81 - Psychology of Abortion

Two Shrinks Pod

For episode 81 we’re taking a comprehensive, research driven look at abortion: what it’s like making the decision, how it impacts people psychologically and what happens if you can’t have one when you want to?
Join us for a discussion of what the research actually says, in all it’s complexity, about how women respond after an abortion.
To skip forward to a particular topic:

05:30 Decision making

19:35 Psychological impacts of having a voluntary abortion

40:25 Impacts on sexual functioning

44:45 Psychological impacts of having an abortion for medical reasons

49:12 Outcomes for women who want an abortion but are denied one

This week’s episode was brought to you by Calabash. Access your free talk at:
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Research (in order of discussion):

Introduction:

• APA Taskforce on Mental Health and Abortion (2008) https://www.apa.org/pi/women/programs/abortion/mental-health.pdf

• Abortion definition (2019) https://www.bmj.com/company/newsroom/nine-out-of-10-abortions-done-before-12-weeks-in-many-high-income-countries/

• Australian abortion rates (2021) https://www.mja.com.au/journal/2021/215/8/estimating-abortion-rate-australia-national-hospital-morbidity-and

Decision making:

• Bracken & Kasl (1975) Delay in seeking induced abortion: a review and theoretical analysis
  https://doi.org/10.1016/0002-9378(75)90929-1

• Miller (1992) An empirical study of psychological antecedents and consequences of induced abortion
  https://doi.org/10.1111/j.1540-4560.1992.tb00898.x

• Allanson (2007) Abortion decision and ambivalence: Insights via an abortion decision balance sheet
  https://www.tandfonline.com/doi/abs/10.1080/13284200701675767

• Pereira, Pires & Canavarro (2019) Decision-making trajectories leading to termination of an unplanned pregnancy: specificities among adolescent and adult women https://doi.org/10.1080/02646838.2019.1566596

• Leithner et al (2021) Three or less? Decision making for or against selective reduction and psychological outcome in forty women with a triplet pregnancy
  https://doi.org/10.1080/0167482X.2020.1750005

Psychological responses following a voluntary abortion:

• Steinberg et al (2016) Psychosocial factors and pre-abortion psychological health: the significance of stigma
  https://doi.org/10.1016/j.socscimed.2015.12.007

• Horvath & Schreiber (2017) Unintended pregnancy, induced abortion, and mental health
  https://doi.org/10.1007/s11920-017-0832-4

• Rocca et al (2013) Women’s emotions one week after receiving or being denied an abortion in the United States
  https://pubmed.ncbi.nlm.nih.gov/24020773/

• O’Donnell, O’Carroll and Toole (2018) Internalized stigma and stigma-related isolation predict women’s psychological distress and physical health symptoms post-abortion
  https://doi.org/10.1177%2F0361684317748937

• Foster et al (2015) A comparison of depression and anxiety symptom trajectories between women who had an abortion and women denied one
  https://pubmed.ncbi.nlm.nih.gov/25628123/

• Toffol et al (2016) Anxiety and quality of life after first-trimester termination of pregnancy: a prospective study
  https://doi.org/10.1111/aogs.12959

• Van Ditzhuijzen et al (2018) Long-term incidence and recurrence of common mental disorders after abortion. A Dutch prospective cohort study
  https://doi.org/10.1016/j.jpsychires.2018.04.001

• Biggs et al (2017) Women’s mental health and well-being 5 years after receiving or being denied an abortion: a prospective, longitudinal cohort study
  https://pubmed.ncbi.nlm.nih.gov/27973641/

• Biggs et al (2018) Five-year suicidal ideation trajectories among women receiving or being denied an abortion
  https://pubmed.ncbi.nlm.nih.gov/27973641/

• Holmlund et al (2014) Psychological ill-being experienced by first-time mothers and their partners in pregnancy after abortion: a cohort study
  https://pubmed.ncbi.nlm.nih.gov/27973641/

Sexual functioning:

• Limoncin et al (2017) The effect of voluntary termination of pregnancy on female sexual and emotional well-being in different age groups
  https://doi.org/10.1080/0167482X.2017.1285901

Psychological responses after an abortion for medical reasons:

• Nazare, Fonesca & Canavarro (2013) Adaptive and maladaptive grief responses following TOPFA: actor and partner effects of coping strategies
  https://doi.org/10.1080/02646838.2013.806789

• Nazare, Fonesca & Canavarro (2013) Trauma following termination of pregnancy for fetal abnormality: is this the path from guilt to grief?
  https://doi.org/10.1080/15325024.2012.743335

• Lafarge, Mitchell & Fox (2017) Posttraumatic growth following pregnancy termination for fetal abnormality: the predictive role of coping strategies and perinatal grief
  https://doi.org/10.1080/15325024.2012.743335

Outcomes for women who want an abortion and can’t have one:

• Rocca et al (2013) Women’s emotions one week after receiving or being denied an abortion in the United States
  https://doi.org/10.1363/4512213

• Horvath & Schreiber (2017) Unintended pregnancy, induced abortion, and mental health
  https://doi.org/10.1007/s11920-017-0832-4

• The harms of denying a woman a wanted abortion: findings from the turnaway study
  https://www.ansirh.org/sites/default/files/publications/files/the_harms_of_denying_a_woman_a_wanted_abortion_4-16-2020.pdf

• Ludermir et al (2010) Common mental disorders in late pregnancy in women who wanted or attempted an abortion
  https://doi.org/10.1017/s003329170999184x

• Herd et al (2015) The implications of unintended pregnancies for mental health in later life
  https://ajph.aphapublications.org/doi/10.2105/AJPH.2015.302973

Concluding remarks:

• Rebuttal to Coleman’s paper https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3699180/

• Rebuttal to Reardon’s work https://www.bmj.com/rapid-response/2011/10/31/reardon-response-russo-and-schmeige-misleads-omission-and-commission

• Quote from Surgeon General C Everett Koop https://www.apa.org/pi/women/programs/abortion/mental-health.pdf

The following resources supported our understanding of abortion legislation and access but were not cited in the show:

• Upadhyay et al (2021) Barriers to abortion care & incidence of attempted self-managed abortion
  https://www.contraceptionjournal.org/article/S0010-7824(21)00385-1/fulltext

• de Londras et al (2022) The impact of provider restrictions on abortion-related outcomes
  https://doi.org/10.1186/s12978-022-01405-x

• Faundes & Shah (2015) Evidence supporting broader access to safe legal abortion
  http://dx.doi.org/10.1016/j.ijgo.2015.03.018

• Reingold & Gostin (2019) State abortion restrictions and the new supreme court
  https://pubmed.ncbi.nlm.nih.gov/31166573/

• Pierson (2022) Roe v Wade overturned: what abortion access and reproductive rights look like around the world
  https://theconversation.com/roe-v-wade-overturned-what-abortion-access-and-reproductive-rights-look-like-around-the-world-184013