In late April, the Oklahoma legislature passed a bill that would pull the medical licenses of physicians who provide abortions. Although the governor vetoed the bill in late May, this makes Oklahoma the first state (so far) to attempt to place abortion services outside of the bounds of professional conduct by a physician. But the majority of states have implemented myriad strategies—from mandatory waiting periods to physician admitting privileges to required ultrasounds—to limit if not completely prohibit abortion at the state level.
In the last five years, state legislators adopted as many restrictions to abortions—288 in all—as they have in the previous 15 years. Many of these restrictions are developed and defended as providing important safety and health protections for women. Rarely a part of these policy discussions, however, are the health and well-being consequences for the women who have unwanted pregnancies and births. New research provides a cautionary perspective: women who bring unwanted pregnancies to term may be at greater risk for poor mental health.
Anti-abortion advocates used to focus solely on fetal rights as a justification for restrictive reproductive health policies. However, in a critical shift, such advocates have increasingly argued that such restrictions are in the best interest of women. In the case of Whole Woman’s Health v Hellerstedt, argued before the Supreme Court on March 2, 2016, the justices and other policymakers were essentially tasked with evaluating whether restrictions on abortion services actually protect women’s health. (Barely mentioned is the evidence demonstrating that abortion is 14 times safer than giving birth and is associated with no increased risk of mental health problems.)
But policymakers and court-watchers have ignored another key aspect of this issue: the health consequences for women who actually have those unwanted births. Courts must also ask: If women are limited in their ability to prevent or end unwanted pregnancies, will their well-being suffer? Despite the all-too-common occurrence of unwanted pregnancies and births in the US, we know surprisingly little about how women fare when they carry unwanted pregnancies to term. However, two new studies provide important preliminary insights.
First, using a 60-year study out of the University of Wisconsin-Madison, we documented long-term mental health outcomes for about 2,500 Wisconsin women who had pregnancies in the years prior to Roe v. Wade. More than one-in-five (22 percent) of these mostly white, married women reported unwanted pregnancies, especially for “higher order” births such as the third, fourth, or fifth.
In other words, many women thought they were done with having children, but then became pregnant again. They didn’t have access to legal abortion services. Then, even 20-30 years later, those women who carried unwanted pregnancies to term showed persistent negative mental health effects, including more depressive symptoms and a greater likelihood of a significant episode of depression. These effects remained strong even after accounting for a variety factors that could contribute to both mental health and unintended pregnancy, from education to personality to early-life socioeconomic status.
These findings cannot be considered causal. We did, however, run statistical tests which ruled out a long list of alternative explanations. The dataset allowed us to control for many plausible confounders, including prospectively measured early-life economic and social conditions, high school academic performance, IQ, depression before childbearing, and personality.
The Wisconsin study sheds light on the possible long-term effects of unwanted pregnancies that occurred in an earlier era. But these findings are also relevant today. In the ongoing Turnaway Study, investigators at the University of California, San Francisco have been studying almost 1,000 women who sought abortions at over 30 clinics across the country. The study compares two groups of women: those who received the abortions they sought and those who were denied abortions due to being slightly over a clinic’s gestational limit.
Preliminary results suggest either similar or better outcomes for those women who received abortions compared to the “turnaways,” most of whom carried the pregnancies to term and began raising the resulting children. The investigators have not yet found depression differences, perhaps because they employ a more conservative measure of mental disorders. They have, however, found differences in other important aspects of women’s well-being.
For example, those denied abortion reported higher levels of initial anxiety; two-and-a-half years later, they also had increased likelihood of experiencing violence from the man involved in the pregnancy. Women who received abortions were also over six times more likely to report that they had aspirational one-year plans such as education or employment goals, when compared to women who were turned away then carried the pregnancy to term and began raising the child. (While we highlight mental health and well-being outcomes here, turnaways also suffered significantly increased risk of physical health complications, including mortality.)
We hope the findings from these few studies will catalyze additional research on the tolls of unwanted pregnancy — as well as additional support from policymakers on the importance of such research to women’s health. Regardless, these preliminary findings are cause for concern — particularly given the current direction of reproductive health policy in the US.
More than 20 percent of states have moved to slash funding for any family planning provider who provides abortion services, even though the majority of services offered at such health centers help women prevent unintended pregnancies and other negative health outcomes. As states do so, they set the stage for more unwanted pregnancies and potentially persistent negative effects to women’s health and well being. For women who are told by policymakers that reproductive restrictions are intended to protect women’s health, a grim irony is that they may in fact do the opposite.
Jenny Higgins is a board member of the Guttmacher Institute, whose work is cited in this post.