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The relationship between induced abortion and mental health is an area of political 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. Some claim 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. However there are studies that prove otherwise...

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." "Currently, there are active attempts to convince the public and women considering abortion that abortion frequently has negative psychiatric consequences. Some say this assertion is not borne out by the literature: the vast majority of women tolerate abortion without psychiatric sequelae."</ref> 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. However, other scientists sustain otherwise. In a study of post-abortion patients only 8 weeks after their abortion, researchers found that 44% complained of nervous disorders, 36% had experienced sleep disturbances, 31% had regrets about their decision, and 11% had been prescribed psychotropic medicine by their family doctor. (An excellent resource is Thomas Strahan’s Detrimental Effects of Abortion: An Annotated Bibliography with Commentary (Third Edition) This resource includes brief summaries of major finding drawn from medical and psychology journal articles, books, and related materials, divided into major categories of relevant injuries. An online version can be found at AbortionRisks.org) Dr. David Reardon, American director of the Elliot Institute says that there is great anxiety for abortion to be legalized in developing countries and that is why the myth that abortion is saver than delivery is so disseminated. In an effort to evaluate the accuracy of maternal death reports, STAKES (the statistical analysis unit of Finland’s National Research and Development Center for Welfare and Health) researchers pulled the death certificate records for all the women of reproductive age (15-49) who died between 1987 and 1994–a total of 9,192 women. They then culled through the national health care data base to identify any pregnancy-related events for each of these women in the 12 months prior to their deaths. Since Finland has socialized medical care, these records are very accurate and complete. In this fashion, the STAKES researchers identified 281 women who had died within a year of their last pregnancy. The unadjusted mortality rate per 100,000 cases was 27 for women who had given birth, 48 for women who had miscarriages or ectopic pregnancies, and 101 for women who had abortions. Risk of suicide allowing birth was half of that of the general population of women; while risk of suicide within the year of abortion was more than seven times higher than risk of suicide within a year of the child's birth. Suicide rate is the highest in China where there is a strict "one child policy" and sometimes even forced abortion. Besides, it is the only country where more women die of suicide than man (women under the age of 45 suicide rate is twice that of man). Elliot Institute survey of 256 post-abortive women found that nearly 60% stated they began to lose there temper more easily after their abortions with a 48% saying they also became more violent when agered. Women wew more prone to anger and confrontations. Others studies by Elliot Institute (non-profit) show that from a total of 4,463 women thatsurveyed about depression and uninteded pregnancy from which 421 had their children born the married women wew 138% more likely to be a high risk of clinical depression comepared to women who had carried thir unintended pregnancy (eight years later). This study took data from the study of Amerycan youth and used it to conduct research published in the prestigious British Medical Journal.

Current and historical reviews

Despite the evidence, 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. 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 not taken into account. Other studies have 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. On the other hand, some studies that suport this have been proved to be wrong (http://theirlastchoice.0catch.com/kevin.html) or not serious enough (http://www.righttoliferoch.org/nAPAdepression.htm) 

 "Even though this important study was published in the top Scandinavian obstetrics journal, it has been completely ignored by the American press," Reardon said. "Even worse, abortion counselors continue to lie to American women. They are telling women that abortion is safer than childbirth, when this and other irrefutable studies prove exactly the opposite. The entire body of medical literature clearly shows that abortion contributes to a decline in women's physical and mental health. Women aren't hearing this. Nor are they being told that giving birth actually contributes to women's overall health, not only in comparison to those who abort but also in comparison to women who have not been pregnant."

Reardon sustains that abortion providers are collaborating with population control zealots to conceal the risks of abortion in order to advance their own financial and social engineering agendas. "If they were really pro-choice, they would want women to know about abortion's true risks," he said. "Instead, they are offering women a bundle of half-truths and complete fabrications."


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." Koop, for his part, did not relish the assignment. On at least two occasions Koop attempted to convince the president to withdraw his request for a report. When his petitions were rejected, Koop assigned the task to an assistant explaining that he wanted to "distance" himself from the report. Koop simply did not like being dragged back into the abortion controversy, especially in an official role as an "expert" on the health effects of abortion. He knew, far better than the president, that every piece of evidence, every conclusion, every nuanced statement that Koop might make was going to be dissected and attacked by one side or the other. The forensics experts at the O.J. Simpson trial faced less of a grilling than that which confronted Koop. In fact, the final "report" was not a report at all. Instead it was merely a letter to the President explaining why there was insufficient data on which to base a report. Koop concluded the letter by stating that a prospective five year study, costing between $10 and $100 million would best address the lack of unassailable data. Even in this, however, he was noncommittal. His statements regarding the possibility of a prospective study had the tone of "if you really want to know, this is what should be done." Nowhere did he actually champion the pressing need for such a study on the grounds that abortion is one of the most common surgeries in America and lack of adequate research about abortion sequelae is simply unconscionable.

Most curiously, in the furor of confusion following his letter, it became clear that Dr. Koop in fact had two positions. His public position was that of the uneasy Sergeant Schultz who claims: "I know nothing!" This non-opinion was all that he could confidently defend as the Surgeon General for the United States. But as he also held the private opinion (which because it was private was somehow above criticism) that there was sufficient and compelling evidence which left "no doubt in my mind" that there are serious physical complications and "tremendous psychological problems" resulting from abortion.


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."

An APA task force issued an updated summary of medical evidence in August 2008, concluding that among adult women who have an unplanned pregnancy, it is no more dangerous to have a single, legal, first-trimester abortion than to deliver the pregnancy. Noting that there was a lack of data on multiple abortions, 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.

Johns Hopkins (2008)

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."

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 psychological reactions to abortion fall into many categories, some women experience all or some of they symptoms of post-traumatic stress disorder (PTSD). The lowest incidence rate of PTSD reported following abortion is 1.5%, which would translate to over 600,000 cases of abortion induced PTSD.2 Another study found that 14% of American women have all the symptoms of PTSD and attribute them to their abortions, with as many as 65% reporting some, but not all symptoms of PTSD.3

Yet another random study found that a minimum of 19% of post-abortion women suffer from diagnosable post-traumatic stress disorder (PTSD). Approximately half had many, but not all, symptoms of PTSD, and 20 to 40 percent showed moderate to high levels of stress and avoidance behavior relative to their abortion experiences. (6)

PTSD is a psychological dysfunction which results from a traumatic experience which overwhelms a person’s normal defense mechanisms resulting in intense fear, feelings of helplessness or being trapped, or loss of control. The risk that an experience will be traumatic is increased when the traumatizing event is perceived as including threats of physical injury, sexual violation, or the witnessing of or participation in a violent death. PTSD results when the traumatic event causes the hyperarousal of “flight or fight” defense mechanisms. This hyperarousal causes these defense mechanisms to become disorganized, disconnected from present circumstances, and take on a life of their own resulting in abnormal behavior and major personality disorders. As an example of this disconnection of mental functions, some PTSD victim may experience intense emotion but without clear memory of the event; others may remember every detail but without emotion; still others may reexperience both the event and the emotions in intrusive and overwhelming flashback experiences. (7)

Women may experience abortion as a traumatic event for several reasons. Many are forced into an unwanted abortions by husbands, boyfriends, parents, or others. If the woman has repeatedly been a victim of domineering abuse, such an unwanted abortion may be perceived as the ultimate violation in a life characterized by abuse. Other women, no matter how compelling the reasons they have for seeking an abortion, may still perceive the termination of their pregnancy as the violent killing of their own child. The fear, anxiety, pain, and guilt associated with the procedure are mixed into this perception of grotesque and violent death. Still other women, report that the pain of abortion, inflicted upon them by a masked stranger invading their body, feels identical to rape. (8) Indeed, researchers have found that women with a history of sexual assault may experience greater distress during and after an abortion exactly because of these associations between the two experiences. (9) When the stressor leading to PTSD is abortion, some clinicians refer to this as Post-Abortion Syndrome (PAS).

The major symptoms of PTSD are generally classified under three categories: hyperarousal, intrusion, and constriction.

Hyperarousal is a characteristic of inappropriately and chronically aroused “fight or flight” defense mechanisms. The person is seemingly on permanent alert for threats of danger. Symptoms of hyperarousal include: exaggerated startle responses, anxiety attacks, irritability, outbursts of anger or rage, aggressive behavior, difficulty concentrating, hypervigilence, difficulty falling asleep or staying asleep, or physiological reactions upon exposure to situations that symbolize or resemble an aspect of the traumatic experience (eg. elevated pulse or sweat during a pelvic exam, or upon hearing a vacuum pump sound.)

Intrusion is the reexperience of the traumatic event at unwanted and unexpected times. Symptoms of intrusion in PAS cases include: recurrent and intrusive thoughts about the abortion or aborted child, flashbacks in which the woman momentarily reexperiences an aspect of the abortion experience, nightmares about the abortion or child, or anniversary reactions of intense grief or depression on the due date of the aborted pregnancy or the anniversary date of the abortion.


Constriction is the numbing of emotional resources, or the development of behavioral patterns, so as to avoid stimuli associated with the trauma. It is avoidance behavior; an attempt to deny and avoid negative feelings or people, places, or things which aggravate the negative feelings associated with the trauma. In post-abortion trauma cases, constriction may include: an inability to recall the abortion experience or important parts of it; efforts to avoid activities or situations which may arouse recollections of the abortion; withdrawal from relationships, especially estrangement from those involved in the abortion decision; avoidance of children; efforts to avoid or deny thoughts or feelings about the abortion; restricted range of loving or tender feelings; a sense of a foreshortened future (e.g., does not expect a career, marriage, or children, or a long life.); diminished interest in previously enjoyed activities; drug or alcohol abuse; suicidal thoughts or acts; and other self-destructive tendencies.

As previously mentioned, Barnard’s study identified a 19% rate of PTSD among women who had abortions three to five years previously. But in reality the actual rate is probably higher. Like most post-abortion studies, Barnard’s study was handicapped by a fifty percent drop out rate. Clinical experience has demonstrated that the women least likely to cooperate in post-abortion research are those for whom the abortion caused the most psychological distress. Research has confirmed this insight, demonstrating that the women who refuse followup evaluation most closely match the demographic characteristics of the women who suffer the most post-abortion distress. (10) The extraordinary high rate of refusal to participate in post-abortion studies may interpreted as evidence of constriction or avoidance behavior (not wanting to think about the abortion) which is a major symptom of PTSD.

For many women, the onset or accurate identification of PTSD symptoms may be delayed for several years. (11) Until a PTSD sufferer has received counseling and achieved adequate recovery, PTSD may result in a psychological disability which would prevent an injured abortion patient from bringing action within the normal statutory period. This disability may, therefore, provide grounds for an extended statutory period.

SEXUAL DYSFUNCTION: Thirty to fifty percent of aborted women report experiencing sexual dysfunctions, of both short and long duration, beginning immediately after their abortions. These problems may include one or more of the following: loss of pleasure from intercourse, increased pain, an aversion to sex and/or males in general, or the development of a promiscuous life-style. (12)


SUICIDAL IDEATION AND SUICIDE ATTEMPTS: Approximately 60 percent of women who experience post-abortion sequelae report suicidal ideation, with 28 percent actually attempting suicide, of which half attempted suicide two or more times. Researchers in Finland have identified a strong statistical association between abortion and suicide in a records based study. The identified 73 suicides associated within one year to a pregnancy ending either naturally or by induced abortion. The mean annual suicide rate for all women was 11.3 per 100,000. Suicide rate associated with birth was significantly lower (5.9). Rates for pregnancy loss were significantly higher. For miscarriage the rate was 18.1 per 100,000 and for abortion 34.7 per 100,000. The suicide rate within one year after an abortion was three times higher than for all women, seven times higher than for women carrying to term, and nearly twice as high as for women who suffered a miscarriage. Suicide attempts appear to be especially prevalent among post-abortion teenagers.(13)


INCREASED SMOKING WITH CORRESPONDENT NEGATIVE HEALTH EFFECTS: Post-abortion stress is linked with increased cigarette smoking. Women who abort are twice as likely to become heavy smokers and suffer the corresponding health risks. (14)

Post-abortion women are also more likely to continue smoking during subsequent wanted pregnancies with increased risk of neonatal death or congenital anomalies. (15)

ALCOHOL AND DRUG ABUSE: Over twenty studies have linked abortion to increased rates of drug and alcohol use.1 Abortion is significantly linked with a two fold increased risk of alcohol abuse among women.(16) Abortion followed by alcohol abuse is linked to violent behavior, divorce or separation, auto accidents, and job loss.(17) In addition to the psycho-social costs of such abuse, drug abuse is linked with increased exposure to HIV/AIDS infections, congenital malformations, and assaultive behavior. (18)


EATING DISORDERS: For at least some women, post-abortion stress is associated with eating disorders such as binge eating, bulimia, and anorexia nervosa. (19)


CHILD NEGLECT OR ABUSE: Abortion is linked with increased depression, violent behavior, alcohol and drug abuse, replacement pregnancies, and reduced maternal bonding with children born subsequently. These factors are closely associated with child abuse and would appear to confirm individual clinical assessments linking post-abortion trauma with subsequent child abuse. (20)


DIVORCE AND CHRONIC RELATIONSHIP PROBLEMS: For most couples, an abortion causes unforeseen problems in their relationship. Post-abortion couples are more likely to divorce or separate. Many post-abortion women develop a greater difficulty forming lasting bonds with a male partner. This may be due to abortion related reactions such as lowered self-esteem, greater distrust of males, sexual dysfunction, substance abuse, and increased levels of depression, anxiety, and volatile anger. Women who have more than one abortion (representing about 45% of all abortions) are more likely to require public assistance, in part because they are also more likely to become single parents. (21)


REPEAT ABORTIONS: Women who have one abortion are at increased risk of having additional abortions in the future. Women with a prior abortion experience are four times more likely to abort a current pregnancy than those with no prior abortion history. 

This increased risk is associated with the prior abortion due to lowered self esteem, a conscious or unconscious desire for a replacement pregnancy, and increased sexual activity post-abortion. Subsequent abortions may occur because of conflicted desires to become pregnant and have a child and continued pressures to abort, such as abandonment by the new male partner. Aspects of self-punishment through repeated abortions are also reported.

Approximately 45% of all abortions are now repeat abortions. The risk of falling into a repeat abortion pattern should be discussed with a patient considering her first abortion. Furthermore, since women who have more than one abortion are at a significantly increased risk of suffering physical and psychological sequelae, these heightened risks should be thoroughly discussed with women seeking abortions.

A complete listing of psychological problems 

associated with abortion can be found at at AbortionRisks.org

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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  17. see http://afterabortion.org/2000/abortion-four-times-deadlier-than-childbirth/
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  39. R.F. Badgley, D.F. Caron, M.G. Powell, Report of the Committee on the Abortion Law, Minister of Supply and Services, Ottawa, 1977:313-319.
  40. Jeff Nelson,”Data Request from Delegate Marshall” Interagency Memorandum, Virginia Department of Medical Assistance Services, Mar. 21, 1997.
  41. Carl Tischler, “Adolescent Suicide Attempts Following Elective Abortion,” Pediatrics 68(5):670, 1981; E. Joanne Angelo, Psychiatric Sequelae of Abortion: The Many Faces of Post-Abortion Grief,” Linacre Quarterly 59:69-80, May 1992.
  42. D.C. Reardon and P.G. Ney, “Abortion and Subsequent Substance Abuse” Am J Drug Alcohol Abuse 26(1):61-75.
  43. David Reardon, “Psychological Reactions Reported After Abortion,” The Post-Abortion Review, 2(3):4-8, Fall 1994
  44. Personal communication with Mika Gissler, March 8, 2000.
  45. 19. D. Berkeley, P.L. Humphreys, and D. Davidson, “Demands Made on General Practice by Women Before and After an Abortion,” J. R. Coll. Gen. Pract. 34:310-315, 1984.
  46. Philip G. Ney, Tak Fung, Adele Rose Wickett and Carol Beaman-Dodd, “The Effects of Pregnancy Loss on Women’s Health,” Soc. Sci. Med. 48(9):1193-1200, 1994.
  47. Gissler, et.al. (1997) 652.
  48. 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)
  49. 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)
  50. 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)

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