Among women seeking abortion care, those denied access to such care are more likely than those able to access it to experience mental health issues in the short term, according to a study published Wednesday in JAMA Psychiatry, the New York Times reports.
According to the Times, the findings counter antiabortion-rights laws passed based on claims that abortion is linked to negative mental health outcomes. The Guttmacher Institute reports that 22 states require women to receive counseling about possible emotional and psychological effects of abortion care. In nine states, the counseling is almost entirely on alleged negative effects (Belluck, New York Times, 12/14).
Methodology
The new study draws data from the ongoing Turnaway Study (Biggs et al., JAMA Psychiatry, 12/14).
The study included 452 women who received abortion care within two weeks of the gestational limit at the facility where they sought care, 231 women who were denied abortion care because their pregnancy was up to three weeks after the facility's limit and an additional 273 women who received first trimester abortion care. Among the 231 women turned away, 161 gave birth and 70 either experienced a miscarriage or obtained abortion care elsewhere.
For the study, researchers conducted an initial interview with women one week after they sought abortion care, and then followed up with each woman every six months for five years (New York Times, 12/14). The researchers noted that 37.5 percent of women initially asked to participate did so, and that 42 percent of those 956 women were lost in the follow up over the five-year period (Walker, MedPage Today, 12/14).
According to lead author Antonia Biggs of the University of California-San Francisco, the study made comparisons among women who were seeking abortion care as opposed to comparing women seeking abortion care with women who wanted to continue pregnancy (Seaman, Reuters, 12/14). The study also accounted for women's previous mental health history.
Key findings
The researchers found that within six months of having sought abortion care, women who were denied care experienced more depression, anxiety, low self-esteem and dissatisfaction than women who received it. Further, the researchers observed that women who received abortion care did not see a higher incidence of mental health issues than women who had to continue their pregnancies.
In addition, the researchers found that women who received abortion care during the first trimester were not more or less affected by the experience than women who received abortion care later in pregnancy.
After about six months to one year of having sought abortion care, women who were denied care and women who received it reported similar mental health. However, the number of women reporting depression and anxiety in the turnaway group who did not carry a pregnancy to term remained static, rather than improving over time.
Discussion
According to Biggs, the findings suggested that "expanding access to abortion care is more likely to protect women's mental health than restricting women's access to abortion care" (New York Times, 12/14).
Citing state laws that require providers tell women seeking abortion care that accessing such care can endanger mental health, Briggs added, "This research shows the information they are mandating women receive (is) inaccurate and out of date." Briggs continued, "We don't have evidence that abortion leads women to have worse mental health." However, the researchers cautioned that the findings did not show that denying women abortion care caused the increase in mental health issues (Reuters, 12/14).
Separately, 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 new study "provides the best scientific evidence" on the topic and is likely to be influential in court challenges to state laws. "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," Rochat said, adding, "But the evidence of this study says that just isn't true" (New York Times, 12/14).
Jessica Atrio, a physician at Montefiore Hospital and Albert Einstein College of Medicine, also discussed the study's findings in relation to biased counseling laws. "Abortion care is mired in social stigma and entangled in legislative barbed wire that ultimately harms women and obstructs a physician's ability to compassionately take care of women," she said. Atrio continued, "It is immoral and unethical to require women to undergo a consent process that addresses medically inaccurate and false information such as her risk of depression or breast cancer. Similarly it is unethical to delay the provision of care with mandated [delays] or unindicated procedures and testing."
Steven Goldstein, an OB-GYN physician at NYU Langone Medical Center, said, "This study goes a long way to finally demonstrate scientifically that being denied an abortion may initially be associated with more psychological harm to women than having one" (MedPage Today, 12/14).
Raegan McDonald-Mosley, chief medical officer at Planned Parenthood Federation of America, also praised the study. "Every woman should have accurate information about all of her options," she said, noting, "That information should support a woman, help her make a decision for herself, and enable her to take care of her health and well-being. It should not be provided with the intent of coercing, shaming, or judging a woman" (Reuters, 12/14).
