A Verywell Report: Restricting Abortion Will Cost Women Their Lives

The Supreme Court on Friday overturned Roe v. Wade, reversing the constitutional right to abortion. While the ruling does not prohibit abortion in every state, the absence of federal protection means it is now up to individual states to regulate or ban the procedure.

At least 13 states with the so-called "trigger" laws will immediately ban abortion after the reversal of Roe v. Wade. About a dozen more states are expected to follow suit.

Banning or restricting abortion has a detrimental impact on maternal health. Pregnancy-related deaths have increased in certain states that have already enforced anti-abortion laws.

From 2016 to 2020, the maternal mortality rate in the United States rose by nearly 40%, according to the most recently available data from the National Center for Health Statistics at the Centers for Disease Control and Prevention (CDC). Over the same time frame, states enacted over 200 abortion restrictions.

Over those five years, the population living in states with certain abortion restrictions in place saw a maternal mortality rate 27% to 61% higher than those living in states without those restrictions.

Without the protection of Roe v. Wade, further restrictions on abortion are on the horizon. In 2021 alone, states passed more than 100 abortion restrictions, more than in any year since 2011.

Verywell’s analysis found statistically significant differences in maternal death rates among the population living in states with four major restrictions:

• Requiring that a licensed physician perform the abortion in most cases
• Limits on when Medicaid can be used to cover an abortion
• A mandatory waiting period of anywhere from 18 to 72 hours between seeing a provider and getting the abortion
• Requiring mandatory counseling before the procedure on the fetal experience of pain, a link to breast cancer, and/or negative psychological effects

People living in states with gestational limits on abortion or restrictions on whether private insurance can cover abortion also saw higher maternal mortality rates, but the differences were not statistically significant. 

Previous studies found similar patterns: Tulane researchers found that from 2015 to 2018, maternal mortality rate was higher in states with more restrictive abortion policies in 2015. Dovile Vilda PhD, a research assistant professor at the Mary Amelia Center for Women's Health Equity Research at Tulane University and the lead author on the study, wrote in an email to Verywell that she expects that relationship to have only gotten stronger in more recent years because so many more restrictions have been enacted.

Licensed Physician Restriction Made the Harshest Impact

The greatest difference in both Vilda’s study and Verywell’s analysis was states’ requirement that a licensed physician must perform the abortion. Vilda found that states with this policy had a 51% higher total maternal mortality rate than states that didn’t; Verywell’s analysis found restricted states had a maternal mortality rate 61% higher.

The licensed physician restriction is one of several targeted regulations of abortion providers (TRAP) laws that places restrictions on the provider or clinics, limiting overall access to abortions by preventing certain practitioners from providing them.

Studies have shown that abortions can be safely performed by nurse practitioners, physician assistants, and certified nurse midwives.

"There are people who absolutely could safely provide a version of abortion services, so restricting it to physicians is just a way to make it harder to access," Sarah Gutman, MD MSPH, Complex Family Planning Fellow at the University of Pennsylvania, told Verywell.

Abortion Is Safer Than Pregnancy

In the U.S., pregnancy risks are higher than the health risks of an abortion procedure itself. The rate of abortion-related deaths was 0.41 per 100,000 legally-induced abortions from 2013 to 2018, the CDC found, far lower than the maternal mortality rate of 17.4 deaths per 100,000 live births during the same time frame.

"There are risks with pregnancy, labor and delivery, and with being postpartum that are forced upon a person who otherwise would have chosen not to be pregnant," Gutman said.

Vilda adds that in some cases, maternal mortality can be a direct result of restricting abortion access.

"Maternal death results from health-related complications developed or exacerbated during pregnancy, and thus women with chronic health conditions, who are not able to access abortion care...are forced to carry unwanted pregnancy to term even if their health and lives are in danger," Vilda said.

Abortion Restriction Isn't the Only Issue

Abortion policies aren’t the only explanation for disparities in maternal mortality in the U.S.

Maternal mortality rates are disproportionately higher among people of color. In 2020, the maternal mortality rate among non-Hispanic Black women was nearly three times higher than the rate among non-Hispanic white women, according to the CDC.

"The main causes of maternal mortality in this country include hypertension—especially preeclampsia—which disproportionately affects Black women," Anna Whelan, MD, an OB-GYN specializing in high-risk pregnancies in Rhode Island and Fellow with Physicians for Reproductive Health, told Verywell. "[This is] likely due to systemic racism and prolonged effects of systemic racism on generations of people, as well as less access to care."

Whelan also cited hemorrhage, intimate partner violence, and maternal mental health as common complications leading to maternal death. 

Vilda said that abortion restrictions often happen in tandem with other reproductive restrictions, including a limit on publicly-funded contraceptive and family planning services and inadequate sex education. States with the most abortion restrictions in her study also had the worst socioeconomic conditions.

Those seeking abortions who can afford to travel to a state with less restrictive policies, take time off work, and pay for childcare will be able to obtain an abortion anyway, Whelan said, but lower-income women won’t.

According to Gutman, limiting abortion restrictions is only the first step toward lowering maternal mortality rates.

"Being proactive and actually enacting legislation that promotes maternal health and parental health, like protecting [abortion] access, matters," she said. "[But] having review boards that look at statistics like disparities in maternal mortality by race and having action plans to try to address those disparities is also really important."