Impact of reproductive health restrictions on women's mental health

Suicide represents a leading cause of maternal morbidity, with up to one in five maternal deaths in the United States resulting from suicide or overdose. Suicidal ideation and self-harm (suicidality) in the peripartum period are nearly 30 times more common than suicide death, and suicidality has steadily increased in the US. Perinatal

mood and anxiety disorders (PMAD) affects at least one in five birthing individuals and often underlie suicidal behaviors. Although mental health (MH) conditions predispose individuals for suicidality, environmental influences, including health or economic stressors, may precipitate suicidal behavior. For instance, among

delivering women, an unintended or unwanted pregnancy represents a strong risk factor for both PMAD and suicidal behavior. Macro-level stressors, such as restrictive state policies on marriage, divorce and reproductive health services also increase suicide rates. But it remains unknown how state policies impact PMAD and MH

related maternal morbidity specifically. Restricted access to reproductive health services will disproportionately affect subgroups of delivering individuals (low-income, geographically remote, or racial/ethnic groups) who are already at risk for PMAD and its consequences because they are less able to overcome barriers. Consequently,

these policies may exacerbate existing disparities in maternal MH outcomes. The overarching goal of our work seeks to characterize the consequences of restricting reproductive health service access on population health. In this proposal, we will leverage the natural experiment created by the enactment of reproductive health

service restrictions on maternal health outcomes. We will assess the relationship between state policies and PMAD rates (Aim 1), maternal morbidity (suicidality) (Aim 2), and mental health service utilization (Aim 3). We will examine these relationships among Medicaid and commercially insured women within and across states with

and without state policies that restrict access to reproductive health services. This study directly responds to NIMH High-Priority Areas for Research on Women’s Mental Health during the Perinatal Period (NOT-MH- 21-270), namely: research on perinatal depression and suicidal ideation and behaviors; research on perinatal

MH disorders in relation to engagement in medical care and clinical outcomes; research that identifies mutable factors that impact utilization and outcomes, including disparities, which may serve as targets in future perinatal MH care service delivery intervention development. It also addresses the Implementing a Maternal health and

PRegnancy Outcomes Vision for Everyone (IMPROVE) initiative, which supports research on reducing preventable causes of maternal deaths and improving health before, during, and after delivery.