Women's Mental Health After Abortion

Martha Shuping
Reproduced with Permission

+ Increased Drug and Alcohol Abuse after Induced Abortion

Many studies have shown significant associations between induced abortion and drug and alcohol abuse.1,2,3,4,5,6 Some studies show substance use problems starting after an abortion, not before.7,8

+ Increased Drug and Alcohol Abuse during Subsequent Pregnancy after Abortion, Increasing Risk of Poor Pregnancy Outcomes

Mothers with a history of previous abortion are more likely to use illegal drugs and alcohol during subsequent pregnancy.9,10,11,12,13,14 In a study of pregnant women, there was no difference in risk of substance abuse between women who wanted the pregnancy compared to those who did not want the pregnancy. But higher rates of drug abuse during pregnancy were found in women who had a previous abortion compared to women who had no prior abortion.15 An increase in drug and alcohol abuse among women is a special concern because substance abuse during pregnancy has been linked to poor pregnancy and birth outcomes.16,17

+ Increased Risk of Suicide after Induced Abortion

A large record based study in Finland reported a 650% higher risk of suicide after abortion compared to women who carried to term. This study linked actual death certificates to medical records.18

A study of more than 173,000 California Medicaid records showed an increased rate of suicide that persisted for 8 years, which was not explained by prior mental illness.19

A records based U.K. report comparing suicide attempts before and after abortion indicated the increase in suicide rates after abortion was not related to prior suicidal behavior but was most likely related to adverse reactions to the abortion.20

There are reports of attempted or completed suicides coinciding with the anniversary date of the abortion or expected due date of the aborted child.21,22

+ Increased Clinical Depression after Induced Abortion

In Fergusson's 2006 study (New Zealand), women had increased rates of depression and suicidal thoughts and attempts after abortion; the association persisted after controlling for confounding factors.23

A 2003 review article, all large, long term studies in English through 2002, concluded that abortion was clearly associated with depression serious enough to cause risk of self-harm, and that women should be warned in the informed consent process.24

+ Increased Posttraumatic Stress Disorder (PTSD) after Induced Abortion

Studies show Posttraumatic Stress Disorder and symptoms of posttraumatic stress are experienced by post-abortive women.25,26 Post-abortive women in Russia and U.S. had higher scores on a trauma test compared to a population of battered women.27 PTSD has been shown to be a predictor of poor general health.28 Effects of trauma can be very long-lasting, with The National Comorbidity Study showing that more than one third of people with this disorder fail to recover even after many years.29


References:

1 Yamaguchi D, Kandel D. Drug use and other determinants of premarital pregnancy and its outcome: A dynamic analysis of competing life events. Journal of Marriage and the Family 1987; 49: 257-270. [Back]

2 Reardon DC, Ney P. Abortion and subsequent substance abuse. Am Journal of Drug & Alcohol Abuse. 2000; 26: 61-75. [Back]

3 Drower SJ, Nash ES. Therapeutic abortion on psychiatric grounds. Part I: A local study. South African Medical Journal 1978;54:604-608. [Back]

4 Houston H, Jacobson L. Overdose and termination of pregnancy: an important association? British Journal of Private Practice 1996;46:737-738. [Back]

5 Klassen AD, Wilsnack SC. Sexual experience and drinking among women in a U.S. national survey. Arch Sex Behav 1986;15:363-92. [Back]

6 Mendelson MT, Maden CB, Daling, JR. Low birth weight in relation to multiple induced abortions. American Journal of Public Health 1992;82:391-394. [Back]

7 Morrissey ER, Schuckit MA. Stressful events and alcohol problems seen at a detoxification center. Journal of Studies on Alcohol 1978;39:1559-76. [Back]

8 Coleman, PK. Induced Abortion and Increased Risk of Substance Abuse: A Review of the Evidence. Current Women's Health Reviews. 2005;1:21-34. [Back]

9 Coleman PK, Reardon DC, Rue V, Cougle J. Prior history of induced abortion in relation to substance use during subsequent pregnancies carried to term. American Journal of Obstetrics and Gynecology. 2002;187:1673-78. [Back]

10 Kuzma J, Kissinger D. Patterns of alcohol and cigarette use in pregnancy. Neurobehav Toxicol Teratol 1981;3:211-21 [Back]

11 Gladstone J, Levy M, Nulman I, et al. Characteristics of pregnant women who engage in binge alcohol consumption. CMAJ 1997;156:789-794. [Back]

12 Frank DA, et al. Cocaine use during pregnancy: Prevalence and correlates. Pediatrics 1988; 82: 888-895. [Back]

13 Graham K, Koren G. Characteristics of pregnant women exposed to cocaine in Toronto between 1985 and 1990. CMAJ 1991;144:563. [Back]

14 Oro AS, Dixon, SD. Prenatal cocaine and methamphetamine exposure: maternal and neo-natal correlates. Pediatrics 1987;111:571-578. [Back]

15 Coleman PK, Reardon DC, Cougle J. Substance use among pregnant women in the context of previous reproductive loss and desire for current pregnancy. British Journal of Health Psychology. 2005; 10 (2):255-268 (14). [Back]

16 Hutchings DE. The puzzle of cocaine's effects following maternal use during pregnancy. Are there reconcilable differences? Neurotoxicology and Teratology 1993;15:281-286. [Back]

17 Ondersma S J, Simpson S M, Brestan EV, et al. Prenatal drug exposure and social policy: The search for an appropriate response. Child Maltreatment: Journal of the American Professional Society on the Abuse of Children 2000;5: 93-108. [Back]

18 Gissler M, Hemminki E, Lonnqvist J. Suicides after pregnancy in Finland: 1987-1994: register linkage study. British Medical Journal 1996; 313: 1431-4. [Back]

19 Reardon DC, Ney PG, Scheuren FJ, Cougle JR, Coleman PK, Strahan T. "Deaths associated with pregnancy outcome: a record linkage study of low income women," Southern Medical Journal. 2002; 95 (8):834-841. [Back]

20 Morgan CM, Evans M, Peter JR, Currie C. Suicides after pregnancy: mental health may deteriorate as a direct effect of induced abortion. British Medical Journal 1997; 314: 902. [Back]

21 Tischler C. Adolescent suicide attempts following elective abortion, Pediatrics 1981; 68(5):670-671. [Back]

22 Reardon DC, Strahan TW, Thorp Jr. JM, Shuping MW. Deaths associated with abortion compared to childbirth - a review of new and old data and the medical and legal implications. Journal of Contemporary Health Law and Policy. 2004; 20(2):279-327. [Back]

23 Fergusson DM, Horwood LJ, Ridder EM. Abortion in young women and subsequent mental health. Journal of Child Psychology & Psychiatry 2006; 47(1): 16-24. [Back]

24 Thorp, JM. Jr., Hartmann, KE, Shadigian E. Long-Term Physical and Psychological Health Consequences of Induced Abortion: Review of the Evidence, Obstetrical & Gynecological Survey. 2003; 58(1):67-79. [Back]

25 Rue VM, Coleman PK, Rue JJ, et al. Induced abortion and traumatic stress: A preliminary comparison of American and Russian women. Medical Science Monitor, 10, SR5-S16. [Back]

26 Barnard C. The Long-Term Psychological Effects of Abortion. 1990. Portsmouth, NH: Institute for Pregnancy Loss. [Back]

27 Rue, op. cit. [Back]

28 Lauterbach D, Vora R, Rakow M.The relationship between posttraumatic stress disorder and self-reported health problems. Psychosomatic Medicine. 2005 Nov-Dec 67(6):939-47. [Back]

29 Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the National Comorbidity Survey. Archives General Psychiatry 1995; Dec 52(12):1048-60. [Back]

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