Marie Anderson, MD, on association of abortion restrictions and maternal deaths in the US

According to a new study abstract presented at the Society of Maternal-Fetal Medicine’s 2026 Pregnancy meeting in Las Vegas, Nevada, the “restriction of abortion at the state level is strongly associated with increased rates of maternal death in the United States,” found Marie C. Anderson, MD, resident physician, Obstetrics & Gynecology, Columbia University, and colleagues.

Though the Dobbs v. Jackson Women’s Health case overturned the federal right to abortion in 2022, the study noted state-level restrictions have limited access to abortion care long prior, especially in the 2000s to 2010s.

The study investigators used case-level data on deaths among US-women aged 15 ti 54 years from 2005 to 2023, collected from the Centers for Disease Control and Prevention.

“A quasi-experimental difference-in-difference model determined the increased number of deaths attributable to having stringent abortion restrictions (≥5 restrictions, top tercile of states),” wrote the authors in the abstract. “This form of analysis largely isolates the impact of an intervention.”

From 2005 to 2023, there were 22,380 pregnant/postpartum women who died, with violence, unintentional drug overdose, and cardiovascular disease being the 3 leading causes of death. In the same time period, the number of abortion restrictions increased from 2.7 to 5.3 restrictions per state. In 2005, there were 5 states that were considered the “most restrictive”—defined as 5 or more restrictions—compared to 2023, when 27 states had this designation.

Findings revealed that 6 of 10 abortion restrictions were linked with higher rates of maternal death, with 4 restrictions associated with higher rates of violent death.

“States with ≥5 abortion restrictions had higher rates of maternal deaths from any cause, violent deaths, and cardiovascular disease,” noted the authors.

Below, find a written Q&A interview with study author Marie C. Anderson, who explores the investigators’ findings and highlights important takeaways for women’s health care professionals. The discussion below is based on abstract 48 presented at SMFM, titled “State Abortion Restrictions and Maternal Deaths in the United States: 2005 – 2023.”

Reference:

Anderson MC, Azad, Goin D, et al. State abortion restrictions and maternal deaths in the United States: 2005 - 2023. Abstract. Presented at: SMFM 2026 Pregnancy Meeting. February 8-13, 2026. Las Vegas, Nevada.

Click here for more of Contemporary OB’GYN’s coverage of the 2026 Pregnancy meeting in Las Vegas, Nevada.

Discussing abortion access and maternal deaths in the US from 2005 to 2023

Contemporary OB/GYN:

What prompted you to examine the relationship between state-level abortion restrictions and maternal mortality, and what gap in the evidence were you aiming to fill?

Marie C. Anderson, MD:

We know that abortion is a safe medical procedure and that carrying a pregnancy to term carries higher risks.¹ Despite this, states have steadily increased abortion restrictions over the past 20 years – well before the Dobbs decision. What we don’t know is how these policies may have influenced maternal deaths at the population level.

Prior work has focused on legal debates, has studied a particular type of restriction, or has had a shorter study time period. Fewer studies have examined whether the increase of state-level restrictions is associated with measurable changes in maternal deaths over time. We aimed to fill that gap by using a statistical analysis that allowed us to examine the changing trends in maternal deaths as states transitioned from a less restrictive to more restrictive legal landscape.

Contemporary OB/GYN:

Your analysis found that states with five or more abortion restrictions had higher rates of maternal death from any cause. What do you see as the most important takeaway for clinicians?

Anderson:

Our takeaway is that reproductive policy intersects with maternal health in measurable ways – what happens in houses of legislature affects the patients we take care of every day. For clinicians, this reinforces that maternal health is influenced not only by care in the hospital or clinic but also by structural and policy environments. Understanding that context is essential in our care of pregnant and postpartum patients.

Contemporary OB/GYN:

Six of ten abortion restrictions were associated with higher maternal mortality, and several were linked to violent deaths. What mechanisms might explain these associations?

Anderson:

This was a national observational study using death certificate data, so we cannot determine what factors played a role for any individual death. However, while our study does not directly test mechanisms, there are a few plausible pathways based on prior research.

First, abortion restrictions may increase the number of people continuing pregnancies in the setting of medical, financial, or interpersonal hardships. We know that pregnancy and the postpartum period are times of increased risk for intimate partner violence and homicide.2,3 Intimate partner violence has also been linked to unintended pregnancy.4 Since pregnancy can be a time of heightened risks, some patients may seek abortion in the context of unsafe relationships.

Additionally, restrictions that limit access to abortion by limiting insurance coverage, imposing waiting periods, or other logistical barriers to abortion can increase financial strain. Economic instability is a risk factor for mental health conditions and substance use, as well as more traditional causes of maternal deaths, including cardiovascular disease.

Our findings are consistent with these broader patterns, but they reflect population-level associations rather than individual causal pathways.

Contemporary OB/GYN:

Violence, overdose, and cardiovascular disease were leading causes of maternal death. How do abortion restrictions potentially intersect with these broader drivers of maternal mortality?

Anderson:

In the US, maternal deaths due to violence and overdose are now the leading causes of pregnancy-associated deaths.5 This is a strong message that maternal health is deeply connected to social and structural conditions. Abortion restrictions operate within this ecosystem. Prior longitudinal research has shown that being denied a wanted abortion is associated with worse financial stability, physical health, and mental health.6 Those downstream effects are linked with these leading causes of death in pregnancy.

Again, while our study does not establish a direct pathway, the associations we observe are consistent with the broader body of evidence suggesting that reproductive autonomy, financial stability, and safety are determinants of maternal health.

Contemporary OB/GYN:

From a provider perspective, how can clinicians use these findings to inform counseling, advocacy, or care for pregnant and postpartum patients in restrictive states?

Anderson:

These findings reinforce the importance of screening for violence, mental health conditions, and substance use in pregnancy, especially in environments with more restrictive reproductive health policies. They also highlight the need for counseling about all reproductive options including abortion.

Additionally, these findings may inform continued advocacy efforts regarding reproductive rights. Clinicians are uniquely positioned to speak out about how policy affects patients. The evidence we present can help support these advocacy efforts with data.

Contemporary OB/GYN:

Is there anything else you would like to include relative to your study or overall?

Anderson:

One important point to highlight is that the increase in state-level restrictions began long before the Dobbs decision. The policy landscape shifted to become significantly more restrictive over the 2000s and 2010s, and our study reflects that longer trajectory.

Additionally, our findings should be interpreted as population-level effects attributable to policy environments under a quasi-experimental framework. They do not imply that any individual death can be traced to a single law. Rather, they suggest that the cumulative policy environment may shape maternal health outcomes.

Maternal mortality is complex and multifactorial. But policy is part of that complexity — and it deserves careful, evidence-based attention.

References:

1. Raymond EG, Grimes DA. The comparative safety of legal induced abortion and childbirth in the United States. Obstet Gynecol. February 2012. doi:10.1097/AOG.0b013e31823fe923
2. Wallace M, Gillispie-Bell V, Cruz K, Davis K, Vilda D. Homicide During Pregnancy and the Postpartum Period in the United States, 2018-2019. Obstet Gynecol. 2021 November 1. 138(5):762-769. doi: 10.1097/AOG.0000000000004567
3. Violence and pregnancy. Centers for Disease Control and Prevention. Updated December 5, 2024. Accessed February 12, 2026. https://www.cdc.gov/intimate-partner-violence/about/violence-and-pregnancy.html
4. Miller E, Decker MR, McCauley HL, et al. Pregnancy coercion, intimate partner violence and unintended pregnancy. Contraception. 2010 April. 81(4):316-22. doi:10.1016/j.contraception.2009.12.004.
5. Campbell J, Matoff-Stepp S, Velez ML, Cox HH, Laughon K. Pregnancy-Associated Deaths from Homicide, Suicide, and Drug Overdose: Review of Research and the Intersection with Intimate Partner Violence. J Womens Health. 2021 Feb;30(2):236-244. doi:10.1089/jwh.2020.8875.
6. Foster DG, Biggs MA, Ralph L, Gerdts C, Roberts S, Glymour MM. Socioeconomic Outcomes of Women Who Receive and Women Who Are Denied Wanted Abortions in the United States. Am J Public Health. 2018 Mar;108(3):407-413. doi: 10.2105/AJPH.2017.304247.