A study led by researchers at the Johns Hopkins Bloomberg School of Public Health estimates that infant deaths in Texas rose more than expected in the year after the state banned abortions in early pregnancy in 2021, especially among babies with birth defects.
The Texas law banning abortions after a fetal heartbeat can be detected — as early as five or six weeks — went into effect on Sept. 1, 2021. At the time, the law, Senate Bill 8, or SB 8, was the strictest state abortion law in the country. It did not allow exemptions for birth defects.
Researchers’ analysis of monthly death certificate data in Texas and the rest of the United States revealed that between 2021 and 2022, child deaths in Texas increased from 1,985 to 2,240, a year-over-year increase of 255 deaths. This corresponds to a 12.9% increase in child deaths in Texas versus a 1.8% increase in child deaths in the rest of the United States during the same period. The study defines babies as those younger than 12 months.
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 decision. dobbs decision, the historic ruling that overturned Roe v. Wade and returned abortion policymaking to the states.
To approximate the causal impact of SB 8, the authors limited their analysis to examine changes in the expected number of infant deaths in Texas from March to December 2022, the period that captures the first set of pregnancies under SB 8. The researchers estimate there were 216 additional infant deaths in Texas that likely would not have occurred between March and December 2022 had the state’s abortion law not been in place. This amounts to a 12.7 percent increase above the 1,697 infant deaths projected for this period. There were 1,913 deaths observed in Texas from March to December 2022.
An analysis of neonatal deaths (deaths in the first 28 days) found similar patterns, with an estimated excess of 145 deaths in the post-policy period. These results were not observed in other states.
The new study is believed to be the first to examine how 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. Previous 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, less severe abortion restrictions and primarily examine correlation.
“Our study is particularly relevant given the month of June 2022. dobbs “The Supreme Court decision that returned abortion legislation to the states and the subsequent rollbacks of reproductive rights in many states,” says Alison Gemmill, PhD, an assistant professor in the Department of Population, Family, and Reproductive Health at the Bloomberg School and one of the study’s senior authors. “These findings suggest that restrictive abortion policies may have significant unintended consequences in terms of child health and the associated trauma to families and medical costs.”
For their month-by-month causal analysis, the researchers relied on child death certificates from Texas and 28 comparison states between 2018 and 2022. They excluded the District of Columbia and several states that had fewer than 10 child deaths in any month between 2018 and 2022, as exact counts are not provided in the currently publicly available data. The researchers selected March 2022 as the first cohort exposed to Texas’ abortion policy because these babies, if born full term, would have been approximately 10 to 14 weeks gestation when the Texas law went into effect in September 2021. Before the enactment of SB 8, people would have been able to request a termination of pregnancy if a fetal problem was detected during evaluation before 20 weeks of gestation.
In a cause-of-death analysis using all death certificate data from 2021 and 2022, researchers found that Texas had outlier increases in infant deaths due to congenital anomalies, the leading cause of infant death. Infant deaths attributable to birth defects increased 22.9 percent in Texas between 2021 and 2022, compared to a 3.1 percent decline in the rest of the U.S. during the same period. Another divergent cause of death pattern in Texas was child accident deaths, which increased 21 percent in Texas versus a one percent increase in the rest of the US.
“Our results suggest that restrictive abortion policies that limit pregnant women’s ability to terminate pregnancies, particularly those with fetal abnormalities diagnosed later in pregnancy, may lead to increased infant mortality,” said Suzanne Bell, PhD, MPH, an assistant professor in the Bloomberg School’s Department of Population, Family, and Reproductive Health and one of the study’s senior authors. “These findings make clear the potentially devastating consequences that abortion bans can have on pregnant women and families who are unable to overcome barriers to accessing this essential reproductive health service.”
The authors note that the data did not include maternal and clinical characteristics of infant deaths, limiting their ability to explore possible mechanisms behind these findings.
Researchers are currently studying the impact that abortion bans have on live births and infant mortality in socioeconomic groups in Texas and other states that banned abortion after… dobbs.
This study was supported by the Hopkins Population Center of the National Institute of Child Health and Human Development (P2CHD042854).