Study shows: Infant mortality in Texas jumped after restrictive abortion law

The Texas law, which took effect on September 1, 2021, bans abortions after a fetal heartbeat is detected, with no exceptions for incest, rape or fetal abnormalities, although it does include a provision for medical emergencies. Previously, abortions were allowed up to 20 weeks.

While anti-abortion activists celebrated the law as a groundbreaking victory, critics pointed out that many women do not even know they are pregnant at six weeks, and that the deadline is long before tests to detect fetal abnormalities are available.

The law was implemented about nine months before it was struck down by the Supreme Court. Roe v. Wade. Researchers warn about the results could herald changes in other states where abortion is currently completely or largely banned.

“Our findings suggest that restrictive abortion policies that limit pregnant women’s ability to terminate their pregnancy may lead to increased infant mortality, particularly among women with fetal abnormalities diagnosed later in pregnancy,” Suzanne Bell, one of the study’s lead authors, said in a press release.

“These findings highlight the potentially devastating consequences that abortion bans can have on pregnant women and families who are unable to overcome barriers to accessing this important reproductive health service,” added Bell, an assistant professor in the Department of Population, Family and Reproductive Health at the Hopkins Bloomberg School of Public Health.

Between 2021 and 2022, Texas’ infant mortality rate increased 8.3 percent, compared to a national increase of 2.2 percent. Texas’ rate reflects a 12.9 percent increase in the actual number of deaths of children before their first birthday.

And while the death rate for babies 28 days old or younger decreased overall in other states, it increased by 5.8 percent in Texas.

Infant deaths due to fetal abnormalities, the leading cause of death for babies under 1 year old, rose 22.9 percent in Texas in 2022 but fell 3.1 percent in the rest of the country, the study found. Infant deaths due to unintentional injuries also rose 20.7 percent in Texas during the same period, compared to 1.1 percent nationwide.

The study’s authors acknowledged that further research and analysis are needed, and John Guillebaud, professor emeritus of family planning and reproductive health at University College London, noted in an email Tuesday that the link between the increase in deaths and the Texas law “does not prove a causal relationship.”

Nevertheless, says Guillebaud, “the fact that congenital anomalies are the most common cause of early infant deaths and that there is a strict law prohibiting induced abortions after the cessation of embryonic cardiac activity and making no exceptions for congenital anomalies makes a causal link much more likely.”

“Congenital abnormalities would be less likely to be detected in early pregnancy,” Guillebaud continued, “because testing for them would be of little use if no intervention in the form of induced abortion could be taken.”

The researchers analyzed publicly available data on death certificates of children under one year of age in Texas and 28 other states between January 2018 and December 2022.

The team assumed that deaths occurring from March 2022 onwards would be the first to be affected by the ban, as full-term infants born after that date would have been 10 to 14 weeks gestation when the law came into force. These pregnancies would have been too early to be screened for chromosomal abnormalities before the law came into force.

The researchers acknowledged some limitations of their research, including that the available 2022 data did not include the birth month or gestational age of the infants and other details relevant to infant deaths, “leading to difficulties in identifying those exposed to the Texas law.” They also said they were unable to examine factors such as whether an increase in deaths occurred more frequently among certain populations.

The researchers noted that an earlier analysis had estimated that there were about 10,000 additional births in Texas between April and December 2022 due to the ban. Their new findings suggest that these births “disproportionately included pregnancies at increased risk of infant mortality.”

The researchers also said that existing evidence suggests higher infant mortality among non-Hispanic black women due to abortion restrictions, and the impact of infant mortality on parental well-being more broadly.

Although the 2021 law allows exceptions for abortions based on medical emergencies, some women said their medical care was delayed or denied by doctors. Some women who have sued the state spoke about the harm they suffered; one woman said she developed sepsis and nearly died, and another said she was forced to give birth to a fetus without a complete skull.

In another case that attracted much attention last year, Kate Cox, a Dallas woman whose fetus suffered from a fatal genetic disease, left the state to have an abortion after the Texas Supreme Court overturned a lower court’s decision to grant her an exemption from the strict ban on medical grounds.