Thursday, July 19, 2007

The Mental Health 'Risks' of Abortion

31 October 2006 Abortion Review

The mental health ‘risks’ of abortion

Ellie Lee examines the basis for claims in the Times (London) that ‘abortion exposes women to higher risk of depression’.‘Abortion exposes women to higher risk of depression’, asserted a headline in the Times (London) on 27 October 2006. The story was provoked by a Letter to the Editor, signed by 15 doctors, which ran under the heading ‘Risks of abortion’.

The Times letter asserts that recently published research provides definitive evidence that abortion and the development of psychiatric conditions are causally linked. Those who signed the letter claim, on this basis, that the practice of abortion providers should be altered.The media coverage of the abortion issue resulting from this letter tells us little about what we might learn from academics’ attempts to consider the relationship between reproductive events and women’s state of mind, and how this might inform abortion practice. It tells us much, however, about the current state of the abortion debate and those opposed to abortion who participate in it.

The research to which the letter refers was published in the Journal of Child Psychology and Psychiatry in January 2006 and is titled ‘Abortion in young women and subsequent mental health’. It concludes that: ‘The findings suggest that abortion in young women may be associated with increased risks of mental health problems’. For those who take research seriously, this single line suggests very different conclusions to those presented in the Times.

The study was of young women – it considered the experience of women aged 15-25 who experienced a pregnancy. The researchers make no claims about women in general; indeed, their interest appears to be in the experience of adolescents and young adults. (It should also be noted that these young women grew up in a particular area of New Zealand, which may be significant for the relevance of the results for other societies).

The most important word in the study’s conclusion, however, is may. Where the signatories to the Times letter make strong assertions and argue for policy changes, the journal article is full of riders.

These are:Confounding factors that this study may not have accounted for. The authors note that their findings may not have taken into account factors other than abortion that might account for the observed association between abortion and particular states of mind.

Under-reporting of abortion in the sample. This is a well-known problem with research about abortion. For this study, the authors note there was a statistically significant difference between the rate of abortion in the sample and that in the general population.

Contextual factors associated with abortion-seeking to which the study could not be sensitive.

The authors note: ‘It is clear the decision to seek (or not seek) an abortion following pregnancy is likely to involve a complex process’ and that as a result, ‘it could be proposed that our results reflect the effects of unwanted pregnancy on mental health rather than the effects of abortion per se on mental health’.

This last point, about the effects of unwanted pregnancy, is especially important. The comparator groups to participants in this study who had an abortion were those who stated they had not experienced a pregnancy, and those who continued a pregnancy to term. It was against this background that an association between abortion and poorer mental health emerged.

Yet this study was conducted in a context where abortion is legal, and relatively freely available. It should therefore be taken into account that it may be that the only group of women among these three groups compared who experienced a pregnancy that was truly and consistently unwanted were those who went on to terminate the pregnancy.

This point can be developed further. Since this study was conducted in a context where abortion is legal, and relatively freely available, it is likely that the pregnancies of those who continued to term and gave birth were in the majority self-defined as wanted. The importance of this point is that it raises questions about what experiences are being compared.

The most valid comparator group to women who have an abortion is women with an unwanted pregnancy who are denied abortion and then give birth. Where these groups are compared it can at least be assumed that the context of pregnancy in similar, and what is being compared is the effects of the resolution of the pregnancy (birth or abortion). Yet this study – for obvious reasons given the abortion law in New Zealand - did not include such a group of women.

Other research, however, has - most notably, that by Henry David, perhaps the most prolific researcher and writer on this subject. It shows that denied abortion and unwanted childbirth has stronger association with poor mental health than abortion.

On this basis, the authors of the Journal of Child Psychology and Psychiatry article are correct to be tentative in their conclusions. They are correct to make their strongest conclusion that ‘the issue of whether or not abortion has harmful effects on mental health remains to be fully resolved’, and call for more research into the area.

In taking this approach, they also reflect what seems to be something of a consensus about this area of abortion research. Academic research about the psychological effects of abortion is widely recognised to be a complicated enterprise. As Henry David has noted, designing research that can make definitive statements about the psychological effects of abortion (and other reproductive events) is complex.

It is harder to make definitive statements than it is for physical health (where clear statements regarding the relative safety of abortion can be made). It is for this reason that, very wisely, the British Royal College of Obstetricians and Gynaecologists (RCOG) takes stock, periodically, of the range of published studies on this issue, when drawing up its Evidence-based Guideline for abortion providers.

In its leaflet for women considering abortion and their families, the RCOG states, on the basis of this evidence: ‘How you react will depend on the circumstances of your abortion, the reasons for having it and on how comfortable you feel about your decision. You may feel relieved or sad, or a mixture of both’.The RCOG also notes: ‘Some studies suggest that women who have had an abortion may be more likely to have psychiatric illness or to self-harm than other women who give birth or are of a similar age. However, there is no evidence that these problems are actually caused by the abortion; they are often a continuation of problems a woman has experienced before’.

This reads like a balanced approach that takes careful account of available evidence. It tells women and their loved ones what published, peer-reviewed evidence suggests overall. This contrasts greatly with the line those associated with the Times letter now want medical authorities to take.On the basis of one study from New Zealand of women aged under 25 which actually makes only tentative claims, the letter’s signatories claim: ‘doctors have a duty to advise about the long-term psychological consequences of abortion’.

How could this conclusion be drawn? The emphasis on the ‘risks of abortion’ and their alleged implications for abortion practice clearly arises not from balanced consideration and debate about well-designed academic research. Rather its roots lie in the sociology of abortion. In the current context it is hard for those who are hostile to abortion to find support for arguments framed in moral terms. We live in an age where, for a range of reasons, few agree that abortion is simply ‘wrong’, so few agree with those who moralise against abortion. In turn, the language of risk more and more provides a medicalised vocabulary in which anti-abortion argument is made.

Those of us with training in social science can work to draw to public attention this ‘medicalisation’ of anti-abortion argument, and seek to provoke discussion of its consequences. It is to be hoped that those with scientific and medical expertise will respond by upholding the highest possible standards in relation to evidence-based abortion care.

Dr Ellie Lee is a lecturer in social policy at Kent University, and co-ordinator of Pro-Choice Forum. She is also author of Abortion, Motherhood and Mental Health: Medicalizing Reproduction in the US and Britain, published by AldineTransaction.
Buy this book from Amazon.

Doctors’ letter sparks debate over abortion and mental health, Abortion Review, 30 October 2006
The Care of Women Requesting Induced Abortion, Evidence-based Clinical Guideline Number 7, RCOG September 2004
Abortion in young women and subsequent mental health. Fergusson DM, Horwood LJ, Ridder EM. Journal of Child Psychology and Psychiatry. 2006 Jan;47(1):16-24.

Friday, June 15, 2007

North Dakota Supeme Court Throws Out Abortion-Breast Cancer Lawsuit Against Clinic

North Dakota Supreme Court Throws out Abortion-Breast Cancer Lawsuit Against Clinic

September 23, 2003 Bismarck, ND

Today, the North Dakota Supreme Court ruled that an anti-choice protestor had no right to use a false advertising law to harass the state’s sole abortion clinic. The decision maintains a lower court ruling that recognized there is no established link between abortion and breast cancer.
"As a result of today’s ruling, anti-abortion activists will no longer be able to use North Dakota’s false advertising law to harass abortion providers," said Linda Rosenthal, staff attorney for the Center for Reproductive Rights and lead counsel for the defendants. "Anti-abortion extremists should think twice before suing abortion providers over frivolous claims, such as the debunked abortion-breast cancer link."

After a three-day trial in March 2002, a judge ruled that the clinic’s brochures, which state that there is no established link between abortion and breast cancer, were truthful and not misleading. The plaintiff, Amy Jo Kjolsrud (née Mattson), appealed the lower court’s decision to the North Dakota Supreme Court. In today’s ruling the Supreme Court held that the plaintiff, whose only connection to the clinic was as a protestor, had no standing to sue the Red River Women’s Clinic under North Dakota’s consumer protection law.

The lower court had also awarded the Red River Women’s Clinic more than $30,000 to reimburse it for the costs of defending against the lawsuit. The plaintiff is liable for these costs.
Efforts to falsely link abortion and breast cancer have been part of a campaign by anti-choice activists to frighten women away from choosing abortion. The consensus of the scientific community is that induced abortion does not increase the risk of breast cancer. The largest and most reliable study in this field examined data on millions of women born in Denmark over several decades and determined conclusively that there is no association between abortion and breast cancer.

And as recently as February, the National Cancer Institute convened approximately one hundred leading scientists and advocates in the field of breast cancer research to review the body of evidence on the alleged abortion and breast cancer link. The group stated unequivocally that induced and spontaneous abortions do not lead to an increased risk of breast cancer. The experts declared that their conclusion was "well established" by scientific evidence, thus issuing the strongest statement allowed by the Institute.

Thursday, June 14, 2007

Ipas Briefing Paper- Mental Health and Abortion

Mental Health and Abortion

Twenty countries around the world allow for abortion to preserve a woman’s mental health (Center for Reproductive Rights). This briefing paper provides an overview of how mental health is defined, relevant guidance from international organizations and professional bodies, information on mental health and abortion, and experience of providers in applying a mental health indication for abortion.

What is mental health?
Authoritative conceptions of mental health have resisted fixed definitions. Scholars from different cultures have defined mental health in various ways, including "subjective well-being, perceived self-efficacy, autonomy, competence, intergenerational dependence, and self-actualization of one’s intellectual and emotional potential" (World Health Organization) According to a report of the United States Surgeon General,
Mental health refers to the successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with adversity. Mental health is indispensable to personal well-being, family and interpersonal relationships, and contribution to community or society (emphasis added), (U.S. Department of Health and Human Services).

The World Health Organization’s definition of health, which includes mental health, encompasses a variety of factors. As defined by the WHO Constitution, health is "not merely the absence of disease or infirmity," but rather, "a state of complete physical, mental and social well-being." Mental health under this definition is "broader than a lack of mental disorders" (World Health Organization).

A multitude of factors contribute to one’s state of mental health. Mental well-being is "influenced by age, gender, race, and culture as well as additional facets of diversity that can be found within all of these population groups" (World Health Organization). According to the WHO, there is evidence that mental health disorders are influenced by socioeconomic status and other factors such as urbanization, poverty and technological change. Sexism and racism can also contribute to poor mental health. Women in particular are at risk for mental health disorders as they "continue to bear the burden of responsibility associated with being wives, mothers, educators and careers of others," (World Health Organization) while they are increasingly responsible for generating income for the family.

How is a woman’s mental health affected by unwanted pregnancy and abortion?
Studies have indicated that the impact of safe, legal abortion on women’s mental health is largely positive. According to the American Psychological Association, the ability of women to make decisions about their own childbearing is necessary for their health—including mental health—as well as for the health of their families (American Psychological Association). Abortion has been found to have a positive impact to women’s well being, due to "abortion’s important role in controlling fertility … and its relationship to coping resources" (Russo NF, Zierk KL). Studies have found that the most prominent emotional response of most women to first-trimester abortions is relief (Planned Parenthood Federation of America).

Research on the impact of denying a woman an abortion and thereby forcing her to continue with an unwanted pregnancy has pointed to a detrimental impact upon a woman’s mental health. Transition to parenthood can involve risk to mental health and this risk is oftentimes heightened when the pregnancy is unplanned (Schmiege, Sarah and Russo, Nancy Felipe). Delivering a first unwanted pregnancy has been associated with risk factors for depression such as lower education and income and larger family size (Schmiege, Sarah and Russo, Nancy Felipe). Studies have shown that women’s risk for depressive symptoms is higher among women with young children and increases with number of children (Schmiege, Sarah and Russo, Nancy Felipe).

The mental health impact of continued unwanted pregnancy has been particularly emphasized by legal authorities. In the decision of Karen Noelia Llantoy Huamán v. Peru, the Human Rights Committee acknowledged the negative mental health impact of denying a woman with an anencephalic pregnancy access to abortion. The Committee describes the psychological effect upon the claimant in the case as a violation of her human right to be free of cruel, inhuman and degrading treatment – which includes freedom from mental suffering. In the seminal case that made abortion legal for all American women, Roe v. Wade, Justice Harry Blackmun discussed the impact of denying a woman an abortion, with a particular emphasis on her mental health.

Justice Blackmun writes,
"The detriment that the State would impose upon the pregnant woman by denying this choice [to terminate a pregnancy] altogether is apparent. Specific and direct harm medically diagnosable even in early pregnancy may be involved. Maternity, or additional offspring, may force upon the woman a distressful life and future. Psychological harm may be imminent. Mental and physical health may be taxed by child care. There is also the distress, for all concerned, associated with the unwanted child, and there is the problem of bringing a child into a family already unable, psychologically and otherwise, to care for it. In other cases, as in this one, the additional difficulties and continuing stigma of unwed motherhood may be involved. …"
Scientific research on the mental health impact of abortion has been skewed by unfounded claims by anti-abortion activists wishing to reduce women’s access to safe abortion. These assertions state that women who choose abortion suffer from emotional trauma as a result – a condition that has been labeled "post-abortion trauma," or "post-abortion stress disorder" (Planned Parenthood Federation of America).

The claims of emotional trauma following abortion are primarily based on flawed studies of self-selected women who had abortion, but regarded abortion as an immoral choice (David, Henry P.). Further, poor mental health outcomes that are reported may be due, in part, to the stigmatization and shame that some women experience with abortion (Russo NF, Zierk KL). A review of studies found that "the weight of the evidence is that legal abortion as a resolution to an unwanted pregnancy, particularly in the first trimester, does not create psychological hazards for most women undergoing the procedure" (Adler, N., et. al.). The best available studies on the psychological responses to abortion in the United States—where safe and legal abortion is available—indicate that severe negative reactions are infrequent (Adler, N., et. al.), and less frequent than with childbirth (Adler, N., et. al.).

What questions should be considered in assessing whether a woman’s continued pregnancy is a risk to her mental health?
The particular circumstances of a woman’s pregnancy, together with factors that affect her overall mental health, influence the degree to which a continued pregnancy is a risk. Research has found that a woman’s response to pregnancy depends on factors such as whether a pregnancy was planned, whether the woman has adequate resources to care for a child, whether the partner is supportive, and whether there is an indication of genetic abnormality (Adler, N., et. al.). Other psychological studies have shown that the outcome of stressful life events, such as unwanted pregnancy, depend on what is identified by leading psychologists as "coping resources." These resources have been identified as factors such as employment, income, education and marital status (Russo NF, Zierk KL).

Doctors in Great Britain usually consider social circumstances in interpreting the mental health indication in British abortion law. The British abortion law allows for abortion when (among other circumstances) "the pregnancy has not exceeded its twenty-fourth week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family." In England and Wales, according to a 1997 report, 97.6% of abortions were performed under these grounds (Information & Statistics Division). Most medical doctors in Great Britain apply the World Health Organization definition of health when assessing the impact of the pregnancy on the mental health of the woman or her children.

As reported in 2000 by the Royal College of Obstetricians and Gynaecologists,
The WHO definition of ‘health’ is ‘a state of physical and mental well-being, not merely an absence of disease or infirmity.’ Most doctors apply this broad definition of health in interpreting the Abortion Act. Thus, to meet the terms of the Act, a woman need not have a psychiatric illness when she makes her abortion request but there must be factors that would threaten her mental health if the pregnancy were to continue. Thus, the abortion is not carried out for social reasons although a woman’s social circumstances may be taken into account in assessing the risks to her health.

This briefing paper has reviewed information and guidance from a range of international sources, the scientific literature, and practical experience in the provision of services where the law permits abortion for mental health reasons. In considering the inclusion and interpretation of a mental health indication for abortion, policymakers and health care providers should recognize the potential risks of compelling women to continue unwanted pregnancies that would have negative mental health consequences, as well as the individual and social benefits for many women and their families of permitting abortion for mental health reasons.


Adler, N., et. al., Psychological Factors in Abortion - A Review, Am Psychol. 1992 Oct;47(10):1194-204.

Adler, Nancy E. (1989). University of California at San Francisco, Statement on Behalf of the American Psychological Association Before the Human Resources and Intergovernmental Relations Subcommittee of the Committee on Governmental Operations, U.S. House of Representatives: 130-140.

American Psychological Association, APA Briefing Paper on the Impact of Abortion on Women, available at

Center for Reproductive Rights, The World’s Abortion Laws, April 2005, available at

David, Henry P., Abortion and Mental Health, prepared for presentation at the 28th International Congress of Psychology, Beijing, China (2004).

Information & Statistics Division. Abortion statistics 1996 & 1997 (1998) ISD Scotland Health Briefing Edingburgh as cited in Royal College of Obstetricians and Gynaecologists, The Care of Women Requesting Induced Abortion (March 2000).

Karen Noelia Llantoy Huamán v. Peru, Communication No. 1153/2003, UN Doc. CCPR/C/85/D/1153/2003 (2005), para. 6.2, 6.3.

Planned Parenthood Federation of America, The Emotional Effects of Induced Abortion (2001), available at

Roe v. Wade, 410 U.S. 113 (1973).

Royal College of Obstetricians and Gynaecologists, The Care of Women Requesting Induced Abortion, March 2000, available at

Russo NF, Zierk KL. "Abortion, childbearing, and women’s well-being." Professional Psychology: Research and Practice, 1992, 23(4): 269-280.

Schmiege, Sarah and Russo, Nancy Felipe, Depression and unwanted first pregnancy: longitudinal cohort study, British Medical Journal 331,7528 (December 2005): 1303-1306.

U.S. Department of Health and Human Services, Mental Health, A Report of the Surgeon General, Executive Summary (1999), available at

United Kingdom, The Abortion Act 1967, as amended by the Human Fertilization and Embryology Act of 1990.

World Health Organization, The World Health Report 2001 – Mental Health: New Understanding New Hope, Chapter 1: A public health approach to mental health (2001) available at

This briefing paper was prepared by Patty Skuster, J.D., M.P.P., Policy Associate at Ipas, an international non-governmental organization that has worked for over three decades to increase women’s ability to exercise their sexual and reproductive rights and to reduce deaths and injuries of women from unsafe abortion.

April 2006

Guttmacher Policy Review- Abortion and Mental Health: Myths and Reality

Guttmacher Policy Review
Summer 2006, Volume 9, Number 3
Abortion and Mental Health: Myths and Realities
By Susan A. Cohen

Most antiabortion activists oppose abortion for moral and religious reasons. In their effort to win broader public support and legitimacy, however, antiabortion leaders frequently assert that abortion is not only wrong, but that it harms women physically and psychologically. Such charges have been made repeatedly for years, but repetition and even acceptance by members of Congress and other high-ranking political officials do not make them true.

Likely because the science attesting to the physical safety of the abortion procedure is so clear, abortion foes have long focused on what they allege are its negative mental health consequences. For decades, they have charged that having an abortion causes mental instability and even may lead to suicide, and despite consistent repudiations from the major professional mental health associations, they remain undeterred. For example, the "postabortion traumatic stress syndrome" that they say is widespread is not recognized by either the American Psychological Association (APA) or the American Psychiatric Association.

To a considerable degree, antiabortion activists are able to take advantage of the fact that the general public and most policymakers do not know what constitutes "good science" (related article, November 2005, page 1). To defend their positions, these activists often cite studies that have serious methodological flaws or draw inappropriate conclusions from more rigorous studies. Admittedly, the body of sound research in this area is relatively sparse because establishing or conclusively disproving a causal relationship between abortion and subsequent behavior is an extremely difficult proposition. Still, it is fair to say that neither the weight of the scientific evidence to date nor the observable reality of 33 years of legal abortion in the United States comports with the idea that having an abortion is any more dangerous to a woman's long-term mental health than delivering and parenting a child that she did not intend to have or placing a baby for adoption.

Public Health Problem 'Minuscule'
Despite years of trying, antiabortion activists failed to gain any traction with the nation's major medical groups in alleging that abortion posed a direct threat to women's health, especially their mental health, so they turned to the political process to legitimize their claims. In 1987, they convinced President Reagan to direct U.S. Surgeon General C. Everett Koop to analyze the health effects of abortion and submit a report to the president. As Koop had been appointed to his position in no small part because of his antiabortion views, both prochoice and antiabortion factions believed the outcome to be preordained. (An eminent pediatric surgeon as well as an outspoken abortion foe, Koop had no prior experience or background in public health; both public health and prochoice advocates in Congress vehemently opposed his appointment, delaying his confirmation by several months.)

Koop reviewed the scientific and medical literature and consulted with a wide range of experts and advocacy groups on both sides of the issue. Yet, after 15 months, no report was forthcoming. Rather, on January 9, 1989, Koop wrote a letter to the president explaining that he would not be issuing a report at all because "the scientific studies do not provide conclusive data about the health effects of abortion on women." Koop apparently was referring to the effects of abortion on mental health, because his letter essentially dismissed any doubts about the physical safety of the procedure.

Prochoice members of Congress, surprised by Koop's careful and balanced analysis, sought to force his more detailed findings into the public domain. A hearing before the House Government Operations Subcommittee on Human Resources and Intergovernmental Relations was called in March 1989 to give Koop an opportunity to testify about the content of his draft report, which had begun to leak out despite the administration's best efforts. At the hearing, Koop explained that he chose not to pursue an inquiry into the safety of the abortion procedure itself, because the "obstetricians and gynecologists had long since concluded that the physical sequelae of abortion were no different than those found in women who carried pregnancy to term or who had never been pregnant. I had nothing further to add to that subject in my letter to the president".

As to the mental health issue, Koop described anecdotal evidence going in both directions, but emphasized that "individual cases cannot be used to reach scientifically sound conclusions." He discussed the methodological flaws pervading most of the research on this subject, and for this reason, he explained, he could reach no definitive conclusion about the mental health impact of having an abortion. Importantly, however, Koop did state that it was clear to him that the psychological effects of abortion are "minuscule" from a public health perspective.
Given the millions of women who have had abortions, "if severe reaction were common, there would be an epidemic of women seeking treatment."

Representing the APA at the hearing, Nancy Adler, professor of psychology at the University of California, San Francisco, testified that "severe negative reactions are rare and are in line with those following other normal life stresses." While acknowledging that there were flaws in much of the research, she testified nonetheless that the weight of the evidence persuasively showed that "abortion is usually psychologically benign." Echoing Koop's point about the public health implications, Adler said that given the millions of women who had had abortions, "if severe reaction were common, there would be an epidemic of women seeking treatment. There is no evidence of such an epidemic."

More Studies, Similar Conclusions
Later in 1989, the APA itself convened a panel to comprehensively assess the body of research meeting the minimum criteria for scientific validity. The APA review determined that legal abortion of an unwanted pregnancy "does not pose a psychological hazard for most women." As summarized in the Guttmacher Institute's May 2006 report, Abortion in Women's Lives, the APA found that "women who are terminating pregnancies that are wanted or who lack support from their partner or parents for the abortion may feel a greater sense of loss, anxiety and distress. For most women, however, the time of greatest distress is likely to be before an abortion; after an abortion, women frequently report feeling 'relief and happiness.'"

Yet neither the Koop investigation nor the APA review ended the debate. Antiabortion researchers have persisted in trying to prove abortion's harmful mental health effects. Most prominent among them are David Reardon, director of the antiabortion, Illinois-based Elliot Institute, and Priscilla Coleman, family studies professor at Bowling Green State University. Reardon and Coleman believe that abortion harms women, but their own studies and the others upon which they rely to make that assertion are so flawed methodologically that they cannot be said to establish a causal relationship. The studies do not address the fundamental question of whether women who have had abortions experience more adverse reactions than do otherwise similar women who have carried their unwanted pregnancies to term. Again, as described in Abortion in Women's Lives, "none adequately control for factors that might explain both the unintended pregnancy and the mental health problem, such as social or demographic characteristics, preexisting mental or physical health conditions, childhood exposure to physical or sexual abuse, and other risk-taking behaviors.…Because of these confounding factors, even if mental health problems are more common among women who have had an abortion, abortion may not have been the real cause."

By contrast, the Royal Colleges of Obstetricians and Gynaecologists and of General Practitioners in the United Kingdom sponsored a major study that did address that fundamental question. The study followed more than 13,000 women in England and Wales over an 11-year period ending in the early 1990s. Importantly, it considered two groups: women facing an unintended pregnancy who had an abortion and women facing an unintended pregnancy who gave birth. The study's authors concluded that those women who had an abortion following an unintended pregnancy were not at any higher risk of subsequent mental health problems than were women whose unintended pregnancy was carried to term.

Currently, considerable attention is being paid to a study conducted by David Fergusson, a psychology professor who is affiliated with the Christchurch School of Medicine and Health Sciences, New Zealand. Fergusson's study, like the Royal Colleges', has the advantage of being prospective, which means that information is gathered about individual women at multiple points in time and compared across groups. Fergusson and his colleagues have been following the health, education and life progress of a group of 1,265 children in the Christchurch region since their births in mid-1977.

Results released earlier this year suggest some link between abortion as a young woman in New Zealand and subsequent problems with depression, anxiety, suicidal behaviors and substance abuse disorders; however, Ferguson acknowledges that his study has enough shortcomings to warrant caution in reading too much into the findings.

Specifically, the study does not take into account certain preexisting health problems (e.g., mental health problems or exposure to unreported sexual abuse) among the women who had an abortion that may be much more relevant to the women's subsequent mental health conditions than the abortion itself.

Furthermore, he and his coauthors estimate that about one-fifth of the women in the study who had abortions failed to report them, which could skew the findings if women experiencing mental health problems later in life are more likely to report a prior abortion than are women not experiencing such problems. Perhaps most significantly, Ferguson and his colleagues did not separate out for analysis purposes women whose pregnancies were unintended and women whose pregnancies were wanted, as did the Royal Colleges' researchers. The authors themselves admit that this is a significant failing.

The Debate Goes On
Seventeen years after the Koop investigation, there is still no conclusive evidence directly linking abortion to subsequent mental health problems—and not because of a lack of trying. Although it is true that some women who have had an abortion suffer severe mental health problems later in life, the current body of research has not been able to rule out a plethora of preexisting conditions or familial or other contextual factors that could affect or explain those problems. It isalso true, not surprisingly, that some women experience pain and sadness either shortly after having an abortion or even many years later (see below). These emotions, however, are not unique to women who have had an abortion or necessarily more or less common than the pain and sadness felt by many women who have placed a baby for adoption or raised an unplanned child under adverse conditions.

Meanwhile, what Koop described 17 years ago as a “minuscule” public health problem would seem to be at least as miniscule today—especially in light of the fact that more than one in three women in the United States will have had an abortion by age 45. How much more research into the purported abortion–mental health connection is really warranted may depend more on political exigencies than on scientific ones.

Antiabortion activists can be expected to continue to either distort the evidence that does exist or insist that conclusive evidence can still be found. At the time of his investigation, Koop himself called for more and better quality research on the mental health effects of not just abortion but unplanned pregnancy itself, a more expansive view that remains valid today. Also applicable today is Koop’s less noticed but equally important call at that time for more research into contraception and contraceptive use. As he testified to Congress in 1989, “most abortions would not take place if pregnancies were not unplanned and unwanted.”

Abortion Is Safe and No Impediment to Future Fertility
Despite the strong and lengthy history of evidence attesting to the physical safety of abortion, antiabortion activists frequently charge that the procedure threatens women’s future fertility and is a particular risk factor for breast cancer. Neither is true. Abortion foes cite research that suggests that abortion can cause infection or injury, sometimes undetectable at the time of the abortion, which in turn increases women’s risk of preterm and low-birth-weight delivery. Those studies, however, typically fail to account for the fact that factors such as a history of sexually transmitted infection may be more common among women who have unintended pregnancies (and thus abortions) and may lead to premature delivery among women giving birth.

The preponderance of evidence from well-designed and well-executed studies shows no connection between abortion and future fertility problems. Several reviews of the research conclude that first-trimester abortions pose virtually no long-term fertility risks—not only for premature and low-birth-weight delivery but for infertility, ectopic pregnancy, miscarriage and birth defects as well. The evidence is less extensive when it comes to repeat abortion and second-trimester abortion, but the research indicates that the claims of abortion opponents are unfounded.

As for the link between abortion and breast cancer, researchers have studied for years whether the abrupt hormonal changes caused by interrupting a pregnancy alter a woman’s breast in a way that increases her susceptibility to the disease. Until the mid-1990s, the research findings were inconsistent. Abortion opponents seized upon a 1996 analysis that combined the results of numerous flawed studies and concluded that having an abortion did elevate the risk of cancer. However, data from this analysis were unreliable, because they were collected only after a diagnosis of cancer. Furthermore, rather than relying on medical records, the researchers asked the women themselves whether or not they had had an abortion, a process that would be expected to lead to more complete reporting of a prior abortion by women with cancer than by women who did not have cancer.

In 2003, the National Cancer Institute (NCI) convened more than 100 of the world’s leading experts on the topic of abortion and breast cancer. After a lengthy and exhaustive review of all of the research, including a number of newer studies that avoided the flaws of their predecessors, they concluded that “induced abortion is not associated with an increase in breast cancer risk,” noting that the evidence for such a conclusion met NCI’s highest standard. In 2004, an expert panel convened by the British government came to the same conclusion.

Helping Women Cope After Having an Abortion
To be sure, it is not unusual for a woman to experience a range of often contradictory emotions after having an abortion, just as it would not be unusual for a woman who carried her unintended pregnancy to term. It was not until recently, however, that a specialized organization was formed with the purpose to provide postabortion counseling in a nonjudgmental context. Founded in 2000 in Oakland, California, Exhale operates a national telephone hotline by which trained, volunteer peer counselors help women who have had abortions, as well as their partners and families, talk through their feelings, immediately after an abortion or even years later.

Exhale “believe[s] there is no ‘right’ way to feel after an abortion. We also know that feelings of happiness, sadness, empowerment, anxiety, grief, relief or guilt are common.” Executive Director Aspen Baker suggests that giving women an outlet for discussing their feelings—whatever they may be—is a healthy part of the process toward emotional well-being. Baker has observed that a woman’s negative emotions after an abortion may be due, at least in part, to the reaction of her partner or to those of family members, who might condemn or exclude her for having an abortion or for becoming pregnant to begin with. Exhale is helping to remove the stigma surrounding having an abortion, so that women and their support networks are better equipped to cope with their feelings—an essential part of the process that until recently may not have received as much attention as it deserves.

Top 10 Anti-Abortion Myths from

Top 10 Anti-Abortion Myths

From Tom Head,Your Guide to Civil Liberties.

If you've been keeping up with the abortion debate in this country, you have no doubt heard some very interesting claims made by anti-abortion activists. Some of these claims need to be taken seriously, but others...well, not so much. In the spirit of raising the level of discourse, here are ten provably false claims that anti-abortion activists really need to stop repeating.

1) "Human life begins at conception."
False. Human life actually begins prior to conception, because each sperm and egg cell is a living organism. It is more relevant to discuss when sentience, or self-awareness, begins. In 2000, the British House of Lords established a Commission of Inquiry into Fetal Sentience, which estimated that higher-level brain development begins to commence at about 23 weeks.

2) "Pro-choice activists want abortion on demand until the moment of birth."
False. Pro-choice activists work to protect the Roe v. Wade standard, which allows states to ban elective third-trimester abortions. The debate over late-term and partial-birth abortions has to do with abortions performed for emergency medical reasons, not elective abortions.

3) "Pro-choice activists want to increase the number of abortions."
False. Pro-choice activists lead the charge in advocating comprehensive sex education, increased access to birth control, condom use, and emergency contraception, all of which reduce the incidence of abortion. Strangely, anti-abortion activists work equally hard to make these options more difficult to access--creating the impression that the anti-abortion movement is more concerned with sexual purity than abortion.

4) "Banning abortion will get rid of it, once and for all."
False. In El Salvador, abortion is illegal with a possible 30-year prison sentence attached--and women can still easily obtain cheap black market abortificients to induce abortion. The only drawback? No medical supervision. Banning abortion won't put an end to abortion, but it will put women's lives at risk.

5) "Emergency contraception causes abortions."
False. Emergency contraception prevents pregnancy from occurring in the first place by blocking fertilization of the egg and subsequent implantation in the uterus; it does not, and cannot, induce abortions. If your objective is to reduce the number of abortions, then the single most effective thing you can do to achieve that goal is to help make emergency contraception universally available over the counter.

6) "Fetuses become conscious at 8 weeks."
False. Fetuses begin to develop a minimal brain stem at 7 weeks, but are not capable of consciousness until the third trimester and most likely remain unconscious until birth. As one brain scientist puts it: "the fetus and neonate appears incapable of ... experiencing or generating 'true' emotion or any semblance of higher order, forebrain mediated cognitive activity."

7) "Even first-trimester fetuses can feel pain."
False. Fetal nerve cells can react to trauma, but pain reception requires a neocortex--which is not formed until early in the third trimester.

8) "This is what an abortion looks like."
Almost always false. Many abortion protest photographs are artist's renderings or the result of image manipulation, and the bulk of the rest are of very late-term fetuses aborted for emergency medical reasons. The most well-known graphic abortion poster is of a 30-week-old fetus, aborted six full weeks into the third trimester. The vast majority of abortions are performed during the first trimester, and Roe v. Wade only protects first and second trimester abortions.

9) "Abortion causes breast cancer."
Mostly false. In 1997, the New England Journal of Medicine published the largest-scale study ever on this subject--with 1.5 million participants--which concluded that there is no independent link between abortion and breast cancer. Clearly if abortion does increase the risk of breast cancer, it does so by an undetectably small margin. Becoming pregnant and carrying a pregnancy to term may, however, reduce the risk of breast cancer.

10) "You can't be pro-choice and be anti-death penalty/anti-war at the same time."
False. The pro-choice position is predicated on the idea that women have the right to decide whether to carry their pregnancies to term. The victims of the death penalty and war are fully conscious persons rather than presentient entities in a woman's womb, so the moral questions involved are entirely different.

Suggested Reading
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National Abortion Federation- Abortion Factsheets

NAF has worked since 1977 to ensure that women, health care professionals, and policymakers have access to factual information about abortion. NAF has created a series of carefully researched fact sheets that cover topics related to abortion and abortion care.

What Is Medical Abortion? - Information about early abortion using the medication mifepristone (also known as RU-486)

Safety of Abortion - Statistics on the safety of legal abortion; complications that can occur and how to prevent them

Abortion after 12 Weeks - Discussion of the compelling reasons that may cause women to have a later abortion

First-Trimester Abortion: A Comparison of Procedures - A table comparing two types of medical abortion with vacuum aspiration abortion

Facts About Mifepristone (RU-486) - Facts about the medication approved by the U.S. Food and Drug Administration for early medical abortion

Abortion and Breast Cancer - Discussion of research findings concluding that abortion does not cause an increased risk of breast cancer

Post-Abortion Issues - Emotions women may feel following abortion, and conclusions of medical authorities that "post-abortion syndrome" does not exist

Women Who Have Abortions - Statistical highlights about the incidence of abortion in the U.S. and Canada

Economics of Abortion - The costs of abortion and of laws limiting access to abortion

Access to Abortion - Facts about women's declining access to abortion in the U.S. and causes of the decline

Crisis Pregnancy Centers - Information about how CPCs have deceived, harassed and misled women

Teenage Women, Abortion, and the Law - Teenage pregnancy, abortion, and restrictive laws directed at young women

Public Funding for Abortion: Medicaid and the Hyde Amendment - Facts about the Hyde Amendment, a provision that restricts low-income women's access to abortion

FACE Act - The U.S. law that protects abortion providers and their patients from violence and threats of violence

National Abortion Federation- Post-Abortion Syndrome


Many people are interested in learning about the possible effects of abortion on women's emotional well-being, and several hundred studies have been conducted on this issue since the late 1970s. Unfortunately, much of the research on women's psychological responses to abortion can be confusing. Nonetheless, mainstream medical opinions, like that of the American Psychological Association, agree there is no such thing as "post-abortion syndrome."

A Summary of the Scientific Research
Since the early 1980s, groups opposed to abortion have attempted to document the existence of "post-abortion syndrome," which they claim has traits similar to post-traumatic stress disorder (PTSD) demonstrated by some war veterans. In 1989, the American Psychological Association (APA) convened a panel of psychologists with extensive experience in this field to review the data. They reported that the studies with the most scientifically rigorous research designs consistently found no trace of "post-abortion syndrome" and furthermore, that no such syndrome is scientifically or medically recognized.1

The panel 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."2 While some women may experience sensations of regret, sadness or guilt after an abortion, the overwhelming responses are relief and happiness.3

In another study, researchers surveyed a national sample of 5,295 women, not all of whom had had abortions, and many of whom had abortions between 1979 and 1987, the time they were involved in the study. The researchers were able to learn about women's emotional well-being both before and after they had abortions. They concluded at the end of the eight-year study that the most important predictor of emotional well-being in post-abortion women was their well-being before the abortion. Women who had high self-esteem before an abortion would be most likely to have high self-esteem after an abortion, regardless of how many years passed since the abortion.4

Psychological responses to abortion must also be considered in comparison to the psychological impact of alternatives for resolving an unwanted pregnancy (adoption or becoming a parent). While there has been little scientific research about the psychological consequences of adoption, researchers speculate that it is likely "that the psychological risks for adoption are higher for women than those for abortion because they reflect different types of stress. Stress associated with abortion is acute stress, typically ending with the procedure. With adoption, as with unwanted childbearing, however, the stress may be chronic for women who continue to worry about the fate of the child."5

What the Experts Say
In a commentary in the Journal of the American Medical Association, Nada Stotland, M.D., former president of the Association of Women Psychiatrists, stated:
"Significant psychiatric sequelae after abortion are rare, as documented in numerous methodologically sound prospective studies in the United States and in European countries. Comprehensive reviews of this literature have recently been performed and confirm this conclusion. The incidence of diagnosed psychiatric illness and hospitalization is considerably lower following abortion than following childbirth...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."6

Henry P. David, PhD, an internationally known scholar in this area of research, reported the following at an international conference.
"Severe psychological reactions after abortion are infrequent...[T]he number of such cases is very small, and has been characterized by former U.S. Surgeon General C. Everett Koop as 'miniscule from a public health perspective'...For the vast majority of women, an abortion will be followed by a mixture of emotions, with a predominance of positive feelings. This holds immediately after abortion and for some time afterward...[T]he positive picture reported up to eight years after abortion makes it unlikely that more negative responses will emerge later."7

Russo and Dabul reported their conclusions of an eight-year study in Professional Psychology:
"Although an intensive examination of the data was conducted, controlling for numerous variables and including comparisons of Black women versus White women, Catholic women versus non-Catholic women, and women who had abortions versus other women, the findings are consistent: The experience of having an abortion plays a negligible, if any, independent role in women's well-being over time, regardless of race or religion. The major predictor of a woman's well-being after an abortion, regardless of race or religion, is level of well-being before becoming pregnant...Our findings are congruent with those of others, including the National Academy of Sciences (1975), and the conclusion is worth repeating. Despite a concerted effort to convince the public of the existence of a widespread and severe postabortion trauma, there is no scientific evidence for the existence of such trauma, even though abortion occurs in the highly stressful context of an unwanted pregnancy."8 (emphasis added)

The Impact of Anti-Choice Activities
Russo and Dabul8 point out that when women in their study were interviewed from 1979 to 1987, anti-choice efforts to stigmatize abortion had not yet reached prominent levels. Today, anti-choice groups regularly harass clinic staff, intimidate patients at clinics, and use graphic language designed to punish women (e.g. "abortion is murder," "women are baby-killers"). Additionally, the past few years have revealed a new anti-choice strategy of offering "counseling" services to women. Rather than exploring the roots of a woman's psychological distress and providing unbiased therapy, anti-choice counselors tend to direct her anger towards the abortion provider by claiming that women are misinformed about the psychological trauma that abortion inflicts. Due to the political bias of these counselors and their misuse of psychological services, women can be left feeling angry and betrayed.

Russo and Dabul8 concluded that practitioners should acknowledge the detrimental effects of the social ostracism felt by abortion patients. Some post-abortion difficulties may result from a lack of social support because women are expected to bear the brunt of unplanned and unwanted childbearing. The researchers encouraged all practitioners to continue to provide accurate information since many women have been misled by anti-choice sources which may contribute to concerns if they choose abortion. Further, women who have concerns after an abortion should be encouraged to see a professional psychologist or join a support group supervised by a professional mental health provider, rather than one sponsored by any anti-choice organization.


American Psychological Association. "APA research review finds no evidence of 'post-abortion syndrome' but research studies on psychological effects of abortion inconclusive." Press release, January 18, 1989.

Adler NE, et al. "Psychological responses after abortion." Science, April 1990, 248: 41-44.

Adler NE, et al. "Psychological factors in abortion: a review." American Psychologist, 1992, 47(10): 1194-1204.

Russo NF, Zierk KL. "Abortion, childbearing, and women's well-being." Professional Psychology: Research and Practice, 1992, 23(4): 269-280.

Russo NF. "Psychologicalaspects of unwanted pregnancy and its resolution." In J.D. Butler and D.F. Walbert (eds.), Abortion, Medicine, and the Law (4th Ed., pp. 593-626). New York: Facts on File, 1992.

Stotland N. "The myth of the abortion trauma syndrome." Journal of the American Medical Association, 1992, 268(15): 2078-2079.

David HP. "Comment:post-abortion trauma." Abortion Review Incorporating Abortion Research Notes, Spring, 1996, 59: 1-3.

Russo NF, Dabul, AJ. "The relationship of abortion to well-being: Do race and religion make a difference?" Professional Psychology: Research and Practice, 1997, 28(1): 1-9.