Chapter 18 Summary: Depression, suicide, substance abuse

Research on the mental health effects of abortion is controversial, especially because of its political implications and methodological issues such as attrition. The weight of evidence, as well as women's testimonies, supports the conclusion that for a significant minority of women, abortion has a devastating psychological impact. A recent meta-analysis by Coleman discovered an overall 81 per cent greater risk of mental health problems (including anxiety, depression, substance abuse, and suicidal behaviour) for women who had an abortion compared to those who did not.1 She also calculated the overall population-attributable risk to be 9.9 per cent, meaning that nearly 10 per cent of all mental problems experienced by women are attributable to abortion alone. Coleman's methodology was sharply criticized by other researchers but without substantive evidence. Several studies have found results similar to Coleman's.2

Coleman criticizes previous meta-analyses which concluded that abortion poses no greater risk to a woman's mental health than does carrying an unintended pregnancy to term. Her reasons are threefold: 1) some pertinent literature was excluded from previous meta-analyses without explanation; 2) there was a lack of "sufficient methodologically based selection criteria;"3 and 3) there was no quantification of effects.

The Academy of Royal Medical Colleges published its own review which found a lack of correlation between abortion and mental health problems. The report also acknowledged that other factors could trigger mental health problems related to abortion, "such as pressure from a partner to have an abortion and negative attitudes towards abortions in general and towards a woman's personal experience of the abortion."4 Unfortunately, the Report has a number of serious flaws that render its findings questionable.  Many sound studies are ignored, while others are dismissed for vague or inappropriate reasons. Its conclusions are based on a very small number of studies that are not properly rated for quality. This has resulted in women being misinformed about the potential negative impact of abortion.

In short, the evidence is very strong that, for a significant minority of women, abortion has a devastating psychological impact.

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  • 1. Coleman PK. Abortion and mental health: quantitative synthesis and analysis of research published 1995-2009. British Journal of Psychiatry 2011; 199(3): pp. 180-6; 200(1): pp. 77-80.
  • 2. E.g. Morgan CL, Evans M, Peters JR. Suicides after pregnancy. Mental health may deteriorate as a direct effect of induced abortion. BMJ 1997 March; 314(7084): pp. 902-3; Mota NP, Burnett M, Sareen J. Associations between abortion, mental disorders, and suicidal behaviour in a nationally representative sample. Canadian Journal of Psychiatry 2010; 55(5): 239-247, p. 241.
  • 3. Coleman, p. 181.
  • 4. National Collaborating Centre for Mental Health (NCCMH). Induced abortion and mental health: a systematic review of the mental health outcomes of induced abortion, including their prevalence and associated factors. London: Academy of Medical Royal Colleges, December 2011.