Maternal Deaths, Illness Rise in Some States as Policy Changes Affect Reproductive Care Access
August 1, 2025 6 minutes read
By Melinda Young
New national and state policy changes in reproductive healthcare — including the July 4, 2025, signing of a federal bill that cuts Medicaid and defunds Planned Parenthood — are expected to affect reproductive-aged women. New research shows that more pregnancy-capable people in the United States could have difficulty accessing contraceptives. Also, maternal deaths and morbidity are rising and could continue to rise because of additional policy changes.1,2
Some of the actions that may contribute to public health issues for reproductive-aged people are:
- Congress passed a large spending bill that ties tax cuts with major cuts to Medicaid and defunding nonprofits that offer abortions, ending in-clinic access for many. This would include Planned Parenthood health centers that serve medically underserved areas. The Medicaid changes would add a new $35 co-payment to patients with income above the federal poverty level, and states can charge them up to 5% of their annual income. There are work requirements, and while pregnant women are exempted from the cuts, other women could lose affordable access to contraception and other non-pregnancy reproductive healthcare. The Congressional Budget Office estimates it would result in 11.8 million Americans losing health insurance by 2034. Similar cuts to Planned Parenthood in Texas have led to women losing access to contraception and healthcare.1,3-7
- The bill makes it more difficult for people to sign up for Affordable Care Act (ACA) insurance and raises the cost for many people, including lawful permanent residents and most immigrants. People will have to be verified for eligibility of subsidies before receiving premium help. Unlike the instant access to subsidized ACA exchange insurance that people have used since the ACA was passed, the changes will require people to wait up to 90 days to be deemed eligible. Automatic reenrollment will end within a few years.3
- The administration lifted the mandate under the Emergency Medical Treatment and Labor Act (EMTALA) that all states, including abortion-ban states, have to provide emergency medical screening and stabilizing treatment to anyone seeking care, including pregnant patients having a pregnancy crisis that requires an abortion procedure.2 The EMTALA change adds to legal confusion among health systems and providers in abortion-ban states when they have pregnant patients with medical emergencies, says Silpa Srinivasulu, MPH, PhD candidate and director of programs and evaluation at Reproductive Health Access Project in New York, NY.
“It just makes it so much harder for clinicians, who are in these states and want to do right by their patients, to have to navigate these legal confusions,” Srinivasulu says. “Clinicians are pressured by institutions and lawyers, who are conservative in the sense of being careful to follow laws, to not come under fire, and to not do something that will draw attention of lawmakers to the hospitals that are treating pregnant people.”8
Without the mandate and clear protection under EMTALA, providers have to question every move they make when they see someone in need of healthcare, she adds. “It is so wrong that medical providers cannot live their oath to do no harm to patients,” Srinivasulu says. “They have to question every move they make when they see someone who needs healthcare.”
Pregnant patients need access to emergency abortion services, and it is worrisome that the federal government is no longer providing this guidance, says Dana Howard, PhD, MS, an assistant professor in the division of bioethics, department of biomedical education and anatomy, department of philosophy, at The Ohio State University in Columbus.
“Federal guidance is very important because it adds certainty and clear guidelines for hospital staff,” Howard says. “Changing the guidelines makes it harder for clinicians who want to provide emergency abortion care,” Howard adds. “It adds more uncertainty, and that’s dangerous for patients.”
The barriers pregnant people face when needing emergency care for miscarriages and other pregnancy crises is already a major problem. This is partly because of the U.S. Supreme Court’s decision in 2024 to not settle the constitutionality of the Biden-era EMTALA mandate that requires health systems to provide emergency care to preserve the health and lives of pregnant patients.9
Now, the situation is even more dangerous for pregnant patients facing emergency medical problems. “It is deeply concerning and will only worsen outcomes of maternal morbidity and mortality,” Srinivasulu says.
In a recent survey, 20% of office-based OB/GYNs nationally reported they felt restraints on the ability to provide miscarriage and pregnancy-related emergency care since the Dobbs decision. Among providers in states with abortion bans, the figure is 40%.10 “It comes from the legal institutional sense of unnecessary caution because someone in power cares more about following a bad law than practicing medicine and taking care of the health of the person in front of you,” Srinivasulu says.
New data show that one in three women say they have gone to a Planned Parenthood clinic for care, and nearly half of Black women have gone to a Planned Parenthood clinic.11
“We found in those cases that clinics strive to provide high-quality care and try to bridge that gap, but the gag rule was only for two years,” says Alicia VandeVusse, PhD, a senior research scientist with Guttmacher Institute in New York, NY. “The Title X system has been under immense strain for quite some time, and we saw a big drop in clinics with the first gag rule,” VandeVusse says.
A new report offers a glimpse into how cutting federal funding of Planned Parenthood would affect women. Researchers looked at what happened in Texas after the state began to defund Planned Parenthood services by excluding them as providers under the Healthy Texas Women (HTW) program. There was a 56% decrease in contraceptive use by people enrolled in HTW from 2011 to 2023.6,12
When Texas launched its women’s health program in 2007 as part of a Medicaid demonstration waiver, it provided women with well-woman services, breast exams, and birth control at low or no cost to low-income women who were not eligible for Medicaid. It had a 90% federal Medicaid match. But the state changed it in 2011, reducing the state’s family planning budget from $111 million to $38 million, leading to 82 family planning clinics closing in the state. Then, in 2020, the state started HTW services with Medicaid waiver funding but excluded Planned Parenthood providers.6,12
Srinivasulu’s research shows evidence of increased maternal mortality and severe maternal morbidity in states that ban or severely restrict abortion care.8 The study found that additional deaths and serious maternal morbidity would occur in 14 states that ban/restrict abortion over a four-year period.8
The prediction of increased maternal morbidity and mortality is based on current data showing an increase in people continuing their pregnancies in states with abortion bans. These are pregnancies that would have ended if abortion was accessible in the states, Srinivasulu says. “The study is only a partial analysis of the consequences of Dobbs and how maternal health is harmed,” she adds. “We are seeing how abortion bans are creating this environment of poor healthcare, overall, for pregnant people, whether it is a wanted pregnancy or not.”
Melinda Young has been a healthcare and medical writer for 30 years. She currently writes about contraceptive technology.
References
1. Freking K, Mascaro L. What’s in the tax and spending bill that Trump has signed into law. Associated Press. July 4, 2025. https://apnews.com/article/what-is-republican-trump-tax-bill-f65be44e1050431a601320197322551b
2. ACLU. Trump administration rescinds EMTALA guidance and sends clear signal: Emergency abortion care remains at risk. ACLU news release. June 3, 2025. https://www.aclu.org/press-releases/trump-administration-rescinds-emtala-guidance-and-sends-clear-signal-emergency-abortion-care-remains-at-risk
3. Weixel N. How Trump’s megabill will impact health care. The Hill. July 4, 2025. https://thehill.com/policy/healthcare/5384707-how-trumps-megabill-will-impact-health-care/
4. Planned Parenthood Action Fund to President Trump: Every undetected cancer is on you. Planned Parenthood. July 4, 2025. https://www.plannedparenthoodaction.org/pressroom/planned-parenthood-action-fund-to-president-trump-every-undetected-cancer-is-on-you
5. ICYMI: “How defunding Planned Parenthood impacts health care.” Planned Parenthood Pressroom. June 6, 2025. https://www.plannedparenthoodaction.org/pressroom/icymi-how-defunding-planned-parenthood-impacts-health-care
6. Every Texan. Data report: How provider exclusion has reshaped care for Texas women. June 10, 2025. https://everytexan.org/2025/06/10/limited-access-how-provider-exclusion-has-reshaped-care-for-texas-women/
7. Sanger-Katz M. GOP bill has $1.1 trillion in health cuts and 11.8 million losing care, CBO says. The New York Times. June 29, 2025. Updated July 1, 2025. https://www.nytimes.com/2025/06/29/us/politics/trump-policy-bill-health-insurance-cuts.html
8. Srinivasulu S, Heiland FW. How will abortion bans affect maternal health? Forecasting the maternal mortality and morbidity consequences of banning abortion in 14 U.S. states. J Womens Health (Larchmt). 2025;34(6):843-854.
9. Christensen J. Trump administration’s guidance on emergency care law adds to ‘chaos,’ not clarity, in states with strict abortion laws, some doctors say. CNN. June 20, 2025. https://edition.cnn.com/2025/06/20/health/emtala-abortion-guidance-hhs
10. Frederiksen B, Ranji U, Gomez I, Salganicoff A. A national survey of OBGYNs’ experiences after Dobbs. KFF. June 21, 2023. https://www.kff.org/womens-health-policy/report/a-national-survey-of-obgyns-experiences-after-dobbs/
11. Frederiksen B, Ranji U, Slganicoff A. Major federal and state funding cuts facing Planned Parenthood. KFF. May 15, 2025. https://www.kff.org/womens-health-policy/issue-brief/major-federal-and-state-funding-cuts-facing-planned-parenthood/
12. Every Texan. Limited Access: How provider exclusion has reshaped care for Texas women. May 2025. https://everytexan.org/wp-content/uploads/2025/06/ProviderExclusion_Report_EveryTexan_May2025.pdf
New research shows that more pregnancy-capable people in the United States could have difficulty accessing contraceptives. Also, maternal deaths and morbidity are rising and could continue to rise because of additional policy changes.
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