Abortion bans in the US linked to increased births and infant mortality, studies find

Johns Hopkins Bloomberg School of Public Health researchers analyzed the effects of abortion bans in the U.S., identifying increases in both birth rates and infant mortality in states that implemented complete or six-week abortion bans.

Abortion policies in the U.S. have undergone rapid changes since 2021, with Texas implementing a six-week ban in September 2021 and the Supreme Court's Dobbs v. Jackson Women's Health Organization decision in June 2022 allowing state-level abortion restrictions. By late 2024, 21 states had enacted abortion bans, leading to significant declines in legal abortion access, though national abortions rose slightly overall due to increases in other states.

In the study, "US Abortion Bans and Fertility," published in JAMA, researchers examined birth certificates and U.S. Census Bureau data from 2012 through 2023 for all 50 states and the District of Columbia.

Researchers used a Bayesian panel data model to estimate state-specific changes in fertility rates associated with abortion bans, analyzing data by age, race and ethnicity, marital status, education, and insurance payer.

The analysis focused on 14 states with abortion bans, estimating an average increase of 1.01 births per 1,000 reproductive-aged females (60.55 observed vs. 59.54 expected), translating to 22,180 excess births.

The overall fertility rate increased by 1.70%, with the most significant increases among racially minoritized individuals (~2%), unmarried individuals (1.79%), individuals younger than 35 years (~2%), Medicaid beneficiaries (2.41%), and those without college degrees (high school diploma, 2.36%; some college, 1.58%).

State-level differences were observed, with Texas experiencing the largest estimated increase (2.32%), followed by Kentucky (1.41%) and Mississippi (1.35%). Southern states showed approximately double the increase in fertility rates compared with non-Southern states. Race, ethnicity, and education differences explain most of the variability in state-level fertility changes.

Another study by Johns Hopkins Bloomberg School of Public Health, "US Abortion Bans and Infant Mortality," also published in JAMA, examined infant death rates using national birth and death certificate data from 2012 through 2023.

The study employed a Bayesian panel data model to compare observed infant mortality rates in states with bans to predicted rates based on pre-ban data and trends in states without bans.

In states that implemented complete or six-week abortion bans, the observed infant mortality rate was 6.26 per 1,000 live births compared with an expected rate of 5.93, marking a 5.60% increase (absolute increase: 0.33 per 1,000), translating to an estimated 478 excess infant deaths.

Texas accounted for a significant portion of the increase, with an observed rate of 5.79 per 1,000 live births versus an expected rate of 5.30.

Estimated increases in infant mortality were higher in Southern states and disproportionately affected Black infants. Among Black infants, the mortality rate increased by 10.98% (11.81 observed vs. 10.66 expected per 1,000 live births), with an absolute increase of 1.15 per 1,000, resulting in 265 excess deaths.

Infant deaths associated with congenital anomalies also increased, with an observed rate of 1.37 per 1,000 live births compared with an expected rate of 1.24, marking a 10.87% increase. Mortality not attributed to congenital anomalies increased to 4.89 per 1,000 live births from an expected 4.69.

Findings from both studies indicate that U.S. states with abortion bans experienced higher-than-expected fertility and infant mortality rates, particularly affecting Black infants, younger individuals, those with lower education levels, and Medicaid recipients.

Southern states exhibited the most significant increases. Excess births occurred in states with among the worst maternal and child health outcomes, raising concerns about the long-term consequences of abortion restrictions on public health and health disparities.

Alyssa Bilinski, Ph.D., of Brown University School of Public Health, analyzed findings from the two studies on the effects of abortion restrictions in the U.S. Her editorial, "Abortion May Be Controversial—Supporting Children and Families Need Not Be," was also published in JAMA. In it, she contextualized these studies within broader public health concerns and policy implications.

The two studies in JAMA estimate a 1.7% increase in birth rates, translating to approximately 22,000 excess births, and a 6% increase in infant mortality, corresponding to about 500 additional infant deaths between 2021 and 2023. Births associated with abortion bans had infant mortality rates roughly four times higher than those in the general population (24 per 1,000 vs. ~ 6 per 1,000).

Bilinski points out how these findings align with previous research, including the Turnaway Study, which has linked the inability to access abortion to long-term adverse health, financial, and social outcomes.

Bilinski states the imperative need for policy interventions to support affected individuals and families through Medicaid expansion, parental leave, affordable childcare, and enhancements to the child tax credit. She also emphasizes the necessity of equipping health care professionals with guidance on navigating new legal and medical complexities introduced by abortion bans.

Future research is needed to assess long-term effects on maternal and child health, health care access, and social outcomes. Bilinski concludes that, while abortion policy remains a contentious issue, ensuring adequate support for children and families should be a shared priority across political divides.

Something of note from the data is how the bans largely affect people of lower socioeconomic status. This is likely due in part to the bans being local, not national. Those with the means to travel out-of-state or acquire self-managed medication abortions still have all but perhaps emergency access to abortion.

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