'How many people need to speak up?': Biden SOTU guest to ABC News on abortion access

Last fall, Kate Cox found herself at the center of the national reproductive rights debate when she unsuccessfully sued Texas for an emergency abortion during her pregnancy, seeking a medical exception from the state's near-total abortion ban.

On Thursday night, Cox, along with her doctor, Damla Karsan, will be front and center once again as guests of first lady Jill Biden at President Joe Biden's State of the Union address at the Capitol.

Their presence in the chamber underscores Biden's focus on abortion access heading into the presidential election year. Many House and Senate and House Democrats have also invited other women and health care providers affected by the restrictive abortion laws that have gone into effect in more than a dozen states after the U.S. Supreme Court's decision overruling Roe v. Wade in 2022.

In their first joint interview, with ABC Senior Congressional Correspondent Rachel Scott, Cox and Karsan said they are looking forward to Biden's speech and the spotlight on reproductive rights.

"It's an incredible honor," Cox said. "I'm so grateful we're having this conversation."

"It's so important that the country be aware of what's going on, and what's at stake," Karsan said.

Cox said she and her husband were "so excited" when they learned about her third pregnancy -- ready to expand their growing young family.

"As soon as I got a positive pregnancy test, I ran into the playroom where my husband was wrestling with the other kids and showed him the test, and we were both just so excited and celebrated," she said. "It was a really joyful time."

But then she said she found out something was terribly wrong: Her fetus was diagnosed with a fatal genetic condition known as trisomy 18 -- and had little chance of survival.

"It's really heartbreaking because I was so excited for our third baby. It's the hardest news I've ever received. And it's hard to walk around pregnant with a belly, especially usually with my other two kids. When people ask you, you know, 'What do you do? What are you having? Do you have a name?' ... It's really hard when you know you're right. How do you explain? I wish I could have be a baby, but she'll never survive," Cox said, fighting back tears.

Her uterus was at risk of rupturing, jeopardizing her health and the possibility of future pregnancies, Dr. Karsan said.

"The risks increase by the day. The risk of hemorrhage, the risk of uterine rupture," Cox's doctor told ABC News.

"This, unfortunately, was a pregnancy plagued with pain and suffering, and it was never going to result in a baby that we could take home," Cox told Scott.

Texas bans abortions outright with a narrow exception to prevent bodily harm or save the life of the mother. Kate believed that would apply to her.

Her case went all the way to the Texas Supreme Court. But Kate couldn't wait for a decision to be made and was forced to flee the state for an abortion.

Ultimately, the court determined she didn't qualify for an abortion.

"Are your hands tied as a medical professional in the state of Texas to care for your patients?" Scott asked.

"Most physicians are afraid," Dr. Karsan told ABC News. "You can lose your medical license for up to 99 years in prison and $100,000 fine. So. you know, physicians are terrified. They they're not willing to take that risk."

"It was a crushing time when the final ruling came down, and to have to travel out of state added a lot of pain and suffering to what was already the most devastating time in my life," Cox said. "I mean, I wanted to be home. I wanted to be close to my doctor. I wanted to be able to hug my babies after, to cry on my own pillow. I didn't want to have to travel."

"What do you want to see changed?" Scott asked.

"I'd love to see the government get out of decision-making," Karsan said. "I'd love to have to decisions be between my patients and myself."

"I also hope that people learn from what we've gone through," Cox said. "How many people have to speak up? How many women have to tell their most painful journey publicly before something changes?"