In the wake of the Supreme Court’s decision to overturn the national right to abortion in June 2022, 18 states have implemented abortion bans that explicitly exclude mental health or suicidality as qualifying health-related exceptions for women. This deviation is occurring despite a growing national momentum advocating for the equal treatment of physical and mental health. The impact of these exclusions is particularly concerning given that suicide ranks among the leading causes of death among women of reproductive age, with nearly 23 percent of pregnancy-related deaths attributed to mental health conditions, according to the Centers for Disease Control and Prevention.
Constance Guille, founder and director of the Women’s Reproductive Behavioral Health Division at the Medical University of South Carolina, emphasized the severity of mental health conditions, stating, “These conditions are absolutely just as deadly as many other conditions in medicine.” The exclusion of mental health as a valid reason for an abortion raises questions about the broader understanding of health emergencies and the potential consequences for women’s well-being.
Despite the Dobbs v. Jackson Women’s Health Organization decision overturning the federal right to an abortion, federal law still mandates states to provide abortions in cases of medical emergencies or risk losing Medicare funding, a significant source of revenue for states. However, the definition of a medical emergency lacks uniformity, particularly in a legal context. The lack of explicit protections for mental health emergencies has created confusion among medical providers, leading to concerns about potential legal repercussions.
The trend of distancing mental health from physical health in state abortion laws contrasts with broader bipartisan acceptance and decreasing stigma related to mental health issues. Congress has passed bipartisan mental health parity laws, requiring equal coverage for mental health and physical conditions. In 2022, a bipartisan mental health and gun safety law was also enacted, highlighting the recognition of mental health as a critical aspect of overall well-being.
Some state laws disqualifying mental health as a medical emergency exception acknowledge the risks associated with certain mental health conditions, but only in the context of abortion risks or complications. In Tennessee, for instance, physicians can seek an exemption for an emergency abortion to prevent death or “impairment of a major bodily function,” but the language specifically excludes “psychological or emotional conditions” of the pregnant woman.
The origins of state abortion laws singling out mental health trace back to a federal push in 2005-06 to limit non-custodial adults from aiding minors seeking abortions across state lines. Despite the evolving landscape of mental health awareness, 32 abortion bills introduced since 2012 clarify that exemptions do not include “psychological or emotional conditions.”
While data collection on mental health emergencies and abortion is challenging, the exclusion of mental health conditions raises concerns about potential stigmatization. Conflating mental health emergencies with loopholes to allow abortions for any reason oversimplifies the complex reality of mental health conditions, perpetuating stigma and potentially compromising women’s access to necessary healthcare.
Elisabeth Smith, director of state policy and advocacy at the Center for Reproductive Rights, highlighted the lack of public explanation from lawmakers regarding their positions on mental health exclusions, emphasizing the need for a more comprehensive and informed legislative conversation on the matter. As the nation grapples with the evolving landscape of reproductive rights, the role of mental health in these discussions remains a critical and often overlooked aspect that demands careful consideration.
