Commonly cited data on the mortality risk of pregnancy when compared to abortion in the U.S. is a vast undercount, according to a study out today in JAMA Network Open.
“It is widely understood by scientists that continuing a pregnancy carries a much higher risk of death than having an abortion. Our new analysis shows that it is far more dangerous to be pregnant than to have an abortion and this gap in mortality risk is even larger than previously recognized,” said Dr. Maria Steenland, assistant professor at University of Maryland’s School of Public Health (UMD SPH) and a lead author of the study.
These findings suggest that by taking away the option to end a pregnancy, abortion bans force pregnant people to take on the substantially increased health risks associated with continued pregnancy, researchers note. For example, someone who is denied an abortion and forced to continue a pregnancy faces several kinds of additional risk, including things like hemorrhage and high blood pressure.
Our new analysis shows that it is far more dangerous to be pregnant than to have an abortion and this gap in mortality risk is even larger than previously recognized.
The research found that the mortality risk from pregnancy (including up to one year postpartum) is 44 to 70 times higher than the mortality risk from abortion – three times higher than previously estimated. Prior to this study, a commonly cited statistic was that the risk of death associated with childbirth is approximately 14 times higher than that of abortion. This statistic was based on data from 1998 to 2005 that found a maternal mortality rate of 14.5 per 100,000 live births. The current study, using data from 2018 to 2021, found 32.3 maternal deaths per 100,000 live births, with the highest rate of 43.9 in 2021.
One major factor involved in the new estimates was the availability of new data. In 2003, a pregnancy checkbox option was added to death certificates to indicate whether the deceased person was pregnant. When the checkbox was fully implemented in 2018, it addressed prior undercounting of maternal deaths, but also led to a potential problem of overcounting, where the cause of death for the deceased person may have been misclassified as being related to pregnancy.
To account for possible overcounting of maternal deaths, the study removed nonspecific causes of pregnancy-related mortality, such as “other specified pregnancy-related conditions" which prior research showed was likely to be misclassified. The study also excluded deaths from COVID and deaths of people whose pregnancy ended because of miscarriage or self-induced abortion.
“Even with this conservative approach to calculating maternal mortality, we found the risk of dying from pregnancy and childbirth far exceeded the risk of dying from abortion. People deserve access to updated information about these comparative risks and policies that reflect these realities,” said Dr. Marie Thoma, reproductive and perinatal epidemiologist and Associate Professor at UMD SPH. The research team also included Dr. Benjamin Brown from Brown University and Kerra Mercon, a UMD doctoral student in maternal and child health.
The study defined pregnancy-related deaths as occurring during pregnancy or within 1 year from the end of pregnancy and were further identified by hundreds of specific underlying pregnancy-related causes such as hypertension disorders, obstetric hemorrhage, complications from chronic heart and kidney disease and various infections occurring while pregnant.
The data also highlight the urgent need to lower mortality rates for all pregnant, birthing, and postpartum people.
“Our findings underscore how dangerous abortion bans are for pregnant people: forcing someone to continue a pregnancy puts them at a dramatically higher risk of death — along with so many other harms,” said Brown, Mimi Pichey Assistant Professor of Obstetrics and Gynecology at Brown’s Alpert Medical School.
“The data also highlight the urgent need to lower mortality rates for all pregnant, birthing, and postpartum people.”
The risk of death due to abortion has decreased since the previous study period, most likely because more people who have an abortion have it earlier in the pregnancy, which is generally safer, says the research team. They note that increased restrictions to abortion access will likely affect maternal health going forward.
To calculate pregnancy-related death rates, the research team analyzed data on deaths and births (live and stillbirth) from the U.S. National Vital Statistics System, as well as abortion-related deaths from the Pregnancy Mortality Surveillance System between 2018 to 2021. Data on the number of abortions in that time period came from the Guttmacher Institute, a nonpartisan research non-profit that monitors abortion surveillance data in the U.S. and globally.
Media: To set up an interview with the researchers, please email sph-comm@umd.edu.