New claims about abortion and mental illness

02.12.2008 New research published in the British Journal of Psychiatry from two studies in New Zealand and Australia has been reported in the UK press as evidence of a link between abortion and mental illness. In fact, the studies make far more limited claims.

The New Zealand study, by Professor David Fergusson and colleagues from the University of Otago, claimed that women who had abortions had rates of mental health problems that were almost 30 per cent higher than in the other women in the study. The conditions most associated with abortion included anxiety disorders and substance use disorders.

However, the researchers concluded the overall effects of abortion on mental health were small.

The study assessed some 500 women aged 15-30 who were born in Christchurch, South Island. Overall, 284 women reported a total of 686 pregnancies. These included 153 abortions in 117 women and 138 pregnancy losses, including miscarriage and stillbirths. At each interview, the women were assessed for depression, anxiety disorders, alcohol and drug dependence. None of the pregnancy outcomes other than abortion was linked with a significantly increased risk of mental health problems.

The researchers estimated that exposure to abortion accounted for 1.5-5.5 per cent of the overall rate of mental disorder in the group of women studied.

Professor Patricia Casey, professor of adult psychiatry at University College Dublin and the Mater Hospital, Dublin, in an invited commentary published alongside the research, said there was an obligation on abortion providers to inform women of the new findings.

“There are immediate medico-legal implications flowing from the finding; namely, the prospect of litigation against abortion providers for failing to provide women with information of a possible causal link between abortion and subsequent health problems,” she said. “The focus should be on identifying vulnerable groups of women and providing optimum treatment for them, whatever the aetiology of their mental health problems.”

But a second commentary from Dr Margaret Oates, consultant perinatal psychiatrist with Nottinghamshire Healthcare Trust , and her colleagues Dr Ian Jones and Dr Roch Cantwell argued against the need for mandatory counselling and informed consent for all women seeking abortion. “Informed consent for surgery does not include a warning of psychological hazard. We do not believe that the evidence is strong enough to support mandating such advice for abortion,” they said.

Oates and colleagues continued:

“Perhaps the Royal College of Psychiatrists should not have a statement on abortion. Some medical Royal Colleges have this policy. There will never be a consensus among the College’s members; indeed, there are a range of opinions among the authors of this commentary. We do, however, agree that abortion is not a psychiatric but a moral, ethical and legal issue, and that the views of College members will be as diverse as in the population at large.”

Commenting on his findings, Professor Fergusson said:

“The conclusions drawn above have important implications for the ongoing debates between pro-life and pro-choice advocates about the mental health effects of abortion. Specifically, the results do not support strong pro-life positions that claim that abortion has large and devastating effects on the mental health of women. Neither do the results support strong pro-choice positions that imply that abortion is without any mental health effects. In general, the results lead to a middle-of-the-road position that, for some women, abortion is likely to be a stressful and traumatic life event which places those exposed to it at modestly increased risk of a range of common mental health problems.”

A second study published in the British Journal of Psychiatry shows that women who lose a baby by the age of 21 – either through an abortion or a miscarriage – are three times more likely to develop a drug or alcohol problem than others.

Researcher Kaeleen Dingle, of the University of Queensland, Australia, said: “Abortion and miscarriage are stressful life events that have been shown to lead to anxiety, sadness and grief and, for some women, serious depression and substance use disorders.”

This research should be looked at in context. In August 2008, the American Psychological Association (APA) issued findings from a comprehensive two-year review of published research on abortion and mental health. This found that some studies indicate that some women experience sadness, grief and feelings of loss following an abortion, and some may experience ‘clinically significant disorders, including depression and anxiety.’ However, the task force found ‘no evidence sufficient to support the claim that an observed association between abortion history and mental health was caused by the abortion per se, as opposed to other factors.’

The APA concluded that there is ‘no credible evidence that a single elective abortion of an unwanted pregnancy in and of itself causes mental health problems for adult women’. Its review examines previous studies in this area by Fergusson and colleagues, and explains why the results of these should be treated with caution.

The UK Royal College of Obstetricians and Gynaecologists’ Guideline on induced abortion, published in 2004, states:

‘[S]ome studies suggest that rates of psychiatric illness or self-harm are higher among women who have had an abortion compared with women who give birth and to non-pregnant women of similar age. It must be borne in mind that these findings do not imply a causal association and may reflect continuation of pre-existing conditions’.

Abortion and mental health disorders: evidence from a 30-year longitudinal study. David M. Fergusson, PhD, L. John Horwood, MSc and Joseph M. Boden, PhD. The British Journal of Psychiatry (2008) 193: 444-451. doi: 10.1192/bjp.bp.108.056499

Invited commentaries on… Abortion and mental health disorders. Patricia Casey, Margaret Oates, Ian Jones, and Roch Cantwell. The British Journal of Psychiatry (2008) 193: 452-454. doi: 10.1192/bjp.bp.108.059550

Pregnancy loss and psychiatric disorders in young women: an Australian birth cohort study. Kaeleen Dingle, MPH and Rosa Alati, PhD. The British Journal of Psychiatry (2008) 193: 455-460. doi: 10.1192/bjp.bp.108.055079

Call for mental health support after abortion. Irish Times, 2 December 2008

Abortions linked to mental illness. Daily Telegraph, 30 November 2008

Also read:

Debating abortion in a therapy culture, by Dr Ellie Lee. Abortion Review, 14 October 2008