State-level variation in severe maternal morbidity, 2019-2023

In 2022 fourteen states implemented abortion bans without exceptions, after which abortion became extremely rare in states with a ban. Researchers have hypothesized that these restrictions may have adversely affected maternal health because childbirth is associated with greater risk than abortion, and because some patients with life-threatening pregnancies have reported being delayed or denied abortion care. However, little evidence exists on the impact of abortion restrictions on maternal health. This research aims to examine evidence on the impact of abortion restrictions on severe maternal morbidity (SMM), defined as significant short- or long-term consequences to a pregnant woman’s health, and the extent to which changes in state restrictions have affected existing maternal health differences between groups. The project will create a comprehensive dataset using hospitalization records from 42 U.S. states (2019-2023) that includes inpatient healthcare, health outcomes, and state abortion policies. Using state of the art design and methods we will compare changes in SMM in states with and without abortion bans. We will then examine the change in state-level hospitalizations that include SMM focusing specifically on state-level hospitalizations in which the patient had a life-threatening obstetric condition and experienced SMM. This project will have the following three Aims: • Aim 1. Generate a novel dataset using hospitalization records from 42 U.S. states and Washington DC (2019-2023) that includes inpatient healthcare and health outcomes alongside state abortion restrictions. • Aim 2. Examine the impact of changes in state restrictions on incidence in pregnancy hospitalizations with SMM. • Aim 3. Examine the impact of changes in state restrictions on incidence of SMM among hospitalized patients with a subset of life-threatening pregnancy conditions. This project will generate a population-level estimate of whether and how state restrictions have affected maternal health to inform state and federal policies and to safeguard health during pregnancy. Project Number: 5R01HD116812-02 | Fiscal Year: 2026 | NIH Institute/Center: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) | Principal Investigator: Maria Steenland | Institution: UNIV OF MARYLAND, COLLEGE PARK, COLLEGE PARK, MD | Award Amount: $291,388 | Activity Code: R01 | Study Section: Social Sciences and Population Studies A Study Section[SSPA] View on NIH RePORTER: https://reporter.nih.gov/project-details/5R01HD11681202