Mental crises are excluded from some state abortion exemptions

Mental health advocates say there’s a cruel quirk in several states’ abortion bans: There are exceptions for life-threatening emergencies, but psychiatric crises don’t count.

It doesn’t make sense for an Arizona mother of three who killed herself during her fourth pregnancy and says an abortion saved her life. Or researcher Kara Zivin, who almost died from a suicide attempt during pregnancy and whose work suggests that these crises are not uncommon.

Zivin has a healthy baby, but she empathizes with women facing urgent mental health issues who believe their only option is to terminate the pregnancy.

“People often try to treat mental health as different from physical health, as if your brain is somehow removed from the rest of your body,” said Zivin, a professor of psychiatry, obstetrics and gynecology and health management at the University of Michigan.

Abortion crackdowns enacted or enforced since Roe v. Wade was overturned in June illustrate the dichotomy. In at least eight states that allow exemptions for life-threatening conditions, physical health is the focus. Maternal mental health is not included.

Some of these exceptions are vaguely worded. Others are explicit.

Florida’s exemption includes life-threatening illnesses “other than a psychological condition.”

Laws in Georgia, Nebraska and West Virginia specify that medical emergencies do not include suicidal threats. A district judge’s ruling striking down the Georgia law on Tuesday is being appealed.

Some abortion opponents say the laws are intended to prevent women from faking mental illness to get doctors to terminate their pregnancies.

Patricia, who is 31, married, and “an ordinary neighborhood Chicana,” says her agony was painfully real. The Phoenix woman spoke to The Associated Press on the condition that only her first name be used, citing safety and privacy concerns.

She says a wave of severe depression hit her in the summer of 2018 and broke “not only my mind, but my heart and soul.” She could not eat, sleep or properly care for her three young daughters. She panicked and had suicidal thoughts. When she learned a few weeks later that she was pregnant again, she knew she was in no shape to mother another.

Her abortion was legal in Arizona at the time. The state recently instituted an almost total ban, although it has been temporarily put on hold.

Postpartum depression is well recognized – studies in the US show it affects around 1 in 8 women – but evidence suggests that depression during pregnancy may be even more common.

Mental health conditions, including suicide and substance use, became the leading cause of pregnancy-related deaths in 2017-19, ahead of bleeding, heart disease and infections, according to a report by the Centers for Disease Control and Prevention.

Zivin co-authored a study published last year that found that suicidal thoughts and behaviors among the commercially insured in the US are on the rise before, during and after pregnancy. Rates were low but increased among people with anxiety or depression from 1 in 10,000 in 2006 to almost 3 in 10,000 in 2017.

Zivin didn’t consider terminating her pregnancy 10 years ago, but she said she understands why a suicidal woman might think abortion is her only option. She called the restricted release laws “deplorable” and said the politicians who wrote them “do not appreciate or understand the severity of mental illness”.

Observers note that before the 1973 Roe v. Wade decision legalizing abortion, a diagnosis of mental illness allowed some women to have an abortion, and some states required psychiatrists to certify the diagnosis.

Opponents of abortion argue that many women before Roe were faking mental illness and that psychiatrists became their accomplices.

The old laws “essentially forced psychiatrists to stretch the truth,” said Carol Joffe, a professor of obstetrics and gynecology at the University of California, San Francisco.

She noted that California once required two psychiatrists to sign off on such abortions.

“It was like everything else about health care and abortion before Roe. It was based on class.” she said. “Most of these psychiatrists weren’t doing it for free. You had to have the money.”

Laws banning mental health exemptions show indifference “to the very real mental illness that some pregnant people have” and show “how inappropriate it is for politicians to make health care policy,” Joffe said.

Congressman Ed Setzler, Republican of Georgia, who sponsored that state’s law, argued that “a claim of stress or mental anguish simply does not rise to the level that the legislature was convinced that the child’s life should be ended as a result. ”

Eric Johnston, president of the Alabama Pro Life Coalition, wrote the state’s near-total abortion ban and said a suicide exception was included at the request of the state medical association. The narrowly drawn measure exempts only suicidal women who are diagnosed by a psychiatrist and requires the abortion to be performed in a hospital.

“If you put it out there and you don’t define it exactly, it’s a hole big enough to drive a truck through,” he said

The National Right to Life Committee, an anti-abortion group that lobbied for the measures, defended the restrictions.

“A mother facing serious mental health issues should receive mental health counseling and care. Abortion will not alleviate mental health issues,” spokeswoman Laura Echevarria said.

According to the American Psychological Association, there is evidence that refusing an abortion can cause psychological distress.

Michelle Oberman, a law professor at Santa Clara University and an expert on reproductive health ethics, said abortion bans that make no exception for severe mental illness are cruel and wrong.

Even if targeting women who try to fake mental illness is among the reasons behind the measures, the laws will inevitably affect those who are truly suffering, she said.

The mindset behind these laws “doesn’t really consider what it would look like to encounter patients with severe mental illness,” Oberman said. “What mental health emergencies look like is kind of mind-boggling,” she said. “They are real and they are life-threatening.”

Copyright 2022 Florida Health News

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