Abortion and Mental Health

1 Abortion and Mental HealthEvaluating the EvidenceBrenda MajorUniversity of California, Santa BarbaraMark AppelbaumUniversity of California, San DiegoLinda BeckmanAlliant International University, Los AngelesMary Ann DuttonGeorgetown University Medical CenterNancy Felipe RussoArizona State UniversityCarolyn WestUniversity of Washington, TacomaThe authors evaluated empirical research addressing therelationship between induced Abortion and women s men-tal Health . Two issues were addressed: (a) the relative risksassociated with Abortion compared with the risks associ-ated with its alternatives and (b) sources of variability inwomen s responses following Abortion .

2 This article reflectsand updates the report of the American PsychologicalAssociation Task Force on Mental Health and Abortion (2008). Major methodological problems pervaded most ofthe research reviewed. The most rigorous studies indicatedthat within the United States, the relative risk of mentalhealth problems among adult women who have a single,legal, first-trimester Abortion of an unwanted pregnancy isno greater than the risk among women who deliver anunwanted pregnancy. Evidence did not support the claimthat observed associations between Abortion and mentalhealth problems arecausedby Abortion per se as opposedto other preexisting and co-occurring risk factors.

3 Mostadult women who terminate a pregnancy do not experiencemental Health problems. Some women do, however. It isimportant that women s varied experiences of Abortion berecognized, validated, and : Abortion , Abortion and Mental Health , psycho-logical responses to Abortion , emotional reactions to abor-tion, postabortion Mental healthSupplemental materials: 1973, the Supreme Court of the United States legal-ized Abortion in the landmark case ofRoe v. more than 35 years have passed since thisdecision, it continues to generate strong emotions as well asmoral and legal controversy.

4 Over the last two decades, oneaspect of this controversy has focused on the claim thatabortion has negative effects on women s Mental Health (Bazelon, 2007; Cohen, 2006; Lee, 2003). This criticalreview of research conducted on the Mental Health conse-quences of Abortion from 1989 to 2008 evaluates the em-pirical evidence for that claim. It is substantially based on,but also updates, the report of the American PsychologicalAssociation (APA) Task Force on Mental Health and Abor-tion (TFMHA) that APA Council received on August 13, debate on the Mental Health implications of abortioncan be traced to 1987, when then-President Ronald Reagandirected then-Surgeon General C.

5 Everett Koop to preparea Surgeon General s report on the public Health effects(both psychological and physical) of Abortion . After con-ducting a comprehensive review of the scientific literature,Koop declined to issue a report; instead, he sent a letter toPresident Reagan on January 9, 1989, in which he con-cluded that the available research was inadequate to sup-port any scientific findings about the psychological conse-quences caused by Abortion (Koop, 1989a). In subsequenttestimony before Congress, Koop stated that his letter didnot focus on the physical Health risks of Abortion because obstetricians and gynecologists had long since concludedBrenda Major, Department of Psychology, University of California, SantaBarbara; Mark Appelbaum, Department of Psychology, University ofCalifornia, San Diego; Linda Beckman, Department of Psychology, Al-liant International University; Mary Ann Dutton, Department of Psychi-atry, Georgetown University Medical Center.

6 Nancy Felipe Russo, De-partment of Psychology, Arizona State University; Carolyn West,Interdisciplinary Arts and Sciences Program, University of Washington, 2006, the APA Council of Representatives established a TaskForce on Mental Health and Abortion with the authors of this article asmembers. This article is an update of the 2008 report of that task Major s contributions to this article were supported in part bygrants from the American Philosophical Society and the James McKeenCattell are extended to Julia Cleaver, Rennie Georgieva, and YelenaSuprunova for library assistance and to Julia Steinberg for also thank the staff of the APA Women s Programs Office fortheir support.

7 Tanya Burrwell, Shari Miles-Cohen, Leslie Cameron, GabeTwose, Liapeng Matsau, and Ashlee concerning this article should be addressed toBrenda Major, Department of Psychology, University of California, SantaBarbara, CA 93106-0001. E-mail: full copy of the 2008 report of the TFMHA is available online 2009 American Psychologist 2009 American Psychological Association 0003-066X/09/$ 64, No. 9, 863 890 DOI: the physical sequelae of Abortion were no differentthan those found in women who carried to term or who hadnever been pregnant (Koop, 1989b, p.)

8 195). Koop alsotestified that although psychological responses followingabortion can be overwhelming to a given individual, thepsychological risks following Abortion were miniscule from a public Health perspective (Koop, 1989b, p. 241).To provide a scientifically informed assessment ofresearch related to this important issue, the APA conveneda panel of scientific experts in February 1989. The panelwas charged with conducting a review of the scientificliterature on psychological responses to Abortion . The panelfocused on empirical studies with the most rigorous re-search designs, reporting findings on the psychologicalstatus of women who had legal, elective, first-trimesterabortions in the United States.

9 On the basis of their reviewof this literature, the 1989 task force concluded that themost methodologically sound studies indicated that severenegative reactions after legal, nonrestrictive, first-trimesterabortion are rare and can best be understood in the frame-work of coping with a normal life stress (Adler et al.,1990, p. 43; see also Adler et al., 1992). The task forcerecognized that some individual women experience severedistress or psychopathology following Abortion but alsonoted that it was not clear that these symptoms are causallylinked to the publication of Koop s letter (Koop, 1989a) andunofficial draft report (Koop, 1989b) and of the 1989 taskforce report (Adler et al.)

10 , 1990, 1992), a number of newstudies were published in peer-reviewed journals that ad-dressed the association between Abortion and women smental Health . Some of these studies supported the conclu-sions of the 1989 task force report, whereas others chal-lenged them. Reviewers of this emerging literature havereached differing conclusions. On the basis of their reviewof the post-1990 literature, for example, Bradshaw andSlade (2003) stated,The conclusions drawn from the recent longitudinal studies look-ing at long-term outcomes following Abortion , as compared tochildbirth, mirror those of earlier reviews ( , Adler et al.