title: State Medicaid Coverage of Medically Necessary Abortions and Severe Maternal Morbidity and Maternal Mortality.
abstract: To estimate the association between state Medicaid coverage of medically necessary abortion and severe maternal morbidity and in-hospital maternal mortality in the United States.
  
  
  
  We used data on pregnancy-related hospitalizations from the Nationwide Inpatient Sample from 2000 to 2011 (weighted n=38,016,845). State-level Medicaid coverage of medically necessary abortion for each year was determined from Guttmacher Institute reports. We used multivariable logistic regression to examine the association between state Medicaid coverage of abortion and severe maternal morbidity and in-hospital maternal mortality, overall and stratified by payer.
  
  
  
  The unadjusted rate of severe maternal morbidity was lower among Medicaid-paid hospitalizations in states with Medicaid coverage of medically necessary abortion relative to those in states without such coverage (62.4 compared with 69.3 per 10,000). Among Medicaid-paid hospitalizations in states with Medicaid coverage of medically necessary abortion, there were 8.5 per 10,000 fewer cases (95% confidence interval [CI] 4.0-16.5) of severe maternal morbidity in adjusted analyses relative to those in states without such Medicaid coverage. Similarly, there were 10.3 per 10,000 fewer cases (95% CI 3.5-17.2) of severe maternal morbidity in adjusted analyses among private insurance-paid hospitalizations in states with Medicaid coverage of medically necessary abortion relative to those in states without such Medicaid coverage. The adjusted rate of in-hospital maternal mortality was not different for Medicaid-paid hospitalizations in states with and without Medicaid coverage of medically necessary abortion (9.2 and 9.0 per 100,000, respectively) nor for private insurance-paid hospitalizations (5.6 and 6.1 per 100,000, respectively).
  
  
  
  State Medicaid coverage of medically necessary abortion was associated with an average 16% decreased risk of severe maternal morbidity. An association between state Medicaid coverage of medically necessary abortion and a reduced risk of severe maternal morbidity was observed in women covered by both Medicaid and private insurance. Results suggest that Medicaid coverage of medically necessary abortion is not harmful to maternal health.
authors.affiliation: Departments of Health Policy and Management and Epidemiology, University of Pittsburgh Graduate School of Public Health, the Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, and Magee-Womens Research Institute, Pittsburgh, Pennsylvania; and the Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Marian
authors.initials: M
authors.lastname: Jarlenski
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Hutcheon
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Bodnar
authors.forename: Hyagriv N
authors.initials: HN
authors.lastname: Simhan
mesh_terms: D000032:Abortion, Therapeutic / Q000191:economics / Q000401:mortality*; D000328:Adult; D000367:Age Factors; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data; D005006:Ethnicity; D005260:Female; D006801:Humans; D008427:Maternal Health Services / Q000706:statistics & numerical data; D008428:Maternal Mortality; D008484:Medicaid / Q000191:economics*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D011247:Pregnancy; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology