DOI: 10.7272/q6m043k1
title: Complex situations: economic insecurity, mental health, and substance use among pregnant women who consider – but do not have – abortions

description: 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 with 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 with 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 with 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.
description: 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. Reasons were coded based on open-ended responses to questions.
 Participants were also asked about their demographic characteristics,
 pregnancy-related experiences, mental health, and substance use.  This is
 a de-identified limited dataset that includes only the variables included
 in some of the models presented in the manuscript.  Because abortion is so
 highly stigmatized and because including all of the detailed demographic,
 mental health, and substance use information could lead to someone being
 identified, we only share this limited de-identified dataset.  If people
 are interested in conducting analyses of other data collected, they should
 contact the Principal Investigator (Dr. Sarah Roberts) to learn about the
 steps that would be involved, including, but not limited to obtaining
 institutional review board approval.