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

Citation

Roberts, Sarah CM; Berglas, Nancy F. (2019), Complex situations: economic insecurity, mental health, and substance use among pregnant women who consider – but do not have – abortions, Dryad, Dataset, https://doi.org/10.7272/Q6M043K1

Abstract

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.

Methods

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.

Funding

David and Lucile Packard Foundation

Susan Thompson Buffett Foundation