The overlooked mental-health consequences of abortion bans

Planned Parenthood president Dr. Leana Wen speaks at a protest against anti-abortion legislation at the U.S. Supreme Court in Washington, U.S., May 21, 2019.
Planned Parenthood president Dr. Leana Wen speaks at a protest against anti-abortion legislation at the U.S. Supreme Court in Washington, U.S., May 21, 2019.
Image: Reuters/James Lawler Duggan
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Update: On June 24, 2022 the US Supreme Court voted to overturn Roe v. Wade, writing that “the Constitution does not confer a right to abortion.”

The US Supreme Court plans to overturn Roe v. Wade, ending federal law protecting the right to abortion, according to a draft opinion by justice Samuel Alito that was leaked to Politico.

The opinion isn’t final, and the Court has not yet announced the results of its vote on Roe. But if the opinion accurately reflects the Supreme Court’s decision, the change will have devastating consequences for women’s freedom, economic security, physical health, and mental health.

It’s a problem to which employers should be attuned as they increasingly recognize their responsibility for employees’ well-being. Their commitments to furthering racial and economic justice also intersect directly with crackdowns on reproductive rights.

“The impact [of abortion restrictions] is going to fall very largely on people of color, who are rural and poor,” says Nada Stotland, a former president of the American Psychiatric Association and a professor at Rush Medical College in Chicago who writes frequently about abortion and psychiatry. “They’re not going to go to their boss and say, I have an unwanted pregnancy and I can’t think straight until I get it taken care of. It will affect the workplace, but it won’t be visible.”

Women denied abortions experience more stress and anxiety

Some of the clearest evidence on the topic of abortions and mental health comes from a 2016 study of nearly 1,000 women in the US, published in JAMA Psychiatry. Researchers from the University of California San Francisco compared the mental-health trajectories of women who were denied abortions because they were just over the facility’s gestational limit to the trajectories of women who were just under the limit and received abortions.

One week after being denied an abortion, women reported higher levels of stress and anxiety, and lower levels of self-esteem, compared to women who received the abortions they sought.

Both groups reported similar levels of depression and post-traumatic stress, which the authors attribute to the difficult conditions that lead some women to seek out abortions in the first place. The most common source of post-traumatic stress that women cited, for example, was having a history of violence and abuse. “Abortion itself doesn’t increase your risk of having post-traumatic stress in any way,” says Antonia Biggs, an associate professor and social psychologist at UCSF who co-authored the study.

Overall, the study’s authors write, “the effects of being denied an abortion may be more detrimental to women’s psychological well-being than allowing women to obtain their wanted procedures.”

The mental health impact of abortion laws like Mississippi’s

If states like Mississippi are permitted to enforce severe restrictions on abortion that force women to travel elsewhere in order to get the procedure, that too will have a mental-health impact, says UCSF’s Biggs. “That’s going to mean taking time off work. It’s going to be expensive. It’s going to impact their existing children in terms of child care and child care costs. And all of those things are going to increase your stress and anxiety and symptoms of depression.”

Moreover, denying abortions to women who are already dealing with mental-health problems may only further exacerbate those issues. “Sometimes people seek abortion because they are not in a good place psychologically to have a child [given] current stress in their lives,” Biggs says.

The loss of autonomy is a mental health issue, too

“We have other research that shows that lack of autonomy in the abortion decision is associated with negative mental health,” says Biggs. One study found that women who live in states that have parental reporting requirements or mandatory wait periods before they can receive an abortion report feeling a loss of autonomy, which in turn places them at higher risk of mental-health issues, including increased levels of stress, anxiety, and depression.

Even women who aren’t actively seeking abortions may suffer mental-health consequences from laws that hack away at their reproductive rights. Taking away people’s human rights is taking away their autonomy and is devaluing them as human beings, and that is going to negatively affect people,” says Biggs. “People inherently want to be valued, and these laws devalue women and disrespect women.”

How abortion stigma impacts mental health

Another mental-health concern is that laws that put ever-increasing limitations on abortions serve to increase the social stigma associated with the procedure. “Most people who seek abortions are worried that other people are going to look down on them or judge,” Biggs explains. “That kind of abortion stigma, the more stigma you experience, the more negative impact that has on your psychological health.”

The effects of this kind of internalized stigma can be long-lasting. A 2020 study that Biggs co-authored with Katherine Brown and Diana Greene Foster, published in PLOS One, found that people who received abortions still perceived stigma about their decision two years later.

How employers can support reproductive rights

There are lots of things companies can do to push back against anti-abortion legislation and support their employees, from speaking out on the subject to offering to cover costs for employees who need to travel to another state for the procedure.

Biggs says that companies also can alleviate the mental-health impact of abortion stigma in the way they communicate about the subject to employees.  The more a workplace can recognize abortion as a normal part of healthcare, she says, and “respect that as they would any kind of medical care,” the less isolated women will feel.

This story was updated May 2 to include news of a leaked Supreme Court draft opinion that would overturn Roe v. Wade.