Study Debunks Theory of “Post-Abortion Syndrome”

Jodi Jacobson

A new study finds little support for the "abortion-as-trauma" framework pushed by anti-choice advocates who claim that a woman who chooses to terminate a pregnancy is at higher risk of mental health problems.

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:

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

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 depressedIn 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.

Analysis Politics

The 2016 Republican Platform Is Riddled With Conservative Abortion Myths

Ally Boguhn

Anti-choice activists and leaders have embraced the Republican platform, which relies on a series of falsehoods about reproductive health care.

Republicans voted to ratify their 2016 platform this week, codifying what many deem one of the most extreme platforms ever accepted by the party.

“Platforms are traditionally written by and for the party faithful and largely ignored by everyone else,” wrote the New York Times‘ editorial board Monday. “But this year, the Republicans are putting out an agenda that demands notice.”

“It is as though, rather than trying to reconcile Mr. Trump’s heretical views with conservative orthodoxy, the writers of the platform simply opted to go with the most extreme version of every position,” it continued. “Tailored to Mr. Trump’s impulsive bluster, this document lays bare just how much the G.O.P. is driven by a regressive, extremist inner core.”

Tucked away in the 66-page document accepted by Republicans as their official guide to “the Party’s principles and policies” are countless resolutions that seem to back up the Times‘ assertion that the platform is “the most extreme” ever put forth by the party, including: rolling back marriage equalitydeclaring pornography a “public health crisis”; and codifying the Hyde Amendment to permanently block federal funding for abortion.

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

Anti-choice activists and leaders have embraced the platform, which the Susan B. Anthony List deemed the “Most Pro-life Platform Ever” in a press release upon the GOP’s Monday vote at the convention. “The Republican platform has always been strong when it comes to protecting unborn children, their mothers, and the conscience rights of pro-life Americans,” said the organization’s president, Marjorie Dannenfelser, in a statement. “The platform ratified today takes that stand from good to great.”  

Operation Rescue, an organization known for its radical tactics and links to violence, similarly declared the platform a “victory,” noting its inclusion of so-called personhood language, which could ban abortion and many forms of contraception. “We are celebrating today on the streets of Cleveland. We got everything we have asked for in the party platform,” said Troy Newman, president of Operation Rescue, in a statement posted to the group’s website.

But what stands out most in the Republicans’ document is the series of falsehoods and myths relied upon to push their conservative agenda. Here are just a few of the most egregious pieces of misinformation about abortion to be found within the pages of the 2016 platform:

Myth #1: Planned Parenthood Profits From Fetal Tissue Donations

Featured in multiple sections of the Republican platform is the tired and repeatedly debunked claim that Planned Parenthood profits from fetal tissue donations. In the subsection on “protecting human life,” the platform says:

We oppose the use of public funds to perform or promote abortion or to fund organizations, like Planned Parenthood, so long as they provide or refer for elective abortions or sell fetal body parts rather than provide healthcare. We urge all states and Congress to make it a crime to acquire, transfer, or sell fetal tissues from elective abortions for research, and we call on Congress to enact a ban on any sale of fetal body parts. In the meantime, we call on Congress to ban the practice of misleading women on so-called fetal harvesting consent forms, a fact revealed by a 2015 investigation. We will not fund or subsidize healthcare that includes abortion coverage.

Later in the document, under a section titled “Preserving Medicare and Medicaid,” the platform again asserts that abortion providers are selling “the body parts of aborted children”—presumably again referring to the controversy surrounding Planned Parenthood:

We respect the states’ authority and flexibility to exclude abortion providers from federal programs such as Medicaid and other healthcare and family planning programs so long as they continue to perform or refer for elective abortions or sell the body parts of aborted children.

The platform appears to reference the widely discredited videos produced by anti-choice organization Center for Medical Progress (CMP) as part of its smear campaign against Planned Parenthood. The videos were deceptively edited, as Rewire has extensively reported. CMP’s leader David Daleiden is currently under federal indictment for tampering with government documents in connection with obtaining the footage. Republicans have nonetheless steadfastly clung to the group’s claims in an effort to block access to reproductive health care.

Since CMP began releasing its videos last year, 13 state and three congressional inquiries into allegations based on the videos have turned up no evidence of wrongdoing on behalf of Planned Parenthood.

Dawn Laguens, executive vice president of Planned Parenthood Action Fund—which has endorsed Hillary Clinton—called the Republicans’ inclusion of CMP’s allegation in their platform “despicable” in a statement to the Huffington Post. “This isn’t just an attack on Planned Parenthood health centers,” said Laguens. “It’s an attack on the millions of patients who rely on Planned Parenthood each year for basic health care. It’s an attack on the brave doctors and nurses who have been facing down violent rhetoric and threats just to provide people with cancer screenings, birth control, and well-woman exams.”

Myth #2: The Supreme Court Struck Down “Commonsense” Laws About “Basic Health and Safety” in Whole Woman’s Health v. Hellerstedt

In the section focusing on the party’s opposition to abortion, the GOP’s platform also reaffirms their commitment to targeted regulation of abortion providers (TRAP) laws. According to the platform:

We salute the many states that now protect women and girls through laws requiring informed consent, parental consent, waiting periods, and clinic regulation. We condemn the Supreme Court’s activist decision in Whole Woman’s Health v. Hellerstedt striking down commonsense Texas laws providing for basic health and safety standards in abortion clinics.

The idea that TRAP laws, such as those struck down by the recent Supreme Court decision in Whole Woman’s Health, are solely for protecting women and keeping them safe is just as common among conservatives as it is false. However, as Rewire explained when Paul Ryan agreed with a nearly identical claim last week about Texas’ clinic regulations, “the provisions of the law in question were not about keeping anybody safe”:

As Justice Stephen Breyer noted in the opinion declaring them unconstitutional, “When directly asked at oral argument whether Texas knew of a single instance in which the new requirement would have helped even one woman obtain better treatment, Texas admitted that there was no evidence in the record of such a case.”

All the provisions actually did, according to Breyer on behalf of the Court majority, was put “a substantial obstacle in the path of women seeking a previability abortion,” and “constitute an undue burden on abortion access.”

Myth #3: 20-Week Abortion Bans Are Justified By “Current Medical Research” Suggesting That Is When a Fetus Can Feel Pain

The platform went on to point to Republicans’ Pain-Capable Unborn Child Protection Act, a piece of anti-choice legislation already passed in several states that, if approved in Congress, would create a federal ban on abortion after 20 weeks based on junk science claiming fetuses can feel pain at that point in pregnancy:

Over a dozen states have passed Pain-Capable Unborn Child Protection Acts prohibiting abortion after twenty weeks, the point at which current medical research shows that unborn babies can feel excruciating pain during abortions, and we call on Congress to enact the federal version.

Major medical groups and experts, however, agree that a fetus has not developed to the point where it can feel pain until the third trimester. According to a 2013 letter from the American Congress of Obstetricians and Gynecologists, “A rigorous 2005 scientific review of evidence published in the Journal of the American Medical Association (JAMA) concluded that fetal perception of pain is unlikely before the third trimester,” which begins around the 28th week of pregnancy. A 2010 review of the scientific evidence on the issue conducted by the British Royal College of Obstetricians and Gynaecologists similarly found “that the fetus cannot experience pain in any sense prior” to 24 weeks’ gestation.

Doctors who testify otherwise often have a history of anti-choice activism. For example, a letter read aloud during a debate over West Virginia’s ultimately failed 20-week abortion ban was drafted by Dr. Byron Calhoun, who was caught lying about the number of abortion-related complications he saw in Charleston.

Myth #4: Abortion “Endangers the Health and Well-being of Women”

In an apparent effort to criticize the Affordable Care Act for promoting “the notion of abortion as healthcare,” the platform baselessly claimed that abortion “endangers the health and well-being” of those who receive care:

Through Obamacare, the current Administration has promoted the notion of abortion as healthcare. We, however, affirm the dignity of women by protecting the sanctity of human life. Numerous studies have shown that abortion endangers the health and well-being of women, and we stand firmly against it.

Scientific evidence overwhelmingly supports the conclusion that abortion is safe. Research shows that a first-trimester abortion carries less than 0.05 percent risk of major complications, according to the Guttmacher Institute, and “pose[s] virtually no long-term risk of problems such as infertility, ectopic pregnancy, spontaneous abortion (miscarriage) or birth defect, and little or no risk of preterm or low-birth-weight deliveries.”

There is similarly no evidence to back up the GOP’s claim that abortion endangers the well-being of women. A 2008 study from the American Psychological Association’s Task Force on Mental Health and Abortion, an expansive analysis on current research regarding the issue, found that while those who have an abortion may experience a variety of feelings, “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.”

As is the case for many of the anti-abortion myths perpetuated within the platform, many of the so-called experts who claim there is a link between abortion and mental illness are discredited anti-choice activists.

Myth #5: Mifepristone, a Drug Used for Medical Abortions, Is “Dangerous”

Both anti-choice activists and conservative Republicans have been vocal opponents of the Food and Drug Administration (FDA’s) March update to the regulations for mifepristone, a drug also known as Mifeprex and RU-486 that is used in medication abortions. However, in this year’s platform, the GOP goes a step further to claim that both the drug and its general approval by the FDA are “dangerous”:

We believe the FDA’s approval of Mifeprex, a dangerous abortifacient formerly known as RU-486, threatens women’s health, as does the agency’s endorsement of over-the-counter sales of powerful contraceptives without a physician’s recommendation. We support cutting federal and state funding for entities that endanger women’s health by performing abortions in a manner inconsistent with federal or state law.

Studies, however, have overwhelmingly found mifepristone to be safe. In fact, the Association of Reproductive Health Professionals says mifepristone “is safer than acetaminophen,” aspirin, and Viagra. When the FDA conducted a 2011 post-market study of those who have used the drug since it was approved by the agency, they found that more than 1.5 million women in the U.S. had used it to end a pregnancy, only 2,200 of whom had experienced an “adverse event” after.

The platform also appears to reference the FDA’s approval of making emergency contraception such as Plan B available over the counter, claiming that it too is a threat to women’s health. However, studies show that emergency contraception is safe and effective at preventing pregnancy. According to the World Health Organization, side effects are “uncommon and generally mild.”

News Abortion

Leading Anti-Choice ‘Expert’ Suggests Women Turn to Crisis Pregnancy Centers to Cope With Abortion Restrictions

Ally Boguhn

Though crisis pregnancy centers often lie to women to persuade them not get an abortion, Priscilla Coleman suggested that people dealing with the additional financial and geographical barriers imposed by waiting periods turn to those organizations for help.

A leading anti-choice “expert” suggested during an interview with Rewire at the National Right to Life Convention last week that women should turn to crisis pregnancy centers to cope with the barriers to abortion care, including obstacles she helped create.

Priscilla Coleman, one of the “False Witnesses” previously featured on Rewire for her egregious falsehoods about the supposed link between abortion and mental health, said that the “scientific information” she provides in her speaking engagements and through her nonprofit, the World Expert Consortium for Abortion Research and Education (WECARE), has helped get anti-choice bills passed in states, particularly South Dakota.

Though her work has been widely discredited by the scientific and medical community, Coleman has nonetheless frequently appeared as an “expert witness” in trials and hearings. As Coleman told Rewire, she is “not a medical doctor” but has nonetheless “been really involved for ten years now with South Dakota” and its anti-choice legislation. This included the South Dakota Informed Consent Law (HB 1166), and what she deemed to be an “anti-coercion bill,” seemingly referring to HB 1217, which requires that a woman seeking an abortion wait 72 hours and visit a crisis pregnancy center prior to the abortion.

Coleman acknowledged that the anti-choice laws in the state such as the waiting period had created barriers to care, as “women have to … get a hotel, you know, or find a way back” to clinics.

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

“And that’s the complaint on the other side, that it’s making access more difficult,” Coleman went on, “but as all the data out there is showing the long-term effects of abortion, spending three more days to make the decision is in the women’s best interest, no matter what side you’re on.”

When pressed to respond to those who note that anti-choice restrictions make accessing abortion more difficult, Coleman replied that she “would just say that it’s worth a three-day hotel room and … if you’re going to pay for an abortion, allow an extra couple hundred dollars … to take some time because it has lifetime implications.”

Coleman, however, struggled to account for how one might come up with that money.

“Well, they’re somehow coming up with the money for the abortion,” said Coleman. “I’m not familiar enough with fees and things, but my understanding is that most women, no matter how poor they are, still have to pay for the procedure. Is that correct?”

Though crisis pregnancy centers often lie to women to persuade them not get an abortion, Coleman suggested that those dealing with the additional financial and geographical barriers imposed by waiting periods turn to those organizations for help.

“I’m sure that if they contacted crisis pregnancy centers … women could find a place to stay for a couple of days,” said Coleman. “I’m sure that many people affiliated with those centers would be happy to house the women in their own home if there is a room for them.”

The other anti-choice law Coleman connected herself with, HB 1166, uses the same falsehoods she claims her research supports. South Dakota’s so-called informed consent law requires doctors to receive consent prior to performing an abortion, and mandates that physicians provide those seeking care with written information that, among other things, falsely claims there is a connection between abortion and both “depression and related psychological distress” and “increased risk of suicide ideation and suicide.”

Coleman “served as an expert in South Dakota” after Planned Parenthood affiliates challenged the legislation, according to WECARE’s website.

As the Guttmacher Institute explains, all states already require patients consent prior to receiving medical care, and materials provided by the states that require mandated abortion counseling often offer “information that is irrelevant or misleading.”