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In Carolinas, mental health becomes part of the abortion debate

Both North and South Carolina's abortion bans bar mental health exceptions

Democratic Rep. Spencer Wetmore unveils Democrats’ bill to safeguard abortion access in South Carolina last February.
Democratic Rep. Spencer Wetmore unveils Democrats’ bill to safeguard abortion access in South Carolina last February. (AP Photo/James Pollard)

As lawmakers raced to pass new abortion bans in the Carolinas last year, Charlotte Driscoll, a 26-year-old North Carolina native with bipolar disorder who has struggled with suicidal thoughts, worried aloud to a statehouse panel.

She’d finally found a medication that had worked for her called Lamotrigine. 

“But unfortunately it makes birth control ineffective. And birth control makes Lamotrigine ineffective,” she told the North Carolina Committee on Rules, Calendar and Operations of the House in May. 

That, she said, combined with other health complications, means she has irregular periods and is ineligible for an IUD — a type of long-active contraceptive.

“I could easily find out that I’m pregnant outside of that 12-week window,” she said, referring to North Carolina’s new, tighter ban. “Abortion is complicated and can’t be legislated like this.”

As state legislatures have revisited abortion bans in the wake of the Supreme Court’s 2022 Dobbs v. Jackson Women’s Health Organization decision to overturn Roe v. Wade, Driscoll and others have raised concerns about the intersection of mental health and abortion. 

Both North and South Carolina implemented stricter abortion bans last year — bans that prevented mental health conditions and suicidal ideation from qualifying as medical emergency exceptions.

While anti-abortion groups have long raised the specter of abortion spurring depression and other mental health conditions, the concern is different for Driscoll and others who live with mental health conditions: Being pregnant could put them at risk of having to discontinue the very medication they need to keep them alive.

“The brain is just another organ of the body, and the brain gets sick,” said Stephanie Berg, a psychiatrist who leads the Prisma Perinatal Mood Disorders Clinic in South Carolina. “We absolutely have to treat it just like we would with any other physical condition.”

Measuring mental health in relation to a decision to consider, have or forgo an abortion is difficult. 

Before the Supreme Court decision, patients did not have to disclose a reason for seeking an abortion. But Dobbs changed that. Now, women seeking an abortion have been compelled to address the mental health implications of carrying out a pregnancy “more than they would have in the past,” said Ashley Crary Lidow, senior director of policy and government relations at the Women’s Rights and Empowerment Network, or WREN, based in South Carolina.

Many state laws passed or implemented in the wake of the Dobbs decision now specifically exclude mental health from the medical exemptions that allow abortions.

N. Dawn Bingham, clinical associate professor of obstetrics and gynecology at the University of South Carolina-Columbia School of Medicine, described the mental health exclusions as “a very closed worldview that says that mental health issue is something that people can just pull themselves up by their bootstraps.”

“The people that wrote these laws are not about mitigating the suffering or being empathetic to physiological clinical issues versus mental clinical issues, or even understand that those things are part and parcel of a similar way of looking at an individual if you’re taking care of them clinically,” said Bingham.

Kelsey Reep, a North Carolina-based licensed clinical social worker, has been partly specializing in abortion-specific support since the fall of 2021. 

“I do have a lot of folks who continue to stay with me for counseling, and where it’s not that we’re just talking about abortion for all that time,” she said. “The best predictor of mental health after an abortion is before your abortion.”

State policy

Spencer Wetmore was frustrated. 

The South Carolina House Judiciary Committee debate over a then-bill that would ban most abortions after six weeks pregnancy was falling along party lines, and one of her concerns had not been addressed: The bill would not allow any exceptions for mental health emergencies.

“It was important to me to raise it as an issue and to sort of speak to that experience,” the South Carolina state representative told CQ Roll Call in November. 

Eight years ago, Wetmore, a Democrat, discontinued her anxiety and depression medications during her pregnancy, which is not an option for everyone, she said.

During the May Judiciary Committee hearing, Wetmore raised concerns that minimizing mental health could impact patients with schizophrenia, severe depression or post-traumatic stress disorder and further exacerbate the ability of the state to recruit doctors because of the “web of confusing laws.” 

House Judiciary Chairman Weston J. Newton, a Republican, said the language was an “effort to narrowly tailor the qualification” to prevent misuse without any documentation.

Rep. Ivory Torrey Thigpen, a Democrat, said he was concerned that this could complicate the circumstances for someone who has severe clinical depression or schizophrenia.

“We could come up with thousands of scenarios and examples,” he said.

“We can pick apart hundreds of different potential medical scenarios,” Newton replied to Thigpen. “I’m not trying to obfuscate, but I think you have to put all those pieces together to determine whether or not the qualification … has been met.”

Vicki Ringer, director of public affairs at Planned Parenthood South Atlantic, said the exceptions in the South Carolina bill were too narrow and pointed to similar issues raised for victims of sexual assault or domestic abuse.

She said anti-abortion advocates see mental health exceptions “as an easy out, just like many people think that rape is an easy out, and we know that’s not happening.”

“The fact that mental health has never been considered an aspect worthy of discussion and protection is not surprising in South Carolina,” she said. “Mental health is treated as just something people make up and a quick easy answer for people when things don’t go their way or when they act inappropriately.”

Wetmore said she had two people privately reach out after her committee remarks about the bill’s mental health language.

“Now, did they ever make an effort to amend it? No, because there was this perception that mental health can be too easily manipulated,” she said to CQ Roll Call. “It never led to an amendment effort in the way that some of my other points did.” 

Abortion rights advocates filed their third post-Dobbs South Carolina lawsuit on Feb. 5, alleging that the current ban’s language is too vague for doctors to follow and pointing to some mental health concerns.

But some see mental health’s omission from the exceptions as reasonable.

Katie Daniel, state policy director for the anti-abortion group Susan B. Anthony Pro-Life America, said states have narrowed the definitions so that “health and medical emergency means what people expect it to mean, like you’re in the hospital” and modeled it after what has worked in other states.

“Our primary concern is just that far too often, we’re seeing abortion being held out as the solution to the problem, rather than actually directly addressing the problem,” she said. “We just don’t see that as helpful for women, regardless of the wantedness of the pregnancy.”

Kimberly Tissot, president and CEO of Able SC, a disability rights organization, countered that people with psychiatric disabilities use medication to keep themselves independent, and a disruption to that routine can be debilitating. Limited access to mental health resources also means people may not have the options to wean off or transition to a different medication if needed during an unexpected pregnancy, Tissot said.

“Nobody’s disabilities should be exacerbated because of any bans, and that’s a concern I’m seeing,” said Tissot, adding that it has been an issue that many legislators are not willing to openly discuss. “The overall bias of psychiatric disability is, I think, really looming.”

This report is part of a series supported through the Rosalynn Carter Fellowship for Mental Health Journalism.

If you or someone you know is facing a mental health crisis, please call the toll-free, 24-hour 988 Suicide and Crisis Lifeline at 9-8-8 to be connected to a trained counselor.

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