Research published in JAMA network open Our findings suggest that the implementation of state-level abortion bans is associated with an increase in suicidal ideation among high school girls. The findings indicate that severe legal restrictions on abortion care can negatively impact the mental health of adolescents in affected areas. This study highlights a potential link between major changes in reproductive health care policy and the psychological well-being of young people across the United States.
Suicide is one of the leading causes of death for youth ages 10 to 24 in the United States. In recent years, public health experts have increasingly investigated how broader social conditions and legal policies shape mental health. Policy decisions that limit access to basic health services tend to increase individuals’ uncertainty and reduce their sense of control over future life events.
In June 2022, the U.S. Supreme Court issued a ruling in Dobbs v. Jackson Women’s Health Institution, overturning the nation’s constitutional protections for access to abortion. Following this landmark ruling, several states quickly passed sweeping abortion bans that outlawed nearly all abortion services within their borders. Prior to this decision, there had been little public discussion of the potential link between reproductive restriction and suicide risk among adolescents.
“In the run-up to the Dobbs decision, there was much speculation about the impact of overturning Roe v. Wade, but little attention was paid to the suicide risk,” said Wendy R. Sheldon, founder and director of Verge Research. She noted that international observations helped inform the research team’s focus on youth mental health.
“Having worked in other countries where abortion was illegal, I knew that some women faced with unwanted pregnancies would go to extraordinary lengths to end the pregnancy, including risking their own lives,” Sheldon explained. “We also knew that young people are hardest hit by abortion restrictions, and that unintended pregnancies at young ages can have particularly devastating consequences. So we wanted to investigate whether there was a link between abortion restrictions and youth suicide rates.”
Adolescent women are often uniquely susceptible to changes in reproductive health care laws. Young women face greater economic, logistical, and social barriers when seeking health services compared to older adults. Furthermore, experiencing an unintended pregnancy as a teen can dramatically alter a young person’s educational, economic, and social trajectory.
“Adolescents have been largely left out of research and public debate about the impact of abortion bans,” Sheldon said. “Young people face particular barriers to accessing abortion care, including financial restrictions, travel difficulties, and parental involvement requirements. However, we still know little about how and to what extent these barriers impact their mental health.”
Adolescence is a critical developmental stage characterized by increased emotional reactivity and increased sensitivity to environmental stressors. Public perception of legal restrictions can cause distress, anxiety, and feelings of helplessness in teens. Even for adolescents who are not currently pregnant, the perceived loss of reproductive autonomy can be a chronic psychological stressor that impacts mental health outcomes.
To find out how these legal changes affect young people’s mental health, researchers analyzed data from the Youth Risk Behavior Survey. The survey, administered by the Centers for Disease Control and Prevention, uses a standardized, anonymous questionnaire to collect national data on health behaviors among high school students. Scientists looked at survey data collected over four different time points: 2017, 2019, 2021, and 2023.
The final dataset included 338,324 public high school students in grades 9 through 12 from 15 states. Just 169,967 of these participants were female, with an overall median age of 16 years. About 10 percent of the total sample lived in states that had implemented blanket bans on abortion following a 2022 Supreme Court ruling.
The researchers divided states into two distinct groups based on their legal environment. Five states in the dataset, including Arkansas, Missouri, Oklahoma, Tennessee, and Texas, enacted blanket bans on abortion for 12 months prior to the 2023 survey. Ten other states in the dataset did not enact blanket bans during the study period and served as baseline control groups, including Maryland, Michigan, Nevada, and Pennsylvania.
To assess changes in mental health, the authors measured two specific outcomes: suicidal ideation and suicide attempts. Suicidal ideation was defined as students who reported seriously considering attempting suicide or making detailed plans to attempt suicide within the past 12 months. Suicide attempt was defined as reporting one or more actual suicide attempts or an attempt that resulted in an injury requiring medical treatment or an overdose.
The authors employed a statistical method known as difference-in-differences analysis. This method compares changes over time in outcomes for a group affected by a policy change to changes over time in outcomes for a comparison group that is unaffected. Using this approach, scientists can separate the specific effects of policy implementation from broader national changes in youth mental health trends.
Statistical models were adjusted for individual student characteristics, including race, ethnicity, and school grade level. The researchers also adjusted for state-level COVID-19 mortality rates in each study year to account for potential differences in the severity of the pandemic that may have affected mental health. Additionally, the authors analyzed data from high school boys as a secondary control group, since teenage males are not directly subject to legal restrictions placed on individual pregnancy choices.
Statistical analysis demonstrated clear differences in mental health trends after the implementation of a total abortion ban. Prior to 2022, female students in states that later enacted bans had similar mental health trends as female students in non-ban states. After the 2023 policy change, suicidal ideation among female students in ban states increased from 33% to 34%, while suicidal ideation dropped from 33% to 29% in non-ban states.
After applying complete statistical controls, a difference-in-differences model showed that a blanket ban on abortion was associated with an adjusted 4.3 percentage point increase in suicidal ideation among high school girls. This difference is statistically significant, indicating that the pattern is unlikely to be the result of random chance. The mathematical model confirmed that pre-policy trends were comparable between the two groups of states.
For female student suicide attempt rates, the unadjusted trend rose from 15% in 2021 to 18% in 2023 in ban states, but remained relatively flat at about 11% in non-ban states. The adjusted statistical model showed a 3.2 percentage point increase in suicide attempts among female students in prohibition states compared to non-prohibition states, but this estimate was less mathematically accurate. In contrast, male students showed no statistically significant changes in suicidal ideation or attempts after the law reform.
“The main conclusion is that abortion bans can have an impact far beyond access to abortion itself,” Sheldon said. “We found that high school girls in states with full abortion bans had an approximately 4 percentage point increase in suicidal ideation compared to girls in states without bans. We found no comparable results for boys. We also found a similar increase in suicide attempts, but those estimates were less precise.”
Sheldon expressed surprise at how quickly these psychological patterns emerged across the nation. “I was surprised by how large an increase in suicidal ideation was among female students in ban states, and how rapidly it appeared after the ban went into effect,” Sheldon told SciPost. “The contrast with male students from the same state was also striking. There was no comparable change in thinking or experimentation among male students, which makes the findings for girls even more concerning.”
Several methodological factors should be kept in mind when reading these conclusions. Youth risk behavior surveys collect cross-sectional data. This means that different groups of students complete the survey each cycle. Because researchers are unable to track individual students over time, this study cannot directly measure how specific students’ mental health changed before and after the policy change.
This study design also means that the individual motivations behind reported suicidal ideation cannot be directly determined. “Our study was not designed to determine why suicidal ideation increased; there are likely multiple factors at play, and these may vary depending on young people’s different life experiences,” Sheldon explained.
“We also do not know whether the students who reported suicidal thoughts personally experienced unwanted pregnancies or sought abortions,” Sheldon added. “Due to the observed population-level increases, these policies may be impacting a broader range of young people, not just those who personally need abortion services.”
Data availability posed additional challenges across participating regions. Response rates for questions regarding suicide attempts were lower than for questions regarding suicidal ideation, reducing statistical precision. Additionally, some students who responded to the survey had lived under a blanket ban on abortion for longer periods of time than others, so exposure to this policy was not completely uniform.
The study sample was limited to teens attending public high schools, and these findings may not automatically apply to home-schooled students, private school students, or youth who have dropped out of school. Additionally, states that have enacted blanket bans on abortion may differ from states that do not have them in broader political or social contexts that were not captured by the study’s demographic controls. Mr Sheldon said: “While our research cannot reveal exactly why this happened, it does suggest that we need to take seriously the potential mental health impacts of these policies, especially on young people.”
To address these open questions, the authors are conducting further research to understand the first-hand experiences of affected youth. “Our next priority is to understand what is driving this relationship,” Sheldon explained. “As a first step, we are partnering with Advocates for Youth to conduct workshops with young, child-bearing people living in prohibition states. We want to hear directly from them about how these policies are impacting the mental health of their communities and what supports they think will make the biggest difference.”
Researchers hope to use these community insights to build practical support systems. “Ultimately, we hope to develop and evaluate interventions designed by and for young people to address suicidal tendencies in communities where abortion is completely prohibited,” Sheldon said. “We are also considering whether the mental health effects of complete abortion bans vary by race, age, and other characteristics. We will continue our analysis using CDC Youth Risk Behavior Survey data and are exploring collaborations that can explore these questions using other data sources.”
Mr Sheldon emphasized the importance of including youth voices in future broader policy evaluations. “We hope that these findings will encourage researchers, policy makers, clinicians, educators, and families to listen more to young people and consider their mental health when developing abortion policy and evaluating its outcomes,” Sheldon said.
The study, “Adolescent Suicide Rates After Complete State-Level Abortion Bans,” was authored by Wendy R. Sheldon, Rayan Wadi, Nicole Chen, and Jason M. Lindo.
