Mindpath Health’s Elisabeth Netherton, M.D. helps discuss how forced pregnancy impacts mental health.
When a leaked document foretold the end of Roe v. Wade, the nation was forced to confront its deeply polarized views on abortion. An abortion is defined as any procedure used to terminate a pregnancy. Some people fear that the loss of access to legal abortions now that Roe has been overturned increases dangerous, self-induced pregnancy termination attempts. Others believe that abortions should be reserved for cases of extreme danger—and sometimes, not even then.
Many arguments against abortion are centered in religious or moral convictions. However, others fear that having an abortion leads to long-term distress–not only physically, but mentally as well. They believe that abortions result not in relief, but in depression, anxiety, guilt, and shame.
What these arguments fail to consider is the flipside: that not having an abortion, or being forced to carry out an unwanted pregnancy, is more likely to result in several physical, mental, social, financial and emotional hardships. Here, we’ll focus on how proven consequences of forced pregnancies affect mental health.
It’s important, first, to understand why abortion opponents are celebrating the demise of Roe v. Wade. In the published opinion, Justice Samuel Alito presented several pervasive counterarguments as reasoning for the decision’s overturning. On behalf of “Americans who believe that abortion should be restricted,” he argues:
“They note that attitudes about the pregnancy of unmarried women have changed drastically; that federal and state laws ban discrimination on the basis of pregnancy; that leave for pregnancy and childbirth are now guaranteed by law in many cases; that the costs of medical care associated with pregnancy are covered by insurance or government assistance; that States have increasingly adopted ‘safe haven’ laws, which generally allow women to drop off babies anonymously; and that a woman who puts her newborn up for adoption today has little reason to fear that the baby will not find a suitable home.”
It is true that many parents have access to more resources and technology than they would have in the 1960s. It’s also true that abortion rates have significantly declined in recent decades. Unfortunately, the reality of unwanted pregnancy is still more grim than Justice Alito presents.
Economic insecurity of people with unwanted pregnancies
In 2018, a groundbreaking study was conducted: Research into the mental health not of people who received abortions, but people who were denied abortions because they were past the gestational age limit. Conducted by a team of researchers at the University of California, San Francisco, The Turnaway Study, illuminated several hardships routinely faced by people forced to carry pregnancies to term. One of the Turnaway Study’s major findings? That “denying a woman an abortion creates economic hardship and insecurity which lasts for years.”
In 2016, the Guttmacher Institute revealed that nearly half of abortion patients live below the federal poverty level, with another 26% being considered low-income.
For them, getting an abortion is objectively less expensive than raising a child would be. In contrast, being forced to have a child could mean years of added expenses, sending the parent even deeper into poverty. The Turnaway Study also showed that after being denied a wanted abortion, women were 3 times more likely to be unemployed than women who had abortions. Those lost wages and higher expenses mean increased financial worries, which could have significant mental health impacts in the long term.
More likely to stay in contact with abusive partner
Research also shows that it’s harder for women to leave an abusive partner after having a baby with that partner. Data from The Turnaway Study show that experiencing violence from a partner is one reason why some women seek abortion if they become pregnant. Anywhere from 6% to 22% of women having abortions report recent abuse from an intimate partner.
“In particular, women who report violence as a reason for abortion describe not wanting to expose children to violence and believing that having the baby will tether them to an abusive partner,” write Roberts, et al., 2014.
Being unable to access abortion care and continuing the pregnancy means that women are more likely to remain in physically abusive relationships for another two and a half years. The mental health impacts of intimate partner violence are significant, ranging from feelings of guilt and shame to conditions like anxiety, depression and post-traumatic stress disorder (PTSD).
What happens to the children a parent already has?
A 2019 follow-up examination using Turnaway Study data found that restricting a woman’s abortion access may have negative developmental and economic consequences for the children they already have. And because 60% of women seeking abortions are already mothers, these consequences are a major factor for many families.
“One of the main reasons people report wanting to have an abortion is so they can be a better parent to the kids they already have,” says Ushma Upadhyay, a professor with Advancing New Standards in Reproductive Health at the University of California, San Francisco, to The New York Times.
For up to four and a half years following a denied abortion, the children of mothers who were not able to receive an abortion had lower average development scores and were more likely to live below the Federal Poverty Level than children of mothers who sought and received an abortion.
Parental mental health is directly connected to a child’s social, emotional and behavioral development. Research also shows that when a parent’s mental health suffers, it’s a major predictor of distress and mental health concerns later in their child’s life.
Risk of future physical and mental health problems
No pregnancy is without risk of potential complications, and restricting abortion access forces some pregnant people to continue their pregnancies to delivery, “leaving them to face the many health risks associated with pregnancy and childbirth,” notes ACOG. “This includes the emergence of new complications associated with pregnancy and worsening of existing conditions.” For Black women, those pregnancy risks are much higher: they’re 3 to 4 times more likely to die in childbirth than white women.
There’s also a direct connection between physical health and mental health. Living with a chronic physical condition such as diabetes or heart disease makes people more likely to experience anxiety and depression.
And because women who seek abortions are more likely to be living under the Federal Poverty Level, it also follows that they may not have access to health care, making their risk of future physical health issues much more grave.
Pregnancy in general is a time for increased risk of mood disorders, especially if you have a history of depression or another mental health condition. And with postpartum depression affecting 1 in 8 women, the postpartum period is also a critical time for increased healthcare support.
Ultimately: “Pregnancy and delivery can be traumatic under the best of circumstances,” says Dr. Elisabeth Netherton, a psychiatrist with Mindpath Health, to Verywell Health.
Denying abortion access impacts mental health
“There are many negative consequences associated with denying an abortion to someone who wants one,” says Kiki Freeman, CEO of Hey Jane, a digital abortion clinic. “[The Turnaway Study] found that, amongst those who had been denied an abortion, there were higher instances of worse economic and mental health than for those who received one. For example: those who had been denied an abortion experienced immediately higher levels of anxiety, poor self-esteem and lowered life satisfaction,” she notes.
Conversely, a 2020 study analyzing data from The Turnaway Study found that nearly all people who have an abortion report five years later that it was the right decision for them, even if the decision was difficult to make at the time.
To remove a person’s access to healthcare—and abortion is healthcare, according to ACOG—immediately saddles someone with significant mental health effects.
“This debunks the idea that most women suffer emotionally from having an abortion,” says Corinne Rocca, PhD, MPH, associate professor in the UCSF Department of Obstetrics, Gynecology and Reproductive Sciences, and first author of the 2020 study, in a statement.
The Turnaway Study authors estimate that more than 4,000 women are turned away from having an abortion every year. That number will only increase once more states pass laws on the gestational limits for abortion, or ban abortion altogether now that Roe v. Wade is overturned.
When women are able to access a wanted abortion, they are more likely to have a positive outlook on the future and achieve aspirational life plans within one year. But denying a woman an abortion results in economic hardship and insecurity—often lasting for many more years to come.
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