Does abortion reduce the mental health risks of unwanted or unintended pregnancy? A re-appraisal of the evidence

Abstract

Objective: There have been debates about the linkages between abortion and mental health. Few reviews have considered the extent to which abortion has therapeutic benefits that mitigate the mental health risks of abortion. The aim of this review was to conduct a re-appraisal of the evidence to examine the research hypothesis that abortion reduces rates of mental health problems in women having unwanted or unintended pregnancy. Methods: Analysis of recent reviews (Coleman, 2011; National Collaborating Centre for Mental Health, 2011) identified eight publications reporting 14 adjusted odds ratios (AORs) spanning five outcome domains: anxiety; depression; alcohol misuse; illicit drug use/misuse; and suicidal behaviour. For each outcome, pooled AORs were estimated using a random-effects model. Results: There was consistent evidence to show that abortion was not associated with a reduction in rates of mental health problems ( p>0.75). Abortion was associated with small to moderate increases in risks of anxiety (AOR 1.28, 95% CI 0.97−1.70; p<0.08), alcohol misuse (AOR 2.34, 95% CI 1.05−5.21; p<0.05), illicit drug use/misuse (AOR 3.91, 95% CI 1.13−13.55; p<0.05), and suicidal behaviour (AOR 1.69, 95% CI 1.12−2.54; p<0.01). Conclusions: There is no available evidence to suggest that abortion has therapeutic effects in reducing the mental health risks of unwanted or unintended pregnancy. There is suggestive evidence that abortion may be associated with small to moderate increases in risks of some mental health problems.