{"id":424,"date":"2026-06-24T09:38:02","date_gmt":"2026-06-24T09:38:02","guid":{"rendered":"https:\/\/atlaslivingmedia.com\/?p=424"},"modified":"2026-06-24T09:38:02","modified_gmt":"2026-06-24T09:38:02","slug":"4-years-after-dobbs-how-do-we-count-the-dead","status":"publish","type":"post","link":"https:\/\/atlaslivingmedia.com\/?p=424","title":{"rendered":"4 Years After \u201cDobbs,\u201d How Do We Count the Dead?"},"content":{"rendered":"<article>\n<p>Four years after the Supreme Court overturned <em>Roe v. Wade<\/em> with its ruling in <em>Dobbs<\/em>, there\u2019s an image I can\u2019t get out of my head. Porsha Ngumezi was living in Texas when she suffered a miscarriage in 2023. Texas punishes medical providers who violate the state\u2019s abortion ban with up to 99 years in prison. After Ngumezi showed up to the hospital bleeding and miscarrying at 11 weeks pregnant, <em>ProPublica<\/em> reported, doctors delayed providing a simple procedure to remove fetal tissue, and so she bled to death. \u00a0<\/p>\n<p>Read more <a href=\"https:\/\/atlaslivingmedia.com\/?p=422\">This Week in \u2018Nation\u2019 History: A New Golden Age for Bicycles?<\/a><\/p>\n<p>For months afterward, Porsha\u2019s 3-year-old son would chase after women who looked like her on the street, shouting, \u201cThat\u2019s Mommy!\u201d That\u2019s the detail I can\u2019t forget. I can\u2019t stop imagining that little boy chasing after strangers on the street.<\/p>\n<p>Behind each death caused by an abortion ban is a loss of such immeasurable magnitude. So when we try to understand how many people have died from such bans since <em>Dobbs<\/em>, we can\u2019t lose sight of the inestimable tragedy each death represents. Further complicating matter is that it\u2019s very difficult for researchers to tell conclusively just how many deaths abortion bans have caused. One of the most comprehensive attempts, led by researchers from Johns Hopkins and UCLA, suggests that the number of such deaths by the end of 2023 might be 68. It\u2019s a number that feels unfathomable, yet smaller than expected.<\/p>\n<div>\n<h4>Also by Amy Littlefield<\/h4>\n<ul>\n<li>\n<h5>Inside the Conference Where Conservative Women Let Loose<\/h5>\n<p><span>June 11, 2026<\/span>\n<\/li>\n<li>\n<h5>How the Abortion Rights Activists Found Their Radical Imagination<\/h5>\n<p><span>March 9, 2026<\/span>\n<\/li>\n<li>\n<h5>What the Pro-Choice Movement Can Learn From Those Who Overturned \u201cRoe\u201d<\/h5>\n<p><span>February 10, 2026<\/span>\n<\/li>\n<\/ul>\n<\/div>\n<p>When the Supreme Court overturned <em>Roe v. Wade<\/em>, many in the reproductive-rights movement assumed that women would die in large numbers. Pregnancy was already more dangerous in the United States than in other developed countries. When more than a dozen states quickly banned abortion, it seemed likely many more people would be forced into pregnancy and some of them would die. Having covered pregnant women\u2019s near-death experiences in Catholic hospitals prior to <em>Dobbs<\/em>, I also anticipated that more people would die in one particular circumstance: when they were miscarrying and doctors refused to end their pregnancy if the fetus still had a heartbeat. Research has revealed that, indeed, states that banned abortion saw an additional 22,180 births, an increase that was particularly high among those who have difficulty accessing abortion, including people of color and those on Medicaid. Additional reports show that at least a dozen women did die when lifesaving care was denied or delayed. But it\u2019s been extremely hard to calculate just how many people have died because of <em>Dobbs.<\/em><\/p>\n<p>One reason for the ambiguity is the impact of the Covid pandemic, which killed a huge number of pregnant people\u2014by some estimates, maternal deaths increased by nearly 60 percent between 2019 and 2021\u2014making it hard to establish a baseline to which to compare post-<em>Dobbs<\/em> numbers. (It\u2019s been especially hard because states that banned abortion also had some of the highest rates of Covid deaths.) In addition, even in a country with maternal mortality as unjustifiably high as ours, such deaths are still rare; in 2023, there were 662 maternal deaths and 1,979 deaths in the broader category of \u201cpregnancy-associated\u201d mortality. Such small sample sizes make it hard for researchers to reach solid conclusions, especially when they\u2019re looking for changes in rural states with small populations. Nor does all the data researchers use to count these deaths appear to be accurate; Alabama, for example, reported fewer than 10 maternal deaths over a six-month period after it banned abortion, an inconceivably sharp departure from its previous track record, which was among the country\u2019s worst. There\u2019s also the fact that the states that banned abortion after <em>Dobbs <\/em>already had a host of abortion restrictions in place before the ruling, and those restrictions fell hardest on poor people of color\u2014the very people most likely to die from pregnancy in America. Finally, there are controversies raging in the research community right now around how maternal mortality should be counted and whether our current approach is accurate.<\/p>\n<p>With all those caveats, an article published in May in the <em>American Journal of Public Health<\/em> is the closest we\u2019ve come to a <em>Dobbs<\/em>-related death toll. The researchers looked at death certificate data across all 50 states and Washington, DC, from 2016 to 2023, eliminated deaths that were attributable to Covid, and estimated that there has been a 9.2 percent increase in the number of pregnancy-associated deaths in the 14 states that banned abortion entirely or at six weeks in 2022<em>. <\/em>That\u2019s the equivalent of 68 additional deaths by the end of 2023. Sixty-eight kids chasing after strangers on the street. Sixty-eight partners going to sleep without their wives. Sixty-eight moms wondering if they could have saved their daughters.<\/p>\n<p>Those 68 deaths are considered \u201cpregnancy-associated deaths,\u201d which is the broadest of the three categories researchers use to track deaths related to pregnancy and childbirth. Pregnancy-associated deaths happen up to a year after delivery, and, while most are related to obstetric causes, about a quarter result from suicide, homicide, or drug overdose. It\u2019s not out of the question to think abortion bans could have exacerbated even these non-obstetric deaths; a few recent studies have tracked an increase in suicides among reproductive-aged women following <em>Dobbs<\/em>, and pregnancy is a known risk factor for domestic-violence-related homicides. Researchers also detected a similar rise in the narrower category of pregnancy-<em>related<\/em> deaths, which are deaths up to a year after delivery that are obstetric in nature. The fact that the researchers didn\u2019t find a rise in the narrowest category, maternal mortality\u2014which includes deaths only up to 42 days post-delivery\u2014doesn\u2019t mean those deaths didn\u2019t rise, given the limitations noted above, including the smaller sample size, which makes it hard to conclusively measure changes.<\/p>\n<p>In fact, given these limitations, study co-author Alison Gemmill said she was surprised they were able to detect a measurable rise at all.<\/p>\n<p>\u201cWhen we first started this, I didn\u2019t think we would be able to detect <em>any<\/em> signal, and then we went ahead and used our model and our methods, and we actually found something,\u201d Gemmill, an associate professor at UCLA, told me, \u201cand it persisted in the many ways that we test the robustness of our findings, so I think that surprised me.\u201d<\/p>\n<p>Her co-author, Suzanne Bell, associate professor at the Johns Hopkins Bloomberg School of Public Health, concurred. \u201cJust the fact that we detected what looked like a pretty strong signal in relation to pregnancy-associated mortality and somewhat less so pregnancy-related [mortality], was honestly a bit shocking to us, and I think speaks to the strength of this potential relationship between abortion and mortality,\u201d Bell said.<\/p>\n<p>\u201cOur findings suggest many preventable deaths have occurred in states that banned abortion,\u201d Bell added, noting that today, even more states ban abortion entirely or at six weeks than the 14 she and her colleagues originally studied. \u201cThe number can only go up from there, so 68 and counting, I think, is a better way to define that number.\u201d<\/p>\n<p>But teasing out exactly how many deaths post-<em>Dobbs<\/em> abortion bans are responsible for will, in some ways, miss the point that such bans are not the only things making pregnancy in America uniquely dangerous. America\u2019s maternal mortality crisis is inseparable from our ongoing twin crises of staggering inequality and structural racism, which make obtaining adequate medical care, especially for Black people, far more difficult than it should be.<\/p>\n<p>\u201cInequality in our country is literally punishing; it gets under people\u2019s skin and it kills them,\u201d Amanda Jean Stevenson, associate professor of sociology at University of Colorado Boulder, told me. \u201cThere\u2019s a causal effect of the fact that it is so hard to make it in America.\u201d<\/p>\n<p>In a country as unequal, stressful, and racist as ours, it\u2019s incredibly difficult to isolate a single policy as the cause of someone\u2019s death. The very states that banned abortion already had higher rates of maternal mortality, particularly among Black people, due to factors like lack of access to health insurance and care providers, Gemmill and Bell noted. Black women in America were already over three times more likely to die of pregnancy-related causes than white women. And abortion bans don\u2019t impact people equally.<\/p>\n<p>Read more <a href=\"https:\/\/atlaslivingmedia.com\/?p=419\">Requiem for Alan Greenspan the Bubble Master<\/a><\/p>\n<p>\u201cThere are many different ways that abortion bans impact deaths, and one of them is by preventing you from having an abortion, but a very important one is by making maternal care less good,\u201d Stevenson added. \u201cAnd who dies when the quality of care goes down? Who do doctors make exceptions for, to save their lives? Those are things that are going to fall along racial and class lines, because this is America.\u201d<\/p>\n<p>There\u2019s a long-standing adage in pro-choice circles that abortion bans don\u2019t stop abortions; they only stop safe abortions. Today, that adage needs a rewrite. The nature of abortion in America has fundamentally changed. Legal innovations in the form of shield laws that allow clinicians in blue states to mail medication abortion into states where it\u2019s banned have driven an <em>increase <\/em>in the number of abortions, in part by extending access to people who couldn\u2019t have made it to a clinic before <em>Dobbs<\/em>. In addition to wealth and geography, someone\u2019s access to abortion today depends on an array of new factors, like whether they trust the Internet, and have a safe place to take abortion pills at home.<\/p>\n<p>So a new adage for our era might be: Abortion bans don\u2019t stop abortions; in fact, when clinicians and lawyers get creative, they can wind up leading to an increase in the number of abortions overall \u2014but also, abortion bans have only exacerbated the crisis of racism and preventable pregnancy-associated death in this country. Or to simplify it a bit, abortion bans don\u2019t stop abortions, but they do kill people. They kill women, in higher numbers, but in many of the same, preventable ways, that these women were dying before. All of which was completely and utterly predictable.<\/p>\n<p>There\u2019s a wider question that all this raises, which is one that preoccupied me as I was writing my book, <em>Killers of Roe<\/em>. It is how we\u2019ve developed such a collective tolerance for women\u2019s deaths. \u201cHow [did] we get to a place where 68 deaths isn\u2019t very many deaths?\u201d Stevenson asked.<\/p>\n<p>The answer is that we started in a place where one death didn\u2019t seem like enough.<\/p>\n<p>In 1977, Rosie Jimenez died in a hospital in agony after contracting an infection from an unsafe abortion that she sought because the Hyde Amendment had cut off Medicaid funding for abortion. Pro-choice activists like Frances Kissling who tried to draw attention to her death at the time were stymied not just by society at large but by their own movement. \u201cI was told over and over that people are not concerned about the death of one woman,\u201d Kissling later wrote.<\/p>\n<p>According to Kissling, some of her peers in the white-led pro-choice movement didn\u2019t see an unmarried Latina who was on her third abortion as a sympathetic enough figure to rally around. So the movement and the country moved on from this death of immeasurable magnitude.<\/p>\n<p>At her mother\u2019s funeral, 4-year-old Monique Jimenez watched as the coffin was lowered into the dirt, and asked, \u201cWhere is my mommy going?\u201d<\/p>\n<p>The policy that killed Jimenez endures to this day and has been renewed by every Congress, whether Democrat or Republican, since 1976. That is how we got here. When one death isn\u2019t enough to stop the march of abortion bans, then that march continues, and more deaths will predictably follow.<\/p>\n<p>\u201cAny maternal death is a tragedy, because you\u2019re thinking about the loss of a person,\u201d Alison Gemmill told me. \u201cBut you\u2019re thinking about the effects that it has on the family, and we know that a lot of mothers who die are not just first-time mothers. They have children at home. They\u2019re part of their community.\u201d<\/p>\n<p>The number 68 is at once surprisingly low and unfathomably large, when you measure it in terms of daughters wondering where their mommies are going, when you measure it in terms of little boys who chase after strangers on the street.<\/p>\n<p>So, to take another shot at updating the adage: Abortion bans don\u2019t stop abortions, but they did kill an estimated 68 people by the end of 2023.<\/p>\n<p>Read more <a href=\"https:\/\/atlaslivingmedia.com\/?p=417\">Rockwell Kent\u2019s View From Greenland<\/a><\/p>\n<p>And that should be more than enough to stop us in our tracks.<\/p>\n<\/article>\n","protected":false},"excerpt":{"rendered":"<p>The Nation Magazine<\/p>\n","protected":false},"author":1,"featured_media":423,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-424","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-news"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>4 Years After \u201cDobbs,\u201d How Do We Count the Dead? 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