U.S. maternal mortality rates, which are already high compared to those in other developed countries, are expected to rise following the demise of Roe v. Wade.
The states with the highest maternal mortality rates — Arkansas, Kentucky, Alabama, Tennessee, Louisiana, and Mississippi — also had trigger laws in place that would ban abortion once the Supreme Court overturned Roe, fueling concerns among social scientists that women unable to obtain abortions will face worse health outcomes and an anemic public welfare system.
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Maternal deaths will increase as states respond to the reversal of Roe simply because women who would have chosen abortion, which has a mortality rate ranging from 0.41 deaths per 100,000 abortions performed to 0.7 deaths per 100,000, will be exposed to the much higher risks of carrying pregnancies to term, according to researchers at the University of Colorado Boulder’s Institute of Behavioral Science.
If the number of abortions performed in 2020 never occurred in the 26 states that have recently banned or are expected to ban abortion, annual maternal deaths in those states would be expected to be greater by a total of 64 deaths overall, or a 14% increase over baseline, due only to increased exposure to the mortality risks of pregnancy.
“Our estimates highlight how we can prevent the post-Dobbs bans on abortion from increasing the already tragically high numbers of deaths due to pregnancy in the U.S.,” said Amanda Stevenson, an assistant professor of sociology at CU Boulder and lead author of the paper. “Pregnancy shouldn’t kill people — in fact in other rich countries it very rarely does.”
Non-Hispanic black women are already at considerably higher risk of experiencing severe problems during and after pregnancy due to a combination of medical bias, a lack of access to routine healthcare, and underlying economic factors that contribute to poor overall health. The maternal mortality rate among black women was 3.5 times that of non-Hispanic white women, according to a review of death certificates from 2016 and 2017 conducted by the Population Reference Bureau.
The PRB’s review also revealed that health disparities were concentrated among a few causes of death, such as postpartum cardiomyopathy and the blood pressure disorders preeclampsia and eclampsia. Maternal deaths tied to these conditions among black women were five times those of white women. Pregnant and postpartum black women were also more than two times more likely than white women to die of severe bleeding or a blood vessel blockage.
Abortion opponents also acknowledge that the end of a guarantee to legal abortion will fuel more deaths related to pregnancy both pre- and postpartum.
“I don’t want to say [maternal deaths as a result of abortion bans] will be zero because obviously, if you compare the sort of health risks of getting an abortion very early on versus carrying a pregnancy to full term and delivery, there’s just, you know, more chances for things to go wrong the longer things go along,” said Patrick Brown, a family policy analyst at the conservative Ethics and Public Policy Center.
Brown added that “any increase in maternal mortality rates should be something that shocks pro-lifers into action.”
Members of both parties have sought to address high mortality in pregnant women and women postpartum through an expansion of Medicaid, the public healthcare program jointly funded by the federal government and states that cover the very poor. The government pays part of the cost depending on a state’s wealth and sets some basic coverage rules, and states decide the rest. Rep. Robin Kelly (D-IL) has advanced a bill to expand Medicaid coverage permanently for postpartum care that has garnered support from top Republicans on the Energy and Commerce Committee.
“It’s certainly a credible fear but, I think, one that we can address through better policy,” Brown said. “We shouldn’t be using abortion as a policy of first resort to address these underlying inadequacies of access to care and making sure the moms have prenatal and postnatal care they need.”
Many states, primarily those led by Republicans, have yet to expand Medicaid despite enhanced federal matching rates provided by Obamacare to states for their expansion populations. Of those states with the highest maternal mortality rates, only Arkansas, Kentucky, and Louisiana have expanded Medicaid.
Some red states have inched closer to a narrow Medicaid expansion by extending benefits for postpartum healthcare. Under current law, Medicaid only covers women postpartum for up to 60 days, but 20 states, among them Louisiana, Tennessee, South Carolina, and Kentucky, have extended the 60-day limit to a full year, and 13 other states, such as Alabama and Georgia, are in the process of enacting the same change.
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The number of births that will result from a larger number of women having to continue their pregnancies remains unclear, but Brown said the birthrate could grow by 10% to 15%, “which will require more resources, and I don’t think Republicans should be naive about that.”
“We need to be clear-eyed about the fact that more moms having more babies is something that we should welcome, and if that requires a little more fiscal outlay than some of our more limited-government-type friends might want, that’s just the price we have to pay for being pro-life,” Brown said.
