Restricting Rights to Abortion Is Direct Assault on Women’s Mental Health

Recent months have brought more anguish to this country. We have lost good and generous neighbors shopping for groceries in Buffalo. Teachers and young children celebrating the end of a school year in Uvalde, Texas, have been laid to rest. Again, we bear witness to the senseless, heartbreaking, infuriating impact of the tyranny of inaction. And as usual, the largest impact has fallen upon the communities, people, and children who have been systematically disinvested and disenfranchised.

As psychiatrists and women’s mental health experts, we are deeply disturbed by the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization. This decision overrules Roe v. Wade, which recognized the constitutional right to abortion. This decision limits and interferes with reproductive care, denies a woman agency over her body, and allows government intrusion into clinical decision making. We firmly believe that this decision will result in negative outcomes for women in terms of their perinatal mental health and physical health and is violative of reproductive rights.

Access to safe and supportive abortion care is a health care right for all individuals and should not be limited by where one lives or by those selected opinions of those in government. Restricting abortion rights reduces women to physical vessels for childbirth who can be forced to carry a pregnancy to term. It overlooks that many women who need these services are victims of violence, have little to no financial resources, live in underserved areas, need to finish school, and are young and often unable to care for a child, possibly due to substance use or mental illness. It also takes away the rights of women who are faced with a life-threatening pregnancy or a severely malformed or nonviable fetus. There is no consideration for how women will care for these children, support their children financially, or provide a home environment where they can thrive. It also does not account for the responsibility of the father/nongestational parent. Additionally, this decision disregards and obviates pregnant women’s medical needs merely because they are pregnant. It offers no safe options to a situation that is untenable for many women.

This decision will result in devastating and long-lasting consequences for women and families far beyond the effects it will have on any one woman with an unwanted or traumatic pregnancy. Lack of access to abortion increases the risk of depression in pregnancy and after delivery, which in turn worsens infant and child outcomes in such areas as intellectual development, mental health, and behavior in exposed children. Perinatal depression is a risk factor for maternal suicide. At present, maternal homicide and suicide are the most common causes of maternal mortality within one year after delivery.

Restricting the right to abortion is completely at odds with current standards of clinical care. In many situations, this decision will result in continuation of unwanted and traumatic pregnancies, including those resulting from rape and incest, regardless of the consequences. It will result in increased morbidity and mortality for women who resort to illegal or self-induced abortion due to desperation and lack of access to simple, safe, early pregnancy termination.

As we have seen in some states, this decision not only restricts but also criminalizes physicians and others who may assist in the decision or care of a woman who seeks abortion care. This will (1) increase polarization and mistrust within families and communities, (2) worsen health inequities, (3) decrease access to medical care, (4) clog our already stressed legal system with such cases, and (5) force physicians to deny patients the safe and evidenced-based medical care that they need and deserve.

The Supreme Court decision to restrict the right to a safe medical abortion is medically unethical and will result in negative consequences, including worsening of existing health inequities. This decision will also do the following:

• Increase rates of maternal mortality, which are already higher in the United States than other countries.

• Further marginalize women and families, particularly those from communities that have been oppressed by racism and classism.

• Increase the risk of maternal psychiatric illness by forcing the paramount responsibility of supporting and raising an unwanted child onto a woman who cannot care for or does not want that child, which, in turn, will worsen infant and child outcomes and maternal outcomes.

• Further traumatize women and families, particularly those at high risk of or already experiencing interpersonal violence or trauma, including reproductive or sexual coercion.

• Insert the government into the patient-physician relationship, violating patient and physician rights to receive and practice evidence-based medical care.

• Open the door to criminalization of medical professionals and other individuals for practicing evidenced-based family planning.

• Free the father/nongestational parent of the baby from any legal responsibility, despite being just as responsible for a pregnancy as the mother.

As an APA position statement on reproductive health care rights states, “Freedom to act to interrupt pregnancy must be considered a mental health imperative with major social and mental health implications.”

We stand with major medical organizations including the AMA, APA, and the American College of Obstetricians and Gynecologists in opposition to this decision. We believe that reproductive health care decisions should be made between individuals and their health care professionals—not the federal or state government. Forcing individuals to carry unwanted pregnancies to term will increase the perinatal mental health care crisis already happening in the United States and will result in other negative outcomes for pregnant individuals and their children. We will continue to work toward reproductive justice for all. ■

The views expressed in this article do not necessarily reflect the views of the institutions where the authors are employed.

Nancy Byatt, D.O., M.B.A., M.S., is a tenured professor of psychiatry, obstetrics/gynecology, and population and quantitative health sciences and director of the Lifeline for Families Center at UMass Chan Medical School and the founding medical director of the Massachusetts Child Psychiatry Access Program (MCPAP) for Moms.

Jennifer L. Payne, M.D., is a professor, vice chair of research, and director of the Reproductive Psychiatry Research Program in the Department of Psychiatry and Neurobehavioral Sciences at the University of Virginia.

Madeleine A. Becker, M.D., is a professor at Thomas Jefferson University, specializing in perinatal mental health and the psychiatric care of medically ill individuals. All authors are members of APA’s Committee on Women’s Mental Health.