The Issue:
Within months of the Supreme Court’s Dobbs decision, which overturned Roe v. Wade and allowed states to ban abortion, a number of states had implemented total abortion bans that effectively eliminated legal access. In new research, we examine whether total abortion bans are linked to changes in suicidal thoughts or behaviors among adolescent females.
The Facts:
Recent research finds that total abortion bans are associated with worse mental health among reproductive-age women, including greater psychological distress, anxiety, and depression. This is consistent with research that finds that women denied an abortion are more likely to experience economic hardship and economic insecurity lasting years than otherwise similar women who received an abortion.
Compared with older reproductive-age women, pregnancies to teenage girls are more likely to be unintended and, while pregnant teens are more likely to want to terminate their pregnancies, they are also more likely to face financial and logistical barriers to the care involved. Adolescence is also a developmental stage when mental health is especially sensitive to stress. Adolescent suicide is a major psychiatric and public health concern, with suicide being the second leading cause of death among individuals aged 10 to 24 in the United States.
We compare trends in suicidal ideation and suicide attempts among female high school students in five states that had total bans in place: Arkansas, Missouri, Oklahoma, Tennessee and Texas, with those in ten states that did not implement bans during the study period: Maryland, Michigan, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, North Dakota, and Pennsylvania.
Before Dobbs, the suicide indicators in the two groups of states moved in tandem; in 2023, they diverged. Between the last pre-policy survey in 2021 and the first post-policy survey in 2023, reported suicidal ideation among female students in ban states held roughly steady, moving from about 33 to 34 percent, while attempts rose from about 15 to 18 percent. Over the same period in states without total bans, both fell. In particular, ideation fell from about 33 to 29 percent and attempts fell from about 12 to 11 percent (see chart).
To determine whether the abortion bans caused the divergence in trends among the states, we compare the change over time in ban states with the contemporaneous change in states without bans while accounting for fixed differences across states and for nationwide shifts affecting all students. Suicidal thoughts among female high school students increased by 4.3 percentage points where total bans took effect relative to places where they did not. Suicide attempts moved in the same direction, though the adjusted estimate was less precise and did not reach conventional levels of statistical significance. The absence of any effect among male students and the parallel pre-policy trends point to abortion policy itself, rather than other differences between these states, as the causal factor responsible for these changes.
The data cannot pin down why suicidal thoughts rose, but the Dobbs decision and the bans that followed were highly publicized. A survey conducted before the ruling found that most adolescents were aware of the potential changes to abortion access and reported anger, fear, and sadness. These emotions have been associated with increased suicide risk among adolescents in prior research. Beyond those directly facing an unwanted pregnancy, a diminished sense of control over one’s future may itself be a source of distress.
