Infant mortality in the US has worsened after the Supreme Court restricted access to abortion

The change became noticeable three months after the June 2022 ruling, with an increased infant mortality rate among babies born with serious birth defects, the researchers found.

By the end of 2023, there were six months in which the mortality rate for infants with serious anatomical problems was significantly higher than in the years leading up to the Supreme Court’s ruling. The researchers also identified three months in which the country’s overall infant mortality rate increased.

However, none of these numbers fell below their historical range in the year and a half following the ruling in Dobbs v. Jackson Women’s Health Organization.

The findings, reported Monday in the journal JAMA Pediatrics, were seen as a clear sign that the Dobbs decision has deterred some women from terminating pregnancies that would otherwise have ended in abortion.

“There’s a very simple mechanism here,” says Alison Gemmill, a demographer and perinatal epidemiologist at the Johns Hopkins Bloomberg School of Public Health, who was not involved in the study.

“Before these abortion bans, people had the option to terminate an abortion if it turned out that the fetus had a serious congenital defect – we are talking about organs that are outside the body and other things that are very serious and incompatible with the life,” Gemmill said. However, if women in these situations had no choice but to continue their pregnancies, “those babies would die shortly after birth,” she said.

Gemmill said the new findings are in line with her own research, including a study published in June that documented a nearly 13% increase in infant deaths in Texas in the wake of a 2021 state law that would ban abortions after about the sixth week of life. pregnancy prohibited. In particular, deaths from birth defects rose by 23%, while they fell in the rest of the country, that study found.

Parvati Singh, an epidemiologist at Ohio State University who studies the effects of sudden changes in health policy, wondered whether the Dobbs decision would have similar consequences for the nation as a whole.

To find out, she and her colleague Maria Gallo, a sexual and reproductive health epidemiologist at Ohio State, pored over live birth and infant mortality data collected by the Centers for Disease Control and Prevention. With those figures they were able to calculate monthly infant mortality rates.

In a large population like the United States, the number of babies born and dying each month tends to be stable, Singh said. What she and Gallo were looking for were significant deviations from that stable average.

The pair started with data from January 2018 to May 2022 — the month before the Dobbs ruling — to identify “the core signal” and the natural “ups and downs around that core signal,” Singh said.

They then used that information to estimate what the country’s monthly infant mortality rates would have been through December 2023 if the Supreme Court had not allowed states to restrict or ban abortion. (According to the Guttmacher Institute, thirteen states have banned abortion altogether, and eight more states ban it at some point during the first eighteen weeks of pregnancy.)

The next step was to compare their monthly estimates of infant mortality with the actual rates based on the CDC data. Nine times the observed infant mortality rate was higher than the expected rate, and the difference was too large to be explained by natural variability or random chance, they found.

Because investigators don’t know the details of every death, they can’t say with certainty whether a specific case involved a pregnant person who was denied an abortion, Singh said. But the patterns suggest that many of them were.

For example, the increase in deaths involving babies with birth defects was first observed in September and October 2022. That timing makes sense, Singh said.

The ultrasound examination that doctors use to ensure that the fetal organs are developing properly takes place 18 to 22 weeks after pregnancy. If an investigation immediately after the Dobbs decision yielded devastating news, but the patient was unable to have an abortion, she would be at risk of premature birth three to four months later.

Eight months after the Dobbs decision, rates were increased again. That could reflect the cases of women who became pregnant around the time of the Dobbs ruling — before they had a chance to reconsider whether they should get pregnant and before they could think of ways to get around the ruling, Singh said.

A year after the ruling, infant mortality rates were back within the normal range, which may indicate that the group of people willing to become pregnant has changed in response to the new restrictive landscape.

Something similar happened early in the COVID-19 pandemic, Singh said.

“Fertility dropped very quickly,” she said. People who chose to become pregnant despite the threat of the new disease were less likely to give birth prematurely and their newborns were less likely to have low birth weight.

“In other words, they were better pregnancies,” Singh said. “Maybe that’s what’s happening here.”

In total, Singh and Gallo noted 247 additional infant deaths in the year and a half after Dobbs, which amounted to an increase of 7%. The vast majority of these deaths – 204 – were due to birth defects, an increase of 10%, the study said.

The fact that infant mortality never fell below expected levels is strong evidence that the abortion ruling was the main cause of the excess deaths, Singh said.

“If our theory is correct, there is no reason for lower than expected infant mortality,” she said.

Gemmill said the increase in infant mortality would likely have been more pronounced if the researchers had focused on changes in states with abortion restrictions rather than looking at the country as a whole.

The increases would likely be highest in places where pregnant people have to travel long distances to reach another state to access abortion, she added.