Birth rates, infant mortality up in states with abortion bans

Researchers conducted two studies to determine the impact of abortion bans on birth rates and infant mortality. Both studies focused on 14 U.S. states that have implemented either complete or 6-week abortion bans.

For the study on birth rates, researchers analyzed birth certificate and census data from 2012 to 2023 for all 50 states. They also used a Bayesian panel data model to "evaluate state-by-subgroup-specific changes in fertility" associated with abortion bans in the 14 states.

The researchers found that there were an estimated 1.01 additional births above expectation per 1,000 women ages 15 to 44 in states that had implemented abortion bans. This is equivalent to 22,180 excess births. Overall, the birthrate increased by 1.7% in states with abortion bans.

"It might seem like a 1.7 percent change in the fertility rate isn't a big deal, but it's actually a very big deal," said Alison Gemmill, a demographer and perinatal epidemiologist at the Johns Hopkins Bloomberg School of Public Health and one of the study's authors. She noted that it is higher than the 1.4% increase in birthrates seen during the COVID-19 pandemic.

The increases in birthrate were higher in communities with socioeconomic disadvantages, as well as states with poor maternal and child health outcomes. The greatest increases were observed in racial minorities (~2.0%), unmarried people (1.79%), people younger than 35 (~2.0%), Medicaid beneficiaries (2.41%), and people without college degrees (1.58% to 2.36%).

For the study on infant mortality, the researchers compared infant mortality rates before and after abortion bans were implemented in the 14 states, as well as to states without abortion bans.

The researchers found that the overall infant mortality rate in the states with abortion bans was 6.26 deaths per 1,000 live births, much higher than the expected rate of 5.93 per 1,000 live births. Infant mortality rates increased in nine states with bans, decreased in four, and had no change in one.

Among non-Hispanic Black infants, the mortality rate increased by 11%, going from 10.66 deaths per 1,000 live births to 11.81 deaths per 1,000 live births. The mortality rate for infants born with congenital issues also increased by 5.6%, going from 1.24 deaths per 1,000 live births to 1.37 per 1,000 live births.

Commentary

In an accompanying editorial for both studies, Alyssa Bilinski, a professor of health policy at Brown University, said the researchers provided "compelling evidence of the significant effects state-level abortion restrictions have on birth rates and infant mortality, especially in vulnerable populations."

However, "[t]hese papers are not going to resolve disagreements about abortion in this country," Bilinski said. "People are going to look at these papers, and particularly the results about birthrates, and I think have very different reactions."

In her editorial, Bilinski called for "thoughtful, family-oriented" policies, such as paid parental leave, affordable childcare, and Medicaid expansion to help "address the harms raised in these studies and foster a healthier and more equitable society for all."

"We should want to prevent infant mortality, and in many cases infant mortality is preventable," she said. "If we are in a world where more people who perhaps didn't plan to and didn't feel prepared to become parents are becoming parents, we should think about what it means to be supporting those families in a real and tangible way."

"I would hope that as a country, looking at these results, we can all kind of agree that those children and families should have an opportunity to thrive," Bilinski added.

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