Increasingly, women are experiencing psychosocial issues because of state restrictions on abortion access, according to recent research.1
“When we think about the post-Roe society, there is this impact on Black women, in particular,” says Tamika C. Odum, PhD, lead study author and an associate professor of sociology at the University of Cincinnati. Researchers heard many stories, especially from Black women, of the financial and emotional cost that abortion care restrictions caused, she says.
Even before the U.S. Supreme Court overturned Roe v. Wade in June 2022, women in Ohio faced many hurdles to seeking abortion care. They experienced waiting periods, gestational limits, and other regulatory obstacles to safe and legal abortion access.
“This caused a lot of women to have to seek care out of state,” Odum says. “This was before Roe was overturned. If they’re already struggling to find resources to getting the care they desire, then what will happen afterward when opportunities are no longer available?”
The financial effect is stressful enough on low-income women. “We had one participant in the study who had to sell plasma to afford paying for the abortion,” Odum recalls. “She said she had to go a couple of times to have enough money.” Another person worried about needing to perform illegal acts to obtain the money to afford the abortion, she adds.
“We had a participant talk about the financial strain on their family causing stress in their relationship with their partner,” Odum says. “That will absolutely be exacerbated because even if you know you need this procedure, it will be more difficult if you don’t have resources in place to get it.”
The cost is especially stressful for low-income families. For instance, if a woman’s family earns $35,000 per year, which is average for some populations, that amounts to less than $700 per week. If the woman wants an abortion and cannot access one in Ohio, she has to travel to Illinois or Michigan for a procedure that costs her more than one week’s salary, Odum explains.
“Think about how they have to pay for travel, lodging, and child care, and it’s more than $1,000 to get the care they need,” she adds. “That’s a huge burden on someone.”
Odum recalls the story of a pregnant woman whose provider found an anomaly on the ultrasound. The facility could not provide her the care — including abortion care — she needed with a possible high-risk pregnancy, so they sent her to another facility four hours away.
Other women begin their search for a local abortion facility early in their pregnancy but are bounced from one city to the next. Then, they cannot receive care because they are past the state’s gestational limit.
“These are all the consequences we saw pre-Dobbs. As restrictions get more stringent, we can expect to see those barriers that people are experiencing will be exacerbated,” Odum says.
Added to the psychosocial stress and toll is the 2022-2023 reality of abortion bans enforced and then blocked by courts, and then unblocked. Someone who already has jumped through the regulatory hoops and set an abortion appointment for Friday may arrive at 8 a.m. that day only to be told that a state court decided the state law banning all or most abortions could now be enforced, so all procedures are canceled. Ohio was one of the states where its anti-abortion law was initially in effect and then blocked by a court, leaving abortion providers and patients in limbo.
Stigma, fear of judgment, and the fear of criminalization of abortion procedures all contribute to women’s psychosocial stress. “Because there is so much confusion and rhetoric around criminalization if you do that, you’re finding folks more apt to keep things secret,” Odum says. “There’s definitely no telling what’s going to happen, and I will not be surprised if there’s a push to criminalization of people seeking abortion care in Ohio. Of course, they’re going to be scared and will not be able to tell people that they need to do what’s best for their own health.”
The current environment is stressful on reproductive health providers as well as patients. When the bans are enforced, no one knows whether a particular abortion procedure is legal, even if it meets the state’s ideas of exceptions to the ban. Women wonder where they can obtain a procedure that may save their lives, and providers struggle with whether a life- or health-saving procedure is legal.
“There’s a huge impact because people will not receive the care they need,” Odum says.
Maternal mortality and morbidity already are high in the United States, especially for Black women. Now, states have passed laws that will prevent seeking medical care that could save a woman’s life. “If we want to improve health outcomes, we need to make sure people have access to healthcare,” Odum stresses.
Physicians need to realize how their conversations with patients about reproductive healthcare need to change in the current environment of abortion bans in many states. “The types of things we’re asking, and how we ask those questions, are pretty critical to getting the information we need,” Odum says. “Physicians need to be as up to date as possible on the legislation.”
It is stressful to patients when one physician interprets the law one way, and another physician interprets it differently. “Having a clear understanding of what your law is, as a physician, is critical,” Odum says. “It’s not just about providing healthcare — you have to know what’s going on in the landscape around you, and you have to be abreast of that.”
Patients also should be able to trust their doctor’s information and advice. This takes time. “Building that level of trust by having conversations is so important, and you should have all the information you need to provide holistic care to improve patients’ health outcomes,” Odum says.
One way to build trust is for providers to learn about the historical role of oppression among Black people and other minorities.
“Be aware of people’s life choices and be aware that this informs different decisions they make,” Odum says. “I don’t have a million-dollar answer, but it needs to move beyond diversity training.”
REFERENCE
- Odum T, Heymann O, Turner AN, et al. Assessing psychosocial costs: Ohio patients’ experiences seeking abortion care. Contraception 2023;117:45-49.
Increasingly, women are experiencing psychosocial issues because of state restrictions on abortion access, according to recent research. Financial pressure, waiting periods, gestational limits, and fear of stigma and judgment all contribute to psychosocial stress.
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