Pregnant women die at higher rates when states restrict abortion

State abortion restrictions put in place during the last two decades have resulted in more women dying during or after childbirth, leading to about 16 additional deaths a year across the states that became more stringent, new research finds.

The study from Columbia University Irving Medical Center found that restrictions have ratcheted up since 2005, when eight states had at least five limitations on things like how and when patients could access the procedure, and who could perform it. By 2023, a year after the Supreme Court overturned Roe v. Wade’s federal protection for abortion, 27 states fell into that most restrictive category.

Pregnant women in those states were more likely to die during or shortly after childbirth if their access to abortion had been curtailed, said Marie Anderson, a resident physician at Columbia and the lead author of the study. Pregnancy is known to boost health risks, and the US already has the highest maternal mortality rate in the developed world.

Anderson noted that abortions aren’t always elective procedures.

“This affects medical complications of pregnancy,” she said. “If the water breaks early, if there are life-limiting anomalies, if there are medical conditions that are affecting the mother that make it unsafe for her to carry a pregnancy to term, these restrictions are affecting those people and causing these deaths. And I wish people understood that.”

The results are being presented at the Society for Maternal-Fetal Medicine’s annual meeting and will be published in the group’s peer-reviewed journal Pregnancy.

Years of scientific evidence has linked restrictive abortion policies with higher maternal mortality, underscoring the serious health risks that pregnancy can pose. More than three years after the Supreme Court reversed the landmark Roe decision, states now wield significant control over access to the procedures. Today, 41 states limit abortion, including 17 that have total bans or prohibit it after six weeks of pregnancy, according to the Guttmacher Institute.

The Columbia University researchers looked at abortion restrictions and maternal deaths from 2005 to 2023, focusing specifically on 10 of the most common state abortion laws. They included maternal deaths that occurred during pregnancy or within weeks of birth, from any cause.

Restrictions expanded over that period to encompass more of the South and Midwest, as well as parts of the Southwest, the Mid-Atlantic and the West. The research only included about a year of data after the landmark Dobbs v. Jackson Women's Health Organization decision, limiting its insights on the impact of overturning Roe’s federal abortion protections.

The leading causes of maternal death included heart attacks and conditions like pulmonary embolism, which can result from pregnancy-related blood clots. Mothers also died from violence — a category that includes homicides and suicides — and unintentional drug overdoses. Those types of deaths can be related to pregnancy because it can exacerbate abuse as well as mental health issues, Anderson says.

“When you have all of these women who hypothetically otherwise might have gotten an abortion and then now can’t, you see an increase in maternal mortality,” Anderson said.