New Summary of Evidence Linking Abortion to Mental Health Problems

Overview

Peer-reviewed research published after 2010 has explored potential negative mental health effects associated with induced abortion, often through systematic reviews, cohort studies, and cross-sectional analyses. While the broader literature includes debates and studies finding no causal links, the following summarizes key publications that specifically report negative associations, such as increased risks of depression, anxiety, substance use disorders, and other mental health issues. These findings are drawn from diverse populations and methodologies, with some highlighting factors like pre-existing conditions or unwanted pregnancies as moderators. Prevalence rates and risks vary, and many studies note limitations like self-reporting biases or heterogeneity in data.

Systematic Reviews and Meta-Analyses

A 2011 quantitative synthesis analyzed 22 studies (published 1995–2009, but the review itself post-2010) involving over 877,000 participants, finding that women with a history of abortion had an 81% increased risk of mental health problems overall, including 37% higher risk of depression, 110% higher risk of alcohol misuse, and 155% higher risk of suicidal behaviors. The analysis controlled for variables like prior mental health but faced criticism for methodological flaws in subsequent critiques.

A 2013 re-appraisal of New Zealand cohort data (Fergusson et al.) found abortion associated with elevated risks compared to unwanted pregnancy carried to term, including 2.3 times higher risk of alcohol misuse, 3.91 times higher risk of illicit drug use/misuse, and 1.69 times higher risk of suicidal behavior. Anxiety risks were higher but not statistically significant.

The 2018 comprehensive literature review by Reardon examined the abortion and mental health controversy, identifying common ground and disagreements. It noted that abortion is consistently associated with elevated rates of mental illness compared to women without an abortion history, and that the abortion experience directly contributes to mental health problems for at least some women. Risk factors such as pre-existing mental illness were highlighted as predictors of greater vulnerability. The review emphasized obstacles like multiple causation pathways, indeterminate reaction timelines, and ideological biases in research. It reported relative risks from various studies, with abortion linked to higher mental health risks (e.g., relative risk ratios from 1.5 to 5.5 for conditions like depression and anxiety across datasets). Population attributable risks were estimated at 8-28% for mental illnesses post-abortion. Recommendations included mixed research teams and better data sharing to address biases. Figures included relative risk comparisons and population attributable fractions for suicide attempts and other outcomes.

A 2023 systematic review and meta-analysis estimated the global prevalence of post-abortion depression at 34.5% (95% CI: 23.34–45.68) based on 15 observational studies involving 18,207 participants, primarily published between 2010 and 2023. The studies were mainly cross-sectional or cohort designs from regions including Asia, Europe, Africa, and Australia, with higher prevalence in lower-middle-income countries (42.91%) and Asia (37.5%). Associated factors included socioeconomic status, geographical location, and screening tools used (e.g., higher rates with the Center for Epidemiological Studies Depression Scale). Limitations included publication bias, lack of representation from some continents, and inconsistent diagnostic criteria.

Cohort and Longitudinal Studies

A 2013 re-appraisal of New Zealand cohort data (Fergusson et al.) found abortion associated with elevated risks compared to unwanted pregnancy carried to term, including 2.3 times higher risk of alcohol misuse, 3.91 times higher risk of illicit drug use/misuse, and 1.69 times higher risk of suicidal behavior. Anxiety risks were higher but not statistically significant.

In a 2016 U.S. longitudinal study using National Longitudinal Study of Adolescent to Adult Health data (Sullins), abortion was linked to a 54% increased risk of mental health disorders in late adolescence and early adulthood, with additive effects for multiple abortions. The study suggested emotional distress from the abortion experience itself contributed to these outcomes.

A 2017 prospective cohort study in the Netherlands (van Ditzhuijzen et al.) reported increased recurrence of common mental disorders post-abortion among women with prior mental health histories, identifying pre-existing conditions as a key risk factor.

A 2023 cohort study by Studnicki et al. followed 4,848 continuously eligible Medicaid beneficiaries (aged 16 in 1999) through 2015, comparing first-pregnancy abortion (n=1,331) to birth (n=3,517) cohorts. Women with abortions had higher risks post-pregnancy outcome: outpatient visits (RR 2.10, 95% CI 2.08-2.12; OR 3.36, 95% CI 3.29-3.42), inpatient admissions (RR 2.75, 95% CI 2.38-3.18; OR 5.67, 95% CI 4.39-7.32), and inpatient days of stay (RR 7.38, 95% CI 6.83-7.97; OR 19.64, 95% CI 17.70-21.78). Abortion cohort women had shorter pre-outcome exposure (6.43 vs. 7.80 years) but longer post-outcome (10.57 vs. 9.20 years). Pre-outcome utilization was higher in the birth cohort, challenging the notion that pre-existing conditions fully explain post-abortion effects. Figures showed utilization rates per patient per year for outpatient visits, inpatient admissions, and days of stay. No conflicts of interest were reported.

A 2025 retrospective cohort study by Auger et al. analyzed 1,257,528 pregnancies (28,721 induced abortions and 1,228,807 births) in Quebec, Canada, from 2006 to 2022, following participants up to 17 years post-pregnancy. Hazard ratios were calculated after adjusting for age and time period at the time of the pregnancy, preexisting mental illnesses, comorbidity (obesity, hypertension, diabetes mellitus, dyslipidemia), socioeconomic status, education, employment, rural/urban residence. Rates of mental health-related hospitalizations were higher following induced abortions (104.0 per 10,000 person-years) than other pregnancies (42.0 per 10,000 person-years). Induced abortion was associated with increased risks of hospitalization for psychiatric disorders (HR 1.81, 95% CI 1.72-1.90), substance use disorders (HR 2.57, 95% CI 2.41-2.75), and suicide attempts (HR 2.16, 95% CI 1.91-2.43). Associations were stronger for women with pre-existing mental illness or those under 25 years old, and risks were elevated within five years post-abortion but decreased over time. The study adjusted for pregnancy characteristics but did not explicitly detail limitations in the abstract. The adjusted population attributable risk (PAR) calculations suggest that 2.0% of all psychiatric admissions, 2.2% of suicide attempts and 2.6% of substance use disorders are attributable to abortion. The PAF estimates the fraction of each disease in the population that would be eliminated if the exposure were removed, assuming the adjusted HR represents a causal effect and that all confounders have been adequately measured and controlled for.

Differences in Mental Health Outcomes Reported by Auger (2025)

Outcome	Adjusted Hazard Ratio (HR)	Adjusted PAF (Using HR)	Unadjusted PAF (Using Raw Rates)
Any Mental Health Admission	1.91	2.02%	3.27%
Psychiatric Disorder	1.81	1.81%	2.99%
Bipolar Disorder	1.45	1.01%	2.27%
Depression	1.64	1.43%	2.86%
Anxiety and Stress	1.81	1.81%	3.20%
Eating Disorders	2.25	2.78%	5.28%
Psychosis	2.06	2.38%	4.71%
Personality Disorders	2.25	2.78%	5.62%
Substance Use Disorder	2.57	3.47%	5.97%
Alcohol Use Disorder	2.49	3.30%	5.43%
Opioids Use Disorder	3.25	4.89%	7.27%
Cannabis Use Disorder	2.57	3.47%	5.97%
Cocaine Use Disorder	3.46	5.31%	8.44%
Stimulant Use Disorder	2.77	3.89%	6.69%
Hallucinogen Use Disorder	5.15	8.66%	15.38%
Sedative Use Disorder	2.85	4.05%	6.54%
Other Illicit Substance Use Disorder	5.39	9.11%	16.67%
Suicide Attempt	2.16	2.58%	5.07%

Cross-Sectional and Regional Studies

A 2012 cross-sectional study in Tehran, Iran (Dadkhah et al.), involving 261 women seeking post-abortion care, found that over one-third experienced psychological side effects, including depression (60.5%), worry about future conception (53.6%), abnormal eating behaviors (48.7%), decreased self-esteem (43.7%), nightmares (39.5%), guilt (37.5%), and regret (33.3%). Less common were suicide attempts (4.7%), smoking (2.7%), and drug abuse (1.5%). The study highlighted cultural stigmas exacerbating these effects.

The best data on American women is found in a 2016 study using the National Longitudinal Study of Adolescent to Adult Health (Add Health) that provided three models of analyses, including controls for eight confounding factors. In addition, the author conducted a fixed-effects regression analysis controlling for within-person variations to control “for all unobserved or unmeasured variance that may covary with abortion and/or mental health.” These lagged models, employed as additional means of examining effects of prior mental illness, confirmed that the risks associated with abortion cannot be fully explained by prior mental disorders.

This study also identified a dose effect, with each exposure to abortion (up to four) associated with a 23 percent increase of relative risk of subsequent mental disorders. In addition, a subsequent 2019 analysis using the same data set revealed that approximately 20% of the women having abortions reported wanting the child. Unsurprisingly, the women who aborted wanted children experienced 122% higher rate of depression and a 244% higher rate of suicidality.

A 2025 cross-sectional survey by Reardon involved 2,829 American females aged 41-45, examining suicide risks by pregnancy outcomes. Aborting women were twice as likely to have attempted suicide compared to others. Those with abortions, especially coerced or unwanted ones, reported higher self-assessed contributions of the abortion to suicidal thoughts, self-destructive behaviors, and attempts (measured via visual analog scales). The study challenged the hypothesis that pre-existing mental health fully explains elevated suicide rates post-abortion, as women's self-reports indicated direct contributions from the abortion experience. No conflicts were noted.

Additional Context from Reviews

The literature published since 2010 has focused on controlling for the effects of prior mental health and has revealed links between abortion and worsened mental health for some women.

References