[Today’s guest article is by Elise Ketch.]

A Finnish study published in 2017 found that women who have abortions as teens are more likely to die by suicide, compared to teen mothers who chose life.

The study participants who received abortions were twice as likely to die by suicide than their peers who gave birth, and 60% more likely to die from injury, poisoning, and other external causes. The researchers concluded that “extra efforts should be made… to provide psychosocial support to teenagers who undergo induced abortion.” This suggests that just as pro-life advocates must do more to help mothers after they birth, pro-choice advocates must do more to help teens after they abort.

What is interesting about the study results?

Most premature deaths after teen pregnancy explained by education level

The subjects who became pregnant as teenagers were found to be 60% more likely to die prematurely compared to the controls (representing their peers). Most of the causes of death studied were better explained by the effects of low educational level than by teenage pregnancy or pregnancy outcomes. The researchers stated, “A low educational level is related to premature mortality and therefore teenage pregnancy may also increase the risk of premature death indirectly.” They noted that both low educational level and teenage pregnancy are markers of challenges early in life, also known as adverse childhood experiences, which are known to lead to social exclusion. To counteract the increased risk of premature death for teens who give birth, the researchers suggested that “all efforts should be made to facilitate and encourage teenage mothers to continue their education.”

Suicide after teen pregnancy not correlated with education level

Only the high suicide rate among the subjects was not better explained by educational level than teenage pregnancy; the pregnant teens were 50% more likely to die by suicide within the following 25 years than the controls. Further – even with education, age, and region taken into account – the teens who aborted were two times more likely to die by suicide and 1.6 times more likely to die from injury, poisoning, and other external causes than their peers who birthed. (In total, about 50 subjects who aborted ultimately died by suicide and around 75 died from external causes, in comparison to about 25 and 60 respectively who birthed.)

Death risk greatest immediately following teen pregnancy & after a decade

Overall, premature deaths of subjects who conceived as teens were consistently more frequent than those of controls throughout the study. However, these differences were only notable 0-4 years and 10-25 years after the end of pregnancy. In the period between 5-9 years after the end of pregnancy, there was not a significant difference in deaths between subjects who experienced teenage pregnancy and the control group of their peers.

How was the study done?

Over a 25-year period the study followed 13,691 Finnish teenagers (up to 19 years old) who had never before been pregnant and who became pregnant sometime between 1987 and 1989. The control group consisted of 41,012 women without teenage pregnancy of similar background to the subjects.

The study is based on large, nationwide Finnish health registers, which cover all births and induced abortions, eliminating selection and recall bias. The long follow-up time after the end of the pregnancy (up to age 43 on average) allowed study of the ultimate cause of premature death in the subjects.

In total, 815 participants died (281 subjects and 534 controls) during the study period, and 17 died before the study period. Mortality rate ratios (MRRs), a statistic comparing the likelihood of one group to die compared to another, were only calculated for causes of death that killed 40 or more subjects. The MRRs were adjusted to account for the effects of educational level, age at beginning of pregnancy, and region of residence.

How does Finland accommodate teen pregnancy?

Finland provides free education and guarantees a right to low-cost day care up to the age of 7 years. Reproductive services, including abortion, are equally available to all women in public hospitals. Parental consent is not required to obtain an abortion. Therefore, obstacles to abortion are few and lack of the choice to abort is unlikely to affect the outcome of pregnancy. The healthcare system offers intense support for teenage mothers free of charge during pregnancy and after childbirth. This kind of support is not available for teenagers who choose induced abortion.

How does mental wellness fit into the study?

Researchers stated that “depressive disorders and substance abuse are risk factors of suicide and the present investigation lacks information about these background factors.” They then cited a Finnish study published the year before that found that teens who birthed were more likely to have known psychiatric disorders before pregnancy than teens who aborted. In fact, psychiatric disorder rates significantly decreased after teens experienced childbirth, while neurosis and injury rates significantly increased after teens experienced abortion. (Childbirth correlated with decreased neurosis and injury rates, while abortion correlated with increased psychiatric disorder rates.) This suggests that pre-existing mental illness does not explain the occurrence of post-abortion (or absence of post-childbirth) suicides.

What else might explain the suicide risk?

The researchers stated that “being a single mother increases the risk of premature death and is likely to further weaken the possibilities of achieving a better educational level.” When teen fathers fail to actively parent, it puts the lives of teen mothers in jeopardy. In contrast, the researchers noted that “motherhood itself may reduce risk-taking behavior” because teen moms are expected – and often expect themselves – to ‘do better’ for their child, which benefits them as well. (As founder of Pro-Black Pro-Life Cherilyn Holloway says, what is good for the child is typically good for the mother too.) It is also possible that abortion has a greater negative impact on self-esteem that is compounded over time and manifests as a disregard for personal safety. (Holloway says, from her personal experience after two abortions, “[abortion will] have you making other decisions that you will not connect until maybe even 10, 15 years down the road.”) Moreover, the Finnish healthcare system does not offer the same intense support for teens who abort as it does for teens who give birth. The researchers propose that more psychosocial support for teens who abort may mitigate their risk-taking behavior later in life.

What should we take away from this study?

There is much to take away from the structure of this study itself. While frequently-cited studies, such as the Turnaway Study, measure subjective outcomes and lifestyle consequences of unwanted pregnancies, this Finnish longitudinal cohort study measures a single objective consequence of unintended pregnancies: the premature deaths of the mothers, which are equally tragic to the deaths of their preborn children. Likewise, while the Turnaway Study only followed 1000 women up to 10 years, this Finnish study followed 13,700 women for up to 25 years, allowing us far broader insight into the consequences of abortion over a lifetime. Furthermore, because this Finnish study suggests that 5-9 years is the period of LEAST consequence post-abortion over a lifetime, it brings into question the conclusions based on that period drawn by the Turnaway study, particularly those about regret.

Additionally, this study prompts two calls to action:

1. Men need to take responsibility for fatherhood and practice solidarity with mothers by parenting, because it literally saves the lives of women who give birth.
2. Pro-choice advocates must not abandon people after they experience abortion, nor should pro-life advocates. Post-abortion care is critical for women’s wellbeing. To start, check out our compilation of secular resources for abortion healing.

Citations:

Eerika Jalanko, Suvi Leppälahti, Oskari Heikinheimo, Mika Gissler, Increased risk of premature death following teenage abortion and childbirth–a longitudinal cohort study, European Journal of Public Health, Volume 27, Issue 5, October 2017, Pages 845–849, https://doi.org/10.1093/eurpub/ckx065

Suvi Leppälahti, Oskari Heikinheimo, Ilkka Kalliala, Päivi Santalahti, Mika Gissler, Is underage abortion associated with adverse outcomes in early adulthood? A longitudinal birth cohort study up to 25 years of age, Human Reproduction, Volume 31, Issue 9, September 2016, Pages 2142–2149, https://doi.org/10.1093/humrep/dew178

[Photo credit: Sydney Sims on Unsplash]

7/30/22 Update:

One of our commenters on the FB post for this piece (herein referred to as “AD”) included many links to research regarding emotional and psychological issues and abortion, and Ms. Ketch responded. We’ve reproduced the exchange in transcript form below for further details:

AD: You may be interested to know that one of the main authors of the study actually rejects the interpretations of the data offered in the article.

Ketch: I’m unsure which interpretation of data are you referring to from our summary. The claims we made are that post-abortive women need more support from society and men. We reported the correlation between suicide and abortion found in this study; if you found an instance where we stated that abortion causes suicide, please screenshot its location in our article and we will correct it. The researchers made it clear that causation could not be determined by this study; however, the data it presents does rule out some common confounders, which is what makes it interesting.

AD: “But Gissler, after studying this cohort for two decades, believes there’s a more complex explanation for the association between abortion and suicide. First, his studies can’t account for pre-existing mental health conditions because the register lacks detailed information about their experiences.

Ketch: We mentioned that in our summary. “They then cited a Finnish study published the year before that found that teens who birthed were more likely to have known psychiatric disorders before pregnancy than teens who aborted. In fact, psychiatric disorder rates significantly decreased after teens experienced childbirth, while neurosis and injury rates significantly increased after teens experienced abortion… This suggests that pre-existing mental illness does not explain the occurrence of post-abortion (or absence of post-childbirth) suicides.”

AD: Gissler also thinks that motherhood itself largely reduces risky behavior like self-harm. The Finnish healthcare system plays a critical role as well by giving teenage mothers, the subject of his latest study, intense support during and after pregnancy. Teens who have an abortion don’t get the same reinforcements.

Ketch: We also noted this in our summary under the sections “How does Finland accommodate teen pregnancy?” and “What else might explain the suicide risk?” We included the same quotes you pulled here.

AD: Though his 1996 study noted the possibility that abortion might negatively affect women, he holds no reservations now. “[I]t’s quite clear it’s not the abortions,” he said. “It’s the complex situation of the women.” Abortion and suicide, he noted, share the same risk factors, including economic instability and limited education.

Ketch: First of all, where did Gissler make this statement? It is uncited, and it’s unclear if it’s in reference to the 1996 study or the 2017 study. Second, this assertion clearly contradicts the findings of the 2017 study, which were notable explicitly because when adjusted for limited education, the suicide trend in the data was still clear. This wasn’t true for death by disease, car accident, or alcohol, whose trends became negligible after adjustment for education; suicide was distinct from these. And it’s true the study could not directly account for socioeconomic status at time of pregnancy, but the researchers defend education as a reasonable proxy for this. Teens who aborted were more likely to have a better socioeconomic status later in life because they were more likely to continue their education than teens who birthed. The fact that the majority of premature deaths happened 10-25 years after the abortion gives us reason to suspect that socioeconomic status did not protect post-abortive women from premature death. I do not know when the majority of suicides were committed, but if distributed evenly with the overall premature death trend, this analysis appears to be reasonable.

AD: Gissler said he’s been courted by anti-abortion researchers, some of whom he characterizes as well-versed in statistics but lacking expertise in mental or reproductive health epidemiology. “They are making wrong conclusions and really bad science, if you can even call it science,” he said.

Ketch: Again, where and when did he say this, and about what? It’s odd to me that he would call his own work “really bad science”. It seems he’s referring to studies done by other researchers. Also, I’m skeptical about Mashable as a source; it certainly isn’t peer-reviewed. I do not believe Dr. Gissler would have signed his name onto a publication that included this correlation in discussion had he adamantly rejected it.

AD: In reply to some critiques raised by other researchers, the authors conceded the main point above as well noting: “…high-quality research shows, abortion itself does not seem to lead to mental health problems or other challenges in later life. Psychiatric morbidity and destructive behavior, such as alcohol and drug abuse, are likely to largely explain the higher premature mortality of women with a history of teenage pregnancy compared with those with no teenage pregnancies.”

Ketch: In this same reply the researchers assert, “it can be hypothesized that teenage girls who undergo abortion are more likely to continue destructive behavior, which in extreme cases may result to death from accident or suicide.” Let’s avoid cherry-picking. Suicide may be an outcome of other conditions more closely tied to trauma from abortion, such as substance abuse. Perhaps suicide isn’t a direct consequence of abortion, and suicide risk is compounded by direct consequences of abortion.

AD: Dr. Gissler also published another study in 2019 which was much more methodologically sound and came to a different conclusion: “..teenage induced abortion in particular does not seem to associate with this increased risk during the immediate postabortion years, but rather represents a part of a larger phenomenon, likely to include other hardships and circumstances these women face in their lives.”

Ketch: We can’t conflate psychiatric morbidity with mortality from suicide. This study includes no mention of suicide. Yes, psychiatric disorders are a risk factor for suicidality, but they are not the cause of it. A case example, school shooters have low rates of psychiatric morbidity but high rates of documented suicidality. Trauma, in particular due to Adverse Childhood Experiences (ACES), is a better determinant of suicide than psychiatric disorders. I recommend reading “The Body Keeps the Score” by Bessel van der Kolk to learn more about the consequences of trauma over a lifetime.

AD: Furthermore, there is plenty of literature that has pretty much shown that there is no statistical weight behind the idea that Abortion is directly correlated with suicide: “Underage abortion was not found to be associated with mental health problems in early adulthood, and socioeconomic outcomes were better among those who experienced abortion compared with those who gave birth.”

Ketch: This is a study by the same authors looking at the same cohort for different trends. This study also includes no mention of suicide, so it neither rules it out nor corroborates it. Again, we can’t conflate mental illness with death by suicide. I recommend looking into the work of Lisa Rowe, LCSW of Support After Abortion regarding the connection of trauma to abortion. Trauma in itself is not a psychiatric disorder; certain responses to it (such as PTSD) can be disordered.

AD: “In a nationally representative, longitudinal dataset, there was no evidence that young women who had abortions were at increased risk of subsequent depressive symptoms compared with those who give birth after an unwanted first pregnancy.” Cambridge University Press

Ketch: Again, this study includes no mention of suicide. One more time: we can’t conflate mental illness with death by suicide. Suicide is often catalyzed by risk factors outside of mental illness, such as personal loss and injury. You can learn more about risk factors for suicide by listening to the second season of “Last Day” by Lemonada.

AD: “Despite its legal significance, age 18 years was not a meaningful cutoff point for psychological response to abortion in this sample. There was no evidence that abortion poses a threat to adolescents’ psychological well-being.” Journal of Adolescent Health

Ketch: No mention of suicide in this study either. Please, do not perpetuate the misconception that one must have a diagnosed psychiatric disorder to experience suicidal ideation, it derails us from effective suicide prevention. And don’t gaslight women who experience intense suicidal ideation with only subdued symptoms of mental illness.

AD: “Adolescents who have an abortion do not appear to be at elevated risk for depression or low self-esteem in the short term or up to five years after the abortion.” Perspectives on Sexual and Reproductive Health

Ketch: Part of what makes this 2017 Finnish study exceptional is that it looks at consequences for 25 years, unlike this study which only covers 5 years (and also doesn’t reference documented suicide instances.) I’m personally very interested in the 10-25 year period post-abortion as it correlates with the timelines of women that seek help from groups such as She Found His Grace (I highly recommend this interview with the founder, who received an abortion at age 13 after being abused by a family member.)

AD: I’m happy to provide more literature on this if need be but safe to say, I don’t see how this study supports the contention in your post at all and I think putting forward ideas in this manner seems to contradict your message of the Pro-Life position being informed by the best science.

Ketch: What contention? If you’re against our claims that post-abortive women need more support from society and men, I think we may be on different pages about doing better by women. It appears you’ve mischaracterized the summary that we published, and I hope this was not intentional.

You’re right that these studies that do not support the correlation of mental illness to abortion add important context. I think they make this Finnish study even more fascinating: why are women dying by suicide in significant correlation of experiencing abortion as a teenager if they were not also diagnosed with mental illness prior to pregnancy or within the timeframe soon after, if ever? We cannot deny that this correlation warrants increased psychosocial support for teens who abort, and for post-abortive women in general. Out of love for these women in our communities, we must be intentional about meeting them where they are at.

The women who aborted in the Finnish study became better educated and therefore had more access to a healthy lifestyle and fulfilling opportunity than their peers who birthed. Then why the hell did 50 ultimately die by suicide within 25 years of experiencing abortion, in contrast to 25 of their peers? What happened to those 25 women? They deserved not to die then. They deserve our attention and research now. We need more studies to determine the variables around abortion and suicide and to determine what is causal and what is just correlated. Chalking it up to “abortion doesn’t hurt women” doesn’t cut it when 25 more women ultimately took their own lives after teen abortion than teen birth.

Abortion may not be hurting women, but refusing to acknowledge this trend absolutely will lead to more deaths. Isn’t that what pro-choicers don’t want, women dying? Isn’t that what pro-lifers want, women living? We must come together to support women. If abortion is a strong indicator that a woman is struggling with risk factors of suicide, we should use it as an intervention point to help her in those areas of her life. I do not want pro-choicers to dismiss this study because doing so also dismisses the opportunity abortion presents to intercept women whose needs aren’t being met.

Again, trauma has life-long consequences, and if abortion causes trauma, its effects may only first be registered a decade or two after the event. Trauma in itself is not mental illness, nor does it have to register as PTSD to have an impact on later decision making and quality of life. A suicide attempt 25 years after an abortion may still be impacted by the trauma introduced to the body by abortion. Trauma does not go away with time, it goes away with treatment.

Trauma after abortion may not be supported by the literature because it isn’t a diagnosis in itself, awareness of it has only gained momentum in the last five years, and women who have trauma are not going to be the women volunteering for research studies. If they are traumatized they won’t follow up with researchers out of shame, fear or general dysfunction. It seems traumatized women wouldn’t be robustly represented in studies; it will mostly be untraumatized women who participate or women with trauma severe enough to be diagnosed as PTSD that have public documentation.

The majority of women just getting by despite their trauma go overlooked; they are functioning enough to fly under the radar of our systems. No one may know how much pain they are in until life makes them snap and it’s too late. These are the completed suicides, the ones no one saw coming. From the outside they seem average; often to themselves they also seem “okay”, but deep down they are in pain and it impacts their decision-making on a subconscious, primal level. There may not be literature to back this up, but there is plenty of anecdotal evidence. All I can ask of you is that you listen to the stories of women published by organizations that provide support after abortion and not dismiss their experiences.

I am not endorsing commenters who misinterpret research, but I only have enough time and energy to respond to commenters who raise legitimate concerns, such as you did. I hope you feel that I took your points seriously, I’m just out here doing my best, as you seem to be.