Abortion Risks: A list of major psychological complications related to abortion

AfterAbortion.org November 2016
REQUIREMENT OF PSYCHOLOGICAL TREATMENT:
A study of the medical records of 56,741 California medicaid patients revealed that women who had abortions were 160 percent more likely than delivering women to be hospitalized for psychiatric treatment in the first 90 days following abortion or delivery. Rates of psychiatric treatment remained significantly higher for at least four years.

In a study of post-abortion patients only 8 weeks after their abortion, researchers found that 44% complained of nervous disorders, 36% had experienced sleep disturbances, 31% had regrets about their decision, and 11% had been prescribed psychotropic medicine by their family doctor. (2)

A 2006 study published in Sleep, the official journal of the Associated Professional Sleep Societies, found that women who experienced abortion were more likely to be treated for sleep disorders or disturbances compared to women who gave birth.(27)

A 5 year retrospective study in two Canadian provinces found significantly greater use of medical and psychiatric services among women with a history of abortion. Most significant was the finding that 25% of women who had abortions made visits to psychiatrists as compared to 3% of the control group. (3) Women who have had abortions are significantly more likely than others to subsequently require admission to a psychiatric hospital. At especially high risk are teenagers, separated or divorced women, and women with a history of more than one abortion. (4)

Since many post-abortive women use repression as a coping mechanism, there may be a long period of denial before a woman seeks psychiatric care. These repressed feelings may cause psychosomatic illnesses and psychiatric or behavioral in other areas of her life. As a result, some counselors report that unacknowledged post-abortion distress is the causative factor in many of their female patients, even though their patients have come to them seeking therapy for seemingly unrelated problems. (5)

All Studies Report Higher Rates of Psychological Problems After Abortion Compared to Other Women
Women who have abortions are 81 percent more likely to experience subsequent mental health problems, according to a new study published by Britain’s Royal College of Psychiatrists. The greatest increases were seen in relation to suicidal behaviors and substance abuse.

The meta-analysis examined and combined results of 22 studies published between 1995 and 2009 and included data on 877,181 women from six countries.   All 22 studies revealed higher rates of mental health problems associated with abortion for at least one symptom, and many for more than one symptom.

Using a standardized statistical technique for combining the results of multiple studies, the meta-analysis revealed that women with a history of abortion face higher rates of anxiety (34 percent higher) and depression (37 percent higher), heavier alcohol use (110 percent higher) and marijuana use (230 percent higher), and higher rates of suicidal behavior (155 percent higher).

The study also found that women who delivered an unplanned pregnancy were significantly less likely to have mental health problems than similar women who aborted unplanned pregnancies.  Women with a history of abortion were 55 percent more likely to have mental health problems than women who did not abort an unplanned pregnancy.(25)

A 2010 study, which was published in the Canadian Journal of Psychiatry and examined a nationally representative sample of more than 3,000 women in the United States, found that women who underwent an abortion had a 98 percent increased risk for any mental health disorders compared to women who did not have an abortion.

Women who had abortions also had:

  • 59 percent increased risk for suicidal thoughts
  • 61 percent increased risk for mood disorders
  • 61 percent increased risk for social anxiety disorders
  • 261 percent increased risk for alcohol abuse
  • 280 percent increased risk for any substance use disorder

Approximately 6 percent of suicidal ideation cases among women nationwide and 25 percent of cases of drug use could be related to abortion, the researchers found.(26)

Further, a meta-analysis combining the results of eight studies of women who experienced unwanted pregnancies, published in 2013, concluded that “there is no available evidence to suggest that abortion has therapeutic effects in reducing the mental health risks of unwanted or unintended pregnancy.”

Lead author Professor David Fergusson, who has described himself in interviews as a pro-choice atheist, also led the research team in a 2008 study that concluded that women who continued an unwanted or mistimed pregnancy did not experience a significant increase in mental health problems. Further, having an abortion did not reduce their mental health risks.

“In general, there is no evidence in the literature on abortion and mental health that suggests that abortion reduces the mental health risks of unwanted or mistimed pregnancy,” the authors wrote. “Although some studies have concluded that abortion has neutral effects on mental health, no study has reported that exposure to abortion reduces mental health risks.”

RISK FACTORS:
Researchers have identified a large number of statistically significant risk factors that identify which women are at greatest risk of experiencing one or more severe reactions to abortion.   The following is list of risk factors identified by the American Psychological Association Task Force on Mental Health and Abortion in their 2008 report:

  1. terminating a pregnancy that is wanted or meaningful
  2. perceived pressure from others to terminate a pregnancy
  3. perceived opposition to the abortion from partners, family, and/or friends
  4. lack of perceived social support from others
  5. various personality traits (e.g., low self-esteem, a pessimistic outlook, low-perceived control over life)
  6. a history of mental health problems prior to the pregnancy
  7. feelings of stigma
  8. perceived need for secrecy
  9. exposure to antiabortion picketing
  10. use of avoidance and denial coping strategies
  11. feelings of commitment to the pregnancy
  12. ambivalence about the abortion decision
  13. low perceived ability to cope with the abortion
  14. history of prior abortion
  15. late term abortion
  16. being an adolescent (not an adult)
  17. having a non-elective (therapeutic or coerced) abortion
  18. prior history of abortion (having a second or third abortion, or more)Please see Identifying High Risk Abortion Patients”  or “Abortion decisions and the duty to screen: clinical, ethical, and legal implications of predictive risk factors of post-abortion maladjustment” for a more complete list of risk factors, including citations to the studies identifying each risk factor.

    SUICIDAL IDEATION AND SUICIDE ATTEMPTS:
    Approximately 60 percent of women who experience post-abortion sequelae report suicidal ideation, with 28 percent actually attempting suicide, of which half attempted suicide two or more times.(13)

Researchers in Finland have identified a strong statistical association between abortion and suicide in a records based study (see figure at the right).  They found that the  mean annual suicide rate for all women was 11.3 per 100,000 but the rate for women following abortion was 34.7 per 100,000, three times higher.  The suicide rate associated with birth, by contrast, was half the rate of all women and less than one-sixth the rate of suicide among women who had abortions.(13)

Besides the Finland study, large record-based studies from the United States and Denmark have found that overall death rates were higher among women following abortion compared to those among women who had given birth.(24)

The U.S. study examined Medi-Cal records for more than 173,000 low-income California women who had experienced abortion or childbirth. Linking these records to death certificates, the researchers found that women who had state-funded abortions were 2.6 times more likely to die from suicide compared to women who delivered their babies. Giving birth, on the other hand, was shown to reduce women’s suicide risk compared to the general population.

Suicide attempts appear to be especially prevalent among post-abortion teenagers. Numerous other studies have also revealed higher rates of suicide and suicide attempts associated with abortion.(13)

ALCOHOL AND DRUG ABUSE: Over twenty studies have linked abortion to increased rates of drug and alcohol use. Abortion is significantly linked with a two fold increased risk of alcohol abuse among women.(16) Abortion followed by alcohol abuse is linked to violent behavior, divorce or separation, auto accidents, and job loss.(17)  In addition to the psycho-social costs of such abuse, drug abuse is linked with increased exposure to HIV/AIDS infections, congenital malformations, and assaultive behavior. (18)

EATING DISORDERS: For at least some women, post-abortion stress is associated with eating disorders such as binge eating, bulimia, and anorexia nervosa. (19)

SEXUAL DYSFUNCTION: Thirty to fifty percent of the women who experience difficulty adjusting to a past abortion report experiencing sexual dysfunctions, of both short and long duration, beginning immediately after their abortions. These problems may include one or more of the following: loss of pleasure from intercourse, increased pain, an aversion to sex and/or males in general, or the development of a promiscuous life-style. (12)

CHILD NEGLECT OR ABUSE: Abortion is linked with increased depression, violent behavior, alcohol and drug abuse, replacement pregnancies, and reduced maternal bonding with children born subsequently. These factors are closely associated with child abuse and would appear to confirm individual clinical assessments linking post-abortion trauma with subsequent child abuse. (20)

POST-TRAUMATIC STRESS DISORDER (PTSD or PAS):
While psychological reactions to abortion fall into many categories, some women experience all or some of they symptoms of post-traumatic stress disorder (PTSD).  The lowest incidence rate of PTSD reported following abortion is 1.5%, which would translate to over 600,000 cases of abortion induced PTSD. Another study found that 14% of American women have all the symptoms of PTSD and attribute them to their abortions, with as many as 65% reporting some, but not all symptoms of PTSD.

Yet another random study found that a minimum of 19% of post-abortion women suffer from diagnosable post-traumatic stress disorder (PTSD). Approximately half had many, but not all, symptoms of PTSD, and 20 to 40 percent showed moderate to high levels of stress and avoidance behavior relative to their abortion experiences. (6)

PTSD is a psychological dysfunction which results from a traumatic experience which overwhelms a person’s normal defense mechanisms resulting in intense fear, feelings of helplessness or being trapped, or loss of control. The risk that an experience will be traumatic is increased when the traumatizing event is perceived as including threats of physical injury, sexual violation, or the witnessing of or participation in a violent death. PTSD results when the traumatic event causes the hyperarousal of “flight or fight” defense mechanisms. This hyperarousal causes these defense mechanisms to become disorganized, disconnected from present circumstances, and take on a life of their own resulting in abnormal behavior and major personality disorders. As an example of this disconnection of mental functions, some PTSD victim may experience intense emotion but without clear memory of the event; others may remember every detail but without emotion; still others may reexperience both the event and the emotions in intrusive and overwhelming flashback experiences. (7)

Women may experience abortion as a traumatic event for several reasons. Many are forced into an unwanted abortions by husbands, boyfriends, parents, or others. If the woman has repeatedly been a victim of domineering abuse, such an unwanted abortion may be perceived as the ultimate violation in a life characterized by abuse. Other women, no matter how compelling the reasons they have for seeking an abortion, may still perceive the termination of their pregnancy as the violent killing of their own child. The fear, anxiety, pain, and guilt associated with the procedure are mixed into this perception of grotesque and violent death. Still other women, report that the pain of abortion, inflicted upon them by a masked stranger invading their body, feels identical to rape. (8) Indeed, researchers have found that women with a history of sexual assault may experience greater distress during and after an abortion exactly because of these associations between the two experiences. (9) When the stressor leading to PTSD is abortion, some clinicians refer to this as Post-Abortion Syndrome (PAS).

The major symptoms of PTSD are generally classified under three categories: hyperarousal, intrusion, and constriction.

Hyperarousal is a characteristic of inappropriately and chronically aroused “fight or flight” defense mechanisms. The person is seemingly on permanent alert for threats of danger. Symptoms of hyperarousal include: exaggerated startle responses, anxiety attacks, irritability, outbursts of anger or rage, aggressive behavior, difficulty concentrating, hypervigilence, difficulty falling asleep or staying asleep, or physiological reactions upon exposure to situations that symbolize or resemble an aspect of the traumatic experience (eg. elevated pulse or sweat during a pelvic exam, or upon hearing a vacuum pump sound.)

Intrusion is the reexperience of the traumatic event at unwanted and unexpected times. Symptoms of intrusion in PAS cases include: recurrent and intrusive thoughts about the abortion or aborted child, flashbacks in which the woman momentarily reexperiences an aspect of the abortion experience, nightmares about the abortion or child, or anniversary reactions of intense grief or depression on the due date of the aborted pregnancy or the anniversary date of the abortion.

Constriction is the numbing of emotional resources, or the development of behavioral patterns, so as to avoid stimuli associated with the trauma. It is avoidance behavior; an attempt to deny and avoid negative feelings or people, places, or things which aggravate the negative feelings associated with the trauma. In post-abortion trauma cases, constriction may include: an inability to recall the abortion experience or important parts of it; efforts to avoid activities or situations which may arouse recollections of the abortion; withdrawal from relationships, especially estrangement from those involved in the abortion decision; avoidance of children; efforts to avoid or deny thoughts or feelings about the abortion; restricted range of loving or tender feelings; a sense of a foreshortened future (e.g., does not expect a career, marriage, or children, or a long life.); diminished interest in previously enjoyed activities; drug or alcohol abuse; suicidal thoughts or acts; and other self-destructive tendencies.

As previously mentioned, Barnard’s study identified a 19% rate of PTSD among women who had abortions three to five years previously. But in reality the actual rate is probably higher. Like most post-abortion studies, Barnard’s study was handicapped by a fifty percent drop out rate. Clinical experience has demonstrated that the women least likely to cooperate in post-abortion research are those for whom the abortion caused the most psychological distress. Research has confirmed this insight, demonstrating that the women who refuse followup evaluation most closely match the demographic characteristics of the women who suffer the most post-abortion distress. (10) The extraordinary high rate of refusal to participate in post-abortion studies may interpreted as evidence of constriction or avoidance behavior (not wanting to think about the abortion) which is a major symptom of PTSD.

For many women, the onset or accurate identification of PTSD symptoms may be delayed for several years. (11) Until a PTSD sufferer has received counseling and achieved adequate recovery, PTSD may result in a psychological disability which would prevent an injured abortion patient from bringing action within the normal statutory period. This disability may, therefore, provide grounds for an extended statutory period.

INCREASED SMOKING WITH CORRESPONDENT NEGATIVE HEALTH EFFECTS: Post-abortion stress is linked with increased cigarette smoking. Women who abort are twice as likely to become heavy smokers and suffer the corresponding health risks. (14) Post-abortion women are also more likely to continue smoking during subsequent wanted pregnancies with increased risk of neonatal death or congenital anomalies. (15)

DIVORCE AND CHRONIC RELATIONSHIP PROBLEMS: For most couples, an abortion causes unforeseen problems in their relationship. Post-abortion couples are more likely to divorce or separate. Many post-abortion women develop a greater difficulty forming lasting bonds with a male partner. This may be due to abortion related reactions such as lowered self-esteem, greater distrust of males, sexual dysfunction, substance abuse, and increased levels of depression, anxiety, and volatile anger. Women who have more than one abortion (representing about 45% of all abortions) are more likely to require public assistance, in part because they are also more likely to become single parents. (21)

REPEAT ABORTIONS: Women who have one abortion are at increased risk of having additional abortions in the future. Women with a prior abortion experience are four times more likely to abort a current pregnancy than those with no prior abortion history. (22)

This increased risk is associated with the prior abortion due to lowered self esteem, a conscious or unconscious desire for a replacement pregnancy, and increased sexual activity post-abortion. Subsequent abortions may occur because of conflicted desires to become pregnant and have a child and continued pressures to abort, such as abandonment by the new male partner. Aspects of self-punishment through repeated abortions are also reported. (23)

Approximately 45% of all abortions are now repeat abortions. The risk of falling into a repeat abortion pattern should be discussed with a patient considering her first abortion. Furthermore, since women who have more than one abortion are at a significantly increased risk of suffering physical and psychological sequelae, these heightened risks should be thoroughly discussed with women seeking abortions.

LEARN MORE
The most complete listing of psychological problems associated with abortion can be found at at AbortionRisks.org

NOTES:
1. An excellent resource is Thomas Strahan’s Detrimental Effects of Abortion: An Annotated Bibliography with Commentary (Third Edition) This resource includes brief summaries of major finding drawn from medical and psychology journal articles, books, and related materials, divided into major categories of relevant injuries.  An online version can be found at AbortionRisks.org

2. Ashton,”They Psychosocial Outcome of Induced Abortion”, British Journal of Ob&Gyn., 87:1115-1122, (1980).

3. Badgley, et.al.,Report of the Committee on the Operation of the Abortion Law (Ottawa:Supply and Services, 1977)pp.313-321.

4. R. Somers, “Risk of Admission to Psychiatric Institutions Among Danish Women who Experienced Induced Abortion: An Analysis on National Record Linkage,” Dissertation Abstracts International, Public Health 2621-B, Order No. 7926066 (1979); H. David, et al., “Postpartum and Postabortion Psychotic Reactions,” Family Planning Perspectives 13:88-91 (1981).

5. Kent, et al., “Bereavement in Post-Abortive Women: A Clinical Report”, World Journal of Psychosynthesis (Autumn-Winter 1981), vol.13,nos.3-4.

6. Catherine Barnard, The Long-Term Psychological Effects of Abortion, Portsmouth, N.H.: Institute for Pregnancy Loss, 1990).

7. Herman, Trauma and Recovery, (New York: Basic Books, 1992) 34.

8. Francke, The Ambivalence of Abortion (New York: Random House, 1978) 84-95.

9. Zakus, “Adolescent Abortion Option,” Social Work in Health Care, 12(4):87 (1987); Makhorn, “Sexual Assault & Pregnancy,” New Perspectives on Human Abortion, Mall & Watts, eds., (Washington, D.C.: University Publications of America, 1981).

10. Adler, “Sample Attrition in Studies of Psycho-social Sequelae of Abortion: How great a problem.” Journal of Social Issues, 1979, 35, 100-110.

11. Speckhard, “Postabortion Syndrome: An Emerging Public Health Concern,” Journal of Social Issues, 48(3):95-119.

12. Speckhard, Psycho-social Stress Following Abortion, Sheed & Ward, Kansas City: MO, 1987; and Belsey, et al., “Predictive Factors in Emotional Response to Abortion: King’s Termination Study – IV,” Soc. Sci. & Med., 11:71-82 (1977).

13. Speckhard, Psycho-social Stress Following Abortion, Sheed & Ward, Kansas City: MO, 1987; Gissler, Hemminki & Lonnqvist, “Suicides after pregnancy in Finland, 1987-94: register linkage study,” British Journal of Medicine 313:1431-4, 1996.C. Haignere, et al., “HIV/AIDS Prevention and Multiple Risk Behaviors of Gay Male and Runaway Adolescents,” Sixth International Conference on AIDS: San Francisco, June 1990; N. Campbell, et al., “Abortion in Adolescence,” Adolescence, 23(92):813-823 (1988); H. Vaughan, Canonical Variates of Post-Abortion Syndrome, Portsmouth, NH: Institute for Pregnancy Loss, 1991; B. Garfinkel, “Stress, Depression and Suicide: A Study of Adolescents in Minnesota,” Responding to High Risk Youth, Minnesota Extension Service, University of Minnesota (1986).

14. Harlap, “Characteristics of Pregnant Women Reporting Previous Induced Abortions,” Bulletin World Health Organization, 52:149 (1975); N. Meirik, “Outcome of First Delivery After 2nd Trimester Two Stage Induced Abortion: A Controlled Cohort Study,” Acta Obsetricia et Gynecologica Scandinavia 63(1):45-50(1984); Levin, et al., “Association of Induced Abortion with Subsequent Pregnancy Loss,” JAMA, 243:2495-2499, June 27, 1980.

15. Obel, “Pregnancy Complications Following Legally Induced Abortion: An Analysis of the Population with Special Reference to Prematurity,” Danish Medical Bulletin, 26:192- 199 (1979); Martin, “An Overview: Maternal Nicotine and Caffeine Consumption and Offspring Outcome,” Neurobehavioral Toxicology and Tertology, 4(4):421-427, (1982).

16. Klassen, “Sexual Experience and Drinking Among Women in a U.S. National Survey,” Archives of Sexual Behavior, 15(5):363-39 ; M. Plant, Women, Drinking and Pregnancy, Tavistock Pub, London (1985); Kuzma & Kissinger, “Patterns of Alcohol and Cigarette Use in Pregnancy,” Neurobehavioral Toxicology and Terotology, 3:211-221 (1981).

17. Morrissey, et al., “Stressful Life Events and Alcohol Problems Among Women Seen at a Detoxification Center,” Journal of Studies on Alcohol, 39(9):1159 (1978).

18. Oro, et al., “Perinatal Cocaine and Methamphetamine Exposure Maternal and Neo-Natal Correlates,” J. Pediatrics, 111:571- 578 (1978); D.A. Frank, et al., “Cocaine Use During Pregnancy Prevalence and Correlates,” Pediatrics, 82(6):888 (1988); H. Amaro, et al., “Drug Use Among Adolescent Mothers: Profile of Risk,” Pediatrics 84:144-150, (1989)

19. Speckhard, Psycho-social Stress Following Abortion, Sheed & Ward, Kansas City: MO, 1987; J. Spaulding, et al, “Psychoses Following Therapeutic Abortion, Am. J. of Psychiatry 125(3):364 (1978); R.K. McAll, et al., “Ritual Mourning in Anorexia Nervosa,” The Lancet, August 16, 1980, p. 368.

20. Benedict, et al., “Maternal Perinatal Risk Factors and Child Abuse,” Child Abuse and Neglect, 9:217-224 (1985); P.G. Ney, “Relationship between Abortion and Child Abuse,” Canadian Journal of Psychiatry, 24:610-620, 1979; Reardon, Aborted Women – Silent No More (Chicago: Loyola University Press, 1987), 129-30, describes a case of woman who beat her three year old son to death shortly after an abortion which triggered a “psychotic episode” of grief, guilt, and misplaced anger.

21. Shepard, et al., “Contraceptive Practice and Repeat Induced Abortion: An Epidemiological Investigation,” J. Biosocial Science, 11:289-302 (1979); M. Bracken, “First and Repeated Abortions: A Study of Decision-Making and Delay,” J. Biosocial Science, 7:473-491 (1975); S. Henshaw, “The Characteristics and Prior Contraceptive Use of U.S. Abortion Patients,” Family Planning Perspectives, 20(4):158-168 (1988); D. Sherman, et al., “The Abortion Experience in Private Practice,” Women and Loss: Psychobiological Perspectives, ed. W.F. Finn, et al., (New York: Praeger Publ. 1985), pp98-107; E.M. Belsey, et al., “Predictive Factors in Emotional Response to Abortion: King’s Termination Study – IV,” Social Science and Medicine, 11:71- 82 (1977); E. Freeman, et al., “Emotional Distress Patterns Among Women Having First or Repeat Abortions,” Obstetrics and Gynecology, 55(5):630-636 (1980); C. Berger, et al., “Repeat Abortion: Is it a Problem?” Family Planning Perspectives 16(2):70-75 (1984).

22. Joyce, “The Social and Economic Correlates of Pregnancy Resolution Among Adolescents in New York by Race and Ethnicity: A Multivariate Analysis,” Am. J. of Public Health, 78(6):626-631 (1988); C. Tietze, “Repeat Abortions – Why More?” Family Planning Perspectives 10(5):286-288, (1978).

23. Leach, “The Repeat Abortion Patient,” Family Planning Perspectives, 9(1):37-39 (1977); S. Fischer, “Reflection on Repeated Abortions: The meanings and motivations,” Journal of Social Work Practice 2(2):70-87 (1986); B. Howe, et al., “Repeat Abortion, Blaming the Victims,” Am. J. of Public Health, 69(12):1242-1246, (1979).

24. See Reardon DC, Coleman PK. Short and long term mortality rates associated with first pregnancy outcome: Population register based study for Denmark 1980-2004. Med Sci Monit 2012;18(9):PH 71 – 76; and Reardon DC, Ney PG, Scheuren F, Cougle J, Coleman PK, Strahan TW.  Deaths associated with pregnancy outcome: a record linkage study of low income women. South Med J 2002 Aug;95(8):834-41.

25.  Source: Coleman PK. Abortion and mental health: quantitative synthesis and analysis of research published 1995–2009. The British Journal of Psychiatry (2011) 199, 180–186.

26. Mota, NP et. al., “Associations Between Abortion, Mental Disorders and Suicidal Behavior in a Nationally Representative Sample,” The Canadian Journal of Psychiatry 55(4): 239-246 (April 2010).

27. DC Reardon and PK Coleman, “Relative Treatment Rates for Sleep Disorders and Sleep Disturbances Following Abortion and Childbirth: A Prospective Record Based-Study,” Sleep 29(1):105-106, 2006.
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