The British medical journal, The Lancet, published an editorial in their August 23 issue regarding appropriate care for women after an abortion. Although the editorial could have taken a stronger stance on the APA report, I believe they have issued an important caution to those reviewing literature on mental health and abortion.
More than a third of American women will have an abortion by the age of 45 years, if current rates continue. A study published in The Lancet last year showed that 1·5 million abortions were done in the USA and Canada in 2003, compared with 42 million abortions worldwide.
Much attention has been given to the ethical considerations of terminating a pregnancy, but little effort has been directed at the long-term mental health effects of abortion on women. In 1989, the American Psychological Association (APA) undertook a systematic review of the literature and concluded that a single elective abortion did not result in long-term mental health problems. However, in 2006, a study published in the Journal of Youth & Adolescence concluded that abortion had a greater risk of adverse mental health outcomes compared with childbirth. This review was used in a South Dakota court to support a proposal to have abortion made illegal. The proposal failed, but doctors in the state must now inform women having a termination that they will be at risk of future mental health problems.
Recognising the need for a definitive decision on the issue, the APA commissioned the Mental Health and Abortion report, released on Aug 13. The authors systematically reviewed 50 studies, published in peer-reviewed journals since their last report in 1989, and concluded that, among adult women who have an unplanned pregnancy, the relative risk of mental health problems is no greater if they have an elective first-trimester abortion than if they deliver that pregnancy.
Although this report shows that there is no causal link between abortion and mental ill-health, the fact that some women do experience psychological problems after a termination should not be trivialised. The APA report concludes that such cases are often the result of confounding issues, such as a history of mental ill-health. Abortion is an important part of comprehensive reproductive health services. Women choosing to terminate must be offered an appropriate package of follow-up care, which includes psychological counselling when needed.