Abortion and Mental Health—Context and Common Ground

Abstract

Zandberg et al 1 used 1974 to 2016 US data on state-level abortion-access restrictions and suicide rates to evaluate the association between abortion restrictions and suicide among women of reproductive age. By examining the relative timing of state-level changes in abortion restrictions and suicide rates, using difference-indifferences analysis and controlling for other variables, one can estimate an association of restrictions with suicide, under the assumption that underlying trends due to other factors in states with vs states without new restrictions are otherwise comparable. The Zandberg et al primary analysis provides evidence that enforcement of a Targeted Regulation of Abortion Providers (TARP) law was subsequently associated with 5.81% higher state-level suicide rates compared with years before such enforcement. While analyses of this type are always subject to the possibility of changes in trends being attributable to some third factor, Zandberg et al 1 control for a number of reasonable candidates and conducted sensitivity analyses indicating that these associations were observed for reproductive-aged women but not for a control group of older women of postreproductive age. They cite evidence that restrictions in access were associated with greater stress and anxiety and extend evidence to suicide rates. The results are of further relevance with the overturning of Roe v Wade and the resulting increase in abortion-access restrictions in many states.In this Editorial, I will consider the absolute number of suicides implied by Zandberg et al's estimates. 1 I will situate these numbers within the US context of the total number of abortions and unintended pregnancies. I will note that these results, and the broader abortion and mental health literature, have important clinical implications. However, in light of the absolute numbers, I also suggest that the relevance of these results for debates over abortion access are more limited and that a greater focus of research on abortion and mental health should be oriented toward actually improving mental health care for women.With respect to absolute numbers, the US Centers for Disease Control and Prevention 2016 statistics indicate 10 238 suicides by US women, including 4363 of reproductive age (15 to 44 years). 2 If approximately half of those women were living in states with abortion-access restrictions, this would correspond to 2182 suicides in those states. A 5.81% higher suicide rate associated with abortion-access restrictions would amount to 127 suicides. These numbers are approximate. As indicated in the Zandberg et al Figure 1, some states had more than 1 TARP law enforced, the underlying suicide rate for reproductive-aged women varied across states, suicide rates in 2016 were higher than in prior years of the study time frame,

Moral controversies and academic public health: Notes on navigating and surviving academic freedom challenges

“…I will now, far more briefly, consider the positions put forward in the Psychology Today blog post [ 79 ] and the JAMA Psychiatry commentary [ 2 ]. The Psychology Today blog post raised the question of whether introducing matters of gender identity in kindergarten was conducive to well-being.…”

“…In the JAMA Psychiatry commentary [ 2 ], I argued that the abortion and mental health literature had been weaponized by both sides of the abortion policy debate; that the moral contours of the policy debate lay elsewhere; and that the abortion and mental health literature should thus be more oriented towards providing for the mental health needs of women regardless of their views. I had pro-choice colleagues write to me indicating, “I find nothing even to disagree with” or to say that the commentary was “thoughtful, beautifully written, and very well balanced.” The commentary was sufficiently centrist that the Harvard Gazette solicited and ran an interview article with me on it [ 65 ].…”

“…The Brief argued that (i) there were two competing views of marriage at play, one more grounded in procreation and providing a stable family environment for children, and another more focused on the bond and personal fulfillment of partners; that (ii) the Constitution itself did not specify a view of marriage, and thus that (iii) it would be better if the matter were taken up by the states and their people rather than by the courts. My signing of the brief was linked in the Twitter posts to a commentary that I had published in JAMA Psychiatry on abortion and mental health [ 2 ]. That commentary had argued that the abortion and mental health literature had been weaponized by both sides of the abortion policy debate; that the moral contours of the policy debate lay elsewhere concerning the moral status of a fetus on the one hand versus autonomy, control, privacy and the rights of women on the other; and that the abortion and mental health literature should thus be more oriented towards providing for the mental health needs of women regardless of their views.…”

Current Challenges for Conscientious Objection by Physicians in Spain

“…Interestingly, VanderWeele and his colleagues at Harvard have highlighted that the complete picture of well-being lies in several areas, and seeking to do good is a major contributor to “human flourishing” (WanderWeele 2017). In the case of abortion, for example, the harmful mental consequences for the mother that voluntarily ends a pregnancy should not be discounted by the doctors in charge (Wanderweele 2023). Both are important for well-being.…”