Psychiatric aspects of pregnancy termination
- Uta Landy, PhD
Uta Landy, PhD
- National Director
- Ryan Residency Training Program
- Fellowship in Family Planning
- University of California, San Francisco
- Philip D Darney, MD, MSc
Philip D Darney, MD, MSc
- University of California, San Francisco
- Section Editors
- Jody Steinauer, MD, MAS
Jody Steinauer, MD, MAS
- Section Editor — Family Planning
- Associate Professor
- Obstetrics, Gynecology and Reproductive Sciences
- University of California, San Francisco
- Jonathan M Silver, MD
Jonathan M Silver, MD
- Section Editor — Mental and Medical Disorders
- Clinical Professor of Psychiatry
- New York University School of Medicine
- Deputy Editors
- Sandy J Falk, MD, FACOG
Sandy J Falk, MD, FACOG
- Senior Deputy Editor — UpToDate
- Deputy Editor — Obstetrics, Gynecology and Women's Health
- Clinical Instructor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
- David Solomon, MD
David Solomon, MD
- Deputy Editor — Psychiatry
- Clinical Associate Professor
- Brown University School of Medicine
In the United States in 2011, approximately 1 million pregnancies were terminated . Approximately half of all pregnancies were unintended and 40 percent of these were terminated, meaning that 21 percent of all pregnancies were aborted. The number of induced abortions declined by 13 percent between 2008 and 2011, but the number of terminations of intended pregnancies has increased due to advances in prenatal testing for fetal abnormalities [1-3]. Although the psychological impact of pregnancy termination is controversial, most studies, especially higher-quality studies, suggest that induced abortion is not associated with an increased risk of serious mental health disorders [4-10]. It is important to note that the psychological context of pregnancy termination varies depending upon whether the reason is an unwanted pregnancy, multiple gestation, or fetal anomalies.
The psychiatric aspects of pregnancy termination are reviewed here. Other issues regarding pregnancy termination are discussed separately. (See "Overview of pregnancy termination".)
EVIDENCE REGARDING POTENTIAL OUTCOMES
Most reviews have concluded that abortion does not harm a women’s mental health [4,5,11-13]. However, some of the evidence regarding the psychiatric aspects of pregnancy termination is of low quality, and study designs are inconsistent . Many studies do not use validated mental health measures or control for pre-abortion mental status and whether the pregnancy is planned, and the presence and type of comparison group varies . Specifically, many studies compare women with unplanned pregnancies to women planning an ongoing pregnancy. The circumstance of an unwanted pregnancy involves factors that are likely to be associated with emotional distress, such as impaired relationships and financial difficulties.
In addition, psychological responses to pregnancy termination often vary by social, cultural, religious, or legal context, so generalizations across populations are difficult to make [14,15]. Emotional responses to abortion would be expected to differ between environments where induced abortion is permissible and where abortion is disapproved. If abortion poses risks such as injury, financial ruin, or incarceration, it is difficult to distinguish psychological responses to abortion from fears of the consequences.
The following sections focus upon mental health outcomes following pregnancy termination for unintended pregnancy. Psychiatric outcomes of pregnancy termination due to fetal abnormalities are discussed in a separate section. (See 'Termination for fetal anomalies' below.)
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- EVIDENCE REGARDING POTENTIAL OUTCOMES
- Mental disorders in aggregate
- Posttraumatic stress disorder
- Substance abuse
- Eating disorders
- POTENTIAL MODIFYING FACTORS
- Factors that may increase risk of postabortion psychiatric problems
- - Mental disorders prior to abortion
- - Social support
- - Violence victimization
- - Attitude toward pregnancy termination
- - Current family size
- - Termination for fetal anomalies
- Factors that do not appear to be related to postabortion mental health
- - Gestational duration
- - History of pregnancy termination
- - Pregnancy termination technique
- - Socioeconomic status
- - Adolescence
- - Multifetal pregnancy reduction
- Identifying women at risk of adverse outcomes
- Counseling before pregnancy termination
- - Source of counseling
- Referring clinician
- Clinician performing the termination
- - Decision-making
- - Emotional support
- Counseling after pregnancy termination