Mental Health Implications of Abortion Restrictions for Historically Marginalized Populations

Ogbu-Nwobodo, L., Shim, R.S., et al.

October 27, 2022

N Engl J Med 2022; 387:1613-1617

DOI: 10.1056/NEJMms2211124

Here is an excerpt:

Abortion and Mental Health

To begin with, abortion does not lead to mental health harm — a fact that has been established by data and recognized by the National Academies of Sciences, Engineering, and Medicine and the American Psychological Association The Turnaway Study, a longitudinal study that compared mental health outcomes among people who obtained an abortion with those among people denied abortion care, found that abortion denial was associated with initially higher levels of stress, anxiety, and low self-esteem than was obtaining of wanted abortion care. People who had an abortion did not have an increased risk of any mental health disorder, including depression, anxiety, suicidal ideation, post-traumatic stress disorder, or substance use disorders. Whether people obtained or were denied an abortion, those at greatest risk for adverse psychological outcomes after seeking an abortion were those with a history of mental health conditions or of child abuse or neglect and those who perceived abortion stigma (i.e., they felt others would look down on them for seeking an abortion). Furthermore, people who are highly oppressed and marginalized by society are more vulnerable to psychological distress.

There is evidence that people seeking abortion have poorer baseline mental health, on average, than people who are not seeking an abortion. However, this poorer mental health results in part from structural inequities that disproportionately expose some populations to poverty, trauma, adverse childhood experiences (including physical and sexual abuse), and intimate partner violence. People seek abortion for many reasons, including (but not limited to) timing issues, the need to focus on their other children, concern for their own physical or mental health, the desire to avoid exposing a child to a violent or abusive partner, and the lack of financial security to raise a child.

In addition, for people with a history of mental illness, pregnancy and the postpartum period are a time of high risk, with increased rates of recurrence of psychiatric symptoms and of adverse pregnancy and birth outcomes. Because of stigma and discrimination, birthing or pregnant people with serious mental illnesses or substance use disorders are more likely to be counseled by health professionals to avoid or terminate pregnancies, as highlighted by a small study of women with bipolar disorder. One study found that among women with mental health conditions, the rate of readmission to a psychiatric hospital was not elevated around the time of abortion, but there was an increased rate of hospitalization in psychiatric facilities at the time of childbirth. Data also indicate that for people with preexisting mental health conditions, mental health outcomes are poor whether they obtain an abortion or give birth.

The Role of Structural Racism

Structural racism — defined as ongoing interactions between macro-level systems and institutions that constrain the resources, opportunities, and power of marginalized racial and ethnic groups — is widely considered a fundamental cause of poor health and racial inequities, including adverse maternal health outcomes. Structural racism ensures the inequitable distribution of a broad range of health-promoting resources and opportunities that unfairly advantage White people and unfairly disadvantage historically marginalized racial and ethnic groups (e.g., education, paid leave from work, access to high-quality health care, safe neighborhoods, and affordable housing). In addition, structural racism is responsible for inequities and poor mental health outcomes among many diverse populations.

The information is here.

Toward an understanding of structural racism: Implications for criminal justice

Julian M. Rucker and Jennifer A. Richeson

Science, 374 (6565)

DOI: 10.1126/science.abj7779

Abstract

Racial inequality is a foundational feature of the criminal justice system in the United States. Here we offer a psychological account for how Americans have come to tolerate a system that is so at odds with their professed egalitarian values. We argue that beliefs about the nature of racism—as being solely due to prejudiced individuals rather than structural factors that disadvantage marginalized racial groups—work to uphold racial stratification in the criminal justice system. Although acknowledging structural racism facilitates the perception of and willingness to reduce racial inequality in criminal justice outcomes, many Americans appear willfully ignorant of structural racism in society. We reflect on the role of psychological science in shaping popular understandings of racism and discuss how to contribute more meaningfully to its reduction.

From the Summary and self-reflection

In this Review, we sought to illustrate key social-psychological factors that shape the maintenance and justification of a racially unjust criminal justice system, despite large scale support for racially egalitarian values.  Psychological motives to substantiate the racial hierarchy and protect one’s self-image work against opportunities to increase exposure to critical education on the structural underpinnings of contemporary racial inequality.  In essence, ignorance and denial of structural racism protect against an indictment of the legitimacy of the criminal justice system. By contrast, acknowledgment of structural racism in society motivates efforts to reduce racially disparate outcomes. With this framework, it becomes clear that merely holding egalitarian attitudes is insufficient to reform and dismantle systems that reproduce racial inequality—a structural understanding of racism is integral to these objectives.

The paper is here.

Structuring Local Environments to Avoid Diversity: Anxiety Drives Whites’ Geographical and Institutional Self-Segregation Preferences

Anicich, E., Jachimowicz, J., 

(2021, February 16). 

https://doi.org/10.31234/osf.io/yzpr2

Abstract

The current research explores how local racial diversity affects Whites’ efforts to structure their local communities to avoid incidental intergroup contact. In two experimental studies (N=509; Studies 1a-b), we consider Whites’ choices to structure a fictional, diverse city and find that Whites choose greater racial segregation around more (vs. less) self-relevant landmarks (e.g., their workplace and children’s school). Specifically, the more time they expect to spend at a landmark, the more they concentrate other Whites around that landmark, thereby reducing opportunities for incidental intergroup contact. Whites also structure environments to reduce incidental intergroup contact by instituting organizational policies that disproportionately exclude non-Whites: Two large-scale archival studies (Studies 2a-b) using data from every U.S. tennis (N=15,023) and golf (N=10,949) facility revealed that facilities in more racially diverse communities maintain more exclusionary barriers (e.g., guest policies, monetary fees, dress codes) that shield the patrons of these historically White institutions from incidental intergroup contact. In a final experiment (N=307; Study 3), we find that Whites’ anticipated intergroup anxiety is one driver of their choices to structure environments to reduce incidental intergroup contact in more (vs. less) racially diverse communities. Our results suggest that despite increasing racial diversity, White Americans structure local environments to fuel a self-perpetuating cycle of segregation.

General Discussion

Across five studies using a mix of experimental, archival, and survey methods, we provide evidence of a cycle of intergroup avoidance that is reflected in Whites’ efforts to structure their local environments in ways that reduce incidental intergroup contact: Whites experience more intergroup anxiety in the face of local racial diversity, and as such, work to segregate themselves geographically and institutionally from racial outgroup members. This, in turn, reduces the likelihood of incidental intergroup contact, which has the potential for debiasing effects.Specifically, in Studies 1a and 1b, we found that when given the opportunity to do so, Whites exhibited a preference to racially self-segregate when making decisions about the racial distribution of residents in a diverse city even in a controlled experimental setting. In Studies 2a and 2b, we constructed a rich archival dataset using information about every tennis and golf facility in the United States. We found that the gatekeepers of these historically White institutions restrict access in more versus less racially diverse communities by maintaining private (vs. public) access, higher monetary barriers, and stricter dress codes. Finally, Study 3experimentally manipulated the racial composition of a fictitious city and found that Whites who imagined living in a more versus less racially diverse city more strongly endorsed exclusionary policies in their institutions and anticipated feeling more stressed when confronted with the prospect of navigating through a diverse part of town, effects which were statistically mediated by feelings of intergroup anxiety.

Taken together, the current research offers important insights into how local racial diversity shapes Whites’ intergroup avoidance strategies, and ultimately results in Whites structuring communities in ways that reduce incidental intergroup contact and the frequency of potentially debiasing encounters.Moreover, such decisions block critical opportunities (economic, social, etc.) for racial minorities themselves, thus contributing to the persistence of structural racism, even in the face of increasing racial diversity (see also Kraus & Torrez, 2020).

The research is here.

Structural Competency Meets Structural Racism: Race, Politics, and the Structure of Medical Knowledge

Jonathan M. Metzl and Dorothy E. Roberts
Virtual Mentor. 2014;16(9):674-690.
doi: 10.1001/virtualmentor.2014.16.9.spec1-1409.

Here is an excerpt:

The Clinical Implications of Addressing Race from a Structural Perspective

These brief case examples illustrate the complex ways that seemingly clinically relevant “cultural” characteristics and attitudes also reflect structural inequities, medical politics, legal codes, invisible discrimination, and socioeconomic disparities. Black men who appeared schizophrenic to medical practitioners did so in part because of the framing of new diagnostic codes. Lower-income persons who “refused” to eat well or exercise lived in neighborhoods without grocery stores or sidewalks. Black women who seemed to be uniquely harming their children by using crack cocaine while pregnant were victims of racial stereotyping, as well as of a selection bias in which decisions about which patients were reported to law enforcement depended on the racial and economic segregation of prenatal care. In this sense, approaches that attempt to address issues—such as the misdiagnosis of schizophrenia in black men, perceived diet “noncompliance” in minority populations, or the punishment of “crack mothers”—through a heuristic aimed solely at enhancing cross-cultural communication between doctors and patients, though surely well intentioned, will overlook the potentially pathologizing impact of structural factors set in motion long before patients or doctors enter exam rooms.

Structural factors impact majority populations as well as minority ones, and structures of privilege or opulence also influence expressions of illness and health. For instance, in the United States, research suggests that pediatricians disproportionately overdiagnose ADHD in white school-aged children. Until recently, medical researchers in many global locales assumed, wrongly, that eating disorders afflicted only affluent persons.

Yet of late, medicine and medical education have struggled most with addressing ways that structural forces impact and disadvantage communities of color. As sociologist Hannah Bradby rightly explains it, hypothesizing mechanisms that include the micro-processes of interactions between patients and professionals and the macro-processes of population-level inequalities is a missing step in our reasoning at present…. [A]s long as we see the solution to racism lying only in educating the individual, we fail to address the complexity of racism and risk alienating patients and physicians alike.

The info is here.

American Psychiatric Association Presidential Task Force to Address Structural Racism Throughout Psychiatry

Press Release
American Psychiatric Association
2 July 2020

The American Psychiatric Association today announced the members and charge of its Presidential Task Force to Address Structural Racism Throughout Psychiatry. The
Task Force was initially described at an APA Town Hall on June 15 amidst rising calls from psychiatrists for action on racism. It held its first meeting on June 27, and efforts, including the planning of future town halls, surveys and the establishment of related committees, are underway.

Focusing on organized psychiatry, psychiatrists, psychiatric trainees, psychiatric patients, and others who work to serve psychiatric patients, the Task Force is initially charged with:

1. Providing education and resources on APA’s and psychiatry’s history regarding structural racism;
2. Explaining the current impact of structural racism on the mental health of our patients and colleagues;
3. Developing achievable and actionable recommendations for change to eliminate structural racism in the APA and psychiatry now and in the future;
4. Providing reports with specific recommendations for achievable actions to the APA Board of Trustees at each of its meetings through May 2021; and
5. Monitoring the implementation of tasks 1-4.

The info is here.

13th is now free on YouTube

Combining archival footage with testimony from activists and scholars, director Ava DuVernay's examination of the U.S. prison system looks at how the country's history of racial inequality drives the high rate of incarceration in America.

This piercing, Oscar-nominated film won Best Documentary at the Emmys, the BAFTAs and the NAACP Image Awards.

 US Rating: TV-MA For mature audiences. May not be suitable for ages 17 and under.

Structural Racism and Supporting Black Lives — The Role of Health Professionals

Rachel R. Hardeman, Eduardo M. Medina, and Katy B. Kozhimannil
The New England Journal of Medicine
Originally posted October 12, 2016

Here is an excerpt:

Structural racism, the systems-level factors related to, yet distinct from, interpersonal racism, leads to increased rates of premature death and reduced levels of overall health and well-being. Like other epidemics, structural racism is causing widespread suffering, not only for black people and other communities of color but for our society as a whole. It is a threat to the physical, emotional, and social well-being of every person in a society that allocates privilege on the basis of race.  We believe that as clinicians and researchers, we wield power, privilege, and responsibility for dismantling structural racism — and we have a few recommendations for clinicians and researchers who wish to do so.

First, learn about, understand, and accept the United States’ racist roots. Structural racism is born of a doctrine of white supremacy that was developed to justify mass oppression involving economic and political exploitation.3 In the United States, such oppression was carried out through centuries of slavery premised on the social construct of race.

Our historical notions about race have shaped our scientific research and clinical practice. For example, experimentation on black communities and the segregation of care on the basis of race are deeply embedded in the U.S. health care system.

The article is here.