(829) Targeted regulation of abortion providers and infant mortality

Targeted regulation of abortion providers (TRAP laws) are medically unindicated restrictions limiting the provision of abortion, even in states where abortion is legal. Restrictions on reproductive rights have been associated with adverse maternal and neonatal outcomes. We aimed to evaluate the association of the existence of TRAP laws in a state and state rates of infant mortality.

Study Design:

This cross-sectional analysis was performed utilizing 2016-2021 Phase 8 data from the Pregnancy Risk Assessment Monitoring System (PRAMS). PRAMS data were linked with Guttmacher Institute data about state TRAP laws from 2016-2021. Infant death rates were calculated using PRAMS data, which uses respondent self-report. In the PRAMS questionnaire, participants are asked “Is your baby alive now?” If participants answer “no,” they are coded as having an infant death. Multivariable Poisson regression testing the association between the existence of TRAP laws in a state and infant mortality was performed, adjusting for individual-level sociodemographic factors from PRAMS.

Results:

Among 183,849 participants, representing a weighted population of 9,792,533, 45.2% people lived in states (n=18) that had at least one TRAP law during the study period (Figure). During the 2016-2021 study period, 0.4% of participants reported an infant death. In adjusted analysis, there was a 29% increased likelihood of infant mortality (aIRR 1.29, 95% CI 1.08, 1.55) in states with TRAP laws in comparison to those without TRAP laws (Table).

Conclusion:

TRAP laws are associated with an increased likelihood of infant mortality, even after accounting for individual-level confounders. Restricted access to abortion may result in people with high-risk maternal or fetal health conditions to continue pregnancy rather than receive desired abortion services.