Rates of maternal death in 2020 were more than 60% higher in states that banned or restricted abortion than in those that have preserved access to the procedure, according to a new report from researchers at the Commonwealth Fund and Boston University.
The study also found that perinatal deaths were 15% more likely to occur in states that restricted abortion than in those with freer access. Infant mortality was 41% higher for non-Hispanic Asian infants, 34% higher for non-Hispanic White infants, and 12% higher for non-Hispanic Black infants in restrictive states than in those with greater access to abortion, researchers reported.
Eugene Declercq, PhD, a professor at the Boston University School of Public Health and a co-author of the new study, said that the poorer outcomes are the result of maternity care deserts — areas where access to hospitals, midwife services, or obstetric care is limited or absent.
Nearly 40% of counties in states that have restricted abortion were characterized as maternity care deserts compared with 25% of counties in states with freer access to the procedure.
“Fewer maternity care providers in abortion-restrictive areas is a problem that is expected to grow worse with obstetricians moving to states to avoid the concern about running afoul of new and sometimes vague practice guidelines,” Declercq said.
For the study, the researchers analyzed national birth and death data from 2020 and earlier for 24 states and the District of Columbia where abortion is widely accessible to 26 states with restricted access.
They found that 55% of births in 2020 occurred in abortion-restrictive states. More than half (57%) of those births were to women younger than 30 years, which is unsurprising given that teenagers and young adults are forced to keep unwanted pregnancies in these states, according to the researchers.
Declercq and his colleagues found that the rate of maternal mortality in 2020 was 62% higher in states that have restricted access to abortion than in those that have not curtailed access to the procedure (28.8 vs 17.8 per 100,000 births).
Between 2018 and 2020, the rate of maternal mortality rose nearly twice as fast in states with abortion restrictions as in those without, the study found.
“Notably, this trend is prior to the Dobbs decision and is hopefully not a harbinger of a growing gap in women’s health between states,” he said, referring to the ruling in June by the US Supreme Court overturning Roe v Wade, which established a federal right to abortion.
Women in states that restricted abortion fared worse in other ways, too. The study found that the overall death rates for women in these states were 34% higher than for those in states with greater access to abortion services (104.5 vs 77 per 100,000 people, respectively).
Obstetricians were not surprised by the findings but expressed concern about the direction in which the nation’s healthcare system is heading.
“Forcing someone to continue a pregnancy they wish to terminate puts them at risk of uncontrolled bleeding or infection from self-managed abortions,” said Lucky Sekhon, MD, a reproductive endocrinologist and ob-gyn at Reproductive Medicine Associates of New York, who was not involved with the new study.
The lack of access to Medicaid or private insurance can exacerbate existing socioeconomic factors related to pregnancy and create barriers to seeking adequate care, according to the report.
“Working with state and local teams to bring best insurance options or Medicaid services to pregnant people will be beneficial,” said Ronald Iverson, Jr, MD, MPH, vice chair of obstetrics and gynecology at Boston Medical Center, who was not involved in the study. “This coverage helps them access care early in pregnancy to identify and mitigate risk factors for healthier deliveries and reduce infant disease or risk of preterm birth.”
Increasing the public’s education about current state restrictions and supporting organizations that aim to improve access to reproductive healthcare is one way to curb rates of maternal and infant mortality.
In June, Sekhon co-founded Doctors for Fertility, a non-profit organization promoting access to fertility treatments and reproductive care for pregnant people as well as access to hospitals and doctors.
“Doctors for Fertility’s mission is to amplify the voices of patients who are affected by abortion bans and implement measures to recruit healthcare workers, especially in states that have deserts,” Sekhon said.
The authors reported no relevant financial relationships.
Commonwealth Fund. Published December 14, 2022. Source
Pooja Shah is a freelance writer and lawyer based in New York City. She writes on health, wellness, culture, and travel. More of her work is at www.pooja-shah.com.