This challenge is compounded by the fact that abortion-related complications and deaths are often reported as pregnancy-related complications or deaths. In 2017 an otherwise healthy twenty-three-year-old Black woman named Keisha Atkins died of a pulmonary thromboembolism (a blood clot in the lungs) during a late-term abortion: she was twenty-four weeks pregnant at the time. (Ninety-two percent of abortions take place before the thirteenth week of gestation.) According to the medical examiner, Atkins had begun the abortion process and was at a clinic preparing for the final stage. While there, she began to experience symptoms of distress—cramping (normal during an abortion), but also shortness of breath and low blood oxygen levels. She was transferred to a hospital, where she continued to have cramping, an elevated heart rate, and low blood-oxygen levels. Further testing revealed fluid in her lungs and reduced heart function. The medical examiner goes on to explain:
Due to rapid decomposition in her clinical status (requiring the placement of a breathing tube) and the concern for a significant infection, she was taken emergently to the operating room to complete the abortion procedure. During the operation, she sustained a cardiac arrest. Extensive resuscitation efforts were ultimately unsuccessful.
The medical examiner notes that Atkins had a septic uterus due to the abortion procedure itself, and the autopsy “revealed a well-developed, well-nourished young woman with extensive medical intervention.” Her family went on to sue the abortion clinic and hospital, which settled for $1.26 million in May 2022. Still, Atkins’s death certificate reports her cause of death as “pulmonary thromboembolism due to pregnancy.” The CDC would not say whether her case made it into the national statistical data “because all states do not report to the CDC.” While New Mexico, Atkins’ home state, does report abortion data to the CDC, it does not report complications. Thus, even though she died during an abortion procedure, her death would be categorized as a pregnancy-related mortality, not an abortion-related mortality.
Another challenge in assessing abortion-related risk is that statistics often lump together abortions at every stage of gestation. Pregnancy is not a static physiological phenomenon but one that dramatically changes over the course of forty weeks. Dr. Monique Chireau Wubbenhorst, an ob-gyn and former professor of obstetrics and gynecology at Duke University School of Medicine, notes that the risk of abortion mortality increases with gestational age, just like the risk of pregnancy-related mortality. A study led by Dr. Linda Bartlett that was published in the journal, Obstetrics & Gynecology, shows that death from abortion increases exponentially by 38 percent for each additional week of gestation. The same study shows that abortion mortality for women of color is three times that for white women. Other data also suggest that after eighteen weeks’ gestation the mortality rate for vaginal childbirth (3.6 deaths per 100,000) is less than half the mortality rate for abortions performed during the same period (7.4 deaths per 100,000). This directly contradicts the undifferentiated claim that abortion is safer than pregnancy.
Some abortion-rights advocates have suggested that the increased mortality rate associated with late-term abortions is due to the fact that they are much more likely to be the result of medical emergencies that threaten a pregnant woman’s life. Appearing on Face the Nation in the wake of the Planned Parenthood fetal-tissue scandal in 2015, Hillary Clinton said, “I think that the kind of late-term abortions that take place are because of medical necessity. And, therefore, I would hate to see the government interfering with that decision.” The Annenberg Public Policy Center fact-checked this statement: “A spokesman for Clinton’s campaign told us that she meant that many late-term abortions—not all or even most—are because of medical reasons. But that’s not what she said. Her statement left the impression that the majority, if not all, late-term abortions are medically necessary. The available evidence does not support that assertion.” Most available data suggest that late-term abortions, such as the one Atkins underwent, are not medically necessary. In 1997, Dr. Ron Fitzsimmons, the then-executive director of the National Coalition of Abortion Providers, told the New York Times that “the procedure is performed far more often than his colleagues have acknowledged, and on healthy women bearing healthy fetuses.” We can thus conclude that, after a certain point in gestation, a healthy pregnant woman is safer giving birth to a child than aborting it. Yet abortion-rights advocates often claim that even late-term abortions are safer than live childbirth. The L.A. Times op-ed made this very claim even though the article they cited in support of it includes no maternal-mortality statistics.
In our current debates, economically vulnerable women and women of color are routinely held up as the reason we need to maintain unrestricted access to elective abortion. The previously cited L.A. Times op-ed claims that “scientific and medical research consistently shows that childbirth is far riskier than terminating a pregnancy, particularly for poor and minority women.” Women of color, especially Black women, are three times more likely to die during pregnancy or childbirth than white women, regardless of income or education. This is not evidence of the efficacy of abortion, but an indictment of our failure to address inequities in maternal health. Setting aside the challenges of assessing abortion-related data, we might ask ourselves why abortion is so often presented as the silver bullet for addressing poor maternal-health outcomes for poor women and women of color despite the fact that the poor and people of color are more likely to oppose abortion than wealthy and white people. Evidence from other industrialized nations also suggests that our failure to address maternal mortality among women of color is not related to abortion access, but to our failure to provide adequate health care.
The Dobbs ruling is no doubt polarizing, but it may also give us a rare opportunity to build a bipartisan consensus around ways to address maternal mortality, particularly for the most vulnerable women. A recent study from the Commonwealth Fund, a non-partisan independent research organization, concluded that “high maternal mortality in the U.S. is not the result of any single factor, and reducing it will require an integrated effort involving policy and practice changes to improve hospital and community care for all women while advancing racial equity.” The report goes on to note “the shortage of maternity care providers (both ob-gyns and midwives) relative to births,” adding that “in most other countries, midwives outnumber ob-gyns by severalfold, and primary care plays a central role in the health system. Although a large share of [U.S.] maternal deaths occur post-birth, the U.S. is the only country not to guarantee access to provider home visits or paid parental leave in the postpartum period.” It is worth noting that the researchers do not include abortion access in their list of policy recommendations, but focus on bolstering health care, insurance coverage, postpartum care, and parental leave.
Addressing our scandalous level of maternal mortality will require that all states—especially those like Texas and Mississippi that have passed strict restrictions on elective abortion and where maternal-health outcomes are among the worst in the nation—increase funding for programs that provide mothers and their children with the support they need. Any state that invokes the sanctity of life needs to start from a principle formulated by the former Archbishop of Canterbury, Rowan Williams: “the poor deserve the best.” This would require that all women have access to quality health care—before, during, and after birth, when they are still vulnerable to life-threatening infections and other complications. A focus on reducing maternal mortality would mean prioritizing underserved populations and addressing health inequities between white women and women of color. First, it is vital to ensure that women receive quality health care before they become pregnant, as many pregnancy-related deaths stem from underlying health conditions. Second, women must have access to quality prenatal and postnatal care, and should be encouraged to use it. Third, it is critical to ensure paid parental leave for all employees, especially those who work entry-level or hourly positions. Fourth, states ought to invest in robust midwife-led care, which is proven to reduce maternal and neonatal mortality. Such measures will require major investments in vulnerable communities and in the education of nurses and midwives.
Pro-life activists should not imagine that one can build an authentic culture of life without greater public investment in health care and social services. But pro-choice activists, politicians, and journalists should not pretend that the only way to protect women from life-threatening complications of pregnancy is to ensure that they have unrestricted access to elective abortion, or that we know more about the relative risks of abortion and pregnancy than we actually do. The sooner we come to terms with these realities and let the needs of vulnerable mothers and babies dictate our policies, the sooner we can do the important work of making pregnancy as safe in the United States as it is elsewhere in the world. Liberal abortion laws did not keep us from having the highest maternal-mortality rates among industrialized nations, nor will new abortion restrictions alone be adequate to meet the needs of pregnant mothers and lower the maternal-mortality rate. Maternal mortality is not mainly a function of abortion access; it is a function of how well or poorly we provide for expectant mothers.