Abortion law, suicide rate study add to heated debate. But are we missing the point? – Harvard Gazette

A study published in December Show a connection between restrictive abortion laws and the increasing incidence of suicide by women of childbearing age in the United States. The research, conducted by scientists from the University of Pennsylvania, examined data between 1974 and 2016, and therefore did not take into account changes since the US Supreme Court overturned Roe v. Wade The latter is public, but dramatically rising tensions over the issue have prompted Tyler VanderwellThe John Loeb and Frances Lyman Loeb Professor of Epidemiology Harvard T.H. Chan School of Public Healthl argues in a recent editorial At JAMA Psychiatry, heated debate over politics should not overshadow what research shows are real mental health challenges for pregnant patients considering abortion, no matter what they decide to do. VanderWeele, who is also a director Human Prosperity Program At the Harvard Institute for Quantitative Social Sciences, I spoke with OJ about this.

Gazette: Let’s talk about a study on abortion and suicide by Jonathan Zandberg of the University of Pennsylvania. What results do you think are important?

Vanderwale: The study was looking at the laws that restrict access to abortion in states, how they have changed over time, and from an analytical standpoint, what the mental health consequences are. You can look at the timing of changes in restrictions and changes in mental health. It’s complicated because there are all kinds of trends happening simultaneously, but when you have 50 states and 40 years of data, you can control for other variables and try to roughly quantify the effect of those laws. Any observational study in which you don’t randomize is not definitive – which is the case with this study – but from a methodological perspective, this was a very good design. She indicated that the enactment of these laws led to an increase in suicides by about 5 percent. It’s a small increase, but we’re a big country, and that translates to roughly 125 suicides a year. This is a small part of the total number of suicides, but in my view every life matters.

Gazette: And over the course of 40 years, we’re talking about more than 5,000 suicides.

Vanderwale: And these are completed suicides, so this indicates greater mental anguish, greater suicidal ideation than just complete suicides. So there are real mental health difficulties and challenges around this issue, not necessarily for all women, but for many. There has been some studies on this suggesting that access restrictions for those who wish to have an abortion lead to mental health challenges – anxiety and stress – and then some literature suggesting that abortion actually leads to higher rates of depression and suicidal ideation. It is disputed and the quality of these studies is not great, but it is entirely plausible that they both point to the need for better mental healthcare.

Gazette: Are you worried this will be used as a weapon in the political battle over abortion versus highlighting the mental health issue we need to address?

Vanderwale: I’m no expert on the subject—my primary interaction with it has been through the research literature—but my sense is that, to some extent in reporting research and largely in media uptake, these various associations have been used by both sides to weaponize research to advocate for policies Pro-life or pro-choice.

This is problematic in two respects. First, I don’t think this is where the center of the debate lies. I think what happens is, on the pro-choice side, there are concerns about women’s autonomy and control and privacy. And on the pro-life side, there is the belief that the fetus is human life and that this is the deliberate destruction of human life and that is wrong. This is essentially a moral – and on some level metaphysical – debate: when does life begin? I think the intractable nature of political debate is because there are very different points of view on these issues. So to say then, “We will make this decision according to mental health statistics,” is to ignore the bottom lines of the discussion and, in a sense, to stop trying to understand and engage with the other side’s perspective. Certainly, there are limitations in terms of policies that reasonably take both sides into account, but I’m not sure we’ve exhaustively explored everything that might be possible. So in some ways, weaponizing research turns the discussion where it shouldn’t be.

The second problematic aspect is the shift of empirical research away from the mental health care needs of women who often face very difficult situations, regardless of the decision they make. An unwanted pregnancy is challenging and often accompanied by other challenging circumstances regarding financial status, relationships, and work/life complications. Therefore abortion and mental health research should focus on the very real needs of women’s mental health care.

Gazette: Are there specific population groups that are most affected by this?

Vanderwale: There is evidence that black women and women of lower socioeconomic status have higher rates of miscarriage and greater difficulties obtaining mental health care. They are particularly affected by the neglect resulting from the focus of reproductive health, abortion, and mental health research on questions of policy rather than women’s needs.

All of these studies give us averages comparing groups of women with unwanted pregnancies who face different laws or make different decisions but who actually face challenges, with higher mental health struggles. Both groups need help trying to navigate these difficult situations, regardless of policies on the issue of abortion. And individual women’s experiences will be different from the average. There will be individuals in both groups who really need mental health care. So redirecting the mental health, abortion, and abortion literature to accessing what mental health care needs are and how they can be met would be beneficial to all. I think this is something that both sides of the political debate can bring together: How do we provide for women’s mental health needs?

Gazette: What kinds of things can be done to help prevent this from happening?

Vanderwale: One might divide this into the policy level, the research level, and the 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 lack of a stable partner, to serious financial constraints, to concerns about the care of existing children, to a lack of independence, and other things. We could put in place better paternity leave policies in this country, which do not compare favorably with other developed countries. This, of course, will not cure all of these cases where pregnancy is unwanted, but it will help.

I believe that more work – this is part of the work of the Human Prosperity Program – can be devoted to supporting and promoting better relationships. Social well-being is integral to the WHO definition of health as a state of complete physical, mental and social well-being. However, it was only very recently that the World Health Organization launched an initiative on social welfare. We know a few things about how to support relationships and there are growing evidence-based interventions about what leads to greater stability in marriage. Again, it’s just a piece of the puzzle, but I think it’s important.

On the research front, as I said in the commentary, we can move away from these comparisons toward understanding mental health care needs. Under what circumstances are depression, anxiety, and suicidality most likely to appear and when, during the reproductive care process, are they most likely to appear? On the clinical side, examining mental health challenges can help as well as talking about the mother’s life circumstances, financial constraints, child care concerns, etc.

The bigger debate touches on a lot of other issues, but in terms of mental health we can do better in terms of policy, we can do better in research, we can do better in clinical care in ways that are ignored in part because of orientation. To research the issue of access to abortion rather than mental health care.

If you or someone you know needs access to mental health services at Harvard, come visit the university Counseling and mental health service Or call 617-495-2042. For more information about resources at Harvard and the We All Human Wellbeing initiative, visit: www.harvard.edu/wellbeing.

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