Contraceptive Barriers and Psychological Well-Being After Repeat Induced Abortion: A Systematic Review.

BACKGROUND: Repeat induced abortion (defined as ≥two lifetime procedures) is becoming more common worldwide, yet its independent influence on women's psychological health remains contested, particularly in settings where access to modern contraception is restricted. OBJECTIVES: This review sought to quantify the burden of depression, anxiety, stress, and generic quality of life (QoL) among women with repeat abortions and to determine how barriers to contraceptive access alter those outcomes. METHODS: Following the preregistered PRISMA-2020 protocol, PubMed, Embase and Scopus were searched from inception to 31 June 2025. RESULTS: Eight eligible studies comprising approximately 262,000 participants (individual sample sizes up to 79,609) revealed wide variation in psychological morbidity. Prevalence of clinically significant symptoms ranged from 5.5% to 24.8% for depression, 8.3% to 31.2% for anxiety, and 18.8% to 27% for perceived stress; frequent mental distress affected 12.3% of women in neutral policy environments but rose to 21.9% under highly restrictive abortion legislation. Having three or more abortions, compared with none or one, increased the odds of depressive symptoms by roughly one-third (pooled OR ≈ 1.37, 95% CI 1.13-1.67). Contextual factors exerted comparable or stronger effects: abortions sought for socioeconomic reasons elevated depression odds by 34%, unwanted disclosure of the abortion episode increased depressive scores by 0.62 standard deviations, and low partner support raised them by 0.67 SD. At the structural level, every standard deviation improvement in a state's reproductive rights index reduced frequent mental distress odds by 5%, whereas enactment of a near-total legal ban produced an absolute increase of 6.8 percentage points. QoL outcomes were less frequently reported; where measured, denied or heavily delayed abortions were associated with a 0.41-unit decrement on a seven-point life satisfaction scale. CONCLUSIONS: Psychological morbidity after abortion clusters where legal hostility, financial hardship, or interpersonal coercion constrain contraceptive autonomy while, in comparison, the mere number of procedures is a weaker predictor. Interventions that integrate stigma-free mental health support with confidential, affordable, and rights-based contraception are essential to protect well-being in women who experience repeat abortions.