Fatal Restrictions: Exploring State-Level Abortion Laws, Sociodemographic Contexts, and Maternal Mortality in the United States

Abstract

The United States reports one of the highest maternal mortality rates (MMR) among high-income nations, reflecting a persistent public health crisis. Pregnancy-related deaths disproportionately affect individuals across racial and socioeconomic lines, illustrating long-standing systems of disadvantage. In the wake of the 2022 Dobbs v. Jackson Women’s Health Organization decision, which overturned Roe v. Wade, understanding the policy and structural drivers of maternal mortality is increasingly urgent. This study independently examines how state-level abortion laws and key sociodemographic factors, including race, immigration status, poverty, health insurance coverage, public assistance, unemployment, and income, shape variation in MMR across U.S. states from 2018 to 2022. Using a state-level analysis, I classify abortion laws along a restrictive-protective continuum and use multiple linear regression models to assess the independent effects of sociodemographic factors. Results show that restrictive abortion laws consistently emerge as a significant predictor of higher maternal mortality rates. Additionally, states with larger Black populations, higher poverty and unemployment rates, greater proportions of uninsured residents, and increased participation in Supplemental Nutrition Assistance Program (SNAP) experience elevated MMR, each exhibiting a statistically significant association within their respective models. Interaction effects further reveal that socioeconomic resources, such as income and education, moderate the impact of abortion restrictions. These findings demonstrate that maternal mortality is influenced by both restrictive policies and entrenched structural inequality. This research provides critical insight into the potential consequences for maternal health in a post-Dobbs landscape, where legal restrictions on reproductive care intersect with broader social disparities