We cannot forget mental health in this nation’s debate about abortions

As a board-certified obstetrician/gynecologist who has been practicing for almost 20 years, I want to address an issue that seems to have been overlooked in the debate about abortion access: mental health issues surrounding pregnancies. We talk a lot about abortion bans and restrictions as a physical health issue, but they also have a profound impact on a pregnant person’s mental health.

My father was also an OB/GYN. He has shared stories of women dying under his care due to complications from back-alley abortions before Roe v. Wade. I am speaking out now on behalf of my patients. I am not speaking on behalf of my employer.

Mental health awareness and support make up a large part of my OB/GYN practice. We are all familiar with postpartum depression, but I’m referring to other aspects of mental health.

Over the years, I have treated patients with a wide variety of concerns. I have treated women with anxiety and depression. I have treated patients with bipolar disorder and they are afraid to pass those genes on to a child. If they were to conceive, termination feels like their only option, for the mental health well-being of the next generation. I help women manage grief surrounding stillbirth and fear of being pregnant again and losing another baby. I have counseled patients who had to terminate very desired pregnancies because the mother would die due to health conditions that were exacerbated by the pregnancy.

I am thankful to practice in Colorado, where we can safely provide termination options to patients up to 24 weeks of pregnancy. But as I closely watch what is happening in Texas and at the Supreme Court, I had to speak up. I am not an abortion provider. But on behalf of my patients, I am so thankful I can refer them to safe, well-trained physicians when termination is the right answer.

We are all aware of the opioid crisis in our country. If a person is pregnant and they do not want to be, they might self-medicate with drugs and alcohol — harming themselves and the fetus. If a person cannot afford to provide for a child and they are forced to carry the pregnancy, how is that best for the child?

Especially for people who have underlying mental health conditions, forcing a pregnancy on them would likely exacerbate any mental health problem: anxiety, depression, reactivation of past trauma, substance abuse, etc.

Being able to give a child up for adoption is a very difficult choice for many people. And let’s not forget that planning to give a child up for adoption requires the person to go through pregnancy and delivery. Delivery can be life-threatening to both the mother and the fetus. I respect my patient’s choice to not risk her own life for a baby she does not want to, or cannot, care for. For some people, pressure from their community or family members might make them choose to keep a child, at their own expense.

In a recent analysis of maternal mortality by the Colorado Department of Public Health & Environment (CDPHE), the most frequent causes of all 145 pregnancy-associated deaths between 2008 and 2013 were injury-related (44) and mental health conditions (40); in fact, these two causes accounted for nearly six out of every ten maternal deaths. “Maternal mortality” statistics encompass the first year after a baby is born.

And please don’t start with the “if they don’t want kids they shouldn’t be having sex” argument — the new Texas ban does not provide an exemption for rape or incest. Please do not imply those people volunteered for their abuse or attack.

I need to have all options available to treat my patients safely, whatever that may look like. Period.

Abortion restrictions place unnecessary stress on patients who are already going through an emotional roller coaster surrounding pregnancy and parenthood. Neither patients nor doctors need politicians looking over their shoulders and making personal decisions for them at a time when they are under enormous physical and emotional strain.

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