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

Introduction: On 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. Methods: We 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. Results: Compared 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. Conclusion: Texas 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. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement No funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: CDC WONDER: https://wonder.cdc.gov I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors