Increased Neonatal Deaths in Texas After SB8, a Cardiac Activity-Based Abortion Ban.

IntroductionOn September 1, 2021, Texas enacted Senate Bill 8 (SB8), a law banning abortions after the detection of fetal heart activity, without exceptions for early detectable fetal abnormalities with low survival probability. The effect on neonatal mortality is unknown. MethodsWe deployed difference-in-differences (primary analysis), and Joinpoint and seasonal autoregressive moving integrated averages (sensitivity analyses) to determine whether all-cause mortality among Texas neonates increased after SB8 was enacted, and compared the findings to states with permissive abortion laws. Changes in mortality due to congenital malformations, deformations and chromosomal abnormalities were also measured. ResultsCompared with states where abortion remained legal, approximately 177 all-cause excess neonatal deaths (2.3 per 10,000 births, interaction p<0.003) occurred in Texas. A sensitivity analysis using Joinpoint logistic regression spontaneously identified a mortality trend change in Texas coinciding with SB8 enactment. Approximately 113 excess deaths (1.5 per 10,000 births, interaction p<0.001) due to congenital malformations, deformations and chromosomal abnormalities occurred among Texas neonates after SB8 enactment. Compared to expected deaths based on prior internal trends (sARIMA), Texas recorded 289 (95% CI 18-559) excess neonatal deaths (3.7 per 10,000 births; 95% CI 0.2-7.2) in 2022-2023. A preliminary analysis of post-SB8 shares of neonates listed as "not alive" on birth certificates by race/ethnicity found increased relative contributions from non-Hispanic White and Hispanic populations. ConclusionTexas SB8 was responsible for between 177-289 excess neonatal deaths from Quarter 4, 2021-Quarter 4, 2023. These results suggest that if other SB8-like abortion bans are enacted, increases in neonatal mortality may occur elsewhere.