The relationship between state-level abortion policy and maternal mortality in the United States: a scoping review

Abstract

Introduction

The United States has a high rate of maternal mortality compared to similar countries. Following the overturning of Roe v. Wade and federal protections to abortion, multiple US states have adopted new policies related to legal abortion access. No published scoping or systematic reviews have comprehensively examined existing literature related to state-level abortion policy and maternal mortality in the United States. This study seeks to assess the extent of evidence on the relationship between state-level abortion policy and maternal mortality in the United States.

Methods

The scoping review is guided by the Joanna Briggs Institute (JBI) methodology and had no publication date restriction to capture pre- and post-Roe v. Wade studies.

Results

Ten articles met inclusion criteria, with years of analysis from 1959 to 2020. Studies consistently found that restrictive abortion policies are associated with increases in maternal mortality at the state level. Limitations with the ability to compare findings across studies should be considered.

Conclusion

Across published studies, policies that restrict access to abortion are consistently associated with increases in maternal mortality, underscoring the significant impact of policy decisions on maternal health outcomes. Future research with updated policy and health outcomes data is needed as the policy landscape evolves.

Introduction

In June 2022, the United States Supreme Court issued a decision in Dobbs v. Jackson Women's Health, overturning Roe v. Wade and eliminating the federal standard protecting the right to abortion.¹ Within one year of this decision, the policy landscape related to abortion in the United States became increasingly fragmented and polarized. Multiple US states have adopted new policies related to legal abortion access, favoring bans on abortion or other restrictive policies. More specifically, as of December 2023, most abortions were banned in 14 states as laws restricting the procedure took effect, with an additional seven states severely restricting abortion with a gestational limit ranging from 6 to 15 weeks.² At the same time, several states passed legislation protecting or expanding access to abortion services.³

Prior to the overturning of Roe v. Wade, additional legislation placed further restrictions on abortion access for subsets of the US population, including the Hyde Amendment (1977), which banned the use of federal funds such as Medicaid for abortion except in cases of life endangerment or pregnancies resulting from rape or incest.⁴ States are still able to use state Medicaid funding to cover medically necessary abortions, but the majority of states have historically followed the federal standard and allowed Medicaid funding only for abortion in those circumstances, with only 17 states allowing the use of state Medicaid funds for abortion beyond the federal limitations set by the Hyde Amendment.⁴

Both the United Nations and the World Health Organization (WHO) recognize abortion as an important element of maternal and child health and a key feature of reproductive health services.⁵ Considerable evidence links unsafe abortions with increased maternal morbidity and mortality,⁶ and estimates suggest that unsafe abortions result in 68 000 deaths globally each year.⁷ Further, several prior studies suggest an association between abortion restrictions and adverse maternal health outcomes in the United States, including maternal mortality.^5-8

Maternal mortality, broadly defined by both the Centers for Disease Control and Prevention (CDC) and the WHO as “the death of a woman while pregnant or within 42 days of termination of pregnancy,”⁹ has been widely accepted as a key indicator of the health and well-being of a society.¹⁰ While maternal mortality has historically been recognized as a challenge primarily among developing or low-income countries, the United States has one of the highest maternal mortality rates (MMR) among comparable high-income countries,^11-14 with a ratio of 20.3 deaths per 100 000 live births in 2023.¹⁵ Existing data further illustrates an increase in the MMR in the United States between 1990 and 2019.¹⁶ However, efforts to understand trends in maternal mortality over the past 20 years in the United States have been limited by inconsistent use of terminology, differences between states in definitions of maternal mortality, and differential timing in the addition of a standard pregnancy question to death certificates, known as the “pregnancy check box.”^17,18 Several recent analyses have found that the MMR remained stable in the United States from 1990 to 2021, with a temporary marked increase during the COVID-19 pandemic.^18,19 Nonetheless, the MMR in the United States remains the highest among comparable nations, with wide disparities by race and ethnicity.^13,18 As an illustration, non-Hispanic Black women are nearly three times more likely to die from pregnancy-related complications than non-Hispanic White women.^5,20 These disparities persist even when controlling for maternal comorbidities and social determinants such as level of education.^13,18

Evidence further suggests that more than 60% of maternal deaths in the United States are preventable,⁵ and nearly two-thirds occur in the postpartum period.¹⁴ In the first week postpartum, severe bleeding, high blood pressure, and infection are the most common contributors to maternal deaths, with cardiomyopathy as the leading cause of later deaths.¹⁴ Existing literature suggests that contributing factors to maternal mortality in the United States include the relatively high cost of health care, lack of universal health coverage, and lack of support, such as home visits and guaranteed maternity leave, during the critical postpartum period.^14,18 There is also growing evidence that social determinants of health, particularly systemic racism, play an important role for minoritized populations.⁸

Policies restricting access to abortion may impact maternal health outcomes in direct and indirect ways. While deaths from legal, induced abortion procedures are rare, abortion restrictions can lead to greater numbers of unsafe, illegal, or self-inflicted abortions, which have been found to contribute to increased rates of maternal mortality on a global level.⁵ According to the WHO,²¹ abortion is considered unsafe if performed by a person lacking the necessary skills, if the environment where the abortion is conducted does not meet minimal medical standards, or both. Estimates suggest that worldwide, unsafe abortions account for up to 13% of maternal deaths each year,²² with populations in low-income or developing countries disproportionately affected.²³ Further, maternal deaths due to abortion, particularly in unsafe environments, may be misclassified and underreported given the potential for stigma surrounding the procedure.²⁴ Existing evidence also demonstrates that countries with restrictive abortion laws have a significantly higher proportion of unsafe abortions compared to those with more permissive laws.²³ As evidence has evolved and access to medication abortion has expanded over the past 25 years, the provision of safe abortions became available in a broader array of settings, with access in a given context shaped by factors such as laws and policies, socioeconomic conditions, service availability, and abortion stigma.²³

Within the United States, there may be multiple mechanisms connecting restricted legal abortion access and maternal mortality beyond the safety of abortions. Contrary to expectations, the number of abortions in the United States overall has increased slightly in the 2 years following the Dobbs decision.²⁵ This may be due to increased interstate travel for abortion, telehealth abortion care, and self-managed medication abortion.^25,26 However, restrictive policies at the state level and the accompanying financial and geographic barriers disproportionately limit access to abortion for minoritized populations and individuals of low socioeconomic status.²⁷ Further, findings from Bell et al.²⁸ show that fertility rates were higher than expected in states with complete or 6-week abortion bans through the end of 2023. The increase in births was in states with the worst maternal and child health outcomes and disproportionately among groups with higher rates of adverse pregnancy outcomes.

Emerging evidence additionally underscores how abortion bans in the United States, despite including narrow exceptions for circumstances where abortion may be provided, may not be well aligned with the complexity of medical carewhich may foster uncertainty among health care providers and influence the provision of life-saving interventions.^29,30 Grossman et al.³⁰ collected 50 clinician-submitted cases from states with post-Dobbs restrictions, revealing delays or inability to provide standard interventions for complications such as previable premature rupture of membranes, ectopic pregnancy, and miscarriage, leading to adverse health outcomes. These disruptions may be a key mechanism in the rise in maternal morbidity and mortality in affected states, underscoring the importance of recognizing care delays as a potential pathway through which restrictive abortion policies impact maternal health outcomes.

While existing literature supports the link between restricted access to abortion and maternal mortality in low- and middle-income countries, there is limited evidence on the impact of policy related to abortion restrictions on maternal death in the United States.⁵ Further, though there is increased research interest following the overturn of Roe v. Wade, including a recently published narrative review on reproductive health policy and outcomes in the United States,³¹ and some studies suggest an association between abortion restrictions and increased rates of maternal mortality in the United States,^5,8 no systematic or scoping reviews have comprehensively examined and summarized the body of existing literature related to state-level abortion policy and maternal mortality in the United States. Along with the rapidly evolving legislative landscape related to abortion access in the United States, two recently published commentaries further illustrate the need for an understanding of the impact of abortion restrictions on maternal mortality,^7,20 highlighting the public health importance of research examining whether the enactment of policies restricting or banning legal access to abortion will lead to increased rates of maternal mortality. Therefore, the purpose of this scoping review is to assess and summarize the extent of available evidence on the relationship between abortion policy and maternal mortality in the United States.

Methods

This review followed the Joanna Briggs Institute methodology for scoping reviews.³² The protocol was registered on the Open Science Framework (OSF) in February 2024.³³ The reporting is consistent with the PRISMA-ScR guidelines. The following databases were searched: PubMed, NCBI (1809-present); ASSIA, ProQuest (1987-present); HeinOnline (1754-present); HealthSource: Nursing/Academic Edition, EBSCOhost (1950-present); Policy File Index, ProQuest (1990-present); Academic Search Premier, EBSCOhost (1930-present); Embase, Elsevier (1947-present); PsycINFO, EBSCOhost (1997-present); CINAHL, EBSCOhost (1937-present); Dissertations & Theses, ProQuest (1637-present); Web of Science, Clarivate Analytics (1900-present); Google Scholar; and Scopus, Elsevier (1788-present). The following gray literature sites were selected based on subject matter expertise and hand-searched accordingly: Guttmacher Institute, Ibis Reproductive Health, International Planned Parenthood Federation, US Planned Parenthood, Ipas, Marie Stopes International, Population Council, Population Services International, Women on Waves, Commonwealth Fund, Pew Research Center, and Kaiser Family Foundation. The following journals were hand-searched: American Journal of Public Health, Perspectives on Sexual and Reproductive Health, Sexuality Research and Social Policy, Contraception, and Journal of Adolescent Health. Forward citation tracking was conducted on all included articles. Searches were conducted at the end of February 2024 and in March 2024 with updated searches run on October 25, 2024, with date limited to the year 2024 and June 26, 2025, with date limited to 2024 and 2025.

Eligibility

The included studies were in the United States or territories and Washington, District of Columbia, published in the English language, analyzed maternal mortality as an outcome, included state-level abortion policy as part of the analysis, and included the following study types: quantitative, descriptive, observational study design, original peer-reviewed research, dissertations and theses, and literature on a selected number of gray literature resources based on researcher expertise.

For the purposes of this review, policy is defined as “a law, regulation, procedure, administrative action, incentive or voluntary practice of governments and other institutions.”³⁴ Maternal mortality is commonly defined as “the death of a woman while pregnant or within 42 days of termination of pregnancy.”⁹ However, definitions of maternal mortality may vary in existing literature and may include deaths up to one year from the end of pregnancy.³⁵

This review did not include a publication date limit and excluded articles that did not mention maternal mortality and state-level abortion policy or did not take place within the United States. Following the methodology described above for scoping reviews, inclusion decisions did not require a formal appraisal of methodological quality.³²

Search

The search was developed by the health sciences librarian with the guided subject matter expertise of the research team. The search utilized keywords and subject headings when available. The search was created in PubMed and translated across bibliographic databases. The PubMed search strategy is provided in Appendix A¹. (To access the Appendix, click on the Details tab of the article online)

Selection of sources of evidence

After the searches were complete, the citations were uploaded into Covidence.³⁶ All identified citations were first screened in title/abstract by two independent reviewers with a third research team member in reserve for consensus on conflicts. Interrater reliability was calculated in a pilot phase to ensure appropriate agreement of inclusion criteria among reviewers with an established a prior standard of at least 0.70 at each phase.³⁷ Included articles then proceeded to a full-text review with two independent reviewers and a third researcher to resolve conflicts. Articles that met all inclusion criteria were then included in the data analysis. Figure 1 visually presents the article selection process.

Figure 1.

PRISMA diagram of study screening and inclusion. Source: Covidence.

Results

The search and screening process yielded 10 articles that met all inclusion criteria. Years of publication ranged from 2017 to 2023, with years of analysis from 1959 to 2020. Of the included articles, 60% (n = 6) are original, peer-reviewed research articles, 20% (n = 2) are published abstracts of conference presentations, one is a report from the gray literature, and the final article is an editorial that includes relevant descriptive analysis. A summary of the included studies, including resource type, study design/methodology, states and years analyzed, study population, and policy analysis, is presented in Table 1.

Table 1.

Summary of the included studies.

Author (Year)	Resource type	Study design and methods	Number of states included (years of analysis)	Study population	Policy analysis
Addante et al.8	Original, peer-reviewed research	Cross-sectional, retrospective, negative binomial regression	50 states (1999-2017)	Unspecified	State-level restrictiveness based on Guttmacher Institute
Declercq et al.38	Gray literature	Cross-sectional, retrospective, descriptive study	50 states (2020)	Ages 15-44	State-level restrictiveness based on Guttmacher Institute
Farin et al.39	Original, peer-reviewed research	Quasi-experimental, two-way fixed effects estimation and an Interaction-Weighted estimator	50 states (1959-1980)	Ages 15-44	State-level abortion legality prior to Roe v Wade
Harper et al.40	Original, peer-reviewed research	Cross-sectional, retrospective, generalized estimating equations	50 states (2000-2019)	Ages 15-49	State-level restrictiveness based on Guttmacher Institute
Hawkins et al.41	Original, peer-reviewed research	Quasi-experimental, difference-in-differences zero-inflated negative binomial regression model	38 states (2007-2015)	Ages <45	Percent change in Planned Parenthood clinics, laws restricting abortion based on gestational age, laws requiring abortion providers to obtain admitting privileges or transfer agreements, laws restricting abortion coverage on state marketplace insurance plans, and implementation of state-level mortality review committee
Jarlenski et al.42	Original, peer-reviewed research	Cross-sectional, retrospective, logistic regression	43 states (2000-2011)	Ages 15-44	State-level Medicaid coverage of medically necessary abortions
McDonald43	Conference Presentation	Quasi-experimental, two-way fixed effects estimation	50 states (1965-1978)	Unspecified	Year of abortion decriminalization; if and when a model abortion law was enacted
Robbins et al.44	Conference Presentation	Retrospective cohort, generalized estimating equation	50 states (2000-2018)	Unspecified	State-level restrictiveness based on Guttmacher Institute
Vilda et al.5	Original, peer-reviewed research	Retrospective ecological analysis, Poisson regression	49 states (2015-2018)	Ages 10-44	State-mandated counseling before abortion, mandatory waiting periods, mandatory ultrasounds, mandatory parental involvement for minors, gestational age restrictions for abortions, licensed physician requirements, denial of coverage for abortion in private insurance plans, and restriction on public funding for abortions
Williams et al.45	Editorial with descriptive analyses	Cross-sectional, retrospective, descriptive study	29 states (2018-2020)	Unspecified	State-level restrictiveness based on Guttmacher Institute

Source: Authors’ analysis of literature search from multiple databases.

Definitions of maternal mortality

Many included studies (n = 4) broadly defined maternal mortality in accordance with the definition provided by the CDC and WHO.^5,8,38,41 Four studies defined maternal mortality in accordance with specified International Classification of Diseases (ICD)-9 or ICD-10 codes in alignment with existing literature and the definition of maternal mortality outlined by the WHO.^39,40,44,45 McDonald⁴³ also utilized data that identified maternal deaths based on ICD codes, with revisions occurring twice during years of analysis, and acknowledged broader challenges with accurate measurement. Relatedly, Jarlenski et al.⁴² identified maternal deaths as those where a hospital discharge for a pregnancy-related hospitalization had a value indicating that the patient died in the hospital.

Abortion policies assessed

The majority of included studies (n = 6) utilized Guttmacher Institute policy data to identify relevant state-level abortion policies for inclusion in analyses.^5,8,38,41 More specifically, utilizing Guttmacher Institute policy data, Addante et al.⁸ identified states as restrictive, neutral, or protective; Declercq et al.³⁸ identified states as restrictive, very restrictive, most restrictive, or an abortion access state; Harper et al.⁴⁰ identified states as restrictive, moderate, or protective; Robbins et al.⁴⁴ identified states as restrictive, middle-ground, or supportive; and Williams et al.⁴⁵ identified states as restrictive or protective. According to the most recent Guttmacher Institute methodology and sources for their updated interactive policy map, states are identified as belonging to policy categories such as those described in the included studies by assessing a range of policies related to abortion by state including, but not limited to, gestational duration bans, waiting periods, insurance coverage bans, and medication abortion restrictions, as well as protective policies such as state constitutional protections, abortion funding, insurance coverage, and protections for patients or health care providers. States are then assigned to a category based on the policies currently in effect in the year of analysis and the cumulative impact of those policies on abortion rights.³

Hawkins et al.⁴¹ categorized states based on five factors related to policies, including the percent change in Planned Parenthood clinics, gestational age restrictions, provider admitting privileges or transfer agreements, regulation of abortion coverage on state marketplace insurance plans, and implementation of a state-level maternal mortality review. Vilda et al.⁵ utilized a composite policy index consisting of eight state-level abortion policies including mandatory counseling, mandatory waiting periods, mandatory ultrasound, mandatory parental involvement for minors, gestational age restrictions, licensed physician requirement, private insurance coverage for abortions, and restrictions on public funding. Lastly, both Farin et al.³⁹ and McDonald⁴³ analyzed policies enacted shortly before Roe v. Wade, with Farin et al.³⁹ focusing on the states that repealed their criminal abortion laws and provided legal abortion access and McDonald⁴³ observing states by the year when abortion was either decriminalized or a Model Penal Code (MPC) was enacted. Aside from Farin et al.³⁹ and McDonald,⁴³ who both used data from before 1973, the remaining included studies (n = 8) analyzed data from 1999 to 2020.

Study methods

The included studies used an array of methodologies to assess the relationship between abortion policy and maternal mortality. Broadly, Declercq et al.³⁸ and Williams et al.⁴⁵ relied on descriptive statistics, while the majority (n = 8) utilized a form of regression analysis. Of these, five were observational, retrospective analyses using methodologies including logistic regression⁴² and generalized estimating equations.^40,44 The remaining three studies relied on quasi-experimental study designs, utilizing naturally occurring differences in policies to compare different sets of states and thereby draw stronger causal inferences. More specifically, these studies utilized a two-way fixed effects estimate,^39,43 an interaction-weighted estimator,³⁹ and a difference-in-differences zero-inflated negative binomial regression model.⁴¹

Abortion policy and maternal mortality

Across the included studies, findings consistently demonstrate that restrictive abortion policies are associated with increases in maternal mortality at the state level. States that restrict abortion, as defined by the study authors, were found to have higher maternal mortality than states that either protect or are neutral toward abortion or where abortion is accessible.^8,38 As an illustration, states with gestational age restrictions were found to have maternal mortality rates higher than those of states without such restrictions,⁴¹ and decriminalization of abortion was found to have a positive effect on rates of maternal death.^39,43 Further, licensed physician requirements were found to be particularly detrimental and resulted in a 51% higher total maternal mortality, while restrictions on state Medicaid funding for abortion were associated with a 29% higher total maternal mortality.⁵ Hawkins et al.⁴¹ additionally found that reducing the proportion of Planned Parenthood clinics by 20% increased maternal mortality by 8%. The included studies further found that states with increasing numbers of laws or policies restricting abortion access had higher rates of maternal mortality,^5,40,44 and Vilda et al.⁵ found that states with a higher number of abortion-restricting policies had a 7% increase in total maternal mortality. Interestingly, Williams et al.⁴⁵ found that restrictive states have higher maternal mortality but lower severe maternal morbidity. The authors explain that this may be partially due to several factors including higher maternal age in protective states, varying reporting standards, or rurality across states. Williams et al.⁴⁵ further suggest that higher rates of morbidity in protective states may reflect greater access to abortion for women at risk which, in turn, increases morbidity while decreasing mortality.

Two included studies assessed additional related outcomes, including all-cause mortality among reproductive-age females and in-hospital maternal deaths. In contrast to the previously mentioned studies highlighting the negative impacts of restrictive abortion policies, Jarlenski et al.⁴² found that the average predicted risk of in-hospital maternal mortality was not significantly different among Medicaid-paid hospitalizations when comparing states with coverage of medically necessary abortions to those without. Finally, Harper et al.⁴⁰ found that increasingly restrictive abortion legislation was not associated with an increase in all-cause mortality among reproductive-aged females, but their study further supports the finding that increasing the number of laws restricting abortion was associated with increasing maternal mortality. Their findings further indicate that the presence of trigger laws, which would result in a ban on abortion immediately after the overturn of Roe v. Wade, was significantly associated with multiple adverse maternal and child health outcomes, including all-cause mortality in reproductive-age females and maternal mortality.⁴⁰

Discussion

Broadly, the findings from studies included in this review consistently demonstrate that restrictive abortion policies are associated with increases in maternal mortality at the state level in the United States. Notably, there were key differences in measurement across studies related to both maternal mortality and the states’ policy environments. First, there was variation in the specificity of definitions and measurement of maternal mortality described by the included studies. The WHO and CDC share a common definition of maternal mortality,^9,35 broadly applied by several included studies in their data collection.^5,8,38,41 Several additional included studies utilized pre-defined ICD-9 or ICD-10 codes in their definition of maternal mortality,^40,44,45 in alignment with the CDC and WHO definition. Jarlenksi et al.⁴² utilized ICD-9 codes to identify pregnancy-related hospitalizations, and a maternal death was defined as a hospital discharge among those hospitalizations with a value indicating that the patient had died in the hospital. This definition differs from that utilized in other included studies and may, therefore, lead to challenges in comparing their findings. More specifically, their study may comparatively underestimate maternal mortality by excluding maternal deaths that occur either prior to delivery or after hospital discharge. However, across studies, the definitions of maternal mortality share core characteristics, allowing study results to be reviewed comprehensively.

Importantly, there was also variation in how state abortion policies were categorized and defined across studies. Most included studies utilized the Guttmacher Institute as a source of policy data, with policy categories and definitions ranging from supportive/protective to restrictive, with varying categories in between. Though the differences in the classifications are subtle and may reflect the evolution of abortion policy over time, the lack of consistency across studies may complicate the ability to synthesize findings across studies, highlighting the value of additional research examining the association between abortion policies and maternal mortality utilizing consistent policy and health outcomes measures. Further, the policy landscape related to abortion and reproductive health in the United States continues to change, and there is a limited body of evidence on the effect of abortion policy following Dobbs v. Jackson Women's Health. As updated data becomes available, future research utilizing the most recent policy and health outcomes data is needed.

Policy implications

This review highlights that across published studies, policies that restrict access to abortion are consistently associated with increases in maternal mortality, underscoring the significant impact of policy decisions on maternal health outcomes. In the United States, even in states with legal access to abortion, other restrictions such as those imposed on the use of federal Medicaid funds by the Hyde Amendment may create functional barriers to access care for many individuals.⁴ These restrictions on coverage may serve as a mechanism of indirectly making abortion inaccessible, particularly for low-income populations or other groups historically marginalized. Further, these restrictions may exacerbate health disparities in adverse maternal health outcomes, as a disproportionate share of Black and Hispanic women are insured by Medicaid and therefore subject to these restrictions.⁴⁶ Findings in the included studies demonstrate that states with more restrictive policies had significantly worse outcomes in relation to maternal mortality than states designated as neutral or protective, a relationship that may be even greater if states identified as protective had policies allowing for Medicaid coverage of abortion. Together, this points to the public health benefit of access to safe, legal abortion, including policy establishing a minimum level of essential coverage for abortion to promote equitable access.

In response to the change in abortion policy that Roe v. Wade introduced, some states have taken new approaches to developing state-level abortion policies. Traditionally, abortion-related policy was dictated by state legislators, with almost 1400 restrictions passed at the state level between Roe's decision date and 2022.⁴⁷ However, in the years following the reversal of Roe v. Wade, many citizens have sought to determine abortion access on their own terms through direct democracy.⁴⁸ While approaches vary with either legislatively referred or citizen-initiated ballot measures being used,⁴⁹ the results have been relatively consistent with most states voting to expand access to abortion. In the 2024 election, there were 10 abortion-related measures on the ballot, with seven out of the 10 measures passing.⁵⁰ These ballot initiatives provide opportunities for individuals to dictate how they want abortion policy conducted in their respective states, indirectly impacting the rate of maternal mortality. Future research quantifying the impact of these abortion ballot measures on maternal mortality is needed, further highlighting the importance of continued research following the Dobbs decision.

Limitations

In line with the broad nature of a scoping review, there are several limitations that deserve consideration. First, as noted above, there is variation in measurement of maternal mortality and abortion policies across studies, which may present challenges when collating results. The variation in methodologies across the included studies may further complicate comparisons across studies and limit the ability to reach causal conclusions. Publication bias, or the potential for publication decisions to be based on statistical significance, direction, or magnitude of findings, may also be an important consideration in the overall presentation of existing literature related to the relationship between abortion policy and maternal mortality.⁵¹ All data analyzed is also prior to Dobbs v. Jackson, potentially limiting the applicability of this review to the current policy landscape. Finally, though this review included a systematic and comprehensive search of the literature, there remains the potential that relevant articles were inadvertently omitted, particularly gray literature. However, including an experienced librarian as a co-author has helped minimize this risk.

Conclusion

The purpose of this review was to provide a summary of existing literature examining the relationship between abortion policy and maternal mortality in the United States. Across the included studies, restrictive abortion policies were shown to be consistently associated with increases in maternal mortality at the state level. However, limitations with the ability to compare findings across studies should be taken into consideration when interpreting results. Future research with updated policy and health outcomes data is needed, particularly as the policy and legislative landscape related to abortion access in the United States continues to shift.

Supplementary material

Supplementary material is available at Health Affairs Scholar online.

Funding

None.