Chapter 1: Introduction to the Texas "Heartbeat" Law

This week, I want to draw attention to a study that uncovers the far-reaching effects of public policy, often beyond what was initially intended. It centers on Texas Senate Bill 8 (SB8), commonly referred to as the "heartbeat bill." This legislation imposes strict abortion limitations, and recent findings suggest that it may have contributed to a notable rise in infant mortality rates within the state.

Let's establish the timeline. On May 19, 2021, SB8 passed through the Texas legislature and was signed into law by Governor Greg Abbott. The law took effect on September 1, 2021, restricting abortion access once a fetal heartbeat is detected—typically around six weeks into pregnancy.

This legislation also permits private citizens to file lawsuits against anyone who performs or assists in an illegal abortion, with a minimum penalty of $10,000. Notably, the law does not allow exceptions for cases of rape, incest, or congenital anomalies, with the sole exception being if the mother's life is in imminent danger.

Researchers from Johns Hopkins University sought to investigate the implications of this law. As discussed in a paper published in JAMA Pediatrics, they posited that limiting access to abortions due to congenital anomalies would likely result in increased rates of neonatal and infant mortality after the law's implementation.

Chapter 2: The Study's Findings

Congenital anomalies are the leading cause of infant mortality in the United States.

Analyzing this data posed some challenges. The primary source of data was the Provisional Multiple Cause of Death Database maintained by the CDC, which includes death certificates listing primary and secondary causes of death, along with demographic data. However, it does not provide gestational age at birth—a crucial limitation.

Given this limitation, the researchers adopted a conservative approach, categorizing any death occurring from March 2022 onwards as a consequence of the law's enactment—six months post-implementation. This seems reasonable, as congenital anomalies are typically identified during a 12-week ultrasound. However, it's essential to recognize that some infants classified as having died prior to the law's effect may have still faced its repercussions, introducing a degree of misclassification bias that could skew results.

The data reveals a clear upward trend in both neonatal (deaths within 28 days of birth) and infant (deaths within one year of birth) mortality rates following the law's implementation.

Specifically, in 2022, Texas experienced a 12.9% rise in infant mortality, compared to a mere 1.8% increase in the rest of the country. Additionally, neonatal mortality rates surged by 10.4% in Texas, while only increasing by 1.6% nationwide.

Congenital anomalies remained the primary cause of infant mortality both in Texas and nationally, but Texas saw a 22.9% increase in these cases in 2022, contrasting with a 2.9% decrease elsewhere in the country. Other causes, such as Sudden Infant Death Syndrome and necrotizing enterocolitis, also showed significant increases in Texas compared to the national trends.

While these statistics are illuminating, it's important to note that correlation does not imply causation. Other factors, such as the ongoing COVID-19 pandemic, may also have influenced these outcomes. However, using data from other states as a control can help mitigate these effects.

It's plausible, though not conclusively proven by this data, to suggest that some women carrying fetuses with congenital anomalies—typically detected around the 12-week mark—were unable to access necessary abortions. This inability may have contributed to the observed increase in infant mortality as these pregnancies were carried to term.

Of course, the gravity of this increase in infant mortality is subjective and can depend significantly on one's stance on abortion. Nonetheless, it is crucial to recognize that every policy decision yields various outcomes, both intended and unintended. As a physician, I assess the quality of policy decisions based on their capacity to alleviate suffering. I empathize deeply with any family enduring the loss of an infant.

I value the effort to incorporate scientific inquiry into a debate that often transcends mere facts. Progress on contentious issues often begins with a shared understanding of the facts. For now, we allow the data to convey its own narrative.

The first video, The Unintended Consequences of the Texas 'Heartbeat' Law, delves deeper into the study's findings and implications, offering a comprehensive overview of the effects of this legislation.

The second video, First Test of Texas Abortion Law, discusses the initial reactions and outcomes following the implementation of SB8, providing context to the ongoing debate surrounding abortion rights.