Researchers found the care gap between states with accessible abortion laws versus those where it is banned or severely restricted is significant. Pregnant people and people of childbearing age in these states, especially lower-income people and people of color, may experience infrequent or inaccessible care and coverage. Researchers say the overturning of Roe v. Wade could make things even more difficult—with potentially dire consequences.
Maternal Death Rates in Restrictive Abortion States
What Commonwealth’s researchers found was concerning, namely that both maternal and infant death rates are higher in states with restrictive abortion access. According to the study, maternal death rates are 62% higher in those restrictive areas. Mortality rates are already high in the United States when compared to other high-income countries, especially among people of color. Commonwealth’s researchers utilized public data between 2018 and 2020, drawing from several sources including the Centers for Disease Control and Prevention (CDC), the March of Dimes maternity care deserts report, and the Government’s Area Health Resources Files. They used the Guttmacher Institute ratings to determine each state’s abortion restrictiveness level. The team then analyzed the availability of maternal care resources, maternal and child health status, health coverage policies, and equitable access and care in the 26 U.S. states that have been determined as having restrictive, very restrictive, or the most restrictive abortion laws. Infant death rates are also impacted by a lack of access to adequate care. Perinatal death rates (defined as fetal or infant deaths in the first week of life) were found to be 15% higher in abortion-restrictive states. The study found that mortality rates in the first year among Black infants were at least double that in both restrictive and access states. “I wouldn’t say any of the findings are new, but what it does is it compiles it together in such a way that it allows regular people, policymakers, journalists [among others] to look at the context we’re starting with now and try to understand where we are going,” explains Laurie Zephyrin, MD, MPH, MBA, the senior vice president at the Commonwealth Fund, co-author of the study and an OB/GYN. It’s not just pregnant people and infants who are dealing with higher mortality rates; the study also found that the death rates for women of reproductive age (ages 15-44) were 34% higher in abortion-restrictive states. On the other side, both Black and White people fared better in states with more abortion access. They had better preventative care and access to insurance providers and healthcare systems.
Connection Between Abortion Rights and Maternal Care
Abortion rights and maternal and reproductive care go hand in hand. For example, abortion providers like Planned Parenthood also offer sex education, birth control, pelvic exams, STD testing and so much more. Maternal care, like ultrasounds and regular checkups, is an essential part of ensuring a healthy pregnancy, delivery, and subsequently a more healthy baby. But pregnant people in abortion-restrictive states may not be able to easily access the care they need. “If you’re having trouble with wrapping your head around having a pregnancy, there’s a reason why,” explains Dr. Danielle Jones, a board-certified OB/GYN and online educator under the name Mama Doctor Jones. “We know based on data that those reasons revolve around the inability to access safe care, being in a violent situation, having no money to take care of another mouth, a lower socioeconomic level—all of the things that lead people to seek abortion are risk factors for increased risk in pregnancy and neonatal deaths.” Researchers found 39% of counties in states that have banned or restricted abortion access are considered maternity care deserts. A maternity care desert is defined as a county where access to maternity care services is limited or completely nonexistent. That number drops to 25% of counties in abortion-access states. People of color and lower-income people of reproductive age continue to be most affected by these inequities. “When we think about birthing people who lack financial resources, they’ll suffer the most,” says Dr. Zephyrin. “Wealth inequality can shape every aspect of access to healthcare. There are a number of interlocking factors that really make this an even more inequitable issue [and showcase] where we have broken, inequitable systems.” As more states begin to enact their trigger bans and restrictions, access to care will become even more difficult for many of these individuals. “You basically have a group of people with trouble accessing healthcare because of historical and systemic racism that puts them in a lower socioeconomic class,” explains Dr. Jones. “If you can’t afford to take time off, you don’t have childcare and don’t have access to money to get [care], you’re going to be at an increased risk.” Abortion-restrictive states have fewer maternal healthcare providers in general. According to the study, these states have a 32% lower ratio of obstetricians to births and a 59% lower ratio of certified nurse midwives to births. Researchers also found that the rate of pregnant people giving birth with little to no prenatal care was 62% higher in the abortion-restrictive states versus states with abortion access.
Impact of Overturning Roe v. Wade
How will the recent Dobbs vs. Jackson ruling and subsequent overturning of Roe vs. Wade impact maternal care and death rates in the future, as states reconsider their abortion laws or ban them entirely? Many states have already banned abortion entirely. While the study centered on findings from 2018 to 2020, the disparity may be even further divided by the decision to overturn Roe v. Wade. Abortions aren’t the only thing that will be difficult or impossible to access in a post-Roe world. Reproductive healthcare in general, from condoms to birth control pills and regular exams, could be greatly affected by stricter regulation. “These additional bans could really make all manner of reproductive healthcare even harder to get,” says Dr. Zephyrin. “[Overturning Roe] launches maternal and reproductive health to the forefront. I think the impact of this decision is that there’s a risk of harming so many people due to the inequities that we see,” The Supreme Court decisions push maternal and reproductive health to the forefront and Dr. Zephyrin says there’s a risk of harm to people due to inequities. “As an OB/GYN, I can tell you that pregnant people need access to healthcare and providers who respect them, and they need their freedom to choose their reproductive future,” says Dr. Zephyrin. “When we think about these findings, many people don’t have these things and not through any fault of their own.” Dr. Jones foresees the rights of people of reproductive age in a post-Roe political climate diminishing. “The GOP has long said that they won’t come after birth control and we have plenty of evidence to say that that’s not the case,” she shares. “You see it chipping away, and eventually it’s completely gone.” Dr. Zephyrin hopes this study will help raise awareness of these inequities, drive policy change and encourage states to expand and address reproductive healthcare. “I’m hoping that this continues to galvanize people to continue to focus on the importance of access to reproductive and maternal health care and the broader aspects of healthcare that we all need.”
