Moderators and mediators of the relationship between receiving versus being denied a pregnancy termination and subsequent binge drinking

Changes in Alcohol, Tobacco, and Other Drug Use Over Five Years After Receiving Versus Being Denied a Pregnancy Termination

OBJECTIVE

Research on effects of pregnancy termination on women's alcohol, tobacco, and other drug (ATOD) use suffers from methodological and conceptual problems. Improving on prior methodologies, this study examines changes in ATOD use over 5 years among women seeking terminations.

METHOD

Data are from the Turnaway Study, a longitudinal study of 956 women seeking terminations at 30 U.S. facilities. Participants presented just below a facility's gestational limit and received terminations (Near-Limits) or just beyond the limit and were denied terminations (Turnaways). Using mixed-effects logistic regression, we assessed differences in ATOD use over 5 years among Near-Limits and Turnaways.

RESULTS

There were no differences in ATOD use before pregnancy recognition; 1 week after termination seeking, Turnaways had lower odds than Near-Limits of any and heavy episodic alcohol use (p < .001), but not alcohol problem symptoms, tobacco use, or other drug use. Although both groups increased in any alcohol use over time, Turnaways increased more rapidly. Neither group increased any other ATOD measures over time. Turnaways' lower odds of heavy episodic alcohol use at 1 week after termination seeking were maintained throughout the subsequent 5 years. There was no differential change in problem alcohol use or in tobacco or other drug use over time, yet fewer Turnaways than Near-Limits reported problem alcohol symptoms 6 months through 3.5 years.

CONCLUSIONS

There is no indication that terminating a pregnancy led women to increase heavy episodic or problem alcohol use or to increase tobacco or other drug use. Women denied terminations had temporary or sustained reductions in all alcohol measures, but not tobacco or other drugs, suggesting that relationships between pregnancy/parenting and ATOD differ across substances.

Unintended Pregnancy, Induced Abortion, and Mental Health

PURPOSE OF REVIEW

The early medical literature on mental health outcomes following abortion is fraught with methodological flaws that can improperly influence clinical practice. Our goal is to review the current medical literature on depression and other mental health outcomes for women obtaining abortions.

RECENT FINDINGS

The Turnaway Study prospectively enrolled 956 women seeking abortion in the USA and followed their mental health outcomes for 5 years. The control group was comprised of women denied abortions based on gestational age limits, thereby circumventing the major methodological flaw that had plagued earlier studies on the topic. Rates of depression are not significantly different between women obtaining abortion and those denied abortion. Rates of anxiety are initially higher in women denied abortion care. Counseling on decision-making for women with unintended pregnancies should reflect these findings.