Abortion among young women and subsequent life outcomes

Abstract

Publication informationBest Practice and Research: Clinical Obstetrics and Gynaecology, 24 (4): 491-502Publisher Elsevier Item record/more information http://hdl.handle.net/10197/5799 Publisher's statementThis is the author's version of a work that was accepted for publication in Best Practice and Research: Clinical Obstetrics and Gynaecology. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Best Practice and Research: Clinical Obstetrics and Gynaecology (VOL 24, ISSUE 4, (2010) AbstractThis paper will discuss the nature of the association between abortion and mental health problems. Studies arguing that both side of the debate as to whether abortion per se is responsible will be presented. The prevalence of various psychiatric disorders will be outlined and where there is dispute between studies these will be highlighted. The impact of abortion on other areas such as education, partner relationships and sexual function will also be considered and the question as to whether abortion helps women's mental health will be addressed. Suggestions for early identification of illness will be made. The absence of specific interventions will be highlighted Word count: 7225 including practice points, research agenda, multiple choice questions and references 3 Abortion among young women and subsequent life outcomesInduced abortion is the most common surgical procedure in the Western World with an estimated 42 million pregnancy terminations taking place worldwide each year according to The Alan Guttmacher Institute. The relationship between abortion and subsequent life outcomes, particularly those relating to mental health outcomes, is one that has been discussed, often acrimoniously, in peer reviewed journals for several decades although this was hampered by significant methodological flaws in the earlier studies. It is an important question to resolve since an increase in the incidence of mental health problems post abortion would impact significantly on resources as well as on personal wellbeing.A number of questions present themselves in relation to the subsequent life outcome for women who terminate their pregnancies. These are:1. What is the usual emotional reaction to abortion? 2. Is there a specific psychiatric disorder associated abortion? 3. Is abortion associated with an increase in mental health problems and if so is the relationship a causal one? 4. What psychiatric disorders are associated with abortion? 5. Does abortion impact on social outcomes such as education, employment and relationships? 6. Does terminating an unwanted pregnancy help women's mental health? 7. What therapeutic interventions are available when a woman has an adverse reaction and do these have impact on subsequent life outcomes?Each of these questions will be considered in...

Posttraumatic stress among women after induced abortion: a Swedish multi-centre cohort study

“…Ambivalence about the decision, strong maternal feelings, poor social support, moral and religious objections to abortion, coerced abortion, intimate partner violence and young age are all risk factors associated with adverse reactions after abortion [27,28]. In the present study, we have not explored the underlying causes for the women’s decision for the termination of the pregnancy because it was not a study aim.…”

Increased Risk for Postpartum Psychiatric Disorders Among Women with Past Pregnancy Loss

“…23,26,27 Very little data exist to determine whether a prior abortion increases the likelihood of a depressive or anxiety disorder in a subsequent postpartum period. 28 One study found higher levels of depressive affect in women with past abortions at 1, 6, and 12 months after the birth of the index baby than in women without this history, but did not assess for a depressive diagnosis. 29 In the late 1970s, researchers hypothesized about ''reactivated mourning'' in women suffering mental health issues during pregnancy who had undergone past abortions, but this has not been studied in recent years.…”

“…29 In the late 1970s, researchers hypothesized about ''reactivated mourning'' in women suffering mental health issues during pregnancy who had undergone past abortions, but this has not been studied in recent years. 28,30 Although many women who experience pregnancy loss have additional pregnancies that end in live birth, few studies examine the effects of prior reproductive events-including miscarriage, stillbirths and induced abortion-on women's mental health during subsequent pregnancies or postpartum periods. One study reported that a history of mental health issues and recent life stressors were important predictors for increased anxiety and depression at 6 months and 5 years after their loss in women who experienced either miscarriage or abortion, compared with the general population.…”

Stigma and agency: exploring young Kenyan women’s experiences with abortion stigma and individual agency

“…However, most prior studies which discuss the empowerment and positive coping of women after an abortion have been cited in the United States and Western Europe, not in an environment such as Kenya, where there is still considerable legal ambiguity, and where abortion is largely stigmatised. [27][28][29][30] Collectively, these studies recognise that among the risk factors for negative coping after an abortion are important interpersonal and contextual vulnerabilities, such as lack of social support, societal stigma, and negative cultural attitudes towards abortion. [27][28][29] As such, one would anticipate that the young Kenyan women interviewed in this study would be more prone towards expressing negative or conflicting emotions after having their abortions, as opposed to the decisional autonomy and self-confidence they displayed.…”