In the United States, infant mortality increased after the Dobbs decision on abortion

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In the United States, infant mortality increased after the Dobbs decision on abortion

Infant deaths have increased in the United States since the Supreme Court ruled that Roe v. Wade overturned and allowed states to make abortion illegal, researchers reported Monday.

The change became noticeable three months after the June 2022 judgment with a high rate of infant mortality involving babies born with severe congenital anomaliesthe researchers discovered.

At the end of 2023, there were six months where the mortality rate of infants with serious anatomical problems was significantly higher than in the years before the High Court ruling. The researchers also identified three months in which the country’s overall infant mortality rate increased.

However, none of these rates fell below their historical range in the year and a half following the decision to Dobbs v. Jackson Women’s Health Organization.

The findingsreported Monday in the journal JAMA Pediatrics, are seen as a clear sign that the Dobbs decision has prevented some women from terminating a pregnancy that otherwise would have resulted in an abortion.

“There is a very simple mechanism here,” said Alison Gemmilldemographer and perinatal epidemiologist at the Johns Hopkins Bloomberg School of Public Health, who was not involved in the study.

“Before these abortion bans, people had the option of terminating their pregnancies if the fetus had a serious birth defect – we’re talking about organs located outside the body and other things that are very serious and incompatible with life,” says Gemmill. However, if women in these situations had no choice but to continue their pregnancies, “these babies would die shortly after birth,” she said.

Gemmill said the new findings are consistent with his own research, including a study published in June that documented a almost 13% increase in infant mortality in Texas following a 2021 state law that abortions banned after around the sixth week of pregnancy. Deaths due to congenital anomalies notably increased by 23% while they were decreasing in the rest of the country, according to this study.

Parvati Singhan epidemiologist at Ohio State University who studies the effects of sudden changes in health policy, wonders whether the Dobbs decision would have similar consequences for the country as a whole.

To find out, she and her colleague Maria Gallosexual and reproductive health epidemiologist at Ohio State, delved into data on live births and infant deaths. collected by the Centers for Disease Control and Prevention. These figures allowed them to calculate monthly infant mortality rates.

In a population as large as the United States’, the number of babies born and dying each month tends to be stable, Singh said. What she and Gallo were looking for were significant deviations from this stable average.

The pair started with data from January 2018 to May 2022 — the month before the Dobbs decision — to identify “the primary signal” and the “natural ups and downs around that primary signal,” Singh said.

They then used this information to estimate what the nation’s monthly infant mortality rates would have been through December 2023 if the Supreme Court had not allowed states to limit or ban abortion. (According to the Guttmacher Institute13 states have banned abortion altogether, and eight more ban it at some point during the first 18 weeks of pregnancy.)

The next step was to compare their monthly infant mortality estimates with the actual numbers based on CDC data. Nine times the observed infant mortality rate was higher than the expected rate, and the difference was too large to be explained by natural variability or chance, they found.

Because researchers don’t know the details of each death, they can’t say for sure whether a particular case involved a pregnant person who was denied an abortion, Singh said. But trends suggest many of them were.

For example, the increase in deaths of infants with birth defects was first observed in September and October 2022. This timing makes sense, Singh said.

THE ultrasound examination that doctors use to ensure that fetal organs are developing properly occurs between 18 and 22 weeks into pregnancy. If a test produced devastating news immediately after the Dobbs decision but the patient was unable to have an abortion, she would be at risk of giving birth prematurely three to four months later.

Rates started to rise again eight months after the Dobbs decision. This could reflect the case of women who conceived right around the time of the Dobbs decision — before they had a chance to reconsider pregnancy and before they could find ways around the ruling, Singh said.

Infant mortality rates had returned to the normal range a year after the ruling, which could indicate that the pool of people wanting to become pregnant had changed in response to the new restrictive landscape.

Something similar happened at the beginning of Covid-19 pandemicSingh said.

“Fertility declined very quickly,” she said. People who chose to get pregnant despite the threat posed by the new disease were less likely to give birth prematurely and their newborns were less likely to suffer from it. low birth weight.

“In other words, these were healthier pregnancies,” Singh said. “Maybe that’s what’s happening here.”

In total, Singh and Gallo documented 247 additional infant deaths in the year and a half after Dobbs, representing a 7 percent increase. The vast majority of these deaths – 204 – were due to birth defects, an increase of 10%, according to the study.

The fact that infant mortality never fell below expected levels is strong evidence that the abortion ruling was the root cause of the additional deaths, Singh said.

“If our theory is correct, there is no reason why infant mortality should be lower than expected,” she said.

Gemmill said the increase in infant mortality would likely be more pronounced if researchers had focused on changes in states with abortion restrictions instead of looking at the country as a whole.

The increases would likely be higher in places where pregnant women must travel long distances to reach another state to access abortion, she added.

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