Abortion Restrictions and Mental Health in a Post-Roe World
And why reproductive freedom matters for everyone
I firmly believe that if you care about the health and well-being of parents (among other things), you should care about abortion.
The majority of people who get abortions in this country are parents. As I recently discussed, states that had more restrictive abortion policies in 2017 had higher rates of homicide and intimate partner violence involving pregnant and postpartum women in 2018-2020. Additionally, the mental health consequences related to being denied an abortion appear to outweigh the consequences of receiving one.
Clearly there are negative consequences on restricting reproductive choice for people who can get pregnant. But what about everyone else?
A study published in July by Anderson and colleagues from Science attempts to answer this question as it pertains to mental health distress in the months following the overturn of Roe v. Wade. Using the Household Pulse Survey, a nationwide survey conducted by the US Census Bureau, the researchers examined questions related to how anxious (“feeling nervous, anxious, or on edge”), worried (“not being able to stop or control worrying”), disinterested (“having little interest or pleasure in doing things”), and depressed (“feeling down, depressed, or hopeless”) participants felt when the survey was administered from July 2021 through June 2023. They then examined whether these outcomes changed when specific states instituted more restrictive abortion policies.
They found that restricting abortion access was related to significantly more anxiety and disinterest in participants when compared to states and periods where no restriction was present. Interestingly, these findings did not appear to differ based on the sex, race, marital status, sexual orientation, or age of participant. However, mental health consequences were worse for people with lower incomes (especially for those who reported a household income below $25,000) and less education (those who did not complete high school).
Of course, measuring mental health distress is not the same as understanding whether abortion policies affect conditions like anxiety or major depressive disorder. This data doesn’t address how these policies directly affect those with diagnosable conditions or people experiencing other psychiatric symptoms (e.g. sleep difficulties, psychosis, suicidality, etc.).
At the same time, this study has many strengths, including using a nationally representative data set and comparing experiences both between states with different abortion policies as well as within the same state before and after an abortion policy changed. I also found it compelling that these changes in distress were the same for people regardless of a host of demographic factors. It really emphasizes the consequences these policies have on everyone.
In an interview with Gordon Burtch, one of the study’s authors, he discussed why policy changes like this don’t just affect pregnant people:
But these policy changes extend to a much broader population than we typically realize, like family members and caregivers. This could create stress for the entire family, for anybody that’s connected to an individual that is in a position of needing an abortion. There’s also a lot of people worried about what could come next. After Roe was overturned, that led to questions about same-sex marriage rights and other rights that could be impacted by the courts. We have a lot of reasons to expect that these national changes will have a broad influence, beyond the stress that comes with contemplating abortion and going through an abortion.
Indeed, states that restrict abortion access have policies that are worse for LGBTQ+ people compared to states where abortion remains legal. The Movement Advancement Project tracks over 50 different LGBTQ-related laws and policies and creates a “tally” score based on a state’s laws related to things like parental recognition, nondiscrimination, and health care. As of 2023, 13/15 states that have a negative tally score restrict abortion access.1
In that same interview, Burtch also brought up the excellent point that mental distress is not just from the restriction of abortion access itself, but the ambiguity around how and when these policies are enforced:
In the recent example in Idaho, where the state challenged the federal government’s rule on providing emergency [abortion] medical care, the Supreme Court didn’t rule in favor of the state—they basically threw it out and said that this challenge shouldn’t have made it to the Supreme Court. So, they didn’t resolve it. As of now, doctors need to keep providing emergency [abortion] care until they say otherwise. But it’s still a legal gray area that impacts medical providers and patients. So long as this remains unresolved, and we don’t have clarity around what’s allowed in different places, that’s linked to so much stress.
Higher rates of mental health distress may indicate that people living in states with less clear or more restrictive abortion policies might benefit from increased access to mental health services.
Unfortunately, these states also falter when it comes mental health treatment.
The organization Mental Health America ranks each state (and the District of Columbia) on mental health care access each year, considering factors like the proportion of adults with a mental health concern who did not receive treatment, those who were uninsured, number of children with private insurance that did not cover mental health concerns, and mental health care workforce availability.
In 2022, nine of the 10 lowest ranking states have banned or restricted abortion access after the overturn of Roe V. Wade.2 Abortion remains legal in the top 15 highest ranking states regarding mental health care access.3
To add insult to injury, three states (Georgia, Florida, and Idaho) explicitly exclude mental health as a legal exception for abortion. In other words, if a person is suicidal or otherwise wants to terminate a pregnancy due to mental health needs, legally they have to be denied.
Abortion access is the canary in the coal mine that tells you that a state (a policy, a people) cares about and respects the rights and welfare of all of its citizens.
It’s not a coincidence that Kamala Harris is outspokenly in favor of abortion access and that the Biden-Harris administration supported many policies in favor of parents and mental health. Forty-seven states now offer Medicaid postpartum coverage for 12 months, compared to only three back in 2021. This is incredibly important as the Medicaid program funds 40% of births in the country. Additionally, the administration pledged $46.8 million in May towards funding opportunities for mental health, including growing the behavioral health care work force.
Similarly, it’s not a coincidence that the same states that restrict or ban abortion also have poorer mental health care access and worse policies for LGBTQ+ people. Do not believe the lie that restricting abortion access is meant to “save lives” or “care about the children.” Of the 22 states that currently restrict abortion access, none have mandatory paid family leave policies.4 Additionally, these states combined have higher infant mortality rates and teen birth rates compared to states where abortion remains legal.
Abortion access matters for everyone.
Other things I’ve been reading:
I can’t endorse Jessica Valenti’s Abortion, Every Day enough, a vital news source for all things related to reproductive rights. Check out her recent writing on how c-section rates have increased since the overturn of Roe, Kamala Harris’ record on reproductive choice, what Project 2025 has to say about limiting the rights of women and reproductive freedom, and more data after Dobbs.
“I don’t even know what feminism means anymore” (In Pursuit of Clean Countertops): As always, Sara Petersen has the best take on “trad wives” and that Ballerina Farm viral profile (a great example of something that I knew nothing about a week ago and now probably know way too much). I love the way she breaks down various definitions of feminism and the harm and exclusion of defining it solely around individual choice.
Men Could Care More (More to Hate): I have been obsessed with philosopher Kate Manne since devouring Down Girl: The Logic of Misogyny (super academic, thorough, compelling) and Entitled: How Male Privilege Hurts Women (covers similar territory but more accessible and still very good). I appreciated this celebration around what Tim Walz represents and how important prioritizing care is for all of us:
What if we raised boys and men to believe that they can, and should, care? What if we raised them to be babysitters, teachers, nurses, aides, both active fathers and members of broader mutual aid and community networks? What if we raised them to pick up their own dirty socks and put on a load of everyone’s laundry? What if we taught them to feel, not anxiously expectant, waiting for women’s sexual and social labor to materialize, but obligated to care for others in lifelong, reciprocal ways? What if we taught men that none of this is beneath them and that caring for others can in fact be their highest calling?
And more on sleep!
Is Sleep Training Harmful? (The Pudding): Obviously I loved this thorough, engaging infographic covering the evidence related to the safety and efficacy of sleep training, as well as dissecting the overblown controversies and misinformation surrounding it.
There Are Safer Ways to Bedshare With a Baby (Scientific American): This excellent piece was published months before mine, which is why I didn’t feel the need to go in depth around choices like co-sleeping. Our family did not choose to bedshare for many reasons, though we definitely feel the loss of a specific type of joy this experience has brought other parent friends of ours. Just like so much parenting advice out there, a lot of nuance is lost in the majority of conversations around the safety of co-sleeping.
The other states with a negative tally are Montana and Wyoming, where abortion bans have been blocked by the courts (for now).
In descending order, those states are: Texas (51st), Alabama (50th), Florida (49th), Georgia (48th), Mississippi (47th), Arizona (46th), Tennessee (45th), South Dakota (43rd), Idaho (42nd), and Missouri (41st). Kansas was ranked 44th but abortion is protected in the State constitution and remains legal up to 22 weeks. (Source: Mental Health America)
In ascending order, those states/districts are: Vermont (1st), Massachusetts (2nd; woo!), Maine (3rd), Wisconsin (4th), Minnesota (5th), New Hampshire (6th), Rhode Island (7th), Pennsylvania (8th), Connecticut (9th), District of Columbia (10th), Washington (11th), Montana (12th), Illinois (13th), Maryland (14th), and New York (15th). (Source: Mental Health America)
Alabama, Arkansas, Florida, Tennessee, and Texas have voluntary paid family leave policies. These states ban abortion at 6 weeks or earlier. (Source: Bipartisan Policy Center)