Mental Health Outcomes After Having or Being Denied an Abortion

Abstract

To the Editor Studies comparing women who were denied or obtained an abortion, such as that of Biggs et al, 1 pose important questions as to the needs of women with unwanted pregnancies, so that interventions aimed to support them can be developed. Indeed, as states limit access to abortion services, alternatives to abortion, such as birth and adoption, may need to be explored as a research priority.A key finding of this study is that more than 50% of the turnaway group later gave birth. While the study does not specify, some participants may have resolved the pregnancy by choosing birth and parenting. For some women, the phenomenon of "wantedness" of a pregnancy may not be a finite construct, but one that may be fluid, on a continuum, and modifiable over time. Psychosocial factors, such as increased partner/family support, improved finances, reduced work obligations, and/or material resources, can influence women's desire to continue the pregnancy and prevent exposure to abortion risks. It would be critical to follow up these women and identify their genuine needs. The high dropout rate suggests that some may have experienced a stress response associated with the abortion, and the statement that results at 6 or 12 months will remain constant is not based on data. The only other study 2 comparing women with unwanted pregnancies who either had an abortion or were denied an abortion found a 70% higher rate of suicidal and self-destructive behavior after abortion as compared with after delivery.Robinson and colleagues 3 stated that although each study concludes more studies are needed, public policy must be made on the current state of knowledge. The findings in the Biggs et al study 1 are a contributory negative finding but insufficient to guide public policy. Their conclusion that "there is no evidence to justify laws that require women seeking abortion to be forewarned about negative psychological responses," is well beyond the scope of the study and the limited literature review. By overstating the findings, this study fails to meet guidelines for proper scientific conduct. 4 Evidence on potentially life-threatening risks of all medical procedures should inspire more not less investigation and surveillance of women's welfare. Instead, by not acknowledging such risks, the authors render a disservice to women, as well as clinicians who treat them.