In a recent study, the rate of infant deaths was increased by 5.6% in US states implementing abortion bans.
Infant mortality rates were higher than expected in US states with abortion bans after the bans were implemented, according to a recent study published in JAMA.1
Total abortion bans were reported in 13 states and 6-week bans in 6 more as of November 2024. Data has indicated a 2% to 3% increase in live births above expectation in these states.2
A decline has been observed in infant mortality in the United States, at 5.6 deaths per 1000 live birth in 2022 vs 6.9 in 2020.1 However, according to investigators, “abortion bans have the potential to counteract this progress, as they may increase infant deaths through the continuation of pregnancies with congenital malformations.”
The study was conducted to determine how abortion bans impacted infant mortality in US states. Biannual data of neonatal and infant mortality was collected alongside corresponding live birth data between January 2012 and December 2023 from the National Center for Health Statistics.
Separate data extraction was performed for racial and ethnic groups, and the number of infant deaths caused by congenital anomalies was also reported. The infant mortality rate was reported as the primary outcome, per 1000 live births for each state. Rates were reported, overall, based on race and ethnicity, based on the timing of death, and based on the cause of death.
The imposition of a total or 6-week abortion ban was considered the exposure. Fourteen states with bans implemented between September 21, 2021, and August 25, 2022, were included in the analysis, as birth cohorts could not be observed for an appropriate duration in states with later bans.
Trends were observed in states without bans, states with bans excluding Texas, and Texas alone. Investigators noted a declining trend in US infant mortality before the COVID-19 pandemic, but this trend reversed during the pandemic, especially in early 2021.
The expected infant death rate was 5.93 per 1000 live births. In states with abortion bans, an additional 0.33 deaths were reported, leading to a relative increase of 5.6%. When excluding Texas, the rate rose by 0.14 deaths per 1000 live births. This indicated 94 excess infant deaths, vs 478 when including Texas.
When evaluating changes based on states, rates shifted from -3.1% to 9.4%. Texas and Kentucky experienced the greatest changes, at 0.49 additional deaths per 1000 live births in both states. Compared to nonsouthern states, Southern states had significantly increased changes, with a posterior probability of differences of 0.99.
Black infants experienced a significantly greater increase in mortality rates vs other racial and ethnic groups, at 10.98% higher than expected. Black infant mortality differed between states, from 0.19 per 1000 live births in Idaho to 1.98 in Kentucky.
Similar effects were observed for age, with an increase of 0.23 for neonatal deaths vs 0.11 for non-neonatal deaths. These indicated increases of 6.2% and 4.8%, respectively. Increases were also seen for deaths caused by congenital anomalies, at 1.37 vs the expected rate of 1.24.
A correlation was reported between state-level changes in fertility and state-level changes in infant mortality. There were 22,180 excess births and 478 excess deaths reported, indicating an infant mortality rate of 24 deaths per 1000 live births when assuming excess deaths were linked to patients who would have undergone abortion but could not.
These results indicated higher than expected infant mortality rates in states with abortion bans after the bans were implemented. Investigators noted “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.”
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