Infant deaths increased after Texas banned abortion in early pregnancy

Since Texas’ ban on abortion went into effect, infant deaths in the state increased by nearly 13%, according to a new analysis published on Monday in JAMA Pediatrics. In the rest of the country, infant mortality increased less than 2% over the same period.

“We had read the literature that was showing an association [of infant death increases] with prior abortion restrictions or states that are hostile to abortion,” said lead author Alison Gemmill, a demographer and perinatal epidemiologist at Johns Hopkins Bloomberg School of Public Health. But they weren’t sure how strong the connection was.

In order to establish the ban’s potential impact on infant mortality, the researchers looked at deaths that occurred starting in March 2022. Babies born in that month were about 10 to 14 weeks along when the Texas abortion ban — known as SB 8 — went into effect on Sept. 1, 2021. The ban, one of the most restrictive in the country, prohibits abortions after about six weeks of pregnancy.

The researchers found that in 2022, 2,240 infants under the age of 1 died in Texas, more than half of whom died before 28 days of life. In 2021, there were 1,985 infant deaths, a statistically significant difference.

“I actually don’t think that it was obvious that there would be increases in infant deaths, and so just that there is itself an important finding,” said Amanda Jean Stevenson, a professor of sociology at the University of Colorado Boulder, whose work focuses on the impact of abortion and family planning policy. “There would be an argument to be made that we wouldn’t expect to see statistically significant increases, because this is such a rare outcome, and abortion had already been restricted in Texas pretty substantially,” said Stevenson, who was not involved in the study.

The findings, she said, show the huge impact that a restriction on abortion can have, even starting from low levels of access. Before SB 8 went into effect, abortion in Texas was essentially banned after 22 weeks, and the state imposed other restrictions, such as requiring hospital admitting privileges to provide an abortion and curtailing access for minors. “We think it’s actually a causal effect,” said Gemmill.

The study had limitations, including the fact that the gestational age was not included in infants’ death certificates. The low absolute number of deaths prevented more detailed demographic analyses, too. But the researchers focused on building apples-to-apples comparisons by accessing the same Centers for Disease Control and Prevention data for Texas and the rest of the country. They only included states where infant deaths exceeded 10 in any given month between 2018 and 2022, as data for smaller states didn’t provide the same level of granularity.

“Given the really substantial rigor that this article uses in its analysis, I am confident that this is something that happened exactly when SB 8 went into effect,” said Stevenson. “I think that it’s very strong evidence that SB 8 is the cause of the observed increase.”

Among the causes of infant deaths, one increased the most: congenital abnormalities, which increased 22.9% in Texas in children between 2021 and 2022, while they decreased 2.9% in the rest of the country. That trend suggests that at least in some cases, parents were forced to carry a pregnancy to term while knowing their children had little to no chance of survival, said Gemmill.

“What we know from the literature is that any infant death is a traumatic event to experience,” she said. “But I can imagine that carrying that fetus to term when you could have had the option to terminate is going to just add that additional trauma and heartbreak to the situation.”

Significant increases were also found in babies who died because of maternal complications of pregnancy; in Texas, those deaths increased by 18.2% between 2021 and 2022, compared to 7.8% in the rest of the country. Infant deaths caused by unintentional injuries, which can be associated with unwanted pregnancies, also increased by 20.7%, compared to a 1.1% increase elsewhere in the U.S.

These numbers only paint a partial picture of the long-term impact of abortion bans, said Gemmill, who is planning to focus her research on infant morbidity. Babies born with congenital abnormalities can face extremely difficult life circumstances, and require immense practical and emotional investment from parents.

Deadly fetal abnormalities can’t be corrected through medical intervention, leaving the prevention of these deaths to policy. “The most effective way to prevent these unnecessary infant deaths is clearly to not restrict abortion,” said Stevenson. “The other thing that is possible is to support people leaving Texas and states that ban abortion to get abortion in other places. So there also is an opportunity for policy intervention in the form of facilitating people crossing state lines for care,” she said.

In the short term, Gemmill said, stronger support is needed for the families facing the loss of an infant. Stevenson agrees: “The grief that parents experience, the burden that caring for terminally ill infants places on families and health care providers — there are a lot of ways that our society doesn’t support people who are dealing with traumas like these.”