Rising Above

The intersection of reproductive health and mental health

It appears that the conservative majority on the Supreme Court is preparing to overturn Roe v. Wade, which has safeguarded a woman’s right to abortion for almost half a century.

There are a host of issues that will arise from this move. Regardless of your political leanings, overturning a 50-year precedent is a radical reshuffling of public policy. But because my area of expertise is mental health, I will confine my comments today to the impacts we are likely to see in that area.

I want to acknowledge up front that this is a hard post to write. I know that there are very strong opinions in this space and hope that this post is simply seen as another factor to consider in our ongoing debate on this topic.

So, what are some of the impacts of this potential legal decision?

Economic Precarity

The immense economic hardship that often accompanies unplanned or unwanted pregnancies can create additional stress. Not only can an unintended birth potentially limit a woman’s earning potential by affecting her participation in the labor force, but a recent study showed women who were denied abortion care were at a much higher risk of having increased financial debt, declaring bankruptcy, and having a below-prime credit score for up to five years after birth.

In recent years, unintended pregnancies -- and thus the request for abortions -- has become more concentrated among low-income populations. The rate of unintended births among women whose income falls below the Federal Poverty Line is five times greater than women whose income was 200% of the FPL. And the rate among Black women was more than double that among White women. Further restriction of abortion access could exacerbate these existing income disparities.

Effect on Children

The ramifications of being denied abortion care are, unfortunately, not necessarily limited to the woman seeking one. A finding of the Turnaway Study, which was a five-year longitudinal study of women from across the country who sought abortion care and were denied due to their facility’s gestational age limit, showed that the existing children of women who had been denied abortions had lower child development scores on average, and were more likely to be living below the Federal Poverty Level.

Denial of abortion care can also lead to poor maternal bonding between the mother and child, adversely affecting the child’s emotional growth. And it may force some women to stay in physically or emotionally abusive relationships, keeping them reliant on a violent partner that poses their own threat to her and/or her children.

Loss of Personal Autonomy

It should be asked what role, if any, the government should have in regulating or intervening in the confidential relationship between a woman and her medical provider. After all, health is a “fundamental human right,” according to the World Health Organization, and “the right to health also means … having access to sexual and reproductive information and services, free from violence and discrimination.” A 2020 study showed that women who faced barriers to receiving an abortion, including state-mandated wait times, reported feeling a loss of autonomy as well as concern about the stigma that would come from disclosing their pregnancy, both of which correlated with increases in stress, anxiety, and depression.

Emotional Repercussions

Advocates of restricting choice have popularized anecdotes of women who later regretted having an abortion. This is a deeply personal decision -- one of the most personal someone can make -- and we should expect people to experience this differently.

However, the research is clear that denying choice causes significant issues with mental health. Another finding of the Turnaway Study showed that women who were denied abortions displayed significantly more symptoms of anxiety, low self-esteem, and low life satisfaction than women who had received abortions. Conversely, women who did receive abortions were nearly unanimous in reporting feelings of relief and confidence in their decision after five years.

A study by the National Institute of Health found that women who carried through unwanted pregnancies were more likely to experience symptoms of postpartum depression than those who had planned pregnancies.

In addition, carrying an unwanted pregnancy to term, or being given medically inaccurate information as a means to deter abortion (e.g., that abortion increases the risk for breast cancer) can lead to extremely elevated stress levels that can have detrimental effects not only on the mother’s physical health, but also increase the risk of serious birth complications, and potentially increase infant mortality.  

Women everywhere deserve equal rights to safe, comprehensive medical care. With accessibility to reproductive care facing an uncertain future, it is all the more critical that we broaden and guarantee access to quality mental health care to help as many women as possible. During this national dialogue on abortion, we must think about the multitude of implications on women’s overall mental health and well-being, too.