Study finds much higher use of mental health services for women who abort first pregnancy

Image credit: Jose Luis Navarro (CC BY-SA 4.0)

Having a first pregnancy which ends in abortion as opposed to birth is linked to much higher use of mental health services, a new peer reviewed study from the Charlotte Lozier Institute has found. 

Moreover, authors said, these women were less likely to have a prior history of use of mental health services – suggesting that abortion contributes to the difference.

The study, published in the Journal of Women’s Health in June, was undertaken by researchers in the U.S. to determine whether a first pregnancy ending in induced abortion, as opposed to giving birth, is associated with an increased risk and likelihood of mental health morbidity. It is the first study to take a comprehensive view of mental health services on an outpatient versus an inpatient basis following abortion.

“A Cohort Study of Mental Health Services Utilization Following a First Pregnancy Abortion or Birth” was authored by Dr. James Studnicki, Tessa Longbons, Dr. John Fisher, Dr. David Reardon, Dr. Ingrid Skop, Dr. Christina Cirucci, Christopher Craver, Dr. Maka Tsulukidze, and Dr. Zbigniew Ras. The interdisciplinary research team analysed Medicaid claims data for more than 4,800 Medicaid-enrolled women over a period of 17 years.

Most U.S. abortion mental health studies are flawed due to voluntary reporting and biased cohort selection, but this can be overcome with records-linkage of all abortions and subsequent events…Abortion induces mental health complications. https://t.co/BHePPl2THa

— Ingrid Skop MD (@docskop) July 12, 2023

Participants in the study were those continuously eligible for Medicaid aged 16 in 1999, and were assigned to two separate cohorts based upon whether their first pregnancy had ended in abortion (1331 women) or a live birth (3517 women).

The women were followed through to 2015, with outcomes being mental health outpatient visits, inpatient hospital admissions, and hospital days of stay. Exposure periods prior and after the first pregnancy outcome – a total of 17 years – were determined for both cohorts of women.

Because the study took place across seven U.S. states where state taxpayer funds were used to pay for abortions, and where all claims for the whole time period were submitted, the researchers avoided the limitations of surveys which rely on self-reporting – such as low participation, loss to follow-up, and recall bias. 

The study found that, compared to women whose first pregnancy was a birth, higher rates of use of mental health services were observed for women whose first pregnancy was ended in abortion, and this observation held in three mental health service categories: 

For women who had an abortion in a first pregnancy as opposed to giving birth, outpatient visits were 3.4 times more likely to increase; Inpatient hospital admissions were 5.7 times more likely to increase; and days of hospital stay were 19.6 times more likely to increase.

Thus, “there is a very large risk and likelihood of extended stays for psychiatric admissions following induced abortion,” researchers said.

In drawing their conclusions, researchers noted: “A first pregnancy abortion, compared to a birth, is associated with significantly higher subsequent mental health services utilisation following the first pregnancy outcome.

“The risk attributable to abortion is notably higher for inpatient than outpatient mental health services. Higher mental health utilisation before the first pregnancy outcome for birth cohort women challenges the explanation that pre-existing mental health history explains mental health problems following abortion, rather than the abortion itself.”

Noting possible limitations of the research, the authors pointed out that women in the birth cohort were, on average, about 14 months older than abortion cohort women at the time of the first outcome. 

“This explains the differences in the exposure time pre–post between the two cohorts,” they said, adding: “In addition to the differences in the time of exposure for possible health issues, the cohorts differ in the amount of that time during which they are pregnant. 

“For a year of pre-outcome exposure, for example, the birth cohort women will have spent nine months pregnant. Therefore, birth cohort women have a larger exposure time prior to the first outcome but also spend a proportionately greater percentage of that time pregnant. 

“Studies indicate that several psychiatric conditions are commonly experienced by pregnant women, most notably depression and anxiety. A number of correlates of antenatal psychiatric morbidity have been identified and, not surprisingly, a history of past illness is frequently mentioned.”

Authors also pointed out that because the study population is composed of Medicaid eligible women the findings may not be generalizable to a population with different sociodemographic characteristics. 

Claims data has other limitations – services received by beneficiaries but not paid for by Medicaid would not be included in this dataset, and different types of provider delivering a coded service may not be discernible (eg, psychiatrist or psychologist). 

Authors also explained that certain contextual variables which could be useful for analytical purposes such as marital status, education and religious affiliation were not available. 

“While the use of comprehensive composite indices of mental health services across a 17-year observation period is a strength of the research design, it does not allow conclusions regarding any specific mental health illness, disorder or problem,” they said.

“Similarly, the total cohort as the unit of analysis may mask any number of associations that could be specific to some subpopulation of the cohort; eg, post-pregnancy outcome service utilization for women with and without histories of specific mental illness.”

‘WOMEN HAVE A RIGHT TO KNOW THIS’

The Charlotte Lozier Institute, which carried out the research, is the education and research arm of pro-life non profit organisation, Susan B. Anthony List (SBA).

In a statement on Monday publicising the study, the Charlotte Lozier Institute said that the difference in mental health outcomes observed in women was “not explained by prior mental health history.”

Lead author James Studnicki, Sc.D., a veteran public health scientist and CLI’s vice president and director of data analytics at the Charlotte Lozier Institute, pointed to studies from Finland, Italy, China, Germany, Korea and the United States, all linking abortion with an increased risk of adverse mental health outcomes including anxiety, depression and suicide.  

“Some researchers insist that any limits on abortion to protect mothers and children create ‘mental health harms,’” he said, adding: “Our study using years of claims data adds to an extensive body of international, peer-reviewed science showing the opposite – abortion itself has a significant negative impact on several measures of mental health.”

Tessa Longbons, Lozier’s senior research associate and a co-author of the study, said that the evidence “is clear” that abortion of a first pregnancy is “associated with substantial mental health harms” to women.

“Women have a right to know this and to understand the extent of these harms before they make such a life-changing decision,” she said.

The Lozier Institute on Monday pointed to an earlier study in the series that found that women whose first pregnancy ended in abortion had more pregnancies, more miscarriages, more than four times as many abortions, and only half as many live births as women whose first pregnancy ended in a live birth.

The Institute’s Unwanted Abortion Studies have found that the majority of women with a history of abortion report high levels of pressure to abort, describing their abortions as unwanted, coerced or inconsistent with their own values and preferences, which in turn is strongly associated with a self-described decline in mental health.

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This piece was first published on Gript.