California has become a haven for reproductive care, but is now absorbing the consequences of a national public health failure. The United States has one of the highest maternal mortality rates among high-income countries and it is only getting worse.
A growing body of research shows that abortion bans are driving this crisis, increasing preventable deaths, especially among communities already burdened by systemic inequalities. He Women's Reproductive Rights Assistance Project (WRRAP)A national abortion fund based in Los Angeles, is witnessing this increase firsthand, as more patients cross state lines and require financial support to access even the most basic and urgent care.
Maternal mortality has traditionally reflected deep structural problems in a health system that does not serve all people equally. In 2024, the maternal mortality rate in the United States rose again, reversing a brief decline and showing that the crisis is far from over. Experts point to a variety of causes, including reduced access to prenatal care, maternity care deserts and overburdened hospital systems; All the problems intensified in states with severe restrictions on abortion and in cities like Minneapolis and Chicago that have faced the largest presence of ICE agents.
TO comprehensive analysis A Gender Equity Policy Institute study published in April 2025 shows that people living in states that have banned abortion are nearly twice as likely to die during pregnancy, childbirth, or shortly after compared to those in states where abortion remains legal and accessible. What's more, in states where abortion remains legal, maternal mortality has decreased by approximately 21% since 2022, indicating that access to comprehensive reproductive care saves lives.
Restricting abortion does more than eliminate a medical procedure; It forces people to have pregnancies that pose very real health risks. Delivery It carries risks from bleeding and infection to hypertensive disorders and cardiac events, and the risk of death from pregnancy is at least 44 times greater than from abortion. When abortion is inaccessible, people are forced to continue with unwanted or medically unsafe pregnancies, increasing deaths that could otherwise have been prevented. WRRAP helps patients overcome these barriers through funding, but the increased need reflects a system that increasingly fails to provide care at the point of service.
Racial and socioeconomic disparities in maternal mortality did not begin with the reversal of Roe v. Wade in 2022. Black pregnant women in the U.S. have long faced significantly higher mortality rates than white pregnant women due to deep structural racism in health care, poverty, chronic stress, and economic inequality. But abortion bans have exacerbated these inequalities.
In states where abortion is prohibited, pregnant black women are more than three times more likely to die from pregnancy-related causes. States with the worst results They include Louisiana, Mississippi, and Texas and are all concentrated in the South, where these states have enacted some of the most restrictive abortion laws.
These disparities are compounded by declining access to early prenatal care. Nationwide, early prenatal care has declinedwith the steepest declines among black patients. Delayed care is strongly associated with worse outcomes and is exacerbated by the closure of maternity wards in rural areas of the United States.
For immigrant and undocumented communities, the maternal mortality crisis is even more serious. Fear of immigration authorities, including ICE, prevents many from seeking care, even during emergencies. In states like Texas, Arizona and Florida, where abortion bans intersect with aggressive immigration enforcement, undocumented patients often delay or avoid care altogether, increasing the risk of serious complications or death.
Many undocumented people lack insurance, are afraid to report, or face economic barriers that make it impossible to travel for medical care. These structural obstacles not only delay care, but can also cost lives.
In Georgia, the consequences of restricted reproductive autonomy have taken troubling forms. In one widely reported case, a pregnant woman was forced to go to court while in labor about whether she could refuse a doctor-recommended cesarean section, raising urgent questions about bodily autonomy and medical coercion. These cases underscore how quickly the erosion of reproductive rights can extend beyond abortion access to broader violations of patient autonomy.
California offers a stark contrast, as it has one of the lower maternal mortality rates in the united states As a State that has protected access to abortion and expanded reproductive health coverage, it has made measurable progress in reducing maternal mortality.. However, disparities persist, particularly for Pregnant black women are three times more likely to die from pregnancy-related causes.
At the same time, California providers are absorbing a growing number of patients from other states due to abortion bans. WRRAP continues to see an increase in those traveling from restricted states, including more than 42% of patients in 2025, many of whom face financial hardship, logistical barriers and delays that increase medical risk. California is now part of the national security network.
Critics of abortion argue from moral or ideological positions, but the evidence shows that access to abortion care is fundamentally a public health issue. Bans do not reduce the prevalence of abortion; They reduce their safety, push people into riskier medical scenarios, and leave pregnant women with fewer options even when their health is at stake.
We know how to prevent many maternal deaths: access to abortion and comprehensive reproductive care, strengthen prenatal and postpartum support, increase Medicaid coverage, invest in maternity care infrastructure, and address the systemic inequalities that determine who lives and who dies. This is already working in states like California, where protections for reproductive care have helped stabilize outcomes even as the rest of the country regresses.
California cannot be alone. As patients continue to arrive from states where care is restricted or denied, the pressure on providers and support systems will only grow.
To ignore this crisis is to accept an avoidable death. The evidence is clear. The question is whether we will act or continue to allow geography, race, and income to determine who survives pregnancy in the United States.
Sylvia Ghazarian is executive director of the Women's Reproductive Rights Assistance Project.
