State abortion bans linked to increased fertility rates
A new study found that US states with 6-week or complete abortion bans saw a 1.70% rise in fertility rates, with the greatest increases observed in Texas, Kentucky, and Mississippi.
State abortion bans linked to increased fertility rates | Image Credit: © Parilov - © Parilov - stock.adobe.com.
There is an association between state-wide abortion bans and increased fertility rates, according to a recent study published in JAMA.1
Significant changes in the abortion landscape have been observed in the United States since the Supreme Court’s Dobbs v. Jackson Women's Health Organization decision, with abortion bans implemented in 21 states. These bans have been linked to increased travel time for abortion, telehealth abortion care, and self-managed medication abortion.2
Barriers to abortion access may increase the rate of births, but according to investigators, “the effects of recent US abortion policy changes on fertility are still unclear.”1 Therefore, a study was conducted to evaluate the link between abortion bans and subnational fertility rates in the United States.
Bimonthly live birth data from 2012 to 2023 was obtained from the National Center for Health Statistics (NCHS). NCHS estimates were also used to determine population counts for fertility rate calculations.
Alongside calculating fertility rates for the female population aged 15 to 44 years, investigators calculated rates among subpopulations based on age, race and ethnicity, marital status, educational attainment, and insurance payer for the delivery. NCHS population counts were used to determine population counts based on age and race and ethnicity.
The imposition of a 6-week or complete abortion ban in the 14 states implementing a ban from September 1, 2021, to August 25, 2022, was considered the primary exposure. A lack of sufficiently exposed cohorts prevented states with more recent abortion bans from being included in the analysis. Exposure was determined using the month of birth.
Models were developed for states without bans, states with bans excluding Texas, and Texas. Notably, fertility rates across the United States decreased prior to the COVID-19 pandemic, with a more significant decline reported during late 2020, followed by a fertility rebound.
Overall, a 1.70% increased fertility rate was observed in states with a 6-week or complete abortion ban. This indicates an additional 1.01 birth per 1000 reproductive-aged women. When excluding Texas, the rate increased by 0.78%.
State-level increases ranged from 0.29% to 2.32% above expectation. Texas, Kentucky, and Mississippi reported the greatest changes, at 2.32%, 1.41%, and 1.35%, respectively. A 2-fold increased percentage was reported in Southern states with abortion bans vs nonsouthern states with abortion bans.
Data indicated greater changes in patients aged under 35 years vs older individuals, with a posterior probability of subgroup difference of 0.88. Changes were also greater among racially minoritized individuals vs non-Hispanic White individuals, with a posterior probability of subgroup difference of 0.99.
Additional factors increasing fertility rates included being unmarried, having only high school or some college level education, and having a low income. Estimated changes in fertility across subcategory remained largest for Texas and Missouri, while the smallest changes were reported for Missouri.
According to post-hoc analyses, most differences in state-level fertility changes associated with abortion bans were caused by differences in education level and race and ethnicity, at 81% and 75%, respectively. Significantly less explanatory power was found for other characteristics.
These results indicated greater than expected fertility in US states with abortion bans. With these changes occurring in states with weaker social services, investigators concluded the excess births are “potentially deepening existing disparities and placing additional burdens on already strained resources.”
References
- Bell SO, Franks AM, Arbour D, et al. US Abortion bans and fertility. JAMA. 2025. doi:10.1001/jama.2024.28527
- Aiken ARA, Wells ES, Gomperts R, Scott JG. Provision of medications for self-managed abortion before and after the Dobbs v Jackson Women’s Health Organization decision.JAMA. 2024;331(18):1558-1564. doi:10.1001/jama.2024.4266
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