Mental health conditions are rarely considered medical exceptions for abortion care

Of the 24 states with laws that either ban or restrict abortion care, only one gives an exception for mental illness. 

Alabama is the only abortion-restrictive state with an exception to its ban on abortion for someone with a “serious mental illness” diagnosed by a psychiatrist. According to the Kaiser Family Foundation, Georgia, Kentucky, Louisiana, Ohio, Tennessee, Idaho, Florida, Iowa, West Virginia, and Wyoming all explicitly exclude mental health as exceptions to bans on abortion care. 

According to data gathered from 2017 to 2019 by maternal mortality review committees in 36 states, mental health conditions are one of the six leading causes of pregnancy-associated deaths.

“When you’re looking at any cause of death when a person is pregnant or in the year thereafter, 13% of those deaths are substance abuse-related, and 7% of those deaths were suicide,” obstetrician-gynecologist Amanda Williams told the American Independent. “So when you have forced ongoing pregnancy, you are increasing the patient’s likelihood of death.”

Williams, an adjunct faculty member in Stanford University School of Medicine’s Department of Obstetrics and Gynecology, said that Black pregnant patients experience symptoms of mental health conditions at a higher rate than their white peers. 

According to a fact sheet published by the Maternal Mental Health Leadership Alliance, “almost 50% of Black mothers will experience maternal mental health conditions.” The Alliance reports Black mothers face a slew of issues, including the effects of systemic racism, a distrust of the health care system, stigma in the Black community around acknowledging mental health issues, and the time and resources needed to address them.

“So if one were turned away for abortion services, you can’t believe that that would be better, because we know that when people are turned away, that their mental health is worse,” Williams said. “When you are talking about a maternal death rate for Black and Indigenous birthing people that is two to three times higher when you are forcing birth, you are forcing that increased death rate as well.”

Dr. Daniel Grossman is the director of the University of California San Francisco’s Department of Advancing New Standards in Reproductive Health. He’s the lead author of a recent study titled “Care Post-Roe: Documenting cases of poor-quality care since the Dobbs decision.” The report, which tells the stories of 50 patients across the country, includes a case in which a pregnant person’s existing mental condition was exacerbated by having to travel out of an abortion-restrictive state to receive care. 

“She traveled on an airplane for the first time ever, using her whole paycheck to buy tickets, rent a hotel,” a health care provider who treated the patient said in the study:

She left our clinic today by [emergency medical services], transported to the local [emergency department (ED)] for suicidal ideation. She was raped two months ago. Each episode of morning sickness causes [post-traumatic stress disorder (PTSD)] so intense she tried to take her life yesterday. If abortion was legal in her home state, several things would be different 1) she could have accessed an abortion more promptly 2) perhaps therefore, she wouldn’t have had an escalation of PTSD such that she tried to kill herself, [and] 3) she’d have more money in her bank account, super important given she’s a single parent and her family who doesn’t support abortion even in cases of rape, just kicked them both out.

Grossman told the American Independent that he was not sure whether the patient ever obtained an abortion. 

“We know that anxiety and depression and suicidal ideation were better for those who received termination in the year following, compared to those who were turned away,” Williams said. 

In what was called the Turnaway Study, demographer Diana Green Foster, a member of Grossman’s department, followed 1,000 women across the nation for 10 years starting in 2007, comparing outcomes of patients who were able to access abortion care with outcomes of those who were not.  She found that 95% of those who obtained an abortion confirmed they’d made the right decision. 

Cindy Lee Herrick, a senior researcher and editorial manager at the Policy Center for Maternal Mental Health, a national bipartisan nonprofit think tank, told the American Independent that maternal mental health is often ignored. 

“Mental health has always been overlooked. And this is true in the general population, but specifically in the maternal population, and I think that the bigger discussion is, why isn’t it considered part of someone’s wellness?” Herrick said. 

“Whether it’s abortion or anything, we see that physical health and mental health get treated separately. And it can be partially because of the way the U.S. system is. We have a bifurcated system, especially in insurance, with reimbursement for behavioral health being separate from physical health,” she added. “It’s not holistic.”

Melissa Fowler, chief program officer of the National Abortion Federation, told the American Independent that abortion should be accessible without restrictions.

“When you get into exceptions, you’re stigmatizing abortion,” Fowler said. “You’re still making it harder for people to access care. And people should be able to access the health care they need to preserve their physical health, their mental health, to preserve their life, and also to exercise their free choice and their autonomy over their life and their body.”