Higher Infant Mortality Rates Associated With Restrictive Abortion Laws

Contrary to professed intent, the states where abortion access was most restricted experienced the highest levels of infant mortality in the United States from 2014–2018, according to new research opens in new tab/windowin the American Journal of Preventive Medicine opens in new tab/window, published by Elsevier. The findings showed that states with the most restrictive laws (11-12 laws) had a 16% increased infant mortality rate (IMR) compared to states with the least number of restrictive abortion laws (1-5 laws).

Lead investigator Lois K. Lee, MD, MPH, Division of Emergency Medicine, Boston Children’s Hospital, and Departments of Pediatrics and Emergency Medicine, Harvard Medical School, explained, “As pediatricians and obstetricians, we are concerned about how threats to comprehensive reproductive care affect our patients and their infants. Given the current changing legal landscape in the US regarding reproductive health policy, it is essential that we consider the larger impacts of restricting access to abortion, not just to birthing individuals, but also on infant births.”

In order to examine the association of abortion access not just on birthing individuals, but also on infant births, the research team performed a national ecologic study using county-level birth cohort linked files (linking maternal and infant data) on infant mortality from the National Center for Health Statistics for 2014–2018 (before the SCOTUS decision on Dobbs v. Jackson Women’s Health Organization). While previous studies had primarily examined state-level infant mortality rates, these data are novel because of the more granular analysis of county-level infant mortality.

Investigators categorized 48 states (excluding Hawaii and Alaska) by the number of restrictive abortion laws and factored in driving distance to an abortion facility, key demographic characteristics, and state Medicaid expansion status.

In addition to the impact of restrictive abortion laws, demographic characteristics such as Black ethnicity of the birthing parent, high school education attainment or less, smoking during pregnancy, and inadequate prenatal care were associated with elevated IMR.

The investigators were surprised to find that increased driving distance to an abortion facility was not statistically associated with an increased county-level IMR, as had been determined by previous studies. This may be because prenatal care access is more of a contributor to infant mortality than abortion facility access.

The investigators stressed that if pregnant women with limited financial means have increasingly limited access to comprehensive reproductive healthcare, including contraception and pre-conception planning, the long-term health and wellbeing outcomes for these individuals and their children may affect future population health.

Dr. Lee elaborated, “Maternal health directly influences infant and child health—and ultimately population health. From our study findings, it is important to understand that limiting access to abortion as part of comprehensive reproductive care not only affects birthing individuals, but also their infants. Without the implementation of more equitable access to comprehensive reproductive care, there will be continued disparities in access to care and health outcomes, varying especially by geography in the US.”

She added, “It will take years to truly understand the long-term public health impact of the SCOTUS decision on Dobbs v. Jackson Women’s Health Organization and other challenges to comprehensive reproductive health care services. Given the well-established disparities in maternal and infant mortality by race and geography, we are concerned more restrictions on comprehensive reproductive care will exacerbate these disparities, especially among lower-income individuals.”

Notes for editors

The article is “Abortion Restrictiveness and Infant Mortality: An Ecologic Study, 2014–2018,” by Kendall J. Burdick, MD, Catherine G. Coughlin, MD, Gabrielle R. D’Ambrosi, MPH, Michael C. Monuteaux, ScD, Katherine E. Economy, MD, Rebekah C. Mannix, MD, MPH, and Lois K. Lee, MD, MPH (https://doi.org/10.1016/j.amepre.2023.10.010 opens in new tab/window). It appears online in advance of the American Journal of Preventive Medicine, volume 66, issue 3 (March 2024), published by Elsevier.

Full text of this article is available to credentialed journalists upon request; contact Jillian B. Morgan at +1 734 936 1590 or [email protected] opens in new tab/window for more information or to request author interviews.

About the American Journal of Preventive Medicine

The American Journal of Preventive Medicine opens in new tab/window is the official journal of the American College of Preventive Medicine opens in new tab/window and the Association for Prevention Teaching and Research opens in new tab/window. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health. The journal features papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women's health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and alcohol and drug abuse. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. The journal also publishes official policy statements from the two co-sponsoring organizations, health services research pertinent to prevention and public health, review articles, media reviews, and editorials. www.ajpmonline.org opens in new tab/window

About Elsevier

As a global leader in scientific information and analytics, Elsevier helps researchers and healthcare professionals advance science and improve health outcomes for the benefit of society. We do this by facilitating insights and critical decision-making with innovative solutions based on trusted, evidence-based content and advanced AI-enabled digital technologies.

We have supported the work of our research and healthcare communities for more than 140 years. Our 9,500 employees around the world, including 2,500 technologists, are dedicated to supporting researchers, librarians, academic leaders, funders, governments, R&D-intensive companies, doctors, nurses, future healthcare professionals and educators in their critical work. Our 2,900 scientific journals and iconic reference books include the foremost titles in their fields, including Cell Press, The Lancet and Gray’s Anatomy.

Together with the Elsevier Foundation opens in new tab/window, we work in partnership with the communities we serve to advance inclusion and diversity in science, research and healthcare in developing countries and around the world.

Elsevier is part of RELX opens in new tab/window, a global provider of information-based analytics and decision tools for professional and business customers. For more information on our work, digital solutions and content, visit www.elsevier.com.