Abortion bans enacted following the Dobbs v Jackson Women’s Health Organization decision may not be associated with a statistically significant increase in pregnancy-associated mortality, according to early national data, although mortality declines were smaller in ban states compared with nonban states and varied across subgroups.
In a retrospective, population-based cohort study, investigators analyzed US National Center for Health Statistics birth and mortality data from 2018 to 2023, including just over 22 million live births and 12,993 pregnancy-associated deaths. They compared 14 states with complete or 6-week abortion bans with 37 states and the District of Columbia as control states using synthetic control methods to estimate policy-associated changes in mortality.
The pregnancy-associated mortality rate declined by 9.8% in nonban states, from 54.5 to 49.2 deaths per 100,000 live births. In contrast, declines were smaller in ban states: 2.4% in states excluding Texas (83.2 to 81.2 per 100,000) and 3.3% in Texas (54.2 to 52.4 per 100,000).
Descriptive subgroup analyses showed increases among some racial groups in ban states excluding Texas. Among non-Hispanic Asian patients in these states, the pregnancy-associated mortality rate rose 41%, from 39.5 to 55.7 deaths per 100,000 live births, while among non-Hispanic Black patients, mortality increased 17.8%, from 140.2 to 165.2 per 100,000.
However, in synthetic control models designed to estimate policy effects, the differences weren't statistically significant. The estimated change in pregnancy-associated mortality in ban states was 5.1 deaths per 100,000 live births compared with synthetic controls. Estimates for pregnancy-related mortality (–2.0), maternal mortality (–3.0), and nonobstetric causes (1.2) per 100,000 live births were similarly not significant.
State-level estimates varied in direction but didn't reach statistical significance.
The investigators used synthetic control methods with staggered adoption to account for differences in the timing of abortion bans across states, constructing weighted comparisons to estimate counterfactual mortality trends.
They noted that pregnancy-associated mortality rates peaked during the COVID-19 pandemic, particularly in 2021, with subsequent declines in 2023 potentially reflecting a rebound rather than underlying improvements in maternal health outcomes.
The findings added to early post-Dobbs evidence on abortion bans and pregnancy-associated mortality.
Key limitations included the short postban observation window, which produced wide uncertainty in estimates, and potential exposure misclassification because of increased abortion access in neighboring states and variation in policy implementation. Additional limitations included possible misclassification in death records and suppression of small subgroup counts.
“These findings should be interpreted as early and imprecise estimates, rather than definitive evidence of no effect, given the short postban observation window and wide [confidence intervals],” wrote lead study author Hiluf Ebuy Abraha, MSc, of the Department of Epidemiology and Biostatistics at the University of South Carolina, and colleagues.
Senior study author Nansi S. Boghossian, MPH, PhD, reported grant support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institute on Minority Health and Health Disparities during the study period. The study authors reported no other conflicts of interest. The study was funded by the Society of Family Planning.
Source: JAMA Network Open
