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Maternal death rates higher in states that ban, restrict abortion: research

States with restrictive abortion laws have a 62 percent higher maternal death rate than states with greater abortion access.

Story at a glance

  • In the wake of the Supreme Court’s decision to overturn Roe v. Wade, many states’ trigger laws went into effect, immediately curtailing access to abortion. 

  • A new report shows states that ban or restrict access to the procedure have higher rates of maternal and infant death, fewer maternity care providers, and greater racial inequity across health systems. 

  • The United States already had the highest maternal mortality rate among developed countries prior to the overturn. 

States that have banned or restricted abortion access in the wake of the Roe v. Wade overturn also have higher rates of maternal mortality and infant death — especially among women of color — compared with states where abortion remains accessible.

That’s according to a new report from The Commonwealth Fund published Wednesday. 

Data showed maternal death rates were 62 percent higher in 2020 in states with restrictive policies than those without, while from 2018 to 2020 “the maternal mortality rate was increasing nearly twice as fast in states with abortion restrictions,” authors wrote.

States with limited abortion access also tended to have fewer maternity care providers, more maternity care deserts, a 34 percent higher death rate among women of reproductive age, and greater racial inequity across health care systems, data showed. 

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Even before the overturn of Roe v Wade, Black women were three times more likely to die from a pregnancy-related cause than white women, while throughout the COVID-19 pandemic, U.S. maternal mortality rates spiked, especially among Hispanic mothers. The U.S. also already has the highest preventable maternal mortality rate compared with 10 other wealthy nations

The new findings from The Commonwealth Fund confirm what many advocates feared: scrapping Roe v. Wade would have a disproportionate impact on women of color and worsen maternal health overall.  

Researchers compared the current status of maternal and infant health in states that already implemented bans, or are likely to implement bans on abortion, with states that will preserve abortion access, using data from the CDC, March of Dimes and Guttmacher Institute.

Prior to the overturn of Roe v. Wade, many states implemented so-called “trigger laws” that would immediately ban all or most abortions once national protections for the procedure ended. 

Broken down by racial/ethnic group, maternal death rates in restrictive states are 20 percent higher among non-Hispanic Black women, 33 percent higher among non-Hispanic white women, and 31 percent higher among Hispanic women. 

Slightly more than half of all births in 2020 took place in the 26 states with abortion bans or restrictions. In these states, larger proportions of births were to non-Hispanic white mothers, while states with abortion access saw more births to women of color. 

Births in states with restricted access also tended to be among younger mothers under the age of 30. 

Researchers defined maternal care deserts as “counties in which access to maternity health care services is limited or absent, either through lack of services or barriers to a woman’s ability to access that care within counties.” Nearly 40 percent of counties in abortion-restriction states were considered maternal care deserts compared with just 25 percent in states that maintained access. 

However, this could be due to the fact that states with restrictive policies tend to be more rural.

These states also had a 32 percent lower ratio of obstetricians to births and a nearly 60 percent lower ratio of certified nurse midwives to births, researchers found. This disparity could worsen going forward, as some maternal care providers express hesitancy toward working in states where they may face legal challenges. 

In 2019, fetal or infant deaths within the first week of life occurred at a 15 percent higher rate in restrictive states than in states with broader access. Restrictive states also saw higher neonatal death rates within 27 days of life, and higher postneonatal mortality rates between 28 days and a year after birth, authors said. 

In addition to the rurality of states where abortion access is curbed, many have not expanded Medicaid coverage under the 2021 American Rescue Plan Act. Currently, federal law requires care to be covered for 60 days postpartum, but states who opt into the expansion could extend Medicaid coverage for up to one year. 

Although almost half of states with abortion access have adopted the extension or plan to do so, less than one-third of abortion-restrictive states have done the same. 

“Such policy decisions help explain why residents of states with abortion bans or restrictions are more likely than residents of states where abortion is legal to begin a pregnancy less healthy, to lack insurance coverage, and to face barriers when seeking maternity and reproductive health care,” authors wrote. 

Researchers recommend states meet the challenges outlined by working to recruit more maternity care providers. Increased federal funding for reproductive and maternal care could also help mitigate the problems exacerbated by Roe’s overturn.

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