A study led by researchers at Johns Hopkins Bloomberg School of Public Health estimates that infant deaths in Texas rose more than expected in the year following the state’s 2021 early-pregnancy abortion ban, particularly among infants with congenital anomalies.
The Texas law, Senate Bill 8 (S.B. 8), which prohibits abortions after a fetal heartbeat is detected—usually around five or six weeks—went into effect on September 1, 2021. At the time, it was the strictest state abortion law in the country and did not allow exemptions for congenital anomalies.
Researchers analyzed monthly death certificate data in Texas and the rest of the United States, finding that from 2021 to 2022, infant deaths in Texas increased from 1,985 to 2,240, a rise of 255 deaths. This 12.9 percent increase in Texas compared to a 1.8 percent increase in the rest of the U.S. during the same period. Infants are defined as those under 12 months old.
The study, published online on June 24 in JAMA Pediatrics, arrives as more states enact stricter abortion laws following the U.S. Supreme Court’s 2022 Dobbs decision, which overturned Roe v. Wade and returned abortion policymaking to the states.
To approximate the impact of S.B. 8, the authors focused on changes in the expected number of infant deaths in Texas from March to December 2022, covering the first set of pregnancies under S.B. 8. They estimate there were 216 excess infant deaths in Texas during this period, a 12.7 percent increase over the expected 1,697 deaths. Observed deaths in Texas from March to December 2022 were 1,913.
An analysis of neonatal deaths (deaths in the first 28 days) showed similar patterns, with an estimated 145 excess deaths post-policy. These results were not observed in other states.
This study is believed to be the first to examine how the Texas abortion ban may have impacted infant deaths and 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 higher infant deaths than those without. However, these studies evaluated less severe abortion restrictions and primarily examined 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 used infant death certificates from Texas and 28 comparison states from 2018 through 2022, excluding the District of Columbia and several states with fewer than 10 infant deaths in any month from 2018 to 2022 due to data limitations. March 2022 was selected as the first cohort exposed to the Texas abortion policy, as these infants would have been 10 to 14 weeks gestation when S.B. 8 went into effect in September 2021. Before S.B. 8, people could seek termination for fetal issues detected during screening before 20 weeks gestation.
Analyzing cause of death using all 2021 and 2022 death certificate data, the researchers found atypical increases in infant deaths due to congenital anomalies, the leading cause of infant death. Infant deaths from congenital anomalies rose by 22.9 percent in Texas from 2021 to 2022, compared to a 3.1 percent decrease in the rest of the U.S. Another divergent cause of death pattern in Texas was infant deaths from accidents, which increased by 21 percent in Texas versus a 1 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 the data did not include maternal and clinical characteristics of infant deaths, limiting their ability to explore potential mechanisms behind these findings.
Researchers are currently studying the impact of abortion bans on live births and infant mortality across socioeconomic groups 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).
