MHIP Issue 9: One year since Dobbs v. Jackson Women's Health
Reflections on mental health in a post-Roe world
Saturday June 24 marked the one year anniversary of the Dobbs v. Jackson Women’s Health Organization decision, which overturned the ruling made in Roe v. Wade in 1973 protecting the right to have an abortion. I remember the moment that the decision dropped – I was sitting at my desk in my home office as the breaking news alert came through on my phone, and my stomach instantly dropped. My phone started to buzz with texts from friends sharing their shock, fear, and grief at the news — years of organizing and persistence from a minority determined to control our bodies1 worked. As we processed the news, we were collectively asking ourselves — now what?
Today’s newsletter takes a walk through the history of reproductive freedom in the U.S., a year in this post-Roe world, and what it means for our mental health and wellbeing as a country.2
A brief timeline of Roe, Dobbs, and reproductive healthcare in the U.S. It wasn’t until the 19th century that abortion became a controversial procedure and focus of legal debate. By the early 1900s, all states had anti-abortion laws in place, and notably, women still did not have the right to vote. At the time, abortion, though illegal, was not the politically-charged topic it is today – it wasn’t until after the Roe decision that the Republican party and evangelicals took on abortion as a leading issue. The 1920s-70s saw a rise in the fight to secure abortion access in the U.S., and doctors began advocating for abortion to be treated like any other medical procedure, a decision that is made between a patient and their medical provider. Before Roe, the Supreme Court took on a case that would have important implications for reproductive health and freedom – Griswold v. Connecticut. In a 7-2 vote, the court protected the right for married couples to access contraception, and just a few years later, in 1972, Eisenstadt v. Baird extended this right to unmarried people. Then, in another landmark 7-2 decision, Roe v. Wade was decided, and the right to abortion was established in the U.S. That is, until the Dobbs decision in 20223.
Indeed, Republicans continued to pursue opportunities to challenge Roe, and in Dobbs v. Jackson Women’s Health Organization, they finally found their winner. This case centered on the state of Mississippi, which enacted a 15-week abortion ban in 2018. At the time, Mississippi was home to only one abortion clinic – Jackson Women’s Health Organization. Jackson Women’s Health sued the state following the passage of the 15-week ban, and the case eventually made its way to the Supreme Court in 2022. In a stunning 6-3 decision, Roe was effectively overturned, and it was determined that abortion is not a constitutional right.
Where we are today. In the year since Roe was overturned, states have acted quickly to restrict abortion. To date, 25 states have passed restrictions on abortion, leaving millions of people without access to fundamental reproductive care. Tennessee, for example, banned abortion at 6-weeks with no exceptions — meaning abortion is fully banned in the state. For a comprehensive look at laws across the U.S., check out the Center for Reproductive Rights interactive map. The map is bleak — and Republican candidates gunning for the 2024 Presidential nomination have stated they would seek a national 15-week ban on abortion. Meaning things could get even worse.
A recent poll conducted by KFF, a nonprofit focused on health policy research and polling, examined OBGYNs experiences after the Dobbs decision. The survey was completed by 569 providers between March-May of this year, and asked providers about their experiences providing reproductive healthcare. Findings indicate that approximately 42% of providers express concern about legal risks associated with reproductive care, with that number increasing in states with abortion bans in place. Further, 36% of OBGYNs reported that their ability to practice within the standard of care is impacted negatively in the aftermath of Dobbs, again with that number increasing in states where abortion is banned. Preliminary findings from the Care Post-Roe Study out of UCSF found that from healthcare providers’ perspectives, laws enacted since Dobbs have contributed to worsened health outcomes for those seeking reproductive care.
Abortion bans have a devastating impact not only on those seeking elective abortions, but also those suffering from miscarriages and pregnancy-related medical emergencies. Take, for example, the experiences of five women in Texas who are suing the state for being denied potentially live-saving medical care under the state’s extremely restrictive abortion laws. In a country with rising maternal mortality rates, the implications of Dobbs continue to unfold.
What does this mean for our mental health? First, let’s start with what we know about the impacts of abortion on mental health. Abortion does not cause mental health problems. In fact, evidence from a longitudinal study of women seeking abortions suggests that being denied access to abortion, rather than receiving an abortion, is associated with poorer mental health outcomes. Further, data from this study found women denied abortion also face greater economic hardship, which is also associated with poor mental health. Several factors also contribute to increased risk of mental health problems after seeking an abortion, including prior mental health history and increased perceived abortion stigma.
Importantly, to understand abortion in the context of mental health, we must consider the intersection of abortion rights, mental health, and structural racism in the U.S. I strongly urge you to read this article by Dr. Ogbu-Nwobodo and colleagues in the New England Journal of Medicine, which outlines the mental health implications of Dobbs through an intersectional lens. Limiting access to abortion and reproductive healthcare is likely to exacerbate existing health inequities in the U.S.
It is also important to put the Dobbs ruling into the context of how the U.S. supports new parents. Many new parents will experience postpartum depression, anxiety, and other mental health distress, which has psychological impacts on both parents and their child. Yet, access to mental health supports in the U.S. is abysmal — and perhaps not surprisingly, in states where abortion is banned, access to mental health care is the worst. In addition, the Pew Research Center found the U.S. ranks last in government-mandated paid parental leave when compared to 41 other countries, requiring many parents to return to work immediately (or just a few short weeks) after giving birth. So, we have laws in place that force people to give birth — yet we provide little to no support for them once the child is born. How very “pro-life”…
The impacts of Dobbs on mental health will continue to unfold, and the future of abortion and reproductive freedom in the U.S. remains uncertain. The fight ahead can feel quite daunting, but it’s important to remember that a majority of Americans support the right to choose.
Take action. Support local organizations doing the hard work in your state to protect and promote access to reproductive healthcare (and in the case of states where abortion is banned, are working to help people seek care elsewhere). The Yellowhammer Fund, Abortion Care Tennessee, Mountain Access Brigade, and ARC Southeast are just a few organizations doing great work in the Southeast. Feel free to share in the comments any others that you support.
Thank you for reading, subscribing, and sharing Mental Health is Political. I’ll be taking a break from the newsletter next week for the holiday, so I’ll see you in 2 weeks.
Often the language of abortion rights focuses on women, to the exclusion of trans and gender diverse people who can and do get pregnant. Attacks on reproductive freedom impact more than just women, and its important that our language reflects this truth.
There are many folks who have covered the abortion and reproductive healthcare landscape in great detail for a long time. I recommend following Jessica Valenti’s substack, Abortion, Every Day, for ongoing and in depth coverage of these issues.