Texas Is Forcing Women to Give Birth to Babies That Won’t Survive

Samantha Casiano says she should have been able to get an abortion when she received a fatal fetal diagnosis in 2023, but Texas showed her “no mercy.” Because of the state’s abortion ban and because she was unable to afford traveling for care, Casiano was forced to carry her doomed pregnancy for three more months. Her daughter Halo was born at 33 weeks; parts of her skull and brain never developed, and she died after four hours. Casiano’s story is not uncommon in Texas, as the state prohibits abortions even in cases of fatal fetal abnormalities. If these experiences aren’t compelling enough evidence that the state is forcing women to give birth to babies that won’t survive, a new study released this week by Johns Hopkins University offers hard numbers. According to researchers, Texas saw a striking spike in deaths from congenital abnormalities after it banned abortion nearly three years ago.

In September 2021, Texas enacted what was the most extreme anti-abortion law in the country at the time, foreshadowing the crisis of care that would befall patients across the nation when the Supreme Court overturned Roe v. Wade nine months later. Texas’s “bounty hunter” law, also known as SB8, banned abortions after fetal electro-cardiac activity is detected — which happens around six weeks of gestation, before most people know they are pregnant. The law only made an exception for narrowly defined medical emergencies, and it also empowered citizens to sue anyone suspected of providing or aiding an abortion. The number of abortions in the state quickly dropped as a result, and researchers later found there were 9,800 additional births in Texas through 2022.

In a new study, published in JAMA Pediatrics, researchers compare the rate of infant deaths between Texas and 28 other states from 2018 to 2022. They found that the number of newborn and infant deaths in Texas rose from 1,985 in 2021 to 2,240 in 2022 — a nearly 13 percent increase. During that same time period, infant deaths nationwide rose by just 2 percent. The study also found that there was a nearly 23 percent increase in the deaths of babies born with congenital anomalies in Texas, while nationwide there was a 3 percent decrease in those cases.

To the team behind the report, these findings are evidence of the substantial harm unleashed by abortion bans. “Our results in Texas provide insight into what we might expect to see in other states that have banned or restricted early abortion following the Supreme Court’s 2022 Dobbs decision,” says Suzanne Bell, an associate professor at Johns Hopkins Bloomberg School of Public Health and one of the study’s authors. “This is perhaps foreshadowing what other states might see in relation to their infant health outcomes.”

Bell spoke with the Cut about the study’s most striking findings and the devastating impacts SB8 has had on newborn and infant mortality.

You’ve previously researched how SB8 led to an increase in births in Texas. What made you want to then look at the ban’s connection to the state’s infant mortality rate?

We had seen in prior research looking at the relationship between abortion laws and infant health and mortality that there was a relationship whereby states that were hostile to abortion had higher infant mortality rates on average. However, this work was evaluating fundamentally different and less severe abortion restrictions, and those studies tended to be correlational in nature. We had the opportunity to use more rigorous causal inference techniques to provide more compelling evidence regarding the impact of abortion bans on infant mortality. Our prior study showed a significant increase in live births in Texas following the imposition of Senate Bill 8. That was further motivation for us to investigate additional possible downstream impacts of this policy on population health outcomes and, specifically in this case, infant mortality.

Can you tell me what research has found when it comes to infant and newborn mortality in the U.S. in general?

Infant mortality — which is the death of an infant before one year of age — has actually been decreasing in the U.S. since the mid-’90s but slightly increased recently. The U.S. infant mortality rate is around 5.6 infant deaths per 1,000 live births. This observed increase that we saw in Texas following SB8 was a real divergence from that trend. There’s several potential mechanisms for the association of abortion restrictions with an increase in infant death, which led us to pursue this research question. One of the main thoughts is that infant mortality would increase simply as a result of increases in the number of live births that our prior study showed, which results in an increase of infants that are exposed to the risk of death. But another mechanism that we found evidence for is potential increases in death involving congenital malformations, which are the leading cause of infant mortality in the U.S. and account for more than one in five infant deaths. This cause of death could increase specifically as people may be forced to continue pregnancies involving fetal diagnosis of genital congenital malformations that may be highly incompatible with life.

What were some of your biggest findings?

The findings make clear the potentially devastating consequences abortion bans can have on pregnant people and families who are unable to overcome barriers to this essential reproductive health-care service. When we were employing these more rigorous causal inference methods, where we compared Texas to a synthetic version of Texas, we saw an increase of about 13 percent additional infant deaths above what we would have expected had this policy not been imposed. This has significant consequences in terms of trauma to families as well as medical costs in Texas and potentially in other states that have since banned abortion or restricted it in early pregnancy. When we look specifically at the descriptive statistics that we have access to by cause of death, what was particularly striking in Texas was that we saw an increase in the share of infant death due to congenital anomalies. It provides evidence for this notion of people having to continue pregnancies with a diagnosed fetal abnormality that was highly unlikely to be compatible with life, which resulted in some cases in a neonatal or infant death in that first year.

Reading the study, I could not help but think about some of the women who sued in Zurawski v. State of Texas after being forced to carry their nonviable pregnancies to term — a challenge the state Supreme Court rejected recently.

We have really compelling and heartbreaking evidence of the impact of this potentially preventable increase in infant mortality. The repercussions are significant. Our findings provide further evidence of the substantial suffering that abortion bans can cause. We know from the literature that experiencing an infant death is an incredibly traumatic event for the pregnant person and their family. Behind each of these infant deaths are people who may still be struggling in the aftermath of this horrific experience. And there may be far more infants who were born with serious complications and survive with long-term care implications.

What are some of the limitations of your research? 

We have existing evidence of disparities in who is most likely to be impacted by observed increases in infant mortality due to abortion restrictions, with non-Hispanic Black women having more than two times the rate of infant death than Hispanic and non-Hispanic white women. We also know from prior research that the impact of abortion ban falls disproportionately on poor and minority people who may be unable to overcome barriers and travel outside the state for timely care. But we lack that individual-level data with pregnancy characteristics and other features of the delivery or infant health outcomes to be able to investigate that more fully. Those sorts of socioeconomic characteristics — maternal race, ethnicity, level of education, whether the birth was paid for by Medicaid or not — provide some insight into who might be most impacted by this ban and its effects on infant mortality.

We also didn’t have information on gestational age or age at death. We had to use our best guess to identify which infant deaths were most likely the results of pregnancies exposed to SB8, so there could have been some misclassification there. We think, if anything, that means our results are more conservative than they might otherwise have been.

What does the increase in infant mortality tell us about SB8 and abortion bans in general?

The real takeaway is that we can prevent these effects — the excess infant deaths and the associated suffering families experience — by not restricting abortion and allowing pregnant people to decide how to handle their specific pregnancy. In the absence of that, we need to ensure families who are caring for a terminally ill infant and who experience an infant death have access to much-needed support as they process their grief. We also need to ensure adequate medical and other support is available for those who have an infant born with severe complications that require long-term care.

This interview has been edited and condensed for length and clarity.

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