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Both Sides Await Report That Charts The Effects on Mental Health
By STEPHANIE SIMON
For decades, the cultural battle over abortion has been about what goes on inside a woman's womb. But more and more, the focus is shifting to what goes on inside her head.
Activists on both sides are awaiting a comprehensive report reviewing two decades of published research on mental health and abortion, to be presented this week at the American Psychological Association's annual conference in Boston.
The report comes at a pivotal time as some judges and lawmakers have begun to make decisions in part based on peer-reviewed studies suggesting women who have had abortions are at higher risk of anxiety, depression and substance abuse.
Abortion opponents cite these studies, as well as testimony from women who describe years of psychological turmoil after abortions, to make the case that the state must restrict abortion to protect women's mental health.
The U.S. Supreme Court cited this reasoning last year in upholding a ban on a late-term procedure known as partial-birth abortion. South Dakota incorporated the same rationale into a new mandate that abortion doctors must tell prospective patients they will be putting themselves at risk for psychological distress and suicide.
The abortion-hurts-women view is also being used to promote a broad abortion ban on South Dakota's fall ballot. The argument: A woman may think she wants to end a pregnancy, may even feel relief when she does, but she will suffer for it later. So the state has a duty to stop her.
To supporters of legal abortion, this is equivalent to saying the state has a duty to warn women away from giving birth because some might later suffer postpartum depression. They acknowledge some women may regret their decision or feel sad about it, but say there is no proof abortion leads to serious mental illness -- or that women would be better off if they were forced to carry unwanted pregnancies.
Both sides agree the mental-health issue has powerful potential to shape public policy for years to come. And both hope to use the American Psychological Association's report to their advantage.
The organization has long held that abortion has no negative mental-health consequences for most women. Indeed, the psychologists' group and the separate American Psychiatric Association say it is crucial for women's mental health that they have access to safe, legal abortions.
About two years ago, the psychological association pulled its fact sheet on mental health and abortion from its Web site for updating. The result is exhaustive but ambiguous, according to reviewers who have seen drafts.
These reviewers cautioned that they haven't seen the final report. But they said the drafts state that some women may experience higher rates of emotional distress after abortions. Most vulnerable: teens and young women who feel pressured into or ambivalent about their abortions and who lack solid support networks.
The brisk conclusion paragraph on a recent draft, however, focuses on adult women seeking elective abortions in the first trimester of an unwanted pregnancy -- which covers the majority of abortions. The takeaway message: They have no greater risk of mental-health problems.
The American Psychological Association wouldn't comment until the final report is released.
But reviewers on both left and right are troubled by the draft language. Supporters of legal abortions want a more sweeping statement that abortion is safe for mental health. They say the studies that suggest potential harm are riddled with methodological error.
"I would hope it would say that there is no convincing empirical evidence that abortion is a significant cause of psychiatric illness," said Nada Stotland, president of the American Psychiatric Association, which isn't affiliated with the psychological association.
From the antiabortion side, there is frustration that the report focuses on women who do well after abortions instead of warning patients and their doctors about those who may need help.
Priscilla Coleman, a researcher at Bowling Green State University in Ohio whose work is often cited approvingly by abortion opponents, said at least 10% to 20% of women suffer serious, prolonged ill effects from abortion. "We're not doing women any favors by hiding this," she said.
For all the heated rhetoric on both sides, in the real world of clinics and crisis counselors, a middle ground appears to be emerging.
Supporters of legal abortion are increasingly acknowledging the sorrow that can come with the decision, and independent support groups are promising to help women work through their loss without promoting a political agenda.
But in 35 years of providing abortions, Susan Hill, a clinic director based in Raleigh, N.C., said she has noticed that "women today need less counseling, less psychological care than they did in 1973," when abortion was legalized but still carried an enormous stigma. Ms. Hill, who runs clinics in five southern states, has tried offering postprocedure counseling sessions -- but very few women show up, she said. "They want to get past it and move on with their lives."
Quantifying any possible mental-health effect of abortion is extremely difficult, though scores of researchers have tried. Many studies share the flaw that they rely on women self-reporting their abortion history, which is notoriously unreliable. There is also the issue of what is an appropriate control group: All women? Women who have given birth? Women who have carried an unwanted pregnancy and given the baby up for adoption?
Another problem: determining cause and effect. A woman who has had an abortion may be depressed, but that doesn't mean the abortion caused the depression. Perhaps she was in an abusive relationship, or had money trouble, or felt alone and abandoned.
Recent research has tried to control for such variables. A much-cited 2006 study drew on a New Zealand health survey that tracked a group of women for 25 years. The authors controlled for more than a dozen factors -- family stability, educational achievement, self-esteem and so on -- and still found that young women who had abortions were more likely to suffer mental-health ills than those who carried a pregnancy to term (or those who never got pregnant).
The study has limitations. It covered just 139 young women who self-reported abortions. But the study's lead author, David Fergusson, supports legal abortion -- and said he was "irked" by his own finding -- which gives his conclusion some added heft in a world in which both sides use charges of authorial bias to dismiss studies they disagree with.
Mr. Fergusson, a professor at the University of Otago in New Zealand, said he is leaning toward a belief that abortion is associated with negative mental-health outcomes, but he said it is too early to "draw strong conclusions either way." Plus, he said, even if his hunch is correct, there may be counterbalancing benefits. Aborting an unwanted pregnancy could allow a woman to finish school, get a better job and build more-fulfilling personal relationships.
He hopes the upcoming report will provide some clarity -- but with such an incendiary topic, that might be tough. As he put it: "Both sides have been able to reconstruct the same evidence to meet their agendas."
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