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America without Roe: More mental health concerns and a rise in abortion pills

People who are denied abortions are more likely to report mental health issues, like anxiety and depression, one study found.
Amanda Furdge
Amanda Furdge, a mother of three boys, at her home in Mississippi.Ariel Cobbert for NBC News

In 2014, Amanda Furdge, then a single parent of a toddler son, was an unemployed college student who had recently moved home to Mississippi to escape an abusive relationship.

She couldn’t afford to take care of another child, she said, so when she began experiencing pregnancy symptoms, she made plans to have an abortion.

“I was already feeling the financial pressure of raising one,” Furdge, 34, said. “At this point, it wasn’t fair to my kid.”

But by the time she was able to secure an appointment at an abortion clinic in Jackson, she was told she was too far along for an abortion in Mississippi. 

She was forced to carry her pregnancy to term and experienced depression and anxiety as a result, she said.

Amanda Furdge
Amanda Furdge says she is still living paycheck to paycheck. Ariel Cobbert for NBC News

Abortion advocates warn that Furdge’s experience could soon become more common. The leak this month of a Supreme Court draft opinion indicating that Roe v. Wade would be overturned has spurred many questions about the future of abortion rights in the U.S. 

If the landmark decision is overturned, 26 states are certain or likely to ban abortion, making it largely inaccessible in about half of the U.S., according to the Guttmacher Institute, a research organization that studies reproductive health rights.

In that future, people who can afford to do so will have to cross state lines to get abortions. But not everyone will be able to travel out of state, and many will be forced to carry pregnancies to term, like Furdge, or attempt self-managed abortions in various ways. Such situations could lead to mental, financial and physical health consequences, experts said. However, the major difference from the time before Roe v. Wade is medication abortion, which typically involves a combination of two pills. 

“Before Roe, illegal abortion was very dangerous,” said Carole Joffe, a professor in the Advancing New Standards in Reproductive Health program at the University of California, San Francisco. “Illegal abortion will be much safer with the use of pills. If you have a computer and an email, you can get them.”   

Abortion denial linked to economic hardships and health consequences

People who are denied abortions are more likely to report mental health issues, such as anxiety, depression and low self-esteem, in the months afterward, according to an analysis of data from the Turnaway Study, a nationwide project that examined the long-term effects of either having an abortion or being turned away.

Furdge said she experienced depression and anxiety after she was turned away. She also struggled to make ends meet.

“I was already living below the poverty level. The only way we were able to survive was sleeping on my parents’ pull-out couch and getting financial assistance from the state of Mississippi, which was nothing but barely enough,” said Furdge, who is still living paycheck to paycheck.  

Those who are denied abortions had almost four times greater odds of being below the federal poverty level, according to the Turnaway Study. Meanwhile, people who carried unwanted pregnancies to term experienced a 78 percent spike in debt that was a month or more past due after the time of birth and an 81 percent increase in reports of bankruptcies, evictions and tax liens compared to others who had access to abortion care. 

“When people can’t access abortion services, they face long-term economic harm. It’s not just the women who are affected. It’s their existing kids and the child born because the mom was denied an abortion,” said the lead researcher of the Turnaway Study, Diana Greene Foster, a professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco.

Increase in self-managed medication abortions likely

Meanwhile, with abortion harder to access in some states, pregnant people may seek out abortion pills from unregulated markets online or community members or by word of mouth. 

“We know that in areas where abortion is restricted, people choose to self-manage [with medication abortion]. As restrictions increase, we will see an uptick in folks choosing that,” said Dr. Stephanie Rand, an OB-GYN in New York and a fellow with Physicians for Reproductive Health. 

Still, people may have difficulty accessing pills without medical providers, or they don’t want to use medication to terminate their pregnancies. As a result, people are still likely to turn to unsafe methods, Rand said. 

Daily requests for abortion pills sent by mail spiked by nearly 1,200 percent in the first week after Texas’ six-week ban took effect in September. Over the next three months, Aid Access, which provides abortion medication by mail, got 29.5 requests a day, compared to 10.8 before the law took effect. 

When Emma, 29, found out she was pregnant in February, she was “surprised,” because she was actively taking birth control and another medication that could cause fetal anomalies. 

“I immediately knew that I didn’t want to proceed with the pregnancy,” said Emma, who lives in South Texas and asked to be identified by only her first name to protect her privacy.

Emma at her home in San Antonio.
Emma at her home in South Texas.Josie Norris for NBC News

However, she was too far along in her pregnancy to get an abortion at a clinic nearby because of Texas’ restrictive law, which bans abortion once cardiac activity is detected, usually around six weeks — before most people know they are pregnant.

“It was extremely frustrating to know that had this been occurring six months prior, I would have had access to care here locally,” said Emma, who was referred to a clinic eight hours away in New Mexico.  

Instead, she decided to self-manage her abortion with medication obtained from a friend in an abortion activist community who regularly buys the pills in Mexico, Emma said.  

A woman who self-managed her abortion holds a packet of misoprostol.
Emma holds a packet of misoprostol.Josie Norris for NBC News

After that attempt — using one medication, misoprostol — failed, Emma asked her friend again for abortion pills. Two weeks later, she successfully terminated her pregnancy using a combination of mifepristone and misoprostol, which has a higher efficacy rate than misoprostol alone.

“I was less concerned about how this medication was impacting my body and more concerned about my body being criminalized,” she said. 

According to a study published this year, about 1 percent of people who self-managed medication abortions reported treatment for serious adverse effects, and no deaths were recorded.

Emma added: “We are at the forefront of a post-Roe society. I have already lived and experienced it, and so many more folks could be impacted.”