Texas showed the sharpest increase of maternal deaths of all U.S. states between 2000 and 2014, with that rate doubling in the two-year period after the state slashed funding for Planned Parenthood and women's health programs, according to a study to be published next month.

Many of the family planning clinics that lost funding or closed were an "entry point into the health care system" for women—leading to a ripple effect of difficulty obtaining care.

The analysis (pdf), forthcoming in the September issue of Obstetrics and Gynecology, found that after a "modest increase" in maternal mortality in Texas between 2000 and 2010, the rate of pregnancy-related deaths nearly doubled in 2011 and 2012—a trend the researchers found "puzzling." They point to everything from revisions to Texas' death certificate to data processing and coding changes to the closing of several women's health clinics as possible reasons for the jump.

"Still, in the absence of war, natural disaster, or severe economic upheaval, the doubling of a mortality rate within a two-year period in a state with almost 400,000 annual births seems unlikely," the authors write. "A future study will examine Texas data by race–ethnicity and detailed causes of death to better understand this unusual finding."

However, as Sarah Wheat, a spokeswoman for Planned Parenthood of Greater Texas, told the Dallas Morning News, many of the family planning clinics that lost funding or closed were an "entry point into the health care system" for women—leading to a ripple effect of difficulty obtaining care.

"Chances are they're going to have a harder time finding somewhere to go to get that first appointment," Wheat said. "They may be delayed in getting that initial pregnancy test and then a prenatal referral."

Indeed, other studies have detailed how politically-motivated attacks on Planned Parenthood are hindering women's access to quality healthcare in Texas and nationwide. "People have lost access to preventative healthcare, including birth control, and have lost access to their trusted healthcare provider," said Heather Busby, executive director at NARAL Pro-Choice America Texas, earlier this year.

Meanwhile, the study also found that the maternal mortality rate for 48 states and Washington, D.C., from 2000 to 2014 was "higher than previously reported, is increasing, and places the United States far behind other industrialized nations."

And that's "a national embarrassment," Eugene Declercq, a professor of community health sciences at the Boston University School of Public Health and one of the study's authors, told Boston's WBUR. "Our rates are comparable to Iran, the Ukraine, and Russia, not countries we generally want to compare our health outcomes to."

As Nora Caplan-Bricker writes for Slate: "Texas, for its part, established a task force in 2013 to study pregnancy-related deaths; it's due to make its first set of recommendations in September. The task force hasn't yet hinted at the contents of its report, but common sense suggests that replenishing the millions of dollars in funding the state has drained from women's health clinics might be a good start."