Ogbu-Nwobodo, L., Shim, R.S., et al.
October 27, 2022
N Engl J Med 2022; 387:1613-1617
DOI: 10.1056/NEJMms2211124
Here is an excerpt:
Abortion and Mental Health
To begin with, abortion does not lead to mental health harm — a fact that has been established by data and recognized by the National Academies of Sciences, Engineering, and Medicine and the American Psychological Association The Turnaway Study, a longitudinal study that compared mental health outcomes among people who obtained an abortion with those among people denied abortion care, found that abortion denial was associated with initially higher levels of stress, anxiety, and low self-esteem than was obtaining of wanted abortion care. People who had an abortion did not have an increased risk of any mental health disorder, including depression, anxiety, suicidal ideation, post-traumatic stress disorder, or substance use disorders. Whether people obtained or were denied an abortion, those at greatest risk for adverse psychological outcomes after seeking an abortion were those with a history of mental health conditions or of child abuse or neglect and those who perceived abortion stigma (i.e., they felt others would look down on them for seeking an abortion). Furthermore, people who are highly oppressed and marginalized by society are more vulnerable to psychological distress.
There is evidence that people seeking abortion have poorer baseline mental health, on average, than people who are not seeking an abortion. However, this poorer mental health results in part from structural inequities that disproportionately expose some populations to poverty, trauma, adverse childhood experiences (including physical and sexual abuse), and intimate partner violence. People seek abortion for many reasons, including (but not limited to) timing issues, the need to focus on their other children, concern for their own physical or mental health, the desire to avoid exposing a child to a violent or abusive partner, and the lack of financial security to raise a child.
In addition, for people with a history of mental illness, pregnancy and the postpartum period are a time of high risk, with increased rates of recurrence of psychiatric symptoms and of adverse pregnancy and birth outcomes. Because of stigma and discrimination, birthing or pregnant people with serious mental illnesses or substance use disorders are more likely to be counseled by health professionals to avoid or terminate pregnancies, as highlighted by a small study of women with bipolar disorder. One study found that among women with mental health conditions, the rate of readmission to a psychiatric hospital was not elevated around the time of abortion, but there was an increased rate of hospitalization in psychiatric facilities at the time of childbirth. Data also indicate that for people with preexisting mental health conditions, mental health outcomes are poor whether they obtain an abortion or give birth.
The Role of Structural Racism
Structural racism — defined as ongoing interactions between macro-level systems and institutions that constrain the resources, opportunities, and power of marginalized racial and ethnic groups — is widely considered a fundamental cause of poor health and racial inequities, including adverse maternal health outcomes. Structural racism ensures the inequitable distribution of a broad range of health-promoting resources and opportunities that unfairly advantage White people and unfairly disadvantage historically marginalized racial and ethnic groups (e.g., education, paid leave from work, access to high-quality health care, safe neighborhoods, and affordable housing). In addition, structural racism is responsible for inequities and poor mental health outcomes among many diverse populations.
