TIt is extremely dangerous to become pregnant in the United States. The U.S. maternal mortality rate—nearly 24 deaths per 100,000 live births, as of 2020—is far higher than in comparable developed nations, and research shows it has gotten worse in recent years, not better. Black mothers have 55 per 100,000 births, compared with 19 per 100,000 for white women.
These numbers are expected to rise, experts fear. Roe v. WadeThis decision has been overturned and the Constitution’s right to abortion was eliminated. It also triggered a series of bans at state level that limit access to reproductive health care.
“Even a low-risk pregnancy and birth has higher risks to a mother than a termination,” says Michelle Drew, a family nurse practitioner and midwife who is the executive director of the Ubuntu Black Family Wellness Collective, a Delaware-based nonprofit. When you consider “forced gestation and forced birth, with a pregnancy that may not be well-timed or desired or that may be high-risk,” Drew says, the stakes only grow higher.
According to a 2021 study, abortion would be banned by the U.S. indefinitely. This would result in a rise of more than 20% among pregnant women, including 3% for Black women. That estimate doesn’t apply exactly to the present day, since abortion is expected to remain available in about half of U.S. states even without Roe. But research clearly suggests that when abortion access increases, maternal deaths go down—and vice versa.
However, there are significant differences in how the U.S. impacts different demographics. After abortion was legalized in the U.S., culminating with the Supreme Court’s original Roe v. Wade In 1973, the U.S. government made a decision to reduce maternal mortality by 30% among women of color. White women saw only a small decline, according to a postprint from last year. Almost all of the decline was due to fewer abortion-related deaths among women of color, says co-author Lauren Hoehn-Velasco, an assistant professor of economics at Georgia State University—suggesting that, before abortion was broadly legal in the U.S., many women of color resorted to unsafe methods for ending an unwanted pregnancy.
“I don’t know that we can say exactly how things will look going forward,” Hoehn-Velasco says, noting that advances like abortion pills can now help provide safe access even in states where abortion is restricted.
There is still an association between maternal mortality and abortion access in the United States, even with the availability of medication abortion. According to 2021 research published in The Journal, states with restricted abortion policies (e.g., gestational age limits or waiting periods) had an average of 28.5 maternal deaths per 100,000 births. This compares to the 15.7 rate in states that allow abortion access. Contraception. Another study, also from the same year and published in American Journal of Public HealthSimilar trends were observed in states that have significant restrictions on the provision of abortion care. This led to a 7 percent increase in maternal deaths between 2015 and 2018.
These dynamics could have many causes. The states with restrictive abortion policies are also those without expanded Medicaid or who have fewer practicing physicians. This can hinder people’s access to quality health care. “Incidentally, they also happen to be states that have large populations of families living in poverty and especially large populations who are people of color, who are earning low wages,” Drew says.
These socioeconomic factors are directly linked with risk factors such as having pre-existing health problems and insufficient access to prenatal care. This can increase your chances of developing complications during pregnancy. Blue Cross Blue Shield, a health insurance company found that the rate of pre-existing conditions and more women getting pregnant in the U.S. increased birth rates. The report also found that a third of women had fewer than the 10 recommended prenatal medical appointments during pregnancy—and of those who didn’t, nearly a quarter had childbirth complications.
Dr. Mark Hoofnagle is a Washington University School of Medicine trauma surgeon and co-author of the Contraception Study found that many types of abortion care are provided by clinics. Policies that reduce the ability for them to thrive can lead to trickle-down consequences. “Planned Parenthood does way more than just abortions,” Hoofnagle says. “When you attack the clinics in general, you’re aggravating an existing inequity.”
Most people do not have life-threatening conditions when they are pregnant. In the United States, there were 861 maternal deaths and 3.6 million births in 2020. But particularly for people who enter pregnancy with existing health problems, “carrying a pregnancy to term is so much riskier than having an abortion in this country,” says Dovile Vilda, a research assistant professor who studies maternal and child health at the Tulane University School of Public Health and Tropical Medicine and a co-author of the American Journal of Public Health study. Without Roe, and with many people unable to travel out of state to get an abortion, more individuals “will be forced to carry unwanted and high-risk pregnancies to term even if their health and lives are in danger,” she says.
The risks of that situation aren’t hypothetical. In a study conducted in 2015, about 850 American women sought to have abortions. Some of the women turned down were over their gestational age limits. These ranged anywhere from 10 weeks to 20 weeks. About 6% of the individuals who were denied abortions and gave birth went on to report a potentially life-threatening complication, such as hemorrhaging or eclampsia, compared to about 1% of people who got an abortion near their state’s gestational age limit and about 0.4% of those who got a first-trimester abortion. After her abortion was denied, one mother died.
Vilda states that at this stage, it is obvious from the research: Making abortions more difficult to access means that more mothers and babies will become sicker and eventually die. “We have enough data and we have enough research and we have enough evidence,” she says. “What we truly need now is political will.”
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