CHICAGO (AP) 鈥� The weeks after Kaniya Harris found out she was pregnant were among the hardest in her life.
Final exams were fast approaching for the college junior. Her doctors told her she had an ovarian cyst, and the risk of ectopic pregnancy was high. The for abortion clinics near her city of Bethesda, Maryland, seemed impossibly long. And she couldn鈥檛 visit her family in Kentucky because of the .
Harris was having regular panic attacks. It all felt like too much, she said.
"My mental health was at the lowest point it鈥檚 ever been in my life," said Harris, who had an abortion last May.
As advocates push this year for aiming to protect abortion rights, key differences have emerged in the language of proposed measures. Among them is the inclusion of
would allow lawmakers to restrict abortions after , except if an abortion 鈥渋s needed to protect the life or physical or mental health of the pregnant person.鈥� A similar measure has been proposed in . In 2022, voters passed an abortion rights amendment with a mental health exception for viability limits.
Meanwhile, proposed ballot measure language in only says 鈥減hysical health,鈥� excluding a mental health exception. Proposed abortion rights initiatives in other states, including , Montana and Nebraska, don鈥檛 explicitly mention mental health.
鈥淚t鈥檚 heartbreaking to hear about these policies ignoring mental health,鈥� said Harris, now 21. 鈥淎n abortion can save someone鈥檚 life, including when they鈥檙e in a mental health emergency.鈥�
Most states with abortion bans include exemptions for life-threatening emergencies, but only Alabama鈥檚 includes an exception for 鈥渟erious mental illness鈥� that could result in the death of the mother or fetus. Lawmakers added the provision after getting pressure from the state鈥檚 medical association, which was concerned about women at high risk for suicide.
, passed in 2019, was among the strictest abortion restrictions in the country at the time. It did not include exceptions in cases of rape or incest and considered performing an abortion to be a felony. Alabama began enforcing the ban in 2022 after the U.S. Supreme Court , which once granted a federal right to abortion.
Abortion bans in at least 10 states 鈥� Florida, Georgia, Idaho, Iowa, Kentucky, Louisiana, Ohio, Tennessee, West Virginia and Wyoming 鈥� explicitly exclude mental health conditions as a possible exception. Others are murkier, allowing for exemptions for the 鈥渓ife and health鈥� of the woman without defining if mental health is included.
Medical experts say even states that do allow mental health exceptions require patients to jump through hoops that may be inaccessible to some people, especially those with low incomes. Alabama, for example, requires a state-licensed psychiatrist with at least three years of clinical experience to certify the mental health condition as an emergency.
Some days, when Harris would get home from class, she would be "so overwhelmed that I鈥檇 have a breakdown on the floor,鈥� she said. For two months, she cried every day. But facing an abortion ban in her home state and stigma from doctors, Harris said she didn鈥檛 feel comfortable speaking about her experience with a mental health professional.
鈥淧eople shouldn鈥檛 have to jump through hoops and prove their pain to have access to the care they need,鈥� she said.
Mental health conditions were the leading underlying cause of pregnancy-related deaths from 2017 to 2019 with nearly 23% of pregnancy-related deaths attributed to mental health conditions, including suicides and overdoses from substance use disorders, .
About one in eight women experience postpartum depression, . But mental health struggles during pregnancy, especially the psychological trauma of those forced to carry unwanted pregnancies, are understudied, said Michelle Oberman, a Santa Clara University law professor researching the impact of abortion restrictions.
鈥淭hese statistics, these stories of women鈥檚 suffering have been really haunting me,鈥� Oberman said. 鈥淲e don鈥檛 as a society have a great track record of treating mental health the same way we do physical health.鈥�
Policies that dismiss mental health as less important than physical health put lives at risk, said Columbia University psychiatrist Paul Appelbaum. He said there is also that being denied an abortion causes significant mental distress. This distress has been apparent in of women forced to flee their states or continue pregnancies despite serious risks to their health.
鈥淚 am extremely concerned by the exclusion of mental health exceptions in these ballot measures,鈥� said Appelbaum, former president of the American Psychiatric Association. 鈥淚t鈥檚 absolutely cruel and will lead to the suffering deaths of pregnant women in these states.鈥�
Jayme Trevino, an OB-GYN in Missouri and fellow with Physicians for Reproductive Health, said she has seen first-hand how being denied abortion care can affect a patient鈥檚 well-being, including their mental health.
鈥淚t鈥檚 a devastating, regular reality for my patients,鈥� she said, adding that she was grateful for the mental health exemption in the state鈥檚 proposed ballot measure language.
Mallory Schwarz, a spokesperson for Missourians for Constitutional Freedom, said the initiative鈥檚 language 鈥渋s written to make sure that doctors 鈥� not politicians 鈥� are able to determine what鈥檚 best for their patients.鈥�
Conversely, an Arkansas initiative only includes exemptions 鈥渢o protect a pregnant female鈥檚 life or to protect a pregnant female from a physical disorder, physical illness, or physical injury."
Previous versions of the proposal included broader exceptions, said Gennie Diaz, executive director of For AR People. Initially, she said, 鈥淲e wanted to craft language for a constitutional amendment that would be as broad as possible and would hopefully account for something like mental health.鈥�
But when handed a proposal with exceptions to 鈥減rotect the life and health鈥� of the mother, the state鈥檚 attorney general, a Republican, rejected the language, saying it must define 鈥渉ealth.鈥�
鈥淭hat was a signal to us that we were going to have to make a choice,鈥� Diaz said. 鈥淎nd another unfortunate factor is that the majority of Arkansas voters are unlikely to support mental health as a reason for an abortion after a particular timeframe. We felt it was unlikely for a version that explicitly names mental health to pass.鈥�
Arkansas advocates were also worried the opposition campaign would target a mental health exception, Diaz said.
The National Right to Life Committee鈥檚 model state legislation for abortion bans explicitly excludes mental health exceptions. These exceptions allow pregnant women 鈥渢o kind of bypass those laws and still abort pregnancies of children that were viable,鈥� said Ingrid Duran, state legislative director of the NRLC.
鈥淲e specifically exclude mental health exemptions because we saw how that creates a loophole in a law and it leaves that unborn child at risk of dying for a sometimes treatable, sometimes temporary condition that the mother may be experiencing,鈥� she said.
When asked if targeting mental health exceptions will be part of their strategy for campaigning against abortion ballot measures in 2024, she said, 鈥淚 can鈥檛 necessarily say that would be part of the strategy.鈥� Still, said Duran, 鈥淲hen I see mental health exceptions like this, my heart drops.鈥�
Oberman from Santa Clara University said she expects to see the anti-abortion movement 鈥渆mploy a strategy of minimizing and dismissing the mental health consequences of forced pregnancy.鈥�
鈥淭he mental health issues of pregnant people remain in the shadows and highly stigmatized,鈥� she said. 鈥淎nd that clouds our judgment of what a medical emergency looks like during pregnancy.鈥�
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Christine Fernando, The Associated Press
