Since the Supreme Court’s 2022 decision in Dobbs v. Jackson Women’s Health Organization ended the constitutional right to abortion, Caroline Rouse, MD, said her maternal-fetal medicine practice in Indianapolis has profoundly changed.

Under Indiana’s near-total ban, patients who could previously receive time-sensitive care in their own community are now unable to and/or forced to travel to other states.

“Not being able to provide the patient with the care that they need in their community for reasons that have nothing to do with medicine is a huge affront to my morality and my ability to practice medicine in the way that I know is best,” Rouse told Medscape Medical News.

Rouse is not alone in her discomfort. A recent study published in JAMA Network Open showed that clinicians providing care in abortion-restricted states had double the moral distress of peers living in states without such restrictions.

For patients, the mental health consequences of abortion bans extend beyond the immediate need for abortion care with some clinicians reporting that the mental health cost is now surfacing even among patients who have never been pregnant but fear losing control over future reproductive decisions.

“It’s not so much about people having anxiety because they cannot have an abortion….It’s way bigger than that. People saying, ‘I want to be sterilized because I don’t want to be at risk of getting pregnant and having a bad outcome,” Camila Arnaudo, MD, and perinatal psychiatrist who works with Rouse in Indianapolis, told Medscape Medical News.

Arnaudo said she also worries that fear may lead patients to isolate themselves and avoid necessary care, increasing the risk for adverse and sometimes fatal outcomes.

The impact of abortion bans is also visible at the population level. A 2022 study showed enforcement of abortion restrictions is associated with a 6% increase in annual suicide rates among women compared to the years before such laws took effect.

As Rouse and Arnaudo continue to adjust their practice to the post-Dobbs era, they wonder if the mental health cost of abortion bans is only just beginning.

A Fragmented Legal Landscape

These mental health harms are occurring in a rapidly changing legal environment.

In nine states and Washington, DC, there is no ban or gestational limit for abortion, 28 states enforce bans based on gestational limits, and 13 have total abortion bans with limited exceptions.

One such exception applies when the pregnant patient’s life is in danger. The only state with a total abortion ban that includes an exception for serious psychiatric illness is Alabama.

In a JAMA Psychiatry Special Communication, researchers argued that abortion bans without explicit psychiatric exceptions place women with mental illness at heightened risk for adverse outcomes and leave them without recourse.

“We as clinicians may be treating somebody and we know her life could be in danger because she’s suicidal, but we are not allowed to state that could be a reason that the mother’s life is in danger,” Lauren Osborne, MD, lead author of the report and associate professor of psychiatry and vice chair of clinical research in the Department of Obstetrics and Gynecology, Weill Cornell Medicine in New York City, told Medscape Medical News.

Mental health conditions are already a leading cause of pregnancy-related mortality, accounting for about 23% of maternal deaths. “It’s very much the case that a mental health reason could lead to the death of the mother if a woman weren’t able to terminate the pregnancy,” said Osborne.

“You swear that you will do no harm, and yet we are causing harm by not providing needed medical care to patients who are requesting it, desiring it, and needing it. And I think that’s a very difficult thing for a physician,” she said.

Flawed Research

Yet despite broad medical consensus, the relationship between abortion and mental health is still contested, with studies on both sides of the access issue cited in legal and political arguments.

However, the current scientific consensus is that women who obtain abortions are no more likely to develop mental health problems than those who carry an unwanted pregnancy to term.

“The data do not suggest that having an abortion worsens mental health outcomes. That is not supported by the research. Period. In fact, what the data suggest is that lack of access to abortion is what worsens mental health outcomes,” Nancy Byatt, DO, MS, MBA, DFAPA, perinatal psychiatrist and professor of psychiatry, ob/gyn, and population and quantitative health sciences at UMass Chan Medical School in Worcester, Massachusetts, told Medscape Medical News.

“We as physicians should not be in a situation where we have to decide between a potential arrest or doing what we feel is in the patient’s best interest and the family’s best interest based on the scientific data,” Byatt said.

Abortion restrictions have often been justified by policymakers as measures intended to protect women’s mental health and well-being. However, researchers say some of the mental health studies frequently cited in abortion policies and legal challenges contain unreliable or invalid evidence.

For example, a 2009 study of national comorbidity data led by Priscilla Coleman, PhD, and now retired professor of human development and family studies at Bowling Green State University in Bowling Green, Ohio, showed an association between abortion and an increased risk for several mental health disorders. The paper was used in at least 11 court cases and four legislative hearings, despite methodological issues, which were subsequently revealed.

Julia Steinberg, PhD, associate professor in the Department of Family Science at the University of Maryland, College Park, Maryland, said, given her familiarity with the data, the paper immediately raised concerns. When she reanalyzed it using the reported methods, she was unable to replicate the results and later concluded the methods described did not match what was actually done.

Specifically, the researchers used lifetime diagnoses of mental health issues rather than post-pregnancy outcome measures as detailed in the methods, leading to incorrect conclusions that abortion contributed to mental health problems, Steinberg and other researchers outlined in The BMJ analysis.

Results from the 2009 paper and other studies were used for a 2011 meta-analysis by Coleman which had further statistical and methodological errors, they wrote. This meta-analysis was repeatedly used as evidence in the Dobbs v. Jackson case that ended the constitutional right to abortion and cited in an additional 25 court cases.

Allowing “inaccurate information to remain in the scientific record can have lasting and deleterious effects on law, public policy, clinical practice, and public health,” The BMJ authors wrote, calling for the papers to be retracted.

Both studies remain in the literature. Coleman declined to comment.

No Regrets

In contrast, experts say the strongest evidence comes from studies specifically designed to avoid those methodological pitfalls and include relevant comparison groups to assess the relationship between abortion and mental health.

Byatt and other experts point to the Turnaway Study as one of the most comprehensive investigations into abortion and long-term mental health outcomes. Over 5 years, researchers followed nearly 1000 women who either obtained abortions or were denied care after surpassing gestational limits.

Women seeking abortions often have preexisting mental health conditions, making the choice of comparison group critical. Unlike earlier studies that compared women who had abortions to those carrying pregnancies to term, both groups in the Turnaway Study sought abortion care, allowing researchers to directly compare outcomes in those who did and did not have an abortion.

Of those who had an abortion, 95% reported they had no regrets and believe it was the right decision for them. The findings also showed no association between abortion and an increased risk for adverse mental health outcomes.

In contrast, those who were denied an abortion reported higher levels of anxiety, stress, and lower self-esteem and life satisfaction. Over time, this association weakened and those who had an abortion or were denied one had comparable psychological outcomes after 1 year.

However, children born to women who were denied an abortion were more likely to report poor maternal bonding and greater subjective poverty than children born to women who previously had an abortion.

“When you conduct high-quality research like the Turnaway Study and use appropriate comparison groups, adjust for appropriate confounding factors — something that the previous literature was not doing in a rigorous way — we find that policies that restrict access to abortion using the claim that it negatively affects people’s mental health are not evidence-based,” Turnaway study investigator Antonia Biggs, PhD, associate professor and social psychologist at the Advancing New Standards in Reproductive Health program at University of California San Francisco, Oakland, California, told Medscape Medical News.

While some have criticized the study for its low participation rate, Biggs noted a rate of 37.5% is within the expected range for a 5-year study. A previous critique of the Turnaway study by Coleman that claimed that women with the most significant mental health needs were likely underrepresented in the final sample and that outcome measures for mental health were assessed too simplistically was retracted due to compromised peer review.

Impact on Clinicians

Clinicians report that language describing what exceptions are allowed under an abortion ban is often vague, and a shifting legislative landscape creates confusion that can delay time-sensitive clinical decision-making.

Most states with bans also prohibit “aiding and abetting” an abortion, terminology which, experts argue, is open to broad interpretation that suggests even discussing an out-of-state abortion could create legal risk for clinicians.

“How far a clinician can go in a context like this is just unclear,” Paul Appelbaum, MD, Elizabeth K. Dollard Professor of Psychiatry, Medicine and Law, and director of the Division of Law, Ethics and Psychiatry at Columbia University, New York City, told Medscape Medical News.

He pointed to a lawsuit where a New York-based doctor was sued in Texas for prescribing abortion pills to a Texas patient via telemedicine and ordered to pay a $113,000 judgement. As of late 2025, New York dismissed that case, citing a shield law that protects the state’s clinicians from being charged elsewhere for providing abortion care.

However, the efficacy of state shield laws remains a gray area as they have not yet been tested in the appellate courts, Appelbaum said. “For one state to say we’re simply ignoring the laws of another state because we think they’re against sound public policy is a stance that has not yet been validated.”

For physicians, this type of legal uncertainty can become its own source of psychological strain that can negatively affect their mental health.

Arnaudo, the Indianapolis-based perinatal psychiatrist, said clinicians in abortion-restricted states now practice under the constant fear that doing what is medically right for a patient could cost them their license, expose them to criminal liability, and spill over into their family lives.

That chronic burden has a measurable toll on physicians’ mental health. A 2024 study published in JAMA Network Open showed that among ob/gyns practicing in 13 states with abortion bans, 70% reported symptoms of depression and anxiety following the Dobbs v. Jackson decision.

In addition, nearly all physicians in the study reported moral distress over delays in essential care, describing cases in which they were advised to wait until a patient became septic or began hemorrhaging before intervening, or were unable to act during an emergency because of legal constraints.

“Such cases leave lasting scars on ob/gyns,” the researchers wrote. “In addition to widespread distress and anxiety, the state of hypervigilance we observed in several participants — constantly worrying about potential consequences of providing care or counseling — increases the risk for longer-term physical and mental health problems.”

Guidance for Physicians

Reports of clinicians relocating to states with stronger protections could further exacerbate maternity “care deserts,” which are areas with little or no access to ob/gyn services, according to the American College of Obstetricians & Gynecologists.

In an effort to ease some of this collective anxiety, Byatt and Appelbaum have published a resource guide psychiatrists in the post-Roe era. It outlines strategies to help clinicians support patients whose mental health has been affected by abortion bans and delayed care and includes recommendations for conducting trauma-informed discussions with vulnerable patients and guidance for evidence-based decision-making.

The authors called for more reproductive mental health training among clinicians, noting that obstetricians and family physicians will increasingly have to fill gaps in maternal mental health care to meet growing demand.

That reality is especially tangible for clinicians like Rouse, who continue to care for patients in states with abortion restrictions.

Yet despite the challenges, she remains committed to delivering care to her community in Indianapolis.

“I think there’s something important to be said about the people who stay behind and are working within the system to do the best that they can,” she said. “There are limits for everybody though.”

Steinberg disclosed previously testifying on the science of abortion and mental health in US court cases. Byatt, Biggs, Appelbaum, Rouse, Arnaudo, and Osborne reported having no relevant disclosures.