Op-Ed: As a psychologist, I fear the mental health problems we’ll see post-Roe
The morning the Supreme Court struck down our federal protection for abortion, I reflected on the ruling at home with my son and his girlfriend. For each of us, this ruling was deeply personal. My son expressed anxiety about what would happen if he experienced a birth control mishap.
For his girlfriend, a 19-year-old from Mississippi, the decision left her feeling hopeless, without control of her body and future. She described what she thought would be the devastating effect of denying young people access to abortion in her home state, which mandates abstinence-only sex education and allows pharmacists to refuse requests for emergency contraceptives. Then the last abortion clinic in Mississippi closed on July 6.
For me, the decision goes against years of findings from careful research on this topic. I study the psychological consequences of denying access to abortion, and I fear we are seeing only the beginning of the far-ranging repercussions this ruling will have on the well-being of pregnant people and their families.
Some states exempt fertility care from abortion bans. But what does that mean for bodily autonomy?
My research shows that the burden people experience through reduced autonomy of their bodies — having to navigate more barriers and potentially face increased abortion stigma — is very likely to heighten psychological distress. Those who are denied an abortion experience elevated levels of stress, anxiety and low self-esteem.
In addition to the emotional challenges of trying to exercise one’s reproductive autonomy, people who are denied an abortion are more likely to stay in contact with a violent partner and to experience economic hardship and insecurity that lasts for years because they were forced to carry a child they couldn’t afford to raise. These issues spill over to their children and can compound mental health challenges.
The Dobbs decision is expected to disproportionately harm people of color and other marginalized populations and further exacerbate structural inequities. We need to consider the many groups who will be most affected. They include people in abortion-ban states with limited resources to travel, such as young women, people caring for children, people who can’t take time off work and those who are incarcerated or are too sick to travel. People who discover their pregnancies later, or who have health conditions that are diagnosed later in pregnancy, will have less time to access facility-based care.
Stress and anxiety may grow too among all people of reproductive age — women, men and gender-expansive people, pregnant and not — as they confront the new reality that their reproductive and bodily autonomy has been stripped away.
With the fall of Roe vs. Wade, almost half the country is likely to lose access to abortion. That will increase the need to travel, the cost of seeking care and the difficulty in finding a clinic and scheduling an appointment. The surge of patients going to a limited number of states, such as California, Colorado and Illinois, will likely affect people even in places where abortion is still accessible. Expanding access of medication abortion in these states through alternative models, such as telemedicine and advance provision, can help meet this demand.
States may try to write laws that selectively support pregnant people’s health, but they will fail.
Although options for people living in states with abortion bans are extremely limited, information on how to access and use medication abortion is available and can provide a safe substitute to risky or ineffective methods. We have good evidence that medication abortion pills are safe and effective for people to use on their own.
Nonprofit and community health groups play an important role in providing information as well as emotional and financial support for people who lack abortion access. Helplines such as All-Options can provide emotional care around the pregnancy decision, and the National Network of Abortion Funds can provide financial assistance for travel, lodging and related services.
If you are having an abortion on your own by using pills, there are mobile apps and hot lines that provide information and emotional support. There are real concerns, though, about the criminalization of those who self-manage their abortions, particularly of people who are already disproportionately targeted by the criminal justice system. It is important to know your legal rights around self-managing an abortion and to know where to get legal help, if needed. Given that mental health problems are likely to rise in a post-Roe world, our support systems are critical to meeting this challenge.
M. Antonia Biggs is an associate professor and social psychologist at UC San Francisco’s Advancing New Standards in Reproductive Health program.
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