Researchers estimate 80% of pregnancy-related deaths are preventable.
A news report by the Commonwealth fund reiterates the tragic correlation between abortion restrictions or denials and high maternal death rates in the United States. contributing to a 62% higher maternal death rate compared to states where abortion is more easily accessible.
Maternal deaths are high in the U.S. relative to other high-income countries, and there are significant inequities by race and ethnicity. Still, for every major racial or ethnic group, maternal death rates are higher in abortion-restriction states compared to abortion-access states, including 20 percent higher among non-Hispanic Black people, 33 percent higher among non-Hispanic white people, and 31 percent higher among Hispanic people.
Fetal or infant deaths in the first week of life are also worse in states with abortion bans or restrictions: in 2019, perinatal deaths occurred at a 15 percent higher rate, on average, than in states with abortion access. States with abortion bans or restrictions also had higher neonatal death rates in the first 27 days of life post neonatal mortality rates between 28 and 365 days after birth.
Mortality in the first year of life among non-Hispanic Black infants was at least double that of other groups in both abortion-restriction and abortion-access states. In all cases, infant mortality was higher in abortion-restriction states: 41 percent higher for non-Hispanic Asian infants, 34 percent higher for non-Hispanic white infants, and 12 percent higher for non-Hispanic Black infants.
An already Fractured System
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. 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 result is a deepening of fractures in the maternal health system and a compounding of inequities by race, ethnicity, and geography.
States have it within their power to avoid that outcome. In partnership with health plans, providers, and residents, state leaders could attempt to recruit more maternity care providers — including midwives, physicians, doulas, and nurses — and promote the operation of more birthing facilities, such as hospital units and birthing centers. Additional support could be provided to community-based organizations and to perinatal health care teams, through a combination of Medicaid and public health funding. Provider financial incentives could drive better quality in maternal health care. And by adopting the Affordable Care Act’s Medicaid eligibility expansion for low-income adults and extending Medicaid postpartum coverage to one year, states could enhance the health and well-being of mothers and infants before, during, and beyond pregnancy. Increased federal funding for reproductive health care, family planning, and maternity care, could mitigate the impact of the Dobbs decision and state abortion bans on people’s lives. State, congressional, and executive branch actions are all needed to protect the health of women and birthing people and ensure optimal and equitable outcomes for mothers and infants.
People of color, those who are uninsured and those who live on low incomes or in underserved (especially rural) areas already face additional risks that threaten their lives during pregnancy, such as difficulty accessing consistent pre- and post-natal care, said Dr. Laurie Zephyrin, the senior vice president for advancing health equity at the Commonwealth Fund. “Then, on top of all that, you’re adding this variation in abortion services, reproductive health services, by states,” Zephyrin said. “We’re just adding on to an already fractured system.”
