July 1, 2022 • 14 mins
Being denied an abortion can have a long-term impact on a woman's mental and physical well-being. Dr. Saltz looks at the data behind the headlines, and advises a listener who finds herself pregnant and unsure about what to do.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
Bees are challenging times, but you don't have to navigate
them alone. Welcome to how can I help? I'm Dr
Gail Salt. I'm a clinical Associate Professor of psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:26):
hopefully with understanding, insight and advice. Last week, the Supreme Court,
in a stunning ruling, overturned Roe v. Wade, eliminating the
over fifty year federal civil rights to all women to
receive an abortion if they choose to. Shortly thereafter, numerous
(00:49):
states trigger laws went into effect, banning abortion, many even
in cases of rape and incest. As a psychiatrist, I
understand that this will have serious mental health consequences for
women denied the right and ability to choose if they
are willing and able to bring a pregnancy to term
(01:11):
and to have a child. Today, I am answering a
question from a woman I just received about her mental
state an abortion. Research shows that the dominant emotion that
women express after having an elective abortion is relief, not sadness,
not anxiety. It's not to say that women have not
(01:35):
had regret, but by and large that is in the
vast minority. The landmark Turnaway Study, performed between the years
two thousand and eight and two thousand and sixteen by
researchers at the University of California, San Francisco's Program Advancing
New Standards in Reproductive Health, was designed to investigate the
(01:58):
long term impacts of abortion. The study followed nearly a
thousand people and compared outcomes for participants who received abortions
with outcomes for those who sought out abortions but were denied.
Researchers followed the participants for five years and regularly checked
(02:19):
in with them about various aspects of both their physical
and their mental well being. Using data from the Turnaway Study,
research was published in Jamma Psychiatry that's really the foremost
journal in psychiatry in two thousand and seventeen, and it
found that people who were denied abortions reported more symptoms
(02:42):
of stress and anxiety one week after the event than
those who received abortions. Over time, the psychological well being
of all groups in the Turnaway Study, including those who
were denied abortions and ultimately did give birth, converged, but
These findings do not support policies that restrict women's access
(03:05):
to abortion on the basis that abortion harms women's mental health.
Other research based on data from the same study was
published in the American Journal of Psychiatry in two thousand
and eighteen and found there were no major differences in
suicide risk among women who received or were denied an
abortion over the five years after the event. Those women
(03:30):
who were most likely to have an elevated risk for
suicide or self harm in the study were those who
had a previous history of mental health conditions, or of
abuse or of violence. The study found no evidence to
support the idea that abortion increases people's mental health risks,
and instead found that really the denial of abortion was
(03:54):
overall worse for people's mental health in a state meant.
Following the Supreme Court ruling on Friday, Frank Worrell, who
was the president of the American Psychological Association, said, this
ruling ignores not only precedent but science and will exacerbate
(04:14):
the mental health crisis America is already experiencing. We are
alarmed that the Justices would nullify ROW despite decades of
scientific research demonstrating that people who are denied abortions are
more likely to experience higher levels of anxiety, lower levels
(04:34):
of life satisfaction, and lower self esteem compared with those
who are able to obtain abortions. Another paper from the
Turnaway study in Social Science and Medicine in found that
more than of participants who had abortions felt they made
(04:55):
the right decision even five years later, and at every
point during the five years participants were surveyed, relief was
the most common emotion. Most commonly, women in the short
term feel a mix of emotions guilty, angry, sad, relieved,
(05:16):
even happy. But research shows that over time all of
these emotions basically go down, and those who do feel
regret often feel really regretful of the situation, not the abortion,
of the situation they are in, rather than the decision
(05:36):
to have an abortion. For most women who choose to
have an abortion, they feel it is the right decision
for them. Abortion is not anyone's preferred method of birth control.
It is a difficult decision a woman makes with herself
and with her doctor. For about half of the women
(05:58):
in this country, the ability to make that decision has
been taken away, so with that right after the break
we'll get to my listener's question. Welcome back. Let's get
(06:24):
to my listener's question and see how can I help,
dear doctor Saltz. I am twenty years old and just
discovered I am pregnant. I do not want to have
a child. I'm not married, I have no income as
I am a student. I want to finish college and
I want to apply to law school. To me, this
(06:48):
is a disaster. There is absolutely zero part of me
that wants to have a baby, and the very idea
fills me with terror. The guy I had sex with
also does not want a baby. My parents are very religious.
If they knew I was considering an abortion, they would
(07:08):
be horrified. I think as a result, I feel very
guilty and ashamed thinking I want an abortion. This has
made me unsure of what to do, mostly because I
fear being shamed if anyone finds out being labeled that
girl having my parents think I'm a bad person. How
(07:30):
do I decide what to do? Given if I keep waiting,
the answer will be made for me because I only
have until fifteen weeks of pregnancy to make a decision
in my state. First off, let me say I am
sorry that you are in a crisis situation at all,
having to balance your needs and the internalized fears of
(07:54):
society's judgment is a lot to bear, especially because is
you've been raised to believe that abortion is wrong and sinful,
it's hard not to have that feeling. Our parents do
inform a lot of the way we see the world.
At the same time, many people feel there is nothing
(08:16):
wrong about abortion at all, and while they may not
want to need one, they accept it as a choice
for a woman who is pregnant and for whatever her
reasons may be, does not want to have this child.
It turns out that from a mental health perspective, the
worst psychological impact of abortion is really that of stigma
(08:42):
and self stigma. In particular, we can be our own
worst enemies. Of course, I advise you to at least
know of your options. The option of having a baby,
the option of having a baby but putting it up
for adoption, and the option of having and abortion. Each
of these options comes with a set of difficulties for you,
(09:05):
and they each have consequences that you will need to
accept if you choose that route. But beyond the factual
ifs and butts of the concrete outcomes, of each choice,
I do advise you to examine whether choosing to do
something out of shame and guilt is a good course
of action for you. Generally, acting out of shame doesn't
(09:30):
have a good outcome. Shame prevents you from thinking through
your true wishes and creates a heavy burden that can
lead to depression. You at twenty are an independent adult allowed,
and I would say I encourage you to have your
(09:51):
own set of personal morals and values. That is what
you need to examine. Would you shame and shun a
girlfriend who had an abortion? If you would understand a friend,
can you not at least be a friend to yourself?
This is a very private choice, one you are not
(10:13):
obligated to share with anyone else, even your parents, but
it is one you may decide to share with a
therapist as you are trying to sort out your own feelings.
I must stay here that if you are thinking of
getting an abortion in a place that outlaws it, or
at a time that it is outlawed, please understand that
(10:34):
as it stands right now, it appears that any therapist
can have their record subpoena to be used to prosecute
the breaking of a law. As a psychiatrist and psychoanalyst,
I am highly disturbed by this current state of affairs,
but there doesn't seem to be anything mental health professionals
(10:55):
can do about that. So I urge you to think
this quickly, and if in need of a therapist which
could really help you, make an emergent appointment such than
anything you share there that is acted upon is acted
upon in keeping with the laws in your state. As
(11:17):
a psychiatrist who especially treats women, I find the overturning
of Roe v. Wade soul crushing. I fear this will
have a very negative influence on women's health in general
and women's mental health in particular. And in particular this
will affect women who are in poverty and women of
(11:41):
color disproportionately in a tragic way. To be denied your
choice is far worse than making a difficult choice in
terms of mental health. I hope this was helpful. The
psychological toll also disproportionately impacts those with fewer resources, people
(12:06):
who can't afford to take time off or pay for
childcare to travel to another state for the procedure should
they get pregnant. All this does is actually increased the
psychological stress, the anxiety, and the burden on certain segments
of society. Research also demonstrates a strong relationship between unwanted
(12:28):
pregnancy and interpersonal violence. Specifically, the research suggests that the
inability to obtain an abortion increases the risk for domestic
abuse among those who are forced to stay in contact
with violent partners, putting them and their children at risk.
(12:49):
The impact of this decision will fall hardest on people
who already faced discriminatory obstacles to healthcare, especially black, Indigenous,
and other people of color, people with disabilities, people in
rural areas, young people, undocumented people, and those having difficulty
making ends meet at all. Our nation is already experiencing
(13:15):
a mental health crisis. This is yet another factor that
will contribute to negative mental health outcomes of our society.
The American Psychiatric Association, the American Psychological Association, and the
National Association of Social Workers are all pledging to work
with Congress and state policy makers in an effort to
(13:36):
protect access and availability of abortion services. They are also
pledging to work to ensure that mental health and medical
professionals are not criminalized for doing their jobs in supporting
pregnant people, in making difficult decisions regarding reproductive health care needs.
(13:56):
These changes are desperately needed, but to date they do
not exist. Do you have a problem I can help with?
If so, email me yet. How can I help? At
Seneca women dot com, Paul Centers remain anonymous and listen
every Friday too. How can I help with me? Doctor
(14:18):
Gale's Salts
Bees are challenging times, but you don't have to navigate
them alone. Welcome to how can I help? I'm Dr
Gail Salt. I'm a clinical Associate Professor of psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:26):
hopefully with understanding, insight and advice. Last week, the Supreme Court,
in a stunning ruling, overturned Roe v. Wade, eliminating the
over fifty year federal civil rights to all women to
receive an abortion if they choose to. Shortly thereafter, numerous
(00:49):
states trigger laws went into effect, banning abortion, many even
in cases of rape and incest. As a psychiatrist, I
understand that this will have serious mental health consequences for
women denied the right and ability to choose if they
are willing and able to bring a pregnancy to term
(01:11):
and to have a child. Today, I am answering a
question from a woman I just received about her mental
state an abortion. Research shows that the dominant emotion that
women express after having an elective abortion is relief, not sadness,
not anxiety. It's not to say that women have not
(01:35):
had regret, but by and large that is in the
vast minority. The landmark Turnaway Study, performed between the years
two thousand and eight and two thousand and sixteen by
researchers at the University of California, San Francisco's Program Advancing
New Standards in Reproductive Health, was designed to investigate the
(01:58):
long term impacts of abortion. The study followed nearly a
thousand people and compared outcomes for participants who received abortions
with outcomes for those who sought out abortions but were denied.
Researchers followed the participants for five years and regularly checked
(02:19):
in with them about various aspects of both their physical
and their mental well being. Using data from the Turnaway Study,
research was published in Jamma Psychiatry that's really the foremost
journal in psychiatry in two thousand and seventeen, and it
found that people who were denied abortions reported more symptoms
(02:42):
of stress and anxiety one week after the event than
those who received abortions. Over time, the psychological well being
of all groups in the Turnaway Study, including those who
were denied abortions and ultimately did give birth, converged, but
These findings do not support policies that restrict women's access
(03:05):
to abortion on the basis that abortion harms women's mental health.
Other research based on data from the same study was
published in the American Journal of Psychiatry in two thousand
and eighteen and found there were no major differences in
suicide risk among women who received or were denied an
abortion over the five years after the event. Those women
(03:30):
who were most likely to have an elevated risk for
suicide or self harm in the study were those who
had a previous history of mental health conditions, or of
abuse or of violence. The study found no evidence to
support the idea that abortion increases people's mental health risks,
and instead found that really the denial of abortion was
(03:54):
overall worse for people's mental health in a state meant.
Following the Supreme Court ruling on Friday, Frank Worrell, who
was the president of the American Psychological Association, said, this
ruling ignores not only precedent but science and will exacerbate
(04:14):
the mental health crisis America is already experiencing. We are
alarmed that the Justices would nullify ROW despite decades of
scientific research demonstrating that people who are denied abortions are
more likely to experience higher levels of anxiety, lower levels
(04:34):
of life satisfaction, and lower self esteem compared with those
who are able to obtain abortions. Another paper from the
Turnaway study in Social Science and Medicine in found that
more than of participants who had abortions felt they made
(04:55):
the right decision even five years later, and at every
point during the five years participants were surveyed, relief was
the most common emotion. Most commonly, women in the short
term feel a mix of emotions guilty, angry, sad, relieved,
(05:16):
even happy. But research shows that over time all of
these emotions basically go down, and those who do feel
regret often feel really regretful of the situation, not the abortion,
of the situation they are in, rather than the decision
(05:36):
to have an abortion. For most women who choose to
have an abortion, they feel it is the right decision
for them. Abortion is not anyone's preferred method of birth control.
It is a difficult decision a woman makes with herself
and with her doctor. For about half of the women
(05:58):
in this country, the ability to make that decision has
been taken away, so with that right after the break
we'll get to my listener's question. Welcome back. Let's get
(06:24):
to my listener's question and see how can I help,
dear doctor Saltz. I am twenty years old and just
discovered I am pregnant. I do not want to have
a child. I'm not married, I have no income as
I am a student. I want to finish college and
I want to apply to law school. To me, this
(06:48):
is a disaster. There is absolutely zero part of me
that wants to have a baby, and the very idea
fills me with terror. The guy I had sex with
also does not want a baby. My parents are very religious.
If they knew I was considering an abortion, they would
(07:08):
be horrified. I think as a result, I feel very
guilty and ashamed thinking I want an abortion. This has
made me unsure of what to do, mostly because I
fear being shamed if anyone finds out being labeled that
girl having my parents think I'm a bad person. How
(07:30):
do I decide what to do? Given if I keep waiting,
the answer will be made for me because I only
have until fifteen weeks of pregnancy to make a decision
in my state. First off, let me say I am
sorry that you are in a crisis situation at all,
having to balance your needs and the internalized fears of
(07:54):
society's judgment is a lot to bear, especially because is
you've been raised to believe that abortion is wrong and sinful,
it's hard not to have that feeling. Our parents do
inform a lot of the way we see the world.
At the same time, many people feel there is nothing
(08:16):
wrong about abortion at all, and while they may not
want to need one, they accept it as a choice
for a woman who is pregnant and for whatever her
reasons may be, does not want to have this child.
It turns out that from a mental health perspective, the
worst psychological impact of abortion is really that of stigma
(08:42):
and self stigma. In particular, we can be our own
worst enemies. Of course, I advise you to at least
know of your options. The option of having a baby,
the option of having a baby but putting it up
for adoption, and the option of having and abortion. Each
of these options comes with a set of difficulties for you,
(09:05):
and they each have consequences that you will need to
accept if you choose that route. But beyond the factual
ifs and butts of the concrete outcomes, of each choice,
I do advise you to examine whether choosing to do
something out of shame and guilt is a good course
of action for you. Generally, acting out of shame doesn't
(09:30):
have a good outcome. Shame prevents you from thinking through
your true wishes and creates a heavy burden that can
lead to depression. You at twenty are an independent adult allowed,
and I would say I encourage you to have your
(09:51):
own set of personal morals and values. That is what
you need to examine. Would you shame and shun a
girlfriend who had an abortion? If you would understand a friend,
can you not at least be a friend to yourself?
This is a very private choice, one you are not
(10:13):
obligated to share with anyone else, even your parents, but
it is one you may decide to share with a
therapist as you are trying to sort out your own feelings.
I must stay here that if you are thinking of
getting an abortion in a place that outlaws it, or
at a time that it is outlawed, please understand that
(10:34):
as it stands right now, it appears that any therapist
can have their record subpoena to be used to prosecute
the breaking of a law. As a psychiatrist and psychoanalyst,
I am highly disturbed by this current state of affairs,
but there doesn't seem to be anything mental health professionals
(10:55):
can do about that. So I urge you to think
this quickly, and if in need of a therapist which
could really help you, make an emergent appointment such than
anything you share there that is acted upon is acted
upon in keeping with the laws in your state. As
(11:17):
a psychiatrist who especially treats women, I find the overturning
of Roe v. Wade soul crushing. I fear this will
have a very negative influence on women's health in general
and women's mental health in particular. And in particular this
will affect women who are in poverty and women of
(11:41):
color disproportionately in a tragic way. To be denied your
choice is far worse than making a difficult choice in
terms of mental health. I hope this was helpful. The
psychological toll also disproportionately impacts those with fewer resources, people
(12:06):
who can't afford to take time off or pay for
childcare to travel to another state for the procedure should
they get pregnant. All this does is actually increased the
psychological stress, the anxiety, and the burden on certain segments
of society. Research also demonstrates a strong relationship between unwanted
(12:28):
pregnancy and interpersonal violence. Specifically, the research suggests that the
inability to obtain an abortion increases the risk for domestic
abuse among those who are forced to stay in contact
with violent partners, putting them and their children at risk.
(12:49):
The impact of this decision will fall hardest on people
who already faced discriminatory obstacles to healthcare, especially black, Indigenous,
and other people of color, people with disabilities, people in
rural areas, young people, undocumented people, and those having difficulty
making ends meet at all. Our nation is already experiencing
(13:15):
a mental health crisis. This is yet another factor that
will contribute to negative mental health outcomes of our society.
The American Psychiatric Association, the American Psychological Association, and the
National Association of Social Workers are all pledging to work
with Congress and state policy makers in an effort to
(13:36):
protect access and availability of abortion services. They are also
pledging to work to ensure that mental health and medical
professionals are not criminalized for doing their jobs in supporting
pregnant people, in making difficult decisions regarding reproductive health care needs.
(13:56):
These changes are desperately needed, but to date they do
not exist. Do you have a problem I can help with?
If so, email me yet. How can I help? At
Seneca women dot com, Paul Centers remain anonymous and listen
every Friday too. How can I help with me? Doctor
(14:18):
Gale's Salts
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