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Understanding the Mental Health Impacts of Unintended Pregnancy – Thought Leadership

Understanding the Mental Health Impacts of Unintended Pregnancy

 

Behavioral Health Insights

By Micah Hoffman, MD, DABPN, FAPA,

AllMed Behavioral Health Medical Director

 

With the recent Supreme Court ruling to overturn the status of Roe v. Wade, it’s a timely moment to consider mental health concerns surrounding abortion care.  Clearly, these concerns impact many in the United States. Current estimates indicate that fully half (51 percent) of all U.S. pregnancies are unintended.1 Based on recent data, 30 percent of U.S. women will have had an abortion by the time they reach age 45.2 It makes sense—and the scientific literature validates—that experiencing unwanted pregnancy or fetal loss, regardless of cause, can contribute to the development of mental health symptoms.3 Given this reality, it’s helpful to take a close look at the research in this area, so that we can be guided by evidence as we make determinations on patient mental health care.

 

Historically, it was often assumed that women who underwent abortion had higher rates of mental illness and lower quality of life scores than those who did not. These assumptions persist today, forming the basis of current legislation in nine states that mandates counseling before a woman can obtain an abortion. Yet prospective data from a recent 5-year longitudinal study shows that denial of access to abortion care leads to higher levels of anxiety, lower levels of self-esteem and well-being, and no significant difference in rates of depression as compared to obtaining abortion services.4 A study published in The New England Journal of Medicine yielded similar results, finding no association between medical abortion and increased risk of mental health problems.5

 

Examining whether a first abortion increases the risk of mental health disorders compared with a first childbirth, research based on the National Comorbidity Survey-Replication arrived at similar conclusions. After accounting for confounding factors, most notably the pre-pregnancy mental health of the mother, the research found that abortion was not a statistically significant predictor of the development of mood, anxiety, impulse-control, or eating disorders nor of suicidal ideation.6 This study did find an increased prevalence of substance abuse disorders in those who received abortion care. The authors acknowledge that this may reflect inadequate review controls and recommend additional research in this area.

 

The reviewed research into the mental health impacts of unintended pregnancy suggests a strong and persistent relationship between unintended pregnancy resulting in live birth and poorer later-life mental health outcomes. This correlation is particularly strong for women who have already had as many children as they want.7 Considering these findings when evaluating the potential short-and long-term mental health impacts of an unintended pregnancy is key to providing optimal care to women. Now more than ever, given the current climate in the U.S. around this issue, basing mental health care decisions on evidence is fundamental to women’s well-being.

 

References:

 

  1. Finer LB, Zolna MR. Shifts in intended and unintended pregnancies in the United States, 2001–2008. Am J Public Health. 2014;104(suppl 1):S43–S48.
  2. Jones RK, Kavanaugh ML. Changes in abortion rates between 2000 and 2008 and lifetime incidence of abortion. Obstetrics & Gynecology. 2011;117(6):1358–1366
  3. Bellieni, C.V. and Buonocore, G. (2013), Abortion and psychiatry. Psychiatry Clin Neurosci, 67: 301-310. https://doi.org/10.1111/pcn.12067
  4. Biggs MA, Upadhyay UD, McCulloch CE, Foster DG. Women’s Mental Health and Well-being 5 Years After Receiving or Being Denied an Abortion: A Prospective, Longitudinal Cohort Study. JAMA Psychiatry. 2017;74(2):169–178. doi:10.1001/jamapsychiatry.2016.347.
  5. Templeton, A., & Grimes, D. A. (2011). A request for abortion. New England Journal of Medicine, 365(23), 2198-2204.
  6. Steinberg, J. R., McCulloch, C. E., & Adler, N. E. (2014). Abortion and mental health: findings from The National Comorbidity Survey-Replication. Obstetrics and gynecology, 123(2 Pt 1), 263–270. https://doi.org/10.1097/AOG.0000000000000092
  7. Pamela Herd, Jenny Higgins, Kamil Sicinski, and Irina Merkurieva, 2016: The Implications of Unintended Pregnancies for Mental Health in Later Life American Journal of Public Health 106, 421_429, https://doi.org/10.2105/AJPH.2015.302973

 

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