Abortion and mental health

Scientific and medical expert bodies have repeatedly concluded that abortion poses no greater mental health risks than carrying an unintended pregnancy to term.^[1][2][3] Nevertheless, the relationship between induced abortion and mental health is an area of political controversy.^[4][5] In 2008, the American Psychological Association concluded after a review of available evidence that induced abortion did not increase the risk of mental-health problems. In 2011, the U.K. National Collaborating Centre for Mental Health similarly concluded that first-time abortion in the first trimester does not increase the risk of mental-health problems compared with bringing the pregnancy to term.^[3][6] In 2018, The National Academies of Sciences, Engineering, and Medicine concluded that abortion does not lead to depression, anxiety, or post-traumatic stress disorder.^[1] The U.K. Royal College of Obstetricians and Gynaecologists likewise summarized the evidence by finding that abortion did not increase the risk of mental-health problems compared to women carrying an unwanted pregnancy to term.^[7] Two studies conducted on the Danish population in 2011 and 2012 analysed the association between abortion and psychiatric admission found no increase in admissions after an abortion. The same study, in fact, found an increase in psychiatric admission after first child-birth.^[8] A 2008 systematic review of the medical literature on abortion and mental health found that high-quality studies consistently showed few or no mental-health consequences of abortion, while poor-quality studies were more likely to report negative consequences.^[9]

Despite the weight of scientific and medical opinion, some

Major medical and psychiatric expert groups have consistently found that abortion does not cause mental-health problems. In 2008, the American Psychological Association reviewed the literature on abortion and mental health and concluded that the risk of mental health problems following a single, first-trimester induced abortion of an adult women is no greater than carrying an unwanted pregnancy to term. While observing that abortion may both relieve stress and "engender additional stress," they explicitly rejected the idea that abortion is "inherently traumatic."^[2] Among those women who do experience mental health issues following an abortion, the APA concluded that these issues are most likely related to pre-existing risk factors.^[2] Since these and other risk factors may also predispose some women to more negative reactions following a birth, the higher rates of mental illness observed among women with a prior history of abortion are more likely to be caused by these other factors than by abortion itself.^[2] The panel noted severe inconsistency between the outcomes reported by studies on the effect of multiple abortions. Additionally, the same factors which predispose a woman to multiple unwanted pregnancies may also predispose her to mental health difficulties. Therefore, they declined to draw a firm conclusion on studies concerning multiple abortions.^[2][19][20]

In December 2011, the U.K.

A 2020 long term-study among US women found that about 99% of women felt that they made the right decision five years after they had an abortion. Relief was the primary emotion with few women feeling sadness or guilt. Social stigma was a main factor predicting negative emotions and regret years later. The researchers also stated: "These results add to the scientific evidence that emotions about an abortion are associated with personal and social context, and are not a product of the abortion procedure itself."[21]

Some women do experience negative emotions after an abortion, but not at rates different from women who wanted an abortion and did not have one or from women who have miscarriages.^[2][18][22] Women having abortions may receive support from abortion providers,^[4][23] or national call centers like Exhale,^[24][25] as well as All-Options.^[26]

Post-abortion syndrome

The idea that abortion has negative psychological effects was widely promoted by crisis pregnancy centers in the 1970s and the term "post-abortion syndrome" has widely been used by anti-abortion advocates to broadly include any negative emotional reactions attributed to abortion.^{[4][15][22][27]}

Post-abortion syndrome has not been validated as a discrete psychiatric condition and is not recognized by the American Psychological Association, the American Psychiatric Association, the American Medical Association, the American College of Obstetricians and Gynecologists, nor the American Public Health Association.^{[10][16][22][28][29][30]} The Guttmacher Institute reports that as of August 2018, of the 22 U.S. states that include information on possible psychological responses to abortion, eight states stress negative emotional responses.^[31] Recent literature that has addressed the psychological impacts of abortion have emphasized a need to study women who have a predisposition to mental health risk before having an abortion.^[32]

Legal and political history

Under the 1967 Abortion Act, abortion in the United Kingdom was legalized only when two doctors agreed that carrying the pregnancy to term would be detrimental to a woman's physical or mental health. Consideration of mental health also played a role in the 1973 U.S. Supreme Court decision Roe v. Wade which ruled that state governments may not prohibit late terminations of pregnancy when "necessary to preserve the [woman's] life or health".^[33] This rule was clarified by the 1973 judicial decision Doe v. Bolton, which specifies "that the medical judgment may be exercised in the light of all factors—physical, emotional, psychological, familial, and the woman's age—relevant to the well-being of the patient."^[34][35][36] It is by this provision that women in the US can legally choose abortion when screenings reveal abnormalities of a viable fetus.^[37][38][39]

In 1987, U.S. President

Koop ultimately reviewed over 250 studies pertaining to the psychological impact of abortion. In January 1989, Koop wrote in a letter to Reagan that "scientific studies do not provide conclusive data about the health effects of abortion on women."[42] Koop acknowledged the political context of the question in his letter, writing: "In the minds of some of [Reagan's advisors], it was a foregone conclusion that the negative health effects of abortion on women were so overwhelming that the evidence would force the reversal of Roe vs. Wade."^[43] In later testimony before the United States Congress, Koop stated that the quality of existing evidence was too poor to prepare a report that "could withstand scientific and statistical scrutiny". Koop added that "there is no doubt about the fact that some people have severe psychological effects after abortion, but anecdotes do not make good scientific material."^[43] In his congressional testimony, Koop stated that while psychological responses to abortion may be "overwhelming" in individual cases, the psychological risks of abortion were "minuscule from a public health perspective."^{[4][41][44][45]}

Subsequently, a Congressional committee charged that Koop refused to publish the results of his review because he failed to find evidence that abortion was harmful, and that Koop watered down his findings in his letter to Reagan by claiming that the studies were inconclusive. Congressman

Later in 1989, responding to the political debate over the question, the American Psychological Association (APA) undertook a review of the scientific literature. Their review, published in the journal Science, concluded that "the weight of the evidence from scientific studies indicates that legal abortion of an unwanted pregnancy in the first trimester does not pose a psychological hazard for most women." The APA task force also concluded that "severe negative reactions after abortions are rare and can best be understood in the framework of coping with normal life stress."^[44][46]

In 1994, the U.K.'s House of Lord's Commission of Inquiry into the Operation and Consequences of The Abortion Act published a report (commonly referred to as the Rawlinson Report) which concluded that there was no scientific evidence that abortion provided any mental health benefits but instead may put women at risk for psychiatric illness greater than if woman carried to term.^[47][48][49] The Commission recommended that abortion providers "should initiate independent and long-term follow up of those clients considered to be most at risk of emotional distress." In a press release, the Rawlinson commission stated that the Royal College of Psychiatrists (RCP) had provided written testimony stating that there are "no psychiatric indications for abortion," noting that this "raises serious questions given that 91% of abortion are carried out on the grounds of the mental health of the mother."^[48] In response, the RCP issued a statement that the Rawlinson commissions summary of their written statement was "an inaccurate portrayal of the College's views on abortion," adding that "There is no evidence of increase risk of major psychiatric disorder or of long lasting psychological distress [following abortion]".^[48]

In 2006, the U.K.'s House of Commons Science and Technology Committee undertook another inquiry into scientific developments and included a request for the RCP to update their 1994 statement on abortion in light of more recent studies.^[50][51] In 2008, the RCP did update their position statement to recommend that women should be screened for risk factors that may be associated with subsequent development of mental health problems and should be counselled about the possible mental health risks of abortion.^[51][52][53] The revised RCP position statement included a recommendation for a systematic review of abortion and mental health with special consideration of "whether there is evidence for psychiatric indications for abortion."^[51] This modified opinion was influenced by a growing body of literature showing a link between abortion and mental health problems, including a 30-year longitudinal study of about 500 women born in Christchurch New Zealand,^[51][52][53] and a Cornwall inquest into the abortion related suicide of a well known British artist, Emma Beck.^[52][54] This recommendation resulted in the 2011 review conducted by the National Collaborating Centre for Mental Health.^[3]

See also

• Childbirth-related posttraumatic stress disorder
• Postpartum depression
• Postpartum psychosis
• Psychiatric disorders of childbirth

References