An error in this article was corrected at 2:23 pm, Tuesday, December 21st. The earlier version provided an incorrect link. The link to the actual paper on the study reported in this article can be found here and below.
A study published this fall in the leading journal Social Science and Medicine found little support for the “abortion-as-trauma” framework pushed by anti-choice advocates who claim that a woman who chooses to terminate an unintended and untenable pregnancy is at higher risk for mental health problems because of the procedure, including everything from depression to suicide.
In fact, authors of the new study, conducted by Julia R. Steinberg (Department of Obstetrics, Gynecology, and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California) and Lawrence Finer (Guttmacher Institute) attempted–and were unable–to replicate results from an earlier study by Priscilla Coleman and colleagues (2009).
Using the US National Co-morbidity Survey (NCS), write Steinberg and Finer:
Coleman, Coyle, Shuping, and Rue (2009) published an analysis indicating that compared to women who had never had an abortion, women who had reported an abortion were at an increased risk of several anxiety, mood, and substance use disorders.
But, Steinberg and Finer continue, “[Coleman's] results are not replicable.”
That is, using the same data, sample, and codes as indicated by those authors, it is not possible to replicate the simple bivariate statistics testing the relationship of ever having had an abortion to each mental health disorder when no factors were controlled for in analyses.
Replication involves the process of testing research results and is a critical factor in developing evidence because it helps assure results are valid and reliable, helps identify the variables that may play a role in research findings, can be used to test the application of results to the real world, and may suggest new avenues of research to further refine scientific findings.
“We were unable to reproduce the most basic tabulations of Coleman and colleagues,” says Steinberg, postdoctoral fellow at UCSF, in a statement.
“Moreover, their findings were logically inconsistent with other published research—for example, they found higher rates of depression in the last month than other studies found during respondents’ entire lifetimes. This suggests that their results are substantially inflated.”
(See another article debunking anti-choice mental health claims on which we reported in November.)
The authors carefully examined the question of whether abortion is a causal factor in mental health outcomes or whether pre-existing mental health conditions may be co-factors in unintended pregnancies leading to abortion.
[A]mong women with prior pregnancies in the NCS, we investigated whether having zero, one, or multiple abortions (abortion history) was associated with having a mood, anxiety, or substance use disorder at the time of the interview. In doing this, we tested two competing frameworks: the abortion-as-trauma versus the common-risk-factors approach. Our results support the latter framework. In the bivariate context when no other factors were included in models, abortion history was not related to having a mood disorder, but it was related to having an anxiety or substance use disorder. When prior mental health and violence experience were controlled in our models, no significant relation was found between abortion history and anxiety disorders. When these same risk factors and other background factors were controlled, women who had multiple abortions remained at an increased risk of having a substance use disorder compared to women who had no abortions, likely because we were unable to control for other risk factors associated with having an abortion and substance use.
Steinberg and Finer also examined other well-established risk factors for post-pregnancy mental health problems, such as preexisting mental health disorders and sexual or physical violence before the abortion, and found that women who had had multiple abortions were more likely to have experienced these risk factors prior to the abortion than women who had had one or no abortions. Once they controlled for these factors, they found no significant relationship between abortion history and subsequent mood or anxiety disorders. These findings support the view that previous mental health status, and not abortion experience per se, is the strongest predictor of post-abortion mental health.
[W]e found little support for the abortion-as-trauma framework. Instead, our findings suggest that structural, psychological, and sociodemographic risk factors associated with both having an abortion and having poor mental health drive a relationship between abortion and mental health.
“Antiabortion activists have relied on questionable science in their efforts to push inclusion of the concept of ‘postabortion syndrome’ in both clinical practice and law,” says Finer, director of domestic research at the Guttmacher Institute. “Our inability to replicate the findings of the Coleman study makes it clear that research claiming to find relationships between abortion and poor mental health indicators should be subjected to close scrutiny.”
What seems clear is that given these findings, the public discourse about abortion and mental health is not only misplaced, but, by dismissing the real issues confronting women with unintended pregnancies, may also be further reinforcing those factors of powerlessness, voicelessness, and despair that drive conditions like depression in the first place.
This makes perfect–though devastating–sense. For example, low-income women and women hit hardest by the economic recession have a harder time accessing preventive care such as contraceptive supplies and ongoing care, such as support for depression and other mental health problems. This is self-reinforcing; the inability to seek or afford help increases isolation and the feelings of despair that contribute to depression.
The current economic situation is another factor. The recession has increased the number of women struggling to afford and access basic health care. Using Census data, for example, Guttmacher has calculated that the number of women ages 15 to 44 covered by private insurance fell by 2.3 million, from almost 39 million in 2008 to only 36.7 million in 2009.
Meanwhile, the number of women who were uninsured rose by more than 1.3 million, and the number of women on Medicaid increased by more than one million. In 2009, 22.3% of all women of reproductive age were uninsured and 14.8% were on Medicaid, compared with 20.1% and 13.2%, respectively, in 2008. Notably, the rate of reproductive age women who are uninsured rose faster—and was significantly higher—than for the U.S. population overall.
Women from low-income groups are about twice as likely as those from higher-income groups to be depressed. In one study, the depression rate for women of all income groups was 20.4 percent. Higher rates of depression also have been reported in low-income minority groups, specifically blacks, as well as young mothers and women without a social support network.
A woman facing serious economic hardship and already struggling to take care of her family while also struggling to gain consistent access to contraceptive supplies is more likely to experience an unintended pregnancy. Any depression experienced likely has more to do with those pre-existing conditions than with any decision to terminate that pregnancy, should she decide to do so. Deciding to terminate an unintended or untenable pregnancy might, in fact, help alleviate depression by allowing a woman some modicum of control over her own life. But her needs are not even in the public conversation about these issues because of the obsessive fixation with trying to prove abortion is “bad.”
It is perhaps not surprising then that Steinberg and Finer conclude that “policy, practice, and research… should focus on assisting women at greatest risk of having unintended pregnancies and having poor mental health—those with violence in their lives and prior mental health problems.” In other words, help solve the problem and stop focusing on the symptom.