Abortion and mental health

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A new study from New Zealand, published in the Journal of Child Psychology and Psychiatry, raises important questions about the effect of abortion on women's mental health. Researchers found those reporting an abortion prior to age 21 had rates of mental disorders from age 21 to 25 more than 11/2 times higher than the rates for women who did not become pregnant and those who became pregnant but did not abort. The relationship between abortion and mental health problems persisted even when the researchers took into account the mental health of the women prior to the abortion. The researchers concluded, "Abortion in young women may be associated with increased risks of mental health problems."

Although virtually ignored in the United States, the study has provoked political debate over abortion in the Lands Down Under. Predictably, pro-choice groups have criticized the study and New Zealand pro-life supporters have petitioned their government to review abortion laws and procedures.

Does the New Zealand study support policies aimed at restricting access to abortion in the United States?

No, according to Nancy Felipe Russo, Regents professor of psychology and women's studies at Arizona State University. The American Psychological Association referred me to Dr. Russo for comment on the New Zealand study. Dr. Russo pointed out that in 1969 the APA adopted the position that abortion should be a civil right. She added, "To pro-choice advocates, mental health effects are not relevant to the legal context of arguments to restrict access to abortion."

According to Dr. Russo, pro-choice researchers have a different agenda. "To someone who believes that the decision to have a child is a personal decision, protected by a right of privacy, evidence about negative effects of abortion is important, but for a different policy goal -- to provide women accurate information so they can make informed choices in their pregnancy decisionmaking process."

Thus, Dr. Russo considers the more interesting scientific question, "Why do women vary in their responses to abortion?" She believes for U.S. women, pre-existing mental health problems, relationship quality, and whether the pregnancy was wanted or unwanted are key factors determining postabortion mental distress, not the abortion itself.

She also believes telling women an abortion is wrong may create guilt and shame in some, but those feelings are rooted in social disapproval and not abortion per se.

About the New Zealand study, she said: "The study was not designed to separate the effects of abortion from simply having an unplanned pregnancy. It does show that women who have unplanned pregnancies terminating in abortion have a poorer mental health profile than other women. But this is not a new finding." Dr. Russo asserts studies linking abortion and mental distress were poorly designed. She concludes, "There has yet to be a well designed study that finds that abortion itself contributes to increased risk for mental health problems."

On the other hand, Professor David Fergusson, lead author of the New Zealand report, said the results cannot be so easily dismissed. He explained: "We took into account social background, education, ethnicity, previous mental health, exposure to sexual abuse, and a series of other factors. It's true we did not take into account specifically whether a pregnancy was wanted or not. However, this limitation is not sufficient grounds for dismissing the results."

Mr. Fergusson's report singled out APA for criticism over its handling of research on women's post-abortion psychological adjustment. He quotes the APA's briefing paper on abortion: "Well-designed studies of psychological responses following abortion have consistently shown that risk of psychological harm is low. Some women experience psychological dysfunction following abortion, but postabortion rates of distress and dysfunction are lower than pre-abortion rates."

In an interview, Mr. Fergusson said he believes the APA's conclusions imply a greater certainty than is warranted by existing studies. In fact, Mr. Fergusson is generally critical of all research on postabortion distress, saying: "It borders on scandalous that one of the most common surgical procedures performed on young women is so poorly researched and evaluated. If this were Prozac or Vioxx, reports of associated harm would be taken much more seriously with more careful research and monitoring procedures."

Why isn't there better research on the effect of abortion on women? Mr. Fergusson says the political issues surrounding abortion crowd out scientific objectivity. In his view, "The abortion debate and its implications drive out the science."

In her own way, Ms. Russo agrees, "There is a pro-life political agenda to prove abortion is harmful to women in order to overturn Roe v. Wade. The research that specifically aims to causally link mental health problems and abortion has been conducted by those opposed to abortion."

So was Professor Fergusson out to link mental health problems with abortion? "I'm immune from that charge because I'm pro-choice," he says. In a remarkably candid statement, Mr. Fergusson reveals, "I might rather not have found what we did, but we found it and you can't be intellectually honest and only publish results you like."

Although Mr. Fergusson agrees with Ms. Russo that abortion should be a civil right, he is critical of the APA's rejection of possible adverse reactions to abortion.

About his views, the researcher says, "It's one thing to have a civil right to do something and quite another thing is the consequences of doing it. It may well turn out that the procedure has risks we did not foresee."

Those possible "risks we did not foresee" should inspire less certainty and more research on abortion and mental health. In the meantime, health professionals might consider: When women come forward, unprovoked, saying their abortion decision continues to affect them, they might just be right.

Warren Throckmorton is a fellow for public policy and psychology at the Center for Vision and Values, Grove City College in Pennsylvania.