State abortion bans linked to spike in maternal deaths, study finds

Abortion restrictions in US states were linked to higher maternal deaths during pregnancy and within 42 days after birth, a new study suggests.

The research examined links between different abortion restrictions introduced across US states between 2005 and 2023 and deaths during pregnancy or in the first 42 days after giving birth.

Unlike much earlier work, it used a broad definition of maternal deaths, including deaths from any cause such as homicide, suicide and drug overdose, as well as medical causes.

A total of 22,482 maternal deaths were identified over the study period. The annual incidence rose from 21.3 per 100,000 live births in 2005 to 33.6 per 100,000 live births in 2023.

Violence was the leading cause at 10.6 per cent, followed by unintentional drug overdose at 10.2 per cent and cardiovascular disease at 9.6 per cent.

Presented at the Society for Maternal-Fetal Medicine annual meeting by Marie Anderson of Columbia University Irving Medical Center in New York City, the study found states with five or more types of abortion restriction had an average of 16.1 additional maternal deaths each year compared with less restrictive states.

Anderson said: “When states adopt multiple abortion restrictions, we see measurable increases in deaths among pregnant and postpartum people.

“The associations we observed were broad, affecting deaths from any cause, cardiovascular disease, and violence, and underscore that reproductive health policy is inseparable from maternal health.

“Traditional definitions of maternal deaths exclude homicide, suicide, and unintentional drug overdoses, but these often overlooked causes of death are an important part of the abortion conversation as there are data which show that being denied a wanted abortion is associated with worse mental health outcomes, intimate partner violence, and lasting economic hardship.”

At the start of the study period in 2005, only five states were classed as more restrictive. By 2023, that number had reached 27.

The US Supreme Court’s Dobbs decision in 2022, which overturned the federal right to abortion, prompted a wave of new restrictions.

Of 10 types of restriction examined, six were linked to higher rates of maternal death.

These included bans on public funding for abortion, bans on coverage through health insurance marketplace plans, laws requiring biased counselling, second trimester bans, mandatory waiting periods and compulsory ultrasound requirements.

Public funding bans, insurance coverage bans, waiting periods and physician-only requirements were also associated with higher rates of violent death.

David Hackney, of Case Western Reserve University in Cleveland, who was not involved in the research, said including those factors was the right approach.

Hackney said: “There’s so many different ways that abortion bans could increase the mortality rates and I think it was absolutely correct to include homicide, suicide, and drug use because those, unfortunately, are risks of being pregnant when you don’t want to be pregnant,”