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Psychiatric admissions of low-income women following abortion and childbirth

From the Elliot Institute, Springfield, Ill. (Reardon); the Department of Psychology, University of Texas-Austin, Austin, Tex. (Cougle); the Institute for Pregnancy Loss, Stratham, NH (Rue); John Bosco Institute, Winston-Salem, NC (Shuping); the Department of Human Development and Family Studies, Bowling Green State University, Bowling Green, Ohio (Coleman); the Department of Family Practice, University of British Columbia, Vancouver, BC (Ney).

Correspondence to: Dr. David C. Reardon, Elliot Institute, PO Box 7348, Springfield IL 62791-7348, USA; fax 217 525-8212; dreardon{at}mine4ever.net

Background: Controversy exists about whether abortion or childbirth is associated with greater psychological risks. We compared psychiatric admission rates of women in time periods from 90 days to 4 years after either abortion or childbirth.

Methods: We used California Medicaid (Medi-Cal) records of women aged 13–49 years at the time of either abortion or childbirth during 1989. Only women who had no psychiatric admissions or pregnancy events during the year before the target pregnancy event were included (n = 56 741). Psychiatric admissions were examined using logistic regression analyses, controlling for age and months of eligibility for Medi-Cal services.

Results: Overall, women who had had an abortion had a significantly higher relative risk of psychiatric admission compared with women who had delivered for every time period examined. Significant differences by major diagnostic categories were found for adjustment reactions (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.1–4.1), single-episode (OR 1.9, 95% CI 1.3–2.9) and recurrent depressive psychosis (OR 2.1, 95% CI 1.3–3.5), and bipolar disorder (OR 3.0, 95% CI 1.5–6.0). Significant differences were also observed when the results were stratified by age.

Interpretation: Subsequent psychiatric admissions are more common among low-income women who have an induced abortion than among those who carry a pregnancy to term, both in the short and longer term.

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