Emotional side effects are not uncommon after an abortion, or pregnancy termination, whether it was planned or not. In some cases, depression can occur. However, the link between pregnancy termination and depression remains unclear.
The decision to terminate a pregnancy is rarely an easy one, and it is not always the individual's preferred choice. Whether they choose a termination freely or not, they can have mixed feelings after the procedure.
In the United States, around half of all pregnancies are unplanned. This is one reason for choosing a termination. However, the reasons for not wanting to continue a pregnancy are varied.
Reasons include, but are by no means limited to, social, financial, or relationship pressures and physical or mental health problems in the parent or unborn child.
Regardless of the reason, the emotional response to a termination can range from relief, calm, and happiness to sadness, grief, loss, and regret, depending on the individual' situation.
If negative feelings are severe and persistent, they could be a sign of depression.
The issue of planned termination is a controversial one, and so is the question of mental health following a termination.
The important thing to remember is that each person's experience and response will be different.
As researchers for the American Psychological Association (APA) said in 2009, "it is important that women's varied experiences of abortion be recognized, validated, and understood."
For many people, terminating a pregnancy can be a stressful life event.
It is not unusual to experience a range of psychological and emotional responses.
Some people may feel relief at having made the right choice for them and taken action to resolve a difficult situation, while others may experience a range of negative emotions.
Any pregnancy loss will lead to an interruption in the hormone cycle. The negative feelings that occur after a planned termination may be at least partly due to hormonal changes, which are similar to those that occur after an unplanned pregnancy loss.
According to the American Pregnancy Association, common negative feelings include:
- remorse or regret
- loss of self-esteem or self-confidence
- feelings of isolation and loneliness
- sleep problems and bad dreams
- relationship problems
- thoughts of suicide
The National Suicide Prevention Lifeline offers free and confidential support 24/7. The number to call is 1-800-273-8255.
Religious beliefs, relationship problems, and social stigma can make it harder to cope, especially if these mean that the individual has nobody to talk to about what has happened.
In most cases, as time passes, these negative feelings will subside.
However, if there are additional issues, such as a sense of isolation or previous history of mental health problems, there may be a higher chance of depression occurring.
Depression is a mental health condition and mood disorder.
People with depression may have these signs and symptoms:
- feeling low or sad
- having difficulty thinking, focusing, and making decisions
- feeling irritable
- lacking energy
- sleeping too much or too little
- loss of interest in sex
- loss of interest in activities that they previously enjoyed
There may also be feelings of guilt and low self-esteem.
Depression can make it hard to work or carry out daily chores. Complications can include relationship breakdown and job loss. For some people, psychotic symptoms may develop.
Depression versus grief
The grief that follows the loss of a loved one can lead to sadness and other symptoms similar to those of depression.
Feelings of grief, sadness, loss, and regret can also occur after a termination or pregnancy loss.
If a person's symptoms gradually improve with time, it is unlikely that they have depression.
However, symptoms that persist or worsen could indicate depression, in which case it is essential to seek medical help.
Anyone who experiences distress after a termination may find it helpful to seek the support of family, friends, or a community group.
This can help prevent feelings of grief and sadness from developing into depression.
If depression occurs, it is a treatable condition.
Treatment may involve:
- support, for example, that of a community group or health worker
- counseling, including cognitive behavioral therapy (CBT)
- medications, such as antidepressants
Lifestyle factors that may help include:
- eating a healthful diet
- taking regular exercise
- reducing stress as far as possible
- learning relaxation techniques, such as yoga or meditation
Reducing the risk
Before deciding on a termination, it is advisable to try the following:
- speaking to people who you can trust
- weighing up all your options
- seeking medical help and asking a health worker as many questions as you can
- trying to avoid isolation, as this can lead to depression
- avoiding giving in to pressure to do something you do not want to do, whether this is the termination or continuation of the pregnancy
Terminating a pregnancy can also involve some physical risks, in the same way as any other medical or surgical procedure.
It is vital to seek treatment in a registered facility with qualified and experienced professionals to reduce the risk of harm.
The existence of a link between a planned termination and depression remains controversial.
A study published in 2015 suggested that people who have mental health problems before pregnancy may have a higher risk of experiencing negative emotions after a termination.
Research published in 2011 concluded that there was a "moderate to highly increased risk of mental health problems after abortion." The researchers suggested that undergoing a termination increased the risk by 81 percent and attributed 10 percent of this risk to the termination itself.
Other scientists, reporting in 2008 on a 30-year study, estimated that abortion increased women's risk of mental health disorders by between 1.5 and 5.5 percent.
In 2008, the American Psychological Association (APA) Task Force on Mental Health and Abortion found that certain conditions appeared to increase the risk of depression after a range of pregnancy outcomes, including a planned termination.
These conditions included:
- a history of violence or emotional problems
- a history of drug or alcohol use
- previous unwanted childbirth
The APA have also identified the following risk factors for depression following a termination:
- perceived stigma and lack of social support
- a history of mental health problems
- personality traits, such as low self-esteem
- features of the pregnancy, including whether the individual wanted it or not
The most important factor appears to be whether or not the mental health problems were already present before the pregnancy.
The American Pregnancy Association add the following as factors that might increase the risk of depression:
- having a termination due to coercion or persuasion by others
- moral or ethical conflict due to religious beliefs or personal views
- having a termination in the later stages of pregnancy
- lacking support from a partner or significant others
- ending a pregnancy because of genetic or fetal abnormalities
Genetic factors and life events, such as the loss of a loved one, may also increase the risk of depression.
Other possible risk factors for depression include:
- a reduced ability to cope with life's pressures
- being female
- exposure to factors that cause stress daily, such as financial or relationship insecurity
However, the exact causes of depression, including pregnancy-related depression, are not known.
In 2009, researchers for the APA noted that the risk of poor mental health was the same whether people chose to terminate or continue their pregnancy.
A study published in The BMJ in 2016 concluded that the likelihood of post-traumatic stress symptoms (PTSS) up to 4 years after a termination was no higher for those who had the procedure than for those who were not allowed to have a termination due to advanced gestational age.
In August 2018, researchers published findings of a study involving nearly 400,000 women in Denmark. The results suggested that, although women who have an abortion are more likely to use antidepressants, the risk factors leading to this are likely to stem from causes other than the termination.
The researchers conclude: "Policies based on the notion that abortion harms women's mental health may be misinformed."
People should also weigh the risk of depression after a termination against the possible health risks of continuing with a pregnancy.
One study, for example, included women who wanted to have a termination but were not able to. Some of these women experienced a range of potentially life-threatening health consequences, such as eclampsia and hemorrhage.
Researchers need to carry out more research to fully understand any links between pregnancy termination and depression.