The Relationship Between Access to Abortion and Mental Health in Women of Childbearing Age: Analyses of Data From the Global Burden of Disease Studies

Abstract

Background It has often been suggested that restricting access to legal abortion could have a negative impact on the mental health of women seeking this procedure. The recent judgment of the United States Supreme Court in the Dobbs case has brought the question of the psychological impact of changes in abortion policy into focus. The results of studies on the link between induced abortion and mental health are contradictory, and interpreting the results of these studies is complex due to a multitude of potential confounding factors. However, there is little data on the relationship between the availability of legal abortion and its effects on the mental health of women of childbearing age in the general population. Objective The objective of the current study was to examine cross-sectional and longitudinal associations between access to legal abortion and the prevalence of common mental disorders in women of childbearing age at a cross-national level while correcting for potential confounding factors. Methods The current study employs both cross-sectional and longitudinal analyses of nation-level data for 197 countries and regions. As data on global abortion policy were compiled in 2009 and 2017 by the Guttmacher Institute, data on access to legal abortion for these years were examined in relation to the prevalence of anxiety disorders and depression in women of childbearing age for each country, obtained from the Global Burden of Disease Studies for the most recent subsequent year (2010 and 2019). The relationship between changes in abortion policy and changes in the prevalence of these disorders in each country was examined for the aforementioned period. All analyses were adjusted for the potential confounding effects of gender development, gender inequality, and intimate partner violence. Cross-sectional associations were examined using Pearson's bivariate and partial correlations, while longitudinal associations were examined using a general linear model and analyses of covariance. Results At the cross-sectional level, broad legal access to abortion was associated with a lower prevalence of depression in women aged 25-49 years, however, this association was not significant after correcting for measures of gender development, gender inequality, and intimate partner violence. At the longitudinal level, a slight but significant decrease in the prevalence of anxiety disorders in women aged 25-49 years was observed in countries where access to legal abortion was broadened in the period 2009-2017. This association remained marginally significant after adjustment for the above confounders. Conclusions The current study suggests that there is a modest relationship between access to legal abortion and its effects on the mental health of women aged 25-49 years. However, this relationship appears to be largely indirect in nature and influenced by factors, such as gender development, gender inequality, and intimate partner violence. These results may lead to further exploration of the links between reproductive rights and mental health of women in the general population and draw attention to the influence of gender inequality and intimate partner violence on mental health of women of childbearing age.

Keywords: abortion; anxiety; depression; intimate partner violence; medical termination of pregnancy; mental health; reproductive rights.

Figure 1. Wider effects of access to abortion on the mental health of women.

This figure depicts the potential mental health impacts of abortion legislation on women. Though the largest impact would be expected in women seeking an abortion for various indications, it is possible that significant (though smaller) impacts may be observed in women of childbearing age and even in women in the general population who do not belong to these two groups.