| According to new research by the Society of Family Planning's abortion tracking project WeCount, the monthly average number of abortions in the US this year is 20% higher than it was in 2022, the year the Supreme Court overturned Roe v. Wade. Although not every state has seen an increase, there doesn't seem to be much of a difference between states with near-total abortion bans and states that have expanded abortion access. A rise in telehealth appointments have allowed women who live in states with strict abortion bans to still terminate their pregnancies from out-of-state providers who are protected under newly enacted shield laws. In fact, in South Dakota, which in 2022 banned all abortions except in cases where a mother's life was in danger, the number of abortions has doubled since 2022.
But a curious thing happened. Infant mortality has increased, too.
A study published this week in JAMA Pediatrics, which used provisional CDC data for 2023, found a 7% rise in overall infant mortality since the Dobbs decision. (Infant mortality is defined as the death of a baby under one year old. It's usually measured per 1,000 births.) Most of the rise in deaths—82%, in fact—were among babies born with "congenital anomalies," as researchers put it. The researchers noted that their findings are consistent with those of an earlier study, also published in JAMA Pediatrics, which looked only at Texas and found a 13% rise in infant mortality after the state enacted its abortion ban.
At first glance, these two findings seem contradictory. If American women are still obtaining abortions, even in states with strict abortion bans, wouldn't the rate of babies born with severe birth defects go down?
The answer is complicated. First, the rise in abortions appears to be largely due to a rise in abortion pills prescribed via telehealth appointments. For most part, abortion pills are only available to women within the first 12 weeks of pregnancy. But many congenital anomalies aren't detected until well after that 12-week mark. Fetal growth scans—the anatomy ultrasounds that doctors use to make sure a fetus is growing properly—don't occur until around 18 to 22 weeks of pregnancy, sometimes even later.
If the scan reveals a fatal abnormality, mothers are often too far along in their pregnancies for medical abortion to even be an option. Kate Cox, who unsuccessfully sued the state of Texas to terminate a wanted pregnancy because her child had a fatal genetic condition, was 18 weeks pregnant when she first received a diagnosis and 20 weeks when she sued. Cox did receive an abortion, but to do so she had to leave the state. Not everyone can afford to do that, of course. Hence the rise in infant mortality due to congenital abnormalities at a time when abortion bans are getting stricter. Secondly, America's infant mortality rate actually started rising in 2020, two years before the Dobbs decision. The reasons for that rise have nothing to do with abortion. The United States, like most other countries, has enjoyed a steadily decreasing infant mortality rate over the last century, going from 86 deaths in 1920 to a low of 5.4 deaths in 2020. Much of this decline is due to medical advancements but it's also due to the development of diagnostic tests that can detect fatal conditions, allowing women to terminate nonviable pregnancies rather than carry them to term.
America's overall decline in infant mortality is good news, of course, but compared to other wealthy countries it's not actually that impressive. In fact, the US infant mortality rate is still surprisingly high. According to a 2023 analysis of 11 of the wealthiest countries — Britain, Germany, South Korea, Australia, and so on—by the Commonwealth Fund, the US has both the highest infant mortality rate and maternal mortality rate of all of them. America's lowest infant morality rate ever—5.4 deaths in 2020—was still 50% higher than in France, and three times higher than in Norway or Japan. In fact, an infant morality rate of 5.4 may be something to cheer in the US, but Japan hasn't seen anything that high since 1985. Read more: Trump, Harris and the State-by-State Battle Over Abortion in the US In many ways, this is not surprising. The US has a lower life expectancy than many other wealthy countries and pregnant women have comparatively poor access to prenatal care. (In Arkansas, for example, 28% of pregnant women don't have a prenatal check-up until their second trimester). According to the Commonwealth Fund, Americans are less likely to see a physician regularly and the country has one of the lowest rates of practicing doctors and hospital beds per 1,000 people among OECD countries. According to the March of Dimes, 52% of counties in the US do not have a hospital that offers obstetric care.
It's within this context, starting in 2020, that infant mortality started creeping back up. The change was small, going from 5.4 deaths in 2020 to 5.6 deaths per 1,000 births in 2022, but it was the first time it had risen in decades. The Covid-19 pandemic may have played a part—Covid has been linked to some pregnancy complications and higher rates of preterm birth — but then again, the pandemic was worldwide and other wealthy countries did not see their infant mortality rates rise in the same way. France, for example, has had an infant mortality rate of about 3.3 since 2016, a figure that remained steady throughout the pandemic.
So what should we make of all of this? Well, for one thing, abortion restrictions may have exacerbated America's comparatively poor maternal and infant health outcomes, but they're not the sole cause of them. They also don't seem to be keeping women from successfully terminating early pregnancies. Still, infant deaths are rising, largely among babies born with congenital health conditions. Instead of keeping women from terminating healthy pregnancies, abortion bans may simply be preventing pregnant women from choosing how to cope with the discovery that the child they're carrying will never be able to survive. | 
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