Assertions that abortion causes mental illness often fail to consider the woman’s mental health before she has an abortion, Robinson said.
“If you have psychiatric problems beforehand, an abortion is not going to cure them, but having the baby isn’t going to cure them either,” said Robinson. “So the greatest predictor of distress afterward is psychiatric distress beforehand, and a lot of studies don’t even look at this.”
Robinson cited several other methodological problems as well:
• Many of the studies used large data sets, but the medical records do not contain information about relevant key variables, such as a woman’s mental health history or reasons for wanting an abortion.
• Some studies use biased clinical samples—women who gather to tell each other how miserable they felt and how every problem in their life is because they had an abortion.
• Some studies confuse emotions with psychiatric illness. Some women may experience sadness, grief, and regret following an abortion, but that does not usually signify psychiatric illness.
• Many of the studies are retrospective, and perspectives can change over time because of intervening events, including marriage, fertility problems, and childbirth.
• Some long-term studies attribute any negative consequences in a woman’s life to her having had an abortion.
• Some studies fail to address the impact of social pressure and misinformation on the mental health of women who have abortions, such as being confronted by demonstrators outside an abortion clinic or being told that the medical procedure they are about to undergo will very likely cause mental and physical problems.
In her review of studies with methodological problems, Robinson discussed the work by Cougle and colleagues.3 These researchers compared data on women from the National Longitudinal Survey of Youth who experienced their first pregnancy event (abortion or childbirth) between 1980 and 1992. Eight years later, on average, women whose first pregnancies ended in abortion were 65% more likely to be at high risk for clinical depression than women whose pregnancies resulted in a birth, after controlling for age, race, marital status, divorce history, income, education, and prepregnancy psychological state.
In contrast, Schmiege and Russo4 examined the same data and analyzed numerous variables using much more rigid methodological criteria, Robinson said. They found similar scores for depression across the delivery and abortion groups: 28.6% of those in the delivery group were at high risk for depression compared with 24.8% in the abortion group.
Robinson cited 2 additional studies that avoided key methodological errors. Zabin and colleagues5 studied young, underprivileged girls in the inner city who got pregnant, and followed them for 2 years. Those who terminated their pregnancy had better outcomes (eg, graduating from high school, better off economically) than those who delivered.
Major and associates6 followed 882 women who obtained a first-trimester abortion for an unintended pregnancy, 442 of them for 2 years. Prior mental health was examined as a predictor of postabortion psychological responses. Two years postabortion, 301 of 418 women (72%) were satisfied with their decision; 306 of 441 (69%) said they would have the abortion again. Six of 442 (1%) reported posttraumatic stress disorder. Prepregnancy history of depression was a risk factor for depression, lower self-esteem, and more negative abortion-specific outcomes 2 years postabortion.
Robinson concluded: “The studies with negative findings are very, very flawed. There is no evidence for the existence of the so-called abortion trauma syndrome. Unfortunately, public policy is often being determined on the basis of assumptions and preconceived beliefs rather than on research.”