Last month, the American Journal of Preventive Medicine published a study by a group of economists and public health scholars. It analyzed state data to argue that various pro-life policies increased state maternal mortality rates. Specifically, this study purportedly found that state level pro-life laws which limit late-term abortions increase the maternal mortality rate. It also purportedly found that reductions in Planned Parenthood facilities also result in an increased rate of maternal mortality. This study was covered by Reuters and was subsequently picked up by a number of other news outlets.
However, these findings should be treated with caution. Another recent study that used state data to calculate and analyze maternal mortality rates contained significant errors.
READ: Washington Post: No proof that pro-life laws worsen maternal mortality rate
In 2016, an article published in Obstetrics and Gynecology used state mortality data to report a sharp increase in the maternal mortality rate in Texas. Many commentators were quick to blame state funding cuts to Planned Parenthood — even though the reported increase in the maternal mortality rate took place before the funding cuts took effect. More importantly, revised data published in Obstetrics and Gynecology in 2018 found that the actual maternal mortality rate in Texas was half of what was previously reported.
Additionally, there are methodological problems with the recent American Journal of Preventive Medicine study. The authors were only able to analyze 4,767 of the 6,620 maternal deaths that took place between 2007 and 2015, which means 28 percent of maternal deaths were not analyzed. Similarly, data from only 38 of the 50 states was analyzed in this study.
Some economic factors that might impact maternal mortality rates – like the state poverty rate – are not held constant in the study. Additionally, the fact that limits on late-term abortion are correlated with statistically significant increases in maternal mortality rates seems unusual. This is because many of these limits are unenforced and only a relatively small percentage of abortions are performed in the third trimester.
Another methodological problem is that the study analyzes percentage fluctuations in the number of Planned Parenthood facilities. The number of Planned Parenthood facilities in each state varies widely. It is possible that the closure of one Planned Parenthood facility in a low population state might represent a large percentage decrease and distort the results. For instance, the lone Planned Parenthood in Washington, D.C., shut down in 2015. The study reports that D.C. had a 100 percent decline between 2007 and 2015. This is misleading for a couple reasons. First, DC residents would have been able to access Planned Parenthood facilities in nearby Maryland. Second, a new Planned Parenthood facility opened in D.C. in 2016. Overall, it would have been more methodologically appropriate to consider changes in Planned Parenthood facilities per capita.
READ: No, Texas’ maternal mortality rate did not spike after defunding Planned Parenthood
Finally, the study analyzes a considerable amount of data that is not particularly useful. For instance, for each U.S. state, the authors calculate the respective maternal mortality rate for Whites, Blacks, Hispanics, and other races. While this sounds fine, many states have a small population of racial and ethnic minorities. For example, analyzing the maternal mortality rate of African American women in North Dakota provides us with little information about the factors which impact maternal mortality rates, because relatively few African American women of childbearing age live in North Dakota. Furthermore, when analyzing a low population demographic, even one maternal death would make the maternal mortality rate look exceptionally high and could potentially distort the results.
Overall, this American Journal of Preventive Health study is the latest in a long line of attempts to try make the case that pro-life policies worsen public health. In contrast, however, good research shows that pro-life laws improve public health outcomes. Since Texas excluded Planned Parenthood from the state family planning program in 2011, there has been a 57 percent decline in the abortion rate for minors, and a 49 percent decline in the birth rate for minors in the Lone Star State. Ireland, which up until recently protected the preborn, has had consistently lower maternal mortality rates than Britain and Scotland where abortion has been legal for a long time. Unfortunately, these kinds of statistics are rarely, if ever, cited by mainstream media outlets.
Michael J. New is a Visiting Assistant Professor at The Catholic University of America and an Associate Scholar at the Charlotte Lozier Institute. Follow him on Twitter @Michael_J_New.
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