Abortion in young women and subsequent
David M. Fergusson, L. John Horwood, and Elizabeth M. Ridder Christchurch Health and Development Study, Christchurch, New Zealand
Background: The extent to which abortion has harmful consequences for mental health remains controversial. We aimed to examine the linkages between having an abortion and mental health outcomes over the interval from age 15–25 years. Methods: Data were gathered as part of the Christchurch Health and Development Study, a 25-year longitudinal study of a birth cohort of New Zealand children. Information was obtained on: a) the history of pregnancy/abortion for female participants over the interval from 15–25 years; b) measures of DSM-IV mental disorders and suicidal behaviour over the intervals 15–18, 18–21 and 21–25 years; and c) childhood, family and related confounding factors. Results: Forty-one percent of women had become pregnant on at least one occasion prior to age 25, with 14.6% having an abortion. Those having an abortion had elevated rates of subsequent mental health problems including depression, anxiety, suicidal behaviours and substance use disorders. This association persisted after adjustment for confounding factors. Conclusions: The ﬁndings suggest that abortion in young women may be associated with increased risks of mental health problems. Keywords: Abortion, pregnancy, mental disorder, depression, anxiety, suicidal behaviour, substance dependence.
There have been ongoing debates about the issue of
abortion as a response to unwanted pregnancy.
These debates have centred around a series of ethical, religious and other issues concerning the rights of the fetus and the mother in circumstances of unwanted pregnancy (Blanchard, 2002; Chen, 2004; Major, 2003). Although much of the debate in this
area has focused on ethical issues, it has also involved empirical concerns about the linkages between unwanted pregnancy, abortion and long-term mental health.
Speciﬁcally, a number of authors have proposed
that abortion may have longer-term adverse mental
health effects owing to feelings of guilt, unresolved
loss and lowered self-esteem (Ney, Fung, Wickett, &
Beaman-Dodd, 1994; Speckhard & Rue, 1992).
These concerns have been most clearly articulated
by Reardon and colleagues who claim that abortion
may increase risks of a wide range of mental disorders, including substance abuse, anxiety, hostility, low self-esteem, depression and bipolar disorder (Cougle, Reardon, & Coleman, 2003; Reardon &
Cougle, 2002; Reardon et al., 2003). Despite such
claims, the evidence on the linkages between abortion and mental health proves to be relatively weak with some studies ﬁnding evidence of this linkage
(Gissler, Hemminki, & Lonnqvist, 1996; Reardon &
Cougle, 2002; Reardon et al., 2003) and others failing to ﬁnd such linkages (Gilchrist, Hannaford, Frank, & Kay, 1995; Major et al., 2000; Pope, Adler,
& Tschann, 2001; Zabin, Hirsch, & Emerson, 1989).
Furthermore, the studies in this area have been
marked by a number of design limitations, including
the use of selected samples, limited length of followup, retrospective reports of mental health prior to
abortion, and failure to control confounding (Adler,
2000; Major et al., 2000).
Perhaps the most comprehensive analysis of this
topic is provided by an analysis of the National
Longitudinal Study of Youth (NLSY) reported by
Cougle et al. (2003). This analysis found that women
who reported induced abortion were 65% more likely
to score in the high-risk range for clinical depression
than women whose pregnancies resulted in birth.
This association was evident after control for a
number of prospectively assessed confounders
including pre-pregnancy psychological state. However, there were potential limitations of this study. First, the study failed to provide...