Most women do not regret the decision to have an abortion, and instead feel relief after some years, according to researchers from the University of California San Francisco (UCSF).
The team found that five years after having an abortion, over 96% of the women said it was the right decision for them.
The researchers at UCSF's Advancing New Standards in Reproductive Health (ANSIRH) found no evidence that women began to regret their decisions as years passed. On the contrary, the women reported that both their positive and negative feelings about abortion diminished over time.
At five years, the large majority of women or 84% had either primarily positive emotions or no emotions whatsoever about their abortion decision, and 6% expressed primarily negative emotions.
"Even if they had difficulty making the decision initially, or if they felt their community would not approve, our research shows that the overwhelming majority of women who obtain abortions continue to believe it was the right decision. This debunks the idea that most women suffer emotionally from having an abortion,” says Dr Corinne Rocca, associate professor in the UCSF Department of Obstetrics, Gynecology and Reproductive Sciences, and first author of the study.
The findings come as many states are requiring waiting periods and counseling for women seeking abortions, based on the assumption that they may regret having them.
“In the later decades of the twentieth century, opponents of abortion put forward an argument against access to legal abortion premised on the idea that abortion harms women by causing negative emotions and regret. The theoretical grounding for this proposed phenomenon is only weakly established. It typically relies on a framework founded on paternalistic, and often religious, beliefs about women's “nature” and supposedly innate maternal desire that constructs abortion as inherently stressful,” say researchers in the study.
They explain in recent years, this assertion has undergirded US court decisions as well as the development and passage of state-level laws in the US regulating abortion. “In eight states, for example, state-mandated materials that every abortion patient receives include claims that abortion causes lasting emotional (and mental health) harm,” they add.
According to the Guttmacher Institute, a US-based research organization, 34 states require that women receive counseling before an abortion is performed. It says 29 of these states detail the information a woman must be given, and four states have abortion-specific requirements generally following the established principles of informed consent.
Similarly, 27 states require patients seeking an abortion to wait a specified period of time, usually 24 hours, to ensure that they have had sufficient time to decide if abortion is right for them (Khazan, 2015), a rationale premised on the assumption that regret is likely.
“Twenty-seven of these states also require women to wait a specified amount of time — most often 24 hours — between the counseling and the abortion procedure. Fourteen states require that counseling be provided in person and that the counseling takes place before the waiting period begins, thereby necessitating two separate trips to the facility,” it says.
The institute further says: “Every state requires that a patient consent before undergoing medical treatment and that the consent be 'informed.' Three interrelated elements underlie the long-standing tradition of informed consent: Patients must possess the capacity to make decisions about their care; their participation in these decisions must be voluntary, and they must be provided adequate and appropriate information. However, abortion counseling requirements sometimes run afoul of these principles by requiring information that is irrelevant or misleading.”
The study findings
For the current study, the researchers analyzed data from the Turnaway Study, a longitudinal study investigating the health and socio-economic consequences of receiving or being denied an abortion in the US. Between January 2008 and December 2010, the team recruited 956 women seeking an abortion from 30 geographically diverse US facilities. The analysis included 667 participants who had abortions at the start of the study. The women were surveyed a week after they sought care and every six months thereafter, for a total of 11 times.
Relief was the most prominent emotion reported by all groups at the end of the study, just as it was at every time point in the study, say researchers.
“We found no evidence of emerging negative emotions over 5 years post-abortion. High proportions of women felt abortion was the right decision across all 5 years. Relief was the most commonly felt emotion at all times over 5 years post-abortion. The predicted percent of women reporting that the abortion was the right decision increased gradually from over 97% one-week post-abortion to 99% at five years,” says the study published in Social Science & Medicine.
While women did not report regretting their decision, many did struggle initially to make it. About half of participants felt that deciding to have the abortion was very difficult (27%) or somewhat difficult (27%), while almost half felt it was not a difficult decision (46%).
About 70% also reported feeling they would be stigmatized by their communities if people knew they had sought an abortion, with 29% reporting low levels and 31% reporting high levels of community stigma.
“Decision difficulty at baseline increased with higher levels of perceived abortion stigma in their community: among those reporting the decision was very difficult, 45% perceived high levels and 26% perceived no stigma; these figures were 24% and 46%, respectively, among those having no difficulty. There were no differences in difficulty deciding by participant age, race, education, or history of depression/anxiety,” says the study.
Those who struggled with their decisions or felt stigmatized were more likely to experience sadness, guilt, and anger shortly after obtaining the abortion. Over time, however, the number of women reporting these negative emotions declined dramatically, particularly in the first year after their abortion. This was also true for those who initially struggled with their decision, says the research team.
"This research goes further than previous studies, in that it follows women for longer, and was conducted on a larger sample from many different clinics throughout the US. It shows that women remain certain in their decision to get an abortion over time. These results clearly disprove claims that regret is likely after abortion, says Dr Julia Steinberg, an assistant professor in the department of family science at the University of Maryland, College Park, who wrote an accompanying commentary on the study in Social Science & Medicine.