ProPublica has recently gained significant media attention by revealing tragic instances of maternal deaths in a post-Dobbs landscape. Readers may be familiar with the cases of Amber Thurman, a Georgia woman who died after doctors inexplicably delayed miscarriage treatment, and Candi Miller, another Georgia woman who died from infection after using the abortion pill and was found to have traces of opioids in her system.
But it’s Texas, in particular, that’s garnered outsized media attention, as ProPublica has highlighted the cases of Josseli Barnica, Porsha Ngumezi, and Naveah Crain, who all suffered tragic, and most likely preventable, deaths during pregnancy complications.
By examining maternal death certificates, investigations by ProPublica have exposed what are, in many cases, preventable maternal deaths across the nation, and the substandard prenatal care practices that precipitated them. These deaths must be taken seriously, in the evaluation of what is considered America’s rising maternal mortality crisis, concentrated disproportionately among black women. According to some reports, the US continues to have the highest maternal mortality rate in the developed world, with 80 percent of maternal deaths categorized as preventable, like the cases highlighted by ProPublica.
The pro-abortion lobby wrongly attributes the cause of preventable maternal deaths to abortion regulations. The truth is more complex. In the absence of an honest approach to evaluating these tragedies, pregnant women will continue to suffer.
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These changes represented a 62 percent increase in the MMR in 2020 and a 119 percent increase in the Texas MMR in 2021. This rate of increase is shocking and has culminated in pointed media attention blaming the passage of Texas abortion restrictions in SB 8, the Texas law that limits most abortions in the state.
But it’s not abortion regulation that’s contributed to a rise in maternal mortality. No woman highlighted by ProPublica was in need of an induced abortion to end the life of her baby. But perhaps the absence of legalized and widely available abortion could reveal something more sinister happening to American prenatal care. Could doctors, unused to treating pregnant patients without the band-aid of abortion, be increasingly ill-equipped to handle prenatal complications, thus contributing to rising maternal mortality in select cases? Secondly, could incomplete and missing data on maternal mortality in the US be driving political narratives that harm the pro-life cause?
To examine these hypotheses, we propose a series of questions that the pro-life community must ask (and answer) to combat rampant disinformation propagated by the pro-choice lobby. Making sense of maternal mortality numbers is notoriously challenging. Still, pro-life supporters must be willing to push for both increased clarity in data collection and improved standards of care nationwide.
1) How many women are truly dying during pregnancy, as well as during and after childbirth in our country?
The CDC defines the maternal mortality rate as the number of maternal deaths per 100,000 live births. An effective maternal mortality surveillance system consists of the standardization of reporting and complete coverage of the target population being measured.
The current maternal mortality reporting system fails to meet these requirements. There is no standardization of reporting. Historically, gathering accurate maternal mortality data at both the state and national levels has been fraught with errors, leading to the inability to draw meaningful conclusions. In 2018, the National Center for Health Statistics (NCHS) released the first national estimate of maternal mortality in more than a decade because data collection was so poor.
It is also worth noting that the US may count maternal deaths differently than other countries, which may be significantly undercounting their own maternal deaths by comparison.
Our current surveillance system does not identify the deaths of all pregnant women. The current measurement of maternal mortality using the number of live births as the denominator only includes women who deliver a live baby. Approximately 60 to 70 percent of all pregnancies in the United States result in a live birth, and this number is even lower in non-Hispanic black women. Our current surveillance system excludes an estimated 30 to 50 percent of pregnancies in which the pregnancy ends by natural fetal loss (e.g., miscarriage, ectopic pregnancy, molar pregnancy) or by induced abortion.
By excluding all these women, the denominator is smaller and automatically leads to a higher maternal mortality rate. For example, in the current surveillance system, fifty deaths per 100,000 live births is a maternal mortality rate of 0.05 percent. If the same number of women (fifty) died, but the denominator included all pregnant women (200,000), the maternal mortality rate would be cut in half (0.025 percent) simply because all women were included.
Approximately 20 percent of all pregnancies end in abortion, yet there is no mandatory requirement to report the number of induced abortions or complications of abortions nationally. This has led to an incongruence in the reported number of induced abortions since abortion was legalized in 1973. The CDC estimates 43 million induced abortions, while the Guttmacher Institute estimates 63 million induced abortions. This 20 million count difference highlights the serious flaws in our monitoring system.
In Texas’s Maternal Mortality and Morbidity Review Committee Report cited above, maternal deaths associated with abortions are not even legally allowed to be included in the analysis provided by the committee. This lack of concern for the safety of women who choose to have an induced abortion is appalling given an estimated one in four women in the United States will have had an induced abortion by age forty-five.
Without accurate data, an answer to this question of how many women die during pregnancy is impossible. The newly nominated Center for Disease Control and Prevention (CDC) director, Dr. David Weldon, should be tasked with overhauling the maternal mortality surveillance system to accurately answer this question to improve prenatal standards of care for American women.
2) What are the causes of death of women during pregnancy, childbirth, and after?
Eighty percent of maternal deaths are probably preventable, according to a 2022 CDC report. American women do die during pregnancy, during childbirth, and after pregnancy. The CDC’s data demonstrate that approximately one-quarter of the deaths occur during pregnancy, one-quarter occur on the day of delivery, and half occur between seven days and one year after pregnancy. The most common causes include hemorrhage, infection, blood clots, heart-related conditions, disorders related to blood pressure, and mental health conditions. Dr. Wanda Barfield, the CDC Director of the Division of Reproductive Health, stated that because the majority of pregnancy-related deaths were preventable, we must ensure that all who are pregnant or postpartum “get the right care at the right time.”
We couldn’t agree more, but sadly, this is far from happening in our country. In addition to determining who is dying by improving our data surveillance system, we can and must do better at determining why women are dying and how we prevent them from doing so.
Robert F. Kennedy Jr. (RFK) has been nominated as head of the Department of Health and Human Services. If appointed, RFK’s HHS must look at the root causes of maternal mortality and seek answers in a way we have never done before to improve prenatal healthcare nationwide.
3) What are the necessary steps to stop the spread of misinformation about pregnancy care and ensure all women receive exceptional health care?
Pro-life state laws both pre- and post-Dobbs prevent the intentional killing of preborn human beings, not essential obstetric care such as the treatment of pregnancy complications before, during, and after childbirth. Any misunderstandings to the contrary on the part of physicians probably stem from rampant misinformation about abortion laws.
Medical professional organizations, state legislatures, medical boards, and other organizations and industry leaders must step in to correct the record and equip physicians with an accurate understanding of their state laws so they can confidently provide excellent healthcare to their patients. To that end, the American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG) has published a variety of educational materials, including, most recently, an online course featuring a high-risk obstetrician discussing how she and other physicians continue to provide excellent healthcare to all women in states with abortion regulations. Women and their children benefit when physicians are free to provide them with life-affirming healthcare. Every law in the nation allows this.
Doctors must put their patients first. Withholding or changing one’s approach to care because of fear of repercussions is substandard medicine. In the US to date, not a single physician has been prosecuted, including in Texas where approximately 120 abortions have been performed for pregnancy complications since the Dobbs decision. Doctors in Texas and other pro-life states who did not perform induced abortions even before Dobbs have not altered their approach to offering women the care that they need. In fact, these laws are consistent with how the majority of OB/GYNs who do not perform induced abortions practice.
Determining causes of maternal mortality is a challenging but necessary endeavor to protect women from harm and ensure high standards of prenatal care nationwide. The pro-life community must lead the push for increased data clarity that holds physicians to high standards when treating pregnant women. While any maternal death is a tragedy, abortion regulations have not been responsible for a single maternal death nationwide; women’s lives are protected in all fifty states. Instead, a pattern of substandard care for women may be the true culprit when it comes to rising maternal mortality in America.
All pregnancies end. It is time to look underneath the band-aid and determine how to keep all women safe during and after pregnancy, whether the pregnancy ends by birth, natural loss, or induced abortion.
Image by Alena Ozerova and licensed via Adobe Stock.