Tag Archives: mental health

Able of Mind and Body: Why Reproductive Justice Needs to Address Mental Health in Pregnancy

11 Sep

“An estimated 500,000 pregnancies in the United States each year involve women who have or who will develop psychiatric illness during the pregnancy.”

Think about that. Half a million women each year.

We know about 1 in 4 Americans suffer from mental disorders, 15-20% of American women suffer from depressive symptoms DURING pregnancy, and that depression during pregnancy is a global issue. Clearly, psychiatric disorders during pregnancy are common, and in my experience are not acknowledged nearly often enough.

Depression is a symptom of pregnancy seen all over the globe, and most moms do just fine. Is it fun? No, but that’s why it’s called depression. It is the opposite of fun. Does that preclude you from carrying a pregnancy to term? No. Can we connect the dots to say that if women who experience temporary mental illness shouldn’t be stopped than women who experience semi-permanent mental illness shouldn’t be impeded from carrying to term? Yes, yes we can. [President Obama gets a shout out after all the women’s health love at the DNC. Though I’m pretty sure he would still be afraid to have one of us AGers go up on stage.]

“Mental competence” in pregnancy is surely often an excuse stemming from socially unjust motivations to prevent a pregnancy from going to term. Its more socially acceptable for some people to be a parent than others. Poor people, shouldn’t parent. Rich people, should parent. Some folks have too few kids, others too many. Women contending with mental illness shouldn’t. Not because they are inherently incapable, but because they are disenfranchised. These cases are not about mental capabilities, but about privilege. Social injustice is the determining factor here. This is just another realm where we see the same patterns replicated, only with different excuses.

What is perhaps most strange to me, is that there is a cultural dialogue about postpartum depression, see: Gwyneth Paltrow’s confession, but almost no external discussion of depression during pregnancy. We are all so beholden to the image of the glowing orb of sunshine pregnant person, there is no space for an alternative leaving women without models and information. We need to create this space, and we need to make sure to discuss mental health at-large.

The two major stories I’ve seen make their way through the reproductive health circuits (which does not mean there are not more) are one of a young schizophrenic woman was who ruled mentally incompetent, and her parents forced her to have an abortion and be sterilized against her will. The ruling was made on the basis that if the young woman, Mary Moe, were “mentally competent” she would have sought an abortion. The other is thankfully slightly more uplifting. Here a woman pro-actively chooses to stop taking her mental health medication to pursue a pregnancy to term and paid a full-time babysitter to keep her from hurting herself. We need to hear more of these stories, or really the half a million women grappling with mental illness (in a wide range of forms), each year during pregnancy need to hear these stories. They need to know they are not alone. That there are women in situations more difficult than themselves, and women who have made conscious choices after considering their options (and that this is something they can be empowered to do too). We especially need models for dealing with depression during pregnancy, which is the most common illness faced.

Now we got that out of the way, what about the women who decide to continue using medications for mental disorder during their pregnancy? Though the scientific evidence is still limited, the results are tentatively promising, but women still need to be educated about the risks of drugs on themselves and the fetus, and enabled to make decisions for themselves. But there is a clear need for more research, especially studies longer periods of over time. In the interim, if you decide not to go off your medication, you are not without alternatives to care. However, many women are faced with slightly more complicated medical circumstances and often run from doctors who either says your only choices are to go off/not start medication or have an abortion, which happens. It is very common for women with mental illness to be untreated because they are pregnant, not just untreated with medication, but unable to get a spot at a psychiatric hospital. So everything I said about alternative care is true, to the point you can actually access it. Which without access, it all goes out with the baby and the bath water and we are left back where we began with disenfranchisement through social injustice.

Remember the 500,000 pregnancies are affected each year, in the US. It could easily be you one day sitting across from a doctor leaving you a choice between an abortion or your necessary medication, and simply ignoring your choice to carry to term in the best way you deem fit.

South Dakota: Where We Don’t Practice Science

27 Jul

In 2005, South Dakota passed a law which at the time was the pinnacle of crazy anti-abortion laws.  It contained a wide range of provisions which ended up going back and forth in the courts for the past several years.  Ultimately, the biological disclosure and “all known medical risks” disclosure stayed on the books, but the decision on a suicide advisory remained divided in the courts.  It became its own spin-off case, and only this week did a decision come down.

Though you may have already read how the 8th circuit ruled , 7-4, with the majority in favor of keeping the suicide advisory, i.e. doctors must tell women seeking abortions that they have an increased risk of suicide if they seek an abortion, on the grounds that is not misleading and irrelevant.

Some things you should know about the case before we dive into this:

  1. The parties are two crisis pregnancy centers versus Planned Parenthood.
  2.  The “friends of the court” of the crisis pregnancy centers include: Christian Medical & Dental Associations; American Association of Pro-life Obstetricians & Gynecologists; Catholic Medical Association; Physicians for Life; National Association of Pro-Life Nurses; Family Research Council; Care Net; Heartbeat International, Incorporated; National Institute of Family and Life Advocates, Incorporated; Eagle Forum Education and Legal Defense Fund; and the American College of Pediatricians.  Yes, you read that last one right.  Who knew?
  3.  The author most cited in the majority opinion for the “evidence” of an increased risk of suicide and suicidal ideation among women who had an abortion might have her major paper on the topic retracted because it is not scientifically sound.  Said author, Coleman, is referenced 14 times by name in the majority opinion.

But what stood out to me was the bizarre argument throughout the majority opinion about relative risk, increased risk, and causation.  Anyone who has taken epidemiology 101 can parrot that correlation is not causation.  Essentially, science is all about theories and making your way as close to the “truth” as possible.  But will we ever know an absolute truth?  No, we wouldn’t.  This is 7th grade science people.  Stay with me.

The majority opinion states how the suicide disclosure cannot be misleading or irrelevant only if there is “medical and scientific uncertainty,” then goes on to say “in order to render the suicide advisory unconstitutionally misleading or irrelevant, Planned Parenthood would have to show that abortion has been ruled out, to a degree of scientifically accepted certainty, as a statistically significance causal factor in post-abortion suicides.”

So for example let’s say I have a theory that doughnuts cure cancer and I go out there and find some evidence of this and get published, but someone retorts saying this is blatantly false.  We now have medical and scientific uncertainty.  Fine.  But then according to the 8thcircuit the only reason I can’t force pediatricians to tell children to eat doughnuts is if I can show that doughnuts don’t cure cancer.   Doughnuts for everyone?

Now let’s return to 7th grade.   You can’t prove something is not a causal factor.  You can no less prove it is a causal factor.  You can be very sure one thing leads to another, e.g. smoking and cancer.  But proving that the doughnuts do not cure cancer is impossible, so it would be impossible to fulfill this alleged requirement.  Then what does the evidence tell us?

What we do know is that most scientists agree that risk of suicide does not increase with abortion.  There is some shaky evidence of a possible association between abortion and suicide due outside underlying factors, i.e. if you have poor mental health you are more likely to seek an abortion and more likely to be suicidal.   But it is a spurious relationship, it is the outside factor that connects them, the connection between the two is completely unfounded.

What is most upsetting is that the four dissenting justices even say how the majority recognizes that there is no proof in the literature that abortion causes suicide and that telling women that abortion causes an increased risk of suicide is untruthful.  They know this, they recognize it, and yet here we are.  Women across South Dakota will now be forced to listen to these lies before obtaining an abortion.   How is that not misleading and irrelevant?