, reproductive rights advocates called for changes to the medically inaccurate information.

State lawmakers passed the Texas Woman’s Right to Know Act in 2003, requiring abortion providers to inform pregnant people of the medical risks associated with abortion care, as well as the probable gestational age of the fetus and the medical risks of carrying a pregnancy to term.

Heather Busby, executive director of NARAL Pro-Choice Texas, said in a press release that the state is “playing politics with people’s health care.”

“This pamphlet is riddled with errors and promotes misinformation designed to stigmatize abortion and dissuade women from making their own decisions about their health care,” Busby said. “The state health agency should not be in the business of providing propaganda and interfering in the doctor-patient relationship.”

The pamphlet includes a number of medical inaccuracies common in anti-choice literature.

“In consideration of the potential for fetal pain,” the pamphlet states, “Texas law currently limits abortion to under 20 weeks.” But the theory that a fetus is capable of experiencing pain at 20 weeks, which is based on a few selected studies, has been medically disproven. The medical consensus is that a fetus is unable to perceive pain before the third trimester.

In a section of the pamphlet titled “Breast Cancer Risk,” the state claims that “doctors and scientists are actively studying the complex biology of breast cancer to understand whether abortion may affect the risk of breast cancer.”

The link between abortion and cancer, however, has been repeatedly debunked by scientific research.

“Scientific research studies have not found a cause-and-effect relationship between abortion and breast cancer,” according to the American Cancer Society. And a report by the National Cancer Institute explains that “having an abortion or miscarriage does not increase a woman’s subsequent risk of developing breast cancer.”

Texas’ pamphlet emphasizes the medical risk of abortion care, even though government reports show that abortion is a highly regulated and overwhelmingly safe procedure.

The pamphlet states that there are “0.73 legal abortion-related deaths per 100,000 reported legal abortions in the United States from 2008-2011,” according to Centers for Disease Control and Prevention (CDC).

The most recent reporting by the CDC found that abortion mortality has decreased, and the “national legal induced abortion case-fatality rate for 2008–2012 was 0.65 legal induced abortion-related deaths per 100,000 reported legal abortions.”

Meanwhile, statistics reveal that it continues to be far safer to have an abortion than to carry a pregnancy to term in Texas. Between 2008 to 2013, there were 691 maternal deaths in Texas, compared to one death due to abortion complications from 2008 to 2014. Researched published this year found that Texas’ maternal mortality rate doubled between 2010 and 2012.

More than 34 percent of the information found in the previous version of the state’s “A Woman’s Right to Know” pamphlet, published in 2013, was medically inaccurate, according to a study by a Rutgers University research team.

Republican-held legislatures around the country have passed laws mandating that states provide written materials to pregnant people seeking abortion services. These so-called informed consent laws often require that the material include inaccurate or misleading information pushed by organizations that oppose legal abortion care.

The updated pamphlet adds a warning for pregnant people who might feel pressure to have an abortion, stating that “if you are feeling pressure (also called coercion) from someone to have an abortion,” there are a number of options, including calling 911 for emergency help.

This addition has drawn criticism from law enforcement officials arguing that emergency calls are for life-threatening situations. Charley Wilkison, executive director of the Combined Law Enforcement Associations of Texas, told the Houston Chronicle that such calls would strain departments’ limited resources.  

“Texas police are short-staffed all over the state in big urban departments and in small rural places and everything in between, so unless someone’s holding you down trying to force you to have an abortion, then you’re going to be placed on a priority two or three,” Wilkison said.

Emily Horne, a lobbyist for the anti-choice group Texas Right to Life, told the Houston Chronicle that her organization had pushed DSHS to include the language.

“[Women who] are possibly in an abusive situation or heading back into an abusive situation, they’re under threat for abuse if they don’t have this abortion, and so that is the idea to get her immediate help to get her out of that situation,” Horne said. “Overall, I’m excited to get the language in there at all.”