Abortion and Mental Health: What Are the Facts?

The relationship between abortion and depression is clear.

Posted May 14, 2018

As many of you will be aware, on the 25th May, the Republic of Ireland faces a referendum on the 8th Amendment to the constitution. This amendment makes any sort of access to abortion within the state extremely difficult, and penalizes doctors who perform terminations with a life-ruining sentence (fourteen years) if they misjudge a situation. The net result of this is that about ten women a day go to seek abortions in the neighboring United Kingdom. Many of these women feel stigmatized, unsupported, and badly let down. Out of sight and out of mind. Some recent anti-abortion campaigners have been trying to argue that abortion harms the mother—that she always regrets her decision. What does psychological research have to say on this matter?

“We didn’t need any of that psychology nonsense when I was a youngster”

Yes you did. You just pretended that you didn’t. Allow me to illustrate:

co/w wikipedia commons
How Our Lady's looked in 1939.
Source: co/w wikipedia commons

My window looks out onto the rather magnificent gothic building above. This Hogwarts-like edifice (still the longest in Ireland) is Our Lady’s Mental Hospital, a.k.a The Grey Building, a.k.a Eglinton Lunatic Asylum. It was built in the 1840s, and by the end of the nineteenth century we had confined something like 1/300 members of the population in buildings like this. Out of sight, and out of mind. Conditions were frequently appalling. Care was rudimentary, at best. A report by the 1937 Cork Examiner described it as a “chapter of horrors”.

One of the success stories of the last hundred years is that we have got a better understanding of human behavior, mental health, and helpful interventions. When people ask me “what is the point of psychology?” One of the points is that we have closed buildings like this. More importantly, we have closed the attitudes that led to our using them. We have learned how to treat people better. However, ceasing to brush problems out of sight and out of mind has been a battle--Our Lady’s only finally closed in 2002. One of the things we have learned is to how to diagnose, treat, and care for people with mental illness.

The Psychological Society of Ireland has issued a summary of research into abortion and mental health, and I can do no better than to pass on the findings. They paint a clear picture:  

1) Women who choose abortion do so because of the negative effects of continuing the pregnancy on their mental health and that of their existing children and significant others.

For example, of the 3625 women who travelled from Ireland to the UK in 2016, 70% were married or with a partner. 50% had had a previous child. A typical reason given is “the adverse effects of continuing the pregnancy on the life of the woman and significant others [after] taking into account their own needs, a sense of responsibility to existing children and the potential child, and the contribution of significant others, including the genetic father”

2) The overwhelming majority of women report feelings of relief after an abortion. Those who maintain feelings of regret over time are affected mostly by societal stigma and the lack of social support

From 95-99% of the women surveyed at various times points up to three years after a termination report that this was the right decision for them. What about the remaining 1-5%? They are the ones who need our support the most—and they say that social stigma and low social support are the primary causes of their misery.

3) Those who have a history of mental health difficulties are the most likely to experience these same difficulties following an abortion

If you were depressed before pregnancy, then you are likely to be depressed after it. Abortion was not the likely cause.

4) Robust, high quality scientific research by organisations such as the American Psychological Association (APA) and the Academy of Medical Royal Colleges (AMRC) has concluded that abortion does not harm women’s mental health.

Some of the best medical data comes from meta-analyses. These are studies where we compare findings across multiple studies, dropping those with poor methodologies (such as failing to control for prior mental health conditions). Here, the data are plain: Abortion is not associated with mental health decline.

5) Women are at their most vulnerable during the perinatal period compared to any other point of time in their lives and rates of mortality during this time are highest with regard to mental health difficulties.

Women are at their most psycholgically vulnerable in the times surrounding the birth—before and after. This is the time where anxiety, depression, and even suicidal ideation (fortunately still rare) are at their most likely to occur. Things like being abandoned by one’s partner, being a victim of violence, having an unplanned or unwanted pregnancy, or anxiety over access to abortion services all increase the chance of distress.

“We didn’t need any of that psychology nonsense when I was a youngster”

...and most slave-owners didn’t feel any pressing needs for change either. We have been applying scientific methods to humans for over a hundred years now, and the results have been generally to improve the human condition. The “good old days” turn out, all too often, to seem better only through failures of memory, and successes at covering up the realities of the past. Buildings like Our Lady’s should remain as a lasting testament to how far we have progressed, and a reminder not to get complacent.  

References

Abortion: Access and safety worldwide. (2018, March 24). The Lancet, 391(10126), p. 1121.

Academy of Medical Royal Colleges (AMRC) (2011). Induced Abortion and Mental Health. Retrieved from https://www.aomrc.org.uk/wp-content/uploads/2016/05/Induced_Abortion_Mental_Health_1211.pdf

American Psychological Association Task Force on Mental Health and Abortion. (2008). Report of the Task Force on Mental Health and Abortion. Washington, DC. Retrieved from http://www.apa.org/pi/wpo/mental-health-abortion-report.pdf

Biggs, MA., Upadhyay, UD., McCulloch, CE., Foster, DG. (2017). Women's mental health and well-being 5 years after receiving or being denied an abortion: A prospective, longitudinal cohort study. JAMA Psychiatry, 74(2), 169-178. doi: 10.1001/jamapsychiatry.2016.3478.

Bunreacht na hÉireann - Constitution of Ireland (1937). Eighth Amendment of the Constitution Act, 1983. Dublin: Government Publications

Center for Reproductive Rights (2014). Abandoned and stigmatized - The impact of Irish abortion law on women. New York, NY: publications@reprorights.org. Retrieved from: https://www.reproductiverights.org/sites/crr.civicactions.net/files/documents/AbandonedAndStigmatized_ImpactOfIrishAbortionLaw.pdf

Charles, V., Polis, CB., Sridhara, SK., and Blum, RW. (2008). Abortion and long-term mental health outcomes: a systematic review of the evidence. Contraception, 78, pp.436-450.

Department of Health (1998) Why mothers die: Report on the confidential enquiries into maternal deaths in the United Kingdom 1994-1996. London: HMSO

Gauthreaux, C., Negron, J., Castellanos, D., Ward-Peterson, M., Castro, G., Rodriguez de la vega, P. and Manuel Acuna, J. (2017). The association between pregnancy intendedness and experiencing symptoms of postpartum depression among new mothers in the United States, 2009-2011. Medicine, 96(6): e5851. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5312985/

Gentile, S. (2011). Suicidal mothers. Journal of Injury and Violence Research, July; 3(2): pp. 90–97. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3134924/

Kessler, RC. and Schatzberg, AF. (2012). Commentary on Abortion Studies of Steinberg and Finer (Social Science & Medicine 2011;72:72-82) and Coleman (Journal of Psychiatric Research 2009;43:770-6 & Journal of Psychiatric Research 2011;45:1133-4). British Journal of Psychiatric Research, 46(3), pp. 410-411

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Kirkman, M., Rowe, H., Hardiman, A., Mallett, S. and Rosenthal, D. (2009). Reasons women give for abortion: a review of the literature. Archives of Women’s Mental Health. 12(6), pp. 365-378.

Lohr, Dr. Patricia. (2017). Joint Committee on the 8th Amendment of the Constitution debate - November 22. Dublin, Ireland. Houses of the Oireachtas

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Major, B., Appelbaum, M., Beckman, L., Dutton, MA., Russo, NF., & West, C. (2009) Abortion and Mental Health: Evaluating the Evidence. American Psychologist. 64(9), pp 863-890.

Newport et al. (2007) Suicidal ideation in pregnancy: assessment and clinical implications Archives in women’s mental health. Vol 10(5); pp 181-187. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/17726640

O’Hare MF, Manning E, Corcoran P, Greene RA on behalf of MDE Ireland. Confidential Maternal Death Enquiry in Ireland, Report for 2013 - 2015. Cork: MDE Ireland, December 2017

https://www.ucc.ie/en/media/research/maternaldeathenquiryireland/Confidential-Maternal-Death-Enquiry-Report-2013---2015--Web.pdf

Rocca, CH., Kimport, K., Roberts, SCM., Gould, H., Neuhaus, J., & Foster, DG (2015). Decision rightness and emotional responses to abortion in the United States: A longitudinal study. PLOS ONE 10(7): e0128832. https://doi.org/10.1371/journal.pone.0128832

https://www.irishexaminer.com/viewpoints/analysis/cork-fire-a-history-of-our-ladys-hospital-they-deserve-our-best-they-have-got-our-worst-454129.html

https://harrowingp.blogspot.ie/2013/01/st-annes-asylum-cork-ireland.html

https://www.imt.ie/features-opinion/enquiring-into-irelands-asylums-why-did-the-situation-grow-so-large-05-09-2014/

https://www.thejournal.ie/st-kevins-building-mental-hospital-history-3479819-Jul2017/

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