The study came about after Barzilay, Zandberg, and Waller recognized that their research interests overlapped. Zandberg examines how reproductive care restrictions affect gender inequality, while Barzilay examines the factors that influence the trajectory of a person’s mental health and suicide risk. Waller is interested in environmental stressors that affect parents and ultimately child development. Elina Visoki, a data scientist in Barzilay’s lab, also contributed to this research.

Zandberg’s previous research found that more limited access to reproductive care comes at a cost to women’s work aspirations and decisions to start a family. The researchers chose to look at other parts of this dynamic, particularly the mental health consequences of tight reproductive rights enforcement and, more specifically, the risk of suicide, the leading cause of death among people aged 25 to 44 in the United States.


Using state-level data from 1974 to 2016, they conducted a disparity analysis covering the entire population of adult women during that period. “We created three indices that looked at state-level implementation of legislation to measure access to reproductive care,” Zandberg said. “Every time a state has enacted a reproductive care law, we’ve included it in the index.” The researchers then compared suicide rates among women of reproductive age before and after the laws went into effect, comparing them with national suicide trends and rates in places without such restrictions.

“By comparison, women who were shocked by this kind of restrictive law had a significantly higher suicide rate,” Zandberg said. The researchers then investigated whether the finding was specific to women of reproductive age or whether it could be found in other populations. For comparison, they did the same study on all women aged 45 to 64 between 1974 and 2016. They had no effect. Finally, they looked at another common cause of death, motor vehicle deaths, and found no difference. Controlling for potential factors such as the economy and political climate did not affect the findings.

Although the results did not establish that restricting access to abortion increases suicide rates, the researchers argue that the analytical methodology is one of the most rigorous methods for drawing causal inferences. “This organization is strong and has nothing to do with politics,” says Barzilay. “It’s all backed up by data.” These results have limitations, including that the researchers did not have access to data on the women’s individual experiences or mental health. In other words, “we’re looking at the relationship between the aggregate data on state-level causes of death and policy and politics over decades. “But each death represents a unique tragedy,” Waller argues. “There’s more. We need to learn what these findings mean for individual suicide risk.”

Despite these limitations, the researchers believe the findings have clinical, policy, and ethical implications. Recognizing this link, for example, could change how doctors and other health care providers assess suicide risk in women of reproductive age. In addition, it highlights the need to improve suicide prevention measures and informs the ethical debate about abortion.

Overall, understanding current patterns is critical to planning for future scenarios where partial restrictions evolve into full-fledged restrictions or even criminalization of abortion. “Whatever your stance on all of this is, it’s all over the news. It’s over,” Waller adds. “Women who internalize what they’re hearing are going to be affected by these restrictions.”


  1. Association between state-level access to reproductive care and suicide rates among women of reproductive age in the United States – (

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