Here’s Why Maternal Mortality Rates Will Increase

Abortions are statistically safer than childbirth. Research from 2012 shows the risk of death during childbirth is 14 times higher than a safe and legal abortion.

What’s more, research from 2022 indicates that even self-managed abortions, when performed under the guidance of a physician, can be safe and effective. In 2021, the Food and Drug Administration issued a permanent approval for prescription abortion pills by mail, permitting doctors to meet with out-of-state patients via telemedicine and prescribe the medication.

Dr. Sarah Prager, MAS, a UW Medicine professor in the department of obstetrics and gynecology, told Healthline the primary way people will likely try to self-manage an abortion will still be with medication regimens using mifepristone and misoprostol. But these medications are only approved for up to 10 weeks gestation, which means that self-managed abortions beyond 10 weeks are unsafe.

Prager warned that the safety of managing an abortion outside of a medical system will diminish as a pregnancy continues. “People who cannot access abortion [may] become desperate quickly and will resort to any means they can to not be pregnant.”

Maternal mortality can affect anyone who becomes pregnant.

Experts have warned that people of all backgrounds will die from untreated pregnancy complications, such as an incomplete miscarriage. Others have expressed concern for pregnant people experiencing intimate partner violence, which could increase the number of maternal homicides.

But restricted abortion access is more likely to increase maternal mortality rates among People of Color, especially Black women. The CDC reports that Black, American Indian, and Alaska Native (AI/AN) women are 2 to 3 times more likely to die of pregnancy-related causes than white women.

According to the CDC, contributing factors to higher pregnancy-related deaths among People of Color may include:

  • structural racism and implicit bias
  • lack of access to quality healthcare
  • underlying chronic conditions
  • social determinants of health that prevent people from receiving fair opportunities for economic, physical, and emotional health (i.e., rural location, transportation issues, lack of insurance)

Here are some ways that being denied access to safe abortion could be lethal.

Limitations on miscarriage care

Research from 2022 estimates that 26% of pregnancies end in miscarriage — that’s over a quarter of all pregnancies.

Miscarriage care, including medications or medical procedures, is similar to abortion care.

Limitations on medical miscarriage care due to pregnancy complications can be fatal, putting medical professionals in a complicated ethical position in the emergency room.

“Doctors are ethically obligated to treat patients, and it may [also] be a violation of the states’ anti-abortion laws,” Prager said. “Even if it’s not in violation, there will be confusion for many clinicians about what is and is not allowed, which will also potentially create confusion about how they can legally proceed.”

Already media reports have cited stories from people who faced obstacles in getting miscarriage care.

Ruptured ectopic pregnancy

Ectopic pregnancies — when a fertilized egg implants outside of the uterus — affect about 1–2% of all pregnancies. These pregnancies are not viable and can result in a medical emergency. Delaying treatment due to abortion bans may cause further complications or even result in death.

“A [person] with an incomplete miscarriage can bleed to death if the uterine contents aren’t evacuated, an ectopic pregnancy can rupture and the [person] can bleed to death,” said Kecia Gaither, MD, MPH, FACOG, the director of Perinatal Services at NYC Health + Hospitals/Lincoln in New York City. “In both cases, intervention is necessary.”

Maternal sepsis

Maternal sepsis, or “septic uterus,” affects 11% of maternal deaths globally. In fact, the World Health Organization (WHO) reports that maternal sepsis is the third most common cause of maternal mortality.

For instance, if a pregnant person’s water breaks before 20 weeks gestation, it could cause a severe bacterial infection and sepsis (or blood poisoning) if left untreated. Sepsis may also occur during an incomplete miscarriage.

In these cases, physicians may be forced to wait for the patient to become severely ill before providing an abortion or wait until the fetal heartbeat stops.

Delayed care for cancer patients

In some cases, cancer care during pregnancy may be delayed since it may cause harm to the fetus.

“A variety of cancer treatments compromise the immune system and suppress bone marrow, which increases the risk of bleeding,” explained Mitzi Krockover, MD, host of the women’s health podcast, Beyond The Paper Gown. “Denial of [abortion] care can cause a patient to lose too much blood or become septic.”

Krockover added that delaying cancer treatment that could harm a fetus, such as chemotherapy or radiation, could decrease a person’s chances of remission, thus decreasing their overall chances of survival.

In some scenarios, Krockover explained, doctors may elect to use suboptimal therapy that is less harmful to the fetus but not as effective for successful cancer treatment.

Other complications

Pregnant people with significant comorbid conditions face additional risks if they cannot terminate a pregnancy, which may result in death.

A cohort study of California mothers delivering between 1997 and 2014 published in 2020 shows that severe maternal mortality (SMM) increased by 160% during that time. The study noted that medical comorbidities made up a substantial number of maternal mortality rates, increasing 111% during the study period. Obstetric comorbid conditions increased by 30% to 40%.

According to Gaither, comorbidities elevating the risk for maternal mortality may include:

Suicidal ideation and attempt

According to the American Psychological Association (APA), restricting abortion access may increase the risk of mental health issues.

Being denied an abortion may lead to an increase in anxiety, depression, post-traumatic stress disorder (PTSD), and even suicidal ideation, according to the APA.

Suicide is a leading cause of maternal mortality in the United States. In fact, a 2021 study looking at data from 2006 to 2017 shows that suicidal ideation and self-harm significantly increased among pregnant people during the year before and after giving birth.

“According to the Turnaway study, people who were denied abortion access experienced higher levels of depression and anxiety and overall worse mental health outcomes than people who were allowed to have an abortion,” said Dr. Mary Jacobson, chief medical officer at Alpha Medical.

By contrast, Jacobson cited another study, which showed that levels of suicidal ideation were similarly low between people who had abortions and people who were denied abortions.

The researchers concluded there’s not enough evidence to suggest that having an abortion increases a person’s risk for suicide. They noted that some studies had shown a higher risk of deliberate self-harm among women denied an abortion but concluded that more rigorous research is still needed.

“Based on these facts, one may hypothesize that maternal mortality due to suicidality may increase, but this hypothesis is debatable,” Jacobson said.

Domestic violence and maternal homicide

Research from 2021 shows that homicide is another top cause of maternal mortality in the United States, with marginalized groups and People of Color more likely to be impacted, particularly those of younger ages.

Data shows there were about 4 homicides per 100,000 live births among people who were pregnant or within 1 year postpartum, which was 16% higher than homicide prevalence among nonpregnant and nonpostpartum people of reproductive age.

Intimate partner violence is associated with maternal mortality. Advocates for survivors of domestic violence have said that pregnant people are especially at risk for an increase in intimate-partner violence in a post-Roe world if they’re denied an abortion.

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