In the year since the Supreme Court outlawed the state’s right to abortion, 18 states have enacted abortion bans that specify that mental health and suicidal tendencies do not fall under women’s health-related exceptions. The deviations come despite growing national momentum for abortion. Treat physical health and mental health equally.
Suicide is one of the leading causes of death among women of reproductive age. According to the Centers for Disease Control and Prevention, nearly 23% of pregnancy-related deaths are thought to be caused by mental health conditions.
Constance Gill, founder and director of the Department of Women’s Reproductive and Behavioral Health at the Medical University of South Carolina, said: “These are conditions that kill women, and the absolute greatest risk factors for women are depression and substance use disorders. and other mental health conditions.” . “Thus, these symptoms are as deadly as many other symptoms in medicine.”
Even though the June 2022 Dobbs v. Jackson Women’s Health Authority decision overturned the federal right to abortion, federal law still requires states to provide medical assistance in the event of a medical emergency or otherwise. It requires abortions to be provided in cases where there is a risk of losing Medicare funding, an important source of state revenue.
However, what constitutes a medical emergency is not uniform, at least in a legal sense. Although state laws vary in specificity, no state explicitly provides protections for mental health emergencies.
Gray areas can be confusing for healthcare providers.
“There’s a lot of confusion. There’s a lot of anxiety, especially when you link that to the possibility of prosecution of providers,” said Gill, the reproductive psychiatrist. “People are afraid to step in and do the right thing or pay attention because they’re afraid they’ll do something illegal, especially when the law is complicated and they’re not sure. I am.”
Seeking equivalence elsewhere
The move to distance mental health from physical health in state abortion laws comes despite decreasing stigma and broad bipartisan acceptance of policies related to many areas of mental health. It is being said.
Congress passed the bipartisan Mental Health Parity Act in 1996 and 2008, requiring insurance companies to provide equal coverage for mental health and physical conditions. And in 2022, Congress passed bipartisan mental health and gun safety legislation.
Even some state laws that disqualify mental health as a medical emergency acknowledge the risks posed by certain mental health conditions, but only when it comes to the risks and complications of abortion.
In Tennessee, for example, state law says doctors can seek an exemption from that ban to perform emergency abortions to prevent death or “major impairment of a bodily function.” However, that language specifically excludes the “psychological or emotional condition” of a pregnant woman.
But the same law also requires doctors to report post-abortion medical complications, including “psychological complications such as depression, suicidal ideation, anxiety, and sleep disturbances.” and other adverse events. ”
“Lawmakers are debating exclusions for mental health issues and suicidal ideation because they don’t want malicious actors to use them as reasons for people to get an abortion,” said clinical associate professor N. Dawn Bingham. I will.” She received her doctorate in obstetrics and gynecology from the University of Southern California, Columbia Medical School. “They’re looking for some reason to show that abortion actually harms women.”
origin
The United States is not alone in questioning what constitutes a mental health emergency and whether abortion is justified.
Ireland had the strictest abortion restrictions in the European Union until voters repealed the ban in 2018. But the country has allowed exceptions for suicide risk since a landmark 1992 Irish Supreme Court ruling.
In the United States, state abortion laws focused on mental health were part of a 2005-2006 federal push to restrict non-custodial adults from assisting minors seeking abortions across state lines. has its roots.
The bill, introduced in 2005, states that if the delay “causes serious and irreversible impairment of the minor’s major bodily functions resulting from the continued pregnancy, not involving a psychological or emotional condition,” It contained language providing for exceptions.
Doug Johnson, a lobbyist for the National Right to Life Committee, helped draft the bill, which passed both chambers but failed to become law.
Since then, federal lawmakers have introduced 32 other abortion bills that clarify that the exception “does not include mental or emotional conditions,” beginning in 2012 after states began adopting similar language. submitted.
In 2010, Nebraska enacted a 20-week abortion ban with medical exceptions, but not cases related to suicidal ideation. The bill was based on a model bill drafted by Mary Spalding Balch, then the NRLC’s state law director.
Alabama passed its own 20-week ban in 2011, with language that also prohibited medical exceptions related to suicidal ideation and expanded it more broadly to all mental health conditions.
According to a CQ roll call analysis of laws passed since 2005, two states listed only suicide risk as disqualifying for seeking a medical exemption for abortion, nine states listed only mental health as disqualifying, and seven states listed mental health as disqualifying. Disqualifying both suicide risks. .
Before Dobbs, states could implement mental health restrictions before fetal viability. The decision allows states to remove these exceptions and impose stricter bans.
The analysis also found that Oklahoma passed six laws between 2011 and 2021 that incorporated the most commonly used mental health exception language. Between 2011 and 2023, Kansas passed five laws with identical language specifying an exception for suicidal ideation.
Tightly regulated exceptions are rare.
In 2019, Alabama passed another bill with language that would create a near-total abortion ban. The bill would also create a narrow exception that would allow for a mental health emergency exception if an Alabama-licensed psychiatrist with at least three years of clinical experience certifies that the mental health condition is an emergency. Ta.
This provision allows state-certified doctors with admitting privileges to perform abortions. The law, which took effect in June 2022 following the Dobbs decision, also does not include exceptions for rape or incest.
In June 2022, prior to the Dobbs decision, the NRLC unveiled model legislation for state-level abortion bans, including that mental health and suicidal thoughts would be considered medical emergency exceptions in the post-Dobbs law. It contained language that made it clear that it should not be done.
“We’ve seen in the past that the health exception is basically a loophole that allows abortion for any reason. For example, ‘But I might kill myself because I’m anxious.’ some women may say,” said Ingrid Duran, NRLC’s state legislative director. “If we’re really concerned about someone’s mental health, forcing them to have an abortion is not the way to solve it.”
stigma
In practice, laws that separate mental health from physical health may make the situation more difficult for health care providers to understand, and health care providers may be concerned that this may further stigmatize mental health. I am concerned that there is.
“This is basically saying that even though they are life-threatening conditions, these are not equal conditions. That’s not true,” Gill said.
Collecting data on mental health emergencies and abortions is difficult. States are not required to report abortion statistics to the CDC. Patients traveling to states without mental health-related restrictions may not be required to disclose whether mental health was a factor in seeking an abortion.
“When this language was adopted in various states, there was no real legislative conversation, either in committee or on the floor, about what we were doing to improve mental health,” says State Policy. Director Elizabeth Smith said. Rights advocacy activities at the Reproductive Rights Center.
“I don’t know that these legislators have ever had to publicly explain their position or grapple with what this means.”
This article is part of a series supported through the Rosalynn Carter Fellowship for Mental Health Journalism.
If you or someone you know is experiencing a mental health crisis, call the 24-hour toll-free 988 Suicide and Crisis Lifeline (9-8-8) to speak to a trained counselor. Please connect to.