Abortion Mental Health Research
Update and Quality of Evidence

Association for Interdisciplinary Research in Values and Social Change
Priscilla Coleman, Ph.D.
Associate Professor at Bowling Green State University
Reproduced with Permission

Recent years have brought a dramatic increase in the number of scientific studies published world-wide documenting the psychological damage frequently ushered in by abortion. Negative effects of abortion on various aspects of women's mental health and quality of life are now well-established. The newer research has overcome many methodological shortcomings plaguing earlier work, leading to much clearer answers to several basic questions including the following: 1) Does abortion introduce risks to women's mental heath? 2) Does abortion adversely impact other aspects of women's lives (e.g. intimate relationships, parenting, etc.) even if they do not suffer from a diagnosable ailment? 3) Are the risks associated with abortion greater than those associated with childbirth?

A wide range of adverse psychological and behavioral effects have been reported in the aftermath of abortion. Common negative outcomes documented in the research literature include the following:

• Guilt, resulting from violation of one's sense of what is right or moral. For women who believe they have consented to killing a human being, the burden of guilt can be unbearable.

• Anxiety experienced in various ways: tension (inability to relax, irritability, etc.), physical responses (dizziness, pounding heart, upset stomach, headaches), difficulty concentrating, disturbed sleep, etc.

• Psychological numbing is reported among some people who experience painful losses. Women who abort may avoid a wide range of emotions to escape the pain of abortion. Close interpersonal relationships may become impaired as a result.

• Depression and thoughts of suicide are often experienced by women after an abortion. Many women develop symptoms of depression including sad moods, sudden and uncontrollable crying episodes, low self-esteem; sleep, appetite, and sexual disturbances; reduced motivation; and disruption in interpersonal relationships. One woman who completed a survey for our ongoing online data collection effort (www.abortionresearch.net) described the pain well: "If I had it to do over again, then I would never take the route of abortion. I struggle every day with depression and regret. My heart hurts so bad that it feels like I'm having a heart attack. My husband and family are drained and tired of hearing of my heartache."

• Alcohol and drug abuse in post-abortive women often begin as a form of self-medication, a way of coping with the psychological pain of abortion memories.

• Unwanted re-experiencing of the abortion in the form of distressing, recurring 'flashbacks' or reoccurring nightmares about babies are reported by some women.

• Avoidance of stimuli associated with abortion, pregnancy, mothers, children and particularly infants is not uncommon.

• Compromised parenting occurs following some abortions. A woman might not allow herself to properly bond with future children because of a fear of loss. Over-protectiveness has been reported as well.

Women with particular psychological and demographic characteristics are more vulnerable to post-abortion mental health problems. Risk factors for problematic psychological functioning after abortion are well-substantiated and an abbreviated list is provided below.

Among the most commonly reported negative effects of abortion in the literature are anxiety, depression, and substance use. Based on an extensive review of the literature, Bradshaw and Slade (2003) recently concluded that up to 30% of women experience clinical levels of anxiety and/or high levels of general stress one month post-abortion.

Increased risk for substance use has also been found to be strongly associated with abortion. Using data from a nationally representative sample, Coleman and colleagues (2002) reported in the American Journal of Obstetrics and Gynecology that pregnant women with a prior history of abortion, compared to women without a history, were 10 times more likely to use marijuana, 5 times more likely to use various illicit drugs, and were twice as likely to use alcohol. In a paper published in the American Journal of Drug and Alcohol Abuse, in which Reardon and colleagues (2004) compared women who aborted to women who carried an unintended pregnancy to term, those who aborted were twice as likely to use marijuana and reported more frequent use of alcohol.

In 2006 New Zealand pro-choice researcher David Fergusson published results revealing that young women who aborted were at a higher risk for various psychological problems compared to women who carried to term and those who were never pregnant. By age twenty-five 42% reported major depression, 39% suffered from anxiety disorders, 27% reported experiencing suicidal ideation, and 6.8% indicated alcohol dependence.

Dr. Fergusson and his colleagues challenged the American Psychological Association's conclusion that: "Well-designed studies of psychological responses following abortion have consistently shown that risk of psychological harm is low." He noted this conclusion was based on a small number of studies, which suffer from significant methodological problems as well as a general disregard for studies showing negative effects.

According to the research, a minimum of 20-30% of women experience adverse, prolonged post-abortion psychological reactions. The results of the four largest, record-based studies in the world have shown abortion is associated with increased risk for mental health problems.

In 2001 Ostbye and colleagues published data on 41,089 women with an abortion history compared to a matched group of 39,220 women without a history of abortion, relative to hospitalization for psychiatric problems. The results revealed a 165% higher rate of hospitalization for the abortion group. In the second study, David et al. (1981) found the overall rate of psychiatric admission was 18.4 and 12.0 per 10,000 for women who had aborted and delivered respectively. For those who were divorced, separated, or widowed, the psychiatric admission rate was 63.8 per 10,000 for women who aborted versus 16.9 for those who delivered.

The remaining two studies were conducted by Coleman, Reardon, Rue, and Cougle (2002) and by Reardon, Cougle, Rue, Shuping, Coleman, and Ney, (2003) in the U.S. using data from over 54,000 low-income women on state medical assistance in California. Women who had an abortion had significantly higher rates of outpatient psychiatric diagnoses than women with only birth experience and no history of subsequent abortions after eliminating all cases with psychiatric claims 12-18 months prior to the initial pregnancy. This difference was apparent when data for the full time period were examined (17% higher) and when only data from women with claims filed on their behalf within 90 days (63% higher), 180 days (42% higher), 1 year (30% higher), and 2 years (16% higher) of the pregnancy event were considered. Data using the same sample and focusing on inpatient claims revealed similar findings.

Not only is there scientific evidence for a correlation between abortion and poor mental health including substance abuse, but studies have indicated that abortion is related to problems in intimate relationships (e.g., an increased likelihood of sexual dysfunction, interpersonal communication problems, and separation or divorce.) For example, in a study led by Rue (2004) published in the Medical Science Monitor, 6.2% of Russian women and 24% of American women sampled reported sexual problems that they directly attributed to a prior abortion.

Perhaps most alarming are the results of new research revealing that emotional difficulties and unresolved grief responses associated with abortion may harm parenting by reducing parental responsiveness to child needs through interference with attachment processes or by instilling anger, which is a common component of grief. In one study Coleman and colleagues (2005) reported that women with one prior abortion had a 144% higher risk for engaging in child physical abuse than women without an abortion experience. A history of one miscarriage/stillbirth was not associated with increased risk of child abuse. Scientific evidence indicating that the loss of a child through abortion may negatively impact the ability of some women to nurture later-born children contradicts the pro-choice argument that abortion will result in a reduction of child maltreatment if all children are born as the result of wanted pregnancies.

Finally several large-scale studies have shown a higher risk of death associated with abortion compared to childbirth. A record-based study conducted in Finland by Gissler and colleagues (1997) established post-pregnancy death rates within one year that were nearly 4 times greater among women who aborted their pregnancies than among women who delivered their babies. The suicide rate was nearly 6 times greater among women with a history of abortion compared to women who gave birth.

In a U.S. record-based study conducted by Reardon and colleagues (2002), with adjustments for age, women who aborted when compared to women who delivered, were 62% more likely to die from any cause. Increased risk estimates associated with specific causes of death were also identified in the study: violent causes (81%), suicide (154%), and accidents (82%). In a third study published last year by Gissler and colleagues (2004), the mortality rate was lower after a birth (28.2 per 100,000) than after an induced abortion (83.1 per 100,000). In Gissler and colleagues' (2005) most recent publication, an age-adjusted induced abortion related mortality rate from all external causes (homicide, suicide, unintentional injuries) of 60.3 per 100,000 was observed in comparison to a 10.2 age-adjusted mortality rate per 100,000 for pregnancy or birth. For suicide, the age-adjusted mortality rate for abortion was 33.8, compared to 5.5 for pregnancy or birth.

The newest wave of research is higher quality science based on several collective strengths of the studies: (a) the use of an appropriate control group (unintended pregnancy carried to term), (b) controls for pre-existing psychological problems, (c) controls for personal characteristics and situational factors associated with the choice to abort, (d) collection of data for several years beyond the abortion, (e) use of medical claims data (with diagnostic codes assigned by trained professionals), (f) and use of large samples (most in the 1000s and many nationally representative.)

Table 1 provides an overview of 15 studies my colleagues and I have conducted since 2002. The methodological strengths of each study are highlighted. Based on the improvements characterizing these studies, prior work indicating that abortion is an emotionally benign medical procedure for most women should be questioned. In all the analyses we conducted, women with a history of abortion were never found to be at a lower risk for mental health problems than their peers with no abortion experience. When compared to unintended pregnancy carried to term and other forms of perinatal loss, abortion poses more significant mental health risks.

Women with a history of induced abortion are at a significantly higher risk for the following:

Researchers need to conduct more substantive individual interviews from large, geographically diverse samples in order to more fully understand the depth and breadth of experiences. As noted by Kero and colleagues (2001) "The relief to be saved from unwanted parenthood did not exclude painful feelings that may reflect experiences of ethical conflicts and feelings of loss. This complexity is seldom recognized in abortion studies."

The conclusion that abortion increases mental health risks is reasonable and scientifically accurate, rendering it misleading to suggest to women that abortion has no significant mental health risks, much less is "psychologically safer" than carrying to term. Women facing an unwanted pregnancy often feel desperate and alone, fearing loss of their personal autonomy, destruction of their plans for the future, loss of others' esteem, and altered relationships in addition to viewing a baby as a responsibility that they are ill-prepared to assume. What women typically fail to see is how their decision to abort may significantly compromise the quality of their own lives and those closest to them for many years beyond the decision. They also frequently fail to see the many life enhancing aspects of having a child.

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