Content Warning: This chapter discusses and describes suicidal ideation.
You have put me in the depths of the Pit, in the regions dark and deep.
—Psalm 88: 6
Psalm 88 is a prayer of despair and desperation. “My soul is full of troubles,” the psalmist writes. “I am like those who have no help, like those forsaken among the dead” (vv. 3–4). I feel the raw descriptions of hopelessness, of feeling forsaken and cut off from God deep in my soul. These ancient words transport me back to the moment more than a decade ago when I first received a diagnosis of clinical depression. Much like the psalmist who likens their condition to a deep, dark pit, I remember journaling about feeling like I had fallen into an inescapable hole: the more I tried to pull myself out of it, the more deeply I fell. It was more than metaphorical. Physically I felt like something or someone was pushing my body down toward the ground, leaving me too worn out to get out of bed some days. I tried everything I could think of to make myself better. I used up every internal and external resource, anything that I had turned to in the past when I was feeling down or discouraged: exercising regularly, getting enough sleep, journaling what I was feeling, and talking to supportive friends and family. Nothing I tried helped lift me out of that deep place. I knew I needed professional help.
Just like experiences of abortion, having a mental health disorder like depression is common; one in five adults in the United States experiences some form of mental health illness every year.1 More than half of all adults will receive a mental health diagnosis in their lifetime.2 Unfortunately, many people who need mental health care never access it. First, there is the barrier of cost. Those most in need of services are less likely to have health insurance.3 A single one-hour therapy session can cost anywhere from $65 to $250 and up. Paying out of pocket isn’t feasible if you’re unemployed, or underpaid, or living paycheck to paycheck. At the time of my diagnosis, I was working full time as an independent contractor and was ineligible for benefits, including health insurance coverage. I identified a therapist who offered fees on a sliding scale based on income, which I could afford out of pocket. Otherwise, I’m not sure how I would have gotten the care I needed.
Economic injustice is a significant barrier, but it’s not the only obstacle. Similar to the stigma of abortion, there is a widespread stigma associated with having a mental health issue. This discourages people from seeking help or even recognizing that they have a disorder at all. Mistrust in the mental health care system also plays a role. The roots of the field are steeped in anti-Black ideology, and that deeply embedded racism continues to shape the field today. Black individuals with mental health disorders are more likely to be misdiagnosed, undiagnosed, underdiagnosed, or incarcerated for their condition.4 The fields of psychology, social work, and psychiatry are overwhelmingly white. Less than 5 percent of all professionals in these roles are women of color.5
These multiple and intersecting obstacles to mental health care prevent far too many people from getting the services they need. The same types of barriers exist for most people who seek abortion care. Our lived experiences with mental illness and disorders, much like our experiences of abortion, often remain shameful secrets. The hiddenness of these lived realities often stands in the way of the healing process. When I asked interviewees about what has helped them find healing after their abortions, the most common response was therapy. The stories I share in this chapter will reveal how access to abortion and access to mental health care are intertwined.
Before turning to these stories, though, we need to be mindful of one of the central (and false) premises of the antiabortion movement: that terminating a pregnancy causes long-term emotional trauma and distress. This is a flat-out lie. Let me reiterate once again that no scientific study has ever confirmed that abortion causes any long-term mental health issues—not in the immediate aftermath of an abortion or in the years after one.
But the pro-life insistence on this correlation between abortion and mental health prompted me to ask a more pressing question: Are there mental health risks in not having an abortion when one is needed?
Given my own experience of depression and anxiety during and after pregnancy, as well as what I heard during the interviews for this book, I wanted to know if there were mental health risks for those who want to end a pregnancy but who, for whatever reason, are unable to obtain abortion care. I turned to one of the most comprehensive studies on the short-term and long-term impacts of abortion care, the Turnaway Study, to shed some light on this question. Directed by Dr. Diana Greene Foster and managed by a team of scientists across multiple disciplines, the Turnaway Study followed one thousand women, who either had received abortion care or were denied it, over a period of ten years. Dr. Foster, a professor of reproductive sciences at the University of California and director of research at Advancing New Standards in Reproductive Health (ANSIRH), tests the assertion that abortion hurts those who have them. The data from the study soundly refute the claim that abortion leads to increased rates of mental health disorders. What the study does show, however, is that being denied an abortion leads to increased rates of anxiety and stress and lowered rates of life satisfaction and self-worth. Dr. Foster concludes, “To the extent that abortion causes mental health harm, the harm comes from the denial of services, not the provision.”6
In reading the Turnaway Study, another question emerged for me. Postpartum depression affects about one in eight individuals postbirth,7 but what about depression during pregnancy? Was the state of pregnancy itself a risk factor for new or recurrent mental health issues? Studies on antenatal, or before birth, depression and anxiety have estimated that anywhere between 7 percent and 20 percent of pregnant people experience these conditions at some point. While rates of mental health issues among those who are pregnant are similar to those who are not, pregnant people who have a history of abuse, lack a supportive partner and/or social support, experience other stressful life events, or are having an unintended pregnancy are at an increased risk for mental health disorders while pregnant—and those who have experienced mental illness previously are especially vulnerable to recurrences and/or intensification of these conditions during pregnancy.8 One storyteller, who has bipolar disorder and whose story I will share in another chapter, brought this home for me: “Before I even knew I was pregnant, I was hit with a wave of depression where I couldn’t get out of bed for three days. Pregnancy was not livable for me. When you have bipolar disorder, pregnancy hormones work against your medication. If I had continued the pregnancy, I would have had to go off of my mood stabilizers. If someone had taken those from me, I would’ve died. I would not have lived to give birth.” For Heidi and Jeana, whose stories are included in this chapter, the experience of having an abortion was not the cause of their mental health issues. In Heidi’s case, it was the pregnancy as well as the circumstances surrounding it that triggered preexisting conditions and exacerbated her struggles. For Jeana, having a therapist helped her work through the layers of feelings she had about her life at the time, including her abortion experience. Access to both mental health care and abortion care was essential to their overall well-being—in particular, their mental and spiritual wellness. While their experiences vary in degree of severity, they both speak to the necessity of having access to a full range of health care services in order to heal from loss and trauma and experience wholeness in their lives.
“It can be the right decision even when it hurts.”
What started for Heidi as a wanted and planned pregnancy suddenly became a living nightmare. It was the end of 2013, and she was only a few weeks pregnant when she experienced a rapid, frightening decline in her physical and mental health. She described her state of mind at the time like this: “Every day I woke up and the first thought in my head was about how I was going to kill myself that day.” I had heard others talk about severe depression during pregnancy, but Heidi was the first to describe the gravity of her illness in such frank terms. From our conversation, I could tell how much she loves being a mother to her two children and how much she wanted a third child. She still does today. But she knew that she would not survive nine months of constant suicidal thoughts. “I had to save myself,” she said.
She shared about her previous pregnancies and the trauma surrounding them. When Heidi was twenty-seven, she was in a committed relationship with a man whom she loved and planned to marry when she discovered that she was pregnant. They were both happy and excited about starting a family together. Heidi’s partner suffered from severe bipolar disorder, and while he had been forthcoming about his condition, Heidi had yet to witness the extent of his mental illness. During her first trimester, he had a violent psychotic episode after abruptly stopping his mood-stabilizing medication. Shocked and traumatized by what she had witnessed, Heidi fled to a women’s shelter.
In the aftermath of that trauma, she questioned if continuing her pregnancy was the right thing to do. Could she ever recover from what happened and stay in a romantic relationship with this person? What would it mean to parent a child while caring for someone with a severe and at times volatile mental illness? As she considered what to do, she spoke with her circle of trusted friends, many of whom told her about abortions they had in the past. One of them said to her, “Heidi, you could end this pregnancy, but I could also see you being an amazing parent regardless of what happens to your relationship.” Heidi did schedule an appointment to have an abortion, but in the end, she never went in for the procedure. She decided to continue her pregnancy, even if that meant she would be parenting alone.
Later that year, Heidi gave birth to a healthy baby boy and later married her partner. From the outside, they looked like a happy family, but Heidi was the one holding their life together. She was a full-time caretaker of both her child and her mentally ill husband, all while she single-handedly struggled to earn enough money to support them.
Despite her enormous caretaking load and lack of support at home, Heidi sought all of the resources that she could to care for her own mental health. Throughout her adult life, she had suffered from bouts of depression. Over the years, she worked closely with therapists, sticking with treatment even when she struggled to see the benefit, and took antidepressants. Because of these experiences, she told me, “I thought I had mastered my depression. I thought I knew what to look out for. I thought I knew the warning signs.” But after the life-threatening labor and delivery of their second child, which lasted more than three days and ended in an emergency C-section, Heidi was beyond depleted. Soon after the birth of her daughter, she rapidly fell into a postpartum depression so severe that she spent over a month in the hospital receiving psychiatric treatment.
In 2010, Heidi ended the marriage with her children’s father. She knew that this would impact her kids’ relationship with him, but she wanted and deserved more: a real partnership rooted in mutuality. A year after her separation, Heidi found herself in another toxic relationship, this time with an abusive, controlling man. “I felt like I was under some kind of spell,” Heidi said. “I knew that the relationship was toxic and I wasn’t supposed to be in it, but at the same time I was also in the relationship.” She couldn’t see a way out.
Two years into their relationship, Heidi and this new partner decided that they wanted to have a child together. After experiencing a miscarriage, Heidi conceived a second time. Quickly she realized that there was something different about this pregnancy—and not in a good way. Within a few weeks, she was feeling so fatigued and depressed that she could not get out of bed. “I couldn’t get my bearings,” she said. “I was in a fog.” Her partner didn’t show her any sympathy; he berated her for being tired all of the time and not going to work.
Heidi knew that she needed professional help, but she couldn’t afford it. Her Medicaid insurance had lapsed, and there was no money to pay for therapy. She was pregnant, depressed, and in a toxic relationship—all while she continued to take care of her two children.
“I was caring for others when I needed to be cared for,” she told me. Even though she wanted another baby, she had to make a decision for her own life and for the lives of the children she already had. When he found out about her decision to end the pregnancy, Heidi’s partner became enraged. He screamed at her, “You’re killing our baby! You’re killing my baby!” The emotional abuse continued to escalate, but in spite of the threats and manipulation, Heidi was resolved in her decision to have an abortion. What she needed was help paying for it.
One of the biggest barriers to abortion care is the cost, especially for low-income people. Advocates for reproductive justice have been working for years to bring an end to the Hyde Amendment, enacted by Congress every year since 1976, which prohibits the use of federal funds for abortion services except in the cases of rape, incest, and life endangerment. This means that anyone who is insured through Medicaid or any other federally funded health program has no coverage for abortion, which directly impacts young people, poor people, communities of color, and other marginalized groups. In Heidi’s case, she had the support of her mother, who was willing and able to help come up with the $800 she needed. So many others have nowhere to turn.
Heidi’s appointment at the health center was positive and relatively uneventful, but she told me that she was surprised by how clinical it was. “There was no one there whose role was to help me heal,” she said. Sitting in the waiting room, Heidi connected with some of the other patients who were there to have abortions, most of whom were parents too. (In fact, the majority of people who get abortions are already parents.9) As she prepared to go back for her procedure, a song popped into her head: “I Will,” a Beatles song covered by Allison Krauss. I wasn’t familiar with it, so Heidi sang a few lines for me. It was beautiful in that kind of haunting yet calming way with lyrics about how love remains forever, across time and space. She told me that she hadn’t thought of the song in years and remembering it at that very moment felt like a sign of comfort that had been sent to soothe her.
A week after her abortion, Heidi went to visit a friend in Maine. She finally had some space to breathe. As the pregnancy hormones left her body, the depression started to lift, and her thoughts became clearer. “I could see that this man was not for me, and I could never have a child with him,” she said. She recalled a couple’s counseling session they once had when their therapist, a military veteran who worked with incarcerated people, said to her privately, “You need to run as fast as you can from this man. He is one of the most antisocial people I have ever seen, and he’s not going to change.” Now that the pregnancy was over, she could see the truth for what it was: he would have used their child to control and manipulate her.
Reproductive coercion is a common way that abusers attempt to control their partners, as Heidi’s had done when she shared her plan to end the pregnancy. Abortion access is critical to addressing and ending gender-based violence because those who are denied abortion care are more likely to stay in a toxic relationship.10 After her abortion, Heidi left her abuser, and her psychological health stabilized. She has not had a depressive episode since.
Even though Heidi’s abortion was more than five years ago, she shared with me that it still feels raw when she thinks about it. Now Heidi is in a loving relationship and feels ready to welcome a third child into her life. There are moments when she wonders what would have happened if she had just pushed through that pregnancy: “What if I had sacrificed more?” But when those thoughts come up, she recognizes that those are opportunities to deepen her own healing and self-compassion.
We ended our conversation with a rich discussion about the divine and our spiritual practices. She shared this amazing experience she had not long after her abortion when during a time of ritual, she had a vision of what she described as the “divine mother.” During the encounter, this presence shared with Heidi that her abortion was a “medicine you have to carry” in order to help others heal. Since that time, Heidi has become an energy healer and a shamanic practitioner. She worked with spiritual mentors and trained in Reiki, a form of therapy to move energy around the body and promote healing and pain relief. Today she offers her spiritual services to individuals and to her community through the nonprofit she cofounded called Motherful, which works to connect with and provide resources to single mothers in the Columbus area.
Heidi knows that her sacred purpose in this life is to help others heal, but before she could help anyone else, she needed to do her own work first. She commented, “Many of us come to healing work and helping others because we don’t have a sense of a separate self. It’s true that in helping others heal, we are healed. But I first had to do my own healing for things to begin to click. I came into healing work because I needed to heal myself.”
Who among us is not in need of some kind of healing? We all go through painful experiences in our lives that leave wounds and need our loving attention. Looking at these places takes courage, and releasing old thought patterns, behaviors, and relationships takes an enormous amount of courage. We are conditioned to believe that choosing ourselves is an act of selfishness when in fact it is often an act of faith—and a pathway to helping others find their healing.
“I feel very grateful for the abortion that I had. It was life-defining for me in a lot of ways. The fact that I was making a decision about my life, my body, and my future on my own, not needing permission from anyone else, was a powerful experience for me. It also set me on this life path that I would never have pursued if it weren’t for my own lived experience.”
One of the first things I noticed when Jeana and I connected over Zoom was a tattoo on the inside of her forearm. I was particularly interested because I’d just gotten my first ink, an American robin, earlier that month. After catching a glance of hers a few times, I could make out that it was some kind of bird. I’d intended to ask her about its significance, but then I got so swept up in our conversation that I forgot to bring it up. The following day, just as I sat down to write Jeana a quick thank-you email, one from her popped into my inbox:
Almost immediately after we ended our call, I realized I had more to say! I have a tattoo in the shape of the Repeal Hyde11 bird with the words “you are sacred” written inside of it. I had gone through phases of deconstructing my faith prior to my abortion, and afterward I started to seek a theology to fill the space that this deconstruction had left. I felt drawn toward theological frameworks that emphasized embodiment and life here on earth, rather than the disembodied soul and heaven. My experiences in the reproductive justice movement, as well as my personal abortion experience, have led me to see the body (particularly nonwhite, non-cis male bodies) as sacred and worth protecting.
Jeana grew up in College Station, Texas, a predominantly white and conservative evangelical community where the antiabortion campaign 40 Days for Life got its start. Jeana described the church of her childhood not as a stereotypical “fire and brimstone, Bible-thumping” kind of congregation that many people associate with evangelicalism but rather as one where the focus was on grace (“Grace was even in the name of the church,” Jeana shared). The trouble was that the messages about vulnerability, community, and grace that were preached from the pulpit didn’t line up with the community’s actual practices. They used loving language, but they didn’t implement it.
At Jeana’s church, being antiabortion was implied, not explicit. The congregation supported crisis pregnancy centers, and the strong presence of 40 Days for Life in the town was impossible to ignore. Being pro-life was just a given. Once, Jeana’s mother halfheartedly joked about having an abortion if she were to get pregnant again. “I was scandalized,” Jeana remembered, chuckling. “I was twelve years old, and I got on my soapbox to say, ‘Mom, you can’t say things like that. That’s terrible.’” I laughed as I remembered my own clueless self-righteousness at that age. By the time Jeana got to high school, her political views had changed, and she started to question and examine what she’d been taught about God and life at church.
What she didn’t question was the love and care of her church friends. As we talked more about her abortion, the loss she felt had little to do with the decision itself and much more to do with the fear of losing her community and closest relationships. “The grief I felt was knowing that [my abortion] was going to change significant relationships in my life, even if I never told them,” she said. In spite of the fact that her faith community preached about the beauty of vulnerability and the unconditional love of God, she knew that her particular abortion story would not be deemed acceptable in their sight. In order to fit into their theological framework, she said, “You have to have certain feelings about your abortion for your experience to be viewed as legitimate by the community and for your faith to be seen as authentic.” Unless she was willing to say that her abortion was wrong and that she regretted it, there wouldn’t be a place for her. Much of the healing she has done in the aftermath of her abortion has to do with reconciling her relationship with the church, a journey that she is still on now.
Jeana had taken a break from college in order to deal with some mental health issues she was experiencing. She was working with a therapist, seeking answers to the questions she had about her future. Two years ago, she had entered college with the plan to become a doctor, but once it became clear that was not the right path for her, she was feeling lost. One day, when her mom was visiting, Jeana mentioned some nausea she’d felt. Her mom offhandedly asked, “Are you pregnant? You should get a pregnancy test.” As it turns out, Jeana was pregnant. She scheduled her abortion right after Thanksgiving, and while Jeana was home with family, she kept her pregnancy and scheduled termination to herself.
When I asked how she felt during that time, Jeana answered that she mostly blocked it out. She was focused on getting the procedure done. There was a clinic close to campus, a popular location for abortion protesters. “I remember it was really crowded inside the clinic, but I felt really cared for,” she recalled. At seven weeks pregnant, she opted for a procedure over a medication abortion, and when it was done, her partner drove her home and brought her an orchid, a gesture of love and support. The following day, Jeana put the abortion behind her and resumed her daily life.
Jeana never felt any regret about her abortion, but she still had to deal with the “scripts” about abortion that she’d picked up at church. She didn’t know anyone who’d had an abortion, and she didn’t tell anyone about hers. For several months she managed to avoid thinking much about it. Then one day she read a column about someone who had a miscarriage, and it triggered all sorts of emotions and doubts. She went to her therapy appointment in tears, wondering if she had killed her baby. Her therapist helped normalize the abortion experience. Knowing it would be helpful for Jeana, they had a discussion about the science of fetal development. Together they sorted through all of Jeana’s feelings and questions that finally had risen to the surface. She told Jeana, “You don’t have to hold onto these stories anymore. They don’t serve you.” As she began to let go of the stories and the scripts of her childhood, all of her lingering doubts and difficult feelings about her abortion dissipated.
When I asked Jeana how she thinks of her abortion now, she told me she sees the experience as sacred. It was a life-defining moment for her, and she described it as “the first major decision I made for myself as an adult.” This experience set Jeana on a life path that she never anticipated. She began volunteering with reproductive justice organizations in Texas and started working as a counselor at the same clinic where she’d had her procedure. Later she became a public storyteller with We Testify and shared that while some of her church friends haven’t accepted her story, others have. She has found another community through her reproductive justice work too. When we talked, she was about to start graduate school in mental health counseling. Jeana has always felt a calling to help others; her abortion helped her discern what path that would take.
Jeana shared a piece she wrote entitled “I Hope the Christian Church Makes Room for Abortion Stories like Mine”:
I am a Christian, and I had an abortion. Experiences like mine were never discussed in the evangelical community I grew up in, which was riddled with stigmatizing rhetoric and shame about abortion that unfortunately persists today.
Before and after my abortion, I experienced painful emotional distress from the fear of judgment and isolation I felt, having gone through an experience few of my friends would understand or support. There was no doubt in my mind that I had made the right decision for myself, and I felt immense relief in the days after my abortion, but it was still difficult for me to distinguish that personal grief from the anti-abortion rhetoric I had internalized in my childhood.
Not only is my faith consistent with my beliefs about abortion and true justice, it also drives my activism. I want to ensure that no one is shamed or punished for making decisions based on their own conscience and knowing what’s best for them. When I served as a patient counselor at Houston Women’s Clinic, an independent abortion provider, I spoke with countless people who identified as anti-abortion because of their religious beliefs but who ultimately believed that God would understand their own decision to end their pregnancy. I’ve chosen to share my story this Lenten season because I want people who have had abortions—whatever their faith or spiritual beliefs—to know that they are not alone, and there is no right or wrong way to feel about your abortion.
My faith is still deeply important to me; it just looks different than it did in my childhood. I wouldn’t trade my church upbringing for the world. I know that there are other stories out there like mine. I have hope that the church will make room for them someday.12
We have seen how a pregnancy, even one that is wanted, can trigger a psychological emergency. Having the ability to make critical decisions about our bodies, families, and futures is essential to our mental well-being and our overall flourishing as individuals, families, and communities. And sometimes ending a pregnancy truly is a matter of life or death.