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Abortion has no long-term negative effects on women's mental health, study finds

Protesters demonstrating in front of the U.S. Supreme Court in March.
REUTERS/Kevin Lamarque
Protesters demonstrating in front of the U.S. Supreme Court in March.

Study after study has found no evidence that having an abortion leads to depression or other negative mental health outcomes, and the few studies that have suggested such outcomes have been shown to have serious scientific flaws.

Yet that hasn’t stopped nine states — Kansas, Louisiana, Michigan, Nebraska, North Caroline, South Dakota, Texas, Utah and West Virginia — from passing laws requiring women seeking an abortion to be counseled before an abortion that the procedure can lead to long-term psychological problems, including “feelings of grief, anxiety, lowered self-esteem, regret, sexual dysfunction, avoidance of emotional attachment, flashbacks, and substance abuse” (according to one Texas brochure).

In other words, the counselors must lie.

A new study published late last week in the journal JAMA Psychiatry — one that followed women for a full five years after they had either received or been denied an abortion — underscores the scope of that lie. It found that women who had an abortion were no more likely to develop psychological problems than those who tried to get an abortion but were denied one and ended up giving birth.

In fact, women in the study who were denied an abortion reported, on average, more depression and anxiety during the first six to 12 months after receiving the denial than did the women who wanted and underwent the procedure. 

“These findings do not support policies that restrict women’s access to abortion on the basis that abortion harms women’s mental health,” conclude the University of California, San Francisco (UCSF) researchers who conducted the study.

Study details

For the study, the UCSF researchers used five years of data from the Turnaway Study, a prospective longitudinal study designed to determine the effects of unintended pregnancy on women’s lives. The data was collected from 956 women (average age: 25) from 30 different abortion clinics in 21 states between January 2008 and December 2010.   

The women fell into three categories: 1) women (273) who received an abortion in the first trimester (12 weeks) of pregnancy; 2) women (452) who sought an abortion up to two weeks under a facility’s gestational limit (which ranged from 10 weeks through the end of the second trimester) and were able to receive one; and 3) women (231) who sought an abortion up to three weeks past a facility’s gestational limit and were turned away without receiving an abortion. The “turnaway” group were furthered divided into those who eventually gave birth (161) and those who later miscarried or had an abortion elsewhere (70).

There were no significant differences among the three groups of women in terms of their educational level, martial status, mental health history or prior drug or alcohol use — factors that might affect their psychological health. The study, therefore, was able to compare two similar groups of women whose main differentiating characteristic was whether they succeeded or failed to obtain a wanted abortion. And it was able to follow them for a significant period of time.

That hadn't been done before.

Key findings

The women were interviewed on the phone 11 times: eight days after having or being denied an abortion, and then every six months for five years. The questions they were asked included ones designed to assess their mental health.

About 5 percent of the 956 women were “lost” to the study at the time of each interview. On average, the women participated in 8.2 interviews, and 558 women completed all 11 interviews.

During the initial interview, the women who had been denied an abortion reported higher levels of anxiety, lower self-esteem and lower life satisfaction than the women who received the procedure.

Those initial elevated levels of distress “may be a response to being denied an abortion, as well as other social and emotional challenges faced on discovery of unwanted pregnancy and abortion seeking,” the UCSF researchers write. “The reasons women give for seeking abortion — not having enough money, partner issues, bad timing, needing to focus on existing children, and not being emotionally or mentally prepared — are indicative of their difficult circumstances at the time they seek an abortion.”

Within six months to a year, however, the symptoms had improved among the women denied an abortion and were similar to those reported by the other women.

As for depression, the women who had the fewest symptoms eight days after seeking an abortion were those who had undergone a first-trimester abortion. Symptoms of depression dropped over time for all of the study’s groups, however, although it eventually stopped falling and plateaued for the subgroup of women who had been denied an abortion and went on to give birth.

“Similar to what has been found in other studies, the most significant factors associated with experiencing adverse mental health outcomes following abortion were a history of mental health conditions and experiences of traumatic life events, such as child abuse and neglect,” the UCSF resesarchers point out.

“Women with such a history are at greater risk of experiencing adverse outcomes and may have poorer mental health outcomes if they are denied an abortion that if they receive a wanted abortion,” they add. “By understanding that each woman’s experience is unique and that women will vary in their responses to having an abortion or being denied an abortion, we can better serve women’s individual needs.”

Needed: accurate information

The current study, like all studies, has its limitations. Most notably, the study lost 42 percent of its participants by the end of the five years — a factor that could have affected the results, as women with adverse mental health outcomes may have been less likely to continue to answer the researchers’ questions. The researchers believe, however, that other statistical characteristics of the study mitigate those concerns.

Yet even with its limitations, the study’s findings are impressive, for, as its authors point out, the study takes into account pre-existing mental health conditions and compares the experiences of women with both possible outcomes of an unwanted pregnancy — abortion and carrying the pregnancy to term.  

And it followed the women for a significant period of time.

“There is no evidence to justify laws that require women seeking abortion to be forewarned about negative psychological responses,” the UCSF researchers conclude.

“Women considering abortion are best served,” they add, “by being provided with the most accurate, scientific information available to help them make their pregnancy decisions.”

In other words, they are best served by being told the truth..

FMI: You can download and read the study in full at the JAMA Psychiatry website.

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