After the Supreme Court struck down the constitutional right to abortion in 2022, President Joe Biden issued an executive order tasking the federal government with assessing the “devastating impact on women’s health” of new state abortion bans.
Experts warn the bans will disrupt critical medical care and lead to preventable deaths. And states that pass these laws have no incentive to track their consequences.
Biden directed the secretary of Health and Human Services to ensure federal agencies “accurately measure the impact of access to reproductive care on maternal health outcomes.” He called on the National Institutes of Health and the Centers for Disease Control and Prevention to promote targeted research and data collection.
But the Biden administration missed a key opportunity to illustrate how abortion bans interfere with maternal health care, leading to death and irreversible harm: The CDC did not urge state commissions that review maternal deaths to review the role of these new laws.
The CDC, which leads national efforts to track and reduce maternal mortality, has spent nearly $90 million over the past five years to fund state panels of health experts who analyze death tolls to spot trends and recommend reforms. While it cannot require states to collect or report certain data, the CDC provided detailed guidance for committees to assess whether deaths were preventable and what factors contributed to them.
Under the guidance, factors the committee considers include obesity, mental health issues, substance abuse, homicide and suicide. In 2020, the CDC added a checkbox to its model case review form for committees to indicate whether discrimination played a role.
However, the agency has yet to issue any guidance to address the recent rollback of reproductive rights or direct committees to consider how abortion bans affect deaths. Some state officials pointed to this silence as the reason their committees haven’t made any changes to the process. “Boards must follow state guidelines for maternal mortality review commission death investigations,” said a spokesman for the Oklahoma State Health Department, which oversees the state’s boards.
Researchers say this could mask the impact of abortion bans.
“In a way, it hides it — like we don’t want to count it, we don’t want to know what’s happening,” said Maeve Wallace, an epidemiologist at the University of Arizona who has published research on intersections. What happened.” Intimate Partner Violence and Maternal Deaths, which found that maternal homicides increased where abortion restrictions increased.
When asked about the matter, the CDC said the information submitted by states was sufficient to understand the impact of abortion bans.
“The Maternal Mortality Review Committee has comprehensively reviewed all deaths that occur during pregnancy and within one year after the end of pregnancy, including abortion-related deaths,” said David Goode, chief health scientist for the CDC’s Maternal Death Prevention Team. Mann said. “The current process involves documenting and understanding the influencing factors.”
But experts say the CDC’s current guidance does not provide committees with a standard way to consider the role abortion bans play in maternal deaths, making it more difficult to study deaths related to restrictions and provide an evidence base for recommendations. difficulty.
The Georgia Maternal Mortality Review Commission blamed the state’s abortion ban as a factor in the death of Candy Miller investigated by ProPublica. The 41-year-old mother-of-three ordered abortion pills online and developed complications but did not see a doctor “due to current legislation”, her family told the coroner in a statement recorded . Committee members told ProPublica clear references in the record show the law creates barriers to care.
Amber Thurman’s situation is less clear-cut. She took abortion pills at home and sought treatment at a Georgia hospital for complications similar to Miller’s. Doctors discussed but did not offer dilation and curettage surgery to remove infected tissue from her uterus because she suffered from sepsis for 20 hours, records show. Records reviewed by the committee did not indicate any impact the law might have had on doctors’ decision-making.
The committee concluded that one of the factors that contributed to her preventable death was delays in care. While members were able to check the “discrimination” box in Thurman’s case, they had no way of showing that she experienced delays in receiving a procedure that is commonly used and recently criminalized in abortion and miscarriage.
Maternal health researchers say if the CDC created such a category, researchers would be able to see whether delays in post-abortion care are increasing.
Experts told ProPublica that this classification likely covers the three other deaths reported by ProPublica, in which Texas women had not considered terminating their pregnancies but needed the same procedure to manage a miscarriage. ProPublica’s report found that in those cases, as well as Thurman’s, doctors deviated from the standard of care, raising serious questions about how criminal abortion bans affect abortion care.
“Publicly available data from the CDC show alarming increases in maternal mortality in states that ban abortion,” said Nancy L. Cohen, director of the Gender Equity Policy Institute, a nonpartisan research group. . “Our analysis of the evidence and other factors strongly suggests that bans are driving this increase, but it is currently impossible to determine whether abortion restrictions are causing specific deaths based on publicly available data.”
She said the CDC “has the authority to correct this problem” by requiring states to collect information on whether abortion restrictions lead to deaths.
Inas Mahdi, a maternal health researcher who worked at the CDC for 15 years, said officials at her previous agency knew the power of investigating the impact of policies. “The CDC is clear, without data there is no action,” she said. But she added that without more direct support from the government, officials may feel “terrified” about wading into a “polarizing” topic.
In Republican-led states, there is little interest in studying the harmful effects of laws their leaders enthusiastically support, and any backlash could stymie bipartisan efforts to improve maternal health, she said.
Her CDC alumnus, Dr. Zsakeba Henderson, agrees. “If the CDC asked the Maternal Mortality Review Commission to do this, I know there would be resistance at the state level,” said Henderson, who previously worked in the agency’s reproductive health division supporting the state’s perinatal care program. Quality cooperation. The maternal mortality program is voluntary and states can simply opt out. Last year, for example, Texas decided to forego federal funding and not share maternal death data with the CDC. CDC officials declined to comment on the reasons for the change. A spokesman for the Texas Department of State Health Services said the Legislature directed the agency to do so.
In response to a question from ProPublica about whether his order is being implemented, a Biden administration spokesperson listed a series of efforts to collect and provide data on contraceptive use and maternal health outcomes. They said the administration also “amplified” data from other sources on the impact of the abortion ban in a memo.
Asked why the CDC had not created a checkbox to track abortion-related deaths, a spokesman for the U.S. Department of Health and Human Services, the CDC’s parent agency, said the CDC “had received State Feedback on Data Fields.” The spokesperson noted that the discrimination checkbox was “added at the request of the state” following a multi-year process by a working group.
The spokesperson also said the lack of a checkbox does not mean HHS is failing to achieve the goals of Biden’s order. The spokesperson forwarded a 73-page update on the maternal mortality crisis that was submitted to Congress in July this year. The report is packed with information on progress in tackling major maternal health risks: task forces to support mental health, initiatives to address the opioid crisis, research on intimate partner violence.
It does not include any mention of abortion access.
Ushma Upadhyay, a public health scientist at the University of California, San Francisco, said collecting data is critical to understanding how the new abortion ban affects maternal health. Research she conducted through WeCount, a program of Planned Parenthood, helped determine that the number of abortions has increased nationwide since Roe v. Wade was overturned.
She said that although she participated in roundtable meetings with Department of Health and Human Services officials to discuss how to better support abortion-related reproductive health research, she never saw the agency take action based on those talks. (When asked what those conversations led to, the agency shared a press release during an expert roundtable on contraception and said its work on how abortion restrictions affect maternal health is ongoing.)
Upadhyay said sending an update on maternal mortality to Congress without mentioning abortion access as evidence of compliance with the order “kind of says it all.” When it comes to measuring the impact of abortion restrictions, “the Department of Health and Human Services hasn’t done much.”
Upadhyay said the federal government’s biggest contribution to this effort has been millions of dollars in National Institutes of Health funding for academics to study the effects of abortion restrictions. But more than two years after the Dobbs v. Jackson Women’s Health decision allowed the abortion ban to take effect, none of the studies have been published, and it’s unclear whether the incoming administration will continue to fund them.
Researchers tracking reproductive health lament that the sector failed to think creatively and take urgent action to monitor the impact of abortion bans when they had the chance.
“The Biden administration’s missed opportunity is that it saw Dobbs as a political moment that gave Democrats an advantage,” said Tracy Weitz, director of the Center for Health, Risk and Society at American University. “It failed to treat this as a Take this public health crisis seriously.”
That window is closing as President-elect Donald Trump prepares to take office. It will be nearly impossible for a Republican administration to try to collect data to help illuminate the impact of abortion bans, which were unanimously passed by Republican-majority statehouses.
Last week, Trump named Ed Martin, a prominent anti-abortion activist, as chief of staff in his Office of Management and Budget, which oversees the management of the federal budget. Martin opposes abortion exceptions, supports a nationwide ban, and discusses the idea that women and doctors should be prosecuted for abortions.
If Project 2025 is any guide to how the Trump administration approaches abortion, the CDC may soon be launching a very different plan: launching a mandatory nationwide surveillance program aimed at reducing abortion care. Portrayed as dangerous.
A conservative blueprint for reshaping the federal government recommends the agency require all states to report detailed data on abortions, miscarriages and stillbirths or risk losing federal funding.
It states that the CDC “should ensure that abortion is not considered medical care.” Instead, “it should fund research into the risks and complications of abortion.”
Mariam Elba contributed research.