Oral Concurrent Session 4 - Equity, Public Health, and Public Policy
Oral Concurrent Sessions
Marie C. Anderson, MD (she/her/hers)
Resident Physician in Obstetrics & Gynecology
Columbia University
New York, New York, United States
Hooman A. Azad, MD, MPH (he/him/his)
OB/Gyn Resident Physician
Columbia University
Columbia University, New York, United States
Dana Goin, PhD
Columbia University
Columbia University, New York, United States
Uma M. Reddy, MD, MPH
Professor
Columbia University Irving Medical Center
New York, New York, United States
Mary E. D'Alton, MD
Obstetrician and Gynecologist-in-Chief
Willard C. Rappleye Professor and Chair
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center
New York, New York, United States
Erika E. Levi, MD, MPH
Columbia University
Columbia Univeristy, New York, United States
Lisa Nathan, MD, MPH
Associate Professor of Obstetrics & Gynecology
Columbia University Irving Medical Center
New York, New York, United States
The federal right to abortion in the US was protected by Roe v. Wade (1973) until the precedent was overturned by Dobbs v. Jackson Women’s Health (2022). However, state-level restrictions eroded access to abortion, especially in the 2000s-2010s. This study aims to investigate the effect of state-level abortion restrictions on maternal deaths in the US.
Study Design:
Case-level data on deaths in US women ages 15-54 years (2005-2023) were collected from the CDC’s National Vital Statistics System. Ten common state-level abortion laws were catalogued using LexisNexis. Random-effects negative binomial models compared the effect of individual restrictions on maternal deaths, controlling for state-level factors. A quasi-experimental difference-in-difference model determined the increased number of deaths attributable to having stringent abortion restrictions (≥5 restrictions, top tercile of states); this form of analysis largely isolates the impact of an intervention.
Results:
22,380 pregnant/postpartum women died in the US from 2005-2023. Violence, unintentional drug overdose, and cardiovascular disease were the 3 leading causes. The number of abortion restrictions increased from average 2.7 to 5.3 restrictions per state from 2005-2023. In 2005, only 5 states were considered “most restrictive” (≥5 restrictions); in 2023, 27 states had this designation. (Figure 1)
Six of ten abortion restrictions were associated with higher rates of maternal death. Four restrictions were associated with higher rates of violent death. A sensitivity analysis during the pre-Dobbs era had similar findings. States with ≥5 abortion restrictions had higher rates of maternal deaths from any cause, violent deaths, and cardiovascular disease. (Table 1)
Conclusion:
Abortion is a safe alternative to continuing pregnancy. Restriction of abortion at the state level is strongly associated with increased rates of maternal death in the United States. Further restriction of abortion after Dobbs may result in higher rates of maternal death in coming years.