Zoe (a pseudonym) always had irregular periods marked by longer cycles. So when she found out during a routine doctor’s appointment that she was eight weeks pregnant, it was a surprise. Single and at the start of her career as a teacher in the New Orleans public-school system, she was not ready to have a baby. But the state of Louisiana, which banned abortion after a detectable fetal heartbeat in 2019, was going to make that decision hard for her.
The nurse handed her the ultrasound picture and told her she could wrap it up as a Christmas present for her husband, Zoe recounts. Because she couldn’t initially take time off work to travel to a state where she could more easily get an abortion, she had to wait it out. “I basically had to have these four miserable weeks,” she says now. She eventually traveled to a clinic in California and terminated her pregnancy at 12 weeks. “If you’ve ever been pregnant, you might understand that a month is an eternity. I was sick every day, having to think through my decision. From a mental health perspective, it was awful.” Unlike many, Zoe could afford to leave the state and underwent a successful and healthy abortion. But it still had a lasting and palpable impact on her mental health.
As a result of the Dobbs decision in 2022, 25 million women of childbearing years now live in a state where access to abortion is restricted or banned. In Louisiana, Texas, Tennessee, and South Dakota, you can be criminally prosecuted for having an abortion. Of the 14 states with near-total bans, only five allow exceptions for rape. In 2021, Texas passed SB 8, which banned most abortions after six weeks (before most women know they are pregnant). Just this week, Florida followed suit, instituting a six-week ban.
We know that denying access to abortion has dire short-term physical health consequences, including an increase in pregnancy-related complications and deaths. Studies have also found that in the long term, women who were denied abortions experienced overall poorer health five years later compared to those who did receive abortions. But what about the unseen and often ignored harm: the damage that interfering with reproductive care has on our mental health?
Anti-abortion activists have long claimed that abortions harm the mental health of women. They argue women who go through with their abortions will suffer from grief, stress, and even PTSD due to their decision—a patronizing supposition proven incorrect by research. A University of Maryland study showed that abortion was not associated with increased anxiety or mood disorders. The Turnaway Study, a landmark 2022 report, found that only 6% of women who received abortions expressed primarily negative feelings about the decision. Conversely, wanting and being denied an abortion has been associated with heightened anxiety symptoms and lower self-esteem and life satisfaction compared to those who desired and received an abortion. It may seem obvious that being denied abortion care is associated with negative mental health outcomes. But two years into the post-Dobbs era—as increasingly restrictive bans are put into place—new research reveals just how significant and alarming the effects are.
It should be acknowledged that there is already a maternal mental health crisis in this country. According to the CDC, 60% of women who have abortions are already mothers, and half of them have two or more children. Twenty percent of women experience anxiety or depression throughout the perinatal period; for women of color, incidents of maternal mental illness are almost double. What’s worse, 70% of US counties don’t have enough practicing maternal mental health providers, according to the Policy Center for Maternal Mental Health. By comparison, countries like the Netherlands, with strong governmental support for new mothers, as well as Asian cultures that emphasize rest and multigenerational help tend to have lower levels of maternal mental illness.
There is evidence that suggests that abortion bans may exacerbate or already have exacerbated these conditions. A 2024 study from the Johns Hopkins Bloomberg School of Public Health looked at data from close to 720,000 residents of states that had passed trigger abortion bans, a term that refers to the stringent restrictions that went into place as soon as Dobbs fell. It found that people experienced a significant increase in anxiety and depression symptoms compared to residents of states without such bans within a baseline period. (The study surveyed both men and women, and the results reflect the impact abortion bans have on family systems and whole communities.) A 2023 study out of the University of Pennsylvania found that restrictions to reproductive care represent a macro-level risk factor for suicide among reproductive-age women.
But there are less measurable effects as well. “You can’t quantify the pain,” said Amna Dermish, MD, a practicing obstetrician and chief operating and medical services officer at Planned Parenthood of Greater Texas. “When we’re forced into a decision that doesn’t feel right, we know that it has negative mental health impacts.” Dermish described the pervasive culture of fear that exists in Texas and other states that restrict abortion. She said it leads to “widespread anxiety and low self-esteem” among her patients. “I’ve seen so many panic attacks in the hallway. It is just this moment of intense despair. Women just fall apart in front of you, and you can’t do anything about the pain they feel.” The fear of criminalization and surveillance is so high, Dermish said, that many of her patients leave their cell phones behind when they travel out of state to receive abortion care.
Unsurprisingly, the states limiting or banning abortion care have not devoted many resources to maternal mental health. According to a 2023 report from the Policy Center for Maternal Mental Health, no state where abortion was banned or severely restricted received a grade higher than a D+ on measures of maternal mental health care, like access to therapists, psychiatrists, or treatment programs. “A big issue relating to mental health connected to abortion denial is shame and stigma,” said Aisha Mills, interim president of the National Institute for Reproductive Health. “Your head is held down at the exact same moment you’re trying to get care.” Still, the NIRH and other reproductive-rights groups are optimistic about ballot measures in several states in 2024: There is a movement in Colorado to enshrine abortion within the state constitution with a ballot initiative this fall; a similar ballot initiative in Florida will seek to undo the six-week ban; and New Yorkers will be able vote to ratify the Equal Rights Amendment for the state’s constitution, which offers protections for reproductive autonomy.
Trauma, which impeding access to abortion can certainly create, is a known predictor for maternal mental illness. For Zoe, life moved forward, but the experience was hard to forget. Last year, when she had a planned pregnancy with her first child, the trauma of having to wait and travel for her abortion returned to her. She dreaded her visits to the ob-gyn. She suffered from anxiety and depression during her pregnancy and after the baby was born. “Part of me couldn’t connect with the pregnancy because that meant connecting with that experience,” she said. “It impacted my ability to bond after the baby was born and feel happy. It really messed with me.”