Infant mortality got worse after Roe reversal, leading experts to investigate

Hundreds more babies died than expected in the year and a half after the Supreme Court ended the constitutional right to abortion in June 2022, raising questions about the ripple effects of the ruling on maternal and child health.

In findings published this week in JAMA Pediatrics, researchers said the shift was detectable several months after the decision. In some months, infant mortality jumped by as much as 7%, or 247 excess deaths, from the baseline before Dobbs v. Jackson Women’s Health Organization.

Alison Gemmill, a demographer at the Bloomberg School of Public Health at Johns Hopkins University who was not involved in the new research, said she was surprised by the magnitude of the change.

“I don’t want to say it definitely is due to Dobbs, but it strongly suggests that it is meaningful,” Gemmill said.

Parvati Singh, the lead author of the study and an assistant professor of epidemiology at Ohio State University College of Public Health, and Maria Gallo, a sexual and reproductive health epidemiologist also at Ohio State, used Centers for Disease Control and Prevention epidemiological data from 2018 to 2023. The data showed the most significant increases in deaths were in infants with congenital anomalies or birth defects. Following Dobbs, numerous states introduced full or partial abortion bans. As of October, 13 states have total abortion bans in effect and 8 states have bans in the first 18 weeks of pregnancy, according to the Guttmacher Institute, a research and advocacy group that favors abortion rights. Many other states restrict abortion at later stages of pregnancy.

“This suggests it could be due to fetuses incompatible with life were being carried to term,” Singh said.

Researchers said it’s unclear whether the trend will continue or if it’s a product of the confusion and turmoil in the months after Dobbs.

Ushma Upadhyay, a professor specializing in reproductive science at the University of California at San Francisco, said there are many health-care changes caused by the Supreme Court decision overturning Roe v. Wade beyond access to abortion. She said previous research shows, for example, that people with unwanted pregnancies are less likely to obtain basic health services, which might increase the risk of complications.

“The people who are most marginalized are the ones being forced to carry pregnancies to term - those who are the poorest, with the least access to information,” Upadhyay said.

Upadhyay, who studies abortion access, said she was greatly concerned by the jumps in infant mortality, defined as a death in the first year of life, and what that means for the future of these women. Infant mortality rates have generally fallen over time thanks to modern medicine, but the United States has long stood out for its abysmally high rates as compared with those of other wealthy nations. Singh’s study did not look at breakdowns by state or race, but some states have significantly higher rates than others, and Black babies are at much higher risk.

“Infant mortality is very uncommon, so small increases mean large changes. It’s 2024, and we should not be seeing increases. We should be seeing decreases,” she said.

Moreover, in states that have banned abortion, some doctors are no longer offering obstetric care due to worries about the changing legal landscape or moving to new areas, creating health-care “deserts” that may have made it difficult for pregnant women to get the care they need. A study by Gemmill and others looking at the impact of Texas’s abortion ban on infant mortality found that maternal complications played a big role in the increase.

Singh studies national-level “shocks” that impact health care and in the past has looked at the impact of George Floyd’s death, the 9/11 terrorist attacks and economic recessions that she described as creating “this ambient stressful environment regardless of someone’s individual-level circumstance.” She said the new analysis suggests Dobbs is on that level.

“For something to elicit a national response is a rare phenomenon,” she said.