California has become a refuge for reproductive care, but it’s 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’s 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 inequities. The Women’s Reproductive Rights Assistance Project (WRRAP), a national abortion fund headquartered in Los Angeles, is witnessing this surge firsthand, as more patients cross state lines and require financial support to access even the most basic, time-sensitive care.
Maternal mortality has traditionally reflected deep structural problems in a healthcare system that fails to serve all people equally. In 2024, the U.S. maternal mortality rate ticked upward again, reversing a brief decline and demonstrating that the crisis is far from over. Experts point to a range of causes, including reduced access to prenatal care, maternity care deserts and strained hospital systems; all problems intensified in states with severe abortion restrictions and in cities like Minneapolis and Chicago that have faced the increased presence of ICE agents.
A comprehensive analysis by the Gender Equity Policy Institute 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 soon after compared with those in states where abortion remains legal and accessible. What’s more, in states where abortion has remained legal, maternal mortality has declined by about 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 carry pregnancies that pose very real health risks. Childbirth carries risks from hemorrhage and infection to hypertensive disorders and cardiac events and the risk of death from pregnancy is at least 44 times higher than from abortion. When abortion is inaccessible, people are compelled to continue unwanted or medically unsafe pregnancies, increasing deaths that could otherwise have been prevented. WRRAP helps patients overcome these barriers through funding, but the surge in need reflects a system increasingly failing to provide care at the point of service.
Racial and socioeconomic disparities in maternal mortality did not begin with the reversal of Roe vs. Wade in 2022. Black pregnant people in the U.S. have long faced significantly higher death rates than white pregnant people due to deep structural racism in healthcare, poverty, chronic stress and economic inequality. But abortion bans have exacerbated these inequities.
In states with abortion bans, Black pregnant people are more than three times as likely to die from pregnancy-related causes. States with the worst outcomes 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. Nationally, early prenatal care has dropped, with the steepest declines among Black patients. Delayed care is strongly linked to worse outcomes and is exacerbated by the closure of maternity wards across rural America.
For undocumented and immigrant communities, the maternal mortality crisis is even more severe. Fear of immigration enforcement, including by 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 severe complications or death.
Many undocumented people lack insurance, fear reporting or face economic barriers that make traveling for care impossible. These structural obstacles do not just delay care, they can cost lives.
In Georgia, the consequences of restricted reproductive autonomy have taken disturbing forms. In one widely reported case, a pregnant woman was forced into court while in labor over whether she could refuse a medically recommended C-section, raising urgent questions about bodily autonomy and medical coercion. Such cases underscore how quickly reproductive rights erosion can extend beyond abortion access into broader violations of patient autonomy.
California offers a stark contrast, owning one of the lowest maternal mortality rates in the U.S. As a state that has protected abortion access and expanded reproductive health coverage, it has made measurable progress in reducing maternal mortality. Yet disparities persist, particularly for Black pregnant people who are three times more likely to die from pregnancy-related causes.
At the same time, California providers are absorbing a growing number of out-of-state patients due to abortion bans. WRRAP continues to see a surge 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 safety net.
Critics of abortion argue from moral or ideological positions, but evidence shows that access to abortion care is fundamentally a matter of public health. Bans do not reduce the prevalence of abortion; they reduce its safety, push people into riskier medical scenarios and leave pregnant people 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 confront the systemic inequities 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 backslides.
California cannot stand alone. As patients continue to arrive from states where care is restricted or denied, the strain on providers and support systems will only grow.
To ignore this crisis is to accept preventable 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.
This story originally appeared in Los Angeles Times.