How Abortion Bans Harm Mental Health

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COMMENTARY

Frozen embryos are children, rules Alabama Supreme Court,¹ meanwhile Alabama’s maternal mortality rate is the third highest in the nation.² Instead of legislation aimed at reducing pregnancy-related deaths, Alabama’s government banned abortion in 2022 and now paves the way for more restrictions on reproductive care. Pregnant individuals living in states with abortion bans are more likely to die from a pregnancy-related complication than those living in states where abortion is legal.³ Meanwhile maternal mental health issues are driving an increase in death rates in the United States.⁴

Lack of abortion access fuels mental illness by exacerbating stress, poverty, and domestic violence.

Mental illness is one of the most common health problems in the United States. In fact, more than 1 in 5 individuals in the United States are living with a mental illness.⁵ A 2023 Gallup Survey found that 29% of US adults have been diagnosed with depression, an increase from 19.6% in 2015.⁶ Rates of depression among US adults tripled in the pandemic, resulting in part from collective trauma and isolation.⁷ Add on top of that the 2022 Supreme Court decision enabling state governments to ban abortion, leading to increased distress for those who could become pregnant.⁸ In fact, a review examining data from across the United States found a nearly 6% increase in suicides among reproductive-aged individuals corresponding with the enforcement of targeted restrictions of abortion providers.⁴

I have encountered patients with severe mental illness who have an unwanted pregnancy compounding their distress. I have seen both teens and adults taken off all psychiatric medication due to discovery of a pregnancy they want to end. A 2022 study discovered an association between increased risk of psychiatric emergencies for those who discontinued medication during pregnancy when compared to those who continued treatment throughout their pregnancy.⁹ In addition to mental health issues, being denied a wanted abortion is correlated with more serious health issues and pregnancy complications.¹⁰

Research demonstrates that when a wanted abortion is denied, families are more likely to spend extended time impoverished.¹⁰ Across the United States, rates of poverty have increased from 7.4% in 2021 to 12.4% in 2022.¹¹ This number has more than doubled for children. Increased levels of economic stress, social stigma, and shame, among other issues, are factors contributing to the development of mental illness.^12-14 Lack of financial stability increases levels of stress and feelings of shame.^15,16 Impoverished communities have higher rates of mental illnesses such as depression than those with access to more resources.¹⁷ In addition, individuals with existing mental illnesses are more likely to become impoverished, so the cycle continues.¹⁸ Combine this with the fact that individuals living below the poverty line experience unintended pregnancy at 5 times the rate of those with higher incomes and have abortions at 6 times the rate.¹⁹

As a licensed clinical social worker specializing in abortion care, I see patients in positions of desperation who have considered self-harm in an effort to induce a miscarriage. Despite the decriminalization of abortion in Queensland Australia in 2018, those reaching out for support to an all-options pregnancy counseling service described encounters with pregnancy people seeking services who reported considering suicide or actively self-harming in an attempt to end their pregnancy.²⁰ Nearly half of all abortions worldwide are unsafe abortions, leading to preventable morbidity and mortality. Methods range from ingesting dangerous chemicals, self-induced physical injuries, and procedures performed in unsanitary conditions or by unskilled practitioners.²¹ Many of the individuals I see for care rely on financial assistance provided by abortion funds and would be unlikely to afford care otherwise. I have conducted many assessments and formed safety plans for individuals experiencing significant emotional distress if their care is delayed or if they are unable to get an abortion due to their length of pregnancy. Abortion providers, funds, practical support organizations, and organizers work tirelessly to mitigate the harm caused by abortion restrictions and bans, yet we are deeply aware that there are many individuals across the United States who are unable to access care. Diminishing access to abortion for the most vulnerable and promotes social conditions that contribute to mental illness and preventable suffering.

Pregnancy is also a vulnerable time for intimate partner violence, and those who are denied a needed abortion are more likely to stay in contact with their abusers.¹⁰ Violence often escalates in pregnancy. In fact, homicide is a leading cause of maternal mortality.²² Experiencing domestic violence increases the risk for posttraumatic stress disorder, depression, and suicide.²³ Children raised in homes where they witness domestic violence are at an increased risk for a variety of mental and physical illnesses and are more likely to find themselves in violent relationships as they grow older.²⁴ Violence in the home, often compounded by lack of resources, creates the perfect conditions for mental illness to begin. And so the cycle of violence often repeats itself.

To be sure, the overwhelming majority of individuals do not intentionally harm themselves or their infants. However, psychological distress, desperation, and many other factors contribute an increased risk of self-harm and suicide. Unplanned pregnancies are associated with the development of postpartum depression,²⁵ and in the United States nearly half of all pregnancies are unplanned.²⁶ I have spent my career working with patients facing unplanned, unwanted, and mistimed pregnancies. Desperation can lead individuals to do anything in their power to end a pregnancy. While self-managed abortion with misoprostol is a safe way to have an abortion outside of a clinical setting, not everyone has access to that information or to resources to obtain these medications, and there is a risk of criminalization.²⁷ I have spoken with folks who consider various forms of self-harm in an attempt to induce an abortion, regardless of the impact to themselves—a direct result of psychological distress. In the US, mental health care is woefully inaccessible,²⁸ but even when it is, mental health services cannot solve the problem of feeling out of control of what is happening to your body and life.

Patients need access to the time-sensitive life-saving health care that is abortion. Organizations like the Online Abortion Resource Squad provide individuals with vital information about accessing safe abortion care. Abortion funds allow individuals to get abortions regardless of ability to pay. Independent clinics who have less resources than organizations with more name recognition provide the majority of abortions nationwide.²⁹ But more funding is always needed. In addition to financial support, we need to disseminate accurate information about abortion, including self-managed abortion,³⁰ and how it can be life-saving and protective against mental illnesses. Even talking openly about abortion is a good start.

Mx Hanz Dismer is a Public Voices fellow of The OpEd Project and AcademyHealth.

References

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2. Sacks K, Mansell L, Shearon B. Maternal mortality among vulnerable communities. Milken Institute. August 2023. Accessed February 26, 2024. https://milkeninstitute.org/sites/default/files/2023-07/MaternalMortalityamongVulnerableUSCommunities.pdf

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