Anti-choice activists and politicians really want women to believe that abortion causes mental illness. Nine states even have laws requiring doctors to scare women seeking abortion by telling them, without a shred of evidence, that such a link exists. A Texas pamphlet entitled "A Woman's Right to Know", despite paying lip service to the fact that many women feel relief after an abortion (around 90 percent, actually), is clearly geared toward terrifying women into believing that this safe and legal medical procedure will shut them off from ever feeling joy again.
It's technically true, of course, that some women have negative mental health outcomes after abortion. It's also true that some women have negative mental health outcomes after eating lunch or a day at the beach. But that doesn't mean that beach outings or lunches cause depression, and there's no evidence that abortion does, either.
On the contrary, a new study published in JAMA Psychiatry, a journal of the American Medical Association, shows that poor mental health outcomes aren't linked with abortion at all. They may, however, be linked with being denied an abortion. The study, titled "Women’s Mental Health and Well-being 5 Years After Receiving or Being Denied an Abortion," was conducted by Advancing New Standards in Reproductive Health (ANSIRH), based at the University of California, San Francisco.
The study is part of an ongoing research project called the Turnaway Study, which follows 1,000 women who sought abortions and compares the outcomes of those who successfully aborted with those showed up at the clinic past the gestational limits and were turned away.
"We can say strongly at this point there is no evidence of emerging mental health problems after having an abortion," Dr. Antonia Biggs, a researcher on the study, explained over the phone.
If anything, it was in the aftermath of not getting an abortion where researchers found a linkage to mental health problems. What the Turnaway team found was that most women seeking an abortion had higher than usual rates of anxiety and low self-esteem. That's not surprising, considering how many cultural messages they may have absorbed depicting women who seek abortion services as promiscuous, lazy or stupid. As Biggs pointed out, unintended pregnancy is, in itself, a stressful event.
But women who were turned away at the clinic had even higher levels of negative mental health outcomes that women who got their abortions.
“The women who were denied an abortion, at the time they were denied an abortion, they do have more anxiety, lower self-esteem and less life satisfaction," Biggs noted.
[caption id="attachment_14658843" align="alignnone" width="619"]
Figure from "Women’s mental health and well-being five years after receiving or being denied an abortion" published in JAMA Psychiatry[/caption]
Both groups of women — women who had abortions and those who were turned away — saw a lessening of these symptoms over time. Within six months to a year, most women who were turned away saw their heightened anxiety levels drop toward the lower levels experienced by women who got abortions.
“What we found is that women are resilient, that they adapt to their current situation, and that they make the best of it," Biggs said. "At the same time, six months of feeling anxiety or low self-esteem is not something we want for women."
[caption id="attachment_14658848" align="alignnone" width="618"]
Figure from "Women’s mental health and well-being five years after receiving or being denied an abortion" published in JAMA Psychiatry[/caption]
In many states, anti-choice activists have defended restrictions on abortion, and propagandistic pamphlets like the one in Texas, on the grounds that abortion presents a genuine threat to women's mental health. To back this claim up, they have leaned on poorly designed studies, which the American Psychological Association finds unconvincing, that attempt to link mental illness and abortion.
One problem with many of these studies is they compare women who gave birth to those who had abortions. About two-thirds of women who give birth planned to become pregnant, whereas almost no women who get abortions did, which makes this a classic case of comparing apples to oranges.
The Turnaway Study, in contrast, compares apples to apples.
“Previously, we didn’t have great evidence on the impact of abortion on mental health outcomes, so one could argue that we didn’t know," Biggs said. "But I feel that this study design is so strong, by comparing two very similar groups of women. It provides very solid evidence of what the effects of abortion on women’s mental health are."
Furthermore, she says, the evidence is strong that while getting an abortion has no negative impact on women's mental health, being denied an abortion can do real damage. “If we want to protect women’s mental health, this evidence shows we want to expand access to abortion, not restrict it," Dr. Biggs said.
Despite this study's careful design and rigorous methodology, it's unlikely that the anti-choice movement will accept the findings. After all, many in the religious right continue to assert that homosexuality is a mental illness that can be "cured" through Christian-themed therapy, even though the scientific consensus, as expressed by the American Psychological Association, is that there's nothing wrong with being gay and there's no evidence you can change someone's sexual orientation by therapeutic means.
Many of the same characters promoting the homosexuality-as-disease line are pushing the notion that abortion causes mental illness. These two beliefs are clearly linked, not by scientific evidence — since there is none, for either — but by a belief that there's something unnatural or unhealthy about a person who makes sexual choices outside the confines of conservative Christian morality. Since religious conservatives believe that the primary purpose of women is to have babies, women who choose not to do so — even if they have had a baby before an abortion, or choose to have one later — must be damaged or broken.
That is an ideological or religious belief about the roles of women, not a hypothesis with any scientific support. This new study shows, yet again, that there's nothing wrong with women who have abortions, either before or after they have the procedure. On the contrary, the relationship between negative mental health outcomes and being denied an abortion suggests that women are better judges of what they need than a bunch of scolds and puritans who want to force childbirth on them.
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