Until last Friday, my daughter, born in the 1990s, had the same constitutional rights I did growing up in the Roe v. Wade era. The new Supreme Court decision has changed the rules of the game.
No longer will my daughter take for granted her right to control her reproductive health. If this decision proves to be the first step on a slippery slope (as Justice Thomas suggests it might be), her same-sex friend couples may find their right to marry erased. Many of us never believed it would happen.
We were lucky, or naïve, believing that, of course, we could make our own decisions regarding our bodies. Why wouldn’t we? And then came the decision that would change the lives of more than half of the US population.
In his review of 13th-century English Common Law, Justice Alito cited Henry de Bracton’s treatise:
If a person has struck a pregnant woman, or has given her poison, whereby he has caused an abortion, if the foetus has already formed and animated, and particularly if it be animated, he commits homicide.
However, de Bracton also said, “this slave, this estate, this horse, this garment,” equating slaves to items such as his house and his animal. His views on women were no more enlightened: “Women differ from men in many respects , for their position is inferior to that of men.” And that about sums up how the decision affects the female population concerning our right to make decisions over our bodies; we do not have the same rights as men regarding our reproductive health.
I practice psychiatry just outside the nation’s capital, and I am sure I will see the effects of this decision on my patient’s mental health, just as I did after the 2016 election.
What we know about the effect of abortion denial on mental health
In 1989, the US Surgeon General concluded that “the scientific studies do not provide conclusive data about the health effects of abortion on women” and recommended a long-term study to provide the necessary conclusive data on the topic.
In 2017, The Journal of the American Medical Association published the results of The Turnaway Study. This was the first study to rigorously examine how receiving vs. being denied an abortion affected women and their children. Nearly 1,000 women seeking abortion from 30 facilities around the country participated.
Researchers conducted interviews over five years and compared the mental health of the women who received a wanted abortion to those who were turned away because they were past the facility’s gestational age limit. Not surprisingly, the women who were able to obtain a wanted abortion fared much better in terms of their mental health than those who were turned away.
The main finding of The Turnaway Study was that receiving an abortion does not harm the health and well-being of women, but being denied an abortion results in worse financial, health, and family outcomes.
What we know about unwanted pregnancy
Pregnancy intention may influence attitudes and behaviors in parenting and eventually have an impact on child development. According to multiple research studies, women who conceived unintentionally were more likely to smoke cigarettes, drink alcohol, and take illicit drugs. They were less likely to take a prenatal vitamin or attend prenatal care appointments.
On the other hand, if the pregnancy was intended, once born, the babies had a greater likelihood of receiving prolonged breastfeeding as well as receiving proper vaccinations. Pregnancy intention also has long-term influences on child health. Children born after unintended pregnancy showed a cognitive delay at three years old, more behavioral problems at five and seven years old, and increased problem behaviors and substance use at 14 years old than their counterparts. Unwanted births may also cause poor effects on the mother’s mental health.
Effects on mothers’ mental health
Postpartum depression is maternal depression occurring after birth, typically within the first month after delivery. According to the Centers for Disease Control and Prevention, 10-15 percent of mothers experience postpartum depression within the first year after delivery.
Perinatal depression (PND) is a major depressive episode that occurs during pregnancy or within four weeks after childbirth up to a year. Risk factors for PND include stressful life events, history of depression, poor social support, unplanned and unwanted pregnancies, poor relationship quality, current or previous abuse, and low socioeconomic status.
This mental disorder has been shown to negatively affect mothers’ quality of life and their intimate relationships, birth outcomes, and breastfeeding likelihood, as well as long-term effects on children’s cognitive and emotional development.
In the United States, 50–70 percent of women with PND and/or PPD go undiagnosed, and nearly 85 percent go untreated. This is because, until recently, it was not standard practice to screen for the conditions during routine pregnancy checkups or at the six-week postpartum follow-up visit.
Although robust literature exists on the well-being of women who terminate pregnancies, we know relatively little about the ramifications for the well-being of women who continue unplanned pregnancies to term. One of the reasons for this is that until last week, women in the US were afforded a constitutional right to terminate their pregnancy.
Since the Supreme Court ruling, we are in a new era of women wondering about their options for terminating an unwanted pregnancy either due to force (rape or incest) or due to ineffective or unavailable family planning.
However, a long-term 2016 study from the American Journal of Public Health examined pregnancies resulting in births before Roe v. Wade and found persistent negative mental health effects for women with unwanted pregnancies. These included higher levels of depressive symptoms and a greater likelihood of having had a significant episode of depression for the women who carried unwanted pregnancies to term.
What does this mean for the future?
In January 2022, The Virginia Healthcare Foundation stated:
The COVID-19 pandemic has brought a tsunami of stressors, resulting in a mental health crisis. Behavioral health (BH) professionals throughout the Commonwealth are overwhelmed and Virginians are unable to get the help they need.
Most mental health experts indicate that various pandemic-related traumas (eg, depression, anxiety, panic disorder) and their after-effects will continue far into the future. Unfortunately, the need for BH services is expected to continue to outpace the capacity of Virginia’s licensed BH workforce.
I practice in Virginia, where the shortage of mental healthcare providers will continue to be an issue. This statement was published prior to the Supreme Court decision. I cannot imagine what the increase in demand will be for mental health services once the right to abortion is officially unavailable in at least half of the states.
Women who can travel and have financial means will be able to access abortions in states like Maryland that have laws to ensure safe and available abortion centers. But what about women without financial means or those who must travel a great distance to a state where abortion remains legal?
The justices who voted in favor of striking down a 50-year precedent guaranteeing reproductive freedom seem to care little for what effect this will have on millions of women and their children.