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The relationship between abortion and mental health has been an area of political and scientific controversy. A number of studies have concluded that abortion has generally positive or neutral effects on womens' mental health, and the American Psychological Association has concluded that abortion poses no threat to mental health. However, some studies have suggested 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, may increase the likelihood of experiencing severe negative feelings after an abortion.

Some negative psychological effects of abortion have been referred to, primarily 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 post-abortion syndrome has been described by some physicians and pro-choice advocates as a myth created by the pro-life movement for political purposes.

Neutral and positive psychological effects of abortion

Studies have indicated that those who have undergone abortion have experienced positive or no change to their mental health and well-being. A 1989 study of teenagers who sought pregnancy tests found that counting from the beginning of pregnancy until two years later, the level of stress and anxiety of those who had an abortion did not differ from that of those who had not been pregnant or who had carried their pregnancy to term. A study done in Washington State University found no correlation between abortion and suicide.

Another study in 1992 found that having one abortion was positively associated with higher global self-esteem, particularly feelings of self-worth, capableness, and not feeling one is a failure. It also noted that adverse emotional reactions to the abortion are influenced by pre-existing psychological conditions and other negative factors and, furthermore, that well-being was separately and positively related to employment, income, and education, but negatively related to total number of children. In a 2005 US study, the evidence was inconclusive as to whether abortion as compared to completion of an undesired first pregnancy was related to increased risk of depression.

Negative feelings experienced after abortion

Various studies suggest that some women experience stress after a miscarriage or abortion. The kind of stress and the amount of stress women experience varies from culture to culture. Studies also suggest that an individual woman's stress level is influenced by her economic status, family situation and the status of her mental health before the pregnancy. Although no studies have been able to establish a causal relationship between abortion and depression or stress, many studies cite the pre-existence of depression and stress in a sub-set of women who procure abortions. No causal link has been established between abortion and mental illness. Emotional distress may occur in a minority of women who are contemplating or have had an abortion due to a number of factors, including pre-existing mental health problems, the status of the woman's relationship with her partner, poor economic status, poor social network, or conservative views held on abortion.

Post-abortion syndrome

Post-abortion syndrome (PAS) is a term used to describe a set of adverse psychopathological characteristics, with possible connections to post-traumatic stress disorder, which are proposed to occur in a small percentage of women following an induced abortion. Primarily a term used by pro-life advocates, PAS is not a medically recognized syndrome; PAS is not listed in the Diagnostic and Statistical Manual of Mental Disorders, and neither the American Psychological Association nor American Psychiatric Association recognize it. Some physicians and pro-choice advocates have argued that attempts to popularize the term "post-abortion syndrome" are a tactic used by pro-life advocates for political purposes.

While some studies have shown a correlation between abortion and clinical depression, anxiety, suicidal behaviors, or adverse effects on women's sexual functions for a small number of women, these correlations may be explained by pre-existing social circumstances and emotional health. According to the American Psychological Association, 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 have either failed to establish a causal relationship between abortion and negative psychological symptoms experienced by women, or been inconclusive. On the other hand, a number of researchers have concluded that abortion has positive or neutral effects on women's psychological well-being.

Studies by major institutions

United States Surgeon General

In 1987 President Reagan directed U.S. Surgeon General, C. Everett Koop to issue a report on the health effects of abortion. Koop subsequently began review of over 250 studies pertaining to the physical and psychological impact of abortion, but refused to publish the result, which was later found to have concluded that the procedure has no long-term mental health effects. Koop wrote a letter to President Reagan in January of 1989 stating that he could not issue a conclusive report because the available "scientific studies do not provide conclusive data about the health effects of abortion on women."To address the inadequate research in the field, he recommended a $100 million dollar prospective study would be required to conclusively examine the mental health effects of abortion.

In subsequent testimony before a congressional committee regarding his review of the literature, Koop claimed that while scientific studies have been inconclusive, he was certain that "some people have severe psychological effects after abortion." In yet a subsequent Congressional hearing, when Koop was pressed to address the question of whether his view of the inadequate studies he had reviewed indicated that abortion posed a public mental health threat, Koop stated that in his opinion it was "miniscule from a public-health perspective."

1987-1990 APA Task Force Review

When Koop was assigned to review information on abortion, he invited input from individuals and organizations." The American Psychological Association Division on Population and Environmental Psychology prepared and presented to Koop their own summary of the literature and recommendations for his report. After Koop refused to issue their findings, division members published a synthesis of their own findings in which they concluded that "The weight of the evidence does not pose a psychological hazard for most women."

The task force 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."

They noted that some women do experience "severe distress or psychopathology after abortion" but the negative reactions are "infrequent in the immediate and short-term aftermath, particularly for first-trimester abortions. 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."

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 new task force report is expected to be published in 2008.

Nada Stotland

Psychiatrist Nada Stotland of the University of Chicago, current vice president of the American Psychiatric Association, argued in a 1992 commentary published in the Journal of the American Medical Association (JAMA): "There is no evidence of an abortion-trauma syndrome.” In 2003, Stotland wrote, "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."

Mika Gissler

A government record-based study of all Finnish women found that in the year following a pregnancy outcome the rate of suicide 5.9 per 100,000 for women who gave birth, 18.1 per 100,000 for women who had miscarriages, 34.7 per 100,000 following abortion and 11.4 per 100,000 for women who had not been pregnant in the prior year.

Hanna Söderberg -- Reactions One Year Post-Abortion

The research also compared pre-operative data on the women who agreed to participate in the one year followup and data on women who refused to participate, who represented approximately one-third of all women who had abortions at the hospital. Based on socio-demographic factors, reproductive history and reasons given for the abortion, the researchers concluded that women who are most likely to experience negative post-abortion reactions are also least likely to participate in post-abortion research, stating that "for many of the women, the reason for non-participation seemed to be a sense of guilt and remorse that they did not wish to discuss. An answer very often given was: ‘I do not want to talk about it. I just want to forget'."

References

1. ^ Adler NE, David HP, Major BN, Roth SH, Russo NF, Wyatt GE. "Psychological responses after abortion." Science, April 1990, 248: 41-44.
2. ^ Grimes DA, Creinin MD (2004). "Induced abortion: an overview for internists". Ann. Intern. Med. 140 (8): 620–6. 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."
3. ^ Is There a Post-Abortion Syndrome? By Emily Bazelon. Published in the New York Times Magazine, January 21 2007. Accessed January 11 2008.
4. ^ Research and Destroy, by Chris Mooney. Published in Washington Monthly, October 2004.
5. ^ Stotland NL (2003). "Abortion and psychiatric practice". J Psychiatr Pract. 9 (2): 139–49. 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."
6. ^ Stotland NL. The myth of the abortion trauma syndrome. JAMA. 1992 Oct 21;268(15):2078-9. PMID 1404747.
7. ^ American Psychological Association. "APA research review finds no evidence of 'post-abortion syndrome' but research studies on psychological effects of abortion inconclusive." Press release, January 18, 1989.
8. Zabin, L.S., Hirsch, M.B., Emerson, M.R. (1989). When urban adolescents choose abortion: effects on education, psychological status and subsequent pregnancy. Family Planning Perspectives, 21 (6), 248-55. Retrieved September 8, 2006.
10. Russo, N. F., & Zierk, K.L. (1992). Abortion, childbearing, and women. Professional Psychology: Research and Practice, 23(4), 269-280. Retrieved September 8, 2006.
11. Schmiege, S. & Russo, N.F. (2005). Depression and unwanted first pregnancy: longitudinal cohort study Electronic version. British Medical Journal, 331 (7528), 1303. Retrieved 2006-01-11.
12. Legal abortion: a painful necessity - Sweden
13. Psychological effects of abortion Portugal
14. Gómez Lavín C, Zapata García R (2005). "Diagnostic categorization of post-abortion syndrome". Actas Esp Psiquiatr. 33 (4): 267–72. PMID 15999304.
15. Science in support of a cause: the new research, by Michael Kranish. Published in the Boston Globe on July 31 2005; accessed November 27 2007.
16. Cooper, Cynthia L. Abortion Under Attack
17. Russo NF, Denious JE (2005). "Controlling birth: science, politics, and public policy". J Soc Issues. 61 (1): 181–91. PMID 17073030.
18. TIME. Abortion on Demand
19. "Reagan's officials 'suppressed' research on abortion" New Scientist
20. [http://query.nytimes.com/gst/fullpage.html?res=950DE2DC143DF932A25752C0A96F948260&sec=&spon=&pagewanted=1 "Koop's Stand on Abortion's Effect Surprises Friends and Foes Alike" THE NEW YORK TIMES January 11, 1989
21. New York Times: Koop Says Abortion Report Couldn't Survive Challenge
22. ^ "Dr. Koop's Abortion Advice" New York Times
23. Family Planning and Perspectives by Nancy Adler
24. Abortion and American Psychology Warren Throckmorton, PhD
25. Gissler M, Hemminki E, Lonnqvist J. Suicides after pregnancy in Finland: 1987-94: register linkage study. BMJ 1996;313:1431-4)
26. Söderberg, H., Andersson, C., Janzon, L., & Sjöberg, N-O. (1998). Selection bias in a study on how women experienced induced abortion. European Journal of Obstetrics & Gynecology and Reproductive Biology, 77:67-70.

External links

Major media coverage

• Is There a Post-Abortion Syndrome? By Emily Bazelon; published in The New York Times Magazine
• Post-Abortion Politics: a 2007 video investigation by PBS.

Pro-choice sources

• The Emotional Effects of Induced Abortion, from the Planned Parenthood website.

Pro-life sources

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

• Abortion debate
• Medical controversies