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With the U.S. Supreme Court set to issue a ruling that could potentially overturn the 49-year-old landmark Roe v. Wade decision that granted pregnant people the constitutional right to an abortion, researchers and mental health professionals are concerned about the potential harm of denying people access to abortion care.
On May 3, the day after Politico first reported a leaked draft opinion that showed the nation’s highest court was set to strike down the ruling, the American Psychological Association said in a statement that it was “deeply concerned” about the prospect, citing the potential “harm to women’s mental health.”
“Rigorous, long-term psychological research demonstrates clearly that people who are denied abortions are more likely to experience higher levels of anxiety, lower life satisfaction, and lower self-esteem compared with those who are able to obtain abortions,” the professional organization’s president, Frank C. Worrell, said.
Antonia Biggs, an associate professor and social psychologist at the University of California San Francisco’s Advancing New Standards in Reproductive Health program, has been studying the psychosocial burden experienced by people accessing abortion care from different perspectives for more than a decade.
She said that overturning Roe would have a “huge” impact on the mental health of Americans trying to access abortion care.
Through a five-year turnaway study, which examined the effects of receiving versus being denied a wanted abortion, Biggs said researchers found that denying people access to a wanted abortion led to increased symptoms of stress, anxiety, and low self-esteem, compared to being able to get a wanted abortion.
The study also found a relationship between “perceived abortion stigma and negative adverse psychological consequences,” Biggs said.
“We also found from the turnaway study that having an abortion — the most common emotion experienced after having an abortion — was relief and that the majority of people, so 99 percent of people who had an abortion, said that they felt that the abortion was the right decision for them,” Biggs told the Capital-Star.
A Matter of International Understanding
Earlier this year, Nancy Russo, regents emeritus professor of psychology and women’s studies at Arizona State University, wrote to her colleagues in the International Psychology Bulletin that the United Nations has embraced “concepts of reproductive justice and equity.”
Russo said that the precedents set by court cases brought to international and regional human rights bodies and courts worldwide recognized “that denial of legal abortion services can violate a range of human rights, including the right to be free from cruel, inhuman and degrading treatment, and the right to privacy,” among others.
“In recognizing that denial of access to lawful abortion can amount to cruel, inhuman and degrading treatment, the standards highlight that this treatment encompasses both physical pain and mental suffering,” Russo wrote. “The U.S. has much to learn from the experiences of diverse countries in the quest to improve the health of women and children at home and around the world.”
According to a 2013 report by the United Nations’ Department of Economic and Social Affairs, nearly two-thirds (64 percent) of countries permitted abortion when the physical or mental health of the mother was in danger, compared to 52 percent of countries in 1996.
As of 2013, 126 countries around the world allowed for abortions to preserve a woman’s mental health compared to 99 countries in 1996.
Similarly, the report found that 86 percent of countries in developed regions allowed abortions to preserve a woman’s mental health compared to 57 percent in developing regions.
The Negative Effect of Unwanted Pregnancies
Russo also said that the mental health effects of denying pregnant people an abortion extend beyond the individual.
“Prospective studies have found that if a pregnant woman identifies a pregnancy as unwanted, her subsequent child will be at risk for a wide range of negative outcomes, including deficits in cognitive, emotional, and social processes,” Russo wrote in Salud Mental, a Mexican psychiatric journal, in 2014. “These effects can begin prenatally, emerge at different stages over the life cycle and be transmitted intergenerationally.”
Two studies — one conducted in Sweden and the other in Finland — found that the mental impact of being forced to carry an unwanted pregnancy to term reached into adulthood for the child, leading to a higher risk of schizophrenia.
Similarly, research suggests that the children of unwanted pregnancies have a higher likelihood of engaging in criminal behavior, being on welfare, having an unstable marriage, and receiving mental health services, according to a 2011 article published in the American Journal of Orthopsychiatry by researcher Henry P. David.
Impact on Inequities
The ramifications don’t end there, Biggs said, noting the hurdles young people, those with limited resources, or those who discover their pregnancies late, might have to endure.
“This decision — overturning Roe — really has the potential and is very likely to further exacerbate structural inequities that are going to lead to a host of negative outcomes, not just to mental health outcomes, but we’re more likely to see the physical consequences of forced birth, increases in psychological distress, financial and economic insecurity, which will have a huge impact on the pregnant people and their families,” Biggs continued.
“I worry about people with limited resources who are unable to travel, about people who discover their pregnancies late, and they need facility-based care, so they have very few options. And then I think about young people who have particularly limited resources or people who speak a language other than English, or people who might be more targeted by the criminal justice system.”
Biggs also expressed concern over the potential effect that forced pregnancy — and forced birth — could have on a person’s ability to leave violent partners.
Data gathered from the turnaway study showed that people who were denied an abortion, and who also experienced partner violence, were more likely to remain in contact with their abuser.
“In the post-Roe scenario, we’re probably more likely to see people who are tethered to violent partners because they’re unable to get their wanted abortion,” Biggs said.
The Bottom Line
Russo and Biggs told the Capital-Star that there are myriad consequences to denying people access to abortion care if Roe is overturned by the Supreme Court.
The mental health impacts of abortion and abortion access are complex and depend on the characteristics of the woman and her personal context, Russo said. “Having an abortion is a stressful life event, but then it’s over, and the majority of women cope with the stress and move on. Having a child is a chronically stressful life event that will require substantially more coping resources. I suspect that if Roe is overturned completely, the mental health of women who were just fine after having an abortion years ago will take a deep dive if – as has been threatened – states define abortion as ‘murder’ and decide to go after them.”
As of June 13, more than a dozen states have “trigger laws” that would ban all or nearly all abortions should Roe be overturned, according to the Guttmacher Institute, which studies reproductive health policies.
“I guess, what I want to emphasize is this is going to affect everybody, not just people living in those states that lose access to care,” Biggs said. “The challenges to meet the surge in patients in just a few states is going to be huge and impact everyone in need of care.”
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