Using records from the Danish health registry, researchers looked to see if a person’s first medication or procedural abortion was related to filling a mental health prescription for the first time, as a way to measure whether abortion method affects mental health. The studied group had never previously filled a mental health prescription.

The study tracked prescriptions filled for a variety of psychiatric conditions, such as depression and anxiety, following a person’s first abortion. From one-year post-abortion and beyond, the researchers found no statistically significant increase in fulfillment of mental health medication when adjusting for multiple tests. More than five years afterwards, filling such prescriptions decreased when adjusting for multiple tests.

“Counter to a common perception around abortion, the results showed neither medication nor procedural abortion caused the use of  psychotropic medications, which suggests that neither method increases risk of mental health issues,” said Dr. Julia Steinberg, lead author of the study and an associate professor in the Department of Family Science at UMD’s School of Public Health.

Steinberg and her Danish colleagues analyzed thousands of Danish health records of women and girls, aged 12 to 38, who had an abortion by medication or procedure in their first trimester of pregnancy and between the years 2000 and 2018. Denmark has provided abortions through its nationalized health care since legalization in 1973.

Researchers compared prescriptions from one year before the person’s abortion with prescriptions claimed in the first year, one to two years afterwards, two to five years afterwards, and over five years afterwards.

The study looked at all mental health medications, treating a wide variety of conditions including sleep disorders and ADHD, as well as medications that specifically target anxiety and depression.

“This research helps us better understand the association between abortion method and mental health. We did not investigate social factors like cultural stigmas around abortion, which could impact the mental health of a person after having an abortion, and are likely to vary by place and culture,” Steinberg said.

Within the year after a first abortion, the data showed a slight increase in psychiatric prescription use. However, after applying a common statistical adjustment necessary when analyzing a high number of variables and comparisons, researchers found the risks in that first year were no longer statistically significant.

The study used data from the Danish population, where over 94% of people are white and where the national culture, legal framework and access to abortion and health care differs from the United States.

“While the study focused on Danish data, the results are an important rebuttal to claims that abortion – particularly medication abortion – harms mental health,” Steinberg said.

Steinberg co-led a 2024 study examining whether mental health disorders, measured by psychiatric diagnoses, increased after a medication or procedural abortion, finding neither abortion method increased risk of psychiatric diagnoses in the short or long-term.

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The research team found that the number of women undergoing tubal ligations — a surgical procedure that permanently prevents pregnancy — increased 51% across four academic medical centers in four states in the year after the Supreme Court decision compared to the prior year. A greater proportion of those seeking the procedure were also younger and had never given birth before.

The study, which was published in the journal Contraception, is the first to examine the impact of political factors on patients deciding to seek female permanent contraceptive procedures. Almost half of those seeking the procedure reported that their decision was somewhat or very related to the current political climate, even in states considered to be protective of abortion access.

“The Dobbs decision was an inflection point that made people think about their future plans,” said Sarah Horvath, associate professor and vice chair of research in the department of obstetrics and gynecology and co-author on the study. “More than anything, we saw that the Dobbs decision impacted the timing for people seeking tubal ligations more than it influenced the actual decision to have the procedure.”

Tubal ligations are a safe and effective method of preventing pregnancy permanently, explained Horvath. After the Dobbs decision, she and her colleagues witnessed an uptick in the number of people pursuing tubal ligations or asking about the procedure, a trend that has been noted in other studies in the field. But there wasn’t much information available on the reasons why individuals were seeking this method of contraception.

The researchers collected data from four academic medical centers across states with a range of abortion policies and compared procedure volumes the year before and after the Dobbs decision — from July 2021 to June 2022 and from July 2022 to June 2023, respectively. The centers were located in New York, Pennsylvania, Florida and Tennessee.

In New York and Pennsylvania, the researchers also asked patients to complete a survey during their consultation appointment to learn more about their decision-making process. The survey included questions about how long a patient has known they wanted permanent contraception, any prior attempts to obtain permanent contraception, reasons for choosing this method of contraception over reversible options, reasons for seeking the procedure at this time and if their decision was related to the current political climate.

Across all four centers, the number of procedures increased from 445 in the year prior to Dobbs to 674 in the year after, an increase of 51%. The profile of those seeking permanent contraception shifted, too, with more individuals under the age of 30. The proportion of patients who haven’t previously given birth also increased from 10.2% to 21.2%.

“I didn’t really have anyone come in who had never thought about permanent contraception before Dobbs and now, all of a sudden, they wanted the procedure. That didn’t happen,” Horvath said. She explained that most patients she encountered were satisfied with their current reversible contraceptive method but were worried that their options would be more limited in the future or that their insurance wouldn’t cover their preferred method anymore. Those concerns prompted them to seek a permanent method to prevent pregnancy.

The data also showed differences across states that didn’t align with the degrees of abortion restrictiveness in the state, the researchers explained. New York, a state considered to be protective of abortion access saw the biggest jump in monthly procedures, increasing by 128%. Procedures increased by 70.6% and 32.6% in Tennessee and Florida, respectively — states that are more restrictive when it comes to abortion — whereas procedures increased 28.4% in Pennsylvania.

Among individuals in New York and Pennsylvania, 47% reported that the current political climate was somewhat or very related to their decision to obtain permanent contraception. While most individuals sought the procedure because of its effectiveness and permanence, one in five individuals cited concerns about future access to reproductive health options including abortion in addition to permanent and reversible contraception options.

“There was a lot of fear after Dobbs that people would no longer have control over their reproductive rights,” said co-author Alice Cai, who earned her medical degree and completed her residency at Penn State College of Medicine during the time of the study and currently practices in West Chester, Pennsylvania. “We saw that even in states with more protective policies like New York, people still made decisions based off of that fear.”

Other authors on the paper include Rachel Flink-Bochacki and Sarah Pogge from Albany Medical Center; Amelia Llerena and Cheryl Godcharles from the University of South Florida; and Megan Young, William Havron IV and Nikki Zite from the University of Tennessee Medical Center.

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Researchers looked at population data from ICES to examine abortion service availability changes in Ontario from January 2017 to December 2022. Between 2017 and 2022, there were more than 226 000 abortions provided to 175 091 people. The proportion of regions with a pharmacy that dispensed mifepristone increased from 20% in 2017 to 82% in 2022. Only 37% of abortion service users lived in a region with either a mifepristone-dispensing pharmacy or procedural provider in 2017, but this increased to 91% by 2022.

Access to abortion services increased in both urban and rural areas.

“Despite these rapid gains in access to procedural or medication abortion services, in 2022, 6% of regions had no pharmacy at all, nearly 20% of regions with a pharmacy still lacked a pharmacy that dispensed mifepristone, and roughly 9% of abortion service users lived in a region without a local procedural provider or a pharmacy that dispensed mifepristone,” writes Dr. Laura Schummers, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, with coauthors.

The authors note that the expansion of mifepristone to community pharmacies shifted the delivery of abortions from procedural abortions to more accessible mifepristone abortions, a trend they expect to continue.

“Abortion service needs are time-sensitive, as risks of abortion complications increase exponentially with increasing gestational age. It is likely that the proportion of abortions provided by medication in Ontario will continue to increase beyond our study period, mirroring trends elsewhere.”

“Changes in local access to mifepristone dispensed by community pharmacies for medication abortion in Ontario: a population-based repeated cross-sectional cohort study” is published April 7, 2025.

Media contact: Media relations, ICES, media@ices.on.ca

General media contact: Kim Barnhardt, CMAJ, kim.barnhardt@cmaj.ca

Please credit CMAJ, not the Canadian Medical Association (CMA). CMAJ is an independent medical journal; views expressed do not necessarily reflect those of its owner, CMA Impact Inc., a CMA company, or CMA.

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The study relied on data from the Household Pulse Survey, a monthly online survey by the United States Census Bureau in collaboration with other federal agencies that gathers a vast array of data on representative samples of American adults from all 50 states and the District of Columbia. Investigators analyzed information on the 126,834 adults in waves 41–49, roughly capturing the period between January and September of 2022—before and after the Supreme Court ruling.

Women of reproductive age, especially those with young children, living in states where abortion became illegal after the ruling reported greater increases in anxiety symptoms relative to both older women living in the same states and similar-age women living in other states where abortion access remained unchanged. Younger men (especially white men and men without children) in states where abortion became illegal reported decreases in anxiety symptoms.

“The survey data shows just how strongly people feel about abortion policies,” said corresponding author J. Michael Collins, PhD, of the University of Wisconsin–Madison. The study’s co-author, Vivekananda Das, PhD, of the University of Utah, added that “younger women are highly aware of state-level abortion policy changes, and this awareness can take a toll on their mental health. The contrast with younger men in the same states highlights a notable gender gap in response to these policies.”

URL upon publication: https://onlinelibrary.wiley.com/doi/10.1111/coep.12678

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What We Know: Mifepristone and misoprostol taken together remain the standard for medical management of early pregnancy loss (EPL) and first-trimester abortion. While misoprostol is readily available, distribution of mifepristone has been restricted, regardless of reason for its use. Despite its documented safety, mifepristone is regulated by a Risk Evaluation and Mitigation Strategy (REMS) program—a barrier for both labeled and off-label use.

What This Study Adds: Study authors created standard processes for ordering and documenting mifepristone administration that were in compliance with the new regulations restricting use of this medication. This process reduced barriers to providing both management of early pregnancy loss and first-trimester abortion care.

Streamlining the Use of Mifepristone for Early Pregnancy Loss Across a Large Health Care System Sets the Stage for Rapid Expansion of Medication Abortion Access in a Post-Roe Environment

Nicole Chaisson, MD, MPH, University of Minnesota Medical Center Residency Program, Department of Family Medicine and Community Health, University of Minnesota Medical School, St. Paul, Minnesota, and Katherine Montag Schafer, PharmD, St. John’s Hospital Family Medicine Residency Program, Department of Family Medicine and Community Health, University of Minnesota Medical School, St. Paul, Minnesota

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