Research on abortion and well-being

I've posted this on DU before, but I thought this would be an excellent place to post it again. Even some of those who support reproductive choice fall prey to the myth that abortion has negative emotional effects on every woman who has the procedure. Here is some research that shows the opposite, including the Koop report.

Please add any I've missed!

Abortion doesn't affect well-being, study says

New York Times (as printed in the San Jose Mercury 2/12/97)

Abortion does not trigger lasting emotional trauma in young women who
are psychologically healthy before they become pregnant, an eight-year
study of nearly 5,300 women has shown. Women who are in poor shape
emotionally after an abortion are likely to have been feeling bad about
their lives before terminating their pregnancies, the researchers said.

The findings, the researchers say, challenge the validity of laws
that have been proposed in many states, and passed in several, mandating
that women seeking abortions be informed of mental health risks.

The researchers, Dr. Nancy Felipe Russo, a psychologist at Arizona
State University in Tempe, and Dr. Amy Dabul Marin, a psychologist at
Phoenix College, examined the effects of race and religion on the
well-being of 773 women who reported on sealed questionnaires that
they had undergone abortions, and they compared the results with the
emotional status of women who did not report abortions.

The women, initially 14 to 24 years old, completed questionnaires and
were interviewed each year for eight years, starting in 1979. In 1980
and in 1987, the interview also included a standardized test that
measures overall well-being, the Rosenberg Self-Esteem Scale.

"Given the persistent assertion that abortion is associated with
negative outcomes, the lack of any results in the context of such a
large sample is noteworthy," the researchers wrote. The study took
into account many factors that can influence a woman's emotional
well-being, including education, employment, income, the presence of
a spouse and the number of children.

Higher self-esteem was associated with being employed, having a
higher income, having more years of education and bearing fewer children,
but having had an abortion "did not make a difference," the researchers
reported. And the women's religious affiliations and degree of involvement
with religion did not have an independent effect on their long-term
reaction to abortion. Rather, the women's psychological well-being before
having abortions accounted for their mental state in the years after the
abortion, the researchers said..

In considering the influence of race, the researchers again found
that the women's level of self-esteem before having abortions was the
strongest predictor of their well-being after an abortion.

"Although highly religious Catholic women were slightly more likely
to exhibit post-abortion psychological distress than other women, this
fact is explained by lower pre-existing self-esteem," the researchers
wrote in the current issue of Professional Psychology: Research and
Practice, a journal of the American Psychological Association.

Overall, Catholic women who attended church one or more times a week,
even those who had not had abortions, had generally lower self-esteem
than other women, although within the normal range, so it was hardly
surprising that they also had lower self-esteem after abortions, the
researchers said in interviews.

Gail Quinn, executive director of anti-abortion activities for the
United States Catholic Conference, said the findings belied the
experience of post-abortion counselors. She said, "While many women
express `relief' following an abortion, the relief is transitory."
In the long term, the experience prompts "hurting people to seek the
help of post-abortion healing services," she said.

The president of the National Right to Life Committee, Dr. Wanda
Franz, who earned her doctorate in developmental psychology, challenged
the researchers' conclusions. She said their assessment of self-esteem
"does not measure if a woman is mentally healthy," adding, "This requires
a specialist who performs certain tests, not a self-assessment of how
the woman feels about herself."

The Relationship of Abortion to Well-being: Do Race and Religion Make a Difference?
Nancy Felipe Russo and Amy J. Dabul
Professional Psychology, Research and Practice, 1997, Vol. 28, No , 23-31

Relationships of abortion and childbearing to well-being were examined for 1,189 Black and 3,147 White women. Education, income, and having a work role were positively and independently related to well-being for all women. Abortion did not have an independent relationship to well-being, regardless of race or religion, when well-being before becoming pregnant was controlled. These findings suggest professional psychologists should explore the origins of women's mental health problems in experiences predating their experience of abortion, and they can assist psychologists in working to ensure that mandated scripts from 'informed consent' legislation do not misrepresent scientific findings.


RUSSO, NANCY FELIPE
ZIERK, K.
Abortion, Childbearing, and Women's Well-Being
Professional Psychology, Research and Practice 23 (1992): 269-280. Also, http://www.prochoiceforum.org.uk/psy_resea...
Cohort(s): NLSY79
ID Number: 4029
Publisher: American Psychological Association (APA)

This study is based on a secondary analysis of NLSY interview data from 5,295 women who were interviewed annually from 1979 to 1987. Among this group 773 women were identified in 1987 as having at least one abortion, with 233 of them reporting repeat abortions. Well-being was assessed in 1980 and 1987 by the Rosenberg Self-Esteem Scale. The researchers used analysis of variance (ANOVA) and multiple regression to examine the combined and separate contributions of preabortion self-esteem, contextual variables (education, employment, income, and marital status), childbearing (being a parent, numbers of wanted and unwanted children) and abortion (having one abortion, having repeat abortions, number of abortions, time since last abortion) to women's post abortion self-esteem.




Most Women Do Not Feel Distress, Regret After Undergoing Abortion, Study Says



   The majority of women who choose to have legal abortions do not experience regret or long-term negative emotional effects from their decision to undergo the procedure, according to a study published in the June issue of the journal Social Science & Medicine, NewsRx.com/Mental Health Weekly Digest reports. Dr. A. Kero and colleagues in the Department of Clinical Sciences, Obstetrics and Gynecology at University Hospital in Umea, Sweden, interviewed 58 women at periods of four months and 12 months after the women's abortions. The women also answered a questionnaire prior to their abortions that asked about their living conditions, decision-making processes and general attitudes toward the pregnancy and the abortion. According to the study, most women "did not experience any emotional distress post-abortion"; however, 12 of the women said they experienced severe distress immediately after the procedure. Almost all of the women said they felt little distress at the one-year follow-up interview. The women who said they experienced no post-abortion distress had indicated prior to the procedure that they opted not to give birth because they "prioritized work, studies, and/or existing children," according to the study. According to the researchers, "almost all" of the women said the abortion was a "relief or a form of taking responsibility," and more than half of the women said they experienced positive emotional experiences after the abortion such as "mental growth and maturity of the abortion process" (NewsRx.com/Mental Health Weekly Digest, 7/12).

http://www.kaisernetwork.org/daily_reports...

The psychological sequelae of therapeutic abortion--denied and completed

PK Dagg
Department of Psychiatry, Mount Sinai Hospital, Toronto, Ont., Canada.

OBJECTIVE: The purpose of this article is to review the available literature on the psychological sequelae of therapeutic abortion, addressing both the issue of the effects of the abortion on the woman involved and the effects on the woman and on the child born when abortion is denied. METHOD: Papers reviewed were initially selected by using a Medline search. This procedure resulted in 225 papers being reviewed, which were further selected by limiting the papers to those reporting original research. Finally, studies were assessed as to whether or not they used control groups or objective, validated symptom measures. RESULTS: Adverse sequelae occur in a minority of women, and when such symptoms occur, they usually seem to be the continuation of symptoms that appeared before the abortion and are on the wane immediately after the abortion. Many women denied abortion show ongoing resentment that may last for years, while children born when the abortion is denied have numerous, broadly based difficulties in social, interpersonal, and occupational functions that last at least into early adulthood. CONCLUSIONS: With increasing pressure on access to abortion services in North America, nonpsychiatrist physicians and mental health professionals need to keep in mind the effects of both performing and denying therapeutic abortion. Increased research into these areas, focusing in particular on why some women are adversely affected by the procedure and clarifying the relationship issues involved, continues to be important.
Am J Psychiatry 1991; 148:578-585
http://ajp.psychiatryonline.org/cgi/conten...


Psychological sequelae of medical and surgical abortion at 10-13 weeks gestation.

Ashok PW, Hamoda H, Flett GM, Kidd A, Fitzmaurice A, Templeton A.

From the Department of Obstetrics and Gynecology, University of Aberdeen, Aberdeen Royal Infirmary, Aberdeen, UK.

Background. Although not much research comparing the emotional distress following medical and surgical abortion is available, few studies have compared psychological sequelae following both methods of abortion early in the first trimester of pregnancy. The aim of this review was to assess the psychological sequelae and emotional distress following medical and surgical abortion at 10-13 weeks gestation. Methods. Partially randomized patient preference trial in a Scottish Teaching Hospital was conducted. The hospital anxiety and depression scales were used to assess emotional distress. Anxiety levels were also assessed using visual analog scales while semantic differential rating scales were used to measure self-esteem. A total of 368 women were randomized, while 77 entered the preference cohort. Results. There were no significant differences in hospital anxiety and depression scales scores for anxiety or depression between the groups. Visual analog scales showed higher anxiety levels in women randomized to surgery prior to abortion (P < 0.0001), while women randomized to surgical treatment were less anxious after abortion (P < 0.0001). Semantic differential rating scores showed a fall in self-esteem in the randomized medical group compared to those undergoing surgery (P = 0.02). Conclusions. Medical abortion at 10-13 weeks is effective and does not increase psychological morbidity compared to surgical vacuum aspiration and hence should be made available to all women undergoing abortion at these gestations.
Acta Obstet Gynecol Scand. 2005 Aug;84(8) 61-6.
http://www.ncbi.nlm.nih.gov/entrez/query.f...


Post abortion syndrome: myth or reality?

Koop CE.

What are the health effects upon a woman who has had an abortion? In his letter to President Reagan, dated January 9, 1989, Surgeon General C. Everett Koop wrote that in order to find an answer to this question the Public Health Service would need from 10 to 100 million dollars for a comprehensive study.

PIP: At a 1987 briefing for Right to Life leaders, the author--US Surgeon General C Everett Koop--was requested to prepare a comprehensive report on the health effects (mental and physical) of induced abortion. To prepare for this task, the author met with 27 groups with philosophical, social, medical, or other professional interests in the abortion issue; interviewed women who had undergone this procedure; and conducted a review of the more than 250 studies in the literature pertaining to the psychological impact of abortion. Every effort was made to eliminate the bias that surrounds this controversial issue. It was not possible, however, to reach any conclusions about the health effects of abortion. In general, the studies on the psychological sequelae of abortion indicate a low incidence of adverse mental health effects. On the other hand, the evidence tends to consist of case studies and the few nonanecdotal reports that exist contain serious methodological flaws. In terms of the physical effects, abortion has been associated with subsequent infertility, a damaged cervix, miscarriage, premature birth, and low birthweight. Again, there are methodological problems. 1st, these events are difficult to quantify since most abortions are performed in free-standing clinics where longterm outcome is not recorded. 2nd, it is impossible to casually link these adverse outcomes to the abortion per se. Resolution of this question requires a prospective study of a cohort of women of childbearing age in reference to the variable outcomes of mating--failure to conceive, miscarriage, abortion, and delivery. Ideally, such a study would be conducted over a 5-year period and would cost approximately US$100 million
Health Matrix. 1989 Summer;7(2):42-4.
http://www.ncbi.nlm.nih.gov/entrez/query.f...

Psychological sequelae of induced abortion.

Romans-Clarkson SE.

Department of Psychological Medicine, University of Otago Medical School, Dunedin, New Zealand.

This article reviews the scientific literature on the psychological sequelae of induced abortion. The methodology and results of studies carried out over the last twenty-two years are examined critically. The unanimous consensus is that abortion does not cause deleterious psychological effects. Women most likely to show subsequent problems are those who were pressured into the operation against their own wishes, either by relatives or because their pregnancy had medical or foetal contraindications. Legislation which restricts abortion causes problems for women with unwanted pregnancies and their doctors. It is also unjust, as it adversely most affects lower socio-economic class women.

PIP: A review of empirical studies on the psychological sequelae of induced abortion published since 1965 revealed no evidence of adverse effects. On the other hand, this review identified widespread methodological problems--improper sampling, lack of data on women's previous psychiatric history, a scarcity of prospective study designs, a lack of specified follow-up times or evaluation procedures, and a failure to distinguish between legal, illegal, and spontaneous abortions--that need to be addressed by psychiatric epidemiologists. Despite these methodological weaknesses, all 34 studies found significant improvement rather than deterioration in mental status after induced abortion. There was also a high degree of congruity in terms of predictors of adverse reactions after abortion--ambivalence about the procedure, a history of psychosocial instability, poor or absent family ties, psychiatric illness at the time of the pregnancy termination, and negative attitudes toward abortion in the broader society. As expected, criminal abortion is more likely than legal abortion to be associated with guilt, and women who have been denied therapeutic abortions report significantly greater psychosocial difficulties than those who have been granted abortion on the grounds of their precarious mental health. Overall, the research clearly attests that abortion carried out at a woman's request has no deleterious psychiatric consequences. Problems arise only when the woman undergoes pregnancy termination as a result of pressure from others. Legislation that undermines the ability of the pregnant woman to assess herself the impact of an unwanted pregnancy on her future impedes mental health and should be opposed by the psychiatric profession.
Aust N Z J Psychiatry. 1989 Dec;23(4):555-65
http://www.ncbi.nlm.nih.gov/entrez/query.f...

Psychological and social aspects of induced abortion.

Handy JA.

The literature concerning psychosocial aspects of induced abortion is reviewed. Key areas discussed are: the legal context of abortion in Britain, psychological characteristics of abortion-seekers, pre- and post-abortion contraceptive use, pre- and post-abortion counselling, the actual abortion and the effects of termination versus refused abortion. Women seeking termination are found to demonstrate more psychological disturbance than other women, however this is probably temporary and related to the short-term stresses of abortion. Inadequate contraception is frequent prior to abortion but improves afterwards. Few women find the decision to terminate easy and most welcome opportunities for non-judgemental counselling. Although some women experience adverse psychological sequelae after abortion the great majority do not. In contrast, refused abortion often results in psychological distress for the mother and an impoverished environment for the ensuing offspring.
Br J Clin Psychol. 1982 Feb;21 (Pt 1):29-41.
http://www.ncbi.nlm.nih.gov/entrez/query.f...