Observational study finds pregnancy-related death risk 44 times higher than abortion risk — Evidence Review
Published in JAMA Netw Open, by researchers from University of Maryland's School of Public Health
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Table of Contents
A new analysis finds that the risk of death from pregnancy in the US is at least 44 times higher than from abortion, a figure substantially greater than previous estimates. Most existing studies, including prior national analyses, agree that abortion is markedly safer than childbirth, and the updated risk ratio reported in this study is consistent with the direction of earlier findings, though it highlights that prior estimates may have significantly understated the current disparity (journal name).
- Previous research established that childbirth carries a substantially higher risk of death than abortion, with earlier estimates putting the risk at around 14 times higher; the new study's figure of 44 times higher suggests that the gap has widened, possibly due to improved tracking and increases in maternal mortality rates (9,10).
- Multiple related studies also demonstrate persistent and significant disparities in pregnancy-related mortality by race, age, and access to care, findings echoed by the new analysis's observation of variable risks among different populations (1,5).
- Research consistently shows that most pregnancy-related deaths are preventable and that abortion restrictions are associated with higher maternal mortality, supporting the new study's emphasis on the policy implications of restricting abortion access (3,13,14).
Study Overview and Key Findings
Recent debates over reproductive healthcare have raised questions about the comparative safety of pregnancy and abortion in the United States. This new analysis was prompted by concerns that much-cited risk comparisons rely on outdated data, potentially underestimating pregnancy-related mortality. The study uses the latest national data to provide an updated, more precise assessment of the risks, with findings that may inform ongoing policy discussions.
| Property | Value |
|---|---|
| Study Year | 2026 |
| Organization | University of Maryland's School of Public Health |
| Journal Name | JAMA Netw Open |
| Authors | Maria Steenland, K Mercon, BP Brown, ME Thoma |
| Population | Pregnant individuals in the US |
| Methods | Observational Study |
| Outcome | Pregnancy-related and abortion-related mortality rates |
| Results | Pregnancy-related death risk is 44 times higher than abortion risk. |
The study, published in JAMA Network Open, re-examines mortality risks associated with pregnancy and abortion in the US using data from 2018-2021. Researchers found an average of 32.3 maternal deaths per 100,000 births during this period, a rate more than double that reported in earlier studies from the early 2000s. In contrast, the risk of abortion-related death remained extremely low at 0.46 deaths per 100,000 abortions. These findings led to the conclusion that the risk of death from pregnancy is at least 44 times higher than from abortion—a threefold increase compared to previously reported ratios.
The authors note that this updated ratio may be due to both improved detection of pregnancy-related deaths and actual increases in the US maternal mortality rate. The study also highlights important limitations, such as the exclusion of early pregnancy losses like ectopic pregnancies and miscarriages from the analysis. The findings underscore the importance of accessible, high-quality maternal care and the potential health consequences of restricting abortion access, particularly for marginalized populations.
Literature Review: Related Studies
To provide context for the new findings, we searched the Consensus database of over 200 million research papers, focusing on studies that compare the risks of pregnancy and abortion and examine trends in maternal mortality. The following queries were used:
- pregnancy death risk statistics
- abortion safety comparison studies
- maternal mortality versus abortion outcomes
Literature Review Table
| Topic | Key Findings |
|---|---|
| How do mortality risks compare between pregnancy and abortion in the US? | - Childbirth has a much higher mortality risk compared to abortion, with previous studies estimating the risk at about 14 times higher (9,10). - The safety of abortion has been consistently affirmed, with serious complications and mortality being rare (11,8). |
| What trends are observed in US maternal mortality rates and disparities? | - US maternal mortality rates have increased over time, with notable racial, ethnic, and socioeconomic disparities persisting (1,2,4,5). - Most pregnancy-related deaths are preventable, and the risk is disproportionately higher for Black and Native American women (3,5). |
| How do abortion access and related policies impact maternal mortality? | - States with more restrictive abortion policies have higher maternal mortality rates, and policy changes that increase abortion access may reduce maternal mortality (12,13,14). - Restricting abortion access does not independently reduce maternal mortality; other factors like healthcare access and socioeconomic conditions are critical (15). |
| How do abortion methods and settings affect safety and outcomes? | - Both clinic-based and home-based (including telemedicine) medical abortions are safe and effective, with no significant differences in outcomes (7,8). - Unsafe abortions, often in settings with restrictive laws or limited access, contribute significantly to maternal deaths globally (6). |
How do mortality risks compare between pregnancy and abortion in the US?
The new analysis aligns with earlier research showing that pregnancy carries a much higher risk of death than legal abortion, although the estimated risk gap has widened. Earlier studies using data from the late 1990s and early 2000s reported that childbirth had a 14 times greater risk of death compared to abortion, while the new study reports this figure as at least 44 times higher (9,10). These findings are consistent with research documenting the relative safety of abortion, particularly when performed legally and under medical supervision (11,8).
- Earlier studies consistently showed childbirth is associated with a much higher mortality risk than abortion (9,10).
- The safety of abortion, both in clinics and at home, has been well established, with serious adverse events being rare (8,7).
- The new study’s higher risk ratio may reflect both improved death reporting and real increases in maternal mortality (4).
- Findings reinforce that abortion is one of the safest medical procedures when legally accessible (11,8).
What trends are observed in US maternal mortality rates and disparities?
Multiple studies have documented a steady increase in US maternal mortality rates over recent decades, as well as persistent disparities by race, age, and socioeconomic status (1,2,4,5). Black and Native American women face mortality risks several times higher than their white counterparts, a pattern that has not improved over time. The new study’s findings of rising mortality rates and disparities are consistent with this body of research.
- National data show that US maternal mortality rates have increased, with ratios rising from around 14.5 to over 32 per 100,000 births (4,1,2).
- Racial and ethnic disparities are pronounced, with Black women experiencing a risk three to four times higher than white women (1,5).
- Most pregnancy-related deaths are considered preventable, highlighting gaps in healthcare access and quality (3).
- The new analysis echoes these disparities, finding particularly high risks in marginalized populations (5).
How do abortion access and related policies impact maternal mortality?
Research indicates that legal and accessible abortion is associated with lower maternal mortality, while restrictive abortion laws correlate with higher risks (12,13,14). Policy changes that expand access to safe abortion tend to reduce maternal deaths. However, some studies also note that broader social determinants—such as healthcare infrastructure, education, and socioeconomic conditions—play a critical role (15).
- States with restrictive abortion policies have higher maternal mortality rates, even after adjusting for other factors (13,14).
- Expanding the legal grounds for abortion is associated with significant reductions in maternal mortality at the country level (12).
- Studies suggest that abortion legislation alone does not explain all differences in maternal mortality; broader social and health system factors are also important (15).
- The new study’s warning about the impacts of abortion restrictions is supported by this literature (13,14).
How do abortion methods and settings affect safety and outcomes?
The safety of abortion is not limited to clinical settings; both home-based and telemedicine-supported medical abortions have been shown to be highly effective and safe (7,8). Globally, unsafe abortions—often occurring where legal access is restricted—remain a significant contributor to maternal mortality (6).
- No-test telemedicine abortions are as safe and effective as in-person procedures and improve access (7).
- Home-based and clinic-based medical abortions have similar safety profiles and high acceptability among patients (8).
- Unsafe abortions are primarily a problem in countries with restrictive laws and limited access to safe services (6).
- The extremely low abortion-related mortality rate reported in the new US study is consistent with these findings (7,8).
Future Research Questions
While this study advances our understanding of the relative risks of pregnancy and abortion in the US, several important questions remain. Further research is needed to clarify the factors driving rising maternal mortality, to monitor the effects of changing abortion laws, and to address persistent disparities in outcomes.
| Research Question | Relevance |
|---|---|
| How do state-level abortion restrictions impact maternal mortality over time? | As abortion laws change across the US, understanding their direct impact on maternal mortality is critical for informing policy and public health strategies (13,14). |
| What are the primary drivers of rising maternal mortality rates in the US? | Identifying and addressing the main causes of increasing maternal deaths, including healthcare system factors, is essential to reversing this trend (1,2,4). |
| How do racial and socioeconomic disparities affect pregnancy-related and abortion-related mortality? | Persistent disparities in maternal outcomes highlight the need for targeted interventions to improve equity in reproductive health (1,5). |
| What is the effect of telemedicine and home-based abortion services on abortion safety and access? | As telemedicine expands, evaluating its impact on safety, effectiveness, and accessibility will help shape future service delivery models (7,8). |
| How will future data limitations affect the monitoring of abortion and maternal mortality trends? | With anticipated reductions in public reporting, understanding how data gaps may hinder surveillance and research is crucial for ongoing public health efforts ([news article]). |
This article is for informational purposes only and is not intended as medical advice.