TDNet Discover

Background: Despite global improvements, the United States continues to report one of the highest maternal mortality rates among high-income nations, with significant racial and age disparities. Existing literature suggests that access to reproductive healthcare, including abortion services, may be a key contributing factor. Purpose: This study primarily aimed to evaluate the association between the restrictiveness of state-wide abortion policies, including the Dobbs v. Jackson Women’s Health Organization decision, and maternal health outcomes in the United States between 2018 and 2023. Secondarily, it sought to identify patterns and disparities that may inform future public health and policy decisions. Methodology: This retrospective ecological study used International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes to analyze maternal and late maternal deaths from the National Center for Health Statistics (NCHS) Restricted Vital Statistics across all 50 states between January 1, 2018, and December 31, 2023, excluding ICD10 codes related to COVID-19. State maternal and late maternal mortality data was categorized as Restrictive, Mixed, or Protective based on monthly scores derived from cumulative abortionrelated legislations and used to calculate maternal mortality ratio, maternal mortality rate, pregnancy-related maternal death, late maternal deaths, and cause-specific maternal deaths using data from the Center for Disease Control (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) and the United States Census Bureau. Results: This study analyzed 4,215 maternal deaths, 2,632 late maternal deaths, and 8,159 pregnancy-related deaths, revealing that Restrictive states exhibited significantly higher maternal mortality rates and ratios from 2018 to 2023. Similarly, both Restrictive and Mixed states had v higher counts of pregnancy-related maternal deaths and late maternal deaths compared to Protective states throughout the study. Although the study observed slight declines in mortality rates in 2022 and 2023, disparities amongst secondary outcomes persisted among policy categories, namely in deaths related to sepsis and abortive outcomes. Conclusion: The findings of this study suggest an association between restrictive abortion policies and adverse maternal health outcomes. Although causality was not assessed due to the study’s ecological design, the consistently elevated maternal mortality metrics observed in Restrictive states appear to be linked to cumulative legal constraints on abortion access rather than a single policy change, such as the Dobbs v. Jackson Women’s Health Organization decision. The analysis also highlighted gaps in mental health care and inconsistencies in late maternal death classifications, suggesting systemic weaknesses beyond traditional mortality metrics. These findings underscore the need for improved surveillance systems, standardized reporting, and targeted interventions to reduce preventable maternal deaths and promote health equity.