Teens Cope With Unwanted Births Better Than Abortion: Resolution of Unwanted Pregnancy During Adolescence Through Abortion Versus Childbirth: Individual and Family Predictors and Psychological Consequences
Induced Abortion Seen As a Risk Factor for Subsequent Preterm Birth
National Study Finds Teens Who Abort Are More Likely to Experience Subsequent Mental Health Problems Compared to Those Who Give Birth to Unplanned Children
Adolescent girls who abort unintended pregnancies are five times more likely to seek subsequent help for psychological and emotional problems compared to their peers who carry "unwanted pregnancies" to term, according to a new nationally representative study published in the Journal of Youth and Adolescence.
Dr. Priscilla Coleman, a research psychologist at Bowling Green State University, also found that adolescents who had abortions were also over three times more likely to report subsequent trouble sleeping, and nine times more likely to report subsequent marijuana use. The results were compiled after examining 17 other control variables, like prior mental health history and family factors, that might also influence subsequent mental health.
The data was drawn from a federally-funded longitudinal study of adolescents from throughout the U.S. who participated in two series of interviews in 1995 and 1996. About 76 percent of girls who had abortions and 80 percent of girls who gave birth were between the ages of 15 and 19 during the survey, with the remainder being younger.
Researcher Dr. David Reardon, who has contributed to more than a dozen studies examining psychological outcomes after abortion, said that Coleman's study was particularly important because it examines pregnancy "wantedness," in addition to a large number of other control variables.
"Over the last six years, numerous studies have conclusively linked higher rates of mental illness and behavioral problems associated with abortion compared to childbirth." said Reardon. "But abortion advocates have generally dismissed these findings, insisting that while women who abort may fare worse than women who give birth to planned children, they may fare better than the important subgroup of women who carry unintended pregnancies to term. Coleman's study addresses this argument and shows that the facts don't support abortion advocates' speculations."
According to the Alan Guttmacher Institute, which tracks abortion statistics throughout the U.S., about a quarter of the abortions that take place each year are performed on girls younger than 20. Previous studies have found that younger abortion patients may be more likely to experience difficulties coping after abortion compared to older women, perhaps because they are more likely to be pressured into unwanted abortions or to undergo abortions later in the pregnancy, leading to more physical and emotional risk.
A 2004 survey of American and Russian women published in the Medical Science Monitor found that 64 percent of American women reported that they felt pressured into abortion.
Coleman said that for teens, the pressure probably comes from the fact that they are more likely to be perceived as unready to be parents and that abortion is often seen by those around them as the best solution.
"When women feel forced into abortion by others or by life circumstances, negative post-abortion outcomes become more common," she wrote. "Adolescents are generally much less prepared to assume the responsibility of parenthood and are logically the recipients of pressure to abort."
Coleman pointed out that, while having a child as a teen may be problematic, "the risks of terminating seem to be even more pronounced." Other studies comparing outcomes for abortion versus delivery of unintended pregnancies have found higher rates of clinical depression, anxiety, and substance abuse among women who abort, while studies that did not look only at unplanned pregnancies also find that women who aborted are at increased risk for suicidal behavior, psychiatric problems, symptoms of post-traumatic stress, and sleep disorders, which are often linked to trauma.
While previous studies have often been criticized for methodological shortcomings, studies that have come out in the last several years have been designed to address those problems and have gone through vigorous scrutiny from peer-review panels before publication, she added.
"The scientific evidence is now strong and compelling," Coleman said. "Abortion poses more risks to women than giving birth."
Reardon, who directs the Springfield, IL-based Elliot Institute, also said that while there has been a long-standing assumption that such problems are related to mental health problems that existed before abortion, a large-scale study conducted in New Zealand last year found that this wasn't the case.
"The standard theory has been that women who have problems coping after abortion were probably already mentally unstable and therefore more likely to be even worse off if they continued the pregnancy," he said. "The researchers in New Zealand thought that their study would confirm this theory, so they specifically controlled for pre-existing mental health problems. What they found, however, was that women who were mentally stable before abortion were still more likely to experience mental health problems after abortion."
Although the pregnancy rate among American teens has dropped steadily in the past few decades, among developed countries the U.S. still has the highest rates of teen pregnancy and childbirth.
In her paper, Coleman highlighted a need for additional research on this issue. She pointed out that while "hundreds of thousands" of teens experience an unintended pregnancy each year, her study is one of only a few to examine the impact of abortion on women versus the impact of carrying to term, all of which have indicated worse outcomes associated with abortion.
Reardon echoed the call for more research, as well as the need for medical and mental health professionals to be attuned to the risks of abortion and present women and teens with accurate information about the physical and psychological
effects of the procedure.
"The findings that are emerging show that abortion leads to negative outcomes for many women, regardless of whether the pregnancy was planned or wanted," Reardon said. "Indeed, not a single study has ever shown statistically significant benefits associated with abortion compared to birth. In terms of maximizing women's health and well-being, the scientific evidence overwhelmingly indicates that birth is preferable to abortion."
Source:
Priscilla K. Coleman, "Resolution of Unwanted Pregnancy During Adolescence Through Abortion Versus Childbirth: Individual and Family Predictors and Psychological Consequences," Journal of Youth and Adolescence (2006).
Additional Studies:
VM Rue et. al., "Induced abortion and traumatic stress: A preliminary comparison of American and Russian women," Medical Science Monitor 10(10): SR5-16 (2004).
David M. Fergusson, et. al., "Abortion in young women and subsequent mental health," Journal of Child Psychology and Psychiatry 47(1): 16-24 (2006).
[Springfield, IL Aug. 10, 2006]
Abstract of the Actual Study:
Resolution of Unwanted Pregnancy During Adolescence Through Abortion Versus Childbirth: Individual and Family Predictors and Psychological Consequences
J Youth Adolescence
DOI 10.1007/s10964-006-9094-x
ORIGINAL PAPER
Priscilla K. Coleman
Received: 14 April 2005 / Accepted: 6 June 2005
_C Springer Science+Business Media, Inc. 2006
Abstract. Using data from the National Longitudinal Study of Adolescent Health, various demographic, psychological, educational, and family variables were explored as predictors of pregnancy resolution. Only 2 of the 17 variables examined were significantly associated with pregnancy resolution (risk-taking and the desire to leave home). After controlling for these variables, adolescents who aborted an unwanted pregnancy were more inclined than adolescents who delivered to seek psychological counseling and they reported more frequent problems sleeping and more frequent marijuana use. No significant differences were observed for cigarette smoking, frequency of alcohol use, and problems with parents based on alcohol use after the controls were instituted; however without controls, significant associations were observed, underscoring the importance of the use of psychological and situational controls in studies of the consequences of abortion. The information derived from this study is potentially useful to parents and professionals who provide guidance to adolescents regarding pregnancy resolution…
Studies comparing resolution of pregnancy through abortion versus delivery
As common as adolescent pregnancy is in our society, it is surprising that few relative risk studies have been conducted to ascertain whether unintended pregnancy resolved through abortion or delivery is associated with greater risk to adolescent psychological well-being…
One analysis of the National Longitudinal Study of Youth (NLSY) (Reardon and Cougle, 2002) revealed that women who aborted a first pregnancy were significantly more likely to be at risk for clinical depression compared to women who carried a first unintended pregnancy to term. This difference was observed even after controlling for age, income level, race, and a psychological measure taken prior to the women’s first pregnancies. In a second study using data from the NLSY, Reardon and colleagues recently reported that women who aborted when compared to those who carried to term were twice as likely to use marijuana and reported more frequent use of alcohol after controlling for age, race, marital status, income, education, and prior psychological well-being (Reardon et al., 2004)…
P. K. Coleman
Human Development and Family Studies, Bowling Green State University, 16D Family and Consumer Sciences Building, Bowling Green, OH 43403, USA
Acknowledgements This research is based on data from the National
Longitudinal Study of Adolescent Health (Add Health), directed by J.
Richard Udry, Kenan Professor of Maternal and Child Health and Sociology
and a fellow of the Carolina Population Center at the University
of North Carolina at Chapel Hill. Funding for the study is provided by
NICHD and 17 other federal agencies.
References
Adler NF, David HP, Major BN, Roth SH, Russo NF,Wyatt GE (1990)
Psychological responses after abortion. Science 248:41–44
Adler NF, Dolcini P (1986) Psychological issues in abortion for adolescents.
In: Melton G (ed) Adolescent abortion: psychological and
legal issues. University of Nebraska Press, Lincoln, pp. 74–95
Alan Gutttmacher Institute (AGI) (1994) Abortion in the United States.
Facts in Brief. Author, New York
Alan Gutttmacher Institute (AGI) (1996) Facts at a glance: induced
abortion. Author, New York
Alan Gutttmacher Institute (AGI) (1999) Facts in brief: Teen Sex and
Pregnancy. AGI, New York
Alan Gutttmacher Institute (AGI) (2000) The status of major abortionrelated
laws in the States [on-line].Available at http:/www.agiusa.
org
Anthanasiou R, OppelW, Michelson L, Unger T, Yager M (1973) Psychiatric
sequelae to term birth and induced early and late abortion:
A longitudinal study. Fam Plann Perspect 5:227–231
Bailey PE, Bruno ZV, Bezerra MF, Queiros I, Oliveira CM (2003) J
Biosoc Sci 35:71–82
Barnard C (1990) The long term psychosocial effects of abortion. Institute
for Pregnancy Loss, Jacksonville, Florida
Bradley CF (1984) Abortion and subsequent pregnancy. Can J Psychiatry
29:494
Braveman P, Marchi K, Egerter S, PearlM,Neuhaus J (2000) Barriers to
timely prenatal care amongwomenwith insurance: the importance
of prepregnancy factors. Obstet Gynecol 95:874–880
Brown SS, Eisenberg L (1995) The best intentions: unintended pregnancy
and the well-being of children and families. National
Academy Press, Washington, DC
Carlson ML, Kaiser KL, Yeaworth RC, Carlson RE (1984) An exploratory
study of life-changing events, social support, and pregnancy
decisions in adolescence. Adolescence 19:765–780
Cohen T, Roth S (1984) Coping with abortion. J Hum Stress 10:140–
145
Coleman PK, Rue V, Coyle C, Maxey DC (submitted). Induced Abortion
and child-directed aggressive behaviors among mothers of
children who have been maltreated. Psychosomatic Medicine
Coleman PK, Reardon DC, Rue V, Cougle J (2002a) Prior history
of induced abortion and substance use during pregnancy. Ame J
Obstet Gynecol 187:1673–1678
Coleman PK, Reardon DC, Rue V, Cougle J (2002b) State-funded
abortions vs. deliveries: a comparison of outpatient mental health
claims over four years. Am J Orthopsychiat 72:141–152
Coleman PK, Reardon DC, Cougle J (in press). Substance use among
pregnant women in the con
text of previous reproductive loss and
desire for current pregnancy British Journal of Health Psychology
Cougle J, Reardon DC, Coleman PK (2003) Depression associated with
abortion and childbirth: a long-term analysis of the NLSY cohort.
Med Sci Monit 9(4):CR105–CR112
Cougle J, Reardon DC, Coleman PK (2005) Generalized anxiety associated
with unintended pregnancy: A cohort study of the 1995 National Survey of Family Growth. J Anxiety Disord 19:137–142
Dubow EF, Luster T (1990) Adjustment of children born to teenage
mothers: the contribution of risk and protective factors. JMarriage
Fam 52:393–404
Eisen M, Zellman GL, Leibowitz A, Chow WK, Evans JR (1983) Factors
discriminating pregnancy resolution decisions of unmarried
adolescents. Genet Psychol Monographs 103:69–95
Evans A (2001) The influence of significant others on Australian
teenagers’ decisions about pregnancy resolution. Fam Plann Perspect
33:224–230
Franco KN, Tamburrino M, Campbell N, Pentz J, Jurs S (1989) Psychological
profile of dysphoric women post abortion. J Am Med
Women Assoc 44:113
Franz W, Reardon D (1992) Differential impact of abortion on adolescents
and adults. Adolescence 27:161–172
Hellerstedt WL, Pirie PL, Lando HA, Curry SJ, McBride CM, Grothaus
LC, Nelson JV (1998) Differences in preconceptual and prenatal
behaviors in women with intended and unintended pregnancies.
Am J Public Health 88:663–666
Henshaw SK (1998) Unintended pregnancy in the United States. Fam
Plann Perspect 30:24–29 & 46
Henshaw SK, and Kost K (1992) Parental involvement in minors’ abortion
decisions. Fam Plann Perspect 24:196–208
Henshaw SK, Silverman J (1988) Characteristics and contraceptive use
of abortion patients. Fam Plann Perspect 20:158
Hope TL, Wilder EI, Watt TT (2003) The relationships among adolescent
pregnancy, pregnancy resolution, and juvenile delinquency.
Sociol Quart 44:555–576
Hulsey TM (2001) Association between early prenatal care and
mother’s intention of and desire for the pregnancy. J Obst Gyn
Neonatal Nursing 30:275–282
Jones EF, Forrest JD (1992) Contraceptive failure rates based on the
1988 NSFG. Fam Plann Perspect 24:12–19
Joyce TJ, Kaestner R, Korenman S (2000) The effect of pregnancy
intention on child development. Demography 37:83–94
Klepinger D, Lundberg S, Plotnick R (1999) How does adolescent
fertility affect the human capital and wages of young women? J
Human Resourc 34:421–448
Kost K, Landry DJ, Darroch JE (1998) Predicting maternal behaviors
during pregnancy: does intention status matter? Fam Plann Perspect
30:79–88
Leathers SJ, Kelley MA (2000) Unintended pregnancy and depressive
symptoms among first-time mothers and fathers. Am J Orthopsychiatry
70:523–531
Lemkau JP (1988) Emotional sequelae of abortion: implications for
clinical practice. Psychol Women Quart 12:461–472
Lewis WJ (1997) Factors associated with post-abortion adjustment
problems: Implications for triage. Can J Human Sexuality 6:9–
17
Major B (2003) Psychological implications of abortion—highly
charged and rife with misleading research. Can Med Assoc J
168:1257–1258
Major B, Cozzarelli C (1992) Psychological predictors of adjustment
to abortion. J Soc Issues 48:121–142
Major B, Cozzarelli C, Cooper ML, Zubek J, Richards C, Wilhite M,
Gramzow RH (2000) Psychological responses of women after
first-trimester abortion. Arch Gen Psychiatry 57:777–84
Major B, Gramzow RH (1999) Abortion as stigma: cognitive and emotional
implications of concealment. J Pers Soc Psychol 77:735–
745
Mayor JP (1997) Unintended childbearing, maternal beliefs, and delay
of prenatal care. Birth 24:247–52
Miller WB (1992) An empirical study of the psychological antecedents
and consequences of induced abortion. J Soc Issues 48:67–93
Miller BC, Moore KA (1990) Adolescent sexual behavior, pregnancy,
and parenting: research through the 1980s. J Marriage Fam
52:1025–1044
Moore KA (1989) Facts at a glance. Child Trends, Inc, Washington,
DC
Moseley DT, Follongstad DR, Harley H, Heckel RV (1981) Psychological
factors that predict reaction to abortion. J Clin Psychol
37:276–279
Olson L (1980) Social and psychological correlates of pregnancy decisions
among adolescent women. Am J Orthopsychiatry 50:432–
445
Osofsky JD, Osofsky HJ (1972) The psychological reaction of patients
to legalized abortion. Am J Orthopsychiatry 42:48–60
Pagnini DL, Reichman NE (2000) Psychosocial factors and the timing
of prenatal care among women in New Jersey’s HealthStart
Program. Fam Plann Perspectives 32:56–64
Reardon DC, Coleman PK, Cougle J (2004) Substance use associated
with prior history of abortion and unintended birth: a national
cross sectional cohort study. Am J Drug Alcohol Ab 26:369–383
Reardon DC, Cougle J (2002) Depression and Unintended Pregnancy
in the National Longitudinal Survey of Youth: a cohort Study. Brit
Med J 324:151–152
Reardon DC, Cougle J, Rue VM, Shuping M, Coleman PK, Ney PG
(2003) Psychiatric admissions of low-income women following
abortion and childbirth. Can Med Assoc J 168:1253–1256
Reardon DC,Ney PG (2000) Abortion and subsequent substance abuse.
Am J Drug Alcohol Ab 26:61–75
Santelli JS, Amba J, Ventura S, Lindberg L, Morrow B, Anderson JE,
Lyss S, Hamilton BE (2004) Can changes in sexual behaviors
among high school students explain the decline in teen pregnancy
rates in the 1900s? J Adolesc Health 35:80–90
Shusterman LR (1979) Predicting the psychological consequences of
abortion. Soc Sci Med 13:683–689
Singh S, Darrach JE (2000) Adolescent pregnancy and childbearing:
Levels and trends in developed countries. Fam Plann Perspect
32:14–23
Squires S (May 9, 1995). Most pregnancies unplanned or unwanted,
study says. Washington Post Health 11(19):7
StataCorp (2003) Stata Statistical Software: release 8.0. Stata Corporation,
College Station, TX
Thorp JM, Hartmann KE, Shadigian E (2003) Long-term physical and
psychological health consequences of induced abortion: Review
of the evidence. Obstet Gynecol Surv 58:67–79
Tomal A (2001) The effect of religious membership on teen abortion
rates. J Youth Adolesc 30:103–116
Yamaguchi D, Kandel D (1987) Drug use and other determinants of
premarital pregnancy and its outcome: a dynamic analysis of competing
life events. J Marriage Fam 49:257–270
Zabin LS, Cardona KM (2002) Adolescent pregnancy. In: Wingood
GM, DiClemente RJ (eds) Handbook of women’s sexual and reproductive
health: Issues in women health. U.S. Kluwer Academic
Plenum Publisher, New York, pp. 231–253
Zabin LS, Hirsch MB, Emerson MR (1989) When urban adolescents
choose abortion: effects on education, psychological status, and
subsequent pregnancy. Fam Plann Perspect 21:248–255
Zavodny M (2001) The effect of partners’ characteristics on teenage
pregnancy and its resolution. FamPlann Perspect 33:192–199, and
205
Zolese G, Blacker CVR (1992) The psychological complications of
therapeutic abortion. Brit J Psychiatry 160:742–749
Other research articles by Dr. Priscilla Coleman:
Coleman, P. K., Reardon, D. C., & Cougle, J. (in press). Substance use
among pregnant women in the context of previous reproductive loss and desire for current pregnancy. British Journal of Health Psychology.
Cougle, J., Reardon, D. C., & Coleman, P. K. (in press). Generalized anxiety associated with unintended pregnancy: A cohort study of the 1995 National Survey of Family Growth. Journal of Anxiety Disorders.
Coleman, P. K., Reardon, D. C., Strahan, T., & Cougle, J. (in press). The psychology of abortion: A review and suggestions for future research. Psychology and Health.
Reardon, D. C., & Coleman, P. K. (in press). Letter to the editor pertaining to a study published in AJOG by Gissler, Berg, Bouvier-Colle, and Buekens entitled "Pregnancy-associated mortality after birth, spontaneous abortion or induced abortion in Finland, 1987-2000." American Journal of Obstetrics and Gynecology.
Rue, V. M., Coleman, P. K., & Reardon, D. C. (in press). The context of elective abortion and traumatic stress: A comparison of U. S. and Russian Women. Medical Science Monitor.
Reardon, D. C., Coleman, P. K., & Cougle, J. (2004). Substance use associated with prior history of abortion and unintended birth: A national cross sectional cohort study. American Journal of Drug and Alcohol Abuse, 26, 369-383.
INDUCED ABORTION: A RISK FACTOR FOR SUBSEQUENT PRETERM BIRTH??
TWO RECENT EUROPEAN STUDIES AFFIRM A CONNECTION
A number of investigations into a possible association between induced abortion and subsequent preterm birth have occurred over the past 30 years. Many of the early studies found no association. Then, as larger studies with improving methodology were performed, there were some that began to find an increased risk of preterm birth following an induced abortion. Arguments could be made that the methodology of some of these studies was less than desired, and that confounding factors could account for these findings–allowing those who didn’t want to believe there was an association to continue in their disbelief. But the studies finding an association continued to accumulate, and there weren’t many, if any, that were finding no association.
In the last couple of years two important studies in this area have emerged that deserve attention. The first, published in 2004, was a study that evaluated preterm birth and its relationship to prior induced abortion from the EUROPOP survey dataset, a case-control study from many countries across Europe.(1) This dataset was collected in 1994-1997 and has been used for a number of studies looking at factors associated with preterm birth.
For this particular study, data from ten different European countries was evaluated, including countries from Western, Northern and Eastern Europe. Among women who had one or more induced abortions there was a subsequent adjusted odds ratio of 1.5 for very preterm births (22-32 weeks EGA). They also found that the adjusted odds ratio increased to 1.8 when women with two or more prior abortions were analyzed separately. The adjustments took into account most all of the major known risk factors for preterm birth.
The second study, published in 2005, took a page from the first study, and used the EPIPAGE case-control dataset that had been collected at various maternity centers in France in 1997.(2) Data from France had not been included in the prior study. Again, in this study, adjustments were made for major known risk factors for preterm birth.
Among women who had one or more abortions there was a subsequent adjusted odds ratio of 1.5 for very preterm births (22-32 weeks EGA). When data was analyzed separately for women who had two or more abortions the adjusted odds ratio for preterm birth increased to 2.6. In this particular study they also looked at extremely preterm deliveries (22-27 weeks) and found an adjusted odds ratio of 1.7 for those who had at least one prior abortion.
The abortions obtained by women in these studies were virtually all by dilatation and curettage or suction curettage and therefore do not give us any information about abortions obtained by medical methods.
It should be noted that there were a number of authors who took part in both studies. This imparts the advantage of two different datasets being evaluated in a similar fashion, leading to a uniformity of analysis that would be difficult to achieve with two entirely separate groups of researchers. On the other hand, any biases that might have been introduced by the researchers are likely to be present in both studies. It is interesting to note how closely the findings of the two studies correlate.
Both studies were unmatched case-control studies. Given the nature of the subject matter this is probably the best study methodology we will see for this particular issue, although a matched case-control study might be somewhat more reliable. The EUROPOP study suffers from the weakness of the abortion history being obtained from the mothers after they had delivered. The authors appropriately note that this could introduce a recall bias into the study, with mothers who had just delivered preterm perhaps as a group being either more or less likely to report a prior abortion to a researcher. However, in the EPIPAGE study, the data regarding prior abortions was obtained at the beginning of pregnancy, and any selective reporting of abortions would likely be spread more evenly between those who subsequently delivered preterm and those who delivered at term. In fact, looking at prior studies that have evaluated patient characteristics related to underreporting of abortions suggests that, if anything, underreporting of abortion in the EPIPAGE study may have led to an underestimation of risk for preterm delivery following abortion. What is notable is that both studies came out with very similar results, despite these potential difficulties.
It is important to keep these results in a proper perspective. Smoking has also been associated with preterm delivery. The EPIPAGE dataset has been evaluated for the effect of smoking on preterm birth, while adjusting for other risk factors.(3) The result is that the adjusted odds ratio for preterm birth (27-32 weeks EGA) is 1.7 for smokers. Therefore the association between smoking and preterm birth approximates the association between prior induced abortion and preterm birth.
The bottom line is this: The most recent and best studies looking at the issue of induced abortion and subsequent risk of preterm birth confirm the findings of many prior studies which may have been less rigorous in study design.
Induced abortion IS associated with subsequent preterm birth; it is even more strongly associated with extremely preterm births, and having two or more abortions further increases these risks.
These studies have made it increasingly impossible to ignore the association of preterm birth with prior induced abortion.
One may quibble about study methodology and hope that a future study will find something different, but for the time being, these results represent the state of the art.
References:
Ancel P, et al. History of induced abortion as a risk factor for preterm birth in European countries: results of the EUROPOP survey. Hum Reprod 2004;19:734-40.
Moreau C, et al. Previous induced abortions and the risk of very preterm delivery: results of the EPIPAGE study. Br J Obstet Gynaecol 2005;112:430-437.
Burguet A. The Complex Relationship Between Smoking in Pregnancy and Very Preterm Delivery. Results of the EPIPAGE Study. Br J Obstet Gynaecol 2004;111:258-265.
[AAPLOG, April 2006]