Abortion and Mental Health: Let’s Let the Facts Speak for Themselves
As politicians have grown increasingly active in their attempts to limit abortion access, one of the concerns they often cite is potential psychological harm to people who have abortions. When South Carolina was considering a 6-week abortion ban in 2019, one of the themes cited by people arguing for the ban was that people who have abortions are the “victims” of serious, negative, and lasting emotional consequences. Several states require pre-abortion “counseling” that goes above and beyond the informed consent requirements for other medical procedures and specifically requires warnings about negative psychological impacts of abortion. Even the US Supreme Court is not immune; in their 2007 Gonzales vs. Carhart decision (which allowed certain types of second-trimester abortions to be outlawed by Congress), the majority cited protecting women by preventing potential “regret” over their abortions as a reason to allow the banning of these procedures. But do these arguments hold any water?
What Is the Turnaway Study and Why Does It Matter?
As a practice specializing in reproductive mental health, we want to assure you that the answer is no. This is not just our opinion. There is no evidence that abortion causes short-term or lasting mental health problems. But how do we know? A lot of the data that will be discussed in this post comes from The Turnaway Study, which is a large, multi-site study that looked at women seeking abortions around the US between 2008-2010. They collected data both from women who were able to get the abortions they were seeking, as well as from women who were turned away from having an abortion (typically due to being past a clinic’s gestational age limit). The researchers also collected follow-up data from both groups of women so they could look at potential longer-term consequences of having or being denied a wanted abortion. This study is not only important because of its large scope and scale, but also because it examines the impacts of being denied an abortion and unwanted childbearing, which, up to the point of the study, was not something that was often considered when discussing abortion.
Myth: Abortion leads to serious negative mental health consequences.
Fact: Having a wanted abortion is not associated with mental health harm.
Despite the oft-expressed worries about the potential mental health harm of abortions, there is no evidence to support the idea that having an abortion is psychologically harmful. In the Turnaway study, the researchers found that women who had been denied abortions had higher levels of distress than those who were able to have abortions shortly after the denial, and that over time, there were no significant differences in distress, suicidal ideation, substance abuse, or mental health problems between these two groups.
Research has shown, however, that perceiving a high degree of abortion stigma (that is, thinking others would judge you if they knew you had an abortion) is associated with increased psychological distress years post-abortion. High perceived social stigma around abortion has been associated with depressive symptoms, even when women did not express a high degree of self-judgment over their abortions. Similarly, people who experience barriers to obtaining abortions (such as having to travel or wait for abortions due to restrictions where they live) experience more anxiety and distress at the time of seeking abortion due to these obstacles. Thus, it is not the procedure itself or self-judgment that causes distress, but worries about being judged by others that have a negative impact. This suggests that the stigma we attach to abortion appears to be an important factor in influencing how people feel about abortions; the very mechanisms our society puts into place to ostensibly “protect” health and well-being actually contribute to distress post-abortion, because they increase stigma.
Myth: Most people regret having an abortion.
Fact: The most common emotion people experience post-abortion is relief.
The Turnaway study found that the vast majority of women who had abortions (97%) felt it was the right decision a week later; five years later, this increased to 99% of women expressing that the abortion was the right decision for them. Notably, the same study found that at all the time points that women were asked about their emotions post-abortion, the predominant emotion was relief. Regret for other elective medical procedures such as plastic and bariatric surgeries is far higher than what is reported for abortion. This throws cold water on the paternalistic notion that we must prevent abortion due to a high degree of post-abortion regret, especially when we allow other elective procedures to proceed without the high degree of regulation and rigmorale required to obtain an abortion.
Myth: Abortion restrictions are necessary to keep women from being coerced into abortions by abusive partners.
Fact: Making abortions difficult or legally perilous to obtain is associated with an increased likelihood of violence in a relationship or increased likelihood of staying with an abusive partner.
Despite rhetoric about women being forced into having abortions by abusive partners, research has shown that women are more likely to be coerced/forced into pregnancy versus into abortion by abusive partners. Women also often cite abusive partners as a reason that they wish to obtain an abortion; they cite either hoping to end the relationship or not wanting an ongoing tie to their abuser. The Turnaway Study found that women who were denied an abortion were more likely to stay in contact with violent partners than women who were not. Additionally, as states have criminalized helping someone seeking abortion care or attempted to criminalize leaving the state to seek care, there has been an increase in reports of abusive partners threatening to involve the police if women seek abortions. Thus, making it difficult to obtain an abortion appears to make people less safe and more subject to the very real negative consequences of intimate partner violence.
What This Tells Us About Stigma
Of course, people can have myriad complicated emotional responses to abortion. It is not our job to say what is the “right” response or course of action when someone is making reproductive health decisions. However, we must acknowledge the reality that, by and large, abortion is not the emotionally destructive force that some suggest it is and that, when there are negative emotional consequences, they are often associated with stigma, as opposed to regret or feelings of despair around terminating a pregnancy. This suggests that instead of working towards shaming people out of seeking abortion, we need to work on increasing our acceptance of this very common procedure and conversations on how to help women be seen, heard, and supported.
We Are Here for Whatever You Are Feeling
If you are looking for a stigma-free space to process whatever feelings have come up after an abortion, we are here to help. Our providers are outspoken about our support for reproductive autonomy so that our patients can trust they will receive supportive care no matter what. Interested in learning more? Reach out to us today.
Author:
Jillian Neill, PsyD is a licensed psychologist at Dr. Emma Basch & Associates, specializing in perinatal mental health, neurodivergence, and ADHD in women. She works with pregnant and postpartum individuals, new parents, and couples navigating the profound transition to parenthood. Learn more about Dr. Neill →
