Mental health advocates say there’s a cruel quirk in several states’ abortion bans: There are exemptions for life-threatening emergencies, but psychiatric crises don’t count.
It makes no sense to an Arizona mother of three who became suicidal during her fourth pregnancy and says an abortion saved her life. Or researcher Kara Zivin, who nearly died of a suicide attempt while pregnant and whose work suggests such seizures are not uncommon.
Zivin had a healthy baby, but she sympathizes with women facing mental health emergencies who feel their only option is to terminate a pregnancy.
“People often try to treat mental health as separate from physical health, as if your brain is somehow separate from the rest of your body,” said Zivin, professor of psychiatry, obstetrics and gynecology and management. health at the University of Michigan.
The crackdown on abortion adopted or enforced since the overturning of Roe v. Wade in June illustrates the dichotomy. In at least eight states that allow exemptions for life-threatening conditions, physical health is a primary concern. Maternal mental health is not included.
Some of these exemptions are obscurely worded. Others are self-explanatory. Laws in Georgia, Nebraska and West Virginia specify that medical emergencies do not include suicide threats. A county judge’s decision to strike down the Georgia law on Tuesday is on appeal. Florida’s exemption includes life-threatening illnesses “other than a psychological condition.”
Some abortion haters say the laws are aimed at preventing women from faking mental illness to get doctors to terminate their pregnancies.
Patricia, who is 31, is married and “your average neighborhood chicana”, says her agony was painfully real. The Phoenix woman spoke to The Associated Press on the condition that only her first name be used, citing security and privacy concerns.
She says a wave of severe depression hit her in the summer of 2018 and shattered “not only my mind, but my heart and my soul”. She could not eat, sleep or properly care for her three young daughters. Panic and suicidal thoughts bombarded her. When she learned a few weeks later that she was pregnant again, she knew she was in no condition to mother another.
Her abortion was legal in Arizona at the time. The state recently enacted a near-total ban, although it is temporarily suspended.
Postpartum depression is well known – US studies show it affects around 1 in 8 women – but evidence suggests that depression during pregnancy may be even more common.
Mental health issues, including suicide and substance use, became the leading underlying cause of pregnancy-related deaths in 2017-2019, ahead of bleeding, heart disease and infections, the Centers said. for Disease Control and Prevention in a September report.
Zivin co-authored a study published last year that found suicidal thoughts and behaviors among commercially insured American individuals before, during and after pregnancy were on the rise. Rates were low, but increased among people with anxiety or depression, from 1 per 10,000 in 2006 to nearly 3 per 10,000 in 2017.
Zivin was not considering terminating her pregnancy 10 years ago, but said she understands why a woman who becomes suicidal would feel like an abortion is her only option. She called the limited exemption laws “unfortunate” and said the politicians who drafted them “do not appreciate or understand the burden of mental illness”.
Observers note that prior to the Roe v. Wade’s 1973 legalizing abortion, a diagnosis of mental illness allowed some women to have abortions, and some states required psychiatrists to certify the diagnosis.
Abortion haters argue that many women before Roe faked mental illness and that psychiatrists became their accomplices.
The old laws “essentially required psychiatrists to stretch the truth,” said Carole Joffe, professor of OB-GYN at the University of California, San Francisco.
She noted that California once required two psychiatrists to approve such abortions.
“It was like everything about health care and abortion before Roe. It was class-based,” she says. “Most of these psychiatrists weren’t doing it for free. You had to have the money . »
Laws banning mental health exceptions show indifference “to the very real mental illness that some pregnant women suffer from” and show “how inappropriate it is for politicians to craft mental health care policy.” health,” Joffe said.
Representative Ed Setzler, a Georgia Republican who sponsored that state’s law, argued that “an allegation of mental stress or anguish simply does not rise to the level at which the legislator was confident that the life of the child was to result. ”
Eric Johnston, president of the Alabama Pro Life Coalition, wrote of the near total ban on abortion in that state and said a suicide exemption was included at the request of the state medical association. The narrowly defined measure only exempts suicidal women who are diagnosed by a psychiatrist and requires the abortion to be performed in a hospital.
“If you put it in there and you don’t define it tightly, it’s a big enough hole to fit a truck through,” he said.
The National Committee for the Right to Life, an anti-abortion group that lobbied for the measures, defended the restrictions.
“A mother facing serious mental health issues should receive mental health counseling and care. Having an abortion will not alleviate mental health issues,” spokeswoman Laura Echevarria said.
According to the American Psychological Association, there is evidence that refusing an abortion can cause mental distress.
Michelle Oberman, a law professor at Santa Clara University and an expert in reproductive health ethics, said abortion bans that make no exceptions for serious mental illnesses are cruel and wrong.
Even though targeting women who try to fake mental illness is part of the reason for these measures, the laws will inevitably affect those who are really suffering, she said.
The mindset behind these laws “doesn’t really reflect on what it would be like to be faced with patients with serious mental illness,” Oberman said. “What mental health emergencies look like is kind of breathtaking,” she said. “They are real and they are life threatening.”
Associated Press writers Kim Chandler in Montgomery, Alabama, and Jeff Amy in Atlanta contributed.
Follow AP Medical Editor Lindsey Tanner on @LindseyTanner.
The Associated Press Health and Science Department is supported by the Howard Hughes Medical Institute Department of Science Education. The AP is solely responsible for all content.
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