Maternal mental health care becomes more complicated after Dobbs

Since the Supreme Court’s decision to overturn Roe v. Wade, the landscape for pregnant women has become far more complicated, not just for those with unplanned pregnancies, but also for those with planned pregnancies and those struggling with infertility. It’s even more complicated for those navigating the nation’s complex patchwork of mental health resources.

Pregnant people who also struggle with mental health issues don’t always find clear answers or resources, and many states lack specific mental health resources for those seeking or unable to get an abortion.

Availability of services varies by region, new regulations have driven obstetrician-gynecologists out of some states, and the US is also experiencing a shortage of mental health care providers.

People seeking both types of care can face a variety of obstacles.

Several people who became pregnant after the Dobbs incident told CQ Roll Call that it was difficult to get a clear decision on whether they could continue taking psychiatric medication while weighing their options.

Some women had mental health issues before pregnancy that were exacerbated by pregnancy.

Some were seeking mental health and logistical support for the first time.

Next steps

National efforts to improve already deteriorating maternal mental health rates are in their early stages, with the federal government releasing a policy blueprint last month outlining ways to broadly improve maternal mental health.

“The tangible impact of restrictive laws enacted after Dobbs and limited reproductive choices is another source of anxiety and stress for women of reproductive age,” said Carol Johnson, director of the Health Resources and Services Administration, which supports the National Maternal Mental Health Hotline.

Both the hotline and the formation of the task force that spearheaded the blueprint were the result of congressional action that predated Dobbs.

Federal and state legislatures have floated several legislative solutions, but those bills have made little progress. For bills to gain traction, they typically need to address a broader range of maternal health issues, as specific calls to abortion or anti-abortion pregnancy centers could stifle bipartisan momentum.

Various needs

The mental health impact of the Dobbs decision has fallen primarily on community groups and specialist service providers, who face their own costs and shortages.

“There are a lot of people who need help, but we can’t actually reach out to them or reach them because of budget and resource constraints,” said Aye Johnson, blueprint manager for Apiary, a national organization that provides logistical support to groups that connect people to abortion services. “We’re really trying to create a holistic way to care for people with very limited resources.”

If you need emotional support, Johnson said, you might be directed to All Options, which runs a hotline for expectant parents and new parents wanting to discuss their options, or Exhale Provoice, a text-based line for emotional support after an abortion. Or you might be referred to a doula for support before, during and after the abortion.

Sumeyye K., helpline coordinator for ARC-Southeast, speaks to a variety of callers in emotionally challenging situations, including wanted pregnancies with fetal abnormalities, pregnancies resulting from sexual violence and mothers calling on behalf of their teenage daughters.

“These conversations definitely carry emotional weight,” said Sumayeh, who declined to give her last name for this article to protect her privacy. “I think a lot of these people are just looking for someone to listen, and because of the stigma, that can be really hard to find.”

Simran Singh Jain, membership coordinator for the southern reproductive justice group Sistersong, said the timeline for patients seeking psychological support is different: Before the bans were put in place, “almost all of the work I did was within a week before or after the actual abortion,” she said.

Now, many people still contact me three to six months after the procedure to discuss their abortion and its consequences. The Dobbs case has caused people to focus on the immediate process and changes to the law rather than their own emotional well-being.

“People are so scared of abortion right now. They’re so scared that something bad will happen, that’s all they can think about,” she said.

While some providers offer specialized postpartum therapy, Kelsey Reape, a licensed clinical social worker in North Carolina, said there are “a lot of areas that are missing” to focus more on abortion and miscarriage support.

Leape said she was seeing an increase in patients reporting issues including anticipatory anxiety that they might need an abortion but might not be able to get one, and the shame they feel from not being able to talk about the barriers they face.

Allison Terracio, advocacy campaigns manager for Planned Parenthood South Atlantic, said the reality on the ground is that after navigating logistics, travel, expenses and the flow of protesters, “all of these stressors pile on top of each other.”

In May, the Maternal Mental Health Policy Center graded states on their efforts to support maternal mental health. Only four states — Washington, Utah, Pennsylvania and California — received a grade above a C+.

“These are just two systems that are part of a larger system that has a lot of problems,” Terracio said. “It’s really hard to get abortion care, it’s really hard to get mental health care.”

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