Regulations on abortion in the U.S. have changed in recent years, starting in 2021. In September 2021, the state of Texas passed Senate Bill 8, which prohibits abortions after six weeks of gestation. However, in June 2022, the Supreme Court ruling in Dobbs v. Jackson Women’s Health Organization returned the authority to regulate abortion to individual states.
As of November 2024, thirteen states had total bans on abortion, and four other states banned abortion after six weeks of gestation. While it is difficult to measure the exact numbers because of data limitations, states that outlawed abortion usually observed a slight expansion of 2-3% in live births.
These new policies raise significant questions concerning their impact on maternal and infant health. Notably, six states do not allow exceptions for required treatment to protect the mother’s health. However, 13 states do not allow exceptions for potentially lethal fetal conditions. Researchers are carefully observing how these policies affect health outcomes related to pregnancy.
This serial, cross-sectional, population-based study used a Bayesian panel model to contrast infant mortality rates in 14 states that executed either entire or six-week abortion prohibitions. These rates were then matched to post-ban rates inferred from pre-ban trends as well as data from states with no such bans. The research included birth and infant mortality records from all 50 U.S. states and the District of Columbia during the time of 2012-2023. The models controlled for time trends and state variables with analyses stratified by ethnicity and race, death timing, and death cause.
The target of the study was the infant mortality rate, that is, the number of infants that died for every 1,000 live births in each state over 12 years. Data were spotted every six months, indicating a total of 1,224 observations.
A recent study determined that infant mortality was larger than anticipated in those states encompassing abortion bans. In these states, the infant mortality rate increased from an anticipated 5.93 to an observed 6.26 per 1,000 live births. An absolute increase of 0.33 (95% credible interval [CrI], 0.14-0.51) and a relative increase of 5.60% (95% CrI, 2.43%-8.73%). This resulted in nearly 478 more infant fatalities across 14 states through the abortion ban time.
The upsurge was increased in Black infants with an observed rate of 11.81 per 1,000 live births compared to the projected 10.66. This translated into an absolute increase of 1.15 (95% CrI, 0.53-1.81) and a relative increase of 10.98% (95% CrI, 4.87%-17.89%).
Infant mortality due to congenital anomalies increased to a rate of 1.37 per 1,000 live births from the expected 1.24 (absolute increase of 0.13 [95% CrI, 0.04-0.21]; relative increase of 10.87% [95% CrI, 3.39%-18.08%]). For non-congenital anomaly deaths, the observed rate was 4.89 per 1,000 live births versus an assumed 4.69 (absolute increase of 0.20 [95% CrI, 0.02-0.38]; a relative increase of 4.23% [95% CrI, 0.49%-8.23%]). Texas had the most powerful impact on the collective outcomes, and the advances were higher in the southern states than in the non-southern states.
Texas experienced the largest increase due to its high population, prolonged exposure to the ban, and limited abortion access. The research also identified increased infant mortality due to both congenital and noncongenital causes. Researchers noted that bans resulted in more pregnancies being carried to term despite lethal fetal anomalies.
Reference: Gemmill A, Franks AM, Anjur-Dietrich S, et al. US Abortion Bans and Infant Mortality. JAMA. Published online February 13, 2025. doi:10.1001/jama.2024.28517
