1
|
Littell JH, Young S, Pigott TD, Biggs MA, Munk‐Olsen T, Steinberg JR. Abortion and mental health outcomes: A systematic review and meta-analysis. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1410. [PMID: 38779333 PMCID: PMC11109527 DOI: 10.1002/cl2.1410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 04/17/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024]
Abstract
This is a protocol for a systematic review and meta-analysis of research on mental health outcomes of abortion. Does abortion increase the risk of adverse mental health outcomes? That is the central question for this review. Our review aims to inform policy and practice by locating, critically appraising, and synthesizing empirical evidence on associations between abortion and subsequent mental health outcomes. Given the controversies surrounding this topic and the complex social, political, legal, and ideological contexts in which research and reviews on abortion are conducted, it is especially important to conduct this systematic review and meta-analysis with comprehensive, rigorous, unbiased, and transparent methods. We will include a variety of study designs to enhance understanding of studies' methodological strengths and weaknesses and to identify potential explanations for conflicting results. We will follow open science principles, providing access to our methods, measures, and results, and making data available for re-analysis.
Collapse
Affiliation(s)
- Julia H. Littell
- Graduate School of Social Work and Social ResearchBryn Mawr CollegeBryn MawrPennsylvaniaUSA
| | - Sarah Young
- Hunt LibraryCarnegie Mellon UniversityPittsburghPennsylvaniaUSA
| | - Therese D. Pigott
- College of Education and Human DevelopmentGeorgia State UniversityAtlantaGeorgiaUSA
| | - M. Antonia Biggs
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, School of MedicineUniversity of California San FranciscoOaklandCaliforniaUSA
| | - Trine Munk‐Olsen
- Department of PsychiatryUniversity of Southern DenmarkOdenseDenmark
| | - Julia R. Steinberg
- Department of Family Science, School of Public HealthUniversity of MarylandCollege ParkMarylandUSA
| |
Collapse
|
2
|
Goueslard K, Jollant F, Cottenet J, Bechraoui-Quantin S, Rozenberg P, Simon E, Quantin C. Hospitalisation for non-lethal self-harm and premature mortality in the 3 years following adolescent pregnancy: Population-based nationwide cohort study. BJOG 2023. [PMID: 36808811 DOI: 10.1111/1471-0528.17432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/22/2023]
Abstract
OBJECTIVE To evaluate the risk of non-lethal self-harm and mortality related to adolescent pregnancy. DESIGN Nationwide population-based retrospective cohort. SETTING Data were extracted from the French national health data system. POPULATION We included all adolescents aged 12-18 years with an International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) code for pregnancy in 2013-2014. METHODS Pregnant adolescents were compared with age-matched non-pregnant adolescents and with first-time pregnant women aged 19-25 years. MAIN OUTCOME MEASURES Any hospitalisation for non-lethal self-harm and mortality during a 3-year follow-up period. Adjustment variables were age, a history of hospitalisation for physical diseases, psychiatric disorders, self-harm and reimbursed psychotropic drugs. Cox proportional hazards regression models were used. RESULTS In 2013-2014, 35 449 adolescent pregnancies were recorded in France. After adjustment, pregnant adolescents had an increased risk of subsequent hospitalisation for non-lethal self-harm in comparison with both non-pregnant adolescents (n = 70 898) (1.3% vs 0.2%, HR 3.06, 95% CI 2.57-3.66) and pregnant young women (n = 233 406) (0.5%, HR 2.41, 95% CI 2.14-2.71). Rates of hospitalisation for non-lethal self-harm were lower during pregnancy and higher between 12 and 8 months pre-delivery, 3-7 months postpartum and in the month following abortion. Mortality was significantly higher in pregnant adolescents (0.7‰) versus pregnant young women (0.4‰, HR 1.74, 95% CI 1.12-2.72), but not versus non-pregnant adolescents (0.4‰, HR 1.61, 95% CI 0.92-2.83). CONCLUSIONS Adolescent pregnancy is associated with an increased risk of hospitalisation for non-lethal self-harm and premature death. Careful psychological evaluation and support should be systematically implemented for adolescents who are pregnant.
Collapse
Affiliation(s)
- Karine Goueslard
- Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, Dijon, France
| | - Fabrice Jollant
- Department of Psychiatry, Paris-Saclay University and Academic Hospital (CHU) Bicêtre, Le Kremlin-Bicêtre, France.,Department of Psychiatry, Nîmes Academic Hospital (CHU), Nîmes, France.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,MOODS Research Team, Centre de recherche en Epidémiologie et santé des populations (CESP), Institut national de la santé et de la recherche médicale (Inserm), Le Kremlin-Bicêtre, France
| | - Jonathan Cottenet
- Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, Dijon, France
| | - Sonia Bechraoui-Quantin
- Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, Dijon, France.,Gynecology, Obstetrics and Fetal Medicine, University Hospital, Dijon, France
| | - Patrick Rozenberg
- Department of Obstetrics and Gynecology, Hôpital Intercommunal de Poissy, Université Versailles Saint-Quentin, Poissy, France
| | - Emmanuel Simon
- Gynecology, Obstetrics and Fetal Medicine, University Hospital, Dijon, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, Dijon, France.,Inserm, High-Dimensional Biostatistics for Drug Safety and Genomics, CESP, Université Paris-Saclay, Université Versailles Saint-Quentin, Université Paris-Sud, Villejuif, France
| |
Collapse
|
3
|
Rossier C, Owolabi O, Kouanda S, Bangha M, Kim CR, Ganatra B, Feehan D, Breen C, Zan M, Compaoré R, Baguiya A, Ouédraogo R, Oduor C, Bagnoa V, Athero S. Describing the safety of abortion at the population level using network-based survey approaches. Reprod Health 2022; 19:231. [PMID: 36575489 PMCID: PMC9795788 DOI: 10.1186/s12978-022-01518-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 10/21/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Despite the negative impact of unsafe abortions on women's health and rights, the degree of abortion safety remains strikingly undocumented for a large share of abortions globally. Data on how women induce abortions (method, setting, provider) are central to the measurement of abortion safety. However, health-facility statistics and direct questioning in population surveys do not yield representative data on abortion care seeking pathways in settings where access to abortion services is highly restricted. Recent developments in survey methodologies to study stigmatized / illegal behaviour and hidden populations rely on the fact that such information circulates within social networks; however, such efforts have yet to give convincing results for unsafe abortions. OBJECTIVE This article presents the protocol of a study whose purpose is to apply and develop further two network-based methods to contribute to the generation of reliable population-level information on the safety of abortions in contexts where access to legal abortion services is highly restricted. METHODS This study plans to obtain population-level data on abortion care seeking in two Health and Demographic Surveillance Systems in urban Kenya and rural Burkina Faso by applying two methods: Anonymous Third-Party Reporting (ATPR) (also known as confidantes' method) and Respondent Driven Sampling (RDS). We will conduct a mixed methods formative study to determine whether these network-based approaches are pertinent in the study contexts. The ATPR will be refined notably by incorporating elements of the Network Scale-Up Method (NSUM) to correct or account for certain of its biases (transmission, barrier, social desirability, selection). The RDS will provide reliable alternative estimates of abortion safety if large samples and equilibrium can be reached; an RDS multiplex variant (also including social referents) will be tested. DISCUSSION This study aims at documenting abortion safety in two local sites using ATPR and RDS. If successful, it will provide data on the safety profiles of abortion seekers across sociodemographic categories in two contrasted settings in sub-Saharan Africa. It will advance the formative research needed to determine whether ATPR and RDS are applicable or not in a given context. It will improve the questionnaire and correcting factors for the ATPR, improve the capacity of RDS to produce quasi-representative data on abortion safety, and advance the validation of both methods.
Collapse
Affiliation(s)
- Clémentine Rossier
- Institute of Demography and Socioeconomics, University of Geneva, 40 Bd du Pont d'Arve, 1211, Geneva, Switzerland. .,Institut National d'Etudes Démographiques, Paris, France.
| | - Onikepe Owolabi
- grid.417837.e0000 0001 1019 058XGuttmacher Institute, New York, USA
| | - Seni Kouanda
- grid.457337.10000 0004 0564 0509IRSS, Ouagadougou, Burkina Faso
| | - Martin Bangha
- grid.413355.50000 0001 2221 4219APHRC, Nairobi, Kenya
| | - Caron R. Kim
- grid.3575.40000000121633745UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Bela Ganatra
- grid.3575.40000000121633745UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Dennis Feehan
- grid.47840.3f0000 0001 2181 7878University of California, Berkeley, Berkeley USA
| | - Casey Breen
- grid.47840.3f0000 0001 2181 7878University of California, Berkeley, Berkeley USA
| | - Moussa Zan
- grid.8591.50000 0001 2322 4988Institute of Demography and Socioeconomics, University of Geneva, 40 Bd du Pont d’Arve, 1211 Geneva, Switzerland
| | | | - Adama Baguiya
- grid.457337.10000 0004 0564 0509IRSS, Ouagadougou, Burkina Faso
| | | | - Clement Oduor
- grid.413355.50000 0001 2221 4219APHRC, Nairobi, Kenya
| | - Vincent Bagnoa
- grid.457337.10000 0004 0564 0509IRSS, Ouagadougou, Burkina Faso
| | | |
Collapse
|
4
|
Abstract
The overturning of Roe v Wade has resulted in the loss of reproductive rights for millions of women in the United States. It has also put these women at risk of severe mental and physical health consequences. When legal abortions are restricted, there is a rise in illegal abortion with the risk of hemorrhage, infection, infertility, and death. There are many more risks of carrying a pregnancy to term than health or psychological risks of a legal abortion. Women who have a miscarriage risk having to prove they did not abort. In cases of medical emergencies, doctors may be restricted from performing life-saving abortions for fear of penalties. Women or children who have been victims of rape or incest will have to either have an illegal abortion or carry an unwanted pregnancy to term. In states that allow an abortion in cases of severe risk to a mother's health, panels of internists and psychiatrist may, again, be charged with deciding whether her risks are valid. Women's physical and mental health will suffer.
Collapse
|
5
|
The influence of feminist abortion accompaniment on emotions related to abortion: A longitudinal observational study in Mexico. SSM Popul Health 2022; 19:101259. [PMID: 36238820 PMCID: PMC9552094 DOI: 10.1016/j.ssmph.2022.101259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/28/2022] [Accepted: 10/02/2022] [Indexed: 11/22/2022] Open
Abstract
Emotions can reflect how individuals internalize identities, social roles, and broader power structures, including abortion stigma. Abortion accompaniment, in the form of logistical, informational, and emotional support offered by individuals and organizations, takes a person-centered, feminist, and rights-based approach. We tested the extent to which abortion accompaniment may decrease negative and increase positive feelings an individual holds related to their abortion. Using observational longitudinal data collected between January 2017 and mid-2018, we compared negative and positive emotional responses to a personal abortion experience one month and six months following the abortion to emotions immediately prior to the abortion ("baseline"), among women travelling from outside of Mexico City to abortion clinics in Mexico City with and without support of the accompaniment organization, Fondo MARIA. We used doubly robust longitudinal mixed effects models with inverse probability weighting methods. At baseline, accompanied and unaccompanied participants experienced an average of 4.9 and 4.4 negative emotions out of eight respectively (i.e., anguish, nervousness, scared, anxious, sadness, guilt, anger, shame) and 1.7 and 1.9 positive emotions of out 4 respectively (happiness, calmness, decidedness, and relief). From our model results, women accompanied (n = 77) had larger decreases in negative feelings (p < .05) and larger increases in positive feelings (p < .01) toward their abortion compared to those who were not accompanied (n = 119) at six months. These changes led the majority of accompanied respondents to have primarily positive feelings about their abortion by endline. Abortion accompaniment through Fondo MARIA in Mexico City was associated with a larger decrease in negative feelings, particularly those related to stigma, and a larger increase in positive feelings six months after abortion. Accompaniment's focus on person-centered support, self-determination, and autonomy may enable people seeking abortion to view their decision as one that is valid and legitimate, and resist the predominant stigmatizing narratives framing abortion as something that is transgressive.
Collapse
|
6
|
Madzia J, Kudrimoti M, Turner AN, Bessett D, Gallo MF. Ohio survey data assessing perceptions of abortion safety. Contraception 2021; 110:86-92. [PMID: 34971612 DOI: 10.1016/j.contraception.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 11/14/2021] [Accepted: 11/18/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Despite overwhelming data supporting the safety of abortion care in the U.S., public perceptions of abortion safety vary widely. While evidence suggests that the public overestimates abortion risk, few studies have analyzed why people think abortion is safe or unsafe. STUDY DESIGN Using data from the Ohio Survey of Women, a representative survey of women aged 18-44 years with a residential address in Ohio, we examined responses to two questions about abortion safety perceptions: the first asked respondents to rate abortion safety in Ohio, and the second asked respondents why they chose this rating of abortion safety. We analyzed these responses with inductive and deductive approaches. RESULTS There were 2,529 responses, of which 1,368 (54%) provided a response to the open-ended question about abortion safety. From this subset, 529 gave open-ended responses indicating that they perceive abortion as safe, with 47% attributing this perception to the procedure being performed by a professional in a regulated environment. In contrast, 370 gave open-ended responses indicating that they perceive abortion as unsafe; the most common explanations referred to health risks (19%) and that safety depends on pre-existing health conditions (19%). CONCLUSION Many participants perceived abortion as safe because it is performed by professionals in a clinical environment or because of personal experiences with abortion. Those perceiving a lack of safety provided more varied responses, including that abortion was dangerous due to a detrimental effect on mental health or protesters at abortion clinics.
Collapse
Affiliation(s)
- Juliana Madzia
- University of Cincinnati Dept. of Sociology, 301 Clifton Ct, Cincinnati, OH 45219, USA.
| | - Meghana Kudrimoti
- The Ohio State University College of Medicine, 370 W 9(th) Ave, Columbus, OH 43210, USA
| | - Abigail Norris Turner
- The Ohio State University College of Public Health, 250 Cunz Hall, 1841 Neil Ave, Columbus, OH 43210, USA
| | - Danielle Bessett
- University of Cincinnati Dept. of Sociology, 301 Clifton Ct, Cincinnati, OH 45219, USA
| | - Maria F Gallo
- The Ohio State University College of Public Health, 250 Cunz Hall, 1841 Neil Ave, Columbus, OH 43210, USA
| |
Collapse
|
7
|
Auger N, Ghadirian M, Low N, Healy-Profitós J, Wei SQ. Premature mortality after pregnancy loss: Trends at 1, 5, 10 years, and beyond. Eur J Obstet Gynecol Reprod Biol 2021; 267:155-160. [PMID: 34773878 DOI: 10.1016/j.ejogrb.2021.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 10/08/2021] [Accepted: 10/26/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Little is known on the long-term risk of mortality following pregnancy loss. We assessed risks of premature mortality up to three decades after miscarriage, induced abortion, ectopic or molar pregnancy, and stillbirth relative to live birth. STUDY DESIGN We carried out a longitudinal cohort study of 1,293,640 pregnant women with 18,896,737 person-years of follow-up in Quebec, Canada, from 1989 to 2018. We followed the women up to 29 years after their last pregnancy event to determine the time and cause of future in-hospital deaths before age 75 years. We used adjusted Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association of miscarriage, induced abortion, ectopic pregnancy, molar pregnancy, and stillbirth with premature mortality, compared with live birth. RESULTS Premature mortality rates were higher for most types of pregnancy loss than live birth. Compared with live birth, pregnancy loss was associated with an elevated risk of premature mortality (HRmiscarriage 1.48, 95% CI 1.33, 1.65; HRinduced abortion 1.50, 95% CI 1.39, 1.62; HRectopic 1.55, 95% CI 1.35, 1.79; and HRstillbirth 1.68, 95%. CI 1.17, 2.41). Molar pregnancy was not associated with premature mortality (HR 0.87, 95% CI 0.33, 2.32). Miscarriage and induced abortion were associated with most causes of death, whereas ectopic pregnancy was associated with cardiovascular (HR 2.18, 95 % CI 1.39, 3.42), cancer (HR 1.38, 95 % CI 1.11, 1.73), and suicide-related mortality (HR 4.94, 95 % CI 2.29, 10.68). Stillbirth was associated with cardiovascular mortality (HR 4.91, 95 % CI 2.33, 10.36). CONCLUSION Pregnancy loss is associated with an elevated risk of premature mortality up to three decades later, particularly cardiovascular, cancer, and suicide-related deaths.
Collapse
Affiliation(s)
- Nathalie Auger
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada; Institut national de santé publique du Québec, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada.
| | - Mona Ghadirian
- Institut national de santé publique du Québec, Montreal, Quebec, Canada; School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, Quebec, Canada
| | - Nancy Low
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Jessica Healy-Profitós
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada; Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Shu Qin Wei
- Institut national de santé publique du Québec, Montreal, Quebec, Canada; Department of Obstetrics and Gynecology, Sainte-Justine Research Center, University of Montreal, Montreal, Quebec, Canada
| |
Collapse
|
8
|
Lyon R, Botha K. The experience of and coping with an induced abortion: A rapid review. Health SA 2021; 26:1543. [PMID: 34230858 PMCID: PMC8252142 DOI: 10.4102/hsag.v26i0.1543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 05/18/2021] [Indexed: 11/29/2022] Open
Abstract
This rapid review was conducted to determine the scientific evidence available on how women experience induced abortion and how they cope with the subjective experience thereof. The aim of this review was to systematically explore and synthesise scientific evidence on how women experience and cope with induced abortion. The guidelines of the National Institute for Health and Clinical Excellence were used as a framework to review current international and national literature. The researchers made use of Ebsco Discovery Service to search for relevant studies. This was done by employing key concepts and related synonyms. Eleven relevant studies were identified. As the study was exploratory in nature, covering a relatively small selection of studies, heterogeneous in methodology and cultural focus, only a few general trends were highlighted. Not much information was found for women in the South African context. The study found that socio-economic disadvantages and premorbid relationships are important factors that should be better researched, understood and managed in a South African context. Despite many studies on how women experience and cope with induced abortion, the review revealed the need for research related to specific challenges and experiences of South African women.
Collapse
Affiliation(s)
- Roché Lyon
- Department of Psychology, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Karel Botha
- Department of Psychology, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| |
Collapse
|
9
|
"Gummy Bears" and "Teddy Grahams": Ultrasounds as religious biopower in Crisis Pregnancy Centers. Soc Sci Med 2021; 277:113925. [PMID: 33878663 DOI: 10.1016/j.socscimed.2021.113925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 11/21/2022]
Abstract
Scholars, activists, and medical professionals critique Crisis Pregnancy Centers (CPCs) for disseminating medical misinformation and deceptive counseling practices. Yet much of the scholarship examining CPC's counseling and medical practices relies upon discourse analyses or surreptitious approaches. I use observational data from client appointments in an evangelical CPC in the U.S. West and in-depth interviews with clients and staff to explore how guided ultrasounds construct the experience of pregnancy. I describe the "medical model of care" at this CPC and then analyze how the ultrasound becomes a socio-religious practice that shapes the social and physical experience of pregnancy. I argue this is a unique form of 'religious biopower' (Foucault 1990). Importantly, clients overwhelming describe these appointments as positive and point to how centers seemingly fill a void of care in the healthcare system. These findings reveal processes whereby faith-based, antiabortion organizations produce a 'digital quickening' through ostensibly neutral medical technologies of visualization, reinforce conservative discourses about fetal personhood and motherhood, and spread medical misinformation.
Collapse
|
10
|
Cacique DB, Passini Junior R, Duarte Osis MJM, Oliveira HC, Padilha KM, Tedesco RP, Vettorazzi J, Nascimento DJ, Coutinho PR, Coutinho IC, Feitosa FEDL. Perspectives of healthcare workers on the morality of abortion: a multicenter study in seven Brazilian public hospitals. Health Care Women Int 2019; 41:761-776. [PMID: 31580777 DOI: 10.1080/07399332.2019.1672169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We used the questionnaire "Mosaic of Opinions on Induced Abortion" to conduct a multi-centered study to evaluate the perspectives of physicians, nurses, social workers, psychologists and pharmacists on the morality of abortion. In all, 254 participants constituted the sample. The inadequate knowledge on Brazilian abortion laws was the only determinant negatively associated with the construct "Sexual and Reproductive Rights", corroborating the hypothesis that a better understanding of abortion legislation could mitigate the opposition of some professionals to the ethical perspective that access to safe abortion should be seen as a sexual and reproductive right.
Collapse
Affiliation(s)
- Denis Barbosa Cacique
- Department of Obstetrics and Gynecology, University of Campinas School of Medicine, Campinas, Brazil.,Woman's Hospital Prof. Dr. J. A. Pinotti-CAISM, Campinas, Brazil
| | - Renato Passini Junior
- Department of Obstetrics and Gynecology, University of Campinas School of Medicine, Campinas, Brazil.,Woman's Hospital Prof. Dr. J. A. Pinotti-CAISM, Campinas, Brazil
| | | | | | | | | | - Janete Vettorazzi
- Hospital of Clinics of Porto Alegre (HCPA) - UFRGS. Rua Ramiro Barcelos, Porto Alegre, Brazil
| | - Denis José Nascimento
- Hospital of Clinics of Federal University of Paraná. Rua General Carneiro, Curitiba, Brazil
| | | | | | | |
Collapse
|
11
|
Brauer M, van Ditzhuijzen J, Boeije H, van Nijnatten C. Understanding Decision-Making and Decision Difficulty in Women With an Unintended Pregnancy in the Netherlands. QUALITATIVE HEALTH RESEARCH 2019; 29:1084-1095. [PMID: 30574835 PMCID: PMC7322937 DOI: 10.1177/1049732318810435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Previous research indicates that a considerable number of women with an unintended pregnancy experience difficulty deciding about continuing or terminating the pregnancy. We examined the decision-making processes of women who experienced high decision difficulty and women who experienced little decision difficulty, to gain insight in the factors that contribute to experienced decision difficulty. Sixty-nine women who had an abortion, and 40 women who had decided to continue their unintended pregnancy, participated in qualitative interviews. We found that women's decision processes varied on 11 relevant criteria. The decision-making processes of women who experienced little decision difficulty differed from that of women who experienced high decision difficulty, but the decision-making processes of women who carried their pregnancy to term and the high decision difficulty abortion group were strikingly similar. Implications of our findings for future research and for professional care for women who are in need of support during decision-making are discussed.
Collapse
Affiliation(s)
- Marieke Brauer
- Utrecht University, Utrecht, The Netherlands
- PsyQ Mental Health Services, Purmerend, The Netherlands
| | - Jenneke van Ditzhuijzen
- Utrecht University, Utrecht, The Netherlands
- Jenneke van Ditzhuijzen, Department of Interdisciplinary Social Sciences, Faculty of Social and Behavioural Sciences, Utrecht University, PO Box 80.140, 3508 TC, Utrecht, The Netherlands.
| | | | | |
Collapse
|
12
|
Camilleri C, Beiter RM, Puentes L, Aracena-Sherck P, Sammut S. Biological, Behavioral and Physiological Consequences of Drug-Induced Pregnancy Termination at First-Trimester Human Equivalent in an Animal Model. Front Neurosci 2019; 13:544. [PMID: 31191234 PMCID: PMC6549702 DOI: 10.3389/fnins.2019.00544] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 05/13/2019] [Indexed: 12/31/2022] Open
Abstract
Given the significant physiological changes that take place during and resulting from pregnancy, as well as the relative absence of such information in relation to pregnancy termination, this study investigated the potential for developing a valid animal model to objectively assess the biological, physiological and behavioral consequences of drug-induced pregnancy termination. Female Long-Evans rats were divided into four groups (n = 19-21/group), controlling for drug [mifepristone (50 mg/kg/3 ml, i.g.)/misoprostol (0.3 mg/kg/ml, i.g.) or vehicle (1% Carboxymethylcellulose Sodium/0.2% Tween® 80 suspension, i.g.)] and pregnancy. Drug administration took place on days 12-14 of gestation (days 28-40 human gestational equivalent). Vehicle was administered to the controls on the same days. Parameters measured included rat body weight, food intake, vaginal impedance, sucrose consumption/preference, locomotor activity, forced swim test, and home-cage activity. At the termination of the study, rats were deeply anesthetized using urethane, and blood, brain, and liver were collected for biochemical analysis. Following drug/vehicle administration, only the pregnancy termination group (pregnant, drug) displayed a significant decrease in body weight, food intake, locomotor activity-related behaviors and home-cage activity relative to the control group (non-pregnant, vehicle). Additionally, the pregnancy termination group was the only group that displayed a significant reduction in sucrose consumption/preference during Treatment Week relative to Pre-Treatment Week. Vaginal impedance did not significantly decrease over time in parous rats in contrast to all other groups, including the rats in the pregnancy termination group. Biochemical analysis indicated putative drug- and pregnancy-specific influences on oxidative balance. Regression analysis indicated that pregnancy termination was a predictor variable for body weight, food intake and all locomotor activity parameters measured. Moreover, pertaining to body weight and food intake, the pregnancy termination group displayed significant changes, which were not present in a group of naturally miscarrying rats following pregnancy loss. Overall, our results appear to suggest negative biological and behavioral effects following pregnancy termination, that appear to also be distinct from natural miscarriage, and potential benefits of parity pertaining to fecundity. Thus, our findings indicate the importance for further objective investigation of the physiological and behavioral consequences of medical abortion, in order to provide further insight into the potential implications in humans.
Collapse
Affiliation(s)
- Christina Camilleri
- Department of Psychology, Franciscan University of Steubenville, Steubenville, OH, United States
| | - Rebecca M. Beiter
- Department of Psychology, Franciscan University of Steubenville, Steubenville, OH, United States
| | - Lisett Puentes
- School of Medicine, Universidad San Sebastián, Conceptión, Chile
| | | | - Stephen Sammut
- Department of Psychology, Franciscan University of Steubenville, Steubenville, OH, United States
| |
Collapse
|
13
|
Kelly K, Gochanour AA. Men and ‘post abortion syndrome’: claims versus evidence. EUR J CONTRACEP REPR 2019; 24:13-17. [DOI: 10.1080/13625187.2018.1563066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Kimberly Kelly
- Department of Sociology, Mississippi State University, Mississippi State, MS, USA
| | - Amanda A. Gochanour
- Department of Sociology, Mississippi State University, Mississippi State, MS, USA
| |
Collapse
|
14
|
Taft AJ, Powell RL, Watson LF, Lucke JC, Mazza D, McNamee K. Factors associated with induced abortion over time: secondary data analysis of five waves of the Australian Longitudinal Study on Women's Health. Aust N Z J Public Health 2019; 43:137-142. [PMID: 30727034 DOI: 10.1111/1753-6405.12874] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 11/01/2018] [Accepted: 12/01/2018] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE A trend analysis of associations with induced abortion. METHODS Secondary analysis of the 1973/78 cohort of the Australian Longitudinal Study of Women's Health of women responding to two or more consecutive surveys out of five (N=9,042), using generalised estimating equations. RESULTS New abortions dropped from 7% to 2% at surveys 4 and 5. By survey 5, 16% of respondents reported abortions, only 2% of them new. Women aged in their twenties were more likely to terminate a pregnancy if they reported less-effective contraceptives (aOR2.18 CI 1.65-2.89); increased risky drinking (aOR1.65 CI 1.14-2.38); illicit drugs ≤12 months (aOR3.09 CI 2.28-4.19); or recent partner violence (aOR2.42 CI 1.61-3.64). By their thirties, women were more likely to terminate if they reported violence (aOR2.16 CI 1.31-3.56) or illicit drugs <12 months (aOR2.69 CI 1.77-4.09). Women aspiring to be fully- (OR1.58 CI 1.37-1.83) or self-employed (OR1.28 CI 1.04-1.57), with no children (OR1.41 CI 1.14-1.75) or further educated (OR 2.08 CI 1.68-2.57) were more likely to terminate than other women. CONCLUSIONS Abortion remains strongly associated with factors affecting women's control over reproductive health such as partner violence and illicit drug use. Implications for public health: Healthcare providers should inquire about partner violence and illicit drug use among women seeking abortion, support women experiencing harm and promote effective contraception.
Collapse
Affiliation(s)
| | | | | | - Jayne C Lucke
- Australian Research Centre in Sex, Health and Society, La Trobe University, Victoria.,School of Public Health, University of Queensland
| | - Danielle Mazza
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Victoria
| | - Kathleen McNamee
- Department of Obstetrics and Gynaecology, Monash Health, Victoria
| |
Collapse
|
15
|
Reardon DC. The abortion and mental health controversy: A comprehensive literature review of common ground agreements, disagreements, actionable recommendations, and research opportunities. SAGE Open Med 2018; 6:2050312118807624. [PMID: 30397472 PMCID: PMC6207970 DOI: 10.1177/2050312118807624] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/26/2018] [Indexed: 12/26/2022] Open
Abstract
The abortion and mental health controversy is driven by two different perspectives regarding how best to interpret accepted facts. When interpreting the data, abortion and mental health proponents are inclined to emphasize risks associated with abortion, whereas abortion and mental health minimalists emphasize pre-existing risk factors as the primary explanation for the correlations with more negative outcomes. Still, both sides agree that (a) abortion is consistently associated with elevated rates of mental illness compared to women without a history of abortion; (b) the abortion experience directly contributes to mental health problems for at least some women; (c) there are risk factors, such as pre-existing mental illness, that identify women at greatest risk of mental health problems after an abortion; and (d) it is impossible to conduct research in this field in a manner that can definitively identify the extent to which any mental illnesses following abortion can be reliably attributed to abortion in and of itself. The areas of disagreement, which are more nuanced, are addressed at length. Obstacles in the way of research and further consensus include (a) multiple pathways for abortion and mental health risks, (b) concurrent positive and negative reactions, (c) indeterminate time frames and degrees of reactions, (d) poorly defined terms, (e) multiple factors of causation, and (f) inherent preconceptions based on ideology and disproportionate exposure to different types of women. Recommendations for collaboration include (a) mixed research teams, (b) co-design of national longitudinal prospective studies accessible to any researcher, (c) better adherence to data sharing and re-analysis standards, and (d) attention to a broader list of research questions.
Collapse
|
16
|
Campo-Arias A, Herazo E. Voluntary Interruption of Pregnancy in Colombia: Contributions to the Debate from Public Mental Health. ACTA ACUST UNITED AC 2018; 47:201-203. [PMID: 30286841 DOI: 10.1016/j.rcp.2018.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Adalberto Campo-Arias
- Programa de Medicina, Facultad de Ciencias de la Salud, Universidad del Magdalena, Santa Marta, Colombia.
| | - Edwin Herazo
- Instituto de Investigación del Comportamiento Humano, Bogotá, Colombia
| |
Collapse
|
17
|
Ely GE, Hales TW, Jackson DL, Kotting J, Agbemenu K. Access to choice: Examining differences between adolescent and adult abortion fund service recipients. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:695-704. [PMID: 29687508 DOI: 10.1111/hsc.12582] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/28/2018] [Indexed: 06/08/2023]
Abstract
The results of a study examining differences between U.S. adolescent and adult abortion fund service recipients are presented in this paper. Using existing case data from 2010 to 2015 from the National Network of Abortion Funds (N = 3,288), a secondary data analysis was conducted to determine whether or not the experiences of adolescent (n = 481) and adult abortion patients (n = 2,807) who received financial assistance to help pay for an abortion differed. Fisher's exact tests examined differences in dichotomous variables, and regression examined differences in procedural costs, patient resources and expected travel distances to obtain an abortion. Results show that a greater proportion of adolescents in this data set identified as African American, and that adolescents were more likely to report seeking an abortion due to lack of contraception, and rape, while adult patients were more likely to be seeking an abortion due to contraceptive failure and partner violence. Results are discussed using a trauma-informed framework.
Collapse
Affiliation(s)
- Gretchen E Ely
- School of Social Work, University at Buffalo, The State University of New York, Buffalo, NY
| | - Travis W Hales
- School of Social Work, University at Buffalo, The State University of New York, Buffalo, NY
| | - D Lynn Jackson
- Department of Social Work, Texas Christian University, Ft. Worth, TX
| | | | - Kafuli Agbemenu
- School of Nursing, University at Buffalo, The State University of New York, New York, NY
| |
Collapse
|
18
|
Ntontis E, Hopkins N. Framing a 'social problem': Emotion in anti-abortion activists' depiction of the abortion debate. BRITISH JOURNAL OF SOCIAL PSYCHOLOGY 2018; 57:666-683. [PMID: 29488234 DOI: 10.1111/bjso.12249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 02/07/2018] [Indexed: 11/27/2022]
Abstract
Social psychological research on activism typically focuses on individuals' social identifications. We complement such research through exploring how activists frame an issue as a social problem. Specifically, we explore anti-abortion activists' representation of abortion and the abortion debate's protagonists so as to recruit support for the anti-abortion cause. Using interview data obtained with UK-based anti-abortion activists (N = 15), we consider how activists characterized women having abortions, pro-abortion campaigners, and anti-abortion campaigners. In particular, we consider the varied ways in which emotion featured in the representation of these social actors. Emotion featured in different ways. Sometimes, it was depicted as constituting embodied testament to the nature of reality. Sometimes, it was depicted as blocking the rational appraisal of reality. Our analysis considers how such varied meanings of emotion shaped the characterization of abortion and the abortion debate's protagonists such that anti-abortion activists were construed as speaking for women and their interests. We discuss how our analysis of the framing of issues as social problems complements and extends social psychological analyses of activism.
Collapse
Affiliation(s)
| | - Nick Hopkins
- School of Social Sciences, University of Dundee, UK
| |
Collapse
|
19
|
Gomez AM. Abortion and subsequent depressive symptoms: an analysis of the National Longitudinal Study of Adolescent Health. Psychol Med 2018; 48:294-304. [PMID: 28625180 DOI: 10.1017/s0033291717001684] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Twenty states currently require that women seeking abortion be counseled on possible psychological responses, with six states stressing negative responses. The majority of research finds that women whose unwanted pregnancies end in abortion do not subsequently have adverse mental health outcomes; scant research examines this relationship for young women. METHODS Four waves of data from the National Longitudinal Study of Adolescent Health were analyzed. Population-averaged lagged logistic and linear regression models were employed to test the relationship between pregnancy resolution outcome and subsequent depressive symptoms, adjusting for prior depressive symptoms, history of traumatic experiences, and sociodemographic covariates. Depressive symptoms were measured using a nine-item version of the Center for Epidemiologic Studies Depression scale. Analyses were conducted among two subsamples of women whose unwanted first pregnancies were resolved in either abortion or live birth: (1) 856 women with an unwanted first pregnancy between Waves 2 and 3; and (2) 438 women with an unwanted first pregnancy between Waves 3 and 4 (unweighted n's). RESULTS In unadjusted and adjusted linear and logistic regression analyses for both subsamples, there was no association between having an abortion after an unwanted first pregnancy and subsequent depressive symptoms. In fully adjusted models, the most recent measure of prior depressive symptoms was consistently associated with subsequent depressive symptoms. CONCLUSIONS In a nationally representative, longitudinal dataset, there was no evidence that young women who had abortions were at increased risk of subsequent depressive symptoms compared with those who give birth after an unwanted first pregnancy.
Collapse
Affiliation(s)
- A M Gomez
- Sexual Health and Reproductive Equity (SHARE) Program, School of Social Welfare, University of California,Berkeley, Berkeley, CA,USA
| |
Collapse
|
20
|
Guillaume A, Rossier C. L’avortement dans le monde. État des lieux des législations, mesures, tendances et conséquences. POPULATION 2018. [DOI: 10.3917/popu.1802.0225] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
21
|
Wallin Lundell I, Sundström Poromaa I, Ekselius L, Georgsson S, Frans Ö, Helström L, Högberg U, Skoog Svanberg A. Neuroticism-related personality traits are associated with posttraumatic stress after abortion: findings from a Swedish multi-center cohort study. BMC WOMENS HEALTH 2017; 17:96. [PMID: 28969621 PMCID: PMC5625823 DOI: 10.1186/s12905-017-0417-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 08/08/2017] [Indexed: 11/23/2022]
Abstract
Background Most women who choose to terminate a pregnancy cope well following an abortion, although some women experience severe psychological distress. The general interpretation in the field is that the most consistent predictor of mental disorders after induced abortion is the mental health issues that women present with prior to the abortion. We have previously demonstrated that few women develop posttraumatic stress disorder (PTSD) or posttraumatic stress symptoms (PTSS) after induced abortion. Neuroticism is one predictor of importance for PTSD, and may thus be relevant as a risk factor for the development of PTSD or PTSS after abortion. We therefore compared Neuroticism-related personality trait scores of women who developed PTSD or PTSS after abortion to those of women with no evidence of PTSD or PTSS before or after the abortion. Methods A Swedish multi-center cohort study including six Obstetrics and Gynecology Departments, where 1294 abortion-seeking women were included. The Screen Questionnaire-Posttraumatic Stress Disorder (SQ-PTSD) was used to evaluate PTSD and PTSS. Measurements were made at the first visit and at three and six month after the abortion. The Swedish universities Scales of Personality (SSP) was used for assessment of Neuroticism-related personality traits. Multiple logistic regression analyses were performed to investigate the risk factors for development of PTSD or PTSS post abortion. Results Women who developed PTSD or PTSS after the abortion had higher scores than the comparison group on several of the personality traits associated with Neuroticism, specifically Somatic Trait Anxiety, Psychic Trait Anxiety, Stress Susceptibility and Embitterment. Women who reported high, or very high, scores on Neuroticism had adjusted odds ratios for PTSD/PTSS development of 2.6 (CI 95% 1.2–5.6) and 2.9 (CI 95% 1.3–6.6), respectively. Conclusion High scores on Neuroticism-related personality traits influence the risk of PTSD or PTSS post abortion. This finding supports the argument that the most consistent predictor of mental disorders after abortion is pre-existing mental health status.
Collapse
Affiliation(s)
- Inger Wallin Lundell
- Department of Women's and Children's Health, Uppsala University, -751 85, Uppsala, SE, Sweden. .,Sophiahemmet University, Box 5605, - 114 86, Stockholm, SE, Sweden.
| | - Inger Sundström Poromaa
- Department of Women's and Children's Health, Uppsala University, -751 85, Uppsala, SE, Sweden
| | - Lisa Ekselius
- Department of Neuroscience/Psychiatry, Uppsala University, -75185, Uppsala, SE, Sweden
| | - Susanne Georgsson
- Sophiahemmet University, Box 5605, - 114 86, Stockholm, SE, Sweden.,Department of Clinical Science, Intervention and Technology, Karolinska Institute, -171 77, Stockholm, SE, Sweden
| | - Örjan Frans
- Department of Psychology, Uppsala University, Box 1225, -751 42, Uppsala, SE, Sweden
| | - Lotti Helström
- Department of Clinical Science and Education, Karolinska Institute, -118 83, Stockholm, SE, Sweden
| | - Ulf Högberg
- Department of Women's and Children's Health, Uppsala University, -751 85, Uppsala, SE, Sweden
| | - Agneta Skoog Svanberg
- Department of Women's and Children's Health, Uppsala University, -751 85, Uppsala, SE, Sweden
| |
Collapse
|
22
|
Johnson-Mallard V, Kostas-Polston EA, Woods NF, Simmonds KE, Alexander IM, Taylor D. Unintended pregnancy: a framework for prevention and options for midlife women in the US. Womens Midlife Health 2017; 3:8. [PMID: 30766709 PMCID: PMC6299952 DOI: 10.1186/s40695-017-0027-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 09/05/2017] [Indexed: 12/15/2022] Open
Abstract
Recently unintended pregnancies have been described as "a new kind of mid-life crisis." Given the high prevalence of unwanted or mistimed pregnancy in the US, we examined the sexual and reproductive health patterns of sexually active midlife women. An examination of the prevalence of unintended pregnancy among midlife women revealed a gap in data indicating unmet sexual and reproductive health needs of midlife women. The application of a framework for primary, secondary and tertiary prevention for unintended pregnancy may assist with guiding care for women and identifying implications for reproductive health policy and potential political interference as they relate to sexual and reproductive health in midlife women.
Collapse
Affiliation(s)
- Versie Johnson-Mallard
- Department of Family, Community, and Health System Science, Robert Wood Johnson Nurse Faculty Scholar Alum, University of Florida, College of Nursing, Gainesville, FL USA
| | - Elizabeth A. Kostas-Polston
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD USA
| | - Nancy Fugate Woods
- Biobehavioral Nursing and Health Informatics, Interim Associate Dean for Diversity, Equity, and Inclusion, University of Washington School of Nursing, Seattle, WA USA
| | | | | | - Diana Taylor
- UCSF School of Nursing, Research Faculty, Advancing New Standards in Reproductive Health Program (ANSIRH), UCSF Bixby Center for Global Reproductive Health, University of California, San Francisco, CA USA
| |
Collapse
|
23
|
LaRoche KJ, Foster AM. “I kind of feel like sometimes I am shoving it under the carpet”: Documenting women’s experiences with post-abortion support in Ontario. Facets (Ott) 2017. [DOI: 10.1139/facets-2017-0059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Abortion has been available without criminal restriction in Canada since 1988, and approximately 33 000 terminations take place in Ontario each year. Objectives: This study aimed to explore women’s expressed desire for post-abortion support services, document the priorities expressed by women in seeking post-abortion support, and identify actionable strategies to improve post-abortion support services in Ontario. Methods: Between 2012 and 2014 we conducted in-depth, open-ended interviews with 60 Anglophone women from across Ontario who had recently had an abortion. We aimed to rigorously explore the compounding issues of age and geography on women’s abortion experiences. We analyzed our data for content and themes and reported on the findings related to post-abortion support. Results: One third of our participants expressed a desire for post-abortion support, yet few were able to access a timely, affordable, non-directive service. Women were uncertain about how to find services; most contacted a provider recommended by the clinic or searched online. Women were enthusiastic about a talkline format citing anonymity and convenience as the main advantages. Conclusion: Our results suggest that exploring ways to expand post-abortion support services in Ontario is warranted. A talkline format could provide an anonymous, convenient, non-judgmental, and non-directive way to address this unmet need.
Collapse
Affiliation(s)
- Kathryn J. LaRoche
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Angel M. Foster
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Institute of Population Health, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| |
Collapse
|
24
|
Hornberger LL, Breuner CC, Alderman EM, Garofalo R, Grubb LK, Powers ME, Upadhya KK, Wallace SB. Options Counseling for the Pregnant Adolescent Patient. Pediatrics 2017; 140:peds.2017-2274. [PMID: 28827379 DOI: 10.1542/peds.2017-2274] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Each year, more than 500 000 girls and young women younger than 20 years become pregnant. It is important for pediatricians to have the ability and the resources in their offices to make a timely pregnancy diagnosis in their adolescent patients and provide them with nonjudgmental pregnancy options counseling. Counseling includes an unbiased discussion of the adolescent's legal options to either continue or terminate her pregnancy, supporting the adolescent in the decision-making process, and referring the adolescent to appropriate resources and services. Pediatricians who choose not to provide such discussions should promptly refer pregnant adolescent patients to a health care professional who will offer developmentally appropriate pregnancy options counseling. This approach to pregnancy options counseling has not changed since the original 1989 American Academy of Pediatrics statement on this issue.
Collapse
Affiliation(s)
| | - Cora C. Breuner
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
| | - Elizabeth M. Alderman
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
| | - Robert Garofalo
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
| | - Laura K. Grubb
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
| | - Makia E. Powers
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
| | - Krishna Kumari Upadhya
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
| | - Stephenie B. Wallace
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
| | | |
Collapse
|
25
|
Marecek J, Macleod C, Hoggart L. Abortion embedded and embodied in social relations: Challenges for feminist psychology. FEMINISM & PSYCHOLOGY 2017. [DOI: 10.1177/0959353517704877] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
26
|
van Ditzhuijzen J, Ten Have M, de Graaf R, Lugtig P, van Nijnatten CHCJ, Vollebergh WAM. Incidence and recurrence of common mental disorders after abortion: Results from a prospective cohort study. J Psychiatr Res 2017; 84:200-206. [PMID: 27760409 DOI: 10.1016/j.jpsychires.2016.10.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 09/30/2016] [Accepted: 10/10/2016] [Indexed: 11/19/2022]
Abstract
Research in the field of mental health consequences of abortion is characterized by methodological limitations. We used exact matching on carefully selected confounders in a prospective cohort study of 325 women who had an abortion of an unwanted pregnancy and compared them 1-to-1 to controls who did not have this experience. Outcome measures were incidence and recurrence of common DSM-IV mental disorders (mood, anxiety, substance use disorders, and the aggregate measure 'any mental disorder') as measured with the Composite International Diagnostic Interview (CIDI) version 3.0, in the 2.5-3 years after the abortion. Although non-matched data suggested otherwise, women in the abortion group did not show significantly higher odds for incidence of 'any mental disorder', or mood, anxiety and substance use disorders, compared to matched controls who were similar in background variables but did not have an this experience. Having an abortion did not increase the odds for recurrence of the three disorder categories, but for any mental disorder the higher odds in the abortion group remained significant after matching. It is unlikely that termination of an unwanted pregnancy increases the risk on incidence of common mental disorders in women without a psychiatric history. However, it might increase the risk of recurrence among women with a history of mental disorders.
Collapse
Affiliation(s)
- Jenneke van Ditzhuijzen
- Department of Interdisciplinary Social Sciences, Utrecht University, Utrecht, The Netherlands.
| | - Margreet Ten Have
- Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, The Netherlands
| | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, The Netherlands
| | - Peter Lugtig
- Department of Methodology and Statistics, Utrecht University, Utrecht, The Netherlands
| | | | - Wilma A M Vollebergh
- Department of Interdisciplinary Social Sciences, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
27
|
Castillo-Bueno MD, Moreno-Pina JP, Castaño-Molina MA, González-Sánchez M, García-Arsac I. Effectiveness of non-pharmacological interventions for the prevention and management of psychological and social morbidity in women who have an elective abortion: a systematic review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2016; 14:25-37. [PMID: 28009664 DOI: 10.11124/jbisrir-2016-003222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The objective of this review is to synthesize the best available evidence on the effectiveness of non-pharmacological interventions for the prevention and management of psychological and social morbidity in women who have an elective abortion.The specific review question that will be addressed is: In women (aged 13 years or more) with unwanted pregnancies who decide to have an elective abortion, which non-pharmacological interventions should be provided before, during and after the elective abortion procedure both in community and hospital environments to prevent and manage psychological and social morbidity?
Collapse
Affiliation(s)
- María Dolores Castillo-Bueno
- 1Consejería de Sanidad y Política Social de la Región de Murcia, Murcia, Spain 2The Spanish Centre for Evidence Based Nursing and Healthcare: a Joanna Briggs Institute Centre of Excellence 3Servicio Murciano de Salud de la Región de Murcia, Murcia, Spain 4Consejería de Sanidad, Servicio de Salud del Principado de Asturias, Asturias, Spain
| | | | | | | | | |
Collapse
|
28
|
Širvinskienė G, Žemaitienė N, Jusienė R, Šmigelskas K, Veryga A, Markūnienė E. Smoking during pregnancy in association with maternal emotional well-being. MEDICINA-LITHUANIA 2016; 52:132-8. [PMID: 27170487 DOI: 10.1016/j.medici.2016.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 02/11/2016] [Accepted: 02/23/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of the study was to investigate psychosocial predictors of smoking during pregnancy. MATERIALS AND METHODS It was a cross-sectional analysis of a prospective birth-cohort study. The participants were 514 mothers of full-term infants. Women completed questionnaires during hospital stay after delivery. Questionnaire included items on sociodemographic characteristics, planning and emotional acceptance of pregnancy, reproductive history, health-related behavior, emotional well-being, and relationships with a partner. RESULTS Smoking during pregnancy was reported by 14.8% of the participants. Prenatal smoking was associated with secondary or lower education, maternal age less than 20 years, childbirth outside of marriage, history of elective abortion, unplanned pregnancy, lack of positive emotional acceptance of pregnancy by mother and father, emotional distress and alcohol consumption during pregnancy. Smoking during pregnancy remained significantly associated with prenatal alcohol consumption, previous elective abortion, and lack of positive emotional acceptance of pregnancy by mother even after adjustment for maternal age, education, and family structure. CONCLUSIONS Results support an idea of complexity of the relationships among smoking, alcohol use, and emotional well-being. Lack of positive emotional acceptance of pregnancy by mother and history of elective abortions can be considered as possible associates of smoking during pregnancy and suggest that strengthening of positive attitudes toward motherhood could add to lower smoking rates among pregnant women.
Collapse
Affiliation(s)
- Giedrė Širvinskienė
- Department of Health Psychology, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania; Health Research Institute, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Nida Žemaitienė
- Department of Health Psychology, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania; Health Research Institute, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Roma Jusienė
- Department of General Psychology, Psychological Innovations and Research Training Center, Faculty of Philosophy, Vilnius University, Vilnius, Lithuania
| | - Kastytis Šmigelskas
- Department of Health Psychology, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania; Health Research Institute, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Aurelijus Veryga
- Department of Health Psychology, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania; Health Research Institute, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Eglė Markūnienė
- Department of Neonatology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| |
Collapse
|
29
|
Biggs MA, Rowland B, McCulloch CE, Foster DG. Does abortion increase women's risk for post-traumatic stress? Findings from a prospective longitudinal cohort study. BMJ Open 2016; 6:e009698. [PMID: 26832431 PMCID: PMC4746441 DOI: 10.1136/bmjopen-2015-009698] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To prospectively assess women's risk for post-traumatic stress disorder (PTSD) and of experiencing post-traumatic stress symptoms (PTSS) over 4 ears after seeking an abortion, and to assess whether symptoms are attributed to the pregnancy, abortion or birth, or other events in women's lives. DESIGN Prospective longitudinal cohort study which followed women from approximately 1 week after receiving or being denied an abortion (baseline), then every 6 months for 4 years (9 interview waves). SETTING 30 abortion facilities located throughout the USA. PARTICIPANTS Among 956 women presenting for abortion care, some of whom received an abortion and some of whom were denied due to advanced gestational age; 863 women are included in the longitudinal analyses. MAIN OUTCOME MEASURES PTSS and PTSD risk were measured using the Primary Care PTSD Screen (PC-PTSD). Index pregnancy-related PTSS was measured by coding the event(s) described by women as the cause of their symptoms. ANALYSES We used unadjusted and adjusted logistic mixed-effects regression analyses to assess whether PTSS, PTSD risk and pregnancy-related PTSS trajectories of women obtaining abortions differed from those who were denied one. RESULTS At baseline, 39% of participants reported any PTSS and 16% reported three or more symptoms. Among women with symptoms 1-week post-abortion seeking (n=338), 30% said their symptoms were due to experiences of sexual, physical or emotional abuse or violence; 20% attributed their symptoms to non-violent relationship issues; and 19% said they were due to the index pregnancy. Baseline levels of PTSS, PTSD risk and pregnancy-related PTSS outcomes did not differ significantly between women who received and women who were denied an abortion. PTSS, PTSD risk and pregnancy-related PTSS declined over time for all study groups. CONCLUSIONS Women who received an abortion were at no higher risk of PTSD than women denied an abortion.
Collapse
Affiliation(s)
- M Antonia Biggs
- Advancing New Standards in Reproductive Health, A Program of the University of California, San Francisco, Oakland, California, USA
| | - Brenly Rowland
- Advancing New Standards in Reproductive Health, A Program of the University of California, San Francisco, Oakland, California, USA
| | - Charles E McCulloch
- Department of Epidemiology & Biostatistics, University of California, San Francisco, California, USA
| | - Diana G Foster
- Advancing New Standards in Reproductive Health, A Program of the University of California, San Francisco, Oakland, California, USA
| |
Collapse
|
30
|
Toll free but not judgment free: evaluating postabortion support services in Ontario. Contraception 2015; 92:469-74. [DOI: 10.1016/j.contraception.2015.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 06/30/2015] [Accepted: 08/05/2015] [Indexed: 11/21/2022]
|
31
|
Biggs MA, Neuhaus JM, Foster DG. Mental Health Diagnoses 3 Years After Receiving or Being Denied an Abortion in the United States. Am J Public Health 2015; 105:2557-63. [PMID: 26469674 DOI: 10.2105/ajph.2015.302803] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We set out to assess the occurrence of new depression and anxiety diagnoses in women 3 years after they sought an abortion. METHODS We conducted semiannual telephone interviews of 956 women who sought abortions from 30 US facilities. Adjusted multivariable discrete-time logistic survival models examined whether the study group (women who obtained abortions just under a facility's gestational age limit, who were denied abortions and carried to term, who were denied abortions and did not carry to term, and who received first-trimester abortions) predicted depression or anxiety onset during seven 6-month time intervals. RESULTS The 3-year cumulative probability of professionally diagnosed depression was 9% to 14%; for anxiety it was 10% to 15%, with no study group differences. Women in the first-trimester group and women denied abortions who did not give birth had greater odds of new self-diagnosed anxiety than did women who obtained abortions just under facility gestational limits. CONCLUSIONS Among women seeking abortions near facility gestational limits, those who obtained abortions were at no greater mental health risk than were women who carried an unwanted pregnancy to term.
Collapse
Affiliation(s)
- M Antonia Biggs
- M. Antonia Biggs and Diana G. Foster are with Advancing New Standards in Reproductive Health, University of California, San Francisco, Oakland. John M. Neuhaus is with the Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - John M Neuhaus
- M. Antonia Biggs and Diana G. Foster are with Advancing New Standards in Reproductive Health, University of California, San Francisco, Oakland. John M. Neuhaus is with the Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Diana G Foster
- M. Antonia Biggs and Diana G. Foster are with Advancing New Standards in Reproductive Health, University of California, San Francisco, Oakland. John M. Neuhaus is with the Department of Epidemiology and Biostatistics, University of California, San Francisco
| |
Collapse
|
32
|
Abstract
Pregnant minors can obtain an abortion without parental consent through a judicial bypass procedure in 38 states. To grant such a petition in Ohio, the Court must determine that the young woman is either "sufficiently mature and well enough informed to intelligently decide whether to have an abortion," or that notification of her parents is "not in her best interest," usually due to abuse. For the sake of anonymity in these emotionally and politically charged cases, the evaluee is referred to as "Jane Doe." This project sought to describe characteristics of teenagers seeking judicial bypass for abortion, which have not been well described in the scientific literature. Data were collected from Jane Doe evaluations completed at a metropolitan juvenile court psychiatric clinic, over 3 years. The mean age of the evaluees (N = 55) was 16.4 years. The vast majority (95%) were granted a judicial bypass. They usually had long-term boyfriends of comparable age. They had often told trusted adults about their pregnancy, though not their parents, due to concerns of violence or being excluded from the family. This study presents the first comprehensive description of characteristics of minors seeking judicial bypasses for abortion. Psychiatrists may apply general principles of informed consent in such evaluations, including ascertaining whether the decision is being made voluntarily, knowingly, and with sufficient decision-making capacity.
Collapse
|
33
|
Holmlund S, Kaljonen A, Junttila N, Räihä H, Mäkinen J, Rautava P. Psychological ill-being experienced by first-time mothers and their partners in pregnancy after abortion: a cohort study. J Psychosom Obstet Gynaecol 2014; 35:132-9. [PMID: 25403546 DOI: 10.3109/0167482x.2014.974542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The psychological effects of abortion have been much discussed lately, with recently published studies indicating that induced abortion (IA) may, contrary to the general consensus, be contributing to psychological symptoms post-abortion. Using a cohort of first-time mothers, we assessed the likelihood of them experiencing psychological ill-being at the midpoint of their pregnancy, depending on their IA history. We also examined the psychological symptoms of their partners, the hypothesis being that ill-being in IA-experienced mothers might reflect onto their partners. Altogether 680 future first-time mothers (9.8% of whom had an IA history) and their partners were selected. Most mothers attended their 16 check-ups at maternity health clinics (MHC), where the family's physical and emotional well-being were checked. Several internationally validated questionnaires, which gauged psychological ill-being, were filled in at the 20th week of pregnancy. There were no significant differences between the study and the control group in terms of psychological ill-being during the pregnancy. The contribution of prior IA to psychological ill-being during the next pregnancy seems to be minimal. The availability of IA procedures, intensive MHC services in Finland, as well as this society's neutral attitude towards IA, may be among the reasons why the results are so positive for mothers who have previously undergone one or more IAs.
Collapse
Affiliation(s)
- Susanna Holmlund
- Department of Public Health, University of Turku , Turku , Finland
| | | | | | | | | | | |
Collapse
|
34
|
Steinberg JR, Rubin LR. Psychological Aspects of Contraception, Unintended Pregnancy, and Abortion. POLICY INSIGHTS FROM THE BEHAVIORAL AND BRAIN SCIENCES 2014; 1:239-247. [PMID: 25938133 PMCID: PMC4416399 DOI: 10.1177/2372732214549328] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The knowledge of important biopsychosocial factors linking women's reproductive health and mental health is increasing. This review focuses on psychological aspects of contraception, unintended pregnancy, and abortion because these are common reproductive health experiences in U.S. women's lives. This review addresses the mental-health antecedents and consequences of these experiences, mostly focusing on depression and depressive symptoms before and after unintended pregnancy and contraception. As mental-health antecedents, depressive symptoms predict contraceptive behaviors that lead to unintended pregnancy, and mental-health disorders have been associated with having subsequent abortions. In examining the mental-health consequences, most sound research does not find abortion or contraceptive use to cause mental-health problems. Consequently, evidence does not support policies based on the notion that abortion harms women's mental health. Nevertheless, the abortion-care setting may be a place to integrate mental-health services. In contrast, women who have births resulting from unintended pregnancies may be at higher risk of postpartum depression. Social policies (e.g., paid maternity leave, subsidized child care) may protect women from mental-health problems and stress of unplanned children interrupting employment, education, and pre-existing family care responsibilities.
Collapse
Affiliation(s)
- Julia R. Steinberg
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Lisa R. Rubin
- Department of Psychology, New School for Social Research, New York, NY, USA
| |
Collapse
|
35
|
Harris LF, Roberts SCM, Biggs MA, Rocca CH, Foster DG. Perceived stress and emotional social support among women who are denied or receive abortions in the United States: a prospective cohort study. BMC Womens Health 2014; 14:76. [PMID: 24946971 PMCID: PMC4080695 DOI: 10.1186/1472-6874-14-76] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 06/16/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Examining women's stress and social support following denial and receipt of abortion furthers understanding of the effects of unwanted childbearing and abortion on women's well-being. This study investigated perceived stress and emotional social support over time among women who were denied wanted abortions and who received abortions, and compared outcomes between the groups. METHODS The Turnaway Study is a prospective cohort study of women who sought abortions at 30 abortion facilities across the United States, and follows women via semiannual phone interviews for five years. Participants include 956 English or Spanish speaking women aged 15 and over who sought abortions between 2008 and 2010 and whose gestation in pregnancy fit one of three groups: women who presented up to three weeks beyond a facility's gestational age limit and were denied an abortion; women presenting within two weeks below the limit who received an abortion; and women who received a first trimester abortion. The outcomes were modified versions of the Perceived Stress Scale and the Multidimensional Scale of Perceived Social Support. Longitudinal mixed effects models were used to assess differences in outcomes between study groups over 30 months. RESULTS Women denied abortions initially had higher perceived stress than women receiving abortions near gestational age limits (1.0 unit difference on 0-16 scale, P = 0.003). Women receiving first-trimester abortions initially had lower perceived stress than women receiving abortions near gestational age limits (0.6 difference, P = 0.045). By six months, all groups' levels of perceived stress were similar, and levels remained similar through 30 months. Emotional social support scores did not differ among women receiving abortions near gestational limits versus women denied abortions or women having first trimester abortions initially or over time. CONCLUSIONS Soon after being denied abortions, women experienced higher perceived stress than women who received abortions. The study found no longer-term differences in perceived stress or emotional social support between women who received versus were denied abortions.
Collapse
Affiliation(s)
- Laura F Harris
- University of California Berkeley, University of California San Francisco, Joint Medical Program, 570 University Hall #1190, Berkeley, CA 94720, USA
| | - Sarah CM Roberts
- Advancing New Standards in Reproductive Health (ANSIRH), University of California San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA
| | - M Antonia Biggs
- Advancing New Standards in Reproductive Health (ANSIRH), University of California San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA
| | - Corinne H Rocca
- Advancing New Standards in Reproductive Health (ANSIRH), University of California San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA
| | - Diana Greene Foster
- Advancing New Standards in Reproductive Health (ANSIRH), University of California San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA
| |
Collapse
|
36
|
Biggs MA, Upadhyay UD, Steinberg JR, Foster DG. Does abortion reduce self-esteem and life satisfaction? Qual Life Res 2014; 23:2505-13. [PMID: 24740325 PMCID: PMC4186981 DOI: 10.1007/s11136-014-0687-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2014] [Indexed: 11/30/2022]
Abstract
Purpose This study aims to assess the effects of obtaining an abortion versus being denied an abortion on self-esteem and life satisfaction. Methods We present the first 2.5 years of a 5-year longitudinal telephone-interview study that follows 956 women who sought an abortion from 30 facilities across the USA. We examine the self-esteem and life satisfaction trajectories of women who sought and received abortions just under the facility’s gestational age limit, of women who sought and received abortions in their first trimester of pregnancy, and of women who sought abortions just beyond the facility gestational limit and were denied an abortion. We use adjusted mixed effects linear regression analyses to assess whether the trajectories of women who sought and obtained an abortion differ from those who were denied one. Results Women denied an abortion initially reported lower self-esteem and life satisfaction than women who sought and obtained an abortion. For all study groups, except those who obtained first trimester abortions, self-esteem and life satisfaction improved over time. The initially lower levels of self-esteem and life satisfaction among women denied an abortion improved more rapidly reaching similar levels as those obtaining abortions at 6 months to one year after abortion seeking. For women obtaining first trimester abortions, initially higher levels of life satisfaction remained steady over time. Conclusions There is no evidence that abortion harms women’s self-esteem or life satisfaction in the short term.
Collapse
Affiliation(s)
- M A Biggs
- Advancing New Standards in Reproductive Health, University of California, San Francisco, San Francisco, CA, USA,
| | | | | | | |
Collapse
|
37
|
Curley M, Johnston C. Exploring treatment preferences for psychological services after abortion among college students. J Reprod Infant Psychol 2014. [DOI: 10.1080/02646838.2013.879566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Maureen Curley
- University of Florida College of Nursing, Gainesville, Florida, USA
| | | |
Collapse
|
38
|
Kelly K. The spread of ‘Post Abortion Syndrome’ as social diagnosis. Soc Sci Med 2014; 102:18-25. [DOI: 10.1016/j.socscimed.2013.11.030] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 11/08/2013] [Accepted: 11/13/2013] [Indexed: 11/26/2022]
|
39
|
Implementing a Prospective Study of Women Seeking Abortion in the United States: Understanding and Overcoming Barriers to Recruitment. Womens Health Issues 2014; 24:e115-23. [DOI: 10.1016/j.whi.2013.10.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 10/17/2013] [Accepted: 10/18/2013] [Indexed: 11/30/2022]
|
40
|
Wallin Lundell I, Georgsson Öhman S, Frans Ö, Helström L, Högberg U, Nyberg S, Sundström Poromaa I, Sydsjö G, Östlund I, Skoog Svanberg A. Posttraumatic stress among women after induced abortion: a Swedish multi-centre cohort study. BMC WOMENS HEALTH 2013; 13:52. [PMID: 24364878 PMCID: PMC3879178 DOI: 10.1186/1472-6874-13-52] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 12/18/2013] [Indexed: 12/04/2022]
Abstract
Background Induced abortion is a common medical intervention. Whether psychological sequelae might follow induced abortion has long been a subject of concern among researchers and little is known about the relationship between posttraumatic stress disorder (PTSD) and induced abortion. Thus, the aim of the study was to assess the prevalence of PTSD and posttraumatic stress symptoms (PTSS) before and at three and six months after induced abortion, and to describe the characteristics of the women who developed PTSD or PTSS after the abortion. Methods This multi-centre cohort study included six departments of Obstetrics and Gynaecology in Sweden. The study included 1457 women who requested an induced abortion, among whom 742 women responded at the three-month follow-up and 641 women at the six-month follow-up. The Screen Questionnaire-Posttraumatic Stress Disorder (SQ-PTSD) was used for research diagnoses of PTSD and PTSS, and anxiety and depressive symptoms were evaluated by the Hospital Anxiety and Depression Scale (HADS). Measurements were made at the first visit and at three and six months after the abortion. The 95% confidence intervals for the prevalence of lifetime or ongoing PTSD and PTSS were calculated using the normal approximation. The chi-square test and the Student’s t-test were used to compare data between groups. Results The prevalence of ongoing PTSD and PTSS before the abortion was 4.3% and 23.5%, respectively, concomitant with high levels of anxiety and depression. At three months the corresponding rates were 2.0% and 4.6%, at six months 1.9% and 6.1%, respectively. Dropouts had higher rates of PTSD and PTSS. Fifty-one women developed PTSD or PTSS during the observation period. They were young, less well educated, needed counselling, and had high levels of anxiety and depressive symptoms. During the observation period 57 women had trauma experiences, among whom 11 developed PTSD or PTSS and reported a traumatic experience in relation to the abortion. Conclusion Few women developed PTSD or PTSS after the abortion. The majority did so because of trauma experiences unrelated to the induced abortion. Concomitant symptoms of depression and anxiety call for clinical alertness and support.
Collapse
Affiliation(s)
- Inger Wallin Lundell
- Department of Women's and Children's Health, Uppsala University, SE-751 85 Uppsala, Sweden.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
van Ditzhuijzen J, ten Have M, de Graaf R, van Nijnatten CHCJ, Vollebergh WAM. Psychiatric history of women who have had an abortion. J Psychiatr Res 2013; 47:1737-43. [PMID: 23941742 DOI: 10.1016/j.jpsychires.2013.07.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 07/16/2013] [Accepted: 07/23/2013] [Indexed: 12/18/2022]
Abstract
Prior research has focused primarily on the mental health consequences of abortion; little is known about mental health before abortion. In this study, the psychiatric history of women who have had an abortion is investigated. 325 Women who recently had an abortion were compared with 1902 women from the population-based Netherlands Mental Health Survey and Incidence Study (NEMESIS-2). Lifetime prevalence estimates of various mental disorders were measured using the Composite International Diagnostic Interview 3.0. Compared to the reference sample, women in the abortion sample were three times more likely to report a history of any mental disorder (OR = 3.06, 95% CI = 2.36-3.98). The highest odds were found for conduct disorder (OR = 6.97, 95% CI = 4.41-11.01) and drug dependence (OR = 4.96, 95% CI = 2.55-9.66). Similar results were found for lifetime-minus-last-year prevalence estimates and for women who had first-time abortions only. The results support the notion that psychiatric history may explain associations that have been found between abortion and mental health. Psychiatric history should therefore be taken into account when investigating the mental health consequences of abortion.
Collapse
|
42
|
Wallin Lundell I, Sundström Poromaa I, Frans O, Helström L, Högberg U, Moby L, Nyberg S, Sydsjö G, Georgsson Öhman S, Östlund I, Skoog Svanberg A. The prevalence of posttraumatic stress among women requesting induced abortion. EUR J CONTRACEP REPR 2013; 18:480-8. [PMID: 23978220 PMCID: PMC3852718 DOI: 10.3109/13625187.2013.828030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Objectives To describe the prevalence and pattern of traumatic experiences, to assess the prevalence of posttraumatic stress disorder (PTSD) and posttraumatic stress symptoms (PTSS), to identify risk factors for PTSD and PTSS, and to analyse the association of PTSD and PTSS with concomitant anxiety and depressive symptoms in women requesting induced abortion. Methods A Swedish multi-centre study of women requesting an induced abortion. The Screen Questionnaire – Posttraumatic Stress Disorder was used for research diagnoses of PTSD and PTSS. Anxiety and depressive symptoms were evaluated by the Hospital Anxiety and Depression Scale (HADS). Results Of the 1514 respondents, almost half reported traumatic experiences. Lifetime- and point prevalence of PTSD were 7% (95% confidence interval [CI]: 5.8–8.5) and 4% (95% CI: 3.1–5.2), respectively. The prevalence of PTSS was 23% (95% CI: 21.1–25.4). Women who reported symptoms of anxiety or depression when requesting abortion were more likely to have ongoing PTSD or PTSS. Also single-living women and smokers displayed higher rates of ongoing PTSD. Conclusions Although PTSD is rare among women who request an induced abortion, a relatively high proportion suffers from PTSS. Abortion seeking women with trauma experiences and existing or preexisting mental disorders need more consideration and alertness when counselled for termination.
Collapse
Affiliation(s)
- Inger Wallin Lundell
- * Department of Women's and Children's Health, Uppsala University , Uppsala , Sweden
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
The Characteristics and Severity of Psychological Distress After Abortion Among University Students. J Behav Health Serv Res 2013; 40:279-93. [DOI: 10.1007/s11414-013-9328-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
44
|
Rosen JD. The public health risks of crisis pregnancy centers. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2012; 44:201-5. [PMID: 22958665 DOI: 10.1363/4420112] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- Joanne D Rosen
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| |
Collapse
|
45
|
Zulčić-Nakić V, Pajević I, Hasanović M, Pavlović S, Ljuca D. Psychological problems sequalae in adolescents after artificial abortion. J Pediatr Adolesc Gynecol 2012; 25:241-7. [PMID: 22840934 DOI: 10.1016/j.jpag.2011.12.072] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 12/20/2011] [Accepted: 12/27/2011] [Indexed: 11/19/2022]
Abstract
UNLABELLED STUDY AND OBJECTIVES: Controversy exists over psychological risks associated with unwanted pregnancy and consecutive abortion. The aim of this study was to assess the psychological health of female adolescents following artificial abortion up to 12(th) week of pregnancy. DESIGN The control case study. SETTING The study was carried out in the Department of Gynecology and Obstetrics, University Clinical Center Tuzla, in Bosnia-Herzegovina. PARTICIPANTS We assessed 120 female adolescents. The mean (SD) age of the patients was 17.7 (1.5) years experiencing sexual intercourse in the age of 14-19 years for trauma experiences, presence of posttraumatic stress symptoms, depression and anxiety as state, and anxiety as trait. Sixty adolescents had intentional artificial abortion and 60 had sexual intercourse but did not become pregnant. MAIN OUTCOME MEASURES We used the PTSD Questionnaire, the Beck Depression Inventory, and the Spielberger State Trait Anxiety Inventory (Form Y) for assessment of anxiety in adolescents. Basic socio-demographic data were also collected. RESULTS PTSD presented significantly more often in adolescents who aborted pregnancy (30%), than in adolescents who did not abort (13.3%) (odds ratio = 4.91 (95%CI 0.142-0.907) P = 0.03). Anxiety as state and as trait were significantly higher in the abortion group, as the mean (SD) anxiety score of patients was 59.8 (8.9), 57.9 (9.7) respectively, than in non-abortion group 49.5 (8.8), 47.3 (9.9) respectively (t = 6.392, P < 0.001; t = 5.914, P < 0.001, respectively). Adolescents who aborted pregnancy had significantly higher depression symptoms severity 29.2 (5.6) than controls 15.2 (3.3) (t = 8.322, P < 0.001), and they presented significantly more often depression (75%), than adolescents who did not abort (10%) (χ(2) = 53.279, P < 0.001). Logistic regression showed that only experience of life threatening(s) and injury of other person(s) reliably predicted PTSD, whereas abortion and experience of life threatening(s) reliably predicted depression. CONCLUSION Adolescents who aborted pregnancy presented significantly greater prevalence of PTSD and depression, and significantly greater depression severity and anxiety as state and trait than those who did not abort. Abortion predicted depression only, and did not predict PTSD.
Collapse
Affiliation(s)
- Vesna Zulčić-Nakić
- Department of Gynecology and Obstetrics, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | | | | | | | | |
Collapse
|
46
|
Steinberg JR, Trussell J, Hall KS, Guthrie K. Fatal flaws in a recent meta-analysis on abortion and mental health. Contraception 2012; 86:430-7. [PMID: 22579105 DOI: 10.1016/j.contraception.2012.03.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 03/21/2012] [Accepted: 03/28/2012] [Indexed: 01/19/2023]
Abstract
Similar to other reviews within the last 4 years, a thorough review by the Royal College of Psychiatrists, published in December 2011, found that compared to delivery of an unintended pregnancy, abortion does not increase women's risk of mental health problems. In contrast, a meta-analysis published in September 2011 concluded that abortion increases women's risk of mental health problems by 81% and that 10% of mental health problems are attributable to abortions. Like others, we strongly question the quality of this meta-analysis and its conclusions. Here we detail seven errors of this meta-analysis and three significant shortcomings of the included studies because policy, practice and the public have been misinformed. These errors and shortcomings render the meta-analysis' conclusions invalid.
Collapse
Affiliation(s)
- Julia R Steinberg
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA.
| | | | | | | |
Collapse
|
47
|
Howard LM, Rowe M, Trevillion K, Khalifeh H, Munk-Olsen T. Abortion and mental health: guidelines for proper scientific conduct ignored. Br J Psychiatry 2012; 200:74; discussion 78-9, author reply 79-80. [PMID: 22215867 DOI: 10.1192/bjp.200.1.74] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
48
|
Robinson GE, Stotland NL, Nadelson CC. Abortion and mental health: guidelines for proper scientific conduct ignored. Br J Psychiatry 2012; 200:78; discussion 78-9, author reply 79-80. [PMID: 22215872 DOI: 10.1192/bjp.200.1.78] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
49
|
|
50
|
Hennelly M, Yi J, Batkis M, Chisolm MS. Termination of pregnancy in two patients during psychiatric hospitalization for depressive symptoms and substance dependence. PSYCHOSOMATICS 2011; 52:482-5. [PMID: 21907072 DOI: 10.1016/j.psym.2011.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2010] [Revised: 08/04/2010] [Accepted: 08/06/2010] [Indexed: 10/26/2022]
Affiliation(s)
- Meghann Hennelly
- Dept. of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD 21287, USA.
| | | | | | | |
Collapse
|