For Black people who give birth, the Supreme Court’s decision to overturn Roe v. Wade in Dobbs v. Jackson Women’s Health Organization will have a disproportionately negative effect on their mental health. In fact, a confluence of factors point toward a coming mental health crisis among Black birth givers, especially in the largely Southern states that have already or will soon outlaw abortion. Black people who give birth are at higher risk for perinatal or postpartum mood and anxiety disorders (PMADs). Given that bans on abortion will cause more Black people to bring pregnancies to term and give birth, especially pregnancies that are unplanned or unwelcome, more of this group will be at risk for these mental health challenges with serious lasting impacts.
PMADs occur during and after about 15 to 20% of all pregnancies in the United States; however, for Black populations, this number is often double. Black people experience postpartum depression at rates 25 to 52% higher than the general population. Black people also face more barriers to mental health care and less access to treatment. Some of these barriers are socioeconomic. In part due to systemic racism’s effect on socioeconomic status, Medicaid covers the births of more than 65% of Black babies in the country. In the states that have not expanded Medicaid, many of which are also hostile to abortion, about 29% of women who are of reproductive age are Black and uninsured. Although pregnancy makes a patient eligible for Medicaid, prenatal care may be delayed because previously uninsured pregnant people may be unaware of their pregnancy status or may take time to sign up for Medicaid. Therefore, the onset of PMAD symptoms may go undiagnosed and untreated as care is not accessed promptly.
Additional medical complications for birth givers and their infants also contribute to the greater prevalence of PMADs among Black birth givers, like the fact that Black mothers are two times more likely to have their baby die within the child’s first year of life, and that Black people who give birth are also twice as likely to experience a severe maternal morbidity (SMM) event or life-threatening pregnancy complication. These events can bring on or worsen symptoms of PMADs. Discrimination, racial stressors, and racial trauma during the birthing process all contribute to the pressure placed on a new Black parent who has given birth.
To help stave off this crisis, Medicaid access must be expanded in the states that have not done so already. In 2019, 58.7% of Black people in the country lived in the South. With the loss of abortion healthcare in the Southern states, more mental healthcare will be needed for Black people who give birth. Beyond Medicaid access, more culturally appropriate screenings for mental health problems must be performed for parents-to-be. The earlier and more often symptoms of PMAD can be caught and addressed in Black birth givers, the better for parents, children, and communities.
Krista L. R. Cezair is a 2022 summer legal intern at the O’Neill Institute and a rising 3L at Harvard Law School and Master of Public Health candidate at the Harvard T.H. Chan School of Public Health.