Revisiting Social Policies: Acknowledging Reproductive Loss
Approximately one half of all pregnancies worldwide ends in reproductive loss[1] – by reproductive loss I mean the spontaneous loss of a miscarriage or stillbirth, or the induced loss of an abortion. This is a shocking statistic yet, despite the striking frequency of reproductive loss worldwide, there is relatively little public discussion about its harms even though its consequences for mental health have been widely researched. Not surprising, groups with different points of view reach different conclusions about the extent of these harms, and the issue continues to be hotly debated if not politically exploited, leaving post abortive grieving women, their partners and their families in the cross hairs. In this presentation I will survey the large body of research surrounding reproductive loss and its association with mental health harms. Let’s first define some basic terms:
Perinatal Loss refers to the spontaneous loss of miscarriage and 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]
Lets turn first to Perinatal Loss – the spontaneous loss of a Miscarriage or Stillbirth
Every year, about one in four pregnancies ends in perinatal loss. This includes approximately 23 million miscarriages, 2.6 million stillborn deaths and 1.8 million neonatal deaths worldwide.[3] These numbers could be even higher because miscarriages and stillbirths are not systematically recorded even in developed countries.[4]
Subsaharan Africa makes up about 95 – 98% of perinatal loss due to such risk factors such as child marriage, female genital mutilation, diseases like malaria or syphilis, poor nutrition, and socioeconomic circumstances. [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 reporting a striking 40 stillbirths for every 1000 births. By comparison, Western Europe reported only 3 stillbirths out of every 1000 total births. [6]
Although most women who have a miscarriage will go on to carry a baby to term in the future, previous miscarriage is associated with a higher 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] For some expectant mothers, the emotional toll of perinatal death is sufficiently severe to lead to a psychiatric diagnosis.[9] 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.[10] Studies show that women who miscarry have 2.5 times the risk for major depressive disorder compared to controls;[11] 1 in 3 women have symptoms of PTSD one month after miscarriage and 1 in 4 have symptoms of moderate to severe anxiety.[12] 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– even when they have gone on to have healthy babies.”[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]
As Madeleine will discuss next, social stigma and a lack of mental health interventions can prolong and even exacerbate the grief whereas care received immediately after a pregnancy loss can have an enduring impact on psychological health.[15]
Now let’s turn to the 2d kind of reproductive loss, medically induced abortion. According to the WHO’s last Fact Sheet on abortion worldwide, dated Nov. 25, 2021,[16] about 3 out of 10 of all pregnancies and about six out of 10 of all unintended pregnancies end in induced abortion This results in about 73 million induced abortions taking place worldwide each year.[17] In Uganda, in 2021, more than 46.2 percent of pregnancies were unplanned and roughly a fourth of these terminated in abortion.[18]
After an abortion, some women experience intense and prolonged grief, while others acknowledge minimal or no grief. Some studies report a high incidence of mental health disorders following abortion; opposing studies claim these disorders are 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.”[19] Of course, bias is inescapable and the presence of bias doesn’t distinguish abortion research from inquiries in any other fields of study.
But what we do need is an understanding of relevant factors that affect outcomes of the studies. What factors should we consider? [20] The composition and size of the research pool as well as as the length of the study are significant factors to consider when evaluating the research. Regarding the composition of the research pool, Table 1 lists generally accepted risk factors for mental health outcomes after abortion that are commonly shared by women and cited in existing research. [Show power point with Table 1
- Εxposure to multiple abortions is a significant risk factor for mental health outcomes that affects approximately 50% of women having abortions, at least in the United States.
- Feeling pressured to abort is another risk factor which affects between 20% and 64% of the population of women who abort. Yet, as we will see, studies like those of AMH routinely exclude women in this category.
- Feeling ambivalence or moral conflict affects about half of women and are also more likely to result in negative mental health reactions such as PTSD.[21]
- Being of a young age elevates the overall risk of mental disorders by 45%.[22]
- Having a history of mental health disorders, however, a number of researchers agree that the risks associated with abortion cannot be fully explained by prior mental disorders.[23]
Second, the smaller the size of the research pool, the less representative it will be of the population, so studies with small pools carry little evidentiary weight. [24] Finally, the longer the time frame for the study, the more likely that mental health symptoms will arise and be recorded. 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. Unfortunately, the WHO, and hospitals in the U.S and Canada among others have historically only recorded complications that occurred in the short term, following abortions which skews results.
Now that we know what factors to look at, let me highlight excerpts from some of the more significant studies and literature reviews from the last 30 years.
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.[25]
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 various day surgery issues. Within 3 months, the group that had the induced abortions reported a 4 times increase in medical admissions and a 5 times increase in surgical admissions to the hospital. Table 3 shows for example that aborted women had a rate of 5.2 per thousand hospitalizations for psychiatric problems compared to a rate of 1.1 per thousand for the control group.[26]
In 2003, the de Veber Institute for Bioethics, a pro life research organization based in Toronto, Canada reviewed the results of over 500 international studies and published “Women’s Health after Abortion: The Medical and Psychological Evidence,” which found regular increases in mental health outcomes for post abortive women such as these:
- 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.[27]
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. 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 with non pregnant women. So, he conducted a longitudinal study of 1265 young women in intervals over the course of 15 to 25 years. Of all the young women they studied, 41% became pregnant and 14.6% of those had had an abortion.
As we see in Table 1 published in the journal of Child Psychology and Psychiatry, women who terminated their pregnancy by abortion suffered higher rates of mental disorders than those who were either never pregnant or who were pregnant but did not abort. For example: POINT TO – 78.6% of 15-18 year olds had major depression compared to 35.7 for pregnant no abortion and 31.2 not pregnant.[28]
Although these findings were opposite to Fergusson’s preconceptions, he submitted them for publication anyway – and then, interestingly, the New Zealand government’s Abortion Supervisory Committee asked him to withhold the results, which he didn’t do. [29] Instead, Fergusson extended his study of 534 of the original women to 30 years.[30] and published his new findings showing that for ages 15 – 30 [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,”[31] but, “the overall effects of abortion on mental health proved to be small.[32] [See Fergusson Tables 1 and 2 ]
So, Fergusson basically found that abortion had a significant rate of harms for women, but the harms themselves were typically not severe, which was reasonable because as Fergusson conceded that “the study was not able to examine the role of abortion in more serious forms of mental illness.”[33]
That same year, American Psychological Association’s (APA) Task Force on Mental Health and Abortion also claimed to review the body literature on abortion and concluded 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.”
So, here the APA Task Force is 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 significant increases in mental health harms among post abortive women, and the APA Task Force which found none. The answer relates to the factors we discussed earlier; the Task Force study excluded women with a number of risk factors listed here:
- It excluded the 48%–52% of 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.[34]
After excluding these groups of people from the pool, the risk of harms dramatically decreased. What is interesting is that the chair of this task force, Brenda Majors, continued to track the remaining pool of women for the next 2 years and discovered that after 2 years, 38% of the research pool had significantly rising rates of depression and negative reactions and lowering rates of positive reactions, relief, and decision satisfaction. [35] 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.
In 2011 two comprehensive reviews again offered contradictory assessments of research. First, the British Journal of Psychiatry published a meta-analysis by Dr Priscilla Coleman that pooled results from 22 studies involving 877 181 participants, 163 831 of whom 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.[36]
Coleman’s systemic review was criticized for 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, 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. [37] Meanwhile, other researchers, including Angela Lanfranchi and David Fergusson, came to her defense and endorsed her findings, which findings were in many ways corroborated by Natalie Mota’s 2010 systematic review of literature confirming a strong association between abortion and mental disorders and high risk of suicide [38] And in January 2018, Cambridge University Press republished Coleman’s study.
A second major 2008 study was the United Kingdom’s National Collaborating Center for Mental Health for the Academy of Medical Royal Colleges (AMRC) which also 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.” Again we have a major discrepancy, this time with Coleman’s finding of an 81% increase in mental health outcomes. But according to critics, the AMRC’s study is weak because: it only includes three literature reviews, while skipping over nineteen others; it excludes thirty-five peer reviewed studies simply because they took place within the first three months of the abortion; it ignores extensive contrary data.[39] [Include Charles study?[40]]
In 2013, DeVeber Institute for Bioethics and Social Research published Angela Lanfranchi’s extensive work, Complications: Abortion’s Impact on Women . This book, reprinted in its 2d edition in 2018, documents extensive global scientific peer reviewed research from more than 650 research papers and reports that “the increase in rates of depression, anxiety, substance abuse and suicide among women who have had abortions is drastic and incontrovertible,” affects developed as well as developing countries, and is not limited to unsafe abortions as some would suggest.[41] 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[42]
In 2016, Donald Sullins conducted a 13 year longitudinal study of a nationally representative cohort of 8005 women in adolscenece/ early adulthood and examined them for risk of depression, anxiety, suicidal ideation, alcohol abuse, drug abuse, cannabis abuse, and nicotine dependence by pregnancy outcome (birth, abortion, and involuntary pregnancy loss). Sullins concluded that after extensive adjustment for confounding, abortion was consistently associated with increased risk of mental health disorder and the overall risk was elevated 45%.[43]
In 2018, David Reardon published, “The abortion and mental health controversy: A comprehensive literature review of common ground agreements, disagreements, actionable recommendations, and research opportunities.” [44]This is a seemingly exhaustive review of all the research published since 2005 including a review of the sources cited in the research studies. 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.
After analyzing mountains of data, Reardon claims that comprehensive studies on all sides of the abortion debate collectively show that :
- 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.
- There are no findings of mental health benefits associated with abortion.
Fig. 2 shows the measurable risks for a host of mental health disorders, with substance abuse the highest. [Discuss Highlights from REARDON TABLE 2]
Reardon explains however that quantifying the rate of negative reactions to abortion is complicated because among other things: 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, since questions about abortion are frequently associated with feelings of shame, women’s defense mechanisms, like avoidance, denial, repression, or rationalization, can contribute to the conscious or unconscious underreporting of symptoms as well as to the unexpected rates of drop out during the studies. [45]
Such data distortion seems to explain the skewed results of the widely publicized 2015 Turnaway study where only 27% of the original pool of women participated in the 3 year assessment because the majority had dropped out. Nevertheless, the Turnaway researchers concluded that “Women experienced decreasing emotional intensity over time, and the overwhelming majority of women felt that termination was the right decision for them over three years.” [46] Not surprisingly, newspaper headlines proclaimed, “[T]he overwhelming majority of women are glad they had their abortions” when this was not what the data showed. Time magazine went even further and said, “ninety-five percent of women who have had abortions do not regret the decision to terminate their pregnancies.”[47] As Reardon explains, what the Turnaway data actually revealed was that at 3 years, only a majority of the 27% of eligible women participating in the study felt that termination was the right decision for them.
Let’s Briefly discuss Chemical Abortion
Chemical abortion usually refers to the medications, mifepristone and misoprostol, taken in sequence to terminate the pregnancy of a developing baby within the first 10 weeks. Medication abortion accounted for 54% of all abortions in 2020 (compared with 3% in 2001).[48] 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. Nevertheless, women who abort with medication proved to have a complication rate four times that of surgical abortion, and 34% of women will report an adverse emotional change, including depression, anxiety, substance abuse and thoughts of suicide.[49] And, three to seven out of every hundred women who choose chemical abortion early in pregnancy will need follow-up care to finish the abortion.[50]
Several months ago, Fifth Circuit Court Judge Mathew Kacsmaryk revoked regulatory approval for the widely used chemical abortion drug, mifepristone after acknowledging the FDA’s utter failure to study the psychological effects of its use. Judge Kacsmaryk concludes 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. 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.
One last point before I close is that in addition the risk factors that can affect results of a study, knowing how data is reported significantly affects the statistics. England, is illustrative: as of November 2023, the UK government reports that “there is no commonly agreed definition of what hospitals should record as an abortion complication under either the Abortion Notification System or the National Health Service.” England is not alone. Neither North America, nor Canada nor the WHO have implemented standard reporting procedures for complications following induced abortions. In the U.S., only 28 states require providers to report post abortion complications, and the complications which are reported typically are those that arose in the short term.[51] In addition, irregular coding in hospitals and by the Centers for Disease Control fails to attribute many reproductive problems, such as infertility or ectopic pregnancies, to previous abortions even though abortion has been shown to trigger these events. [52]
In November, 2023, England’s government revealed that complication rates for legal abortions in the UK from 2017 – 2021 were actually 11.9 times higher than had been previously been reported in the annual abortion statistics bringing the rate to 18.16 for every 1000 abortions (including incomplete abortions), and the rates were even higher for women under 20 years old.[53] The reason – the UK had been using the Abortion Notification System to calculate abortion complication rates but in 2023, it recalculated these rates based on Hospital Episode Statistics (HES) system. Why the disparity? It appears that the ANS collects data only for complications that occur up until the time of discharge, whereas HES records complications that occur after discharge.[54] This highlights some serious reporting gaps.
What can we conclude? Elective abortion is often underestimated as a loss because of excluded risk factors, poor reporting, a lack of mental health screenings and a politicized environment. Calling for retribution against pro-life groups and researchers for simply exposing the realities of reproductive loss accomplishes nothing and inflicts greater wounds on women. Instead, we must accept the consensus of research and collaborate on ways to provide ongoing mental health resources to pregnant and post abortive women.
[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://www.sciencedirect.com/science/article/pii/S0165032721011009);
[10] 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.
[11] [COPY TABLES FROM THESE ARTIClES FOR POWER POINT?] Gladys Ibanez, Marie-Aline Charles, Anne Forhan, Guillaume Magnin, Olivier Thiebaugeorges, Monique Kaminski, Marie-Josèphe Saurel-Cubizolles, Depression and anxiety in women during pregnancy and neonatal outcome: Data from the EDEN mother–child cohort, Early Human Development, Volume 88, Issue 8 (2012). pp. 643-649. https://doi.org/10.1016/j.earlhumdev.2012.01.014; 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
[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] “Why We Need to Talk About Losing a Baby.” Spotlight (2023)
[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] https://www.who.int/news-room/fact-sheets/detail/abortion
[17] WHO Fact Sheet. Abortion. (Nov. 25, 2021) https://www.who.int/news-room/fact-sheets/detail/abortion
[18] 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
[19] 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.
[20] Fergusson, D. et al, The British Journal of Psychiatry (2008)
193, 444–451. doi: 10.1192/bjp.bp.108.056499
[21] 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
[22] Sullins DP. Abortion, substance abuse and mental health in early adulthood: Thirteen-year longitudinal evidence from the United States. SAGE Open Medicine. 2016;4. doi:10.1177/2050312116665997
[23] STRONG; citing [24] Sullins DP. Abortion, substance abuse and mental health in early adulthood: Thirteen-year longitudinal evidence from the United States. 2016.
[24] 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
[25] 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 Instead he claimed the 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. Cited in Reardon
[26](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.
[27] https://www.deveber.org/womens-health-after-abortion/
[28] 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
[29] See Reardon, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6207970/
[30] 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).
[31]Id. p. 449
[32] 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
[33] Id. at p. 450
[34] 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.
[35] 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 .
[36] 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
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[38] Mota NP, Burnett M, Sareen J. Associations between abortion, mental disorders, and suicidal behaviour in a nationally representative sample. Can J Psychiatry. 2010 Apr;55(4):239-47. doi: 10.1177/070674371005500407. PMID: 20416147.
[39] See Lanfranchi, p. 403
[40] Charles VE, Polis CB, Sridhara SK, Blum RW. Abortion and long-term mental health outcomes: a systematic review of the evidence. Contraception. 2008 Dec;78(6):436-50. doi: 10.1016/j.contraception.2008.07.005. Epub 2008 Sep 23. PMID: 19014789.
[41] Lanfranchi, A. Complications: Abortion’s Impact on Women, DeVeber Institute for Bioethics and Social Research (2013)
[42] [42] Lanfranchi, A. Complications: Abortion’s Impact on Women, DeVeber Institute for Bioethics and Social Research (2013), p. 44
[43] 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.
[44] 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.
[45] Reardon, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6207970/
[46] 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.
[47] https://time.com/3956781/women-abortion-regret-reproductive-health/
[48] 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/
[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] “Fact Sheet: Risks and Complications of Chemical Abortion.” Charlotte Lozier Institute (August 23, 2023). / 21-16926 3 5 E/CN.5/2024/NGO/
[51] 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://icdcdn.who.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
[52] https://www.nationalrighttolifenews.org/2023/12/complications-rates-160-times-higher-for-medical-abortions-at-20-weeks-and-after-compared-to-before-10-weeks-according-to-gov-review/
[53] https://righttolife.org.uk/news/government-review-shows-abortion-complication-rates-likely-much-higher-than-being-reported-by-abortion-providers
[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