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Pregnancy- and Abortion-Related Mortality in the US, 2018-2021
Maria W Steenland1, Kerra Mercon1, Benjamin P Brown2
1Department of Family Science, School of Public Health, University of Maryland, College Park, College Park.
JAMA Network Open
|January 21, 2026
Summary
Updated data shows pregnancy-related deaths are significantly riskier than abortion-related deaths. The mortality ratio is at least 3 times higher, highlighting the health risks of forced pregnancy continuation.
Area of Science:
- Public Health
- Reproductive Health
- Mortality Statistics
Background:
- The Dobbs v. Jackson Women's Health Organization decision has intensified discussions on abortion access and maternal health.
- Previous estimates (1998-2005) indicated childbirth mortality was ~14 times higher than abortion mortality.
- Updated data is needed to reflect current maternal death detection and abortion safety.
Purpose of the Study:
- To calculate the ratio of pregnancy-related to abortion-related mortality using recent data (2018-2021).
- To compare updated mortality ratios with historical estimates.
- To assess the impact of abortion restrictions on maternal health risks.
Main Methods:
- Cross-sectional study using National Vital Statistics System data (2018-2021) for births and pregnancy-related deaths.
- Abortion-related deaths sourced from the Pregnancy Mortality Surveillance System; abortion numbers from the Guttmacher Institute.
- Mortality ratios calculated per 100,000 births/abortions, with sensitivity analyses excluding certain ICD-10 codes and COVID-19 deaths.
Main Results:
- Between 2018-2021, there were over 14.9 million births and 3.6 million abortions.
- The mean pregnancy-related to abortion-related mortality ratio ranged from 44.3 to 69.6, depending on exclusions.
- This updated ratio is at least 3 times higher than the 1998-2005 estimate of 14.7.
Conclusions:
- The risk of death from pregnancy is substantially higher than from abortion, based on 2018-2021 data.
- Abortion bans compel individuals to undertake greater health risks associated with continuing a pregnancy.
- Ensuring access to abortion is critical for mitigating maternal health risks.
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