March 8, 2024

U-M team to study impact of reproductive health policy changes on women's mental health

A team of University of Michigan researchers has received a $3 million grant from the National Institute of Mental Health to study the mental health impacts of recent changes in reproductive health policy on women living in states where abortion access has changed in the past two years. 

To date, no research has documented the impact of abortion policy changes on mental health outcomes at the population level, including mood and anxiety disorders, suicidal ideation, and self-harm among those who are pregnant or have recently given birth.

Clarifying relationships between changes in state abortion policies and maternal mental outcomes has reached new urgency following the Supreme Court’s overturning of Roe v. Wade through a ruling in the case of Dobbs v. Jackson Women’s Health Organization in June 2022. This decision led to state-level policy changes about the timing and circumstances for pregnancy termination in some states.

Half of reproductive-age women now live in a state that has limits on surgical and/or medical abortions. Individuals who cannot travel or access telehealth-based prescription services for medication-based abortions may go on to give birth after an unintended pregnancy, which past research has linked to higher rates of adverse pregnancy outcomes beyond perinatal mood and anxiety disorders.

Researchers have already shown that lack of access to a full range of reproductive health care disproportionately affects low-income, geographically remote, and racial/ethnic minorities, and may exacerbate existing, well-documented disparities in maternal mental health-related outcomes.

The new grant will fund an effort called the Restricting Access to Reproductive Health Services and Mental Health Outcomes (RAVEN) study.

“This study will generate critical information by quantifying the mental health impacts of abortion bans on birthing individuals overall, and within groups vulnerable to barriers created by these restrictions”

- Vanessa K. Dalton, M.D., Timothy R. B. Johnson M.D. Collegiate Professor of Global Women's Health, Associate Chair of Research and Professor of Obstetrics and Gynecology, and founding director of the Program on Women’s Health Care Effectiveness Research (PWHER).

“What we learn could also inform future interventions aimed at mitigating negative effects of these policies.”

Dalton is partnering on the new study with co-principal investigator Kara Zivin, Ph.D., who is the Marcia A. Valenstein, M.D. Collegiate Professor of Psychiatry and a professor of Obstetrics and Gynecology.

Dalton and Zivin collaborate in the U-M Perinatal Mental Health Services and Policy Program, where Zivin leads a multi-disciplinary team on several interrelated studies funded by the National Institutes of Health that examine the impacts of federal and state behavioral health policy changes on clinical and economic outcomes among childbearing individuals and infants.

RAVEN builds on previous studies that have found that state-level abortion policy changes are associated with higher rates of suicide among all reproductive age women and other studies reporting that individuals who give birth after an unintended pregnancy have higher rates of perinatal mood and anxiety disorders and suicidality.

Previous research suggests that although abortion policy changes designed to reduce the rate of abortions performed by providers in a state largely succeed, state residents who can do so often turn to telehealth-based medical abortion options or travel to states with different policies to obtain surgical abortion services. But these options may be harder to access for some and may raise risks of negative outcomes.

“We know that perinatal mood and anxiety disorders are common and have long-lasting, negative ramifications for mothers, children, and families. We also know that suicide represents a leading cause of maternal mortality in the U.S.,” Zivin said. “Our study will help inform policy makers and public health officials about downstream consequences of restrictions and inform clinical experts who can improve screening and treatment to mitigate some consequences, even if policies remain in place. This timely and urgent work on the front lines represents meaningful research on behalf of women.”

Dalton and Zivin are both members of the U-M Institute for Healthcare Policy and Innovation.