Jul 5, 2022 - Health

Health experts see rise in maternal mortality post-Roe

Note: Select mortality data unavailable due to reliability and confidentiality restrictions; Data: CDC; Map: Jacque Schrag/Axios

The six states with the highest maternal mortality rates in the nation each quickly banned abortion following the decision to overturn Roe v. Wade, fueling concerns about more children being born in areas with poor health outcomes and with fewer safety net programs for mothers and children.

Why it matters: U.S. women already were likelier to die during or after pregnancy than anywhere else in the developed world, and public health experts predict things will get worse in the post-Roe landscape as health providers weigh legal exposure against clinical decisions.

Driving the news: Arkansas, Kentucky, Alabama, Tennessee, Louisiana and Mississippi top the CDC's list of states with the highest maternal mortality, each with more than 30 deaths per 100,000 live births. Each had "trigger" laws, or abortion bans that took effect in the immediate aftermath of the Supreme Court eliminating a federal right to the procedure.

  • Maternal death rates in states with "trigger" laws are on average almost two times higher than those in states with laws protecting abortion access.
  • Most of those states are identified as having "maternity care deserts" that lack hospitals offering obstetric care, birth centers and no obstetric providers.
  • The combination of more restrictive abortion laws, more births and insufficient care could leave those states "completely unprepared for the ramifications in the lives and health and wellbeing of women and children and families that these bans are going to cause," said Andrea Miller, president of the National Institute for Reproductive Health, which advocates for access to abortion care.
  • The maternal death rate in the U.S. could increase by 24% if a nationwide abortion ban was enacted, according to a University of Colorado study.
  • If abortion was illegal in the 26 states that have either already banned abortion or are likely to do so, there would have been 64 more maternal deaths in 2020, the research — which is not yet peer-reviewed — found.

The other side: Anti-abortion forces dispute any connection between abortion bans and maternal mortality.

  • It is "dishonest and scientifically inaccurate" to claim that there is a connection because the CDC's data is "incomplete," said Tara Sander Lee, senior fellow, and director of life sciences at Charlotte Lozier Institute, an anti-abortion research organization.
  • The data "makes it impossible to calculate the true maternal mortality rate in the United States," Lee added.

The big picture: Maternal mortality is driving health policy decisions, with more states taking steps like expanding Medicaid coverage of maternity services.

  • A rise in pregnancy-related deaths in minority communities is drawing more attention to the patchwork of maternal health standards and ingrained health disparities.
  • The subject is getting subsumed into the white-hot national abortion debate.
  • The University of Colorado study, which hasn't been peer-reviewed, projected that in the first year following a nationwide abortion ban, the number of maternal deaths would increase 13%, from a baseline of 861 to 969. In subsequent years, maternal deaths would increase 210, or 24%. 

Between the lines: States with restrictive laws instead of outright bans — such as Ohio, which outlaws the procedure after six weeks into a pregnancy — could also see an increase in maternal deaths, said Katie McHugh, an OB-GYN and abortion provider in Indiana and board member with Physicians for Reproductive Health.

  • "There is a possibility that we can intervene and end a pregnancy early," McHugh told Axios, but added that "when people decide to end their pregnancies for a medical reason, that is almost always discovered later."
  • "Medical conditions develop and are diagnosed throughout the pregnancy, and that does not minimize the risk to long-term consequences on the pregnant person's health. In fact, sometimes the diagnoses that are made in the middle of pregnancy are the most devastating."

What we're watching: Some state laws contain exceptions to save the life of the pregnant person. But the way that leaves doctors having to prove which patients qualify in an emergency could put providers in an untenable position and be "confusing to those practicing medicine," said Jen Villavicencio, lead for equity transformation at the American College of Obstetricians and Gynecologists.

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