Complex situations: Economic insecurity, mental health, and substance use among pregnant women who consider – but do not have – abortions

Autoři: Sarah C. M. Roberts aff001;  Nancy F. Berglas aff001;  Katrina Kimport aff001
Působiště autorů: Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences University of California San Francisco (UCSF), San Francisco, California, United States of A aff001
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article


We examine characteristics and experiences of women who considered, but did not have, an abortion for this pregnancy. Participants were recruited at prenatal care clinics in Louisiana and Maryland for a mixed-methods study (N = 589). On self-administered surveys and structured interviews, participants were asked if they had considered abortion for this pregnancy and, if so, reasons they did not obtain one. A subset (n = 83), including participants who considered abortion for this pregnancy, completed in-depth phone interviews. Multivariable logistic regression analyses examined characteristics associated with having considered abortion and experiencing a policy-related barrier to having an abortion; analyses focused on economic insecurity and of mental health/substance use as main predictors of interest. Louisiana interviews (n = 43) were analyzed using modified grounded theory to understand concrete experiences of policy-related factors. In regression analyses, women who reported greater economic insecurity (aOR 1.21 [95% CI 1.17, 1.26]) and more mental health diagnoses/substance use (aOR 1.29 [1.16, 1.45] had higher odds of having considered abortion. Those who reported greater economic insecurity (aOR 1.50 [1.09, 2.08]) and more mental health diagnoses/substance use (aOR 1.45 [95% CI 1.03, 2.05] had higher odds of reporting policy-related barriers. Interviewees who considered abortion and were subject to multiple restrictions on abortion identified material and instrumental impacts of policies that, collectively, contributed to them not having an abortion. Many described simultaneously navigating economic insecurity, mental health disorders, substance use, and interpersonal opposition to abortion from family and the man involved in the pregnancy. Current restrictive abortion policies appear to have more of an impact on women who report greater economic insecurity and more mental health diagnoses/substance use. These policies work in concert with each other, with people’s individual complex situations–including economic insecurity, mental health, and substance use–and with anti-abortion attitudes of other people to make abortion care impossible for some pregnant women to access.

Klíčová slova:

Alcohol consumption – Health economics – Louisiana – Mental health and psychiatry – Pregnancy – Regression analysis – Termination of pregnancy – Maryland


1. Lai KKR. Abortion bans: 9 states have passed bills to limit the procedure this year. NY Times. 2019. May 29, 2019

2. O'Connor E. All of these new anti-abortion laws are part of a national effort to overturn Roe v. Wade. Buzzfeed News. 2019. May 16, 2019.

3. Gordon M, Hurt A. Early abortion bans: which states have passed them? Kaiser Health News. 2019. June 26,2019

4. Roe v. Wade. 22 Jan 1973. 1973;410:113–78.

5. Roberts SCM, Kimport K, Kriz R, Holl J, Mark K, Williams V. Consideration of and reasons for not obtaining abortion among women entering prenatal care in Southern Louisiana and Baltimore, Maryland. Sex Res Social Policy. 2018;Epub ahead of print.

6. Upadhyay UD, Weitz TA, Jones RK, Barar RE, Foster DG. Denial of abortion because of provider gestational age limits in the United States. Am J Public Health. 2014;104(9):1687–94. doi: 10.2105/AJPH.2013.301378 23948000

7. Grossman D, Baum S, Fuentes L, White K, Hopkins K, Stevenson A, et al. Change in abortion services after implementation of a restrictive law in Texas. Contraception. 2014;90(5):496–501. doi: 10.1016/j.contraception.2014.07.006 25128413

8. Roberts SCM, Johns NE, Williams V, Wingo E, Upadhyay UD. Estimating the proportion of Medicaid-eligible pregnant women in Louisiana who do not get abortions when Medicaid does not cover abortion. BMC Womens Health. 2019;19(1):78. doi: 10.1186/s12905-019-0775-5 31215464

9. Henshaw SK, Joyce TJ, Dennis A, Finer LB, Blanchard K. Restrictions on Medicaid funding for abortions: a literature review. New York: Guttmacher Institute. 2009.

10. Roberts SCM, Biggs MA, Chibber KS, Gould H, Rocca CH, Foster DG. Risk of violence from the man involved in the pregnancy after receiving or being denied an abortion. BMC Med. 2014;12:144. doi: 10.1186/s12916-014-0144-z 25262880

11. Gerdts C, Dobkin L, Foster DG, Schwarz EB. Side effects, physical health consequences, and mortality associated with abortion and birth after an unwanted pregnancy. Womens Health Issues. 2016;26(1):55–9. doi: 10.1016/j.whi.2015.10.001 26576470

12. Foster DG, Biggs MA, Raifman S, Gipson J, Kimport K, Rocca CH. Comparison of health, development, maternal bonding, and poverty among children born after denial of abortion vs after pregnancies subsequent to an abortion. JAMA pediatrics. 2018. Epub ahead of print

13. Foster DG, Biggs MA, Ralph L, Gerdts C, Roberts S, Glymour MM. Socioeconomic outcomes of women who receive and women who are denied wanted abortions in the United States. Am J Public Health. 2018;108(3):407–13. doi: 10.2105/AJPH.2017.304247 29345993

14. Ralph LJ, Schwarz EB, Grossman D, Foster DG. Self-reported physical health of women who did and did not terminate pregnancy after seeking abortion services: a cohort study. Ann Intern Med. 2019. Epub ahead of print

15. Guttmacher Institute. An overview of abortion laws 2019. Available from:

16. Fuentes L, Lebenkoff S, White K, Gerdts C, Hopkins K, Potter JE, et al. Women's experiences seeking abortion care shortly after the closure of clinics due to a restrictive law in Texas. Contraception. 2016;93(4):292–7. doi: 10.1016/j.contraception.2015.12.017 26768858

17. McCarthy M, Upadhyay U, Biggs MA, Anthony R, Holl J, Roberts SC. Predictors of timing of pregnancy discovery. Contraception. 2018;97(4):303–8. doi: 10.1016/j.contraception.2017.12.001 29242084

18. Foster DG, Jackson RA, Cosby K, Weitz TA, Darney PD, Drey EA. Predictors of delay in each step leading to an abortion. Contraception. 2008;77(4):289–93. doi: 10.1016/j.contraception.2007.10.010 18342653

19. Foster DG, Kimport K. Who seeks abortions at or after 20 weeks? Perspect Sex Reprod Health. 2013;45(4):210–8. doi: 10.1363/4521013 24188634

20. Glenza J. Louisiana's Restrictive Abortion Law Blocked by Federal Judge. The Guardian http://wwwtheguardiancom/world/2014/sep/01/louisiana-abortion-law-admitting-privileges. September 1, 2014.

21. Guttmacher Institute. State Policies in Brief: Targeted Regulation of Abortion Providers. 2014.

22. Berglas NF, Williams V, Mark K, Roberts SCM. Should prenatal care providers offer pregnancy options counseling? BMC Pregnancy Childbirth. 2018;18(1):384. doi: 10.1186/s12884-018-2012-x 30261849

23. Kimport K, Kriz R, Roberts SCM. The prevalence and impacts of crisis pregnancy center visits among a population of pregnant women. Contraception. 2018;98(1):69–73. doi: 10.1016/j.contraception.2018.02.016 29505747

24. Berglas NF, Kimport K, Williams V, Mark K, Roberts SCM. The health and social service needs of pregnant women who consider but do not have abortions. Womens Health Issues. 2019;29(5):364–9. doi: 10.1016/j.whi.2019.07.002 31387774

25. Burns B, Dennis A, Douglas-Durham E. Evaluating priorities: Measuring women's and children's health and well-being against abortion restrictions in the states. Ibis Reproductive Health, 2014.

26. Institute Guttmacher. State facts about abortion: Louisiana. 2018.

27. Guttmacher Institute. State Policies in Brief: State Funding of Abortion Under Medicaid. September 7, 2015. Available from:

28. Guttmacher Institute. State facts about abortion: Maryland. 2018.

29. Jacob A. The University of Maryland’s nearest Planned Parenthood is closing next week. The Diamondback Retrieved from: http://wwwdbknewscom/2017/03/08/planned-parenthood-silver-spring-closing/ March 29, 2018. 2017.

30. California Department of Health Care Services. Stable Resource Toolkit: AUDIT-C -Overview. Accessed September 4, 2015. Available from:

31. Roberts SCM, Gould H, Kimport K, Weitz TA, Foster DG. Out-of-pocket costs and insurance coverage for abortion in the United States. Women Health Issues. 2014;24(2):e211–8.

32. Moseson H, Herold S, Filippa S, Barr-Walker J, Baum SE, Gerdts C. Self-managed abortion: a systematic scoping review. UCSF Retrieved from https://escholarshiporg/uc/item/1mj5832t. 2019.

33. Roberts SC, Pies C. Complex calculations: how drug use during pregnancy becomes a barrier to prenatal care. Matern Child Health J. 2011;15(3):333–41. doi: 10.1007/s10995-010-0594-7 20232126

34. Berglas NF, Kimport K, Williams V, Mark K, Roberts SCM. The health and social service needs of pregnant women who consider but do not have abortions. Womens Health Issues. 29(5):364–369 doi: 10.1016/j.whi.2019.07.002 31387774

35. Roberts SCM, Foster DG, Gould H, Biggs MA. Changes in alcohol, tobacco, and other drug use over five years after receiving versus being denied a pregnancy termination. J Stud Alcohol Drugs. 2018;79(2):293–301. 29553359

Článek vyšel v časopise


2020 Číslo 1
Nejčtenější tento týden