The 2021 ban on early-pregnancy abortion in Texas is associated with higher rates of infant and neonatal deaths in Texas from 2021 to 2022, according to a recent study published in JAMA Pediatrics.1
Takeaways
- The 2021 Texas abortion ban is associated with a 12.9% rise in infant mortality, significantly higher than the 1.8% increase observed in other states.
- Texas saw a 10.4% increase in neonatal deaths from 2021 to 2022, contrasting with a decrease in neonatal mortality in the rest of the United States.
- The ban has led to more pregnancies with congenital anomalies being carried to term, contributing to higher infant and neonatal death rates.
- From March to December 2022, Texas experienced a 12.7% higher-than-expected rate of infant deaths and significant increases in neonatal deaths, particularly in April and October.
- The study suggests that restrictive abortion policies may result in increased infant and neonatal deaths, causing trauma for families and elevating medical costs.
In general, a decrease in infant mortality has been observed since 1995 in the United States. However, it has been hypothesized that infant mortality would rise following the US Supreme Court’s Dobbs v Jackson Women’s Health Organization decision.
Abortion restrictions lead to forced continuation of pregnancies with anomalies, potentially increasing the number of deaths caused by congenital malformations. People may also be more likely to be exposed to risks associated with carrying a pregnancy because of abortion restrictions.
One study reported a 53.7% increase in single-ventricle cardiac defects, at a rate of 9 more cases per 100,000 live births.2 Investigators found this increase would lead to 531 additional neonatal heart surgeries, 16 heart transplants, and 102 neonatal deaths per year.
Current research about the association between abortion bans and infant death is limited because of the fundamental differences between restrictions and bans and most analyses being correlational.1 These gaps can be resolved using data from Texas, which has the most restrictive abortion laws in the United States.
Investigators conducted a cohort study to determine the impact of abortion bans in Texas on infant and neonatal deaths. Death certificate data was obtained from the Provisional Multiple Cause of Death database, which includes data compiled by the National Center for Health Statistics.1
Information about the underlying cause of death, up to 20 additional causes, and demographics was included in the death certificates. Infant deaths were considered those under 1 year after birth, while neonatal deaths were those under 28 days after birth. Those from January 2018 to December 2022 were included in the analysis.
States with less than 10 infant death in any months during the study period were excluded from the analysis, leading to 28 comparison states in the infant mortality analysis and 19 in the neonatal mortality analysis. Texas Senate Bill 8, which banned abortions after embryonic cardiac activity, was the primary exposure.
Infant and neonatal deaths in Texas during the postexposure period were reported as the primary outcome. Additional outcomes included changes in monthly infant and neonatal deaths and cause-specific infant deaths from 2021 to 2022.1
There were 102,391 infant deaths in the United States between 2018 and 2022, 65.2% of which were neonatal deaths and 10,351 were in Texas. A 255-death increase was observed for infant mortality in Texas between 2021 and 2022, from 1985 to 2240 deaths.1
The increase for infant mortality was 12.9% in Texas, which is significantly higher than the 1.8% increase observed overall in other states. For the infant mortality rate, the increase was 8.3% in Texas vs 2.2% in other states.1
Similar patterns were observed for neonatal deaths, with increases of 10.4% in Texas and 1.6% in the rest of the United States. Neonatal mortality rates increased by 5.8% in Texas but decreased in the rest of the United States from 2021 to 2022.
From March to December 2022, infant deaths in Texas were 12.7% above expectation, at 1913 vs 1697. April, July, September, and October had significant greater-than-expected counts. Similarly, 145 excess neonatal deaths were reported, with significant greater-than-expected increases in April and October.
These results indicated an association between restrictive abortion policies and infant death. Investigators concluded restrictive abortion policies may lead to trauma for families and increased medical costs.1
References
- Gemmill A, Margerison CE, Stuart EA, Bell SO. Infant deaths after Texas’ 2021 ban on abortion in early pregnancy. JAMA Pediatr. 2024. doi:10.1001/jamapediatrics.2024.0885
- Miller HE, Fraz F, Zhang J, et al. Abortion bans and resource utilization for congenital heart disease. Obstetrics & Gynecology. 2023;142(3):652-659. doi:10.1097/AOG.0000000000005291
