Maternal and infant death rates are higher in states that ban or restrict abortion, report says

By Jacqueline Howard, CNN

The rates of mothers and newborn babies dying during pregnancy, at birth or postpartum are much higher in states that currently ban or restrict abortions than in states preserving access, according to a new report.

The researchers analyzed data on deaths and other health outcomes using the most recent data available — from 2020 and earlier — and compared rates based on states’ current abortion access policies, as of November, after the Supreme Court decision this summer that overturned Roe v. Wade.

States that have restricted access to abortion services had maternal death rates in 2020 that were 62% higher than in states preserving access to abortion services. Between 2018 and 2020, the maternal death rate increased twice as fast in states that now have abortion restrictions, according to the report released Wednesday by the research foundation Commonwealth Fund.

Overall, death rates from any cause among women of reproductive age — 15 to 44 — were 34% higher in abortion-restriction states than in abortion-access states, according to the report.

The report also says that in 2019, fetal or infant death rates in the first week of life occurred at a 15% higher rate, on average, in states with abortion restrictions than in states with wider abortion access.

“Making reproductive services inaccessible to women and families can have dire consequences, and particularly, it varies by state,” said obstetrician/gynecologist Dr. Laurie Zephyrin, a co-author of the report and senior vice president for advancing health equity at the Commonwealth Fund.

In June the Supreme Court ruled on Dobbs v. Jackson Women’s Health Organization, which overturned Roe v. Wade, holding that there is no longer a federal constitutional right to an abortion and paving the way for states to ban abortions.

Based on the findings in the report, Zephyrin thinks maternal death rates in the US could worsen after the Dobbs decision.

“More people in the US die from complications of pregnancy and childbirth than any other developed nation, and most are preventable — and our rates are on the rise,” she said. “So I think that’s just very important as we think of this maternal health crisis and this collision of crises with this impact and this Dobbs decision.”

Maternal death rates 62% higher in abortion-restriction states

The new report — by researchers at Boston University and the Commonwealth Fund — includes data on state-by-state abortion policies and health outcomes among mothers and babies from sources including the US Centers for Disease Control and Prevention, the Health Resources and Services Administration and the nonprofit March of Dimes.

The researchers compared the health outcomes in 26 abortion-restricting states with those in the remaining 24 states and the District of Columbia, which appear to be unlikely to pass such restrictions.

The researchers found that slightly more than half — 55% — of US births in 2020 were in the 26 states currently with abortion bans or restrictions. In those states, births tended to be concentrated among women younger than 30, with 57% in women in that age group. In comparison, in abortion-access states, 45% of births were to women under 30.

The analysis also revealed that 39% of counties in states restricting abortion access fit the criteria to be considered “maternity care deserts,” meaning there is limited or no access to maternity health care services, such as an ob/gyn, hospital or birth center with obstetric care or certified midwives. In comparison, 25% of counties in abortion-access states can be considered maternity care deserts.

The researchers noted that a higher number of births in abortion-restriction states are in rural areas, where access to maternity care can be more limited and maternity care deserts more common. Rural areas had 17% of births in abortion-restriction states but 8% in abortion-access states.

The report also says that, between 2018 and 2020, the infant and perinatal mortality rates were 6.2 deaths per 1,000 births in abortion-restriction states, compared with 4.8 per 1,000 in abortion-access states. Across all racial and ethnic groups, infant mortality in the first year of life was higher in abortion-restriction states than in abortion-access states.

“What’s most surprising is, states have within their power to be able to avoid these outcomes,” Zephyrin said. “States really have it in their power to enhance maternal health capacity, really create the systems that are necessary to ensure that every person has an opportunity for a safe and healthy birth and life, whether we’re talking about recruiting maternity providers, providing more birthing centers, supporting the range of reproductive health services, expanding Medicaid, investing in postpartum Medicaid extension.”

Separate research published in 2020 in the journal Women’s Health Issues found that although maternal mortality overall continues to increase in the United States, the maternal death rate in states that have expanded Medicaid has had less of an increase than in non-expansion states.

“Compared with their counterparts in other states, women of reproductive age and birthing people in states with current or proposed abortion bans have more limited access to affordable health insurance coverage, worse health outcomes, and lower access to maternity care providers,” Zephyrin and her colleagues wrote in the new Commonwealth Fund report.

“Making abortion illegal risks widening these disparities, as states with already limited Medicaid maternity coverage and fewer maternity care resources lose providers who are reluctant to practice in states that they perceive as restricting their practice,” the researchers wrote. “The result is a deepening of fractures in the maternal health system and a compounding of inequities by race, ethnicity, and geography.”

‘This is not how healthcare should be’

Dr. Kristyn Brandi, the American College of Obstetricians and Gynecologists’ Darney-Landy Fellow, said she is not surprised by the findings in the new report because the “issues around reproductive health care are intricately linked.“

“My patients that seek abortion care are the same patients that need prenatal care in other pregnancies. Similarly, there is great data that suggests that the places that limit abortion also have higher maternal morbidity rates, less access to insurance, higher teen pregnancy rates, less access to sex education — the maps are overlapping,” Brandi, a practicing ob/gyn who was not involved in the research, wrote in an email to CNN.

She adds that restricting abortion care disproportionately affects marginalized communities, such as people with disabilities or travel limitations.

“It also means, similar to states that have only one abortion clinic, that the places where there are only one or a few labor and delivery units or prenatal care centers, those facilities will become overwhelmed with patients and that may create delays in care,” Brandi said. “This is not how healthcare should be. People should be able to access all reproductive health care services, regardless of their zip code.”

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