March 5, 2026-- Restrictive abortion policies are associated with higher levels of depressive symptoms among women, according to a new 25-year study conducted at Columbia University Mailman School of Public Health. The equivalent of approximately four additional restrictive laws was linked to a 7 percent increase in depressive symptoms among women. The study findings contribute to the small but growing body of literature documenting potential adverse mental health consequences of restrictive abortion legislation. The results are published in the journal SSM-Mental Health .
"Although restrictive abortion legislation is well known to worsen birth outcomes and women's physical health and even lead to rises in female mortality in some cases, its mental health consequences are still being clarified," said Sarah McKetta, MD, PhD, assistant professor of Epidemiology at Columbia Mailman School.
In examining associations between state-level abortion restrictiveness and depression, the researchers surveyed female participants in a large U.S. sample from 1990 to 2015 and concluded that legal protections for reproductive health care may benefit mental health.
"Understanding the long-term mental health burden of restrictive state-level abortion policies over several decades has been methodologically challenging. It is often difficult to isolate the impact of a single policy change," McKetta cautions.
Abortion is a common and safe health care service that most Americans support under many circumstances. Nevertheless, it has remained politically controversial and a frequent target of restrictive legislation in the United States. Efforts to curtail abortion access have been characterized as violations of human rights, reproductively coercive, and contrary to principles of reproductive justice.
The study included 19,881 female respondents from the Monitoring the Future (MTF) panel study, a national prospective population that follows young people from adolescence into adulthood. Participants were first surveyed during their senior year of high school and followed into adulthood, with assessments every two years until age 30 and every five years beginning at age 35.
Depressive symptoms were measured using a four-item index. State-level abortion policy climate was quantified through an annual index capturing 18 standard restrictive policies across states and years. Analyses adjusted for race/ethnicity, age, urbanicity, and state-level characteristics, including unemployment, income inequality, political and legislative composition, demographic composition, and the gender wage gap.
"To further test the robustness of our findings, we assessed negative control outcomes such as motor vehicle crashes and examined male respondents and religious subgroups, as well," noted McKetta. "As we hypothesized, associations in the alternative samples were not statistically significant, were stronger among women compared to men, and were not associated with the negative control outcome of motor vehicle crashes. Associations were strongest among women reporting low religious observance and were not significant among those with high religious interest. These tests help reassure us that the associations we are seeing – between restrictive abortion legislation and adverse mental health – are unlikely to be spurious or due to unmeasured confounding factors."
Prior research on the mental health consequences of restrictive abortion legislation has largely focused on pregnant individuals or those denied abortion care, but recent studies have begun to examine the broader population. Other emerging population-based studies has found that individuals living in states that enacted more abortion restrictions following the Dobbs decision reported more symptoms of depression. According to McKetta. "We provide evidence that, even prior to Dobbs, state-level abortion restrictions were already associated with adverse population mental health."
These findings offer empirical evidence of the population-level mental health consequences of restrictive abortion policies and are crucial for countering misinformation regarding abortion and mental health.
Abortion remains an essential component of health care, and laws that curtail access threaten that care, McKetta notes. "This study adds to a growing body of literature highlighting the broader public health implications of legislative efforts to restrict health care access—not only for those who may become pregnant or seek abortion services, but for the general population. The findings are particularly relevant given the dramatic shifts in the legal landscape following the Dobbs decision, after which many states enacted even more restrictive laws."
Co-authors are Katherine Keyes, Kara Rudolph, and Catherine Gimbrone, Columbia Mailman School of Public Health; Julie Maslowsky, University of Michigan; and Sara Redd, Emory.
The study was supported by the National Institutes of Health and Reproductive Health Research in the Southeast.
The authors report no conflicts of interest.
Columbia University Mailman School of Public Health
