Abortion

Interactive Map: US Abortion Policies and Access After Roe https://states.guttmacher.org/policies/utah/abortion-policies (updated 2023)

State Legislation Tracker
Major Developments in Sexual & Reproductive Health
https://www.guttmacher.org/state-legislation-tracker (updated June 1, 2023)

Guttmacher Institute, “An Overview of State Abortion Laws”, State Laws and Policies, 1 January, 2023, https://www.guttmacher.org/state-policy/explore/overview-abortion-laws

Guttmacher Institute, “State Legislation Tracker”, Major Developments in Sexual and Reproductive Health, 31 December 2022, https://www.guttmacher.org/state-policy#

Guttmacher Institute, “State Legislation Tracker”, Major Developments in Sexual and Reproductive Health, Targeted Regulation, 1 January 2023 https://www.guttmacher.org/state-policy/explore/targeted-regulation-abortion-providers

Abortion Surveillance — United States, 2020
https://www.cdc.gov/mmwr/volumes/71/ss/ss7110a1.htm#methods

A Review of Exceptions in State Abortions Bans: Implications for the Provision of Abortion Services
https://www.kff.org/womens-health-policy/issue-brief/a-review-of-exceptions-in-state-abortions-bans-implications-for-the-provision-of-abortion-services/

According to the Kaiser Family Foundation, 92% of abortions occur in the first trimester of pregnancy.  Furthermore, 43% of abortions occur by six weeks gestation, 36% occur between seven and nine weeks, and 13% occur at 10 to 13 weeks. Ranji, Usha, Diep, Karen, Salganicoff, Alina. “Key Facts on Abortion in the United States.” Kaiser Family Foundation, 12 July 2022, https://www.kff.org/womens-health-policy/report/key-facts-on-abortion-in-the-united-states/#At-what-point-in-pregnancy-do-abortions-occur

According to the Centers for Disease Control and Prevention’s (CDC) 2018 Surveillance Reporting for Abortions in the U.S, 619,591 abortions were reported to the agency from 49 reporting areas. According to the report, 77.7% of individuals had abortions at or before 9 weeks gestation, and 92.2 % had abortions at or before 13 weeks gestation. Kortsmit K, Jatlaoui TC, Mandel MG, et al. Abortion Surveillance — United States, 2018. MMWR Surveill Summ 2020;69(No. SS-7):1–29. DOI: http://dx.doi.org/10.15585/mmwr.ss6907a1

The U.S. Maternal Health Divide: The Limited Maternal Health Services and Worse Outcomes of States Proposing New Abortion Restrictions
https://www.commonwealthfund.org/publications/issue-briefs/2022/dec/us-maternal-health-divide-limited-services-worse-outcomes

Maternal morbidity and fetal outcomes among pregnant women at 22 weeks’ gestation or less with complications in 2 Texas hospitals after legislation on abortion, American Journal of Obstetrics & Gynecology, Research Letter, 2022

Study of pregnancy outcomes and morbidities for women at less than 22 weeks gestation and needing obstetrical management at 2 Texas Hospitals after Texas Bills SB 8 and SB 4 went into effect. The study involved 28 pregnant patients (less than 22 weeks gestation) presenting with obstetrical complications. Prior to the passage of Texas laws SB 4 and SB 8, these individuals would have been “,,,counseled and offered expectant management (closely monitored) or induction of labor.” After Sept. 2021, these patients were “expectantly managed with medical intervention when there was an immediate threat to maternal life.” State-mandated expectant management of obstetrical complications corresponded with significant maternal morbidity. In fact, while most of these patients presented with medical indications for delivery they endured “serious morbidity and fetal outcomes were poor.”
Available at: https://www.ajog.org/action/showPdf?pii=S0002-9378%2822%2900536-1 

Nambiar, Anjali et al., Maternal morbidity and fetal outcomes among pregnant women at 22 weeks’ gestation or less with complications in 2 Texas hospitals after legislation on abortion, American Journal of Obstetrics & Gynecology, Research Letter, 2022, available at: https://www.ajog.org/article/S0002-9378(22)00536-1/pdf

Severe Maternal Morbidity in the United States, Reproductive Health, National Center for Health Statistics, Centers for Disease Control and Prevention (CDC), 2021, at: https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.html

Severe maternal morbidity (SMM) refers to labor and delivery outcomes resulting in short or long-term consequences to the person’s health. “SMM has been steadily increasing in recent years….” In 2014 (most recent available data) it has affected more than 50,000 women in the U.S.”

Severe Maternal Morbidity in the United States: A Primer
https://www.commonwealthfund.org/publications/issue-briefs/2021/oct/severe-maternal-morbidity-united-states-primer

Study Estimating Maternal Mortality Post-Dobbs

National and State specific estimates based upon previously published statistics for maternal mortality are detailed in this study.

• The authors estimate that if none of the 2020 U.S. abortions occurred the result would be 24% more U.S. maternal deaths overall and 39% more U.S. maternal deaths among non-Hispanic Black individuals. (p.3)
• For state specific estimates see chart (p. 15)

Stevenson, Amanda J., et al.  The Maternal Mortality Consequences of Losing Abortion Access. University of Colorado Boulder, SocArXiv, 29 June 2022, available at:  https://osf.io/preprints/socarxiv/7g29k/

Qualitative Studies

Report: Care post-Roe (June 2022-March 2023). Qualitative Study (preliminary findings) documents cases of poor-quality care after Dobbs Study involved submissions from 50 health care providers describing detailed cases of care that deviated from the usual standard in one of fourteen states banning abortions. The reported cases detail harm to patients including increased morbidity, aggravated pregnancy complications, inability to provide time sensitive care, and more delays to receiving care. The existing disparities in healthcare for people of color has deepened.

• The Study documents a wide range of harm Cases fall into following categories (p.4);
  • Obstetric complications in second trimester prior to fetal viability, including preterm labor rupture of membranes, hemorrhage, cervical dilation, and hypertension
  • Ectopic pregnancy
    • Underlying medication conditions that made continuing a pregnancy dangerous
  • Severe fetal anomalies
  • Early miscarriage
  • Extreme delays in obtaining abortion care; and
  • Delays obtaining medical care unrelated to abortion

Care Post-Roe: Documenting cases of poor-quality care since the Dobbs decision, Grossman D., Joffe C., Kaller S., Kimport K., Kinsey E., Lerma K., Morris N, White K, Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, May 2023, available at: https://www.ansirh.org/research/research/how-post-roe-laws-are-obstructing-clinical-care

A National Survey of OBGYN’s Experiences After Dobbs

• Nationally, in states where abortion is banned, four in ten (40%) OBGYNs report they have personally felt constraints on their ability to provide care for miscarriages and other pregnancy-related medical emergencies (p.3)
• 36% of OBGYNs nationally and 55% practicing in states where abortion is banned (or 47% practicing is states where there are gestational limits) report their ability to practice within the standard of care has become worse (p.12-13)
• Four in ten OBGYNs nationally (44%) and six in ten practicing in states where abortion is banned or where there are gestational limits, report their decision-making autonomy has become worse since the Dobbs ruling (p.3)
• 68% of OBGYNs report the ruling has worsened their ability to manage pregnancy-related emergencies (p.3)

• • 64% believe the Dobbs decision has worsened pregnancy-related mortality,
  • 70% believe the decision has worsened racial and ethnic inequities in maternal health
  • 55% believe the decision has worsened the ability to attract new OBGYNs to the field

A National Survey of OBGYNs’ Experiences After Dobbs, KFF, Frederiksen, Brittni et al., June 2023, available at: https://www.kff.org/report-section/a-national-survey-of-obgyns-experiences-after-dobbs-report/

Care Post-Roe: Documenting cases of poor-quality care since the Dobbs decision, Grossman D., Joffe C., Kaller S., Kimport K., Kinsey E., Lerma K., Morris N, White K, Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, May 2023

The report provides preliminary findings (September 2022-March 2023) of poor-quality healthcare in 14 states that have banned or severely restricted abortion since the Dobbs decision.  Health care providers describe case details that deviate from the usual standard of  care. The impact is “…increased morbidity, exacerbated pregnancy complications, an inability to provide time-sensitive care, and increased delays in obtaining care for patients in states with abortion bans. This has impacted both patients and providers and has deepened the existing inequities in the healthcare system for people of color.”

The full report is available at: https://www.ansirh.org/research/research/how-post-roe-laws-are-obstructing-clinical-care

The infant mortality rate (IMR), is based upon the yearly number of infant deaths per 1000 live births up to the age of one year. The IMR is one of the best predictors of a country’s life expectancy and is used as an indicator of population health.  Pabayo, Roman et al. Laws Restricting Access to Abortion Services and Infant Mortality Risk in the United States, Int. J. Environ. Res. Public Health, May 26, 2020, 17(11), 3773; https://doi.org/10.3390/ijerph17113773
citing Anderson, R.N. A method for constructing complete annual U.S. life tables. Vital Health Stat. 2 2000, 129, 1–28.

2021 US Infant Mortality (IMR):  5.44 deaths per 1,000 live births.

Disparate Impact:

• IMR for infants born to Black mothers had the highest rate of 10.55 per 1,000 live births
• IMR for infants born to Native Pacific or Other Pacific Islander mothers was 7.76 per 1,000 live births
• IMR for infants born to American Indian or Alaska Native mothers was 7.46 per 1,000 live births
• IMR for infants born to Hispanic mothers was 4.79 per 1,000 live births
• IMR for infants born to White mothers was 4.36 per 1,000 live births
• IMR for infants born to Asian mothers was 3.69 per 1,000 live births. (This increased 17% from 2020)

Ely, Danielle, Driscoll, Anne K., Infant Mortality in the United States, 2021: Data from the Period Linked Birth/Infant Death File, National Vital Statistics Reports, Vol. 72, No. 11, September 12, 2023, available at: https://www.cdc.gov/nchs/data/nvsr/nvsr72/nvsr72-11.pdf

To view 2021 Infant Mortality Rates by State
See: https://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm
Infant Mortality, Reproductive Health, CDC, Source: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion