Abortion policy, political control, and maternal and infant mortality in the United States: a cross-sectional ecological study

Abstract Background Maternal and infant mortality in the U.S. remain the highest among high-income nations, with disparities worsening after Dobbs v. Jackson Women’s Health Organization. This study examined how abortion bans and partisan political control are associated with maternal and infant mortality, while accounting for sociodemographic, economic, and healthcare factors. Methods We conducted a cross-sectional ecological study of all 50 U.S. states, linking maternal mortality ratios (MMR) and infant mortality rates (IMR) with abortion policy classifications (total ban, ban at ≤ 18 weeks, ban after 18 weeks, no gestational ban) and partisan control of governors, legislatures, and senates. Multivariable regressions adjusted for sociodemographic, economic, and healthcare variables. Results Unadjusted analyses showed MMR and IMR were higher on average in Republican-led states (27 vs. 20 per 100,000; 6.3 vs. 5.0 per 1,000; all p < 0.01), with political control accounting for up to one-quarter of the variance (R²=0.21–0.25). In adjusted models, total abortion bans were correlated with higher MMR (β = 5.28, p = 0.0315, R²=0.81) and IMR (β = 1.15, p = 0.0014, R²=0.86). Higher mortality correlated with greater fertility and larger Black population shares; protective factors included higher income, state investment, education, life expectancy, Hispanic population, and healthcare access. These patterns clustered by party control. Conclusions In this ecological analysis, abortion bans and Republican political control were correlated with higher maternal and infant mortality at the state level. While individual-level causality cannot be inferred, addressing structural disparities may help reduce preventable deaths.