Abortion restrictions linked to higher maternal death rates

The increased number of state-level abortion restrictions in the U.S. was associated with a parallel increase in maternal deaths between 2005 and 2023, according to new research presented today at the Society for Maternal-Fetal Medicine (SMFM) 2026 Pregnancy Meeting™. Researchers found that states with five or more different abortion restrictions had higher rates of maternal deaths from any cause, cardiovascular disease, and violence than those states with fewer restrictions.

"Abortion is a medically safe procedure, and restricting access to it has real consequences," said Marie C. Anderson, MD, a resident in the Department of Obstetrics & Gynecology at Columbia University Vagelos College of Physicians & Surgeons in New York City, who led the study.

Our research adds to a growing body of literature confirming the profound negative impact these restrictions are having on maternal health in this country."

Lisa M. Nathan, MD, co-researcher, Chief of Obstetrics at Columbia University Irving Medical Center

Using the U.S. Centers for Disease Control and Prevention National Vital Statistics System, researchers from Columbia University reviewed state data on the 22,380 deaths that occurred nationwide between 2005–2023 in pregnant people ages 15-54 years. All deaths that occurred while pregnant or within 42 days postpartum were reviewed. The researchers compared deaths in each state before and after the enactment of 10 of the most common state-level abortion laws.

Between 2005–2003, the number of abortion restrictions increased from an average of 2.7 restrictions to 5.3 restrictions per state. In 2005, only five states had five or more abortion restrictions, considered the "most restrictive" states. In 2023, the number of states considered "most restrictive" jumped to 27. These 27 states included: AL, AZ, AR, FL, GA, ID, IN, IA, KS, KY, LA, MI, MS, MO, NE, NC, ND, OH, OK, PA, SC, SD, TN, TX, UT, WV, and WI. Of these states, AR, LA, NE, and WI had the greatest number of abortion restrictions during the study period.

Researchers found that six of the 10 common abortion restrictions were associated with higher rates of maternal death. These six abortion restrictions included bans on Medicaid funding for abortion, ACA Marketplace insurance coverage bans, mandated waiting periods, ultrasound requirements, second-trimester abortion bans, and biased counseling laws.

Four of the 10 abortion restrictions were associated with higher rates of violent death from homicide and suicide. These restrictions included Medicaid coverage and ACA Marketplace coverage bans, waiting periods, and requirements that abortions be provided by physicians only.

"When states adopt multiple abortion restrictions, we see measurable increases in deaths among pregnant and postpartum people," said Anderson. "The associations we observed were broad - affecting deaths from any cause, cardiovascular disease, and violence - and underscore that reproductive health policy is inseparable from maternal health."