Infant mortality increased along with births in most states with abortion bans in the first 18 months after the Supreme Court overturned Roe v. Wade, according to new research.
The findings, in two studies published Thursday in the journal JAMA, also suggest that abortion bans can have the most significant effects on people who are struggling economically or who are in other types of challenging circumstances, health policy experts said.
“The groups that are most likely to have children as a result of abortion bans are also individuals who are most likely, for a number of different reasons, to have higher rates of infant mortality,” said Alyssa Bilinski, a professor of health policy at Brown University, who was not involved in the research.
Overall, infant mortality was 6 percent higher than expected in states that implemented abortion bans, said Alison Gemmill, one of the researchers, who is a demographer and perinatal epidemiologist in the department of population, family and reproductive health at the Johns Hopkins Bloomberg School of Public Health. That number reflected increases in nine states, decreases in four and no change in one.
Dr. Gemmill said that among non-Hispanic Black infants, mortality was 11 percent higher after abortion bans were implemented than would have been expected. Also, there were more babies born with congenital birth defects, situations in which women have been able to terminate their pregnancies if not for abortion bans.
Overall, the researchers found that in the states that implemented near-total abortion bans or bans after six weeks’ gestation during that period, there were 478 more deaths of babies in their first year of life after the bans were implemented than would have been expected based on previous years’ data.
Birthrate increases were higher among communities with socioeconomic disadvantages and in states that have the worst maternal and child health outcomes.
“What happens when you ban abortion is that you create enormous inequality in access to abortion,” said Caitlin Myers of Middlebury College, who studies similar abortion data but was not involved in the new research.
The studies evaluated data from birth and death certificates and census records for all 50 states from January 2012 through December 2023. That time frame allowed researchers to compare trends in births and infant mortality in the years before the Supreme Court overturned the national right to abortion in June 2022 with data in the 18 months afterward.
At the time, 14 states had implemented near-total abortion bans or bans after six weeks’ gestation during that period. Now 16 have.
While national data has shown that, because of factors like telemedicine and out-of-state travel, overall abortion rates have actually increased since the Supreme Court’s ruling, that does not mean that everyone who needed or sought an abortion could obtain one, Dr. Myers said.
She said the research showed that two dynamics were behind the increase in infant mortality. One aspect is that when women are not allowed to end pregnancies of fetuses with congenital anomalies, the babies often die within days or weeks after birth.
The other aspect is that women who cannot obtain abortions by traveling to other states or by ordering pills by mail are “more likely to be poor, more likely to be women of color, and those populations have higher rates of maternal morbidity and mortality, infant complications, infant mortality,” Dr. Myers said.
Much of the overall increase was driven by data from Texas, said Suzanne Bell, a co-author of the studies and a professor in the same department at Johns Hopkins as Dr. Gemmill. Dr. Bell said all but 94 of the additional 478 infant deaths were in Texas, which has a much larger population than any of the other states with bans.
Infant mortality in Texas was 9.4 percent higher after abortion bans were implemented than would have been expected, the research found. In the eight other states with bans that showed increases, that rate ranged from a 1.3 percent increase in Mississippi to an 8.6 percent increase in Kentucky.
The researchers attributed the dominant influence of Texas on the data partly to the fact that in September 2021, about nine months before the Supreme Court’s Dobbs decision, Texas implemented a strict ban on abortions after six weeks of pregnancy. Another factor, Dr. Bell said, was that before that time, a relatively high proportion of Texas women seeking abortions were able to obtain them from health care providers there, but after the bans, clinics and other abortion services closed, forcing women to travel long distances across that sprawling state.
In many of the other states, Dr. Bell said, there were already very few abortion providers before the bans, so women “were already traveling out of state or were already unable to obtain abortion.”
Five states with bans did not show higher infant mortality than expected. In Louisiana, the rate did not change. In Idaho, Missouri, West Virginia and Wisconsin, the rate decreased. The researchers said that was most likely because neighboring states, including Illinois, Washington State and Maryland, were providing expanded access to abortion.
In addition, they said, the demographics and relatively low socioeconomic status of residents in most of the Southern states contributed to higher infant mortality and higher birthrates after abortion bans were imposed.
“There are just very longstanding disparities in these outcomes that are shaped by state policies,” Dr. Gemmill said.
Abortion opponents said they had a different interpretation of the data.
“All of these ‘excess’ children who were born would have been killed in induced abortions,” said Dr. Donna Harrison, who is director of research at American Association of Pro-Life Obstetrician and Gynecologists. “This means that anyone lamenting the results of this study isn’t really concerned that these babies died; rather, they wish they would have been killed earlier: in the womb.”
The analysis of birth data found that in the states with abortion bans, the rate of births per 1,000 women of reproductive age increased by 1.7 percent more than would be expected from previous years’ data.
“It might seem like a 1.7 percent change in the fertility rate isn’t a big deal, but it’s actually a very big deal,” Dr. Gemmill said. She said that demographers considered such an increase very significant and noted that it was higher than the 1.4 percent increase in birthrates related to the Covid pandemic.
In states with abortion bans, that increase translated to 22,180 more births than expected, the researchers said.
Dr. Bilinski, who wrote an editorial accompanying the studies, said that the findings presented an opportunity to galvanize efforts to improve support systems and funding for pregnant women and infants — regardless of one’s views on abortion.
“These papers are not going to resolve disagreements about abortion in this country,” she said. “People are going to look at these papers, and particularly the results about birthrates, and I think have very different reactions.”
But nobody is in favor of infants dying. “We should want to prevent infant mortality, and in many cases infant mortality is preventable,” she said. She added, “If we are in a world where more people who perhaps didn’t plan to and didn’t feel prepared to become parents are becoming parents, we should think about what it means to be supporting those families in a real and tangible way.”
Dr. Bilinski said the study results underscored the need for policies and programs like Medicaid, the child tax credit, parental leave and affordable child care.
“I would hope that as a country, looking at these results,” she said, “we can all kind of agree that those children and families should have an opportunity to thrive.”
