Predictions and Reality about Abortion and Maternal Mortality

by Sarah Terzo

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After the Dobbs decision was leaked in May 2022, many media outlets predicted that maternal deaths would rise as a result. More women, they said, would die in childbirth if abortion weren’t available.

For example, an article in the Washington Post said “researchers have estimated that maternal deaths could increase by up to 25 to 30 percent.” 

Pro-choice authors Rebecca Little and Colleen Long, in their book I’m Sorry for My Loss: An Urgent Examination of Reproductive Care in America (Naperville, IL: Sourcebooks, 2024) wrote: “[M]aternal mortality rates are alarmingly high, and they are expected to rise even more in the aftermath of the Supreme Court decision to reverse abortion protections” (p. 185).

Despite pro-abortion rhetoric to the contrary, however, the opposite has happened. Maternal mortality has been falling ever since Dobbs.

The Maternal Mortality Ratio since Dobbs

Maternal mortality can be measured in different ways. This article uses the maternal mortality ratio (MMRatio), which represents the number of women who die from pregnancy-related causes per 100,000 live births (the US Centers for Disease Control and Prevention [CDC] refers to this same measure as the “maternal mortality rate”). 

The MMRatios in the United States indeed increased in the late 2010s and early 2020s. The MMRatio was 20.1 in 2019. It rose to 23.8 in 2020. In 2021, the US MMRatio had gone all the way up to 32.9. During this time, abortion was legal in every state. But from 2021 to 2023, the MMRatio dropped dramatically.

Dobbs took effect on June 24, 2022. In 2022, the MMRatio fell to 22.3 deaths per 100,000 live births. By the end of 2023, the first full year after Dobbs, it had gone all the way down to 18.6. 

As Thomas Hilgers, MD, notes in his book The Fake and Deceptive Science behind Roe v. Wade: Settled Law v. Settled Science (New York: Beaufort Books, 2020), the US MMRatio is now comparable to pre-Roe v Wade levels, which in 1971-1972 were 18.8 (see pp. 30–31).

The overturning of Roe may not be the reason the MMRatio has gone down. The drop may have more to do with the COVID-19 pandemic subsiding. However, the fact that the MMRatio has now dropped to a lower rate than before the pandemic suggests that there may be more to the story.

MMRatios after Abortion Was Banned

Further evidence that restricting abortion may actually be related to lower MMRatios comes from other countries. The pattern of the MMRatio going down after abortion is banned is actually quite common. (Except where otherwise noted, international MMRatio numbers are from the World Bank’s database on the subject: https://data.worldbank.org/indicator/SH.STA.MMRT.) 

It happened in Chile. From 1931 to 1988, abortion was legal in Chile for certain medical reasons. In 1989, it was banned in all cases, although some exceptions were allowed in 2017.

If abortion were necessary to save pregnant peoples’ lives, we would expect the MMRatio to skyrocket. But that is not what happened. In 1988, when abortion was legal for medical reasons, Chile’s MMRatio was 64. By 2016 (when abortion was banned in all cases), the MMRatio had fallen to only 13. 

Poland banned abortion in almost all cases in 1993. Since then, the MMRatio has dropped, going from 16 in 1992 to 2 in 2023.

In 1998, El Salvador banned abortion for any reason. In 1997, it had an MMRatio of 67 deaths per 100,000 live births. By 2023, its MMRatio was 39.

Nicaragua banned abortion in 2006. In 2005, its MMRatio was 124. In 2023, it was 60.

MMR after Abortion Was Legalized

We’ve also seen the opposite: a rise in the MMRatio when abortion is legally expanded. 

In South Africa, abortion was legal only in limited cases until the mid-1990s. But in 1996, the law was changed to allow abortion for any reason in the first trimester and allow it under some circumstances later in pregnancy. Shortly thereafter, the MMRatio, which had generally been dropping for years, began to rise.

In 1995, South Africa’s MMRatio was 125. By 2006, it had jumped up to 283. After that, the MMRatio began falling, and by 2023 it was 118—roughly the same level as before abortion was more broadly legalized in the 1990s.

Countries with vs. without Legal Abortion

Finally, we see cases where the MMRatio is lower in countries without legal abortion than in comparably wealthy countries with it. 

Ireland in 2017, the year before the country legalized abortion, had an MMratio of 4, lower than that of the United Kingdom, which had legal abortion, that year (9). 

Malta had an MMRatio of 8 in 2023. Up until that year, abortion was illegal even to save the mother’s life—in 2023, the law was revised to allow an exception for saving the mother’s life. Yet Malta’s MMRatio was the same as that in the United Kingdom that year.

Hungary had an MMRatio of 12 in 2023 (substantially higher than Poland’s MMRatio that year). Ukraine had an MMRatio of 20 in 2013 (the last year before its civil war and later the invasion by Russia, which presumably skewed MMRatios). In 2013, the Russian Federation had an MMRatio of 16. Abortion is legal in all these countries. 

Mexico allows individual states to have their own abortion laws. A study in the British Medical Journal found that states with more restrictive laws had MMRatios approximately 25% lower than those with more permissive laws.

Possible Reasons for the Statistics

All this data may be explained by factors unrelated to abortion (this was the conclusion reached by the authors of the Mexican study noted above). After all, numerous factors influence a country’s maternal mortality rate.

However, researchers Angela Lanfranchi, Ian Gentles, and Elizabeth Ring-Cassidy, in their book Complications: Abortion’s Impact on Women (Toronto: The deVeber Institute for Bioethics and Social Research, 2^nd ed., 2018) wrote: 

The reality seems to be that countries that do not allow abortion are much more likely to make sustained efforts to improve the quality of care for pregnant women and mothers.

They offer better emergency obstetric care, transportation to emergency obstetric care, delivery by trained birth attendants, education for women, and better postnatal care for mothers and infants… In short, countries that do not offer abortion on request have a much better record of promoting maternal and infant health than countries that do (p. 6).

Despite media stories and pro-abortion claims, women are not dying left and right due to pro-life laws. If they were, we would see the US maternal mortality ratio going up. Instead, we see it going down.

The CDC is not a pro-life source, but its statistics tell a pro-life story. The evidence does not support the position that pro-life laws are causing an increase in national maternal mortality.

Pro-Abortion Misinformation Continues

Of course, these facts don’t stop pro-abortion activists from claiming that the maternal mortality ratio is rising. 

In the online newsletter, “Abortion, Every Day,” Jessica Valenti and Kylie Cheung wrote that pro-life concern about abortion coercion is a “messaging tactic [that] makes it appear like they care about women—something they desperately need as the maternal death rate skyrockets.”

Pro-lifers should be aware of the actual statistics, so we can correct pro-abortion misinformation when we see it.