Infant mortality spiked in Texas after abortion ban, study reveals

A new study focused on Texas looks at the year after its law banning all abortions after six weeks with no exceptions for rape, incest or fetal abnormalities. The research found a significant increase in infant deaths, much higher than the rest of the country. Amna Nawaz discussed more with one of the authors of the study, Suzanne Bell of the Johns Hopkins Bloomberg School of Public Health.

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Amna Nawaz: In the wake of today’s Supreme Court ruling allowing Idaho hospitals to provide emergency abortions for now, questions remain about the impact of restrictions on access to abortion.

A new study focused on Texas looks at the year after its so-called Heartbeat Act went into effect banning all abortions after six weeks, with no exceptions for rape, incest or fetal abnormalities. It found a significant increase in infant deaths, much higher than the rest of the country.

One of the authors of the study joins us now.

That’s Professor Dr. Suzanne Bell of the Johns Hopkins Bloomberg School of Public Health.

Professor Bell, welcome. Thanks for joining us.

Dr. Suzanne Bell, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health: Thanks. Happy to be here.

Amna Nawaz: So the study looks at a period from 2021 to 2022 after the Texas ban went into place,but before Roe v. Wade was overturned by the Supreme Court, we should point out. And it found infant deaths in Texas rose nearly 13 percent compared to an increase of just 1.8 percent in the rest of the country.

What did your study show was driving that increase?

Dr. Suzanne Bell: Our findings regarding changes in the cause of death suggest deaths due to fetal anomalies that were incompatible with life were the largest source of the overall increase in infant mortality that we saw in Texas.

Death due to birth defects increased by 23 percent in Texas from 2021 to 2022, while, in the rest of the United States, they decreased by 3 percent. And in the absence of an abortion ban, pregnant people that receive a diagnosis of a fetal anomaly would be counseled on the option to terminate, which is the choice many people make when the anomalies are incompatible with life or would cause significant suffering for the child.

Amna Nawaz: And so the key question here, right, is about correlation versus causation. So, can you say for sure that you know the abortion ban that passed in Texas led to that increase in infant deaths?

Dr. Suzanne Bell: That’s a great question, Amna.

So correlation means that two things are related to one another, that they may change in tandem, but it does not necessarily mean that a change in one leads to a change in the other. We believe S.B.8 did in fact lead to an increase in infant deaths in Texas.

We used one of the strongest study designs for estimating causality, looking over time and across states to see if increases in infant mortality were above what we would have expected, given ongoing trends prior to the policy, which make us confident that the increase in infant mortality we observed in Texas during this period was a result of S.B.8.

And when we conducted these same analyses in other states, we did not see the same pattern we observed in Texas. If the increase in infant mortality we saw in Texas following S.B.8 is not due to S.B.8, then those who don’t think this is causal would need to come up with an alternative explanation that was unique to Texas in this post-S.B.8 period.

Amna Nawaz: And just to clarify, S.B.8 is, of course, the Heartbeat Act that we referred to earlier.

We should note, when the ban was passed in Texas, it was among one of the more restrictive bans in the entire country. Now we have a number of states who have imposed similar bans. Here’s a look at a map that shows the 14 states that have a total ban and the seven states that have partial bans that ban abortion access up to about 18 weeks or so.

I guess, Professor Bell, the question is, are the findings in Texas indicative of what you would expect to find in other states with similar bans? I mean, is that something you can extrapolate from what you saw in your study?

Dr. Suzanne Bell: We do expect to see potentially similar outcomes to what we have seen in Texas in other states that banned abortion after the Supreme Court’s Dobbs decision.

The same potential mechanisms would lead us to suspect an increase in infant deaths via more live births, which would mean more infants at risk of death, and more live births specifically with congenital anomalies that have a higher risk of infant death.

Amna Nawaz: And tell me a little bit more about the impact of a fetal anomaly in this case. And we were talking about the six-weeks ban in Texas is typically well before any kinds of tests to detect those anomalies are even carried out.

So, when those pregnancies are carried to term, what does it mean in terms of implications to consider, access to care, the level of support needed, the cost of care and so on?

Dr. Suzanne Bell: Fundamentally, these are really heartbreaking experiences for the pregnant person and the family who received this diagnosis and then is not able to receive evidence-based care in the state where they reside.

And we have stories from people like Kate Cox, who was forced to travel out of state to receive reproductive health care that she should have been able to receive at home in Texas. And this causes incredible trauma to the birthing person and their family, with potential long-term consequences in terms of the health of the child if they do survive long-term care.

And then people may still be struggling in the aftermath of this horrible experience for those who have experienced an infant death.

Amna Nawaz: I mean, we look at the impact of these bans, and this gives us insight into one state in one moment in time.

I’m just curious from your perspective, as a researcher in this space, what other questions do you think we should be looking to answer right now, as we live in this patchwork of laws across the entire country?

Dr. Suzanne Bell: Researchers will be studying the impact of recent abortion bans for many years, as there’s so many potential negative effects of these policies.

With regard to infant health outcomes specifically, we think infant mortality is likely just the tip of the iceberg. We suspect abortion bans have also led to significant increases in infants born with serious complications, but who survived, with long-term care implications. We have also seen increases in live births in relation to S.B.8 and in recently published work on the fertility impacts of abortion bans imposed following the Dobbs decision.

And we also anticipate and intend to study the potential effects of abortion bans on maternal morbidity, with more people forced to continue high-risk pregnancies, the heartbreaking stories of which we have heard about in the media. And there are many other negative physical, mental and financial health impacts that we might expect to see in relation to not only the pregnant person, but also their partner and existing children.

Amna Nawaz: All right, that is Professor Dr. Suzanne Bell of the Johns Hopkins Bloomberg School of Public Health.

Professor Bell, thank you for joining us.

Dr. Suzanne Bell: Thank you.