Long-Terms Effects of Abortion

Thomas W. Strahan Memorial Library
Index
Standard of Care for Abortion
Abortion Decision-Making
Psychological Effects of Abortion
Social Effects and Implications
Physical Effects of Abortion
Abortion and Maternal Mortality
Adolescents and Abortion
Definition of Terms
Women's Health After Abortion
Material Yet to be Cataloged
Strahan Summary Articles

Sub-Index
Psychological Effects
Validity of Studies
Reviews
Risk Factors
PTSD
Grief and Loss
Guilt
Ambivalence or Inner Conflict
Anxiety
Intrusion / Avoidance / Nightmares
Denial
Dissociation
Narcissism
Self-Image
Self Punishment
Depression
Psychiatric Treatment
Self-Destructive Behavior
Substance Abuse
Long-Terms Effects of Abortion
Replacement Pregnancies
Sterilization
Impact of Abortion On Others
Violence
Rape, Incest, Sexual Assault
After Late Term Abortion

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2010

Motherhood: is it good for women's mental health? Holtona S, Fishera J, Rowea H. Journal of Reproductive and Infant Psychology, Volume 28, Issue 3 August 2010 , pages 223 - 239

Abstract

There is ongoing debate regarding whether the child-bearing years, including the postpartum period, are a time of increased risk for mental health problems in women. Comparisons of the mental health of mothers and childless women have inconsistent findings. This is probably attributable to differences in the kinds of mothers and non-mothers investigated, and variations in the conceptualisation of mental health, but suggests that firm conclusions about the relationship between motherhood and women's mental health remain less clear than claimed. This study investigated the relationship between motherhood and mental health in a population-based, cross-sectional survey of a broadly representative sample of 569 women aged 30-34 years living in Victoria, one Australian state, in 2005. It was found that the rates of mental health conditions in mothers, including those who had given birth in the preceding year, were no higher than in women without children. Further, mothers reported significantly better subjective well-being and greater life satisfaction than childless women. These data suggest that being a mother is associated with enhanced mental health for women, and challenge the view that the child-bearing years are a period of diminished psychological well-being for women.

Long term follow-up of emotional experiences after termination of pregnancy: women's views at menopause. Dykesa K, Sladeb P; Haywood A. Journal of Reproductive and Infant Psychology,, First published on: 20 October 2010

Abstract

The objective was to explore women’s long-term experiences and perspectives on their terminations of pregnancy (TOP) when perimenopausal. Eight women attending a menopause clinic who had experienced termination a minimum of 10 years previously (mean 24 years) completed semi-structured interviews. Transcripts were analysed using Template Analysis. Five TOP themes were identified: ‘Impression left’ involved sadness, regret, and guilt which affected women’s self-perceptions. ‘Judgement’ encompassed judgement on themselves and how censure was feared from others. ‘Growth and development’ noted the development of resilience and compassion for others. ‘Coming to terms and managing effects’ identified beliefs in the correctness of the decision, but effortful avoidance of thoughts still intruding into life. ‘Contradictions’ identified dramatic inconsistencies within almost all individual accounts indicating lack of resolution and full acceptance. Considering menopause and TOP together revealed a further three themes; Changes to thinking, Menopause as a time of reflection and Linkages or separateness. For some women termination may be continually reappraised in their changing life context and remain an active yet hidden feature managed through active avoidance. Menopause was viewed as a time of vulnerability to TOP-related negative thoughts, especially where wishes for more children were unfulfilled. Accessibility of post-termination counselling throughout life is recommended.

Conduct disorder symptoms and subsequent pregnancy, child-birth and abortion: A population-based longitudinal study of adolescents. Pedersen W, Mastekaasa A. J Adolesc. 2010 Dec 9.

Abstract: Research on teenage pregnancy and abortion has primarily focused on socio-economic disadvantage. However, a few studies suggest that risk of unwanted pregnancy is related to conduct disorder symptoms. We examined the relationship between level of conduct disorder symptoms at age 15 and subsequent pregnancy, child-birth and abortion. A population-based, representative sample of Norwegian adolescent girls (N = 769) was followed from early adolescence until their mid-20s. Even with control for socio-demographic and family variables, conduct disorder symptoms at age 15 were strongly associated with pregnancy in the 15-19 age group, and a weaker association persisted in the 20-28 age group. Similar results were obtained for abortions, but here a strong relationship with conduct disorder symptoms was found even after age 20. After adjustment, no significant association between conduct disorder symptoms and subsequent child-birth was observed. More targeted preventive programmes aimed at girls with conduct disorder symptoms may be warranted.

Review Papers

Abortion and subsequent mental health: Review of the literature. Bellieni CV, Buonocore G. Psychiatry Clin Neurosci. 2013 Jul;67(5):301-10. doi: 10.1111/pcn.12067.

Abstract

The risk that abortion may be correlated with subsequent mental disorders needs a careful assessment, in order to offer women full information when facing a difficult pregnancy. All research papers published between 1995 and 2011, were examined, to retrieve those assessing any correlation between abortion and subsequent mental problems. A total of 36 studies were retrieved, and six of them were excluded for methodological bias. Depression, anxiety disorders (e.g. post-traumatic stress disorder) and substance abuse disorders were the most studied outcome. Abortion versus childbirth: 13 studies showed a clear risk for at least one of the reported mental problems in the abortion group versus childbirth, five papers showed no difference, in particular if women do not consider their experience of fetal loss to be difficult, or if after a fetal reduction the desired fetus survives. Only one paper reported a worse mental outcome for childbearing. Abortion versus unplanned pregnancies ending with childbirth: four studies found a higher risk in the abortion groups and three, no difference. Abortion versus miscarriage: three studies showed a greater risk of mental disorders due to abortion, four found no difference and two found that short-term anxiety and depression were higher in the miscarriage group, while long-term anxiety and depression were present only in the abortion group. In conclusion, fetal loss seems to expose women to a higher risk for mental disorders than childbirth; some studies show that abortion can be considered a more relevant risk factor than miscarriage; more research is needed in this field.

abortion reduce the mental health risks of unwanted or unintended pregnancy? A re-appraisal of the evidence. Fergusson DM, Horwood LJ, Boden JM. Aust N Z J Psychiatry. 2013 Apr 3.

Objective:There have been debates about the linkages between abortion and mental health. Few reviews have considered the extent to which abortion has therapeutic benefits that mitigate the mental health risks of abortion. The aim of this review was to conduct a re-appraisal of the evidence to examine the research hypothesis that abortion reduces rates of mental health problems in women having unwanted or unintended pregnancy.

Methods:Analysis of recent reviews (Coleman, 2011; National Collaborating Centre for Mental Health, 2011) identified eight publications reporting 14 adjusted odds ratios (AORs) spanning five outcome domains: anxiety; depression; alcohol misuse; illicit drug use/misuse; and suicidal behaviour. For each outcome, pooled AORs were estimated using a random-effects model.

Results:There was consistent evidence to show that abortion was not associated with a reduction in rates of mental health problems (p>0.75). Abortion was associated with small to moderate increases in risks of anxiety (AOR 1.28, 95% CI 0.97-1.70; p<0.08), alcohol misuse (AOR 2.34, 95% CI 1.05-5.21; p<0.05), illicit drug use/misuse (AOR 3.91, 95% CI 1.13-13.55; p<0.05), and suicidal behaviour (AOR 1.69, 95% CI 1.12-2.54; p<0.01).Conclusions:There is no available evidence to suggest that abortion has therapeutic effects in reducing the mental health risks of unwanted or unintended pregnancy. There is suggestive evidence that abortion may be associated with small to moderate increases in risks of some mental health problems.

Abortion and mental health: quantitative synthesis and analysis of research published 1995-2009. Coleman PK. Br J Psychiatry. 2011 Sep;199(3):180-6. doi: 10.1192/bjp.bp.110.077230.

BACKGROUND: Given the methodological limitations of recently published qualitative reviews of abortion and mental health, a quantitative synthesis was deemed necessary to represent more accurately the published literature and to provide clarity to clinicians.

AIMS: To measure the association between abortion and indicators of adverse mental health, with subgroup effects calculated based on comparison groups (no abortion, unintended pregnancy delivered, pregnancy delivered) and particular outcomes. A secondary objective was to calculate population-attributable risk (PAR) statistics for each outcome.

METHOD: After the application of methodologically based selection criteria and extraction rules to minimise bias, the sample comprised 22 studies, 36 measures of effect and 877 181 participants (163 831 experienced an abortion). Random effects pooled odds ratios were computed using adjusted odds ratios from the original studies and PAR statistics were derived from the pooled odds ratios.

RESULTS: Women who had undergone an abortion experienced an 81% increased risk of mental health problems, and nearly 10% of the incidence of mental health problems was shown to be attributable to abortion. The strongest subgroup estimates of increased risk occurred when abortion was compared with term pregnancy and when the outcomes pertained to substance use and suicidal behaviour.

CONCLUSIONS: This review offers the largest quantitative estimate of mental health risks associated with abortion available in the world literature. Calling into question the conclusions from traditional reviews, the results revealed a moderate to highly increased risk of mental health problems after abortion. Consistent with the tenets of evidence-based medicine, this information should inform the delivery of abortion services.

Abortion and mental health: Evaluating the evidence. Major B, Appelbaum M, Beckman L, Dutton MA, Russo NF, West C.A m Psychol. 2009 Dec;64(9):863-90. doi: 10.1037/a0017497.

The authors evaluated empirical research addressing the relationship between induced abortion and women's mental health. Two issues were addressed: (a) the relative risks associated with abortion compared with the risks associated with its alternatives and (b) sources of variability in women's responses following abortion. This article reflects and updates the report of the American Psychological Association Task Force on Mental Health and Abortion (2008). Major methodological problems pervaded most of the research reviewed. The most rigorous studies indicated that within the United States, the relative risk of mental health problems among adult women who have a single, legal, first-trimester abortion of an unwanted pregnancy is no greater than the risk among women who deliver an unwanted pregnancy. Evidence did not support the claim that observed associations between abortion and mental health problems are caused by abortion per se as opposed to other preexisting and co-occurring risk factors. Most adult women who terminate a pregnancy do not experience mental health problems. Some women do, however. It is important that women's varied experiences of abortion be recognized, validated, and understood.

Older

Reactions to abortion and subsequent mental health. Fergusson DM, Horwood LJ, Boden JM. Br J Psychiatry. 2009 Nov;195(5):420-6.

BACKGROUND: There has been continued interest in the extent to which women have positive and negative reactions to abortion. AIMS: To document emotional reactions to abortion, and to examine the links between reactions to abortion and subsequent mental health outcomes.

METHOD: Data were gathered on the pregnancy and mental health history of a birth cohort of over 500 women studied to the age of 30.

RESULTS: Abortion was associated with high rates of both positive and negative emotional reactions; however, nearly 90% of respondents believed that the abortion was the right decision. Analyses showed that the number of negative responses to the abortion was associated with increased levels of subsequent mental health disorders (P<0.05). Further analyses suggested that, after adjustment for confounding, those having an abortion and reporting negative reactions had rates of mental health disorders that were approximately 1.4-1.8 times higher than those not having an abortion.

CONCLUSIONS: Abortion was associated with both positive and negative emotional reactions. The extent of negative emotional reactions appeared to modify the links between abortion and subsequent mental health problems.

"Induced Elective Abortion and Perinatal Grief," Gail B. Williams, Dissertation Abstracts Int'l. 53(3): 1296B, Sept. 1992.

A study of 83 white women with one first trimester abortion, no documented psychiatric history and no self-reported prenatal losses in the last 5 years an average of 11 years postabortion. The Grief Experience Inventory was used as a test instrument and found a range of scores from 27-82. 50 represents at least minimal grief on 12 bereavement/research scales. Various scales measured included anger/hostility, social isolation, loss of control, death anxiety, loss of vigor, physical symptoms, dependency, somatization, sleep disturbance, loss of appetite, optimism/despair, denial. It was concluded that some women experienced persistence of various aspects of grief for long periods of time following induced abortion.

The Psycho-Social Aspects of Stress Following Abortion, Anne C. Speckhard, (Kansas City: Sheed and Ward, 1987)

In a study of 30 women stressed by abortion after 5-10 years following their abortion, women reported feelings of sadness, regret, remorse or a sense of loss [100 percent]; feelings of depression [92 percent]; feelings of anger [92 percent]; feelings of guilt [92 percent]; fear that others would learn of the pregnancy and abortion experience [89 percent]; many expressed surprise at the intensity of the emotional reaction to the abortion [85 percent]; Other adverse reactions included feelings of lowered self-worth [81 percent]; feelings of victimization [81 percent]; preoccupation with the characteristics of the aborted child [81 percent]; feelings of depressed effect or suppressed ability to experience pain [73 percent]; and feelings of discomfort around infants and small children [73 percent]. In this study the most common behavioral reactions included frequent crying [81 percent]; inability to communicate with others concerning the pregnancy and abortion experience [77 percent]; flashbacks of the abortion experience [73 percent]; sexual inhibition [69 percent]; suicide ideation [65 percent] and increased alcohol use [61 percent].

"Aborted Women: Silent No More," David C. Reardon, (Chicago: Loyola Press, 1987)

In a detailed study of 252 women with prior abortions who are members of Women Exploited by Abortion approximately 10 years after their abortion, 95% were now dissatisfied with the abortion choice and 94% attributed negative psychological effects to their abortion.

"Mental Disorders After Abortion," B. Jansson, Acta Psychiatrica Scandinavica41:87 (1965).

In a Swedish study of 57 women with prior psychiatric problems who subsequently had induced abortions, three committed suicide as determined by long-term follow-up studies 8-13 years after their abortion. In contrast, of 195 women with previous psychiatric problems who carried children to term, none committed suicide.

"Risk of Admission to Psychiatric Institutions Among Danish Women Who Experience induced Abortion," Ronald L. Somers, Ph.D. Thesis/ UCLA (1979)

Among women with 2 or more abortions the rate of psychiatric admissions among women 35-39 (approx. 9%) was about 4 times higher than women 25-29 years of age (approx. 2.3%) and 8-18 times higher than women 20-24 years of age (0.5-1.1%) during 1973- 1975.

"Psychological Aspects of Abortion," Edna Ortof in Psychological Aspects of Pregnancy, Birthing and Bonding, ed. Barbara L. Blum (New York: Human Sciences Press, 1980)

Several examples of post-abortion dreams are provided. One woman had the following dream 11, years after a self-induced abortion:

"I was in my old home town with two girlfriends and about to go horseback riding... (but) we couldn't get a horse. Then some lady came over and handed me a bundle wrapped in a sheet and blankets/ like a baby. I was delighted to hold it... when I opened the bundle ... there was a kid there and it looked like it was shrinking. Like it was wasting away and I wanted the mother to come and take it away before it would die in my arms... The more I looked, the more anxious I got." The therapist reported this woman had an enormous sense of unfinished business about the pregnancy and abortion. She still had periodic intercourse without use of contraceptives with the prospective father hoping to "undo" that event. At times her guilt was overwhelming and her sense of loss increased with the passing years.

A Survey of Post-Abortion Reactions, David C. Reardon, (Springfield, Illinois: Elliot Institute, 1987)

A 1987 survey of 100 women an average of 11 years post-abortion who were contacted through state Women Exploited by Abortion chapters found that only 54% felt they had fully reconciled their abortion experience; 62% experienced the majority of their negative experience one year or more post-abortion; 97% regretted having the abortion; 62% said they felt more callused and hardened; 70% felt a need to stifle feelings; 45% said they had feelings of relief after abortion; 42% became sexually promiscuous; 50% reported aversion to sexual intercourse or sexual unresponsiveness; 54% thought the abortion choice was inconsistent with their own ideals; 64% ended the relationship with their sexual partner following the abortion (41% within one month, 9% more within 6 months and 14% more within one year.

The Long-Term Psychological Effects of Abortion, Catherine A Barnard, (Portsmouth, NH: Institute for Pregnancy Loss, 1990) Summarized in Association for Interdisciplinary Research in Values and Social Change Newsletter 3(4):1 (1991)

A random sample of 984 women who had abortions during 1984-84 at a clinic in Baltimore, Maryland were selected for study. However, only 160 women could be contacted 3-5 years later, Of the 160 contacted only 80 actually completed the research packets. Research instruments used were the DSM-IIIR, Impact of Events Scale, and the Millon Clinical Mulitaxial Inventory. The prevalence of Post Traumatic Disorder was 18.8%. High stress levels ranging from 39-45% were prevalent in such areas as sleep disorers, hypervigalence, or flashbacks. The variables that predicted high stress reactions were: a negative relationship with mother, a past history of emotional problems in the family of origin, a conflictual relationship with the father of the child, and poor aftercare at the clinic. The number of reported prior abortions did not predict the incidence of PTSD. 30% of the women had abortions between 14-18 years of age and few were religious at the time of their abortion.

"Methodological considerations in empirical research on abortion," RL Anderson et al in Post-Abortion Syndrome. Its Wide Ramifications, ed. Peter Doherty (1995) 103

A study at Pine Rest Christian Hospital in Grand Rapids, Michigan which provided psychiatric outpatient services, compared women who presented with a history of elective abortion and sought psychiatric outpatient services in response to a negative adjustment to abortion ( the abortion distressed group), to a control group which also had a history of elective abortion but who presented for outpatient psychiatric services for reasons which were not abortion related. (the abortion non-distressed group). The average length of time from the abortion to the time of the study was 9 years. Seventy-three percent (73%) of the abortion distressed group met the criteria for Post Traumatic Stress Disorder (DSM-IIIR) which was significantly higher than the abortion non-distressed group. Women in the abortion distressed group more often reported they believed abortion to be morally wrong compared to the abortion non-distressed group. There were no significant differences among groups in psychopathology as measured by MMPI-2, on overall social support, or religiosity. Abortion distressed women experienced fewer recent adverse life events compared to abortion non-distressed women.

Canonical variates of postabortion syndrome, Helen P Vaughan, (Portsmouth, NH: Institute for Pregnancy Loss, 1990)

Questionnaires were distributed nationwide to 62 crisis pregnancy centers to women who had reported symptoms of postabortion syndrome and 232 questionnaires were returned. The mean length of time from their abortion was 11 years. It was found that postabortion syndrome was comprised of anger, guilt, grief, depression, and stress reactions. Two different dimensions of negative postabortion adjustment were noted. One dimension included high levels of anger and guilt, with a significant absence of any grief feelings. The second dimension showed high guilt and stress with a significant absence of anger. The various personality characteristics and circumstances of women in each dimension were discussed.

" Psychological Profile of dysphoric women postabortion," KN Franco et al, Journal of the American Medical Women's Association 44(4): 113, 1989

Eighty-one women in a patient-led postabortion support group years who described themselves as having poorly assimilated their abortion experience 1-15 years postabortion were studied. 78% were single at the time of their abortion and only 19% married the father of the child. The Bech Depression Inventory for women with one abortion was 4.7(none to minimal depression) and for women with multiple abortions was 9.4(moderate depression). The Millon Clinical Mulitaxial Inventory (MCMI) suggested personal pathology in the form of anxiety (48%), somatoform disorders (58%), and dysthymia (36%). Those with multiple abortions scored on the borderline personality subscales. Some 48% of the group underwent psychotherapy after their abortion; 50% of women with multiple abortions made a suicide attempt sometime after their abortions; anniversary reactions were clearly reported by 42% of the sample. For additional studies on this sample of postabortion women see "Anniversary Reactions and Due Date Responses Following Abortion," K Franco et al, Psychother Psychosom 52:151, 1989; "Abortion in Adolescence," NB Campbell et al, Adolescence, 23(92), 1988

Post-Abortion Trauma, 9 steps to Recovery, Jeanette Vought, (Grand Rapids: Zondervan, 1991).

In a study of women in a religiously-based postabortion recovery group 10-15 years post- abortion, 90% reported guilt and shame related to their abortion, 74% feelings of isolation, 60% expressed anger toward others, 24% were more fearful of sexual intercourse after their abortion, 31% tried to avoid pregnant women, 53% said they desired to get pregnant again to compensate for their loss; 76% suffered from depression, 78% struggled with low self-esteem and 49% said they felt alienated from God. Following their abortion, women reported insomnia (25%), negative and hurtful relationships with men (38%, abortion had a negative effect on parenting (32.4%), frequent alcohol use (17.8%), frequent drug use (9.2%) as well as other negative personal or relational problems.

"Physical and Psychological Injury Following Abortion: Akron Pregnancy Services Survey," L.H. Gsellman, Association For Interdisciplinary Research Newsletter 5(4):1-8, Sept/Oct 1993.

In a questionnaire study of 344 post-abortal women receiving a variety of services at a pregnancy service center an average of 6 years following their abortion, 66% expressed guilt, 54% expressed regret or remorse, 46% had an inability to forgive self, 57% reported crying or depression, 38% reported lower self-esteem and 36% reported anger or rage, 16% reported suicidal impulses and 7% made suicide attempts. 18.4% of the abortions were at 13 weeks gestation or more; 22% reported two abortions and 4.3% reported three or more abortions.

"Prolonged Grieving After Abortion. A Descriptive Study," D Brown et al, The Journal of Clinical Ethics 4(2):118, 1993.

Upon request, women from a large protestant congregation in Florida wrote descriptive letters on the negative effects of abortion. 45 letters contained sufficient information to compile statistical information, 81% were first trimester abortions and 71% occurred after Roe v Wade was decided. 42% reported negative emotional sequelae that lasted over 10 years. Frequently mentioned long term experiences included guilt feelings (73.3%), fantasizing about the aborted fetus( 57.8%), masking their experience with the appearance of well-being (35.5%), suicide ideation (15.5%), recurrent nightmares(15.5%), marital discord (15.5%), phobic responses to infants (13.3%), as well as fear of men (8.9%) and disinterest in sex (6.7%).