Abortion and Mental Health

Draft Short Summary

The issue of abortion and mental health is very controversial. In 1989, Surgeon General C. Everett Koop reported that no definitive conclusions could be made regarding either the positive or negative mental health effects related to abortion because all available research at that time was too methodlogically flawed. A year later, a team of psycholgists with the American Psychological Association published their own review of the literature. They concluded that the "The weight of the evidence does not pose a psychological hazard for most women" but also noted that "case studies have established that some women experience severe distress or psychopathology after abortion." They also noted that certain groups of women were at higher risk of experiencing negative reactions, including: "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."

In a 1992 review of research on abortion and mental health lead editor concluded that "[t]here is now virtually no disagreement among researchers that some women experience negative psychological reactions postabortion," and that the issues of disagreement are centered on (1) how prevelant negative reactions are, (2) the severity of negative reactios, (3) determination of what level of negative reactions consitutes a public or mental health problem, and (4) how severe reactions should be classified.

In the subsequent ten years, case-control studies have found that abortion is associated with higher rates of psychiatric treatment anxiety, depression,alcohol use,, post-traumatic stress disorder, drug use,, increased requests for medical treatement and worsening of general health, suicidal thoughts completed suicides, and child maltreatment.

Self-esteem scores are not significantly affected by abortion. Students who abort an unintended pregnancy are significantly more likely to complete high school than similar classmates who choose to give birth.

It is has not been conclusively shown if the mental health problems staistically associated with abortion are directly caused by the abortion itself, by experiences associated with the unintended pregnancy, or if the abortion related experiences may only serve to aggravate, trigger, or in some manner contribute to pre-existing mental health problems. An alternative explanation is that the statistical associations between abortion and psychiatric illnesses are entirely incidental. Along these lines it has been proposed that women who already have mental problems are more likely to have unwanted pregnancies ending in abortion.

Post-abortion counseling programs are offered by a wide number of peer support groups and professional counseling services. Many programs reflect a pro-choice perspective which attempt to help women deal with negative reactions while validating the choice to abort. Others reflect a pro-life perspective which includes an element of repentance for the abortion choice.

The controversy over abortion and mental health is fueled by the potential effects this issue may have on the political and judicial debate over abortion. In it's most recent ruling on abortion, Gonzales v Carhart the majority opinion indicated that abortion was "fraught with emotional consequences." The minority opinion, however, while acknowleding that "for most women, abortion is a painfully difficult decision" insisted there is no reliable evidence that women who regret their abortions suffer from "[s]evere depression and loss of esteem."

Proposed Intro

The relationship between abortion and mental health has been an area of political and scientific controversy. While most experts agree that some women have significant negative emotional reactions related to abortion, the incidence rate, severity, and causes are not fully understood.

A number of studies have concluded that abortion is associated with no more psychological risk than carrying an unwanted pregnancy to term. Other studies have reported a statistical correlation between abortion and negative psychological effects, though no studies have found a causal relationship. 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 a 1990 review, the American Psychological Association has found that "severe negative reactions [after abortion] are rare and are in line with those following other normal life stresses." The 2008 Britian's Royal College of Psychiatrists issued an official report stating that abortion may expose women to significant mental health risks.

The existence of "post-abortion syndrome" is not recognized by any medical or psychological organization. Some 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.

Post-Abortion Syndrome

Post-abortion syndrome (PAS), is a highly controversial term first proposed by psychologist Vincent Rue to describe a variant of post-traumatic stress disorder (PAS) where the stressor was a traumatic abortion. The term "post-abortion syndrome", however, has been popularized by opponents of abortion in such a way that it is more generally understood to refer to any negative emotional or psychological reactions to abortion, not just traumatic symptoms.

The American Psychological Association and the American Psychiatric Association do not recognize PAS as a valid diagnosis and it is not included in the Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR or ICD-10 list of psychiatric conditions. It has been argued that the concept of abortion causing traumatic reactions is a "myth" created by opponents of abortion for political purposes.

"Post-abortion stress syndrome" (PASS) and "abortion trauma syndrome." are additional terms sometimes used to discuss emotional problems purportedly associated with abortion. For the sake of reference, these terms are also used by those who deny that there any unique emotional problems are in fact caused by abortion.

As PAS, PASS, and "abortion trauma syndrome" are commonly understood to refer to any negative emotional reactions to abortion this article addresses the issue of abortion and mental health in all respects. In doing so, it examines both history and controversy surrounding questions related to abortion and mental health and the peer reviewed studies related to abortion and mental health.

Brief History of the Abortion Mental Health Controversy

American Psychological Association - 1969

In 1969, American Psychological Association Council member Henry P. David proposed the the APA should adopt a postion favoring legalization of abortion as a civil right. The petition was

WHEREAS, termination of unwanted pregnancies is clearly a mental health and child welfare issue, and a legitimate concern of APA; be it resolved, that termination of pregnancy be considered a civil right of the pregnant woman, to be handled as other medical and surgical procedures in consultation with her physician...

At the same time, the APA established the Task Force on Psychology, Family Planning and Population Policy to "(a) to prepare "a review of the current state of psychological research related to family planning and population policy and (b) to make recommendations for encouraging greater research and professional service participation by psychologists in this emerging area of social concern." The Task Force was made up of APA members with an interest in family planning and population control and was instrumental in the establishing in 1974 the APA Division 34 on Population and Environmental Psychology (APA Division 34) The members of this division subsequently contributed information to Surgeon General Koop and published an important review of the literature on abortion and mental health in 1990 (discussed below).

Vincent Rue

In 1981 psychologist and trauma specialist Vincent Rue testified before Congress that he had treated women who had experienced traumatic reactions to abortion resulting in the same type of post-traumatic stress disorder he had treated in VietnNam Vets, with the exception that the stressor in this case was abortion rather than battlefield violence. He proposed the name "Post-Abortion Syndrome" (PAS) and the term was soon picked up and used by abortion opponents to refer to any negative emotional reactions associated with abortion, not just PTSD as Rue had intended it.

Soon after giving this testimony, Rue was threatened with legal action by the general counsel the American Psychiatric Association if any notes he published making reference to the PTSD diagnosis for abortion did not include a specific disclaimer stating that the APA denies that there is "any clinical evidence for the basis of the diagnosis of ‘post-abortion syndrome."

WEBA

In 1982, a group called Women Exploited by Abortion (WEBA)was formed as a peer-support group for women struggling with negative reactions after abortion. Based on the testimonies of these women, the view that abortion was harmful to women's well-being became a popular theme among abortion critics.

Surgeon General Koop's Letter

In 1987 President Reagan directed U.S. Surgeon General, C. Everett Koop to issue a report on the health effects of abortion on women. Koop subsequently began review of over 250 studies pertaining to the physical and psychological impact of abortion. In a letter to President Reagan in January of 1989 Koop stated 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 the letter Koop also stated the view that "In the minds of some [abortion opponents], 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 subsequent testimony before a congressional committee regarding his review of the literature, Koop stated that while the scientific studies available at that time were not methodologically sound enough to draw unimpeachable conclusions, "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 yet a subsequent Congressional hearing, Congressman Ted Weiss questioned Koop saying: "And yet the American Psychological Assocation's conclusion that severe long-term psychological effects of abortion are rare seems to be consistent with your remarks at several meeting on this topic in which you refer to the psychological problem as "minuscule" from the public health perspective." In response, Koop stated, "From a public health perspective, that is true. From the personal perspective, from the family perspective, it is overwhelming. All this leads up to my conclusion to the President that we don't know what we are talking about, and if you want to know what you are talking about and feel certain about what you are saying you have to do a prospective study...[1]}}

[1]Medical and Psychological Impact of Abortion, Committee on Government Operations, United States Congress, House of Representatives, page 241 (1989). Excerpts available from Google Books here and here.

While in office, Surgeon General of the United States C. Everett Koop, who is self-described as pro-life, conducted a review of 250 studies that included the medical and psychological impact of abortion on women as directed by President Reagan. After reviewing the report prepared by his staff refused to publish the report because he believed the research on which it was based was too methodologically weak to support any definitive conclusions. Instead, Koop sent a letter to the President explaining why he could not issue a definitive report in which he stated "scientific studies do not provide conclusive data about the health effects of abortion on women." In subsequent testimony, Koop stated "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 yet a subsequent Congressional hearing, Congressman Ted Weiss questioned Koop saying: "And yet the American Psychological Assocation's conclusion that severe long-term psychological effects of abortion are rare seems to be consistent with your remarks at several meeting on this topic in which you refer to the psychological problem as "minuscule" from the public health perspective." In response, Koop stated, "From a public health perspective, that is true. From the personal perspective, from the family perspective, it is overwhelming. All this leads up to my conclusion to the President that we don't know what we are talking about, and if you want to know what you are talking about and feel certain about what you are saying you have to do a prospective study..."

1987-1990 APA Task Force Review

When Koop was assigned to review information on abortion, he invited input from any individuals and organizations with material to present. 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. 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 the findings, division members published a synthesis of their own findings in which they concluded that "Case studies have established that some women experience severe distress or psychopathology after abortion" but "severe 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."

The task force further 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," and that "The weight of the evidence does not pose a psychological hazard for most women."

The task force concluded that "case studies have established that some women experience severe distress or psychopathology after abortion" but "severe 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....Despite methodological shortcomings of any single study, in the aggregate, 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."

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.

Julius Fogel

For a 1989 article regarding the Koop letter, Washington Post columnist Colman McCarthy interviewed 75-year-old Dr. Julius Fogel, a Washington based physician who was both a psychiatrist and an obstetrician who had performed over 20,000 abortions. Fogel told Coleman:

There is no question about the emotional grief and mourning following an abortion. It shows up in various forms. I've had patients who had abortion a year or two ago--women who did the best thing at the time for themselves--but it still bothers them. Many come in--some are just mute, some hostile. Some burst out crying... There is no question in my mind that we are disturbing a life process.

McCarthy reported that Fogel had made similar statements in an 1971 interview at a time when he was doing "therapeutic abortions" before Roe v Wade

Nada Stotland

Psychiatrist Nada Stotland of the University of Chicago, current 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.” She identified only three groups of women as being at risk: "Significant psychiatric illness following abortion occurs most commonly in women who were psychiatrically ill before pregnancy, in those who decided to undergo abortion under external pressure, and in those who underwent abortion in aversive circumstances, for example, abandonment. Lask attributed the adverse reaction in 11% of the subjects he studied to these factors."

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."

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."

In a 1992 commentary published in the Journal of the American Medical Association (JAMA), psychiatrist Nada Stotland of the University of Chicago (who is currently vice president of the American Psychiatric Association) argued "There is no evidence of an abortion-trauma syndrome.” To support her thesis, she cited research showing that only 11% of patients had significant short term emotional problems related to their abortions. Her term "abortion trauma syndrome" was different than that of Rue.

In a subsequent 1998 paper, Stotland describes treating a patient who experienced a severe delayed reaction to a prior abortion following a a subsequent miscarriage. She reports discovering first-hand "the psychological complexities of induced abortion" and concludes that the failure to address these issues "leaves the person vulnerable to reminders and reenactments, to difficulties that may surface in life and in subsequent psychotherapy." Despite a woman's political or moral views of abortion, she writes, "abortion is experienced by that woman as both the mastery of a difficult life situation and as the loss of a potential life. There is the danger that the political, sociological context can overshadow a woman's authentic, multilayered emotional experience."

Journal of Social Issues Review

In 1992, the Journal of Social Issues dedicated an entire issue to research relating to the psychological effects of elective abortion. In an overview of the contributors papers the editor, Dr. Gregory Wilmoth, concluded: "There is now virtually no disagreement among researchers that some women experience negative psychological reactions postabortion. Instead the disagreement concerns the following: (1) The prevalence of women who have these experiences . . . , (2) The severity of these negative reactions . . . , (3) The definition of what severity of negative reactions constitutes a public health or mental health problem . . . , [and] (4) The classification of severe reactions . . . "

In 1992, the Journal of Social Issues dedicated an entire issue to research relating to the psychological effects of elective abortion. In an overview of the contributors papers the editor, Dr. Gregory Wilmoth, concluded: "There is now virtually no disagreement among researchers that some women experience negative psychological reactions postabortion. Wilmoth goes on to describe four issues of interest: (1) identifying the prevalence of negative reactions, (2) identifying the severity of negative reactions, (3) defining what level of negative reactions constitutes a public health problem, and (4) classification of severe reactions.

NLSY Studies

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Philip Ney

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Hanna Söderberg -- Reactions One Year Post-Abortion

Interviews with of 854 women one year after they had abortions at a hospital in Sweden, found that approximately 60 percent of the women had experienced some level of emotional distress from their abortions and in 30% of the cases the reactions were classified as "severe."

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. According to Söderberg, "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'."

Gissler

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

Nancy Russo

Nancy Russo is a significant figure in the APA subgroup involved pro-choice advocacy. In a letter in the APA's newsletter responding to the subgroups one sided promotion of pro-choice activism, Russo wrote:

In 1969, APA's Council of Representatives resolved that abortion be considered a "civil right of the pregnant woman." More recently, pro-life misrepresentation of research findings led the council to resolve that APA disseminate scientific information on reproductive issues to policy-makers and the public. Our work is a direct response to that mandate.

Gallagher naïvely assumes findings with implications for women's lives can be "apolitical." Science always reflects the values of scientists--the difference here is that we state our values up front and do not pretend scientific methods make findings value-free....
Finally, the Phillip Morris analogy is inapt. We have no interest, economic or otherwise, in portraying abortion as a risk-free event. A pro-choice position means that we believe abortion is the woman's choice, that women should be given accurate information and informed consent in making their reproductive choices, and that they be supported in their decisions. The charge that this activity, which is congruent with APA policy and conducted in conformance with scientific standards, "undermines the integrity" of APA is without basis.

Russo expressed similar sentiments to a columnist with the Washington Times in dismissing the significance of the Fergusson study: "To pro-choice advocates, mental health effects are not relevant to the legal context of arguments to restrict access to abortion."

Similarly, she told a science reporter from the Toledo Blade newspaper saying "As far as I'm concerned, whether or not an abortion creates psychological difficulties is not relevant...it means you give proper informed consent and you deal with it". In 2005, Russo and Denious described the promotion of post-abortion syndrome as part of a campaign to develop a rationale for suing physicians who provide abortions and thus deterring the provision of legal abortion services. The authors wrote that: "There is no scientific basis for constructing (sic?) abortion as a severe physical or mental health threat," describing as "most worrisome... the publication of deeply flawed studies that contain miscoded data and meaningless findings (e.g., Reardon & Cougle, 2002) which are then used as 'evidence' that abortion is harmful to women."

Reardon and Cougle have denied that their studies are flawed, miscoded, or meaningless and have accused Russo of slanting the findings of her own studies to promote a pro-abortion agenda by recoding the data to exclude women who were pressured into unwanted abortions while also adding women who had subsequent abortion into the control group, omitting mention of a 60% concealment rate, failing to describe a large body of studies, including others done by Russo, which have confirmed a persistent association between abortion and depression, and for exaggeration of the importance of satistically insignificant results.

Brenda Major

Insert review of major studies here.

Priscilla Coleman

In a 2005 review of the literature on abortion and mental health, Bowling Green University professor Priscilla Coleman, a research psychologists with many peer reviewed studies in this field[1], wrote:

Abortion tends to bring relief and a reduction in women's perceptions of stress. However, there is relative consensus among scholars in the field that at least 10-20% of women who have had an abortion suffer from serious negative psychological complications. With over 1.3 million abortions performed annually in the U.S., using the more conservative 10% figure would result in 130,000 new cases of women experiencing related psychological problems each year. Among those who are adversely affected, many stress-related symptoms have been identified, including anxiety, depression, sleep disturbances, substance use/abuse, and increased risk of suicide. A few recent studies have further identified relations between maternal history of abortion and problematic parenting.

She also observed that while "most of the existing post-abortion data are based on the exclusive use of narrowly focused questionnaire-based self-reports," more recent studies were gathering more complete data using a structured interview process, for example:

In a large Swedish study of 854 women one year after an abortion, which incorporated a semi-structured interview methodology requiring 45-75 minutes to administer, rates of negative experiences were considerably higher than in previously published studies relying on more superficial assessments. Specifically, 50-60% of the women experienced emotional distress of some form (e.g., mild depression, remorse or guilt feelings, a tendency to cry without cause, discomfort upon meeting children), 16.1% experienced serious emotional distress (needing help from a psychiatrist or psychologist or being unable to work because of depression), and 76.1% said that they would not consider abortion again (suggesting indirectly that it was not a very positive experience).

David M. Fergusson and the APA's Response

In 2006, a team of researchers at the University of Otago Christchurch School of Medicine in New Zealand, published results relating to abortion reactions from a longitudinal study tracking approximately 500 women from birth to 25 years of age. Information was obtained on: a) the history of pregnancy/abortion for female participants over the interval from 15-25 years; b) measures of DSM-IV mental disorders and suicidal behaviour over the intervals 15-18, 18-21 and 21-25 years; and c) childhood, family and related confounding factors. The study concluded that compared to other women in the group those who had an abortion were subsequently more likely to have "mental health problems including depression, anxiety, suicidal behaviours and substance use disorders. This association persisted after adjustment for confounding factors." The authors wrote, "The findings suggest that abortion in young women may be associated with increased risks of mental health problems," and "on the basis of the current study, it is our view that the issue of whether or not abortion has harmful effects on mental health remains to be fully resolved."

The team was led by Professor David Fergusson, a self-described "pro-choice atheist," complained the to press that they had run into political bias at journals which did not want to publish their results, saying they "went to four journals, which is very unusual for us, we normally get accepted the first time."

The team particularly objected to the 2005 position paper by the American Psychological Association which "concluded that ‘well designed studies of psychological responses following abortion have consistently shown that risk of psychological harm is low...the percentage of women who experience clinically relevant distress is small and appears to be no greater than in general samples of women of reproductive age'" According to the researchers, "This relatively strong conclusion about the absence of harm from abortion was based on a relatively small number of studies which had one or more of the following limitations: a) absence of comprehensive assessment of mental disorders; b) lack of comparison groups; and c) limited statistical controls. Furthermore, the statement appears to disregard the findings of a number of studies that had claimed to show negative effects for abortion."

The research prompted the American Psychology Association to withdraw an official statement which denied a link between abortion and psychological harm. In response to Fergusson's criticisms of the APA, the APA's spokesperson on abortion and a member of the 1989 task force, Dr. Nancy Russo, told a Washington Times reporter that the APA's official position on abortion developed from the viewpoint that abortion is a civil right and that "To pro-choice advocates, mental health effects are not relevant to the legal context of arguments to restrict access to abortion." She further stated her opinion that "pre-existing mental health problems, relationship quality, and whether the pregnancy was wanted or unwanted are key factors determining postabortion mental distress, not the abortion itself," She rejected the significance of Fergusson's study stating: "There has yet to be a well designed study that finds that abortion itself contributes to increased risk for mental health problems," and noted that feelings of guilt and shame after abortion may result from social disapproval and efforts to cast abortion as a moral failing, rather than from the procedure itself. Fergusson resopnded that better research was needed, but that "...the abortion debate and its implications drive out the science."

Subsequent to the New Zealand team's criticisms of its position papers, the APA convened a new task force to publish a new report in 2008 regarding abortion and mental health.

Royal College of Psychiatrists

A 2008 official statement from Britian's Royal College of Psychiatrists states that women may be at risk of mental 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.

According to The Times, the Royal College's decision follows in the wake of a number of studies indicating that abortion may contribute to mental health problems. It particularly notes that the controversy over abortion and mental health in Britain "intensified earlier this year when an inquest in Cornwall heard that a talented artist hanged herself because she was overcome with grief after aborting her twins. Emma Beck, 30, left a note saying: 'Living is hell for me. I should never have had an abortion. I see now I would have been a good mum. I want to be with my babies; they need me, no one else does.'"

Academic research

THIS SECTION might be more useful if organized around symptoms rather than country in which the study was conducted....but the following is from other contributors on the day I created this file. Leaving as is for now.

A number of studies have examined the relationship between abortion and negative psychological symptoms. While most studies have found an statistical association between abortion and depression, a causal connection has not been proven.

Neutral and positive effects of abortion

Some studies have indicated that women 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. 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 women's well-being was separately and positively related to employment, income, and education, but negatively related to total number of children.

Denmark

A study conducted at University of Copenhagen has shown legal abortion is associated with few adverse effects on sexual function among women in Denmark. The study was conducted among 941 women who chose elective abortion. Among the many statistics of note, the authors wrote, "Diminished libido was experienced by 15.3% at 8 weeks follow-up, and 6.0% experienced diminished orgasm ability (self-rated changes). Libido was unchanged in 72.4% of the women, 69.7% had no change in orgasm ability and 3.3% had never experienced orgasm." The study concluded that "Overall, 51.0% of the women recommenced coitus within 2 weeks after TOP (Termination of Pregnancy). This figure was significantly higher among women aged 18–24 years (60.6%) than among women in higher age groups (41.7–47.8%)."

Finland

A Finnish study has shown a correlation between miscarriage (or spontaneous abortion) with depression and suicide, as well as between medically induced abortion with depression and suicide among women in Finland. The study found that among 8,980 women, "In total, 30 suicides were committed after women gave birth (42% [of deaths among the women in the study]), 29 after an abortion (40%), and 14 after a miscarriage (19%), of which two were after an extrauterine pregnancy." The study was unable to establish a causal link between abortion and suicide because it was not clear if abortion causes depression and suicide, or if women who are depressed and suicidal are more likely to elect to have an abortion. The article concludes that an "explanation for the higher suicide rate after an abortion could be low social class, low social support, and previous life events or that abortion is chosen by women who are at higher risk for suicide because of other reasons."

Norway

A study in Norway compared the mental distress of women who experienced a spontaneous abortion (miscarriage) and those who had a voluntary abortion. Women who had had a miscarriage exhibited significantly quicker improvement on Impact of Event Scale (IES) scores for avoidance, grief, loss, guilt and anger throughout the observation period. Women who experienced induced abortion had significantly greater IES scores for avoidance and for the feelings of guilt, shame and relief than the miscarriage group after two and five years. Compared with the general population, women who had undergone induced abortion had significantly higher Hospital Anxiety and Depression Scale (HADS) anxiety scores at all four interviews, while women who had had a miscarriage had significantly higher anxiety scores only at ten days. The conclusion of the study showed that women who had experienced a miscarriage experienced more mental distress after 10 days and six months than those who had induced abortions. Furthermore, "The responses of women in the miscarriage group were similar to those expected after a traumatic and sad life event. However, the women in the induced abortion group had more atypical responses. This may be because the mental health of the aborting women was somewhat poorer than that of the miscarrying women before the pregnancy termination event. The more complex nature of the induced abortion event, which includes economic and relationship issues, may also account for differences in the course of psychological responses between the two groups." The study recommended that women be informed about common psychological responses to pregnancy termination and that they be offered talks with health personnel..

South Africa

A study of 155 women seeking voluntary induced abortion sought to investigate whether different forms of pain control had a different effect on pain and psychological distress after the abortion. The researchers examined levels of pain, cortisol levels, and psychological distress in women undergoing surgical termination of pregnancy under local anaesthesia versus intravenous sedation. The authors found that cortisol levels are elevated in women who chose a local anesthetic and that while the choice of anesthetic "does not appear to impact on longer-term psychiatric outcomes or functional status" psychologiclal distress was prevelent among both groups of women. Specifically, they found that 11.4% of women met the criteria for a diagnosis of post-traumatic stress disorder (PTSD) prior to their abortions and that the overal rate of PTSD among the sample rose to 18.2% three months after their abortions, a rise of 61%. However, rates of depression and anxiety were lower after abortion than immediately before. In discussing their findings, the authors write that "Presently the weight of evidence suggests that abortion does not cause lasting negative consequences," but that from their findings regarding mid-term PTSD reactions "[I]t would follow that screening women pre-termination for PTSD and disability and post-termination for high levels of dissociation is important in order to help identify women at risk of PTSD and to provide follow-up care."

Spain

Spanish Social Work researchers claim that some psychopathological characteristics are frequently observed in women who have voluntarily aborted. These include "dreams and nightmares related with the abortion," and "feelings of guilt". Using a cohort of 10 women, Gomez, Lavin C., & Zapata examined ways to categorize PAS under the assumption that it exists and is related to Post Traumatic Stress Disorder. Abortion is illegal in Spain.

Reactions Associated With Abortion

Although many studies have found a significant statistical association between abortion negative emotional reactions, no irrefutable causal link has been proven to show that abortion itself causes the reactions which are statistically associated with it. In other words, negative reactions may be incidental to abortion, not caused by abortion. It may be that women who are predisposed to have these emotional problems are also more predisposed to have abortions. In any event, the following emotional and mental health problems are statistically associated with abortion.

• Guilt
• Anxiety
• Depression
• Sleep disorders
• Anniversary reactions
• Elevated risk of suicide
• Bi-polar disorder

Peer reviwed studies have shown that some women are more likely than others to report emotional or mental health problems after an abortion. The statistically associated risk factors include:

• Low self-efficacy for coping with the abortion
• Low self-esteem
• External locus of control
• Difficulty with the decision to have an abortion
• When there is emotional investment in the pregnancy
• Perceptions of one's partner, family members, or friends as non-supportive
• Timing during adolescence, being unmarried, or poor
• A poor or insecure attachment relationship with one's mother or a childhood history of separation from one's mother for a year or more before age 16
• Involvement in violent relationships
• Traditional sex-role orientations
• Conservative views of abortion and/or religious affiliation
• When a pregnancy is initially intended
• Abortion during the second trimester
• When the woman is in an unstable partner relationship
• Being forced into abortion by one's partner, others, or by life circumstances

Prose Alternative

Although many studies have found a significant statistical association between abortion negative emotional reactions, no irrefutable causal link has been proven to show that abortion itself causes the reactions which are statistically associated with it. In other words, negative reactions may be incidental to abortion, not caused by abortion. It may be that women who are predisposed to have these emotional problems are also more predisposed to have abortions. In any event, the following emotional and mental health problems are statistically associated with abortion: Guilt , anxiety, depression sleep disorders anniversary reactions elevated risk of suicidebi-polar disorder

Peer reviwed studies have shown that some women are more likely than others to report emotional or mental health problems after an abortion. The statistically associated risk factors include:

• Low self-efficacy for coping with the abortion
• Low self-esteem
• External locus of control
• Difficulty with the decision to have an abortion
• When there is emotional investment in the pregnancy
• Perceptions of one's partner, family members, or friends as non-supportive
• Timing during adolescence, being unmarried, or poor
• A poor or insecure attachment relationship with one's mother or a childhood history of separation from one's mother for a year or more before age 16
• Involvement in violent relationships
• Traditional sex-role orientations
• Conservative views of abortion and/or religious affiliation
• When a pregnancy is initially intended
• Abortion during the second trimester
• When the woman is in an unstable partner relationship
• Being forced into abortion by one's partner, others, or by life circumstances

MISC

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=PAS Summary

Post-abortion syndrome (PAS) is a term proposed to describe cases of post-traumatic stress disorder which may be attributable to abortion.

A study of 155 women seeking voluntary induced abortion sought to investigate whether different forms of pain control had a different effect on pain and psychological distress after the abortion. The researchers examined levels of pain, cortisol levels, and psychological distress in women undergoing surgical termination of pregnancy under local anaesthesia versus intravenous sedation. The authors found that cortisol levels are elevated in women who chose a local anesthetic and that while the choice of anesthetic "does not appear to impact on longer-term psychiatric outcomes or functional status" psychologiclal distress was prevelent among both groups of women. Specifically, they found that 11.4% of women met the criteria for a diagnosis of post-traumatic stress disorder (PTSD) prior to their abortions and that the overal rate of PTSD among the sample rose to 18.2% three months after their abortions, a rise of 61%. However, rates of depression and anxiety were lower after abortion than immediately before. In discussing their findings, the authors write that "Presently the weight of evidence suggests that abortion does not cause lasting negative consequences," but that from their findings regarding mid-term PTSD reactions "[I]t would follow that screening women pre-termination for PTSD and disability and post-termination for high levels of dissociation is important in order to help identify women at risk of PTSD and to provide follow-up care."

In 1981 psychologist and trauma specialist Vincent Rue testified before Congress that he had treated women who had experienced traumatic reactions to abortion resulting in the same type of post-traumatic stress disorder he had treated in VietnNam Vets, with the exception that the stressor in this case was abortion rather than battlefield violence. He proposed the name "Post-Abortion Syndrome" (PAS) and the term was soon picked up and used by abortion opponents to refer to any negative emotional reactions associated with abortion, not just PTSD as Rue had intended it.

Soon after giving this testimony, Rue was threatened with legal action by the general counsel the American Psychiatric Association if any notes he published making reference to the PTSD diagnosis for abortion did not include a specific disclaimer stating that the APA denies that there is "any clinical evidence for the basis of the diagnosis of ‘post-abortion syndrome."

Post-abortion syndrome

The term "post-abortion syndrome" was first used in 1981 by Dr. Vincent Rue, a psychologist and trauma specialist, in testimony before Congress in which he stated that he had treated women after their abortions for post-traumatic stress disorder similiar to that he had he had treated in VietnNam Vets, with the exception that the stressor in this case was abortion rather than battlefield violence. He proposed calling abortion induced PTSD by the new name "Post-Abortion Syndrome" (PAS).

The term post-abortion syndrome (PAS) was subsequently popularized and widely used by pro-life advocates to describe a broad range of adverse emotional reactions to abortion. Some have argued that attempts to popularize the term "post-abortion syndrome" are a tactic used by pro-life advocates for political purposes.

The American Psychological Association and the American Psychiatric Association do not recognize PAS as a valid diagnosis and it is not included in the Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR or ICD-10 list of psychiatric conditions.

The American Psychological Association and the American Psychiatric Association do not recognize PAS as a valid diagnosis and it is not included in the Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR or ICD-10 list of psychiatric conditions. It has been argued that the concept of abortion causing traumatic reactions is a "myth" created by opponents of abortion for political purposes.

A small number of studies have found that abortion is associated with subsequent PTSD. One study, using a PTSD scale specifically relating to symptoms attributable to abortion to assess PTSD two years after the abortion found that 1.4% of women had diagnosible abortion related PTSD. Another study found that 11.4% of women met the criteria for a diagnosis of post-traumatic stress disorder (PTSD) prior to their abortions and that the overal rate of PTSD among the sample rose to 18.2% three months after their abortions. Yet another study by Rue himself found that in the samples of women evaluated at a number of medical centers in the United States and Russia, 14.3% of American and 0.9% of Russian women met the full diagnostic criteria for abortion associated PTSD.

Intro and Article

Template:Totallydisputed Template:AbortionDebate The relationship between abortion and mental health is a controvsial issue. A number of studies have concluded that abortion is associated with no more psychological risk than carrying an unwanted pregnancy to term. Other studies have reported a statistical correlation between abortion and negative psychological effects, though no studies have found a causal relationship. 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. Summarizing the evidence, the American Psychological Association has found that "severe negative reactions [after abortion] are rare and are in line with those following other normal life stresses."

Post-abortion syndrome (PAS) is a term proposed to describe cases of post-traumatic stress disorder which may be attributable to abortion. The American Psychological Association and the American Psychiatric Association do not recognize PAS as a valid diagnosis and it is not included in the Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR or ICD-10 list of psychiatric conditions. It has been argued that the concept of abortion causing traumatic reactions is a "myth" created by opponents of abortion 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. 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 at the University of Washington found no correlation between a history of abortion and suicide following a subsequent pregnancy.

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, but that this positive association was not significant after controlling for childbearing and resource variables. 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. The authors concluded that "No evidence of widespread post-abortion trauma was found."

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

In 1981 psychologist and trauma specialist Vincent Rue testified before Congress that he had treated women who had experienced traumatic reactions to abortion resulting in the same type of post-traumatic stress disorder he had treated in VietnNam Vets, with the exception that the stressor in this case was abortion rather than battlefield violence. He proposed calling abortion induced PTSD by the new name "Post-Abortion Syndrome" (PAS).

The American Psychological Association and the American Psychiatric Association do not recognize PAS as a valid diagnosis and it is not included in the Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR or ICD-10 list of psychiatric conditions. It has been argued that the concept of abortion causing traumatic reactions is a "myth" created by opponents of abortion for political purposes.

A small number of studies have found that abortion is associated with subsequent PTSD. One study, using a PTSD scale specifically relating to symptoms attributable to abortion to assess PTSD two years after the abortion found that 1.4% of women had diagnosible abortion related PTSD. Another study found that 11.4% of women met the criteria for a diagnosis of post-traumatic stress disorder (PTSD) prior to their abortions and that the overal rate of PTSD among the sample rose to 18.2% three months after their abortions. Yet another study by Rue himself found that in the samples of women evaluated at a number of medical centers in the United States and Russia, 14.3% of American and 0.9% of Russian women met the full diagnostic criteria for abortion associated PTSD.

Studies by major institutions

United States Surgeon General

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[ing]" 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 acknowleged 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."

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 risk of significant psychological problems was "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, who oversaw the investigation, argued that when Koop found no evidence that abortion was harmful, "he therefore 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."

1987-1990 APA Task Force Review

In response to Surgeon General Koop's review of available data, the American Psychological Association Division on Population and Environmental Psychology prepared and presented their own summary of the literature and recommendations for Koop's 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." 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

In 1992, psychiatrist Nada Stotland of the University of Chicago, and current vice president of the American Psychiatric Association, wrote in Journal of the American Medical Association, "...there is no evidence of an abortion-trauma syndrome." Stotland identified three groups of women as being at risk of negative psychological reactions to abortion: those who were psychiatrically ill before pregnancy, those who undergo abortion under external pressure, and those who underwent abortion in "aversive" circumstances such as abandonment or stigmatization. In a 2003 review article, 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 the suicide rate associated with abortion (34.7 per 100,000) was significantly higher than that associated with giving birth (5.9 per 100,000). The study concluded that "The increased risk of suicide after an induced abortion indicates either common risk factors for both or harmful effects of induced abortion on mental health." The authors of the study noted that women who committed suicide after having an abortion tended to be from lower social classes and also tended to be unmarried. The authors state:

The relation between suicide, mental disorders, life events, social class, and social support is a complex one. Abortion might mean a selection of women at higher risk for suicide because of reasons like depression. Another explanation for the higher suicide rate after an abortion could be low social class, low social support, and previous life events or that abortion is chosen by women who are at higher risk for suicide because of other reasons. Increased risk for a suicide after an induced abortion can, besides indicating common risk factors for both, result from a negative effect of induced abortion on mental wellbeing. With our data, however, it was not possible to study the causality more carefully. Our data clearly show, however, that women [in Finland] who have experienced an abortion have an increased risk of suicide, which should be taken into account in the prevention of such deaths.

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

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