The deadly reality of abortion bans is unfolding in the US—like it once did in Ethiopia

I read with dismay and devastation a recent report from the Gender Equity Policy Institute. The report revealed that pregnant women living in US states with abortion bans are 2 times as likely to die than those in states where abortion care is legal and accessible.1 This grim reality was further compounded this month by the Trump administration’s withdrawal of emergency abortion guidance, stripping away critical federal protections that had ensured access to lifesaving care in urgent medical situations.

The US Supreme Court decided in 2022 to overturn the right to abortion and leave its legality up to individual states in the Dobbs v Jackson case. Three years on, this report is connecting the dots between the states that banned abortion and the knock on effect on maternal mortality. It’s yet another piece of global evidence pointing to the profound harm of abortion bans.

I know all too well how dangerous restrictive abortion laws can be for women’s health and lives. I have lived through an abortion ban in my country, Ethiopia, and have also seen the subsequent transformative effect of liberalising abortion.2 I’ve also seen the positive impacts of expanding access to safe abortion in my role as director of MSI Reproductive Choices Ethiopia, an organisation that provides abortion and other forms of reproductive healthcare. The US can learn from Ethiopia if it wants to save women’s lives.

The maternal mortality rate in the US (18.6 deaths per 100 000 live births) is considerably higher than in other high income countries.3 This wealthy nation is failing pregnant women who are dying from preventable causes.

Two decades ago in Ethiopia, we faced high numbers of maternal deaths. Our hospitals were filled with women who, desperate to end unwanted pregnancies, were risking their lives at the hands of untrained providers, ingesting bleach or inserting sharp sticks into their bodies, developing sepsis, and dying. This public health crisis compelled the government to respond. They introduced World Health Organization recommended guidance on sexual and reproductive healthcare and made a dedicated effort to expand access to contraception. Crucially, our law changed in 2005 to expand safe and legal abortion care. Since then, maternal mortality has decreased by more than 70% from 754 deaths per 100 000 live births in 2005 to 195 per 100 000 in 2023.4

The many states in the US that have restricted abortion, despite the evidence and public health imperative in front of them, are effectively sanctioning maternal deaths.5 Texas, for example, is home to a stringent abortion ban and has the highest maternal mortality in the country. Its maternal mortality rate is 155% higher than California (9.5 maternal deaths per 100 000 live births), which has enshrined the right to abortion and provides public funding for abortion access. While anti-abortion groups boast that Texas’ law is “saving lives,” maternal mortality rose 56% in the first year of the abortion ban alone.1

Other factors like differing access to health insurance and prenatal care are also at play, but the link between expanding abortion access and declining maternal mortality is globally documented. US decision makers turning a blind eye to this amounts to cruel negligence.

The Gender Equity Policy Institute’s report and recent New York Times reporting lays bare appalling health inequities.6 Access to abortion has become harder for many people in the US—yet those facing the greatest barriers are black and Hispanic Americans, younger or less educated people, and people from low income backgrounds. Black pregnant women in states where abortion is banned are dying at a rate 3.3 times higher than white women.1 Black women and girls make up a higher proportion of the population in states that have banned abortion, deepening this inequity.

Working for a global abortion provider, I know all too well that abortion restrictions are disproportionately harmful to marginalised communities. They force women to travel long distances to access the healthcare they need and require them to overcome bureaucratic hurdles or prolonged wait times. These are all things that require time and money that vulnerable people often do not have. Safe healthcare becomes a privilege of the rich. In the US, systemic racism is further depriving people of the healthcare they need.

These bans aren’t even having the effect of reducing abortions that they supposedly set out to do: the number of abortions has increased in the US.7 Abortion bans don’t prevent abortions, they only make them less safe and threaten women’s lives. It begs the question of why anti-abortion groups continue to push for more bans.

History tells us that women will still find ways to end pregnancies they don’t want. Whether that’s by interventions led by activists like accompaniment networks in which people in abortion supportive places help women in restricted settings.8 Or by using innovations like telemedicine, which allows women to self-administer abortions. Or by desperate, unsafe methods like visiting unqualified “abortion providers” or taking matters into their own hands at risk of their lives.

I urge US states to stop letting politics muddy this otherwise safe and straightforward healthcare, which one in four women in America will need in their lifetime.9 The US needn’t look far for examples and evidence based approaches that support women’s maternal health outcomes.

I hope to see America turn this around like Ethiopia did. As healthcare professionals and decision makers, we have a mandate to use the evidence in front of us to safeguard health and protect lives.