Banning abortion would boost maternal mortality by double-digits

Banning abortion nationwide would lead to a 21% increase in the number of pregnancy-related deaths overall and a 33% increase among Black women, according to new University of Colorado Boulder research.

Forthcoming in the journal Demography, the study estimates only the portion of increased deaths that would be due to complications of being pregnant and of delivering a baby.

Any increased death due to unsafe abortions or attempted abortions would be in addition to these estimates.

“The takeaway here is that if you deny people abortion, pregnancy-related deaths will increase because staying pregnant is more dangerous to a woman than having an abortion,” said author Amanda Stevenson, an assistant professor of sociology.

The paper comes as Texas enacts the most restrictive abortion law in the country, banning the procedure after about six weeks—a time when many women don’t yet know they are pregnant. Similar laws have been passed in at least 10 other states, but all face legal challenges.

Stevenson, a demographer who studies the impacts of reproductive health policies, said that media outlets and some supporters of abortion rights often raise the specter of dangerous ‘back alley’ or self-induced abortions. In reality, deaths from such incidents, which numbered in the hundreds annually prior to the 1973 passage of Roe v. Wade, would be far less common today due to the advent of safe, self-managed abortions using medications, including Misoprostol, available via prescription or online.

“We expect a lot of women will turn to these safer forms of self-managed abortions but a lot of women will also just stay pregnant,” said Stevenson. “What happens then?”

To predict the maternal mortality consequences, Stevenson used published statistics on the number of abortions and births that occurred annually in recent years, calculated how many more pregnancies would be continued in the absence of legal abortion and applied pregnancy-related mortality statistics to that number.

Pregnancy riskier to women’s health than abortion

Carrying a pregnancy to term is 33 times riskier than having an abortion, with 0.6 maternal deaths per 100,000 abortions compared to 20.1 maternal deaths per 100,000 live births, according to the Centers for Disease Control.

Research also shows that those most likely to seek abortion care, including women of color, poor women and those with chronic or acute health conditions, are also more likely to encounter serious complications during pregnancy.

The study estimated that in the years following a national ban, an additional 140 women would die annually from pregnancy-related causes, bringing the death toll to 815, a 21% increase. Among non-Hispanic Black women, pregnancy-related deaths would increase by a third.

Black women are more likely to seek an abortion for a variety of reasons, including unequal access to opportunities like housing, education, jobs and healthcare, she said. Meanwhile, the mortality risk of carrying a pregnancy to term is more than three times as high for non-Hispanic Black women compared to non-Hispanic white women.

“Increasing Black women’s exposure to the risk of pregnancy-related mortality by denying them access to abortion would exacerbate an existing public health crisis,” Stevenson said.

The paper does not include an estimate of increased deaths due to unsafe self-induced abortions. While expected to be low, that number may not be zero, she noted, pointing to a recent study showing about 1.5% of reproductive-age women have tried to terminate a pregnancy themselves, often using ineffective and potentially unsafe methods like herbs, drugs or objects.

Going forward, Stevenson said she hopes discussions around reproductive choice will move away from such exceedingly rare cases and toward the looming realities of today.

The study has been peer reviewed and is scheduled to publish in the February issue of Demography. Given the events in Texas, Stevenson posted the paper online last week, on a platform known as a preprint server, so it could inform the ongoing conversation.

“We need to stop talking about coat hangers and start talking in an honest way about how these laws will actually impact women’s lives and mortality,” said Stevenson. “This study provides one piece of the evidence we need to begin that hard conversation.”