Restrictive abortion legislation and adverse mental health during pregnancy and postpartum

Abstract

Purpose: To determine the impact of abortion legislation on mental health during pregnancy and postpartum and assess whether pregnancy intention mediates associations.

Methods: We quantified associations between restrictive abortion laws and stress, depression symptoms during and after pregnancy, and depression diagnoses after pregnancy using longitudinal data from Nurses' Health Study 3 in 2010-2017 (4091 participants, 4988 pregnancies) using structural equation models with repeated measures, controlling for sociodemographics, prior depression, state economic and sociopolitical measures (unemployment rate, gender wage gap, Gini index, percentage of state legislatures who are women, Democratic governor).

Results: Restrictive abortion legislation was associated with unintended pregnancies (β = 0.127, p = 0.02). These were, in turn, associated with increased risks of stress and depression symptoms during pregnancy (total indirect effects β = 0.035, p = 0.03; β = 0.029, p = 0.03, respectively, corresponding <1% increase in probability), but not after pregnancy.

Conclusions: Abortion restrictions are associated with higher proportions of unintended pregnancies, which are associated with increased risks of stress and depression during pregnancy.

Keywords: Abortion policy; Mediation; Mental health; Perinatal health; Women's health.

Figure 1:

Distribution of state-level abortion policy climate, grouped by pregnancy intention, n=4,988 pregnancies to participants in the NHS3, 2010–2017 Policy climate represented standardized, lagged score of 17 policies that either restrict abortion access (e.g., mandatory delays, parental consent laws) or support abortion access (e.g., state constitutional protections for abortion rights). A higher score represents a more restrictive environment, and a 1-unit increase represents a one standard deviation change in the index.