The Brink: What motivated the study?

Burtch: Shortly after Roe v. Wade got overturned, my coauthor Brad and I were talking about all kinds of problems that will happen from this decision and how so many things will be disrupted. One of the first changes was likely to be stress. I was aware of the Household Pulse Survey that had been launched by the Census Bureau during the COVID-19 pandemic, and that it also has questions to capture mental health and indicators of distress. We immediately saw patterns in the data, and we brought in Michaela, who helped us understand these results from the clinical perspective. I think this is giving us a baseline about how extensive the consequences are for people broadly.

The Brink: Why is mental health an important measure in regards to abortion restrictions?

Burtch: Obviously, women of childbearing age are most likely to be affected. But these policy changes extend to a much broader population than we typically realize, like family members and caregivers. This could create stress for the entire family, for anybody that’s connected to an individual that is in a position of needing an abortion. There’s also a lot of people worried about what could come next. After Roe was overturned, that led to questions about same-sex marriage rights and other rights that could be impacted by the courts. We have a lot of reasons to expect that these national changes will have a broad influence, beyond the stress that comes with contemplating abortion and going through an abortion.

The Brink: How did you figure out that spikes in mental distress are specifically related to abortion bans, and not something else?

Burtch: We essentially look at the change over time, from before to after policy change. In this case, the institution of an abortion restriction in a given location. We compare those differences in states with abortion restrictions to states where no policy change happened. This means we’re implicitly controlling for natural sources of variation, like seasonality or the economy. In the paper, we show that nothing is systematically different in states that have not adopted bans; in the ones that do adopt abortion bans, we see an upward tick [in mental distress] relative to ones that didn’t make any change. This is all happening at the population level, and the survey collected over a million responses for every question and then weighted the results to be demographically representative.

The Brink: Why are there disparities among people with lower incomes and education?

Burtch: The most plausible explanation is: When an abortion restriction is imposed in a particular state, how do people deal with that? If someone can’t access an abortion and ends up having the child, there’s an economic cost to that which is much harder for people with less money to bear, and they’ll likely experience more stress about this possibility. If the other option requires travel costs, taking time off a job, paying for childcare, and paying for the procedure or medication, that’s a lot of additional costs too. The fact that mental health effects appear larger among people with lesser education is probably correlated to lesser wealth, so that’s probably a single factor—that people of lower socioeconomic status have more difficulty absorbing new costs that come with dealing with an abortion.

The Brink: Do you think the recent court case about the abortion restriction in Idaho will cause more stress?

Burtch: It’s important to note that a lot of the mental stress that comes with these policy changes isn’t just due to the policy change itself, but also the ambiguity around the change. In the recent example in Idaho, where the state challenged the federal government’s rule on providing emergency [abortion] medical care, the Supreme Court didn’t rule in favor of the state—they basically threw it out and said that this challenge shouldn’t have made it to the Supreme Court. So, they didn’t resolve it. As of now, doctors need to keep providing emergency [abortion] care until they say otherwise. But it’s still a legal gray area that impacts medical providers and patients. So long as this remains unresolved, and we don’t have clarity around what’s allowed in different places, that’s linked to so much stress. I hope this paper reaches lawmakers and medical providers, so they can understand that these policies are creating lots of stress for lots of different people and they should be empathetic to that.