The ‘Open Secret’ on Getting a Safe Abortion Before Roe v. Wade

However ambivalent or decisive they felt, psychiatrists engaged in a formalized, sometimes cynical, ritual to provide women with safe care. Dr. Alan F. Guttmacher, a former president of Planned Parenthood, wrote that more than 85 percent of the abortions performed at Mt. Sinai Hospital in the mid-fifties (when he chaired the OB-GYN department) “at least bent the law, if they did not fracture it.”

In the year before the Roe decision, maternal mental health was the most common indication for a hospital abortion, accounting for more than 85 percent of all cases in the 12 states that reported the stated reason for abortion, according to the government’s abortion surveillance annual summary.

The Roe decision rescued psychiatry from these quandaries. It spared a woman the demeaning ordeal of lying about her mental health and the prospect of being branded “manipulative and malingering” should her deception fail or if she was interviewed by an unsympathetic or a conflicted doctor.

Today, as the nation appears to be moving toward a post-Roe world, we do not fully know what kind of patchwork of restrictions will be applied in different states. The governor of Oklahoma, Kevin Stitt, has already signed a bill whose wording seems emphatically designed to remove psychiatry from the picture. The state’s new ban on abortion excepts a life-threatening “medical emergency” arising from a “physical disorder, physical illness, or physical injury, including a life-endangering physical condition caused by or arising from pregnancy itself.”

Presumably, some states will have a mental health exception to their abortion statutes, but there is only a spotty network of psychiatrists to meet potential need. According to a 2015 estimate based on data from the Bureau of Labor Statistics, there are 76 percent more psychologists or psychiatrists per capita in blue states than in red states. Roughly 60 percent of counties in the United States — including 80 percent of rural counties — do not have a single psychiatrist practicing there, based on a 2017 report. Most of us are in the Northeast and some counties along the West Coast.

Telepsychiatry and licensing reciprocity laws could allow out-of-state psychiatrists to conduct assessments and thus compensate for their skewed national distribution. This, too, will depend on the restrictiveness of the state in which the woman lives, especially if criminal liability is extended to those advising women or coordinating with the physician who would terminate the pregnancy.

I live in Washington, D.C., which will surely take a liberal approach. But if called upon to evaluate a woman seeking an abortion, I would apply an expansive definition of mental health. Where state law limited its definition of “mental health,” I would follow the law.

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