Summary of "Mental Health Diagnosis 3 Years After Receiving or Being Denied an Abortion in the United States," Biggs et al., American Journal of Public Health, December 2015.
"There has been much interest in understanding the effects of abortion, one of the most commonly performed surgical procedures, on women's mental health outcomes," with leading research on the topic finding "no evidence of mental health harm from an abortion," according to M. Antonia Briggs of Advancing New Standards in Reproductive Health at the University of California-San Francisco and colleagues.
According to the researchers, the study "report[s] on the first 3 years of a 5-year longitudinal study, the Turnaway Study, which was specifically designed to examine the psychological consequences of undergoing or being denied an abortion in the United States." They noted that their study "further contributes to the literature" on the topic "by assessing diagnoses of new depression and anxiety disorders that may have occurred in women at any point up to 3 years after having sought an abortion."
Methods
The researchers noted that study participants in the Turnaway Study "were recruited at abortion facilities with the latest gestational limit for providing abortion of any facility within 150 miles," with gestational age limits at participating clinics "rang[ing] from 10 weeks through the end of the second trimester."
According to the researchers, study participants were divided into three groups, including:
- "[T]he near-limit abortion group — women who presented for an abortion up to 2 weeks under a facility's gestational limit and who received abortions";
- "[T]he turnaway group — women who presented for abortion up to 3 weeks over a facility's gestational limit and who were denied abortions; and
- "[T]he first-trimester abortion group — women in their first trimester who received abortions."
According to the researchers, "Study participants included English- and Spanish-speaking women aged 15 years or older with no known fetal anomalies or demise." The participants "presented for abortion care between January 2008 and December 2010 at 30 facilities throughout the United States within the gestational age specifications of" one of the three study groups.
The researchers interviewed study participants by phone eight days after the abortion procedure and again by phone every six months for three years. The interviews "included questions &helip; about [participants'] socio-demographic characteristics, experiences becoming pregnant, pregnancy planning, and the abortion decision-making process." The researchers also asked if and when participants reported a professional diagnosis of depression, a professional diagnosis of anxiety, a self-diagnosis of depression or a self-diagnosis of anxiety.
Results
The researchers assessed a final sample of 877 women: "413 women in the near-limit group, 210 women in the turnaway group, and 254 women in the first-trimester group." According to the researchers, the women in the turnaway group were further divided into those who gave birth (turnaway-birth group) and those who miscarried or had an abortion (turnaway-no-birth group).
Overall, the researchers found that, three years after an abortion, the "cumulative probability" that women would experience a professional diagnosis of depression was between 9% and 14%, with no variation among the study groups. Meanwhile, the probability that women would experience a professional diagnosis of anxiety was 10% to 16%, with no variation among the study groups.
According to the researchers, there was no statistically significant difference among study groups "in new cases of professionally diagnosed depression or anxiety" or self-diagnosed depression. However, the researchers found that "women in the first-trimester and turnaway-no-birth groups were at greater odds of new self-reported anxiety" than women in the near-limit group. Meanwhile, women across all groups were more likely to report a new self-diagnosis of depression "in the first 2 years after having sought an abortion ... than during the 30- to 36-month study interval."
The researchers also conducted "sensitivity analyses limited to the women from sites with high recruitment rates." The findings "were mostly consistent with [the] main findings, with the exception that the turnaway-no-birth group was significantly more likely than near-limit women to report new professional diagnoses of depression ... and the first-trimester group was significantly more likely than the near-limit group to report new self-diagnoses of depression."
Meanwhile, another sensitivity analysis that excluded women in the turnaway-birth group who placed their children up for adoption also was "consistent with [the] main findings, except that the turnaway-birth group was now significantly more likely to experience a new self-diagnosis of anxiety than the near-limit group," the researchers wrote.
Discussion
Noting that their findings are consistent with prior studies, the researchers write that they found that "women who obtained a later abortion were not at increased risk for experiencing a new diagnosed depression or anxiety condition than women who carried an [unintended] pregnancy to term or women who obtained a first-trimester abortion."
According to the researchers, it "is not known" why women in the first-trimester abortion group were slightly more likely than those in the near-limit group to "experience or report" a self-diagnosis of anxiety. Overall, however, the researchers noted that women in the turnaway-no-birth group "were most likely to develop a self-diagnosed anxiety condition," possibly because women "who were able to obtain an abortion after having been denied one likely had to overcome several barriers related to cost, travel, and identifying a provider."
While the researchers found "that the onset of professionally diagnosed depression or anxiety does not differ by study group ... both women who received an abortion and women who gave birth were more likely to report self-diagnoses of depression in the first year after having sought an abortion than at the end of the study period." According to the researchers, this "finding suggests something other than having an abortion, potentially the experience of having an unintended pregnancy or the circumstances that lead women to want to terminate the pregnancy, place women at risk for feeling depressed for some time after seeking an abortion."
Further, the study found that while "self-diagnosed depression was more common closer to the time of seeking abortion than after 3 years, this experience did not differ by study group." According to the researchers, "Among women seeking an abortion near facility gestational age limits, those who obtained one were at no greater risk of depression or anxiety than women who carried an unwanted pregnancy to term." They noted that their findings affirm prior research showing that "abortion is not associated with adverse mental health outcomes" and "cal[l] into question the appropriateness of policies that mandate counseling of all women who obtain an abortion on the psychological effects that can accompany them."
The researchers concluded that "the assumption that all women experience a negative psychological response after an abortion is not supported by this study." Rather, they explained that "[t]he more frequent occurrence of new mental health diagnoses immediately after abortion and being denied an abortion does suggest that other factors in women's lives, not the experience of the abortion procedure or its aftermath, are associated with more adverse mental health outcomes."
