How will restricting access to abortion impact mental health?

Editor’s note: This story includes discussion of suicide. If you or someone you know is considering suicide, resources are available to help. Please see the box below.

Natashia Milburn was 16 when she had an unplanned pregnancy but couldn’t get an abortion in Michigan.

Her Catholic family refused to provide consent, she said, and she didn’t want to go behind their backs and seek permission from a judge.

So Milburn decided to drive with her boyfriend to Chicago and get an abortion there.

Having to plan the trip and travel far from home created “unnecessary anxiety and trauma,” said Milburn, now a 31-year-old Air Force veteran living in St. Petersburg.

As conservative states ban abortion after the U.S. Supreme Court’s decision last month to overturn Roe v. Wade, Milburn said she’s worried that other pregnant people will experience similar stress.

Psychologists and psychiatrists are also raising concerns about the potential mental health fallout from the court’s 5-4 decision.

“This ruling ignores not only precedent, but science, and will exacerbate the mental health crisis America is already experiencing,” Frank Worrell, president of the American Psychological Association, said in a statement.

Abortion opponents, though, have long argued that ending a pregnancy leads to depression, anxiety and post-traumatic stress disorder.

So what has the scientific research on abortion and mental health actually found? What is the emotional toll of being denied — or having — an abortion?

Here’s what we know.

What’s the impact of being denied an abortion?

Women who were denied an abortion experienced more anxiety and lower self-esteem and life satisfaction in the short term — but similar levels of depression — compared to those who underwent one during the five-year Turnaway Study, which ended in 2016.

The study, conducted by the University of California, San Francisco, is the most thorough research to date on abortion and mental health. The study followed nearly 1,000 women who sought abortions at clinics in 21 states. Researchers compared women who had an abortion to those who were denied one because they were too far along. (The study didn’t include transgender men and nonbinary people who can get pregnant.)

“Being denied an abortion may be associated with greater risk of initially experiencing adverse psychological outcomes,” scientists concluded in a peer-reviewed analysis of the Turnaway data.

This is relevant now as some states ban abortion following the decision in Dobbs v. Jackson Women’s Health Organization. Florida Gov. Ron DeSantis said he will “work to expand pro-life protections” in light of the ruling. He signed a 15-week abortion ban into law in April.

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The Dobbs decision is “devastating for women,” said M. Antonia Biggs, a Turnaway researcher and professor in the department of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco.

Curtailing access to abortion, she said, is expected to have a negative effect on the mental health of those seeking one.

What do abortion opponents say?

Anti-abortion groups say the procedure harms mental health.

“Intentionally ending the life of an unborn child leads to much guilt and regret for a woman, triggering symptoms of anxiety, depression, substance abuse and potentially suicidal thoughts,” said a 2019 memo published by the American Association of Pro-Life Obstetricians and Gynecologists.

But having an abortion didn’t place women at a higher risk of experiencing suicidal thoughts or post-traumatic stress disorder compared to those denied one during the Turnaway Study, according to peer-reviewed research papers published in 2016 and 2018.

In the five years after an abortion, “the intensity of negative and positive emotions” declined “with relief predominating at all times,” according to a peer-reviewed Turnaway paper from 2020.

“The overwhelming majority of women felt that the abortion was the right decision for them,” the paper said.

Milburn, the St. Petersburg resident, said she never regretted her choice to undergo the surgical procedure.

“It was just like, ‘Alright I messed up,’” Milburn said. “I needed to figure out how to make this right for my life. ...

“I needed health care.”

Abortion opponents have criticized the Turnaway Study’s findings.

They argue that the five-year study is flawed because only about 37% of women who were asked to participate said they would. And while 956 women completed an initial interview, fewer than 600 completed the final one.

The participation rate “calls into question whether a self-selection bias occurred” since women “more deeply wounded” by an abortion “would reasonably be less likely to participate in such a study,” said the American Association of Pro-Life Obstetricians and Gynecologists.

This could have artificially lowered the number of mental health issues reported among women who received an abortion, the association said.

To be sure, the study had limitations. It excluded those with fetal anomalies. And Turnaway scientists said they couldn’t “rule out the possibility that women with adverse mental health outcomes may have been less likely to participate and/or to be retained.”

Does having an abortion cause mental health problems?

Biggs said critics are “grasping at straws.” She acknowledged that recruiting 2,000 women would have made the Turnaway Study stronger. But she argued that the participation rate wasn’t a limitation. That’s because, she said, it was a “huge feat” to be able to do the study at all.

“It is the best study that we have out there,” Biggs said. “There’s nothing compared to it.”

Other research has reinforced the study’s findings.

In 2014, when accounting for pre-existing mental health, University of Maryland family science professor Julia Steinberg found that having an abortion didn’t predict subsequent suicidal ideation or anxiety, mood, impulse-control or eating disorders.

Instead, a woman’s mental health before a pregnancy was a “strong predictor” of how she would feel afterward.

Steinberg didn’t rely on Turnaway data. She used a survey sample that was nationally representative to compare women who had abortions to those who gave birth.

“Policies shouldn’t be based on this notion that abortion causes mental health problems,” she said. “There’s no scientific evidence” of that.

How does travel affect someone seeking an abortion?

In 2007, Milburn couldn’t receive an abortion in Michigan. So she and her boyfriend left their hometown of Tecumseh early one summer morning and headed to Chicago. His mother let them borrow her car for the four-hour drive, she said.

Illinois allowed minors to undergo the procedure even if they didn’t have permission from their guardians.

To pay for gas, food and the abortion itself, Milburn sold her prized saxophone and cashed in bonds from her grandparents.

She was sure of her decision. But having to travel across state lines made the experience more stressful.

“I just remember being like, ‘I don’t know what’s going to happen. Will it work? Is there a chance it won’t work?’” Milburn said.

Her family’s reaction was also stigmatizing and difficult to handle, she said.

“It impacted my grades and everything. ... The static in the house, at home, it was heavy,” said Milburn, who was in high school at the time. “My stepdad wouldn’t even talk to me.”

Following the Dobbs decision, Milburn said she’s worried that others will face roadblocks to getting an abortion and will experience anxiety and stress.

State laws that increase the distance that pregnant people must travel to receive an abortion may be harmful to mental health, according to a peer-reviewed paper published in 2020 by Biggs and other researchers.

The scientists recruited and surveyed 784 people who were seeking abortions at four clinics in California, Illinois and New Mexico. They found that logistical barriers such as travel or spending time finding a clinic “were associated with more symptoms of stress, anxiety and depression,” Biggs said.

Post-Roe, at least 25 states are expected to ban the procedure, according to the Guttmacher Institute, an abortion rights research organization. People in the Deep South and parts of the Midwest and Mountain West may be forced to travel hundreds of miles to receive an abortion.

“Mental health symptoms around the time of having an abortion” are expected to increase, Steinberg said, because of the “structural barriers that these laws are going to be putting in place.”

Times staff writer Dan Sullivan contributed to this report.

If you need help

If you or someone you know is contemplating suicide, call or text 988 to reach the National Suicide Prevention Lifeline or chat with someone online at 988lifeline.org.

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