Socioeconomic Disparities in Postpartum Depression Following Abortion Restrictions: A Difference-in-Differences Analysis of Medicaid Data Post-Dobbs
Author(s)
Facundo Sepulveda, PhD1, Onur Baser, MS, PhD2, Yuanqing Lu, MS3, Amy Endrizal, MPH, JD3.
1University of Santiago, Santiago, Chile, 2Graduate School of Public Health, City University of New York (CUNY), New York, NY, USA, 3Columbia Data Analytics, New York, NY, USA.
1University of Santiago, Santiago, Chile, 2Graduate School of Public Health, City University of New York (CUNY), New York, NY, USA, 3Columbia Data Analytics, New York, NY, USA.
OBJECTIVES: The 2022 US Supreme Court decision in Dobbs v Jackson Women’s Health Organization led to the implementation of abortion bans or severe restrictions in several states. Prior research links restricted abortion access to increased mental health distress, with low socioeconomic status (SES) populations at heightened risk for postpartum depression (PPD). We evaluated the impact of post-Dobbs abortion restrictions on PPD diagnosis rates across SES groups using Medicaid claims data to predict potential effects in states without current abortion bans.
METHODS: A retrospective cohort study was conducted using claims from the Kythera Labs Medicaid population from 01JAN2019-31DEC2024, capturing 60% of the US Medicaid population. Women aged 12-55 years with pregnancy resulting in live or stillbirth were categorized into SES terciles based on ZIP code-level census data. A difference-in-differences model was used to compare PPD rates before and after Dobbs in states with and without abortion trigger laws, adjusting for demographic, clinical, and state-level factors. Sensitivity analyses addressed the unique legislative context in Texas.
RESULTS: Among low-SES women, residence in a trigger state post-Dobbs was associated with a significant (9.0%) increase in PPD diagnoses vs non-trigger states. No significant effect was observed in medium- or high-SES groups. State-level predictions indicated that the largest increases in PPD rates occurred in states with the greatest socioeconomic disadvantage. Extrapolation to non-trigger states suggested an average increase of 0.97% in PPD diagnoses if similar abortion restrictions were enacted.
CONCLUSIONS: Abortion restrictions following Dobbs significantly increased PPD risk among low-SES women, exacerbating existing health disparities. States with the most vulnerable populations experienced the greatest mental health impact. These findings highlight the need for targeted mental health interventions and policy consideration of SES-related inequities in reproductive health outcomes.
METHODS: A retrospective cohort study was conducted using claims from the Kythera Labs Medicaid population from 01JAN2019-31DEC2024, capturing 60% of the US Medicaid population. Women aged 12-55 years with pregnancy resulting in live or stillbirth were categorized into SES terciles based on ZIP code-level census data. A difference-in-differences model was used to compare PPD rates before and after Dobbs in states with and without abortion trigger laws, adjusting for demographic, clinical, and state-level factors. Sensitivity analyses addressed the unique legislative context in Texas.
RESULTS: Among low-SES women, residence in a trigger state post-Dobbs was associated with a significant (9.0%) increase in PPD diagnoses vs non-trigger states. No significant effect was observed in medium- or high-SES groups. State-level predictions indicated that the largest increases in PPD rates occurred in states with the greatest socioeconomic disadvantage. Extrapolation to non-trigger states suggested an average increase of 0.97% in PPD diagnoses if similar abortion restrictions were enacted.
CONCLUSIONS: Abortion restrictions following Dobbs significantly increased PPD risk among low-SES women, exacerbating existing health disparities. States with the most vulnerable populations experienced the greatest mental health impact. These findings highlight the need for targeted mental health interventions and policy consideration of SES-related inequities in reproductive health outcomes.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HPR187
Topic
Epidemiology & Public Health, Health Policy & Regulatory, Real World Data & Information Systems
Topic Subcategory
Health Disparities & Equity, Reimbursement & Access Policy
Disease
Mental Health (including addition), Reproductive & Sexual Health