Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, University of California, San Francisco, Oakland.
Department of Epidemiology and Biostatistics, University of California, San Francisco.
JAMA Psychiatry. 2017 Feb 1;74(2):169-178. doi: 10.1001/jamapsychiatry.2016.3478.
The idea that abortion leads to adverse psychological outcomes has been the basis for legislation mandating counseling before obtaining an abortion and other policies to restrict access to abortion.
To assess women's psychological well-being 5 years after receiving or being denied an abortion.
DESIGN, SETTING, AND PARTICIPANTS: This study presents data from the Turnaway Study, a prospective longitudinal study with a quasi-experimental design. Women were recruited from January 1, 2008, to December 31, 2010, from 30 abortion facilities in 21 states throughout the United States, interviewed via telephone 1 week after seeking an abortion, and then interviewed semiannually for 5 years, totaling 11 interview waves. Interviews were completed January 31, 2016. We examined the psychological trajectories of women who received abortions just under the facility's gestational limit (near-limit group) and compared them with women who sought but were denied an abortion because they were just beyond the facility gestational limit (turnaway group, which includes the turnaway-birth and turnaway-no-birth groups). We used mixed effects linear and logistic regression analyses to assess whether psychological trajectories differed by study group.
We included 6 measures of mental health and well-being: 2 measures of depression and 2 measures of anxiety assessed using the Brief Symptom Inventory, as well as self-esteem, and life satisfaction.
Of the 956 women (mean [SD] age, 24.9 [5.8] years) in the study, at 1 week after seeking an abortion, compared with the near-limit group, women denied an abortion reported more anxiety symptoms (turnaway-births, 0.57; 95% CI, 0.01 to 1.13; turnaway-no-births, 2.29; 95% CI, 1.39 to 3.18), lower self-esteem (turnaway-births, -0.33; 95% CI, -0.56 to -0.09; turnaway-no-births, -0.40; 95% CI, -0.78 to -0.02), lower life satisfaction (turnaway-births, -0.16; 95% CI, -0.38 to 0.06; turnaway-no-births, -0.41; 95% CI, -0.77 to -0.06), and similar levels of depression (turnaway-births, 0.13; 95% CI, -0.46 to 0.72; turnaway-no-births, 0.44; 95% CI, -0.50 to 1.39).
In this study, compared with having an abortion, being denied an abortion may be associated with greater risk of initially experiencing adverse psychological outcomes. Psychological well-being improved over time so that both groups of women eventually converged. These findings do not support policies that restrict women's access to abortion on the basis that abortion harms women's mental health.
堕胎会导致不良心理后果的观点一直是立法要求堕胎前进行咨询以及其他限制堕胎获取的政策的基础。
评估接受或被拒绝堕胎后 5 年内妇女的心理健康状况。
设计、地点和参与者：本研究提供了来自“拒绝堕胎研究”的数据，这是一项具有准实验设计的前瞻性纵向研究。2008 年 1 月 1 日至 2010 年 12 月 31 日，从美国 21 个州的 30 个堕胎机构招募了妇女，在寻求堕胎后一周通过电话进行了访谈，然后每半年进行一次，总共进行了 11 次访谈，于 2016 年 1 月 31 日完成。我们检查了接近设施妊娠限制（近限组）下接受堕胎的妇女的心理轨迹，并将其与因超出设施妊娠限制而寻求但被拒绝堕胎的妇女（包括堕胎后生育和堕胎后未生育组）进行了比较。我们使用混合效应线性和逻辑回归分析来评估心理轨迹是否因研究组而异。
我们纳入了 6 项心理健康和幸福感指标：使用简明症状量表评估的 2 项抑郁和 2 项焦虑指标，以及自尊和生活满意度。
在研究中的 956 名女性（平均[标准差]年龄 24.9[5.8]岁）中，与近限组相比，被拒绝堕胎的女性报告的焦虑症状更多（堕胎后生育组，0.57；95%置信区间，0.01 至 1.13；堕胎后未生育组，2.29；95%置信区间，1.39 至 3.18），自尊较低（堕胎后生育组，-0.33；95%置信区间，-0.56 至 -0.09；堕胎后未生育组，-0.40；95%置信区间，-0.78 至 -0.02），生活满意度较低（堕胎后生育组，-0.16；95%置信区间，-0.38 至 0.06；堕胎后未生育组，-0.41；95%置信区间，-0.77 至 -0.06），抑郁水平相似（堕胎后生育组，0.13；95%置信区间，-0.46 至 0.72；堕胎后未生育组，0.44；95%置信区间，-0.50 至 1.39）。
在这项研究中，与堕胎相比，被拒绝堕胎可能与最初经历不良心理后果的风险增加有关。随着时间的推移，心理健康状况得到改善，两组妇女最终趋同。这些发现不支持以堕胎会损害妇女心理健康为由限制妇女堕胎获取的政策。
