“Abortion does not cause psychiatric damage, but the claim that it does is a prime strategy of the anti-abortion movement, which has convinced many people in the US,” said former APA president Nada Stotland, MD, MPH.
“So if it wasn’t a psychiatric issue before, it certainly is now, and we psychiatrists have an obligation to know about it,” she added.
One in 3 women in this country will have had an abortion by age 45 years. Worldwide, 1 in 5 pregnancies ends in abortion, according to the Guttmacher Institute’s 2008 reports. Annual estimates are 1.2 million abortions in the US and 42 million globally.
Major reasons cited in that report for having an abortion include inability to afford a child; interference with work, school, or ability to care for other dependents; not wanting to be a single parent; marital or partner problems; and concern about being responsible for others.
Mental health issues
Controversy about the mental health consequences of induced abortion has been intensifying.
For instance, the Elliot Institute, founded by David C. Reardon, PhD, claims that women who have abortions are prone to abortion trauma syndrome and are at increased risk for substance abuse, clinical depression, sleep disorders, and suicide and that their children are prone to behavioral problems.1
Countering those assertions is the American Psychological Association’s Task Force on Mental Health and Abortion, which recently collected, examined, and summarized the most current scientific research on mental health and abortion. The task force’s 2008 report concluded that “among women who have a single, legal, first-trimester abortion of an unplanned pregnancy for nontherapeutic reasons, the relative risks of mental health problems are no greater than the risks among women who deliver an unplanned pregnancy.”2
When bills were introduced in the legislature asserting that abortions cause significant and long-lasting psychological damage, Stotland testified that such allegations are contrary to scientific evidence. In her 2004 testimony before a House Subcommittee on Health, which looked at postpregnancy mental health in women, she told members, “Abortion trauma syndrome does not exist in the psychiatric literature and is not recognized as a psychiatric diagnosis.”
The Supreme Court in 2007 issued a 5-4 decision outlawing a type of late-term abortion. The majority opinion said, “Some women might come to regret their choice to abort the infant life they once created and sustained. Severe depression and loss of esteem can follow.”
In response, Stotland wrote to the New York Times and charged that the Supreme Court was “substituting political propaganda for medical science” and that “meticulous research shows there is no causal relationship between abortions and mental illnesses.”
At the APA symposium, Stotland, onetime vice president of the national Lamaze prepared childbirth organization, said that there are 2 different issues going on.
“One is having a religious, moral belief about whether something is right or wrong. . . . The other has to do with the scientific data and research. I feel very strongly about the misuse of psychiatric terms and the assertion of nondata as data,” she said.
Abortion studies
A second presenter at the APA symposium, Gail Robinson, MD, professor of psychiatry and obstetrics and gynecology at the University of Toronto and director of the Women’s Mental Health Program for University Health Network, focused on the studies that have examined the relationship between abortion and women’s mental health. A more comprehensive article is scheduled for the August issue of the Harvard Review of Psychiatry.
Robinson identified methodological issues in studies used to support claims that induced abortion results in an abortion trauma syndrome or a psychiatric disorder. She then compared those studies with others that avoided those methodological errors.
The valid controls for women who have abortions should be women with unwanted pregnancies who are forced to carry to term, Robinson said. The few studies that have included this comparison found that, in general, the group who carried to term had poor outcomes for both the mothers and the children.
We need to question why a woman would have an abortion in the first place and to differentiate between first- and second-trimester abortions, Robinson added. There may be several reasons women delay until the second trimester, possibly related to access or ambivalence. Mixing up the 2 groups likely muddies the results.
Other issues include whether the pregnancy is wanted; whether the abortion is requested because the woman is a victim of violence, rape, or incest; whether she is being coerced by others to have the abortion; whether she has had a prior abortion; and what types of resources and support are available to her.
