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(Bloomberg) — Women were more than twice as likely to die in or around childbirth in some US states with severe abortion restrictions compared to those with greater access, researchers said, and disparities could worsen as access to the procedure narrows.
Mississippi, Texas, Oklahoma and other states that enacted abortion bans after the Supreme Court’s June 2022 Dobbs decision were among the worst across 32 measures on women’s health that included access to care and mental health services, according to a report Thursday from the Commonwealth Fund, an independent health research foundation. It focused on data collected in 2021 and 2022.
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In spite of its wealth, the US has higher rates of both infant and maternal mortality than most peers, including those in Western Europe along with Canada and Japan. Such grim comparisons may only worsen for the US as maternal care becomes harder to access, the researchers said.
There is a “very deep divide that we’re seeing across the country in women’s health,” said Sara Collins, vice president for health care coverage and access at the Commonwealth Fund and lead author on the report. “Women seem to be experiencing different health-care systems with some very stark differences in access to reproductive health services and health outcomes.”
Rates of maternal mortality — which includes deaths before, during and within 42 days of childbirth — were as high as 51.1 per 100,000 live births in the Mississippi Delta region, according to the report. Vermont, Connecticut and California had the lowest levels, ranging only up to 18.6 per 100,000.
Deaths from any cause among women of reproductive age were almost three times higher in West Virginia, at 204 per 100,000 women, than in Hawaii, where the rate was just 70.5 per 100,000. States with restrictive abortion access also had only half as many maternal care providers as the states with the best access to health care, according to the report.
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The dearth of care may become more severe as applications for medical residencies in states with near-total abortion bans have fallen since the Dobbs decision. The drop has been seen across specialties but is particularly pronounced among prospective obstetricians and gynecologists.
Staffing shortages have several downstream effects that can lead to lower-quality care. Some hospitals perform unnecessary cesarean sections because they don’t have enough staff to support long deliveries, said Emily Harville, an epidemiologist at Tulane University in New Orleans. Cesareans are associated with longer recovery from low-risk pregnancies.
Women in rural areas are especially vulnerable, Harville said. More than half of rural hospitals don’t offer labor and delivery services, and over 200 rural hospitals across the country shuttered those departments in the past decade.
In 2022, postpartum health coverage under Medicaid, the US health program for low-income people, was extended from six weeks to a year. That expansion will do a lot to improve women’s health, said Karina Shreffler, the chair of child health at the University of Oklahoma College of Nursing. Some 47 states have implemented the postpartum extension enabled by the American Rescue Plan Act.
Telehealth and nurse-midwife programs are also approaches researchers cited as crucial to closing the maternal health care gap.
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