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Q&A: Abortion and mental health

This Q&A page provides the O&G perspective on abortion and mental health. It was published by the RCOG in August 2008 to accompany the passage of the Human Fertilisation and Embryology Bill through Parliament.

Abortion has been linked to depression. What does the latest scientific evidence show?

The present RCOG clinical guidelines The Care of Women Requesting Induced Abortion (at time of writing; 2004 edition) state that there is no causal association between an induced abortion for an unwanted pregnancy and future psychiatric illness or self-harm. In the cases where psychiatric illness is detected, this is a result of a pre-existing psychological condition (see recommendation 16.9, p. 35).

The report of the Science and Technology Committee Inquiry1 in October 2007 recommended that there is no evidence to show that mental health risks, such as depression, anxiety and suicidal behaviours, are linked to abortion.

The latest report by the American Psychological Association2 in August 2008, which analysed empirical studies in English published in peer-reviewed journals since 1989, confirm that there is no credible evidence to show that elective abortions carried out on unwanted pregnancies pose a threat to women’s mental health. The authors conclude that the relative risk of mental health problems for adult woman with unplanned pregnancies ‘is no greater than if they have a single elective first-trimester abortion or deliver that pregnancy’.

However, the report authors agree that more research needs to be conducted on the effect of repeat abortions on mental health.

What about the studies which show that there is a link between abortions and mental health problems?

Some studies purporting to demonstrate a link between abortion and mental health problems have been not been considered good quality evidence because of methodological weaknesses. These range from having an unrepresentative sample, selection bias in the presentation of findings and poor control of variables.

Some media reports on the issue have skewed the facts and this has resulted in further confusion over the validity of evidence.

Does this change medical practice and make the case for the counselling of women before and after the abortion?

This does not change medical practice for healthcare professionals offering abortion care.

The RCOG Patient Information3 provides details on the checks and support which women should have prior to an abortion. This includes written information about the risks of abortion and the likely experiences they may have after an abortion. A follow-up appointment within two weeks of an early medical abortion should take place to check on the woman’s mental, physical, contraceptive and sexual health, alongside further counselling if the woman suffers distress after the abortion.

As part of pre-abortion management, the RCOG guidelines recommend that the doctors caring for the women identify those who may require extra support. Risk factors are: women with a psychiatric history, poor social support or lack of a supportive partner, evidence of coercion to have the abortion, ambivalence before the abortion or being a member of a cultural group that considers abortion to be wrong. Care pathways for additional support, including access to counselling and social services, should be available to these women.

There have been calls for more counselling to be given and an introduction of a ‘cooling off’ period prior to approval for the abortion. What is the RCOG’s view?

The RCOG guidelines state that non-directional counselling should be available to women, prior to informed consent being given. However, not all women want this and it should not be forced upon them.

Information provided includes the risks from an induced abortion, the possible complications that may arise due to abortion and future contraception options. Special arrangements should be made for some women and this includes access to a female doctor if requested, interpreter services for non English-speaking women and decision-making counselling if requested.

Calls for mandatory counselling and a period for reflection have the potential to delay the abortion, thereby increasing the risk. Evidence shows that the earlier an abortion is performed, the lower the risk of complications. Complications include hemorrhage, cervical laceration, uterine perforation and infection. It is also questionable that such counselling should be imposed on a woman, even after she has decided to undergo the procedure, unless the intention is to dissuade her from having the abortion.

It is for these reasons that the RCOG does not support the suggestion of a mandatory ‘cooling off’ period.

References

1. House of Commons Science and Technology Committee. Scientific Developments Relating to the Abortion Act 1967, Twelfth Report of Session 2006–07, Volume I (October 2007), pp. 48–51. 

2. Report of the APA Task Force on Mental Health and Abortion (August 2008)

3. RCOG Patient Information. About abortion care: what you need to know. September 2004. 

Contact

For more information, please email policy@rcog.org.uk.

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