The review, carried out by the NCCMH (National Collaborating Centre for Mental Health, part of the Royal College of Psychiatrists), was commissioned by the Academy of Medical Royal Colleges.
The Steering Group sifted through 180 potential published studies from 1990 to 2011 and eventually included 44.
The Review concluded that:
- When a woman has an unwanted pregnancy, her chances of developing mental health problems are increased.
- Terminating an unwanted pregnancy with abortion does not result in a higher risk of mental health problems, compared to seeing that (unwanted) pregnancy to full term.
- What does have an impact on whether a woman who has an induced abortion subsequently might have mental health problems is her mental health history, i.e. a woman with a history of mental health problems has a greater risk of developing mental health problems after an abortion compared to a woman with no history of mental health problems who has an abortion.
- If a woman has a negative overall attitude to abortions, and then has one, there is a greater risk of her having mental health problems afterwards.
- Women who are under pressure from their partners to have an abortion are more likely to have mental health problems, compared to women who abort without such pressure.
- The review added that some other stressful life events may increase a woman's risk of having mental health problems after an abortion.
The authors say future practice and research should concentrate on providing support for all females who have an unplanned or unwanted pregnancy.
Chair of the Steering Group, Dr Roch Cantwell, a consultant perinatal psychiatrist, said:
"Our review shows that abortion is not associated with an increase in mental health problems. Women who are carrying an unwanted pregnancy should be reassured that current evidence shows they are no more likely to experience mental health problems if they decide to have an abortion than if they decide to give birth."
NCCMH Director, Professor Tim Kendall, who is also a member of the Steering Group, said:
"This review has attempted to address the limitations of previous reviews of the relationship between abortion and mental health. We believe that we have used the best quality evidence available, and that this is the most comprehensive and detailed review of the mental health outcomes of induced abortion to date worldwide."
AOMRC Chairman, Professor Sir Neil Douglas, said:
"The Academy recognizes that this is a complex and controversial area, where there have been many conflicting research findings. We welcome this extremely high-quality review from the NCCMH, and endorse its findings."
Response from sexual health charitiesThe Family Planning Association (FPA) and Brook said they welcomed the review. They both stated that there is now compelling evidence that when a woman has had, or is wondering whether to have an abortion, that the procedure is safe and does not have a direct impact on her mental health.
They went on to say that forcing women who are having an abortion to have counseling is both "unnecessary" and "patronizing".
The FPA and Brook jointly wrote:
"Giving women accurate and honest information about abortion is essential and is something that FPA and Brook take extremely seriously. However, we know that misinformation about mental health can be used as a scare tactic by third parties, to try and deter women from considering abortion.
"We hope this new report will prevent this type of scaremongering and ensure women receive the non-judgemental support and information they need."
Response from doctors' organizationsDr Kate Guthrie, a spokesperson from the Royal College of Obstetricians and Gynaecologists (RCOG) said that this latest Review is welcomed. They have revised their own guidelines regarding the care for females seeking induced abortion according to its findings, which include informing the women of what possible emotional responses are possible during and after an abortion.
Dr. Guthrie said:
"It is important that all women, and particularly those with a history of previous mental health problems, are offered appropriate support and if needed follow-up.
It is essential that healthcare workers identify women that are vulnerable in any way and offer the appropriate aftercare.
Abortion including aftercare is an essential part of women's healthcare services, alongside access to contraception and family planning information."
Response from The Society for the Protection of Unborn Children (SPUC)In a published response placed on its website, SPUC mentioned the following points, which are from stories told by a large number of women. The charity adds that several studies with empirical findings demonstrate that there are psychological consequences from having an abortion:
- After an abortion, a woman experiences a wide range of negative emotions, such as shame, regret, doubt, grief, guilt, loneliness and sadness.
- Some women who experience relief after undergoing an abortion, subsequently experience negative emotions.
- Some females may experience PTSD (post-traumatic stress disorder), triggered by an abortion.
- Even though a history of mental health problems may impact on the risk of having mental health problems following an abortion - it in no way accounts for all of the effect.
- The following risk factors increase the chances of a woman suffering psychological harm after an abortion: no social and emotional support, uncertainty and ambivalence about whether to have an abortion, partner violence, and a history of mental health problems.
- Abortion raises the risk of developing bipolar disorder, depressive psychosis, schizophrenia, neurotic depression, anxiety, and depression.
- Abortion raises the risk of subsequent substance abuse and self harm, especially when a woman who had an abortion gets pregnant again.
- Women who have an abortion because of a fetal disability are especially susceptible to psychological damage.
Written by Christian Nordqvist