Roe v. Wade Has Been Overturned: How The Future Of Abortion Care In The U.S. May Impact Mental Health, According To Experts

Since 1973, when the U.S. Supreme Court issued its ruling on the landmark case Roe v. Wade, abortion access had been federally protected as a constitutional right. Specifically, the Court made the following decisions:

• First trimester abortions: The Court ruled that abortions performed during this time cannot be regulated by state governments, leaving the decision up to the pregnant person and their physician.
• Second trimester abortions: The Court granted states permission to regulate second trimester abortions only to reasonably safeguard maternal health.
• Third trimester abortions: In the last trimester of pregnancy, the Court granted states the full ability to restrict abortion access, except in cases in which the pregnant person’s life or health is at risk.

However, with the Supreme Court overturning Roe v. Wade on June 24, access to abortion care may be soon limited—and even restricted—in some states, as the decision has handed the legality of abortion access back to individual states to decide.

Additionally, 13 states have enacted “trigger laws,” meant to severely restrict or ban abortions should Roe v. Wade be overturned. States with trigger laws include Arkansas, Idaho, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, Utah and Wyoming. The Guttmacher Institute, a national research and policy organization, estimates an additional 13 states would enact abortion bans if Roe v. Wade is overturned.

For decades, researchers have performed studies that found abortion procedures to have negative mental health outcomes, like post-traumatic stress disorder and depression. However, a review of this body of literature performed by the American Psychological Association’s Task Force on Mental Health and Abortion (TMFMHA) found that many of these studies were methodologically flawed due to issues with sampling, measurement, design and interpretation^[1]American Psychological Association, Task Force on Mental Health and Abortion. Report of the Task Force on Mental Health and Abortion. (2008). Washington, DC. .

“Well-designed, rigorously conducted scientific research would help disentangle confounding factors and establish relative risks of abortion compared to its alternatives, as well as factors associated with variation among women in their responses following abortion,” the report states. “Even so, there is unlikely to be a single definitive research study that will determine the mental health implications of abortion ‘once and for all’ given the diversity and complexity of women and their circumstances.”

Evaluating all empirical studies conducted between 1989 and 2008, the task force ultimately concluded that the “most methodologically sound research” suggests legally terminating an unwanted pregnancy in the first trimester did not increase risk of negative mental health outcomes.

“There is no research to indicate that abortion is a cause for subsequent mental health diagnoses,” American Psychological Assocation president Frank C. Worrell, Ph.D., said in a statement separate from the report.

Contrary to those early research findings, there’s growing evidence that links lack of abortion access to negative mental health outcomes.

Monica P. Band, Ph.D., a licensed mental health counselor in Washington, D.C., says she’s seen clients struggling with anxiety and depression ahead of the Court’s ruling.

“The potential overturning brought about reports of resignation, hopelessness and disillusionment…,” says Band. “[Individuals] who experienced the ongoing grief of child loss, miscarriage and infertility due to preexisting conditions were equally concerned about their future in conceiving—worried primarily about their access to the medical care, support and education that they relied on in the past.”

Fears over restricting abortion access are shared across ideological lines, a reflection of the estimated 61% of adults in the U.S. who support abortion rights in all or most circumstances, according to data from Pew Research Center^[2]America’s Abortion Quandry. Pew Research Center. Accessed 6/8/2022. . “It’s interesting because even the clients who are very against abortion have voiced empathy for women who need this medical service in certain situations,” says Kristen Casey, Psy.D, a licensed clinical psychologist in Kansas City, Missouri.

Groups that experts noted were experiencing heightened anxiety ahead of the Court ruling include:

Women of Reproductive Age

Pec Indman is a recently retired licensed marriage and family therapist with a specialty in maternal mental health. Licensed in Cupertino, California, Indman, who also worked as a physician’s assistant in family practice, hopes this moment will encourage sexually active people to be smarter about contraceptive use. However, she is quick to note that no contraceptive is 100% effective.

“I’ve had women get pregnant while they were using an IUD,” she says. “I’ve had women get pregnant on the pill. Not all men are willing to use condoms. I think [repealing Roe vs. Wade] will definitely increase anxiety knowing that, worst case scenario, abortion is not available and they will be forced to carry a [pregnancy] to term.”

Jennifer Lincoln, M.D., an obstetrician-gynecologist in Portland, Oregon, has been fielding worries from young followers of her viral TikTok account, a platform she uses to host conversations around sexual health. Dr. Lincoln says young people have been clamoring for her advice on stockpiling emergency contraception and abortion pills in light of the  Supreme Court’s decision. She says people are also expressing concerns about their period tracking apps, worried their data could be used as evidence against them if they ever needed to seek an abortion.

For all people of reproductive age, Indman adds, losing access to abortion care could impact their romantic relationships. “From a mental health perspective, [they] will feel a greater anxiety about having sex. And that is damaging to intimacy.”

Women With Families

In 2019, 60% of abortion recipients were women who had given birth previously, according to a Pew Research Center analysis on Centers for Disease Control (CDC) data^[3]What The Data Says About Abortion In The US. Pew Research Center. Accessed 6/8/2022. . These women likely understand the physical, emotional and financial toll of birthing and raising children, Dr. Lincoln says. “To have their reproductive choice limited—especially when they already know what this subjects them to—is definitely causing fear in people.”

Women in Vulnerable Communities

Research indicates women in lower-income situations are less likely to use contraception than their wealthy counterparts. This results in a rate of unplanned pregnancy that is five times higher for women living in poverty, according to a report from the Brookings Institute^[4]Rich-Poor Divides In Contraception And Abortion Explain Large Gap In Unplanned Pregnancy Brookings’ Reeves Finds. Brookings Economic Studies. Accessed 6/8/2022. .

Since Roe v. Wade was decided in 1973, the Guttmacher Institute notes in a 2021 report that the U.S. has passed 1,336 abortion restrictions at the state level^[5]Roe V. Wade In Peril: Our Latest Resources. Guttmacher Institute. Accessed 6/7/2022. . Many state governments opposed to abortion have shuttered clinics and are expected to close even more in the wake of the Roe v. Wade is reversal. This will leave people in certain states hundreds of miles away from their nearest clinic. And for those living in low-income situations, traveling great distances, whether by car or plane, can be prohibitively expensive, says Dr. Casey.

“We know that women who are poor and of color have less availability of services. The [additional] challenges to seeking abortion care will really increase anxiety, stress and depression,” says Indman.

Women Who Are Victims of Violence and Sexual Abuse

Research indicates that pregnancy increases the risk of domestic violence throughout pregnancy and for 1.5 years postpartum, with a higher share of women reporting new cases of domestic violence during pregnancy and postpartum^[6]Finnbogadóttir H, Dykes AK. Increasing Prevalence And Incidence Of Domestic Violence During The Pregnancy And One And A Half Year Postpartum, As Well As Risk Factors: -A Longitudinal Cohort Study In Southern Sweden. BMC Pregnancy Childbirth 2016;(16),327.. . In turn, domestic violence is a risk factor for unplanned pregnancy, creating a circular issue that puts victims of intimate partner violence at continued risk. Victims of domestic violence have higher rates of mental health conditions such as depression, anxiety, post-traumatic stress disorder, substance abuse and suicidal ideation, according to the National Center on Domestic Violence, Trauma and Mental Health.

“It is very common for [individuals] who are survivors of sexual assault to successfully work through their distress in therapy, only to feel re-traumatized when they give birth,” notes Band. Experiencing childbirth as a result of abuse, rape or incest may require intensive therapy and psychotropic medication, adds Dr. Casey.

For anyone experiencing feelings of stress, anxiety or depression about the future of abortion access in the U.S., Dr. Casey recommends therapy. She says it can be helpful to ask questions, share concerns and explore ideas in a safe place.

To find a licensed therapist, you can ask friends, family and your primary care physician for recommendations for practitioners they trust. You might also contact your insurance provider for a list of therapists in your network. Additionally, the American Psychological Association offers a nationwide directory to search for licensed psychologists in your area. If you cannot afford therapy, reach out to social service departments or national nonprofits like the National Alliance on Mental Illness, as they may be able to connect you with local providers that can fit your financial needs.