Psychological After-Effects of Abortion: the Real Story
copyright January 1997
originally published in The Humanist magazine (New York), March/April 1997 (Vol. 57, No. 2)
by Joyce Arthur
Over the last decade, a general consensus has been reached in the medical and scientific communities that most women who have abortions experience little or no psychological harm. However, women's ability to cope psychologically after an abortion continues to be the subject of heated debates. Vocal anti-choice advocates claim that most women who have abortions will suffer to some degree from a variant of post-traumatic stress disorder called "post-abortion syndrome," characterized by severe and long-lasting guilt, depression, rage, and social and sexual dysfunction. Why is there such a major discrepancy between the scientific consensus and anti-choice beliefs?
Conflicting studies done over the last 30 years have contributed to this atmosphere of confusion and misinformation. A 1989 review article that evaluated the methodology of 76 studies on the psychological after-effects of abortion noted that both opponents and advocates of abortion could easily prove their case by picking and choosing from a wide range of contradictory evidence. For example, many studies, especially those done between 1950 and 1975, purport to have found significant negative psychological responses to abortion. Such studies, though, often suffer from serious methodological flaws. Some were done when abortion was still illegal or highly restricted, thereby biasing the conclusions in favour of considerable (and understandable) psychological distress. In some cases, research was based on women who were forced to prove a psychiatric disorder in order to obtain the abortion. Further, a large number of studies, both early and recent, consist simply of anecdotal reports of a few women who sought psychiatric help after their abortion. In short, many studies that favour anti-choice beliefs are flawed because of very small samples, unrepresentative samples, poor data analysis, lack of control groups, and unreliable or invalid research questions.
Researcher bias on the part of scientists and physicians has also been a serious problem. Indeed, in earlier times, society's views on how women "should" feel after an abortion were heavily skewed toward the traditional model of women as nurturing mothers. In one study done in 1973, post-doctoral psychology students taking psychoanalytic training predicted psychological effects far more severe than those predicted by women themselves before undergoing an abortion. This might be because traditional Freudian theory teaches that a desire to avoid childbearing represents a woman's denial of her basic feminine nature.
Some psychiatric studies, along with much of today's anti-choice literature, tend to cast women who have abortions into one of two roles: victim or deviant (although these terms are not necessarily used). Victims are coerced into abortion by others around them, in spite of their confusion and ambivalence, and against their basic maternal instincts. Deviants have little difficulty with the abortion decision, which is made casually for convenience' sake. Such women have no maternal instinct and are often characterized in a derogatory or pitying fashion as selfish, callous, unfeminine, emotionally stunted, and/or neurotic.
Books written by anti-choice advocates that deal with post-abortion effects are, by and large, heavily infected with bias. Not only is contrary evidence not refuted, it is rarely even mentioned. Incorrect and out-of-date "facts" abound. The authors' pop psychology often seems to be based on little more than their own wishful projections about the nature of women and how they should feel. Here are two typical examples from essays in the 1979 anti-choice book The Psychological Aspects of Abortion:
"It is interesting that women who need self-punishment do not abort themselves more often. . . . Abortion is done 'to' the woman, with her as only a passive participant. This is further indication of masochism." Howard W. Fisher, MD, Abortion: Pain or Pleasure? (pp. 49)
". . . sooner or later [after the abortion], the truth will make itself known and felt, and the bitter realization that she was not even unselfish enough to share her life with another human being will take its toll. If she had ever entertained a doubt as to whether her parents and others really considered her unlovable and worthless, she will now be certain that she was indeed never any good in their eyes or her own. A deep depression will be inevitable and her preoccupation with thoughts of suicide that much greater." Conrad W. Baars, MD, Psychic Causes and Consequences of the Abortion Mentality. (pp. 122)
With the advent of safe, legal, routinely performed abortion, a wealth of good evidence has come to light that is quite contrary to common anti-choice assertions. The typical abortion patient is a normal, mentally stable woman who makes a strongly resolved decision for abortion within a few days after discovery of the pregnancy, and comes through the procedure virtually unscathed. Several scientific review articles support this conclusion (published from 1990 to 1992 in highly respected journals such as Science and American Journal of Psychiatry). The reviews evaluated hundreds of studies done over the last 30 years, noting the unusually high number of seriously flawed studies, and pointing out common methodological problems. Based on the more reliable studies, all the reviews concluded that although psychological disturbances do occur after abortion, they are uncommon and generally mild and short-lived. In many cases, these disturbances are simply a continuation of negative feelings caused by the unwanted pregnancy itself. Serious and/or persistent problems are rare and are frequently related to the circumstances surrounding the abortion rather than the abortion itself.
Further, many women who were denied abortion showed ongoing, long-term resentment, and their resulting unwanted children were more likely to have increased emotional, psychological, and social problems in comparison with control groups of wanted children. These differences continued to widen throughout adolescence and early adulthood. Finally, many good studies show that giving birth is much more likely than abortion to be associated with severe emotional after-effects, such as post-partum depression.
The review articles largely concluded that the most frequently reported emotions felt by women immediately following an abortion are relief and/or happiness, experienced by about 75% of women (one article evaluated only negative effects). Feelings of regret, anxiety, guilt, depression, and other negative emotions are reported by about 5 to 30% of women. These feelings are usually mild and fade rapidly, within a few weeks. Months or years after an abortion, the majority of women do not regret their decision. In fact, for many women, abortion appears to be a positive experience that improves their self-esteem, provides inner strength, and motivates them to refocus their lives in a meaningful way.
Studies on abortion are done primarily through self-report measures, however, and it is possible that some women may be reluctant to admit negative feelings after their abortion. To help quantify this, let's consider the figures: Every year, between 1.3 and 1.6 million abortions are performed in the United States (since 1977). About 21% of all American women between the ages of 15 and 44 have had an abortion. This is a very large number indeed. The American Psychological Association has pointed out that even if only 10% of the millions of women who have had abortions experienced problems, there would be a significant mental health epidemic, clearly evident by large numbers of dysfunctional women requesting help. There is no evidence whatsoever for any such epidemic, thereby supporting the general reliability of self-report measures.
Some women who are disturbed by or unhappy with their abortion decision belong to support groups like Women Exploited by Abortion, and Victims of Choice. Several anti-choice studies and books purporting to demonstrate the overall harmfulness of abortion limit their sample to the membership of such groups. Not only does this introduce an immediate and fatal flaw to their argument, it shows deliberate obfuscation on the part of the authors. This does not mean that post-abortion support groups don't provide a valuable service for certain women. The very existence of such groups points to the strong need for health professionals to identify and provide extra help to women who are most at risk for developing psychological problems related to abortion. Many studies have shown that women at greater risk tend to include:
In spite of psychological problems suffered by a few women after abortion, the existence of "post-abortion syndrome" is doubted by most experts. Indeed, there is little need to posit a unique disorder in this case, since abortion is not significantly different from any other stressful life experience that might cause trauma in certain people. Former Surgeon General C. Everett Koop, himself anti-choice, pointed this out in 1988. Unfortunately, facts, evidence, and common sense rarely get in the way of anti-choice advocates who are determined to prove that women suffer terribly from "post-abortion syndrome." Certainly, if this were true, it would be a lethal weapon in the fight to reverse Roe vs. Wade. In fact, this was the motivation behind a 1989 Surgeon General's report on the health effects of abortion on women, called for by former President Ronald Reagan on behalf of anti-choice leaders. Although the report was duly prepared, the Surgeon General chose not to release it, apparently because it did not support the anti-choice position. Meanwhile, anti-choice literature continues to churn out the Machiavellian myth that women are severely harmed by abortion.
Because abortion is such a volatile issue, it is probably unrealistic to expect this aspect of the controversy to die down soon, if at all. However, by recognizing that a small subset of women may require increased counselling and support during their abortion decision and afterwards, the women's community and health professionals can do much to minimize the damage wrought by the anti-choice movement's dangerous and irresponsible campaign of misinformation.
Rogers, James L., George B. Stoms, and James L. Phifer. 1989. Psychological Impact of Abortion: Methodological and Outcomes Summary of Empirical Research between 1966 and 1988, Health Care for Women International, 10:347-376.
Fingerer, M. 1973. Psychological sequelae of abortion: anxiety and depression. Journal of Community Psychology. 1:221-225.
Mall, David and W.F. Watts (editors). 1979. The Psychological Aspects of Abortion. Washington, DC:University Publications of America.
Adler, Nancy E., Henry P. David, Brenda N. Major, Susan H. Roth, Nancy F. Russo, and Gail E. Wyatt. 1990. Psychological Responses After Abortion. Science. 248:41-43.
Paul K.B. Dagg. 1991. The Psychological Sequelae of Therapeutic Abortion-Denied and Completed. American Journal of Psychiatry. 148:578-585.
Adler, Nancy E., Henry P. David, Brenda N. Major, Susan H. Roth, Nancy F. Russo, and Gail E. Wyatt. 1992. Psychological Factors in Abortion. American Psychologist. 47/10:1194-1204.
Zolese G. and C.V.R. Blacker. The Psychological Complications of Therapeutic Abortion. British Journal of Psychiatry. 160:742-749.
American Psychological Association. 1987. Testimony on the Psychological Sequelae of Abortion. Presented orally to the Surgeon General's office, Washington, DC, December 2.