In response to the U.S. Supreme Court's decision in Dobbs v. Jackson Women's Health Organization, some states are passing laws restricting or denying access to abortion. The new laws appear to set in motion the unintended consequence of increasing infant death rates.

Take, for example, the Texas law known as Senate Bill 8 or S.B. 8. It prohibits abortions once a fetal heartbeat can be detected at five or six weeks of pregnancy. S.B. 8 does not make exceptions for congenital fetal abnormalities.

When a team at Johns Hopkins Bloomberg School of Public Health analyzed death certificate data from January 1, 2018 through February 28, 2022, they found that S.B. 8 was associated with unexpected increases in neonatal and infant deaths.

Between 2021 and 2022, infant deaths in Texas increased by 255, a 13 percent rise.

The results offer a picture of how laws restricting abortion can contribute to significant declines in infant well-being and increased medical costs.

“These findings make clear the potentially devastating consequences abortion bans can have on those who are unable to overcome barriers to this essential reproductive health service,” Suzanne Bell, a lead author on the study and an assistant professor at Bloomberg School of Public Health, said in a statement.

Almost 102,400 infant deaths occurred between 2018 and early 2022 in the 29 U.S. states that reported 10 or more infant deaths. More than 10,300 of those deaths occurred in Texas. The researchers compared the difference between expected and observed infant deaths in Texas to the difference in the 28 comparison states. The researchers confined their analysis to the period between March 2022 and December 31, 2022, a timeframe that included pregnancies occurring after S.B. 8 went into effect on September 1, 2021.

Between 2021 and 2022, infant deaths in Texas increased by 255, an almost 13 percent rise. During the same period, infant deaths in the 28 comparison states increased by slightly less than two percent. An estimated 216 infant deaths occurred in Texas between March and December 31, 2022 that would probably not have occurred if S.B. 8 were not in place — an increase of more than 12.5 percent over the expected number of deaths.

Neonatal deaths — infants who died in the first 28 days of life — followed a similar pattern. An estimated 145 neonatal deaths occurred in Texas between March and December 31, 2022 that would probably not have occurred if S.B. 8 was not in place. The estimated number of neonatal deaths in the other states was not as high.

Texas also had significant increases in the number of deaths from congenital, or hereditary, birth defects in 2021 and 2022 versus the comparison states. Infant deaths in Texas due to congenital birth defects during this time period increased by almost 23 percent, while they decreased by about three percent in the comparison states.

The researchers were not expecting the increase in deaths from congenital birth defects in Texas to be as significant as it was, Alison Gemmill, a lead author on the study, told TheDoctor.

The results offer a picture of how laws restricting abortion can contribute to significant declines in infant well-being and lead to increased medical costs.

The finding suggests, she said, that prior to S.B. 8 becoming law, people chose to terminate pregnancies when the fetus had abnormalities. After S.B. 8 became law, people no longer had that choice.

“People had to carry their pregnancies to term, knowing that in many cases the infant would die shortly after birth because these defects are highly incompatible with life,” Gemmill, an assistant professor at the Johns Hopkins Bloomberg School of Public Health, explained.

Gemmill and her team are currently looking at the effects of the Supreme Court's Dobbs decision on infant mortality in states with total abortion bans. They are also analyzing how pregnancy complications and maternal health may be affected by changes in pregnancy care because of these laws.

The study and a related editorial are published in JAMA Pediatrics.