State Abortion Policies and Maternal Death in the United States, 2015‒2018

• Published in: American journal of public health (1971) Vol. 111; no. 9; pp. 1696 - 1704
• Main Authors: Vilda, Dovile, Wallace, Maeve E., Daniel, Clare, Evans, Melissa Goldin, Stoecker, Charles, Theall, Katherine P.
• Format: Journal Article
• Language: English
• Published: Washington American Public Health Association 01-09-2021
• Subjects: Abortion; Abortion, Access to Care; Births; Black people; Childrens health; Confidence intervals; Counseling; Errors; Gestational age; Government programs; Indexes; Inequality; Maternal & child health; Maternal mortality; Medicaid; Mortality; Open-Themed Research; Other Maternal and Infant Health; Policies; Pregnancy; Public health; Racial differences; Ratios; Regression analysis; Regression models; Reproductive health; Research & Analysis; Robustness (mathematics); Statistical analysis; Ultrasonic imaging; Women's Health; Womens health; Washington DC; United States > US
• ISSN: 0090-0036; 1541-0048; 1541-0048
• DOI: 10.2105/AJPH.2021.306396

Objectives. To examine associations between state-level variation in abortion-restricting policies in 2015 and total maternal mortality (TMM), maternal mortality (MM), and late maternal mortality (LMM) from 2015 to 2018 in the United States.
Methods. We derived an abortion policy composite index for each state based on 8 state-level abortion-restricting policies. We fit ecological state-level generalized linear Poisson regression models with robust standard errors to estimate 4-year TMM, MM, and LMM rate ratios and 95% confidence intervals (CIs) associated with a 1-unit increase in the abortion index, adjusting for state-level covariates.
Results. States with the higher score of abortion policy composite index had a 7% increase in TMM (adjusted rate ratio [ARR] = 1.07; 95% CI = 1.02, 1.12) compared with states with lower abortion policy composite index, after we adjusted for state-level covariates. Among individual abortion policies, states with a licensed physician requirement had a 51% higher TMM (ARR = 1.51; 95% CI = 1.15, 1.99) and a 35% higher MM (ARR = 1.35; 95% CI = 1.09, 1.67), and states with restrictions on Medicaid coverage of abortion care had a 29% higher TMM (ARR = 1.29; 95% CI = 1.03, 1.61).
Conclusions. Restricting access to abortion care at the state level may increase the risk for TMM.