Abortion policy, political control, and maternal and infant mortality in the United States: a cross-sectional ecological study

Maternal and infant mortality in the U.S. remain the highest among high-income nations, with disparities worsening after Dobbs v. Jackson Women’s Health Organization. This study examined how abortion bans and partisan political control are associated with maternal and infant mortality, while accounting for sociodemographic, economic, and healthcare factors. We conducted a cross-sectional ecological study of all 50 U.S. states, linking maternal mortality ratios (MMR) and infant mortality rates (IMR) with abortion policy classifications (total ban, ban at ≤ 18 weeks, ban after 18 weeks, no gestational ban) and partisan control of governors, legislatures, and senates. Multivariable regressions adjusted for sociodemographic, economic, and healthcare variables. Unadjusted analyses showed MMR and IMR were higher on average in Republican-led states (27 vs. 20 per 100,000; 6.3 vs. 5.0 per 1,000; all p < 0.01), with political control accounting for up to one-quarter of the variance (R²=0.21–0.25). In adjusted models, total abortion bans were correlated with higher MMR (β = 5.28, p = 0.0315, R²=0.81) and IMR (β = 1.15, p = 0.0014, R²=0.86). Higher mortality correlated with greater fertility and larger Black population shares; protective factors included higher income, state investment, education, life expectancy, Hispanic population, and healthcare access. These patterns clustered by party control. In this ecological analysis, abortion bans and Republican political control were correlated with higher maternal and infant mortality at the state level. While individual-level causality cannot be inferred, addressing structural disparities may help reduce preventable deaths. Maternal and infant deaths remain higher in the United States than in other wealthy countries. These problems have become worse since the Dobbs v. Jackson Women’s Health Organization decision, which allowed many states to ban or restrict abortion. Our study looked at whether abortion laws and political control in each state are related to the number of women who die during or shortly after pregnancy (maternal mortality) and the number of infants who die before their first birthday (infant mortality). We studied all 50 states uosing publicly available data. We compared maternal and infant death rates with state abortion policies (from total bans to no gestational bans) and with whether Republicans or Democrats controlled the governor’s office and state legislatures. We also considered other important factors such as income, education, access to healthcare, and racial/ethnic makeup of the population. We found that states with abortion bans and Republican political control had higher maternal and infant death rates than states without bans and with Democratic control. For example, maternal mortality was about one-third higher in Republican-led states. Higher fertility rates and larger Black populations were linked with more deaths, while protective factors included higher income, greater state investment, more education, longer life expectancy, and larger Hispanic populations. Our findings show that restrictive abortion policies and political control are linked with worse outcomes for mothers and infants. Although this type of study cannot prove direct cause, it highlights the need to address underlying inequalities to save lives.