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Forced Choice and No Voice: Mental Health and Abortion Laws

The mental health consequences of being unheard.

Key points

  • The overturning of Roe v. Wade increases the emotional and financial burden on individuals in need of abortion services.
  • Women of color and low-income women are likely to experience more barriers to care.
  • Psychologists must be aware of their state’s and neighboring states’ abortion laws and available abortion and sexual health services.
Mizuno K / Pexels
Mizuno K / Pexels

By Gemariah Valencia, Ph.D., and Erica D. Marshall-Lee, Ph.D., ABPP, on behalf of the Atlanta Behavioral Health Advocates

On June 24, 2022, the U.S. Supreme Court reversed the landmark 1973 Roe v. Wade ruling, demolishing women’s constitutional right to abortion, which had previously been enacted for almost 50 years. This decision has impacted women physically, emotionally, mentally, and spiritually at micro, meso, and macro levels.

It again pains me to acknowledge that this is nothing new. Women have been dismissed, devalued, underappreciated, and unheard practically since the beginning of time. We scream to be heard only to be ignored, mocked, and placated in our homes, our communities, and our nation.

As an African-descended female, I know firsthand the impact of limited or no access to mental and physical healthcare, disparities in every aspect of life, and inequitable personal, professional, and public practices on navigating day-to-day experiences. I am accustomed to my voice not counting, my body not mattering, and my heart breaking. Those of us whose ancestors were slaves still hold that trauma in our bodies; our inner voices are in constant conflict.

The fight between asserting ourselves in the hopes of being recognized, understood, and respected, and internalized racism is ever-present. We know what it is like to not be in control of our bodies. We feel policed virtually everywhere we go, in what we say, the tone of voice we use, and how we behave, just to name a few.

Individuals from highly marginalized and oppressed communities are at increased risk of experiencing psychological distress (Ogbu-Nwobodo et al., 2022). Denial of abortion services can lead to anxiety, depression, suicidal ideation, substance use, and increased vulnerability to developing other mental health concerns (Ogbu-Nwobodo et al., 2022). Reproductive injustice and structural racism are healthcare concerns and social determinants of physical and mental health with widespread consequences (Ogbu-Nwobodo et. al., 2022).

When it comes to abortion-related legislation and discussion around restricting abortions, lawmakers may not consider the impact of such policies on individuals and communities, especially those with lower socioeconomic status. In addition, the media affects the understanding and emotional response of the public.

When Roe v Wade was overturned, there was noticeable uproar and heated discourse in the news, on social media, and among various healthcare providers. Increased fear and anxiety were palpable due to the loss of the constitutional right to abortion and the added confusion about the process and decision-making that lead to the need for abortion. For many, the loss of a constitutional right and freedom to choose has been experienced as an attack on the core values of this country. It is also experienced as a direct removal of power to choose and decide for one’s own body.

After the federal right was overturned, states responded with further abortion bans or created protective laws for individuals to obtain an abortion. States that allowed and protected individuals’ rights to abortion also welcomed those who are able to travel across state lines to get the service done. However, those who cannot afford to travel across state lines do not have the option to get the service.

Studies have shown that women of color and low-income women are affected by unintended pregnancy more than their White or higher-income counterparts (Finer et al., 2014; Lara et al., 2015). Results from surveys in 2019 demonstrate that about 18.1 million (28 percent) of women ages 18-49 live in the 17 states with abortion bans (Hill et al., 2022).

Among these women, 22 percent are Hispanic, 14 percent are Black, and 4 percent are Asian. Women of color experience many barriers to care compared to their White counterparts and have more financial and transportation limitations. In addition, due to immigration-related fears, women of color may hesitate to travel across state borders. The picture gets more complicated when individuals may not understand the abortion laws and rights in their own states (Assifi et al., 2016). The lack of awareness and knowledge can impact one’s decision to seek care and services.

While studies examining the impact of the overturned Roe v Wade are limited, one study has shown that the state restrictions on abortion have placed an emotional and financial burden on patients directly affected by the laws (Koenig et al., 2019). Depending on the state laws, there are limited or no options for seeking abortion services. There can also be limited time available for patients to make informed decisions about abortion. Moreover, the added guilt and stigma of using these services can further increase emotional distress.

Considerations for Psychologists:

  1. Learn about the abortion laws and services in your state and neighboring states. Each state has its own restrictions and protections. Become aware of resources beneficial for the population you serve. Becoming knowledgeable about the available resources in neighboring states could also provide vital information and options to your patients. Be sure to learn about potential risks associated with discussing abortion services with your clients.
  2. Assess for awareness and knowledge, and consider providing more accurate information. Each patient has their own understanding of abortion laws. Identifying misconceptions and addressing gaps in knowledge can provide hope and clarity to individuals affected by these laws. Patients can make appropriate and informed decisions with increased knowledge. Therefore, learning more about state laws and resources (and laws /resources of neighboring states) could aid in patients’ decision-making process and alleviate some distress.
  3. Assess the impact of abortion laws on your population. Directly asking for patients’ reactions and responses can provide avenues to support them therapeutically. The level of impact varies between individuals, and we can open the conversation to discuss negative and positive reactions without judgment. We can also guide the conversation to increase empathy and understanding.
  4. Become involved in advocacy and support initiatives that increase healthcare access and equity. Consider your impact as a healthcare professional in the legislative community and actively engage in advocacy work to impact local, state, and national legislation.

Resources to be aware of:

To find a therapist near you, visit the Psychology Today Therapy Directory.

References

Assifi, A. R., Berger, B., Tunçalp, Ö., Khosla, R., & Ganatra, B. (2016). Women’s awareness and knowledge of abortion laws: A systematic review. PLoS ONE, 11(3). https://doi-org.proxy.library.emory.edu/10.1371/journal.pone.0152224

Finer, L. B., & Zolna, M. R. (2014). Shifts in intended and unintended pregnancies in the United States, 2001-2008. American journal of public health, 104 Suppl 1, S43–S48. https://doi.org/10.2105/AJPH.2013.301416

Hill, L., Artiga, S., Ranji, U., Gomez, I. (2022, July 15). What are the implications of the overturning of Roe v. Wade for racial disparities? KFF. Retrieved November 27, 2022, from https://www.kff.org/racial-equity-and-health-policy/issue-brief/what-ar…

Koenig, S., Simi, E., Goldenberg, A., Magasi, S., & Wicklund, C. (2019). Exploring prenatal genetic counselors' perceptions of abortion laws in restrictive states. Journal of genetic counseling, 28(4), 790–801. https://doi.org/10.1002/jgc4.1120

Lara, D., Holt, K., Peña, M., & Grossman, D. (2015). Knowledge of abortion laws and services among low-income women in three United States cities. Journal of Immigrant and Minority Health, 17(6), 1811–1818. https://doi-org.proxy.library.emory.edu/10.1007/s10903-014-0147-z

Ogbu-Nwobodo, L., Shim, R. S., Vinson, S. Y., Fitelson, E. M., Biggs, M. A., McLemore, M. R., ... & Mangurian, C. (2022). Mental Health Implications of Abortion Restrictions for Historically Marginalized Populations. New England Journal of Medicine, 387(17), 1613-1617.

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