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CHICAGO (AP) — After finding out she was pregnant, Kaniya Harris experienced some of the hardest weeks of her life.
Final exams were approaching. Her doctors informed her that she had an ovarian cyst, and would be at high risk for an ectopic pregnancy. Wait times at abortion clinics near her hometown, Bethesda, Maryland, were very long. She couldn’t even visit her family in Kentucky, a state that bans abortion.
Harris suffered frequent panic attacks. It all seemed overwhelming, he said.
“My mental health was at the lowest point of my life,” said Harris, who had an abortion in May last year.
As abortion rights groups have been pushing for legislation to protect this right this year, significant differences in the wording of the proposed measures have become apparent. These also include including mental health among the legal grounds for abortion.
A Missouri proposal would allow lawmakers to restrict abortion after a fetus is deemed viable, except when the abortion is “necessary to protect the life or physical or mental health of the pregnant person.” A similar measure has been proposed in Arizona. In 2022, Michigan voters approved an abortion rights amendment that included a mental health exception to the feasibility limit.
On the other hand, the text proposed for ballot in Arkansas refers only to “physical health” and does not consider mental health causation. Mental health is not explicitly mentioned in abortion rights initiatives launched in other states such as Florida, Montana and Nebraska.
“It’s devastating to hear about these policies that ignore mental health,” said Harris, now 21. “Abortion can save someone’s life, even if they have a serious mental health condition.”
Most states that ban abortion provide grounds for life-threatening emergencies, but only Alabama includes grounds for “serious mental illness” that could result in the death of the mother or fetus. Lawmakers added the exception after pressure from the state medical association, which was concerned about women who face a higher risk of suicide.
The law, passed in 2019, was one of the strictest abortion restrictions in the country at the time. It did not include reasons for rape or incest and considered that performing an abortion was a serious crime. Alabama began implementing the ban in 2022, after the U.S. Supreme Court overturned Roe v. Wade, which once guaranteed the federal right to abortion.
Bans on abortion in at least 10 states—Florida, Georgia, Idaho, Iowa, Kentucky, Louisiana, Ohio, Tennessee, West Virginia and Wyoming—explicitly exclude mental health conditions as a possible cause. Others are more vague, and allow grounds for the woman’s “life and health” without clarifying whether mental health is included.
Medical experts say states that allow mental health cases also force patients to undergo complex conditions that may be inaccessible to some people, especially those with low incomes. For example, Alabama requires a state-licensed psychiatrist with at least three years of clinical experience to certify that a mental disorder is an emergency.
There were days, she recalled, when Harris would come home from school and “feel so overwhelmed that I would collapse on the floor in panic.” He cried every day for two months. But amid abortion bans in her home state and stigmatization of doctors, Harris said she didn’t feel comfortable talking about her experience with a mental health professional.
“People shouldn’t have to go through difficult situations and display their pain to get the care they need,” she said.
Mental health conditions were the leading underlying cause of pregnancy-related deaths from 2017 to 2019, when approximately 23% of pregnancy-related deaths were attributed to mental health conditions, including suicide and drug use disorder overdoses. According to the Centers for Disease Control and Prevention (CDC).
According to the CDC, approximately one in eight women suffers from postpartum depression. But mental health problems during pregnancy, particularly the psychological trauma of those who are forced to maintain an unwanted pregnancy, are also at risk, said Michelle Oberman, a law professor at Santa Clara University who has researched the effects of abortion restrictions. , is understood.
“Those statistics, those stories of women’s suffering, are troubling to me,” Oberman said. “As a society, we don’t have as good a track record of taking care of mental health as we do physical health.”
Policies that dismiss mental health because they view it as less relevant than physical health are life-threatening, said Paul Appelbaum, a psychiatrist at Columbia University. He also indicated that there is increasing evidence that refusing an abortion causes serious mental distress. This suffering is highlighted in recent stories of women who were forced to flee their states or pursue pregnancies despite serious risks to their health.
Appelbaum, former president of the American Psychiatric Association, said, “I am deeply concerned about the exclusion of mental health exceptions in these ballot measures.” “This is completely cruel and will lead to tragic deaths of pregnant women in these states.”
Jayme Trevino, an obstetrician-gynecologist in Missouri and part of Physicians for Reproductive Health, said she saw firsthand how abortion denial can affect patients’ well-being, including their mental health.
“This is a devastating and common reality for my patients,” he said, adding that he was grateful the mental health issue was included in the text of the election measure proposed by the state.
Mallory Schwarz, spokeswoman for Missourians for Constitutional Freedoms, said the bill’s language “is written to ensure that doctors – and not politicians – are able to determine what is best for their patients.”
In contrast, Arkansas’s initiative only covers “protecting the life of a pregnant woman or protecting a pregnant woman from physical disorder, physical illness, or physical injury.”
Jenny Diaz, general director of For AR People, said previous versions of the proposal covered a broader base. Initially, he indicated, “We wanted to develop a text for a constitutional amendment that was as broad as possible and hopefully took something like mental health into account.”
But when he was presented with a proposal based on “protecting the life and health” of the mother, the state attorney general, a Republican, rejected the text, saying he would have to define “health.”
“It was a signal to us that we had to make a decision,” Diaz said. “And another unfortunate factor is that the majority of Arkansas voters are unlikely to support mental health as a reason for abortion after a certain time frame. “We thought it was unlikely that a version with the name explicitly named Mental Health would be approved.”
Diaz said Arkansas activists were also concerned that the opposition campaign would focus on the issue of mental health.
The National Right to Life Committee’s model bill to ban abortion in the state does not explicitly include mental health grounds. These grounds allow pregnant women to “evade these laws and terminate pregnancies with viable children,” said Ingrid Duran, the committee’s state legislative director.
He said, “We specifically singled out the mental health grounds because we saw how a loophole was created in the law and left fetuses at risk of dying from a sometimes treatable, sometimes temporary condition. Due to which the mother could have suffered.”
When asked if targeting on mental health grounds would be part of his strategy to campaign against abortion ballot measures in 2024, he responded: “I can’t necessarily say it would be part of the strategy.” Still, “when I see mental health causes like this, my heart starts beating faster,” he said.
Santa Clara University’s Oberman said he envisions the anti-abortion movement “will adopt strategies of minimizing and dismissing the mental health consequences of forced pregnancy.”
“The mental health problems of pregnant people remain in the shadows and are highly stigmatized,” she said. “And that clouds our judgment about what a medical emergency looks like during pregnancy.”
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