Abortion and Infant Mortality: Termination Does Not Prevent Death

It is estimated that the Supreme Court decision in Dobbs v Jackson Women's Health Organization will leave approximately 33 million US women in states without available abortion services. Even before this decision, there was wide variation in abortion access across the United States. In 2019, 43% of reproductive-age women lived in states with policies overall restrictive to abortion because of the 26 abortion bans that had been enacted, with many more introduced. In contrast, other states have passed laws supportive of and protective of abortion. Many laws restricting abortion were supposedly aimed at protecting women's health by regulating abortion facilities as ambulatory surgery centers, dictating the types of health care providers who can perform abortion, and requiring admitting privileges to hospitals for clinicians providing abortion care. Opponents of these regulations assert that they are designed to restrict access without evidence that they decrease risks associated with abortion. These laws purporting to protect women with safer abortions have actually done the opposite; restricted abortion access results in increased pregnancy-related deaths. The focus of abortion regulations and restrictions is also aimed at protecting the fetus (and subsequent neonate), but prior studies have demonstrated an association between restricted access to abortion and increased infant mortality. Moreover, prior studies demonstrated that abortion restrictions increase maternal and infant mortality. The aim of this retrospective cohort study was to evaluate the association between state-level abortion legislation and all-cause mortality among females of reproductive age and maternal, fetal, and infant mortality. This study compared mortality rates in states categorized as supportive, moderate, and restrictive with regard to their laws. The Centers for Disease Control and Prevention's WONDER (Wide-ranging ONline Data for Epidemiologic Research) database was used. The association between supportive, moderate, and restrictive state abortion regulations and all-cause mortality in reproductive-age females was estimated using generalized estimating equations. The primary study outcome was all-cause mortality in reproductive-age females (aged 15–49 years). Issues examined included specific, common legal restrictions placed on abortion, including in-person counseling, restrictions on insurance coverage, waiting periods, requiring inaccurate or misleading counseling to pregnant women (such as information on medical abortion reversal or fetal personhood), prohibiting telemedicine for medication abortion, and requiring parental consent for minors. Secondary outcomes included maternal mortality, fetal mortality, and infant mortality. All-cause mortality in reproductive-age females was defined as death at a reported age of 15 to 49 years. Compared with restrictive states, moderate and supportive states were not associated with a significant decrease in all-cause mortality, and maternal mortality (per 100,000 live births) was significantly lower in moderate (25.79; 95% confidence interval [CI], 29.88–21.70), but not supportive states (22.51; 95% CI, 26.75–1.72). In both moderate (20.56; 95% CI, 21.09–20.04) and supportive (21.10; 95% CI, 21.56–20.64) states, infant mortality (per 1000 live births) was significantly lower. In moderate states, fetal mortality was significantly lower (20.69; 95% CI, 21.18–20.20) but not in supportive states (20.64; 95% CI, 21.14–0.13). With each additional abortion regulation, there was an increase in both maternal mortality (1.09; 95% CI, 0.36–1.82) and infant mortality (0.20; 95% CI, 0.12–0.26). These findings show that compared with restrictive laws, moderate state abortion legislation is associated with lower rates of maternal, fetal, and infant mortality but not lower all-cause mortality in reproductive-age females. Restrictive laws enacted with the purported intent of protecting women's health and fetal health by regulating abortion fail to do so and do not decrease all-cause mortality in reproductive-age women or maternal mortality. Repealing certain types of laws may decrease all-cause mortality in reproductive-age females, maternal mortality, and infant mortality. Allowing an abortion at any gestational age does not substantially increase fetal death rates compared with states that restricted termination after a certain gestational age.

Time-Series Analysis of Infant Mortality Disaggregated by Race, Ethnicity, and Specific Causes After 6-Week Abortion Ban.

Prior observational research has shown that infants born in states with more abortion restrictions are more likely to die during infancy. It is unclear how recent and more severe abortion bans in the US have impacted infant mortality. To examine whether Texas Senate Bill 8 (SB8), which banned abortions after embryonic cardiac activity and did not allow exemptions for congenital anomalies, is associated with infant mortality in the state of Texas. This population-based cohort study of all recorded infant deaths from the state of Texas and 28 comparison states used a comparative interrupted time series analysis with an augmented synthetic control approach and national birth certificate data from January 1, 2018, to December 31, 2022, to estimate the difference between the number of observed and expected infant and neonatal deaths and death rates among monthly cohorts exposed to Texas' SB8. Deaths in March 2022 were treated as the first cohort exposed to the Texas' SB8 abortion policy because these infants (if born full term) were approximately 10 to 14 weeks' gestation when SB8 went into effect on September 1, 2021. The exposure period was thus March through December 2022. Our outcomes were monthly counts and rates of infant (aged <1 year) and neonatal (aged <28 days) deaths in the exposure period in Texas. In secondary analyses, annual changes in cause-specific infant deaths between 2021 and 2022 in Texas and the rest of the US were examined. Between 2018 and 2022, there were 102 391 infant deaths in the US, with 10 351 of these deaths occurring in the state of Texas. Between 2021 and 2022, infant deaths in Texas increased from 1985 to 2240, or 255 additional deaths. This corresponds to a 12.9% increase, whereas the rest of the US experienced a comparatively lower 1.8% increase. On the basis of the counterfactual analysis that used data from Texas and eligible comparison states, an excess of 216 infant deaths (95% CI, -122 to 554) was observed from March to December 2022, or a 12.7% increase above expectation. At the monthly level, significantly greater-than-expected counts were observed for 4 months between March and December 2022: April, July, September, and October. An analysis of neonatal deaths found somewhat similar patterns, with significantly greater-than-expected neonatal deaths in April and October 2022. Descriptive statistics by cause of death showed that infant deaths attributable to congenital anomalies in 2022 increased more for Texas (22.9% increase) but not the rest of the US (3.1% decrease). This study found that Texas' 2021 ban on abortion in early pregnancy was associated with unexpected increases in infant and neonatal deaths in Texas between 2021 and 2022. Congenital anomalies, which are the leading cause of infant death, also increased in Texas but not the rest of the US. Although replication and further analyses are needed to understand the mechanisms behind these findings, the results suggest that restrictive abortion policies may have important unintended consequences in terms of trauma to families and medical cost as a result of increases in infant mortality. These findings are particularly relevant given the recent Dobbs v Jackson Women's Health Organization US Supreme Court decision and subsequent rollbacks of reproductive rights in many US states.

1041 State-level reproductive legislative climate and maternal, fetal, and infant mortality

Objectives. To evaluate the impact of state-level abortion restrictions enacted between 2018 and 2023 on infant mortality in the United States, comparing mortality trends across restricting and nonrestricting states. Methods. Using a difference-in-differences approach, we drew infant mortality data from the Centers for Disease Control and Prevention's WONDER (Wide-ranging Online Data for Epidemiologic Research) database and categorized deaths by age and cause, incorporating information on abortion restrictions and legal exceptions from the Center for Reproductive Rights and the Kaiser Family Foundation. We calculated estimates at the state-year level. Results. Infant mortality increased by 7.2% in restricting states. The increase is predominantly attributable to early (aged < 1 day) and late (aged 1 month to 1 year) infant deaths. Effects were largest for perinatal and noncongenital causes of death. Health exceptions did not significantly moderate the effects. Conclusions. Curtailing abortion access increases infant deaths. Fetal and maternal health exceptions do not moderate this effect. Excess deaths are not exclusively attributable to congenital abnormalities. Further work is needed to understand how restrictions contribute to late deaths and the long-term effects of infant deaths on families and communities. (Am J Public Health. 2025;115(11):1895-1902. https://doi.org/10.2105/AJPH.2025.308228).

To estimate the association between state-level abortion legislation and all-cause mortality among all females of reproductive age and maternal, fetal, and infant mortality. We conducted a retrospective cohort study using the Centers for Disease Control and Prevention's WONDER (Wide-ranging ONline Data for Epidemiologic Research) database. Generalized estimating equations were used to estimate the association between supportive, moderate, and restrictive state abortion regulations and all-cause mortality in reproductive-aged females. Secondary outcomes included maternal, fetal, and infant mortality. The association of the number and type of laws on mortality were estimated. Moderate and supportive states were not associated with a significant decrease in all-cause mortality compared with restrictive states. Maternal mortality (per 100,000 live births) was significantly lower in moderate (-5.79, 95% CI -9.88 to -1.70) compared with restrictive states, but not supportive states (-2.51, 95% CI -6.75 to 1.72). Infant mortality (per 1,000 live births) was significantly lower in both moderate (-0.56, 95% CI -1.09 to -0.04) and supportive (-1.10, 95% CI -1.56 to -0.64) states. Fetal mortality was lower in moderate states (-0.69, 95% CI -1.18 to -0.20) but not in supportive states (-0.64, 95% CI -1.14 to 0.13). Each additional abortion regulation was associated with an increase in maternal mortality (1.09/100,000 live births, 95% CI 0.36-1.82) and infant mortality (0.20/1,000 live births, 95% CI 0.12-0.26). Moderate state abortion legislation was associated with lower rates of maternal, fetal, and infant mortality but not lower all-cause mortality in reproductive-aged females compared with restrictive laws. An increasing number of laws restricting abortion was associated with increased maternal and infant mortality.

&lt;sec&gt;&lt;st&gt;Aims&lt;/st&gt; Infant mortality rates (IMRs) and causes of death vary according to ethnicity in the UK. IMRs are highest in infants of Pakistani ethnicity. Incidence of congenital anomaly (CA) death is higher in Asian infants. Child Death Overview Panels (CDOPs) perform statutory reviews of all child deaths to identify potentially modifiable factors and prevent future deaths. Reviews are multi-professional, detailed, and systematic. Using CDOP data, we aimed to further describe factors associated with CA infant deaths, in an ethnically diverse, deprived district, with a high IMR. &lt;/sec&gt; &lt;sec&gt;&lt;st&gt;Methods&lt;/st&gt; Anonymised CDOP data for all infant deaths 2008– 2013 was used to compare CA deaths (CDOP Category 7 – Chromosomal, genetic and CAs), with deaths from all other causes. IMRs per 1000 live births were calculated using denominator data obtained from maternity information systems, for all causes, and for CA cause, according to ethnic group (Pakistani, White British and Other) and for all ethnic groups combined. Logistic regression analysis was performed to assess independent associations with CA mortality. &lt;/sec&gt; &lt;sec&gt;&lt;st&gt;Results&lt;/st&gt; There were 166 Pakistani, 96 White British and 53 Other deaths. IMRs from all causes (2008–2013) were: Pakistani 9.45 (CI 8.12–10.99), White British 4.09 (CI 3.35–4.99), Other 5.20 (3.98–6.80) and All 6.15 (CI 5.51–6.86). IMRs from CA cause (2008–2013) were: Pakistani 5.46 (CI 4.48–6.66), White British 1.19 (CI 0.83–1.72), Other 1.57 (CI 0.97–2.55) and All 2.73 (CI 2.32–3.22). CA death was independently associated with Pakistani ethnicity (OR 3.40, CI 1.89–6.09), parental consanguinity (OR 4.27, CI 2.32–7.89), and term birth (OR 4.52, CI 2.15– 9.53). CA deaths were not associated with deprivation. CA deaths were less likely to be from limitation of life sustaining treatment (OR 0.38, CI 0.22–0.66), less likely to be ‘modifiable’ (OR 0.18, CI 0.06–0.58), and less likely to be associated with maternal smoking (OR 0.39, CI 0.17–0.89). All p£0.025. &lt;/sec&gt; &lt;sec&gt;&lt;st&gt;Conclusions&lt;/st&gt; The high IMR in this district’s Pakistani infants is substantially explained by an excess of deaths from CA cause. CA deaths occurred more commonly in consanguineous families. Sensitive use of this information may enable better professional and community understanding of genetic inheritance, improve access to appropriate services, and could contribute to reducing congenital anomaly deaths in future. &lt;/sec&gt;

The secular changes and regional differences in perinatal, infant and early childhood mortality rates were studied for the period 1967 through 1986 using the health statistics issued by the Kagoshima prefectural government. The inter-relation of these mortality rates was also discussed. The following findings were made. 1) The infant mortality rate and early childhood mortality rates have generally declined progressively in the course of a 20-year period 1967 through 1986, the decrease was much more marked in infant mortality rate than in early childhood mortality rates and much greater in the first 15 years than afterward. The current low rates of infant mortality suggest that further decrease will be slower or difficult to achieve . Since 1980, in particular, the 1-year-old mortality rate has practically increased rather than stagnated. Then, a hypothesis was proposed that the increased rate in 1-year-old mortality was one of the causes of the decline in infant mortality rate by delaying deaths into the post-infant period. The late fetal death rate has also declined over the study period, the decrease was consistent with the pattern of infant mortality rate. 2) There were no marked differences between males and females for the changing patterns in infant and early childhood mortality rates. However, considerable differences in these mortality rates between male and female infants existed, in that male infants had consistently higher rates of mortality as compared with female infants . 3) Among 16 community-bases regional groups within the health center's jurisdiction, the income level was inversely correlated with both infant mortality rate and 1-4 year mortality rate. This correlation was significant for female infants but not for male infants. This fact raised a quetion whether the beneficial effects of urbanization in local communities on the infant and early childhood mortality rates were shown firstly among male infants. In contrast, fetal component of perinatal mortality was inversely correlated with female infant mortality rate but not with male infant mortality rate. The lower mortality rate reported for female infants may be partly attributed to the poor registration of infant deaths, since eraly neonatal deaths are sometimes reported as fetal death.

Maternal and infant mortality in the U.S. remain the highest among high-income nations, with disparities worsening after Dobbs v. Jackson Women’s Health Organization. This study examined how abortion bans and partisan political control are associated with maternal and infant mortality, while accounting for sociodemographic, economic, and healthcare factors. We conducted a cross-sectional ecological study of all 50 U.S. states, linking maternal mortality ratios (MMR) and infant mortality rates (IMR) with abortion policy classifications (total ban, ban at ≤ 18 weeks, ban after 18 weeks, no gestational ban) and partisan control of governors, legislatures, and senates. Multivariable regressions adjusted for sociodemographic, economic, and healthcare variables. Unadjusted analyses showed MMR and IMR were higher on average in Republican-led states (27 vs. 20 per 100,000; 6.3 vs. 5.0 per 1,000; all p < 0.01), with political control accounting for up to one-quarter of the variance (R²=0.21–0.25). In adjusted models, total abortion bans were correlated with higher MMR (β = 5.28, p = 0.0315, R²=0.81) and IMR (β = 1.15, p = 0.0014, R²=0.86). Higher mortality correlated with greater fertility and larger Black population shares; protective factors included higher income, state investment, education, life expectancy, Hispanic population, and healthcare access. These patterns clustered by party control. In this ecological analysis, abortion bans and Republican political control were correlated with higher maternal and infant mortality at the state level. While individual-level causality cannot be inferred, addressing structural disparities may help reduce preventable deaths. Maternal and infant deaths remain higher in the United States than in other wealthy countries. These problems have become worse since the Dobbs v. Jackson Women’s Health Organization decision, which allowed many states to ban or restrict abortion. Our study looked at whether abortion laws and political control in each state are related to the number of women who die during or shortly after pregnancy (maternal mortality) and the number of infants who die before their first birthday (infant mortality). We studied all 50 states uosing publicly available data. We compared maternal and infant death rates with state abortion policies (from total bans to no gestational bans) and with whether Republicans or Democrats controlled the governor’s office and state legislatures. We also considered other important factors such as income, education, access to healthcare, and racial/ethnic makeup of the population. We found that states with abortion bans and Republican political control had higher maternal and infant death rates than states without bans and with Democratic control. For example, maternal mortality was about one-third higher in Republican-led states. Higher fertility rates and larger Black populations were linked with more deaths, while protective factors included higher income, greater state investment, more education, longer life expectancy, and larger Hispanic populations. Our findings show that restrictive abortion policies and political control are linked with worse outcomes for mothers and infants. Although this type of study cannot prove direct cause, it highlights the need to address underlying inequalities to save lives.

Preconception care for improving perinatal outcomes: the time to act.

China has achieved substantial reductions in infant mortality; however, pronounced subnational disparities persist, particularly in western and rural regions. In the context of demographic change and evolving perinatal risk profiles, region-specific evidence is essential to guide targeted interventions and support progress toward Sustainable Development Goal (SDG) 3.2. This population-based observational study analyzed data from the Maternal and Child Health Surveillance System (MCHSS) in Shaanxi Province, China, from 2014 to 2023. A total of 320,259 live births and 954 infant deaths were recorded across 141 surveillance sites. Temporal trends in infant mortality rates (IMRs) were assessed using Joinpoint regression to estimate average annual percentage changes (AAPCs). Urban-rural differences and temporal trends were further evaluated using generalized linear models. The IMR in Shaanxi Province declined from 4.18 per 1,000 live births in 2014 to 2.16 in 2023 (AAPC: -6.31%, P < 0.001). Declines were observed in rural (AAPC: -10.58%, P < 0.001) and urban areas (AAPC: -5.44%, P = 0.003), although regression analysis did not identify statistically significant differences in temporal trends between residence groups (P = 0.152). Most infant deaths occurred during the neonatal period (62.1%). The leading causes of infant death were congenital heart defects (CHDs), birth asphyxia, pre-term birth and/or low birth weight (preterm/LBW), pneumonia, other congenital anomalies, and accidental asphyxia. Cause-specific mortality from congenital anomalies declined significantly (CHDs: AAPC -6.18%, P = 0.002; other congenital anomalies: AAPC -6.44%, P = 0.002). Pneumonia-related mortality also decreased markedly, particularly in urban areas (AAPC: -41.19%, P = 0.028). Infant mortality in Shaanxi Province declined substantially between 2014 and 2023, with broadly parallel trends in urban and rural populations. Despite this progress, pre-maturity-related conditions and injuries remain important contributors to infant death. Strengthening neonatal care systems, expanding birth defect prevention programs, and implementing targeted injury prevention strategies, particularly in underserved rural areas, may support further reductions in infant mortality and promote equitable progress toward SDG 3.2.

Infant mortality is still a major problem in our country as its level has remained relatively high by European standards. This points to the need for better preventive measures particularly as regards infant mortality and other adverse consequences of pregnancy, as key indicators of health and health care for mother and child. Namely, the analysis of movement in infant mortality in low mortality countries shows that it can be decreased relatively easily if certain social and health care measures are undertaken. For that reason, it is necessary to engage in permanent organized research to explain and measure both the relative impact of individual factors or groups of factors in our country which are significant in terms of infant mortality and their mutual relationships. We should also try to gain from the experiences of other countries which had already made progress in this respect. One of the elements of prevention is certainly the analysis of causes of infant morbidity and mortality primarily during the pre-natal period with the aim of specifying the most frequent causes of death to enable their elimination and to induce a subsequent decline in infant mortality. Besides showing the efficiency of health service activities, data on causes of infant death also point to the specific measures that should be undertaken and may be used as a base for planning and programming the development of health services, i.e. implementation of health policy as part of the population policy. With the decline in infant mortality in our country there has also been registered a change in the composition of diseases as the most frequent cause of death. During the initial observation period when the general level of infant mortality was exceptionally high, the share of infectious diseases and those of the respiratory system was very large. These deaths were mainly induced by exogenous factors, that is the diseases which the society in general and health services in particular could most easily have checked both by measures to improve the general living conditions and by preventive and curative health care measures. The period from 1989 to 1996 is characterized by endogenous causes of infant mortality primarily during the neonatal period and have to do with the constitutional features of the live-born children, congenital anomalies, premature birth, respiratory distress, etc. Thus, from the socio-medical point of view, the primary causes of infant mortality in this period are genetically induced or can be attributed to the mother in labour birth which modern men and modern medicine cannot influence to a larger extent. The analysis of infant death frequency by group of causes of death points that there still exist possibilities of eliminating the exogenous causes of death (as the same causes prevail in the socio-economically least developed regions of the country). Besides, some improvement can also be expected in the area of endogenous mortality (improvement in pre-natal diagnostics and other measures of health care for pregnant women and those who have just given birth, better conditions for child delivery and application of modern techniques to care for the prematurely born children. The semanatal mortality is probably the major socio-medical problem in our country both because it accounts for the highest percentage in neo-natal mortality and because it displays an almost negligible downward tendency. This justifies another request - for a more extensive and comprehensive analysis of this problem as well as for participation of other scientific disciplines besides medicine. Among the leading causes of semanatal mortality in the most recent observation period are premature birth, congenital anomalies, respiratory distress syndrome and intrauterine hypoxia and asphyxia at birth.

Human development index as a predictor of infant and maternal mortality rates

Primary care services in the United Kingdom are managed by 303 Primary Care Trusts (PCTs), each one covering a separate local area. PCTs determine the need of health services in a local community and are responsible for providing them. There is considerable variation between rates of both infant and perinatal mortality in many PCTs and rates are high in some. Those with the worst health and deprivation indicators have been designated as having “Spearhead” status. Although Spearhead PCTs have inferior health outcomes for infant and perinatal mortality, it is unclear whether these poor outcomes result from population characteristics, such as ethnicity and deprivation, inadequate service provision, and/or lack of health service funding for maternity services. This study used prognostic multivariable mixed models to identify PCTs with higher than expected rates of perinatal and infant mortality and investigated factors that might explain this observed variability between PCTs. Data were obtained from each PCT on the number of infant and perinatal deaths, deprivation, ethnicity, Spearhead status, maternal age, and PCT spending on maternal services. Spearhead status was designated in 88 (29%) PCTs. Measures of deprivation, ethnicity, and maternal age were included in the final models for infant and perinatal mortality. The primary study outcome measures were rates of perinatal and infant mortality across PCTs. The final fitted model accounted for 70% of the between-PCT variability for infant mortality and 80.5% of the between-PCT heterogeneity in perinatal mortality. PCT spending on maternal services had no predictive effect on the rates of either perinatal or infant mortality. The rate of perinatal mortality was substantially higher than the expected rate in 2 PCTs. Neither of these trusts had Spearhead status. The investigators conclude from these findings that social deprivation, ethnicity, and maternal age are predictors of both infant and perinatal mortality. However, higher PCT spending on maternity services does not appear to explain differences in rates of infant and perinatal mortality.

Primary care services in the United Kingdom are managed by 303 Primary Care Trusts (PCTs), each one covering a separate local area. PCTs determine the need of health services in a local community and are responsible for providing them. There is considerable variation between rates of both infant and perinatal mortality in many PCTs and rates are high in some. Those with the worst health and deprivation indicators have been designated as having status. Although Spearhead PCTs have inferior health outcomes for infant and perinatal mortality, it is unclear whether these poor outcomes result from population characteristics, such as ethnicity and deprivation, inadequate service provision, and/or lack of health service funding for maternity services. This study used prognostic multivariable mixed models to identify PCTs with higher than expected rates of perinatal and infant mortality and investigated factors that might explain this observed variability between PCTs. Data were obtained from each PCT on the number of infant and perinatal deaths, deprivation, ethnicity, Spearhead status, maternal age, and PCT spending on maternal services. Spearhead status was designated in 88 (29%) PCTs. Measures of deprivation, ethnicity, and maternal age were included in the final models for infant and perinatal mortality. The primary study outcome measures were rates of perinatal and infant mortality across PCTs. The final fitted model accounted for 70% of the between-PCT variability for infant mortality and 80.5% of the between-PCT heterogeneity in perinatal mortality. PCT spending on maternal services had no predictive effect on the rates of either perinatal or infant mortality. The rate of perinatal mortality was substantially higher than the expected rate in 2 PCTs. Neither of these trusts had Spearhead status. The investigators conclude from these findings that social deprivation, ethnicity, and maternal age are predictors of both infant and perinatal mortality. However, higher PCT spending on maternity services does not appear to explain differences in rates of infant and perinatal mortality.