After Dobbs, maternal mental health care is even more complicated

In the wake of the Supreme Court’s decision to overturn Roe v. Wade, the ecosystem for pregnant women has become much more complicated—not just for women with unexpected pregnancies, but also for women with planned pregnancies and women with fertility issues. It’s even more complicated for pregnant women who also have to navigate the country’s complicated patchwork of mental health services.

Those who are pregnant and also managing their mental health don’t always find clear answers or resources. And many states do not have specific mental health resources for those who want or cannot get an abortion.

What’s available may vary by region. OB-GYNs have fled some states due to new regulations, and at the same time the U.S. is facing a shortage of mental health providers.

Those seeking both types of care may face a host of obstacles.

Several people who became pregnant after Dobbs told CQ Roll Call that they struggled to gain clarity about whether they could continue their medications for mental health disorders while they considered their options.

Others experienced mental health problems before pregnancy that were exacerbated by the pregnancy.

Others sought mental health care or logistical support for the first time.

Next steps

National efforts to tackle already poor maternal mental health are in a preliminary stage. The federal government last month released a policy blueprint outlining ways to improve maternal mental health overall.

“The real-world consequences of post-Dobbs restrictive laws and restrictions on reproductive opportunities are another source of fear and anxiety for women of childbearing age,” said Carole Johnson, administrator of the Health Resources and Services Administration, which oversees the National Maternal Mental supports. Health Hotline.

The hotline and the formation of the task force that led the blueprint are both the result of congressional action prior to Dobbs.

Congress and state legislatures have offered a number of legislative solutions, but little progress has been made on these bills. Bills typically need to be broader in scope on maternal health to gain momentum, as specific appeals to abortion or anti-abortion pregnancy centers can thwart either party’s momentum.

Different needs

The mental health consequences of the Dobbs decision have largely fallen on the shoulders of community organizations and specialty providers, who face their own costs and shortage issues.

“There are so many people who need support that we can’t actually support or reach out to just because of budget constraints or limited resources,” said Ayé Johnson, blueprint manager for Apiary, a national organization that provides logistics assistance. to groups that connect people with abortion services. “We’re really trying to create a holistic way to care for people with very limited resources.”

If people need emotional support, Johnson said they could be referred to All Options, which runs a hotline for pregnant individuals and new parents who want to talk about their options; or Exhale Pro-Voice, a text line for emotional support after an abortion. Or they can be paired with a doula for support before, during or after an abortion.

Sumeyye K., helpline coordinator at ARC-Southeast, speaks to callers in a number of emotionally difficult situations: intended pregnancies with fetal abnormalities, pregnancies resulting from sexual violence, mothers calling on behalf of their teenage daughters.

“There is definitely an emotional weight to these conversations,” said Sumeyye, who declined to use her last name in this report for privacy reasons. “I think a lot of these callers are just looking for someone to listen, and because of the stigma, it’s very difficult to find that.”

Simran Singh Jain, membership coordinator for SisterSong, a reproductive justice group in the South, said she has seen a different timeline among patients seeking spiritual support. Before the bans, “almost all the work I did within a week’s time frame was around the actual abortion,” she said.

Now people often reach out even three or six months after the procedure to process and talk about their abortion. Thanks to Dobbs, people are more focused on navigating immediate logistics and changing laws than on their mental health.

“People are so scared about their abortion now because they’re so scared that something bad is going to happen, that’s all they can think about,” she said.

While there are some providers offering postpartum-specific therapy, Kelsey Reep, a North Carolina-based licensed clinical social worker, said there is a “very missing area” to focus more on abortion and miscarriage support.

Reep said she’s hearing more and more from patients dealing with issues like anticipatory anxiety — possibly needing an abortion and not having the option to get one, or feelings of stigma and shame because they can’t talk about the barriers they face. have had to deal with.

Allison Terracio, campaigns manager for Planned Parenthood South Atlantic, said the reality on the ground is that after navigating the logistics, travel, costs and flow of protesters, “all of these stressors are compounded.”

In May, the Policy Center for Maternal Mental Health rated states on their efforts to support maternal mental health. Only four states – Washington, Utah, Pennsylvania and California – exceeded a C+.

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

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