Do Abortion Bans Affect Reproductive and Infant Health? Evidence from Texas's 2021 Ban and its Impact on Health Disparities

Abstract

In June 2022,  the U.S. Supreme Court's Dobbs v. Jackson decision overturned Roe v. Wade, triggering a wave of abortion bans across the country. However, prior to Dobbs v. Jackson, Texas's Senate Bill 8 (SB 8) took effect in 2021, banning abortions after six weeks of pregnancy. This paper examines the causal impacts of Texas' abortion ban on reproductive and infant health outcomes, including birth weight and mortality, with a focus on racial and ethnic disparities.  Using a unique dataset of county-level and individual-level data, this study finds that the ban led to a 5 percent increase in very low birth weight incidence and a 6 percent rise in infant mortality rates, disproportionately affecting Black non-Hispanic infants, who experienced an approximately fourfold increase in mortality rates relative to white non-Hispanic infants. Additionally, geographic disparities emerged, with counties farther from states with less restrictive abortion policies experiencing more severe outcomes. To explain these disparities, the paper constructs an expanded abortion decision tree to measure unmet reproductive health needs, revealing how groups adjusted fertility choices post-ban. Results indicate a 4 percent increase in fertility and a 40 percent decline in abortion rates after the ban, with Black non-Hispanic women and those in counties far from non-restrictive states facing the largest increases in fertility and unmet needs. The ban also led to shorter interpregnancy intervals (the time between pregnancies), a factor associated with adverse maternal and infant health outcomes. Furthermore, both unintended and intended births exhibited higher rates of infant health complications, indicating spillover effects on the broader reproductive health system. These findings underscore that abortion bans not only significantly impact reproductive health but also amplify pre-existing health disparities, with the most profound consequences for marginalized populations.

Keywords: Reproductive Health, Abortion, Fertility, Infant Health, Abortion Ban, Texas

JEL Classification: I18, J13, K32