A new report from the Commonwealth Fund provides a frightening preview of what’s to come in the wake of Roe v Wade being effectively struck down. It shows that infant and maternal health care outcomes, including mortality rates, were already worse in U.S. states where abortion services were more restricted prior to 2022. Many of these states have since or are now planning to pass even more abortion restrictions and outright bans, which will likely only accelerate this divide, the report authors say.
The Commonwealth Fund is a nonprofit organization focused on health care reform. For its latest report, researchers wanted to compare the current status of maternal and infant health in states where abortion access is being protected compared to states where it’s being threatened. To do this, they turned to various sources of mortality and health data recently collected by the Centers for Disease Control and Prevention and others. They then cross-referenced this data with recent state-by-state rankings on abortion access tabulated by the Guttmacher Institute, a research and policy organization focused on reproductive rights.
Based on Guttmacher’s data, 26 states had restrictive abortion polices, such as laws that ban abortion before the end of the first trimester (about 13 weeks of gestation). The Commonwealth report authors found that these restrictive states consistently had poorer health outcomes in recent years when compared to states where abortion access is protected.
In restrictive states, for instance, 39% of counties were considered maternity care deserts in 2020, compared to 25% of counties in permissive states. These deserts are areas where “access to maternity health care services is limited or absent,” the authors say. There were also fewer dedicated maternal care providers in restrictive states, such as obstetricians and certified nurse midwives. And while most expectant mothers do receive some amount of prenatal care, those living in restrictive states were more likely to receive none at all (7.3% vs. 4.5%). The affordability and accessibility of health care systems was worse in these states, too.
Perhaps most tragically, the maternal mortality rate in 2020 was 62% higher in restrictive states than in permissive states (28.8 vs 17.8 maternal deaths per 100,000 live births). The rise in maternal mortality was also nearly twice as fast in these states between 2018 and 2020. Perinatal or infant mortality was higher in restrictive states as well, with the rate of perinatal deaths (deaths immediately before or after birth) 15% higher. And many of these gaps were even more lopsided for people of color.
The Supreme Court’s ruling in Dobbs v. Jackson Women’s Health Organization in June 2022 has ceded abortion policy completely to the states—the end goal of a long campaign by Republicans. Many of these restrictive states already had laws on the books that were meant to further restrict abortions in a post-Roe world or are planning to pass such laws. In light of that, it’s almost certain that these states will only become worse at providing adequate health care to families, the authors say.
“Making abortion illegal risks widening these disparities, as states with already limited Medicaid maternity coverage and fewer maternity care resources lose providers who are reluctant to practice in states that they perceive as restricting their practice,” the authors wrote. “The result is a deepening of fractures in the maternal health system and a compounding of inequities by race, ethnicity, and geography.”
Reproductive health advocates have been trying to ensure that abortion remains widely available throughout the country, even in the face of opposition from Republican lawmakers. But the authors say that big changes are needed to prevent this approaching downslide in maternal and infant care.
“In partnership with health plans, providers, and residents, state leaders could attempt to recruit more maternity care providers—including midwives, physicians, doulas, and nurses—and promote the operation of more birthing facilities, such as hospital units and birthing centers,” they wrote. And on the federal level, the government could increase funding for reproductive health care, family planning, maternity care, they say.