Pregnancy Is Riskier Than Abortion
The idea that abortion causes physical and mental damage to those who choose it has permeated our culture for decades. But evidence shows pregnancy is the riskier state of affairs.
By Emily Willingham
Popular opinion holds that those who choose abortion suffer a variety of harms, from lifelong feelings of guilt and grief to future infertility to breast cancer and even death. Though unsupported by any evidence, the concept that abortion will damage pregnant people has become embedded in media and pervades our culture across the political spectrum as a basic truth.
Just look at the straight-talking ensemble TV show Sex and the City. When attorney Miranda Hobbes learns she is pregnant in 2001, an entire episode focuses on her decision to have an abortion. Carrie Bradshaw, the show’s lead character and a writer, had an abortion 13 years earlier, at age 22. Miranda asks her, “How long until you felt back to normal?” And Carrie responds, with tremendous pathos, “Any day now.” Miranda gets on a waiting list for the procedure; her own doctor tells her she doesn’t do them, adding, “No judgment.” Miranda: “That’s the way she said it. Like it was all one word. ‘I-don’t-perform-them-no-judgment.’ ” In the end, Miranda decides against the abortion, a decision met with joy from her three friends: “Three aunts were born,” Carrie says in the voiceover. On a modern show known for frank depictions of cosmopolitan women freely enjoying the sex lives of their choosing, the striking thing about this story line is its inclusion of common, but incorrect, wisdom about abortion: that the burden of having one lasts for years.
The view that abortion harms those seeking it began percolating up after the U.S. Supreme Court legalized the procedure across the nation in 1973. At the time, the partisan divide on abortion access was not the unbridgeable abyss it is today. But as the years went on, conservatives began positioning themselves as the champions of “family values"; by the 1980s, efforts were in full swing to see Roe v. Wade overturned and abortion rights curtailed.
Meanwhile, religion-driven groups like Operation Rescue, founded in 1987, took the position that abortion constituted murder and began the practice of dramatically blocking access to abortion clinics. Completing the picture were the crisis pregnancy centers, or CPCs, that often positioned themselves as abortion clinics while in fact on a mission to prevent the practice. It was from these centers that claims of damage to abortion seekers were loudest of all.
Heartbeat International is a giant of the CPC world that put down its roots in 1971, anticipating that “legalized abortion would spread rapidly around the world.” Drawing support from Catholic and evangelical adherents, the group had a mission “to make abortion unwanted.” Today its hundreds of centers span six continents. Its sometime partner in these efforts, Care Net, began as the Christian Action Council, which established its first CPC in 1981 and says it now has 1,200 centers in the United States and Canada. Collectively, there are more than 2,500 CPCs in the United States, and in many states they far outnumber abortion clinics. Texas, for example, currently has some 21 abortion clinics and an estimated 203 CPCs.
The websites for these centers assure visitors that abortion carries dire risks for everything from infection to depression to thoughts of suicide. The centers have a reputation for drawing in clients seeking an abortion and then pressuring them to continue the pregnancy. That pressure can, in some instances, include deliberately offering false information. In one study of 32 CPCs in North Carolina, 86 percent were found to have false or misleading information on their websites, including false claims about “post-abortion stress.”
Some of that false information has created its own reality. One study tracked almost a century of abortion-related story lines in U.S. television and film, from 1916 to 2013. These have increased through the decades, with endings reflecting cultural attitudes. Before Roe v. Wade, adoption and pregnancy loss made up 4.4% of plot resolutions in shows addressing unwanted pregnancies. After 1973, 13.2% of such shows ended this way. Though we don’t have the latest metrics, any viewer can see that abortion is rarely the go-to choice in shows of today, much less a personal choice with positive outcomes.
Some risks that CPCs try to tie to abortion, such as infection and heavy bleeding, are slight with abortion and actually much higher with pregnancy and delivery. For other claims that these anti-abortion groups make, such as increased risk of breast cancer, miscarriage, or death with abortion, the evidence does not support any linkage at all. And mental health effects are worsened by unwanted pregnancy and birth, not abortion.
Here are corrections to some of the most egregious claims:
CLAIM: Abortion plays havoc with mental health.
CORRECTION: CPCs often claim that abortion increases risk for mood disorders, relationship difficulties, guilt, and post-traumatic stress disorder. But evidence indicates that abortion is not associated with negative mental health outcomes. Risks are not increased for post-traumatic stress disorder, anxiety, self-esteem issues, or substance use. A 2013 study found that 95 percent of those who’d had an abortion felt that it was the right decision.
What really seems to cause mental health distress is being denied an abortion, which is linked to increased risk for depression or anxiety. In a five-year study that tracked 877 pregnant people seeking abortions at 30 U.S. facilities, those who obtained an abortion were no more depressed or anxious at two years than those who had been denied one. Another analysis of the same study participants showed that those who’d been denied an abortion had acute spikes in anxiety and declines in self-esteem and life satisfaction.
These findings are in keeping with many earlier reports. One especially rigorous study was done in 2011 in Denmark, where health-care outcomes are carefully tracked for each person in the country. The authors found no change in how often people sought psychiatric care before and after having an abortion. This suggests that when obtaining an abortion is not held as a moral or religious failing, doing so doesn’t worsen mental health. Furthermore, these researchers found that people who did deliver a child had higher odds of seeking psychiatric care, especially just after the birth.
A large study from Finland, another country that carefully tracks health-care data, compared outcomes between teenagers who had an abortion and those who gave birth. The authors monitored 29,041 study participants until they reached age 25 and found no differences in psychiatric-related outcomes. What they did find was that people who had an abortion had fewer social and economic struggles. In yet another study, this one with 742 women in Sweden, anxiety declined and quality of life improved after abortion.
The American Psychological Society has concluded, on the basis of evidence from studies spanning decades, that denying people abortions has negative psychological consequences and that children born as a result of unwanted pregnancies are at risk for negative social and emotional outcomes.
CLAIM: Abortion increases risk of negative outcomes in subsequent pregnancies.
CORRECTION: Despite claims by religion-driven anti-abortion groups, studies going back decades show no link between abortion and miscarriage of a subsequent pregnancy. For example, a 1980 study in Denmark found no increase in risk for spontaneous abortion, usually defined as a first-trimester pregnancy loss, among people with a previous induced abortion.
The situation regarding preterm birth is more complicated. A 2016 meta-analysis—which takes findings from several studies with similar designs and evaluates them together—indicated a slightly increased risk for preterm birth for people who had had surgical abortion in the past; those authors wrote that surgical techniques might be to blame for risk increases. But a separate research team noted that many of the included studies hadn’t properly considered other factors that increase risk for preterm birth, including smoking and a short time between pregnancies. Note that these results relate only to surgical abortions. A 2018 analysis showed that preterm birth rates in subsequent pregnancies are lower when abortion is done via medication rather than surgery. Giving people early access to this abortion method is one way to minimize risk and cost.
CLAIM: Abortion carries higher medical risks than pregnancy and childbirth.
CORRECTION: Scientific studies show no link between abortions and breast cancer risk, yet the claim is one that crisis pregnancy centers often highlight. A large study published in 1997 showed zero association between the two in a cohort of more than 1.5 million women, confirming a series of previous reports, some of which even described a reduced breast cancer risk following induced abortion.
Every medical intervention—from an adhesive bandage to open-heart surgery—carries some risk, and abortion is no different. But anti-abortion groups overstate these risks and fail to highlight the much greater dangers of childbirth. Abortion-related risks for infection or bleeding are very small, and major complications even smaller, occurring in less than a quarter of a percent of procedures. A 2015 study of 54,911 abortions in California found that rates of major complications were 0.23 percent with medication abortion, 0.16 percent with first-trimester surgical abortion, and 0.41 percent for abortions after the first trimester.
Overall, abortion is much safer than childbirth. A 2014 study in Norway found that with medical abortion at home among 1,018 study participants, just one needed a transfusion because of significant hemorrhage. A careful review of 20 studies that included 33,846 women found that from three to six of every 10,000 individuals undergoing a medical abortion needed a blood transfusion. According to the Centers for Disease Control and Prevention, the rate of hemorrhage requiring a blood transfusion after childbirth was 39.7 for every 10,000 U.S. hospital deliveries in 2014.
Infections are similarly rare after abortion, with rates in one 2015 study ranging from 0.20 to 0.27 percent, depending on the type of abortion. For comparison, rates of infection related to childbirth are 1 to 3 percent for vaginal delivery, 5 to 15 percent for scheduled cesarean delivery, and 15 to 20 percent for unscheduled cesarean delivery.
CLAIM: Legal abortion results in surprising numbers of maternal deaths.
CORRECTION: Claims about death from legal abortion could be the most overblown statistic of all. In the most statistically significant and extended study exploring this claim to date, researchers found that from 1988 to 2010, there were 108 deaths among 16.1 million legal abortions performed in the United States, a mortality rate of 0.7 deaths per 100,000 procedures. That’s far less than the 8.8 deaths per 100,000 births, an almost thirteenfold difference. Studies show that pregnancy-related death rates climb in places where abortion access is restricted.
Pill-induced abortions appear especially safe, so much so that in the winter of 2021, the U.S. Food and Drug Administration made it possible for pregnant people to get the pills without going to a medical office. Today a clinician can prescribe the drugs remotely after a telehealth session. Some states, however, including Texas and Indiana, have made both illegal outright or after a certain number of weeks.
In the real world, people living in poverty and in rural areas are already losing abortion access. And evidence shows that those denied abortions experience increased risk for mental, physical, and economic harms.
In 2017 in the United States, almost one in five pregnancies ended in abortion. According to a 2018 report from the U.S. National Academies of Science, Engineering, and Medicine, 72 percent of people having abortions in the United States are under age 30, 85 percent are unmarried, and 75 percent are low income or below the federal poverty level. A majority (61 percent) are people of color.
Many states are establishing laws to limit abortion access. Texas now has a law that limits abortions to the first six weeks of pregnancy, when most people don’t yet have a clue that they’re pregnant. The Texas legislator who proposed the bill calls it the “heartbeat bill,” but the pulse that can usually be detected via ultrasound at six weeks reflects the rhythmic contractions of cells where the heart eventually will form; the full development of a functional heart does not happen until week 16. If the Supreme Court overturns or diminishes Roe, as many anticipate it will, a dozen states have “trigger laws” at the ready to immediately outlaw abortion, and several more are poised to enact similar legislation. Many of these laws are predicated on claims about the “harms” abortion can do to pregnant people. The reality is that the denial of abortions as a result of these laws poses far greater risk of harm.
THE BOTTOM LINE
The World Health Organization says that abortions are safe for pregnant people when they can be done, well, safely—with the right medication or the right person performing the procedure. The American College of Obstetricians and Gynecologists says that “abortion is healthcare” and lists many reasons why abortion might be needed, including contraceptive failure, intimate partner violence, rape, and illness during pregnancy. Sometimes pregnancy is life-threatening and abortion is the only thing that can prevent death. In all cases, the risk of negative mental and physical outcomes from abortion pale in comparison with the long-term risks of harm from abortion denied.
May 5, 2022