Texas Abortion Ban Linked to Worsening Maternal Mental Health

Mothers living in Texas reported significantly worse mental health following the state's 2021 abortion ban compared with mothers in states without active restrictions during the same period, according to a new study published today in JAMA Network Open.¹ The findings add to a growing body of evidence that abortion restrictions carry health consequences extending well beyond individuals seeking to terminate a pregnancy.^1,2

The study, led by researchers at the Harvard Pilgrim Health Care Institute, the University of Maryland, and the RAND Corporation, examined the association between Texas Senate Bill 8 (SB8) and maternal mental health outcomes.¹ Enacted in September 2021, SB8 was among the nation's most restrictive abortion laws at the time, banning abortions after embryonic cardiac activity—as early as 5 to 6 weeks' gestation—with no exemptions for congenital anomalies.

Measuring the Mental Health Toll

Using a difference-in-differences design and data from the National Survey of Children's Health (2016-2023), researchers compared 4323 reproductive-age mothers in Texas with more than 152,000 mothers in 29 states that served as a control group because they had not enacted similar bans during the study's timeline. The primary outcome was self-reported fair or poor mental and emotional health.

The results were stark; the proportion of Texas mothers reporting fair or poor mental health nearly doubled after SB8 took effect, rising from 4.6% in the pre-ban period to 9.3% afterward. Mothers in comparison states also saw an increase, but a far more modest one, from 5.4% to 7.5%. After adjusting for household, maternal, and child characteristics, researchers estimated that Texas mothers experienced a statistically significant 2.52 percentage-point greater increase in the likelihood of reporting fair or poor mental health compared with their counterparts in the control states (95% CI, 0.02-5.01).

Disproportionate Impact on Vulnerable Populations

The impact was sharpest among economically vulnerable mothers. Among mothers whose children were covered by public insurance, including Medicaid and the Children's Health Insurance Program, the adjusted difference was 7.06 percentage points (95% CI, 0.83-13.29), more than double the overall estimate. While subgroups stratified by younger age and lower education levels also showed visible upward trends in poor mental health, these shifts did not meet the strict threshold for statistical significance due to smaller sample sizes.

Importantly, sensitivity analyses found no significant association between SB8 and mothers' physical health outcomes or fathers' mental health—a finding the authors say strengthens the case that the effect is specific to maternal mental health rather than a reflection of broader environmental stressors.

Immediate Stress vs Long-Term Systemic Failures

In the immediate aftermath of the ban, the sharp decline was likely driven by psychological factors, as abortion restrictions can erode a sense of reproductive autonomy and generate anticipatory stress, even among individuals who are not pregnant or seeking abortion care. Research has also shown that the financial burden of navigating abortion restrictions is itself a mental health risk: patients facing catastrophic out-of-pocket costs for abortion care report significantly higher rates of anxiety and depression.³

At a systems level, documented clinician shortages and an exodus of obstetrics and gynecology residents have compounded the problem.¹ A 2024 Commonwealth Fund scorecard found that states with abortion restrictions have substantially fewer maternity care providers, and that Texas, along with Mississippi and Oklahoma, ranks among the lowest-performing states overall on women's health care access, quality, and outcomes.²

"The shortage of medical residents and the exodus of clinicians from the state suggests that the observed decline in mental health may be a negative externality of a strained maternal health infrastructure that affects all mothers," the authors wrote.¹

Study Limitations and Policy Implications

The study has limitations; data are self-reported rather than clinically diagnosed, and SB8 was enacted during the COVID-19 pandemic, which may have compounded its effects. The cross-sectional design limits causal inference, and the study period ends in 2023, capturing only short-term impacts.

Still, the findings carry significant policy implications in the post-Dobbs landscape, where more than a dozen states have enacted abortion bans of varying scope—a policy environment that has already been linked to a 7% national increase in infant mortality following the Supreme Court's 2022 ruling.⁴ The authors call for expanded mental health services for mothers and better integration of mental health screening into routine prenatal and postpartum care, regardless of whether a patient is seeking abortion services.¹

Maternal mental health disorders affect approximately 1 in 5 US women during the perinatal period and remain among the leading contributors to maternal mortality, much of it going untreated; behavioral health conditions now account for more than 20% of maternal deaths, making them the leading cause.⁵ This study suggests that restrictive abortion policies may be quietly compounding that burden.¹

References

1. Ali MM, Burnett AL, Cantor JH, et al. The Texas abortion ban and maternal mental health. JAMA Netw Open. 2026;9(6):e2619396. doi:10.1001/jamanetworkopen.2026.19396
2. Grossi G. New report shows worsening health outcomes for women in states with abortion bans. AJMC^®. July 18, 2024. Accessed June 17, 2026. https://www.ajmc.com/view/new-report-shows-worsening-health-outcomes-for-women-in-states-with-abortion-bans
3. Grossi G. Financial, psychological burden of abortion care in US raises calls for expanded insurance. AJMC. November 13, 2024. Accessed June 17, 2026. https://www.ajmc.com/view/financial-psychological-burden-of-abortion-care-in-us-raises-calls-for-expanded-insurance
4. Grossi G. Infant mortality increases across US following Dobbs decision. AJMC. October 25, 2024. Accessed June 17, 2026. https://www.ajmc.com/view/infant-mortality-increases-across-us-following-dobbs-decision
5. Hippensteele A. Confronting the maternal mortality crisis in the United States: insights from the 2025 Commonwealth Fund brief. AJMC. July 30, 2025. Accessed June 17, 2026. https://www.ajmc.com/view/confronting-the-maternal-mortality-crisis-in-the-united-states-insights-from-the-2025-commonwealth-fund-brief