In some states in the US today, abortion is no longer legal. In several states, there is not even an exception to the law in cases of rape or incest.
As a licensed marriage and family therapist, I am aware of the traumatic effect the US Supreme Court’s decision to overturn Roe V. Wade has had on people of all sexes. Regardless if one is in a state that does or does not allow abortions, affected people should reach out to a mental health professional to address the psychological and social concerns they have related to this topic. Therapists are trained to provide a safe, confidential space for clients to receive mental health treatment.
Here, I discuss the psychological impact of forced pregnancy, and how therapists can best counsel patients and families under these new conditions.
How Being Forced to Continue Pregnancy May Negatively Impact Mental Health
Several studies have examined the negative impacts of unintended pregnancy on mothers, children, and the family system, with researchers suggesting that denial of abortion can lead to an increase level of anxiety.
For instance, in 2016, professors at the University of Wisconsin – Madison used a 60-year longitudinal study to identify the impact of forced pregnancy and birth on Wisconsin women before Roe V. Wade. “Unwanted pregnancies were strongly associated with poorer mental health outcomes in later life,” they concluded. Other researchers have indicated that unintended pregnancy is associated with greater risk of maternal depression and parenting stress.
Further, researchers published an article in the Journal of Health and Social Behavior have suggested that unintended pregnancy and unwanted births can contribute to lower quality relationships between mothers and children. This included the child born as a result of the unwanted pregnancy, as well as other children within the family, leading to increased levels of depression, low happiness, and issues within parent/child relationships.
Overturning Roe V. Wade Triggers Mental Health Problems
The conservative majority’s decision to send the US back to the pre-Roe era has required people who can get pregnant to cope with losing a long-held constitutional right. In states that no longer protect reproductive rights, citizens who can become pregnant now lack control over their own bodies and, thus, clarity over their futures. In general, when people cannot escape events and must undergo them against their will, they experience them as traumatic.
Under these conditions, it’s natural that even people who are not currently pregnant would feel fear, anxiety, and uncertainty regarding their futures. Even desired, planned pregnancies are associated with depressive symptoms and postpartum depression. Sustaining the growth of a fetus involves hormonal fluctuations and stress, increasing the risk of mood disorders. While these problems can emerge for anyone, the risk is particularly serious for those who have a history of mental illness, or who are navigating an unwanted or mistimed pregnancy.
This depression can turn into unhealthy ways of coping. According to a 2020 investigation, self-injurious behavior and suicidal ideation among pregnant people have increased dramatically since 2006. One of the top causes of maternal fatalities during pregnancy, and up to a year afterwards, is suicide. Those most impacted tend to be low-income, young, and/or Non-Hispanic Black people.
Notably, negative feelings about a pregnancy constitute one of the risk factors for suicide. The overturning of Roe V. Wade may result in an increase in suicidal ideation and attempts. This could be due to pregnant people taking matters into their own hands and engaging in practices to terminate pregnancy without medical support or supervision. Self-induced abortion is nothing new and can cause harm and/or death.
In addition to these mental health issues, pregnancy of any kind takes a heavy toll on the human body and entails medical risks. For some, pregnancy can also result in cardiovascular and metabolic diseases later in life.
Finally, attempting to birth a child in the United States, which has the highest rate of maternal mortality of any developed country, can prove fatal, especially for Non-Hispanic Black people. If that wasn’t bad enough, the CDC has called homicide a “leading cause of death” for pregnant people.
Video: What Overturning Roe v. Wade Means for Abortion Access in the U.S.
The Negative Impact on Those Who Can Impregnate Others
While little discussion has focused on the impact of overturning Roe V. Wade on males and people who can impregnate others, these populations may also deal with mental health issues in consequence. Many struggle to find material ways to help and support partners who have just lost their bodily autonomy and civil rights. Those who risk impregnating others must also ask themselves if the loss of reproductive rights, along with the life-long consequences of forced birth, will discourage partners from engaging in sexual relations.
The threat of fatherhood is now greater for those who do not want children, or at least not now. This is a deeply personal decision with legal, financial, and even educational implications. For example, one study in the Journal of Adolescent Health found that “young men who were involved with a pregnancy and whose partners had an abortion were nearly four times more likely to graduate from college than those whose partners gave birth.”
Males are often involved in family planning and should be considered, yet the Supreme Court has made it more difficult for them to choose for themselves and collaborate with their partners. This may be one of the reasons interest in vasectomies has shot up since the ruling. If faced with an unwanted or mistimed pregnancy, individuals who impregnated others may experience an increase in depression, anxiety, and fear. These difficult emotions may also trigger self-harm and suicidal ideation, and contribute to conflict within romantic, couple, or marital relationships. Therefore, they may benefit from the support of a mental health professional, just like their partners. There is also a case to be made for the utilization of couples therapy with a Licensed Marriage and Family Therapist.
Challenges Accessing Therapy
As mental health professionals, our job is to work with clients and their systems to help address any mental health issues that emerge. The overturning of Roe V. Wade undoubtedly will result in an increased need for mental health services. Mental health issues related to depression, anxiety, fear, self-injurious behavior, and suicidal ideation — among others — should be expected from mental health professionals.
However, many individuals already do not have access to adequate, culturally competent mental health treatment. Barriers such as socio-economic status may influence who does and does not have access to certain services. Likewise, the current shortage of mental health professionals means needed services will not always be provided. This will undoubtedly result in individuals from lower socio-economic status and other marginalized groups being most at risk for health and mental health issues.
How to Help Impacted Patients in Therapy
Therapists must provide a safe, confidential, and non-judgmental space for their clients, setting aside their own beliefs, biases, and preconceived notions in the process. They must be curious about their clients and allow them to tell their own story in a non-threatening environment. Only that way can patients consider what is or is not in their best interests.
For clients who struggle with trauma, depression, or PTSD from having a child against their will, therapists must work to instill hope, promote coping skills, and teach resilience.
For those who are considering an abortion, therapists must provide a safe space and a listening ear. It is not the therapists’ job to influence decisions. Instead, we help our clients talk through their options with a focus on thoughts, feelings, emotions, risks, their family, and their future.
For patients who are struggling to reclaim a sense of control over their own bodies and lives in the wake of this ruling, I recommend channeling these difficult feelings into effective action. This can be done in two primary ways: first, they can advocate for themselves and their families to political officials and medical professionals; second, after paying close attention to how various states choose to move forward on this issue, they may consider options for relocation, as some states are currently creating safe havens for women.
Regardless of where a given therapist is located, they will continue to assist clients with navigating difficult experiences throughout the perinatal process and beyond.