“We have already been at a crisis point,” Mason said. “If you add on top of that a system that restricts access to abortion care and increases unwanted pregnancies, you are potentially cycling more Black and brown women into a system that is already failing them.”
Non-Hispanic Black women receive abortions at a higher rate and account for a greater percentage of abortions than non-Hispanic white women or Hispanic women, according to the federal Centers for Disease Control and Prevention.
Already, the states with the most restrictive abortion laws tend to have the highest maternal mortality rates, according to the CDC. These include Alabama, Arkansas, Kentucky, Louisiana, Mississippi and Tennessee, all of which, the CDC reports, recorded more than 30 maternal deaths per 100,000 births between 2018 and 2020. The CDC analysis used slightly different numbers from the Commonwealth Fund. (Arkansas had the highest, with more than 40 deaths per 100,000 births.)
By contrast, states with more permissive laws on abortion had much lower rates: Illinois, for example, recorded fewer than 13 maternal deaths per 100,000, and California had 10.
Some research suggests a connection between the denial of abortion services and maternal health.
One well-known national 2020 study by the University of California, San Francisco found that women who were denied requested abortions were more likely to die or experience serious complications, such as eclampsia, after their pregnancies. They also were more likely to experience poor physical health for years after the pregnancy, including chronic pain and gestational hypertension. And they were more likely to stay with abusive partners and suffer anxiety and loss of self-esteem in the short term.
The National Right to Life Committee argues that the University of California study is not credible, because “these researchers and their institution have a vested interest, a clear and definite agenda, and it affects the research they choose to do and how they do it,” Randall K. O'Bannon, the committee’s director of education and research, wrote in an email to Stateline.
Amelia Cobb, who works in health equity for the California Health Care Foundation, said another concern is the continued closure of health clinics, such as Planned Parenthood, that provide comprehensive maternal health services, which has already occurred in states that targeted clinics providing abortion services.
Already, according to the organization Power To Decide, which helps guide people to available birth control, more than 19 million women who are of reproductive age and have low incomes, and who need publicly funded birth control, live in areas without easy access to health centers offering comprehensive reproductive health services.
With further abortion restrictions, the situation will get worse, especially for lower-income women and women of color, Cobb said.
Maternal health experts say that aside from allowing abortions, states can take further actions to reduce maternal mortality and morbidity.
Expanding Medicaid eligibility to lower-income women under the Affordable Care Act, they say, is one of the most effective measures. Of the 12 states that have not yet expanded Medicaid, the nine that reported maternal mortality deaths to the CDC all recorded more than 20 deaths per 100,000 births. With the exception of North Carolina, all also have relatively restrictive abortion laws.
Another policy change maternal health advocates have pushed for is extending postpartum Medicaid benefits from the minimum two months to 12 months as many states have done. But other states with high maternal death rates and restrictive abortion laws, such as Missouri, Oklahoma and Texas, have not.
Many states, predominately but not exclusively Democratic-leaning states, also have extended Medicaid benefits to cover the services of doulas, who provide emotional, physical and educational support to women during and after pregnancy.
To reduce racial disparities in maternal health outcomes, a handful of states — California, Maryland, Minnesota and Michigan — have adopted requirements for implicit bias training, at least for those who work in perinatal care. The CDC recorded fewer than 20 maternal deaths per 100,000 for California, Maryland and Michigan. Minnesota, citing confidentiality, didn’t report results.
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