Induced Abortion and the Increased Risk of Maternal Mortality

Abstract

After years of failure to obtain accurate statistics on maternal mortality, the United States noted a sharp increase in its maternal mortality rate with widening racial and ethnic disparities. The 2016 report shocked the nation by documenting a 26 percent increase in maternal mortality from 18.8/100,000 live births in 2000 to 23.8 in 2014. Suggested etiologies of this increase included artifact as a result of improved maternal death surveillance, incorrect use of ICD-10 codes, healthcare disparities, lack of family support and other social barriers, substance abuse and violence, depression and suicide, inadequate preconception care, patient noncompliance, lack of standardized protocols for handling obstetric emergencies, failure to meet expected standards of care, aging of the pregnant patient cohort with associated increase in chronic diseases and cardiovascular complications, and lack of a comprehensive national plan. While some of the increase in maternal mortality may be a result of improved data collection, pregnancy-related deaths are occurring at a higher rate in the United States than in other developed countries. Some have suggested that the increased maternal mortality is due to limiting women's access to legal abortion. In order to discover effective strategies to improve pregnancy outcomes, maternal mortality must be investigated in an unbiased manner. This review explores the relationship between legal-induced abortion and maternal mortality.

Summary: In Finland, where epidemiologic record linkage has been validated, the risk of death from legal induced abortion is reported to be almost four times greater than the risk of death from childbirth. It is difficult to do this comparison in the United States not only because prior induced abortion history is often not recorded for a pregnancy-related death but also because less than one-quarter of the states require health care providers to report abortion deaths for investigation. These omissions are important because mortality risk in pregnancies subsequent to abortion is increased due to abortion-induced morbidities such as preterm birth and abnormal placentation. Legal induced abortion is a root cause of the racial and ethnic disparity noted in maternal mortality. In the United States, the death rate from legal induced abortion performed at 18 weeks gestation is more than double that observed for women experiencing vaginal delivery.

Keywords: Abortion; Abortion complications; Abortion-related mortality rate; Contextual-level social determinants of health; Incestuous citing; Maternal mortality; Maternal mortality ratio; Placenta accreta; Structural inequality; Women’s reproductive issues.