Some Stuff on Abortion

A discussion on when life starts, mental health, regret, sex education, and more.

Feb 25, 2022

Abortion is a pretty complex issue, and it’s even made more complex and boring by the philosophical arguments surrounding the issue of if abortion is okay or not. This article does not deal with those issues, readers who want that can tune into almost any abortion debate or article, but this article deals more with the effects of abortion, where quantitative data can be analyzed in absence of dork-related stuff (erm, like philosophy).

The article deals with issues like when life begins, regret, etc., but should not be taken as an article on if abortion is good or not, so none of this is to support a pro-life position or a pro-choice one. For those who want to skip to a section, just CLTR+F the titles below and skip to where you find it in bold.

When Life Begins
Mental Health
Regret Among Men and Women
Sex Education and Abortion
Back-Alley Abortion Myth
Reasons for Abortions

When Life Begins

If you’ve ever watched a debate on abortion, one of the biggest issues is when life begins—with most debates getting stuck on that question and never progressing. However, as Jacobs (2018) found in a survey of 2,899 adults, most think that biologists should answer the question of when life begins, and so Jacobs surveyed biologists to answer this question.

A sample of 5,502 biologists from 1,058 academic institutions found that among pro-life and pro-choice biologists, most agreed that life begins at fertilization.

DeVos in the Insitute for Youth Policy criticizes Jacob’s study because not only is the sample not random and thus not generalizable, but there is a difference between cell life and organism life. However, Devos’ criticisms are based on faulty logic. First off, the majority of studies do not have random samples and are voluntary. The reason for this is that getting a random sample takes a lot of money and time, something researchers don’t always have the funds to do. Because of this, non-random samples are often used for sampling, so this only slightly weakens the Jacob study, but not by much.

Second, DeVos’ second criticism is also void since Jacobs found that most biologists still agreed on when life begins for humans, which are organisms. Why DeVos did not mention this is unknown but doesn’t strengthen her point.

The issue of when a fetus has legal consideration is still unknown, but Jacob’s study helps us get past the main issue that abortion debates get stuck on.

Alongside the issue of when life begins, issues stemming from abortion are oftentimes paired up to argue against abortion, with some of these issues being regret and lower mental health, for example. Because of this, it’s important to know if these issues are valid or not.

Mental Health

The issue of mental health issues stemming from abortion is a difficult one because of what pro-lifers have argued about the situation. For example, the Caring Network, a pro-life advocacy group, argued that “there is a moderate to high increased risk of mental health problems for women who chose abortion compared to women who gave birth after an unplanned pregnancy.” The Nebraska Family Alliance said that when compared to women who did not have an abortion, those that did were at an “81% increased risk for mental health problems, 10 percent of which is directly attributable to the abortion.” Indeed, some studies have shown a relationship to exist.

Studies Showing Negative Effects

One of the most popular studies on the issue is a paper by Coleman. In a meta-analysis of 22 studies published between 1995 and 2009, Coleman (2011) found that women who had abortions experienced an 81% increased risk of mental health issues. According to Coleman, 10% of the variation in mental health issues could be attributed to abortion. Considering it shows a negative effect, it’s of no surprise to see this study cited by the Life Institute and the Christian Medical Fellowship (Taylor 2018). However, there are significant flaws with this meta-analysis.

As Steinberg et al. (2012) noted, there were several errors in Coleman’s meta-analysis. The first error was Coleman’s violation of guidelines for conducting a meta-analysis, in which Coleman did not include any information on his inclusion criteria, and 11/22 papers in the analysis were papers from Coleman himself. The second error was Coleman treating the effect sizes analyzed as independent rather than dependent. Because there were 14 data sets, there should have been 14 effect sizes analyzed, but instead, Coleman reported on 36 effect sizes. When calculating the population attributable risk, Coleman found that 10% of the variance can be explained by mental health, but a population attributable risk can only be calculated if causation is demonstrated, so Coleman’s variance number was not appropriate for his analysis. Coleman makes other errors, like not adhering to his inclusion/ exclusion criteria, misclassifying comparison groups, adjusting effect sizes for different factors when the effect sizes in this study did not adjust for the same variables, and making invalid inferences. Furthermore, many of the studies cited by Coleman were of poor quality and lacked controls, making the findings from Coleman’s study invalid.

Akin to Coleman, Gissler, Hemminki, and Lonnqvist (1996) looked at 9,192 women who had abortions and gathered data from some of their death certificates. According to the researchers, women who had abortions were more likely to commit suicide after having an abortion at all age levels.

Some of the CIs for this study were pretty wide; an issue since due to large CIs, we have little knowledge about the effect we’re measuring. However, it still shows an effect, which can’t be ignored. Furthermore, no controls for prior mental health issues were adjusted for, an issue which changes the results in another study below.

Reardon and Ney (2009) distributed a survey to 4,929 random women through a mailing list and had 700 people complete and return their survey. Women who had abortions were more likely to experience substance abuse when compared to women who carried to term. No variables were controlled for, and there was a low response rate for the study (14.2%), casting doubt on the validity of these findings. Looking at depression through the National Longitudinal Survey of Youth, Reardon and Cougle (2002) and Cougle, Reardon, and Coleman (2003) found that women who had abortions scored higher on depression scales, even after adjusting for sociodemographic variables.

As Schmiege and Russo (2005) note, Reardon and Cougle and Cougle, Reardon, and Coleman had multiple coding errors in their analysis, like “misidentification of unwanted first pregnancies and exclusion of women at highest risk of depression associated with early childbearing” (see Major et al. 2009 for more). Once running the same analysis and using more precise coding variables, there were no significant differences in depression rates between women who had abortions and those who did not once when race, age at first pregnancy, marital status, family income, and education were controlled for.

In Pedersen (2007)’s longitudinal data set, women who had abortions were more likely to turn to substance abuse than those who delivered, and women who aborted but lived with the father also didn’t, even after controlling for confounding variables. Regardless of this, the sample size for women who had abortions were small (n=76).

In a second study by Pedersen (2008), he examined the association between depression and history of pregnancy and controlled for parental education level, parental smoking habits, parental support, and depression. There was no difference in depression rates between women who have had abortions and those who delivered.

Although women who reported having an abortion in their mid-twenties reported significantly higher rates of depression than those who delivered, the sample for the women who were above Pedersen’s cut-off was too small (n=21 for both cohorts).

Sullins (2016) was more rigorous than the previous study and controlled for more variables when looking at data from the NLSY. Even after prior-mental health, age, race, parental education, childhood poverty, and region of origin were adjusted for, abortion was associated with an increase in mental health issues.

However, Sullins only adjusted for age, race, parental education, childhood poverty, region of origin, and prior-mental health. Adjustment for the number of pre-first abortion or pre-first childbirth mental health problems, the number of pre-pregnancy adverse exposures, and pre-pregnancy miscarriage history were not adjusted for in this study. Sullins also used self-reported data on abortions, an issue the National Academy of Science has discussed:

Several studies have demonstrated underreporting of past abortions in surveys of American women (Beral et al., 2004; Jones and Kost, 2007; Steinberg et al., 2011). Women who have had an abortion have a tendency not to recall—or not to report—having had an abortion when asked (Anderson et al., 1994; Bouyer et al., 2003; Hogue, 1975; Jones and Kost, 2007; Lindefors-Harris et al., 1991). Jones and Kost (2007) pooled data from the 1997 to 2001 annual National Survey of Family Growth to assess the accuracy of women's reports of the number of their past pregnancies and the timing and outcome of each pregnancy. Data were collected from face-to-face interviews and computer-assisted, self-administered questionnaires. Tallies of the survey responses were compared with national estimates of the number of abortions performed during the time period. Overall, the number of self-reported abortions was only 47 percent of the total estimated number of abortions performed in the United States during the study period. Inconsistencies also were seen between women's responses during the interviews and on the self-administered questionnaire.

Another similar study to Sullins found similar results once further variables were adjusted for. Fergusson, Horwood, and Boden (2008) utilized longitudinal data of more than 500 women from New Zealand. Variables like childhood socioeconomic status, parental adjustment, family functioning, exposure to child abuse, individual characteristics, and achievement, adolescent adjustment, and lifestyle were used as covariates.

There are a few issues with this analysis though. First off, some of the CIs in the study are wide, especially in the 5-year lagged model which is based on a longitudinal data set. Second off, as the Gutmatcher Insistute notes:

The 2008 Fergusson study likewise did not separate women who had multiple abortions from those who had only one, and it did not account for underreporting of abortion. This study also did not determine that women who had abortions were more likely than women who had unintended births (or other pregnancy outcomes) to have subsequent mental health problems; instead, the authors compared women who experienced each pregnancy outcome (abortion, pregnancy loss, unintended birth, intended birth) with women who had not experienced that particular pregnancy outcome (e.g., women who had an abortion were compared with all women who had not had an abortion, when the appropriate comparison group would have been all other women whose unintended pregnancy did not end in abortion).

Fergusson, Horwood, Boden (2013) conducted a meta-analysis and found that “There is suggestive evidence that abortion may be associated with small to moderate increases in risks of some mental health problems.” However, some of the studies used to come from Coleman’s paper cited above, so there’s no reason to take this analysis seriously.

As can be seen from the top studies, it does seem like having an abortion casually leads to lower mental health, but this does not seem to be the case once further variables are adjusted for.

Studies Showing No Negative Effect

In a systemic review for the American Psychological Association, Major et al. (2009) concluded that there was no causal correlation between abortion and lower mental health. Akin to Mota, Burnett, and Sareen (2010) in their discussions, the correlation could be due to prior-existing factors and other co-occurring risk factors.

Steinberg, McCulloch, and Adler (2014) looked at 259 women post-abortion and 677 women post-childbirth. After adjusting for the number of pre-first abortion or pre-first childbirth mental health problems, the number of pre-pregnancy adverse exposures, pre-pregnancy miscarriage history, age at first pregnancy, race or ethnicity, and childhood economic status, abortion was not a statistically significant predictor of anxiety, mood, impulse control, eating disorders or suicidal ideation.

Looking at suicide, women who had abortions had a higher increase of suicide attempts a year later when compared to women who didn’t have an abortion (aIRR=2.54). However, the increased risk was also there a year before the abortion (aIRR=2.46), and the risk decreased as time went on from 1-5 years later (aIRR=1.90) and 5 years or more later (aIRR=1.73 [Steinberg et al. 2019]). Thus, abortion does not lead to an increase in suicide attempts, and the effect decreases as time goes on.

Steinberg, Becker, and Henderson (2011) found that once further variables were adjusted, abortion was not significantly related depression, suicidal ideation, and self-esteem.

Related results are found for substance abuse, too. Roberts et al. (2018) found that women who had abortions and abused drugs and alcohol did so before they even knew they were pregnant.

Warren et al. (2010) find no correlation between abortion and later depression and low self-esteem in a sample of 298 females from the NLSY after race, household structure, family economics, socioeconomic, and demographic characteristics, and prior mental health were held constant.

Steinberg and Finer (2011) attempted to replicate Coleman et al. (2009) finding negative effects, but they were unable to do so. Instead, when prior mental health and violence experience were adjusted, there was no relationship between having had an abortion and anxiety disorders.

Women who had multiple abortions were more likely to have substance use disorder, but according to the authors, “women who had multiple abortions remained at an increased risk of having a substance use disorder compared to women who had no abortions, likely because we were unable to control for other risk factors associated with having an abortion and substance use.”

The National Academy of Science reported:

Two recent studies used Finnish registry data to analyze mental health outcomes after abortion. Leppalahti and colleagues (2016) conducted a longitudinal retrospective cohort study of girls born in Finland in 1987 to examine the effect of abortion on adolescent girls. The comparison groups were girls who had had an abortion (n = 1,041) or given birth (n = 394) before age 18 and a group with no pregnancies up to age 20 (n = 25,312). The girls were followed until age 25. The researchers found no significant differences between the underage abortion group and childbirth group with respect to risk of any psychiatric disorder (including psychoactive substance use disorder, mood disorder, or neurotic or stress-related disorders) after the index pregnancy (aOR = 0.96; 95% CI = 0.67–1.40).

Major et al. note,

“The research by Broen and colleagues followed two groups of Norwegian women from 10 days to 5 years after a first-trimester induced abortion (N 80) or early miscarriage ( 17 weeks; N 40). Comparisons between the miscarriage and induced-abortion groups, with potential confounders controlled for, revealed no significant differences in anxiety, depression, or subjective well-being at any time point.”

Looking at the data, Fergusson (2008) notes that the data on abortion and mental health is neither negative nor no effect, but inconclusive. But in a systemic review of the literature in 2008, Charles et al. (2008) looked at 21 studies published between January 1, 1989, and August 1, 2008. The highest-quality studies were more likely to find no effect or were neutral, but studies with flawed methodology were more likely to find negative effects.

Thus, the findings depend on the quality of the studies.

When low mental health does come before an abortion, it can be attributed to stigma and childhood and partner adversities (Steinberg et al. 2015).

One thing worth mentioning is the mental health of women who are denied abortions. Women who are denied an abortion are more likely to report more anxiety symptoms, lower self-esteem, and lower life satisfaction, according to one longitudinal study (Biggs et al. 2017).

Similar results are also seen in women who are forced to give birth and women who put their kids up for adoption (see Kornfield and Geller 2009).

In conclusion, there seems to be no causal effect between abortion and lower mental health, especially once other variables are held constant. The link between them could be due to other variables, or simply does not exist at all – hence the studies find no statistically significant association once other variables are adjusted for.

Regret Among Men and Women

Regret stemming from abortion has been one argument clung to by pro-life individuals. However, the evidence does not indicate that a majority of women end up regretting their abortions later on in their lives, and actually feel a sense of relief rather than regret.

Using 5-year’s worth of longitudinal data from the Turnaway Study from a sample of 667 people included in the study, Rocca et al. (2020) found that about half of the sample (51%) reported positive emotions (relief & happiness), 20% felt few or no emotions, 17% felt mostly negative emotions (regret, guilt, sadness, anger) and 12% felt both positive and negative emotions at baseline, a week after the abortion.

As time went on, the majority of women felt none or few emotions, and the number of women who felt negative emotions decreased from 17% at baseline to 6% after 5 years. There was no evidence of emergent or positive feelings as time went on. Of women who reported that their abortion was a very difficult decision, they reported feeling more sadness after a week rather than those who thought it wasn’t a difficult decision. However, feelings of sadness, including for those who thought it was a difficult decision, decreased; the same was found for levels of relief.

Adler et al. (1990) reviewed some studies at the time and found that the majority of included studies did not find regret, sadness, or guilt among the majority of participants. Looking at 442 women after first-trimester abortion, Major et al. (2000) found that “Most women were satisfied with their decision, believed they had benefited more than had been harmed by their abortion and would have the abortion again.” Thus, both past reviews and studies on the issue and longitudinal data have now shown that there are a large number of women who end up regretting their abortion.

Why do women tend to feel positive emotions though? As Rocca et al. have found, this is due to relief and happiness, with the happiness most likely being attributable to the fact that after a woman has an abortion, they feel as if they took back control of their life. Thus, the positive emotions women feel after abortions are due to taking back their bodily autonomy in some sense. However, even if women aren’t regretting their abortion, how do men compare?

Focusing on men specifically, Coyle and Rue (2015) utilized an internet convenience sample of 89 men and found 3 common themes: (1) loss and grief; (2) helplessness and/ or victimization; and (3) spiritual healing. Although of interest, the sample is small and no mention is made of how many men reported these themes, so it’s hard to know how prevalent they were.

Coyle (2007) examined 28 studies that reviewed how men felt about their partner’s abortion, but most studies suffered from multiple issues. The case studies included do not allow for generalizations, the clinical observations had small sample sizes, and the intervention studies and most of the qualitative studies had small samples. This really only leaves us with the quantitative data which seems to be of higher quality, to a certain degree. Some had small samples, only one had a large sample. One cited study, which seems to be the only one with a large sample, found that

Post-abortion emotions among men included sadness (85%), depression (47%), anger (33%), fear (37%), guilt (22%), failure (26%), relief (32%), isolation (20%), and withdrawn (32%). Somatic symptoms such as crying, irritability, and loss of concentration were reported by 50%, 38%, and 41% of men respectively. Relationship difficulties were most likely to occur between 3 and 6 months post-abortion. Fifty percent of the couples reported a decrease in frequency of sexual intercourse due to sadness, depression, fear of pregnancy, or deterioration of relationship.

These were the same results in the quantitative studies with smaller samples. Overall, though, the review of the literature pertaining to how men react seems to be consistent: while abortion does bring relief to men, it also is associated with lower mental health when it comes to thoughts about abortion. A significant limitation with these studies is the small sample sizes and lack of control groups. The issue of how abortion affects men is filled with poor studies, but they do show consistent results. More research is needed for this specific population.

Overall, it does not seem like regret is something faced by the majority of women after having an abortion, and as time goes on, those who do feel regret have a change in opinion as time goes on. Men, however, do face some psychological issues, which is important for some people who see men as important in the argument on abortion. Their data is based more on poorly done studies, so more research is needed for them.

Those are the only negative effects I could really find argued by pro-lifers, so the discussion ends there until I can find anything else. However, one thing I find interesting is the lack of talk about sex education to lower abortions among some pro-lifers. Due to this, it would be interesting to see the effects sex education has on abortion rates.

Sex Education and Abortion

Stanger-Hall and Hall (2011) analyzed data on abstinence education from 30 states that had abstinence-only education and organized them into an ordinal category (0-3). Those with higher ordinal scores put more emphasis on abstinence until marriage, a score of 2 indicated promoting abstinence in school-aged teens without talks on contraception pills, a score of 1 indicated covered abstinence among school-aged teens with talks about HIV/STDS (2-3 did not talk about this), and a score of 0 indicated sex education laws/ or HIV education in which abstinence was not mentioned.

Teens in states with more abstinence education were more likely to become pregnant, and abortion rates were not significantly correlated with abstinence education (rho=-0.136, p=0.415). Teen pregnancies were actually higher among states that had more emphasis on abstinence when teaching sex education.

So, it doesn’t seem like abstinence-only sex education actually works when it comes to limiting teen pregnancies and is not correlated with abortion rates. Furthermore, we should not expect teens to not be sexually active, so teaching abstinence sex education seems counterintuitive.

The issue of teenagers being sexually active, and thus having abstinence sex education not work, are an issue found in a review of the literature by Santelli et al. (2017). According to the authors,

The most useful observational data in understanding the efficacy of abstinence intentions comes from examination of the virginity pledge movement in the National Longitudinal Survey of Youth (Add Health) [37,38]. Add Health data suggest that many adolescents who intend to be abstinent fail to do so, and that when abstainers do initiate intercourse, many fail to use condoms and contraception to protect themselves [37,38]. Other studies find higher rates of human papillomavirus and nonmarital pregnancies among adolescent females who took a virginity pledge than those who did not [39]. Consequently, these studies suggest that user failure with abstinence is high.

Sex education should not be based around abstinence, especially since teenagers tend to not work in such a way that they’d reframe from having sex. Since abstinence sex education does not seem to ward off teen pregnancies and stop teenagers from having sex, more sex-positive sex education should be implemented.

One study by Kohler, Manhart, and Lafferty (2008) found that adolescents who received comprehensive sex education (i.e. “abstinence messages, but also provide information on birth control methods to prevent pregnancy and condoms to prevent STDs”) were less likely to report teen pregnancies and a lower likelihood of engaging in vaginal intercourse.

Thus, if pro-lifers seek to lower teen pregnancies and lower the number of teenagers having sex, to ward off abortions as an outcome, then they should support comprehensive sex education that teaches abstinence and birth control methods.

Up until now, the article seems pretty anti-pro-life since many of the claims being responded to are typically made by the pro-life crowd, but they also happen to just make more claims up and thus the article will tend to lean more on what they say. However, pro-choicers also do make some claims which aren’t true, so this part of the article will focus on that.

Back-Alley Abortion Myth

One of the most popular myths surrounding the criminalization of abortion is the myth of back-alley abortions, in which women would have to go to back-alleys to have an abortion like during pre-Roe v. Wade or use dangerous methods to induce an abortion or have one (see NPR 2019; Los Angeles Times 2021). However, while some of this did happen, it wasn’t as prevalent as some have suggested it.

First off, illegal abortions were still performed by physicians, but “back-alley” simply refers to how women entered the building—through the back-alley. As Calderone (1960) noted,

Fact No. 3-Abortion is no longer a dangerous procedure. This applies not just to therapeutic abortions as performed in hospitals but also to so-called illegal abortions as done by physicians. …. Second, and even more important, the conference estimated that 90 per cent of all illegal abortions are presently being done by physicians. Call them what you will, abortionists or anything else, they are still physicians, trained as such; and many of them are in good standing in their communities. They must do a pretty good job if the death rate is as low as it is.

Calderone notes how abortion deaths were pretty low, as they were mostly done by physicians rather than random strangers or untrained nurses. These facts are further hammered down by Calderone when they note that

Another corollary fact: physicians of impeccable standing are referring their patients for these illegal abortions to the colleagues whom they know are willing to perform them, or they are sending their patients to certain sources outside of this country where abortion is performed under excellent medical conditions.

Seems like even illegal abortions were still pretty safe, contrary to what pro-choicers have argued when it came pre-Roe v. Wade, and what would possibly happen if abortion was criminalized. Calderone notes that 90% of illegal abortions were performed by physicians, but what about the remaining 10%? As the blog Real Choice notes, 5% were performed by trained non-physicians, 3% by untrained accomplices, and 2% by the women themselves.

Akin to this argument, there’s also a claim that abortion deaths were very high at this time. Grimes (2015) says that “In the 1950s, estimates of numbers of illegal, unsafe abortions ranged widely, from 200,000 to 1.2 million per year. The methods used were often ineffective and dangerous. Desperate women were driven into the back alley, where they endured danger and abuse, sometimes sexual.” These numbers seem very high, and indeed, one should be very cautious when reading this based on their higher bound estimate of 1.2 million. In reality, while deaths were still high themselves, they weren’t high as argued by people like Grimes.

These higher bound figures come from a 1958 book called “Abortion in the United States”, which comes from Planned Parenthood. Page 180 of the book notes that

There is no objective basis for the selection of a particular figure between these two estimates as an apporximation of the actual frequency.

Nathanson (1979) wrote that the actual number was somewhere between 5,000 to 10,000 a year, but he knew the high figures originally claimed were failed. This did not matter because “in the morality of our revolution, it was a useful figure.”

Back-alley abortions seem to be described in a such way that isn’t true, and weren’t that dangerous, to begin with. Along with this, the number of deaths cited by pro-abortion activists does not seem to be true.

The final section of this post deals with reasons for abortion. For anyone who has been in an abortion debate, the issue of rape and incest for reasons to have an abortion is sometimes brought-up but seems like most people don’t have abortions for this reason.

Reasons for Abortions

Chae et al. (2017) found that data from 14 countries show that most people have abortions because of concerns related to socioeconomic and childbearing.

Data about abortions due to incest and sexual assaults are limited, but Kirkman et al. (2009) found that abortions due to these reasons happen at a rate of less than 1%. However, even then this estimate should be taken with caution since

It is not always possible to assess whether violence was included as a reason in surveys, nor whether women were enabled to raise the subject in interviews.

In conclusion, this is neither a pro-life nor pro-choice article, just an article about the facts surrounding abortion. Whether the facts support pro-choice or pro-life positions doesn’t matter to me as a gap separates facts from judgments on if abortion is okay or not.