Thursday, February 9, 2023

Psychiatrists Describe What Abortion Restriction Could Mean for People With Psychiatric Disorders

The Supreme Court decision in Dobbs v Jackson Women’s Health Organization to end the constitutional guarantee of a right to abortion will not only impact the 1 in 4 people in the United States who seek abortions—it’s likely to also impact psychiatric practice. So wrote psychiatrists Katherine Wisner, M.D., M.S., and Paul Appelbaum, M.D., in a Viewpoints article published yesterday in JAMA Psychiatry.

Wisner is the director of the Asher Center for the Study and Treatment of Depressive Disorders at Northwestern Feinberg School of Medicine. Appelbaum, a past APA president, is the Elizabeth K. Dollard Professor of Psychiatry, Medicine, and Law and director of the Center for Law, Ethics, and Psychiatry at Columbia University.

“As psychiatrists, we have specific concerns about the impact of abortion restrictions on people with mental illness,” they wrote, noting that studies have found a higher prevalence of psychiatric disorders among people who have had abortions. “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. … For patients without access to abortion services, attempts at self-injury to induce pregnancy loss will repeat the tragedies of the pre-Roe era.”

There are also long-term consequences for the babies born to people with psychiatric disorders who were compelled to continue unwanted pregnancies.

“In this immediate post-Dobbs period, states vary in the degree of restrictions with respect to the gestational timing limits, personnel who can perform abortions, requirement for pre-termination counseling, rules governing state or private insurance coverage, and exceptions for rape, incest, or congenital malformations,” Wisner and Appelbaum wrote. “Psychiatric disorders also are among conditions that may threaten the life and health of a pregnant person, yet some of the newer statutes appear to exclude mental illnesses as exceptions.”

They pointed to exclusion of mental illness from Oklahoma’s statutory definition of a “medical emergency justifying abortion” as a “a physical disorder, physical illness or physical injury including a life endangering physical condition caused by or arising from the pregnancy itself.” The authors noted that psychiatrists may again be called upon to authorize exceptions to abortions in states that have more lenient restrictions (as was sometimes the case prior to the Roe v. Wade decision).

“The prospect of psychiatrists again serving as gatekeepers is not appealing, given the pressures they will face to authorize exceptions,” the authors wrote. “However, the response cannot be the exclusion of all mentally ill pregnant people whose lives or health are endangered by denial of access to safe abortions. … 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.”

For related information, see the Psychiatric News articles “Experts Share Advice for Post-Roe World: ‘We Have to Be Proactive’” and “APA Responds to End of Roe v. Wade.”

(Image: iStock/SerrNovik)

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