Psychological aftermath of abortion

Commenting on our study of the characteristics of women undergoing repeat induced abortion,¹ L.L. deVeber and Ian Gentles imply that termination of pregnancy causes psychological problems. However, pre-existing differences between women who seek abortion and those who carry pregnancies to term are considerable and may account for differences in psychological status after abortion or delivery. A relevant comparison would assess psychological distress experienced by women seeking and obtaining an abortion and those seeking but denied pregnancy termination. Moreover, a full discussion of the possible consequences of abortion would include consideration of the considerable morbidity and mortality associated with illegal abortion.²

In a CMAJ commentary, Major³ reminded us that “health providers and policy-makers [must] base their conclusions [about the effects of abortion] on reputable scientific research that is methodologically rigorous, conceptually sound and free from ideological bias.”

The research cited by deVeber and Gentles, however, fails to meet this standard. For example, although Ostbye and associates⁴ showed a greater number of hospital admissions for psychiatric problems among women who have had abortions, the most significant predictor of this finding was a history of pre-abortion psychiatric admission (odds ratio 6.58, confidence interval 2.46–17.64). Similarly, although Gissler and colleagues⁵ related abortion to increased risk of suicide, they clearly stated that no conclusion about cause and effect could be made and that the association might be due to common risk factors for both suicide and abortion.

Reardon and collaborators⁶ also showed a greater association between abortion and psychiatric admission among low-income women who had had an induced abortion than among women who carried their pregnancy to term. That study had a number of limitations, however, including lack of information regarding psychiatric history earlier than 1 year before abortion or delivery. On the basis of Canadian findings for psychiatric admissions before abortion,⁴ it may be that greatly elevated rates of psychiatric problems precede abortion experience. Commenting on the study by Reardon and collaborators,⁶ Major³ noted that “Although it is possible that abortion leads to psychiatric problems, it is just as plausible that the direction of causality is reversed, namely, that psychiatric problems cause women who become pregnant to feel less capable of raising a child and to terminate their pregnancy.”

Abortion continues to be a controversial area of research. There is no causal evidence that abortion alone elevates the risk of psychiatric admission. Observational evidence of such an association may be readily interpreted as resulting from confounding pre-existing factors.

Sukhbir S. Singh Department of Obstetrics and Gynaecology William A. Fisher Department of Psychology Department of Obstetrics and Gynaecology University of Western Ontario London, Ont.