Postpartum Challenges, Especially if Pregnancies Are Forced

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By Michelle M. Robbins, Ph.D. and Katie Hale, Ph.D., on behalf of the Atlanta Behavioral Health Advocates

How many times have we seen the peaceful image of an adoring mother gently holding her newborn baby? You know, the unconditional love emanating from her eyes as she gazes at her sleeping infant, or the glowing pregnant woman cradling her bump in a flowing sundress. These are the images we are given of motherhood—that of the devoted woman whose very existence rests upon this all-encompassing care for her infant. For some of us, these images resonate. We remember holding our newborns and being intoxicated by their delicious fragrance, which is nature’s way of ensuring–through the release of dopamine and other reward-inducing biological processes–that we stay close to and begin to bond with our new babies. This is what we expect from new mothers, to exhibit the delight that comes from becoming a parent.

But what happens when that isn’t your experience?

Unfortunately, many of us don’t have that joyous experience when we become parents. Some of us feel distant and cut off from our identities, bodies, and offspring during and after pregnancy, even when we yearn for the idyllic infant bond. And, this distance can exacerbate or instigate a slew of mental health and related challenges that can change the course of lives for generations, particularly when the pregnancy was not wanted in the first place.

The reality is that 15-20 percent of people across the globe experience psychiatric disorders related to pregnancy and birth (Vesga-Lopez et al., 2008). Postpartum depression, or PPD, is the most well-studied and common of these disorders. Nearly one in six women develops PPD (Wang et al., 2021), which can include excessive crying, sadness, severe mood swings, unexpected changes in eating or sleeping, low energy, withdrawal from family and friends, and difficulty bonding with babies. To add insult to injury, depression after giving birth is in stark contrast to how mothers are “supposed” to feel, leaving them more isolated, sad, guilty, and full of shame. Both external and internal stigma around mental health interfere with these mothers’ likelihood of seeking help, and some studies estimate that less than 20 percent actually do (Manso-Córdoba et al., 2020).

Healthcare providers and researchers continue to learn about additional, less understood, birth-related mental health challenges like anxiety, obsessive-compulsive disorder (OCD), and posttraumatic stress (Ali, 2018). These symptoms can include non-stop worry, intrusive thoughts about harm and aggression toward the baby, and fear of uncleanliness and contamination. Parents who experience this can feel imprisoned by rigid rules and avoidance. Further, it’s terrifying to disclose thoughts about harming an infant to a healthcare provider, so many parents suffer in silent shame. Parents who do find the courage to disclose these symptoms risk misdiagnosis, inappropriate care, involuntary hospitalization, and even separation from families.

Unfortunately, the longer mothers go without intervention for disorders during pregnancy or postpartum, the risk for physical, mental, and financial health problems increases. As symptoms persist and worsen, mothers tend to withdraw more from their infants and toddlers, who are less likely to develop a secure attachment, which can have long-term consequences for development throughout childhood, adolescence, and even into adulthood, when they may become parents. Without needed treatment, mothers may try to cope with drugs or alcohol. It is a sad reality that OCD is the fifth leading cause of disability for women ages 15-44 (Speisman et al., 2011), and suicide and overdose are the two most common causes of death of new mothers.

Pregnancy and the postpartum period are not only risky for the onset of psychiatric disorders, pre-existing mental health problems can be exacerbated during this time as well. Pregnancy can require significant changes in lifestyle from the jobs we have to the medications we take. Huge financial costs add to the heavy burden. Because many medications for mental illness are not classified as safe for fetuses and infants, people are often advised to stop taking them during pregnancy and nursing. Extended breaks from psychiatric medication combined with financial stress and job and lifestyle changes can lead to a mental health disaster. And, this is the reality families face during a chosen pregnancy and birth.

What happens when people are forced to complete a pregnancy they did not want?

Landmark research published in the 2020 book The Turnaway Study examined the impact of being denied the ability to terminate one’s pregnancy with 1,000+ participants over many years (Foster, 2020). The data are clear and go beyond mental health implications. Having a wanted abortion was not associated with negative mental health outcomes; however, women denied abortions experienced more anxiety, stress, and harm (physical and financial) than women who had abortions. They had more life-threatening complications during the pregnancy and more chronic medical problems afterward. They (and their children) were more likely to live in poverty, with more challenges paying for food and housing, more debt, and a lower credit score. They (and their children) were more likely to remain with a violent partner or to have no partner or family support. They were less likely to bond well with the child born of a denied abortion. When women denied abortions experience these social, physical, and financial problems, the negative consequences for that child’s development are inevitable.

We would all like to believe in the fairytale of pregnancy and new parenthood. Our greatest hope is that every baby is wanted and cherished and every mother has the resources and healthcare she needs to thrive in the peripartum period. But reality forces us to acknowledge the serious mental health consequences of pregnancy and question the ethics of forced pregnancy in the face of this reality. Not just medical emergencies threaten the lives of pregnant people. Denying women abortions can lead to life-altering consequences that burden offspring, families, and communities now and in future generations.