September 26, 2013 — Summary of "Women's Emotions One Week After Receiving or Being Denied an Abortion in the United States," Rocca et al., Perspectives on Sexual and Reproductive Health, September 2013.
The notion that abortion is psychologically damaging has "gained traction" both in policymaking and public opinion, but "[r]eviews of studies on mental health and emotions following abortion consistently point to methodological flaws of existing research," according to Corinne Rocca and colleagues from Advancing New Standards in Reproductive Health at the University of California-San Francisco's Bixby Center for Global Reproductive Health.
"[G]aps in the literature may explain the persistence of the belief that abortion harms women," the researchers wrote. They noted that research to date has mostly focused on first-trimester abortion patients, been conducted in narrow geographic locations and failed to account for concurrent positive and negative emotions. Further, "[m]ost studies examining women's postabortion emotional experience lack an appropriate comparison group," according to Rocca and colleagues.
They developed a study with a control group and "more nuanced consideration of women's emotions regarding abortion versus pregnancy" in order to directly compare the emotional responses of women who obtained abortions with those who wanted the procedure but were not able to obtain it.
The researchers used baseline interview data from the Turnaway Study, a five-year, longitudinal project tracking women after receiving or being denied an abortion.
Participants were divided into three groups: the turnaway group, which included women who were denied abortions because they had exceeded the facility's gestational limit by up to three weeks; the near-limit group, who obtained abortions in the two weeks prior to the gestational limit; and the first-trimester group, who obtained abortions in the first trimester of pregnancy. The final analytic sample included 843 women.
Study participants answered a series of interview questions about their emotions, circumstances and experiences related to their pregnancies and receiving or being denied abortion services, one week afterward. The researchers created a scale to assess the extent of participants' negative emotions (anger, guilt, regret and sadness) and positive emotions (happiness and relief).
"Participants in all three groups expressed a range of emotions about their pregnancy," as well as their abortion experience, the researchers found. Most commonly, women felt some sadness, regret or guilt about their pregnancies (62% to 74%), while fewer felt happiness (33%) and relief (25%).
Among women who obtained abortions, 96% in the first-trimester group and 90% in the near-limit group felt relief about their abortion experience. By contrast, sadness was the most common emotion related to the abortion experience among women in the turnaway group (60%).
Participants "reported negative and positive emotions about their abortion experience concurrently," the researchers noted. For example, 87% of women in the near-limit group who reported feeling regret also reported feeling relief, while 39% of women in the same group who reported feeling relief also reported feeling regret.
Ninety-five percent of women who obtained abortions said one week later that it was the right decision for them. "The greater the extent to which women had planned the pregnancy, the less likely they were to feel that abortion was the right decision," the researchers wrote.
Further, there was a positive association between seeking an abortion because it was not the right time to have a child and feeling that abortion was the right choice. However, there was a negative association between seeking an abortion because of a reason related to the woman's partner and feeling that it was the correct decision.
Discussion and Conclusion
The findings "highlight the importance of disentangling emotions regarding an unwanted pregnancy from those regarding an abortion," the researchers wrote, noting that prior studies that attributed negative emotions about an unwanted pregnancy to a woman's abortion experience might have "inadvertently cofounded feelings about these related but distinct events."
Despite the wide variations in participants' emotions in the week after an abortion, nearly all of them "reported that abortion was the right decision for them," which demonstrates that having strong emotions after an abortion "does not indicate that a woman feels she made the wrong decision," the researchers wrote.
Because post-abortion emotions appear to vary "largely as a function of life circumstances, difficulty with decision making and social support," regulations that apply to all women "do not address these issues and may, in fact, exacerbate negative emotions," according to the researchers. They concluded, "Efforts may be better directed toward identifying women having difficulty with the abortion decision and guiding them to individualized counseling in reproductive health care settings."