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Being denied an abortion harms mental health more than getting one, research shows

TODAY logo TODAY 6/24/2022 Sarah Jacoby

At 25, Olive* learned she was pregnant. She'd noticed physical symptoms, like tender breasts, so it wasn't a total surprise. Early in her career in finance and in a relationship with an abusive partner, Olive knew immediately what she wanted to do.

"Without hesitation, I knew that I was going to get an abortion," she told TODAY. She recalled walking into the clinic "proud and appreciative," and taking them up on the offer to get an IUD, which she's had ever since.

Olive had a medication abortion, the most common type of abortion in the U.S., according to statistics from the Guttmacher Institute, a research organization that advocates for access to reproductive care. Now successful in her career and in a committed, healthy relationship at 31, she knows she wants to have kids someday and has "zero regrets" about her abortion.

"Looking back on the last 15 years of my life, I've accomplished a lot," she said. "I came from very little. If I needed to make this choice to protect my success and future life, I have no shame in that."

Despite narratives that people who end their pregnancies end up wracked with guilt, regret and even depression, research shows that stories like Olive's are far more common: In fact, most people who terminate their pregnancies don't feel regret — they feel relief, a 2020 study found.

Experts told TODAY that overturning Roe v. Wade, which could end up banning abortion in half of states, could have negative impacts on mental health for those unable to access abortion care, in addition to the physical and financial burden that can come with carrying an unwanted pregnancy.

What effect does abortion have on mental health?

Researchers say it's a common misperception that people who have abortions end up feeling intense regret or negative mental health consequences after their decision. In a previous Supreme Court decision, Gonzales v. Carhart, Justice Kennedy even wrote, "While we find no reliable data to measure the phenomenon, it seems unexceptionable to conclude some women come to regret their choice to abort the infant life they once created and sustained." 

But researchers who have specifically studied abortion and mental health say that's not true.

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"Most research shows that the dominant emotion that women express subsequently is relief — not sadness, not grief," Brenda Major, Ph.D., distinguished professor in the department of psychological and brain sciences at University of California, Santa Barbara, and former chair of the American Psychological Association's task force on mental health and abortion, told TODAY.

That's not to say that people never have negative emotions around their abortion experience, she added, but regret is not the norm.

The landmark Turnaway Study — performed between 2008 and 2016 by researchers at University of California, San Francisco's program Advancing New Standards in Reproductive Health — was designed to investigate the long-term impacts of abortion. The study of nearly 1,000 people compares outcomes for participants who received abortions with outcomes for those who sought out abortions but were denied. Researchers followed participants for five years and regularly checked in with them about various aspects of their physical and mental well-being.

Using data from the Turnaway Study, research published in JAMA Psychiatry in 2017 found that people who were denied abortions reported more symptoms of stress and anxiety one week after the event than those who received abortions.

Over time, the psychological well-being of all groups in the Turnaway Study, including those who were denied abortions and ultimately gave birth, converged. But these "findings do not support policies that restrict women’s access to abortion on the basis that abortion harms women’s mental health," authors wrote.

Other research based on data from the Turnaway Study, published in the American Journal of Psychiatry in 2018, found no major differences in suicide risk among women who received or were denied an abortion over the five years after the event. Those who were most likely to have an elevated risk for suicide or self-harm in this study were those who had a previous history of mental health conditions, abuse or violence.

More than 50 scientific papers have been published in peer-reviewed journals using data from the Turnaway Study.

“We found no evidence to support the idea that abortion increases people’s mental health risks, and instead found that, really, the denial of abortion was worse for people’s mental health,” co-author of the 2017 and 2018 studies Antonia Biggs, Ph.D., associate professor and social psychologist at University of California, San Francisco, told TODAY. 

In a statement following the Supreme Court ruling, Frank C. Worrell, Ph.D., president of the American Psychological Association, said: “This ruling ignores not only precedent but science, and will exacerbate the mental health crisis America is already experiencing. We are alarmed that the justices would nullify Roe despite decades of scientific research demonstrating that people who are denied abortions are more likely to experience higher levels of anxiety, lower life satisfaction and lower self-esteem compared with those who are able to obtain abortions."

How often do people regret their abortions?

In one paper, published in Social Science & Medicine in 2020, researchers used data from the Turnaway Study to look at this exact question. The results showed that more than 95% of participants who had abortions felt they made the right decision even five years later. And, at every point during the five years participants were surveyed, relief was the most common emotion they reported.

"The overwhelming majority of people felt the abortion was the right decision for them,” co-author of the 2020 study Corinne Rocca, Ph.D., an epidemiologist at University of California, San Francisco, told TODAY.

Feeling confident that an abortion was the right decision is something Dr. Nancy Stanwood, section chief of family planning, obstetrics, gynecology and reproductive sciences at Yale School of Medicine, has seen in her own patients. "People know where they want their life to go. They are steering their own ship," she told TODAY. "We help get them on their way by providing the medical care that they need."

But that's not to say that everyone has an easy, uncomplicated experience. "Women really did feel a mix of emotions — positive and negative. Some sadness, some guilt, some anger, and then also relief and happiness," Rocca explained. "And then when you follow them over time, the intensity of all of those emotions goes down." 

She and Biggs both cited the work of lawyer and bioethicist Katie Watson, who writes about the difference between "situational" regret and "decisional" regret. "In studying people who have an abortion, they can regret their situation," Biggs explained. Maybe they don't feel like this is the right time for them to have a baby or they wish they were with a different partner who they might want to parent with, for instance.

"But for nearly all women, when they get an abortion, they do it because they want to. And they're there despite all of those mixed emotions and, maybe, negative feelings about their circumstances," Biggs said. "They feel that the abortion was the right decision for them."

Stefanie Lyn Kaufman-Mthimkhulu is one of those who dealt with a complex range of emotions around abortion. “People live in a messy, complicated place,” Kaufman-Mthimkhulu, who uses they/she pronouns, told TODAY.

Just a few months after giving birth to their first child, Kaufman-Mthimkhulu found out they were pregnant again.

"Literally, I took a breath, and the next thing I did was pick up the phone and call Planned Parenthood. ... I knew there was no way I was going to have another child right now," she recalled. "But I very much remember feeling like I was doing something really wrong."

Part of it came from a sense of duty, they explained. "There was a level of beating myself up, like, 'Oh, you weren't careful enough and it's your responsibility,'" Kaufman-Mthimkhulu said. "(But) responsibility doesn't mean that you are forced to carry and raise a child. That just means you need to deal with what's happening in whatever way that you choose."

Today, Kaufman-Mthimkhulu may think about what it would be like if things had gone another way and their child had a sibling, for instance. But they don't regret their decision.

Emotional consequences after — but not because of — an abortion

There may be emotional challenges associated with the abortion that don’t come directly from the procedure, Rocca said. Instead, they may come from circumstances around the need to make a tough decision or feeling isolated after their choice due to stigma.

"It's not the having or the needing and having of abortion care that can be stressful for people emotionally," Stanwood added. "What is stressful is the stigma and shame that is forced upon (people who have or need abortions) by their social network or by society writ large."

For instance, despite being so confident in her decision, Olive only began to feel comfortable discussing her abortion with her mother in the last year or so. She was also afraid to tell her current boyfriend about the abortion because she was worried he would see her as sexually promiscuous or have doubts about her being a good mother one day.

Similarly, Renee Cotsis, 28, had an abortion when she was in college. "I am someone who has struggled with depression and anxiety my entire life. And I would not connect my abortion to any of my depression or anxiety," she told TODAY.

Cotsis does, however, have negative feelings about one aspect of her experience: "The way that the guy that got me pregnant acted upset me more than anything related to the abortion whatsoever," she said.

In other research, Biggs said her team found that challenges in seeking abortion care — such as having to travel out of state and scheduling appointments, she said — were associated with an increase in symptoms of anxiety, stress and depression. Feeling a lack of autonomy — for example, when you're forced to wait for an appointment or have to disclose information about the pregnancy or abortion to other people, she said — was also associated with an increase in those mental health symptoms.

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Challenges like these definitely affected Kristin's* mental health. At her 20-week anatomy scan, she was told her daughter had hypoplastic left heart syndrome and that surgery wasn’t a viable option in their case. So, she was left to decide whether to terminate her pregnancy or to give birth and keep her baby comfortable with palliative care until she passed away.

But Kristin had to endure Arizona’s mandatory 24-hour waiting period and offers to view the ultrasound images. She had to walk through anti-abortion protesters outside the clinic. And an issue with the anesthesia during her abortion left her with symptoms of post-traumatic stress disorder for years afterward.

She called the experience "torturous" and "just awful," but doesn't regret her decision. “The damage that (the abortion) did to my mental health was only because of the laws that were in place,” she told TODAY. “If I had to watch my daughter die in front of me instead, my mental health would have been much worse.”

Now, Kristin shares her story to advocate for better, more compassionate access to care than she had. “And for those that try and make it so that people like me don’t have the options, I make sure they understand exactly what they’re taking away,” she said.

Access to abortion can be an essential part of caring for mental health

A week after her 19th birthday, Jenn Chalifoux went to a hospital in New York City and had an abortion. In the midst of treatment for a severe eating disorder, “I was having a really hard time taking care of myself,” Chalifoux told TODAY. “It was pretty obvious to me right away that I wasn’t in any state to parent.”

Chalifoux, now 30, said the abortion was an overwhelmingly positive experience. She dealt with lasting mental health effects not from the procedure — performed by such caring providers that she considered becoming one herself — but from the trauma of living in a body changing against her will.

Chalifoux said that being forced to go through with the pregnancy would have been even worse for her mental health and could have led to her taking her own life.

“If I had been denied an abortion, I would be dead right now. I really don’t doubt that,” she said. Instead, she’s recovered from her eating disorder and is now in law school, hoping to work in reproductive justice. “I am so grateful for the life that I have that abortion made possible for me,” Chalifoux said.

With the dismantling of Roe v. Wade, Biggs said more people would have to face the burden of traveling for an abortion, self-managing an abortion and carrying unwanted pregnancies to term. “All of those things have the potential to affect their emotional and physical and psychological well-being,” she explained.

One thing that has changed is that some of the younger generation of patients seem to have less of that internalized abortion stigma, Stanwood said. While there's no clear research on that yet, "anecdotally, yes, people do feel freer to talk about their experiences," she said, crediting movements like Shout Your Abortion with helping to make those conversations less taboo.

"We want it to be a choice. That's the bottom line: It needs to be a free choice," Major said. "And to say that it is hurting women to have that choice is simply wrong."

*Only first name was used to protect the person's privacy

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