The Excerpt: Abortion Bans Linked to Rising Infant Mortality
Introduction
In a stark assessment of the post-Roe v. Wade landscape, The Excerpt podcast delved into the alarming correlation between abortion restrictions and a surge in infant mortality rates across the United States. Hosted by Dana Taylor, the podcast featured Suzanne Bell, an assistant professor at Johns Hopkins University and a lead author of two groundbreaking studies published in the esteemed medical journal JAMA. These studies revealed a concerning trend: states with stringent abortion limits or outright bans are experiencing a faster-than-expected rise in infant mortality, particularly impacting women of color. The research, meticulously analyzed using birth certificate, death certificate, and census data from 2012 to 2023, sheds light on the far-reaching consequences of restricted abortion access on maternal and infant health.
The Scope of the Research
Bell meticulously explained the methodology and findings of the two companion studies. The researchers analyzed comprehensive vital statistics data encompassing all 50 states and the District of Columbia. Employing a sophisticated Bayesian panel data model, they estimated the potential fertility and infant mortality rates had abortion restrictions not been implemented in the 14 states with complete or six-week abortion bans. This analytical approach allowed for a direct comparison between projected and observed outcomes, providing a clearer understanding of the impact of these policies.
Key Findings: Fertility and Infant Mortality Surge
The studies presented compelling evidence linking abortion bans to increased fertility and infant mortality rates. The research team estimated an additional birth per 1,000 reproductive-age females in states with abortion bans, representing a 1.7% increase in the fertility rate. This translates to over 22,000 additional births by the end of 2023. The studies indicated that approximately 10% of abortions that would have been expected in these states resulted in live births instead.
Highlighting the disproportionate impact of these bans, Bell emphasized that if Texas, which implemented an abortion ban nearly a year prior to the Dobbs decision, was excluded, the remaining 13 states with bans saw 6,000 additional births above expectation, equivalent to an 8% increase. This underscored the significant role Texas played in driving the overall increase in births.
Concerningly, the research revealed a 6% surge in infant mortality rates in states that banned abortion, equating to an estimated 478 excess infant deaths. Alarmingly, 80% of these excess deaths occurred in Texas, further emphasizing the state’s outsized impact on the findings.
Disparities in Impact: Race, Socioeconomic Status, and Geography
Bell underscored the unequal impacts of abortion bans, revealing that racially minoritized individuals, particularly Black and Hispanic people, those without a college degree, individuals with low income who qualify for Medicaid, unmarried individuals, and younger individuals residing in southern states, bore the brunt of these policies.
The analysis of infant mortality data unveiled a staggering disparity: Black infants died at a rate 11% higher than would have been expected without abortion bans, compared to a 5% increase among white infants. This stark racial divide illuminated the systemic inequities exacerbated by restricted abortion access. The geographical analysis further revealed that southern states experienced larger increases in infant mortality compared to non-southern states.
Causes of Death and the Limitations of Exceptions
The research delved into the causes of death among infants, revealing that increases were higher for deaths due to congenital malformations. There was an 11% increase in the rate of mortality due to these causes, compared to a 4% increase among all other causes of death. Bell argued that legal exceptions based on fetal anomalies were insufficient to fully mitigate the adverse effects of abortion bans on infant health.
Surprising Yet Saddening Results
Bell expressed surprise at the significant impacts observed, given the efforts of various groups and providers supporting access to abortion. She found the more than twofold larger increase in infant mortality among Black infants compared to white infants, particularly saddening. While earlier work in Texas had indicated similar trends, the researchers were uncertain whether these impacts would be replicated across other states.
State-Specific Findings and Contextual Factors
The research revealed significant disparities between states, with southern states, particularly Texas and Kentucky, exhibiting consistent and large impacts across fertility and infant mortality analyses. Bell emphasized that even prior to the abortion bans, states hostile to abortion already had worse maternal and infant health outcomes, with many counties considered maternity care deserts, especially in the South. The findings suggest that restricting reproductive autonomy worsened these existing disparities, disproportionately burdening states with weaker social services and poorer health outcomes.
Reversal of Progress and Policy Implications
Bell highlighted that the observed increase in infant mortality represented a potential reversal of decades of progress in improving infant health outcomes. She stressed the need for policymakers to consider the downstream repercussions of abortion restrictions on maternal and infant health, as well as the potential for worsening existing disparities.
Infant Health as a Bellwether for Population Health
Bell emphasized that infant health serves as a harbinger of future population health. She expressed concern that the observed shifts in infant mortality bode poorly for the health of future generations, especially in states with abortion bans. Bell argued that infant mortality is merely the tip of the iceberg, with many more individuals, infants, and families struggling with severe conditions requiring ongoing support.
Prescriptive Solutions and the Need for Comprehensive Care
Bell acknowledged the lack of apolitical solutions to the issue of abortion access. However, she stressed the need for quality obstetric and pediatric care, especially given the increased likelihood of pregnancies continuing to term with fatal fetal diagnoses or other complications. She also highlighted the importance of ensuring that this care is accessible to people regardless of their zip code or location, especially in light of continued obstetric and hospital closures, particularly in rural areas.
Bell acknowledged that the research indicates that many pregnant people were unable to overcome barriers to abortion access and were forced to carry unwanted or unsafe pregnancies to term, including those with fetal anomalies. The researcher reiterated that these effects are not uniformly felt, with the greatest estimated impacts on fertility among populations experiencing the most significant structural disadvantages. Bell ended by stating that repealing abortion bans is the most obvious way to reduce the population health impacts of these bans. Many legislators and groups are also trying to include additional fetal anomalies in the list of exceptions allowed under these bans. Also, pregnancy is inherently a risky and nuanced condition, and no list of exceptions could ever fully encompass every situation and risk a pregnant person might face.
Conclusion
The Excerpt podcast effectively conveyed the alarming findings of the JAMA studies, providing a platform for Suzanne Bell to articulate the devastating consequences of abortion bans on maternal and infant health. The research highlights the urgent need for policymakers to consider the far-reaching impacts of these policies and to prioritize access to comprehensive reproductive healthcare, particularly for vulnerable populations.
