More on the infant mortality study

Mother Jones takes a closer look at a recent study that showed a significant increase in infant mortality in Texas since the passage of SB8 in 2021.

Since then, as wave after wave of post-Dobbs abortion restrictions have been enacted in deep-red states, reproductive rights advocates and journalists have—rightly—focused their attention on the effects of those draconian laws on the health and autonomy of women.

The reports of harm to pregnant patients, however, though wrenching, have been anecdotal, which has limited their ability to move the most conservative hearts and minds. Then there is an additional factor: It’s not clear that many far-right lawmakers and courts actually care about the well-being of women.

But they do claim to care about babies, which is why a new study about SB8 and infant mortality is so important. A team of researchers at Johns Hopkins University has spent the two-and-a-half years since SB8 took effect crunching data on infant deaths in Texas and other states, then re-crunching it to confirm their results. They found that as women whose access to abortion was drastically curtailed by SB8 began to give birth in 2022, those infants were dying at much higher rates compared both to the period before the law took effect and to other states that didn’t have near-bans.

The likeliest reason, according to Alison Gemmill, a lead author on the study, is that more women were forced to carry what are sometimes called “medically futile” pregnancies to term. These are pregnancies in which the fetus had catastrophic genetic and other anomalies incompatible with life outside the womb. Unsurprisingly, many of those newborns quickly died. The study’s measured academic language— “Restrictive abortion policies may have important unintended consequences in terms of trauma to families and medical cost”—barely hints at the depth of suffering imposed by SB8.

I mentioned the study in passing here, but haven’t seen much written about it since then. For all the obvious and understandable focus on effects on maternal health, there are very few instances of women dying after childbirth annually, and not all such deaths may be the result of childbirth, all of which makes statistical analysis challenging. But there are a lot more infant deaths, and they are just simply the death of a child under the age of one year, so there are no questions about what “counts”. From the interview with Professor Gemmill:

Once you did your analysis, what stood out?

Overall, we found a 13 percent increase in the number of infant deaths in Texas after the law went into effect. For the rest of the United States, the increase was 2 percent. And deaths due to congenital anomalies—a fancy term for birth defects and the leading cause of infant mortality overall—rose by 23 percent in Texas, while in the rest of the US, there was a decline.

We expected to find an increase, based on the prior studies. But I was surprised at the magnitude of the change, especially the increase in babies who died from congenital anomalies.

We did our analyses in a number of different ways, and the findings were consistent. All of this very much points to a causal connection between the abortion policy and an increase in infant deaths.

Do you have an idea of what might have caused that spike in infant deaths?

No doubt, some deaths were related to complications suffered by the mother. The connection between maternal complications, for example preeclampsia [pregnancy-related hypertension], and the health of the infant is very real. But above and beyond that, there’s a more direct mechanism. Before SB8 parents who got a diagnosis of a serious fetal abnormality had the option to terminate. But after the law took effect, abortion was completely off the table. So you’re going to see more births of babies with congenital anomalies that are incompatible with life. And shortly after birth, those infants are going to die.

Could you explain what kind of birth defects you are talking about?

There are many types of congenital abnormalities, some of which are less serious. But in the case of this study, these were profound abnormalities—things like major heart defects, or vital organs that are missing or incomplete or not functioning properly. These are conditions that wouldn’t be detected before six weeks of pregnancy and once they were detected, might lead many parents to choose termination, because there’s a lot of potential suffering and pain associated with those cases, for the infant and for the families that have to go through that. But because the Texas law didn’t have an exception for fetal anomalies, they had to carry the pregnancy to term, even knowing the baby would die.

[…]

Since Dobbs, 14 states have enacted laws that are more draconian than SB8, including Texas itself, which now has a near-total ban. What would you expect to see as you begin looking at infant mortality data in states that ban abortions at any gestational age with no exceptions for fetal anomalies?

We have no reason to think that the relationship between those abortion policies and infant mortality would be any different in other states. This is something we’re looking into now.

Recently, I’ve been hearing a lot of anti-abortion leaders taking up the same message: abortion supporters who talk about pregnancy emergencies and life-threatening complications are just “fear-mongering.” You know, “Complications hardly ever happen, you’re exaggerating the risks.” Your study seems to show the opposite—a big rise in infant mortality is not what I’d call “fear-mongering.”

To be clear, from the maternal health standpoint, pregnancy can be very dangerous for women. While maternal death itself is rare, severe maternal complications are not nearly as rare as people might think, especially if you have risk factors. In the US, a lot of people have risk factors.

And then there are complications like miscarriage, which are a very common experience that people don’t talk about enough. About 10 to 20 percent of known pregnancies in the US end in miscarriage. Miscarriage management is an important issue to bring into this conversation because sometimes you need to have an induced abortion to treat that miscarriage.

Another complication that comes to mind is preterm birth. In the US, 1 in 10 babies are born prematurely, and the rate is much higher if you’re Black or live in certain states. About 1 in 12 babies are born too small. These are not rare outcomes, and they have lifelong impacts.

As you study the effects of abortion restrictions on infant health, what are the kinds of things you and your colleagues are looking at next?

We’re looking at the subgroup effects—disparities by race and other characteristics. We’re interested in infant morbidity [complications] because deaths are just the tip of the iceberg. Are abortion bans associated with changes in rates of complications like preterm birth and low birth weight? How long do infants have to stay in neonatal intensive care? For children with severe congenital anomalies, what kinds of medical interventions will they require?

And we’re looking at impacts on pregnancy care—what happens to people who show up to the clinic with life-threatening conditions in states that have bans? Did they experience severe maternal morbidity that potentially could have been avoided if they had received the care that they would have gotten prior to these bans?

There’s more, so read the rest. I’m a little surprised this hasn’t gotten more attention, but who knows why those things do or don’t happen. As the body of research increases, and undoubtedly continues to show the harmful effects of abortion bans, this will get out there.

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One Response to More on the infant mortality study

  1. Flypusher says:

    Back when I was in grad school, I had a minor disagreement with friends to the left of me, that pro-life was all about power and control over women. My disagreement was that some people had a moral conviction that personhood started at the fertilized egg stage. Not that I agreed with that, but rather I understood the motivation. I would not make that observation today. It’s not because I don’t still think some people have those moral convictions, but rather that the power and control people are firmly in charge of the pro life movement. Their refusal to acknowledge even the extreme hard case exceptions, like Kate Cox, like the 10 year old rape victim in OH, tell me that these people are not reasonable, nor are they compassionate. You would be foolish to trust them.

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