U.S. maternal mortality rates are certain to rise as more states restrict abortion following the fall of Roe v. Wade, experts said, a sobering prediction as new statistics show the Covid pandemic’s already outsize effect on maternal deaths.
With a higher rate than any other developed country, maternal mortality in the United States is astonishingly high, particularly for women of color.
Statistics from before the pandemic showed that about 700 women were dying of pregnancy-related complications each year, with Black and American Indian/Alaska Native women about three times as likely to die from a pregnancy-related cause compared to white women, according to the Centers for Disease Control and Prevention.
An analysis published Tuesday in JAMA Network Open found that maternal deaths increased in 2020 by as much as 41% after the pandemic was declared. The increases were starkest for Hispanic and Black women.
As states across the country curtail access to abortion, women’s health advocates and researchers foresee the maternal mortality rate and its racial disparities only getting worse — particularly because states that are banning abortion are often the ones that already have high maternal mortality rates.
“There’s no question in my mind that we should anticipate that the already abysmal and unconscionable maternal mortality and morbidity rates will be increased,” said Andrea Miller, president of the National Institute for Reproductive Health, referring to maternal deaths and pregnancy-related conditions that negatively affect women’s health.
Part of it, she said, is a numbers game. With more limits on who can access abortion, there will be more pregnancies and more chances for complications.
“Some of those pregnancies will be healthy pregnancies, some of those pregnancies will face complications,” Miller said. “And even those who have healthy pregnancies will add to the strain that already exists in our health care system when it comes to pregnancy-related care.”
Maternal deaths are defined by the CDC as death during pregnancy or within a year following delivery from any cause related to or aggravated by a pregnancy or its management.
Tuesday’s JAMA Network Open analysis compared maternal mortality data from 2018 to March 2020 to data from April to December 2020.
Maternal deaths — those during pregnancy or within 42 days of delivery — increased 33.3% after March 2020 compared to before the pandemic, while late maternal deaths — those more than 42 days but less than a year of delivery — increased 41%.
The Guttmacher Institute, a research organization that supports reproductive rights, anticipates 26 states are certain or likely to ban abortion now that there are no federal protections, including 13 that had trigger laws with abortion bans that were designed to go into effect once Roe v. Wade was overturned.
Among them is Mississippi, the state at the center of the decision reversing Roe, which a 2019 report found had a maternal mortality rate nearly twice the national average.
The state offers few health and social nets for mothers. Earlier this year, Republican leaders of the Mississippi House killed a bill that would have expanded Medicaid coverage for a year for mothers after giving birth, up from two months.
Mississippi’s racial disparities are particularly shocking: It is nearly 118 times more dangerous for Black women to give birth there than it is for them to have an abortion, according to Michele Bratcher Goodwin, author of “Policing the Womb: Invisible Women and the Criminalization of Motherhood,” citing state health data.
In Louisiana, where Republican Sen. Bill Cassidy recently created a firestorm for comments downplaying the racial disparity in maternal mortality, Black mothers are four times more likely to die than white mothers. Maternity care “deserts” in the state have been correlated with particularly poor pregnancy outcomes.
Reasons for the racial disparities in those states and across the country are multifactorial, said Rachel Hardeman, Blue Cross endowed professor of health and racial equity at the University of Minnesota School of Public Health.
They include structural racism and a lack of investment in the communities where Black, Latinx and Indigenous people live, work and play, she said; potential lack of access to reproductive health care, from prenatal care to abortion services; and “weathering,” the notion that day-to-day exposure to racism deteriorates health and advances aging on a biological level.
Overturning Roe has implications for so much more than women’s health care, she said.
“It’s important to think about both the Supreme Court’s decision and its direct impact on access to reproductive health and abortion services, but also, it’s important to think about it as part of a larger part of health policies that are perpetuating racism and white supremacy,” Hardeman said.
As for what Roe’s fall will do to maternal mortality’s racial disparities, “we are going to exacerbate that gap,” she said.
How to prevent a spike in maternal deaths
As abortion bans come into place, so-called sanctuary states are absorbing more patients.
The Feminist Women’s Health Center in Atlanta has received calls from hundreds of women from neighboring states seeking appointments since Roe was overturned, Executive Director Kwajelyn Jackson said.
Travel to such places can be burdensome for many women, financially or otherwise. And with Georgia awaiting a court ruling on a strict abortion ban, the health center’s ability to perform abortions may soon be severely restricted.
Jackson said successful grassroots organizations should be leading the discussions around the country on how to prevent maternal deaths.
“What I want to see more of is looking to the expertise and experience of Black people who have been doing this work in their communities,” she said, citing the Black Mamas Matter Alliance, a nonprofit organization advancing Black maternal health rights, as an example. She also urged more investments in local, customized expertise.
“The interventions that we need in Alaska are not going to look like the interventions that we need in Mississippi,” she said.
Hardeman said it will take an “all-hands-on-deck” approach to prevent maternal deaths, particularly preventing them among women of color. The next election cycle will be key to this, she said, and therefore doing everything to prevent voter suppression will be, too.
“Everyone is going to be impacted by the additional strain on our health care system, on the additional strain on our economy and the additional strain on communities."
Miller said advocacy work should be focused on expanding affordable health care for contraception, pregnancy-related care and abortions, including eliminating the copays for abortions.
She said she hoped more people would take this on as a cause that they care about given the effect it will have on their lives — even if indirectly.
“Everyone is going to be impacted by the additional strain on our health care system, on the additional strain on our economy and the additional strain on communities and community supports,” Miller said. “It’s not just a ripple effect. It’s like a tsunami effect.”