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Key points
- Lack of available abortion care will likely increase rates of miscarriage and stillbirth among pregnant women.
- Depression and anxiety commonly follow early pregnancy loss.
- The mental health challenges of miscarriage and stillbirth disproportionately affect mothers of color.
The Supreme Court’s recent ruling overturning Roe v. Wade is certain to be highly debated and spur further controversy over abortion rights in America. But among the rancor and cacophony of voices arguing pro-life or pro-choice stances, few have acknowledged the voice and plight of women who may feel forced to continue a pregnancy that will not lead to a live birth due to miscarriage and stillbirth.
Miscarriage is generally defined as pregnancy loss before fetal viability (approximately 23 weeks gestation). The term “stillbirth” often refers to fetal deaths later in pregnancy. Statistics indicate that miscarriage and stillbirth are both common. Approximately 23 million miscarriages occur annually worldwide, equating to 44 pregnancy losses every minute.
At least 10 percent of women have experienced one or more miscarriages, although these numbers may underreport the condition since some women experience pregnancy loss even before they become aware that they are pregnant.
According to the American College of Obstetricians and Gynecologists, stillbirth outcomes occur in approximately one in 160 pregnancies in the United States. One can predict that Roe’s annulment means an increased number of women compelled to carry a pregnancy unwillingly who may face pregnancy loss through miscarriage or stillbirth.
Numerous factors contribute to increased risk for miscarriage and stillbirth pregnancy. Chromosomal abnormalities of the fetus are a common cause of miscarriage. Other patient-centric risk factors include advanced maternal age, prior miscarriage or stillbirth, clotting disorders, viral infections, obesity, diabetes, smoking, and alcohol use. Some, such as air pollution and pesticide exposure, are environmental.
Miscarriage and stillbirth disproportionately affect people of color. Black women are 43 percent more likely to experience miscarriage than white women. Additionally, black women are far more likely to die from pregnancy-related complications than their counterparts.
The psychological and mental health challenges of miscarriage are well-documented but often go unspoken. A 2020 study revealed moderate to severe anxiety and depression in 24 percent of women at one month following early pregnancy loss and 17 percent after nine months.
Among highly vulnerable groups such as female adolescents, miscarriage doubles the risk of suicide attempts later in life. Similar findings exist for mothers of stillborn infants, many of whom report higher rates of depression, anxiety, and PTSD as compared to mothers of live births.
Regrettably, the psychological impact and gravity of such losses is also skewed. Black women with early pregnancy loss are significantly more likely to develop major depression than non-Black women, even when accounting for baseline rates of depression.
Experiencing a miscarriage or stillbirth pregnancy has economic implications for both individuals and communities at large. Evaluation of such costs has mostly focused on the medical costs of needed aftercare (eg, surgical interventions such as dilatation and curettage).
Surprisingly, the economic impact of psychological morbidity is less well-studied, but the loss of productivity and personal income from missed days of work is a frequent and significant non-health care cost.
Some may assert that women forced to carry a pregnancy they wished to terminate may experience less emotional distress when a subsequent loss occurs. As a consulting psychiatrist for 17 years in a large academic medical center in Chicago, I have witnessed the same in some patients, including survivors of sexual assault that results in an unwanted pregnancy.
But this argument is overly reductionist and discounts the fact that any loss invariably carries a strong emotional signature and toll on the mother, regardless of pretext. Shame and guilt are common and trauma-informed care requires an affirming empathic presence.
Depriving women of the choice of whether to carry a pregnancy has significant mental health consequences for women in America. Beyond the emotional distress that comes with the loss of bodily autonomy to proceed with a pregnancy or end it, the frequency of miscarriage and stillbirths in the United States will increase, since some pregnancies that might otherwise have been terminated will result in fetal demise.
Overturning Roe exposes a larger proportion of American women to the negative repercussions and mental health consequences of these adverse pregnancy outcomes, with the most deleterious and harmful impact on women of color who already live with inequity on a daily basis in a system imbued with structural racism.
