Psychiatrists urge consideration of mental health in abortion laws

Legislators must take mental health implications into account when writing abortion laws, psychiatrists wrote in a Viewpoint in JAMA Psychiatry.

“As psychiatrists, we have specific concerns about the impact of abortion restrictions on people with mental illness,” wrote Katherine L. Wisner, MD, MS, director of the Asher Center for the Study and Treatment of Depressive Disorders at Northwestern University Feinberg School of Medicine, and Paul S. Appelbaum, MD, of the Center for Law, Ethics and Psychiatry at Columbia University. “Vulnerable pregnant people will be subject to devastating levels of distress associated with denial of access to abortion, as in giving birth to the child of a rapist. The pregnant person loses value and autonomy and becomes a mere container for the embryo/fetus. For patients without access to abortion services, attempts at self-injury to induce pregnancy loss will repeat the tragedies of the pre-Roe era.”

People who experience psychiatric disorders during or after pregnancy are at risk for similar conditions in subsequent pregnancies, Wisner and Appelbaum wrote. They cited that patients who previously had postpartum depression are 20% to 25% more likely to experience postpartum depression again, and patients with a history of postpartum psychosis have more than a 50% risk for recurrence.

Additionally, they wrote that the medications of pregnant people with mental illnesses may bear negative impacts, such as congenital malformations, for a fetus. However, because congenital malformations may not be detected until 20 weeks’ gestation, patients in states with abortion restrictions would not be able to terminate these pregnancies.

Prenatal psychiatric conditions may also affect the neurodevelopment of the child and the parents’ ability to raise them, as well the health of the person themselves, Wisner and Appelbaum wrote.

“Ignoring the impact that mental illness can have on the lives and health of pregnant individuals seems intended to avoid the situation that existed in some states prior to the legalization of abortion by Roe v. Wade,” they wrote.

They urged that “at the very least, states legislating abortion restrictions must recognize the impact of undesired pregnancies on people with or at risk for mental disorders and create mechanisms to keep them safe.”