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The subject of abortion and mental health is highly controversial. While only a few studies have shown a correlation between abortion and positive effects on mental health, many shown a correlation between abortion and negative psychological effects in a minority of women. But it is difficult to study the causal effects of the abortion procedure on mental health, therefore no causal relationship between abortion and negative psychological effects have yet been proved.

Some have argued that attempts to popularize the term "post-abortion syndrome," and to advocate that abortion results in negative psychological effects, are tactics used by opponents of abortion for political purposes. In the Journal of the American Psychiatric Association, Nada 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."

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.

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 , 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." He also noted that while the psychological effects of abortion had not been adequately studied "...doctors had long ago concluded that the physical results of abortion are not major health factors and required little additional study."

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, when Koop was pressed to address the question of whether his view of the inadequate studies he had reviewed indicated that abortion posed a public mental health threat, Koop stated that in his opinion it was "miniscule from a public-health perspective."

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. After Koop refused to issue and conclusive 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."

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

In 1989 Dr. Julius Fogel, who is both a psychiatrist and an obstetrician who had performed over 20,000 abortions, affirmed that in his expert opinion abortion is psychologically traumatic:

Every woman--whatever her age, background or sexuality--has a trauma at destroying a pregnancy. A level of humanness is touched. This is a part of her own life. When she destroys a pregnancy, she is destroying herself. There is no way it can be innocuous. One is dealing with the life force. It is totally beside the point whether or not you think a life is there. You cannot deny that something is being created and that this creation is physically happening.... Often the trauma may sink into the unconscious and never surface in the woman's lifetime. But it is not as harmless and casual an event as many in the proabortion crowd insist. A psychological price is paid. It may be alienation; it may be a pushing away from human warmth, perhaps a hardening of the maternal instinct. Something happens on the deeper levels of a woman's consciousness when she destroys a pregnancy. I know that as a psychiatrist.

Nada Stotland

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 her surprise at treating a patient 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 . . . , (4) The classification of severe reactions . . . "

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."

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.

Neutral and positive psychological effects observed after abortion

Many 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. 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 psychological effects observed 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 many women who seek abortions. It should be noted that many of these effects have also been shown to occur in patients that have undergone miscarriages.

Post-abortion syndrome

Post-abortion syndrome (PAS) is a term used to describe a set of adverse psychopathological characteristics, with possible connections to post-traumatic stress disorder, which are proposed to occur in a small percentage of women following an induced abortion. Primarily a term used by pro-life advocates, PAS is not a medically recognized syndrome; PAS is not listed in the Diagnostic and Statistical Manual of Mental Disorders, and neither the American Psychological Association nor American Psychiatric Association recognize it. Some physicians and pro-choice advocates have argued that attempts to popularize the term "post-abortion syndrome" are a tactic used by pro-life advocates for political purposes.

While some studies have shown a correlation between abortion and clinical depression, anxiety, suicidal behaviors, or adverse effects on women's sexual functions for a small number of women, these correlations may be explained by pre-existing social circumstances and emotional health. According to the American Psychological Association, various factors, such as emotional attachment to the pregnancy, lack of support, and conservative views on abortion, may increase the likelihood of experiencing negative reactions. Studies have either failed to establish a causal relationship between abortion and negative psychological symptoms experienced by women, or been inconclusive. On the other hand, a number of researchers have concluded that abortion has positive or neutral effects on women's psychological well-being.

References

1. ^ Zabin, L.S., Hirsch, M.B., Emerson, M.R. (1989). When urban adolescents choose abortion: effects on education, psychological status and subsequent pregnancy. Family Planning Perspectives, 21 (6), 248-55. Retrieved September 8, 2006.
2. ^ Russo, N. F., & Zierk, K.L. (1992). Abortion, childbearing, and women. Professional Psychology: Research and Practice, 23(4), 269-280. Retrieved September 8, 2006.
3. ^ Schmiege, S. & Russo, N.F. (2005). Depression and unwanted first pregnancy: longitudinal cohort study Electronic version. British Medical Journal, 331 (7528), 1303. Retrieved 2006-01-11.
4. ^ Stotland NL (2003). "Abortion and psychiatric practice". J Psychiatr Pract. 9 (2): 139–49. PMID 15985924. "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."
5. ^ David, H. "Retrospectives" From APA Task Force to Division 34" Population & Environmental Psychology Bulletin 1999, 25(3):2-3.
6. Abortion and American Psychology Warren Throckmorton, PhD
7. Vincent Rue, "Abortion and Family Relations," testimony before the Subcommittee on the Constitution of the US Senate Judiciary Committee, U.S. Senate, 97th Congress, Washington, DC (1981).
8. David Reardon, Aborted Women, Silent No More Loyola University Press, 1986.
9. ^ A copy of the Koop letter to President Reagan ishere.
10. New York Times: Koop Says Abortion Report Couldn't Survive Challenge
11. ^ Adler NE, David HP, Major BN, Roth SH, Russo NF, Wyatt GE. "Psychological responses after abortion." Science, April 1990, 248: 41-44.
12. ^ Abortion and American Psychology Warren Throckmorton, PhD
13. Coleman McCarthy "The Real Anguish of Abortions," The Washington Post, Feb. 5, 1989.
14. Stotland NL.The myth of the abortion trauma syndrome JAMA. 1992 Oct 21;268(15):2078-9.
15. Ibid, citing B. Lask, "Short-term psychiatric sequelae to therapeutic termination of pregnancy," Br J Psychiatry. 1975; 126:173-177 (1975).
16. NL Stotland. Abortion: Social Context, Psychodynamic Implications" Am J Psychiatry, 155(7):964-967, 1998.
17. Wilmoth G. Abortion, Public Health Policy, and Informed Consent Legislation. J Social Issues, 48(3):1-17 (1992).
18. ^ Fergusson, D.M., Horwood, L.J., & Ridden, E.M. (2006. Abortion in young women and subsequent mental health. Journal of Child Psychology and Psychiatry, 47(1), 16-24.
19. Ruth Hill, “Abortion Researcher Confounded by Study” New Zealand Herald 1/5/06, See also: Abortion increases mental health risk: study an ABC interview with Fergusson.
20. ^ Warren Throckmorton. "Abortion and mental health."] Washington Times. January 21, 2005.
21. Gómez Lavín C, Zapata García R (2005). "Diagnostic categorization of post-abortion syndrome". Actas Esp Psiquiatr. 33 (4): 267–72. PMID 15999304.
22. Research and Destroy, by Chris Mooney. Published in Washington Monthly, October 2004.
23. Is There a Post-Abortion Syndrome? By Emily Bazelon. Published in the New York Times Magazine, January 21 2007. Accessed January 11 2008.
24. Science in support of a cause: the new research, by Michael Kranish. Published in the Boston Globe on July 31 2005; accessed November 27 2007.
25. Grimes DA, Creinin MD (2004). "Induced abortion: an overview for internists". Ann. Intern. Med. 140 (8): 620–6. PMID 15096333. Key summary points: "Abortion does not lead to an increased risk for breast cancer or other late psychiatric or medical sequelae." On p. 624, the authors state: "The alleged 'postabortion trauma syndrome' does not exist."
26. Stotland NL. The myth of the abortion trauma syndrome. JAMA. 1992 Oct 21;268(15):2078-9. PMID 1404747.
27. Cooper, Cynthia L. Abortion Under Attack
28. Russo NF, Denious JE (2005). "Controlling birth: science, politics, and public policy". J Soc Issues. 61 (1): 181–91. PMID 17073030.
29. TIME. Abortion on Demand
30. 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.

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.

Articles from pro-choice sources

• The Emotional Effects of Induced Abortion, from the Planned Parenthood website.

Articles from pro-life sources

• Women Who Have Abortions: Their Reflections on the Unborn, by David Reardon

• Misplaced Pages neutral point of view disputes from December 2007
• Abortion debate
• Popular psychology