Figure 1.

States were determined to be restrictive or protective of abortion based on the Alan Guttmacher Institute criteria as previously described.³⁷ The CDC Wide-ranging ONline Data for Epidemiologic Research (WONDER) was queried for the years 1999–2019 for multiple causes of death with assault (X85–Y09) and/or intentional self-harm (X60–X84) as the underlying cause of death in women ages 10–54 and obstetric codes (O00–O99) as contributing for each subset of states. For the years when the CDC suppressed the value due to low numbers (< 10 /year), the highest possible suppressed value of “9” was entered as the high end of possible deaths. The rate was calculated against the listed population in that age group at that time and then also normalized against the number of live births in the included states (CDC) for that year. The pregnancy “check box” was notably added to all state death certificates during the years 2003–2017 (most states completed addition by 2010) allowing for greater sensitivity for detection of maternal death since ~2003; however, in previous reverse binomial regression analyses, state addition of the check box did not significantly correlate in time with increases seen in maternal mortality between the states.³⁷ CDC, Centers for Disease Control and Prevention.