Hundreds More Infants Died After Dobbs Ruling

Nationwide, infant mortality was higher than expected in the months that followed the Supreme Court decision Dobbs v. Jackson Women’s Health Organization that eliminated federal abortion protections, researchers found.

After the Dobbs decision in June 2022, approximately 0.38 (95% CI 0.09-0.67) additional infant deaths per 1,000 live births overall and 0.13 (95% CI 0.09-0.17) additional infant deaths per 1,000 live births with congenital anomalies occurred through 2023 compared with rates from 2018 to the ruling, reported Parvati Singh, PhD, and Maria Gallo, PhD, both of Ohio State University in Columbus.

These findings corresponded with a 7% absolute increase in infant mortality overall, representing 247 excess deaths, and a 10% increase in infant mortality with congenital anomalies, for about 204 excess deaths, they noted in JAMA Pediatrics.

The nationwide findings mirrored those from previous research focused on the state of Texas.

“This research provides preliminary evidence of the harmful consequences of federal abortion restrictions in terms of infant mortality outcomes,” Singh told MedPage Today. “Prior work by Gemmill and colleagues reported an increase in infant mortality following Texas’s SB8 legislation, and results from our study suggest that the Dobbs decision may have had a similar effect at the national level.”

The Texas study showed an excess of 216 infant deaths from March to December 2022 — a 12.7% increase above expected rates — following that state’s 2021 ban on abortion in early pregnancy, as MedPage Today previously reported.

“When we started this work, we were skeptical about observing any national changes in infant mortality within the first 12 months post-Dobbs because national trends do not reflect the wide variation in state-level abortion restrictiveness,” Singh said. “Our results, especially with respect to infant mortality with congenital anomalies, took us somewhat by surprise and indicated that the Dobbs decision likely served as a population-level shock that was strong enough to elicit a national-level, aggregated response in infant mortality.”

“It would be very interesting to see state-level analyses of infant mortality post Dobbs as we expect substantial variation in infant mortality changes post Dobbs based on state-level policies,” Singh added.

Singh and Gallo used national monthly data on total live births and infant deaths from the CDC’s Wide-Ranging Online Data for Epidemiologic Research (WONDER) database for the years 2018 to 2023 to complete their study.

Overall, from 2018 through 2023, national monthly infant mortality averaged 5.6 deaths per 1,000 live births, Singh and Gallo reported. And infant mortality with congenital anomalies averaged 1.3 deaths per 1,000 live births.

Application of prediction intervals to residuals (deviations of observed values from expected values of the outcomes) identified higher-than-expected residuals of overall infant mortality in October 2022, March 2023, and April 2023, as well as higher-than-expected residuals of infant mortality with congenital anomalies in September and October 2022, as well as February through June 2023.

No months after June 2022 showed lower-than-expected infant mortality.

Limitations of the study included the use of provisional data for 2023 for the analysis.

“Aggregate level studies, such as ours, should not be used for individual-level inference,” Singh told MedPage Today. “We advise caution in using these aggregate findings to inform individual-level practices. Overall, the implications at the population level could include consideration of inadvertent, harmful consequences of abortion restrictions in the formulation of future laws and regulations.”