US Abortion Bans and Pregnancy-Associated Mortality.

Importance: Few studies, mostly from the era before the Dobbs v. Jackson Women's Health Organization US Supreme Court decision, have projected increases in pregnancy-related and maternal mortality in states with restrictive abortion laws. However, the association between post-Dobbs abortion bans and pregnancy-associated mortality remains unclear. Objective: To examine the associations of complete and 6-week abortion bans with pregnancy-associated mortality in the US. Design, Setting, and Participants: This retrospective, population-based cohort study included 14 states with abortion bans and 37 control states, including the District of Columbia, without abortion bans. US National Center for Health Statistics birth and mortality data from 2018 to 2023 were analyzed using synthetic control methods with staggered adoption, comparing ban states to their synthetic controls. Data were analyzed from July to December 2025. Exposure: State-level implementation of complete or 6-week abortion bans. Main Outcomes and Measures: The primary outcome was pregnancy-associated mortality. Secondary outcomes included pregnancy-related, maternal, and nonobstetric causes of death. Mortality ratios were examined quarterly and between preban and postban periods. Results: From 2018 to 2023, there were 22 011 131 live births and 12 993 pregnancy-associated deaths. Pregnancy-associated mortality declined by 9.8% in nonban states (54.5 [95% CI, 53.3 to 55.8] to 49.2 [95% CI, 46.5 to 52.0] deaths per 100 000 live births). In states with bans, smaller declines were observed: 2.4% in states excluding Texas (83.2 [95% CI, 80.1 to 86.3] to 81.2 [95% CI, 74.5 to 88.4] deaths per 100 000 live births) and 3.3% in Texas (54.2 [95% CI, 50.5 to 58.1] to 52.4 [95% CI, 47.4 to 57.7] deaths per 100 000 live births). Increases were largest among non-Hispanic Asian (41.0%; from 39.5 [95% CI, 27.7 to 54.7] to 55.7 [95% CI, 26.7 to 102.4] deaths per 100 000 live births) and non-Hispanic Black or African American (17.8%; from 140.2 [95% CI, 131.7 to 149.1] to 165.2 [95% CI, 144.2 to 188.3] deaths per 100 000 live births) individuals in ban states excluding Texas. Synthetic control analyses yielded an estimated difference of 5.1 (95% CI, -7.9 to 18.2) pregnancy-associated deaths per 100 000 live births, which was not statistically significant. Overall estimates for pregnancy-related mortality (-2.0; 95% CI, -11.5 to 7.5), maternal mortality (-3.0; 95% CI, -10.2 to 4.2), and nonobstetric causes (1.2; 95% CI, -7.3 to 9.7) were likewise not statistically significant. State-specific estimates were heterogeneous, but none reached statistical significance. Covariate-adjusted models yielded similar results. Conclusions and Relevance: This cohort study found that abortion bans were not associated with statistically significant overall or state-specific increases in pregnancy-associated mortality. The short postban observation window and wide CIs highlight the need for continued surveillance as more post-Dobbs data become available.