As of January 1, 2025, roughly 62.7 million women and girls lived under state abortion bans.
Even before abortion was outlawed, the states that subsequently banned abortion had worse outcomes on key indicators of reproductive health, as reported in The State of Reproductive Health in the United States (January 2023). “Maternal Mortality in the United States After Abortion Bans,” the fourth publication in Gender Equity Policy Institute’s series on Reproductive Health in the United States, presents GEPI’s analysis of 2019-2023 Centers for Disease Control and Prevention (CDC) data on maternal mortality to compare maternal health outcomes in the banned states, the supportive states, and the U.S. overall. The year 2023 is the most recent one for which annual data is publicly available from the CDC. Thirteen states enforced bans for the entirety of this year. (See Appendix 3.)
Women who lived in states that ban abortion were significantly more likely to die during pregnancy, while giving birth, or soon after the birth of their child, compared to those who lived in states where abortion care was legal and accessible, our analysis shows. A mother’s risk of dying was nearly twice as high in the banned states. In some states, the risk was even higher. Mothers in Louisiana, for example, were three times as likely as mothers in supportive states to die during pregnancy, childbirth, or soon after giving birth.
In the 24 states where abortion is legal and accessible (supportive states), mothers are more likely to survive pregnancy. Likewise, the trends on maternal mortality are moving in an encouraging direction. Maternal mortality went down 21 percent in these states post-Dobbs. A decline of 16 percent took place in the U.S. overall.
This fall in maternal mortality—outside the banned states—is a positive development, especially given that the U.S. has one of the highest maternal mortality rates among wealthy advanced democracies.
Texas: Early Ban, Alarming Trends
Texas was the only state to outlaw abortion and enforce a ban before the 2022 Dobbs decision. In September 2021, Texas Senate Bill 8 (S.B. 8), banning abortion at approximately six weeks, went into effect after the U.S. Supreme Court rejected a request for a stay. Through S.B. 8, abortion was effectively outlawed in Texas approximately nine months before any other state moved after Dobbs to enforce a ban.
In the first full year of Texas’s state abortion ban (2022), maternal mortality increased significantly. The maternal mortality rate in Texas rose 56 percent. Among White mothers, it was up 95 percent. Over the same time period, maternal mortality overall increased just 11 percent in the United States.
In 2023, Texas’s maternal mortality rate was also substantially higher than the rate in the United States. Overall, maternal mortality was up 33 percent post-ban. Within Texas, Black women were 2.5 times as likely as White women to suffer maternal death in 2023.
Mothers in Texas were 1.7 times as likely to suffer maternal mortality as mothers in supportive states. Latina and White mothers in Texas faced double the risk of maternal mortality, compared to their counterparts living in supportive states.
Two Americas: Texas versus California
More maternal deaths occur in Texas than in any other state, and a disproportionate share of U.S. maternal deaths take place in the state.
To be sure, Texas is the second most populous state in the country, and a larger number of maternal deaths would be expected there than in less populous states. However, comparing Texas to the country’s most populous state—California—illuminates how perilous it is to a woman’s health to be pregnant in Texas.
California had the lowest maternal mortality rate of any state reporting data in 2023. At 9.5 maternal deaths per 100,000 live births, it was roughly half the rate of the United States overall (18.6).
California’s laws, policies, and practices on reproductive healthcare are dramatically different than Texas’s. Even though 59% of Texans support abortion in all or most cases, according to new research by PRRI, elected officials in Texas have enacted some of the most stringent anti-abortion laws in the nation.
In California, by contrast, voters enshrined the right to abortion and contraception in the state constitution. California provides public funding for contraception and abortion care and a year of post-partum health coverage for mothers and babies under state Medi-Cal. Texas bans public and private insurers from covering abortion and has not accepted Medicaid expansion under the ACA, which provides no-cost contraception. California proactively protects the legal rights of abortion care providers and patients traveling from other states to access care. Recently, the Texas Attorney General arrested a midwife, charging her with performing illegal abortions, a felony which is punishable by up to 20 years in prison.
While many factors affect maternal mortality, the outcomes in Texas and California are dramatically different. Texas has persistently higher maternal mortality than California across all years.
In 2023, Texas’s maternal mortality rate was 155 percent higher than California’s. Latina mothers in Texas faced nearly triple the risk of maternal mortality as those in California. White mothers in Texas faced more than double the risk, compared with their counterparts in California.
Black women in banned states at the highest risk of maternal death
Black women and girls are disproportionately concentrated in states that banned abortion. One in eight women and girls in the U.S. are Black; one in four lived in banned states in 2023.23 That proportion has grown substantially since the southern states of Florida, South Carolina, Georgia began enforcing bans in 2024.
The maternal mortality rate in banned states for Black women, 60.9 maternal deaths per 100,000 live births, was significantly higher than the rate for White (18.2) or Latina (18.2) women. (The observed increase between 2019 and 2023 in Black maternal mortality in banned states was not statistically significant. Data is insufficient to report on Asian and Pacific Islander or Native American women in banned states.)
Black mothers living in banned states were more than three times as likely to die as White mothers in those states. Put another way, Black maternal mortality was 234 percent higher than White maternal mortality in the banned states. The Black-White gap in maternal mortality also widened significantly post-bans. In 2019, the last year before the COVID pandemic spike in maternal deaths, Black mothers living in states that went on to ban abortion had been 2.2 times as likely as White mothers to die during pregnancy, childbirth, or shortly after giving birth; by the end of 2023, that disparity had grown to 3.3 times.
Not only did Black women suffer worse outcomes within the banned states, compared to women of other races and ethnicities, but they were also at significantly higher risk of death than Black women who lived in supportive states.
Latina and White mothers likewise faced increased risk of dying while pregnant or giving birth in banned states compared to supportive states. Latina maternal mortality was nearly twice as high in banned states as in supportive states. White maternal mortality was 1.6 times as high. (Estimates of the maternal mortality rate for Native American women in the U.S. in 2023 were unreliable.)
Conclusion
The right to control if and when to have children is foundational to women’s freedom; it is globally recognized as a fundamental human right. Nearly 63 million women and girls in the United States have lost that right, now that 16 states have banned abortion.
The number of women in America who die in pregnancy, childbirth, and soon after giving birth is tragically high. This is true throughout the country. Nevertheless, as this report has documented, women in states that banned abortion are at significantly higher risk of maternal death, and longstanding racial disparities in maternal mortality are significantly worse in banned states.
