State Abortion Policies and Maternal Death in the United States, 2015‒2018
Restricting access to abortion care at the state level may increase the risk for TMM, and ecological state-level generalized linear Poisson regression models with robust standard errors are fit to estimate 4-year T MM, MM, and LMM rate ratios and 95% confidence intervals associated with a 1-unit increase in the abortion index.
Abstract
<jats:p> Objectives. To examine associations between state-level variation in abortion-restricting policies in 2015 and total maternal mortality (TMM), maternal mortality (MM), and late maternal mortality (LMM) from 2015 to 2018 in the United States. </jats:p><jats:p> Methods. We derived an abortion policy composite index for each state based on 8 state-level abortion-restricting policies. We fit ecological state-level generalized linear Poisson regression models with robust standard errors to estimate 4-year TMM, MM, and LMM rate ratios and 95% confidence intervals (CIs) associated with a 1-unit increase in the abortion index, adjusting for state-level covariates. </jats:p><jats:p> Results. States with the higher score of abortion policy composite index had a 7% increase in TMM (adjusted rate ratio [ARR] = 1.07; 95% CI = 1.02, 1.12) compared with states with lower abortion policy composite index, after we adjusted for state-level covariates. Among individual abortion policies, states with a licensed physician requirement had a 51% higher TMM (ARR = 1.51; 95% CI = 1.15, 1.99) and a 35% higher MM (ARR = 1.35; 95% CI = 1.09, 1.67), and states with restrictions on Medicaid coverage of abortion care had a 29% higher TMM (ARR = 1.29; 95% CI = 1.03, 1.61). </jats:p><jats:p> Conclusions. Restricting access to abortion care at the state level may increase the risk for TMM. </jats:p>