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It has been suggested that this article be split into articles titled Politics of abortion and mental health and Talk:Abortion_and_mental_health#Rename_this_Article.3F_Split_article.3F. (discuss) (September 2011)

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. There is scientific evidence of a causal relationship between abortion and poor mental health., though some argue 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.

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. 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.

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."

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.

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.

Other studies

According studies derived from pro-abortion sources courtesy of The Alan Guttmacher Institute and Planned Parenthood's Family Planning Perspectives in the United States, while white women obtain 60% of all abortions, their abortion rate is well below that of minority women. Black women are more than 3 times as likely as white women to have an abortion, and Hispanic women are roughly 2 times as likely. 1% of all abortions occur because of rape or incest; 6% of abortions occur because of potential health problems regarding either the mother or child, and 93% of all abortions occur for social reasons (i.e. the child is unwanted or inconvenient). Moreover, 83% of all abortions are obtained in developing countries and 17% occur in developed countries. This statistics suggest to some investigators thar there are powerful economical and social reasons to legalize abortion in devoloping countries in order to reduce their population as there is a growing overpopulation problem. India for example had a total of 17,143,717 abortions throughout 1972-2004, while Finland held only 632,412 1951-2008. France in the years 1936-2007 held 5,979,726 compared to a 1976-2000 (71 years time) 11,713,366 abortions in Vietnam in 1976-2000 (24 years time). There is also a national study in Finland made by which showed significantly higher death rates associated with abortion than with childbirth. The record-based study is from STAKES, the statistical analysis unit of Finland’s National Research and Development Center for Welfare and Health. In an effort to evaluate the accuracy of maternal death reports, STAKES 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. Statistics showed women dying in the year they gave birth as being half that of women who are not pregnant, whereas women who have abortions are 76 percent more likely to die in the year following abortion compared to non-pregnant women. Compared to women who carry to term, women who abort are 3.5 times more likely to die within a year. Such figures are always subject to statistical variation from year to year, country to country, study to study. For this reason, the researchers also reported what is known as “95 percent confidence intervals.” This means that the available data indicates that 95 percent of all similar studies would report a finding within a specified range around the actual reported figure. Using a subset of the same data, STAKES researchers had previously reported that the risk of death from suicide within the year of an abortion was more than seven times higher than the risk of suicide within a year of childbirth. Teens are generally at higher risk for both suicide and abortion. In a survey of teenaged girls, researchers at the University of Minnesota found that the rate of attempted suicide in the six months prior to the study increased ten fold–from 0.4 percent for girls who had not aborted during that time period to 4 percent for teens who had aborted in the previous six months. In this most recent study from Finland, the STAKES researchers also reported that the risk of death from accidents was over four times higher for women who had aborted in the year prior to their deaths than for women who had carried to term. The risk of dying from homicide for post-abortive women was more than four times greater than the risk of homicide among the general population. This finding, especially when combined with the suicide and accident figures, once again reinforces the conclusion that women who abort are more likely to engage in risk-taking behavior. An Elliot Institute survey of 256 post-abortive women found that nearly 60 percent stated that they began to lose their temper more easily after their abortions, with 48 percent saying they also became more violent when angered. Increased tendencies toward anger and violence after abortion were also significantly associated with substance abuse and higher suicidal tendencies. Comparing abortion to birth, death from natural causes was significantly higher (60 percent higher in this sample) for women who had an induced abortion in the prior year compared to those who carried to term or had a natural pregnancy loss. One possible explanation would be that the women who died after an abortion were already in ill health before the abortions and sought the abortion to protect their health. But this hypothesis was rejected by the STAKES researchers when an examination of abortion registry records showed that only a single woman in this group had her abortion for reasons of maternal health. The STAKES data would appear to support the view that induced abortion produces an unnatural physical and psychological stress on women that can result in a negative impact on their general health.

Chili Study

Dr. Elard Koch, an epidemiologist on the faculty of medicine at the University of Chile compared data from 1957 and 2008 about maternal mortality for abortion. His studies showed that the latter reduced 97.6% in the last 51 years. After the prohibition of abortion in 1989 there was a reduction of 13.62 to 1.25 per 100,000 live births, which means a 87.9% This news follows a report from the World Economic Forum in December which showed that countries with restrictive abortion laws are often the leaders in reducing maternal mortality. Ireland, which is under pressure to change its Constitutional protection of the unborn child, leads the world in maternal health performance, with 1 death for every 100,000 live births. Poland, which has tightened its abortion law, ranks 27 on the WEF list with 8 deaths per 100,000. In the United States, where there are virtually no restrictions on abortion, the ratio is 17 deaths per 100,000. C-FAM cites other examples from its analysis of the WEF report which prove the point.

See also

• Postpartum depression
• Postpartum psychosis
• Psychiatric disorders of childbirth

References

1. ^ Bazelon, Emily (2007-01-21). "Is There a Post-Abortion Syndrome?". New York Times Magazine. Retrieved 2008-01-11. {{cite news}}: Italic or bold markup not allowed in: |publisher= (help)
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.
5. ^ Joyce, Christopher (1989-12-16). "Reagan's officials 'suppressed' research on abortion". New Scientist. Retrieved 2008-02-18. {{cite news}}: Italic or bold markup not allowed in: |publisher= (help)
6. ^ "More on Koop's study of abortion". Fam Plann Perspect. 22 (1): 36–9. 1990. doi:10.2307/2135437. JSTOR 2135437. PMID 2323405.
7. ^ 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.{{cite journal}}: CS1 maint: multiple names: authors list (link)
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.
9. Steinberg JR, Russo NF (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. {{cite journal}}: Unknown parameter |month= ignored (help)
10. ^ "Task Force on Mental Health and Abortion" (PDF). American Psychological Association. Retrieved 2008-08-28.
11. ^ Carey, Benedict (2008-08-12). "Abortion Does Not Cause Mental Illness, Panel Says". New York Times. Retrieved 2008-08-12. {{cite news}}: Italic or bold markup not allowed in: |publisher= (help)
12. ^ 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.{{cite journal}}: CS1 maint: multiple names: authors list (link)
13. "Induced Abortion and Mental Health: A systematic review of the mental health impact of induced abortion". Royal College of Psychiatrists. Retrieved August 1, 2011.
14. 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."
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)
16. ^ 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."
17. ^ Stotland NL (1992). "The myth of the abortion trauma syndrome". JAMA. 268 (15): 2078–9. doi:10.1001/jama.268.15.2078. PMID 1404747. {{cite journal}}: Unknown parameter |month= ignored (help)
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. "Abortion on Demand". TIME. 1973-01-29. Retrieved 2008-11-18. {{cite news}}: Italic or bold markup not allowed in: |publisher= (help)
20. ^ Mooney, Chris (October 2004). "Bucking the Gipper". Washington Monthly. Retrieved 2008-02-18. {{cite news}}: Italic or bold markup not allowed in: |publisher= (help)
21. 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)
22. ^ 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)
23. "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)
24. 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)
25. ^ 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)
26. "Abortion not seen linked with depression". MSNBC. December 4, 2008. Review of studies found no evidence of emotional harm after procedure
27. 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).
28. 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.
29. Kranish, Michael (2005-07-31). "Science in support of a cause: the new research". Boston Globe. Retrieved 2007-11-27. {{cite news}}: Italic or bold markup not allowed in: |publisher= (help)
30. Cooper, Cynthia (August/September 2001). "Abortion Under Attack". Ms. Retrieved 2008-11-18. {{cite news}}: Check date values in: |date= (help); Italic or bold markup not allowed in: |publisher= (help)
31. 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.
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)
35. http://www.abortionno.org/Resources/fastfacts.html
36. http://www.johnstonsarchive.net/policy/abortion/index.html#AD
37. http://afterabortion.org/2000/abortion-four-times-deadlier-than-childbirth/
38. Mika Gissler, Elina Hemminki, Jouko Lonnqvist, “Suicides after pregnancy in Finland: 1987-94: register linkage study” British Medical Journal 313:1431-4, 1996.
39. B. Garfinkle, H. Hoberman, J. Parsons and J. Walker, “Stress, Depression and Suicide: A Study of Adolescents in Minnesota” (Minneapolis: University of Minnesota Extension Service, 1986)
40. David Reardon, “Psychological Reactions Reported After Abortion,” The Post-Abortion Review, 2(3):4-8, Fall 1994
41. Personal communication with Mika Gissler, March 8, 2000.

External links

Reviews by major medical bodies

• 2008 "Report of the Task Force on Mental Health and Abortion". American Psychological Association. 2008. {{cite web}}: Check |url= value (help)
• "The Care of Women Requesting Induced Abortion" (PDF). Royal College of Obstetricians and Gynaecologists. 2004.

Major media coverage

• Bazelon, Emily (2007-01-21). "Is There a Post-Abortion Syndrome?". New York Times Magazine. Retrieved 2010-04-23.
• "Post-Abortion Politics". Public Broadcasting Service. 2007.

Pro-choice sources

• "The Emotional Effects of Induced Abortion". Planned Parenthood.

Pro-life sources

• Reardon, David. "Women Who Have Abortions: Their Reflections on the Unborn".

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