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Three years ago, the U.S. Supreme Court struck down the constitutional right to abortion care established by Roe v. Wade in 1973, leaving abortion access decisions to the states. To date, 13 states have a complete abortion ban and seven ban abortion at or before 18 weeks’ gestation.
While research has demonstrated and predicted the maternal health impacts of banning abortion, gaps exist in understanding how present and dynamic conditions – like the rise of access to self-managed abortion, telehealth care, and travel out-of-state – may affect maternal mortality and morbidity across states and racialized identities.
In a study published in a special issue of the Journal of Women’s Health, CUNY SPH PhD student Silpa Srinivasulu and Professor Frank Heiland, associate director of CUNY’s Institute for Demographic Research, sought to forecast the increase in maternal deaths and severe maternal morbidity arising from banning abortion and continuing unwanted pregnancies in 14 states with abortion bans or no providers over a four-year period.
They compiled national, state, and race/ethnicity-specific data on abortion, maternal mortality rate, and severe maternal morbidity to estimate a ratio of births resulting from denied abortions. However, to estimate this birth ratio in a dynamic policy and healthcare access environment, they considered variability in practical experiences of self-managed abortion and travel out-of-state, and conducted sensitivity analyses to generate a range of plausible scenarios. Then, they calculated maternal deaths and severe maternal morbidity cases arising from these additional births over a four-year period. Overall, they predicted 42 (95% CI: 30.4, 51.7) additional maternal deaths, with a range of 17.0-66.9 deaths under various conditions. They predicted 2,174-2,693 new cases of severe maternal morbidity in the 14 states. Among 10 states, they predicted 63% of new maternal deaths will be among Black women.
“Despite innovative efforts from abortion advocates, public health organizations, and policymakers to expand access and offer alternatives to in-state, in-clinic care, not all the harms of Dobbs will be ameliorated,” says Srinivasulu. “State policymakers, medical associations, [Maternal Mortality Review Committees], departments of health, and hospitals must investigate causes of maternal deaths, clarify emergency health care allowed…and improve pregnancy care for their most vulnerable populations.”
