The day that Americans knew was coming is finally here. Roe v. Wade, the Supreme Court decision that created a constitutional right to abortion, is gone.
In many ways, we know what this means. More than half of American women live in states that are hostile to abortion rights. They will lose access to abortion in the coming weeks and months. The majority of those seeking abortion care live below the poverty line and will find it difficult to travel to where the procedure is legal. Reproductive justice activists are scrambling to meet those urgent needs by organizing support for abortion funds and coordinating travel to other states.
Yet there's a little-discussed aspect of abortion access that can have enduring consequences: its impact on mental health. Research tells us that being denied an abortion leads to worse short-term mental health and that it raises the likelihood of living in poverty and being tethered to an abusive partner, neither of which are good for well-being.
Beyond those facts, the decision should prompt us to wonder — and research — what happens when women and people who can become pregnant live in a state where abortion care is no longer just hard to get, as it is currently in many states, but banned with rare exceptions.
Will the Supreme Court's decision and subsequent state bans lead to low-level dread for people who can become pregnant but know they don't have the resources to travel elsewhere should they need an abortion? Will it intensify anxiety for women of color, trans men, and nonbinary people who know they may be targeted and criminalized if they self-manage an abortion? Such questions will be hard to answer without rigorous research designed to disentangle the complex factors that affect a person's mental health, but we urgently need to better understand what this decision means for people's well-being.
Dr. M. Antonia Biggs, Ph.D., an associate professor and senior researcher at the University of California at San Francisco who's studied what happens to women's mental health when they can't access abortion, suspects the decision will lead to worse emotional and psychological experiences.
"This is fundamentally a loss of bodily autonomy, which is not good for people's mental health," says Biggs, who is a social psychologist.
Her research found that when women were denied an abortion, they initially had higher levels of anxiety and lower self-esteem than those who had the procedure. While those disparities faded between six and 12 months later, the women forced to give birth subsequently experienced more long-term physical health problems and financial insecurity. They were more likely to live in poverty, experience financial hardship, and be with a violent partner. These are troubling cascading effects that heighten the risk of experiencing anxiety, depression, and post-traumatic stress disorder.
"This is fundamentally a loss of bodily autonomy, which is not good for people's mental health."
It makes no sense to look at the data and suggest that abortion is what harms people's mental health, which is what its opponents insist. When I wrote about this subject in 2017, a number of experts told me this idea was based on debunked and flawed research. One even told me of anti-abortion researchers: "They are making wrong conclusions and really bad science, if you can even call it science."
Those who've fought to overturn Roe for years or decades may feel personal relief or even joy now, but this is a perverse justification to offer anyone who fears remaining pregnant and being forced to give birth.
Biggs' research also found women who received an abortion were more likely to perceive stigma and more likely to experience psychological distress years later. She believes that pregnant people may internalize new state bans as stigmatizing, increasing the odds that they'll feel worse about themselves in the future. A preliminary finding from the study, which needs further exploration, revealed that those who had to make disclosures about seeking or receiving abortion care, typically because they needed help paying for it and related travel costs, experienced negative mental health symptoms, too.
"There's so many compounding effects of being denied abortion that impacts so many aspects of your life," says Biggs. "It's overwhelming and incredibly sad to think about that."
Imagine, too, the reality that many pregnant people living in a state where abortion is banned may be alone with their struggles, worried that discussing the possibility of seeking care elsewhere could be used against them. We know that emotional isolation is painful, but the Supreme Court decision all but guarantees countless pregnant people will feel more alone than they ever have. We shouldn't forget them, because they deserved so much better than this.
If you want to talk to someone, Crisis Text Line provides free, confidential support 24/7. Text CRISIS to 741741 to be connected to a crisis counselor. Contact the NAMI HelpLine at 1-800-950-NAMI, Monday through Friday from 10:00 a.m. – 10:00 p.m. ET, or email [email protected] You can also call the National Suicide Prevention Lifeline at 1-800-273-8255. Here is a list of international resources.
