Abortion and Mental Health: Separating Science from the Junk


Not all studies on the mental
health impact of abortion are created equal. Antiabortion activists
often attempt to capitalize on the fact that the public and many policymakers
cannot distinguish between well-conducted studies and those that fall
in the "junk science" category. Fortunately, two respected teams
of researchers recently conducted separate reviews of the scientific
literature on abortion and mental health. In short: Based on the best
scientific evidence available, there is no credible evidence that abortion,
in and of itself, causes mental health problems for most women.  

In fact, according to the review by
American Psychological Association (APA)
,
methodological flaws are "pervasive in the literature on abortion
and mental health," and "the best scientific evidence indicates
that the relative risk of mental health problems among adult women who
have an unplanned pregnancy is no greater if they have an elective first-trimester
abortion than if they did deliver the pregnancy." 

Another comprehensive review
of the scientific literature, by researchers
at Johns Hopkins University
,
likewise found that "the highest-quality research available does not
support the hypothesis that abortion leads to long-term mental health
problems. Lingering post-abortion feelings of sadness, guilt, regret,
and depression appear to occur in only a minority of women." The Johns
Hopkins review also found a "clear trend" by which "the highest
quality studies had findings that were mostly neutral" in terms of
mental health outcomes for women obtaining abortions. By contrast, they
found that studies with the most flawed methodologies consistently found
negative mental health outcomes to be associated with abortion.  

Assessing the evidence  

The APA identified a number
of major flaws in the literature on abortion and mental health: failing
to compare mental health outcomes between women who have abortion and
women who have unintended pregnancies, failing to take into account
preexisting mental health conditions (that could account for both abortion
and later mental health problems), using samples that were too small
or too restricted to allow for generalizations to the larger population
of women, failing to account for the fact that many women do not report
abortions, and using faulty measurement of mental health outcomes.  

Take, for example, a recent
study authored by Priscilla Coleman and her colleagues, published in
the Journal of Psychiatric Research. The authors use data from
a nationally representative sample of women aged 15-54 years old in
1990-1992. After taking into account 21 background characteristics of
respondents, they assert that abortion is associated with 12 of the
15 mental health outcomes examined in their analysis. But several fundamental
flaws detract from the validity of their findings. Previous research
has established that only about half of abortions are reported on nationally
representative surveys, a shortcoming for which Coleman fails to correct.
If half of women who have abortions aren’t reporting them, then researchers
cannot determine if those abortions are, or are not, associated with
subsequent mental health outcomes. The authors are also unable to adequately
control for potentially pre-existing mental health problems. For example,
women who have bipolar disorder may be more likely to have an unintended
pregnancy and subsequent abortion than women who do not have bipolar
disorder. The authors’ inability to control for these types of pre-existing
mental health condition leads them to assert that abortion leads to
bipolar disorder – an unlikely causal chain given that genetic factors
are a major contributor to this particular disorder.  

Even studies with better research
designs still have their limitations. For instance, two studies from
New Zealand suggest that abortion may be associated with, or cause,
later mental health problems. These studies employed a more rigorous
methodology than many prior studies addressing the issue. The principal
methodological strength of both studies, which were conducted by David
Fergusson and colleagues, is that they followed the same groups of women
over an extended period of time. Nonetheless, the APA review of the
2006 study cautions that "several design features limit conclusions
that can be drawn from this study," among them failing to control
for the wantedness or intentionality of pregnancy, not separating women
who had multiple abortions from those who had only one, and not accounting
for the underreporting of abortion.  

A more recent Fergusson
study (published in 2008) likewise did not separate women who had multiple
abortions from those who had only one, and it did not account for underreporting
of abortion. Another problem lies in its inadequate comparison groups.
Women unable to obtain abortions go on to have unintended, or even unwanted
births, and this outcome may also have negative mental health outcomes.
The challenge, therefore, is to compare mental health outcomes between
these women and women who have abortions. The manner in which Fergusson
and his colleagues attempted to address this in their most recent study
was inadequate. Instead of directly comparing these two groups of women,
the authors compared women who had abortions to all those who had not
and women who had unintended births to all those who had not.  

The research design of one
study is judged by experts, including at the APA, as close to ideal.
The study was conducted in the United Kingdom by the Royal College of
General Practitioners and the Royal College of Obstetricians and Gynecologists.
According to the APA, this study of 13,000 women in England and Wales
"stood out from the rest in terms of its methodological rigor."
It was based on a large, representative sample; used established diagnostic
categories to measure post-pregnancy/post-abortion mental health; controlled
for mental health and other factors that may have existed prior to the
pregnancy; and had appropriate comparison groups. The study, according
to the APA "provides high-quality evidence that among women faced
with an unplanned pregnancy, the relative risks of psychiatric disorder
among women who terminate the pregnancy are no greater than the risks
among women who pursue alternative courses of action."  

The bottom line is this: A
woman’s mental health before she faces an unwanted pregnancy is the
best indicator as to her likely mental health after an abortion. As
the APA report says, "Across studies, prior mental health emerged
as the strongest predictor of postabortion mental health."

That said, however, it is important
to acknowledge that for some small group of women, abortion may be directly
associated with negative mental health outcomes. These may, in fact,
be due to a number of factors that are difficult to separate from the
abortion per se, including perceived stigma, difficult life circumstances
surrounding the pregnancy, or the termination of an intended pregnancy
for health reasons. For purposes of screening and counseling, research
that seeks to determine which women may be most vulnerable to these
types of outcomes would be useful. At the same time, as both the APA
and Johns Hopkins reviews note, women typically experience a
range of emotions following an abortion. While relief is the most common
reported emotion, some women also experience feelings of sadness or
guilt. More efforts are therefore needed to help women deal with these
emotions – whether or not they rise to the level of "negative mental
health outcomes" – through post-abortion counseling or hotlines such
as Exhale and Backline.  

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To schedule an interview with Rachel K. Jones please contact Communications Director Rachel Perrone at rachel@rhrealitycheck.org.

  • invalid-0

    An insider’s view of what went behind the APA’s conclusions may be of interest:
    http://reclaimingourchildren.typepad.com/lumina_a_ray_of_light_aft/2008/08/rachel-macnair-reports-on-apa.html

    I will concede to the many of the aforementioned weaknesses of the Fergusson study. In fact, I’ll add a newsflash: All studies have weaknesses . . . which is why it is intellectually dishonest of the author to glorify the Gilchrest study while ignoring its glaring flaws. Namely, the study design makes its conclusions non-generalizable to women in the United States: http://wiki.afterabortion.org/index.php?title=Gilchrist#Weaknesses (Yes, it’s a Wiki, but the concerns that it raises are valid and worthy of being addressed).

    Bottom line: APA officials cherry-picked studies in order to buttress a position that they wanted to hold all along. In doing so, the APA has inadvertently encouraged its members to dismiss the lived experiences of clients who regret their abortions. In the mental health field, allowing personal ideology to overshadow professional conduct with clients is normally considered unethical. I suppose that the APA was willing to make an exception for abortion.

  • emily-douglas

    Rachel, thank you for this very informative and educational post. It’s easy to dismiss research out-of-hand as biased, but much harder to explain in-depth, as you do, what makes for a good social science study. This will come in handy as we evaluate studies released for years to come. Thank you!

  • invalid-0

    you people don’t have a clue what you are talking about.

    You think there is no physcological effect after a women kills her unborn child?

  • wendy-banks

    It’s you, Jason, that has no clue! How many (non-fundy) women have you talked to that have had an unplanned pregnacy? That have raised a child alone? Very few I guess. Prehapes you are more interested in preaching to them than truely listening. Try reading more accurate scientific studies– Ones that AREN’T writen by someone that is sponored by or underwritten by a chruch or religon.

    And take off those fundimental christian blinders once and a while and look at the real world around you, it’s 2008, not 1008.

  • wendy-banks

    Sorry, Jasper, called you Jason– I was thinking about Jason and the Argonauts…

  • invalid-0

    Oh my Wendy. How judgemental you sound. Have you ever had an abortion? Are you speaking from experience or just ideological ideas? Do you know anyone who has found out they are pregnant and only think of it as a few cells growing in their body that they need to eliminate? Whenever any woman gets pregnant, young or old, they think of a BABY. From there they make decisions such as “Can I raise this baby?”, “What am I going to do about this baby?”, “Does my boyfriend/husband want this baby?” etc. It is not so simple as removing a wart. The pain that goes into the decision of ridding yourself of the baby goes far deeper then most abortion activist are willing to admit. I don’t care to debate the abortion issue but don’t down play the psychological trauma of it.

  • wendy-banks

    No, I didn’t have an abortion– But I had a miscarrage, and if I didn’t have the miscarrage before I really knew I was pregnate, I would have most likely had a abortion because there would have been NO WAY POSSIBILE I could have had a child at that point in my life. It is wrong to bring a child into the world when you are financialy, pysically, and mentally incable of taking care of it. Adoption, you say? And risk it growing up to be a rageing Fundie? (Please) What about the father? He threw me out.

    As it was, I did choose to have child (Whom is now seven) and ‘though I love her very much, she drove me into poverty (That’s the unvarnised truth). But, I do what I have to do, because she is mine and I choose to give birth to her.

    Sad about my miscarrige? Yeah, sometimes– But much more glad that I didn’t HAVE to have that child at the worst time in my life. Life’s about trama, joy, sadness, and many other things so GET OVER IT. Trust me I was much more tramatized to be molested by a male baby-sitter when I was three. But, I got over that too. So don’t harp at ME about trama Fundie Boy!

    As my Dad always says "Life’s a bitch, and then you die"

    So, grow up, face reality and stand up and fight– We ladies (an guys) here are NOT backing down!

    Goddess bless RH

  • therealistmom

    .. there would certainly be emotional repercussions. However, during my first trimester abortion I ended a pregnancy in it’s early stages, with an embryo (which at that stage was in no way self-sufficient, or even really resembled a human… more like a shrimp) that had the potential to possibly be born a child had the pregnancy continued to term. Keeping that in mind, the emotion I felt was relief that it was all over.

     A mass of dividing cells with human DNA is not the same as a child. If that was a case, we all would have to mourn tumors when they were excized.

  • invalid-0

    First of all this article does not glorify the Gilchrest study. Neither does the APA. But, you don’t understand this because you don’t understand how to interpret research findings or organizational claims. Both the author and the APA state that this study is methodologically rigorous compared to the field of studies on the topic. That is not a ringing endorsement when the “field of studies” is being cited with methodological flaws. The claims of “close to ideal” should not be considered a glowing endorsement either. We expect a study to be ideal. Basically, that means you did an ok job. An ideal study conforms to the conceptual, methodological, and analytical principles for which it was designed. When we want to glorify a study, we will classify it as exceptional or authoritative. That means that you have really analyzed the topic and carefully measured and analyzed every known variable extremely well.

    Second, you are citing wiki. Get real.

    Third, your language is ideological. You state that the APA “APA officials cherry-picked studies” and “encouraged its members to dismiss the lived experiences of clients who regret their abortions.” I guess your proof that the APA is intentionally cherry-picking studies is based upon a blog or some other source that does not have documentary evidence to support these strong claims. Who is cherry-picking?

    Additionally, and most insulting, you arrive at the conclusion that members of the APA will dismiss the lived experiences of clients who regret their abortions. Why would you assume that members would dismiss that regret? Research findings that state that abortions do not cause emotional injury does not mean that members would dismiss an individuals regret. Members do not dismiss any regret if it is significant to the individual, we treat the individual based upon what the individual expresses to us.
    Our clients have a range of issues, some of them can’t leave the house without counting everything, which was not caused by abortion, but we would not dismiss it.

    This is insulting because you don’t know what you are talking about and you accuse those of us who help women with emotional distress of being dismissive. Talk about dismissive, you have not even researched the topic enough to have a basic level of understanding. We are the ones who are their everyday, helping the people society dismisses, not you. We are the ones who care. We spend our lives caring. Of course, organizations have bad apples and the APA is no different, but those actions and individuals are not typical and are marginalized in peer reviewed discourse. You make a lot of claims with no evidence besides the links you provide. Both are unreliable.

    The only noticeable problem with the content of the article is that the author uses the statement “direct association”. This term is used but it is an expression that violates itself-conceptually. An association is just that, an association. It is specifically not a causal relationship. Therefore, any finding of association can not be interpreted as a cause. So, unless you have a study set up to examine causality then a researcher can never claim that aborts do or do not cause emotional harm. Even if an association is strong it is not causal.

    For example, crime rates and ice cream sales are perfectly correlated every year without fail. The association is extremely strong and if you map out a trend line over the summer months you will see that as one goes up the other goes up and they peak and then fall during similar time/space parameters. But ice cream sales don’t cause crime rates to increase. They both peak in the summer, I wonder if something going on there has something to do with both. Duh.

    Look, women who have unplanned pregnancies are not typical of any population. Therefore, that subgroup has a lot of things going on that are very complex. Those who choose termination are an even smaller subgroup and more complex. You can not use comparative analysis to examine the potential for emotional harm as caused by the abortion procedure. The only why to support such a claim is to track the emotional well being of women who have abortions before they are even pregnant. Otherwise you can not show that a specific event caused harm because you need a series of before and after measurements, which would include measures before the pregnancy. Regretting an abortion does not mean that an abortion caused emotional harm. A person might regret an abortion because someone that she values called her a baby killer. Before that conversation she might have felt at peace with her decision and then someone made her feel like shit about it. So, maybe we should be studying the negative emotional harm cause by narrow minded people who want to force their views on everyone else. Maybe that should be illegal, but its not because we don’t make things illegal just because they cause harm. In a free country, people are allowed to take calculated risks and suffer the consequences of mistakes. Its called being an adult.

    Your obviously a pro-lifer. I respect your decision not to get an abortion. You are not required to. You can have as many babies as you want and not even be able to support them, but you can continue to have them. So why don’t you respect other peoples decision to have an abortion and stop trying to force your religious and ideological world view down other peoples throats. If you don’t think abortion is right, then don’t get one. If you care so much about women’s mental health, then do something. What is stopping you from supporting a women who is considering an abortion, financially and emotionally, so that she gives birth? What is stopping you from supporting her for the rest of the child’s adolescence? Wait for it-wait for it-wait for it-

    Its not your responsibility, right? How dismissive!

  • mellankelly1

    Do you know anyone who has found out they are pregnant and only think of it as a few cells growing in their body that they need to eliminate?

    Um… no matter what a woman feels about her early pregnancy, it is only dividing cells.  I know that for three out of my four pregnancies I was looking forward to a healthy pregnancy and birth so that I could welcome a(nother) child into my family.  I know that one out of my four pregnancies was very much unwanted and the thought of gestating and giving birth to another child was abhorrent to me.  Did how I feel about those pregnancies change what they were?  Absolutely not.  Would I terminate my second pregnancy again under those same circumstances?  Oh yes… without even one little doubt.  Am I perfectly happy with all of my choices?  You betchya.  Under NO circumstances would I allow legislatures to make these decisions for me.

    Whenever any woman gets pregnant, young or old, they think of a BABY.

    Does it surprise you that women are aware that if a pregnancy is healthy and provided no complications she will give birth to a baby?  Do you believe that women think they’ll have a kitten after forty weeks of gestating a pregnancy?

    The pain that goes into the decision of ridding yourself of the baby goes far deeper then most abortion activist are willing to admit. I don’t care to debate the abortion issue but don’t down play the psychological trauma of it.

    Most women who terminate their pregnancies feel relief… if you’re so concerned with the psychological well-being of women then you would certainly not suggest that women be forced to gestate, give birth to and either raise or voluntarily relinquish their children to strangers.  The bottom line is that the pregnant woman is the most qualified person to be making decisions regarding her pregnancy.

  • invalid-0

    “First of all this article does not glorify the Gilchrest study.”

    In its very omission of the many flaws of the Gilchrest study, the article does in fact raise it on a pedestal. As delineated below, there are far too many flaws to classify the study as “close to ideal.” I would have liked to see Jones call them to attention. Surely it is not unreasonable to expect that from a site that claims to be giving us all a “reality check.”
    “Second, you are citing wiki. Get real.”
    Instead of taking the easy way out, how about actually addressing the tenets of the criticism?
    One of the golden rules of scientific inquiry is never to base conclusions on a complex issue from one single study; a meta-analysis of multiple studies is required at a minimum. In resting most if not all of its position on one study conducted over a decade ago in a nation with vastly different abortion screening procedures, the APA patently violated this precept. Have you read the actual report? If you go to p. 68, the conclusion dismissing abortion’s mental health consequences cites one—count ‘em—one source: Gilchrest. So it shouldn’t be surprising that that study is all that Jones could provide for us, as well.

    And on that line, have you actually read or at least reviewed the Gilchrest study? Had you done so—and at that, with a critical eye—you would have noticed that the authors did not disclose the selection process, nor the relevant demographic variables of the participants.

    Also, the psychiatric follow-ups in the Gilchrest study were performed by General Practitioners, who lack the training for in-depth DSM-IV (or ICD9 in this case) diagnoses, and not mental health professionals. Even the study’s authors conceded to this flaw.

    The most damning weakness, however, is that British law requires a rigorous screening process before women have abortions; in the study itself, in fact, 700 women in the study sample did not follow through with abortions following the requisite risk-benefit screening. We have nothing even close to this protocol in the United States, and to generalize the results of this study to our experience here is ignorant and laughable at best and deliberately dishonest at worst.

    These issues were not just raised in the Wiki that you so readily dismissed, but they are also blatantly evident in the Gilchrest study itself. Jones, whose employer is quite transparent about its ideological agenda, has brushed these flaws under the rug.
    I invite you to address them, however, and hopefully this time with a more substantive response than “get real.”
    Also for a more thorough and rigorous discussion on the topic, I suggest you take a look at the March 2008 statement by Britain’s Royal College of Psychiatrists: http://www.rcpsych.ac.uk/member/currentissues/mentalhealthandabortion.aspx

    “I guess your proof that the APA is intentionally cherry-picking studies is based upon a blog or some other source that does not have documentary evidence to support these strong claims.”

    Actually as a psychologist and APA member herself, the blogger cited in my post was a first-hand witness to the process. Short of surreptitious videotaping, I’m not sure what sort of documentary evidence you’re seeking. I’m also not sure if you’re accusing the blogger of concocting a fictitious testimony. If you are, please back the accusation with some hard evidence. Most revealing it that all of the panel members for the APA decision were avowed pro-choicers. Inviting a pro-life voice into the mix would have at least safeguarded the panel against any competing (read: ideological) interests.

    “Additionally, and most insulting, you arrive at the conclusion that members of the APA will dismiss the lived experiences of clients who regret their abortions. Why would you assume that members would dismiss that regret?”
    With all due respect, this does not even come close to what I was saying. I stated that the APA is “inadvertently encouraging its members” to be dismissive, not that its individual members are necessarily heeding the call.
    We are the ones who are their everyday, helping the people society dismisses, not you.
    And again, with all due respect, you don’t know who I am, what I do for a living, or whether or not I “[help] the people that society dismisses.” You do not know my history, my passions, my beliefs, or my own lived experiences. If you are indeed a mental health professional, I would hope that you don’t make such hasty judgments with your clients . . . and it’s not too much to ask that you don’t make them with me. I understand that this topic can generate some heavily emotional responses, but this discussion will make a lot more progress if we keep it respectful and nix “ad hominem” statements.
    “The only why to support such a claim is to track the emotional well being of women who have abortions before they are even pregnant. Otherwise you can not show that a specific event caused harm because you need a series of before and after measurements, which would include measures before the pregnancy.”
    And knowing full well the difference between cause and correlation, I would have to agree, which is why it is all the more regrettable that the APA came to the conclusions that it did. Those 700 women who did not have abortions following the screening may have had poor emotional well being. Or maybe they were “screened out” due to other factors. We’ll never know.

    “Your obviously a pro-lifer. I respect your decision not to get an abortion. You are not required to. You can have as many babies as you want and not even be able to support them, but you can continue to have them. So why don’t you respect other peoples decision to have an abortion and stop trying to force your religious and ideological world view down other peoples throats. If you don’t think abortion is right, then don’t get one.”
    OK (deep breath) here we go. I suppose that a response to my original post would inevitably contain the usual abortion rights platitudes, but I’m not averse to addressing them. First of all, your statement against forcing views on others is self-refuting, if nothing else because you’re forcing your view on me that it’s wrong to do that. More important, however, is that my argument against abortion has nothing to do with individual preference, so it’s hardly fair to frame it as an individual-choice issue. I argue that abortion unjustly kills a defenseless human being. I also hold that the abortion rights mentality is based on a patriarchal assumption that violent and invasive corrective surgery is the solution to women’s oppression. These are not statements of preference. I take abortion as seriously as I do every other human rights violation. As soon as pro-lifers are addressed with this in mind, our national discussion on abortion will make some progress. But as long as pro-life arguments are misrepresented, the debate will remain as fruitless and Sisyphean as it’s been for over 35 years.
    If you’re celebrating any of them, Happy Holidays.

  • invalid-0

    THERE SEEMS TO BE VERY ANGRY PEOPLE OUT THERE CONCERNING THIS ISSUE. I HAD AN ABORTION AT 17. I THOUGHT IT WAS MY ONLY CHOICE. FOLLOWING THE ABORTION I BECAME VERY PROMISCIOUS,(sp?) AND BECAME PREGNANT AGIN, HAD 2ND ABORTION. STILL THOUGHT IT WAS OK, ONLY THING TO DO AT THE TIME. I THOUGHT I WAS OK WITH MY DECISION BUT TRUTHFULLY THE SIGHT OF A FETUS BE IT IN BIOLOGY BOOKS ON IN A MAGAZINE WOULD SEND SHIVERS DOWN MY SPINE. I CHOSE TO IGNORE THESE FEELINGS AND WENT ON WITH MY LIFE AS USUAL, AVOIDING THESE TRIGGERS. IT WAS NOT UNTIL YEARS LATER WHEN I BECAME PREGNANT WITH MY 2 CHILDREN THAT I REALIZED THESE BLOBS OF CELLS, EMBRYOS, FETUS OR WHATEVER YOU CHOOSE TO CALL THEM ACTUALLY FEEL PAIN AT 10 WEEKS. IT TOOK TIME TO COME TO TERMS WITH MY CHOICE, IT YOU CAN CALL IT THAT. I DIDN’T REALLY FEEL I HAD A CHOICE, FELT IT WAS THE ONLY THING TO DO AT THE TIME. CHOICE WOULD HAVE INVOLVED A LITTLE MORE THOUGHT AND INFORMATION.

  • therealistmom

    .. for a 10-week human embryo to feel pain. The central nervous system is nowhere near developed enough to send signals to the brain, particularly something as specific as "pain".

     I am truly sorry you have had regrets or issues with your choice. That is exactly what the vast majority of pro-choice advocates want to avoid. We want to make sure information on EVERY option is available, that women can make their decisions with all of the facts, and that support is available for whatever she herself decides to do, without coersion. 

    Your experience is not the norm for women who are educated about their decisions and go into them willingly.

  • invalid-0

    when does it feel pain?

  • therealistmom

    … but credible sources all indicate there is NO way for a human embyro to feel pain. Pain sensors begin development fairly early in development, but the "wiring" is not in place until signifigantly later in the fetal stage. Many researchers seem to feel that the ability to feel the sensation of "pain" comes at some point during the third trimester of pregnancy, often citing approximately the 26 week mark. Because of this, on the rare occasions that a later-term abortion is performed, the doctor may choose to anaesthesize the fetus "just to be sure".

    One source I have used is religioustolerance.org, they are good researchers and try to be neutral on "hot topics". Their essay on the issue of fetal pain can be found here: 

    http://www.religioustolerance.org/abo_pain1.htm

     

  • mellankelly1

    I ditto that, realistmom… I have never been anything but happy and relieved that I ended my second pregnancy.  If I hadn’t I might never have been the woman and mother that I am to my three children.  I thank God daily that I was born into a country at a time when abortion was a safe and legal option for me.  Let’s pray that our daughter and sisters are offered the same.

     

  • invalid-0

    appreciate your reply, I would prefer a medical professional website rather than a religious one, do you know of any?

  • mellankelly1

     I would prefer a medical professional website rather than a religious one, do you know of any?

    Here is one from the Journal of the American Medical Association.

     

     

     

  • mellankelly1

     I would prefer a medical professional website rather than a religious one, do you know of any?

    Here is one from the Journal of the American Medical Association.

     

     

     

  • http://pcscleaners.com invalid-0

    Abortion can truly trigger mental health problems, why?

    Because we are made to produce life not take life,even in the bible, God said never to take someone’s life, is abortion not taking someone’s life? I’m sorry if the rest will be offended but that is my opinion, i respect everyone’s opinion so i think i should get that respect too.

    And i might add that abortion is the product of having sex at a very young age or having sex just because you feel like it.

    Better be careful, after all, we face the consequences of our actions.

  • http://www.universityloveconnection.com invalid-0

    Just curious here…

    When an Unplanned Pregnancy happens? lols
    , I am little curious about this phrase…it sounds like..oppps “I forgot that having sex can make a girl pregnant”..oppps “sorry I pop in you!”

    Its a very sounding like Unplanned Pregnancy sounds like a BIG ALIBI for having sex and being pregnant over and over again…