Doctors’ letter sparks debate over abortion and mental health

In a letter to The Times (London) on 27 October, 15 senior obstetricians and psychiatrists claimed that women who have abortions are risking depression and other mental illness and should be told of the dangers.

The letter reads:

‘Sir, Research published in The Journal of Child Psychology and Psychiatry in January has shown that even women without past mental health problems are at risk of psychological ill-effects after abortion. Women who had had abortions had twice the level of mental health problems and three times the risk of major depressive illness as those who had given birth or never been pregnant. 

‘This research has prompted the American Psychological Association to withdraw an official statement denying a link between abortion and psychological harm.

‘Since women having abortions can no longer be said to have a low risk of suffering from psychiatric conditions such as depression, doctors have a duty to advise about long-term adverse psychological consequences of abortion.

‘We suggest that the Royal College of Obstetricians and Gynaecologists and the Royal College of Psychiatrists revise their guidance, and that future abortion notifications clearly distinguish between physical and mental health grounds for abortion.’

The letter was challenged by the pro-choice campaign Abortion Rights, who said that the doctors were exaggerating the risks. ‘On average one in three women will have an abortion in her lifetime, it is thus a clear exaggeration to say that all these women suffer long-term psychological trauma,’ said Anne Quesney, the director. ‘The consensus of all authoritative psychiatric and medical opinion is that, for the large majority of women, the effects on psychological health of having an abortion are neither major nor long-lasting. Most women report feeling a sense of relief. They suggest that the most stressful thing is coming to the decision to terminate, particularly when the circumstances are difficult. Some women may experience feelings of sadness and loss; this is not a mental illness, it is just a normal reaction to what can be a negative event.’

The Royal College of Obstetricians and Gynaecologists’ (RCOG) Guideline The Care of Women Requesting Induced Abortion, which was revised in 2004, notes that ‘some studies suggest that rates of psychiatric illness or self-harm are higher among women who have had an abortion compared with women who give birth and to nonpregnant women of similar age’. However, it continues: ‘It must be borne in mind that these findings do not imply a causal association and may reflect continuation of pre-existing conditions’.

The anniversary of the legalisation of abortion has also triggered a new row over the time limits for abortion, which stand at 24 weeks. The campaign for change in the law will be advanced by Nadine Dorries, MP for Mid-Bedfordshire, who presents a bill to Parliament calling for the limit to be reduced to 21 weeks, and for a cooling off period after a woman has decided to have an abortion.

Abortion exposes women to higher risk of depression, The Times, 27 October 2006

Letter: Risks of abortion, The Times, 27 October 2006

The Care of Women Requesting Induced Abortion, Evidence-based Clinical Guideline Number 7, RCOG September 2004, p9

Abortion in young women and subsequent mental health. Fergusson DM, Horwood LJ, Ridder EM. Journal of Child Psychology and Psychiatry. 2006 Jan;47(1):16-24. 

Tory MP pursues abortion restrictions, Abortion Review, 18 October 2006