Did the Dobbs Decision Impact Maternal Death Rates?

While 12-month sums of maternal deaths dipped after Dobbs v. Jackson Women’s Health Organization struck down Roe v. Wade in June 2022, this decline was actually attributable to increased levels of maternal deaths during the 2021 spike in COVID-19 deaths, according to a cross-sectional study of National Center for Health Statistics (NCHS) data.

From August 2022 through January 2023, the 12-month ending sums of maternal deaths dropped 28.2%, from 1,069 to 768 deaths, reported Amanda Jean Stevenson, PhD, and Leslie Root, PhD, both of the University of Colorado Boulder, in JAMA Network Open.

During this period, monthly maternal deaths were stable, beginning at 63 deaths and ending at 62 deaths (mean monthly deaths 65.2). But from August 2021 to January 2022, monthly maternal deaths had been elevated, corresponding with a spike in COVID deaths (mean monthly deaths 115.7).

“These elevated death counts moved through the 12-month ending sum as a large positive shock, which drove the sum up as they entered from 908 in July 2021 (the month before deaths rose abruptly in August 2021) to 1,236 in January 2022 and drove the sum down as they exited from 1,167 in July 2022 to 768 in January 2023,” Stevenson and Root wrote.

“For example, of the 125-death decline in the 12-month sum between August and September 2022, a 92.9-death decline (74%) was due to excluding August deaths from the sum,” they added.

“Given the heterogeneous timing and scope of abortion bans and the many processes by which they may influence maternal health, we must clearly articulate the limitations of available measures and specify when and how impacts may be observed,” the authors concluded.

In an accompanying editorial, Paula Lantz, PhD, of the University of Michigan Ford School of Public Policy in Ann Arbor, noted that some pro-life advocates have claimed “that the recent observed decline in pregnancy-related death is the counterintuitive result of more restrictive abortion policies” post-Dobbs, but this study is necessary proof that the decline in maternal deaths is actually “the result of a resolution of the COVID-19 mortality shock, not because of new restrictive abortion laws being passed by state legislatures.”

She pointed out that past research has shown that reduced abortion access increases “the risk and incidence of myriad adverse maternal and infant health outcomes,” as well as child poverty, financial instability, and pressure on social welfare systems. In addition, abortion restrictions impact where physicians want to train, practice, and receive obstetric care.

Lantz also put out a call to action for funding public policy evaluation research to combat “the erroneous musings of amateur analysts of all ideological perspectives” on the topic of abortion and beyond.

Stevenson and Root explained that the NCHS publishes annual national maternal mortality rates “and reflects the flow of mortality data by also publishing monthly 12-month ending provisional maternal mortality counts more frequently.” Each month’s 12-month count is the sum of maternal deaths in the 12-month period ending that month, combining final and provisional data as necessary. For example, the June 2021 data included all maternal deaths from July 1, 2020 to June 30, 2021.

The researchers used CDC data from 2018 to 2023 to report the monthly counts of maternal deaths from both final and provisional data, as well as the provisional counts of COVID deaths, among women ages 15 to 44. They decomposed the monthly change in the total 12-month sum of maternal deaths.

From January 2018 to September 2023, there were 4,802 maternal deaths, averaging 69.6 per month. May 2023 had the lowest number of maternal deaths at 37, while September 2021 had the highest at 182.

The authors noted that the study was limited by its descriptive nature and its reliance on death certificates to count maternal deaths.