PROVIDENCE, R.I. [Brown University] — Commonly cited statistics on the mortality risk of pregnancy when compared to abortion in the U.S. are is a vast undercount, according to a study in JAMA Network Open led by researchers at the University of Maryland and Brown University.
Amid national discussions of the importance of abortion access for maternal health, the goal of the study was to estimate risks using updated data to provide accurate information that could help inform decisions by patients, clinicians and policymakers.
“It is widely understood by scientists that continuing a pregnancy carries a much higher risk of death than having an abortion,” said lead study author Maria Steenland, an assistant professor at the University of Maryland’s School of Public Health. “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 findings suggest that abortion bans force pregnant people who otherwise would have sought abortion care to take on the substantially increased health risks associated with continued pregnancy, the researchers noted, including hemorrhage and high blood pressure.
“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 study author Dr. Benjamin Brown, an assistant professor of obstetrics and gynecology at Brown University’s Warren Alpert Medical School. “The data also highlight the urgent need to lower mortality rates for all pregnant, birthing and postpartum people.”
Steenland, whose research goal is to identify policy options to increase the equity and quality of women’s health services, and Brown, an OB-GYN with a subspecialty in complex family planning (including complex abortion and contraception care), connected while Steenland was an assistant professor of health services, policy and practice (research) at Brown University’s School of Public Health.
The new analysis 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, and during that timeframe, mortality rates for people with ongoing pregnancies have been estimated to be between 8.8 and 14.5 per 100,000 live births. The current study, using data from 2018 to 2021, found an annual average of 32.3 maternal deaths per 100,000 live births, with the highest rate of 43.9 occurring in 2021.
The study defined pregnancy-related deaths as occurring during pregnancy or within one year from the end of pregnancy. They 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.
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 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 during that time came from the Guttmacher Institute, a nonpartisan research nonprofit that monitors abortion surveillance data in the U.S. and globally.
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-19 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,” said study author Marie Thoma, a reproductive and perinatal epidemiologist and an associate professor at the University of Maryland. “People deserve access to updated information about these comparative risks and policies that reflect these realities.”
The risk of death due to abortion has decreased since previous studies were conducted, most likely because more people who have an abortion have it earlier in the pregnancy, which is generally safer, the researchers said. They noted that increased restrictions to abortion access will likely affect maternal health going forward.