Abortion Bans Linked to Higher Infant Mortality, Disproportionately Impact Black Infants

Across all 50 US states, the states enforcing complete or 6-week abortion bans experienced higher-than-expected infant deaths.¹ The research estimated 478 excess infant deaths in 14 states with bans, with the largest increases among Black infants.

States with abortion bans saw increased infant deaths, with the greatest impact on Black infants and congenital anomaly-related deaths. | Image credit: JenkoAtaman - stock.adobe.com

This population-based study was published today in JAMA.

“This study found that states that banned abortion had infant mortality rates higher than would have been expected without such bans,” wrote the researchers of the study. “The largest estimated changes were observed among southern states and Black infants.”

The reversal of Roe v Wade in June 2022 led to significant health care consequences for women in the US, altering both access to reproductive health care services and how providers can treat pregnancy complications in the 21 states that ban or restrict abortion access.² Additionally, the Supreme Court's Dobbs decision was linked to a 7% absolute increase in overall infant mortality—equivalent to 247 excess deaths—and a 10% increase among infants with congenital anomalies, corresponding to 204 additional deaths, according to recent research.

In the current study, the researchers aimed to evaluate the association of abortion bans with changes in infant mortality, as well as compare this association across racial and ethnic groups.¹

The researchers compared observed infant mortality rates in 14 states with bans with predicted rates based on pre-ban trends and data from states without bans. The analysis included all live births and infant deaths across all 50 US states and the District of Columbia from 2012 to 2023. The model accounted for temporal trends and state-specific factors, with stratified analyses by race and ethnicity, cause of death, and timing of death.

Results showed that states implementing complete or 6-week abortion bans experienced higher-than-expected infant mortality rates. Across the 14 states with bans, the observed infant mortality rate was 6.26 per 1000 live births compared with an expected rate of 5.93, resulting in an absolute increase of 0.33 (95% credible interval [CrI], 0.14-0.51) and a relative increase of 5.60% (95% Crl, 2.43%-8.73%). This translated to an estimated 478 excess infant deaths during the months affected by the bans.

Furthermore, the increases were most pronounced among non-Hispanic Black infants, who experienced a relative mortality increase of 10.98% (95% CrI, 4.87%-17.89%). Additionally, mortality due to congenital anomalies rose by 10.87% (95% CrI, 3.39%-18.08%), while non-congenital causes saw a 4.23% (95% CrI, 0.49%-8.23%) increase.

Texas had a dominant influence on the overall findings, and the impact was more significant in southern states compared with non-southern states.

However, the researchers acknowledged that accounting for state-level variations in infant mortality while mitigating other factors, such as the COVID-19 pandemic, was challenging. Second, the study lacked information on parental characteristics beyond race and ethnicity, fetal deaths, gestational age, and age at death, which may have led to misclassification. Lastly, 2023 data were provisional, and small sample sizes prevented further analysis of specific racial groups and noncongenital causes of death.

Despite these limitations, the study suggests that abortion bans may exacerbate existing racial disparities in infant health, particularly in southern states, and highlights concerns about congenital anomaly-related deaths, they noted.

“Using population-based data, this study provides new evidence that infant deaths were higher than expected in states that imposed abortion bans after the bans took effect,” wrote the researchers. “The estimated relative increases in infant mortality were larger for deaths due to congenital causes and among groups that had higher than average infant mortality rates at baseline, including Black infants and those in southern states.”

References

1. Gemmill A, Franks A, Anjur-Dietrich S, et al. US abortion bans and infant mortality. JAMA. doi:10.1001/jama.2024.28517

2. Grossi G. Infant mortality increases across US following Dobbs decision. AJMC. October 25, 2024. Accessed February 13, 2025. https://www.ajmc.com/view/infant-mortality-increases-across-us-following-dobbs-decision