Almost one half of all pregnancies worldwide ends in reproductive loss.[1] This is a shocking statistic yet, despite the striking frequency of reproductive loss, there is relatively little public discussion about its harms. Not surprising, researchers with different points of view reach different conclusions about the extent of these harms, and these issues continue to be hotly debated and politically exploited, leaving post abortive grieving women and their loved ones in the cross hairs. In this presentation, I’ll summarize the body of research surrounding reproductive loss and its association with mental health harms.
Perinatal Loss refers to the spontaneous loss of miscarriage or stillbirth. In general. a baby who dies before 28 weeks of pregnancy is referred to as a miscarriage, and babies who die at or after 28 weeks of pregnancy and up to one month after birth are stillbirths.
Reproductive Loss refers to either perinatal loss or the induced loss of an abortion.
Loss is a deprivation of or painful separation from a beloved.[2]
Every year, about one in four pregnancies ends in perinatal loss worldwide. This includes approximately 23 million miscarriages, 2.6 million stillborn deaths and 1.8 million neonatal deaths.[3] These numbers could be even higher because miscarriages and stillbirths are not systematically recorded even in developed countries.[4]
About 95 – 98% of all perinatal losses occur in Subsaharan Africa, due to such socioeconomic risk factors as child marriage, female genital mutilation, and disease. [5] In 2019, about 22 out of every 1000 total births in sub-saharan Africa were stillbirths, with Uganda reporting about 18 stillbirths for every 1000 total births and northern Uganda reported a striking 40 stillbirths for every 1000 births. By comparison, Western Europe reported only 3 stillbirths out of every 1000 total births. [6]
Perinatal loss is associated with a high risk of physical and mental health disorders that leave some families with a trail of financial hardship and emotional poverty. Beyond the many physical complications from miscarriage, such cardiovascular disease, premature mortality, and diabetes, [7] what is too often not discussed – is that women can be mentally affected or even traumatized by perinatal loss. Many mothers who experience a perinatal death report immediate sadness, depressed mood, preoccupation, and irritability.[8] As the World Health Organization confirms, “Many women who lose a baby in pregnancy can go on to develop mental health issues that last for months or years,” and for some expectant mothers, the emotional toll of perinatal death is sufficiently severe to lead to a psychiatric diagnosis.[9] [10] A 2022 meta-analysis examining 29 studies from 17 countries showed that miscarriage was associated with an increased risk of depressive/anxiety disorders, obsessive-compulsive disorders and post-traumatic stress disorders.[11] Women who miscarry have 2.5 times the risk for major depressive disorder;[12] 1 in 3 women who miscarry have symptoms of PTSD one month after miscarriage, and 1 in 4 have symptoms of moderate to severe anxiety.[13]
Left untreated, mental disorders following perinatal loss can lead to further psychiatric symptoms, such as major depressive disorder, post-traumatic stress disorder, anxiety, and complicated grief, and these complications can in turn predispose mothers to physical disease, marital break-up and financial hardship.[14] and a lack of mental health interventions can prolong and even exacerbate the grief.[15]
Now let’s turn to the 2d kind of reproductive loss, medically induced abortion About 1/3 of all pregnancies and about 2/3 of all unintended pregnancies ends in induced abortion. This means about 73 million induced abortions worldwide each year.[16] In the U.S. in 2020, 1 in 5 pregnancies ended in abortion totaling more than 930,000 abortions that year. In Africa in 2020, abortion rates ranged from 12% in Western Africa to 24% in Southern Africa; rates in Middle, Eastern and Northern Africa are 13%, 14% and 23%, respectively. In Africa, there have been studies that suggest that abortion based mother mortality has increased with increased abortion rates. In Mozambique, abortion-related deaths rose from consistently around 3% of maternal deaths to 5.7% in 2012 and 7.0% in 2013. Similar results were shown in Rwanda and Ethiopia. In Uganda, in 2021, more than 46.2 percent of pregnancies were unplanned and roughly a fourth of these terminated in abortion.[17]
After an abortion, some women experience intense and prolonged grief, while others acknowledge minimal or no grief. Many Studies report a high incidence of mental health disorders following abortion; opposing studies however claim many of these disorders were not caused by the abortion. Not surprisingly groups that oppose abortion are likely to find many significant harms while groups that favor abortion are likely to minimize the harms.”[18] Of course, bias is inescapable and the presence of bias doesn’t distinguish abortion research from inquiries in any other fields of study.
How do we interpret the research? What are some determinants? [19] Obviously the size of the research pool is a significant consideration, and the smaller the size of the pool, the less representative it is; [20] Also, the time period is important: the shorter the time period covered in ar research study, the less likely that results will capture women who have delayed mental health outcomes. Many women feel immediate relief after their abortion, but weeks, months, years and sometimes even decades later, their emotions are deeply triggered. At Concept of Truth a fair share of women who call the Helpline devastated by grief report that they had aborted years earlier.
[Show Table 1 ]Finally, the composition of a research group also determines the outcome of a study. Table 1 from the American Psychological Association lists common risk factors for mental health outcomes after abortion and these affect the composition of a research pool.
For instance,
- Feeling pressured to abort is a risk factor which affects between 20% and 64% of women.
- Having a history of mental health disorders affects 31% – 51% of the women, although researchers now agree that the risks associated with abortion cannot be fully explained by prior mental disorders.[21]
- Feeling ambivalence or moral conflict affects about half of the women and these are also more likely to result in negative mental health reactions such as PTSD.[22] [Rebecca – in case you’re asked, you should know that if you read the study you see that the 87% number for picketing was combined with preexisting moral conflict .]
So with this background to help us, let’s now look some of the more significant studies and literature reviews from the last 30 years.[23]
[Table 3] In 2001 the College of Physicians and Surgeons of Ontario published a study comparing admission rates of about 40,000 patients in area hospitals. Half of the patients were admitted for induced abortion but were otherwise healthy women with no co-morbidities; the other half were admitted for non-abortion surgeries. Within 3 months, the group that had the induced abortions reported a 4 times increase in medical admissions and a four- fold increase in psychiatric problems.[24]
[Show points below] In 2003, the de Veber Institute for Bioethics reviewed the results of over 500 international studies and published “Women’s Health after Abortion: The Medical and Psychological Evidence,” and found regular increases in mental health outcomes for post abortive women:
- Post-abortive women are more likely to display self-destructive behaviors including drug, alcohol and tobacco abuse, eating disorders, mutilation, and suicide.
- Suicide rates were 3.25 times greater in Wales (1987); nearly 6 times greater in Scandinavia (1996) and 2.6 times in the U.S.(2006).
- Many post-abortive women who seek support to recover from post-abortion distress only do so years after the abortion.[25]
In November 2006, David Fergusson, a self-proclaimed pro-choice atheist in New Zealand, embarked on a study believing his data would demonstrate that there were little or no mental health risks associated with abortion. He conducted a study of 1265 young women over the course of 25 years. Of the young women , 41% became pregnant and 14.6% of those had an abortion. As wee see in Table 1, the young women who aborted suffered higher rates of mental disorders than those who were either never pregnant or who were pregnant but did not abort. For example: we see 78.6% of the post abortive 15-18 year olds had major depression compared to only 35.7% of pregnant women who had no abortion and compared to 31.2% of women who were not pregnant.[26]
Although these findings were opposite to Fergusson’s preconceptions, he submitted them for publication anyway – and then, interestingly, the New Zealand government asked him to withhold the results, which he didn’t do. [27] Instead, Fergusson extended his study of 534 of the original women to 30 years.[28] and published his new findings showing that for ages 15 – 30 [Show Tables 1&2] “[W]omen who had had abortions had rates of mental health problems that were about 30% higher than rates of disorder in other women. . . [especially] anxiety disorders and substance use disorders,”[29]
But although the rates of harms were high, Fergusson admitted d that the overall harms themselves were not determined to be severe[30] but this was because as Fergusson had prefiewouly stated “the study was not able to examine the role of abortion in more serious forms of mental illness.”[31]
That same year, The American Psychological Association’s (APA) Task Force on Mental Health and Abortion concluded from a review of the literature that while some women experience clinically significant disorders, including depression and anxiety, nevertheless, “the relative risk of mental health problems among adult women who have a single, legal, first-trimester abortion of an unwanted pregnancy for non-therapeutic reasons is no greater than the risk among women who deliver an unwanted pregnancy.”
[Show slide] So, here the APA Task Force is apparently saying there is no measurable difference in mental health outcomes between women who abort and those who don’t. What could account for the disparity between Fergusson, who found a 30% increase in the rate of mental health harms, although modest, and the APA Task Force which found no difference in outcomes?
The answer is that the Task Force excluded women with a number of the important risk factors we discussed earlier:
- It excluded the 48%–52% of post abortive women who already had a history of one or more abortions.
- It excluded the 18% of abortion patients who were minors,
- It excluded the 11% of patients who were beyond the first trimester;
- It excluded the 7% of patients aborting for therapeutic reasons regarding their own health or concerns about the health of the fetus;
- And it excluded the 11%–64% of women whose pregnancies were wanted;[32] and
- It excluded later term abortions.
After excluding these groups of people from the pool, the risk of harms dramatically decreased. What’s really interesting is that the chair of this task force, Brenda Majors, continued to track the remaining pool of women for the next 2 years after they did the study and she found that after 2 years, 38% of that research pool had significantly rising rates of depression and lowering rates of positive reactions and relief [33] This shows that studies that only track women in the short term, as many do, are not going to have a complete picture of harms.
[SHOW COLEMAN CHARTS] In 2011 Dr Priscilla Coleman published a meta-analysis in the British Journal of Psychiatry that pooled results from 22 studies involving 877, 181 participants. Of these, 163 831 had experienced an abortion. This was perhaps the largest quantitative estimate of mental health risks associated with abortion then available in the world literature. Coleman concluded that women who had an abortion had an 81% increased risk of mental health problems and were 55 percent more likely to exhibit suicidal behavior than those who do not abort. And, nearly 10% of the mental health problems that arose in the participants were shown to be attributable to the abortion.[34]
Although Dr. Coleman was criticized for her methodology, [HAVE SLIDE OF THESE CRITICISMS: not listing studies she excluded from her review, for citing her own research in the review, for suggesting that abortion can by itself cause mental health harms, and for including studies that combined intended and unintended pregnancies. Coleman published a lengthy defense of her research [SHOW SLIDE OF DEFENSES] claiming essentially that other researchers also failed to list excluded studies and reached similar conclusions as hers but were not held to to the same standards; that she has the most publications in the field, so it makes sense that she would cite some of her own research; that one can reasonably infer a level of causation from substantial correlation; that researchers cannot meaningfully segregate “intended” and “unintended” pregnancies.. Note in bold that in January 2018, Cambridge University Press republished Coleman’s study.[35] and other researchers, including Dr. Angela Lanfranchi and David Fergusson, came to her defense and endorsed her findings, which were corroborated in other studies.[36]
In 2013, Dr. Angela Lanfranchi, a renown U.S. cancer surgeon, published an extensive survey of more than 650 peer reviewed global studies on abortion harms called Complications: Abortion’s Impact on Women, which documents what she describes as “drastic and incontrovertible” worldwide increases in mental disorders, substance abuse and suicide from abortion, affecting developed as well as developing countries.[37] Lanfranchi also reports that in Uganda even though abortion is illegal except to save the life of the mother, complications from abortion accounted for a substantial proportion of obstetric admissions, and accounted for nearly 11% of direct obstetric deaths[38]
In 2018, David Reardon published an exhaustive and even-handed review of all significant abortion literature since 2005 called “The abortion and mental health controversy: A comprehensive literature review of common ground agreements, disagreements, actionable recommendations, and research opportunities.” [39] Reardon set out to impartially identify and analyze the areas of agreement and disagreement on abortion and mental health to better prepare physicians and mental healthcare providers with more accurate and helpful information for advising and counseling women before or after an abortion. He extensively discusses the methodology of research, the effects of bias, and the obstacles researchers face.
[SHOW LIST] Reardon generally concludes that comprehensive studies on all sides of the abortion debate collectively show there is a statistically significant increase in mental health disorders for post abortive women, with substance abuse ranked highest and 50% of women have negative emotional reactions that increase with time. Significantly, Reardon also found that there were no known mental health benefits of abortion.
- The association between abortion and higher rates of anxiety, depression, substance use, traumatic symptoms, sleep disorders, and other negative outcomes is statistically significant in most analyses.
- The minority of analyses that do not show statistically significant higher rates of negative outcomes do not contradict those that do.
- There are numerous risk factors that can be used to identify which women are at greatest risk of negative psychological outcomes following one or more abortions.
- Although a minority of women have diagnosable mental illnesses following abortion, the majority of women – 50% – experience negative emotional reactions and the percentage of women experiencing negative reactions increases with time.
- Induced abortion is consistently found to be associated with the onset of PTSD symptoms, which may be immediate or later triggered by subsequent reproductive events such as miscarriage, infertility, or even a wanted birth.
- SUbstance abuse has the highest incidence of harms as reported in various studies
- There are no findings of mental health benefits associated with abortion.
- Reardon explains that quantifying the rate of negative reactions to abortion is complicated because different research used different time periods .
- Short term studies exclude women who have delayed emotional reactions while long term studies exclude women who may have recovered from their reactions before the assessment.
- Also, because women drop out of the studies, this changes the composition of the pool. [40]
Our slide shows some other major studies that we don’t have time to discuss. These and many others either corroborate the existence harms or have flaws, and as we’ve seen, it’s crucial to know what factors a study has used in order to evaluate its findings. [Summarize the studies below in a power point]
In 2008 the Academy of Medical Royal Colleges (AMRC) purportedly reviewed the existing literature and concluded that, “The rates of mental health problems for women with unwanted pregnancy were the same whether they had an abortion or gave birth.” The AMRC’s findings are weak: the study included only three literature reviews and ignored over nineteen others that were relevant. It also excluded thirty-five peer reviewed studies simply because they took place within the first 3 months of the abortion, and post abortive women in this time period often manifest significant harms.
In 2015, researchers conducted the widely publicized Turnaway study of 956 women.[41] After three years, only 27% of the original pool of women remained until the assessment because the majority had dropped out.[42] Newspaper headlines touted the Turnaway study’s findings that : 1) there are only minimal mental health outcomes for women who abort; 2) there are significant mental health harms for women who are denied abortion; 3) the “majority of women are glad they had their abortions,” ”[43][44] As Reardon explains, the results only represented data of the remaining 27% of women, and they were not representative because the women with greater mental health harms are more likely to be the ones to drop out since questions in the study about their abortion are frequently associated with feelings of shame and women’s defense mechanisms can contribute to the conscious or unconscious underreporting of symptoms and drop out during the studies. ”[45]
In 2016, sociologist Dr. Donald Sullins, conducted a 13 year longitudinal study of a nationally representative cohort of 8005 young women and concluded that abortion was consistently associated with increased risks of mental health disorders and the overall risk of mental health harms was elevated by 45%.[46]
In the end, as we evaluate all the information out there, it’s crucial to focus on the factors: for literature reviews, which studies were included and which weren’t and why; for the studies themselves, how big was the research pool, how long did the study last, who was included in the study – did it include
We can’t leave this subject without specifically discussing Chemical Abortion
witng refers to the medications, mifepristone and misoprostol, taken in sequence to terminate a pregnancy within the first 10 weeks. Medication abortion currently accounted for more than 50% of all abortions in the U.S. in 2020 (compared with 3% in 2001) and that number is increasing.[47] In December 2021, the US Food and Drug Administration (FDA) made medication abortion more accessible by allowing women to receive abortion medications through the mail. On Aug. 3, 2022, President Biden signed an executive order designed to further expand access to abortion pills and help women cross state lines to receive abortions. Women who abort with medication have complication rates four times that of surgical abortion and they are at a 53% greater risk of visiting the ER for an abortion-related reason. In addition, 3 to 7% of women will need follow-up care to finish the abortion, [48] and 34% of women will report an adverse emotional change, including depression, anxiety, substance abuse and thoughts of suicide.[49]
Several months ago, a U.S. Fifth Circuit Court Judge revoked the FDA’s approval for mifepristone because of the FDA’s utter failure to study the psychological effects of its use. The Judge concluded that given the “intense psychological trauma and post-traumatic stress from excessive bleeding and seeing the remains of their aborted children,” that women often experience from chemical abortion, the FDA’s omissions are bound to cause “lasting damage” to women who take the pill.[50]
How can it be that we hear and read public statements that abortion is “very safe,” and that the abortion pills are “very effective?”[51]
One website claims, “Both in-clinic and medication abortions are very safe. In fact, abortion is one of the safest medical procedures out there — it has a lower complication rate than other common medical procedures, like getting your wisdom teeth pulled. And abortion pills are safer than medicines like penicillin, Tylenol, and Viagra.[52]
Well, knowing how data is reported is important! Reporting is not standardized.
In the U.S., only 28 states require providers to even report post abortion complications, and those who do report typically only track complications that arise in the short term[53] Neither North America, nor Canada nor the WHO had implemented standard reporting procedures for complications following induced abortions as of __ and that appears to still be the case. So, when the WHO suggests that it is only the “unsafe” abortions which lead to complications, that conlcusion is controversial at best given the lack of reliable reporting worldwide.
In the UK, as of November 2023, the hospital reporting systems had no agreed-upon definition of the term “abortion complication,” and hospitals only collected data for complications that occurred up until the time of discharge.[54]
After switching to a reporting system that tracks complications after discharge, the UK announced that overall complication rates for legal abortions in the UK were actually 11.9 times higher than had been previously been reported for the period 2017 – 2021[55] Also, the complication rates increased with the gestational age of the baby, and medical abortions at 20 weeks and over were 160 times higher than complication rates for medical abortions at 2 to 9 weeks gestation.[56]
As of ___ the WHO had no standard reporting procedures for complications following abortions.
In conclusion, we’ve ween that reproductive loss harms women. And we’ve seen that abortion’s mental health harms are often underestimated because of excluded risk factors, poor reporting, a lack of mental health screenings and a politicized environment. Challenging those who expose the realities of reproductive loss accomplishes nothing and inflicts greater wounds on women and their loved ones.
[1] Colleen Doyle, Mambo Che, Zhanni Lu, Michelle Roesler, Karin Larsen, Lindsay A. Williams,
Women’s desires for mental health support following a pregnancy loss, termination of pregnancy for medical reasons, or abortion: A report from the STRONG Women Study,
General Hospital Psychiatry, Volume 84, 2023, Pages 149-157. https://www.sciencedirect.com/science/article/abs/pii/S0163834323001184?via%3Dihub .
[2] Naji Abi-Hashem, Grief, Bereavement, and Traumatic Stress as Natural Results of Reproductive Losses, 32 ISSUES L. & MED. 245 (2017). Other definitions: Bereavement is the state of having suffered a loss. Mourning is the public expression of bereavement. Trauma is an unusual troubling event, which generates substantial anxiety, acute stress responses, sense of horror, and overwhelming helplessness.
[3] Miscarriage: worldwide reform of care is needed, The Lancet, Volume 397, Issue 10285, 1597. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00954-5/fulltext; Danielle Herbert, Kerry Young, Maria Pietrusińska, Angus MacBeth,
The mental health impact of perinatal loss: A systematic review and meta-analysis,
Journal of Affective Disorders,
Volume 297, 2022, Pages 118-129, ISSN 0165-0327,
https://doi.org/10.1016/j.jad.2021.10.026.
(https://www.sciencedirect.com/science/article/pii/S0165032721011009); Kipkorir M. Kirui, Onsongo N. Lister, Lived Experiences of Mothers Following a Perinatal Loss, Midwifery, Volume 99, 2021, https://doi.org/10.1016/j.midw.2021.103007.
(https://www.sciencedirect.com/science/article/pii/S0266613821000863)
[4] Miscarriage: worldwide reform of care is needed, The Lancet, Volume 397, Issue 10285, 1597, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00954-5/fulltext;
[5] Kipkorir M. Kirui, Onsongo N. Lister,
Lived Experiences of Mothers Following a Perinatal Loss, Midwifery, Volume 99, 2021,
https://doi.org/10.1016/j.midw.2021.103007.
(https://www.sciencedirect.com/science/article/pii/S0266613821000863)
[6] Arach, A.A.O., Kiguli, J., Nankabirwa, V. et al. “Your heart keeps bleeding”: lived experiences of parents with a perinatal death in Northern Uganda. BMC Pregnancy Childbirth 22, 491 (2022). https://doi.org/10.1186/s12884-022-04788-8https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-022-04788-8
[7] Miscarriage: worldwide reform of care is needed, The Lancet, Volume 397, Issue 10285, 1597. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00954-5/fulltext; [7] Kipkorir M. Kirui, Onsongo N. Lister,
Lived Experiences of Mothers Following a Perinatal Loss, Midwifery, Volume 99, 2021,
https://doi.org/10.1016/j.midw.2021.103007.
(https://www.sciencedirect.com/science/article/pii/S0266613821000863)
[8] Arach, A.A.O., Kiguli, J., Nankabirwa, V. et al. “Your heart keeps bleeding”: lived experiences of parents with a perinatal death in Northern Uganda. BMC Pregnancy Childbirth 22, 491 (2022). https://doi.org/10.1186/s12884-022-04788-8 https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-022-04788-8# ;
[9] Danielle Herbert, Kerry Young, Maria Pietrusińska, Angus MacBeth,
The mental health impact of perinatal loss: A systematic review and meta-analysis,
Journal of Affective Disorders,
Volume 297, 2022, Pages 118-129, ISSN 0165-0327,
https://doi.org/10.1016/j.jad.2021.10.026.
(https://www.sciencedirect.com/science/article/pii/S0165032721011009);
[10] “Why We Need to Talk About Losing a Baby.” Spotlight (2023)
[11] Danielle Herbert, Kerry Young, Maria Pietrusińska, Angus MacBeth,
The mental health impact of perinatal loss: A systematic review and meta-analysis,
Journal of Affective Disorders,
Volume 297, 2022, Pages 118-129, ISSN 0165-0327,
https://doi.org/10.1016/j.jad.2021.10.026;
(https://www.sciencedirect.com/science/article/pii/S0165032721011009);
Cited in Doyle, C. “Women’s Desires for Mental Health Support Following a Pregnancy Loss.” General Hospital Psychiatry, Vol. 84 (2023), citing: Neugebauer R, Kline J, Shrout P, Skodol A, O’Connor P, Geller PA, et al. Major
depressive disorder in the 6 months after miscarriage. JAMA 1997;277:383–8;
Brier N. Anxiety after miscarriage: a review of the empirical literature and
implications for clinical practice. Birth 2004;31:138–42.
[12] Doyle, C. “Women’s Desires for Mental Health Support Following a Pregnancy Loss: STRONG Women Study” General Hospital Psychiatry, Vol. 84 (2023). https://www.sciencedirect.com/science/article/abs/pii/S0163834323001184?via%3Dihub
[13] Farren J, Jalmbrant M, Falconieri N, et al. Posttraumatic stress, anxiety and depression following miscarriage and ectopic pregnancy: a multicenter, prospective, cohort study. Am J Obstet Gynecol (Dec. 2019) DOI: https://doi.org/10.1016/j.ajog.2019.10.102
[14] Kipkorir M. Kirui, Onsongo N. Lister,
Lived Experiences of Mothers Following a Perinatal Loss, Midwifery, Volume 99, 2021,
https://doi.org/10.1016/j.midw.2021.103007.
(https://www.sciencedirect.com/science/article/pii/S0266613821000863)
[15] Doyle, C. “Women’s Desires for Mental Health Support Following a Pregnancy Loss: STRONG Women Study” General Hospital Psychiatry, Vol. 84 (2023). https://www.sciencedirect.com/science/article/abs/pii/S0163834323001184?via%3Dihub
[16] WHO Fact Sheet. Abortion. (Nov. 25, 2021) https://www.who.int/news-room/fact-sheets/detail/abortion
[17] https://www.newvision.co.ug/news/1482667/462-pregnancies-uganda-unplanned-report; https://www.cdc.gov/mmwr/volumes/72/ss/ss7209a1.htm; https://www.guttmacher.org/fact-sheet/unintended-pregnancy-united-states
[18] Fergusson, D. et al, The British Journal of Psychiatry (2008)
193, 444–451. doi: 10.1192/bjp.bp.108.056499 As Fergusson claims, “weak research evidence has been used to support strongly stated opinions on the harms or benefits associated with abortion.
[19] Fergusson, D. et al, The British Journal of Psychiatry (2008)
193, 444–451. doi: 10.1192/bjp.bp.108.056499
[20] Also, it is impossible to conduct randomized double-blind studies to investigate abortion-associated outcomes because such studies would require random selection of women to have abortions. See Reardon
[21] STRONG; citing [24] Sullins DP. Abortion, substance abuse and mental health in early adulthood: Thirteen-year longitudinal evidence from the United States. 2016.
[22] See, Coleman, P. “Women Who Suffered Emotionally From Abortion.” Journal of American Physicians and Surgeons, Vol. 22, No. 4 (Winter 2017); Carleton, T. and Sondgrass, J. The Development of Moral Injury Post Abortion. (e-book, New York, August 2022); See Burke T, Reardon DC. Forbidden grief: the unspoken pain of abortion. Springfield, IL: Acorn Books, 2007, 334 pp
[23] Not that In 1992, Greg Wilmoth, editor of the Journal of Social Issues announced, “There is now virtually no disagreement among researchers that some women experience negative psychological reactions post-abortion. Disagreement concerns the following: (1) The prevalence of women who have these experiences …, (2) The severity of these negative reactions …, (3) The definition of what severity of negative reactions constitutes a public health or mental health problem …, [and] (4) The classification of severe reactions. Wilmoth GH. Abortion, public health policy, and informed consent legislation. J Soc Issues. 1992;48(3):1-17. doi: 10.1111/j.1540-4560.1992.tb00895.x. PMID: 11656501
[24](Ostbye et al., American Journal of Medical Quality, 2001) [WHAA, 3] (Ostbye T, Wenghofer EF, Woodward CA. American Journal of Medical Quality 2001 Table 3.
[25] https://www.deveber.org/womens-health-after-abortion/
[26] Fergusson, D. et al. Abortion in young women and subsequent mental health.
Journal of Child Psychology and Psychiatry 47:1 (2006), pp 16–24 (2006). https://www.unav.edu/documents/16089811/16216616/aborto_psych_JChildPsych2006_Fergusson.pdf
Fergusson stated at the outset that the evidence linking abortion and mental health outcomes was at best controversial, in part because research failed to compare mental health outcomes in post abortive women with non pregnant women.
[27] See Reardon, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6207970/ It was the NZ government’s Abortion Supervisory Committee
[28] Fergusson, D. “Abortion and Mental Health Disorders: Evidence from a 30-year Longitudinal Study.” The British Journal of Psychiatry, Vol. 193 No. 6. (Dec. 2008).
[29]Id. p. 449
[30] Estimates of the attributable fraction suggested that exposure to abortion accounted for 1.5–5.5% of the overall rates of mental disorder in this cohort.” p. 449
[31] Id. at p. 450
[32] Reardon DC. The abortion and mental health controversy: A comprehensive literature review of common ground agreements, disagreements, actionable recommendations, and research opportunities. SAGE Open Med. 2018 Oct 29;6:2050312118807624. doi: 10.1177/2050312118807624. PMID: 30397472; PMCID: PMC6207970.
[33] Major B, Cozzarelli C, Cooper ML, et al. Psychological responses of women after first-trimester abortion. Arch Gen Psychiatry 2000; 57(8): 777–784. [PubMed] [Google Scholar]. https://www.apa.org/pi/women/programs/abortion/mental-health.pdf .
[34] Coleman P. “Abortion and Mental Health: A Quantitative Synthesis and Analysis of Research.” British Journal of Psychiatry (2011). https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/abortion-and-mental-health-quantitative-synthesis-and-analysis-of-research-published-19952009/E8D556AAE1C1D2F0F8B060B28BEE6C3D
[35] See Lanfranchi p. 402; Coleman See Mota, Canadian Journal of Psychiatry 2010 p 241 A large study of British women found that post abortive women were 225 times more likely to attempt suicide
[36] See e.g., Natalie Mota’s 2010 systematic review of literature confirming a strong association between abortion and mental disorders and high risk of suicide
[37] Lanfranchi, A. Complications: Abortion’s Impact on Women, DeVeber Institute for Bioethics and Social Research (2013)
[38] [38] Lanfranchi, A. Complications: Abortion’s Impact on Women, DeVeber Institute for Bioethics and Social Research (2013), p. 44
[39] Reardon DC. The abortion and mental health controversy: A comprehensive literature review of common ground agreements, disagreements, actionable recommendations, and research opportunities. SAGE Open Med. 2018 Oct 29;6:2050312118807624. doi: 10.1177/2050312118807624. PMID: 30397472; PMCID: PMC6207970.
[40] Reardon, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6207970/
[41] Five-Year Suicidal Ideation Trajectories Among Women Receiving or Being Denied an Abortion
M. Antonia Biggs, Ph.D., Heather Gould, M.P.H., Rana E. Barar, M.P.H., Diana G. Foster, Ph.D.
Published Online:24 May 2018https://doi.org/10.1176/appi.ajp.2018.18010091
[42] Rocca CH, Kimport K, Roberts SC, Gould H, Neuhaus J, Foster DG. Decision Rightness and Emotional Responses to Abortion in the United States: A Longitudinal Study. PLoS One. 2015 Jul 8;10(7):e0128832. doi: 10.1371/journal.pone.0128832. PMID: 26154386; PMCID: PMC4496083.
[43] https://time.com/3956781/women-abortion-regret-reproductive-health/
[44] Rocca CH, Kimport K, Roberts SC, Gould H, Neuhaus J, Foster DG. Decision Rightness and Emotional Responses to Abortion in the United States: A Longitudinal Study. PLoS One. 2015 Jul 8;10(7):e0128832. doi: 10.1371/journal.pone.0128832. PMID: 26154386; PMCID: PMC4496083.
[45] https://time.com/3956781/women-abortion-regret-reproductive-health/
[46] Sullins DP. Abortion, substance abuse and mental health in early adulthood: Thirteen-year longitudinal evidence from the United States. SAGE Open Med. 2016 Sep 23;4:2050312116665997. doi: 10.1177/2050312116665997. PMID: 27781096; PMCID: PMC5066584.
[47] Israel, M. CDC’s Latest Abortion Numbers: A Sobering Reminder of Monumental Task Ahead. The Daily Signal, Dec. 19, 2023. https://www.dailysignal.com/2023/12/19/cdcs-latest-abortion-numbers-a-sobering-reminder-of-monumental-task-ahead/
[48] “Fact Sheet: Risks and Complications of Chemical Abortion.” Charlotte Lozier Institute (August 23, 2023). / 21-16926 3 5 E/CN.5/2024/NGO/; See also; https://lozierinstitute.org/public-health-threat-chemical-abortion-leads-to-significantly-higher-rate-of-er-visits/
[49] Daillabrida, Eilleen, Study Shows Long Term Negative Impact of Medication Abortion (Oct. 2022) White Paper https://supportafterabortion.com/wp-content/uploads/2022/10/Study-Shows-Long-Term-Negative-Impact-of-Medication-Abortion.pdf
[50] Alliance for Hippocratic Medicine v. U.S. Food and Drug Administration, No. 23-10362 (5th Cir. 2023). The U.S. Supreme Court has agreed to hear the appeal.
[51] See, Planned Parenthood, The Abortion Pill, https://www.plannedparenthood.org/learn/abortion/the-abortion-pill
[52] “What facts about abortion do I need to know?” Planned Parenthood. https://www.plannedparenthood.org/learn/abortion/considering-abortion/what-facts-about-abortion-do-i-need-know (viewed January 12, 2023.
[53] Deveber; WHO, ICD11 Reference Guide, .225.4.2 “Definitions and reporting criteria concerning the lower limit for fetal deaths or spontaneous abortions may differ depending on different national legislation.” https://icdcdnho.int/icd11referenceguide/en/html/index.html; Guttachmacher Institute. Abortion Reporting Requirements as of September 2023. https://www.guttmacher.org/state-policy/explore/abortion-reporting-requirements
[54] Official Statistics, UK Government. Complications from abortions in England: comparison of Abortion Notification System data and Hospital Episode Statistics 2017 to 2021. Published 23 November 2023. https://www.gov.uk/government/statistics/complications-from-abortions-in-england-2017-to-2021
[55] https://righttolife.org.uk/news/government-review-shows-abortion-complication-rates-likely-much-higher-than-being-reported-by-abortion-providers
[56] Right to Life News. Complications rates 160 times higher for medical abortions at 20 weeks and after compared to before 10 weeks, according to Gov. review (Dec. 12, 2023)