Worse Psychological Outcomes for Women Denied Abortion

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Women experienced the worst psychological outcomes in the first week after an abortion denial.
Women experienced the worst psychological outcomes in the first week after an abortion denial.

Findings published in JAMA Psychiatry refute the myth that abortion causes psychological harm to women who have one,1 a claim still used to justify legislation creating obstacles to abortion access despite the lack of evidence to support it. (For example, 9 US states require that women receive pre-abortion counseling regarding the supposed negative psychological effects of the procedure.)

In the current investigation, researchers at the University of California, San Francisco, analyzed data from the Turnaway Study, a 5-year prospective, longitudinal study of women who sought an abortion and either obtained one or were denied the procedure. Though several studies examining this evidence throughout the investigation showed no evidence of an increased risk of depression, anxiety, or post-traumatic stress disorder in women who obtained an abortion, it has been proposed that the negative effects may be delayed beyond the timepoints examined.2-4

To that end, the study explored the link between abortion and mental health outcomes using all 5 years of data from the Turnaway Study. Researchers recruited 956 study participants from 30 abortion facilities in 21 states over a period of 3 years, and divided them into 3 groups: women who received a first-trimester abortion (n=273); those who received an abortion within the 2 weeks prior to the facility's gestational limit (near-limit group, n=452); and those who sought an abortion during the 3 weeks following the facility's limit and were turned away (turnaway group, n=231). The turnaway group was subdivided into women who went on to give birth (turnaway-birth group, n=161) and those who obtained an abortion elsewhere or ultimately miscarried (turnaway-no-birth group, n=70).

All participants participated in structured phone interviews with the researchers 8 days after obtaining or being denied an abortion, followed by interviews conducted every 6 months for 5 years. Mental health and wellbeing were assessed with 2 measures each of depression and anxiety, and 1 measure each of self-esteem and life satisfaction. The authors controlled for potentially confounding variables such as age, educational level, marital status, and history of depression or anxiety.

Though the findings reveal that psychological outcomes became similar between groups in the long-term, women who were denied an abortion experienced the worst effects in the first week after the denial. At that time point, both turnaway groups showed the following outcomes compared with the near-limit group:

  • More anxiety symptoms (turnaway-births, 0.57; 95% (confidence interval [CI], 0.01-1.13; turnaway-no-births, 2.29; 95% CI, 1.39-3.18)
  • Lower self-esteem (turnaway-births, -0.33; 95% CI, -0.56 to -0.09; turnaway-no-births, -0.40; 95% CI, -0.78 to -0.02)
  • Lower life satisfaction (turnaway-births, -0.16; 95% CI, -0.38 to 0.06; turnaway-no-births, -0.41; 95% CI, -0.77 to -0.06),
  • Similar levels of depression (turnaway-births, 0.13; 95% CI, -0.46 to 0.72; turnaway-no-births, 0.44; 95% CI, -0.50 to 1.39)

“These initial elevated levels of distress may be a response to being denied an abortion after overcoming many barriers to seeking care, which may include expenses associated with travel, child care, and time off of work,” explained study co-author M. Antonia Biggs, PhD, a reproductive health researcher at UCSF. “Furthermore, women give a range of reasons for seeking an abortion, including financial reasons, partner-related issues, concern for existing children, and emotional challenges, among other reasons. All of these factors are indicative of the challenges women face at the time of seeking an abortion,” she told Psychiatry Advisor. She advises healthcare professionals to support women in making their own autonomous decisions, and notes that the experience of having or being denied an abortion will vary from woman to woman.

“These findings do not support the assumption that women experience adverse psychological outcomes following an abortion,” said Dr Biggs. “Policies restricting women's access on the basis that they protect women's mental health are not evidence-based.”

References

1. Biggs MA, Upadhyay UD, McCulloch CE, Foster DG. Women's mental health and well-being 5 years after receiving or being denied an abortion: a prospective, longitudinal cohort study. JAMA Psychiatry. 2016; doi:10.1001/jamapsychiatry.2016.3478. 

2. Biggs MA, Rowland B, McCulloch CE, Foster DG. Does abortion increase women's risk for post-traumatic stress? Findings from a prospective longitudinal cohort study. BMJ Open. 2016; 6(2):e009698.

3. Foster DG, Steinberg JR, Roberts SC, Neuhaus J, et al. A comparison of depression and anxiety symptom trajectories between women who had an abortion and women denied one. Psychol Med. 2015; 45(10):2073-2082.

4. Biggs MA, Neuhaus JM, Foster DG. Mental Health Diagnoses 3 Years After Receiving or Being Denied an Abortion in the United States. Am J Public Health. 2015; 105(12): 2557–2563.

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