ABORTION AND MENTAL HEALTH
By Dr Margaret Sparrow, President Abortion Law Reform Association of New Zealand
February 2006
The article “Abortion in young women and subsequent mental health” (Reference 1) from the Christchurch Health and Development Study (CHDS) has put abortion back into the spotlight. Opponents of abortion claim that it proves abortion is harmful to mental health. This it does not do. It suggests that it may do. The research found a link to depression, anxiety, suicidal behaviour and substance abuse, although not alcohol dependence. What is not in dispute is that further well-controlled studies are needed before strong conclusions can be drawn.
Principal author, Professor David Fergusson is the respected Director of the CHDS, a longitudinal study of a birth cohort of 1265 New Zealand children, 635 males and 630 females, all born in Christchurch in mid 1977. Assessments have taken place at birth, 4 months, one year, annually to 16 years then at 18 years, 21 years and 25 years. When the cohort was last interviewed at the age of 25, 80% were still involved. Since 1978 Fergusson has published over 275 articles in peer reviewed journals on a wide range of topics emanating from the CHDS including breast feeding, behavioural problems, substance abuse, suicide and depression. Good researchers point out both the strengths and the weaknesses of their studies and Fergusson does this.
For the paper on abortion and mental health, records were available for between 506 and 520 women depending on the analysis. By age 25, 205 women (41% of the remaining cohort) had become pregnant on at least one occasion and 74 women (14.6% of the remaining cohort) had obtained an abortion at least once. In total these 74 women, had 90 abortions. It is a relatively small sample.
While cohort studies are extremely valuable they have their limitations. Because of the method of collecting the sample from urban Christchurch, the CHDS has never claimed to be representative of the general population. Attrition is also a limiting factor. The 506 remaining may not be representative of the original 630.
The strength of this study is that at age 25 years there are three groups from the same cohort that can be compared, the group having abortions (74), the group who were pregnant but did not have an abortion (131) and a third group with no pregnancies (301). They were able to be analysed according to their history of mental health problems classified as major depression, anxiety disorder, suicidal ideation, alcohol dependence and illicit drug dependence.
The groups could be controlled for the following characteristics: socio-demographic background, family functioning (changes of parent, parental history of offending, childhood sexual abuse, childhood physical abuse), childhood behaviour/educational achievement, childhood personality (neuroticism, self-esteem), adolescent adjustment, living with parents at 18 years+, cohabiting with partner at 18 years+. Although the researchers controlled for as many factors as they could they also caution that other confounding factors may have been overlooked.
While there is a lot of accumulated information on this cohort, important information is missing. There is a lack of what the researchers term “contextual factors” such as the extent to which the pregnancy is seen as unwanted, the extent of family and partner support and the woman’s experience in seeking and obtaining an abortion. The results may reflect the effects of unwanted pregnancy on mental health rather than the effects of abortion per se but the data was insufficient to explore this.
Another important factor that must be taken into consideration is the social environment in which abortion occurs, especially the attitudes to abortion by those with whom women interact and the level of acceptance of abortion by society. In a negative or hostile environment it is likely that there will be a predisposition to regret, guilt and poor psychological adjustment for women who choose abortion.
When compared to the official statistics for New Zealand from the Abortion Supervisory Committee, the observed rate of abortion by age 25 was 81% of the rate expected, suggesting some under reporting of abortion. This is not uncommon in studies on abortion.
A disappointing feature in the paper when discussing other research is the prominence given to American David Reardon’s research without explaining his bias. He is a well known anti-abortionist, author of “Aborted Women- silent no more”. The data that he used from the 1979 National Longitudinal Survey of Youth (USA) linking abortion and depression has since been analysed by others (Refeence 2) who reached different conclusions.
It would be interesting if the researchers of the other New Zealand longitudinal study, the Dunedin Multidisciplinary Health and Developments study, were able to analyse their data for comparison. This is a slightly earlier cohort of 1661 children born at Queen Mary’s Hospital in Dunedin between April 1972 and March 1973. Assessments have taken place at birth, three years, every two years until age 15 and at 18, 21, 26 and 32 years.
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists recently published a resource for health professionals (Reference 3) and looked at the long term risks associated with abortion, including psychological effects. They conclude that abortion is unlikely to cause immediate or lasting negative psychological consequences in healthy women. Where there is a negative association it is difficult to tell whether this is actually due to the abortion or just that there are common risk factors.
The Royal College of Obstetricians and Gynaecologists (UK) has published guidelines for the care of women requesting induced abortion. (Reference 4) They state “some studies suggest that rates of psychiatric illness or self-harm are higher among women who have had an abortion compared with women who give birth and to non-pregnant women of similar age. It must be borne in mind that these findings do not imply a causal association and may reflect continuation of pre-existing conditions.”
Another review of the literature (Reference 5) looks at current research and methodology and concludes that some of the important questions have not been answered e.g. the extent that problems can be attributed to abortion, as opposed to unplanned pregnancy or factors existing before the pregnancy. Few studies have considered the effects of abortion on the incidence of sexual and relationship problems. It is also not clear from current research what aspects of abortion are distressing for women or indeed how this could be reduced.
What we must not forget is that not having access to safe legal abortion is potentially more hazardous to a woman’s physical and mental health.
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