Studies - Depression / Suicide / Mental Health

Abortion has Stronger Emotional Impact on Women than Miscarriage (CMAJ,5/2003; BJOG; PM,5/04)

Researchers in Norway have found that abortion presents a more significant damaging emotional impact on women than miscarriage.

The study found that women who had an abortion two years ago were more likely than women who had miscarriages to be suppressing thoughts and feelings about the death of the baby.

Overall, the study revealed that approximately 17% of 80 post-abortive women surveyed score highly on a scale measuring "avoidance" symptoms [Reuters]. Such symptoms include avoidance of what happened or "intrusion," such as flashbacks or bad dreams.

There were 120 women included in the Norwegian survey — 80 who had abortions prior to the 14th week of pregnancy and 40 who had miscarriages during the first or second trimester.

The study found that 10 days after an abortion decision half of those who miscarried and nearly 30 percent of women who had abortions had negative feelings about the event.

Women were asked to chart their feelings at 10 days, 6 months and two year time periods. Those more likely to experience guilt and shame early on from the abortion were more likely to have such feelings later on.

Georgette Forney [abortion survivor, co-founder of the Silent No More Awareness Campaign, that urges women who regret their abortions to speak out] was glad more research is being conducted into abortion's aftereffects.

"Finally, someone is studying the pain women experience from pregnancy loss by abortion or miscarriage," Forney said.

 

"My experience is that women who miscarry are usually given a small window of sympathy, but women who have abortions often resort to using drugs and alcohol to cover up the pain because the people who told us it was ok to abort our babies, don't want to listen to our crying afterwards," Forney explained.

"I hope this study will encourage additional research into both the short-term and long-term affect of abortion on women's emotional health," Forney concluded. "After 31 years of experimenting on us — it's about time."

Women who had induced abortions were more likely to experience regret and feelings of "guilt and shame".

Only 3% of women who suffered from miscarriages had such symptoms [March/April 2004 medical journal Psychosomatic Medicine] showed.

Dr. Anne Nordal Broen [leading researcher, psychiatry specialist, Univ of Oslo] told Reuters that the findings suggest women who have had abortions or miscarriages need to be able to talk through and work out their feelings.

"We know that suppression of thoughts and feelings connected to an event is not a healthy way to deal with difficult psychological responses," Broen said. "It is better to talk about what happened, let the natural feelings come out." Post-abortion outreach programs have long helped women recover from the emotional, psychological and spiritual complications of an abortion.

 

Previous studies have found higher rates of psychological complications resulting from abortion.

Another prior study in the British Journal of Obstetrics and Gynecology of post-abortion patients only 8 weeks after their abortion, researchers found that 44% complained of nervous disorders, 36% had experienced sleep disturbances, 31% had regrets about their decision, and 11% had been prescribed psychotropic medicine by their family doctor. 

Meanwhile, a five-year retroactive study in Canada, revealed that women in two Canadian provinces who had had abortions were more likely to seek psychological help (25%) compared with the general population (3%).

 

CMAJ, May 2003

A study published in the May 2003 edition of the Canadian Medical Association Journal  — "Psychiatric Admissions of Low-income Women following Abortion and Childbirth" —
reviewed the medical records of 56,741 California Medicaid patients.

It revealed that women who had abortions were 2.6 times more likely than delivering women to be hospitalized for psychiatric treatment in the first 90 days following abortion or delivery.

Rates of psychiatric treatment remained significantly higher for at least four years.

CMAJ 2003;168(10):1253-6
CMAJ • MAY 13, 2003; 168 (10) 1253

Psychiatric Admissions of Low-income Women following Abortion and Childbirth
David C. Reardon, Jesse R. Cougle, Vincent M. Rue, Martha W. Shuping, Priscilla K. Coleman, Philip G. Ney

…The one important and widely cited exception is a record-based study by David and colleagues.8 They used a Danish registry system
to examine psychiatric admissions for 3 months post-partum and post abortion for all residents under the age of 50 years and found that the overall rate of psychiatric admission was 18.4 per 10 000 population for women who had had an abortion and 12.0 per 10 000 population for
women who had given birth.

The goal of the present investigation was to further previous
record-based research by examining psychiatric admissions
relative to previous pregnancy outcome over a longer period of time, while controlling for previous psychiatric history, socioeconomic status, age and months of eligibility for state-funded medical care…

Women who have had an abortion also have significantly higher depression scores compared with women who carry unintended pregnancies to term.12

Additional research has shown that a small percentage of women
(from 1.4%3 to 18.8%13 ) experience abortion as a traumatic
event resulting in the symptoms of post-traumatic stress disorder.14

Abstract
Background:
Controversy exists about whether abortion or childbirth
is associated with greater psychological risks. We compared
psychi

atric admission rates of women in time periods
from 90 days to 4 years after either abortion or childbirth.
Methods: We used California Medicaid (Medi-Cal) records of
women aged 13–49 years at the time of either abortion or childbirth
during 1989. Only women who had no psychiatric admissions
or pregnancy events during the year before the target pregnancy
event were included ( n= 56 741).

Interpretation: Subsequent psychiatric admissions are more common
among low-income women who have an induced abortion than among those who carry a pregnancy to term, both in the short and longer term.

About 27% of all abortions and 34% of all inpatient deliveries in California in 1989 were funded by Medi-Cal.15,16 Of this population, 194,694 (104 078 who had a delivery, 89 716 who
had 1 or more abortions) were citizens whose beneficiary identification
codes could be linked to valid social security numbers and at
least 1 pregnancy event…

Marital status information was not provided…
The cleaned data set left 138,666 cases for examination. Three
additional criteria were then applied to arrive at the final study
population. To avoid confounding effects, women who carried a
pregnancy to term but had a known subsequent abortion were excluded. In addition, to ensure that we could control for at least
1 year of previous psychiatric and obstetric history, we selected
only the cases of women who had their first known abortion or
delivery between July 1 and Dec. 31, 1989…
From the final population (n = 56 741), all women whose first
known pregnancy in the target time period ended in abortion were
selected as our case population (n = 15 299). All women whose pregnancy ended in delivery of a live birth and who had no known subsequent abortions were selected as the control group (n = 41 442)…

Results
The mean age of the women who delivered was 25.5 (standard
deviation [SD] 5.8) years at the time of birth; the mean
age of women who had an abortion was 24.8 (SD 6.1) years
at the time of abortion. The mean number of months eligible
for Medi-Cal assistance within the 4 years after the target pregnancy event was 27.3 (SD 18.4) months among women who delivered and 31.4 (SD 17.6) months among women who had an abortion.

In total, 434 different women were admitted at least once for inpatient psychiatric treatment within 4 years after their first known abortion or delivery…women who had abortions had a significantly higher inpatient admission rate than women who delivered during each time period analyzed

The highest odds ratio was found for the first 90 days after
the pregnancy event, with women who had had an abortion
being 2.6 times more likely to be admitted for psychiatric
treatment than women who had delivered
.

The odds ratios tended to decrease over time…David and colleagues8
found that the greatest disparity in admission rates was among separated, widowed or divorced women. This suggests that social support following an abortion may be a significant mediator of adjustment.

The greatest limitation of this study is lack of access to complete medical histories… Because our own findings reveal that observed differences persist beyond 1 year, the inclusion of women in our childbirth group who actually had a history of abortion is likely to have diluted the observed differences…

Additional research, using data that encompass complete
medical histories, is strongly recommended. Clinicians who are alert to a patient’s history of pregnancy loss may be better able to identify women who would benefit from a referral for counselling.

References
1. Wilmoth GH, de Alterlis M. Prevalence of psychological risks following legal abortion in the U.S.: limits of the evidence. J Soc Issues 1992;48(3):37-66.
2. Rogers J, Phifer J, Nelson J. Psychological impact of abortion: methodological and outcomes summary of empirical research between 1966 and 1988. Health Care Women Int 1989;10:347-76.
3. Major B, Cozzarelli C, Cooper ML, Zubek J, Richards C, Wilhite M, et al. Psychological responses of women after first-trimester abortion. Arch Gen Psychiatry 2000;57(8):777-84.
4. Miller WB, Pasta DJ, Dean CL. Testing a model of the psychological consequences of abortion. In: Beckman LJ, Harvey SM, editors. The new civil war: the psychology, culture, and politics of abortion. Washington: American Psychological Association; 1998. p. 235-67.
5. Söderberg H, Janzon L, Sjöberg NO. Emotional distress following induced abortion: a study of its incidence and determinants among abortees in Malmo, Sweden. Eur J Obstet Gynecol Reprod Biol 1998;79(2):173-8.
6. Jones EF, Forrest JD. Underreporting of abortion in surveys of U.S. women: 1976 to 1988. Demography 1992;29(1):113-26.
7. Söderberg H, Andersson C, Janzon L, Sjöberg NO. Selection bias in a study on how women experienced induced abortion. Eur J Obstet Gynecol Reprod Biol 1998;77(1):67-70.
8. David H, Rasmussen N, Holst E. Post-abortion and postpartum psychotic reactions. Fam Plann Perspect 1981;13(1):32-4.
9. Zolese G, Blacker CVR. The psychological complications of therapeutic abortion. Br J Psychiatry 1992;160:742-9.
10. Bradley CF. Abortion and subsequent pregnancy. Can J Psychiatry 1984;29(6): 494-8.
11. Uruhart DR, Templeton AA. Psychiatric morbidity and acceptability following medical and surgical methods of induced abortion. Br J Obstet Gynecol 1991;98(4):396-9.
12. Reardon DC, Cougle JR. Depression and unintended pregnancy in the National Longitudinal Survey of Youth: a cohort study. BMJ 2002;324:151-2.
13. Barnard CA. The long term psychological effects of abortion. Portsmouth (NH): Institute for Pregnancy Loss; 1990.
14. Speckhard A, Rue VM. Postabortion syndrome: an emerging public health concern. J Soc Issues 1992;48:95-120.
15. Medical Care Statistics Section. Medi-Cal funded induced abortions, 1989. Sacramento (CA): California Department of Health Services; 1991.
16. Medical Care Statistics Section. Medi-Cal funded deliveries, 1989. Sacramento (CA): California Department of Health Services; 1991.
17. International classification of diseases, 9th revision (clinical modification). 5th ed. Washington: US Department of Health and Human Services; 1996. Cat no 86-72897.
18. Major B, Cozzarelli C, Sciacchitano AM, Cooper ML, Testa M. Perceived social support, self-efficacy and adjustment to abortion. J Pers Soc Psychol 1990;59(3):452-63.
19. Major B, Zubek JM, Cooper ML, Cozzarelli C, Richards C. Mixed messages: implications of social conflict and social support within close relationships for adjustment to a stressful life event. J Pers Soc Psychol 1997;72(6):1349-63.
20. Morgan CM, Evans M, Peter JR, Currie C. Mental health may deteriorate as a direct effect of induced abortion. BMJ 1997;314:902.
Reardon et al
 
This article has been peer reviewed.

Methods
The California Department of Health Services (DHS) identified 625 women who had received funding for either an abortion
or delivery in calendar year 1989 under the government funded
medical insurance program for low-income individuals
known as Medi-Cal.

Correspondence to: Dr. David C. Reardon, Elliot Institute,
PO Box 7348, Springfield IL 62791-7348, USA;
fax 217 525-8212;
[email protected]
From the Elliot Institute, Springfield, Ill. (Reardon); the Department of Psychology, University of Texas-Austin, Austin, Tex. (Cougle); the Institute for Pregnancy Loss, Stratham, NH (Rue); John Bosco Institute, Winston-Salem, NC (Shuping); the Department of Human Development and Family Studies, Bowling Green State University, Bowling Green, Ohio (Coleman); the Department of Family Practice, University of British Columbia, Vancouver, BC (Ney).
Competing interests: None declared.

 

Broen's study – http://www.psychosomaticmedicine.org/cgi/content/full/66/2/265
Elliot Institute – http://www.afterabortion.org
CMAJ study –
http://www.cmaj.ca/cgi/content/full/168/10/1253
[Reuters, 5May04; Ertelt, LifeNews.com 6May04, Reardon, Elliot Inst]

 

Risk of Psychiatric Hospitalization Rises After Abortion (CMAJ, 2003)
Is abortion a benign experience for women?
Or can it cause or contribute to emotional problems, even severe ones?  The American Psychological Association (APA), which has consistently lobbied in favor of abortion rights, has frequently insisted that abortion is a benign experience that predominately
brings relief to most women. Some APA members, such as Nancy Adler and Brenda Major of the University of California, have even charged that those who say abortion can cause emotional problems are guilty of misleading the public. To support this
view, Adler has argued that abortion is so common that if it did cause emotional problems, the nation's psychiatric wards would be filled with the evidence.

Now, a new study published in the latest issue of the Canadian Medical Association Journal (CMAJ) shows that such evidence does exist. A review of the medical records of 56,741 California medicaid patients revealed that women who had abortions were 2.6 times more likely than delivering women to be hospitalized for psychiatric treatment in the first 90 days following abortion or delivery. Depressive psychosis was the most common diagnosis. Rates of psychiatric treatment remained significantly higher for at least four years. A previously published study by the same authors revealed that women who had abortions were also more likely to require subsequent outpatient mental health care.

According to the CMAJ study's lead author, David Reardon, Ph.D., a common complaint among participants in post-abortion recovery programs is that when they raised the issue of their past abortions while seeking mental health care, their therapists
dismissed abortion as irrelevant. "Therapists who fixate on the 'abortion is benign' theory, either out of ignorance or allegiance to defensive political views on abortion, are doing a great disservice to women who need understanding and support," said Reardon, who recently co-authored a book, Forbidden Grief: The Unspoken Pain of Abortion.

"This study, based on objective medical records, validates the claims of tens of thousands of women in post-abortion recovery programs." In an effort to offer an opposing view, CMAJ editors invited psychologist Brenda Major, an advocate for the view that abortion is therapeutic, to submit a commentary on the study appearing in the same issue of the CMAJ.

In her commentary, Major charged that the study's implication that abortion can
cause psychiatric problems is misleading. She argued other factors, such as marital status or prior psychological problems, may offer better explanations for the fact that psychiatric problems are more common among aborting women. Reardon concedes that these other factors may also contribute to psychiatric illness but insists that abortion can both aggravate pre-existing problems and trigger new ones.

He dismissed Major's commentary as a product of "the abortion distortion effect." Reardon particularly questioned Major's choice to omit from her comments any mention her own study recently published in the Archives of General Psychiatry. That study revealed that 1.4 percent of the women interviewed two years after their abortions suffered from post-traumatic stress disorder solely attributable to their abortions.

Even such a low percentage, projected on the 1.3 million American women undergoing abortions each year, would result in 18,200 cases of PTSD each year, or over a half million cases since 1973. Including other types of negative reactions, Reardon said, could easily increase the overall complication rate by twenty times or more. 

Among the other studies, also published in major peer reviewed journals, one revealed that among women with an unintended first pregnancy, those who had abortions were at significantly higher risk of clinical depression an average of eight years later compared to similar women who carried their unintended first pregnancies to term. Higher rates of suicide and substance abuse among women who had abortions were also revealed in the other studies published by the research team. More information and a link to the study is available at www.afterabortion.org/news.

Women's Health After Abortion: The Medical and Psychological Impact
The last fifteen years have witnessed a steady growth in awareness about post-abortion complications for women. Previous concerns about damaged reproductive systems and severe psychological reactions have been multiplied with the addition of evidence surrounding the abortion breast cancer link, the connection between abortion and cerebral palsy in subsequent children, and evidence of lower general health and higher death rates among post-abortive women.

"Women's Health After Abortion: The Medical and Psychological Ev

idence," by Elizabeth Ring-Cassidy and Ian Gentles, makes obtaining up-to-date information on this issue easier than ever before. Each of the eighteen chapters offers a very readable summary, analysis, and critique of studies published in each of the areas examined. These are indeed literature reviews and thorough ones.

This book is an invaluable resource not only for the average reader who simply wants to learn more about post-abortion issues, but also for researchers (whether in post-graduate programs or high schools), who will find the chapters helpful in clarifying their thoughts and questions before they dig into the original sources.

Besides examining the standard topics such as abortion's effects on fertility, subsequent pregnancies, mortality, breast cancer, psychological health, and relationships, "Women's Health After Abortion" also explores the psychological reactions following abortion after diagnosis of fetal anomalies and "multifetal pregnancy reduction," a technique developed to eliminate "excess" babies when the use of ovulation drugs or in vitro fertilization results in "too many" babies implanting and thriving. pattern of the best medical journals. available for $19.95 through Acorn Books (1-888-412-2676).
 [Elliot Inst 13May03]