Association Between State Abortion Restrictiveness and Perinatal Depression

Introduction: Abortion services represent a critical component of reproductive health care. Barriers to a full range of reproductive health care may harm mental health. 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. Methods: This cross-sectional analysis used surveillance data from the Pregnancy Risk Assessment and Monitoring System. Restrictive state-level abortion policies were measured using the Guttmacher Abortion Policy Hostility Index. The primary outcome of interest was incident perinatal depression, measured as a self-reported diagnosis of depression during pregnancy or a positive 2-item Patient Health Questionnaire during the postpartum period. Results: 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%). Conclusions: 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.