In two new papers, researchers from Johns Hopkins Bloomberg School of Public Health and colleagues estimate that abortion bans in 14 states resulted in 22,180 additional live births and 478 additional infant deaths above what would have been expected in the absence of these bans.
Texas imposed what was then the country's most stringent abortion ban on September 1, 2021. Additional states have enacted abortion bans since the U.S. Supreme Court overturned Roe v. Wade in its landmark Dobbs decision in June 2022. The researchers limited their analysis to the first 14 states that imposed a complete or six-week abortion ban to allow enough time for outcomes and impacts to emerge.
The findings, published online February 13 in JAMA, reveal unequal impacts of abortion bans across and within the 14 states and among subgroups—most of which already experience worse maternal and child health outcomes.
Among the 14 states with abortion bans, the researchers found higher-than-expected live births among racially minoritized individuals (non-Hispanic Black, Hispanic, and "other" races and ethnicities); those without a college degree; Medicaid beneficiaries; unmarried individuals; younger individuals; and those living in Southern states.
The researchers estimate that, among the 14 states with abortion bans, Black infants died at a rate 11% higher than would have been expected in the absence of bans. There were larger increases in infant mortality in Southern states—both overall and among Black infants.
These analyses are believed to be the first to examine abortion-ban impacts across and within states and subgroups since the Dobbs decision in June 2022.
The researchers used publicly available birth and death certificate data from all 50 states and Washington, D.C., and statistical modeling to estimate outcomes had states not enacted abortion bans.
The researchers then examined live births and infant deaths in 14 states that imposed a complete or six-week abortion ban between September 1, 2021, and August 25, 2022: Alabama, Arkansas, Georgia, Idaho, Kentucky, Louisiana, Mississippi, Missouri, Oklahoma, South Dakota, Tennessee, Texas, West Virginia, and Wisconsin. All states but Idaho, Missouri, South Dakota, and Wisconsin are considered Southern states.
The researchers note that the timing of outcomes and impacts periods do not fully align given the staggered adoption of the abortion laws. In Texas, the impact period begins in 2022, while in the other states, it starts in early 2023.
Impacts of Abortion Bans on Live Births
For this analysis , the researchers drew from birth certificate and U.S. Census data from 2012 through 2023 for all 50 states and the District of Columbia changes in fertility rates—measured as live births per 1,000 females aged 15-44—by state and subgroup after abortion bans went into effect in 14 U.S. states.
The researchers estimate that the fertility rate in states with abortion bans was 1.7% higher than expected, with 60.55 live births per 1,000 reproductive-aged females versus the 59.54 expected, resulting in an estimated 22,180 births above expectation had the bans not been enacted. Excluding Texas, which imposed an abortion ban nearly a year earlier, there were 6,019 additional births above expectation across the 13 states with bans, equivalent to a 0.8% increase.
The fertility rate was higher than expected in the 14 states with abortion bans for the following groups:
- Racially minoritized individuals (non-Hispanic Black, Hispanic, and "other" races and ethnicities), about 2.0% higher than expected
- Unmarried individuals, 1.8% higher than expected
- Younger individuals (under age 35), 2% higher than expected
- Medicaid beneficiaries, 2.4% higher than expected
- Individuals without college degrees, 2.4% and 1.6% for those with a high school diploma or some college, respectively
Additionally, the impact in Southern states was approximately two times higher than in non-Southern states.
"These findings indicate that many pregnant people were unable to overcome barriers to access abortion services and instead were forced to continue an unwanted or unsafe pregnancy to term," says Suzanne Bell , PhD, MPH, assistant professor in the Bloomberg School's Department of Population, Family and Reproductive Health and the study's co-lead author. "Importantly, we find the effects of these abortion bans are not uniformly felt, with the largest estimated impacts on fertility among populations experiencing the greatest structural disadvantages and in states with among the worst maternal and child health outcomes."
Across states, estimated changes in fertility rates above expectation ranged from 0.3% to 2.3%, or 0.16 to 1.41 additional births per 1,000 reproductive-aged females, with the largest estimated changes in Texas (2.3%), Kentucky (1.4%), and Mississippi (1.4%). Patterns in subgroup changes were largely consistent across states.
Impacts of Abortion Bans on Infant Deaths
Infant mortality in the U.S. has generally been declining in recent decades, with 5.6 infant deaths per 1,000 live births in 2022 versus 6.9 infant deaths in 2000.
In their new analysis , the researchers estimate that infant deaths were 5.6% higher than they would have been in the 14 states with abortion bans had the bans not been enacted, resulting in an estimated 478 additional deaths. Most of these–384–were in Texas, which enacted an abortion ban nearly a year ahead of other states.
Additional key findings in the 14 states with bans show:
- Black infants died at a rate 11.0% higher than would be expected, equivalent to 265 additional infant deaths, or a 1.15 increase in the death rate per 1,000 live births—10.66 expected per 1,000 versus 11.81 observed.
- The infant mortality rate due to congenital anomalies increased 10.9%, from 1.24 infant deaths expected per 1,000 versus 1.37 per 1,000 observed.
- The infant mortality rate not due to congenital anomalies increased 4.2% from 4.69 infant deaths expected per 1,000 to 4.89 observed.
"These findings suggest that restrictive abortion policies may be reversing decades of progress in reducing infant deaths in the U.S.," says Alison Gemmill , PhD, associate professor in the Bloomberg School's Department of Population, Family and Reproductive Health and the infant-death study's co-lead author. "The data also show a clear pattern of abortion bans disproportionately affecting regions and populations already struggling with poor health outcomes, including Black infants and infants born in the South."
The current study's Texas-specific estimate is in line with a 2023 study led by Gemmill. The new analysis suggests that states that banned abortion following the 2022 Dobbs decision experienced a smaller increase in infant deaths than Texas did following its 2021 state ban.
Taken together, the two studies highlight the unequal impacts of abortion bans across states and subgroups. The authors urge policymakers to consider the downstream health consequences of abortion bans, especially among disadvantaged populations.
The authors note that the studies have limitations. States without abortion bans may have been impacted by policy changes, which could have influenced the findings. Some of the state-specific subgroups may have been too small to detect potential effects, especially infant deaths. The researchers estimated infant deaths in instances where data were incomplete.
Both studies were supported by the National Institute of Child Health and Human Development (P2CHD042854 and R01HD114292) and the National Institute on Minority Health and Health Disparities (U54MD000214).
" U.S. Abortion Bans and Fertility " was written by Suzanne Bell (co-first author), Alexander Franks (co-first author), David Arbour, Selena Anjur-Dietrich, Elizabeth Stuart, Eli Ben-Michael, Avi Feller (co-senior author), and Alison Gemmill (co-senior author).
" U.S. Abortion Bans and Infant Mortality " was written by Alison Gemmill (co-first author), Alexander Franks (co-first author), Selena Anjur-Dietrich, Amy Ozinsky, David Arbour, Elizabeth Stuart, Eli Ben-Michael, Avi Feller (co-senior author), and Suzanne Bell (co-senior author).
