Mental health after unintended pregnancy: insights from a context with available abortion care

To investigate how unintended pregnancy (UP) is associated with the occurrence of mental health (MH) problems one year later among womxn, while also considering pregnancy outcome (abortion/continuation), co-occurring risks and protective factors. We examine this in the Dutch context, given available abortion care up to 24 weeks gestation and high diversity in people's pregnancy intentions. We hypothesized that MH problems are more prevalent among those whose pregnancy was more unintended.

Data from the Dutch BluePrInt study included both womxn who had an abortion (AB, n = 152) and who continued their UP (CT, n = 212). They filled out an online survey shortly after their abortion (AB) or around 14 weeks gestation (CT), and at follow-up one year later. Key variables included pregnancy intendedness (continuously measured), anxiety/depression symptoms (measured with a screening tool based on the CIDI), social- and partner support, abuse experiences, UP-related variables (difficulty deciding, uncertainty, pressure, and negative emotions) and socioeconomic position.

26.5% developed MH symptoms one year after their UP, with no significant differences between AB and CT groups. Pregnancy intendedness and -outcome (abortion vs. continuation), as well as their interaction, were not related to MH symptoms one year later. Previous MH was the strongest predictor of MH risks (OR: 3.54), while perceived social support from family/friends was associated with a lower risk (OR: 0.66).

In a context where abortion care is available, pregnancy intendedness and -outcome do not increase people's risks of MH symptoms one year after experiencing an UP. Instead, previous MH and support from family/friends are important for MH after experiencing an UP. Positioning UP as inherently problematic is not warranted. Policy and practice should center people's lived reproductive experiences and care needs.