Infant mortality, fertility rates ‘higher than expected’ in states with abortion bans
Key takeaways:
- Infant mortality rates were unexpectedly high in states with abortion bans, especially for Black infants.
- States with abortion bans also had higher-than-expected fertility rates.
States that have adopted complete or 6-week abortion bans have “higher-than-expected” infant mortality and fertility rates, according to two studies published in JAMA.
“Primary care providers and pediatricians should recognize the unintended consequences of restrictive abortion laws on their patient populations,” Alison Gemmill, PhD, associate professor in the department of population, family and reproductive health at Johns Hopkins Bloomberg School of Public Health, told Healio. “Health care providers should advocate for expanded access to comprehensive prenatal care, counseling and resources to mitigate these impacts. Additionally, they should engage in policy efforts that prioritize the health and well-being of both birthing individuals and their infants.”
More infant deaths
Gemmill, Suzanne O. Bell, PhD, assistant professor in the department of population, family and reproductive health at the Johns Hopkins Bloomberg School of Public Health, and colleagues conducted a population-based, cross-sectional study using data from all live births and infant deaths in the U.S. from 2012 to 2023 to evaluate infant mortality rates across the 14 states with complete or 6-week abortion bans. Researchers compared infant mortality rates with predictions based on pre-ban mortality rates and states without bans.
After states adopted abortion bans, researchers observed an additional 0.33 infant deaths per 1,000 live births, resulting in an increase of 5.6%, or 478, excess infant deaths. When excluding Texas, which enacted an abortion ban almost 1 year ahead of other states, researchers observed an increase of 0.14 infant deaths per 1,000 live births, or 94 excess infant deaths.
The estimated infant mortality rate was highest for Black infants at 10.98%, resulting in 265 excess infant deaths, or 1.15 additional infant deaths per 1,000 live births above the expected rate of 10.66, compared with infants of other races and ethnicities.
Per 1,000 live births, the observed infant mortality rate caused by congenital abnormalities was 1.37 compared with an expected rate of 1.24, resulting in a relative increase of 10.87%. The infant mortality rate not caused by congenital abnormalities was 4.89 compared with an expected rate of 4.69, resulting in a relative increase of 4.23%.
Larger infant mortality rate increases were observed in southern vs. nonsouthern U.S. states. Researchers also noted that the restrictive abortion ban observed in Texas had a dominant influence on the overall results.
“Given our findings around congenital anomalies, health care providers should prepare for an increase in complex medical cases, including conditions requiring extensive medical intervention,” Bell told Healio. “Additionally, they should advocate for comprehensive prenatal care and counseling to support affected families, and work toward policies that prioritize the health and well-being of both the birthing individuals and their infants.”
According to Bell, primary care providers and pediatricians should be aware of the consequences of highly restrictive abortion bans on their patient populations.
“Further research is needed to examine not only infant mortality but also infant morbidity, including long-term health outcomes for infants affected by abortion bans,” Gemmill told Healio. “Additionally, studies should assess the impact of these policies on maternal health, including pregnancy-related complications, severe maternal morbidity and mental health outcomes.”
Higher-than-expected fertility
In a second analysis published in JAMA, Gemmill, Bell and colleagues analyzed data from birth certificate and U.S. Census Bureau data from 2012 to 2023. Researchers evaluated the state-by-subgroup specific changes in fertility associated with complete or 6-week abortion bans for 14 states and estimated the average percent and change in fertility rates among women.
Per 1,000 reproductive-aged women, researchers estimated an additional 1.01 births above expectation in states with complete or 6-week abortion bans, resulting in a 1.7% increase, or 22,180 excess births.
In addition, researchers observed variation in fertility rates based on state and subgroup. Estimated state-level fertility changes ranged from increases of 0.29% to 2.32% above expectation, or 0.16 to 1.41 excess births per 1,000 reproductive-aged women. The largest estimated fertility changes were observed in Texas (2.32%), Kentucky (1.41%) and Mississippi (1.35%).
In states with complete or 6-week abortion bans, Black and Hispanic women (2%), unmarried women (1.79%), those aged 35 years or younger (2%), Medicaid beneficiaries (2.41%) and with high school diploma only (2.36%) or some college (1.58%) had the largest estimated fertility increases. This was especially true for those living in Southern states, according to the researchers.
“These findings provide evidence that fertility and infant mortality rates in states with abortion bans were higher than would have been expected in the absence of these policies, with the largest estimated differences among populations experiencing the greatest structural disadvantages and in states with among the worst maternal and child health and well-being outcomes,” Bell told Healio. “More research is needed to understand the impact of abortion bans on other pregnancy outcomes, including infant complications that did not result in mortality but have long-term health implications, as well as maternal health outcomes.”
For more information:
Suzanne O. Bell, PhD, can be reached at suzannebell@jhu.edu; X (Twitter): @HopkinsPFRH; Instagram: @HopkinsPFRH; and Bluesky: @HopkinsPFRH.bsky.social.
Alison Gemmill, PhD, can be reached at agemmill@jhu.edu; X (Twitter): @AlisonGemmill; and Bluesky: @Alisongemmill.bsky.social.
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Perspective
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These are thoughtful, rigorously designed studies that demonstrate at the population level what I see among the individual women I care for. Abortion restrictions result in people not being able to obtain the health care they need and result in worse health outcomes. The researchers used 11 years of national data to thoroughly examine differences in fertility and infant mortality rates both across and within states, allowing them to control for other factors that may have influenced their outcomes. A key takeaway is that while these bans affected all pregnant women and their infants, groups that are already experiencing structural barriers to care were disproportionately affected.
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