The first 14 states that restricted abortion after the Supreme Court struck down Roe v. Wade in June 2022 delivered 22,181 more babies into the world as a result, a federally funded study shows.
Public health researchers said this month in the Journal of the American Medical Association that they calculated the tally by analyzing birth certificates and U.S. Census Bureau data for all 50 states from 2012 to 2023.
Grants from the National Institute of Child Health and Human Development and the National Institute on Minority Health and Health Disparities funded the study, which excluded states with later abortion restrictions that cannot be measured yet.
It found that childbearing women aged 15 to 44 in abortion-restricting states delivered 1.01 more babies per 1,000 people than would have been expected statistically before the high court’s ruling. Births were 1.7% higher than projected, with 60.55 births observed per 1,000 women vs 59.54 anticipated.
Study co-author Alison Gemmill, a perinatal epidemiologist at Johns Hopkins Bloomberg School of Public Health, said the findings offer “a more objective and reliable measure” of the laws’ impacts than incomplete national abortion tallies. She noted that unreported abortions among women traveling out of state or self-administering pills at home have likely surged since 2022 in ways traditional estimates cannot capture.
“Births are generally declining across the U.S.,” Ms. Gemmill told The Washington Times. “In states without restrictions, we don’t see the same change in births that we observe in banned states, reinforcing the idea that these policies are driving the differences.”
The Centers for Disease Control and Prevention, which relies on incomplete state reporting, has not released estimates for 2023. The agency reported a 2% decline in abortions from 2021 to 2022.
According to the pro-choice Guttmacher Institute’s direct survey of abortion providers, 1,026,700 abortions occurred in 2023, the highest number in over a decade. Abortion pills accounted for 63% of them, up from 53% in 2020.
This month’s JAMA study started with the effects of a ban Texas enacted on abortions after six weeks of pregnancy in 2021. Texas expanded it to a near-total ban with limited exceptions for rape, incest and maternal health after the Supreme Court’s 2022 ruling.
The survey investigated the effects of six-week bans in Georgia and Oklahoma. It also looked at the effects of a near-total ban in Missouri, which recently legalized abortion again in a ballot referendum.
Alabama, Arkansas, Idaho, Kentucky, Louisiana, Mississippi, South Dakota, Tennessee, West Virginia and Wisconsin were the other states with near-total abortion bans in 2022.
As births increased, researchers estimated that infant mortality rates were also 6% higher than expected in these states from 2021 to 2023, with 500 more deaths than anticipated.
They chalked that up to abortion bans pressing more mothers to carry babies with life-threatening abnormalities to term, leading to more births among low-income women with high risks of maternal complications.
The sharpest increases in births above statistical expectations were for racial minorities (about 2%), unmarried women (1.79%), mothers under 35 years old (2%), Medicaid beneficiaries (2.41%), and women without college degrees (high school diploma, 2.36%; some college, 1.58%).
“These findings indicate that many pregnant people were unable to overcome barriers to access abortion services and instead were forced to continue an unwanted or unsafe pregnancy to term, including doomed pregnancies diagnosed with fatal fetal anomalies,” said Suzanne Bell, a study co-author and professor of population, family and reproductive health at Johns Hopkins Bloomberg School of Public Health.
The study estimated that state fertility rates surged between 0.3% and 2.3% above statistical expectations, or by 0.16 to 1.41 more births per 1,000 women. The biggest estimated changes were in Texas (2.3%), Kentucky (1.4%) and Mississippi (1.4%).
Mixed view
According to outside experts reached for comment, the JAMA findings offer a mixed view on state restrictions since the Supreme Court’s 2022 ruling in Dobbs v. Jackson Women’s Health.
“It would appear Dobbs slowed the trend of increasing abortion numbers but did not reverse it,” said Michael New, a professor of social research at The Catholic University of America and affiliated scholar at the pro-life Charlotte Lozier Institute. “Lower abortion rates in states with pro-life policies were offset by increased abortion rates in states where abortion remained broadly legal. The policy changes that made chemical abortion drugs easier to access have led to rising abortion numbers nationally.”
However, he noted that groups sending abortion pills through the mail “may be inflating their numbers” for political reasons in Guttmaker’s tally.
Tresa Undem, a pollster at left-leaning PerryUndem, could not say whether abortions have gone up or down since Dobbs. But she pointed to a recent poll she conducted that found 67% of voters would favor leaving the decision to have an abortion “to the person and their doctors.”
“Most people support abortion rights and access,” Ms. Undem said.
Both sides must accept the statistical reality that “there is no political consensus on abortion in the United States,” added Daniel K. Williams, a historian at Ashland University in Ohio, where voters approved a 2023 constitutional amendment to protect abortion rights.
“In the last election, the Democrats were unable to win a majority on a platform of legalizing abortion nationwide, but at the same time, the pro-life movement cannot win majority support for restrictive abortion policies in most states,” Mr. Williams said. “I suspect abortion will remain legal in most states, but a few socially conservative states will be able to keep their abortion bans.”
Baby boom
This month’s study comes as older reports suggest fewer women have found work-arounds to state abortion restrictions than pro-choice activists think.
In Texas, a January 2024 study from the University of Houston’s Institute for Research on Women and Gender and Society analyzed the impact of the Texas Heartbeat Act, which restricted most abortions after six weeks of gestation in September 2021.
As births started climbing in April 2022, the study found the Texas fertility rate rose from 60.68 to 61.92 births per 1,000 women aged 15-44 between 2021 and 2022 — the first annual increase since 2014.
A July 2023 analysis by Johns Hopkins researchers associated the Texas law with 9,799 additional births between April and December 2022.
“Dobbs allowed decisions concerning abortion to be made by the states, and the states have chosen policise that would promote population growth,” said Josh Blackman, a constitutional law professor at South Texas College of Law in Houston. “The JAMA study provides evidence of how this decision is panning out.”
In Indiana, which became the 15th state to enact an abortion ban in August 2023, preliminary data suggests similar results.
The Indiana Department of Health estimated last year that just 45 abortions occurred statewide between January and March 2024, down 98% from 1,931 procedures during the same period in 2023 and from over 2,000 in the first quarters of 2020, 2021 and 2022.
“The recent JAMA study shows the impact abortion has had on families,” said Andrea Trudden of Heartbeat International, an international network of over 2,000 crisis pregnancy centers. “We celebrate every life and will continue to support each woman with compassionate care so that she feels confident in her new season.”
In March 2024, an earlier study in the Journal of the American Medical Association found the number of abortion pills pro-choice advocacy groups sent women by mail or outside formal medical settings surged during the six months after the Supreme Court’s ruling.
Researchers from the University of Texas at Austin and two abortion pill advocacy groups — the National Women’s Health Network in Washington, D.C., and Aid Access, Amsterdam in the Netherlands — analyzed self-reported data from groups that provided medications from July 1 to Dec. 31, 2022.
The researchers said “provisions for self-managed abortions” increased by 27,838 over what they projected based on trends before the ruling. By comparison, they pointed to previous research showing that surgical abortions dropped by 32,360 over the same period as state restrictions drove clinics to close in many states.
Brian Westbrook, founder of Coalition Life, a St. Louis-based group that offers sidewalk counseling to pregnant women outside abortion clinics, said state bans have removed some of the social pressure young women felt to terminate pregnancies.
“Once they realize that there is help out there and they are not alone, they begin to consider other options,” Mr. Westbrook said. “We have found that when abortion restrictions or abortion bans are in place, women have more time and incentive to consider all of their options more fully and avoid making a decision they will regret for the rest of their lives.”
• Sean Salai can be reached at ssalai@washingtontimes.com.