ENDEAVOUR FORUM NEWSLETTER No. 130, MAY 2008

 

 

Home | Contact Us | Newsletters

 

WOMEN'S MENTAL HEALTH AFTER ABORTION

 

Increased Drug and Alcohol Abuse after Induced Abortion

Many studies have shown significant associations between induced abortion and drug and alcohol abuse.1,2,3,4,5,6 Some studies show substance use problems starting after an abortion, not before.7,8

•    Increased Drug and Alcohol Abuse during Subsequent Pregnancy after Abortion, Increasing Risk of Poor Pregnancy Outcomes

Mothers with a history of previous abortion are more likely to use illegal drugs and alcohol during subsequent pregnancy.9, 10, 11, 12, 13, 14. In a study of pregnant women, there was no difference in risk of substance abuse between women who wanted the pregnancy compared to those who did not want the pregnancy. But higher rates of drug abuse during pregnancy were found in women who had a previous abortion compared to women who had no prior abortion.15 An increase in drug and alcohol abuse among women is a special concern because substance abuse during pregnancy has been linked to poor pregnancy and birth outcomes.16, 17

•     Increased Risk of Suicide after Induced Abortion

A large record based study in Finland reported a 650% higher risk of suicide after abortion compared to women who carried to term. This study linked actual death certificates to medical records.18

A study of more than 173,000 California Medicaid records showed an increased rate of suicide that persisted for 8 years, which was not explained by prior mental illness.19

A records based U.K. report comparing suicide attempts before and after abortion indicated the increase in suicide rates after abortion was not related to prior suicidal behavior but was most likely related to adverse reactions to the abortion.20

There are reports of attempted or completed suicides coinciding with the anniversary date of the abortion or expected due date of the aborted child.21, 22

•     Increased Clinical Depression after Induced Abortion

In Fergusson's 2006 study (New Zealand), women had increased rates of depression and suicidal thoughts and attempts after abortion; the association persisted after controlling for confounding factors.23

A 2003 review article, all large, long term studies in English through 2002, concluded that abortion was clearly associated with depression serious enough to cause risk of self-harm, and that women should be warned in the informed consent process.24

•     Increased Posttraumatic Stress Disorder (PTSD) after Induced Abortion

Studies show Posttraumatic Stress Disorder and symptoms of posttraumatic stress are experienced by post-abortive women.25, 26 Post-abortive women in Russia and U.S. had higher scores on a trauma test compared to a population of battered women.27 PTSD has been shown to be a predictor of poor general health.28 Effects of trauma can be very long-lasting, with The National Comorbidity Study showing that more than one third of people with this disorder fail to recover even after many years.29

References:

REFERENCES:

  1. Yamaguchi D, Kandel D. Drug use and other detertninanls of premarital pregnancy and its outcome: A dynamic analysis of competing life events. Journal of Marriage and the Family 1987; 49: 257-270.
  2. Reardon DC, Ney P. Abortion and subsequent substance abuse. Am Journal of Drug & Alcohol Abuse. 2000; 26: 61-75.
  1. Drawer SJ, Nash ES. Therapeutic abortion on psychiatric grounds. Part I: A local study. South African Medical Journal 1978; 54:604-608.
  2. Houston H, Jacobson L. Overdose and termination of pregnancy: an important association? British Journal of Private Practice 1996;46:737-738.
  3. Klassen AD, Wilsnack SC. Sexual experience and drinking among women in a U.S. national survey. Arch Sex Behav 1986; l5:363-92.
  1. Mendelson MT, Maden CB, Daling, JR. Low birth weight in relation to multiple induced abortions. American Journal of Public Health 1992;82:391-394.
  2. Morrissey ER, Schuckit MA. Stressful events and alcohol problems seen at a detoxification center. Journal of Studies on Alcohol 1978;39:1559 -76.
  1. Coleman, PK. Induced Abortion and Increased Risk of Substance Abuse: A Review of the Evidence. Current Women's Health Reviews. 2005; 1:21-34.
  1. Coleman PK, Reardon DC, Rue V, Cougle J. Prior history of induced abortion in relation to substance use during subsequent pregnancies carried to term. American Journal of Obstetrics and Gynecology. 2002; 187:1673-78.
  1. Kuzma J, Kissinger D. Patterns of alcohol and cigarette use in pregnancy. Neurobehav Toxicol Teratol 1981; 3:211-21
  2. Gladstone J, Levy M, Nulman I, el al. Characteristics of pregnant women who engage in binge alcohol consumption. CMAJ 1997;156:789-794.
  3. Frank DA, et al. Cocaine use during pregnancy: Prevalence and correlates. Pediatrics 1988; 82: 888-895.
  4. Graham K, Koren G. Characteristics of pregnant women exposed to cocaine in Toronto between 1985 and 1990. CMAJ 199I;144:563.
  5. Oro AS, Dixon, SD. Prenatal cocaine and methamphetamine exposure: maternal and neo-natal correlates. Pediatrics 1987;111:571-578.
  6. Coleman PK, Reardon DC, Cougle J. Substance use among pregnant women in the context of previous reproductive loss and desire for current pregnancy. British Journal of Health Psychology. 2005; 10 (2):255-268 (14).
  1. Hutchings DE. The puzzle of cocaine's effects following maternal use during pregnancy. Are there reconcilable differences? Neurotoxicology and Teratology 1993; 15:281-286.
  1. Onderstna S J, Simpson S M, Brestan EV, et al. Prenatal drug exposure and social policy: The search for an appropriate response. Child Maltreatment: Journal of the American Professional Society on the Abuse of Children 2000;5: 93-108.
  1. GissterM, Hemminki E, Lonnqvist J. Suicides after pregnancy in Finland: 1987-1994: register linkage study. British Medical Journal 1996;313: 1431-4.
  1. Reardon DC, Ney PG, Scheuren FJ, Cougle JR, Coleman PK, Strahan T. "Deaths associated with pregnancy outcome: a record linkage study of low income women, " Southern Medical Journal. 2002; 95 (8):834-841.
  2. Morgan CM, Evans M, Peter JR, Currie C. Suicides after pregnancy: mental health may deteriorate as a direct effect of induced abortion. British Medical Journal 1997; 314: 902.
  3. Tischler C. Adolescent suicide attempts following elective abortion, Pediatrics 1981; 68(5):670-671.
  4. Reardon DC, Strahan TW, Thorp Jr. JM, Shuping MW. Deaths associated with abortion compared to childbirth—a review of new and old data and the medical and legal implications. .Journal of Contemporary Health Law and Policy.   2004; 20(2):279-327.
  1. Fergusson DM, Horwood LJ, Ridder EM. Abortion in young women and subsequent mental health. Journal of Child Psychology & Psychiatry 2006; 47(1): 16-24.
  2. Thorp. JM. Jr., Hartmann, KE, Shadigian E. Long-Term Physical and Psychological Health Consequences of Induced Abortion: Review of the Evidence, Obstetrical & Gynecological Survey. 2003; 58(l):67-79.
  3. Rue VM, Coleman PK, Rue JJ, et al. Induced abortion and traumatic stress: A preliminary comparison of American and Russian women. Medical Science Monitor, 10, SR5-S16.
  • 26.    Barnard C. The Long-Term Psychological Effects of Abortion. 1990. Portsmouth, NH: Institute for Pregnancy Loss.
  • 27.    Rue, op. cit.
  1. Lauterbach D, Vora R, Rakow M.The relationship between posttraumatic stress disorder and self-reported health problems. Psychosomatic Medicine. 2005 Nov-Dec 67(6):939-47.
  1. Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the National Comorbidity Survey. Archives General Psychiatry 1995; Dec 52(12):1048-60.

 

Economic Costs of Induced Abortion

 

The EUROPOP data (2004) shows that “previous induced abortions were significantly associated with preterm delivery and the risk of preterm birth increased with the number of abortions”1. More than 50 published studies to date, from more than twenty countries, show that induced abortion is significantly associated with preterm birth. 2 3 Many large studies involving hundreds of thousands of cases show the risk of preterm birth increased with increasing nubers of abortions. 4 5

 

SHORT-TERM ECONOMIC COSTS OF PRETERM BIRTHS

“Induced Abortion contributes to significantly increased neonatal health costs by causing 31.5% of early preterm births”6. Early preterm birth refers to births at less than 32 weeks gestation. “The total initial financial consequence  of induced abortion attributable to premature deliveries of less than 32 weeks “is greater than $1.2 billion in the U.S. each year”7. This is only for initial newborn hospital care for the early preterm births attributable to induced abortion, not considering long term costs and not considering costs associated with cerebral palsy.

 

COMPLICATIONS WITH PREMATURE BIRTHS

“Low birth weight and premature birth are the most important risk factors for infant mortality or later disabilities.”8 Premature infants are at increased risk for cerebral palsy, mental retardation, blindness, deafness, learning disabilities, and other neurodevelopmental disabilities.9

 

  • INFANT DEATH

Human costs of early preterm birth attributable to abortion include approximately 4094 infant deaths annually in the U.S.10  This cost includes only babies born at less than 32 weeks. Of deaths among early preterm babies, 31.5% of deaths are attributable to induced abortion in the U.S.11

  • CEREBRAL PALSY RISK WITH PRETERM BIRTH

According to a 2007 publication of the Institute of Medicine, prior first trimester induced abortion is an “immutable medical risk factor associated with preterm birth.”12  Risk of cerebral palsy folling extremely early preterm birth (less than 28 weeks) is about 38 times higher  than in overall population of all newborns.13 Conservative calculations show 1,096 additional cerebral palsy cases in the U.S. annually attributable to induced abortion.14 There are at least 22,917 excess preterm deliveries annually in the U.S. due to previous induced abortions.15

 

LONG TERM COSTS OF PRETERM BIRTH:

  • Economic costs for preterm infants extend beyond the newborn hospital care.16 There are significant lifetime consequences and costs of preterm birth including early intervention programs, special education, income supports and health care expenses and various social supports.17 It is not possible to calculate total lifetime costs due to lack of data.18 Both families and governmental agencies experience these costs.19
  • Human costs in caring for a child born preterm can be long-term, and can include maternal depression and psychological distress.20

 

CONCLUSIONS:

A major 2003 review article, accredited for continuing education for physicians stated, “We conclude that informed consent before induced abortion should include information about the subsequent risk of preterm delivery.”21 This is in keeping with the Beijing Platform for Action which states, “Take all appropriate measures to eliminate harmful, medically unnecessary .. medical interventions … and ensure that women are fully informed of their options including .. potential side effects.”22

 

References

REFERENCES:

  • 1.        Ancel P, Leiong N. Papiernik E, Saurel-Cubizolles M. Kaminski M. History of induced abortion as a risk factor for preterm birth in European countries: results of the EUROPOP survey. Human Reproduction 2004; I9:(3)734-760. This study used EUROPOP data from ten countries, and included 2938 preterm births with 4781 controls at term.
  • 2.        Rooney B and Calhoun B. Induced abortion and risk of later premature birth. Journal of American Physicians and Surgeons 2003; 8:(2)46-49 (Accessed February 23, 2008, http://www.jpands.org/vol8no2/rooney.pdf . At the time of ibis 2003 report, at least 49 studies showed these results. Since then, additional studies have been published such as the report by Ancel et al., above, bringing total to more than 50. The article by Rooney and Calhoun list the 49 available at that time.
  • 3.        Calhoun B, Shadigian E. Rooney, B. Cost Consquences of Induced Abortion as an Attributable Risk for Preterm Birth and Impact on Informed Consent. The Jounral of Reproductive Medicine 2007;52:929-937.
  • 4.        Ibid.
  • 5.        Rooney and Calhoun op cit
  • 6.        Calhoun, Rooney, Shadigan op. cit.
  • 7.        Ibid.
  • 8.        Rooney and Calhoun, op. cit., citing Escobar GJ, Liltenberg B. Petitti DB. Outcome among surviving very low birthweight infants; a meta-analysis. Arch Dis Child 1991:66:204-211.
  • 9.        Behrman RE, Buder AS. [Book] Preterm Birth: Causes, Consequences, and Prevention 2007; Washington (DC): Institute of Medicine; 2007. Executive Summary Available at: http://www.nap.edu/nap-cgi/report.cgi?record_id=11622&type=pdfxsum  (Accessed February 23,2008).
  • 10.     Calhoun, Shadiagian, Rooney, op. cit
  • 11.     Ibid.
  • 12.     Belirman RE, Buder AS. [Book] Preterm Birth: Causes, Consequences, and Prevention 2007; Washington (DC): Institute of Medicine; 2007. URL: http://www.nap.edu/openbook.php?record_id=11622&page=625 (Accessed Feb. 24, 2008)
  • 13.     Escobar GJ, Littenberg B, Petitti DB. Outcome among surviving very low birthweight infants; a meta-analysis Arch Dis Child 1991; 66:204-211.
  • 14.      Calhoun. Shadigian, Rooney,
  • 15.     Ibid.
  • 16.     Behrman RE, Butler AS. [Book] Preterm Birth: Causes, Consequences, and Prevention 2007; Washington (DC):Institute of Medicine; 2007. Executive Summary Available at. http://www.nap.edu/nap-cgi/report.cgi?record_id=11622&type=pdfxsum (Accessed February 23,2008).
  • 17.     Ibid
  • 18.     Ibid
  • 19.     Ibid
  • 20.     Ibid
  • 21.     Thorp Thorp JM, Hartmann KE, Shadigian EM. Long-term physical and psychological health consequences of induced abortion: review of the evidence, Obstet Gynecol Survey 2003; 58 (1): 67-79, (Accessed March 4,2007, at http ://www. obgvnsurvey.com )
  • 22.     Beijing Declaration and Platform for Action, United Nations.

 

 

 

 

 

Member Organisation, World Council for Life and Family

NGO in Special Consultative Status with ECOSOC of the UN