New findings link lack of access to abortion and suicide risk among women of reproductive age.

When the Dobbs v. Jackson Supreme Court decision came down in June, overturning the right to abortion in the United States that Roe v. Wade had bestowed in 1973, conversations about access to reproductive care took on a renewed urgency.

Now, findings published in JAMA Psychiatry show that restricting abortion access is linked to increased suicide risk for women of reproductive age. They did not find the same association for older women or death due to motor vehicle accidents.

“Stress is a key contributor to mental health burden and a major driver of increased suicide risk,” says child-adolescent psychiatrist and neuroscientist Ran Barzilay of the University of Pennsylvania’s Perelman School of Medicine and the Children’s Hospital of Philadelphia.

“We found that this particular stressor—restriction to abortion—affects women of a specific age in a specific cause of death, which is suicide. That’s the 10,000-foot view.”

The study emerged after Barzilay, Jonathan Zandberg of the Wharton School, and Rebecca Waller of the psychology department discovered an overlap in their research interests. Zandberg studies how restrictions to reproductive care affect gender inequality, Barzilay, the factors that affect a person’s mental health trajectory and suicide risk. Waller focuses on environmental stressors that influence parents and, in turn, child development. Data scientist Elina Visoki from Barzilay’s lab also contributed to this research.

Zandberg’s prior work had shown that more restricted access to reproductive care creates a costly trade-off for women’s career aspirations and their family formation choices. The researchers decided to examine other aspects of this dynamic, looking at the mental health implications of enforcing strict reproductive rights and more specifically, risk of suicide, the third leading cause of death for 25- to 44-year-olds in the United States.

They conducted what’s called a difference-in-differences analysis, using state-level data from 1974 through 2016 and covering the entire population of adult women during that time. “We constructed three indices that measure access to reproductive care by looking at the enforcement of state-level legislation,” Zandberg says. “Every time a state enforced a law that was related to reproductive care, we incorporated it into the index.” Then, among women of reproductive age, they analyzed suicide rates before and after the laws took effect, comparing those numbers to broad suicide trends and to rates in places without such restrictions.

“Comparatively, women who experienced the shock of this type of restrictive legislation had a significant increase in suicide rate,” Zandberg says.

Next, the researchers examined whether the finding was specific to women of reproductive age or could be observed in other populations. As a comparison, they ran the same analysis for all 45- to 64-year-old women between 1974 and 2016. They did not find any effect. Finally, they examined another common cause of death, motor vehicle death rates, and saw no effect. Controlling for potential confounders like the economy and political climate did not change the results.

Though the findings do not prove that restricting abortion access caused suicide rates to increase, the researchers say the analytic approach is one of the most rigorous methods to enable causal inference. “This association is robust—and it has nothing to do with politics,” Barzilay says. “It’s all backed by the data.”

Read the full article about abortion and suicide risk by Michele Berger at Futurity .