Summary: People seeking abortions face a threefold greater risk of having a mental health disorder, and experts warn that limits on abortion access are likely to increase the number of people who develop mental health problems. Forced continuation of pregnancy also generates physical and emotional stress that can negatively affect fetal brain development and raise the risk of neurodevelopmental disorders.
Source: Northwestern University
Psychiatrists from Northwestern Medicine and Columbia University argue that restricting abortion access will create severe stress and raise the risk of serious psychiatric illness for people forced to continue unwanted pregnancies, in a commentary published in JAMA Psychiatry.
This concern is particularly urgent because individuals who seek abortions are already about three times more likely than the general population to have a psychiatric disorder.
The U.S. Supreme Court’s decision to overturn Roe v. Wade has far-reaching consequences for the roughly one in four pregnant people in the United States who seek an abortion.
“Unwanted pregnancies create intense, sustained stress for people who lack the resources to obtain a safe abortion, which may be hundreds of miles away,” write Dr. Katherine Wisner, Asher Professor of Psychiatry and Behavioral Sciences and professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine, and Dr. Paul Appelbaum, Dollard Professor of Psychiatry, Medicine and Law at Columbia University. “These burdens disproportionately affect people of color, individuals with disabilities, and unmarried parents.”
Severe maternal stress can lead to psychiatric and developmental problems in the child
Research indicates that severe stress experienced by a person carrying an unwanted pregnancy can be transmitted to the developing fetus.
“Exposure to extreme maternal stress during pregnancy can be as harmful as exposure to drugs or serious maternal illness, and it can result in developmental delays and psychiatric conditions in children,” Wisner said. “While medical care aims to reduce pregnancy-related health risks, the emotional strain of being forced to continue an unwanted pregnancy has the opposite effect.”
The JAMA Psychiatry commentary was published Feb. 10.
How limits on abortion access harm pregnant people
Wisner asks readers to consider a familiar scenario: a working parent who is already juggling jobs, childcare costs and limited income.
“About 55% of people who give birth in the U.S. live in poverty,” she noted. “Many individuals who seek abortions already have children and cannot afford another dependent. If an unplanned pregnancy occurs and the person decides that abortion is the best option, they may face a host of obstacles in a state that restricts access.”
Those obstacles include finding a clinic that may be hours or even days away, raising the funds to pay for the procedure and transportation, arranging care for existing children, and covering lost wages when sick leave or paid time off is not available.
“These compounding practical problems create enormous stress,” Wisner said. “For someone with any psychiatric vulnerability—such as depression or an anxiety disorder—that new, intense stress can trigger or worsen illness. Even individuals without prior psychiatric history face an increased risk of developing disorders under these conditions.”
She also highlights the loss of autonomy that many people feel when the law prioritizes the rights of the embryo or fetus over the pregnant person’s bodily autonomy. That loss of control compounds stress and undermines coping ability.
“Some people with preexisting psychiatric illness experience severe episodes related to pregnancy,” Wisner said. “Those with histories of postpartum psychosis or previous suicide attempts are at particularly high risk if pregnancy proceeds against their wishes.”
Medication decisions become more difficult under restrictive laws
Wisner treats patients whose psychiatric medications carry potential pregnancy-related risks, and restrictive abortion policies complicate difficult clinical decisions.
“Take lithium, for example: while the absolute risk of birth defects is low, it is an established association,” she explained. “A person with bipolar disorder might need lithium to remain stable and may plan a pregnancy while weighing prenatal screening results. If a serious fetal anomaly is identified, the option to terminate may be important to that person’s health and life plans.”
“In states that restrict abortion, patients face impossible choices: stop a stabilizing medication and risk relapse into severe mood or psychotic episodes, or continue the medication and potentially deliver a child with major medical needs. Either path can have profound consequences for the parent, existing children, and family.”
About this abortion and mental health research news
Author: Marla Paul
Source: Northwestern University
Contact: Marla Paul – Northwestern University
Image: The image is in the public domain
Original Research: Closed access. “Abortion restriction and mental health” by Katherine Wisner et al., JAMA Psychiatry
Abstract
Abortion restriction and mental health
In June 2022, the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization overturned nearly five decades of constitutionally protected access to abortion. The decision carries substantial implications not only for the one in four pregnant people who seek abortions in the United States but also for psychiatric practice broadly. Unwanted pregnancies create severe stress for people who lack the financial or logistical resources to obtain safe abortion care, often requiring travel of hundreds of miles. These burdens fall disproportionately on racial and ethnic minority groups, people with disabilities, and unmarried pregnant people.
Since abortion was legalized in 1973, many clinicians have not routinely managed the extreme emotional distress that accompanies attempts to obtain an abortion under restrictive legal regimes. As the commentary emphasizes, a failure to acknowledge and learn from past experience risks repeating harms that public health and psychiatric care had worked to minimize.