The Texas Abortion Ban and Maternal Mental Health

Importance: Maternal mental health disorders are among the leading causes of maternal morbidity and mortality. In the US, the 2022 Supreme Court decision in Dobbs v. Jackson Women's Health Organization and ensuing state-level abortion restrictions have raised concerns that such policies may worsen maternal health and mental health outcomes. Objective: To examine the association of the implementation of Texas Senate Bill 8 (SB8) abortion law, which banned abortions after embryonic cardiac activity in September 2021, with maternal mental health outcomes. Design, Setting, and Participants: This repeated cross-sectional study used a difference-in-differences (DiD) design with pooled data from the 2016 to 2023 National Survey of Children's Health. The nationally representative sample included US mothers aged 18 to 49 years who lived with at least 1 child aged 0 to 17 years. Data were analyzed from April to October 2025. Exposure: Mothers residing in Texas represented the treatment group, and mothers in states without abortion bans (Alaska, Arizona, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Kansas, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, Vermont, Virginia, Washington, and Wyoming) served as the control group. Main Outcomes and Measures: The primary outcome was mothers' self-reported fair or poor mental and emotional health. Logistic regression models, adjusted for child-, mother-, and household-level characteristics, were used to estimate changes in the probability of mental health outcomes for mothers coinciding with SB8 implementation. Similar models were estimated with maternal physical health and fathers' mental health as outcomes for sensitivity analyses. Results: The sample included 4323 mothers in Texas (47.2% [95% CI, 45.1%-49.4%] aged 30-39 years) and 152 573 mothers in nonban states (47.1% [95% CI, 46.4%-47.7%] aged 30-39 years). Compared with mothers in nonban states, those in Texas experienced a statistically significant increase in the likelihood of reporting fair or poor mental health following SB8's implementation (DiD estimate, 2.52 percentage points; 95% CI, 0.02-5.01 percentage points). The largest increases were observed among mothers of children with public insurance (DiD estimate, 7.06 percentage points; 95% CI, 0.83-13.29 percentage points). No significant outcomes were observed for mothers' physical health outcomes or fathers' mental health in the sensitivity analyses. Conclusions and Relevance: In this repeated cross-sectional study, the implementation of an abortion ban in Texas was associated with a worsening of maternal mental health among reproductive-age mothers relative to mothers in states without such bans. These results underscore the association of abortion restrictions with maternal mental health and highlight the need to strengthen support in the post-Dobbs policy environment.