CMAJ • August 30, 2005; 173 (5). doi:10.1503/cmaj.1050145.
© 2005 CMA Media Inc. or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
This Article
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Singh, S. S.
Right arrow Articles by Fisher, W. A.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Singh, S. S.
Right arrow Articles by Fisher, W. A.
Related Collections
Right arrow Abuse (child, partner, elder)
Right arrow Abortion

Letters
Correspondance

Psychological aftermath of abortion

Sukhbir S. Singh* and William A. Fisher{dagger}

Department of Obstetrics and Gynaecology;* Department of Psychology, Department of Obstetrics and Gynaecology, University of Western Ontario, London, Ont.{dagger}

Commenting on our study of the characteristics of women undergoing repeat induced abortion,1 L.L. deVeber and Ian Gentles imply that termination of pregnancy causes psychological problems. However, pre-existing differences between women who seek abortion and those who carry pregnancies to term are considerable and may account for differences in psychological status after abortion or delivery. A relevant comparison would assess psychological distress experienced by women seeking and obtaining an abortion and those seeking but denied pregnancy termination. Moreover, a full discussion of the possible consequences of abortion would include consideration of the considerable morbidity and mortality associated with illegal abortion.2

In a CMAJ commentary, Major3 reminded us that "health providers and policy-makers [must] base their conclusions [about the effects of abortion] on reputable scientific research that is methodologically rigorous, conceptually sound and free from ideological bias."

The research cited by deVeber and Gentles, however, fails to meet this standard. For example, although Ostbye and associates4 showed a greater number of hospital admissions for psychiatric problems among women who have had abortions, the most significant predictor of this finding was a history of pre-abortion psychiatric admission (odds ratio 6.58, confidence interval 2.46–17.64). Similarly, although Gissler and colleagues5 related abortion to increased risk of suicide, they clearly stated that no conclusion about cause and effect could be made and that the association might be due to common risk factors for both suicide and abortion.

Reardon and collaborators6 also showed a greater association between abortion and psychiatric admission among low-income women who had had an induced abortion than among women who carried their pregnancy to term. That study had a number of limitations, however, including lack of information regarding psychiatric history earlier than 1 year before abortion or delivery. On the basis of Canadian findings for psychiatric admissions before abortion,4 it may be that greatly elevated rates of psychiatric problems precede abortion experience. Commenting on the study by Reardon and collaborators,6 Major3 noted that "Although it is possible that abortion leads to psychiatric problems, it is just as plausible that the direction of causality is reversed, namely, that psychiatric problems cause women who become pregnant to feel less capable of raising a child and to terminate their pregnancy."

Abortion continues to be a controversial area of research. There is no causal evidence that abortion alone elevates the risk of psychiatric admission. Observational evidence of such an association may be readily interpreted as resulting from confounding pre-existing factors.

References

  1. Fisher WA, Singh SS, Shuper PA, Carey M, Otchet F, MacLean-Brine D, et al. Characteristics of women undergoing repeat induced abortion. CMAJ 2005;172(5):637-41.[Abstract/Free Full Text]
  2. Van Look PF, Cottingham JC. Unsafe abortion: an avoidable tragedy. Best Pract Res Clin Obstet Gynaecol 2002;16:205-20.[CrossRef][Medline]
  3. Major B. Psychological implications of abortion — highly charged with rife and misleading research [editorial]. CMAJ 2003;168(10):1257-8.[Free Full Text]
  4. Ostbye T, Wenghofer EF, Woodward CA, Gold G, Craighead J. Health services utilization after induced abortions in Ontario: a comparison between community clinics and hospitals. Am J Med Qual 2001;16(3):99-106.[Abstract/Free Full Text]
  5. Gissler M, Hemminki E, Lonnquist J. Suicides after pregnancy in Finland, 1987-94: register linkage study. BMJ 1996;313(7070):1431-4.[Abstract/Free Full Text]
  6. Reardon DC, Cougle JR, Rue VM, Shuping MW, Coleman PK, Ney PG. Psychiatric admissions of low-income women following abortion and childbirth. CMAJ 2003;168(10):1253-6.[Abstract/Free Full Text]




This Article
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Singh, S. S.
Right arrow Articles by Fisher, W. A.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Singh, S. S.
Right arrow Articles by Fisher, W. A.
Related Collections
Right arrow Abuse (child, partner, elder)
Right arrow Abortion