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MEDICAL SCIENCE MONITOR: women whose first pregnancies ended in abortion were 65% more likely to score in the 'high-risk' range for clinical depression

The British Medical Journal reports that women who abort a first pregnancy are at greater risk of subsequent long term clinical depression compared to women who carry an unintended first pregnancy to term. Publication of the study coincided with anniversary events related to the Supreme Court's January 22, 1973 Roe v. Wade decision legalizing abortion.

Data from a national study of American youths, begun in 1979, was used to conduct the research. In 1992, a subset of 4,463 women were surveyed about depression, intendedness of pregnancy, and pregnancy outcome. A total of 421 women had had their first abortion or first unintended delivery between 1980 and 1992.

An average of eight years after their abortions, married women who had aborted were 138 percent more likely to be at high risk of clinical depression compared to similar women who carried their unintended first pregnancies to term.

Among women who were unmarried in 1992, rates of high risk depression were not significantly different. The authors suggest that the lack of significance in unmarried women may be explained by the higher rate of non-reporting of abortions among unmarried women.

Compared with national averages, unmarried women in this study report only 30 percent of the expected abortions compared with married women, who report 74 percent of the expected abortions. This may make the results for married women more reliable, say the authors. Another explanation is that unmarried women who are raising a child without the support of a husband experience significantly more depression than their married counterparts.

Since shame, secrecy, and thought suppression regarding an abortion are all associated with greater post-abortion depression, anxiety, and hostility, the authors conclude that the high rate of concealing past abortions in this population (60 percent overall) would tend to suppress the full effect of abortion on subsequent depression. Unreported abortions would result in women who experience depression following an abortion being misclassified as delivering women.

"Given the very high rate of concealment of past abortions, the fact that significant differences still emerged suggests that we are just catching the tip of the iceberg," said David C. Reardon, Ph.D., the study's lead author.

Reardon, the director of the Elliot Institute in Springfield, Illinois, says the study's findings are consistent with other recent research that has shown a four to six fold increased risk of suicide and substance abuse associated with prior abortion. He says the findings are also important because this is the first national representative study to examine rates of rates of depression many years after an abortion, on average approximately eight years later in this sample.

The data set used was the same as that used by feminist psychologist Nancy Russo of Arizona State University, whose examination of a self-esteem scale revealed no significant difference between aborting women and women who carried to term. Russo concluded that the absence of difference in self-esteem scores in this large national data set proved that abortion has no "substantial and important impact on women's well-being."

According to Reardon, Russo's much publicized study has frequently been used to support the claim that, on average, abortion has no significant effect on women's mental health. The Elliot Institute's new analysis of the same data set reveals that significant differences do exist.

"The most serious flaw of the Russo study is that the authors did not even comment on the extraordinarily high rate of concealment of past abortions in the sample," Reardon said. "Women who do not want to mention a past abortion are most likely the ones who will have unresolved feelings of shame, guilt, or grief."

Reardon says that another problem with the prior analysis was that Russo's team relied solely on a measure of self-esteem that is not sensitive to post-abortion stress. He says the examination of depression scores is more relevant to the known negative reactions to abortion.

"Russo's previous analysis of this data set was methodologically weak and was frankly a poor basis on which to build the claim that abortion has no measurable effect on women's well- being," he said. "The results of our reexamination of this data set-especially in combination with other studies showing higher rates of suicide, substance abuse, and other mental health disorders associated with prior abortion-shows that the 'no effect' hypothesis should be rejected. Something is going on here. Where there is this much smoke, despite the problem of high concealment rates, there is likely to be a fire beneath the haze."

Another important aspect of this study, says Reardon, is that is one of only a few studies to use any pre-pregnancy psychological score as a control variable. The most commonly used control variable used in regarding emotional reactions is "pre-abortion" evaluation on the day of the abortion when the woman is in the crux of emotional distress. This is why a pre-pregnancy score is much more useful than a pre-abortion score for evaluating the independent effect of abortion on long term emotional reactions.

Asked what the practical implications of this study are for physicians, Reardon said: "We recommend that physicians should routinely inquire about the outcome of all the patient's pregnancies. The simple question, 'Have you experienced any pregnancy losses such as miscarriage, abortion, adoption, or stillbirth?' may be sufficient to give women permission to discuss unresolved issues related to prior pregnancy losses. Physician's should remember that there are few social contexts in which women feel it is appropriate to discuss unresolved feelings about prior pregnancy loss. Many patients will appreciate the opportunity to discuss their pregnancy losses with an empathetic person and may welcome referrals for additional counseling."

The new study was funded by the Elliot Institute, a non-profit organization that is involved in resear

ch and education regarding post-abortion complications and also promotes outreach and counseling programs for women. Reardon is the author of numerous books on post-abortion issues, including Breaking Down the Walls Which Prevent Post-Abortion Healing, Making Abortion Rare: A Healing Strategy for a Divided Nation, and Forbidden Grief: The Unspoken Pain of Abortion, co-authored with Theresa Burke. Information on these titles and other research conducted by Dr. Reardon and the Elliot Institute can be found at


REFERENCED STUDIES: Reardon DC, Cougle JR. Depression and unintended pregnancy in the National Longitudinal Survey of Youth: a cohort study British Medical Journal, 324: 151-152. Full text available at

Russo NF, Zierk K. Abortion, childbearing, and women's well-being. Professional Psychology: Research and Practice, 1992; 23: 269-280. [British Medical Journal, 324: 151-152; Infonet, 18Jan02;]

This is a sample of references to studies which found abortion to be associated with subsequent substance abuse and suicide attempts.

Gissler M, Hemminki E, Lonnqvist J. Suicides after pregnancy in Finland: 1987-94: register linkage study. British Medical Journal, 1996; 313: 1431- 1434.

Tischler C. Adolescent suicide attempts following elective abortion. Pediatrics, 1981; 68(5): 670- 671.

Morgan CM, Evans M, Peter JR, Currie C. Mental health may deteriorate as a direct effect of induced abortion. British Medical Journal, 1997; 314: 902.

Reardon DC, Ney, PG. Abortion and subsequent substance abuse. American Journal Drug Alcohol Abuse, 2000; 26(1): 61-75.

Frank DA, Zuckerman BS, Amaro H, Aboagye K, Bauchner H, Cabral H, Fried L, Hingson R, Kayne H, Levenson SM, et al Cocaine use during pregnancy, prevalence and correlates, Pediatrics, 1988 Dec; 82(6): 888-95.

Amaro H, Zuckerman B, Cabral H. Drug use among adolescent mothers: profile of risk. Pediatrics, 1989 Jul;84(1):144-51.

Wilsnack RW, Wilsnack SC, Klassen AD. Women's drinking and drinking problems: Patterns from a 1981 national survey. American Journal Public Health, 1984; 74: 1231-1238.

Klassen, A, Wilsnack S. Sexual experience and drinking among women in a U.S. national survey. Archives Sexual. Behavior, 1986; 15(5): 363.



In 1989, then-Surgeon General C. Everett Koop wrote in a government report that national fertility surveys suggest that given published prevalence rates, the percentage of women admitting to having an abortion is only around 50% of that expected. Thus, only half of women will admit to abortion when directly asked.


The study found in the American Journal of Orthopsychiatry (July 2002) uses record-linkage using official records kept by the California Medicaid program. In this study, the rates of first-time outpatient mental health treatment following an abortion or a live birth in 1989 were compared over the next four years. The claim is often made that only those women who have mental health problems prior to having the abortion actually have problems following the abortion. Consequently, for purposes of this study, all women were eliminated who had made claims for mental health care for a year prior to the pregnancy outcome.

After controlling for age, months of eligibility, and the number of pregnancies, the mental health claims of the 54,419 women in the study were analyzed for 90 days, 180 days, one year, two years, three years, and four years following the pregnancy event. The overall rate of mental health claims was 17% higher for the abortion group in comparison with the group who delivered. Within the first 90 days after the pregnancy, the abortion group had 63% more claims than the birth group.

In subsequent time periods, the abortion group also had a higher percentage of claims compared to the birth group: 42% (180 days); 30% (1 year); 16% (two years). In the three- and four-year periods the results were not significantly different. The abortion group had a greater need for mental health care than the childbirth group, which persisted for two years following the pregnancy outcome.

Comparisons were also made between the two groups for specific diagnostic categories. In these comparisons, the aborting women had significantly higher rates of treatment within the categories of adjustment reaction, bipolar disorder, neurotic depression, and schizophrenic disorders. Higher rates of treatment for the abortion group approached significance for the categories of anxiety states and alcohol and drug abuse. The costs of medical care are becoming more and more of an issue for providers and this study clearly demonstrates that there are more claims for services by women who have abortions than by those who give birth to their babies.

Similar findings occurred in an unpublished, in-house study performed in Virginia by the Virginia Department of Medical Assistance Services. They found that of 325 women who had state-funded abortions, 73% had more health claims (85% higher costs) for reproductive health problems compared with a matched sample of women who carried their babies to term. The also found that women who had state-funded abortions had 62% more mental health claims post-dating the procedure (43% higher costs) compared with a matched sample of women covered by Medicaid who had not had state-funded abortions. Virginia only pays for abortions in cases of rape or incest or to save the life of the mother. [American Journal of Orthopsychiatry, July 02; NRLC News, Oct 02]

[May, 2003] In a study using data from the National Longitudinal Survey of Youth (NLSY), women "who experienced their first pregnancy event (abortion or childbirth) between 1980 and 1992 (n=1,884) were followed. Depression scores in 1992, an average of 8 years after the subjects' first pregnancy events, were compared after controlling for age, race, marital status, divorce

history, education, income, and external locus of control scores. The latter was used to control for pre-pregnancy psychological state. Results were also examined separately for groups based on race, marital status, and divorce history.

After controlling for several socio-demographic factors, women whose first pregnancies ended in abortion were 65% more likely to score in the 'high-risk' range for clinical depression than women whose first pregnancies resulted in a birth. Differences were greatest among the demographic groups most likely to report an abortion. Abortion may be a risk factor for subsequent depression in the period of 8 years after the pregnancy event. The higher rates of depression identified may be due to delayed reactions, persistence of depression or some other common risk factor."

[Medical Science Monitor, 2003; 9(4): CR105-112]