Post-roe psychiatry: part I − A systematic review and multilevel meta-analysis investigating the impact of unwanted pregnancy and denied abortion on mental health

Objective: To study the impact of unwanted pregnancies and abortion denials on maternal mental health and the mental health of children born from an unwanted pregnancy. Methods: Using PRISMA guidelines, we performed a systematic search of PubMed up to June 2022. We grouped articles as follows: Unwanted pregnancies and maternal mental health, mental health of children born from an unwanted pregnancy, abortion denials and maternal mental health, mental health of children born after abortion denial. Where sufficient data were available, a random-effects multi-level meta-analysis using the natural logarithm of the odds ratio (logOR) was performed to measure the effect size. Results: The logOR of overall negative maternal mental health outcomes with unwanted pregnancies compared to wanted or wanted/ unintended pregnancies was 0.50 (95 % CI: 0.39–0.61; p < 0.01), corresponding to an odds ratio of 1.65. Data on mental health diagnoses of women denied an abortion or children born from unwanted pregnancies was scant. No studies were identified that investigated mental health of children born after abortion denial. Conclusions: Data show that unwanted pregnancies significantly increase the risk of adverse mental health outcomes in the mothers (e.g. suicidality, depression, alcohol use). This is a major public health concern and will inevitably lead to additional demands on our already overwhelmed mental healthcare system. It is critical to provide access to the full spectrum of reproductive healthcare, strengthen our mental health care delivery system, and expand public health initiatives geared at primary prevention of unwanted pregnancies.