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REPORT OF THE APA TASK FORCEON MENTAL HEALTH AND ABORTION EXECUTIVE SUMMARY
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Executive Summary
The Council of Representatives of the American Psychological
Association charged the Task Force on
Mental Health and Abortion (TFMHA) with “collecting,
examining, and summarizing the scientific research
addressing the mental health factors associated
with abortion, including the psychological responses
following abortion, and producing a report based
upon a review of the most current research.” In considering
the psychological implications of abortion,
the TFMHA recognized that abortion encompasses a
diversity of experiences. Women obtain abortions for
different reasons; at different times of gestation; via
differing medical procedures; and within different personal,
social, economic, and cultural contexts. All of
these may lead to variability in women’s psychological
reactions following abortion. Consequently, global
statements about the psychological impact of abortion
on women can be misleading.
The TFMHA evaluated all empirical studies published
in English in peer-reviewed journals post-1989 that
compared the mental health of women who had an
induced abortion to the mental health of comparison
groups of women (N=50) or that examined factors
that predict mental health among women who have
had an elective abortion in the United States
(N=23). This literature was reviewed and evaluated
with respect to its ability to address four primary
questions: (1) Does abortion cause harm to women’s
mental health? (2) How prevalent are mental health
problems among women in the United States who
have had an abortion? (3) What is the relative risk
of mental health problems associated with abortion
compared to its alternatives (other courses of action
that might be taken by a pregnant woman in similar
circumstances)? And, (4) What predicts individual
variation in women’s psychological experiences following
abortion?
A critical evaluation of the published literature revealed
that the majority of studies suffered from
methodological problems, often severe in nature.
Given the state of the literature, a simple calculation
of effect sizes or count of the number of studies that
showed an effect in one direction versus another was
considered inappropriate. The quality of the evidence
that produced those effects must be considered to
avoid misleading conclusions. Accordingly, the
TFMHA emphasized the studies it judged to be most
methodologically rigorous to arrive at its conclusions.
The best scientific evidence published indicates that
among adult women who have an unplanned pregnancy
the relative risk of mental health problems is
no greater if they have a single elective first-trimester
abortion than if they deliver that pregnancy. The
evidence regarding the relative mental health risks
associated with multiple abortions is more equivocal.
Positive associations observed between multiple
abortions and poorer mental health may be linked
to co-occurring risks that predispose a woman to
both multiple unwanted pregnancies and mental
health problems.
The few published studies that examined women’s
responses following an induced abortion due to fetal
abnormality suggest that terminating a wanted pregnancy
late in pregnancy due to fetal abnormality
appears to be associated with negative psychological
reactions equivalent to those experienced by women
who miscarry a wanted pregnancy or who experience
a stillbirth or death of a newborn, but less than
those who deliver a child with life-threatening abnormalities.
The differing patterns of psychological experiences observed
among women who terminate an unplanned
pregnancy versus those who terminate a planned and
wanted pregnancy highlight the importance of taking
pregnancy intendedness and wantedness into account
when seeking to understand psychological reactions to
abortion.
None of the literature reviewed adequately addressed
the prevalence of mental health problems among
women in the United States who have had an abortion.
In general, however, the prevalence of mental
health problems observed among women in the United
States who had a single, legal, first-trimester abortion
for nontherapeutic reasons was consistent with normative
rates of comparable mental health problems in
the general population of women in the United States.
Nonetheless, it is clear that some women do experience
sadness, grief, and feelings of loss following termination
of a pregnancy, and some experience
clinically significant disorders, including depression
and anxiety. However, the TFMHA reviewed 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.
This review identified several factors that are predictive
of more negative psychological responses following
first-trimester abortion among women in the United
States. Those factors included perceptions of stigma,
need for secrecy, and low or anticipated social support
for the abortion decision; a prior history of mental
health problems; personality factors such as low self-esteem
and use of avoidance and denial coping strategies;
and characteristics of the particular pregnancy, including
the extent to which the woman wanted and felt
committed to it. Across studies, prior mental health
emerged as the strongest predictor of postabortion mental
health. Many of these same factors also predict negative
psychological reactions to other types of stressful
life events, including childbirth, and, hence, are not
uniquely predictive of psychological responses following
abortion.
Well-designed, rigorously conducted scientific research
would help disentangle confounding factors and establish
relative risks of abortion compared to its alternatives,
as well as factors associated with variation among
women in their responses following abortion. Even so,
there is unlikely to be a single definitive research study
that will determine the mental health implications of
abortion “once and for all” given the diversity and complexity
of women and their circumstances.
Read the Report
To view the full report please visit
http://www.apa.org/pi/wpo/mental-health-abortion-report.pdf. 
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