Forget About Abortion, Let’s Focus on the Mental Health Effects of Pregnancy and Parenting


Here’s an idea courtesy of the Guttmacher Institute:

The body of evidence [Editor's note: related to abortion and mental health] is now so robust that researchers should consider shifting their focus to related issues that might be more valuable to explore, such as the factors that cause women to experience mental health problems in the first place.

The latest study in a long history of rigorous research (on which we’ve reported most recently here and here) revealing a lack of cause and effect between abortion and mental health has been released to much media hoo-ha and predictable anti-choice defensiveness. The American Psychological Assocation, as far back as 1989, found that legal abortion “does not pose a psychological hazard for most women.” In 2008, an APA task force, according to the Guttmacher Institute, concluded that:

“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 firsttrimester abortion than if they deliver the pregnancy.”

But here we are. It’s 2011 and we’re still undertaking studies to confirm what we already know. This most recent study, carried out by Danish researchers and published in this month’s New England Journal of Medicine, tracked a whopping 84,620 girls and women in Denmark who had a first trimester abortion or who had birthed a baby (for the first time). Researchers found that those women and girls who had an abortion sought mental health treatment at approximately the same rate both prior- and post-abortion while women who had a baby sought counseling at increased rates, post-partum. Shocked? No, neither was I.

Those who identify politically – first and foremost – as “pro-life,” even if they are public health professionals or healthcare providers, have attempted to dismantle the methodology in this recent Danish study with the precision one might use to carefully dismantle a house of cards, with the goal of discrediting the conclusions. But, at what point do we, as the Guttmacher Institute points out in a more diplomatic way, put this issue to rest?

Perhaps most harmful to women is the fact that we allow crisis pregnancy centers to continue operating using the underlying misrepresentation that abortion causes psychological trauma. It is, in fact, a foundational value for CPCs. Most recently, a report undertaken in Washington State found that every single crisis pregnancy center investigated offered false or misleading information on pregnancy and birth to the young women who visit the centers. Central to the misinformation? The post-abortion stress disorder claim. Center staff told patients, in an effort to scare them away from choosing abortion, to beware of “post-abortion syndrome.” There is no such syndrome which exists and neither the APA nor the American Psychiatric Association recognizes such a disorder.

The Danish study actually confirms that in fact childbirth is more psychologically traumatic for women than is abortion; a significantly well-researched idea that I assume crisis pregnancy centers don’t choose to share with the women they see. Yet, we have heaps of evidence that reveal how much effect childbirth can have on a woman’s mental health – we’ve been advocating long and hard for the research and studies necessary to shine a light on post-partum mood disorders and to find resources to help treat those disorders. Women who decide to carry their pregnancies to term face a greater chance of experiencing some sort of mental health issue than women who choose to have an abortion. Many still don’t know enough about post partum mood disorders as they should. That goes for both mothers-to-be and new parents, as well as providers.

And though this has historically been a less welcomed discussion in all but the most intimate of circles, we must be willing to confront the less comfortable reality that unwanted pregnancies may have a long term mental health consequence as well. As Delia Lloyd writes on Politics Daily:

I’m sure there are many women who’ve had abortions that they regret.

But…I’m also sure that there are many women who regret having had children they’re incapable of raising.

That’s an uncomfortable truth. But that doesn’t make it any less true.

Here lies another inconvenient truth, so to speak. While pregnancy and birth have been presented to girls and women on a silver platter from an early age, we as women understand that the “gift” of pregnancy is not always a welcome one. Deciding to carry a pregnancy to term when you don’t want to may turn out to be the most wondrous experience one could ever hope to have; and it may be an awful nightmare.

Even when it is the most unimaginably blissful of offerings in the form of a wanted pregnancy, childbirth brings with it the risk of postpartum mood disorders ranging from depression and anxiety for many women, to full-blown psychosis for a relatively small few. Postpartum mood disorders are very real for hundreds of thousands of women each year. Given the stunning lack of focus on the issue, however, you’d be hard pressed to know this. In fact, approximately 950,000 women each year suffer from some sort of post-partum mood disorder. And, to be clear, this is the number of women who self-report a mental health struggle postpartum. Clearly, the number is even higher. Still, if that’s a difficult number to put in perspective, allow the expert behind the blog Postpartum Progress to put it into context for you:

How does that compare with the incidence among women of other major diseases in America?

  • Each year less women — approximately 800,000 — will get diabetes. (Nat’l Diabetes Information Clearinghouse)
  • Each year about 300,000 women suffer a stroke.  (Centers for Disease Control)
  • Each year approximately 205,000 women are diagnosed with breast cancer.  (National Cancer Institute)

In fact, more women will suffer from postpartum depression and related illnesses this year than the combined number of new cases for men and women of tuberculosis, leukemia, multiple sclerosis, Parkinson’s disease, Alzheimer’s disease and epilepsy. 

So isn’t it obvious that those who are opposed to women having access to safe, legal abortion in this country have very little concern for the psychological well-being of women and girls? In fact, I’d argue they have a complete disregard for it. How else to explain the exploitation of a non-existent diagnosis to manipulate women into a particular decision – childbirth – which does carry a very real risk of mental health issue for millions of women?

Please don’t misunderstand. I have two children and if a woman wants to be a parent, understanding the risks and benefits for her particular situation and what types of support and resources are available can help immensely. But how is it that we get to the present day, enmeshed in a political battle which uses immense political capital, time and money to present a false case to women that accessing safe, legal abortion care will harm us psychologically, to the point where we should outlaw even the option, while we struggle to find the resources and funding to address real, honest struggles facing women who chose to carry a pregnancy to term?

If these types of studies can do anything to move us towards a more realistic portrait of the impact of women’s reproductive and sexual health decisions upon our psychological health, they can be used to do two things. One, these studies allow us to recognize the range of emotions and experiences women have whether we’re talking about pregnancy, childbirth, abortion, offering a child up for adoption, adopting a child, experiencing a stillbirth of a baby, a miscarriage – in effect, any number of experiences related to pregnancy and procreation. Secondly, the Danish study, by comparing the psychological struggles related to both abortion and childbirth, can help strengthen the case for more funding and support towards postpartum research and treatment.

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  • j-parker

    One, these studies allow us to recognize the range of emotions and experiences women have whether we’re talking about pregnancy, childbirth, abortion, offering a child up for adoption, adopting a child, experiencing a stillbirth of a baby, a miscarriage – in effect, any number of experiences related to pregnancy and procreation.

    Thank you for this, Amie. At Backline (http://yourbackline.org) we know that many women need support both before and after an abortion decision, just as these same women need support before and after the decision to become pregnant, to parent, or to place a child for adoption. We would love to see more attention being paid to the ways that all of us, as advocates, providers and community members, can provide more compassion and unconditional support to women across the spectrum of pregnancy experiences.

    The disproportionate focus on abortion is one of the unfortunate but unsurprising outcomes of the political battle over abortion rights. Over the past few years, we have seen more discussion of adoption from people on both sides of the abortion issue (the discussion is still incomplete, but we are talking about it at least). Yet neither the pro-choice or anti-choice movements have really given the time or energy they could to support the option of parenting for all women – regardless of age, race, income, language, or location. There is so much more we could all be doing to ensure women have the resources and support they need to be the best mothers they can be to their children.

  • amie-newman

    All I can write is, yes yes yes. I agree and only wish for more space in the public realm and on the individual level to have women share experiences honestly and openly whether it’s about abortion, adoption, birth, wanted pregnancies, unwanted pregnancies – not only have women’s bodies been coopted but our experiences as well. We’re afraid to share authentically except in the safest and most intimate of settings (and even then not always) because we fear our experiences and emotions being used or manipulated in some way for political gain.

    Thanks to Backline for the AMAZING work you all do!!!

    Amie

  • notwaff

    Reality Check!

    Psychology Today reports that millions of women experience PASS (Post Abortion Stress Syndrome) :

    “A woman can be of sound and solid mind when she makes a choice to terminate a pregnancy, but it is never an easy decision. Even when it is the right decision, there is sometimes a level of conflict that needs to be addressed so that the woman can be at peace with her choice. Believing that PASS exists does not mean that one does not believe in a woman’s right to choose; it simply means that one believes in supportive and constructive counseling around the trauma symptoms.”

    http://www.psychologytoday.com/blog/somatic-psychology/201010/post-abortion-stress-syndrome-pass-does-it-exist

     

  • arekushieru

    For some women, abortion is a VERY easy decision.  If I were to ever get pregnant, it would be an easy decision.  

    Btw, you’re missing the context, so let me point it out for you: 

    Women’s reasons for having an abortion are always highly personal, but it’s important to remember that some women might choose to have an abortion after experiencing rape at the hands of a stranger or someone they know. Conversely, at times women may feel compelled not to follow through with a pregnancy under pressure from a husband, boyfriend, or family member. In any case, it is usually thought of as a solution to stressful circumstances.

     

    It is important to note that this is not a term that has been accepted by the American PsychiatricAssociation or the American Psychological Association.

     

    Nevertheless, any event that causes trauma can indeed result in PTSD, and abortion is no exception.

    It is noted in the article, itself, that it is not peer-reviewed or medically accredited.  This is merely an opinion blog piece.  Kthxbai.

  • colleen

    Nevertheless, any event that causes trauma can indeed result in PTSD, and abortion is no exception.

    By this definition pregnancy and labor can both result in PTSD.

  • arekushieru

    Exactly.

  • crowepps

    ANY event which is traumatic to the person undergoing it can result in PTSD. 

  • crowepps

    There really is a HUGE difference between a carefully constructed, large double blind study published in a peer reviewed journal and an article on a BLOG linked to a popular science magazine.  I’m sure the author of the article makes a nice living convincing women the root of their unhappiness lies in their abortion.   I suppose if you don’t have any friends to talk to then paying someone to provide “supportive and constructive counseling” is a worthwhile use of your money.  But there isn’t any SCIENCE behind these claims.  They are the equivalent of the myths about satanic cults running daycares that were so popular 25 years ago or so, and frankly, bunkum.

  • ahunt

    Ohhhh, be snotty, crowepps. Your runny nose is often the highlight of my day.

  • prochoiceferret

    “A woman can be of sound and solid mind when she makes a choice to have a baby, but it is never an easy decision. Even when it is the right decision, there is sometimes a level of conflict that needs to be addressed so that the woman can be at peace with her choice. Believing that postpartum depression exists does not mean that one does not believe in a woman’s right to choose; it simply means that one believes in supportive and constructive counseling around the trauma symptoms.”

     

    Postpartum depression (ICD-9 648.4, ICD-10 F53.0) is recognized by the WHO and other mainstream mental-health organizations.

     

    You have been RH Reality Checked!

     

  • crowepps

    Sure do get tired of people who can’t figure out that “This is scientifically proven” is NOT the same as “willing to confirm biases and support prejudices if there’s a buck in it”.

  • ahunt

    Hey…shit sells…

  • crowepps

    And some will believe any lie, no matter how ludicrous, if someone with Rev. in front of their name asks for donations to fight against it.

     

    P.T. Barnum said there was a sucker born every minute.  He should have added that the best place to find collections of them is at church on Wednesday night.

  • ldan

    Precisely. And they don’t each get their own label, unlike Post-partum depression/psychosis/etc. which are not considered to be PTSD.

  • ahunt
  • arekushieru

    And this is exactly what I was saying to Princess Rot and something that colleen mentioned, as well, presenting facts to someone presupposes that they are open-minded to another ideology when the majority of them have shown that not to be the case….

    As a person with a non-verbal learning disability quite a few things appear to have cognitive dissonance, but does that mean I don’t try to reconcile the two seemingly diparate thoughts?  No.  

    So, people like this tend to grate on me.

  • crowepps

    PTSD is an individual REACTION to trauma.  Every single person who is in a car accident does not react the same – some shrug it off in days, some have overcome their anxiety by the time they’re physically recovered, and others develop PTSD and suffer crippling anxiety for years.  The likelihood of developing PTSD may depend on their preexisting functioning levels. 

    To say that “car accidents cause PTSD” would be inaccurate, since MOST people involved in car accidents do NOT develop that problem and instead the cause is the way individual persons REACT to the car accident. 

    Somewhat higher rates of this disorder have been found to occur in African Americans, Hispanics, and Native Americans compared to Caucasians in the United States. Some of that difference is thought to be due to higher rates of dissociation soon before and after the traumatic event (peritraumatic), a tendency for individuals from minority ethnic groups to blame themselves, have less social support, and an increased perception of racism for those ethnic groups, as well as differences between how ethnic groups may express distress.

    ….

    women are twice as likely as men to develop PTSD.

     

    http://www.medicinenet.com/posttraumatic_stress_disorder/article.htm

    So if you want to INCREASE the level of PTSD, you encourage women to bury their honest emotions and tell them they should feel something different, you encourage them to blame themselves, you stigmatize their normal behavior to reduce their social support, and tell them they have to be ‘serve’ others so they understand they have no value.  Sounds like the ProLife platform to me.  No wonder women who hang around with them are driven crazy.

  • crowepps

     presenting facts to someone presupposes that they are open-minded to another ideology when the majority of them have shown that not to be the case….

    There aren’t different facts for different ideologies, and understanding and taking into account established facts doesn’t mean anybody has to be “open-minded to another ideology”.  If, however, ones ideology includes fantasies like “the doctors can always save them both” or “abortion is never necessary to save women’s lives” then it’s absolutely necessary to close your eyes, plug your ears with your fingers and loudly sing la la la la la.  It’s also a total waste of time for other people to attempt discussing things with someone in that position.

  • arekushieru

    All health care is based on certain facts.  There are different ideological approaches to health care based on individual governments’ interpretations of those facts.   As in what would ‘benefit’ them the most.  Most people turn a blind eye to different interpretations of these facts, even when it would be provident to do so.  As the article ahunt linked to pointed out.  

  • crowepps

    I wasn’t criticizing your post at all.  My point was that SOME ideologies depend on totally ignoring those “certain facts” of health care altogether because they prove ON THEIR FACE their ideology is based in fantasy.

     

    As for instance a number of posts about Rep. Speier’s speech which reference that she didn’t really have an abortion at all because it was “treatment for a miscarriage” which apparently magically changes the name of the operation into something else, or which asked plaintively why “the baby wasn’t just delivered” when at 17 weeks along the fetus was less than 7 inches long and weighed less than 5 ounces.

     

    A

  • arekushieru

    Must. Read. More. Carefully. Next time.  Because the following would have been clear evidence as to what you actually meant:

    There aren’t different facts for different ideologies

    *Sigh* Mark it up to an interruption in my brain’s programming…? ><;

  • crowepps

    When I wander off down interesting side paths, I probably need to be a little more clear that’s what I’m doing.  Personally, I have just about zero interest in discussing ideologies; I’m having a hard enough time getting the know facts across to people whose concept of how reproduction works seems to be at the same level as that of the ancient greeks.  Certainly Bobby Franklin’s use of the term homunculus is based in an understanding of reproductive biology that was discredited and discarded by actual scientists about the time our country was founded.