As the Ohio Supreme Court prepares to hear arguments on the abortion ban, evidence shows the fall of Roe v. Wade has deeply impacted the mental health of Ohioans
- Women and birthing people* in Ohio are experiencing negative mental health symptoms due to the overturn of Roe v. Wade.
- Community-based and healthcare professionals feared that if abortion rights are limited or outlawed in Ohio, their clients who are women and birthing people would endure worsening mental health symptoms such as stress, anxiety, depression, and suicide/self-harm.
- Current resources and help from mental health and medical professionals can currently address the mental health conditions among women and birthing people in Ohio.
*Although we use the terms ‘women’ and ‘mothers’ in some cases due to how previous data was reported, we acknowledge and recognize that not everyone who could carry a pregnancy refers to themselves this way. We respect the identity of all pregnant or birthing people.
On June 24, 2022, the Supreme Court of the United States (SCOTUS) overturned Roe v. Wade, which ended the federal constitutional standard that protected abortion rights. Since then, the states have the responsibility to determine abortion rules and there are maps that regularly update each state’s abortion rules.,  According to the Guttmacher Institute, as of August 23, 2023, most states have some level of abortion restriction. Ohio is labeled as restrictive, which means there are laws and regulations that describe under which circumstances a provider can perform an abortion and when a pregnant individual can receive one. The following abortion policies in Ohio are:
- Abortion is illegal at 22 weeks and afterwards.
- Patients must make two trips. First for in-person counseling and the second one at least 24 hours later for the procedure.
- Medicaid does not pay for abortion in the state.
- A parent can give consent for a minor to have an abortion. However, a minor could seek a judicial bypass if they chose not to inform their parents or do not have their parents’ consent.
- Only physicians— no other qualified health professionals—can offer abortions.
- Ohio imposes regulations on the operation of reproductive health clinics that are “without basis in medical standards.” (see footnote 2)
Currently, a judge in Hamilton County Court blocked an abortion ban for Ohio which would have banned abortions at the first detection of fetal cardiac activity. The Ohio Attorney General’s Office appealed the injunction. Hence, the Ohio Supreme Court will hear arguments about the appeal on September 27, 2023.
The Ohio Supreme Court will hear arguments about the appeal on September 27, 2023.
Because abortion is still legal until 22 weeks gestation in Ohio, there has been a slight increase of abortions after the overturn of Roe v. Wade. According to The New York Times, more abortions were conducted in Ohio during most of 2023 compared to 2020. Besides Ohioans seeking abortions in our state, another possible reason why there is an increase in abortion is because individuals from boarding states that banned abortions are traveling to Ohio for the procedure.
Findings of the Turnaway Study and more research
Researchers and other professionals have studied how the denial of abortion impacted women and birthing people’s mental health years before and after SCOTUS’s decision to overturn Roe v. Wade. Before the reversal of Roe v. Wade, the Turnaway Study was conducted by a team of researchers from the University of California San Francisco.
This five-year longitudinal study examined the mental health, physical health and socioeconomic consequences of individuals who were denied an abortion—because they were past their gestational age limit—compared to those who received an abortion. The researchers studied nearly 1,000 women from 30 abortion clinics across the United States. After conducting the study, they determined that getting an abortion does not increase the risk for anxiety, depression, post-traumatic stress disorder (PTSD), suicidal thoughts, and anxiety or stress in the short term. However, the study revealed that women who were denied abortions experienced negative mental health outcomes. Women who were rejected from receiving an abortion:
- Suffered more anxiety than women who obtained them after months of searching for an abortion.
- Experienced their highest levels of both anxiety and stress around the time of the rejection.
- Reported suicidal ideation soon after the rejection. This affected only a small proportion of participants (<2 percent) and declined to less than 0.5 percent in five years.
To deeply understand the emotions women noted in the Turnaway Study, researchers surveyed and interviewed women who were denied an abortion. Specifically, they surveyed 161 women one week after being rejected for an abortion and semiannually for five years after and interviewed 15 participants from 2014-2015. Out of those surveyed, 58 percent reported feeling sadness, 41 percent reported anger, and 49 percent reported regret one week after being denied an abortion.
Some participants—those who were denied an abortion—from the survey initially expressed some positive emotions such as relief (54 percent) and happiness (48 percent). Likewise, interviewees commonly described negative emotions while initially reflecting on their rejection. They explained feelings of being overwhelmed, depression, fear, and devastation. Over time, participants in the study slowly expressed fewer negative emotions and more positive feelings. For instance, some who were interviewed described how they received support from their loved ones during and after their pregnancy. Even though the feelings women expressed were a mixture of both positive and negative, initially elevated negative emotions may correlate to mental health conditions.
Years after the Turnaway Study, researchers have been speculating how women and birthing people’s mental health will negatively be impacted after the SCOTUS overturned Roe v. Wade. Previous researchers noted that unintended pregnancy correlated with perinatal depression and anxiety. The American Psychological Association (APA) President Frank Worrell had concerns about the mental health of individuals after the SCOTUS decision. Particularly, he warned their decision and placing restrictions on safe abortion “would exacerbate America’s mental health crisis.” Likewise, it is reported that abortion restrictions could impact Black women more because they are less likely to obtain mental health care and are five times more likely to get an abortion than white women.
It is reported that abortion restrictions could impact Black women more because they are less likely to obtain mental health care and are five times more likely to get an abortion than white women.
Currently, there is one research study that confirmed other researchers’ speculation that the overturn of Roe v. Wade will impact women and birthing people’s mental health. Some scholars examined the mental stress of women before and after the leak of the Supreme Court draft and after the Supreme Court officially declared a ruling about abortion. The women they sampled lived in states that could possibly ban abortion or where it had been banned and compared them to women who lived in states that continued to permit abortion. After examining data from the Census Bureau Household Pulse Survey, they declared that “the loss of abortion rights was associated with a 10 percent increase in prevalence of mental distress relative to the mean over the 3 months after the SCOTUS decision.”
A notable gap in the literature was that there was not any research pertaining to how the SCOTUS decision to overturn Roe v. Wade affected mental health among women and birthing people in Ohio. Hence, the purpose of this study is to understand how the overturn of Roe v. Wade could impact the mental health of women and birthing people in Ohio and present solutions on this issue.
To understand the correlation between the SCOTUS decision on Roe v. Wade and the mental health impact on women and birthing people in Ohio, The Center for Community Solutions created a survey focused on professionals from community-based organizations and healthcare entities who serve this population. We invited key informants to complete the survey instead of women and birthing people due to privacy reasons. The survey consisted of both closed and opened ended questions. For example, some of the statements were, “I worked with clients who have expressed feeling stressed about efforts to limit and/or outlaw abortion in Ohio,” and, “I work with clients who have experienced depressive symptoms concerning the efforts to limit and/or outlaw abortion in Ohio.” The participants selected the following choices between “yes,” “no,” or “unsure.” One question asked, “If abortion is limited or outlawed in Ohio, do you think that will affect your clients’ mental health?” with a choice between “yes” and “no.” If they answered yes to the question, then they would have to answer a follow up question about how they think the possibility of limiting or outlawing abortion in Ohio would affect their clients’ mental health.
Respondents then completed scales based on perceived stress, depression symptoms and anxiety symptoms. The Perceived Stress Scale was used to understand how a situation affects feelings and perceived stress. For the purposes of the study, Community Solutions modified the scale. Participants were asked to rate statements based on the current climate concerning the overturn of Roe v. Wade and how they thought it impacted their clients within a month. For instance, Community Solutions asked “In the last month, how often have your clients felt that they were unable to control the important things in their lives?” The participants chose the following answers from the Perceived Stress Scale: never, almost never, sometimes, fairly often, and very often.
Likewise, Community Solutions modified two subscales from the Brief Symptom Inventory.  The first subscale examined clients’ depressive symptoms based on the current climate of the overturn of Roe v. Wade. The second subscale explored clients’ anxiety symptoms based on the current situation with Roe v. Wade over a month. Some of the anxiety symptoms included nervousness or shakiness inside, feeling intense or keyed up, and feeling so restless that one could not sit still. They ranked the statements between not all, a little bit, moderately, quite a bit and extremely. It is important to note that researchers from the Turnaway Study also utilized the Perceived Stress Scale and Brief Symptom Inventory  which is why Community Solutions selected the scales for participants to complete. Lastly, participants answered demographic questions about themselves and their clients.
The survey was created and analyzed through Survey Monkey. Community Solutions sent out the survey through a weekly newsletter, 5 Things You Need to Know, Facebook groups, social media and direct emails to nonprofit organizations. Respondents completed the survey in spring 2023.
About the survey respondents
Seventy-six individuals completed the survey. Eighty-six percent were female. Most of the respondents were white at 61 percent, compared to 28 percent who were Black. Five percent of the participants were of Hispanic or Latina/o/x origin. Eighty-four percent worked with mainly female clients. Out of the respondents who completed the survey, 60 percent of them worked in direct practice and 40 percent in administration. The respondents who worked in the direct practice were mainly nurses (17 percent), social workers (14 percent) and community health workers (12 percent). The remaining participants in direct practice were clinical counselors (10 percent) and case workers (7 percent). Both executive staff (19 percent) and administrative staff (12 percent) were the majority of respondents who worked in administration. Within administration, 5 percent of the respondents were research staff while the other 5 percent were program coordinators.
Most of the respondents worked at a nonprofit organization (48 percent). Other respondents were employed in a health care organization (19 percent), community mental health organization (14 percent), federally qualified health center (7 percent), government (7 percent) and hospital (5 percent).
About the respondents’ clients
When it came to their clients, the majority of the respondents’ clients were of Hispanic or Latino/a/x origin at 72.1 percent. The races of their clients were as follows: Black or African American at 34.9 percent, white at 30.2 percent, two or more races at 20.9 percent, and other at 2.3 percent. Some participants preferred not to answer the question about their clients’ race (11.63 percent).
The general questions the respondents answered produced some interesting results. Nearly all (99 percent) were aware of the legal and legislative efforts to limit and/or outlaw abortion in Ohio. Seventy percent of the respondents reported that they worked with clients who expressed feeling stressed about efforts to limit and/or outlaw abortion. As for depressive symptoms, almost 60 percent of the respondents worked with clients who expressed depressive symptoms regarding the efforts to limit and/or outlaw abortion.
When asked whether they served clients who have expressed feeling concerned about their finances if abortion is outlawed in Ohio, 55 percent responded yes, while 25 percent said no and 20 percent selected unsure. If abortion were limited or outlawed in Ohio, 86 percent of respondents believed that it would affect their clients’ mental health.
Four main areas of concern
Respondents who believed that outlawing or limiting abortion in Ohio explained how it would affect their clients’ mental health. Out of the 86 percent who think that would happen, 53 individuals provided further explanations. The themes that will be discussed from the findings of this particular question are barriers or lack of resources, stress and anxiety, depression and suicide/self-harm.
Barriers or a lack of resources
One of the themes that appeared was some individuals thought their clients would experience negative mental health outcomes because of barriers or having lack of resources. Some of their clients were already dealing with barriers and limited resources. Outlawing or limiting abortion will add to stress, anxiety and other mental health concerns. One respondent explained how carrying an unwanted pregnancy would limit more resources for the birthing person:
Mothers of young children are already highly stressed and the possibility that they could be forced to unwillingly carry a pregnancy to term will compound that stress. In low-income families, adding another child will often reduce food and other resources for everyone in the family creating additional food insecurity and poor outcomes for all.
Another respondent expressed what her clients were going through with barriers:
Our clients currently present with a number of different barriers that cause them stress and/or anxiety to begin with … adding the element of abortion legislation, if they are in need, is sure to increase those issues for them.
Other respondents explained their clients will either have limited monetary resources or concerns about their finances. Particularly, some individuals thought that they will have stress or hardships when trying to care for an extra child.
Stress and anxiety
Another theme that appeared throughout the responses was stress and anxiety. Several of the respondents’ clients were already dealing with stressors in their lives. For example, most of a respondent’s clientele already live in poverty. If a client’s autonomy to make choices about their bodies goes away, then it will be distressing for them. Some participants described that they would experience emotional stress or financial stress. Many respondents explained that banning or limiting abortion would increase anxiety and stress in their clients. One respondent expressed how increased anxiety and depression would impact clients:
Increased stress and anxiety about carrying an unwanted birth to term. This increase in stress may also have an unhealthy impact on carrying the baby to term, medical complications may be exasperated as well.
Unfortunately, stress in the pregnant individual will impact the unborn child. According to the March of Dimes, stress from pregnant people could negatively affect their child’s brain development, immune system, have trouble paying attention in school and other mental health conditions.
Depression and hopelessness
Respondents described how ending or limiting abortion could cause depression for their clients. A participant explained that ending or limiting abortion could cause clients to experience an increased feeling of hopelessness. Hopelessness is one of the symptoms of depression. Other respondents explained that depression correlated with barriers, self/harm suicide and anxiety. A respondent described his/her/their concern:
Their mental health would be impacted in a variety of ways—general depression about the direction of this country and lack of access; depression stemming from financial, transportation, childcare-related barriers; sadness stemming from a feeling of loss of control over autonomy and the present/future of Ohio.
The intersection between barriers and mental health conditions appears often in the responses, especially with responses about depression.
Finally, respondents were concerned that their clientele might consider suicide or self-harm if abortion is banned or limited in Ohio. Barriers to access abortion or ending abortion rights can put pressure on clients and may cause a birthing person to worry excessively and consider suicide or self-harm. One respondent stated that women and birthing people could develop suicidal ideation:
Patients will feel forced against their will into making a decision that isn’t theirs. The feeling of being trapped and stuck. Worry about future and finances. Concerns of ability to obtain resources. Worries about their own health if forced to carry against medical advice. All can lead to depression, suicidal thoughts, increase maternal mortality.
Another respondent stated that their clients were having trouble accessing abortion due to challenges with transportation.
I work with patients strongly affected by SDOH [social determinant of health] who would be unable to travel outside Ohio for abortion. Some have said they would attempt self-harm or suicide if forced to carry a child.
Hence, if abortion ended or was limited in Ohio, it would exacerbate negative impacts on the social determinants of health like transportation.
46% of respondents stated their clients fairly often felt like they were unable to control important things in their lives.
Perceived Stress Scale
Results from the Perceived Stress Scale showed that the respondents’ clients experienced many symptoms of stress within a month due to the overturn of Roe v. Wade. For instance, 46 percent of respondents stated their clients fairly often felt like they were unable to control important things in their lives. Most of their clients felt nervous and stressed within a month (very often at 41.5 percent and fairly often at 35.8 percent. Many respondents answered that their clients have felt either very often (36.4 percent) or fairly often (38.2 percent) angry because of things that were outside of their control. Most of their clients sometimes found that they could not cope with all of the things that they had to do (38.9 percent) and sometimes felt confident about their ability to handle personal problems (54.7 percent).
Results from the Perceived Stress Scale
Question: Based on the current climate concerning the overturn of Roe v. Wade. In the past month, how often have your clients:
Brief Symptom Inventory
Results from the depression subscale of the Brief Symptom Inventory showed that the respondents’ clients sometimes experienced depressive symptoms within a month. Nearly 46 percent of their clients sometimes felt blue, almost 46 percent sometimes had no interest in things and 32.6 percent sometimes felt hopeless about the future. The only instance where a prominent segment thought their clients never experienced depressive symptoms was a question about feeling worthless. They reported that around 34 percent of their clients almost never felt worthless and 29.5 percent sometimes felt worthless.
Results from the depressive symptoms subscale of the Brief Symptom Inventory
Question: Considering the overturning of Roe v. Wade, please rate the following statements. I work with clients that were distressed by:
Furthermore, the results from the anxiety subscale of the Brief Symptom Inventory showed that most of their clients sometimes experienced anxiety symptoms within a month. Nearly 39 percent sometimes felt nervousness or shakiness inside, 36.4 percent sometimes felt restless that they could not sit still and 27.3 percent sometimes experienced spells of terror or panic. Only 29.5 percent of the respondents’ clients fairly often felt intense or keyed up.
Question: In the past month, how much were your clients distressed by:
Solutions available right now
Given the results of the survey, women and birthing people in Ohio have been feeling stressed and showing symptoms of anxiety and depression due to the overturn of Roe v. Wade. As Ohioans await the November election and also the Ohio Supreme Court decision on abortion rights, there are solutions in place to address this issue and the negative mental health impact for women and birthing people. Solutions include strategies for both medical and mental health professionals, abortion funds and technological resources.
Strategies for health professionals
Medical and mental health professionals play a key role in the post-Roe world, and they can address the mental health crisis through education/training and advocacy. Some mental health professionals and medical professionals need to understand reproductive and perinatal mental health, especially professionals who are not familiar with the topic. In one study, 142 graduate students and psychologists were quizzed about abortion. Unfortunately, they only answered 68 percent of their questions correctly. One of the professionals reacted to this study by explaining that the mental health field must unpack isms and biases about who receives abortions and why. In addition, OBGYN students should engage in abortion education through travel rotations, remote learning and simulation (see footnote 7).
Mental health professionals can advocate for abortion rights and mental health. For instance, psychologists can reach out to their congressional representative to support legislation or become part of the APA’s Psychology Advocacy Network (see footnote 17). Mental health providers can also advocate for their clients by educating them about community resources and help provide the knowledge and confidence to converse with medical professionals. They can assist clients in deciding if a medical provider should be reported due to refusal to conduct a legally protected procedure (see footnote 17).
Abortion funds are another effective solution for women and birthing people. Abortion funds are organizations that raise and provide funds to individuals who need help paying for abortions, procedures and travel expenses. Abortion Fund of Ohio (AFO) is a statewide organization that offers funds for abortion services, transportation and housing services. Also, they provide funding for those who need contraceptives, including emergency contraceptives. Although they do not directly offer mental health services, they make referrals to post doula support who can help. In addition, AFO operates a legal access supports program so clients can understand their rights.
Technological resources and organizations
Various technological resources are available for women and birthing people who are worried about their reproductive health. The National All Options Talk Line connects people with peer support counselors about any options concerning whether they want to parent, have an abortion or adoption. Peer support counselors also help people who have experienced a miscarriage. The organization offers unbiased trainings and workshops for healthcare and social service providers, counselors and other professionals who work with women and birthing people. Specifically, the Pregnancy Options Workshops include training about pregnancy, parenting, values clarification, adoption and judgement-free options counseling. In addition, the training teaches professionals how to support pregnant individuals with respect and without bias or judgment. The other training, called Spiritual Support and Counseling for Pregnancy Experiences training, is similar to the Pregnancy Options Workshops, “but with a specific focus on supporting people who are seeking spiritual support or counsel, or who are experiencing spiritual conflict while making a pregnancy decision.” This is also unbiased training for professionals. If anyone needs to speak with a peer support counselor, the phone number for the National All Options Talk Line is 1-888-493-0092.
The Rise Up document is a technological source created by Disability Rights Ohio, aimed for individuals under 18 years of age to understand their rights and how to advocate. This document has a section on reproductive health, which listed specific rights they are entitled to without parental permission such as access to contraceptives, getting tested for sexually transmitted diseases or HIV and asking a lawyer for an abortion without parental permission. The guide has another version that lists links to other organizations that provide specific services for this population.
Researchers mentioned that there should be federal leadership to help provide mental health support for people struggling with abortion restrictions. To address the mental health professional shortage, a possible solution is telemedical mental health services (see footnote 8). These services could possibly be offered through reciprocity agreements. During the COVID-19 pandemic, states implemented cross-state telehealth waivers which made providers in one state provide services to patients in a different state. The federal government can encourage continued implementation with funding even though the public health emergency has ended, and the country is dealing with the unwinding process. They can possibly do this through Medicare and a policy about reciprocity is already active for the Veterans Affairs health system. Hence, if a reciprocity policy is tailored to accessing mental health care, then women and birthing people can possibly seek an abortion without the policy being interpreted as a partisan proposal.
Another technological resource is the Ohio Care Line housed within the Ohio Mental Health and Addiction Services. The hotline gives emotional and mental health support for people experiencing a family or personal crisis. Callers will talk to licensed mental health professionals who provide services and refer them to other mental health services. Some of the referrals can be free, covered by insurance or Medicaid or provide a sliding fee scale. The hotline is available 24/7 and their phone number is 1-800-720-9616.
The unpredictable and rapidly changing status of abortion rights has been negatively affecting women’s and birthing people’s mental health in Ohio.
The unpredictable and rapidly changing status of abortion rights has been negatively affecting women’s and birthing people’s mental health in Ohio. Many healthcare and community-based professionals who worked with women and birthing people reported that their clients have been experiencing symptoms of stress, anxiety and depression due to the overturn of Roe v. Wade. If abortion rights are either banned or limited in Ohio, it’s possible that women and birthing people could experience worsening mental health outcomes compounded by barriers they are already struggling with.
Solutions to handle this public health crisis currently include providing strategies for medical and mental health professionals, abortion funds and technological resources. As healthcare professionals, community-based professionals, women and birthing people wait for the Ohio Supreme Court decision and the outcome of the November election concerning abortion rights, they must try their best to handle current negative mental health symptoms before they become worse.
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