Overturning Roe v. Wade: Health Consequences for Pregnant People Likely to Include an Increase in Maternal Sepsis

Experts predict that today’s Supreme Court decision to overturn Roe v. Wade and end the Constitutional right to abortion will increase maternal morbidity and mortality in the United States. Incidence of maternal sepsis, which can develop from any infection that occurs during pregnancy, delivery, or the postpartum period, or after miscarriage or abortion, is also likely to increase as a direct result of this decision.

The United States already has one of the highest maternal mortality rates in the industrialized world and very high maternal morbidity numbers. In 2018, the U.S. experienced 17.4 maternal deaths per 100,000 live births, compared with half that rate or less in Canada, France, the UK, the Netherlands, Norway, and New Zealand.[i] In 2020, the U.S. maternal mortality rate spiked to 23.8 deaths per 100,000 live births.[ii] What’s more, maternal morbidity—which includes “near miss” events that could have resulted in a death, or other pregnancy-related events with significant health consequences—affects approximately 50,000 to 60,000 pregnant people in the U.S. each year.[iii] Today’s Supreme Court decision will likely worsen these trends: data indicate that pregnancy-related deaths could rise 20% or more in the states where abortion will now become severely restricted or completely inaccessible.[iv] “Near miss” and other health events with lasting complications are likely to follow suit.

Maternal sepsis complicates an estimated 10 cases per 10,000 live births in the U.S.[v] and is this country’s second leading cause of pregnancy-related death.[vi] These numbers are similarly likely to increase. “Septic abortion,” which refers to any abortion that is complicated by serious infection leading to sepsis, is ”much more common when induced abortion is illegal,”[vii] largely due to nonsterile techniques and environments. Historical data show that the legalization of abortion beginning in the 1960s contributed to an 89% decline in deaths from septic illegal abortions between 1950 and 1973.[viii] There is also a higher likelihood of negative outcomes, including sepsis, associated with pregnancy continuation and live birth than with safe, legal abortion.[ix] Maternal sepsis and overall maternal mortality are, therefore, likely to increase not only due to unsafe abortions, but also due to an increase in the number of pregnancies carried to term, and a corresponding increase in related complications.[x]

It is important to note that the additional burdens resulting from today’s decision will be felt disproportionately by some birthing people of color, those of lower socioeconomic status, and those whose communities have historically lacked access to high-quality medical care—especially those who live in “maternity care deserts,” or areas in which access to maternity care services is severely limited or absent.[xi]

Improving outcomes for pregnant people has been, and will remain, one of Sepsis Alliance’s top advocacy priorities. Although today’s decision will likely result in an increase in maternal sepsis incidence, worse maternal sepsis outcomes, and an increase in overall maternal morbidity and mortality in the U.S., our organization will continue to amplify and partner with organizations working to improve outcomes for all pregnant people. We will continue to do our part—through public education, provider training, and advocacy—to improve maternal sepsis awareness and care, and to work towards a world in which no one is harmed by sepsis.

 

[i] Roosa Tikkanen, Munira Z. Gunja and Molly FitzGerald et al. Maternal Mortality and Maternity Care in the United States Compared to 10 Other Developed Countries. DOI: 10.26099/411V-9255

[ii] Hoyert DL. Maternal mortality rates in the United States, 2020. NCHS Health E-Stats. 2022. DOI: https://dx.doi.org/10.15620/cdc:113967external icon.

[iii] “Severe Maternal Morbidity in the United States: A Primer.” Commonwealth Fund, 28 Oct. 2021, https://www.commonwealthfund.org/publications/issue-briefs/2021/oct/severe-maternal-morbidity-united-states-primer.

[iv] Amanda Jean Stevenson; The Pregnancy-Related Mortality Impact of a Total Abortion Ban in the United States: A Research Note on Increased Deaths Due to Remaining Pregnant. Demography 1 December 2021; 58 (6): 2019–2028. doi: https://doi.org/10.1215/00703370-9585908

[v] Acosta CD, Knight M, Lee, HC, Kurinczuk, JJ, Gould, JB, & Lyndon, A. The continuum of maternal sepsis severity: incidence and risk factors in a population-based cohort study. PloS one. 2013. 8(7). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3699572/

[vi] “Pregnancy Mortality Surveillance System.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 13 Apr. 2022, https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm.

[vii] Dulay, Antonette T. “Septic Abortion – Gynecology and Obstetrics.” Merck Manuals Professional Edition, Merck Manuals, https://www.merckmanuals.com/professional/gynecology-and-obstetrics/abnormalities-of-pregnancy/septic-abortion.

[viii]  Healthier mothers and babies, National Center for Chronic Disease Prevention and Health Promotion (U.S.). Division of Reproductive Health. Published Date : October 1, 1999. Series : Achievements in public health, 1900-1999. Source : MMWR Morb Mortal Wkly Rep. 1999 Oct 1;48(38):849-58. https://stacks.cdc.gov/view/cdc/107662

[ix] Raymond EG, Grimes DA. The comparative safety of legal induced abortion and childbirth in the United States. Obstet Gynecol. 2012 Feb;119(2 Pt 1):215-9. doi: 10.1097/AOG.0b013e31823fe923. PMID: 22270271.

[x] Amanda Jean Stevenson; The Pregnancy-Related Mortality Impact of a Total Abortion Ban in the United States: A Research Note on Increased Deaths Due to Remaining Pregnant. Demography 1 December 2021; 58 (6): 2019–2028. doi: https://doi.org/10.1215/00703370-9585908

[xi] Kelly BC, Brewer SC, Hanson HA. (2022). Disparities in Distance to Abortion Care Under Reversal of Roe v. Wade. Utah Women’s Health Review. doi: 10.26054/0d-4zt7-ts67