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State Abortion Bans Cause Broad Disparity in Outcomes According to 2 Studies from Johns Hopkins Bloomberg School of Public Health
The 2 analyses of data on fertility and infant mortality were conducted in the first 14 states to impose complete or 6-week bans after the Dobbs decision in June 2022.
Abortion bans in 14 US states have led to an estimated 22 180 additional live births and 478 additional infant deaths beyond what would have been expected in the absence of such bans, according to data from 2 new studies conducted by researchers at Johns Hopkins Bloomberg School of Public Health.
The findings, published online February 13 in JAMA, highlight the disproportionate impact of abortion bans on marginalized groups and in states already burdened by poor maternal and infant health outcomes.
“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,” 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, said in a statement. “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.”
The research team believes their analyses are the first to evaluate the impact of abortion bans across and within states and vulnerable subgroups since the Dobbs decision in 2022, according to the statement.
Texas was the first state to implement a stringent abortion ban on September 1, 2021. After the US Supreme Court’s decision in Dobbs v Jackson Women’s Health Organization overturned Roe v Wade in June 2022, additional states enacted similar bans. Investigators tapped data for this analysis from birth certificates and US Census data from 2012 through 2023 on changes in fertility rates, measured as live births per 1000 women aged 15 to 44 years. The team looked at outcomes by state and by subgroups for birth and infant death rates from 14 states that imposed complete or 6-week abortion bans: Alabama, Arkansas, Georgia, Idaho, Kentucky, Louisiana, Mississippi, Missouri, Oklahoma, South Dakota, Tennessee, Texas, West Virginia, and Wisconsin.
Live birth rates in states with abortion bans were 1.7% higher than expected, with 60.55 live births per 1,000 reproductive-aged women compared to the projected 59.54, resulting in 22,180 births above expectation. Excluding Texas, where a ban was implemented 1 year earlier, the increase was 0.8%, with 6,019 additional births.
The impact was higher than expected in the 14 states with bans for the follwoing 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
The effect was approximately twice as pronounced in Southern states compared to non-Southern states, according to the report.
Impact on Infant Deaths
Infant mortality in the US has been on a general decline, but the new analysis found that in the 14 states with abortion bans, infant deaths were 5.6% higher than expected, accounting for 478 additional deaths. Texas, with its earlier restrictions, experienced 384 of these additional deaths.
Additional findings reported across the 14 states with bans included:
- 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 US,” 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, said in the statement. “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 authors acknowledge limitations across the 2 studies, including potential impacts from policy changes in states without bans and incomplete data in some cases. They urge policymakers to consider the downstream health consequences of abortion bans, particularly among disadvantaged populations.
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).\
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