Planned Parenthood Closures Increased Severe Maternal Morbidity

The recent political climate surrounding access to reproductive health and reproductive rights has left many, including patients, providers, and public health experts, anxious about the state of reproductive, obstetric, and maternal health. In a recent research letter published in JAMA Network Open, Summer S. Hawkins, PhD, MS, and her colleagues discuss the relationship between planned parenthood — and other reproductive health services — closures and increased severe maternal morbidity (SMM).

According to the publication, every instance of maternal mortality in the United States is accompanied by 60 cases of severe maternal morbidity. SMM is indicative of an increased risk of poor maternal outcomes and mortality. The publication also notes that Black individuals are twice as likely as White individuals to experience SMM.

“Planned Parenthood closures and enactment of gestational limits for abortions have been associated with increased maternal mortality, but these factors’ association with increasing SMM remains unknown. We examined associations between state-level reproductive health service changes and delivery-related SMM indicators overall and by race and ethnicity,” Hawkins and her peers said in the letter.

In a cross-sectional study using data from 2009 to 2018, investigators tracked three delivery related-SMM: blood transfusion, eclampsia, and unplanned hysterectomy. Researchers found that 0.5% of individuals experienced one of the three delivery-related SMM. While rates varied across each state and territory analyzed, the data reaffirmed claims by previous studies. They found that SMM prevalence had increased recently as reproductive health access has become more restricted.

According to the publication, a 20% reduction in Planned Parenthood centers led to a 3.79% increase in SMM. Researchers also wrote, “We observed no differences in SMM associated with other state-level indicators and limited evidence of effect modification by race and ethnicity.”

From this, researchers could conclude — and echo the voices of many other healthcare professionals — that restricted access to reproductive healthcare was detrimental to pregnancy and delivery.

“This study has limitations. Research is needed on the implications of state-level factors for family planning and reproductive health-related decisions. The time frame for SMM reporting on birth certificates was restricted to delivery, and only 3 of the 21 SMM indicators were recorded. There is known underreporting of SMM on birth certificates, and postpartum SMM often occurs at higher levels than at delivery. Implications for pregnant individuals of policy decisions restricting reproductive health services require consideration,” added Hawkins and her colleagues in the publication.