Infant Mortality Increases Across US Following Dobbs Decision

The Dobbs decision was associated with 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.

Image Credit: Aliaksei Lasevich - stock.adobe.com

Infant mortality rates in the US have risen sharply following the Supreme Court's Dobbs decision, with the greatest increases among infants born with congenital anomalies.¹ A recent study published in JAMA Pediatrics suggests this surge may be linked to abortion restrictions forcing more high-risk pregnancies to term, echoing similar patterns seen in Texas after the state’s early-pregnancy abortion ban was implemented.

The study identified an increase in infant deaths—especially among those born with congenital anomalies—after the ruling, which overturned the constitutional right to abortion. These results align with earlier findings from Texas, where infant mortality spiked after the passage of Senate Bill 8, which banned abortions in early pregnancy.

“The US Supreme Court decision overturning Roe v Wade in June 2022 has significantly altered both access to reproductive health care services and how providers are able to treat pregnancy complications in the 21 states that ban or restrict abortion access," noted the 2024 State Scorecard on Women’s Health and Reproductive Care by the Commonwealth Fund stated earlier this year.²

The report, part of the Commonwealth Fund’s ongoing series on state health system performance, used 32 measures to evaluate all 50 states and the District of Colombia on health care access, affordability, quality of care, and health outcomes for women nationwide, and found worsening trends in states with abortions bans.

The new study analyzed monthly national CDC data from 2018 through 2023, focusing on infant mortality rates before and after the Dobbs decision.¹ Researchers used time-series analyses to compare trends, focusing on both overall infant mortality (deaths per 1000 live births) and infant mortality among those with congenital anomalies.

Key findings showed that after the June 2022 Dobbs ruling, infant mortality exceeded expected levels in several months, with notable increases in October 2022 and March and April 2023. Mortality among infants with congenital anomalies was especially pronounced, with excess deaths observed in September and October 2022 and again in early 2023.

The Dobbs decision was associated with approximately 0.38 additional infant deaths per 1000 live births overall and 0.13 additional deaths per 1000 live births for infants with congenital anomalies, according to the analysis. This translated 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.

The study authors highlighted the potential health effects of abortion restrictions, particularly on vulnerable infants with congenital conditions. In Texas, after the implementation of Senate Bill 8, a similar rise in infant mortality was observed, likely due to more frail fetuses being carried to term following the restrictions on abortion. A broader, national impact of the Dobbs decision on infant health is needed, the study stated, along with concerns that limiting access to abortion care can have widespread negative effects on maternal and infant outcomes.

Since the Dobbs ruling, the legal landscape of abortion in the country has shifted dramatically, with abortion now banned or heavily restricted in 14 states. This environment of limited access could further exacerbate the observed trends in infant mortality, particularly as some women are forced to carry high-risk pregnancies to term.

Although the study provides critical insights, it is based on provisional 2023 data, and further research is needed as more detailed information becomes available. The authors noted that future analyses will be necessary to investigate how the restrictiveness of state abortion laws correlates with excess infant mortality rates.

"The interval since the Dobbs decision has been marked by rapid changes in state abortion laws," the authors wrote. "As of this writing, abortion is totally banned in 14 states, and 8 states have bans at various times before the first 18 weeks of gestation. The legal status of abortion at any given time does not always translate into an ability to access abortion care. Restricting care can result in widespread negative health effects."

References

1. Singh P, Gallo MF. National trends in infant mortality in the US after Dobbs. JAMA Pediatr. Published online October 21, 2024. doi:10.1001/jamapediatrics.2024.4276

2. Grossi G. New report shows worsening health outcomes for women in states with abortion bans. AJMC®. July 18, 2024. Accessed October 24, 2024. https://www.ajmc.com/view/new-report-shows-worsening-health-outcomes-for-women-in-states-with-abortion-bans