Some states require women seeking abortions to be counseled that they might develop mental health problems. Now a new study, considered to be the most rigorous to look at the question in the United States, undermines that claim. Researchers followed nearly 1,000 women who sought abortions nationwide for five years and found that those who had the procedure did not experience more depression, anxiety, low self-esteem or dissatisfaction with life than those who were denied it.
The findings come as the abortion debate intensifies in the United States, with President-elect Donald J. Trump promising to nominate an abortion opponent to the Supreme Court after taking office next month. The question of the effect of the procedure on women’s health, both physical and mental, has been an effective argument in recent years, used by states to enact a number of regulations and restrictions, and is likely to be a continuing part of the debate.
The study, published on Wednesday in JAMA Psychiatry, found psychological symptoms increased only in women who sought abortions but were not allowed to have the procedure because their pregnancies were further along than the cutoff time at the clinic they visited. But their distress was short-lived, whether they went elsewhere for an abortion or delivered the baby. About six months after being turned away from the first abortion clinic, their mental health resembled that of women who were not turned away and had abortions.
“What I think is incredibly interesting is how everyone kind of evens out together at six months to a year,” said Katie Watson, a bioethicist at Northwestern University’s Feinberg School of Medicine, who was not involved in the study.
“What this study tells us about is resilience and people making the best of their circumstances and moving on,” she said. “What’s sort of a revelation is the ordinariness of it.”
Called the Turnaway Study and run by the Advancing New Standards in Reproductive Health program at the University of California, San Francisco, the research strove to avoid methodological pitfalls of previous studies. Other studies compared women who had abortions with women who chose to give birth, two groups considered so different that many experts said little could be learned from comparing them. Other studies also failed to account for whether women had previous psychological issues, which turns out to put them at greatest risk for mental health problems after abortion.
The Turnaway Study accounted for mental health history and focused on women who were close to or beyond the limit of when a clinic would perform abortions, so researchers could compare women who wanted abortions at the outset. Clinic cutoff limits vary somewhat by state, but also by individual clinic decisions. Limits at the 30 clinics in 21 states in the study ranged from 10 weeks of pregnancy to the end of the second trimester, about 25 weeks.
Dr. Roger Rochat, a former director of reproductive health at the Centers for Disease Control and Prevention and a professor of global health and epidemiology at Emory University, said the study “provides the best scientific evidence” on the subject and was likely to be influential in court challenges to state laws.
“This is an incredibly powerful study,” he said. “States will continue to pass laws that restrict access to abortion services and they will do it in part based on mental health effects of abortion. But the evidence of this study says that just isn’t true.”
Randall K. O’Bannon, director of education and research for National Right to Life, said that “it’s not surprising that there’ll be this immediate sense of anxiety and frustration” for women denied abortions because “they’ve been told that their plans are being squashed.” But he emphasized that the study showed those feelings dissipated quickly, suggesting that effects of denying women abortion “were not entirely negative.”
Dr. O’Bannon had several criticisms of the study. “While it sounds to most people, I suppose, that five years is a sufficiently long time,” some women experience problems long after abortion, he said. “This study would not capture those women who had those experiences at 10 years. There are women who go through some serious trauma later on, multiple sorts of effects that they deal with, anxiety, depression, suicidal thoughts.”
Women seeking abortions are required to be counseled about possible emotional or psychological effects in 22 states, nine of which focus almost entirely on potential negative effects, according to the Guttmacher Institute, a research organization that supports abortion rights.
Although abortions in the United States are overwhelmingly obtained in the first trimester, the study included hundreds of women who sought them later in pregnancy. There were 452 whose pregnancies were within two weeks of the clinic’s limit and who received abortions and 231 women who were denied abortions because their pregnancies were up to three weeks past the clinic’s limit. The study also included 273 women who received first-trimester abortions.
Of the 231 turned away, 161 ended up giving birth and 70 miscarried or received abortions elsewhere, often requiring longer travel and more expense.
Starting one week after women sought abortions, researchers asked questions to assess psychological well-being and re-interviewed each woman every six months for five years.
M. Antonia Biggs, a social psychologist researcher and an author of the study, said that some people “would expect the women who have an abortion to have increasing depression and anxiety over time, but instead we don’t see that.” Instead, she said, the research showed that “women denied an abortion have more anxiety, lower self-esteem, less life satisfaction than women who are able to get an abortion. But by six months to a year, they’re similar to women who had an abortion.”
Another intriguing finding was that women receiving first-trimester abortions were no more or less affected than those ending pregnancies later. “People guessed that it would be more difficult to their mental health to have a later abortion procedure than to have an earlier abortion procedure, and we didn’t find that,” Dr. Biggs said.
Dr. Biggs said the study suggested that “expanding access to abortion care is more likely to protect women’s mental health than restricting women’s access to abortion care,” but she also noted some results that “might not be very pro-choicy.” Those included that none of the groups differed in experiencing depression, and that women denied abortions did not have “more long-term negative mental health consequences.”