Annul Roe v. Wade could increase maternal mental illness

The recent Supreme Court ruling that overturned Roe v. Wade is sure to be hotly debated and spark more controversy over abortion rights in America. But between the resentment and the cacophony of the voices that argue positions in favor of life or the right to decide, few have recognized the voice and the plight of women who may feel compelled to continue with a pregnancy that will not lead to a live birth due to miscarriages and stillbirths.

Miscarriage is generally defined as pregnancy loss before fetal viability (approximately 23 weeks’ gestation). The term “stillbirth” often refers to fetal deaths later in pregnancy. Statistics indicate that miscarriage and stillbirth are common. Approximately 23 million miscarriages occur annually worldwide, which equates to 44 pregnancy losses every minute.

At least 10 percent of women have experienced one or more miscarriages, although these numbers may underestimate the condition as some women experience pregnancy loss before even realizing they are pregnant.

According to the American College of Obstetricians and Gynecologists, stillbirth results in approximately one in 160 pregnancies in the United States. One can predict that RoeAnnulment means more women forced to have a pregnancy against their will who may face pregnancy loss through miscarriage or stillbirth.

Numerous factors contribute to an increased risk of miscarriage and stillbirth. Chromosomal abnormalities of the fetus are a common cause of miscarriage. Other patient-focused risk factors include advanced maternal age, prior miscarriage or stillbirth, bleeding disorders, viral infections, obesity, diabetes, smoking, and alcohol use. Some, like air pollution and pesticide exposure, are environmental.

Miscarriage and stillbirth disproportionately affect people of color. Black women are 43 percent more likely to miscarry than white women. Additionally, black women are much more likely to die from pregnancy-related complications than their counterparts.

The psychological and mental health challenges of miscarriage are well documented, but often go unspoken. A 2020 study found moderate to severe anxiety and depression in 24% of women one month after early pregnancy loss and 17% after nine months.

Among highly vulnerable groups, such as adolescent girls, miscarriage doubles the risk of suicide attempts later in life. Similar findings exist for mothers of stillborn babies, many of whom report higher rates of depression, anxiety, and PTSD compared to mothers of live-born babies.

Unfortunately, the psychological impact and severity of such losses are also biased. African American women with early pregnancy loss are significantly more likely to develop major depression than non-African American women, even when baseline rates of depression are taken into account.

Experiencing a miscarriage or stillbirth has economic implications for both individuals and communities at large. Evaluation of such costs has focused primarily on the medical costs of necessary aftercare (eg, surgical interventions such as dilation and curettage).

Surprisingly, the economic impact of psychological morbidity is less well studied, but lost productivity and personal income from missed work days is a frequent and significant non-healthcare cost.

Some may argue that women forced into a pregnancy they wanted to terminate may experience less emotional distress when a subsequent loss occurs. As a consultant psychiatrist for 17 years at a large academic medical center in Chicago, I have witnessed the same thing in some patients, including survivors of sexual assault that resulted in an unwanted pregnancy.

But this argument is too reductive and discounts the fact that any loss invariably carries a strong emotional imprint and affects the mother, regardless of the pretext. Shame and guilt are common, and trauma-informed care requires an empathic, affirming presence.

Depriving women of the choice to have a pregnancy has significant consequences for the mental health of women in the United States. Beyond the emotional distress that comes with losing bodily autonomy to continue or terminate a pregnancy, the frequency of miscarriages and stillbirths in the United States will increase, as some pregnancies that might otherwise have been terminated will result in stillbirth .

capsizing Roe exposes a greater proportion of American women to the negative repercussions and mental health consequences of these adverse pregnancy outcomes, with the most harmful and damaging impact on women of color who already live with inequity on a daily basis in a system imbued with of structural racism.

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