The association between reproductive rights and access to abortion services and mental health among US women

BACKGROUND: This study examines whether living in US states with (1) restrictive reproductive rights and (2) restrictive abortion laws is associated with frequent mental health distress among women. METHODS: We operationalize reproductive rights using an overall state-level measure of reproductive rights as well as a state-level measure of restrictive abortion laws. We merged data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) with these state-level exposure variables and other state-level information. We used multilevel logistic regression to assess the relationship between these two measures and the likelihood of reporting 14 or more days of frequent mental health distress. We also tested whether associations differed across race, household income, education, and marital status. RESULTS: In the adjusted models, a standard deviation-unit increase in the reproductive rights score was significantly associated with decreased odds of reporting frequent mental health distress (OR = 0.95, 95% CI = 0.91, 0.99). Women in states with very hostile abortion restrictions had higher odds of frequent mental health distress. Associations between state-level abortion restrictions were larger among women 25–34 years old and women with a high school degree. For example, women aged 25–34 years residing in moderate (OR = 1.54, 95% CI = 1.14, 2.04), hostile (OR = 1.59, 95% CI = 1.15, 2.18), and very hostile (OR = 1.29, 95% CI = 1.02, 1.64) states were more likely to report frequent mental health distress than women living in states with less restrictive abortion policies. CONCLUSION: We found the association between state-level restrictions on reproductive rights and abortion access and frequent mental health distress differed by age and socioeconomic status. These results suggest abortion rights restrictions may contribute to mental health inequities among women.