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Protecting Babies and Women’s Rights

Do states with anti-abortion laws have higher infant mortality rates?

Does protecting abortion rights paradoxically lower infant mortality rates? A new study from Health Affairs examined trends in US infant death rates between1960–1980, and though the hypothesis is provocative, the study’s level of evidence is limited due to its descriptive analysis.

Source: lunar caustic (Flickr/CC)

Source: lunar caustic (Flickr/CC)

Several states have introduced hundreds of abortion bills in the past few years. Often referred to as targeted regulation of abortion providers (TRAP), the laws have affected abortion providers and facilities beyond medical necessity. State legislators are trying to legislate abortion out of existence by making it increasingly difficult for women to access the procedure: Thirty states have passed laws requiring a mandatory delay before women can have an abortion. The waiting period ranges from 24 to 72 hours. There is no medical explanation for this delay. The timing of the procedure should be a decision made by the patient and health care provider.

Requiring providers to follow the outdated FDA protocol for medical abortion is another way states have restricted abortion. Since the FDA approval of mifepristone in 2000, more recent studies have demonstrated comparable effectiveness at smaller doses and in fewer office visits. Using evidence-based protocols could make medical abortion safer, less expensive, and eliminate the need for a medically unnecessary follow up office visit.

An alternative tool states use to decrease abortion access is requiring abortion providers to have hospital admitting privileges. This effectively grants hospitals the ability to allow abortion providers to practice.

Forcing facilities to meet the same standards as surgical centers is an additional restriction. The upgrades to the clinic can be prohibitively expensive, and the building in which a clinic operates may not approve the upgrades, essentially granting building owners the ability to allow abortion providers to practice.

These are a few common ways states interfere with women’s health care. Legal abortions are already safe, but legislators are treating it differently from comparably safe health care procedures.

Is there a causal relationship between protected abortion rights and infant mortality rates? This study provides no definitive answer. However, legislators pushing for TRAP laws should think twice about the potential consequences of their actions—could they be protecting a fetus at the expense of a baby?

commentary by May Nguyen, MD, MPH


US infant death rates for 1960 to 1980 declined most quickly in (1) 1970 to 1973 in states that legalized abortion in 1970, especially for infants in the lowest 3 income quintiles (annual percentage change= -11.6; 95% confidence interval: -18.7, -3.8), and (2) the mid-to-late 1960s, also in low-income quintiles, for both Black and White infants, albeit unrelated to abortion laws. These results imply that research is warranted on whether currently rising restrictions on abortions may be affecting infant mortality. PMID: 25713932

Krieger, N, et al. Am J Public Health. 2015; 105 (4): 680-2.

Bich-May Nguyen, MD, MPH
About Bich-May Nguyen, MD, MPH

Dr. Nguyen Bich-May Nguyen, MD, MPH cares for patients at a patient-centered medical home and teaches medical students and residents in the clinic and hospital setting. She received an MD in the Underserved Track from Baylor College of Medicine and an MPH with a concentration in health policy from Harvard School of Public Health. She completed her residency training in Family Medicine at Boston University. Dr. Nguyen is involved with the National Physicians Alliance and serves on the Executive Committee of the New Leaders Council Houston. You can follow her at @bicmay. She began contributing to Policy Prescriptions™ in 2013. Contact: Website | Facebook | Twitter | Google+ | More Posts