How Will Abortion Bans Affect Maternal Health? Forecasting the Maternal Mortality and Morbidity Consequences of Banning Abortion in 14 U.S. States.

Abstract

Abortion bans may exacerbate high maternal mortality and severe maternal morbidity (SMM) in the United States. We estimate the expected increase in maternal deaths and SMM arising from banning abortion and continuing pregnancy in 14 states with bans (or no providers). Compiling national, state, and race/ethnicity-specific data on abortion, maternal mortality rate (MMR), and SMM, we conduct a cross-sectional prediction of additional maternal deaths and SMM overall and by race/ethnicity over a 4-year period, beginning 1 year after a state enforced an abortion ban. Our main prediction assumes all wanted abortions are denied in-state, each abortion denied leads to 0.336 births, and a respective increase in exposure to maternal mortality and SMM occurs. We conduct sensitivity analyses to estimate additional deaths and SMM under various travel and self-managed abortion scenarios. Using state-specific MMRs, we predict 42.0 (95% confidence interval [CI]: 33.5, 51.7) additional maternal deaths over 4 years in the 14 states (sensitivity range: 17.0-66.9) compared with 31.7 (95% CI: 30.4, 33.0) using the national MMR (sensitivity range: 12.9-50.64). Applying 2016-2017 national and region-specific SMM rates, we estimate 2,174 and 2,241 new SMM, respectively. Applying 2018-2021 national SMM rates, we predict 2,693 additional SMM. Among 10 states, we predict 29.6 more maternal deaths, with Black women representing 63%. Racial inequities in maternal deaths are pronounced in certain states. Despite innovative efforts to expand abortion access, not all the harms of Dobbs will be ameliorated. State-level policymakers and practitioners must improve maternal health care to mitigate geographic and racial disparities.