Maternal and infant death rates already were higher in states that later passed or implemented abortion restrictions or bans compared to states where abortion remains accessible, according to a new analysis released today.
For example, in 2020, maternal death rates were 62% higher in states that later passed or implemented abortion restrictions compared to states where abortion remains accessible, the analysis by the nonprofit research group the Commonwealth Fund found.
This disparity holds true across racial and ethnic groups: maternal death rates were 20% higher for Black people, 31% higher for Hispanic people, and 33% higher for white people, according to the research.
The Commonwealth Fund drew on data sources such as the CDC WONDER birth and death files, Area Health Resources Files, and the March of Dimes maternity care deserts report. Reearchers stratified states based on Guttmacher Institute ratings of the restrictiveness of state abortion policies.
To hear more from Laurie Zephyrin, health equity leader with the Commonwealth Fund, listen to our podcast Podnosis
In anticipation of a U.S. Supreme Court decision overturning Roe v. Wade, a number of states passed “trigger laws” that would ban all, or nearly all, abortions once national abortion protections ended. In the months since the Court’s ruling in Dobbs v. Jackson Women’s Health Organization in June, several of these states have in fact banned abortion in most instances.
Other states have enacted bans or severe restrictions since then, and others may do so in the coming months or years,
Researchers assessed the current state of maternal and infant health in these states and looked specifically at the availability of maternal care resources such as maternity care providers, maternal and infant health status and outcomes, health coverage policies related to accessing maternity care and performance of the health system in providing equitable access and care.
The Commonwealth Fund study found that compared to states where abortion is accessible, states that have banned, are planning to ban, or have otherwise restricted abortion have fewer maternity care providers; more maternity care “deserts” and higher overall death rates for women of reproductive age.
Overall death rates for women of reproductive age were 34% higher in abortion-restriction states during the 2018-2020 period, according to the study.
Infant mortality in the first 27 days of life was 30% higher in states with abortion bans or restrictions in 2019. Infant deaths during the first week of life, meanwhile, were 15% higher in those states compared to abortion-access states.
The study found that maternal health services are lacking in states that have since implemented or passed abortion restrictions, which is a threat to all people of reproductive age, according to report coauthor Laurie Zephyrin, M.D., senior vice president for Advancing Health Equity at the Commonwealth Fund, in a statement.
“States can protect access to care for birthing people and their infants by expanding Medicaid eligibility under the Affordable Care Act, extending Medicaid postpartum coverage to one year, recruiting more maternity care providers, and promoting the opening of more birthing facilities. These actions would help to shore up our maternal health system in the face a reproductive health care crisis," Zephyrin said.
The researchers pointed to a lack of health coverage and gaps in maternal care providers and resources as key reasons why women living in certain states struggle with pregnancies and birth.
Abortion-restriction states had a 32% lower ratio of obstetricians to births and a 59% lower ratio of certified nurse midwives to births. Women in these states were also more likely to begin a pregnancy less healthy and to face barriers to needed care compared to women in abortion-access states, the study authors said.
The analysis showed that 39% of counties in abortion-restriction states can be considered maternity care deserts, compared with 25% of counties in abortion-access states. "This disparity may be partially explained by the greater number of births in abortion-restriction states that occur in rural areas, where access to maternity care is more limited and maternity care deserts are more common," the study authors wrote.
In abortion-restriction states in 2020, the proportion of individuals giving birth who had no prenatal care or late prenatal care was 62% greater than for someone giving birth in abortion-access states.
Abortion bans and restrictions widen these disparities, the study authors concluded, 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," the study authors wrote.
Increased federal funding for reproductive health care, family planning, maternity care and care delivery system transformations could help mitigate the impact of the Dobbs decision, they noted.
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 wellbeing of mothers and infants before, during, and beyond pregnancy.