Abstract
Background and Objectives: Abortion on request, contraceptive access barriers, and mental health may jointly shape women's quality of life (QoL). We examined how abortion history, structural barriers, and psychosocial factors relate to modern contraceptive use, depressive and anxiety symptoms, and QoL among women attending a Romanian tertiary center. Methods: We conducted a single-center observational study combining retrospective chart review with an online survey of 200 women aged 18-45 years. Validated instruments (Patient Health Questionnaire-9 [PHQ-9], Generalized Anxiety Disorder-7 [GAD-7], World Health Organization Five-Item Well-Being Index [WHO-5], and World Health Organization Quality of Life-BREF [WHOQOL-BREF]) and indices of access barriers, perceived stigma, and social support were used. Analyses included multivariable regression, structural equation modelling, latent class analysis, and moderation analysis. Results: Overall, 55.0% of women reported ≥1 abortion on request. Compared with those without abortion history, they were older (31.2 ± 4.9 vs. 26.8 ± 4.8 years, p < 0.001), more often had lower levels of education (51.8% vs. 33.3%, p = 0.013), and were less likely to use modern contraception at last intercourse (52.7% vs. 71.1%, p = 0.012). PHQ-9 (8.8 ± 4.0 vs. 7.3 ± 4.3) and GAD-7 (7.0 ± 3.2 vs. 5.7 ± 3.4) scores were higher (both p = 0.010), while QoL was lower (55.4 ± 8.1 vs. 59.5 ± 7.8, p < 0.001). In adjusted models, access barriers (OR per point = 1.3, 95% CI 1.1-1.6), but not abortion history, predicted non-use of modern contraception. QoL correlated strongly with PHQ-9 (r = -0.6) and WHO-5 (r = 0.5; both p < 0.001). Latent class analysis identified a "high-barrier, distressed, abortion-experienced" profile with the poorest mental health and QoL. Conclusions: Structural access barriers and current depressive and anxiety symptoms, rather than abortion history alone, were key correlates of contraceptive gaps and reduced QoL, underscoring the need for integrated reproductive and mental health care.