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APA Briefing Paper on The Impact of Abortion on Women

The Impact of Abortion on Women: What Does the Psychological Research Say?

The research shows that the ability of women to make decisions about their own childbearing (e.g., timing) is a necessary condition for their health and mental health, as well as for their families. Abortion is a safe medical procedure that carries relatively few physical or psychological risks and that yields positive outcomes when the alternative is unwanted pregnancy (Adler, Ozer, & Tschann, 2003). It is an important choice that calls for serious consideration.

Who Has Abortions?

  • According to the Centers for Disease Control and Prevention (2003), the abortion rate was 16 per 1,000 women aged 15 to 44 in 2000. The highest percentage of abortion (52%) was for women under 25 years of age, who were white (57%) and unmarried (81%). Women aged 20 to 24 obtained 33% of all abortions, and teenagers obtained 19%.

  • Of women who had an abortion, 55% were white, 35% were black, and 7% were of other races. Black women were three times as likely as white women to have an abortion (30 versus 10 per 1,000 women), and Hispanic women were about twice as likely (22 per 1,000 women).

  • About three-fourths of all abortions were among never-married women. Over 60% of abortions were among women who had one or more children. About 13,000 women had an abortion following rape or incest.

Physical Risks and Consequences of Abortion

  • Legal abortion is less dangerous than pregnancy. In 1999, as in previous years, deaths related to legal abortions occurred very rarely, at a rate of less than one per 100,000 abortions. The overall pregnancy-related mortality rate was nearly ten times higher (Centers for Disease Control and Prevention, 2003).

  • Abortion may avoid negative health consequences, especially for teenage mothers. Unintended and unwanted childbearing can have negative health consequences, including greater chances for illness for both the mother and child. The adverse consequences of teenagers’ inability to control their childbearing can be particularly severe. Teenage mothers are more likely to suffer toxemia, anemia, birth complications, and death. Babies of teenage mothers are more likely to have low birth weight and suffer birth injury and neurological defects. Such babies are twice as likely to die in the first year of life as babies born to mothers who delay childbearing until after age 20 (Russo & David, 2002).

Psychological Responses Following Abortion

  • Low risk of psychological harm. Well-designed studies of psychological responses following abortion have consistently shown that risk of psychological harm is low. Some women experience psychological dysfunction following abortion, but post-abortion rates of distress and dysfunction are lower than pre-abortion rates. Moreover, the percentage of women who experience clinically relevant distress is small and appears to be no greater than in general samples of women of reproductive age. A recent study showed not only that rates of disorders, such as depression and posttraumatic stress disorder (PTSD), were not elevated in a large sample of 442 women followed for two years post-abortion, but also that the incidence of PTSD was actually lower in women post-abortion than the rate in the general population (Adler et al., 2002).

  • Positive functioning and educational attainment two years later. A study of adolescent abortion followed 360 adolescents over two years after they had been interviewed when seeking a pregnancy test. Some had a negative pregnancy test, some were pregnant and carried to term, and some were pregnant and aborted their pregnancy. The adolescents who chose abortion showed significant drops in anxiety and significant increases in self esteem and internal control in the period immediately following the abortion to two years later. They appeared to be functioning as well as, or even better than, adolescents who had a negative pregnancy test or had carried to term. They were also most likely to have higher economic well-being; most likely to be in high school (and performing at grade level) or to have graduated; and less likely to have a subsequent pregnancy (Zabin, Hirsch, & Emerson, 1989).

  • Psychological measures within normal range. Available data show that mean scores on psychological measures are well within normal bounds for minors as well as for adults who have undergone an abortion. The data do not suggest that legal minors are at heightened risk of serious adverse psychological responses compared with adults following an abortion or with peers who have not undergone an abortion (Zabin et al., 1989).

  • Positive emotions more often experienced. Freely chosen legal abortion, particularly in the first trimester, has not been found to be associated with severe psychological trauma, despite the fact that it occurs in the stressful context of unwanted pregnancy. The time of greatest stress is before the abortion. A woman’s emotional responses after experiencing an unwanted pregnancy terminated by abortion are complex and may involve a combination of positive and negative emotions. Positive emotions are more often experienced, and they are experienced more strongly than negative emotions, both immediately after the abortion and during the months following it (Russo & Zierk, 1992).

  • Higher risk for psychopathology if pre-existing emotional problems. While there is little risk for severe post-abortion psychopathology for women in general, it is important to recognize that some women, particularly those with pre-existing emotional problems, are at higher risk for negative emotional responses after abortion due to their individual history than are other women (Russo & Zierk, 1992).

  • Effects of stress are relative. Abortion may be a stressful experience, however, it may also reduce the stress resulting from an unwanted pregnancy and from the events that led to the pregnancy being unwanted. The effects of abortion cannot be separated from the effects of the experience of unwanted pregnancy and from the effects of the context in which the pregnancy occurred (Russo & Zierk, 1992).


  • Circumstances must be taken into account. In studying responses to abortion, one needs to take into account the circumstances of the conception, as well as those following conception. If the conception is planned, the resulting pregnancy is likely to be wanted. However, changing circumstances (e.g., separation from one’s partner or adverse results of genetic testing) may cause an initially planned, intended, and wanted conception to become an unwanted pregnancy. The circumstances leading to this change may themselves be sources of stress and distress, and should be taken into account in evaluating a woman’s response following abortion. That is, in some cases, it is the unwanted pregnancy that is the source of stress, not necessarily the abortion (Adler, 1992).

  • Poor social outcomes often arise for unwanted children, especially of teenage mothers. Unintended and unwanted childbearing has been linked with a variety of social problems, including divorce, poverty, child abuse, and juvenile delinquency. One study found that unwanted children were less likely to have a secure family life. As adults, they were more likely to engage in criminal behavior, be on welfare, and receive psychiatric services. Another study found that children who were unintended by their mothers had lower self esteem than their intended peers 23 years later. Research has shown that social and psychological problems persist, partially because the mothers are themselves from disadvantaged backgrounds with poor prospects for future education and employment. Children born to teenage mothers are more likely to have lower achievement scores, poorer school adjustment, and more problem behaviors than children born to older women (Russo & David, 2002).


  • Negative outcomes persist in the best of circumstances. Longitudinal research has found that when abortion is denied, the resulting children are more likely to have a variety of social and psychological problems -- even when they are born to adult women who are healthy with intact marriages and adequate economic resources (Russo & David, 2002).

Recommendations

1. Access to legal abortion to terminate an unwanted pregnancy is vital to safeguard both the physical and mental health of women. Research indicates that abortion does not generally have a negative impact on either women’s physical or mental health. A forced, unwanted pregnancy, on the other hand, could place women’s health and well-being at risk.

2. Mental health consultation needs to be readily available for the small number of women who would benefit from such intervention following abortion. Mental health professionals should explore factors, such as psychological distress and low self esteem, that may have contributed to the unwanted pregnancy. Through the therapeutic process, it is vital to enhance the coping ability of women (including adolescents) to equip them with ways to prevent future unwanted pregnancies.

3. Education and career development programs need to be available for young women to enhance self esteem and increase access to resources associated with employment and income. Given the general decline in self esteem among adolescent girls and high rates of unintended pregnancy, the school system must begin teaching young girls that a career is in reach and that early pregnancy is not a viable alternative to a high school diploma. Professional psychologists, social workers, and guidance counselors all have important roles to play in the development of such programs.

References

Adler, N.E. (1992). Unwanted pregnancy and abortion: Definitional and research issues. Journal of Social Issues, 48(3), 19-35.

Adler, N.E., David, H.P., Major, B.N., Roth, S.H., Russo, N.F., & Wyatt, G.E. (1992). Psychological factors in abortion: A review. American Psychologist, 47, 1194-1204.

Adler, N.E., Ozer, E.J., & Tschann, J. (2003). Abortion among adolescents. American Psychologist, 58 (3), 211-217.

Centers for Disease Control and Prevention. (2003). Abortion surveillance-United States, 2000, Morbidity and Mortality Weekly Report, 52(SS12), 1-32.

Prochoice Forum, Division 35, the Society for the Psychology of Women, the American Psychological Association. 2004

Russo, N. F., & Zierk, K.L. (1992). Abortion, childbearing, and women. Professional Psychology: Research and Practice, 23(4), 269-280.

Zabin, L S., Hirsch, M.B., & Emerson, M.R. (1989). When urban adolescents choose abortion: Effects on education, psychological status, and subsequent pregnancy. Family Planning Perpectives, 21, 248-255.

For further information please contact Lori Valencia Greene of the APA Public Policy Office at 202-336-5931.

March 2004


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