Experiences of delay-causing obstacles and mental health at the time of abortion seeking

Abstract

Objectives: The delays and challenges people encounter when seeking abortion are well-documented, but their psychological implications are understudied. Aiming to fill this gap, we explored the associations between experiences of delay-causing obstacles to abortion care and adverse mental health symptoms among individuals seeking abortion care.

Study design: In 2019, we surveyed 784 people (of 1092 approached) ages 15-45 accessing abortion care in four clinics in abortion-supportive states: California, Illinois, and New Mexico. We conducted multivariable Poisson regressions to examine associations between experiencing delay-causing obstacles to abortion care and stress, anxiety, and depression at the abortion appointment. We also used Poisson regression to examine whether some individuals are more likely to experience delay-causing obstacles than others.

Results: Three in five participants (58%) experienced delay-causing obstacles when accessing abortion care. The most prevalent obstacles were cost-related (45%), followed by access-related (43%), and travel time-related (35%) delays. In adjusted analyses, experiencing any type of delay-causing obstacle to abortion care was significantly associated with more symptoms of stress, anxiety, and depression and higher risk of anxiety and depressive disorders. Participants were more likely to experience delay-causing obstacles if they traveled from another state or over 100 miles to reach the clinic, sought abortion beyond 13 weeks gestation, lacked money for unexpected expenses, and found it difficult to pay for the abortion.

Conclusion: Abortion is a time-sensitive healthcare, but most individuals are forced to delay care due to various obstacles that may have a negative impact on their psychological well-being.

Implications: Obstacles causing delays in accessing abortion care may contribute to elevated symptoms of stress, anxiety, and depression and higher risk of anxiety and depressive disorders for abortion patients. As restrictive policies increase, delays are likely to worsen, potentially leading to psychological harm for people seeking abortion.

Keywords: Abortion access; Abortion delay; Burden; Delayed healthcare; Mental health; Psychological well-being.

Fig. 1

Unadjusted prevalence of delay-causing obstacles to abortion care among people seeking abortion in 2019 in four clinics in California, Illinois, and New Mexico (N = 784).

Fig. 2

Predicted mean adverse mental health symptoms and proportion screening at risk of anxiety and depressive disorders by delay-causing obstacles to abortion care among people seeking abortion in 2019 in four clinics in California, Illinois, and New Mexico (N = 784).