Science vs. myths about later abortion

Since the legalization of abortion by the US Supreme Court’s 1973 Roe v. Wade decision, restrictions on abortion have largely been based on ideas about fetal development and the purported negative mental health effects of abortion that are not supported by scientific evidence. Significant research has been conducted in the past decade to shed light on the nature of the misinformation that informs restrictive abortion legislation. The questionable evidence for these restrictions has been centered on three key areas: the impact of abortion on women’s mental health, inaccurate beliefs about whether a fetus can feel pain, and the time at which a fetus could survive outside of a woman’s body. Inaccurate information asserting that abortion is reversible or that it causes cancer has also been used as the basis for legislation and anti-abortion media campaigns.

Does abortion impact mental health?

Contemporary research has found no link between having an abortion and experiencing subsequent mental health problems [1]. The theory that abortion causes depression or a “post-abortion syndrome” has been debunked and the research used to support these claims has been found to be methodologically flawed [2] [3] [4]. The strongest predictor of post-abortion mental health has been found to be pre-pregnancy mental health, yet the flawed studies used to support a link between abortion and poor mental health did not control for this [3]. The meaning and emotional experience of a later abortion may be different for women who obtain an abortion because of a fetal anomaly during a planned pregnancy and women who seek later abortion because of an unplanned pregnancy. Yet a review of the literature between 1989 and 2008 found that few studies accounted for the impact of obtaining an abortion during a wanted pregnancy [4]. Recent studies have found that being denied an abortion has a negative impact on women’s self-esteem and life satisfaction as compared to women who are able to obtain an abortion [5] [6]. In a study following 667 women over the course of three years after obtaining an abortion, 95% of women reported that they felt they had made the right decision [7]. Researchers who followed a group of women for 2.5 years after they either obtained or were denied an abortion found no increased risk of reduced self-esteem or life dissatisfaction for those women who had an abortion [5]. For all groups of women in the study, their levels of life satisfaction and self-esteem returned to baseline within 6 months to 1 year [5]. Analyzing this same group of women, researchers also found no evidence that abortion causes depression or anxiety to increase [8]. Similarly, among women who have abortions, no resultant increase in the use of alcohol or drugs has been found [9] [10].

View tools for advocates about the lack of a link between abortion and mental health here.

Is there such a thing as “fetal pain”?

There is no agreement among medical providers that a fetus can experience pain any earlier than the time period between the very end of the second trimester and the start of the third [11] [12]. Research into the ability of a fetus to feel pain has demonstrated that the neural pathways that make pain processing possible do not fully develop until the third trimester [13]. Thus it is necessary to make an important distinction between the way a self-aware adult may experience pain and the reactions a fetus may have to stimulus before the full development of those neural pathways [11][14]. Despite a lack of conclusive evidence, 11 states prevent women at 22 weeks LMP or later in their pregnancy from having an abortion because of the inaccurate idea that a fetus could experience pain at that point [15]. Twelve US states also require that women be given information about fetal pain during pre-abortion counseling despite this lack of evidence [16]. In a review of the scientific evidence since 2007, the Royal College of Obstetrics and Gynaecologists confirmed in 2010 that there is no methodologically sound research to support the experience of fetal pain any earlier than 24 weeks [17]. The American College of Obstetrics and Gynecology has also supported this finding [18].

View a list of tools for advocates about the myth of fetal pain here.

What is viability?

Despite the predication of the Roe v. Wade decision on the point at which a fetus can survive outside of a woman’s body, called viability, neither the medical community nor the legal community have defined or agreed upon when viability begins. When over 1,000 US obstetricians and gynecologists were surveyed with regard to their intervention and delivery practices, the overwhelming majority indicated 24 weeks LMP as the point at which they considered a fetus to be viable [19]. Studies of infant survival and impairment rates support this range [20] [21] [22]. In studies of preterm infant survival and outcome rates, the risk of neurodevelopmental impairment is greater the earlier an infant is delivered in a pregnancy, with 45% of those infants born between 22-23 weeks having neurodevelopmental impairment, and all infants born between 22 and 25 weeks having a high risk of moderate to severe neurodevelopmental impairment [20] [21].  A study of infant survival rates across 11 US hospitals revealed that only 3.4% of infants born at 22 weeks survived without severe impairment and only 5.1% survived overall at that week of pregnancy [22].

View tools for advocates around the issue of viability here.

Does abortion cause cancer?

The idea that abortion, through the interruption of hormones and cell development in early pregnancy, could increase a woman’s risk of breast cancer has repeatedly been used by those opposed to abortion to attempt to further restrict access to it[23]. The research that initially found this link has been revealed to be methodologically flawed [23]. Although this topic continues to be the subject of ongoing research, the most rigorous and sound scientific evidence shows no link between abortion and cancer [24] [25] [26]. Major medical and professional associations, such as the National Cancer Institute, the American Cancer Society, and the American Congress of Obstetricians and Gynecologists, attest that a link between abortion and breast cancer is unsupported by scientifically sound research [27] [28] [29].

View tools for advocates that debunk the myth of a link between abortion and cancer here.

Can medication abortion be “reversed”?

With the signing of state law SB 1318 by Arizona Governor Ducey in March 2015, doctors in Arizona were mandated to inform women during pre-abortion counseling that abortion is reversible [30]. Although the law has since been put on hold pending a federal court decision, it is the first law to endorse the scientifically unsupported idea of medication abortion reversibility. This concept is based on a series of case studies of seven women whose doctors attempted to reverse a medication abortion by administering progesterone after the women had taken only the first of two medications required for a complete medication abortion [31]. Because the sample size of the study is so small, including one subject that was lost to follow-up, and because there is no control group, it is impossible to discern what effect, if any, the progesterone had on the pregnancies of these women. There is no additional published literature supporting medication abortion reversal, and researchers as well as the American College of Obstetricians and Gynecologists have confirmed that there is no current evidence to support the claim that abortion is reversible or to support the experimental administration of progesterone that the study suggests using for an abortion reversal [32]. A 2013 study of women who chose to continue their pregnancy after taking only the first dose of mifepristone for a medication abortion, and who did not receive progesterone for a "reversal" found that the rate of ongoing pregnancy was approximately 80% [33]. This is not substantially different from the ongoing pregnancy rate after administration of progesterone as reported in the 2012 case study series of women who received progesterone to attempt to reverse a medication abortion [31].  Other research has estimated that the ongoing pregnancy rate for women who take only one of the two doses of medications required for a successful abortion ranges from 30-50% [32]. There is currently no sound evidence that suggests medication abortion can be reversed.

For more factual evidence about later abortion see the Related Research in our archives.

References

1. Charles VE, Polis CB, Sridhara SK, Blum RW. Abortion and long-term mental health outcomes: a systematic review of the evidence. Contraception. 2008; 78(6): 436-450

2. Robinson GE, Stotland NL, Russo NF, Lang JA, Occhiogrosso M. Is there an “abortion trauma syndrome”? Critiquing the evidence. Harvard review of psychiatry. 2009; 17(4): 268-290

3.Steinberg JR. Later abortions and mental health: psychological experiences of women having later abortions—a critical review of research. Women's Health Issues. 2011; 21(3): S44-S48

4Major B, Appelbaum M, Beckman L, Dutton MA, Russo NF, West C. Abortion and mental health: Evaluating the evidence. American Psychologist. 2009; 64(9): 863

5Biggs MA, Upadhyay UD, Steinberg JR, Foster DG. Does abortion reduce self-esteem and life satisfaction? Quality of Life Research. 2014; 23(9): 2505-2513

6Rocca CH, Kimport K, Gould H, Foster DG. Women's emotions one week after receiving or being denied an abortion in the United States. Perspectives on sexual and reproductive health. 2013; 45(3): 122-131

7Rocca CH, Kimport K, Roberts SCM, Gould H, Neuhaus J, Foster DG. Decision Rightness and Emotional Responses to Abortion in the United States: A Longitudinal Study. PLoS ONE. 2015; 10(7): e0128832

8Foster DG, Steinberg JR, Roberts SCM, Neuhaus J, Biggs, M A. A comparison of depression and anxiety symptom trajectories between women who had an abortion and women denied one. Psychological medicine. 2015; 45(10): 2073-2082

9Roberts SC, Delucchi K, Wilsnack SC, Foster DG. Receiving Versus Being Denied a Pregnancy Termination and Subsequent Alcohol Use: A Longitudinal Study. Alcohol and Alcoholism. 2015; agv021

10Roberts SC, Rocca CH, Foster DG. Receiving versus being denied an abortion and subsequent drug use. Drug and alcohol dependence. 2014;134: 63-70

11Lee SJ, Ralston HJP, Drey EA, Partridge JC, Rosen MA. Fetal pain: a systematic multidisciplinary review of the evidence. JAMA, 2005; 294(8): 947-954

12Rowlands S. Misinformation on abortion. The European Journal of Contraception and Reproductive Health Care. 2011; 16(4): 233-240

13Fabrizi L, Slater R, Worley A, Meek J, Boyd S, Olhede S,  Fitzgerald M. A shift in sensory processing that enables the developing human brain to discriminate touch from pain. Current Biology. 2011; 21(18): 1552-1558

14Derbyshire SW. Foetal pain? Best Practice & Research Clinical Obstetrics & Gynaecology. 2010; 24(5): 647-655

15Guttmacher Institute. State policies on later abortions. State Policies in Brief. August 1, 2015. Accessed: August 12, 2015

16Guttmacher Institute. Counseling and waiting periods for abortion. State Policies in Brief. August 1, 2015. Accessed: August 12, 2015

17Royal College of Obstetricians and Gynaecologists. Fetal awareness: Review of research and recommendations for practice. March 2010

18American Congress of Obstetricians and Gynacologists. Facts are important: fetal pain. 2013. Accessed: June 12, 2015

19Morgan MA, Goldenberg RL, Schulkin J. Obstetrician-gynecologists' practices regarding preterm birth at the limit of viability. The Journal of Maternal-Fetal & Neonatal Medicine. 2008; 21(2): 115-121

20Moore GP, Lemyre B, Barrowman N, Daboval T. Neurodevelopmental outcomes at 4 to 8 years of children born at 22 to 25 weeks’ gestational age: a meta-analysis. JAMA Pediatrics. 2013; 167(10): 967-974

21Moore T, Hennessy EM, Myles J, Johnson SJ, Draper ES, Costeloe KL, Marlow N. Neurological and developmental outcome in extremely preterm children born in England in 1995 and 2006: the EPICure studies. BMJ: British Medical Journal. 2012; 345:e7961

22. Rysavy MA, Li L, Bell EF, Das A, Hintz SR, Stoll BJ, Higgins RD. Between-hospital variation in treatment and outcomes in extremely preterm infants. New England Journal of Medicine. 2015; 372(19): 1801-1811

23Russo J, Russo IH. Susceptibility of the mammary gland to carcinogenesis. II. Pregnancy interruption as a risk factor in tumor incidence. The American journal of pathology. 1980; 100(2): 497

24Reeves GK, Kan SW, Key T, Tjønneland A, Olsen A, Overvad K, Riboli E. Breast cancer risk in relation to abortion: Results from the EPIC study. International Journal of Cancer. 2006; 119(7): 1741-1745

25Henderson KD, Sullivan-Halley J, Reynolds P, Horn-Ross PL, Clarke CA, Chang ET, Bernstein L. Incomplete pregnancy is not associated with breast cancer risk: The California Teachers Study. Contraception. 2008; 77(6): 391-396

26Michels KB, Xue F, Colditz GA, Willett WC. Induced and spontaneous abortion and incidence of breast cancer among young women: A prospective cohort study. Archives of internal medicine. 2007; 167(8): 814-820

27National Cancer Institute. Summary report: Early reproductive events and breast cancer workshop. 2003. National Cancer Institute website. Accessed: June 23, 2015

28American Cancer Society. Is abortion linked to breast cancer? June 19, 2014. American Cancer Society website. Accessed: June 23, 2015

29Committee on Gynecologic Practice of the American Congress of Obstetricians and Gynecologists. Induced abortion and breast cancer risk. ACOG Committee Opinion No. 434. Obstet Gynecol. 2009; 113:1417–8

30Rojas, R. (2015, March 31). Arizona Orders Doctors to Say Abortions With Drugs May Be Reversible. The New York Times. Accessed: June 12, 2015

31Delgado G, Davenport M L. Progesterone use to reverse the effects of mifepristone. Annals of Pharmacotherapy. 2012; 46(12): e36-e36

32American Congress of Obstetricians and Gynecologists Arizona Section. Medication abortion reversal. 2015. Accessed: June 23, 2015

33Bernard N, Elefant E, Carlier P, Tebacher M, Barjhoux CE, Bos‐Thompson MA, Vial, T. Continuation of pregnancy after first‐trimester exposure to mifepristone: An observational prospective study. BJOG: An International Journal of Obstetrics & Gynaecology. 2013; 120(5): 568-575

 

 

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