Written by Silpa Srinivasulu, MPH

After the Dobbs v Jackson Women’s Health decision overturned Roe v. Wade in June 2022, nearly half of US states banned or severely restricted access to abortion care. To date, 12 states ban abortion in nearly all circumstances and six restrict abortion at 12 weeks of pregnancy or less. While 2024 ballot measures for protecting abortion in Missouri and Arizona will enable legal access, the second Trump administration stands to threaten sexual and reproductive health access nationwide.

Even prior to Dobbs, the association between state-level abortion restrictions and adverse maternal health outcomes has been well-established.¹ In December 2022, the Commonwealth Fund reported that, compared to states with protective policies, those with restrictive policies have fewer maternity care resources, more maternity care deserts, poorer Medicaid coverage benefits, and higher rates of maternal mortality (15.9 vs. 24.2 maternal deaths per 100,000 live births from 2018-2020).² Maternal mortality disparities persist across all racial/ethnic groups, but are particularly pronounced among non-Hispanic black women: 39.3 deaths in protected states vs. 49.2 in restrictive states. Gaps in maternity care are widening post-Dobbs, as clinicians may leave states where they may face legal challenges to their practice and data suggests that fewer medical residents are choosing to train in abortion ban states.³

Abortion bans and restrictions harm maternal health in two key ways: staying pregnant when wanting an abortion exposes people to pregnancy-related risks they otherwise would not have had and, within such a worsening environment for healthcare, pregnancies themselves are riskier.

Several studies have predicted the maternal mortality consequences of banning abortion. For example, Stevenson et. al. projected 210 additional annual maternal deaths under a hypothetical total abortion ban and 64 more annually in the 26 states Guttmacher believed would ban abortion.⁴ ANSIRH’s Care Post-Roe Study demonstrates an increase in care delays, complications, and morbidities among pregnant people in restrictive states due these laws hindering clinicians’ abilities to provide usual standards of care. The stories of Amber Thurman, Josseli Barnica, Nevaeh Crain, Candy Miller, and others illustrate these harms as these women died due to being unable to access timely medical care in their states.⁵ Furthermore, abortion bans have also impacted infant health. A cohort study found Texas’s 2021 six-week abortion ban was associated with a 12.9% increase in infant and neonatal mortality in 2021 and 2022; whereas the rest of the US experienced a 1.8% increase during this time.⁶

While there are many uncertainties ahead in how and when the Trump administration may erode reproductive autonomy and drive further disparities, clinicians can take steps to protect themselves and their patients.

• Stay informed about state and federal policies that may impact your clinical practice. The Abortion Defense Network has published guides for medical providers to clarify state abortion laws.
• Work with your institutions to develop clear guidelines for responding to pregnancy-related complications and emergencies that may require uterine aspiration.
• Provide patients with information about their health and pregnancy, how to use abortion pills, and trusted resources on where to obtain abortion care like INeedAnA.
• Do not report someone who is self-managing their abortion. To date, legal experts are unaware of any laws requiring a clinician to report self-managed abortion or intention to self-manage to law enforcement.
• Know your rights about interacting with law enforcement if your patients are under investigation. Know your rights and your patients’ rights if immigration officers come to your clinic.

RHAP Resources:

How To Use Misoprostol-Only for a Medication Abortion

How To Use Abortion Pills Fact Sheet

Self-Managed/Self-Sourced Abortion: What Clinicians Need to Know

Approach to Patients Undergoing Self-managed Medication Abortion

Partner Resources:

Abortion Defense Network
If/When/How
ACLU: Know Your Rights
INeedAnA

Sources:

1. Vilda D, Wallace ME, Daniel C, et al. State Abortion Policies and Maternal Death in the United States, 2015‒2018. Am J Public Health 2021;111(9):1696–1704; doi: 10.2105/AJPH.2021.306396.

2. Eugene Declercq et al., The U.S. Maternal Health Divide: The Limited Maternal Health Services and Worse Outcomes of States Proposing New Abortion Restrictions (Commonwealth Fund, Dec. 2022). https://doi.org/10.26099/z7dz-8211

3. Kristen Kolb, “Maternity Care Providers and Trainees Are Leaving States with Abortion Restrictions, Further Widening Gaps in Care,” To the Point (blog), Commonwealth Fund, Oct. 22, 2024. https://doi.org/10.26099/pds5-qf29

4. Stevenson AJ, Root L, Menken J. The Maternal Mortality Consequences of Losing Abortion Access. preprint. SocArXiv; 2022.; doi: 10.31235/osf.io/7g29k.

5. Surana K. Life of the Mother: How Abortion Bans Lead to Preventable Deaths. ProPublica. Published September 16, 2024. https://www.propublica.org/series/life-of-the-mother

6. Gemmill A, Margerison CE, Stuart EA, Bell SO. Infant Deaths After Texas’ 2021 Ban on Abortion in Early Pregnancy. JAMA Pediatr. 2024;178(8):784–791. doi:10.1001/jamapediatrics.2024.0885

Pharma-free: The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or products. The information in the Insights is unbiased, based on science alone.

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