Abortion restrictions may have increased suicide risk among younger women

Restricted access to abortions may have increased suicide risk among women of reproductive age for more than four decades, suggests new research from the University of Pennsylvania.

Although deaths by suicide are rare, they are the second leading cause of death for women ages 20-24 in the United States and the third leading cause for women ages 25-34.

A to study published Wednesday in JAMA Psychiatry found that abortion restrictions may have played a role in some suicide deaths among younger women between 1974 and 2016.

During that period, 21 states enforced at least one Specific Regulation of Abortion Providers (TRAP) law, which imposes mandates on abortion providers or facilities, such as requiring facilities to be located near an abortion facility. hospital or providers are affiliated with a local hospital. From 1974 to 2016, the average annual suicide rate among women of reproductive age in those states was nearly 6% higher than in previous years when the laws were not enforced.

The study is the first of its kind to show an association between abortion restrictions and suicide rates among younger women, said Dr. Ran Barzilay, one of the authors.

The researchers did not find the same association for older women, she said, suggesting that the increased risk of suicide was specific to women directly affected by the TRAP laws. The researchers also ruled out other factors, such as a state’s economy or political climate, in suicide rates.

“For starters, the numbers are small. We see the most adverse and worst outcome,» said Barzilay, an assistant professor of psychiatry at the University of Pennsylvania Perelman School of Medicine and a psychiatrist at Children’s Hospital of Philadelphia.

in a companion editorial published Wednesday, Tyler VanderWeele, a professor of epidemiology at the Harvard TH Chan School of Public Health, estimated that TRAP laws may have been associated with about 127 suicides among women of reproductive age in 2016. High suicide rates in states with more restrictive abortion laws «is cause for clinical concern,» he wrote.

Regardless of the cause of these suicides, he added, the data «indicates a need for mental health care and support» beyond what is currently offered in the US.

Unlike abortion restrictions that are directed at patients, such as the parental consent requirement for minors, TRAP laws place restrictions on providers or facilities that go beyond what is medically necessary, said Nichole Austin, an assistant professor of epidemiology at Dalhousie University in Nova Scotia, Canada.

Laws may stipulate the size of procedure rooms or the width of corridors in an abortion center.

“Certain laws will impose certain requirements on the nature of the facility itself: it must have a certain temperature, certain signage. It really gets a bit ridiculous,» he said.

Austin said TRAP laws can increase travel time to abortion facilities or cause facilities to close, creating barriers for women seeking abortions.

“Instead of being able to drive 5 miles down the road to an abortion provider, maybe your state passed some TRAP law and your closest provider closed. So as a consequence, you find yourself traveling 50 miles,” he said.

The UPenn researchers theorized that the TRAP laws could amplify stress and anxiety among women of reproductive age.

«Stress is associated with a higher mental health burden and, in turn, is associated with a higher risk of suicide,» Barzilay said.

A five year research project called The Turnaway Study found that women who had recently been denied an abortion had elevated levels of anxiety and stress, along with lower levels of self-esteem. But the study also found no difference in suicidal thoughts between women who were denied an abortion versus those who aborted.

However, that investigation ended in 2016, so it’s unclear how new abortion restrictions, like the Supreme Court’s decision to overturn Roe v. Wade, have affected suicide rates among younger women. More than a dozen states have banned abortions since Dobbs’ decision was issued in June.

“I would hope, from a purely speculative standpoint, that the recent Supreme Court decision would have a real impact on an individual level on many women in a way that these TRAP laws would not,” Austin said.

A to study showed that the average travel time to abortion facilities increased from 30 minutes in 2021, before the Dobbs decision, to 100 minutes in September. The proportion of women of reproductive age who lived more than an hour from an abortion facility also increased from 15% to 33% during that time.

Barzilay said Dobbs’ decision could potentially exacerbate stress levels among younger women, though she cautioned that more research is needed to demonstrate that effect.

«What makes a person who needs an abortion stressed? It’s the loss of this option to do it,» he said.

If you or someone you know is in crisis, please call 988 to reach the Suicide and Crisis Lifeline. You can also call the network, formerly known as the National Suicide Prevention Lifeline, at 800-273-8255text HOME to 741741 or visit TalkingSuicide.com/resources for additional resources.