All-Cause Mortality in Reproductive-Aged Females by State: An Analysis of the Effects of Abortion Legislation.

Moderate state abortion legislation was associated with lower rates of maternal, fetal, and infant mortality but not lower all-cause mortality in reproductive-aged females, compared with restrictive laws. OBJECTIVE: To estimate the association between state-level abortion legislation and all-cause mortality among all females of reproductive age and maternal, fetal, and infant mortality. METHODS: We conducted a retrospective cohort study using the Centers for Disease Control and Prevention's WONDER (Wide-ranging ONline Data for Epidemiologic Research) database. Generalized estimating equations were used to estimate the association between supportive, moderate, and restrictive state abortion regulations and all-cause mortality in reproductive-aged females. Secondary outcomes included maternal, fetal, and infant mortality. The association of the number and type of laws on mortality were estimated. RESULTS: Moderate and supportive states were not associated with a significant decrease in all-cause mortality compared with restrictive states. Maternal mortality (per 100,000 live births) was significantly lower in moderate (−5.79, 95% CI −9.88 to −1.70) compared with restrictive states, but not supportive states (−2.51, 95% CI −6.75 to 1.72). Infant mortality (per 1,000 live births) was significantly lower in both moderate (−0.56, 95% CI −1.09 to −0.04) and supportive (−1.10, 95% CI −1.56 to −0.64) states. Fetal mortality was lower in moderate states (−0.69, 95% CI −1.18 to −0.20) but not in supportive states (−0.64, 95% CI −1.14 to 0.13). Each additional abortion regulation was associated with an increase in maternal mortality (1.09/100,000 live births, 95% CI 0.36–1.82) and infant mortality (0.20/1,000 live births, 95% CI 0.12–0.26). CONCLUSION: Moderate state abortion legislation was associated with lower rates of maternal, fetal, and infant mortality but not lower all-cause mortality in reproductive-aged females compared with restrictive laws. An increasing number of laws restricting abortion was associated with increased maternal and infant mortality. [ABSTRACT FROM AUTHOR]