Women’s Mental Health and Well-being 5 Years After Receiving or Being Denied an Abortion: A Prospective, Longitudinal Cohort Study | Anxiety Disorders | JAMA Psychiatry | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 34.239.150.57. Please contact the publisher to request reinstatement.
1.
Koop  CE.  A measured response: Koop on abortion.  Fam Plann Perspect. 1989;21(1):31-32.PubMedGoogle ScholarCrossref
2.
Major  B, Appelbaum  M, Beckman  L, Dutton  MA, Russo  NF, West  C.  Abortion and mental health: evaluating the evidence.  Am Psychol. 2009;64(9):863-890.PubMedGoogle ScholarCrossref
3.
Robinson  GE, Stotland  NL, Russo  NF, Lang  JA, Occhiogrosso  M.  Is there an “abortion trauma syndrome”? critiquing the evidence.  Harv Rev Psychiatry. 2009;17(4):268-290.PubMedGoogle ScholarCrossref
4.
Charles  VE, Polis  CB, Sridhara  SK, Blum  RW.  Abortion and long-term mental health outcomes: a systematic review of the evidence.  Contraception. 2008;78(6):436-450.PubMedGoogle ScholarCrossref
5.
National Collaborating Centre for Mental Health at the Royal College of Psychiatrists.  Induced Abortion and Mental Health: A Systematic Review of the Mental Health Outcomes of Induced Abortion, Including Their Prevalence and Associated Factors. London, England: Royal College of Psychiatrists; 2011.
6.
Stotland  NL.  Induced abortion and adolescent mental health.  Curr Opin Obstet Gynecol. 2011;23(5):340-343.PubMedGoogle ScholarCrossref
7.
Bellieni  CV, Buonocore  G.  Abortion and subsequent mental health: review of the literature.  Psychiatry Clin Neurosci. 2013;67(5):301-310.PubMedGoogle ScholarCrossref
8.
Coleman  PK.  Abortion and mental health: quantitative synthesis and analysis of research published 1995-2009.  Br J Psychiatry. 2011;199(3):180-186.PubMedGoogle ScholarCrossref
9.
Steinberg  JR, Trussell  J, Hall  KS, Guthrie  K.  Fatal flaws in a recent meta-analysis on abortion and mental health.  Contraception. 2012;86(5):430-437.PubMedGoogle ScholarCrossref
10.
Steinberg  JR, Finer  LB.  Coleman, Coyle, Shuping, and Rue make false statements and draw erroneous conclusions in analyses of abortion and mental health using the National Comorbidity Survey.  J Psychiatr Res. 2012;46(3):407-408.PubMedGoogle ScholarCrossref
11.
Robinson  GE, Stotland  NL, Nadelson  CC.  Abortion and mental health: guidelines for proper scientific conduct ignored.  Br J Psychiatry. 2012;200(1):78-80. PubMedGoogle ScholarCrossref
12.
Gold  RB, Nash  E. State abortion counseling policies and the fundamental principles of informed consent. Guttmacher Pol Rev. 2007;10(4):6-13. https://www.guttmacher.org/sites/default/files/pdfs/pubs/gpr/10/4/gpr100406.pdf. Accessed November 1, 2016.
13.
Kelly  K.  The spread of ‘post abortion syndrome’ as social diagnosis.  Soc Sci Med. 2014;102:18-25.PubMedGoogle ScholarCrossref
14.
Guttmacher Institute. An overview of abortion laws. https://www.guttmacher.org/state-policy/explore/overview-abortion-laws. Accessed August 15, 2016.
15.
Biggs  MA, Rowland  B, McCulloch  CE, Foster  DG.  Does abortion increase women’s risk for post-traumatic stress? findings from a prospective longitudinal cohort study.  BMJ Open. 2016;6(2):e009698.PubMedGoogle ScholarCrossref
16.
Foster  DG, Steinberg  JR, Roberts  SC, Neuhaus  J, Biggs  MA.  A comparison of depression and anxiety symptom trajectories between women who had an abortion and women denied one.  Psychol Med. 2015;45(10):2073-2082.PubMedGoogle ScholarCrossref
17.
Biggs  MA, Neuhaus  JM, Foster  DG.  Mental health diagnoses 3 years after receiving or being denied an abortion in the United States.  Am J Public Health. 2015;105(12):2557-2563.PubMedGoogle ScholarCrossref
18.
Biggs  MA, Upadhyay  UD, Steinberg  JR, Foster  DG.  Does abortion reduce self-esteem and life satisfaction?  Qual Life Res. 2014;23(9):2505-2513.PubMedGoogle ScholarCrossref
19.
Speckhard  AC, Rue  VM.  Postabortion syndrome: an emerging public health concern.  J Soc Issues. 1992;48(3):95-119. doi:10.1111/j.1540-4560.1992.tb00899.xGoogle ScholarCrossref
20.
Dobkin  LM, Gould  H, Barar  RE, Ferrari  M, Weiss  EI, Foster  DG.  Implementing a prospective study of women seeking abortion in the United States: understanding and overcoming barriers to recruitment.  Womens Health Issues. 2014;24(1):e115-e123.PubMedGoogle ScholarCrossref
21.
Upadhyay  UD, Weitz  TA, Jones  RK, Barar  RE, Foster  DG.  Denial of abortion because of provider gestational age limits in the United States.  Am J Public Health. 2014;104(9):1687-1694. PubMedGoogle ScholarCrossref
22.
Derogatis  LR.  Brief Symptom Inventory (BSI)-18: Administration, Scoring, and Procedures Manual. Minneapolis, MN: NCS Pearson Inc; 2001.
23.
Robins  RW, Hendin  HM, Trzesniewski  KH.  Measuring global self-esteem: construct validation of a single-item measure and the Rosenberg Self-Esteem Scale.  Pers Soc Psychol Bull. 2001;27(2):151-161. doi:10.1177/0146167201272002Google ScholarCrossref
24.
Diener  E, Emmons  RA, Larsen  RJ, Griffin  S.  The Satisfaction With Life Scale.  J Pers Assess. 1985;49(1):71-75.PubMedGoogle ScholarCrossref
25.
Biggs  MA, Gould  H, Foster  DG.  Understanding why women seek abortions in the US.  BMC Womens Health. 2013;13(1):29.PubMedGoogle ScholarCrossref
26.
Major  B, Cozzarelli  C, Cooper  ML,  et al.  Psychological responses of women after first-trimester abortion.  Arch Gen Psychiatry. 2000;57(8):777-784.PubMedGoogle ScholarCrossref
27.
Coleman  PK, Coyle  CT, Rue  VM.  Late-term elective abortion and susceptibility to posttraumatic stress symptoms.  J Pregnancy. 2010;2010:130519. PubMedGoogle ScholarCrossref
28.
Tinglöf  S, Högberg  U, Lundell  IW, Svanberg  AS.  Exposure to violence among women with unwanted pregnancies and the association with post-traumatic stress disorder, symptoms of anxiety and depression.  Sex Reprod Healthc. 2015;6(2):50-53.PubMedGoogle ScholarCrossref
29.
Steinberg  JR, McCulloch  CE, Adler  NE.  Abortion and mental health: findings from the National Comorbidity Survey-Replication.  Obstet Gynecol. 2014;123(2, pt 1):263-270.PubMedGoogle ScholarCrossref
30.
Hamama  L, Rauch  SA, Sperlich  M, Defever  E, Seng  JS.  Previous experience of spontaneous or elective abortion and risk for posttraumatic stress and depression during subsequent pregnancy.  Depress Anxiety. 2010;27(8):699-707.PubMedGoogle Scholar
31.
Broen  AN, Moum  T, Bödtker  AS, Ekeberg  O.  Psychological impact on women of miscarriage versus induced abortion: a 2-year follow-up study.  Psychosom Med. 2004;66(2):265-271.PubMedGoogle ScholarCrossref
32.
Otchet  F, Carey  MS, Adam  L.  General health and psychological symptom status in pregnancy and the puerperium: what is normal?  Obstet Gynecol. 1999;94(6):935-941.PubMedGoogle Scholar
33.
Jones  RK, Kavanaugh  ML.  Changes in abortion rates between 2000 and 2008 and lifetime incidence of abortion.  Obstet Gynecol. 2011;117(6):1358-1366.PubMedGoogle ScholarCrossref
34.
Jones  RK, Finer  LB.  Who has second-trimester abortions in the United States?  Contraception. 2012;85(6):544-551.PubMedGoogle ScholarCrossref
Original Investigation
February 2017

Women’s Mental Health and Well-being 5 Years After Receiving or Being Denied an Abortion: A Prospective, Longitudinal Cohort Study

Author Affiliations
  • 1Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, University of California, San Francisco, Oakland
  • 2Department of Epidemiology and Biostatistics, University of California, San Francisco
JAMA Psychiatry. 2017;74(2):169-178. doi:10.1001/jamapsychiatry.2016.3478
Key Points

Question  Are there associations between having or being denied an abortion with women’s mental health and well-being?

Findings  This longitudinal cohort study observed 956 women semiannually for 5 years. Eight days after seeking an abortion, women who were denied an abortion reported significantly more anxiety symptoms and lower self-esteem and life satisfaction, but similar levels of depression, as women receiving abortions; outcomes improved or remained steady over time.

Meaning  Abortion denial may be initially associated with psychological harm to women and findings do not support restricting abortion on the basis that abortion harms women’s mental health.

Abstract

Importance  The idea that abortion leads to adverse psychological outcomes has been the basis for legislation mandating counseling before obtaining an abortion and other policies to restrict access to abortion.

Objective  To assess women’s psychological well-being 5 years after receiving or being denied an abortion.

Design, Setting, and Participants  This study presents data from the Turnaway Study, a prospective longitudinal study with a quasi-experimental design. Women were recruited from January 1, 2008, to December 31, 2010, from 30 abortion facilities in 21 states throughout the United States, interviewed via telephone 1 week after seeking an abortion, and then interviewed semiannually for 5 years, totaling 11 interview waves. Interviews were completed January 31, 2016. We examined the psychological trajectories of women who received abortions just under the facility’s gestational limit (near-limit group) and compared them with women who sought but were denied an abortion because they were just beyond the facility gestational limit (turnaway group, which includes the turnaway-birth and turnaway-no-birth groups). We used mixed effects linear and logistic regression analyses to assess whether psychological trajectories differed by study group.

Main Outcomes and Measures  We included 6 measures of mental health and well-being: 2 measures of depression and 2 measures of anxiety assessed using the Brief Symptom Inventory, as well as self-esteem, and life satisfaction.

Results  Of the 956 women (mean [SD] age, 24.9 [5.8] years) in the study, at 1 week after seeking an abortion, compared with the near-limit group, women denied an abortion reported more anxiety symptoms (turnaway-births, 0.57; 95% CI, 0.01 to 1.13; turnaway-no-births, 2.29; 95% CI, 1.39 to 3.18), lower self-esteem (turnaway-births, –0.33; 95% CI, –0.56 to –0.09; turnaway-no-births, –0.40; 95% CI, –0.78 to –0.02), lower life satisfaction (turnaway-births, –0.16; 95% CI, –0.38 to 0.06; turnaway-no-births, –0.41; 95% CI, –0.77 to –0.06), and similar levels of depression (turnaway-births, 0.13; 95% CI, –0.46 to 0.72; turnaway-no-births, 0.44; 95% CI, –0.50 to 1.39).

Conclusions and Relevance  In this study, compared with having an abortion, being denied an abortion may be associated with greater risk of initially experiencing adverse psychological outcomes. Psychological well-being improved over time so that both groups of women eventually converged. These findings do not support policies that restrict women’s access to abortion on the basis that abortion harms women’s mental health.

×