America's largest abortion provider, Planned Parenthood in its latest publication, "The Emotional Effects of Induced Abortion"(2013)1, claims that "legally induced abortion does not pose mental health problems for women" and that "most substantive studies in the last 30 years have found abortion to be a relatively benign procedure in terms of emotional effect.." I looked carefully at the research Planned Parenthood refers to and these claims are false. The two main reviews cited by Planned Parenthood do not support a general claim that abortion does not affect the mental health of women. Planned Parenthood's claims on abortion and mental health are both misleading and irresponsible.
When I read Planned Parenthood's publication and similar statements from other abortion providers, I wondered about claims that abortion does not have emotional effects because so many women have expressed deep and ongoing negative emotional reactions after abortion. It just didn't seem right because although women in general are obviously coping, all the women after abortion who I know personally have suffered so much mentally in private and for a long time and I have read the stories of many more who have gone through similar experiences.
So I spent weeks looking into the actual research on mental health and abortion referenced by Planned Parenthood, reading mammoth reports. Firstly, the 100 page report by the American Psychological Association's Task Force on Mental Health and Abortion (TFMHA)2 in 2008 and then the 250 page report by the Academy of Medical Royal Colleges (AMRC)3 in 2011 (London). These reports are the result of two major systematic reviews that Planned Parenthood cites to support it's own claims on mental health and abortion.
Firstly, Planned Parenthood makes this opening statement, "legally induced abortion does not pose mental health problems for women" and says this is supported by rigorous reviews in the last five years. It goes on to give conclusions from the two reviews by the AMRC and the TFMHA that I just mentioned. However, in doing so, Planned Parenthood fails to make some crucial points which are necessary to understand the context of these reviews and the conclusions they make.
Looking at the AMRC report, it is important to note this review excluded negative emotional effects and research evidence of mental health problems within 90 days of an abortion. Its focus was on clinically diagnosed mental health disorders or mental illness beyond 3 months of an abortion. Planned Parenthood does not mention this. It does not define mental health problems anywhere in it's publication and seems to confuse this term with emotional effects when these two outcomes are actually treated very differently in the TFMHA and AMRC reviews into mental health and abortion.
The AMRC conclusions do not directly support Planned Parenthood's statement, 'legally induced abortion does not pose mental health problems for women.' It concluded that support and proper care should be available for all women who have an unwanted pregnancy "because the risk of mental health problems increases whatever the pregnancy outcome".
Also the TFMHA review does not support Planned Parenthood's opening statement. The TFMHA report did not conclude that no women suffer mental health problems as a result of legal induced abortion. In fact it says, "To state that women in general do not show an increased incidence of mental health problems following a single abortion, however, does not mean that no women experience such problems."(p.91)
The TFMHA also clearly state in their report how crucial it is to define "mental health problems" (which it defines as clinically diagnosed/measured mental disorders). The Planned Parenthood publication fails to share this information. Planned Parenthood fails to inform women that claims made by the paper in reference to mental health problems do not include the negative emotions or behaviour, e.g. sadness, regret, guilt, or even depression below the clinical threshold, that may affect a women's health after an abortion. Unless this is made clear, readers may otherwise think the conclusions made by the APA on mental health problems includes all negative psychological effects, including emotional healh.
Planned Parenthood makes another claim in reference to the AMRC review, falsely stating it, "reviewed all studies about the emotional effects of abortion that had been published in English between 1990 and 2011." As mentioned earlier, the AMRC excluded 'emotional effects' of abortion as being 'beyond the scope' of its review and only concluded on evidence on mental health problems (clinically measured or validated using rating scales) and substance abuse from a very limited number of studies in the end. In fact by the time the AMRC was done with excluding studies because they did not meet inclusion criteria it was left with only 180 studies out of 8909 references from 1990-2011, and drew its final conclusions on mental health outcomes from between 1 & 4 studies only (see p.108-118 of report3). This claim by Planned Parenthood which indicates that the AMRC conducted a rigorous review on emotional effects and abortion is hence false.
As the TFMHA says, "abortion means different things to different women" which may "lead to variability in women's psychological experiences to their particular abortion experience. For these reasons, global statements on the psychological impact of abortion on women can be misleading."(p.9) Planned Parenthood should have noted this important observation of the TFMHA and refrained from making a global statement about abortion and mental health problems that seriously misinforms the public, especially health providers and vulnerable women in pregnancy who may make decisions based on these claims.
1 Planned Parenthood Federation of America, Inc. The Emotional Effects of Induced Abortion. 2013. 1 - 3. http://www.plannedparenthood.org/files/PPFA/Emotional_Effects_of_Induced_Abortion.pdf. Retrieved 10 July 2014.
2 TFMA. Report of the APA Task Force on Mental Health and Abortion. Washington, DC. American Psychological Task Force on Mental Health and Abortion. http://www.apa.org/pi/women/programs/abortion/mental-health.pdf
3 AMRC. Academy of Medical Royal Colleges. (2011). Induced Abortion and Mental Health - A Systematic Review
of the Mental Health Outcomes of Induced Abortion, Including Their Prevalence and Associated Factors. London.
Academy of Medical Royal Colleges/National Collaborating Centre for Mental Health.
http://www.nccmh.org.uk/reports/ABORTION_REPORT_WEB FINAL.pdf Retrieved on 10 July 2014.