Living in an abortion ban state is bad for mental health

The false idea that getting an abortion makes women irreparably depressed and anxious, that it causes a deep psychic wound, has for decades been used by anti-abortion activists to support abortion restrictions.

But the argument is entirely based on anecdotes, personal beliefs, and vibes. No good science has demonstrated this link.

That’s not because nobody’s tried to answer the question of what the mental health impacts of abortion are on the women who obtain them. It’s because the answer to that question, over and over again, is: none. In study after study, researchers have consistently shown that getting an abortion does not cause mental health problems.

What does reliably worsen women’s mental health, however, is banning or restricting abortion access.

A wealth of research has shown that when people are forced to carry unwanted pregnancies, it negatively impacts their physical health and finances — and mental health. In a survey conducted before the US Supreme Court overturned the constitutional right to abortion, women living in states with more abortion restrictions had higher rates of mental distress. In another study, states enforcing abortion restrictions between 1974 and 2016 had higher suicide rates in women of childbearing age in particular.

But when the court decided to overturn Roe v. Wade in 2022, it wasn’t making a decision grounded in science.

Now we’re more than a year and a half into living with the consequences. And when it comes to women’s mental health, the fallout is following the exact pattern scientists predicted.

Research shows the thing we thought was true is, in fact, true

In a study published last month, researchers at Johns Hopkins University found that people living in states that banned abortion in the immediate wake of the Court’s decision have worse symptoms of anxiety and depression than those who live in states without bans.

Using data gathered as part of US Census Household Pulse surveys, the researchers looked at respondents’ self-reported anxiety and depression scores from about six months before and six months after the Court overturned the constitutional right to abortion. They compared scores on a scale of zero to 12 among people in states with and without trigger bans, abortion restrictions that went into effect as soon as the Supreme Court issued its ruling.

What they found was, frankly, predictable: Before the Court’s decision, anxiety and depression scores were already higher in trigger states — a population-wide average of 3.5 compared with 3.3 in non-trigger states. After the decision, that difference widened significantly, largely due to changes in the mental health of women 18 to 45, what the authors defined as childbearing age. Among this subgroup, anxiety and depression scores subtly ticked up in those living in trigger states (from 4.62 to 4.76) — and dropped in those living in non-trigger states (from 4.57 to 4.49). There was no similar effect in older women, nor in men.

These differences were small but statistically meaningful, especially since they sampled the entire population, not just women considering an abortion. Moreover, they were consistent across trigger states, whether their policies and political battles around abortion had been high- or low-profile. Even when the researchers omitted data from states with particularly severe restrictions on women’s reproductive health (looking at you, Texas), the results held up.

It’s notable that the different levels of mental distress across states after Roe was overturned weren’t just a consequence of worsened anxiety and depression in states with trigger bans. Also contributing: an improvement in these symptoms in states without these bans. We can’t tell from the study exactly why that is, but it seems plausible that women living in states that protect their right to access necessary health care simply feel some relief.

Americans don’t need more mental health stressors right now

In bird’s-eye-view studies like this, it can be hard to pick apart the nuances behind a finding. For example, it’s possible other social or cultural factors are more likely to disproportionately affect women in trigger states — like variability in gender equity, interpartner violence, abortion stigma, and mental health care access.

Still, it should set off our alarm bells when high-quality research finds a causal relationship between big societal shifts and worsening depression and anxiety on a population-wide level.

People who sense limitations to their personal freedom and autonomy feel a sense of “violation and powerlessness,” says Benjamin Thornburg, a health economics PhD student who led the study. It stands to reason that the opposite of that, a sense of freedom and autonomy, would improve people’s overall mental health.

Anxiety and depression rates are reaching record highs and are especially pronounced among young adults, and suicide deaths are ticking up. At the same time, Americans are living in an age of broadly unmet mental health care needs: 160 million Americans live in areas with provider shortages and insurance denials, and only one-third of people diagnosed with a behavioral health condition get the care they need.

Policymakers need to understand “there could be an increase in the need for mental health services in states where these bans have happened,” says Thornburg.

But it’s not at all clear they do.

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