Abortions don’t lead to long-term mental health problems for women, but being denied causes anxiety, study suggests

Five years after terminating a pregnancy, a woman who sought and had an abortion was no more likely to be depressed or anxious than was a pregnant woman who was denied an abortion and went on to give birth, new research has found.

Compared with women who gave birth after being turned away from abortion clinics, women who ended their pregnancies had lower rates of depression and anxiety disorders five years later. Those women who gave birth to children they considered aborting reported no higher self-esteem and no more satisfaction with life five years on than did women who terminated their pregnancies.

The new study results suggest that nine U.S. states are imposing unnecessary burdens on women who seek to end pregnancies by requiring them first to be counseled on the negative psychological impact of having an abortion.

If, as expected, the Supreme Court revisits the subject of abortion rights during the Donald Trump administration, the new findings could play a role in the high court’s deliberations.

Under the terms of the 1973 Roe vs. Wade decision, states may restrict a woman’s access to abortion until the point of fetal viability only to protect a mother’s health. Studies have weighed in with different conclusions on the mental health impacts of abortion, though their rigor has been hotly debated. Against that backdrop, 22 states have adopted laws requiring abortion-seeking women to be informed of the procedure’s possible psychological impact. Nine of those states require counseling that stresses the possibility of a woman’s negative emotional response.

The new research, published this week in the journal JAMA Psychiatry, was launched in response to then-Surgeon General C. Everett Koop’s 1989 appeal for “conclusive data about the health effects of abortion on women.” The new study was designed according to the specifications Koop set out as the standard for producing such “conclusive data.”

Over three years starting in 2008, the so-called Turnaway Study recruited women at 30 abortion facilities in 21 states across the country. Eight days after a woman had either received an abortion or been turned away because her pregnancy was too far along for her to be eligible, she agreed to answer researchers’ questions about her physical and mental health, childbearing experiences and intentions, history of traumatic life events and a host of biographical details. Those interviews were repeated every six months for five years.

In all, 558 of the 956 women who were initially enrolled in the study completed it. To compare their levels of mental health over time, the researchers divided those women into four groups:

• Women seeking — and getting — an abortion in their first trimester of pregnancy;
• Women whose pregnancies were more than three months along but who were close to the abortion clinic’s limit on gestational age and received an abortion;
• Women who were turned away because their pregnancies were more advanced than the clinic allowed, but whose pregnancies did not result in childbirth because they miscarried or got an abortion elsewhere; and
• Women who were turned away because their pregnancies were more advanced than the clinic allowed, and who went on the give birth to the child.

A week after seeking abortions, the women in three of those groups did not differ markedly in depression and anxiety symptoms, self-esteem or life satisfaction. Only women who had been turned away from the clinic and who would not go on to give birth to a child showed notably higher levels of anxiety and depression and lower levels of self-esteem and life-satisfaction.

On every measure of mental health, all four groups saw marked improvement a year after seeking an abortion. And, with one exception, they converged on all measures over the five-year period. Women who had sought an abortion but were turned away and ended up giving birth had slightly higher rates of depression at the five-year mark than did any of the other three groups.

“It’s great to have that added evidence, but this study is confirming what we knew,” said sociologist Kimberly Kelly, who directs Mississippi State University’s gender studies program and has studied abortion opponents’ claims that women who terminate pregnancies suffer “post-abortion syndrome.”

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Kelly, who was not involved in the new research, said it may sway Justice Anthony Kennedy, a key swing vote on abortion issues before the Supreme Court. In a major abortion case in 2007, Gonzales vs. Carhart, Kennedy noted an absence of data on pregnancy termination and mental health. But, he wrote, “it seems unexceptionable to conclude that some women come to regret their choice to abort the infant life they once created and sustained.”

The new study was notable for its length, design and rigor, and is a marked departure from any study conducted to date on the subject of women’s mental health after abortions. Those who favor warning women of negative consequences have generally cited research with a major methodological flaw: It compared depression rates among women who had abortions with depression rates in women who completed wanted pregnancies.

Those arguing against mental health warnings for abortion-seeking women have had far more research to cite. But no study to date has tracked women for as long as five years after they got, or sought, an abortion.

That shortcoming has long been used by anti-abortion advocates, who have argued that, over time, a woman’s regret over an abortion would spur depression and post-traumatic stress.

“This ought to put that claim to rest,” said professor Brenda Major of UC Santa Barbara’s department of psychological and brain sciences. Major was not involved in the current research. But she chaired a 2008 task force on mental health and abortion for the American Psychological Association, which found much of the then-existing research on the subject shoddy.

“This is the best study on this subject that’s ever been done,” Major said. “Unfortunately,” she added, “I have come to believe that in this area, data doesn’t matter.”

Under Major, the APA task force did conclude that the best predictor of a woman’s post-abortion mental health was the state of her mental health before she became pregnant. That finding was borne out as well by the Turnaway Study, which found that five years after seeking abortion, “the most significant factor associated with experiencing adverse mental health outcomes following abortion was a history of mental health conditions and experiences of traumatic life events, such as child abuse and neglect.”

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