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Women denied abortion initially report more negative psychological outcomes

The JAMA Network Journals

Women who were denied an abortion initially reported less psychological well-being compared with women who received the wanted procedure, findings that researchers suggest do not support policies restricting women's access to abortion on the basis that the procedure harms their mental health, according to an article published online by JAMA Psychiatry.

The assumption that women experience adverse mental health outcomes has been used as the basis for legislation to mandate counseling or restrict abortion access. Nine states currently require counseling on the negative psychological and emotional responses to abortion for women seeking the procedure, according to the article.

M. Antonia Biggs, Ph.D., of the University of California, San Francisco, and coauthors present data from the Turnaway Study to assess the psychological well-being of 956 women (average age nearly 25) over five years after being denied or receiving an abortion. The women were recruited from 30 abortion facilities in 21 states.

The women were interviewed one week after seeking an abortion and then semiannually for five years. The study groups were women who received an abortion because their pregnancy was within two weeks under the facility's gestational limit (452 women); women who were denied an abortion because their pregnancy was up to three weeks past a facility's gestational limit (231 women); and those women who received a first-trimester abortion (273 women). The group of women turned away for abortions was further divided into those who gave birth (161 women) and those who miscarried or later had an abortion elsewhere (70 women). Gestational age limits varied among facilities.

The authors report that one week after seeking an abortion, those women who were turned away reported more anxiety symptoms, lower self-esteem and lower life satisfaction but similar levels of depression compared with women who received an abortion with pregnancies just under the facility's gestational limits.

The elevated levels of anxiety and lower self-esteem and life satisfaction one week after being denied an abortion improved and approached levels similar to women in the other groups by six months to a year, the authors note.

Limitations of the study include its observational design, which makes causal inferences not possible.

"Thus, there is no evidence to justify laws that require women seeking abortion to be forewarned about negative psychological responses. Women considering abortion are best served by being provided with the most accurate, scientific information available to help them make their pregnancy decisions. These findings suggest that the effect of being denied an abortion may be more detrimental to women's psychological well-being than allowing women to obtain their wanted procedures," the article concludes.

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(JAMA Psychiatry. Published online December 14, 2016. doi:10.1001/ jamapsychiatry.2016.3478; available pre-embargo at the For The Media website.)

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