“Mental disorder, not otherwise specified”

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It is commonly claimed that legal access to abortion is necessary to preserve women’s physical and mental health, says Calum Miller in Chapter 15 of Agency, Pregnancy and Persons. Advocates of abortion claim that abortion is healthcare and that to prohibit it can cause the torture of a psychological burden. 

In the UK, 98% of abortions are performed officially for health reasons, 99.9% of those under the diagnostic code “F99: mental disorder, not otherwise specified” (Dept. of Health and Social Care 2021). In practice, this permits abortion on demand, although the law had intended for abortion to be permitted based on a genuine threat to the mental health of women. 

Miller says that it is worth examining the frequent claim that abortion is good and even necessary for the mental wellbeing of women. 

In fact, he says, there is almost no evidence to support this claim at all.  

Abortion has no substantial long-term health benefits 

It is universally agreed that abortion is not associated with any substantial long-term health benefits. Even the Royal College of Obstetricians and Gynecologists (who are vehemently pro-abortion) says, “Women with an unintended pregnancy should be informed that the evidence suggests that they are no more or less likely to suffer adverse psychological sequelae whether they have an abortion or continue with the pregnancy” (2011, p. 45). Even a recent high-profile study on abortion and mental health concludes that “carrying an unwanted pregnancy to term was not associated with mental health harm” and that “women’s symptoms of depression and anxiety are slowly relieved following an unwanted pregnancy, regardless of how that pregnancy ends” (Foster 2020, p. 109). 

This harmonizes with the fact that women denied abortions almost never experience substantial detriments to their mental health and are almost always glad to have been denied abortions as time goes on, according to the Turnaway Study. In this study, testimonies from women denied abortions indicated grief and horror over the idea that they had once considered abortion. 

There is simply no evidence that abortion provides mental health benefits. So, Miller says, the only debate is in the other direction: whether abortion causes harm, on average, to mental health. 

Miller cites research supporting that it does.  

Abortion harms the mental health of women 

Abortion-specific PTSD is a real phenomenon affecting a significant minority of women, Miller demonstrates. 

And a Fergusson et al. (2008) study, rated by the 2011 NCCMH review as the best study in existence, found abortion causally associated with a variety of mental disorders and a 30% increase in mental disorders overall. Fergusson’s later meta-analysis (2013) also found that abortion, compared to continuing an unplanned or unwanted pregnancy, was associated with statistically significant increases in anxiety, alcohol misuse, illicit drug misuse, and suicidal behavior. Fergusson was himself pro-choice and did not anticipate these findings but was committed to clinical accuracy, saying that abortion should not be performed on a false pretense of mental health, for which there is “no credible scientific evidence” (2013, p. 824).  

Some might argue, says Miller, that poorer mental health outcomes from abortion are primarily the result of a stigma attached to abortion.  

Yet, Miller explains, many studies showing poorer mental health after abortions are from countries with a minimal stigma. And even stigmatizing activity such as anti-abortion protestors outside of clinics was found to have no psychological impact on women at all by just one week after their abortions (Cozzarelli et al. 2000; Foster et al. 2013). 

Abortions themselves cause poorer mental health outcomes 

The poorer mental health outcomes from abortion, Miller explains, are largely internal, not due any an external stigma. Miller cites various research (none by pro-life organizations) finding that seeing embryos and fetuses had detrimental physiological and psychological impacts on the women who aborted them as well as on physicians, nurses, and abortion doctors. These impacts included grief, surprise, traumatic feelings, sleep disturbances, effects on relationships, and moral anguish.  

Miller demonstrates that what are labeled unplanned or unwanted pregnancies often turn out to be highly ambivalent. The best study on women’s feelings found that 63.5% felt guilt about their abortion, with even higher percentages of women feeling sadness (Fergusson et al. 2009).  

Conclusion: abortion is almost never “health care” 

Miller concludes that abortion is, likely causally, associated with poorer mental health outcomes. These findings indicate a plausible case for permitting or even mandating doctors to generally refuse abortions on clinical grounds and for requiring doctors to warn women of various psychiatric risks. Follow up support for women, especially high-risk women, should be required.  

These findings show that abortion, in the vast majority of cases, is not health care. Miller says that the evidence he presents in his chapter is that, when unborn children are harmed, so are their mothers.  

It is justified, therefore, to return to the Hippocratic oath to do no harm.