Controversy over Psychological

Consequences of Abortion Contemporary debates over abortion often focus on psychological issues. One controversy centers on whether abortion is psychologically damaging to women. This controversy became a public policy debate in 1987, when President Ronald Reagan directed Surgeon- General C. Everett Koop to prepare a report on the psychological and physical health effects of abortion. After reviewing the evidence, Koop declined to issue such a report. Rather, in a letter to President Reagan, the surgeon-general concluded that “the scientific studies d6 not provide conclusive data on the health effects of abortion on women.” Individuals on both sides of the abortion debate disagree with Koop’s conclusion. Prolife advocates argue that over time, many or most women who have an abortion suffer psychological damage as a result. Advocates of this view have lobbied the American Psychiatric Association to recognize postabortion syndrome as a psychiatric diagnostic category. Support for this position is based on clinical case studies that derive from two separate sources: (I) women who have sought professional help for psychological problems following their abortions: ( 2 ) women who were specifically solicited as participants because they identified themselves in advance as having suffered psychological trauma following abortion. In addition to relying on samples of women who identified themselves as experiencing postabortion adjustment problems, many of these studies fail to distinguish between whether the abortion was performed legally or illegally and whether it was performed in the first or second trimester of pregnancy.  Because of these methodological issues, this group of studies is likely to be biased in the direction of overestimating the prevalence of postabortion problems among women who obtain legal, first trimester abortions. 

Psychological experts, including the panel convened by the APA, argue in contrast that the very best scientific studies show that freely chosen abortion, particularly in the first trimester of pregnancy, does not pose a significant mental health risk for most women. This conclusion is derived from studies based on random samples of women who have arrived at a doctor’s office, clinic. or hospital for an abortion. They are asked to participate in a study and are then interviewed on the day of their abortion andlor some time afterward.

These studies generally find that most women do not report psychological distress after an abortion and that

the highest rates of distress are generally reported prior to the abortion. The conclusion that abortion does not pose a mental health risk for most women is also derived from epidemiological studies of large populations of women whose prior abortion history is known. These studies generally find no higher incidence of psychological problems among women who have had an abortion than among women who have not. Although these studies also have methodological limitations, they are generally much sounder scientifically than those used to support the argument that severe negative reactions to abortion are common.

Part of the difficulty in drawing firm conclusions about the psychological effects of abortion results from the fact it is impossible to separate the effects of abortion from the effects of experiencing an unwanted pregnancy.

Both of these are potentially stressful events. U1- timately, the mental health risks of abortion must be compared to the mental health risks of its alternativesmotherhood or adoption. However, no well-controlled

studies are available that compare all three groups, perhaps because relatively few women choose the adoption alternative. In contrast, a number of well-designed studies have compared the psychological well-being of women who have had abortions to the well-being of women who have carried an unintended pregnancy to term and kept the child. The measures of well-being that were used in these studies include self-esteem, anxiety, incidence of psychiatric disorder, progress in school, and economic status. All of these studies have reached the same conclusion-that the well-being of women who have abortions is generally either better than, or not significantly different from, that of women who carry an unplanned pregnancy to term and keep the baby.

Although most women do not experience significant psychological distress following an abortion, some do. The reactions of these women should not be dismissed as inconsequential and deserve attention from psychologists. It is important to remember, however, that distress that occurs after an abortion is not necessarily caused by the abortion, even though it may be attributed to this event. Furthermore, it is important to distinguish between feelings such as sadness and regret that can be experienced after any difficult life choice, and significant mental health outcomes, such as depression or psychosis. Women who feel a sense of sadness, loss, or regret over an abortion may not necessarily experience a psychological disorder following an abortion.