The overturn of Roe v. Wade with the Supreme Court's Dobbs decision has paved the way for legislation across the country to restrict reproductive health care. A pair of new studies shows the fallout of restrictive reproductive healthcare policies: More babies were born in states that enacted abortion bans between 2021 and 2023, and infant mortality also rose in these states.
In states that enacted total or six-week abortion bans, there was a 1.7% increase in births between 2021 and 2023, corresponding to 22,000 excess births, according to a study published today in JAMA. Across the same time period, states that enacted bans also experienced a 6% increase in infant mortality, corresponding to 500 excess deaths, the same group reported in a companion study.
Both of these outcomes disproportionately impacted Black mothers and infants, with Black infant mortality 11% higher in states with bans than what would be expected had these bans not been enacted. Younger, unmarried and low-income women were most affected, particularly in southern states.
Overall, infant mortality was about four times higher among births linked to abortion bans than it was in the general population, said Dr. Suzanne O. Bell, lead author of the fertility study and researcher at the Johns Hopkins Bloomberg School of Public Health.
“These excess births are among populations at greater risk of poor pregnancy outcomes, including infant mortality,” Bell told Salon in a phone interview. “Thinking about these papers in conjunction, the additional births and infant deaths resulting from these abortion bans occurred in states with some of the weakest social services and worst health outcomes, potentially deepening existing disparities and placing additional burdens on already strained resources.”
"The additional births and infant deaths resulting from these abortion bans occurred in states with some of the weakest social services and worst health outcomes."
Infant mortality has been on the decline in the U.S. since 1995 when data measuring this outcome became available. In 2022, following the Dobbs decision, it increased 3% from the year prior. These studies show this trend has continued to increase in the years after the fall of Roe v. Wade. Meanwhile, the maternal mortality crisis that disproportionately affects Black women continues to worsen as well.
“Anytime we see a population-level increase in infant mortality, it is telling you that something is very wrong,” Gemmill told Salon in a phone interview. “It is telling you that we are reversing the progress that we have had and something needs to be addressed.”
After the Supreme Court rescinded the federal right to abortion in June 2022, states began enacting full or partial bans limiting abortion access after a certain number of gestational weeks. This study looked at fertility and infant mortality outcomes in 14 states that had full or six-week abortion bans, although since it has been published, more bans have been or are in the process of being enacted in Florida, Iowa, South Carolina and other states.
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In the study, infant mortality and excess births increased by far the most in Texas, which was responsible for 73% of excess births and 80% of excess deaths. Texas introduced an abortion ban nearly a year prior to the Dobbs decision, and was also one of the states where the most women sought abortions prior to the overthrow of Roe v. Wade, which may be what is behind this outsized impact, said Dr. Alison Gemmill, the lead author of the infant mortality study and a researcher at Johns Hopkins Bloomberg School of Public Health.
Last year, the same study group found infant mortality spiked 13% after SB8, the Texas law that bans abortion was enacted in 2021. This work expands on their prior research to look at how abortion bans impact maternal and infant health nationally and across different racial groups.
One of the leading causes of infant mortality in the current study along with the Texas study was congenital anomalies. Most abortion bans have exceptions built in for congenital anomalies, allowing birthing women abortions instead of forcing them to carry the pregnancy to term only to watch the baby die. However, these have been reported to not be granted in many cases. And the fact that the rate of infants dying from congenital anomalies continues to increase suggests that these bans have had far-reaching chilling effects that prevent pregnant people from getting the care they need.
“The bottom line is that it’s very difficult to itemize all of the different ways pregnancy can go wrong in a legal setting,” Gemmill said.
Abortion bans are largely concentrated in the South, forming maternity care deserts. As a result, many women have to spend thousands of dollars in travel expenses alone to get reproductive health care. In this study, infant mortality and increased fertility were also concentrated in Southern states, with Kentucky, Mississippi, Alabama and Oklahoma having some of the highest rates.
“One of the main hypotheses for [Texas’ outsized impact] is not just because of its size, but because the distance to travel for an abortion went up much more for people living in Texas than for some of these other states,” Gemmill said.
The resources needed to get access to care in maternity care deserts mean people who can't afford to travel out of state and unmarried women, along with women of color, have been shown to be less likely to access this care due to systematic disadvantages. These groups were already more likely to seek abortion and have higher risk pregnancies pre-Dobbs, Bell said.
“You have a part of the population that is having difficulty accessing abortion services, and these are also the same groups that have higher risk pregnancies and a higher risk of infant mortality,” Gemmill said.
"Anytime we see a population-level increase in infant mortality, it is telling you that something is very wrong."
Expanding access and funding to Medicaid, which covers 40% of births, could help some pregnant people living in states with restricted abortion access get better care, wrote Dr. Alyssa Bilinski, a researcher at the Brown University School of Public Health, in an editorial accompanying the studies.
“In addition to policy interventions targeted toward children and families, it is also imperative to provide health care professionals caring for patients in states with abortion restrictions the resources and training to address new complexities introduced by abortion restrictions,” Bilinski wrote, including providing resources that help them navigate reproductive healthcare under these bans.
In January, Republican Representative Eric Burlison of Missouri introduced a bill that proposes a national ban on abortion, and the Trump administration has already moved to enact additional barriers for people seeking an abortion. President Donald Trump said he was “proud to be a participant” in overturning Roe v. Wade and issued a series of executive orders in his first weeks in office designed to restrict access to abortion.
Yet experts caution that restricting access to reproductive health care will continue to have long-term physical, mental and economic consequences for birthing people and their families.
“We are still seeing people who are unable to overcome barriers to abortion care imposed by these bans,” Bell said. “Disproportionately, these populations are those experiencing the greatest structural disadvantages.”
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