Abortion and mental health

The relationship between induced abortion and mental health is an area of political controversy.^[1][2][3] The issue has been part of the political debate over abortion, dating to 1988 when U.S. President Ronald Reagan directed 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.^[4] There is no scientific evidence of a causal relationship between abortion and poor mental health.^[5][6] 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.^[7][8][9]

In 1990, the American Psychological Association (APA) found that "severe negative reactions [after abortion] are rare and are in line with those following other normal life stresses."^[6] 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.^[10][11] 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.^[12] 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.^[3]

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,^[13] 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.^{[1][14][15][16]} 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.^[12][17]

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.^[12] 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.^[12] The correlations observed in some studies may be explained by pre-existing social circumstances and emotional health.^[18] 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.

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,^[4] 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[ing]" the pro-life movement by producing evidence of the risks of abortion.^[19] Koop was reluctant to accept the assignment, believing that Reagan was more concerned with appeasing his political base than with improving women's health.^[4]

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."^[20] 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."^[21]

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."^[21] 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."^{[1][5][7][19]}

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."^[5]

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."^[7] 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."^[7]

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."^[7] 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."^[6][22]

In 2007, APA established a new task force to review studies on abortion published since 1989.^[1] 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.^[10][11]

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.^[3]

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."^[23] 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."^[24] 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.^[24]

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."^[12][25] 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.^[26][27]

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.^[1][14][28] "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.^{[15][16][29][30]}

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.^[31] Other studies have suggested that abortion can be a point of conflict when partners disagree about it,^[32] 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.^[33]

See also

• Postpartum depression
• Postpartum psychosis
• Psychiatric disorders of childbirth

References

1. ^ ^{a b c d e} Bazelon, Emily (2007-01-21). "Is There a Post-Abortion Syndrome?". New York Times Magazine. http://www.nytimes.com/2007/01/21/magazine/21abortion.t.html. Retrieved 2008-01-11. 
2. ^ "Post-Abortion Politics". NOW with David Brancaccio (PBS). 2007-07-20. http://www.pbs.org/now/shows/329/index.html. Retrieved 2008-11-18. 
3. ^ ^{a b c} "Position Statement on Women’s Mental Health in Relation to Induced Abortion". Royal College of Psychiatrists. 2008-03-14. http://www.rcpsych.ac.uk/members/nccmh/consultations.aspx. Retrieved 2008-11-20. 
4. ^ ^{a b c} "The C. Everett Koop Papers: Reproduction and Family Health". National Library of Medicine. Archived from the original on June 18, 2011. http://www.webcitation.org/60GpKCVAq. Retrieved June 18, 2011. 
5. ^ ^{a b c} Joyce, Christopher (1989-12-16). "Reagan's officials 'suppressed' research on abortion". New Scientist. http://www.newscientist.com/article/mg12416951.000-reagans-officials-suppressed-research-on-abortion-.html. Retrieved 2008-02-18. 
6. ^ ^{a b c} "More on Koop's study of abortion". Fam Plann Perspect 22 (1): 36–9. 1990. doi:10.2307/2135437. JSTOR 2135437. PMID 2323405. 
7. ^ ^{a b c d e} Adler NE, David HP, Major BN, Roth SH, Russo NF, Wyatt GE (1990). "Psychological responses after abortion". Science 248 (4951): 41–4. doi:10.1126/science.2181664. PMID 2181664. 
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. http://findarticles.com/p/articles/mi_qa3634/is_199707/ai_n8772240. 
9. ^ Steinberg JR, Russo NF (July 2008). "Abortion and anxiety: what's the relationship?". Soc Sci Med 67 (2): 238–52. doi:10.1016/j.socscimed.2008.03.033. PMID 18468755. 
10. ^ ^{a b} APA "Task Force on Mental Health and Abortion". American Psychological Association. http://www.apa.org/releases/abortion-report.pdf APA. Retrieved 2008-08-28. 
11. ^ ^{a b} Carey, Benedict (2008-08-12). "Abortion Does Not Cause Mental Illness, Panel Says". New York Times. http://www.nytimes.com/2008/08/13/health/research/13brfs-ABORTIONDOES_BRF.html. Retrieved 2008-08-12. 
12. ^ ^{a b c d e} Charles VE, Polis CB, Sridhara SK, Blum RW (2008). "Abortion and long-term mental health outcomes: a systematic review of the evidence". Contraception 78 (6): 436–50. doi:10.1016/j.contraception.2008.07.005. PMID 19014789. 
13. ^ Grimes DA, Creinin MD (2004). "Induced abortion: an overview for internists". Ann. Intern. Med. 140 (8): 620–6. doi:10.1001/archinte.140.5.620. PMID 15096333.  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."
14. ^ ^{a b} Mooney, Chris (October 2004). "Research and Destroy: How the religious right promotes its own 'experts' to combat mainstream science". Washington Monthly. http://www.washingtonmonthly.com/features/2004/0410.mooney.html. 
15. ^ ^{a b} Stotland NL (2003). "Abortion and psychiatric practice". J Psychiatr Pract 9 (2): 139–49. doi:10.1097/00131746-200303000-00005. PMID 15985924.  "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."
16. ^ ^{a b} Stotland NL (October 1992). "The myth of the abortion trauma syndrome". JAMA 268 (15): 2078–9. doi:10.1001/jama.268.15.2078. PMID 1404747. 
17. ^ Lazzarini Z (November 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. http://content.nejm.org/cgi/content/full/359/21/2189. "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." 
18. ^ "Abortion on Demand". TIME. 1973-01-29. http://www.time.com/time/magazine/article/0,9171,903771-1,00.html. Retrieved 2008-11-18. 
19. ^ ^{a b} Mooney, Chris (October 2004). "Bucking the Gipper". Washington Monthly. http://www.washingtonmonthly.com/features/2004/0410.mooney2.html. Retrieved 2008-02-18. 
20. ^ Tolchin, Martin (1989-01-11). "Koop's Stand on Abortion's Effect Surprises Friends and Foes Alike". New York Times. http://query.nytimes.com/gst/fullpage.html?res=950DE2DC143DF932A25752C0A96F948260. Retrieved 2008-02-18. 
21. ^ ^{a b} Leary, Warren (1989-03-17). "Koop Says Abortion Report Couldn't Survive Challenge". New York Times. http://query.nytimes.com/gst/fullpage.html?res=950DEEDF1F3CF934A25750C0A96F948260. Retrieved 2008-02-18. 
22. ^ "Study Finds Little Lasting Distress From Abortion". New York Times. 1990-04-06. http://query.nytimes.com/gst/fullpage.html?res=9C0CEEDE133FF935A35757C0A966958260. Retrieved 2008-11-18. 
23. ^ Templeton, Sarah-Kate (2008-03-16). "Royal college warns abortions can lead to mental illness". London: The Times. http://www.timesonline.co.uk/tol/life_and_style/health/article3559486.ece. Retrieved 2008-03-18. 
24. ^ ^{a b} Martin, Daniel (2008-03-16). "Woman 'should have abortions blocked' until mental illness risks are known". Daily Mail. http://www.dailymail.co.uk/pages/live/articles/news/news.html?in_article_id=535908&in_page_id=1770. Retrieved 2008-03-18. 
25. ^ "Abortion not seen linked with depression". MSNBC. December 4, 2008. http://www.msnbc.msn.com/id/28050494/from/ET/. "Review of studies found no evidence of emotional harm after procedure" 
26. ^ 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).
27. ^ Speckhard A, Rue V (1992). "Postabortion Syndrome: An Emerging Public Health Concern". J Soc Issues 48 (3): 95–119. doi:10.1111/j.1540-4560.1992.tb00899.x. 
28. ^ Kranish, Michael (2005-07-31). "Science in support of a cause: the new research". Boston Globe. 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. Retrieved 2007-11-27. 
29. ^ Cooper, Cynthia (August/September 2001). "Abortion Under Attack". Ms.. http://www.msmagazine.com/aug01/pas.html. Retrieved 2008-11-18. 
30. ^ Russo NF, Denious JE (2005). "Controlling birth: science, politics, and public policy". J Soc Issues 61 (1): 181–91. doi:10.1111/j.0022-4537.2005.00400.x. PMID 17073030. 
31. ^ Kero A, Lalos A, Högberg U, Jacobsson L (October 1999). "The male partner involved in legal abortion". Hum. Reprod. 14 (10): 2669–75. doi:10.1093/humrep/14.10.2669. PMID 10528006. http://humrep.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=10528006. 
32. ^ Naziri D (June 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. 
33. ^ Kero A, Lalos A (June 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. 

External links

Reviews by major medical bodies

• 2008 "Report of the Task Force on Mental Health and Abortion". American Psychological Association. 2008. http://www.apa.org/releases/abortion-report.pdf 2008. 
• "The Care of Women Requesting Induced Abortion" (PDF). Royal College of Obstetricians and Gynaecologists. 2004. http://www.rcog.org.uk/files/rcog-corp/uploaded-files/NEBInducedAbortionfull.pdf. 

Pro-choice sources

• "The Emotional Effects of Induced Abortion". Planned Parenthood. http://www.plannedparenthood.org/issues-action/abortion/state-abortion-restrictions/reports/emotional-effects-induced-abortion-6137.htm. 

Pro-life sources

• Reardon, David. "Women Who Have Abortions: Their Reflections on the Unborn". http://studentorgs.vanderbilt.edu/sfl/post_abortion_depression.htm.