This conversation was a long time in coming – how does abortion affect mental health? Opponents of abortion claim that getting an abortion harms mental health, but evidence from the Turnaway study (the largest study on abortion restrictions and mental health to date) shows that being denied an abortion causes more psychological problems in the short term than receiving one, and it also causes more long-term physical and financial issues. Psychological problems include anxiety and lower life satisfaction and self-esteem, though the stresses of unwanted pregnancy may contribute to these symptoms. Analyses of Turnaway indicate that the stigma of seeking an abortion plays a substantial role in stresses women experience, and that having reproductive autonomy is important for mental health. After six months, the mental health of all women in the study improved, regardless of having received an abortion or not – indicative of the psychological resilience of the study subjects. On the other hand, physical issues persist much longer: “Women who were denied an abortion and gave birth reported more chronic headaches or migraines, joint pain and gestational hypertension compared with those who had an abortion. They also reported more life-threatening complications like eclampsia and postpartum hemorrhage, and burdens that included higher exposure to domestic violence and increased poverty.”
However, the Turnaway study did not include women with a fetal diagnosis or maternal health problems and women who could not afford to get an abortion, and most of the women denied an abortion were in their second trimester. Another common criticism of Turnaway is that the participants formed only 37% of the 3,000 women who were asked to participate, and some women dropped out during the five-year-long study (only 5% were lost, however). Citing the 37% statistic, critics claim that women with negative views on abortion were less likely to want to participate in a study about abortion, and so Turnaway was biased towards pro-abortion women. The study leaders respond with the lack of evidence of such bias, instead putting emphasis on the unattractive time commitment of the study as the main cause of the 37%.
Nor is there evidence that having an abortion precipitates a negative effect on the mind. Decades of research have shown that the greatest predictor of mental health after an abortion is the woman’s prior mental health condition. When these factors were taken into account, studies found that abortion was not associated with anxiety, mood, impulse control, eating disorders, suicidal ideation, or post-traumatic stress. Some pro-life advocates assert that women feel grief and regret after an abortion, though data from Turnaway indicates that only 6% of women who received an abortion had primarily negative emotions about it five years later.
Let’s move away from abortion discussions for a moment and talk about women who do give birth. A panel of maternal mental health experts, hosted by CNN, discussed Postpartum Depression (PPD), a mood disorder that affects more than one in ten women who give birth. PPD is poorly understood by the population and neglected by health services, because it is not well recognized that mental health in motherhood can and does affect the physical health of the mother and child directly and indirectly, specifically with respect to “service uptake, health seeking behavior, preterm birth, low birth weight, babies stunting in infants, use of attendance to antiretroviral therapies or other forms of treatment.” One WHO study found that women with PPD were twice as likely to have depression four years later and were more likely to experience chronic diseases. Indeed, mental health conditions are at least as important as infectious diseases which usually garner more attention. Studies have also suggested links between the mental health of the mother and that of the child, which I mention in “Battle of the Brains”. The silence and stigma surrounding PPD contribute to the isolation of mothers, and it is necessary to educate the entire public, not just women, about it. The panel also acknowledged the lack of maternal mental health experts and infrastructure aimed at noticing and treating PPD, as well as the need for community-based, culturally specific interventions.
The panel put forth potential solutions, principally the incorporation of maternal mental health services into the existing health infrastructure of a country, so that the former is not considered separate and thus dependent upon the support of a political faction. The panel also proposed adopting the Edinburgh Postnatal Depression Scale, a standard tool used to identify PPD. Ideally, though, it is best to develop short, simple scales that are specific to regions, in order to maximize effectiveness. It is also important to address risk factors, such as poverty, domestic violence, childhood trauma, and gender inequity in general. Women who experience domestic violence during pregnancy are estimated to be three times more likely to develop PPD, and PPD is two to four times more likely for women living in poverty. As with all social issues, it is best to prevent maternal mental health issues before they appear, through lasting, wide-ranging systemic change.
I shall refrain from offering any opinions on abortion itself, and instead say that mental health of mothers forms another consideration when discussing reproductive rights. More than the abortion itself, it seems that the stigma surrounding the subject and the question of reproductive autonomy cause more stress than anything else, indicating a need for ideological solutions as well demonstrating another way in which discrimination can negatively affect a population. Moreover, it seems that people care more about the health of unborn babies than the health of the already-born mothers. PPD is just one of the many ways that women can suffer without anyone knowing, and it is also exacerbated by gender inequity. I can’t speak for women, but shouldn’t we at least talk about these issues?