A surge of new abortion bans and clinic closures has highlighted the recent rise in America’s maternal mortality rates that are disproportionately affecting women of color, and have placed the US first in maternal deaths among all developed nations.
In April and May alone, the governors of Louisiana, Ohio, Georgia, Mississippi, Missouri, and Alabama signed some of the most restrictive abortion bans in the country into law. These bans represent the most aggressive anti-abortion activity from states with Republican-controlled legislatures in decades.
Louisiana, Ohio, Georgia, Mississippi have moved to ban abortion after fetal cardiac activity can be detected, usually, around five to six of weeks pregnancy with “heartbeat” bills.
Missouri banned abortions after eight weeks, and Alabama passed a law to ban the procedure altogether and punish doctors who perform abortions with jail time.
None of these new laws or any previous six-week ban states have passed have formally gone into effect and all recently-passed laws are being challenged in court. Already, federal and state judges have blocked pre-viability abortion bans passed by Mississippi, Kentucky, North Dakota, and Iowa.
Georgia’s law is the only one to include exceptions for rape and incest victims, with the rest of the laws only making exemptions for cases where pregnancy would threaten the life of the patient.
States with strict abortion restrictions have high infant mortality rates
The states that are attempting to require the vast majority of pregnant people to give birth by force of law also happen to boast some of the worst health outcomes in the nation for both pregnant people and babies.
According to 2017 data from the Centers for Disease Control on infant death rates and a 2018 USA Today investigation on maternal mortality rates in the 46 states with available data, nearly all of the states who have recently passed restrictive bans on abortion rank in the top 10 states for maternal mortality, infant mortality, or both.
- Louisiana ranks first in the nation for maternal mortality, with 58.1 maternal deaths per 100,000 live births. The state ranks 11th in the nation for infant mortality, with 7.1 infant deaths per 1,000 live births.
- Mississippi passed bans on abortion after 15 weeks and six weeks of pregnancy this year, both of which have been blocked by a federal judge. The state ranks first in the nation in infant mortality with 8.6 per 1,000 live births, and 19th in the nation for maternal mortality, with 20.8 maternal deaths per 100,000 live births.
- Arkansas, which moved earlier this year to ban abortion after 18 weeks of pregnancy, ranks second in the nation for infant mortality with 8.2 deaths per 1,000 births and 4th in the nation for maternal mortality, with 37.5 deaths per 100,000 live births.
- Georgia, whose abortion ban is set to go into effect in 2020, ranks second in the nation in maternal mortality with 48.4 deaths per 100,000 births, and 9th in the nation for infant mortality with 7.2 infant deaths per 1,000 live births.
- Alabama ranks 6th in the nation for infant deaths, with 7.4 deaths per 1,000 births, and 29th in the nation for maternal mortality with 18.7 deaths per 100,000 live births.
- Ohio is ranked 8th for infant mortality with 7.2 deaths per 1,000 live births and 26th in maternal mortality with 19.2 deaths per 100,000 births.
- Missouri has the 6th highest maternal mortality rate in the nation with 34.6 per 100,000 live births and ranks 20th in infant mortality with 6.2 deaths per 1,000 births.
- Earlier this year, a federal judge blocked a six-week abortion ban passed in Kentucky from going into effect. The state ranks 13th in maternal mortality with 22.9 deaths per 100,000 live births, and 17th in infant mortality.
Maternal mortality in the US rose by 26% between 2000 and 2014
A 2016 report from the American College of Obstetrics & Gynecology found that maternal mortality rose by 26% between 2000 and 2014, with black women almost three times more likely and Native American women over four times more likely to die from childbirth-related complications than white mothers.
Researchers say nearly half of those deaths are preventable, attributing the heightened mortality rate to a number of factors. These included increases in the number of women with obesity and diabetes, insufficient OBGYN care in many places, and women having children at older ages and opting for more c-sections, as TIME reported in 2017.
Dianna Greene-Foster, a public health and reproductive rights scholar at UC San Francisco, told Wired earlier this month that given the mounting costs of healthcare and childcare, being denied an abortion is directly linked to higher levels of poverty and worse maternal bonding and childhood development outcomes — especially for patients who were already below the poverty line and/or had multiple children.
She also told Wired that pregnancy is a “major predictor of poverty in our country, not because of its prevalence but because we penalize every aspect of it … the supports we have for low-income women are not sufficient to keep them from falling into poverty.”
Over the past several years, Republican-controlled state legislatures have enacted costly restrictions on abortion clinics that forced many to close down, and slashed family planning funding for organizations like Planned Parenthood that provide low-cost contraceptive services, gynecological screenings, and other healthcare.
Researchers note that data collection and research on maternal mortality is spotty and inconsistent in the United States, and it’s difficult to isolate how much of the rise in maternal mortality is due to abortion clinic closures and decreases in access to affordable care. But medical professionals say a lack of adequate care can result in more dangerous outcomes for patients.
“If you have a patient who has a medical condition that increases her risk during pregnancy, and she has no access to contraception, and she gets pregnant, and she dies, that’s a death that could have been prevented if she had contraception or family planning,” University of Texas obstetrics & gynecology professor George Saade told the Texas Tribune in 2016.
Unsafe abortion isn’t currently a major contributing factor to maternal mortality in the US, but evidence from other nations shows that restricting abortion is associated in greater rates of maternal deaths from unsafe abortions and pregnancy complications, which occurred in Romania when the country banned both abortion and contraception under communist dictator Nicolae Ceausescu, as Wired noted.
On the flipside, Wired also pointed out that abortion was legalized again in the early 90s, Romania’s maternal mortality rate fell to half its previous rate, with researchers estimating that unsafe abortions accounted for 87% of maternal deaths. And in Nepal, maternal mortality also fell by more than half after the country made abortion legal in the early 2000s, despite an accompanying increase in abortion-related complications.
“These bans aren’t really about reducing abortion, they’re about reducing women’s freedom and access to care” argued Kristin Rowe-Finkbeiner, the executive director of reproductive and maternal rights advocacy group MomsRising, in a phone interview with INSIDER.
Rowe-Finkbeiner and other advocates for abortion access argue that if such lawmakers were truly concerned with reducing abortion rates and protecting life at every stage, they would expand access to affordable contraception and sex education, and design policies to make healthcare and childcare more accessible — measures most states did not include along with abortion bans.
Row-Finkbeiner described the rise in anti-abortion legislation as “an attack on autonomy, sovereignty, and freedom” and “outrageous in a time when maternal and infant mortality are rising, especially so among black and Native American women.”
“Pro-life means more than being pro-birth.”
Democratic Gov. John Bel Edwards, who signed Louisiana’s abortion ban into law and is up for a tough re-election fight this year, has long described himself as a pro-life Democrat, and said in a statement he believes “that pro-life means more than being pro-birth.”
His statement further touted his work expanding Medicaid in Louisiana and overseeing a record number of children in foster care being adopted out. Last August, his administration also created a “Healthy Moms, Healthy Babies” advisory council to address the racial disparities in maternal mortality in the state.
Senator and 2020 presidential candidate Kamala Harris, who has frequently highlighted the racial disparities in maternal mortality on the campaign trail, wrote in a tweet addressed to him: “…women have agency, women have value, women have authority to make decisions about their own lives—and we will not go backward.”