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The relationship between induced '''] and ]''' is an area of controversy.<ref name="Bazelon"/><ref name="now">{{cite news | url= http://www.pbs.org/now/shows/329/index.html | title = Post-Abortion Politics | publisher = ] | work = ] | date = 2007-07-20 | accessdate = 2008-11-18}}</ref><ref name="rcpsych2008"/> The issue has been part of the ], dating to 1988 when ] ] directed ] ] to produce a report on physical and psychological effects of abortion in the expectation that such a report could be used to justify restricting access to abortion.<ref name="nlm"/> Pre-existing factors in a woman's life, such as emotional attachment to the pregnancy, lack of social support, pre-existing psychiatric illness, and conservative views on abortion increase the likelihood of experiencing negative feelings after an abortion.<ref name="APA89">{{cite journal |author=Adler NE, David HP, Major BN, Roth SH, Russo NF, Wyatt GE |title=Psychological responses after abortion |journal=Science |volume=248 |issue=4951 |pages=41–4 |year=1990 |pmid=2181664 |doi=10.1126/science.2181664}}</ref><ref>{{cite journal | journal=Fam Plann Perspect | title = Abortion Study Finds No Long-Term Ill Effects On Emotional Well-Being | last = Edwards | first = S | volume = 29 | issue = 4 | pages = 193–194 | year = 1997 | url=http://findarticles.com/p/articles/mi_qa3634/is_199707/ai_n8772240 | doi=10.2307/2953388 | jstor=2953388}}</ref><ref>{{cite journal |author=Steinberg JR, Russo NF |title=Abortion and anxiety: what's the relationship? |journal=Soc Sci Med |volume=67 |issue=2 |pages=238–52 |year=2008 |month=July |pmid=18468755 |doi=10.1016/j.socscimed.2008.03.033 |url=}}</ref> The relationship between induced '''] and ]''' is an area of controversy.<ref name="Bazelon"/><ref name="now">{{cite news | url= http://www.pbs.org/now/shows/329/index.html | title = Post-Abortion Politics | publisher = ] | work = ] | date = 2007-07-20 | accessdate = 2008-11-18}}</ref><ref name="rcpsych2008"/> The issue has been part of the ], dating to 1988 when ] ] directed ] ] to produce a report on physical and psychological effects of abortion in the expectation that such a report could be used to justify restricting access to abortion.<ref name="nlm"/> There is no ] of a ] between abortion and poor mental health.<ref name="newscientist"/><ref name="moreonkoop">{{cite journal |author= |title=More on Koop's study of abortion |journal=Fam Plann Perspect |volume=22 |issue=1 |pages=36–9 |year=1990 |pmid=2323405 |doi= 10.2307/2135437|jstor=2135437}}</ref> Pre-existing factors in a woman's life, such as emotional attachment to the pregnancy, lack of social support, pre-existing psychiatric illness, and conservative views on abortion increase the likelihood of experiencing negative feelings after an abortion.<ref name="APA89">{{cite journal |author=Adler NE, David HP, Major BN, Roth SH, Russo NF, Wyatt GE |title=Psychological responses after abortion |journal=Science |volume=248 |issue=4951 |pages=41–4 |year=1990 |pmid=2181664 |doi=10.1126/science.2181664}}</ref><ref>{{cite journal | journal=Fam Plann Perspect | title = Abortion Study Finds No Long-Term Ill Effects On Emotional Well-Being | last = Edwards | first = S | volume = 29 | issue = 4 | pages = 193–194 | year = 1997 | url=http://findarticles.com/p/articles/mi_qa3634/is_199707/ai_n8772240 | doi=10.2307/2953388 | jstor=2953388}}</ref><ref>{{cite journal |author=Steinberg JR, Russo NF |title=Abortion and anxiety: what's the relationship? |journal=Soc Sci Med |volume=67 |issue=2 |pages=238–52 |year=2008 |month=July |pmid=18468755 |doi=10.1016/j.socscimed.2008.03.033 |url=}}</ref>


In 1990, the ] (APA) found that "severe negative reactions are rare and are in line with those following other normal life stresses."<ref name="moreonkoop">{{cite journal |author= |title=More on Koop's study of abortion |journal=Fam Plann Perspect |volume=22 |issue=1 |pages=36–9 |year=1990 |pmid=2323405 |doi= 10.2307/2135437|jstor=2135437}}</ref> The APA revised and updated its findings in August 2008 to account for the accumulation of new evidence, and again concluded that termination of a first, unplanned pregnancy did not lead to an increased risk of mental health problems. The data for multiple abortions were more equivocal, as the same factors that predispose a woman to multiple unwanted pregnancies may also predispose her to mental health difficulties.<ref name="apa-2008"/><ref name="nyt-aug-2008">{{cite news | publisher = '']'' | url = http://www.nytimes.com/2008/08/13/health/research/13brfs-ABORTIONDOES_BRF.html | title= Abortion Does Not Cause Mental Illness, Panel Says | last = Carey | first = Benedict | date= 2008-08-12 | accessdate= 2008-08-12}}</ref> A 2008 ] 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 studies with methodological flaws and other quality problems were more likely to report negative consequences.<ref name="charles-2008">{{cite journal |author=Charles VE, Polis CB, Sridhara SK, Blum RW |title=Abortion and long-term mental health outcomes: a systematic review of the evidence |journal=Contraception |volume=78 |issue=6 |pages=436&ndash;50 |year=2008 |pmid=19014789 |doi=10.1016/j.contraception.2008.07.005}}</ref> As of August 2008, the ] ] is also performing a ] of the medical literature to update their position statement on the subject, which is expected to be published in autumn 2011.<ref name="rcp-2">{{cite web | publisher = ] | title = Induced Abortion and Mental Health: A systematic review of the mental health impact of induced abortion | url = http://www.rcpsych.ac.uk/members/nccmh/consultations.aspx | accessdate=August 1, 2011}}</ref> In 1990, the ] (APA) found that "severe negative reactions are rare and are in line with those following other normal life stresses."<ref name="moreonkoop"/> The APA revised and updated its findings in August 2008 to account for the accumulation of new evidence, and again concluded that termination of a first, unplanned pregnancy did not lead to an increased risk of mental health problems. The data for multiple abortions were more equivocal, as the same factors that predispose a woman to multiple unwanted pregnancies may also predispose her to mental health difficulties.<ref name="apa-2008"/><ref name="nyt-aug-2008">{{cite news | publisher = '']'' | url = http://www.nytimes.com/2008/08/13/health/research/13brfs-ABORTIONDOES_BRF.html | title= Abortion Does Not Cause Mental Illness, Panel Says | last = Carey | first = Benedict | date= 2008-08-12 | accessdate= 2008-08-12}}</ref> A 2008 ] 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 studies with methodologic flaws and other quality problems were more likely to report negative consequences.<ref name="charles-2008">{{cite journal |author=Charles VE, Polis CB, Sridhara SK, Blum RW |title=Abortion and long-term mental health outcomes: a systematic review of the evidence |journal=Contraception |volume=78 |issue=6 |pages=436&ndash;50 |year=2008 |pmid=19014789 |doi=10.1016/j.contraception.2008.07.005}}</ref> As of August 2008, the ] ] is also performing a ] of the medical literature to update their position statement on the subject, which is expected to be published in autumn 2011.<ref name="rcp-2">{{cite web | publisher = ] | title = Induced Abortion and Mental Health: A systematic review of the mental health impact of induced abortion | url = http://www.rcpsych.ac.uk/members/nccmh/consultations.aspx | accessdate=August 1, 2011}}</ref>


Some proposed negative ] effects of abortion have been referred to by ] advocates as a separate condition called "post-abortion syndrome." However, the existence of "post-abortion syndrome" is not recognized by any medical or psychological organization,<ref name="Grimes">{{cite journal |author=Grimes DA, Creinin MD |title=Induced abortion: an overview for internists |journal=Ann. Intern. Med. |volume=140 |issue=8 |pages=620–6 |year=2004 |pmid=15096333 |doi=10.1001/archinte.140.5.620 }} Key summary points: ''"Abortion does not lead to an increased risk for breast cancer or other late psychiatric or medical sequelae."'' On p. 624, the authors state: ''"The alleged 'postabortion trauma syndrome' does not exist."''</ref> and some ]s and ] advocates have argued that the effort to popularize the idea of a "post-abortion syndrome" is a tactic used by pro-life advocates for political purposes.<ref name="Bazelon">{{cite news | publisher = '']'' | url = http://www.nytimes.com/2007/01/21/magazine/21abortion.t.html | title = Is There a Post-Abortion Syndrome? | last = Bazelon | first = Emily | authorlink = Emily Bazelon | date = 2007-01-21| accessdate = 2008-01-11}}</ref><ref name="Mooney">{{cite news | url = http://www.washingtonmonthly.com/features/2004/0410.mooney.html |title = Research and Destroy: How the religious right promotes its own 'experts' to combat mainstream science | last = Mooney | first = Chris | authorlink = Chris Mooney | publisher = '']''| date = October 2004}}</ref><ref name="stotlandreview">{{cite journal |author=Stotland NL |title=Abortion and psychiatric practice |journal=J Psychiatr Pract |volume=9 |issue=2 |pages=139–49 |year=2003 |pmid=15985924 |doi=10.1097/00131746-200303000-00005}} ''"Currently, there are active attempts to convince the public and women considering abortion that abortion frequently has negative psychiatric consequences. This assertion is not borne out by the literature: the vast majority of women tolerate abortion without psychiatric sequelae."''</ref><ref name=stotland_1404747>{{cite journal |author=Stotland NL |title=The myth of the abortion trauma syndrome |journal=JAMA |volume=268 |issue=15 |pages=2078–9 |year=1992 |month=October |pmid=1404747 |doi= 10.1001/jama.268.15.2078|url=}}</ref> Some ] have mandated that patients be told that abortion increases their risk of depression and suicide, despite the fact that such risks are not supported by the bulk of the scientific literature.<ref name="charles-2008" /><ref name="nejm-sd">{{cite journal |author=Lazzarini Z |title=South Dakota's Abortion Script – Threatening the Physician-Patient Relationship |journal=N. Engl. J. Med. |volume=359 |issue=21 |pages=2189–2191 |year=2008 |month=November |pmid=19020321 |doi=10.1056/NEJMp0806742 |url=http://content.nejm.org/cgi/content/full/359/21/2189|quote=''The purported increased risks of psychological distress, depression, and suicide that physicians are required to warn women about are not supported by the bulk of the scientific literature. By requiring physicians to deliver such misinformation and discouraging them from providing alternative accurate information, the statute forces physicians to violate their obligation to solicit truly informed consent.''}}</ref> Some proposed negative ] effects of abortion have been referred to by ] advocates as a separate condition called "post-abortion syndrome." However, the existence of "post-abortion syndrome" is not recognized by any medical or psychological organization,<ref name="Grimes">{{cite journal |author=Grimes DA, Creinin MD |title=Induced abortion: an overview for internists |journal=Ann. Intern. Med. |volume=140 |issue=8 |pages=620–6 |year=2004 |pmid=15096333 |doi=10.1001/archinte.140.5.620 }} Key summary points: ''"Abortion does not lead to an increased risk for breast cancer or other late psychiatric or medical sequelae."'' On p. 624, the authors state: ''"The alleged 'postabortion trauma syndrome' does not exist."''</ref> and some ]s and ] advocates have argued that the effort to popularize the idea of a "post-abortion syndrome" is a tactic used by pro-life advocates for political purposes.<ref name="Bazelon">{{cite news | publisher = '']'' | url = http://www.nytimes.com/2007/01/21/magazine/21abortion.t.html | title = Is There a Post-Abortion Syndrome? | last = Bazelon | first = Emily | authorlink = Emily Bazelon | date = 2007-01-21| accessdate = 2008-01-11}}</ref><ref name="Mooney">{{cite news | url = http://www.washingtonmonthly.com/features/2004/0410.mooney.html |title = Research and Destroy: How the religious right promotes its own 'experts' to combat mainstream science | last = Mooney | first = Chris | authorlink = Chris Mooney | publisher = '']''| date = October 2004}}</ref><ref name="stotlandreview">{{cite journal |author=Stotland NL |title=Abortion and psychiatric practice |journal=J Psychiatr Pract |volume=9 |issue=2 |pages=139–49 |year=2003 |pmid=15985924 |doi=10.1097/00131746-200303000-00005}} ''"Currently, there are active attempts to convince the public and women considering abortion that abortion frequently has negative psychiatric consequences. This assertion is not borne out by the literature: the vast majority of women tolerate abortion without psychiatric sequelae."''</ref><ref name=stotland_1404747>{{cite journal |author=Stotland NL |title=The myth of the abortion trauma syndrome |journal=JAMA |volume=268 |issue=15 |pages=2078–9 |year=1992 |month=October |pmid=1404747 |doi= 10.1001/jama.268.15.2078|url=}}</ref> Some ] have mandated that patients be told that abortion increases their risk of depression and suicide, despite the fact that such risks are not supported by the bulk of the scientific literature.<ref name="nejm-sd">{{cite journal |author=Lazzarini Z |title=South Dakota's Abortion Script – Threatening the Physician-Patient Relationship |journal=N. Engl. J. Med. |volume=359 |issue=21 |pages=2189–2191 |year=2008 |month=November |pmid=19020321 |doi=10.1056/NEJMp0806742 |url=http://content.nejm.org/cgi/content/full/359/21/2189|quote=''The purported increased risks of psychological distress, depression, and suicide that physicians are required to warn women about are not supported by the bulk of the scientific literature. By requiring physicians to deliver such misinformation and discouraging them from providing alternative accurate information, the statute forces physicians to violate their obligation to solicit truly informed consent.''}}</ref><ref name="charles-2008" />


==Post-Abortion Syndrome== ==Post-Abortion Syndrome==
The term "post-abortion syndrome" was first used in 1981 by ], a ], in testimony before ] in which he stated that he had observed ] which developed in response to the stress of abortion. Rue proposed the name "post-abortion syndrome" (PAS) to describe this phenomenon.<ref>Vincent Rue, "Abortion and Family Relations," testimony before the Subcommittee on the Constitution of the US Senate Judiciary Committee, U.S. Senate, 97th Congress, Washington, DC (1981).</ref><ref>{{cite journal | journal = J Soc Issues | author = Speckhard A, Rue V | title = Postabortion Syndrome: An Emerging Public Health Concern | volume = 48 | issue = 3 | year = 1992 | pages = 95–119 | doi = 10.1111/j.1540-4560.1992.tb00899.x}}</ref> The term "post-abortion syndrome" was first used in 1981 by ], a ], in testimony before ] in which he stated that he had observed ] which developed in response to the stress of abortion. Rue proposed the name "post-abortion syndrome" (PAS) to describe this phenomenon.<ref>Vincent Rue, "Abortion and Family Relations," testimony before the Subcommittee on the Constitution of the US Senate Judiciary Committee, U.S. Senate, 97th Congress, Washington, DC (1981).</ref><ref>{{cite journal | journal = J Soc Issues | author = Speckhard A, Rue V | title = Postabortion Syndrome: An Emerging Public Health Concern | volume = 48 | issue = 3 | year = 1992 | pages = 95–119 | doi = 10.1111/j.1540-4560.1992.tb00899.x}}</ref>


The term post-abortion syndrome (PAS) has subsequently been popularized and widely used by pro-life advocates to describe a broad range of adverse emotional reactions which they attribute to abortion.<ref name="Bazelon"/><ref name="Mooney"/><ref name="BostonG">{{cite news | url = http://www.boston.com/news/nation/washington/articles/2005/07/31/science_in_support_of_a_cause_the_new_research/?rss_id=Boston+Globe+--+National+News | title = Science in support of a cause: the new research | last = Kranish | first = Michael | publisher = '']'' | date = 2005-07-31 | accessdate= 2007-11-27}}</ref> "Post-abortion syndrome" has not found widespread acceptance outside the pro-life community; the ] and the ] do not recognize PAS as an actual diagnosis or condition, and it is not included in the ''Diagnostic and Statistical Manual of Mental Disorders'' ] or in the ] list of psychiatric conditions. Some ]s and ] have argued that the focus on "post-abortion syndrome" is a tactic used by pro-life advocates for political purposes.<ref name="stotlandreview"/><ref name="stotland_1404747"/><ref>{{cite news | last = Cooper | first = Cynthia |url = http://www.msmagazine.com/aug01/pas.html | title = Abortion Under Attack | publisher = '']'' | date = August/September 2001 | accessdate = 2008-11-18}}</ref><ref name="JSoc2">{{cite journal |author=Russo NF, Denious JE |title=Controlling birth: science, politics, and public policy |journal=J Soc Issues |volume=61 |issue=1 |pages=181–91 |year=2005 |pmid=17073030 |doi=10.1111/j.0022-4537.2005.00400.x}}</ref> The term post-abortion syndrome (PAS) has subsequently been popularized and widely used by pro-life advocates to describe a broad range of adverse emotional reactions which they attribute to abortion.<ref name="Bazelon"/><ref name="Mooney"/><ref name="BostonG">{{cite news | url = http://www.boston.com/news/nation/washington/articles/2005/07/31/science_in_support_of_a_cause_the_new_research/?rss_id=Boston+Globe+--+National+News | title = Science in support of a cause: the new research | last = Kranish | first = Michael | publisher = '']'' | date = 2005-07-31 | accessdate= 2007-11-27}}</ref> "Post-abortion syndrome" has not found widespread acceptance outside the pro-life community; the ] and the ] do not recognize PAS as an actual diagnosis or condition, and it is not included in the ''Diagnostic and Statistical Manual of Mental Disorders'' ] or in the ] list of psychiatric conditions. Some ]s and ] have argued that the focus on "post-abortion syndrome" is a tactic used by pro-life advocates for political purposes.<ref name="stotlandreview"/><ref name="stotland_1404747"/><ref>{{cite news | last = Cooper | first = Cynthia |url = http://www.msmagazine.com/aug01/pas.html | title = Abortion Under Attack | publisher = '']'' | date = August/September 2001 | accessdate = 2008-11-18}}</ref><ref name="JSoc2">{{cite journal |author=Russo NF, Denious JE |title=Controlling birth: science, politics, and public policy |journal=J Soc Issues |volume=61 |issue=1 |pages=181–91 |year=2005 |pmid=17073030 |doi=10.1111/j.0022-4537.2005.00400.x}}</ref>


⚫ While some studies have reported a ] between abortion and clinical depression, anxiety, suicidal behaviors, or adverse effects on women's sexual functions for a small number of women, these studies are typically methodologically flawed and fail to account for ]. Higher-quality studies have consistently found no causal relationship between abortion and mental-health problems.<ref name="charles-2008"/> The correlations observed in some studies may be explained by pre-existing social circumstances and emotional health.<ref>{{ cite news | publisher = '']'' | url = http://www.time.com/time/magazine/article/0,9171,903771-1,00.html | title = Abortion on Demand | date = 1973-01-29 | accessdate = 2008-11-18}}</ref> Various factors, such as emotional attachment to the pregnancy, lack of support, and conservative views on abortion, may increase the likelihood of experiencing negative reactions.
==Studies==
{{POV-section|Coleman's new meta-analysis|date=September 2011}}
⚫ While some studies have reported a ] between abortion and clinical depression, anxiety, suicidal behaviors, or adverse effects on women's sexual functions for a small number of women, these studies are typically methodologically flawed and fail to account for ].{{Citation needed|date=September 2011}} Higher-quality{{Failed verification|date=September 2011}} studies have consistently found no causal relationship between abortion and mental-health problems.<ref name="charles-2008"/> The correlations observed in some studies may be explained by pre-existing social circumstances and emotional health.<ref>{{cite news | publisher = '']'' | url = http://www.time.com/time/magazine/article/0,9171,903771-1,00.html | title = Abortion on Demand | date = 1973-01-29 | accessdate = 2008-11-18}}</ref> Various factors, such as emotional attachment to the pregnancy, lack of support, and conservative views on abortion, may increase the likelihood of experiencing negative reactions.{{Citation needed|date=September 2011}}


In 2008, a team at ] in ] concluded, in a ] of the medical literature, that "the best quality studies indicate no significant differences in long-term mental health between women in the United States who choose to terminate a pregnancy and those who do not."<ref name="charles-2008"/><ref name=jhu>{{cite news | url = http://www.msnbc.msn.com/id/28050494/from/ET/ | title = Abortion not seen linked with depression | quote = Review of studies found no evidence of emotional harm after procedure | publisher = ] | date = December 4, 2008}}</ref>{{Failed verification|date=September 2011}} Dr. Robert Blum, the senior author on the study, stated: "The best research does not support the existence of a 'post-abortion syndrome' similar to post-traumatic stress disorder." The researchers further reported that "... studies with the most flawed methodology consistently found negative mental health consequences of abortion," and wrote: "Scientists are still conducting research to answer politically motivated questions."{{Citation needed|date=September 2011}} In 2008, a team at ] in ] concluded, in a ] of the medical literature, that "the best quality studies indicate no significant differences in long-term mental health between women in the United States who choose to terminate a pregnancy and those who do not."<ref name="charles-2008"/><ref name=jhu>{{cite news | url = http://www.msnbc.msn.com/id/28050494/from/ET/ | title = Abortion not seen linked with depression | quote = Review of studies found no evidence of emotional harm after procedure | publisher = ] | date = December 04, 2008}}</ref> Dr. Robert Blum, the senior author on the study, stated: "The best research does not support the existence of a 'post-abortion syndrome' similar to post-traumatic stress disorder." The researchers further reported that "... studies with the most flawed methodology consistently found negative mental health consequences of abortion," and wrote: "Scientists are still conducting research to answer politically motivated questions."

In 2011 a review published in the '']'' suggests "that there is a significant increase in mental health problems after abortion."<ref name="BJP">{{cite web|url = http://bjp.rcpsych.org/content/199/3/A11.full#sec-3|title =Abortion, mental health and dental disease|publisher = ]|quote=A comprehensive review of the literature suggests that there is a significant increase in mental health problems after abortion. Coleman (pp. 180–186) suggests that these risks need to be reflected in the delivery of abortion services, and raises the thorny issue that 90% of UK abortions are justified on the presumption that abortion actually reduces the risk to mental health associated with continuing the pregnancy.|accessdate = 1 September 2011}}</ref><ref name="Coleman">{{Cite journal | doi = 10.1192/bjp.bp.110.077230 | volume = 199 | issue = 3 | pages = 180–186 | last = Coleman | first = Priscilla K. | title = Abortion and mental health: quantitative synthesis and analysis of research published 1995–2009 | journal = The British Journal of Psychiatry | accessdate = 2011-09-02 | year = 2011 | archiveurl = http://www.lifesitenews.com/images/pdfs/coleman_review_final_proof%5B1%5D.pdf | archivedate = 2011-09-01 | url = http://bjp.rcpsych.org/content/199/3/180.abstract}}</ref> However, the ] responded to the review with a position statement in which they said that three previously published systematic reviews and the RCOG guideline development group (who reviewed all available literature up to February 2011) have concluded that women who have an abortion are not at increased risk of mental health problems when compared with women who continue an unintended pregnancy. Furthermore, they questioned the fact that while the paper's findings pointed to increased substance misuse and suicidal behaviors among the groups of women, the research did not fully examine if these women had pre-existing mental health complications such as dependency issues and mood disorders before the abortion.<ref>http://www.rcog.org.uk/what-we-do/campaigning-and-opinions/statement/rcog-statement-bjpsych-paper-mental-health-risks-and-a</ref>


==Current and historical reviews== ==Current and historical reviews==
{{POV-section|This article needs to assume that professionals DISAGREE on this major issue. It currently basically assumes only one side.|date=September 2011}}
]s of the scientific literature have concluded that that there are no difference in the long-term mental health of women who obtain induced abortions as compared to women in appropriate control groups.<ref name="charles-2008"/> ]s of the scientific literature have concluded that that there are no difference in the long-term mental health of women who obtain induced abortions as compared to women in appropriate control groups.<ref name="charles-2008"/>


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Ultimately, Koop reviewed over 250 studies pertaining to the psychological impact of abortion. Koop wrote in a letter to Reagan that "scientific studies do not provide conclusive data about the health effects of abortion on women."<ref name="times1-11-89">{{cite news | url = http://query.nytimes.com/gst/fullpage.html?res=950DE2DC143DF932A25752C0A96F948260 | title = Koop's Stand on Abortion's Effect Surprises Friends and Foes Alike | last = Tolchin | first = Martin | publisher = '']'' | date = 1989-01-11 | accessdate = 2008-02-18}}</ref> Koop acknowledged the political context of the question in his letter, writing: "In the minds of some of , 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''."<ref name="times3-17-89"/> Ultimately, Koop reviewed over 250 studies pertaining to the psychological impact of abortion. Koop wrote in a letter to Reagan that "scientific studies do not provide conclusive data about the health effects of abortion on women."<ref name="times1-11-89">{{cite news | url = http://query.nytimes.com/gst/fullpage.html?res=950DE2DC143DF932A25752C0A96F948260 | title = Koop's Stand on Abortion's Effect Surprises Friends and Foes Alike | last = Tolchin | first = Martin | publisher = '']'' | date = 1989-01-11 | accessdate = 2008-02-18}}</ref> Koop acknowledged the political context of the question in his letter, writing: "In the minds of some of , 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''."<ref name="times3-17-89"/>


In later testimony before the ], Koop stated that the quality of existing evidence was too poor to prepare a report "that could withstand scientific and statistical scrutiny." Koop noted that "...&nbsp;there is no doubt about the fact that some people have severe psychological effects after abortion, but anecdotes do not make good scientific material."<ref name="times3-17-89">{{cite news | url = http://query.nytimes.com/gst/fullpage.html?res=950DEEDF1F3CF934A25750C0A96F948260 | title = Koop Says Abortion Report Couldn't Survive Challenge | last = Leary | first = Warren | publisher = '']'' | date = 1989-03-17| accessdate = 2008-02-18}}</ref> In his congressional testimony, Koop stated that while psychological responses to abortion may be "overwhelming" in individual cases, the psychological risks of abortion were "miniscule from a public health perspective."<ref name="Bazelon"/><ref name="APA89"/><ref name="washingtonmonthly"/><ref name="newscientist">{{cite news | url = http://www.newscientist.com/article/mg12416951.000-reagans-officials-suppressed-research-on-abortion-.html | title = Reagan's officials 'suppressed' research on abortion | last = Joyce | first = Christopher | publisher = '']'' | date = 1989-12-16| accessdate = 2008-02-18}}</ref> In later testimony before the ], Koop stated that the quality of existing evidence was too poor to prepare a report "that could withstand scientific and statistical scrutiny." Koop noted that "...&nbsp;there is no doubt about the fact that some people have severe psychological effects after abortion, but anecdotes do not make good scientific material."<ref name="times3-17-89">{{cite news | url = http://query.nytimes.com/gst/fullpage.html?res=950DEEDF1F3CF934A25750C0A96F948260 | title = Koop Says Abortion Report Couldn't Survive Challenge | last = Leary | first = Warren | publisher = '']'' | date = 1989-03-17| accessdate = 2008-02-18}}</ref> In his congressional testimony, Koop stated that while psychological responses to abortion may be "overwhelming" in individual cases, the psychological risks of abortion were "miniscule from a public health perspective."<ref name="Bazelon"/><ref name="newscientist">{{cite news | url = http://www.newscientist.com/article/mg12416951.000-reagans-officials-suppressed-research-on-abortion-.html | title = Reagan's officials 'suppressed' research on abortion | last = Joyce | first = Christopher | publisher = '']'' | date = 1989-12-16| accessdate = 2008-02-18}}</ref><ref name="APA89"/><ref name="washingtonmonthly"/>


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 ] (]-]), who oversaw the investigation, argued that when Koop found no evidence that abortion was harmful, he "decided not to issue a report, but instead to write a letter to the president which would be sufficiently vague as to avoid supporting the pro-choice position that abortion is safe for women."<ref name="newscientist"/> 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 ] (]-]), who oversaw the investigation, argued that when Koop found no evidence that abortion was harmful, he "decided not to issue a report, but instead to write a letter to the president which would be sufficiently vague as to avoid supporting the pro-choice position that abortion is safe for women."<ref name="newscientist"/>


===American Psychological Association (1990, 2008)=== ===American Psychological Association (1990, 2008)===
The ] prepared a literature summary and recommendations for Koop's report. After Koop refused to issue their findings, the APA panel published them in the journal '']'', concluding that "Although there may be sensations of regret, sadness, or guilt, 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."<ref name="APA89"/> The panel also noted that "...women who are terminating pregnancies that are wanted and personally meaningful, who lack support from their partner or parents for the abortion, or who have more conflicting feelings or are less sure of their decision before hand may be a relatively higher risk for negative consequences."<ref name="APA89"/> The ] prepared a literature summary and recommendations for Koop's report. After Koop refused to issue their findings, the APA panel published them in the journal '']'', concluding that "Although there may be sensations of regret, sadness, or guilt, 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."<ref name="APA89"/> The panel also noted that "...women who are terminating pregnancies that are wanted and personally meaningful, who lack support from their partner or parents for the abortion, or who have more conflicting feelings or are less sure of their decision before hand may be a relatively higher risk for negative consequences."<ref name="APA89"/>


The APA task force also concluded that "research with diverse samples, different measures of response, and different times of assessment have come to similar conclusions. The time of greatest distress is likely to be before the abortion. Severe negative reactions after abortions are rare and can best be understood in the framework of coping with normal life stress."<ref name="APA89"/> Nancy Adler, professor of psychology at the ], has testified on behalf of the APA that "severe negative reactions are rare and are in line with those following other normal life stresses."<ref name="moreonkoop"/><ref>{{cite news | url = http://query.nytimes.com/gst/fullpage.html?res=9C0CEEDE133FF935A35757C0A966958260 | title= Study Finds Little Lasting Distress From Abortion | publisher = '']'' | date = 1990-04-06| accessdate = 2008-11-18}}</ref> The APA task force also concluded that "research with diverse samples, different measures of response, and different times of assessment have come to similar conclusions. The time of greatest distress is likely to be before the abortion. Severe negative reactions after abortions are rare and can best be understood in the framework of coping with normal life stress."<ref name="APA89"/> Nancy Adler, professor of psychology at the ], has testified on behalf of the APA that "severe negative reactions are rare and are in line with those following other normal life stresses."<ref name="moreonkoop"/><ref>{{cite news | url = http://query.nytimes.com/gst/fullpage.html?res=9C0CEEDE133FF935A35757C0A966958260 | title= Study Finds Little Lasting Distress From Abortion | publisher = '']'' | date = 1990-04-06| accessdate = 2008-11-18}}</ref>


In 2007, APA established a new task force to review studies on abortion published since 1989.<ref name="Bazelon"/> The APA task force issued an updated summary of medical evidence in August 2008, again concluding that a single first-trimester abortion carried no more mental health risk than carrying a pregnancy to term. The panel noted a lack of quality data on the effect of multiple abortions. Additionally, the same factors which predispose a woman to multiple unwanted pregnancies may also predipose her to mental health difficulties; therefore, they declined to draw a firm conclusion on multiple abortions.<ref name="apa-2008">{{cite web | url = http://www.apa.org/releases/abortion-report.pdf APA | title = Task Force on Mental Health and Abortion | publisher = ] | accessdate = 2008-08-28}}</ref><ref name="nyt-aug-2008"/> In 2007, APA established a new task force to review studies on abortion published since 1989.<ref name="Bazelon"/> The APA task force issued an updated summary of medical evidence in August 2008, again concluding that a single first-trimester abortion carried no more mental health risk than carrying a pregnancy to term. The panel noted a lack of quality data on the effect of multiple abortions. Additionally, the same factors which predispose a woman to multiple unwanted pregnancies may also predipose her to mental health difficulties; therefore, they declined to draw a firm conclusion on multiple abortions.<ref name="apa-2008">{{cite web | url = http://www.apa.org/releases/abortion-report.pdf APA | title = Task Force on Mental Health and Abortion | publisher = ] | accessdate = 2008-08-28}}</ref><ref name="nyt-aug-2008"/>

Revision as of 16:31, 6 September 2011

The relationship between induced abortion and mental health is an area of controversy. The issue has been part of the political debate over abortion, dating to 1988 when President Ronald Reagan directed U.S. Surgeon General C. Everett Koop to produce a report on physical and psychological effects of abortion in the expectation that such a report could be used to justify restricting access to abortion. There is no scientific evidence of a causal relationship between abortion and poor mental health. Pre-existing factors in a woman's life, such as emotional attachment to the pregnancy, lack of social support, pre-existing psychiatric illness, and conservative views on abortion increase the likelihood of experiencing negative feelings after an abortion.

In 1990, the American Psychological Association (APA) found that "severe negative reactions are rare and are in line with those following other normal life stresses." The APA revised and updated its findings in August 2008 to account for the accumulation of new evidence, and again concluded that termination of a first, unplanned pregnancy did not lead to an increased risk of mental health problems. The data for multiple abortions were more equivocal, as the same factors that predispose a woman to multiple unwanted pregnancies may also predispose her to mental health difficulties. 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 studies with methodologic flaws and other quality problems were more likely to report negative consequences. As of August 2008, the United Kingdom Royal College of Psychiatrists is also performing a systematic review of the medical literature to update their position statement on the subject, which is expected to be published in autumn 2011.

Some proposed negative psychological effects of abortion have been referred to by pro-life advocates as a separate condition called "post-abortion syndrome." However, the existence of "post-abortion syndrome" is not recognized by any medical or psychological organization, and some physicians and pro-choice advocates have argued that the effort to popularize the idea of a "post-abortion syndrome" is a tactic used by pro-life advocates for political purposes. Some U.S. state legislatures have mandated that patients be told that abortion increases their risk of depression and suicide, despite the fact that such risks are not supported by the bulk of the scientific literature.

Post-Abortion Syndrome

The term "post-abortion syndrome" was first used in 1981 by Vincent Rue, a pro-life advocate, in testimony before Congress in which he stated that he had observed post-traumatic stress disorder which developed in response to the stress of abortion. Rue proposed the name "post-abortion syndrome" (PAS) to describe this phenomenon.

The term post-abortion syndrome (PAS) has subsequently been popularized and widely used by pro-life advocates to describe a broad range of adverse emotional reactions which they attribute to abortion. "Post-abortion syndrome" has not found widespread acceptance outside the pro-life community; the American Psychological Association and the American Psychiatric Association do not recognize PAS as an actual diagnosis or condition, and it is not included in the Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR or in the ICD-10 list of psychiatric conditions. Some physicians and pro-choice advocates have argued that the focus on "post-abortion syndrome" is a tactic used by pro-life advocates for political purposes.

While some studies have reported a statistical correlation between abortion and clinical depression, anxiety, suicidal behaviors, or adverse effects on women's sexual functions for a small number of women, these studies are typically methodologically flawed and fail to account for confounding factors. Higher-quality studies have consistently found no causal relationship between abortion and mental-health problems. The correlations observed in some studies may be explained by pre-existing social circumstances and emotional health. Various factors, such as emotional attachment to the pregnancy, lack of support, and conservative views on abortion, may increase the likelihood of experiencing negative reactions.

In 2008, a team at Johns Hopkins University in Baltimore concluded, in a systematic review of the medical literature, that "the best quality studies indicate no significant differences in long-term mental health between women in the United States who choose to terminate a pregnancy and those who do not." Dr. Robert Blum, the senior author on the study, stated: "The best research does not support the existence of a 'post-abortion syndrome' similar to post-traumatic stress disorder." The researchers further reported that "... studies with the most flawed methodology consistently found negative mental health consequences of abortion," and wrote: "Scientists are still conducting research to answer politically motivated questions."

Current and historical reviews

Systematic reviews of the scientific literature have concluded that that there are no difference in the long-term mental health of women who obtain induced abortions as compared to women in appropriate control groups.

United States Surgeon General (late 1980s)

In 1987, President Ronald Reagan directed U.S. Surgeon General C. Everett Koop, an evangelical Christian and abortion opponent, to issue a report on the health effects of abortion. Reportedly, the idea for the review was conceived by Reagan advisors Dinesh D'Souza and Gary Bauer as a means of "rejuvenat" the pro-life movement by producing evidence of the risks of abortion. Koop was reluctant to accept the assignment, believing that Reagan was more concerned with appeasing his political base than with improving women's health.

Ultimately, Koop reviewed over 250 studies pertaining to the psychological impact of abortion. Koop wrote in a letter to Reagan that "scientific studies do not provide conclusive data about the health effects of abortion on women." Koop acknowledged the political context of the question in his letter, writing: "In the minds of some of , 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."

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 noted 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." In his congressional testimony, Koop stated that while psychological responses to abortion may be "overwhelming" in individual cases, the psychological risks of abortion were "miniscule from a public health perspective."

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 Theodore S. Weiss (D-NY), who oversaw the investigation, argued that when Koop found no evidence that abortion was harmful, he "decided not to issue a report, but instead to write a letter to the president which would be sufficiently vague as to avoid supporting the pro-choice position that abortion is safe for women."

American Psychological Association (1990, 2008)

The American Psychological Association prepared a literature summary and recommendations for Koop's report. After Koop refused to issue their findings, the APA panel published them in the journal Science, concluding that "Although there may be sensations of regret, sadness, or guilt, 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 panel also noted that "...women who are terminating pregnancies that are wanted and personally meaningful, who lack support from their partner or parents for the abortion, or who have more conflicting feelings or are less sure of their decision before hand may be a relatively higher risk for negative consequences."

The APA task force also concluded that "research with diverse samples, different measures of response, and different times of assessment have come to similar conclusions. The time of greatest distress is likely to be before the abortion. Severe negative reactions after abortions are rare and can best be understood in the framework of coping with normal life stress." Nancy Adler, professor of psychology at the University of California, San Francisco, has testified on behalf of the APA that "severe negative reactions are rare and are in line with those following other normal life stresses."

In 2007, APA established a new task force to review studies on abortion published since 1989. The APA task force issued an updated summary of medical evidence in August 2008, again concluding that a single first-trimester abortion carried no more mental health risk than carrying a pregnancy to term. The panel noted a lack of quality data on the effect of multiple abortions. Additionally, the same factors which predispose a woman to multiple unwanted pregnancies may also predipose her to mental health difficulties; therefore, they declined to draw a firm conclusion on multiple abortions.

Royal College of Psychiatrists (2008)

On March 14, 2008, the United Kingdom Royal College of Psychiatrists released a statement saying that "The specific issue of whether or not induced abortion has harmful effects on women’s mental health remains to be fully resolved. The current research evidence base is inconclusive—some studies indicate no evidence of harm, whilst other studies identify a range of mental disorders following abortion." The statement noted that the Royal College is undertaking a systematic review of the medical literature with the intent of updating its position and possibly recommending changes to the informed consent process for abortion. The final report is expected in autumn 2011.

The Royal College's statement was interpreted variously by the media. The Times wrote that "women may be at risk of mental health breakdowns if they have abortions" and that "women should not be allowed to have an abortion until they are counselled on the possible risk to their mental health." In contrast, the Daily Mail reported that "Updated guidance from the Royal College of Physicians points out that there is still no evidence that abortion causes mental health problems... The college rejects claims by the pro-life lobby that abortion causes mental health problems." The Daily Mail also noted that the Royal College of Psychiatrists report came out at a time when there was a controversial proposal before Parliament to reduce the term limit for abortions from 24 weeks to 20 weeks.

Men

The psychological response of male partners to abortion has been the subject of limited research. A study of 75 men in Sweden found that most participating men agreed with their partner's decision to have an abortion, and that many experienced a complex mix of emotions including anxiety, responsibility, guilt, relief and grief. Other studies have suggested that abortion can be a point of conflict when partners disagree about it, and that like women, many male partners experience an ambivalent mix of emotions in response to their partner's abortion, underscoring the complexity of the abortion issue.

See also

References

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  2. "Post-Abortion Politics". NOW with David Brancaccio. PBS. 2007-07-20. Retrieved 2008-11-18.
  3. ^ "Position Statement on Women's Mental Health in Relation to Induced Abortion". Royal College of Psychiatrists. 2008-03-14. Retrieved 2008-11-20.
  4. ^ "The C. Everett Koop Papers: Reproduction and Family Health". National Library of Medicine. Archived from the original on June 18, 2011. Retrieved June 18, 2011.
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  6. ^ "More on Koop's study of abortion". Fam Plann Perspect. 22 (1): 36–9. 1990. doi:10.2307/2135437. JSTOR 2135437. PMID 2323405.
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  8. Edwards, S (1997). "Abortion Study Finds No Long-Term Ill Effects On Emotional Well-Being". Fam Plann Perspect. 29 (4): 193–194. doi:10.2307/2953388. JSTOR 2953388.
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  15. ^ Mooney, Chris (October 2004). "Research and Destroy: How the religious right promotes its own 'experts' to combat mainstream science". Washington Monthly. {{cite news}}: Italic or bold markup not allowed in: |publisher= (help)
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  18. Lazzarini Z (2008). "South Dakota's Abortion Script – Threatening the Physician-Patient Relationship". N. Engl. J. Med. 359 (21): 2189–2191. doi:10.1056/NEJMp0806742. PMID 19020321. The purported increased risks of psychological distress, depression, and suicide that physicians are required to warn women about are not supported by the bulk of the scientific literature. By requiring physicians to deliver such misinformation and discouraging them from providing alternative accurate information, the statute forces physicians to violate their obligation to solicit truly informed consent. {{cite journal}}: Unknown parameter |month= ignored (help)
  19. Vincent Rue, "Abortion and Family Relations," testimony before the Subcommittee on the Constitution of the US Senate Judiciary Committee, U.S. Senate, 97th Congress, Washington, DC (1981).
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  27. Tolchin, Martin (1989-01-11). "Koop's Stand on Abortion's Effect Surprises Friends and Foes Alike". New York Times. Retrieved 2008-02-18. {{cite news}}: Italic or bold markup not allowed in: |publisher= (help)
  28. ^ Leary, Warren (1989-03-17). "Koop Says Abortion Report Couldn't Survive Challenge". New York Times. Retrieved 2008-02-18. {{cite news}}: Italic or bold markup not allowed in: |publisher= (help)
  29. "Study Finds Little Lasting Distress From Abortion". New York Times. 1990-04-06. Retrieved 2008-11-18. {{cite news}}: Italic or bold markup not allowed in: |publisher= (help)
  30. Templeton, Sarah-Kate (2008-03-16). "Royal college warns abortions can lead to mental illness". London: The Times. Retrieved 2008-03-18. {{cite news}}: Italic or bold markup not allowed in: |publisher= (help)
  31. ^ Martin, Daniel (2008-03-16). "Woman 'should have abortions blocked' until mental illness risks are known". Daily Mail. Retrieved 2008-03-18. {{cite news}}: Italic or bold markup not allowed in: |publisher= (help)
  32. Kero A, Lalos A, Högberg U, Jacobsson L (1999). "The male partner involved in legal abortion". Hum. Reprod. 14 (10): 2669–75. doi:10.1093/humrep/14.10.2669. PMID 10528006. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  33. Naziri D (2007). "Man's involvement in the experience of abortion and the dynamics of the couple's relationship: a clinical study". Eur J Contracept Reprod Health Care. 12 (2): 168–74. doi:10.1080/13625180701201178. PMID 17559016. {{cite journal}}: Unknown parameter |month= ignored (help)
  34. Kero A, Lalos A (2000). "Ambivalence—a logical response to legal abortion: a prospective study among women and men". J Psychosom Obstet Gynaecol. 21 (2): 81–91. doi:10.3109/01674820009075613. PMID 10994180. {{cite journal}}: Unknown parameter |month= ignored (help)

External links

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