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Maternal and infant death rates higher in states that ban or restrict abortion, report finds


A study published Wednesday found maternal death rates in 2020 were higher in areas with significant abortion restrictions, a finding experts say paints a grim picture for the U.S. after the fall of Roe v. Wade.

Maternal death rates in 2020 were 62% higher in states with abortion bans or restrictions compared to states where abortion is accessible, according to a study published Wednesday by the Commonwealth Fund, an independent health care research foundation.

“Abortion-restrictive” state refers to classifications from the Guttmacher Institute, a research and policy organization that supports abortion rights. The institute assesses states by abortion restrictions including gestational age bans, waiting periods, insurance coverage bans and medication abortion restrictions.

The study, using data from 2020, found states that banned or significantly restricted abortion access higher rates of maternal mortality and infant death, especially among women of color; more maternity care “deserts”; fewer maternity care providers; and greater racial inequities across health care systems.

‘No surprise’

Kelli Stidham Hall, associate professor in population and family health at Columbia University’s Mailman School of Public Health, said the findings “are no surprise,” and disparities in maternal and infant health care outcomes will likely worsen as more states ban abortion after the U.S. Supreme Court decision to overturn Roe v. Wade earlier this year.

“For a long time, we’ve been seeing that in the places where these restrictive laws concentrate are the same places where rates of maternal death and infant death, as well as disparities in maternal health outcomes by race and socioeconomic status, are highest,” said Hall, who was not involved in the study.

In a 2021 study, Tulane University researchers similarly found that states with more abortion restrictions had higher maternal mortality rates from 2015 to 2018.

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Maternal health outcomes

The study’s findings related to maternal and infant health outcomes:

  • Maternal death rates in 2020 were 62% higher in states with abortion bans or significant restrictions.
  • Maternal death rates in 2020 were 20% higher for Black people in these abortion-restrictive states, 31% higher for Hispanic people and 33% higher for white people.
  • In 2019, infant deaths in the first week of life were 15% higher in abortion-restrictive states.

Maternity care resources

The study’s findings related to maternity care resources:

  • About 39% of counties in abortion-restrictive states are considered maternity care deserts, compared with 25% of counties in states with abortion access. The study defines maternity care deserts as counties where access to maternity health care services is limited or absent.
  • Abortion-restrictive states tend to have fewer maternal care providers than states with abortion access, including 32% fewer obstetricians to births and 59% fewer certified nurse midwives to births. This disparity could worsen after the fall of Roe v. Wade “as some maternity care providers have been reported to be reluctant to work in states where they might face legal challenges to their practice,” researchers said.
  • In 2020, 62% more individuals giving birth in abortion-restrictive states had no prenatal care or late prenatal care compared to in states with abortion access.

What experts say

Areas with restrictive reproductive health policies also “often limit access not only to abortion services but also to comprehensive reproductive health care and family planning services, such as contraception, STI services and preventive women’s health services in general,” increasing the likelihood for complications and maternal and infant mortality, Hall said.

States with restrictive abortion laws also tend to have “more layers of structural disadvantage” that can contribute to negative health outcomes, including higher rates of poverty and structural racism at neighborhood and community levels, she said.

As abortion bans “sharply increase” after the fall of Roe, Hall said already strained reproductive health care systems are being further strained, and people are being forced to travel across state borders for abortion care.

Laurie Zephyrin, senior vice president for advancing health equity at the Commonwealth Fund and a co-author of the study, suggested states improve maternal and infant health outcomes by expanding Medicaid eligibility, extending Medicaid postpartum coverage, recruiting more maternity care providers and improving access to abortion care.