Without Roe v. Wade, maternal death rates could get even worse

tThe United States is a surprisingly dangerous place to be pregnant. The maternal death rate in the US — nearly 24 deaths per 100,000 live births, as of 2020 — is much higher than in comparable developed countries, and research shows it has gotten worse, not better in recent years. Maternal death rates are particularly high among black women, with 55 deaths per 100,000 births compared to 19 deaths per 100,000 births among white women.

Experts fear these numbers will now only get worse Roe v. Wade has been undone, eliminating the constitutional right to abortion and triggering a series of state-level bans that place restrictions on reproductive health care.

“Even a low-risk pregnancy and birth carry greater risks to a mother than a termination of pregnancy,” said Michelle Drew, a primary care physician and obstetrician who is the executive director of the Ubuntu Black Family Wellness Collective, a Delaware nonprofit. When you think of “forced pregnancy and forced birth, with a pregnancy that may not be timed or desired or could be high risk,” Drew says, the stakes only get bigger.

A 2021 study estimated that if the US completely banned abortion, the total number of pregnancy-related deaths would increase by more than 20% in subsequent years, with a 33% increase among black women. That estimate doesn’t exactly apply to the current time, as abortion is expected to remain available in about half of the US states even without abortion. roe† But research clearly suggests that as access to abortion increases, maternal mortality decreases — and vice versa.

That said, in the US, the effects vary significantly across demographics. After abortion was legalized in the US, culminating in the Supreme Court original Roe v. Wade In 1973, maternal deaths among women of color in the US decreased by more than 30%, while there was a limited effect among white women, according to a study published as a preprint last year. Nearly all of the decline was due to fewer abortion-related deaths among women of color, said study co-author Lauren Hoehn-Velasco, an assistant professor of economics at Georgia State University. women of color resorted to unsafe methods to terminate an unwanted pregnancy.

“I don’t know if we can say exactly what things will look like in the future,” Hoehn-Velasco says, noting that developments such as abortion pills could now help provide safe access, even in states that have restrictions on abortion. is subject.

Even with advances such as drug abortion being available, there is still a link between abortion access and maternal mortality in the US. As of 2017, states with restrictive abortion policies, such as restrictions on gestational age or wait times before the procedure, had an average maternal death rate of 28.5 deaths per 100,000 births, compared with an average rate of 15.7 in states that protected access to abortion, according to a 2021 study published in the journal birth control† A separate study from the same year, published in the American public health magazine, found a similar trend: states with significant restrictions on abortion care registered a 7% increase in overall maternal deaths from 2015 to 2018.

There are a number of possible reasons for this dynamic. States with strict abortion policies also tend to include states that have not expanded Medicaid and have fewer practicing medical professionals, both of which can make it more difficult for people to access good health care. “By the way, they also happen to be states with large families living in poverty and especially large populations of people of color earning low wages,” says Drew.

Socio-economic factors such as these are closely linked to risk factors, such as having underlying health conditions and insufficient access to prenatal care, which increase the likelihood of pregnancy complications. A 2020 report from health insurance company Blue Cross Blue Shield found that the number of pregnancy and birth complications in commercially insured women in the US increased between 2014 and 2018, in part because more people became pregnant with pre-existing health conditions. The report also found that a third of women had fewer than 10 recommended prenatal medical appointments during pregnancy — and of those who didn’t, nearly a quarter had complications in childbirth.

dr. Mark Hoofnagle, a trauma surgeon at Washington University School of Medicine in St. Louis and co-author of the birth control research, notes that abortion clinics often provide many forms of reproductive health care, so policies that make it harder for these facilities to survive can have seepage effects. “Planned Parenthood does a lot more than just abortions,” Hoofnagle says. “If you attack the clinics in general, you exacerbate an existing inequality.”

The vast majority of people who undergo pregnancy do not experience life-threatening problems; there were 861 maternal deaths in the US in 2020 and approximately 3.6 million births. But especially for people who become pregnant with pre-existing health conditions, “to term is so much riskier than an abortion in this country,” said Dovile Vilda, a research assistant professor who studies maternal and child health at Tulane University School of Medicine. Public Health and Tropical Medicine and a co-author of the American Journal of Public Health study. Without roeand because many people are unable to travel out of the state to have an abortion, more people will be “forced to complete unwanted and high-risk pregnancies even when their health and lives are in danger.” she says.

The risks of that situation are not hypothetical. For a 2015 study, researchers followed a group of about 850 women seeking abortions in U.S. facilities. Some were rejected because they had exceeded the gestational age in their states, which ranged from just 10 weeks to more than 20 weeks gestation. About 6% of individuals who were refused an abortion and gave birth reported a potentially life-threatening complication, such as bleeding or eclampsia, compared with about 1% of people who had an abortion near their state’s pregnancy limit and about 0.4 % of those who have had a first trimester abortion. A woman died after being rejected by an abortion clinic and giving birth.

On this point, Vilda says, the research is clear: Making abortions more difficult means more women and babies get sick and die. “We have enough data and we have enough research and we have enough evidence,” she says. “What we really need now is political will.”

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write to Jamie Ducharme at [email protected]