Abortion and Women’s Mental Health

WOMEN’S MENTAL HEALTH AFTER ABORTION

Women’s Mental Health after Abortion

Literature Review

Introduction

According to Steinberg, Tschann, Fergerson, and Harper (2016), a significant percentage of women in the country procure “an abortion before the age of 45” (63). The authors in this case indicate that the said percentage could be as high as 30%. Despite this, abortion remains one of the most controversial issues in the contemporary society. As a consequence of the controversy surrounding this particular issue, many myths have emerged around the subject. This is more so the case in relation to the connection between abortion and physical as well as mental health. According to Steinberg, Tschann, Fergerson, and Harper (2016), most of the myths propagated on this front are not evidence-based. For this reason, there is need to explore available scientific research regarding the impact that abortion has on the health and wellbeing of women – specifically mental health. Towards this end, the present research seeks to find an answer to the query: how does abortion affect mental health? The relevance of a review of this nature cannot be overstated given the huge percentage of women who procure abortion in the country at some point in their lives.

Prior to the 1969, no meaningful data on abortion on abortion was being collected in the U.S. This is because the Centers for Disease Control and Prevention, had not yet commenced the documentation of abortion rates and occurrences. The said surveillance, as Centers for Disease Control and Prevention (2021) indicates, commenced in the year 1969. To a large extent, there exists no standard definition of abortion. This essentially means that in the past, numerous definitions have been floated in an attempt to conceptualize the term in diverse contexts. However, from a legal standpoint, “abortion is defined as an intervention performed by a licensed clinician within the limits of state regulations, that is intended to terminate a suspected or known ongoing intrauterine pregnancy and that does not result in a live birth” (Centers for Disease Control and Prevention, 2021). This is the definition that will be embraced in this text. There are various kinds of abortion procedures that are often performed. The most common ones are the use of pills and vacuum aspiration (Johnson, 2021). According to the author, whereas the former involves the ingestion of a prescription pill (typically mifepristone), the latter involves the removal of the pregnancy via the utilization of gentle suction. Both approaches depend on the pregnancy stage. For instance, the use of pills is ideal during the early stages of the pregnancy, whereas the use of vacuum suction is ideal in later pregnancy stages, i.e. in the second trimester.

According to the American Psychological Association (2018), “there are numerous reasons for a woman to seek an abortion.” In seeking to explore these factors, there would be need to rope in the relevant sociological concepts. The concepts that have been explored in this case are: conflict theory, critical race theory, and cultural theory. To begin with, when it comes to the conflict theory, the focus happens to be on tensions as a consequence of the uneven distribution of power, status, as well as resources in the society. This particular theory was originally proposed by Karl Max. Thus, from a conflict theory perspective, abortion could be as a consequence of competition for limited resources. The focus on this front is on the economic pressures that motivate the decision to procure an abortion. This perspective is reinforced by the fact that as Yazdkhasti, Pourreza, Pirak, and Abdi (2015) point out, unintended pregnancies could in some instances have negative consequences on the economic and financial fronts. In the words of the authors, this is more so in relation to “appreciable socioeconomic burden on individuals and society” (12). Thus, for those women who are unsure of how to provide for the unborn child, procuring an abortion could appear to be the most rational course of action. This is an especially important finding owing to the fact that as the authors further indicate, a significant percentage (up to 50%) of pregnancies in the U.S. could be classified as unwanted. On the other hand, with regard to the critical race theory, the most outstanding factor happens to be the institutionalization of racial discrimination. This is to say that the various procedures, rules, as well as regulations and laws in the country are skewed in favor of some races – which effectively means that differential outcomes by race are largely inevitable (Ziegler, 2020). It is important to note that according to Cohen (2008), African American women tend to have a higher rate of abortion than their white counterparts. Indeed, according to the author, in comparison to their white counterparts, African American women have a 5-fold likelihood of procuring an abortion. In what appears to be consistent with the critical race theory, the author is categorical that “these higher unintended pregnancy rates reflect the particular difficulties that many women in minority communities face in accessing high-quality contraceptive services and in using their chosen method of birth control consistently and effectively over long periods of time” (Cohen, 2008). Lastly, we could also assess the issue of abortion from the perspective of cultural ideology. Cultural ideology largely relates to the various beliefs and viewpoints (rooted in culture) that specific groups or classes identify with. Over the last few decades, the U.S. has moved towards reproductive choice – effectively meaning that unlike was the case a few decades ago, most citizens of this great country now have access to abortion services and care that could be deemed high quality. This is more so the case following what we could now perceive as a landmark decision in 1973 by the Supreme Court that essentially legalized abortion, but permitted states to restrict the same to some extent. This resulted in a shift of sorts in terms of the ideological perspectives regarding access to abortion services.

Abortion and Mental Health

From the onset, it would be prudent to note that there appears to be conflicting findings from various studies about the impact of abortion on mental health. This is to say that whereas some studies indicate that abortion is linked to a wide range of psychological problems including, but not limited to negative feelings, depression and post-traumatic stress disorder (PTSD), there are other studies that have found no evidence of psychological distress among women who have procured an abortion. Reardon (2018) best captures the standoff by pointing out that “the abortion and mental health controversy is driven by two different perspectives regarding how best to interpret accepted facts” (21). There is need to first explore studies that link abortion to negative mental health outcomes.

To begin with, in a 2011 study, it was found that women who had procured an abortion had a higher likelihood of struggling with mental health issues (Coleman, 2018). More specifically, the author made a finding to the effect that women who had procured an abortion had an 81% higher likelihood of experiencing significant mental health changes following the said abortion (Coleman, 2018). As Coleman (2018) further indicates, the mental health issues likely to be presented on this front were inclusive of depression and anxiety. The author also found that those who had an abortion were more likely to abuse marijuana and/or alcohol than those women who had not had an abortion. The author is in this case categorical that the present study calls into question studies that have found no link between abortion and mental health issues. As Coleman (2018) points in his own words, “calling into question the conclusions from traditional reviews, the results revealed a moderate to highly increased risk of mental health problems after abortion” (180). In yet another study incorporating a rather large sample size of more than 8,000 women, it was found that those who had an abortion at some point in their lives presented with a significantly higher risk of mental health disorders (Sullins, 2016). This was after taking into account the relevant differences on the sociodemographic front. Some of the mental health outcomes examined by the authors in this particular study were inclusive of, but they were not limited to; suicidal ideation, anxiety disorder and depression (Sullins, 2016). In yet another relatively recent study, Kulathilaka, Hanwella and Silva (2016) found that “abortion is associated with moderate to high risk of psychological problems such as depression, use of alcohol or marijuana, anxiety, depression and suicidal behaviors” (28).

There are studies, however, that appear to deny or water down the link between abortion and negative mental health outcomes. For instance, according to the American Psychological Association (2018), a comprehensive review of recent scientific literature clearly indicates that “that the relative risk of mental health problems following a single elective first-trimester abortion of is no greater risk to mental health than carrying that pregnancy to term.” Ditzhuijzen, Have, Graff, Nijnatten, and Vollebergh (2017) also indicate that no recent credible research has linked mental disorders to abortion. In yet another study seeking to establish whether there is indeed an association between mental health and abortion, Steinberg, McCulloch and Adler (2014) established that there was no statistically significant link between the procurement of an abortion and the subsequent development of certain mental health concerns including, but not limited to suicidal ideation and anxiety. The authors in this case point out that groups advocating for the outlawing of abortion have in the past claimed that abortion has a negative psychological impact on women who procure the same. However, according to the authors, there is no sufficient scientific evidence in support of these viewpoints (Steinberg, McCulloch and Adler, 2014). It is also important to note that in one particular systematic review, Charles, Polis, Sridhara, abd Blum (2008) came to the conclusion that in most high quality studies, i.e. studies that do not have any methodology flaws, no scientifically significant link between abortion and adverse mental health outcomes have been observed.

Reconciling the Conflicting Findings

The seemingly conflicting positions above appear to be as a consequence of a single phenomenon, i.e. co-occurring factors. On this front, it should be noted that as the American Psychological Association (2018) points out, whether or not a woman experiences negative mental health outcomes following an abortion could be determined by co-occurring risk factors. More specifically, as the American Psychological Association (2018) further indicates, “among women who do experience mental health issues, these issues may be related to co-occurring risk factors that predispose a woman to multiple unwanted pregnancies and mental health problems.” This is an assertion further advanced by Ditzhuijzen, Have, Graff, Nijnatten, and Vollebergh (2017) who indicate that mental disorders following the procurement of an abortion were linked to prior mental health problems and relationship problems. Yet another co-occurring factor that ought to be mentioned on this front is difficulty with which the decision to procure the abortion was made. For instance, in one study seeking to assess the emotions of women shortly after procuring an abortion, it was found that the emotional state of the said women was largely dependent upon the difficulty with which the decision to procure the abortion was made (Rocca, Kimport, Gould, and Foster, 2013). This is to say that women who had struggled with the decision on whether or not to terminate pregnancy had a higher likelihood of experiencing negative feelings a few days after procuring an abortion, than those whose decision to procure an abortion was rather straightforward. In yet another study that appears to further reinforce the findings above, Biggs, Upatdyay, McCulloch and Foster (2017) found that there are adverse mental health outcomes following an abortion that could be triggered by certain factors. The authors identified these factors as; exposure to other traumatic life events and a history of mental health conditions. Yet another co-occurring risk factor that should be taken into consideration is stigma. According to Biggs, Rowland, McCulloch, and Foster (2016), most of those who exhibit signs of distress following an abortion indicate that their distress was largely triggered by negative connotations about abortion and the fear that they could be subjected to shame and disgrace. For instance, in the words of the authors, “some women who experienced distress after an abortion reported that seeing protestors at the clinic had triggered their symptoms” (Biggs, Rowland, McCulloch, and Foster, 2016, p. 97).

Proposed Interventions

As more recent and credible studies have found, whether or not a woman experiences negative mental health outcomes following an abortion is determined by a number of co-occurring factors. Some of the co-occurring risk factors that have been highlighted in this text are inclusive of; prior mental health problems, relationship problems, the difficulty with which the decision to procure an abortion is made, and stigma. These are the concerns that should, thus, be addressed in efforts to minimize the chances of the occurrence of mental disorders among women who procure an abortion.

One of the strategies that could be embraced in this regard relates to ensuring that women have access to counseling prior to and after procuring an abortion (Broen, Moum, Bodtker, and Ekeberg, 2005). Such counseling could especially be instrumental prior to the abortion, i.e. to help the woman with the decision making process which, as has been indicated elsewhere in this text, could result in poor mental health outcomes following the abortion. One of the most crucial resources that offers pre-abortion support is All-Options (https://www.all-options.org/). On the other hand, a key resource for those who have already procured an abortion is Exhale (https://exhaleprovoice.org/).