TY - JOUR
T1 - The association between state-level abortion restrictions and maternal mortality in the United States, 1995-2017
AU - Addante, Amy N.
AU - Eisenberg, David L.
AU - Valentine, Mark C.
AU - Leonard, Jennifer
AU - Maddox, Karen E.Joynt
AU - Hoofnagle, Mark H.
N1 - Funding Information:
Declaration of competing interest: Dr. Eisenberg has the following disclosures: Medicines 360 (PI on Phase 3 trial of LNG-IUS, Scientific advisory board), Merck (served as trainer for Nexplanon® contraceptive implant), FemaSys (Consultant and Scientific advisory board), ACI Clinical (Chair of DSMB for Phase 3 contraceptive trial). Dr. Joynt Maddox receives research support from the National Heart, Lung, and Blood Institute (R01HL143421), National Institute on Aging (R01AG060935), and Commonwealth Fund, and previously did contract work for the US Department of Health and Human Services. The remaining authors have no reported conflicts of interest.
Funding Information:
Funding: Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR002345 .The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2021/11
Y1 - 2021/11
N2 - Objective: To explore the relationship between abortion restrictions and maternal mortality in the United States. Study design: This was a retrospective study examining maternal mortality in the United States from 1995 to 2017. We used the Global Health Data Exchange and the Centers for Disease Control and Prevention WONDER databases to extract maternal mortality data for all 50 states for each year from 1995 to 2017. We categorized states as restrictive, neutral, or protective of abortion access according to policy information published by the Guttmacher Institute. We assessed associations between abortion restrictions and maternal mortality ratios (maternal deaths per 100,000 live births). Results: In 1995, the mean maternal mortality ratios were similar across all groups of states (Restrictive 12.6, 95% CI 11.4-13.6; Neutral 12.2, 95% CI 10.9-13.4; Protective 10.9, 95% CI 9.6-11.9). Maternal mortality ratios increased for each group of states over time and in 2017, the mean maternal mortality ratio was higher in restrictive states than in protective states (Restrictive 28.5, 95% CI 20.7-35.1; Neutral 22.9, 95% CI 16.1-28.6; Protective 15.7, 95% CI 10.7-19.9). Regressions accounting for policy, state and year showed a statistically significant increase in maternal mortality ratios in restrictive states relative to neutral states (1.06, 95% CI 1.01-1.11) and a non-significant decrease associated with protective states (0.89, 95% CI 0.78-1.01). Conclusions: States that restrict abortion have higher maternal mortality than states that either protect or are neutral towards abortion. Further investigation is needed to determine how abortion restrictions are associated with increased maternal mortality. Implications: The association between abortion restrictions and maternal mortality may reflect the overall legislative priorities of individual states as restrictive states are less likely to pass proactive legislation demonstrated to improve maternal outcomes.
AB - Objective: To explore the relationship between abortion restrictions and maternal mortality in the United States. Study design: This was a retrospective study examining maternal mortality in the United States from 1995 to 2017. We used the Global Health Data Exchange and the Centers for Disease Control and Prevention WONDER databases to extract maternal mortality data for all 50 states for each year from 1995 to 2017. We categorized states as restrictive, neutral, or protective of abortion access according to policy information published by the Guttmacher Institute. We assessed associations between abortion restrictions and maternal mortality ratios (maternal deaths per 100,000 live births). Results: In 1995, the mean maternal mortality ratios were similar across all groups of states (Restrictive 12.6, 95% CI 11.4-13.6; Neutral 12.2, 95% CI 10.9-13.4; Protective 10.9, 95% CI 9.6-11.9). Maternal mortality ratios increased for each group of states over time and in 2017, the mean maternal mortality ratio was higher in restrictive states than in protective states (Restrictive 28.5, 95% CI 20.7-35.1; Neutral 22.9, 95% CI 16.1-28.6; Protective 15.7, 95% CI 10.7-19.9). Regressions accounting for policy, state and year showed a statistically significant increase in maternal mortality ratios in restrictive states relative to neutral states (1.06, 95% CI 1.01-1.11) and a non-significant decrease associated with protective states (0.89, 95% CI 0.78-1.01). Conclusions: States that restrict abortion have higher maternal mortality than states that either protect or are neutral towards abortion. Further investigation is needed to determine how abortion restrictions are associated with increased maternal mortality. Implications: The association between abortion restrictions and maternal mortality may reflect the overall legislative priorities of individual states as restrictive states are less likely to pass proactive legislation demonstrated to improve maternal outcomes.
KW - Abortion
KW - Abortion restrictions
KW - Maternal mortality
KW - Targeted regulation of abortion providers (TRAP)
UR - http://www.scopus.com/inward/record.url?scp=85104297848&partnerID=8YFLogxK
U2 - 10.1016/j.contraception.2021.03.018
DO - 10.1016/j.contraception.2021.03.018
M3 - Article
C2 - 33781761
AN - SCOPUS:85104297848
SN - 0010-7824
VL - 104
SP - 496
EP - 501
JO - Contraception
JF - Contraception
IS - 5
ER -