What does it feel like to be a teenager forced to carry an unwanted pregnancy? Evidence suggests it can trigger a severe mental health crisis. In El Salvador, for example, where abortion is completely banned, teen pregnancy has emerged as a leading cause of suicide: According to a 2014 study, hundreds of pregnant girls there die by suicide annually.
With the end of Roe v Wade, we must confront the ways abortion bans will impact our young people. Seventy-five percent of teen pregnancies are unintended, which is why teens are more likely than their adult counterparts to seek abortions. But where abortion is banned, teens will have a harder time than adults in accessing it. Poorer, less mobile, and slower to recognize the signs of pregnancy, in part because their menstrual cycles are less predictable, they will be less likely to have the option of traveling to another state for a legal abortion.
Abortion bans will also end the judicial bypass system, which for decades has safeguarded abortion access among vulnerable pregnant teens. In its place, laws such as Missouri’s, which prohibits “aiding and assisting” youth seeking abortions, will likely inhibit the willingness of adults to support struggling young people. Teens may be left alone to navigate the thicket of misinformation when searching the internet (as they already do) for ways to end their pregnancies.
Indeed, the search itself may be dangerous, subjecting them to exposure and potential legal consequences. While sophisticated users will take steps to protect their privacy, using browsers and search engines that protect their search history, or turning off location tracking on their phones, such precautions are less likely to occur to young people unaware that their online interactions might be tracked, whether by parents, law enforcement or anyone purchasing information from unregulated data brokers.
The emerging online market in abortion medicines—which, based on the experiences of countries around the world, likely will provide relatively easy access to safe, effective abortions for anyone with a debit card—–will be less accessible for teens. Their ability to acquire the pills may turn on whether they know a supportive, informed adult to whom the drugs might be mailed. Not all teens have such support. For those who live in fear that their pregnancy might be met with condemnation or worse, the struggle to find a private way to access both the information and the medicine may be insurmountable.
As a result, pregnant teens may feel overwhelmed, powerless, and left with no good options.
Adolescent suicide is related to what experts call “emotion-relevant impulsivity,” or poor control over reactions following emotions. The American Academy of Child and Adolescent Psychiatry notes that “[a]mong teenagers, suicide attempts may be associated with feelings of stress, self-doubt, pressure to succeed, financial uncertainty, disappointment, and loss.” Unwanted pregnancy exacerbates all of these factors.
To be sure, most teens forced to endure an unwanted pregnancy will not turn to suicide. But that does not mean they will escape without harm to their mental or physical health. Indeed, research suggests that being made to endure an unwanted pregnancy leads to a heightened risk of both mental and physical ailments. Yet lack of access to mental health care for youth has reached crisis proportions. While one in five children and youth under 21 has a mental or behavioral disorder, only 20 percent receive any mental health treatment. Access to mental health treatment varies by state, and the Mental Health America Survey reveals that some of the hardest places for youth to find mental health care are in states with abortion bans, like Oklahoma and Arkansas. In fact, many states with abortion bans—Wyoming, South Dakota, Texas, Tennessee, Mississippi, Alabama—actually declined to expand Medicaid, further limiting their ability to meet the mental health needs of their residents.
In short, there is ample reason to expect a rise in suicides and suicide attempts by pregnant teenagers. The U.S. already is experiencing an epidemic in suicide among adolescent girls. Between 2007 and 2018, the suicide rate for 10- to 24-year-olds increased nearly 60 percent. The pandemic worsened this trend. A 2021 CDC study found an alarming rise in suspected suicide attempts by adolescent girls. During one month in 2021, suicide attempts among girls aged 12–17 were 50 percent higher than they had been during the same period in 2019.
Regardless of one’s position on abortion, no one should view this trend with indifference. Those who attempt suicide and survive will spend the rest of their lives experiencing the trauma common to survivors—such as elevated rates of major depression, substance abuse, and self-harm—plus the potential physical consequences connected with having attempted suicide during their pregnancy. And of course, this trauma cannot help but have intergenerational downstream mental health implications.
The suicide deaths and attempted suicides of pregnant teens are largely preventable by a combination of factors we know would keep teens safer: accurate sex education; free and easy access to contraception; and similarly easy access to confidential all-options counseling from a nonbiased, trustworthy source. Yet each of these solutions seems likely to founder on the shoals of our divided democracy.
While working toward these policies, there are additional, short-term ways to protect our youth: People and organizations that serve teens in any capacity—via hotlines and chat lines, or as teachers, counselors, doctors and coaches—should work with their lawyers to determine how they’ll respond when pregnant teens turn to them for abortion-related advice, and how they’ll handle subpoenas and other requests for information about their clients. Lawmakers should work to protect minors’ privacy, both online and off, and should act quickly to expand access to free, confidential mental health treatment for young people. Finally, those who share a connection with any young person, whether as a parent or a trusted friend, must talk to them about abortion in terms that go beyond platitudes about life or choice. A country with so little support for teens in crisis necessarily drafts each of us into service as first responders.