Importance The 2022 Supreme Court decision Dobbs v. Jackson Women’s Health Organization and the subsequent legal restrictions to abortion have prompted national discussion about the importance of abortion access for maternal health. A commonly cited statistic in these debates, based on data from 1998 to 2005, is that the risk of death associated with childbirth is approximately 14 times higher than that of abortion. Objective To estimate the ratio of pregnancy-related to abortion-related mortality using updated data (2018-2021), capturing increased detection of maternal death and increased safety of abortion since the original estimate. Design, Setting, and Participants This cross-sectional study included all births (live and stillbirths) and pregnancy-related deaths from the National Vital Statistics System from 2018 to 2021. The number of abortion related deaths was obtained from the Pregnancy Mortality Surveillance System, and the number of abortions was obtained from the Guttmacher Institute. Data were analyzed between February and October 2025. Main Outcomes and Measures Pregnancy-related deaths were identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision ( ICD-10 ) codes A34, O10 to O95, O96, O98 to O99. Pregnancy- and abortion-related mortality ratios were calculated per 100 000 births and abortions, respectively, per year and overall. To calculate the ratio, the pregnancy-related mortality rate per 100 000 births was divided by the abortion-related mortality rate per 100 000 abortions. Sensitivity analyses excluded ICD-10 codes commonly misclassified as pregnancy related and COVID-19–related deaths. Results During the period between 2018 and 2021, there were 14 902 571 births and 3 662 580 abortions. The mean ratio between pregnancy-related and abortion-related mortality was 69.6 (range, 52.9-105.2). Excluding nonspecific causes of pregnancy-related death, the mean pregnancy- to abortion-related mortality ratio was 52.9 (range, 38.2-74.2). Further excluding COVID-19–related mortality, the ratio was 44.3 (range, 34.5 to 74.2). Conclusions and Relevance This cross-sectional study found that the ratio of pregnancy- to abortion-related mortality from 2018 to 2021 ranged from 44.3 to 69.6, at least 3 times higher than the ratio of 14.7 calculated using data from 1998 to 2005. These findings suggest that by taking away the option to end a pregnancy, abortion bans force pregnant people to take on the increased health risks associated with continued pregnancy.
Steenland et al. (Wed,) studied this question.