Summary and Resource Information Re: Post-Roe Changes & Advocacy Needs
NHPA Thanks Dr. Chris Chance for her extensive efforts in writing and researching for this content and gathering the resources below.
Please send any questions regarding Post-Roe Changes to Dr. Chris Chance at email@example.com. As additional resources regarding impact on practice, ethics, advocacy, etc. become available, they will also be posted to our community resources page.
I hope this finds you all well, safe, and finding peace within life's storms. I have attempted below to summarize concerns impacting compassionate care provision to our clients and patients, share information about APA’s initial response and predicted pending ethical dilemmas, provide a summary and links to NH state advocacy opportunities and concerns, and provide links/annotated bibliography to additional reading and resources on the topic of abortion access history, rights, and related psychological research. I offer this document to supplement information NHPA leadership is already providing so diligently in this time of a significant change in federal law.
There has been a shift in constitutional interpretation, and we as Psychologists will soon hear more stories of trauma many of us have heard before, as memories set prior to 1973. History has already shown us that laws restricting abortion do not prevent unwanted pregnancy, but do create a situation pushing more already marginalized people into dangerous illegal abortion settings, risking death and other serious physical and mental health consequences, or being turned away from help and forced to give birth to an unintended child.
I started this effort in a state of resonant helplessness, trying to figure out how to do my part to protect traumatized women who will be too afraid to speak up for their civil rights in the current climate. With the input of NHPA leadership, it has evolved into a big research paper. Some statements are research-based, and some represent my interpretation as I have tried to thoughtfully integrate my recent reading with my expertise in trauma treatment, my formal education, and a few decades of life experience. I apologize in advance if any of the sentences to follow cause anyone distress. I offer this document in the spirit of collaboration and deep respect for our rights to have differing opinions in matters of spiritual belief and personal religious practice.
The APA has issued a statement in initial response to the SCOTUS decision:
APA decries SCOTUS decision on abortion: Restrictions on access to reproductive care will worsen mental health
WASHINGTON — The American Psychological Association expressed deep concern and profound disappointment in response to the U.S. Supreme Court’s decision eliminating the constitutional right to abortion.
“This ruling ignores not only precedent but science, and will exacerbate the mental health crisis America is already experiencing,” said APA President Frank C. Worrell, PhD. “We are alarmed that the justices would nullify Roe despite decades of scientific research demonstrating that people who are denied abortions are more likely to experience higher levels of anxiety, lower life satisfaction and lower self-esteem compared with those who are able to obtain abortions.
“A person’s ability to control when and if they have a child is frequently linked to their socioeconomic standing and earning power. Therefore, restricting access to safe, legal abortions is most likely to affect those living in poverty, people of color, and sexual and gender identity minorities, as well as those who live in rural or medically underserved areas.”
Pushing decisions regarding the legality of abortion to the states guarantees that an untold number of people will no longer be able to access the procedure, he said. “And the fact that at least 13 states have ‘trigger laws’ automatically implementing abortion restrictions puts people in immediate jeopardy,” Worrell said.
Research also suggests that adding barriers to accessing abortion services may increase symptoms of stress, anxiety and depression, according to Worrell.
“The number of unsafe abortions is likely to increase as a result of this decision,” Worrell said.
Research also demonstrates a strong relationship between unwanted pregnancy and interpersonal violence. Specifically, psychological science suggests that the inability to obtain an abortion increases the risk for domestic abuse among those who are forced to stay in contact with violent partners, putting them and their children at risk.
Finally, Worrell noted that by eliminating the constitutional right to privacy, the Supreme Court is opening the door to curtailing other rights, including the right to obtain contraception legally and same-sex marriage—both of which APA supports based on the scientific research showing their denial can have negative mental health impacts.
APA has long been a strong and consistent voice for equal access to reproductive health services. The association has passed four policies or resolutions since 1969 affirming a woman’s right to choose and negating assertions regarding the alleged adverse psychological effects of abortion. APA has also filed 11 amicus curiae briefs in cases involving abortion. The most recent policy (PDF, 72KB) was passed in February 2022.
For more information regarding APA’s advocacy and the science surrounding abortion and reproductive health, visit the abortion and mental health webpage.
(Above from https://www.apa.org/news/press/releases/2022/06/scotus-abortion-decision)
Many professional helpers believe in equal rights and the moral imperative of listening to and strengthening the voice of those suffering most from societal inequities. NHPA leaders have appropriately embraced a focus on education in the area of anti-racism/racial equity studies in recent years. Many of us are painfully aware of the connected systemic context we find ourselves in, where the preferences of a privileged minority have achieved the power to dictate the lives of the less privileged. It seems an important moment in history to compile resources to help us as Psychologists get our minds around the scope and relevance of the recent SCOTUS decision to overturn Roe v Wade, handing over abortion rights decisions to state governments.
For decades organizations like the National Abortion Rights Action League (NARAL), National Organization for Women (NOW), and Planned Parenthood have made an effort to provide education about the slippery slope that we have been on where extremist conservative factions might act to sabotage progress toward social equity concerning reproductive and family planning rights. The even larger ethical concern is about bodily autonomy for all, including groups who have fought for more equal rights and finally gained significant ground in recent years (e.g., LGBTG+). The recent supreme court ruling has led to a situation that has predictably dire consequences for many, especially lower SES and BIPOC people with reproductive capacity.
APA leadership facilitated the first (of at least 2) town hall type ZOOM meetings on June 30 to explore the legal and regulatory implications of the SCOTUS decision aftermath, now creating differing contexts in each state with implications for re-tooling various practice processes. Dr. James Bomersbach, Legislative Chair and Dr. Julie Wolter, BHAC Chair at NHPA were tracking this and provided the list serve registration link- please keep an eye out for the next registration link! And thank you again to NHPA leadership for all your help and guidance already! To track current legal realities on the state level we can go to guttmacher.org. This may be especially important for practitioners already enrolled with PsyPact and providing telehealth services in multiple states. Although in many situations privacy laws may protect us to conduct therapeutic conversations as we have before, our ethics may be in direct conflict with state law in various states. For example, in Texas and Oklahoma, “bounty hunter laws” are now in place that provide financial incentives for any citizen to out a practitioner who may have in any way “aided and abetted” the now crime of abortion. According to APA legal consultants, the legal logic in some states (e.g., Texas, Oklahoma) is now defining abortion as murder or child abuse, and our own ethics code regarding mandated reporting will be used to criminalize our actions in counseling peripherally on the topic of abortion choice. So, some psychologists are now mandated reporters of any women seeking abortion. The possible implications/distorted application of Tarasoff/duty to warn guidelines are of concern as we move forward. Psychologists working in health settings in now highly-restrictive states are already seeing problems with oncology patients receiving chemo, as it may cause risk to the embryo or fetus. On the other side of the spectrum, states like Massachusetts are very proactively protecting women seeking abortion services, offering haven for women from other states, and striving to legally protect all practitioners associated with abortion-related counseling.
Psychologists’ ethics code stipulates that if there is conflict between law and our understanding of the ethics code, we may choose ethics. The basic risk management approach (boundaries, consultation, documentation, think about doing no harm) was reviewed by APA ZOOM facilitators as still our best approach, but many clinicians spoke of cautious self-protective measures such as referring a woman to a website where she can read about all aspects of reproductive health including abortion vs saying the word abortion during a session. (Note parallel to dilemma of history teachers in NH now trying to teach history while avoiding teaching “critical race theory” per state law). At this point, there is no clear protection of a state license if a psychologist commits a now felony in a state like Texas in the interest of civil disobedience necessary for compassionate care, goes to jail, and then returns to society hoping to work again. Bodily autonomy of a woman was discussed as something many psychologists consider a basic human right, but this has now legally become an ethical interpretation in conflict with state law in some states. There is a lack of clarity whether state law will always take priority over federal HIPAA guidelines in a case involving abortion-related counseling. Legal consultants remind us to hold sensitive records unless we are forced to release per court order. The question of whether suicidality will be legally viewed as creating an exception given risk of death of mother if requested abortion is denied is unclear. Apparently, we will not know how this plays out until a test case emerges, after someone (or many people) denied an abortion in a restrictive state dies.
The complexity of the current situation is further intensified by continuing political divisiveness in the country. Most of us are concerned about bringing people together for more calm, compassionate, civil discussion versus contributing to volleying hate speech based on fear and blaming. Engagement in debate about what constitutes a human seems a political lightning rod area versus a matter of calm spiritual contemplation. It is predictably difficult to navigate being a thought leader advocating for human rights in the current reactive political climate, fraught with conspiracy theories and misinformation.
As practicing psychologists, we respect the personal religious beliefs and cultural backgrounds of each individual, and also deeply respect and understand the importance of bodily autonomy for a sense of empowerment and good mental health. The hope is society can evolve in the direction of more respect for bodily autonomy versus the direction of an empowered rape culture with a privileged minority of extremists taking control of the bodies of those in a more vulnerable societal position. It is arguable that the latter constitutes a pro-enslavement mentality completely contrary to the ethics of compassionate care.
So, what about the state of NH specifically?
On maps linked to NARAL and Planned Parenthood sites showing which states have severe restrictions against abortion rights, and which states have legislation actively protecting abortion access, NH falls in the middle currently - no solid protections but no active legal restrictions before 24 weeks of gestation.
Given the politicizing of this issue and recent trends during the tenure of NH’s current Governor, some concerning trends are apparent. As detailed below per NH ACLU website, Gov. Shaheen (D) had repealed pre-Row anti-abortion laws, protecting NH women from what some states are now experiencing with “triggered” restrictive state law. However, in 2011, NH passed a new abortion-related restriction law, requiring parental notification for minors (directly in contrast to Planned Parenthood’s ethical position). In 2021 Gov. Chris Sununu (R) signed HB2 into law, which included a ban on abortion after 24 weeks with no exceptions for rape, incest, or fatal fetal diagnosis, and mandating ultrasound for all women seeking abortion regardless of medical necessity. (Per ACLU site information, see link later in doc).
Let’s pause a moment and consider what those of us who have worked with rape and incest survivors know about shame and dissociation. The worst-case scenarios that could play out if women who are victims of heinous violence are then also shamed by the legal system are predictable (as confirmed by prior longitudinal research, such as the Turnaway study sited later in this doc). More women will be stuck living with their abusers, and more children born into violent households, perpetuating generational cycles of abuse, poverty, and despair. Some will turn to substances and further lose control of their lives through addiction. Some will decide suicide is the only tolerable option.
Spring of 2022 efforts to “enshrine” abortion rights before the 24th week were attempted and rejected by the NH House and Senate. In May of 2022, Gov. Sununu added one critical exception to the prior restrictive law for fatal fetal diagnosis, and repealed the ultrasound mandate.
The current state law in NH is not adequate to protect women from being criminalized for making tough decisions after surviving rape and incest. The legislative trends are deeply concerning. They could become even more restrictive, as in Texas where myriad aspects of women’s health care are now compromised by intrusive laws. Where restrictions exist at the state level, some will be able to afford to seek help in neighboring states, but some will be restricted by barriers including inadequate health coverage.
Sadly, the public misinformation and shaming campaign is very active here in NH, according to the ACLU. For example, there are about 20 clinic and mobile vans posing as real health centers that call themselves Crisis Pregnancy Centers or PCPs. They spread propaganda, shame pregnant women and do not provide actual facts about the full range of health care and sexual health options, pressuring women against considering abortion.
The current context is complex. What seems clear is that more voices and actions are needed to hope to maintain existing state rights. Please continue reading to be better informed if more information would be helpful to you, and go to the ACLU website to send an email now to advocate for expanded access and civil rights for all, educate yourself about all the factors of concern, and please give to the reputable state organizations identified by the ACLU to support their organized advocacy efforts.
Below are links to APA’s most recent educational newsletter on this topic, links to research study details, a link to the American Civil Liberties union (ACLU) suggested action steps to preserve and reclaim rights for all, links to take immediate action at the state level in NH, and additional information about recent legislation in NH that has followed the political shift toward restriction of reproductive rights and the current state of reproductive care access.
We are in a time of many challenges. It is my hope that some of the core shared elements of stories we have held in compassion over the years will become a larger part of a necessary civil discourse as we move forward. We as psychologists possess a productive way to educate state leaders about the myriad negative consequences of not allowing people bodily autonomy. History and research should inform us of how problematic this direction surely is.
Chris Chance, Ph.D.
Licensed Clinical Psychologist
Research,Thought, and Advocacy Resources re: Abortion Rights
(In response to 6/22 revocation of women’s choice rights by SCOTUS)
APA News Link:
Zara Abrams summarizes multiple studies debunking myths about abortion being more traumatic than being turned away from getting an abortion when requested. The negative mental health consequences and profound economic disempowerment are clear in the data.The article offers a list of “Credible Healthcare Providers,” Emotional Support access assistance organizations, and financial support options for those seeking abortion services.
More Detail on the “Turnaway study”
UCSF’s 10 year longitudinal “Turnaway study”- followed about 1,000 women over 10 years, who had presented at over 20 clinics all over the US, some had abortions and some turned away due to timing restrictions. Specific findings include turned away women 4x more likely to land living below the fed poverty level, more likely to stay tethered to an abusive partner, increased anxiety, lowered self-esteem, decreased life satisfaction, increased physical health problems. Negative consequences for pre-existing children, and attachment bonding concerns for the children born to turnedaway mothers were also noted. 95% of women who had received an abortion felt doing so had been the right choice, and did not regret their decision.
Quote pointing out slavery parallel and connected historic context:
(Thank you, Sue Kim, for sharing this!)
“We have barely emerged from a week of commemoration of emancipation in which the legacy of coerced pregnancy that was the foundation of enslavement and the source of the profits in the slave trade has yet to be addressed. The consequence of our society’s failure to see coerced pregnancy as a legacy of enslavement has descended once again upon Black women and all pregnant people with lethal force. Had the project of liberation from enslavement been rooted in this recognition, then coerced childbirth would have been prohibited as a foundational principle of freedom. The incompleteness of our conceptions of liberty thus harken back to the unspeakable past and stretch forward into this painful moment, proving once again that the intersections of patriarchy, racism, and heteronormativity will continue to undermine the freedoms that we all take for granted unless we learn how to address them simultaneously. Our response must not be siloed to a problem that is historically and continuously interconnected."
Kimberlé Crenshaw, African American Policy Forum (AAPF) Executive Director
Documentary Film of past US illegal abortion era pre- Roe v Wade (1973):
The Janes, HBO documentary interviewing activist women who facilitated safe illegal abortions for the public in the 1960’s until 1973 in Chicago, circulating posters around the city to reach those in need instructing to call and “ask for Jane” for compassionate help. They sought to help women work around traumatizing and sometimes lethal other illegal abortion options run by disputable organizations like the mob. Many of the Jane’s had experienced traumatic illegal abortions personally, and risked incarceration to give others a kinder experience. A helpful resource for younger clinicians who may not have heard direct stories of women’s experiences pre-1973.
ACLU resource website with advocacy action links specific to NH:
(Text below quoted straight from the website for your convenience - I don’t know how to summarize better than they already have)
The ACLU strongly suggests to take 3 actions ASAP:
Reproductive Freedom Fund of New Hampshire - supporting our community, especially those most marginalized, in the form of providing financial support for abortion services.
Joan G. Lovering Health Center - non-profit reproductive and sexual health center serving NH/MA/ME providing abortion care, GYN services, low-cost contraception, STD/HIV testing and transcare.
Equality Health Center - non-profit healthcare facility serving all genders and sexualities throughout New England - New Hampshire’s longest standing abortion provider.
Planned Parenthood of Northern New England - PPNNE is the largest sexual and reproductive health care provider in northern New England with 20 health centers across Maine, New Hampshire, and Vermont.
The 3-pronged road map:
Pathways suggested to protect rights from here and a brief hx of Legislation in NH:
On Friday, June 24, 2022, the U.S. Supreme Court overturned Roe v. Wade, the landmark Supreme Court case that enshrined federal constitutional abortion protections. Now that the Court has released its final decision, more than half of the states in the country will severely restrict or outright ban abortion – impacting millions of people from accessing care in their home state.
In New Hampshire, abortion remains safe and legal up until 24 weeks. But we still have work to do to protect and expand access to the full range of sexual and reproductive health care throughout the state.
Outlined below are short-and long-term recommendations for New Hampshire in a post-Roe environment. With its proud, bipartisan history of supporting reproductive rights – yet in the shadow of a newly-enacted abortion ban – New Hampshire must commit to, and take proactive steps toward, protecting and expanding access to the full range of sexual and reproductive health care, including abortion. For each policy initiative we work toward, we must center those voices who are most impacted and those with lived abortion experiences
Policy Roadmap: Ensure Access to Abortion in New Hampshire
Funding Roadmap: Strengthen New Hampshire’s Public Health Care Ecosystem
Public Affairs Roadmap: Increase Education and Address Misinformation and Disinformation
With input from: Planned Parenthood NH Action Fund/PPNNE; ACLU-NH; NH Women’s Foundation; Joan G. Lovering Health Center; Equality Health Center; Granite State Progress; Reproductive Freedom Fund of New Hampshire
Abortion Access in New Hampshire Since 1991 - A Brief Timeline