The abortion law and the study of the suicide rate add to the furious debate. But are we missing the point?
A study published in December showed a connection between restrictive abortion laws and the increase in suicides of pregnant women in the US.
The research, conducted by scientists at the University of Pennsylvania, examined data between 1974 and 2016 and therefore did not consider changes since the US Supreme Court John L. Loeb and Frances Lehman Loeb Professor of Epidemiology at the School of Public Health TH Chan of Harvard, for argue in a recent editorial in JAMA Psychiatry that furious political debate should not obscure what research shows to be very real mental health challenges for pregnant patients considering abortionno matter what they decide.
VanderWeele, who is also director of the Human Empowerment Program at Harvard’s Institute for Quantitative Social Sciences, spoke to the Gazette on the subject.
GAZETTE: Let’s talk about the study on abortion and suicide conducted by Jonathan Zandberg of the University of Pennsylvania. What findings do you think are important?
VanderWeele: The study looked at the laws that restrict abortion access in the states, how they changed over time, and from an analytical standpoint, what is the state of mind Health the consequences can be You can see the timing of changes in restrictions and changes in mental health. It’s tricky because there are all kinds of trends happening simultaneously, but when you have all 50 states and 40 years of data, you can control for other variables and try to roughly estimate what the effect of those laws might be. Any observational study that is not randomized is not definitive, and that is the case with this one, but from a methodological perspective, this was a pretty good design. He indicated that the enactment of these laws increased the incidence of suicides by about 5 percent. It’s a small percentage increase, but we’re a big country, so it translates to about 125 suicides per year. That is a small fraction of all suicides, but from my perspective every life is important.
GAZETTE: And in 40 years, we are talking about more than 5,000 suicides.
VanderWeele: And these are completed suicides, so this indicates greater mental distress, greater suicidal ideation than just completed suicides. So there are real mental health difficulties and challenges around this issue, not necessarily for all women, but for many. There have been some studies on this indicating that access restrictions for those wanting an abortion lead to mental health problems (anxiety and stress) and then some literature that actually having an abortion leads to higher rates of depression and suicidal ideation. It is disputed and the quality of these studies is not very good, but it is quite plausible that both point to the need for better mental health care.
GAZETTE: Are you concerned that this is being used as a weapon in the political battle over abortion instead of highlighting a mental health issue that we need to address?
VanderWeele: I’m not an expert on this topic, my main interaction with it has been through the research literature, but I have a feeling that to some extent in the research report and to a large extent in the acceptance of The media, these various associations have been used by both sides to put together research to advocate for pro-life or pro-choice policies.
That is problematic in two respects. In the first place, I do not think that this is the center of the debate. I think what is happening is that, on the pro-choice side, there are concerns about women’s autonomy, control and privacy. And on the pro-life side, there is the belief that a fetus is a human life and that this is the intentional destruction of human life and therefore wrong. This is fundamentally a moral debate, and to some extent a metaphysical one: When does life begin? I think the intractable nature of the political debate is due to the fact that there are very different points of view on these issues. So to say, “We’re going to make this decision based on mental health statistics,” is to ignore the fundamental contours of the debate and to some degree give up trying to understand and engage with the other side’s perspective. Certainly there are policy limitations that reasonably take both sides into account, but I’m not sure we’ve fully explored everything that might be possible. So in a way, putting the investigation together shifts the debate to a place where it shouldn’t be.
The second problematic aspect is that it is taking empirical research away from the mental health care needs of women who face situations that are often very difficult, regardless of the decision they make. Having an unwanted pregnancy is difficult and is often accompanied by other challenging circumstances regarding financial status, relationships, and work and personal complications. Therefore, abortion and mental health research must focus on the very real mental health care needs of women.
GAZETTE: Are there populations in particular that are more affected by this?
VanderWeele: There is evidence that black women and women of lower socioeconomic status have higher abortion rates and more difficulty accessing mental health care. They are particularly affected by the neglect that results from focusing research on reproductive health, abortion, and mental health around policy issues rather than the needs of women.
All of these studies give us averages that compare groups of women with unwanted pregnancies who face different laws or make different decisions but are already facing challenges, with increased mental health problems. Both groups need help trying to navigate these difficult situations, regardless of the politics around the abortion issue. And individual women’s experiences are going to be different than average. There will be people in both groups who really need mental health care. Therefore, a reorientation of the literature on mental health, abortion, and abortion access toward what the mental health care needs are and how they might be met would be to everyone’s advantage. I think it’s something that both sides of the political debate could address together: How do we meet women’s mental health needs?
GAZETTE: What kinds of things could be done to help that aren’t done?
VanderWeele: One could divide this into the policy level and the research and clinical level. At the policy level, these difficulties arise in large part because of the number of unwanted pregnancies. There has been reasonably good work on the reasons for this, ranging from the absence of a steady partner, to serious financial constraints, to existing childcare concerns, to lack of autonomy, and more. We could implement better parental leave policies in this country, which does not compare favorably with other developed countries. That, of course, wouldn’t address all of these cases where pregnancy is unwanted, but it would help.
I think more work could be dedicated, this is part of the work of the Human Flourishment Program, to support and promote better relationships. Social well-being is integrated into the World Health Organization’s definition of health as a state of complete physical, mental and social well-being. However, only recently has the World Health Organization launched an initiative on social well-being. We know a thing or two about how to support relationships, and there are more and more evidence-based interventions about what leads to greater marital stability. Again, it’s just one piece of the puzzle, but I think it’s important.
On the research front, as I said in the comment, we can move away from these comparisons to understand mental health care needs. Under what circumstances are depression, anxiety, and suicide most likely to arise and when, during the reproductive care process, are they most likely to arise? From a clinical point of view, screening for mental health issues, as well as discussing the mother’s life circumstances and financial constraints and childcare concerns, etc., might help.
The broader debate touches on many other issues, but with respect to mental health, we could be getting better in policy, we could be getting better in research, we could be getting better in clinical care in ways that are partly overlooked because of research orientation. towards the issue of access to abortion instead of mental health care.
Tyler J. VanderWeele, Abortion and Mental Health: Context and Common Ground, JAMA Psychiatry (2022). DOI: 10.1001/jamapsychiatry.2022.3530
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