Child deaths have increased in the United States since the Supreme Court ruling overturning Roe v. Wade and allowed states to make abortion illegal, researchers reported Monday.
The change became detectable three months after the June 2022 ruling with a high infant mortality rate involving babies born with serious congenital anomalies, the researchers found.
At the end of 2023, there were six months in which the mortality rate of babies with serious anatomical problems was significantly higher than in the years before the high court decision. The researchers also identified three months in which the country's overall infant mortality rate had increased.
However, none of those rates fell below their historical range in the year and a half following the ruling in Dobbs v. Jackson Women's Health Organization.
The findings, reported Monday in the journal JAMA Pediatrics, were seen as a clear sign that Dobbs' decision has prevented some women from terminating pregnancies that otherwise would have ended in abortion.
“There's a really simple mechanism here,” said Alison Gemmill, a demographer and perinatal epidemiologist at the Johns Hopkins Bloomberg School of Public Health, who was not involved in the study.
“Prior to these abortion bans, people had the option to terminate their abortion if the fetus was determined to have a serious birth defect; “We are talking about organs that are outside the body and other things that are very serious and incompatible with life.” Gemmill said. However, if women in these situations had no choice but to continue their pregnancies, “those babies would die shortly after birth,” she said.
Gemmill said the new findings are in line with her own research, including a study published in June that documented a nearly 13% increase in infant mortality in Texas in the wake of a 2021 state law that banned abortions after about the sixth week of pregnancy. Deaths due to congenital anomalies specifically increased by 23%, while they decreased in the rest of the country, according to that study.
Parvati Singh, an epidemiologist at Ohio State University who studies the effects of sudden changes in health policy, wondered if Dobbs' decision would have similar consequences for the entire nation.
To find out, she and her colleague Maria Gallo, a sexual and reproductive health epidemiologist at Ohio State, analyzed data on live births and infant deaths. brought together by the Centers for Disease Management and Prevention. These figures allowed them to calculate monthly infant mortality rates.
In a large population like the United States, the number of babies born and die each month tends to be stable, Singh said. What she and Gallo were looking for were significant deviations from that stable average.
The pair started with data from January 2018 to May 2022, the month before the Dobbs ruling, to identify “the core signal” and the “natural ups and downs around that core signal,” Singh said.
They then used that information to estimate what the country's monthly infant mortality rates would have been through December 2023 if the Supreme Court had not allowed states to limit or ban abortion. (According to the Guttmacher Institute, 13 states have banned abortion completely and another eight prohibit it at some point during the first 18 weeks of pregnancy.)
The next step was to compare their monthly estimates of infant mortality with the actual numbers based on CDC data. Nine times, the observed infant mortality rate was higher than the expected rate, and the difference was too large to be explained by pure variability or chance, they found.
Because investigators don't know the details of each death, they can't say for sure whether any specific case involved a pregnant person who was denied an abortion, Singh said. But patterns suggest that many of them were.
For example, increases in deaths of babies with birth defects were first observed in September and October 2022. That timing makes sense, Singh said.
He ultrasound examination which doctors use to make sure fetal organs develop properly occurs between weeks 18 and 22 of pregnancy. If an exam returned devastating news right after Dobbs' decision but the patient was unable to abort, she would be at risk of having a premature birth three or four months later.
Rates rose again eight months after the Dobbs decision. That could reflect cases of women who conceived right around the time of the Dobbs ruling, before they had a chance to reconsider whether to become pregnant and before they could devise ways to avoid the ruling, Singh said.
Infant mortality rates were back within the regular range a year after the ruling, which may indicate that the pool of people willing to get pregnant had changed in response to the new restrictive landscape.
Something similar happened at the beginning of the COVID-19 pandemic, Singh said.
“Fertility declined very rapidly,” he said. People who chose to become pregnant despite the threat posed by the new disease were less likely to give birth prematurely and their newborns were less likely to experience low birth weight.
“In other words, they were pregnancies in better shape,” Singh said. “Maybe that's what's happening here.”
Overall, Singh and Gallo recorded 247 additional child deaths in the year and a half after Dobbs, which represented a 7% increase. The vast majority of those deaths (204) were due to congenital anomalies, a 10% increase, according to the study.
The fact that infant mortality has never fallen below expected levels is strong evidence that the abortion ruling was the root cause of the additional deaths, Singh said.
“If our theory is correct, then there is no reason for lower-than-expected infant mortality,” he said.
Gemmill said the increase in infant mortality would likely be more pronounced if researchers had focused on changes in states with abortion restrictions rather than looking at the country as a whole.
The increases would likely be greatest in places where pregnant people have to travel long distances to reach another state to access abortion, he added.
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