PRB

In the wake of the overturn of Roe v. Wade, states with abortion bans have seen over 22,000 additional births, 478 excess infant deaths, and 59 excess pregnancy-associated deaths. These were among the findings shared at a June 9 symposium on the health impact of abortion bans, cosponsored by the Hopkins Population Center, State Innovation Exchange, PRB, and the William H. Gates Sr. Institute for Population and Reproductive Health.

Researchers, medical providers, legislators, and journalists came together in Washington, D.C., to talk about new research, share experiences on the ground, and discuss how data can inform more effective public health policy. The event highlighted a growing body of evidence on health outcomes in states with abortion bans, revealing alarming increases in preventable deaths and pregnancy complications after the 2022 Dobbs decision, which ended the constitutional right to abortion.

Notably, Texas saw a 50% jump in the sepsis rate among women who lost their pregnancies in the second trimester. (Sepsis is a life-threatening condition caused by the body’s extreme reaction to an infection.) Black infants were severely affected, with mortality rates 11% above expected levels.

When Medical Care Meets Legal Uncertainty

Three years post-Dobbs, researchers are documenting the health consequences of abortion bans across America. The effects extend beyond access to abortion itself—the bans have reshaped how doctors practice medicine during pregnancy emergencies.

“This moment reshaped access to abortion across the country and introduced new barriers for patients, providers, and health systems alike. And critically, [it] raised urgent questions about the health consequences of these changes,” said Dr. Feinian Chen, who directs the Hopkins Population Center.

In states with abortion laws, legal gray areas around medical exceptions and treatment for miscarriages have created a patchwork of inconsistent care, where patients in similar situations can receive different treatment depending on their hospital’s legal interpretation. For example, when miscarriage is imminent, but clinicians can still detect a heartbeat, they may deny necessary care until no heartbeat can be detected for fear of breaking anti-abortion laws. Physicians have also reported being forced to delay life-saving care for high-risk patients until they become critically ill.

The stakes are life and death. In one high-profile case, Josseli Barnica, a 28-year-old mother from Honduras, waited 40 hours in a Texas hospital while doctors monitored her fetal heartbeat during an inevitable miscarriage at 17 weeks. Despite wanting to terminate the pregnancy to prevent infection, Barnica was told it would be a crime. She died of sepsis with “retained products of conception,” two days after finally delivering.

This isn’t an isolated incident, but part of a broader pattern documented through investigative journalism, statistical analyses, and clinician interviews. The research reveals how abortion bans have created a public health emergency that disproportionately harms the most vulnerable populations—young women, minorities, and those with limited economic resources.

The Data Behind the Emergency

According to the Society of Family Planning’s #WeCount project, the number of monthly abortions provided in the formal healthcare system dropped in the immediate aftermath of Dobbs, before rebounding and eventually surpassing numbers observed before the decision. However, this data does not capture how many individuals were unable to obtain an abortion in states that implemented bans—nor does it show the impacts of these bans on health outcomes.

Sepsis and Pregnancy Complications

ProPublica’s analysis of Texas hospital billing data revealed a 50% increase in sepsis rates during second-trimester hospitalizations after the state’s six-week abortion ban took effect in 2021. The increase was even more pronounced—61%—among patients who didn’t have documented fetal demise at admission, suggesting doctors may have been waiting for fetal heartbeats to stop before intervening despite near certainty that the pregnancies were no longer viable or endangered the health of the mother.

Regional differences within Texas showed how hospital policies affect outcomes. Dallas’s UT Southwestern medical center changed its protocols after collecting data showing worse outcomes for women made to wait for care, while Houston hospitals maintained more restrictive interpretations of the law. While Dallas saw a 29% increase in sepsis rates in area hospitals, Houston experienced a 63% jump.

Birth Rates

In a separate study, Johns Hopkins researchers analyzing national vital statistics data found that states with abortion bans experienced over 22,000 more births than expected from the Dobbs decision through 2023—equivalent to one additional birth per 1,000 reproductive-age women. The impact differed dramatically by demographics: Hispanic, Black, and other racial minorities saw more than double the increase in fertility rates compared to white women.

Texas accounted for nearly 75% of these excess births, partly due to its earlier implementation of restrictions. Among the remaining 13 states with bans, births totaled 5,600 above expected levels.

Infant Deaths

In the wake of Dobbs, states have also seen excess infant deaths. Infant mortality rates increased 5.6% above expected levels in states with abortion bans, translating to 478 additional deaths. Black infants suffered disproportionately, with an 11% increase in mortality rates compared to a 5% increase for white infants. Deaths from congenital malformations and birth defects rose nearly 11%, suggesting that bans prevented termination of pregnancies with severe fetal abnormalities.

Pregnancy-Associated Deaths

Preliminary findings indicate an 8% increase in pregnancy-associated mortality, equivalent to 59 excess deaths. While the relative increase was similar across all racial groups, the absolute impact was greater for Black women, who already faced higher baseline mortality rates.

Clinical Perspectives

“Dobbs has complicated their ability to offer their patients the standard of care,” reflected Dr. Katrina Kimport, a researcher and professor of obstetrics and gynecology at the University of California, San Francisco. Interviews with 35 clinicians revealed three categories of cases where many felt that abortion bans prevented them from providing the standard of care:

• Patients with pre-existing conditions exacerbated by pregnancy.
• Pregnancy-related complications like preterm rupture of membranes.
• Fetal anomalies incompatible with life.

Patients with high-high risk pregnancies may be surprised to learn that termination may not be legal in some cases. “The law defines high-risk pregnancy where you can intervene at really the most stringent physical risk of harm. But for people, ‘high risk’ means so much more than that,” said Dr. Nisha Verma of Emory University and the American College of Obstetrics and Gynecology (ACOG), who provides clinical care in Georgia and Maryland. “The exception is so narrow that so many people get left behind in that definition.”

Doctors described becoming “law interpreters and enforcers” rather than medical practitioners, forced to delay care until patients became critically ill. Some bypassed hospital administrators entirely, counseling patients to leave the state rather than risk waiting for lawyers or administrators to make potentially harmful decisions.

Policy Implications

The research shows that abortion bans have created a public health emergency extending far beyond abortion access. The findings suggest that clarifying medical exceptions alone won’t solve the fundamental problem—so long as clinicians face criminal penalties for medical decisions, the conflict between legal compliance and patient care will persist.

For now, these experts suggest trying to hold the ground at the federal level and in restricted states to protect against policies that could impose further restrictions. Even clarifying the laws may not help pregnant people and infants. Taking advantage of the vague nature of some abortion bans, ACOG is working with a legal partner to develop state-specific hospital protocols that will push hospitals to be as expansive as possible while providing a statewide standard that benefits patients and providers.

Nineteen states currently have total abortion bans or ban abortion at or before 18 weeks.

“This work is hard in the best of circumstances, and we are far from the best of circumstances today,” said Jesseca Boyer of the Institute for Women’s Policy Research.

But, she added, some states are also taking protective steps. And researchers can help with this effort.

“New publications and data aren’t necessarily going to result in the passage of protective bills this year or next,” Boyer said, but they can “help continue to build support, build new champions in the long term, and may help to keep something bad from being worse in the interim.”