A new study suggests abortion restrictions may increase the risk of suicide among women aged 20 to 34.

Limited access to abortion may have increased the risk of suicide among women of reproductive age for more than four decades., A new study from the University of Pennsylvania suggests.

Although suicide is rare, it is the second leading cause of death among women aged 20-24 in the US and the third leading cause of death among women aged 25-34.

A study published Wednesday in the journal JAMA Psychiatry found that restrictions on abortion may have played a role in some suicides among young women between 1974 and 2016.

During this period, 21 states enacted at least one Termination Provider Targeted Regulation (TRAP) law that imposes requirements on providers or facilities that provide abortion services, such as requiring facilities to be located nearby. with a hospital, or requires providers to be associated with a local hospital. From 1974 to 2016, the average annual suicide rate among women of reproductive age in these states was almost 6% higher than in previous years when the laws were not enforced.

The study is the first of its kind to show a link between abortion restrictions and suicide rates among young women, said Dr. Ran Barzilai, one of the authors.

Researchers didn’t find the same association for older women, he said, suggesting an increased risk of suicide is common among women directly affected by TRAP laws. The researchers also ruled out other factors, such as the state’s economy or political climate, that affect suicide rates.

“Let’s start with the fact that the numbers are small. We looked at the ultimate adverse, worst-case outcome,” said Barzilai, an assistant professor of psychiatry at the University of Pennsylvania’s Perelman School of Medicine and a psychiatrist at Children’s Hospital of Philadelphia.

In an accompanying editorial published Wednesday, Tyler Vanderville, professor of epidemiology at the Harvard School of Public Health. T. H. Chana, estimated that TRAP laws could be linked to approximately 127 suicides among women of reproductive age in 2016. Elevated suicide rates in states with more restrictive abortion laws “are of clinical concern,” he wrote.

Regardless of what is causing these suicides, he added, the data “indicates a need for support and mental health care” beyond what is currently offered in the US.

Unlike restrictions on abortion that are patient-focused, such as requiring parental consent for minors, TRAP laws impose restrictions on providers or facilities that go beyond what is medically necessary, said Nicole Austin, assistant professor of epidemiology at the University of Dalhousie in Nova Scotia, Canada.

Laws may specify the size of treatment rooms or the width of corridors in an abortion clinic.

“Some laws will impose certain requirements on the nature of the objects themselves – you must have a certain temperature, certain signs. It’s really getting a little ridiculous,” she said.

Austin said TRAP laws could increase travel time to abortion centers or cause them to close, creating barriers for women seeking abortions.

“Instead of walking 5 miles down the road to an abortion provider, your state may have passed some kind of TRAP law and your nearest provider has closed. So, as a consequence, you will find yourself traveling 50 miles,” she said.

Researchers at the University of Pennsylvania have suggested that TRAP laws may increase stress and anxiety in women of reproductive age.

“Stress is associated with an increased mental health burden and in turn is associated with an increased risk of suicide,” Barzilai said.

A five-year research project called The Turnaway Study found that women who have recently been denied an abortion have increased levels of anxiety and stress, as well as lower levels of self-esteem. But the study also found no difference in suicidal ideation among women who were denied an abortion compared to those who did.

However, that study ended in 2016, so it’s not clear how new restrictions on abortion, such as the Supreme Court’s decision to overrule Roe v. Wade, affected suicide rates among young women. More than a dozen states have banned abortion since the Dobbs decision was passed in June.

“From a purely speculative standpoint, I expect the recent Supreme Court ruling to have a real impact on many women on an individual level that the TRAP laws will not,” Austin said.

One study found that the average travel time to abortion centers increased from 30 minutes in 2021, before the Dobbs decision, to 100 minutes in September. The proportion of women of reproductive age living more than an hour away from an abortion site also increased from 15% to 33% during this time.

Barzilai said Dobbs’ solution could potentially increase stress levels among young women, although he warned that more research is needed to demonstrate this effect.

“What causes stress in a person who needs an abortion? It is a loss of opportunity to do so,” he said.