Studies - General Research

August 2006: Abortion Research

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."

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
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.

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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.




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.

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]