A major new review by the Academy of Medical Royal Colleges (AOMRC), published today, concludes that having an abortion does not increase the risk of mental health problems. In this, it confirms the findings of other authoritative reviews: most notably, the American Psychological Association's report of 2008.
This review provides useful reassurance for women seeking abortion, and those who treat them. But it is also to be hoped that, with this latest review of the evidence about abortion and mental health, the debate about abortion can move beyond this narrow framework.
In reality, women do not have abortions because they are good for their health, or in spite of them being bad for their health. Abortion is a part of the messy reality of life, subject to a whole range of personal, moral, social and relational factors; and the preoccupation with its health effects can skew the debate away from more subtle questions.
The key point highlighted by the AOMRC's review is that mental health outcomes from induced abortion or childbirth are associated with a woman's mental health before abortion. In other words, if depression follows abortion it is because the woman has a pre-existing mental health condition, not because the abortion itself causes her to be depressed.
Furthermore, it states that mental health outcomes are likely to be the same, whether women with unwanted pregnancies opt for an abortion or birth. The review thus recognises that women seeking abortion must be compared, not with women who are not pregnant or who have wanted pregnancies, but with women in a comparable situation an unwanted pregnancy, which must be carried to term or aborted.
The AOMRC's insistence that the mental health outcomes of abortion and birth are likely to be the same for the woman carrying the pregnancy, depending on any pre-existing mental health conditions she may have, is an implicit recognition of the wider factors at play within the abortion decision.
All reproductive outcomes can have some psychological impact, and in today's society post-natal depression is widely highlighted as one of the possible outcomes of birth. Yet women who want to have babies run that risk, because their desire to have a child outweighs their fear of suffering mental health problems. It would be profoundly wrong to counsel a woman with a history of depression that she should have an abortion because it would be better for her mental health.
By the same token, women who have abortions do so because they do not want, or cannot cope with, having a child or another child at this point in their lives. It would be profoundly wrong to counsel this woman that she should have a baby because this would be better for her mental health. That woman is confronted with a choice, which she can only make by weighing up a complex set of personal and emotional factors. Her decision to have an abortion, or a child, is not a health option but a life decision, and one that only she - not doctors, psychiatrists, or counsellors - can make.
Some argue that the way to avoid women suffering potential mental health problems from abortion or childbirth is to ensure that all pregnancies are wanted, or at least intended, through pushing for better use of contraception. Indeed, this is implicit in the AOMRC review's finding that 'having an unwanted pregnancy is associated with an increased risk of mental health problems', and its recommendation that 'future practice and research should focus on supporting all women who have an unwanted pregnancy'.
But it is worth noting that here again, women's life circumstances and decision-making are not so clear cut; and an 'unwanted pregnancy' is very difficult to define. An unintended pregnancy for example, coming from a failure to use contraception properly, can be a happy surprise, or become a wanted pregnancy; a carefully-planned pregnancy can become unwanted or problematic if a woman's circumstances change.
None of these experiences or emotions can be properly understood through the narrow prism of mental health: they can only be appreciated in the context of women's lives, the problems and pressures they face, and the available means they have of resolving these things.
Meanwhile, the focus on abortion and mental health has often had the unfortunate consequence of professionalising the understanding of women's problems and the help and support that they need. It is often felt that doctors need to 'do more' to help women make their decisions, or to cope with the consequences of their decisions. But while kindness and caring are important qualities for those working in abortion services, they are not qualities that are limited to health professionals.
Women generally make their decisions about abortion, and motherhood, with the support of their partners, families and friends. When they make their decision, the primary role of abortion services should be to respect their autonomy to make it.