A task force of the American Psychological Association has concluded there is no significant evidence that a single elective abortion increases the risk of mental health problems for adult women.
The draft Report of the APA Task Force on Mental Health and Abortion is dated 13 August 2008 and was published online on the APA website on 18th August. It was presented to the APA’s governing Council of Representatives at the association’s Annual Convention in Boston which finished on Sunday.
Chair of the Task Force, Dr Brenda Major, said they found that the best scientific evidence suggests that among adult women who have an unplanned pregnancy:
“The relative risk of mental health problems is no greater if they have a single elective first-trimester abortion or deliver that pregnancy.”
“The evidence regarding the relative mental health risks associated with multiple abortions is more uncertain,” she added.
The Task Force, which started in 2006, reviewed all the empirical studies available in English and published in peer-reviewed journals since 1989 that either compared the mental health of women who elected to have an abortion with counterparts that did not, or investigated predictors of mental health for US women who elected to have an abortion.
They found that many of the studies had serious methodological problems, varied in quality, and failed to control for potentially confounding factors, so they focused only on those whose methods were the best.
While there is some evidence that women experience feelings of loss, sadness and grief after an abortion, and some have “clinically significant disorders, including depression and anxiety“, the task force found there was “no evidence sufficient to support the claim that an observed association between abortion history and mental health was caused by the abortion per se, as opposed to other factors.”
The task force said there was evidence that other factors came into play, regardless of the outcome of a pregnancy, and that failure to take these into account led to misleading links between abortion history and mental health problems. These other co-occurring risk factors were things like being exposed to violence, a history of drug or alcohol use, poverty, a history of emotional problems, and previous unwanted births. These predisposed women to have both unwanted pregnancies, or mental health problems after a pregnancy, said the the task
They said “global statements about the psychological impact of abortion can be misleading”, because women have abortions for lots of different reasons under different personal, social, cultural and economic circumstances, all of which affect a woman’s mental state after an abortion.
The task force said they did find evidence that the women who were most likely to experience negative psychological reactions after an abortion were women who terminated a wanted pregnancy, or who felt under pressure from others to have a termination, or who felt they had to keep their abortion secret from their family and friends for fear of stigma.
The report pointed out that few studies included comparison groups to address the important issue of understanding the mental health implications of abortion compared to other alternatives such as having and keeping the baby or adoption.
The task force said better and more rigourously designed studies were needed, particularly in respect of two things: (1) separating out the effects of confounding factors and, (2) establishing relative risks of having an abortion compared to the alternatives.
The conclusions are similar to a literature review published by the APA in 1990.
“Report of the APA Task Force on Mental Health and Abortion”
Brenda Major, Mark Appelbaum, Linda Beckman, Mary Ann Dutton, Nancy Felipe Russo, and Carolyn West.
American Psychological Association, Report dated 13 Aug 2008, published online 18 Aug 2008.
Written by: Catharine Paddock, PhD