Speculation grows that the circumstances surrounding the 2016 presidential election may have had a uniquely negative effect on the health of the US Latino population.^1-4 The campaign leading to the election was marked by highly racialized rhetoric and promises of punitive, anti-immigrant policies.⁵ Consequently, the 2016 election may have acutely stressed Latino immigrants and their US-born coethnic family members and communities and contributed to heightened fear of deportation and the potential reversal of proimmigrant legislation (eg, the Deferred Action for Childhood Arrivals program).^6-9 Indeed, in the aftermath of the 2016 presidential election, nearly half of US-born Latinos and two-thirds of Latino immigrants reported fearing that a family member or close friend might be deported, regardless of their own status.^6,7

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet

Importance: 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.Objective: 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.Design, Setting, and Participants: 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.Exposure: 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.Main Outcomes and Measures: 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.Results: 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).Conclusions and Relevance: 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.

Importance: The impact of recent abortion bans on infant mortality is not fully understood. There is also limited evidence on how these bans may interact with long-standing racial and ethnic disparities in infant health.Objective: To examine the association of abortion bans with changes in infant mortality and to compare this association in racial and ethnic groups based on analyses within and across states.Design, Setting, and Participants: This population-based, serial, cross-sectional study used a bayesian panel model to examine infant mortality rates in 14 states that implemented complete or 6-week abortion bans and compared them with predictions of infant mortality rates based on pre-ban mortality rates and states without bans. Data included all live births and infant deaths from all 50 US states and the District of Columbia for 2012 through 2023. Models accounted for temporal trends and state-specific factors, with analyses stratified by race and ethnicity, timing of death, and cause of death.Exposure: Complete or 6-week abortion bans.Main Outcome and Measures: Infant mortality rate, analyzed overall and by subgroups.Results: The analysis found higher than expected infant mortality in states after adoption of abortion bans (observed vs expected, 6.26 vs 5.93 per 1000 live births; absolute increase, 0.33 [95% credible interval (CrI), 0.14-0.51]; relative increase, 5.60% [95% CrI, 2.43%-8.73%]). This resulted in an estimated 478 excess infant deaths in the 14 states with bans during the months affected by bans. The estimated increases were higher among non-Hispanic Black infants compared with other racial and ethnic groups, with 11.81 observed vs 10.66 expected infant deaths per 1000 live births, an absolute increase of 1.15 (95% CrI, 0.53-1.81) and relative increase of 10.98% (95% CrI, 4.87%-17.89%). The observed infant mortality rate due to congenital anomalies was 1.37 vs 1.24 expected (absolute increase, 0.13 [95% CrI, 0.04-0.21]; relative increase, 10.87% [95% CrI, 3.39%-18.08%]), while the rate not due to congenital anomalies was 4.89 observed vs 4.69 expected (absolute increase, 0.20 [95% CrI, 0.02-0.38]; relative increase, 4.23% [95% CrI, 0.49%-8.23%]). Texas had a dominant influence on the overall results and there were larger increases in southern vs nonsouthern states.Conclusions: US states that adopted abortion bans had higher than expected infant mortality after the bans took effect. The estimated relative increases in infant mortality were larger for deaths with congenital causes and among groups that had higher than average infant mortality rates at baseline, including Black infants and those in southern states.