{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T12:03:29Z","timestamp":1790251409448,"version":"4.1.0"},"reference-count":49,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2020,5,12]],"date-time":"2020-05-12T00:00:00Z","timestamp":1589241600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Linacre Q"],"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:p>After years of failure to obtain accurate statistics on maternal mortality, the United States noted a sharp increase in its maternal mortality rate with widening racial and ethnic disparities. The 2016 report shocked the nation by documenting a 26 percent increase in maternal mortality from 18.8\/100,000 live births in 2000 to 23.8 in 2014. Suggested etiologies of this increase included artifact as a result of improved maternal death surveillance, incorrect use of ICD- 10 codes, healthcare disparities, lack of family support and other social barriers, substance abuse and violence, depression and suicide, inadequate preconception care, patient noncompliance, lack of standardized protocols for handling obstetric emergencies, failure to meet expected standards of care, aging of the pregnant patient cohort with associated increase in chronic diseases and cardiovascular complications, and lack of a comprehensive national plan. While some of the increase in maternal mortality may be a result of improved data collection, pregnancy-related deaths are occurring at a higher rate in the United States than in other developed countries. Some have suggested that the increased maternal mortality is due to limiting women\u2019s access to legal abortion. In order to discover effective strategies to improve pregnancy outcomes, maternal mortality must be investigated in an unbiased manner. This review explores the relationship between legal-induced abortion and maternal mortality.<\/jats:p>\n                  <jats:sec>\n                    <jats:title>Summary:<\/jats:title>\n                    <jats:p>In Finland, where epidemiologic record linkage has been validated, the risk of death from legal induced abortion is reported to be almost four times greater than the risk of death from childbirth. It is difficult to do this comparison in the United States not only because prior induced abortion history is often not recorded for a pregnancy-related death but also because less than one-quarter of the states require health care providers to report abortion deaths for investigation. These omissions are important because mortality risk in pregnancies subsequent to abortion is increased due to abortion-induced morbidities such as preterm birth and abnormal placentation. Legal induced abortion is a root cause of the racial and ethnic disparity noted in maternal mortality. In the United States, the death rate from legal induced abortion performed at 18 weeks gestation is more than double that observed for women experiencing vaginal delivery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0024363920922687","type":"journal-article","created":{"date-parts":[[2020,5,12]],"date-time":"2020-05-12T05:44:17Z","timestamp":1589262257000},"page":"302-310","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Induced Abortion and the Increased Risk of Maternal Mortality"],"prefix":"10.1177","volume":"87","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8227-8182","authenticated-orcid":false,"given":"Patrick J.","family":"Marmion","sequence":"first","affiliation":[{"name":"American College of Preventive Medicine, Washington, DC, USA"},{"name":"Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Vancouver, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingrid","family":"Skop","sequence":"additional","affiliation":[{"name":"American College of Obstetrics and Gynecology, Washington, DC, USA"},{"name":"Northeast Obstetrics and Gynecology Associates, San Antonio, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2020,5,12]]},"reference":[{"key":"bibr1-0024363920922687","doi-asserted-by":"publisher","DOI":"10.4049\/jimmunol.180.12.8222"},{"key":"bibr2-0024363920922687","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2002.123887"},{"key":"bibr3-0024363920922687","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002565"},{"key":"bibr4-0024363920922687","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002434"},{"key":"bibr5-0024363920922687","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000116260.81570.60"},{"key":"bibr6-0024363920922687","unstructured":"\u201cBirths to Unmarried Women.\u201d 2018. Child Trends. www.childtrends.org\/indicators\/births-to-unmarried-women."},{"key":"bibr7-0024363920922687","unstructured":"Brantley M. D., Callaghan W., Cornell A., Kox S., Goodman D., Haight S., Hatfied-Timajchy K., et al. 2018. Building U.S. Capacity to Review and Prevent Maternal Deaths: Report from Nine Maternal Mortality Review Committees. MMRIA. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services. www.cdcfoundation.org\/sites\/default\/files\/files\/ReportfromNineMMRCs.pdf."},{"key":"bibr8-0024363920922687","doi-asserted-by":"publisher","DOI":"10.3389\/fnins.2019.00544"},{"key":"bibr9-0024363920922687","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000444441.04111.1d"},{"key":"bibr10-0024363920922687","unstructured":"CDC (Centers for Disease Control and Prevention). 2013. \u201cRacial\/Ethnic Disparities in the Awareness, Treatment, and Control of Hypertension\u2014United States, 2003\u20132010.\u201d Morbidity and Mortality Weekly Report 62:351\u201355. w ww.cdc.gov\/mmwr\/preview\/mmwrhtml\/mm6218a2.htm."},{"key":"bibr11-0024363920922687","unstructured":"CDC (Centers for Disease Control and Prevention). 2017. National Diabetes Statistics Report, 2017. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services. www.diabetes.org\/assets\/pdfs\/basics\/cdc-statistics-report-2017.pdf."},{"key":"bibr12-0024363920922687","doi-asserted-by":"publisher","DOI":"10.1177\/0956797618813087"},{"key":"bibr13-0024363920922687","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/cks107"},{"key":"bibr14-0024363920922687","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000174580.24281.e6"},{"key":"bibr15-0024363920922687","unstructured":"Dreweke J. 2017. \u201cU.S. Abortion Rate Reaches Record Low amidst Looming Onslaught against Reproductive Health and Rights.\u201d Guttmacher Policy Review 20. www.guttmacher.org\/gpr\/2017\/01\/us-abortion-rate-reaches-record-low-amidst-looming-onslaught-against-reproductive-health."},{"key":"bibr16-0024363920922687","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2003.08.044"},{"key":"bibr17-0024363920922687","doi-asserted-by":"publisher","DOI":"10.3109\/00016349709024605"},{"key":"bibr18-0024363920922687","unstructured":"Hales C. M., Carroll M. D., Fryar C. D., Ogden C. L. 2017. \u201cPrevalence of Obesity among Adults and Youth: United States, 2015\u20132016.\u201d NCHS Data Brief 188:1\u20138. www.cdc.gov\/nchs\/data\/databriefs\/db288.pdf."},{"key":"bibr19-0024363920922687","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2004.040063"},{"key":"bibr20-0024363920922687","unstructured":"HRSA Maternal Mortality Summit: Promising Global Practices to Improve Maternal Health Outcomes\n                      . 2019. Technical Report. US Department of Health and Human Services. February 15, p. 18. https:\/\/www.hrsa.gov\/sites\/default\/files\/hrsa\/maternal-mortality\/Maternal-Mortality-Technical-Report.pdf."},{"key":"bibr21-0024363920922687","doi-asserted-by":"crossref","unstructured":"Jatlaoui T. C., Boutot M. E., Mandel M. G., Whiteman M. K., Ti A., Peterson E., Pazol K. 2018. \u201cAbortion Surveillance\u2014United States, 2015.\u201d MMWR Surveillance Summaries 67:1\u201345. www.cdc.gov\/mmwr\/volumes\/67\/ss\/ss6713a1.htm;http:\/\/dx.doi.org\/10.15585\/mmwr.ss6713a1.","DOI":"10.15585\/mmwr.ss6713a1"},{"key":"bibr22-0024363920922687","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.ss6624a1"},{"key":"bibr23-0024363920922687","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2011.10.012"},{"key":"bibr24-0024363920922687","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000001810"},{"key":"bibr25-0024363920922687","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.14484"},{"key":"bibr26-0024363920922687","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/des294"},{"key":"bibr27-0024363920922687","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000001559"},{"key":"bibr28-0024363920922687","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000001556"},{"key":"bibr29-0024363920922687","first-page":"19","volume":"36","author":"Marmion P.","year":"2020","journal-title":"Ethics & Medicine: an International Journal of Bioethics"},{"key":"bibr30-0024363920922687","doi-asserted-by":"publisher","DOI":"10.1080\/17471060701200402"},{"key":"bibr31-0024363920922687","doi-asserted-by":"publisher","DOI":"10.3109\/14767058.2015.1034103"},{"key":"bibr32-0024363920922687","volume-title":"The Safety and Quality of Abortion Care in the United States","author":"NAS (National Academies of Science, Engineering and Medicine)","year":"2018"},{"key":"bibr33-0024363920922687","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181b5ccf9"},{"key":"bibr34-0024363920922687","volume-title":"Why I Stand","author":"Owens B.","year":"2018"},{"key":"bibr35-0024363920922687","unstructured":"Patel D. A., Burnett N. M., Curtis K. M. 2003. Maternal Health Epidemiology: Reproductive Health Epidemiology Series\u2014Module 2. Atlanta, GA: DHHS, CDC, and DRH, 21."},{"key":"bibr36-0024363920922687","doi-asserted-by":"crossref","unstructured":"Petersen E. E., Davis N. L., Goodman D., Cox S., Mayes N., Johnston E., Syverson C., et al. 2019. \u201cPregnancy-related Deaths, United States, 2011-2015, and Strategies for Prevention, 13 States, 2013\u20132017.\u201d Morbidity and Mortality Weekly Report 68:423\u201329. www.cdc.gov\/mmwr\/volumes\/68\/wr\/mm6818e1.htm?s_cid=mm6818e1_w.","DOI":"10.15585\/mmwr.mm6818e1"},{"key":"bibr37-0024363920922687","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31823fe923"},{"key":"bibr38-0024363920922687","doi-asserted-by":"publisher","DOI":"10.12659\/MSM.883338"},{"key":"bibr39-0024363920922687","first-page":"279","volume":"20","author":"Reardon D. C.","year":"2004","journal-title":"Journal of Contemporary Health Law and Policy"},{"key":"bibr40-0024363920922687","doi-asserted-by":"publisher","DOI":"10.1177\/2050312117740490"},{"key":"bibr41-0024363920922687","unstructured":"Ricketts E. 1989. \u201cThe Origin of Black Female-headed Families.\u201d Focus 12:32\u201336. www.irp.wisc.edu\/publications\/focus\/pdfs\/foc121e.pdf."},{"key":"bibr42-0024363920922687","unstructured":"Roser M., Ritchie H. 2020. \u201cMaternal Mortality.\u201d https:\/\/ourworldindata.org\/maternal-mortality."},{"key":"bibr43-0024363920922687","unstructured":"Silverman E. 2019. \u201cFew Medical Journals Disclose Conflicts Held by Their Own Editorial Teams.\u201d Pharmalot. 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