CHICAGO– The weeks after Kaniya Harris found out she was pregnant were among the most difficult of her life.
The final exams for the university student were quickly approaching. His doctors told him that he had an ovarian cyst and that the risk of ectopic pregnancy was high. Wait times for abortion clinics near her town of Bethesda, Maryland, seemed incredibly long. And he couldn’t visit his family in Kentucky because of the state’s abortion ban.
Harris suffered panic attacks regularly. It all seemed too much, he said.
“My mental health was at the lowest point of my life,” said Harris, who had an abortion last May.
As advocates push ballot measure initiatives this year aimed at protecting abortion rights, key differences have emerged in the language of the proposed measures. Among them is the inclusion of mental health exceptions.
A Missouri proposal would allow lawmakers to restrict abortions after a fetus is deemed viable, except if an abortion “is necessary to protect the life or physical or mental health of the pregnant person.” A similar measure has been proposed in Arizona. In 2022, Michigan voters approved an abortion rights amendment with a mental health exception to viability limits.
Meanwhile, the language of the proposed ballot measure in Arkansas only says “physical health,” excluding a mental health exception. Proposed abortion rights initiatives in other states, including Florida, Montana and Nebraska, do not explicitly mention mental health.
“It’s heartbreaking to hear that these policies ignore mental health,” said Harris, now 21. “An abortion can save a person’s life, even when they are in a mental health emergency.”
Most states that ban abortion include exemptions for life-threatening emergencies, but only Alabama includes an exception for “serious mental illnesses” that could result in the death of the mother or fetus. Lawmakers added the provision after receiving pressure from the state’s medical association, which was concerned about women at high risk of suicide.
The law, passed in 2019, was among the strictest abortion restrictions in the country at the time. It did not include exceptions in cases of rape or incest and considered that performing an abortion was a serious crime. Alabama began enforcing the ban in 2022 after the U.S. Supreme Court overturned Roe v. Wade, who once granted a federal right to abortion.
Abortion bans in at least 10 states (Florida, Georgia, Idaho, Iowa, Kentucky, Louisiana, Ohio, Tennessee, West Virginia and Wyoming) explicitly exclude mental health conditions as a possible exception. Others are murkier and allow exemptions for a woman’s “life and health” without defining whether mental health is included.
Medical experts say that even states that allow mental health exceptions require patients to overcome obstacles that may be inaccessible to some people, especially those with low incomes. Alabama, for example, requires a state-licensed psychiatrist with at least three years of clinical experience to certify the mental health condition as an emergency.
Some days, when Harris came home from class, she was “so overwhelmed that I collapsed on the floor,” she said. For two months, she cried every day. But faced with an abortion ban in her home state and stigma from doctors, Ella Harris said she didn’t feel comfortable talking about her experience with a mental health professional.
“People shouldn’t have to jump through hoops and demonstrate their pain to get access to the care they need,” she said.
Mental health conditions were the leading underlying cause of pregnancy-related deaths between 2017 and 2019, and nearly 23% of pregnancy-related deaths were attributed to mental health conditions, including suicides and drug use disorder overdoses. substances, according to the US Centers for Disease Control and Prevention. Prevention.
According to the CDC, approximately one in eight women experiences postpartum depression. But mental health problems during pregnancy, especially the psychological trauma of those forced into unwanted pregnancies, have not been studied enough, said Michelle Oberman, a law professor at Santa Clara University who researches the impact of restrictions on abortion.
“These statistics, these stories of women’s suffering have really haunted me,” Oberman said. “We, as a society, don’t have a great track record of treating mental health the same way we do physical health.”
Policies that dismiss mental health as less important than physical health put lives at risk, said Columbia University psychiatrist Paul Appelbaum. He said there is also growing evidence that being denied an abortion causes significant mental distress. This anguish has been evident in recent stories of women forced to flee their states or continue their pregnancies despite serious risks to their health.
“I am extremely concerned about the exclusion of mental health exceptions in these ballot measures,” said Appelbaum, former president of the American Psychiatric Association. “It is absolutely cruel and will lead to the deaths of pregnant women in these states.”
Jayme Trevino, a Missouri OB-GYN and member of Physicians for Reproductive Health, said she has seen firsthand how denial of abortion services can affect a patient’s well-being, including her mental health.
“It is a devastating and common reality for my patients,” she said, adding that she was grateful for the mental health exemption in the state’s proposed ballot measure language.
Mallory Schwarz, spokesperson for Missourians for Constitutional Freedom, said the initiative’s language “is written to ensure that doctors, not politicians, can determine what is best for their patients.”
By contrast, an Arkansas initiative only includes exemptions “to protect the life of a pregnant woman or to protect a pregnant woman from a physical disorder, physical illness, or physical injury.”
Previous versions of the proposal included broader exceptions, said Gennie Diaz, executive director of For AR People. Initially, she said, “we wanted to craft language for a constitutional amendment that was as broad as possible and that hopefully took into account something like mental health.”
But when presented with a proposal with exceptions to “protect the life and health” of the mother, the state attorney general, a Republican, rejected the language, saying he must define “health.”
“That was a sign to us that we were going to have to make a decision,” Díaz said. “And another unfortunate factor is that a majority of Arkansas voters are unlikely to support mental health as a reason for an abortion after a certain period of time. “We felt that a version that explicitly mentions mental health was unlikely to be approved.”
Arkansas advocates were also concerned that the opposition campaign would target a mental health exception, Diaz said.
The National Right to Life Committee’s model state abortion ban legislation explicitly excludes mental health exceptions. These exceptions allow pregnant women to “kind of get around those laws and still abort pregnancies of children that were viable,” said Ingrid Durán, state legislative director of the NRLC.
“We specifically excluded mental health exemptions because we saw how that creates a loophole in a law and leaves the fetus at risk of dying from a sometimes treatable, sometimes temporary condition that the mother may be experiencing,” he said.
Asked whether addressing mental health exceptions will be part of his strategy to campaign against abortion ballot measures in 2024, he said, “I can’t necessarily say that’s part of the strategy.” Still, Durán said, “when I see mental health exceptions like this, my heart drops.”
Oberman, of Santa Clara University, said he hopes the anti-abortion movement “employs a strategy to minimize and dismiss the mental health consequences of forced pregnancy.”
“The mental health problems of pregnant people remain in the shadows and are highly stigmatized,” he said. “And that clouds our judgment about what a medical emergency during pregnancy looks like.”
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