The impact of state-level abortion restrictions on racial differences in severe maternal morbidity
Awarded 2023
Leveraging existing resources to document the impact of Dobbs
Lindsey Yates, PhD, MPH
University of North Carolina at Chapel Hill

Each day in the US, hundreds of birthing people suffer a severe pregnancy-related complication known as Severe Maternal Morbidity (SMM). Recently, the rate of SMM has continued to increase and disparities persist. Black women insured by Medicaid are nearly twice as likely to experience SMM compared to White women. In a post-Dobbs era, many scholars anticipate worsening rates of SMM among marginalized populations. The purpose of this study is to examine the implications of state abortion laws on racial differences in SMM among people insured by Medicaid. We hypothesize that states with the most severe abortion restrictions will have the highest rates of SMM among Black Medicaid beneficiaries, post-Dobbs, while states with the most protective abortions provisions will have lowest rates of SMM among Black Medicaid beneficiaries, post Dobbs. We will use a logistic regression difference-in-difference model with multiple treatment periods. We will use Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF) Research Identifiable Files (RIF) to identify Medicaid beneficiaries who delivered from January 2021 – December 2022 and experienced one of the 21 SMM conditions within 42 days before or after the estimated date of delivery. We will also use the Post-Dobbs State Abortion Restrictions and Protections database to create multiple cohorts of states with the most restrictive and most protective state-level abortion policies, based on the dates that the polices went into effect. The results of this study can be used to advocate for more state abortion protections and more funding for evidence-based interventions aimed at reducing disparities in SMM.