State Abortion Policies and Maternal Death in the United States, 2015‒2018

Abstract

Objectives. To examine associations between state-level variation in abortion-restricting policies in 2015 and total maternal mortality (TMM), maternal mortality (MM), and late maternal mortality (LMM) from 2015 to 2018 in the United States. Methods. We derived an abortion policy composite index for each state based on 8 state-level abortion-restricting policies. We fit ecological state-level generalized linear Poisson regression models with robust standard errors to estimate 4-year TMM, MM, and LMM rate ratios and 95% confidence intervals (CIs) associated with a 1-unit increase in the abortion index, adjusting for state-level covariates. Results. States with the higher score of abortion policy composite index had a 7% increase in TMM (adjusted rate ratio [ARR] = 1.07; 95% CI = 1.02, 1.12) compared with states with lower abortion policy composite index, after we adjusted for state-level covariates. Among individual abortion policies, states with a licensed physician requirement had a 51% higher TMM (ARR = 1.51; 95% CI = 1.15, 1.99) and a 35% higher MM (ARR = 1.35; 95% CI = 1.09, 1.67), and states with restrictions on Medicaid coverage of abortion care had a 29% higher TMM (ARR = 1.29; 95% CI = 1.03, 1.61). Conclusions. Restricting access to abortion care at the state level may increase the risk for TMM.

Measurement and Operationalization of the Social Determinants of Health and Long-Acting Reversible Contraception Use in the U.S.: A Systematic Scoping Review

“…70,71 Abortion restrictions are associated with increased maternal mortality. 72 Moreover, in the absence of programs that promote public health and support parenting such as expanded childcare, healthcare, and higher education, being forced to carry an unwanted or mistimed pregnancy to term may be particularly detrimental to individual, family, and social wellbeing. 73,74,75 To the degree that LARC use may prevent unwanted and mistimed pregnancies in the post-Roe landscape, research, policy, and programs to improve patient-centered LARC provision must be examined.…”

The association of U.S. state-level abortion restrictions with medication abortion service delivery innovations during the early COVID-19 pandemic

“…1 ). We then ranked states into quartiles, categorizing each state as having low (0-4 points), medium (5)(6)(7)(8)(9)(10)(11)(12), high (13)(14)(15)(16)(17), or extreme (18-20) abortion restrictions (Supplemental Table 1). To separately estimate the association of global abortion hostility from the effect of laws that specifically prohibit care innovations such as no-exam visits and telemedicine, we created a separate binary variable to indicate if state-level restrictions specifically mandated a visit for medication abortion care by requiring either (1) an ultrasound or (2) in-person dispensing of mifepristone as a state law, in addition to the FDA requirement.…”

“…[4] Joyce TJ, Henshaw SK, Dennis A, Finer LB, Blanchard K. Strong evidence that difficulty paying for abortion is a primary driver of delayed or denied access to abortion care across states and over time. [9] Henshaw SK, Wallisch LS. The Medicaid cutoff and abortion services for the poor.…”

Maternal and infant health in disasters: Texas’s high-risk landscape

“…Findings from research suggest an association between restrictive abortion policy and maternal health outcomes, specifically that states with stricter abortion policies showed higher maternal mortality rates. 12 Regarding COVID-19, pregnant women have an increased risk for severe illness or death from COVID-19, which disproportionately affects Black and Hispanic women and women with underlying medical conditions like diabetes.…”