Comparing Mortality Risk of Induced Abortion With Mortality Risk of Staying Pregnant

Contraception; November 2023; Vol. 127; 110150; doi:https://doi.org/10.1016/j.contraception.2023.110150

Objectives: We aimed to directly compare the mortality risk of induced abortion with the mortality risk of staying pregnant. Prior work has compared the mortality risk of abortion with the mortality risk of delivery, but this excludes deaths during pregnancy and postpartum and thus understates the counterfactual mortality risk.

Methods: Using US statistics on pregnancy-related mortality (2013–2017), maternal mortality (2020), births, fetal deaths, and induced abortions, we constructed multiple decrement pregnancy life tables by week of gestation and cause-deleted pregnancy life tables to simulate risks in the absence of induced abortion. For each year, we constructed life tables under a wide but plausible range of assumptions (weekly miscarriage probabilities, fetal death underreporting, timing of pregnancy-related deaths during pregnancy, and distributions of induced abortion within reported gestational week ranges). For each set of assumptions, we used the cause-deleted life table to calculate the risk of dying due to staying pregnant at each week of gestation; the risk of dying due to staying pregnant rather than having an abortion is the average of the weekly risk, weighted by weekly induced abortions. We expressed this risk as a multiple of the risk of dying due to having an abortion between 2013 and 2019, 0.43 deaths/100,000 abortions.

Results: In 2020, staying pregnant was 35–39 times deadlier than induced abortion. During 2013–2017, staying pregnant was 32–35 times deadlier than induced abortion.

Conclusions: Induced abortion is much safer than staying pregnant and denying wanted abortions forcibly exposes pregnant people to higher risk of mortality.