Targeted regulation of abortion providers and infant mortality.

INTRODUCTION: Abortion restrictions on pregnant people, such as those that limit gestational age or ban abortion altogether, have been associated with infant mortality, but little is known about whether laws restricting abortion providers and clinics providing abortions have similar associations. This study examines the association between laws that restrict abortion providers, known as TRAP (targeted regulations of abortion providers) laws, and infant mortality on a state level. METHODS: 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 to 2021. Infant death rates were calculated using PRAMS data of self-reported infant deaths. 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 available in PRAMS. The exposure was defined as the existence of at least one TRAP law in a state during the study period. RESULTS: Among 178,210 participants, representing a weighted population of 9,099,586 birthing people, 47.5% people lived in states (n = 19) that had at least one TRAP law during the study period. Overall, 0.4% of participants reported an infant death. In adjusted analysis, there was a 36% greater likelihood of infant mortality (adjusted incident rate ratio [aIRR], 1.36; 95% confidence interval [CI], 1.13-1.63) in states with TRAP laws in comparison to those without TRAP laws. CONCLUSIONS: TRAP laws are associated with a greater likelihood of infant mortality, even after accounting for potential individual-level confounders. Restricted access to abortion may result in people with high-risk maternal or fetal health conditions continuing pregnancy rather than receiving desired abortion services.