Texas abortion ban linked to increase in infant deaths, new study finds

A six-week abortion ban in Texas was linked to a 13% increase in the number of infants who died in their first year of life, a new study published Monday in JAMA Pediatrics suggests.

The study, published two years to the day since the US supreme court overturned Roe v Wade and permitted more than a dozen states across the country to outlaw almost all abortions, is one of the first glimpses into how strict abortion bans impact babies’ health.

The study also estimated that the ban may have led the number of infants in Texas who died within their first month of life to rise more than 10%.

Because Texas enacted its six-week abortion ban in September 2021, months before Roe’s demise, scholars have studied what has happened in Texas for clues about how post-Roe abortion bans are now affecting the rest of the nation. Some of the researchers involved in the Monday study have previously concluded that the Texas ban also led to 10,000 additional births.

“Texas is the harbinger of potentially what’s to come with Dobbs,” said Alison Gemmill, the lead author of the study and an assistant professor at the Johns Hopkins Bloomberg School of Public Health said, referring to Dobbs v Jackson Women’s Health Organization, the case that overturned Roe. “One of the things we’re doing now, as you can imagine, is looking at Dobbs and infant mortality as a next step.”

The study found a 23% jump in infant deaths due to congenital anomalies – the kind of conditions that are often identified in utero and lead to abortions in states where the procedure is legal, since they can be incompatible with life. But that choice is no longer available to pregnant Texans.

“Prior to this policy, if an anomaly was detected, people would have had the ability to legally terminate at least up to maybe about 20 weeks, or even maybe 22 weeks gestation,” said Alison Gemmill, the lead author of the study and an assistant professor at the Johns Hopkins Bloomberg School of Public Health. “Any infant death is tragic, but then layering on top of that, this pregnant person’s situation where they know that they’re carrying a fetus that is incompatible with life, whereas before, they maybe would have had the option to terminate.”

In order to isolate the impact of the Texas ban and establish a causal link between the law and infant mortality, Gemmill and the other researchers analyzed death certificates in Texas and 28 other states from January 2018 to February 2022. They built a “synthetic” statistical model of Texas that calculated the number of infant deaths that may have occurred if Texas had never enacted its six-week ban, then compared that model to the number of deaths that actually occurred in the state.

Two hundred and sixteen more infant deaths occurred due to the Texas six-week abortion ban, the researchers estimated.

Gemmill plans to investigate how Roe’s demise may have led to increases in births among children who did not die but may need continued and substantial medical help to survive.

After Roe collapsed, enabling Texas to outlaw almost all abortions, Texas has also become the epicenter of the debate over doctors’ ability to provide medically necessary abortions. Like every other state with an abortion ban, Texas technically permits abortions in emergencies – but doctors in Texas and across the country have said that abortion bans are worded in such a way that they become unusable. Instead of acting, doctors say they have been forced to wait until patients get sick enough that they can intervene.

Last year, dozens of women who said they had been denied medically necessary abortions sued Texas in the hopes of clarifying its abortion ban. At least one of the women, denied an abortion and unable to leave the state, ended up giving birth to an infant who died within hours of her birth.

In May, the Texas supreme court – which is composed entirely of Republicans – rejected their challenge.

After months of delay and calls for action from both abortion rights supporters and abortion opponents, the Texas Medical Board on Friday issued guidance to clarify that “lack of imminent risk of death or substantial impairment to a patient should not preclude a physician from doing what is medically necessary”, as the board president said in a statement. However, the guidance does not preclude Texas prosecutors from pursuing charges against doctors.

The researchers behind the Monday study did not have access to records that broke down infant deaths by demographic information such as race or ethnicity, so it is not clear if specific groups were more likely to give birth to babies who later died. However, researchers noted, the infant death rate among non-Hispanic Black women is triple that among non-Hispanic white women. Low-income women are also more likely to have lacked the resources needed to flee Texas for abortions in other states.

“This research shows that when attempting to legislate something as complex as pregnancy,” Gemmill said, “it is crucial to design policies based on a thorough understanding of public health impacts and robust scientific evidence.”