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Barriers to abortion access associated with mental health symptoms

Studies have firmly demonstrated that abortion does not increase people’s mental health risk compared to giving birth—but mental health symptoms are higher around the time of seeking abortion. Using a new scale developed to measure the psychosocial burden experienced by those seeking abortion, ANSIRH researchers found that the logistical barriers to accessing abortion care are associated with mental health symptoms.

Key Findings

ANSIRH researchers developed a 12-item scale that providers and researchers can use to measure psychosocial burden. Psychosocial burden is a person’s subjective perception of the burden they experience when seeking abortion care
Researchers identified four key areas associated with abortion patients’ psychological well-being: structural challenges, pregnancy decision-making, lack of autonomy, and reactions to the pregnancy by others
The study demonstrates that logistical barriers to accessing abortion care—such as finding a clinic and scheduling an appointment—are associated with mental health symptoms such as stress, anxiety and depression

Study Design

Researchers developed the scale by consulting experts about a range of items related to timing, financial, travel and other access-related challenges as well as social support and decision-making related to the pregnancy and abortion. They then asked 11 patients seeking abortion about how difficult, worried or relieved they felt about the range of topics since they discovered they were pregnant. From January through June 2019, a total of 784 abortion patients completed an anonymous survey to test the items developed from those interviews.

Previous studies have shown that having an abortion does not increase people’s risk of experiencing psychological symptoms, but mental health symptoms were higher around the time of seeking an abortion, when compared to years later. There are a number of personal and external factors that may increase psychological symptoms at the time of seeking abortion.

In addition to structural challenges, researchers found that the lack of autonomy — including feeling forced to disclose the pregnancy decision or to wait to seek care — emerged as a key psychosocial burden.

Many patients also reported difficulty around pregnancy decision-making, echoing previous studies: just as people may experience some difficulty making other healthcare decisions, abortion is similar. Participants also expressed concern about reactions from parents, friends and other people about the pregnancy, suggesting they may be perceiving and internalizing stigma around abortion care.

Any legal restrictions that increase travel burden, force unwanted abortion disclosure, and make patients wait for care are likely affecting their well-being. In fact, the same restrictions that claim to protect people from mental health harm, may contribute to negative psychological outcomes at the time of seeking abortion.

“The most recent Supreme Court decision in June Medical Services vs Russo reaffirmed that laws that place an ‘undue burden’ on people’s right to an abortion are unconstitutional. Yet burdensome restrictions remain widespread, despite the lack of evidence demonstrating whether these restrictions benefit people seeking abortion, and as shown in this study, may contribute to more elevated levels of psychological distress.”

The study, Developing and validating the Psychosocial Burden among people Seeking Abortion Scale (PB-SAS), is available in PLOS One.