Abortion Restrictions and Maternal Deaths: What 18 Years of US Data Shows

Between 2005 and 2023, the average number of abortion restrictions per US state nearly doubled - rising from 2.7 to 5.3. The number of states classified as most restrictive, defined as having five or more restrictions in place, jumped from five to twenty-seven over that same period. A study presented at the Society for Maternal-Fetal Medicine 2026 Annual Pregnancy Meeting examined whether that accumulation of policy changes corresponded with changes in maternal mortality, and found that it did.

Led by Marie C. Anderson, a resident in obstetrics and gynecology at Columbia University Vagelos College of Physicians and Surgeons, the analysis drew on the CDC National Vital Statistics System. Researchers reviewed 22,380 deaths occurring in pregnant people aged 15 to 54 during pregnancy or within 42 days of delivery. They then tracked how mortality rates shifted as individual states adopted each of ten common abortion restriction types over the study period.

Six Restriction Types Tied to Higher Overall Death Rates

Of the ten restriction types examined, six were associated with higher overall maternal death rates. Those six are Medicaid funding bans for abortion, ACA Marketplace insurance coverage bans, mandated waiting periods, ultrasound requirements, second-trimester abortion bans, and biased counseling laws. Each of these was statistically linked to increases in maternal mortality rates when states adopted them.

Four restrictions were specifically associated with higher rates of violent death - deaths from homicide and suicide. These four are Medicaid coverage bans, ACA Marketplace coverage bans, waiting periods, and physician-only requirements for abortion procedures.

When states adopt multiple abortion restrictions, measurable increases appear in deaths among pregnant and postpartum people, Anderson noted. The associations span deaths from any cause, cardiovascular disease, and violence - indicating that reproductive health policy and maternal health are not separable domains.

How the Study Was Designed

Researchers compared death rates within each state before and after individual restrictions were enacted, tracking changes over time rather than simply comparing more and less restrictive states at a single point. This longitudinal within-state design reduces the influence of fixed differences between states - geography, baseline health infrastructure, demographic composition - that might otherwise confound results.

The study is observational. It documents associations between policy changes and subsequent mortality changes, but cannot establish that the restrictions directly caused deaths. States that adopt abortion restrictions may differ from less restrictive states in other ways that also affect maternal health, and those differences cannot all be accounted for statistically. The CDC vital statistics system may also undercount maternal deaths, particularly those coded as cardiovascular or mental health-related rather than directly obstetric.

The Violence Finding

The association between abortion restrictions and increased violent deaths is one of the study's more striking findings. Intimate partner violence tends to escalate during unwanted pregnancies, a pattern documented across multiple studies. When abortion access is restricted, the pregnancy continues regardless of the circumstances that make it dangerous for a particular person.

The link between Medicaid coverage bans and violent death is particularly notable given the population affected. Medicaid covers a disproportionate share of lower-income patients who already face elevated exposure to poverty-associated violence risks. Removing insurance coverage for a time-sensitive medical procedure effectively extends pregnancies in circumstances where extended pregnancy carries elevated danger.

Which States Were Most Restrictive

The 27 states classified as most restrictive in 2023 include Alabama, Arizona, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Nebraska, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, West Virginia, and Wisconsin. Among these, Arkansas, Louisiana, Nebraska, and Wisconsin accumulated the greatest total number of restrictions over the full study period.

Lisa Nathan, chief of obstetrics at Columbia University Irving Medical Center and co-researcher on the study, noted that the findings add to a growing body of literature confirming serious negative impacts of these restrictions on maternal health in the United States.

What the Data Cannot Tell Us

The study has clear limits beyond the observational design. It covers the period 2005 to 2023, before the Dobbs decision in 2022 fully reshaped the policy landscape. The most severe restrictions became law in several states only at the study period's end, meaning their long-term effects on mortality are not yet captured in this data.

The analysis also cannot specify mechanism. It shows that restricting Medicaid funding for abortion correlates with higher maternal death rates, but cannot determine whether this operates primarily through delayed care, through extended unwanted pregnancies, through financial stress affecting healthcare access more broadly, or through some combination. Mechanistic understanding would require different study designs.

The study was published as Oral Abstract 48 in the February 2026 issue of PREGNANCY, the official peer-reviewed journal of the Society for Maternal-Fetal Medicine.