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A study led by Johns Hopkins Bloomberg School of Public Health researchers estimates that infant deaths in Texas increased more than expected in the year following the state’s 2021 ban on abortion in early pregnancy, especially among infants with congenital anomalies.
The Texas law prohibiting abortions after a fetal heartbeat could be detected — as early as five or six weeks — went into effect September 1, 2021. At the time, the law — Senate Bill 8, or S.B. 8 — was the most stringent state abortion law in the country. It did not allow exemptions for congenital anomalies.
The researchers’ analysis of monthly death certificate data in Texas and the rest of the United States found that between 2021 and 2022, infant deaths in Texas rose from 1,985 to 2,240, a year-over-year increase of 255 deaths. This corresponds to a 12.9 percent increase in infant deaths in Texas versus a 1.8 percent increase in infant deaths in the rest of the U.S. during the same period. The study defines infants as under 12 months old.
The study was published online June 24 in JAMA Pediatrics.
The findings come as more U.S. states enact stricter abortion laws following the U.S. Supreme Court’s 2022 Dobbs decision, the landmark ruling that overturned Roe v. Wade and returned abortion policymaking to the states.
To approximate the causal impact of S.B. 8, the authors narrowed their analysis to examine changes in the expected number of infant deaths in Texas from March to December 2022 — the time period that captures the first set of pregnancies under S.B. 8. The researchers estimate there were 216 excess infant deaths in Texas that would most likely not have occurred from March to December 2022 had the state’s abortion law not been in place. This is equivalent to a 12.7 percent increase above the expected 1,697 infant deaths for this time period. There were 1,913 observed deaths in Texas from March to December 2022.
An analysis of neonatal deaths — deaths in the first 28 days — found similar patterns, with an estimated 145 excess deaths in the post-policy period. These results were not observed in other states.
The new study is thought to be the first to examine how the Texas abortion ban may have impacted infant deaths in the state and is among the first to present evidence evaluating recent abortion bans and pre-viability restrictions. Prior research has shown that states with more abortion restrictions see more infant deaths than those without. The authors note that these earlier studies evaluate fundamentally different and less severe abortion restrictions and primarily examine correlation.
“Our study is particularly relevant given the June 2022 Dobbs Supreme Court decision that returned abortion lawmaking to states and subsequent rollbacks of reproductive rights in many states,” says Alison Gemmill, PhD, assistant professor in the Bloomberg School’s Department of Population, Family and Reproductive Health and one of the study’s lead authors. “These findings suggest that restrictive abortion policies may have important unintended consequences in terms of infant health and the associated trauma to families and medical costs.”
For their month-by-month causal analysis, the researchers drew from infant death certificates in Texas and 28 comparison states from 2018 through 2022. They excluded the District of Columbia and several states that had fewer than 10 infant deaths in any month from 2018 to 2022, as the exact counts are not provided in currently publicly available data. The researchers selected March 2022 as the first cohort exposed to the Texas abortion policy because these infants, if born full term, would have been approximately 10 to 14 weeks gestation when the Texas law went into effect in September 2021. Before S.B. 8’s enactment, people would have been able to seek termination in the event a fetal issue was detected during screening prior to 20 weeks gestation.
In an analysis of cause of death using all 2021 and 2022 death certificate data, the researchers found that Texas had atypical increases in infant deaths due to congenital anomalies, the leading cause of infant death. Infant deaths attributable to congenital anomalies increased 22.9 percent in Texas between 2021 and 2022 versus a decrease of 3.1 percent in the rest of the U.S. during the same period. Another divergent cause of death pattern in Texas was infant deaths from accidents, which increased by 21 percent in Texas versus a one percent increase in the rest of the U.S.
“Our results suggest that restrictive abortion policies that limit pregnant people’s ability to terminate pregnancies, particularly those with fetal abnormalities diagnosed later in pregnancy, may lead to increases in infant mortality,” says Suzanne Bell, PhD, MPH, assistant professor in the Bloomberg School’s Department of Population, Family and Reproductive Health and one of the study’s lead authors. “These findings make clear the potentially devastating consequences abortion bans can have on pregnant people and families who are unable to overcome barriers to this essential reproductive health service.”
The authors note that the data did not include maternal and clinical characteristics of infant deaths, thus limiting the authors’ ability to explore potential mechanisms behind these findings.
The researchers are currently studying the impact across socioeconomic groups that abortion bans have on live births and infant mortality in Texas and other states that banned abortion following Dobbs.
This study was supported by the Hopkins Population Center from the National Institute of Child Health and Human Development (P2CHD042854).