National Partnership for Women & Families

Monthly Women's Health Research Review

Study: Women With Unintended Pregnancies More Likely To Report Depressive Symptoms in Later Life

Summary of "The Implications of Unintended Pregnancies for Mental Health in Later Life," Herd et al., American Journal of Public Health, Dec. 21, 2015.

"[A]lthough a robust literature documents the well-being repercussions for women who terminated pregnancies, as well as the consequences for the well-being of children who result from unplanned pregnancies, we know relatively little about the ramifications for well-being of women who continue unplanned pregnancies to term," according to Pamela Herd of the University of Wisconsin-Madison, and colleagues.

For their study, the researchers examined "the long-term mental health implications for [women] who bear children resulting from unplanned pregnancies," particularly between women whose pregnancies were "simply mistimed" versus "unwanted altogether." Specifically, the researchers "assess[ed] later-life depressive symptoms and episodes among women who reported unwanted and mistimed pregnancies before Roe v. Wade."

Methods

The researchers used data from "the Wisconsin Longitudinal Study (WLS), a nearly 60-year-long longitudinal study of Wisconsin high school graduates from the class of 1957." The WLS data set was chosen for three reasons:

  • Participants "had experienced nearly all their pregnancies before the 1973 Roe v. Wade decision";
  • The study "contains a broad range of prospectively measured items obtained before the births of participants' children, ranging from parental socioeconomic status to participants' sociopsychological characteristics"; and
  • The longitudinal format allowed the researchers "to explore the implications of these unwanted pregnancies for mental health outcomes in later life."

According to the researchers, the data set "was limited to White and mostly married respondents, all of whom had at least a high school diploma." The cohort included 10,317 individuals who graduated from high school in Wisconsin in 1957. The researchers used data collected from surveys in 1957, 1964, 1975 and 1993.

The original WLS sample consisted of 5,326 women. Of those, 4,809 women (90%) were interviewed in 1975 and 4,199 had given birth to at least one child. According to the researchers, a total of 2,749 women "had complete data on pregnancy intentions in 1975, the covariates, and the mental health outcome measures in 1992."

The researchers found the data set particularly useful because they could "assume that the proportion of WLS respondents who sought abortions was exceedingly small" since the procedure was illegal in Wisconsin until 1973. Further, the homogenous participants were "relatively socially advantaged respondents with comparatively strong educational, financial and social resources," which allowed researchers to control for other variables.

The researchers categorized pregnancies as unintended, mistimed or planned by women's responses to the 1975 survey questions about their pregnancy intentions. They assessed participants' mental health from their responses to the Center for Epidemiologic Studies-Depression (CES-D) scale, a self-reported measure of depressive symptoms that was included in the 1992 survey. Meanwhile, the researchers controlled for participants' IQ, socioeconomic status, education, marital status, age at first pregnancy, personality attributes and number of children. They also controlled for the size of hometown and frequency of attending religious service.

Findings

Researchers found that 47% of women had at least one mistimed pregnancy and 21% had at least one unintended pregnancy. Overall, there were 11,789 pregnancies among the study participants, 34% of which were categorized as unintended pregnancies. "Among unintended pregnancies, 71% were mistimed and 29% were unwanted," the researchers wrote.

According to the researchers, "unintendedness (and especially unwanted pregnancies) increased as birth order increased." They found that while "only 2% of first pregnancies were unwanted, 40% of last pregnancies were unwanted." The opposite was true for mistimed pregnancies: "27% of first pregnancies were mistimed," while "about 16% of last pregnancies were mistimed." Meanwhile, women who reported mistimed pregnancies, rather than planned or unwanted pregnancies, "had a previous pregnancy an average of 22 months earlier compared with 34 and 38 months, respectively, for planned and unwanted pregnancies."

Overall, the researchers wrote that their findings "suggest a strong and persistent relationship between having an unwanted pregnancy resulting in a live birth and poorer later-life mental health outcomes, even when controlling for other variables likely to affect both pregnancy intention and mental health."

The researchers found that "[w]omen with unwanted pregnancies have a 3- or 4-point higher CES-D score than do women with mistimed pregnancies and only planned pregnancies, respectively." Specifically, they noted that "those who had at least 1 unwanted pregnancy had significantly higher CES-D scores ... than did those reporting planned pregnancies." According to the researchers, factors that predicted comparably heightened CES-D scores included "having a college degree versus a high school diploma" and "differences between those married and unmarried." However, they found that "[t]he difference between planned and mistimed pregnancies was not statistically significant."

Further, the researchers found that women "with an unwanted pregnancy were more likely to have reported a significant episode of depression (lasting 2 weeks or more) than were those with all wanted pregnancies." Specifically, the study found that "[w]omen with unwanted pregnancies had 1.42 greater odds ... of having a depressive episode than did women who had planned pregnancies." The researchers found that women "with planned pregnancies were more likely to report a depressive episode than were those with mistimed pregnancies," although that "relationship was only marginally significant."

Discussion and Conclusions

"We examined pregnancies resulting in live birth before Roe v. Wade and found persistent negative mental health effects for those with unwanted pregnancies," the researchers wrote. According to the researchers, "These included higher levels of depressive symptoms and a greater propensity to have had a significant episode of depression for the women who carried unwanted pregnancies to term -- even after controlling for potential cofounders," such as "early life socioeconomic status, high school academic performance, IQ, and personality."

The researchers said their study "adds to a small body of research suggesting that health effects [of unintended pregnancy] on women themselves may be both notable and persistent."

It also "add[s] to a large body of literature suggesting that unwanted versus mistimed pregnancies can create tangibly different experiences for women, although they are almost always grouped together under the larger 'unintended' banner,'" they wrote. They explained that "unwanted pregnancies were more likely to be third-, fourth-, and higher-order pregnancies that occurred after women thought they had completed their childbearing." The researchers noted that the survey design reduced the likelihood that women "reported these pregnancies as mistimed rather than unwanted because of social pressures." Further, they wrote that "the average birth spacing leading to pregnancies classified as mistimed (22 months) compared with unwanted (38 months) varied as would be expected, suggesting the validity of our intention measure."

The researchers noted that their study did not aim "to explore the specific life course pathways that might help explain the link between unwanted pregnancies and poorer later-life mental health," but they offered several possible hypotheses based on other research, such as the additional caretaking demands on women who have children after they believe they are done with childbearing and women's potentially delayed re-entry into the workforce.

The authors "encourage researchers and policymakers to attend to the importance of unintended pregnancies and childbearing in both their understandings of women's short- and long-term well-being and their justification for widely available clinical services that help women prevent and terminate unwanted pregnancies." They also called for "better supports for women who choose to continue unwanted pregnancies."