Forecasting the mental health harms of overturning Roe v WadeBMJ 2022; 378 doi: https://doi.org/10.1136/bmj.o1890 (Published 28 July 2022) Cite this as: BMJ 2022;378:o1890
- M Antonia Biggs, associate professor and social psychologist1,
- Corinne Rocca, professor and epidemiologist1
The US Supreme Court’s decision to eliminate the federal right to abortion means that around half of reproductive age women in the US will soon be living in states without access to abortion, with restrictions disproportionately affecting people of colour1 and other marginalised populations.23 This decision is in direct opposition to international human rights standards, discriminates against pregnant women and people, reinforces stigma about abortion, and has left much of the country in profound disbelief.34
In our work as researchers for the Turnaway study5—a five year study looking at the impacts of obtaining or being denied an abortion among nearly 1000 US women—we gained insight into what will happen to people whose reproductive autonomy is stripped away. We found that abortion was not associated with any adverse post-abortion mental health outcomes, including depression, anxiety, post-traumatic stress, suicidal ideation, or substance use disorders.678910
People who obtained an abortion described feeling predominantly positive emotions, most commonly relief, and over 95% described the abortion as the right decision shortly after their abortion and up to five years later.101112 The only harms to psychological health that we found were to people denied an abortion. They experienced short term elevated levels of stress, anxiety, and low self-esteem,678 as well as feelings of regret and anger.10 As more people are unable to access their desired care they are likely to similarly feel stress, anxiety, low self-esteem, and anger.
The people most vulnerable to psychological distress and negative emotions were those with a history of mental health conditions, trauma, or abuse and those who lacked social emotional support, experienced difficulty making a pregnancy decision, or perceived that people would look down on them if they knew that they had sought an abortion.78111213 These same groups will be at the greatest risk of experiencing adverse mental health consequences when their pregnancy options are taken away.
The Supreme Court decision creates a policy environment that condones restricting people’s reproductive choices and stigmatises those needing abortion care.4 This form of structural stigma can lead to internalised feelings of shame and guilt, as well as greater difficulty making a decision—all of which can have mental health repercussions.1415 Already, most people seeking an abortion in the US believe that others look down on them for seeking one, particularly those who lack social support and live in the south.1316 These perceptions of abortion stigma can increase the risk of people experiencing psychological distress and regretting their decision.111315
Our results also suggest that, although people who were denied abortions felt largely negative emotions about the denial initially, their feelings became increasingly positive as they raised the child,17 indicating that people may move towards acceptance. Yet these positive emotions about being denied an abortion were often rooted in fears and disinformation perpetuated by anti-abortion rhetoric, which trade on false narratives of how abortion is dangerous and often leads to regret. Additionally, these shifts in attitude required substantial financial and instrumental assistance and were experienced less among those lacking social support, for whom the decision to want an abortion was clearer, and among those who placed the child for adoption.
Critically, the eventual emotional resilience that many people find after abortion denial does not justify depriving people of their reproductive autonomy.
The new abortion policy landscape in the US will increase stress and anxiety by exacerbating barriers to care and constraining people’s choices. Other research has found that people who experience difficulty navigating the logistical challenges to obtain care, including having to travel, and who feel forced to tell others or to wait to have an abortion after making the decision, have more negative mental health symptoms.18 For too many, these barriers will be insurmountable, particularly among those who lack psychological and emotional resources and the time or money to travel to another state. Those unable to travel will have no choice but to self-manage their abortion19 or to carry their unwanted pregnancy to term.
Research has already provided a grim forecast of the toll the Supreme Court’s decision will take on many critical dimensions of people’s lives. We found that the participants in our research sought abortion because they didn’t feel financially prepared, or out of concern for their children, or owing to health related and other concerns.20 When they were forced to carry their pregnancies to term they experienced many of these anticipated hardships.
Those who were denied an abortion were more likely than those who obtained one to stay in contact with violent partners, to be less optimistic about their future, to experience economic insecurity that lasted for years and extended to their children, and to bond poorly with the baby.21222324 Forced childbirth also led to more adverse physical health and birth outcomes, including two of 160 people denied an abortion who gave birth who tragically died owing to childbirth.2526 This elevated risk is particularly worrying in the many states that already have or are soon to have abortion bans in place, many of which also have the highest rates of infant and maternal mortality in the country.2728
The decision to overturn Roe v Wade disregards decades of research demonstrating the benefits of supporting and respecting people’s reproductive choices, and it will force individuals and families to bolster their own social, financial, and health related support systems to try to buffer the detrimental impacts. We urge policy makers instead to examine the science and create policies that will support people’s health and wellbeing.
Conflicts of interest: We have read and understood BMJ policy on declaration of interests and declare we have no conflicts of interest.
Provenance and peer review: commissioned, not peer reviewed.