Southern States that Banned Abortion Had the Highest Rates of Black Maternal Mortality Even Before ‘Roe’ Fell

In the weeks after Roe v. Wade was overturned in 2022, a Black woman in Louisiana named Nancy Davis said she was denied an emergency abortion for a fetus that lacked a skull and the top of its head, even though continuing the pregnancy severely threatened her health and safety. Davis was ultimately able to travel out-of-state for abortion care; still, her lawyer said state lawmakers had “inflicted unspeakable pain, emotional damage, and physical risk” on his client. Louisiana’s abortion ban sweepingly prohibits the health service with exceptions for a list of specific medical conditions, and Davis wasn’t exempt.

Dwindling or nonexistent access to abortion has made life more dangerous for pregnant people everywhere, but across the deep South, abortion bans have only worsened maternal mortality rates for Black women. In a new research memo first shared with Jezebel this week, the Democratic Legislative Campaign Committee found that southern states that have banned abortion already had the highest maternal mortality rates for Black women in the country, even before Roe fell. In 2023, a report that analyzed CDC data from the Milken Institute showed that maternal mortality rates for Black women were 25% higher than the national average between 2018 and 2021. So while the data slightly predates the overturning of Roe, we know that if maternal mortality outcomes were high before, they’ve only worsened since June 2022. Over the summer, a survey of American OBGYNS showed 64% believe the overturning of Roe worsened pregnancy mortality and 70% said it worsened racial inequities, even as experts say it may take years to understand the full toll of abortion bans on maternal health outcomes.

The DLCC’s memo studied seven Southern states, including Louisiana, noting that the majority of Black Americans live in states that ban abortions, where they “face the compounding impacts of medical racism and deadly abortion bans.” Across the country, Black women are three times more likely to die from pregnancy-related causes than white women. In Alabama, North Carolina, and Texas, Black mothers are twice as likely to die during birth; in Florida, Mississippi, and Louisiana, they’re about four times as likely. In Georgia, Black mothers are more than three times as likely to die from pregnancy complications than white women. 

Georgia state Rep. Park Cannon (D) cautioned Jezebel that maternal mortality rates in her state are the tip of the iceberg: “Just because you don’t show up on a maternal mortality list doesn’t mean you had a positive or dignified birth experience or pregnancy journey.” Cannon says she’s increasingly heard about experiences with “maternal morbidity” in Black communities in Georgia, which consists of complications and cases of near-death experiences related to pregnancy. “There are so many near-misses, people experiencing obstetric violence, people forced into pregnancies by abortion bans, then left with no access to health care.” It doesn’t help, Cannon says, that health care facilities in the state are “severely under-resourced,” the state refuses to expand Medicaid, and 15% of Georgian women ages 19-64 are uninsured. Medicaid expansion has been shown to sharply lower maternal deaths, especially among Black women.

In Davis’ state of Louisiana, Black women are up to four times more likely than white women to die during or after birth, and Black infants are nearly twice as likely to die as white infants, according to Louisiana Pregnancy-Associated Mortality Review data and the National Center for Health Statistics respectively. Louisiana’s maternal mortality rate is also substantially higher than the federal maternal mortality rate: Across the state, 39 out of every 100,000 mothers die during or shortly after childbirth. By comparison, the federal maternal mortality rate for 2021 stood at 32.9 deaths per 100,000 live births, up from 23.8 in 2020 and 20.1 in 2019. 

For the last 1.5 years since the Supreme Court overturned Roe, abortion bans have instilled a culture of secrecy and fear around pregnancy and pregnancy-related decisions, discouraging people from seeking care even in emergencies out of fear of being implicated in the criminal legal system. If they do seek care, they could be denied by health care providers who fear criminalization or loss of their medical license, or they could struggle even to find a provider since abortion bans have pushed so many doctors to leave their states.

In North Carolina, state Sen. Sydney Batch (D) says her state is experiencing a drain in OBGYNs, doctors, and medical residents as a result of their 12-week abortion ban, which took effect in 2023 with the help of a Democratic state legislator defecting to join Republicans. “These bans have made it very difficult for OBGYNs to stay here. Some are worried about being criminally charged,” Batch said. “Some are worried about having to make a decision between what the law is interpreted to say they can do, and saving women’s lives.” 

Black women suffer the brunt of these outcomes, Amanda Williams, medical director of Mahmee and maternal health equity expert, told Jezebel. “It’s important to bring in the context of systemic racism in this conversation,” Williams said. “Not only are our patients not being listened to and being harmed by policies born out of racism—we know Black women were dying at even higher rates before, thanks to bans.”