Maternal death declines after Dobbs possibly affected by COVID-19-related deaths

Key takeaways:

• Twelve-month ending maternal death sums declined by 28.2% from August 2022 to January 2023.
• These declines may be influenced by a spike in COVID-19-related deaths during the summer of 2021.

The decline in maternal deaths after the Dobbs decision was likely affected by a spike in COVID-19-related deaths during 2021, complicating efforts to assess the ramifications of restrictions on abortion access, researchers reported.

“After the Dobbs v. Jackson Women’s Health decision struck down Roe v. Wade in June 2022, half of U.S. states began enforcing new restrictions on abortion, and 14 banned abortion completely or with rare exceptions,” Amanda Jean Stevenson, PhD, sociologist in the department of sociology at the University of Colorado Population Center and the Institute of Behavioral Science at the University of Colorado Boulder, and Leslie Root, PhD, assistant research professor at the University of Colorado Population Center and the Institute of Behavioral Science at the University of Colorado Boulder, wrote in a research letter published in JAMA Network Open. “Scholars hypothesize that abortion bans increase maternal mortality, but supporters of abortion bans claim that maternal death has declined since Dobbs v. Jackson Women’s Health, pointing to precipitous declines in a key national maternal death statistic after the ruling.”

Stevenson and Root conducted a cross-sectional study evaluating monthly counts of maternal deaths from final (2018 to 2021) and provisional (2022 to 2023) mortality surveillance and provisional deaths of women aged 15 to 44 years from January 2020 to September 2023, using data from the U.S. National Center for Health Statistics.

Overall, 4,802 maternal deaths occurred from January 2018 to September 2023 with a mean of 69.6 monthly deaths. Monthly deaths ranged from 37 in May 2023 to 182 in September 2021.

Twelve-month ending sums of maternal deaths fell 28.2%, from 1,069 deaths in August 2022 to 768 deaths in January 2023, according to the researchers. However, monthly maternal deaths remained stable, with a mean of 65.2 monthly deaths from August 2022 to January 2023.

From August 2021 to January 2022, monthly maternal deaths were higher with a mean of 115.7, mirroring a spike in deaths related to COVID-19.

The abrupt increase in high maternal deaths in August 2021, in particular, “moved through the 12-month ending sum as a positive shock,” raising the sum from 908 in July 2021 to 1,236 in January 2022 and lowering the sum from 1,167 in July 2022 to 768 in January 2023. Approximately 74% of the 125-death decline in the 12-month sum from August to September 2022 was caused by excluding August 2021 deaths.

“In general, trends in moving summaries like these reflect changes on both ends of their periods; circumspection is required when they are used for policy evaluation,” Stevenson and Root wrote. “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.”