Risk of death from pregnancy in the US is 44 times higher than that from abortion, new analysis reveals

A figure commonly cited to compare the risks of pregnancy and abortion in the U.S. could be grossly underestimating the risk of death from pregnancy, according to a new analysis.

The research, published Jan. 21 in the journal JAMA Network Open, suggests that the risk of pregnancy-related death might be at least 44 times higher than the risk of abortion-related death. Previously, pregnancy was estimated to carry a roughly 14 times higher risk of death, making the new estimate over three times higher.

"It was already fairly alarming that you face a 14-times greater risk of death from continuing a pregnancy [compared to getting an abortion]," lead study author Maria Steenland, an assistant professor at the University of Maryland's School of Public Health, told Live Science. "But the statistics we report here suggest that this risk is really much, much higher."

The updated figure could help steer conversations surrounding abortion access in the United States, the study authors hope.

"What we're showing in the paper is quite simple: Taking away the option to end a pregnancy exposes people to a much greater risk of death," she said.

A stat based on 20-year old data

When tracing the original estimate of risk back to its source, Steenland and her colleagues realized the statistic was based on a single 2012 study using data that is now almost 20 years old.

That study looked at the Centers for Disease Control and Prevention's (CDC) Pregnancy Mortality Surveillance System for records of deaths that had happened within a year of birth; the data covered about 32,350,000 live births in the United States, between 1998 and 2005. Those data were compared with records of abortions-related deaths collected by the CDC across those same years, which totaled to 65. That was out of about 10 million total abortions, according to the Guttmacher Institute, a research nonprofit that monitors abortion surveillance data in the U.S. and globally.

"You don't have to know a lot about maternal health in the U.S. to think, 'Perhaps that statistic has changed since then,'" Steenland said. A quick "back of the envelope" calculation tipped the researchers off that this ratio might now be critically outdated, she added.

To establish an updated risk ratio, the study authors scoured national databases to pool stats collected between 2018 and 2021. The databases included the CDC's National Vital Statistics System, which provided the total number of births and pregnancy-related deaths in the U.S., out to a year postpartum. The CDC's Pregnancy Mortality Surveillance System documented the number of abortion-related deaths per year, while the total number of abortions per year was obtained from the Guttmacher Institute.

The study authors included both live births and stillbirths in the total number of births, which was not done in the 2012 study. This enabled the researchers to roughly approximate the total number of pregnancies in the U.S., which isn't currently tracked.

While this metric is the next best thing to a count of pregnancies, it still misses some, such as ectopic pregnancies and miscarriages, Steenland noted. Since they couldn't confidently count those earlier-stage pregnancies, the researchers also excluded deaths that occurred in those stages from the overall count, she said; they wouldn't have been able to generate an accurate risk ratio with the missing data.

The study found an annual average of 32.3 maternal deaths per 100,000 births in the U.S. between 2018 and 2021. That included at least 3,662 pregnancy-related deaths over the four years, out of about 15 million births. For comparison, that's at least twice the pregnancy-related mortality rate reported in the 2012 study, which ranged from 8.8 to 14.5 per 100,000 live births.

The increased rate may come down to improved tracking of pregnancy-related deaths, the study authors suggested. Notably, a 2003 revision to U.S. death certificates, which was fully implemented in 2018, introduced a "pregnancy" checkbox.

The risk of abortion-related death reported in the new study remained very low, with 17 abortion-related deaths documented between 2018 and 2021 out of more than 3.5 million documented abortions in the U.S. That put the abortion-related mortality rate at about 0.46 deaths per 100,000 abortions, which is marginally lower than the figure of 0.60 per 100,000 abortions reported in the 2012 paper.

A higher death toll linked with pregnancy

Taken together, the 2026 analysis suggests that the risk of death related to pregnancy is at least about 44 times higher than the mortality risk linked to abortion — a figure that towers over the commonly reported statistic suggesting pregnancy is 14 times more likely to result in death than an abortion is.

But, of course, this new figure captures only part of the story, Stephen Burgess, a statistician at the University of Cambridge who was not involved in the study, told Live Science.

The risk of death from pregnancy is known to vary by the age and socioeconomic status of the pregnant person, as well as their access to health care, he noted. Those factors can make a big difference in how well a pregnancy goes and whether it leads to complications that can result in death. The risk ratio itself is also "highly dependent" on the dataset being used to capture abortion rates across the U.S., he noted.

Of note, the Guttmacher Institute did not report the number of abortions in the U.S. in 2021. In the new study, the study authors duplicated the stats from 2020 for the number of abortions in the U.S. in 2021, making the assumption that they were about the same.

Burgess welcomed the new work, saying it provides a more accurate measure of the mortality risk tied to pregnancy, including postpartum care. However, he questioned whether the figure would be "useful in helping either mothers or policymakers to make good decisions."

But for Steenland, the overarching message is clear.

"I think people should know what they're facing, and policymakers should be required to try to make it possible for everyone to access the highest-quality maternity care, to have the best outcomes that they possibly could have," she said.

Maternal care in the U.S. has been on a steady decline in recent decades, with maternal deaths increasing consistently since the 2000s, per a 2024 report from The Commonwealth Fund. Most of these deaths are likely preventable, the report said.

The 2022 U.S. Supreme Court ruling on Dobbs v. Jackson Women's Health Organization — which overturned Roe v. Wade — also opened the door for states to ban or heavily restrict abortion. The impacts of that decision are already being felt and are anticipated to prevent improvements in the maternal mortality rate in the near future. This disparity is most keenly felt by certain populations, with Black mothers being 3.3 times more likely to die in states that restrict access to abortion than white mothers in those states.

A recent study also suggests that infant deaths have been on the rise since the abortion bans went into effect.

Steenland noted that going forward, it might be difficult to track pregnancy-related deaths, as "it's very unlikely that CDC will continue to release abortion related mortality statistics," following large cuts to the CDC's Division of Reproductive Health staff in 2025.

"That limitation, along with other reductions and publicly available information that can be used to measure these outcomes," she said, "will limit for sure what we can know about how the ratio has changed or will have changed."