Depression associated with abortion and childbirth:
A long-term analysis of the NLSY cohort
Jesse R. Cougle MSc, David C. Reardon, Ph.D., Priscilla K. Coleman,
Poster Presentation at the
First World Congress on Women's Mental Health
Berlin, March 27-31, 2001
Available research indicates that although abortion is generally a stressful
event, most women do not suffer from severe negative reactions at the time
of the initial post-abortion assessment. Among the few studies examining
reactions over a year after the abortion, however, Major et al (2000) and
Miller et al (1998), it has been discovered that delayed reactions are
not uncommon. In addition, the trend line over time is toward increasing
negative emotions and regret. Longitudinal studies examining a period of
time in excess of one year have been recommended.
Our study employed the National Longitudinal Survey of Youth (NLSY),
a general purpose study, which has interviewed 6283 women since 1979. It
contains psychological assessments administered in 1979 (the Rotter Internal-External
Locus of Control scale) and 1992 (the Center for Epidemiological Studies
Depression scale) and variables related to pregnancy outcome.
Compared to post-childbirth women, aborting women (n=735) were found
to have significantly higher depression scores as measured an average of10years
after their pregnancy outcome. Higher depression scores could not be accounted
for by confounding variables.
Controlling for age, total family income, and locus of control scores
prior to the first pregnancy event, post-abortive women were found to be
41% more likely than non-aborting women to score in the "high-risk" range
for clinical depression. Furthermore, in response to a self-assessment
question administered in 1998, aborting women were 73% more likely to complain
of "depression, excessive worry, or nervous trouble of any kind"
an average of 17 years post-abortion.
A weakness of this study is that only 40% of the expected abortions
are reported the NLSY population. Since concealment would tend to dilute
the observed effects, the actual rate of depression in the "high-risk"
range may be considerably higher than suggested by this data. Concealment
of abortions in the NLSY was lowest among whites and married women. As
expected, analysis by race and marital status confirmed that the differences
in depression scores were highest among the groups with the least concealment.
Pre-abortion and pre-childbirth locus of control scores were analyzed.
As predicted, the locus of control scores correlated well with depression
scores for both nulliparous and childbearing women but this correlation
disappeared for aborting women. This suggests that aborting women may either
(1) experience a shift toward a more external locus of control, or (2)
experience a different type of depression than other women.
Additional longitudinal research is warranted. Implications for future
research are discussed.
Post-abortion adjustment has been studied extensively, but most investigations
have been limited in scope and have significant methodological limitations.
Recent research suggests the need for more long-term studies of post-abortion
1. In a longitudinal investigation with women involved in a clinical
trial of RU-486, Miller, Pasta & Dean (1998) found that regret increased
from 2 weeks to 6-8 after the abortion. In regard to delayed reactions,
they concluded that "there is very likely a time course associated with
the coping process that follows abortion and this time course almost certainly
does not show a straight line of improvement. In other words, the low point
following the abortion may not occur for days, weeks, or even months" (p.
2. Most recently, Major and colleagues (2000) analyzed the psychological
state of women one hour pre-abortion, and one hour, one month, and two
years post-abortion. They found an increase in negative emotions and a
decrease in relief and positive emotions between the assessments at one
hour post-abortion and two years post-abortion. In addition, depression
increased and satisfaction with the abortion decision decreased over time.
Two of the largest and most extensive studies of post-abortion adjustment
were carried out using the National Longitudinal Survey of Youth (Russo
& Zierk, 1992; Russo & Dabul, 1997). The authors found comparable
Rosenberg self-esteem scores between aborting and non-aborting women. From
this single finding, the authors drew the broad conclusion that abortion
has no independent effect on women's well-being. That sweeping conclusion,
however, is not actually supportable using the data presented by the authors
for a number of reasons:
1. The Rosenberg Self Esteem scale is not a sensitive measure of post-abortion
adjustment. The results of Miller and colleagues' (1998) investigation
suggested that self-esteem scores remained virtually unchanged at three
different time points while other emotional states varied significantly.
Similarly, Major and colleagues (2000) found that, among post-abortive
women, self-esteem scores increased over time even while negative reactions
2. Analysis of the abortion rate reported by the NLSY cohort compared
to national statistics compiled by the Alan Guttmacher Institute has shown
that women in the NLSY report approximately 40 percent of abortions that
would be expected (Jones & Forrest, 1992). Significant differences
were found in reporting among married and unmarried women (74% vs 30%).
White women (45%) were also much more likely to report an abortion than
Blacks (27%) and Hispanics (19%).
3. Post-abortion research has found that women who conceal their abortion
experience from others are more likely to suppress thoughts of the abortion,
experience more intrusive abortion-related thoughts, and feel greater psychological
distress (Major & Gramzow, 1999). This suggests that the women who
admitted having an abortion in the NLSY study may have been less likely
to experience psychological distress than those who concealed their abortions.
4. The authors neglected to examine other psychiatric measures available
in the NLSY.
The NLSY was used to examine post-abortion and post-childbirth adjustment
among 1,971 women.
The twenty item Center for Epidemiological Studies Depression scale (CES-D;
Radloff, 1977) was presented to women by NLSY interviewers in 1992. This
measure was used in our analysis to gauge post-abortion and post-childbirth
depression. An abbreviated version of the Rotter Internal-External Locus
of Control scale (Rotter, 1966) was given to respondents in 1979 and was
used as a measure of pre-pregnancy mental state. Among all women in the
NLSY, 1979 locus of control scores correlated with 1992 depression scores
The sample used for our analysis included women who had their first pregnancy
events between 1980 and 1992. Three hundred and four had at least one abortion
and 1,667 had at least one childbirth and no abortions. The average year
of both aborting and delivering women's first pregnancy event was 1984.
Among all women with a history of abortion, 23.0% were Hispanic, 24.7%
were Black, and 52.3% were Non-Black and Non-Hispanic. Among all women
with a history of childbirth, 20.8% were Hispanic, 23.9% were Black, and
55.4% were Non-Black and Non-Hispanic. In order to examine the effects
of abortion concealment, univariate and logistic regression analyses were
carried out with special attention to race and marital status. Prior locus
of control scores, age in 1992, and income in 1992 were used as covariates
In 1998, two items relating to mental health were presented to a subset
of the NLSY cohort. These items were also analyzed in regard to post-abortion
and post-childbirth adjustment.
Univariate analyses revealed that 1992 depression scores were significantly
higher for aborting women (M=11.94, SE=0.53) than delivering women (M=9.85,
SE=0.22; F(1,1966)=13.46, p<.0003).
Among aborting women, 27.6% were found to be "at risk" of depression (CES-D
score 16 or greater) compared to 21.9% of delivering women. Logistic regression
analyses revealed that the odds ratio of severe depression scores among
aborting women compared to delivering women was 1.40 (95% CI: 1.05 to 1.86;
Hispanic and black aborting women (M=13.27, SE=0.79) scored significantly
higher in depression than women of the same ethnicity who carried to term
(M=11.25, SE=0.35). Among whites, women with a history of abortion (M=10.89,
SE=0.70) had significantly higher depression scores than delivering women
Significant differences in rates of depression emerged between aborting
and delivering women when examining different demographic groups. The results
of these analyses are given in Table 1.
The 1979 Rotter scale correlated significantly with scores on the 1992
CES-D scale for women who delivered with no reported history of abortion
(r(1667)=.177, p<.0001). Among aborting women, however, the 1979 Rotter
scale did not correlate with scores on the 1992 depression scale (r(304)=.050,
p>.05). A significant correlation reflected the fact that greater external
locus of control in 1979 was associated with higher scores of depression
A subset of the cohort women were asked two items pertaining to mental
health in 1998: "Has a doctor ever told you that you had emotional, nervous,
or psychiatric problems?" and "Are you currently experiencing depression
or excessive worry or nervous trouble of any kind?"
The sample was too small to include only women with Rotter scores prior
to their first pregnancy event. Therefore, all women with an abortion (n=108)
or delivery (n=394) prior to 1998 were included in these analyses. Both
items correlated with 1992 depression scores (Diagnosis: r(480)=.215, p<.0001;
Depression: r(480)=.246, p<.0001). The average year of the first abortion
among post-abortive women was 1983. The average year of the first childbirth
among non-aborting mothers was 1984.
In regard to the first question (doctor's diagnosis), 37 (9.4%) childbirth
women answered in the affirmative compared to 8 (7.4%) aborting women.
Controlling for age and total family income in 1998, logistic regression
analyses revealed no significant differences (OR=0.77, 95% CI: 0.35 to
1.71, Wald=.41, p>.05).
In regard to the second question (depression, excessive worry or nervous
trouble), 27 (25.0%) aborting women answered in the affirmative compared
to 64 (16.2%) mothers without a history of abortion. A logistic regression
analysis revealed significant differences when controlling for age and
income (OR=1.73, 95% CI: 1.03 to 2.89; Wald=4.36, p<.037).
Unintended Pregnancies Analyses
In 1992, the same year as the CES-D assessment, women were asked if they
intended to become pregnant before their first delivery. Women who responded
"yes" or "didn't matter" were excluded from our sample. The following additional
analysis was conducted to compare depression scores of women who carry
an unintended pregnancy to term to women who abort.
The final sample of women used in these analyses includes only women who
had their first abortion or first unintended delivery between 1980 and
1992 and completed both the 1979 Rotter scale and the 1992 CES-D scale
(n=434). On average, aborting women had their first pregnancy in 1984 at
age 22, and delivering women gave birth in 1986 at age 24.
The results of univariate and logistic regression analyses are shown in
Tables 2 and 3.
Overall, women who aborted a first unintended pregnancy had significantly
higher depression scores compared to similar women who carried an unintended
first pregnancy to term and did not report a history of abortion. As before,
the groups in which there was the least concealment of past abortions revealed
the highest relative risk for depression scores in the "high risk" range.
Among women having unintended births, the Rotter scores correlated with
depression scores (r(130)=.176, p<.045), as expected. Among aborting
women, however, Rotter and CES-D scores did not significantly correlate
The present study revealed that women with a prior history of abortion
had significantly higher scores of depression than childbearing women without
a history of abortion. In addition, when controlling for age, total family
income, and locus of control scores prior to the first pregnancy event,
post-abortive women were found to be 40% more likely to score in the "high-risk"
range for clinical depression compared to mothers without a history of
Compared to women who carried a first unintended pregnancy to term, women
who aborted a first unintended pregnancy had significantly higher depression
scores as measured an average of eight years after their abortions.
Correlation between prior locus of control scores and post-pregnancy event
depression was only evidenced for non-aborting mothers. These two scales
did not correlate women who had at least one abortion in the intervening
years (1980-1992). This is most likely due to a shift in locus of control
among aborting women. It may also be attributed to a different type of
depression in this group.
The odds ratios for high-risk depression scores were highest within those
groups who were most likely to report an abortion (married and White).
Conversely, among the groups with the highest concealment rate (all unmarried
and all Blacks and Hispanics) significant differences were lost. A number
of possible explanations exist for these findings:
1. Among groups which have the highest concealment rate, women who
admit an abortion are less likely to experience depression than their counterparts
who conceal their abortions. This explanation is supported by the finding
of Major and Gramzow (1999) that women who conceal their abortion are more
likely to suppress thoughts of the abortion and feel greater psychological
2. Abortion concealment may simply introduce the misclassification of
aborting women as non-aborting women with high depression scores.
3. Unmarried mothers may have higher depression scores due to the inherent
stress of raising a child without support.
The results of our investigation run counter to conclusions that abortion
has no independent effect on women's "well-being" drawn from prior NLSY
research (Russo & Zierk, 1992; Russo & Dabul, 1997). These contradictory
findings can be attributed to the insufficiency of the Rosenberg self-esteem
scale in measuring emotional reactions. Future post-abortion research would
benefit from the inclusion of more state-specific measures.
Our results do not support the hypothesis that depression following unintended
pregnancies is independent of outcome (birth or abortion) and primarily
or solely related to prior mental history (Major et al, 2000). Women who
carried an unintended first pregnancy to term are at less risk of subsequent
depression compared to similar women who aborted.
While Rotter scores correlate well with depression (Costello, 1982), our
investigation was limited in that pre-pregnancy depression scores were
not available. Another shortcoming is that the high rate of abortion concealment
in the NLSY data set (60%)would tend to dilute the observed effects. Future
longitudinal research which specifically examines reproductive events,
life circumstances, and emotional health year by year is warranted.
The present study's findings suggest that future research efforts should
be directed toward the examination of long-term post-abortion reactions.
Such research efforts would be beneficial in attempts to understand why
abortion, or the circumstances surrounding abortion, may be problematic
for some women. A greater knowledge of various abortion-related stressors
would be helpful in pre- and post-abortion counseling.
Funding: Elliot Institute
Conflict of interests: None
David C. Reardon, Ph.D.
PO Box 7348
Springfield, IL 62791 USA
Women scoring in "high-risk" depression range
who had their first abortion or first childbirth between 1980-1992 - by
race and marital status.
||Adjusted Odds-Ratio (95%CI)*
||0.69 (0.40 to 1.21)
||2.23 (1.21 to 4.11)
||1.28 (0.86 to 1.90)
||1.30 (0.60 to 2.81)
||1.79 (1.07 to 3.02)
||1.56 (1.03 to 2.37)
||0.84 (0.54 to 1.30)
||1.93 (1.30 to 2.85)
||1.40 (1.05 to 1.86)
*Adjusted for age, family income in 1992, and
Rotter score in 1979.
Note: Concealment of abortions was lowest among
whites and married women. Among groups with the highest concealment rates,
no significant findings were observed.
Mean and adjusted depression score means of women who had their
first abortion or first unintended childbirth between 1980-1992.
Unintended birth women (n=130)
Adj. Mean* (SE)
||Adj. Mean* (SE)
||6.07 to 10.47
||9.61 to 12.18
||8.67 to 15.05
||11.20 to 15.16
||7.78 to 11.37
||11.05 to 13.35
* adjusting for family income, education, race, age at first pregnancy,
and 1979 Rotter score
Women scoring in "high-risk" range for clinical depression (CES-D
score >15) who had their first abortion or first unintended childbirth
||Unintended birth women
high risk / total
high risk / total
||13 / 75
||43 / 164
||1.09 to 5.22
||16 / 53
||37 / 129
||0.43 to 2.03
||30 / 130
||84 / 304
||0.92 to 2.59
* adjusting for family income, education, race, age at first pregnancy,
and 1979 Rotter score
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David C. Reardon, Ph.D.
PO Box 7348
Springfield, IL 62791 USA