Abortion and mental health: Difference between revisions

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inappropriately downplays scientific consensus in violation of WP:WEIGHT and WP:MEDRS, as detailed on talk page, and there is no consensus for these changes (based on talk page and reverts by multiple editors)
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== Current scientific evidence ==
== Current scientific evidence ==
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[[Systematic review]]s of the scientific literature have concluded that there are no differences in the long-term mental health of women who obtain induced abortions as compared to women in appropriate control groups&mdash;that is, those who carry unplanned pregnancies to term.<ref name="charles-2008"/> While some studies have reported a [[statistical correlation]] between abortion and mental health problems, these studies are typically methodologically flawed and fail to account for [[confounder|confounding factors]], or, as with results of women having multiple abortions, yield results inconsistent with other similar studies.<ref name="apa-2008"/> Higher-quality studies have consistently found no causal relationship between abortion and mental-health problems.<ref name="charles-2008"/> The correlations observed in some studies may be explained by pre-existing social circumstances and emotional health.<ref>{{cite news | work= [[Time (magazine)|Time]] | url = http://www.time.com/time/magazine/article/0,9171,903771-1,00.html | title = Abortion on Demand | date = 1973-01-29 | accessdate = 2008-11-18}}</ref> Various factors, such as emotional attachment to the pregnancy, lack of support, and conservative views on abortion may increase the likelihood of experiencing negative reactions. However, negative mental health impacts can result from any pregnancy outcome.<ref>Dennis CL, Dowswell T. Psychosocial and psychological interventions for preventing postpartum depression. Cochrane Database of Systematic Reviews 2013 Feb 28;2:CD001134.</ref><ref>{{cite journal | author = Grigoriadis S |date=Apr 2013 | title = The impact of maternal depression during pregnancy on perinatal outcomes: a systematic review and meta-analysis | url = | journal = J Clin Psychiatry | volume = 74 | issue = 4| pages = e321–41 | doi=10.4088/jcp.12r07968|display-authors=etal | pmid=23656857}}</ref>
Numerous [[systematic review]]s on the associations between mental health and abortion have been conducted.<ref>{{Cite journal|last=Major|first=Brenda|last2=Appelbaum|first2=Mark|last3=Beckman|first3=Linda|last4=Dutton|first4=Mary Ann|last5=Russo|first5=Nancy Felipe|last6=West|first6=Carolyn|date=2009|title=Abortion and mental health: Evaluating the evidence.|url=https://doi.org/10.1037/a0017497|journal=American Psychologist|language=en|volume=64|issue=9|pages=863–890|doi=10.1037/a0017497|issn=1935-990X}}</ref><ref name="nccmh" /><ref name=":0">{{Cite journal|last=Coleman|first=Priscilla K.|date=September 2011|title=Abortion and mental health: quantitative synthesis and analysis of research published 1995–2009|url=https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/abortion-and-mental-health-quantitative-synthesis-and-analysis-of-research-published-19952009/E8D556AAE1C1D2F0F8B060B28BEE6C3D|journal=The British Journal of Psychiatry|language=en|volume=199|issue=3|pages=180–186|doi=10.1192/bjp.bp.110.077230|issn=0007-1250|via=}}</ref><ref>{{Cite journal|last=Robinson|first=Gail Erlick|last2=Stotland|first2=Nada L.|last3=Russo|first3=Nancy Felipe|last4=Lang|first4=Joan A.|last5=Occhiogrosso|first5=Mallay|date=August 2009|title=Is There an “Abortion Trauma Syndrome”? Critiquing the Evidence|url=https://doi.org/10.1080/10673220903149119|journal=Harvard Review of Psychiatry|volume=17|issue=4|pages=268–290|doi=10.1080/10673220903149119|issn=1067-3229|via=}}</ref><ref name=":2">{{Cite journal|last=Fergusson|first=David M|last2=Horwood|first2=L John|last3=Boden|first3=Joseph M|date=2013-04-03|title=Does abortion reduce the mental health risks of unwanted or unintended pregnancy? A re-appraisal of the evidence|url=https://doi.org/10.1177/0004867413484597|journal=Australian & New Zealand Journal of Psychiatry|language=en|volume=47|issue=9|pages=819–827|doi=10.1177/0004867413484597|issn=0004-8674}}</ref><ref name="charles-2008" /><ref>{{Cite journal|last=Steinberg|first=Julia R.|date=May 2011|title=Later abortions and mental health: psychological experiences of women having later abortions--a critical review of research|url=https://www.ncbi.nlm.nih.gov/pubmed/21530839|journal=Women's Health Issues: Official Publication of the Jacobs Institute of Women's Health|volume=21|issue=3 Suppl|pages=S44–48|doi=10.1016/j.whi.2011.02.002|issn=1878-4321|pmid=21530839|via=}}</ref><ref>{{Cite journal|last=Bellieni|first=Carlo V.|last2=Buonocore|first2=Giuseppe|date=July 2013|title=Abortion and subsequent mental health: Review of the literature|url=http://www.scopus.com/inward/record.url?eid=2-s2.0-84880295971&partnerID=tZOtx3y1|journal=Psychiatry and Clinical Neurosciences|language=en-US|volume=67|issue=5|pages=301–310|doi=10.1111/pcn.12067|issn=1323-1316|via=}}</ref><ref>{{Cite journal|last=Thorp|first=John M.|last2=Hartmann|first2=Katherine E.|last3=Shadigian|first3=Elizabeth|date=January 2003|title=Long-term physical and psychological health consequences of induced abortion: review of the evidence|url=https://www.ncbi.nlm.nih.gov/pubmed/12544786|journal=Obstetrical & Gynecological Survey|volume=58|issue=1|pages=67–79|doi=10.1097/01.OGX.0000045217.37578.0B|issn=0029-7828|pmid=12544786|via=}}</ref> Each has also been the subject of criticism by other reviewers.<ref name=":0" /><ref name=":2" /><ref>{{Cite journal|last=Robinson|first=Gail Erlick|last2=Stotland|first2=Nada L.|last3=Russo|first3=Nancy Felipe|last4=Lang|first4=Joan A.|last5=Occhiogrosso|first5=Mallay|date=2009-08|title=Is There an “Abortion Trauma Syndrome”? Critiquing the Evidence|url=https://doi.org/10.1080/10673220903149119|journal=Harvard Review of Psychiatry|volume=17|issue=4|pages=268–290|doi=10.1080/10673220903149119|issn=1067-3229}}</ref> While many studies have revealed [[statistical correlation]]<nowiki/>s between abortion and mental health problems, correlation does not prove causation. The best evidence indicates that a disproportionate percentage of women having abortions also had ''prior'' mental health problems. This suggests that the higher rates of mental health problems observed after abortion may be wholly, or at least in part, explained by a predisposition toward mental health problems which is more common among the groups of women who are most likely to seek an abortion.


⚫
Major medical and psychiatric expert groups have consistently found that abortion does not cause mental-health problems. In 1989, The [[American Psychological Association]] (APA) published a summary of existing scientific literature in the journal ''[[Science (journal)|Science]]'', concluding that "the weight of the evidence from scientific studies indicates that legal abortion of an unwanted pregnancy in the first trimester does not pose a psychological hazard for most women."<ref name="APA89"/> The APA task force also concluded that "severe negative reactions after abortions are rare and can best be understood in the framework of coping with normal life stress."<ref name="APA89"/><ref>{{cite news | url = https://www.nytimes.com/1990/04/06/us/study-finds-little-lasting-distress-from-abortion.html | title= Study Finds Little Lasting Distress From Abortion | work= [[New York Times]] | date = 1990-04-06| accessdate = 2008-11-18| archiveurl= https://web.archive.org/web/20081205231237/http://query.nytimes.com/gst/fullpage.html?res=9C0CEEDE133FF935A35757C0A966958260| archivedate= 5 December 2008 <!--DASHBot-->| deadurl= no}}</ref>


⚫
Several [[systematic review]]s of the scientific literature have concluded that there are no differences in the long-term mental health of adult women who obtain a single induced abortion as compared to women in appropriate control groups&mdash;that is, those who carry unplanned pregnancies to term.<ref name="charles-2008"/><ref name="apa-2008"/> While some studies have reported a [[statistical correlation]] between abortion and mental health problems, these studies are typically methodologically flawed and fail to account for [[confounder|confounding factors]], or, as with results of women having multiple abortions, yield results inconsistent with other similar studies.<ref name="apa-2008"/> Higher-quality studies have consistently found no causal relationship between abortion and mental-health problems.<ref name="charles-2008"/> The correlations observed in some studies may be explained by pre-existing social circumstances and emotional health.<ref>{{cite news | work= [[Time (magazine)|Time]] | url = http://www.time.com/time/magazine/article/0,9171,903771-1,00.html | title = Abortion on Demand | date = 1973-01-29 | accessdate = 2008-11-18}}</ref> Various factors, such as emotional attachment to the pregnancy, lack of support, and conservative views on abortion may increase the likelihood of experiencing negative reactions. However, negative mental health impacts can result from any pregnancy outcome.<ref>Dennis CL, Dowswell T. Psychosocial and psychological interventions for preventing postpartum depression. Cochrane Database of Systematic Reviews 2013 Feb 28;2:CD001134.</ref><ref>{{cite journal | author = Grigoriadis S |date=Apr 2013 | title = The impact of maternal depression during pregnancy on perinatal outcomes: a systematic review and meta-analysis | url = | journal = J Clin Psychiatry | volume = 74 | issue = 4| pages = e321–41 | doi=10.4088/jcp.12r07968|display-authors=etal | pmid=23656857}}</ref>


In 2008, the American Psychological Association published an updated review of the literature on abortion and mental health, concluding again that the risk of mental health problems following a single, first-trimester [[abortion|induced abortion]] of an adult women is no greater than carrying an unwanted pregnancy to term. While observing that abortion may both relieve stress and "engender additional stress," they explicitly rejected the idea that abortion is "inherently traumatic."<ref name=":1">{{Cite book|title=Report of the APA Task Force on Mental Health and Abortion|last=Major B, Appelbaum M, Beckman L, Dutton MA, Russo NF, West C.|first=|publisher=American Psychological Association|year=2008|isbn=|location=Washington, DC|pages=4–5, 11–12}}</ref> Among those women who do experience mental health issues, the APA concluded that these issues are most likely related to pre-existing risk factors.<ref name=":1" /> Since these and other risk factors may also predispose some women to more negative reactions following a birth, the higher rates of mental illness observed among women with a prior history of abortion are more likely to be caused by these other factors than by abortion itself.<ref name=":1" /> The panel noted severe inconsistency between the outcomes reported by studies on the effect of multiple abortions. Additionally, the same factors which predispose a woman to multiple unwanted pregnancies may also predispose her to mental health difficulties. Therefore, they declined to draw a firm conclusion on studies concerning multiple abortions.<ref name="apa-2008"/><ref name="nyt-aug-2008">{{cite news|url=https://www.nytimes.com/2008/08/13/health/research/13brfs-ABORTIONDOES_BRF.html|title=Abortion Does Not Cause Mental Illness, Panel Says|last=Carey|first=Benedict|date=2008-08-12|work=[[New York Times]]|accessdate=2008-08-12}}</ref><ref>{{cite journal|last1=Major|first1=Brenda|last2=Appelbaum|first2=Mark|last3=Beckman|first3=Linda|last4=Dutton|first4=Mary Ann|last5=Russo|first5=Nancy Felipe|last6=West|first6=Carolyn|title=Abortion and mental health: Evaluating the evidence.|journal=American Psychologist|date=2009|volume=64|issue=9|pages=863–890|doi=10.1037/a0017497}}</ref> The APA report also notes that women who terminate a pregnancy because of abnormalities discovered through fetal screenings have a similar risk of negative mental health outcomes as women who miscarry a wanted pregnancy or experience a still-birth or the death of a newborn.<ref name="apa-2008"/>
In 2008, the American Psychological Association published an updated review of the literature on abortion and mental health, concluding again that the risk of mental health problems following a single, first-trimester [[abortion|induced abortion]] of an adult women is no greater than carrying an unwanted pregnancy to term. While observing that abortion may both relieve stress and "engender additional stress," they explicitly rejected the idea that abortion is "inherently traumatic."<ref name=":1">{{Cite book|title=Report of the APA Task Force on Mental Health and Abortion|last=Major B, Appelbaum M, Beckman L, Dutton MA, Russo NF, West C.|first=|publisher=American Psychological Association|year=2008|isbn=|location=Washington, DC|pages=4–5, 11–12}}</ref> Among those women who do experience mental health issues, the APA concluded that these issues are most likely related to pre-existing risk factors.<ref name=":1" /> Since these and other risk factors may also predispose some women to more negative reactions following a birth, the higher rates of mental illness observed among women with a prior history of abortion are more likely to be caused by these other factors than by abortion itself.<ref name=":1" /> The panel noted severe inconsistency between the outcomes reported by studies on the effect of multiple abortions. Additionally, the same factors which predispose a woman to multiple unwanted pregnancies may also predispose her to mental health difficulties. Therefore, they declined to draw a firm conclusion on studies concerning multiple abortions.<ref name="apa-2008"/><ref name="nyt-aug-2008">{{cite news|url=https://www.nytimes.com/2008/08/13/health/research/13brfs-ABORTIONDOES_BRF.html|title=Abortion Does Not Cause Mental Illness, Panel Says|last=Carey|first=Benedict|date=2008-08-12|work=[[New York Times]]|accessdate=2008-08-12}}</ref><ref>{{cite journal|last1=Major|first1=Brenda|last2=Appelbaum|first2=Mark|last3=Beckman|first3=Linda|last4=Dutton|first4=Mary Ann|last5=Russo|first5=Nancy Felipe|last6=West|first6=Carolyn|title=Abortion and mental health: Evaluating the evidence.|journal=American Psychologist|date=2009|volume=64|issue=9|pages=863–890|doi=10.1037/a0017497}}</ref> The APA report also notes that women who terminate a pregnancy because of abnormalities discovered through fetal screenings have a similar risk of negative mental health outcomes as women who miscarry a wanted pregnancy or experience a still-birth or the death of a newborn.<ref name="apa-2008"/>
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== History of Abortion and Mental Health Issues in the Law and Politics==
== History of Abortion and Mental Health Issues in the Law and Politics==

{{Main|Abortion in the United States}}
{{Main|Abortion in the United States}}
Under the 1973 U.S. Supreme Court decision ''[[Roe v. Wade]]'', state governments may not prohibit [[Late termination of pregnancy|late terminations of pregnancy]] when "necessary to preserve the [woman's] life or health", even if it would cause the demise of a viable fetus.<ref name=Roe_V_Wade>{{cite journal|last1=US Supreme Court|title=Roe V. Wade (410 U.S. 113)|date=January 22, 1973|issue=X|url=https://www.law.cornell.edu/supremecourt/text/410/113|accessdate=1 October 2015}}</ref> In a companion case, ''[[Doe v. Bolton]]'', the Court further ruled "that the medical judgment [to provide an abortion] may be exercised in the light of all factors-- physical, emotional, psychological, familial, and the woman's age-- relevant to the well-being of the patient."<ref name=Doe_V_Bolton>{{cite journal|last1=US Supreme Court|title=Doe V. Bolton, 410 U.S. 179|date=January 22, 1973|volume=IV.C|url=https://www.law.cornell.edu/supremecourt/text/410/179|accessdate=1 October 2015}}</ref><ref name=PBS_Wars>{{cite web|title=Frontline / Abortion Wars / Roe v Wade and Beyond|url=https://www.pbs.org/wgbh/pages/frontline/clinic/wars/cases.html|website=www.pbs.org|accessdate=5 October 2015}}</ref><ref name=ACLU_25>{{cite web|title=The Right to Choose at 25: Looking Back and Ahead|url=https://www.aclu.org/right-choose-25-looking-back-and-ahead|website=www.aclu.org|accessdate=5 October 2015}}</ref>
Under the 1973 U.S. Supreme Court decision ''[[Roe v. Wade]]'', state governments may not prohibit [[Late termination of pregnancy|late terminations of pregnancy]] when "necessary to preserve the [woman's] life or health", even if it would cause the demise of a viable fetus.<ref name=Roe_V_Wade>{{cite journal|last1=US Supreme Court|title=Roe V. Wade (410 U.S. 113)|date=January 22, 1973|issue=X|url=https://www.law.cornell.edu/supremecourt/text/410/113|accessdate=1 October 2015}}</ref> This rule was clarified by the 1973 judicial decision ''[[Doe v. Bolton]]'', which specifies "that the medical judgment may be exercised in the light of all factors-- physical, emotional, psychological, familial, and the woman's age-- relevant to the well-being of the patient."<ref name=Doe_V_Bolton>{{cite journal|last1=US Supreme Court|title=Doe V. Bolton, 410 U.S. 179|date=January 22, 1973|volume=IV.C|url=https://www.law.cornell.edu/supremecourt/text/410/179|accessdate=1 October 2015}}</ref><ref name=PBS_Wars>{{cite web|title=Frontline / Abortion Wars / Roe v Wade and Beyond|url=https://www.pbs.org/wgbh/pages/frontline/clinic/wars/cases.html|website=www.pbs.org|accessdate=5 October 2015}}</ref><ref name=ACLU_25>{{cite web|title=The Right to Choose at 25: Looking Back and Ahead|url=https://www.aclu.org/right-choose-25-looking-back-and-ahead|website=www.aclu.org|accessdate=5 October 2015}}</ref> It is by this provision that women in the US can legally choose abortion when screenings reveal abnormalities of a viable fetus.<ref name=Dailard>{{cite journal|last1=Dailard|first1=Cynthia|title=Issues and Implications, Abortion Restrictions and the Drive for Mental Health Parity: A Conflict in Values?|journal=The Guttmacher Report on Public Policy|date=June 1999|volume=2|issue=3|url=https://www.guttmacher.org/pubs/tgr/02/3/gr020304.html|accessdate=2 October 2015}}</ref><ref name=Palley>{{cite book|last1=Palley|first1=Marian Lief and Howard|title=The Politics of Women's Health Care in the US|date=2014|publisher=Palgrave Pivot|location=New York and London|isbn=9781137008633|pages=74|url=https://books.google.com/books?id=Pa7mAgAAQBAJ&lpg=PA74&ots=gUYm2AQ0Jq&dq=institute%20women's%20health%20doe%20bolton&pg=PA74#v=onepage&q&f=false|accessdate=5 October 2015}}</ref><ref name=PP_After_1st>{{cite news|title=Abortion after the First Trimester in the United States|url=https://www.plannedparenthood.org/files/5113/9611/5527/Abortion_After_first_trimester.pdf|accessdate=5 October 2015|publisher=Planned Parenthood Federation of America|date=February 2014}}</ref>


[[Abortion in the United Kingdom|In the United Kingdom]], abortion (late term or otherwise) is allowed under the [[Abortion Act 1967|1967 Abortion Act]], but only when two doctors agree that carrying the pregnancy to term would be detrimental to a woman's health, physical or mental.<ref name=UK_DOH>{{cite book|last1=Davies|first1=Sally|title=ABORTION ACT 1967 (AS AMENDED): TERMINATION OF PREGNANCY|date=23 February 2012|publisher=UK Department of Health|location=London|page=1|url=https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/215147/dh_132849.pdf|accessdate=5 October 2015}}</ref><ref>{{cite news|title=Q&A: Abortion Law|url=https://www.bbc.com/news/health-19856314|accessdate=5 October 2015|agency=BBC News|date=11 October 2012}}</ref><ref name=RCOG_Approving>{{cite web|title=Q&A: Approving Abortion|url=https://www.rcog.org.uk/en/news/campaigns-and-opinions/human-fertilisation-and-embryology-bill/qa-approving-abortions/|website=rcog.org.uk|publisher=Royal College of Obstetricians and Gynaecologists|accessdate=5 October 2015}}</ref><ref name=BPAS_grounds>{{cite web|title=Statistics briefing (3): Grounds for abortion|url=http://www.abortionreview.org/index.php/site/article/963/|website=www.abortionreview.org|publisher=BPAS - Britain's largest abortion provider|accessdate=6 October 2015}}</ref><ref name=RHM_Reasons>{{cite journal|last1=Ingham|first1=Roger|title=Reasons for Second Trimester Abortions in England and Wales|journal=Reproductive Health Matters|date=May 2006|volume=16|issue=31, Supplement|pages=18–29|doi=10.1016/S0968-8080(08)31375-5|url=http://www.rhm-elsevier.com/article/S0968-8080(08)31375-5/fulltext#Policy%20context%3A%20British%20abortion%20law|accessdate=6 October 2015}}</ref>
[[Abortion in the United Kingdom|In the United Kingdom]], abortion (late term or otherwise) is allowed under the [[Abortion Act 1967|1967 Abortion Act]], but only when two doctors agree that carrying the pregnancy to term would be detrimental to a woman's health, physical or mental. In [[Northern Ireland]], where most abortions are illegal, this law is not applicable.<ref name=UK_DOH>{{cite book|last1=Davies|first1=Sally|title=ABORTION ACT 1967 (AS AMENDED): TERMINATION OF PREGNANCY|date=23 February 2012|publisher=UK Department of Health|location=London|page=1|url=https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/215147/dh_132849.pdf|accessdate=5 October 2015}}</ref><ref>{{cite news|title=Q&A: Abortion Law|url=https://www.bbc.com/news/health-19856314|accessdate=5 October 2015|agency=BBC News|date=11 October 2012}}</ref><ref name=RCOG_Approving>{{cite web|title=Q&A: Approving Abortion|url=https://www.rcog.org.uk/en/news/campaigns-and-opinions/human-fertilisation-and-embryology-bill/qa-approving-abortions/|website=rcog.org.uk|publisher=Royal College of Obstetricians and Gynaecologists|accessdate=5 October 2015}}</ref><ref name=BPAS_grounds>{{cite web|title=Statistics briefing (3): Grounds for abortion|url=http://www.abortionreview.org/index.php/site/article/963/|website=www.abortionreview.org|publisher=BPAS - Britain's largest abortion provider|accessdate=6 October 2015}}</ref><ref name=RHM_Reasons>{{cite journal|last1=Ingham|first1=Roger|title=Reasons for Second Trimester Abortions in England and Wales|journal=Reproductive Health Matters|date=May 2006|volume=16|issue=31, Supplement|pages=18–29|doi=10.1016/S0968-8080(08)31375-5|url=http://www.rhm-elsevier.com/article/S0968-8080(08)31375-5/fulltext#Policy%20context%3A%20British%20abortion%20law|accessdate=6 October 2015}}</ref>


Since most abortions are provided for psychosocial reasons, rather than medical reasons, the question of whether an abortion in any specific case will benefit or harm the emotional and psychological well-being of a woman may be important in qualifying an abortion as legal under U.K. law<ref name=":2" /> and, in the United States, determining if a law regulating abortion is properly limited to protecting the well-being of the patient. Therefore, for abortion opponents, the idea that abortion causes more mental health problems than benefits has been put forward as a reason for more regulation of abortion,<ref name="Bazelon" /><ref name=":3">{{Cite book|url=https://www.worldcat.org/oclc/954003559|title=Peace psychology perspectives on abortion|others=MacNair, Rachel,|isbn=1530838266|location=Kansas City, MO|oclc=954003559}}</ref> and conversely, for defenders of abortion rights the idea that large numbers of women may suffer emotional problems or regrets over past abortions is strongly denounced.<ref name=":3" /> It is in this context that the abortion mental health debate became a major political issue in 1987 when U.S. President [[Ronald Reagan]] directed [[Surgeon General of the United States|U.S. Surgeon General]] [[C. Everett Koop]], an [[evangelical Christian]] and abortion opponent,<ref name="nlm">{{cite web|url=http://profiles.nlm.nih.gov/ps/retrieve/Narrative/QQ/p-nid/88 |archiveurl=https://www.webcitation.org/60GpKCVAq?url=http://profiles.nlm.nih.gov/ps/retrieve/Narrative/QQ/p-nid/88 |archivedate=July 18, 2011 |title=The C. Everett Koop Papers: Reproduction and Family Health |publisher=[[National Library of Medicine]] |accessdate=June 18, 2011 |deadurl=no |df= }}</ref> to issue a report on the health effects of abortion. Reportedly, the idea for the review was conceived by Reagan advisors [[Dinesh D'Souza]] and [[Gary Bauer]] as a means of "rejuvenat[ing]" the anti-abortion movement by producing evidence of the risks of abortion.<ref name="washingtonmonthly">{{cite news | url = http://www.washingtonmonthly.com/features/2004/0410.mooney2.html | title = Bucking the Gipper | last = Mooney | first = Chris | authorlink = Chris Mooney (journalist) | work= [[Washington Monthly]] | date = October 2004 | accessdate = 2008-02-18}}</ref> Koop was reluctant to accept the assignment, believing that Reagan was, according to an National Institute of Health commentary, "more concerned with appeasing his political base than with improving women's health."<ref name="nlm"/>
In 1987, U.S. President [[Ronald Reagan]] directed [[Surgeon General of the United States|U.S. Surgeon General]] [[C. Everett Koop]], an [[evangelical Christian]] and abortion opponent,<ref name="nlm">{{cite web|url=http://profiles.nlm.nih.gov/ps/retrieve/Narrative/QQ/p-nid/88 |archiveurl=https://www.webcitation.org/60GpKCVAq?url=http://profiles.nlm.nih.gov/ps/retrieve/Narrative/QQ/p-nid/88 |archivedate=July 18, 2011 |title=The C. Everett Koop Papers: Reproduction and Family Health |publisher=[[National Library of Medicine]] |accessdate=June 18, 2011 |deadurl=no |df= }}</ref> to issue a report on the health effects of abortion. Reportedly, the idea for the review was conceived by Reagan advisors [[Dinesh D'Souza]] and [[Gary Bauer]] as a means of "rejuvenat[ing]" the anti-abortion movement by producing evidence of the risks of abortion.<ref name="washingtonmonthly">{{cite news | url = http://www.washingtonmonthly.com/features/2004/0410.mooney2.html | title = Bucking the Gipper | last = Mooney | first = Chris | authorlink = Chris Mooney (journalist) | work= [[Washington Monthly]] | date = October 2004 | accessdate = 2008-02-18}}</ref> Koop was reluctant to accept the assignment, believing that Reagan was more concerned with appeasing his political base than with improving women's health.<ref name="nlm"/>


Ultimately, Koop reviewed over 250 studies pertaining to the psychological impact of abortion. Koop wrote in a letter to Reagan that "scientific studies do not provide conclusive data about the health effects of abortion on women."<ref name="times1-11-89">{{cite news | url = https://www.nytimes.com/1989/01/11/us/koop-s-stand-on-abortion-s-effect-surprises-friends-and-foes-alike.html | title = Koop's Stand on Abortion's Effect Surprises Friends and Foes Alike | last = Tolchin | first = Martin | work= [[New York Times]] | date = 1989-01-11 | accessdate = 2008-02-18}}</ref> Koop acknowledged the political context of the question in his letter, writing: "In the minds of some of [Reagan's advisors], it was a foregone conclusion that the negative health effects of abortion on women were so overwhelming that the evidence would force the reversal of ''Roe vs. Wade''."<ref name="times3-17-89"/>
Ultimately, Koop reviewed over 250 studies pertaining to the psychological impact of abortion. Koop wrote in a letter to Reagan that "scientific studies do not provide conclusive data about the health effects of abortion on women."<ref name="times1-11-89">{{cite news | url = https://www.nytimes.com/1989/01/11/us/koop-s-stand-on-abortion-s-effect-surprises-friends-and-foes-alike.html | title = Koop's Stand on Abortion's Effect Surprises Friends and Foes Alike | last = Tolchin | first = Martin | work= [[New York Times]] | date = 1989-01-11 | accessdate = 2008-02-18}}</ref> Koop acknowledged the political context of the question in his letter, writing: "In the minds of some of [Reagan's advisors], it was a foregone conclusion that the negative health effects of abortion on women were so overwhelming that the evidence would force the reversal of ''Roe vs. Wade''."<ref name="times3-17-89"/>
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Subsequently, a Congressional committee charged that Koop refused to publish the results of his review because he failed to find evidence that abortion was harmful, and that Koop watered down his findings in his letter to Reagan by claiming that the studies were inconclusive. Congressman [[Theodore S. Weiss]] ([[Democratic Party (United States)|D]]-[[New York (state)|NY]]), who oversaw the investigation, argued that when Koop found no evidence that abortion was harmful, he "decided not to issue a report, but instead to write a letter to the president which would be sufficiently vague as to avoid supporting the pro-choice position that abortion is safe for women."<ref name="newscientist"/>
Subsequently, a Congressional committee charged that Koop refused to publish the results of his review because he failed to find evidence that abortion was harmful, and that Koop watered down his findings in his letter to Reagan by claiming that the studies were inconclusive. Congressman [[Theodore S. Weiss]] ([[Democratic Party (United States)|D]]-[[New York (state)|NY]]), who oversaw the investigation, argued that when Koop found no evidence that abortion was harmful, he "decided not to issue a report, but instead to write a letter to the president which would be sufficiently vague as to avoid supporting the pro-choice position that abortion is safe for women."<ref name="newscientist"/>


⚫
In 1989, The [[American Psychological Association]] (APA) published a summary of existing scientific literature in the journal ''[[Science (journal)|Science]]'', concluding that "the weight of the evidence from scientific studies indicates that legal abortion of an unwanted pregnancy in the first trimester does not pose a psychological hazard for most women."<ref name="APA89"/> The APA task force also concluded that "severe negative reactions after abortions are rare and can best be understood in the framework of coping with normal life stress."<ref name="APA89"/><ref>{{cite news | url = https://www.nytimes.com/1990/04/06/us/study-finds-little-lasting-distress-from-abortion.html | title= Study Finds Little Lasting Distress From Abortion | work= [[New York Times]] | date = 1990-04-06| accessdate = 2008-11-18| archiveurl= https://web.archive.org/web/20081205231237/http://query.nytimes.com/gst/fullpage.html?res=9C0CEEDE133FF935A35757C0A966958260| archivedate= 5 December 2008 <!--DASHBot-->| deadurl= no}}</ref>


==See also==
==See also==

Revision as of 04:49, 21 August 2018

The relationship between induced abortion and mental health is an area of political controversy.[1][2] Current scientific evidence, as interpreted by major medical bodies including the American Psychological Association and the U.K. Royal College of Psychiatrists, indicates that a single, first-trimester induced abortion for adult women poses no greater mental-health risks than carrying unwanted pregnancies to term.[3][4] The evidence is less clear in situations such as repeat abortions, and late termination of pregnancy due to foetal abnormality.[3]

In 2008, the American Psychological Association concluded after a review of available evidence that induced abortion did not increase the risk of mental health problems. In December 2011, the U.K. National Collaborating Centre for Mental Health similarly concluded that first-time abortion in the first trimester does not increase the risk of mental-health problems compared with bringing the pregnancy to term.[4][5] A 2008 systematic review of the medical literature on abortion and mental health found that high-quality studies consistently showed few or no mental-health consequences of abortion, while poor-quality studies were more likely to report negative consequences.[6]

Despite the weight of scientific and medical opinion, some anti-abortion advocacy groups have continued to allege a link between abortion and mental-health problems.[7] Some anti-abortion groups have used the term "post-abortion syndrome" to refer to negative psychological effects which they attribute to abortion. However, "post-abortion syndrome" is not recognized as an actual syndrome by the mainstream medical community.[8][9] Physicians and pro-choice advocates have argued that the effort to popularize the idea of a "post-abortion syndrome" is a tactic used by anti-abortion advocates for political purposes.[1][7][10][11] Some U.S. state legislatures have mandated that patients be told that abortion increases their risk of depression and suicide, despite the scientific evidence contradicting such claims.[6][12]


Current scientific evidence

Systematic reviews of the scientific literature have concluded that there are no differences in the long-term mental health of women who obtain induced abortions as compared to women in appropriate control groups—that is, those who carry unplanned pregnancies to term.[6] While some studies have reported a statistical correlation between abortion and mental health problems, these studies are typically methodologically flawed and fail to account for confounding factors, or, as with results of women having multiple abortions, yield results inconsistent with other similar studies.[3] Higher-quality studies have consistently found no causal relationship between abortion and mental-health problems.[6] The correlations observed in some studies may be explained by pre-existing social circumstances and emotional health.[13] Various factors, such as emotional attachment to the pregnancy, lack of support, and conservative views on abortion may increase the likelihood of experiencing negative reactions. However, negative mental health impacts can result from any pregnancy outcome.[14][15]

Major medical and psychiatric expert groups have consistently found that abortion does not cause mental-health problems. In 1989, The American Psychological Association (APA) published a summary of existing scientific literature in the journal Science, concluding that "the weight of the evidence from scientific studies indicates that legal abortion of an unwanted pregnancy in the first trimester does not pose a psychological hazard for most women."[16] The APA task force also concluded that "severe negative reactions after abortions are rare and can best be understood in the framework of coping with normal life stress."[16][17]

In 2008, the American Psychological Association published an updated review of the literature on abortion and mental health, concluding again that the risk of mental health problems following a single, first-trimester induced abortion of an adult women is no greater than carrying an unwanted pregnancy to term. While observing that abortion may both relieve stress and "engender additional stress," they explicitly rejected the idea that abortion is "inherently traumatic."[18] Among those women who do experience mental health issues, the APA concluded that these issues are most likely related to pre-existing risk factors.[18] Since these and other risk factors may also predispose some women to more negative reactions following a birth, the higher rates of mental illness observed among women with a prior history of abortion are more likely to be caused by these other factors than by abortion itself.[18] The panel noted severe inconsistency between the outcomes reported by studies on the effect of multiple abortions. Additionally, the same factors which predispose a woman to multiple unwanted pregnancies may also predispose her to mental health difficulties. Therefore, they declined to draw a firm conclusion on studies concerning multiple abortions.[3][19][20] The APA report also notes that women who terminate a pregnancy because of abnormalities discovered through fetal screenings have a similar risk of negative mental health outcomes as women who miscarry a wanted pregnancy or experience a still-birth or the death of a newborn.[3]

In December 2011, the U.K. Royal College of Psychiatrists undertook a systematic review to clarify the question of whether abortion had harmful effects on women's mental health. The review, conducted by the National Collaborating Centre for Mental Health and funded by the British Department of Health, concluded that while an unwanted pregnancy may lead to an increased risk of mental health problems, it is most likely that women faced with unwanted pregnancies have similar rates of mental health problems whether they carry to term or have an abortion.[4]

Post-abortion syndrome

The term "post-abortion syndrome" has widely been used by anti-abortion advocates to broadly include any negative emotional reactions attributed to abortion.[1][10][21] The idea that abortion negative psychological effects was widely promoted by crisis pregnancy centers in the 1970s[22] based on psychiatric literature pre-dating the legalization of abortion in the United Kingdom and the United States.[23] Post-abortion syndrome (PAS) is not included in the Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR or in the ICD-10 list of psychiatric conditions, nor is the term commonly used outside of the anti-abortion community. Some physicians and pro-choice advocates have argued that the focus on "post-abortion syndrome" is a tactic used by anti-abortion advocates for political purposes, and that PAS does not really exist.[7][11][24][25][26]


Counseling

Counseling for women and men who may struggle with a past abortion is available from both anti-abortion crisis pregnancy centers and religious groups[1] and also from pro-choice/pro-voice groups, like Exhale.[27][28] Planned Parenthood provides emotional support to patients.[29][30]

History of Abortion and Mental Health Issues in the Law and Politics

Main article: Abortion in the United States

Under the 1973 U.S. Supreme Court decision Roe v. Wade, state governments may not prohibit late terminations of pregnancy when "necessary to preserve the [woman's] life or health", even if it would cause the demise of a viable fetus.[31] This rule was clarified by the 1973 judicial decision Doe v. Bolton, which specifies "that the medical judgment may be exercised in the light of all factors-- physical, emotional, psychological, familial, and the woman's age-- relevant to the well-being of the patient."[32][33][34] It is by this provision that women in the US can legally choose abortion when screenings reveal abnormalities of a viable fetus.[35][36][37]

In the United Kingdom, abortion (late term or otherwise) is allowed under the 1967 Abortion Act, but only when two doctors agree that carrying the pregnancy to term would be detrimental to a woman's health, physical or mental. In Northern Ireland, where most abortions are illegal, this law is not applicable.[38][39][40][41][42]

In 1987, U.S. President Ronald Reagan directed U.S. Surgeon General C. Everett Koop, an evangelical Christian and abortion opponent,[43] to issue a report on the health effects of abortion. Reportedly, the idea for the review was conceived by Reagan advisors Dinesh D'Souza and Gary Bauer as a means of "rejuvenat[ing]" the anti-abortion movement by producing evidence of the risks of abortion.[44] Koop was reluctant to accept the assignment, believing that Reagan was more concerned with appeasing his political base than with improving women's health.[43]

Ultimately, Koop reviewed over 250 studies pertaining to the psychological impact of abortion. Koop wrote in a letter to Reagan that "scientific studies do not provide conclusive data about the health effects of abortion on women."[45] Koop acknowledged the political context of the question in his letter, writing: "In the minds of some of [Reagan's advisors], it was a foregone conclusion that the negative health effects of abortion on women were so overwhelming that the evidence would force the reversal of Roe vs. Wade."[46]

In later testimony before the United States Congress, Koop stated that the quality of existing evidence was too poor to prepare a report "that could withstand scientific and statistical scrutiny." Koop noted that "... there is no doubt about the fact that some people have severe psychological effects after abortion, but anecdotes do not make good scientific material."[46] In his congressional testimony, Koop stated that while psychological responses to abortion may be "overwhelming" in individual cases, the psychological risks of abortion were "minuscule from a public health perspective."[1][16][44][47]

Subsequently, a Congressional committee charged that Koop refused to publish the results of his review because he failed to find evidence that abortion was harmful, and that Koop watered down his findings in his letter to Reagan by claiming that the studies were inconclusive. Congressman Theodore S. Weiss (D-NY), who oversaw the investigation, argued that when Koop found no evidence that abortion was harmful, he "decided not to issue a report, but instead to write a letter to the president which would be sufficiently vague as to avoid supporting the pro-choice position that abortion is safe for women."[47]


See also

References

  1. ^ a b c d e Bazelon, Emily (21 January 2007). "Is There a Post-Abortion Syndrome?". New York Times Magazine. Archived from the original on April 24, 2009. Retrieved 11 January 2008. {{cite news}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help)
  2. ^ "Post-Abortion Politics". NOW with David Brancaccio. PBS. 20 July 2007. Archived from the original on 20 October 2008. Retrieved 18 November 2008. {{cite news}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help)
  3. ^ a b c d e Major B, Appelbaum M, Beckman L, Dutton MA, Russo NF, West C. (2008). Report of the APA Task Force on Mental Health and Abortion. Washington, DC: American Psychological Association. pp. 4–5, 11–12.{{cite book}}: CS1 maint: multiple names: authors list (link)
  4. ^ a b c "Induced Abortion and Mental Health: A systematic review of the evidence". National Collaborating Centre for Mental Health. December 2011. Archived from the original (PDF) on 25 March 2012.
  5. ^ Dreaper, Jane (December 9, 2011). "Abortion 'does not raise' mental health risk". BBC. Retrieved April 18, 2012.
  6. ^ a b c d Charles VE, Polis CB, Sridhara SK, Blum RW (2008). "Abortion and long-term mental health outcomes: a systematic review of the evidence". Contraception. 78 (6): 436–50. doi:10.1016/j.contraception.2008.07.005. PMID 19014789.
  7. ^ a b c Stotland NL (2003). "Abortion and psychiatric practice". J Psychiatr Pract. 9 (2): 139–49. doi:10.1097/00131746-200303000-00005. PMID 15985924. "Currently, there are active attempts to convince the public and women considering abortion that abortion frequently has negative psychiatric consequences. This assertion is not borne out by the literature: the vast majority of women tolerate abortion without psychiatric sequelae."
  8. ^ Cohen, Susan A. (2006). "Abortion and Mental Health: Myths and Realities". Guttmacher Policy Review. Guttmacher Institute. Retrieved 4 November 2014.
  9. ^ "Q&A: Abortion and mental health". Royal College of Obstetricians and Gynaecologists. August 2008. Retrieved 5 November 2014.
  10. ^ a b Mooney, Chris (October 2004). "Research and Destroy: How the religious right promotes its own 'experts' to combat mainstream science". Washington Monthly. Archived from the original on 4 April 2008. {{cite news}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help)
  11. ^ a b Stotland NL (October 1992). "The myth of the abortion trauma syndrome". JAMA. 268 (15): 2078–9. doi:10.1001/jama.268.15.2078. PMID 1404747.
  12. ^ Lazzarini Z (November 2008). "South Dakota's Abortion Script – Threatening the Physician-Patient Relationship". N. Engl. J. Med. 359 (21): 2189–2191. doi:10.1056/NEJMp0806742. PMID 19020321. The purported increased risks of psychological distress, depression, and suicide that physicians are required to warn women about are not supported by the bulk of the scientific literature. By requiring physicians to deliver such misinformation and discouraging them from providing alternative accurate information, the statute forces physicians to violate their obligation to solicit truly informed consent.
  13. ^ "Abortion on Demand". Time. 1973-01-29. Retrieved 2008-11-18.
  14. ^ Dennis CL, Dowswell T. Psychosocial and psychological interventions for preventing postpartum depression. Cochrane Database of Systematic Reviews 2013 Feb 28;2:CD001134.
  15. ^ Grigoriadis S; et al. (Apr 2013). "The impact of maternal depression during pregnancy on perinatal outcomes: a systematic review and meta-analysis". J Clin Psychiatry. 74 (4): e321–41. doi:10.4088/jcp.12r07968. PMID 23656857.
  16. ^ a b c Adler NE, David HP, Major BN, Roth SH, Russo NF, Wyatt GE (1990). "Psychological responses after abortion". Science. 248 (4951): 41–4. doi:10.1126/science.2181664. PMID 2181664.
  17. ^ "Study Finds Little Lasting Distress From Abortion". New York Times. 1990-04-06. Archived from the original on 5 December 2008. Retrieved 2008-11-18. {{cite news}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help)
  18. ^ a b c Major B, Appelbaum M, Beckman L, Dutton MA, Russo NF, West C. (2008). Report of the APA Task Force on Mental Health and Abortion. Washington, DC: American Psychological Association. pp. 4–5, 11–12.{{cite book}}: CS1 maint: multiple names: authors list (link)
  19. ^ Carey, Benedict (2008-08-12). "Abortion Does Not Cause Mental Illness, Panel Says". New York Times. Retrieved 2008-08-12.
  20. ^ Major, Brenda; Appelbaum, Mark; Beckman, Linda; Dutton, Mary Ann; Russo, Nancy Felipe; West, Carolyn (2009). "Abortion and mental health: Evaluating the evidence". American Psychologist. 64 (9): 863–890. doi:10.1037/a0017497.
  21. ^ Kranish, Michael (2005-07-31). "Science in support of a cause: the new research". Boston Globe. Retrieved 2007-11-27.
  22. ^ Kelly, Kimberly (February 2014). "The spread of 'Post Abortion Syndrome' as social diagnosis". Social Science & Medicine. 102: 18–25. doi:10.1016/j.socscimed.2013.11.030. PMID 24565137.
  23. ^ Germain Grisez, Abortion: the Myths, the Realities, and the Arguments (New York: Corpus Books, 1972)
  24. ^ Cooper, Cynthia (August–September 2001). "Abortion Under Attack". Ms. Retrieved 2008-11-18.
  25. ^ Russo NF, Denious JE (2005). "Controlling birth: science, politics, and public policy". J Soc Issues. 61 (1): 181–91. doi:10.1111/j.0022-4537.2005.00400.x. PMID 17073030.
  26. ^ DADLEZ, E.M.; ANDREWS, WILLIAM L. (7 July 2009). "POST-ABORTION SYNDROME: CREATING AN AFFLICTION". Bioethics. 24 (9): 445–452. doi:10.1111/j.1467-8519.2009.01739.x.
  27. ^ Walter, Shoshana (Jan 14, 2011). "Post-Abortion Counseling Group Finds Itself on the Firing Line". New York Times. Retrieved August 26, 2017. {{cite news}}: Cite has empty unknown parameter: |dead-url= (help)
  28. ^ "Aspen Baker of Exhale, a "Pro-Voice" Group". NOW on PBS. July 20, 2007. Retrieved August 26, 2017. {{cite news}}: Cite has empty unknown parameter: |dead-url= (help)
  29. ^ Bazelon, Emily (January 21, 2007). "Is there a post-abortion syndrome?". The New York Times Magazine. Retrieved 16 September 2015.
  30. ^ Allen, Samantha (July 1, 2015). "pro-lifers harass women after abortions". The Daily Beast. Retrieved 16 September 2015.
  31. ^ US Supreme Court (January 22, 1973). "Roe V. Wade (410 U.S. 113)" (X). Retrieved 1 October 2015. {{cite journal}}: Cite journal requires |journal= (help)
  32. ^ US Supreme Court (January 22, 1973). "Doe V. Bolton, 410 U.S. 179". IV.C. Retrieved 1 October 2015. {{cite journal}}: Cite journal requires |journal= (help)
  33. ^ "Frontline / Abortion Wars / Roe v Wade and Beyond". www.pbs.org. Retrieved 5 October 2015.
  34. ^ "The Right to Choose at 25: Looking Back and Ahead". www.aclu.org. Retrieved 5 October 2015.
  35. ^ Dailard, Cynthia (June 1999). "Issues and Implications, Abortion Restrictions and the Drive for Mental Health Parity: A Conflict in Values?". The Guttmacher Report on Public Policy. 2 (3). Retrieved 2 October 2015.
  36. ^ Palley, Marian Lief and Howard (2014). The Politics of Women's Health Care in the US. New York and London: Palgrave Pivot. p. 74. ISBN 9781137008633. Retrieved 5 October 2015.
  37. ^ "Abortion after the First Trimester in the United States" (PDF). Planned Parenthood Federation of America. February 2014. Retrieved 5 October 2015.
  38. ^ Davies, Sally (23 February 2012). ABORTION ACT 1967 (AS AMENDED): TERMINATION OF PREGNANCY (PDF). London: UK Department of Health. p. 1. Retrieved 5 October 2015.
  39. ^ "Q&A: Abortion Law". BBC News. 11 October 2012. Retrieved 5 October 2015.
  40. ^ "Q&A: Approving Abortion". rcog.org.uk. Royal College of Obstetricians and Gynaecologists. Retrieved 5 October 2015.
  41. ^ "Statistics briefing (3): Grounds for abortion". www.abortionreview.org. BPAS - Britain's largest abortion provider. Retrieved 6 October 2015.
  42. ^ Ingham, Roger (May 2006). "Reasons for Second Trimester Abortions in England and Wales". Reproductive Health Matters. 16 (31, Supplement): 18–29. doi:10.1016/S0968-8080(08)31375-5. Retrieved 6 October 2015.
  43. ^ a b "The C. Everett Koop Papers: Reproduction and Family Health". National Library of Medicine. Archived from the original on July 18, 2011. Retrieved June 18, 2011. {{cite web}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help)
  44. ^ a b Mooney, Chris (October 2004). "Bucking the Gipper". Washington Monthly. Retrieved 2008-02-18.
  45. ^ Tolchin, Martin (1989-01-11). "Koop's Stand on Abortion's Effect Surprises Friends and Foes Alike". New York Times. Retrieved 2008-02-18.
  46. ^ a b Leary, Warren (1989-03-17). "Koop Says Abortion Report Couldn't Survive Challenge". New York Times. Retrieved 2008-02-18.
  47. ^ a b Joyce, Christopher (1989-12-16). "Reagan's officials 'suppressed' research on abortion". New Scientist. Archived from the original on 14 March 2008. Retrieved 2008-02-18. {{cite news}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help)

External links

Reviews by major medical bodies
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