Last Updated: 27 January 2015

 

What is Mental Health?

Psychological Risks of Abortion

Psychological Risks of Abortion are 'Relative Risks'

What are the Mental Health Risks of Abortion?

Women at Risk of Mental Health Problems After Abortion

What is Mental Illness (a Mental Disorder)?

What are Mental Health Problems?

What Does the Evidence Say on Mental Health and Abortion?

 

 

What is Mental Health?

A woman's mental (or 'psychological') health is her general mental well-being.  The World Health Organisation's (WHO) definition of mental health is:

"A state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community"1

 

This definition of good mental health comes from the Mental Health Commission (WA Govt):

 

Good mental health is a sense of wellbeing, confidence and self-esteem.  It enables us to fully enjoy and appreciate other people, day-to-day life and our environment2

 

A woman's well-being is affected by:

  • Her emotional state
  • Acute stress
  • Biological factors such as hormones
  • Substance use
  • Social factors, such as relationships, financial problems, violence, abuse, isolation
  • Her self-esteem
  • Her general sense of satisfaction with life
  • Her ability to cope with day-to-day activities, work or normal stresses of life
  • Any mental health problems
  • Any diagnosed mental illness
 
Psychological Risks of Abortion
 

Psychological risks of abortion are the risks of an abortion negatively affecting the mental health of a woman.  Evidence shows that abortion may pose significant risks to a woman's general mental health.

Women may experience varying psychological reactions to abortion depending on their own personal views of abortion.  A woman's psychological experiences related to an abortion may also vary over time.

 

Psychological Risks of Abortion are 'Relative Risks'

A woman cannot 'undo' a pregnancy.  She cannot return to a state where that pregnancy never existed.  This is an event in her life she will always remember and the outcome.  Once pregnant, a woman has only the option to continue the pregnancy and give birth or have an abortion.  Since there is no going back - as if the pregnancy never existed - the mental health risks of abortion are compared with the only alternatives available to her: give birth and parent or give birth and relinquish the baby to adoption.  This is why the mental health risks of abortion are called 'relative risks'.  In research, the mental health risks of abortion are given relative to the mental health risks of the woman choosing either adoption or parenting.  

On this page, any reference to the psychological risks or mental health risks of abortion means the 'relative risk'.

 

What are the Mental Health Risks of Abortion?

Virtually all researchers agree that some women experience negative emotional effects or reactions after abortion3 including:

  • Guilt
  • Sadness
  • Regret
  • Depression 
  • Dysphoria ("a state of unease or dissatisfaction", or "an emotional state characterised by anxiety, depression or unease"4)

 

For some groups of women in certain situations or who have particular feelings about the pregnancy, an abortion also means an increased risk of:

 

Women at Risk of Mental Health Problems after Abortion

Evidence shows ALL women who have an unwanted pregnancy are at risk of mental health problems regardless of her choice, whether it be for abortion, parenting or adoption.5

The American Psychological Association's (APA) last review on mental health and abortion found that for an adult woman (over 21 years) who has a single, legal, first-trimester abortion for nontherapeutic reasons, the risk of her developing a mental health disorder, i.e. mental illness is no greater than to deliver the baby - unless one of the following applies to her..

 

At risk of mental health problems or mental disorders after abortion are women who: 

  • Have had mental health problems or a mental illness prior to the abortion6
  • Are ambivalent (have mixed feelings) about the abortion decision or difficulty or distress in making a decision7
  • Are coerced or pressured8
  • Are committed to the pregnancy7
  • Have personality factors such as low self-esteem, low perceived control over life and use avoidance/denial strategies to cope9 
  • Are terminating a pregnancy that is "wanted or meaningful"10
  • Are under 21 years old11
  • Have had one or more abortions already12
  • Have had past childhood sexual abuse13
  • Receive poor quality abortion care or inadequate counselling14

 

What is Mental Illness (a Mental Disorder)?

'Mental illness' refers to a group of recognised illnesses that affect the mental state of a person.  A mental illness or mental disoder defined by the Department of Health (Aus) 'is a health problem that significantly affects how a person feels, thinks, and behaves and interacts with other people.  It is diagnosed according to standardised criteria.'15

Mental illnesses include:

  • anxiety disorder

  • post traumatic stress disorder

  • schizophrenia
  • biopolar mood disorder
  • personality disorders
  • eating disorders
  • major depression
  • obsessive compulsive disorders
  • phobias

 

What are Mental Health Problems?

The Department of Health (Aus) says a 'mental health problem' also interferes with how a person thinks, feels and behaves, but to a lesser extent than a mental illness.  Mental heath problems are less severe than mental illnesses, but may develop into a mental illness if they are not effectively dealt with.'15

Mental health problems include:

  • anxiety
  • depression, mood swings
  • substance abuse
  • low self-esteem
  • self-destructive behaviours
  • chronic anger
  • inability to concentrate

 

What Does the Evidence Say on Mental Health and Abortion?

In 2011 and 2008, major systematic reviews were conducted into mental health and abortion by the Academy of Medical Royal Colleges (AMRC), UK and the American Psychological Association (APA), respectively.
 
The APA Task Force on Mental Health and Abortion (TFMHA) reviewed 223 USA and international studies published in peer-reviewed journals from 1990-2007 and gave its findings in a 100 page report.16  
 
Importantly (and confusingly), this review defined 'mental health problems' as clinically diagnosed mental disorders, such as major depression, anxiety disorders or postraumatic stress disorders. (p.7).  Excluded as mental health problems were negative psychological reactions a woman might experience after an abortion, including sadness, grief, dysphoria (a dissatisfaction or unease in life), guilt, regret, distress and even depression and anxiety considered 'below clinical threshold'.  The mental health problems referred to in the APA report are actually what other authorities may define as mental health disorders or mental illness (such as the Aust. Dept. Health).  Other less severe, more common and otherwise recognised mental health problems were not included as 'mental health problems' in the APA review and hence it's conclusions on mental health problems refers to serious mental health illnesses.
 

The APA report, 'Mental Health and Abortion' concludes, "the most methodologically sound research indicates that among women who have a single, legal, first-trimester abortion of an unplanned pregnancy for nontherapeutic reasons, the relative risks of mental health problems is no greater than the risks among women who deliver an unplanned pregnancy."

The APA press release was:  "There is no credible evidence that a single elective abortion of an unwanted pregnancy in and of itself causes mental health problems for adult women.."

Keeping in mind how the APA defined mental health problems, this conclusion means:

  • the risk to an adult woman of a mental health disorder, i.e. mental illness, is no greater for a single, first-trimester, legal abortion of an unwanted pregnancy, for nontherapeutic reasons, than to deliver the baby

 

Similarily, the 2011 AMRC report 'Induced Abortion and Mental Health', states 'the focus of the present review is on mental health outcomes as measured by standardised and validated assessment tools, clinical diagnoses, treatment records and suicide rates.  Because the review aimed to assess mental health problems and substance use and not transient reactions to a stressful event, negative reactions and assessments of mental state confined to less than 90 days following the abortion were excluded from the review...possible negative emotional reactions to abortion such as guilt, shame and regret, although considered important, were beyond the scope of the present review."18

As with the APA review, the mental heath outcomes described by the AMRC as the focus of the review are mental health disorders (i.e mental illness) rather than less severe mental health problems, yet it's conclusions refer to mental health problems.  Despite a 200 page report, it does not give anywhere a definition of 'mental health problems' to clarify this.  The review fails to give any useful conclusions on the risks of abortion to the general mental health of women as it excluded all emotional effects and the mental state of women assessed within 3 months of an abortion. 

Importantly, though the AMRC review confirmed earlier research that a prior history of mental health problems increased the risk of mental health problems after an abortion. Also, that there is a "need to support and care for all women who have an unwanted pregnancy because the risk of mental health problems increases whatever the pregnancy outcome."

 

Footnotes:

1  WHO, 2014. Factsheet on Mental Health. 

2  Govt. of WA, Mental Health Commission, 2010. What is mental health?

 TFMHA, 2008. Report of the APA Task Force on Mental Health and Abortion. 91. 'Abortion is an experience often hallmarked by ambivalence..Some women experience beneficial outcomes, whereas others experience sadness, grief and feelings of loss following the elective termination of a pregnancy.  Some women experience clinically significant outcomes, such as depression or anxiety.' 

4 The Free Dictionary: http://www.thefreedictionary.com/dysphoria

AMRC, 2011. Induced Abortion and Mental Health. 8. Findings of the steering group: 'The rates of mental health problems for women with an unwanted pregnancy were the same whether they had an abortion or gave birth.  An unwanted pregnancy was associated with an increased risk of mental health problems.' 

AMRC, 2011. Induced Abortion and Mental Health. 8. Findings of the steering group: 'The most reliable predictor of post-abortion mental health problems was having a history of mental health problems before the abortion.'

TFMHA, 2008. Report of the APA Task Force on Mental Health and Abortion. 92.  'Feelings of commitment to the pregnancy, ambivalence about the abortion decision, and low perceived ability to cope with the abortion prior to its occurrence also predicted more negative postabortion responses.'

8  AMRC, 2011. Induced Abortion and Mental Health. 8. Findings of the steering group: 'There were some additional factors associated with an increased risk of mental heath problems specifically related to abortion, such as pressure from a partner to have an abortion..'

TFMHA, 2008. Report of the APA Task Force on Mental Health and Abortion. 92.  'Characteristics of the woman also predicted more negative psychological experiences after first-trimester abortion, including a prior history of mental health problems, personality factors such as low self-esteem and low perceived control over her life, and use of avoidance and denial coping strategies.' 

10 TFMHA, 2008. Report of the APA Task Force on Mental Health and Abortion. 90. 'Nonetheless, these studies suggest that terminating a wanted pregnancy, especially late in pregnancy, can be associated with negative psychological experiences comparable to those experienced by women who miscarry a wanted pregnancy or experience a still-birth or death of a newborn.' 

11 TFMHA, 2008. Report of the APA Task Force on Mental Health and Abortion. 89.  'This study thus suggests that women who have one or more abortions at a young age (<21) are at greater relative risk for psychiatric disorder compared to women who deliver a child at a young age or women who do not get pregnant at a young age.' 

12 TFMHA, 2008. Report of the APA Task Force on Mental Health and Abortion. 91. 'Among women who reported multiple abortions, however, the percentage [scoring above the clinical threshold for depression] was higher; 31% met criteria for depression (see Table 6).'

13 Paul M et al. 1999. A Clinician's Guide to Medical and Surgical Abortion. 

14 AMRC, 2011. Induced Abortion and Mental Health. 79. 'Likewise, women who perceived their pre-abortion counselling to be inadequate also scored significantly higher on measures of PTSD [Post Traumatic Stress Disorder], despite controlling for a number of factors.' 

15 Aus Govt., Department of Health, 2007. What is mental health?

16 TFMHA, 2008. Report of the APA Task Force on Mental Health and Abortion.

17 AMRC, 2011. Induced Abortion and Mental Health.10.

18 AMRC, 2011. Induced Abortion and Mental Health. 8.

Go to top