RAVEN
Studying the impact of reproductive health policy changes on mental health
The RAVEN study, funded by the National Institute of Mental Health, evaluates the mental health impacts of recent changes in reproductive health policy on women living in states where reproductive health access has changed in the past two years. In collaboration with the Program on Women’s Healthcare Effectiveness Research (PWHER).
Association between abortion restrictiveness and suicidality among birthing people in the United States 2010 to 2020
Prior research found that suicidality increased among commercially insured women between 2006 and 2017. The 2022 Dobbs v. Jackson Women's Health Organization decision overturned Roe v. Wade and made obtaining an abortion more difficult across the United States, which may have continued negative mental health effects. Dr. Isabel S. Platt led this study that evaluated the relationship between state-level abortion restrictions and a diagnosis of suicidality or self-harm in the 12 months before or after delivery among individuals with employer-sponsored health insurance in the United States who delivered between 2010 and 2020.
Findings: Of the 610,177 deliveries in our final analytic cohort, delivering women residing in states with high abortion restrictiveness were younger (12.8% of birthing people were ages 15-24 compared to 7.8% in low restriction states) and more likely to be Black (10.4% compared to 6.1%). Delivering women living in states with high abortion restrictiveness were more likely to experience suicidality than delivering women living in states with low abortion restrictiveness [odds ratio (OR): 1.5; 95% CI: 1.2, 1.8; p = 0.0012]. When controlling for age, state abortion restrictiveness was not significantly associated with suicidality [adjusted odds ratio (adjOR): 1.2; 95% CI: 1.0, 1.4; p = 0.0603], and delivering women ages 15-24 were substantially more likely than delivering women ages 35-44 to experience suicidality (adjOR: 7.3; 95% CI: 6.5, 8.2; p < 0.001).
Meaning: In the years prior to the Dobbs decision, commercially insured delivering women in states with high abortion restrictiveness experienced a growing mental health crisis, when compared to those in low restriction states. These differences are associated with differences in demographic characteristics, such as age and race. As researchers continue to monitor health outcomes related to the recent enactment of the most severe category of restriction (e.g., bans), these findings remain crucial to recognize and account for in further studies.
Association Between State Abortion Restrictiveness and Perinatal Depression
Abortion services represent a critical component of reproductive health care. Barriers to a full range of reproductive health care may harm mental health. In this study led by Dr. Stephanie V. Hall, we sought to determine whether restrictive state-level abortion policies increase the risk of perinatal depression, overall and among women with intended and unintended pregnancies.
Findings: Women living in states with highly restrictive abortion policies experienced 1.23 (95% confidence interval [CI]: 1.12-1.37) times greater odds of perinatal depression compared to women living in states with less restrictive abortion policies after adjusting for age, race/ethnicity, maternal education, marital status, and insurance type. Women with unintended pregnancies had a higher predicted probability of perinatal depression than women with intended pregnancies in both highly restrictive states (17.3%, 95% CI: 13.9 - 21.3% versus 14.8%, 95% CI: 10.7 - 16.9%) and in less restrictive states (14.8%, 95% CI: 11.7 - 18.5% versus 11.3%, 95% CI: 9.0 - 14.2%).
Meaning: Restrictive state-level abortion policies were associated with an increased risk of perinatal depression regardless of pregnancy intent. Abortion restrictions may contribute to poor mental health outcomes directly, by obstructing access to wanted abortion services, or indirectly, as a marker for states that do not fully support delivering women with adequate health or social services. The mental health of the birthing population represents an important consideration for evolving reproductive health policies.
State Abortion Restrictiveness and Prevalence of Intimate Partner Violence and Domestic Violence Among Recently Birthing Black and White Women
Intimate partner violence (IPV) and non-intimate domestic violence (DV) during pregnancy may result in poor maternal and infant health outcomes. Whether state-level abortion restrictions, enacted by many states even prior to the 2022 Dobbs v. Jackson Women's Health Organization decision, are associated with IPV/DV remains unknown. Dr. Katherine Neff led this study investigating the relationship between IPV/DV during pregnancy and abortion restrictions among Black and White birthing women.
Findings: Overall, birthing women in restrictive states had higher odds of reporting IPV/DV during pregnancy than those in less restrictive states (aOR: 1.36, 95% CI: 1.15-1.60). Within racial groups, we found that Black birthing women in restrictive states had higher odds of reporting IPV/DV than Black birthing women in less restrictive states (aOR:1.75, 95% CI: 1.24-2.47). We saw a similar relationship for White birthing women (aOR:1.50, 95% CI: 1.17-1.94).
Meaning: Even when access to abortion was federally protected, women in restrictive states had higher odds of experiencing IPV/DV than those in less restrictive states, particularly among Black women. These findings suggest possible detrimental impacts of abortion restrictions and their potential to worsen existing health inequities.
