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Pregnancies And  Deaths Numbers Are Difficult To Pin Down

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Pregnancies And  Deaths Numbers Are Difficult To Pin Down

INDIANAPOLIS—In the wake of the overturning of Roe v. Wade, Indiana Democrats are pointing to the effect an abortion ban would have on maternal mortality.

Pregnancies can lead to complications and death, and if those who would have had an abortion can’t, they’re in danger of those risks.

In a meeting with Vice President Kamala Harris, House Minority Leader Phil GiaQuinta, D-Fort Wayne, said, “Make no mistake: An abortion ban will kill women.”

“Indiana leads the nation in maternal and infant mortality outcomes and lacks the infrastructure to support families as it is,” GiaQuinta continued.

“Forced births—coupled with the fact that Indiana lacks the proper social infrastructure to care for the children and families already living here—will have drastic consequences for women,” Rep. Robin Shackleford, D-Indianapolis, said in a statement from the Indiana Black Legislative Caucus.

Shackleford also said that “women in Indiana generally are more likely to die during pregnancy or childbirth than the majority of American women.”

The data on maternal mortality is limited—for example, Indiana’s Maternal Mortality Review Committee has only looked at two years’ worth of statistics—and the numbers vary depending on the system they’re pulled from.

So, how bad is Indiana when it comes to pregnancy-related deaths, and what kind of effect would a ban on abortions have?

Leading The Nation?

America’s Health Rankings’ 2019 list, which uses CDC data, places Indiana as third-worst for maternal mortality rate and tied for seventh-worst for infant mortality among all states.

Indiana also doesn’t lead the nation if you average the two rankings. Averaging the worst is Louisiana, which is No. 1 for maternal mortality and No. 5 for infant mortality.

This data isn’t perfect, however.

It has been shown that at least when it comes to maternal mortality, CDC WONDER—Wide-ranging Online Data for Epidemiologic Research—contains false positives and fails to include all victims.

The CDC has two systems for collecting data: the National Vital Statistics System (NVSS) and the Pregnancy Mortality Surveillance System (PMSS).

As Dr. Marian F. MacDorman and Dr. Eugene Declercqexplained in the journal Birth, in an effort to address underreporting in the NVSS, questions regarding the pregnancy history of the deceased were added to death certificates.

Using death certificates, however, has led to overreporting—the opposite problem.

And while the PMSS is seen by some as the solution, “the NVSS is the main data source used to identify maternal deaths for inclusion in the PMSS, and the problems in the NVSS have created challenges for PMSS case ascertainment,” MacDorman and Declercq wrote.

Indiana Maternal Mortality Review Committee

Indiana’s review committee begins with this data but reviews it and searches for other women who may not have been included.

For the years 2018 and 2019, it discovered 58 false positives and 50 women not included in the NVSS.

“The MMRC-derived data presented in this report more accurately reflect the burden of maternal mortality in Indiana and cannot be compared to other datasets,” the committee said.

The data in the MMRC report found, that between the two years, 123 women died either while pregnant or within one year of giving birth.

Of the 123 deaths, the committee found that 25 (four before birth and 21 after) were caused by the pregnancy—specifically, “from a pregnancy complication, a chain of events initiated by the pregnancy, or the aggravation of an unrelated condition by the physiologic effects of pregnancy.”

These are known as pregnancy-related deaths, while the deaths of pregnant women, regardless of cause, are classified as pregnancy-associated deaths.

According to the state’s Terminated Pregnancy Reports, there were 163,797 births during the same time frame. Comparing the 21 deaths to total births gives a .0128% likelihood of dying from the pregnancy after birth.
If all 14,282 abortions by Indiana residents during the two years had been carried to term—meaning no miscarriages, deaths before birth or out-of-state abortions—and the percentage was applied to those women, there would have been an additional 1.83 pregnancy-related deaths after giving birth.
The likelihood of pregnancy-related death, while a woman was still pregnant, is harder to find. There is no number showing how many women in Indiana were pregnant in 2018 and 2019, as such a number would include, births, miscarriages, deaths while pregnant, and abortions.
Using just births, the likelihood of dying while pregnant because of the pregnancy is .0024%. (A more complete number of pregnancies would result in a lower percentage.)

If the 14,282 abortions were instead continued, applying the rate results in an additional .35 pregnancy-related deaths in the two-year timespan.

Together, this extrapolation—which excludes miscarriages, uses small data points and makes the assumption that a different woman is behind each abortion and birth—estimates there would have been approximately two more pregnancy-related deaths in 2018 and 2019 if all abortions were instead continued as pregnancies.

That would constitute an 8.72% increase—a better prognostication than the one found in an a2021 research article referenced by the IBLC.

What The Studies Say

The author of the study, Amanda Stevenson, assistant professor of sociology at the University of Colorado Boulder, relied on data from the PMSS and NVSS and looked at what would happen if “all wanted induced abortions are denied, that each abortion denied leads to 0.8 births, and that there is a corresponding increase in exposure to pregnancy-related mortality.”

Nationally, Stevenson concludes, there would be a 7% increase in pregnancy-related deaths in the first year and a 21% increase in the following years.

In a study published this year, using 2020 data from NVSS on individual states, Stevenson, as well as Dr. Leslie Root and UCB professor Jane Menken, concluded Indiana would have seen two additional pregnancy-related deaths in 2020 or a 9% increase.

Democrats’ Response

The IBLC, made up solely of Democrats, has criticized the disproportionate effect an abortion ban would have on Black women.

Stevenson’s first study estimated a 33% increase nationally in pregnancy-related deaths for Black women, compared to a 13% increase for white women and a 21% uptick overall.

“We will continue to advocate for Indiana’s Black community and will make it crystal clear to our colleagues in the General Assembly that any legislation that restricts or prohibits abortion will make the already egregious disparities between Black and white Hoosiers even more apparent,” Shackleford said.

GiaQuinta told The Statehouse File a potential abortion ban negatively affects “the health of the mother and her relation—private, personal relationship—with her doctor.”

He also criticized Republicans for not supporting various bills that address the post-birth life of the mother and family.

“We’ve had proposals to expand health care options, offering paid family medical leave and eliminating the tax burdens of equipment used in the first stages of life and motherhood—breastfeeding equipment, diapers, etc.,” GiaQuinta said. “We put proposals forward, and they have been stopped at every turn by the House Republicans.”

Moving Forward

One piece of legislation that did pass this year dealt with Medicaid coverage for pregnant women. The coverage is no longer limited to services specific to the pregnancy.

It was authored by Rep. Ann Vermilion, R-Marion, and had almost unanimous support.

“Ensuring pregnant women and new mothers receive medical care is necessary to boost the overall health of our state,” Vermilion said in a statement on Jan. 26. “To help more pregnant Hoosiers before and after the birth of their babies, I authored legislation that would give mothers greater access to federal health benefits to ensure a healthier start to their lives together.”

Also, maternal mortality is one of the issues the Interim Study Committee on Public Health, Behavioral Health, and Human Services will look at this summer.

FOOTNOTE: Three members of the committee—Rep. Brad Barrett, R-Richmond, Sen. Vaneta Becker, R-Evansville, and Vermilion—could not be reached for comment.