Some could use support after abortion. But quality care can be hard to find.
The Turnaway Study found that women denied an abortion were more likely to have issues with anxiety and low self-esteem in the short term and less likely to have aspirational life plans in the future. (Otto Kitsinger for States Newsroom)
Alex D. turned 23 on the day the U.S. Supreme Court released the decision to overturn Roe v. Wade. She was visiting the Omaha Zoo in Nebraska on vacation, riding the chairlift over the rhino exhibit when she saw the news alert on her phone.
She was also eight weeks pregnant and needed an abortion.
“I felt hated. And I was like, ‘Nobody knows that I’m pregnant right now,’” she said. “I remember walking around the zoo and also feeling like everyone knew at the same time, like they were all looking at me and like my life was falling apart.”
Alex, who asked not to be identified by her last name because she lives in a state with an abortion ban, sobbed while she blew out the candles on her birthday cake, panicking that her appointment in a week would fall through amid the legal chaos. And she cried when she thought of the other women who would need abortions and wouldn’t make the cutoff like she did.
As lawsuits have been filed at the state and federal level over abortion laws since Roe fell in June 2022, anti-abortion advocates continue to argue that the experience of getting an abortion is traumatic by nature. In the order issuing a stay on the approval of mifepristone, one of two drugs used in abortion and miscarriage treatment, U.S. District Judge Matthew Kacsmaryk described adverse mental health outcomes as a reason to pull the drug from the market. His order did not go into effect after the U.S. Supreme Court decided to keep U.S. Food and Drug Administration approval of the drug as-is for now.
Kacsmaryk, appointed by former President Donald Trump, also cited research by David Reardon, who has led the argument that abortion causes depression, anxiety and suicidal thoughts, which anti-abortion advocates often refer to as “post-abortion syndrome.” Reardon’s work has been reviewed and discredited by many studies.
But research shows most women do not regret getting an abortion and do not experience significant emotional harm after the procedure is done. A five-year study of 667 women who had abortions at 30 facilities across the country between 2008 and 2010 showed relief remained the most commonly felt emotion among all participants.
“Most people do not have a clinically charged reaction to an abortion such that would require intervention by psychologists,” said Debra Mollen, a reproductive choice and human sexuality researcher at Texas Woman's University. “No matter how much people want that to be true, it just is not.”
However, a national study of more than 4,000 abortion patients in the U.S. published in 2020 showed nearly two-thirds thought people would look down on them if they knew they had an abortion, and that perceived stigma was associated with higher odds of experiencing psychological distress years later.
That stigma may be increasingly heightened in today’s environment and affect someone’s mental health, Mollen said.
“Somebody who has had an abortion and they’re watching news coverage of people saying people who get abortions should be killed, their doctors should be jailed, things like that,” she said. “Or they’re just talking around the dinner table and hearing people spout off about the evils of abortion or abortion being equated with genocide, and imagining what the effect is on that person. It’s no wonder, then, that some people will be distressed about the abortions they have. But it’s not the abortions, it’s all of the stigma and all of the attitudes and all of the misinformation and stereotypes.”
Abortion is not inherently traumatic, but complex feelings can arise
Mollen said there is no medically or psychologically recognized set of symptoms for “post-abortion syndrome,” but the idea has still taken hold over the past 30 years.
“I think the erroneous nature of that couldn’t help but influence not only people like you and me, but also politicians, who make laws seemingly out of the idea of trying to protect people from the harms of abortion without really understanding the vast majority of people don’t really need a lot of care after abortion, psychologically or medically,” Mollen said.
But Mollen added that doesn’t mean people can’t or don’t have complex feelings about their abortions, just as they can have complicated feelings about their pregnancies and the outcomes of pregnancy. There should be no expectation that abortion is traumatic, but there is room in between for a range of experiences, she said.
“We do this disservice to people by reacting in black and white ways,” Mollen said. “Even in a wanted pregnancy, there’s often a lot of ways people can react.”
Alex D. is quick to admit that her mental health over the past year has not been good, but not because she had an abortion. She struggled long before that with the effects of bipolar disorder, which include depression and anxiety, and it was part of her rationale for not going through with the pregnancy. On many days, she said she can barely care for herself and her possessions, let alone another human being, and her financial situation wasn’t stable either.
“How am I supposed to take care of a child if I can’t take care of my own plants? Or remember to change the oil in my car?” she said. “I wouldn’t have that much to give because I can barely focus on myself.”
The relief that came with knowing she made the right decision outweighed the negative emotions, she said, because she’s confident she would have had more detrimental mental health effects if she had seen the pregnancy through.
The Turnaway Study, another five-year abortion study, found that women denied an abortion were more likely to have issues with anxiety and low self-esteem in the short term and less likely to have aspirational life plans in the future.
Research shows psychologists aren’t well-trained on the subject of abortion
Mollen’s research includes an examination of practicing psychologists and graduate students studying psychology to determine how well informed they are about abortion to be able to effectively treat individuals considering an abortion or seeking support after having one.
The participants in Mollen’s study consistently said their training programs in school did a poor job discussing the topic of abortion if it was discussed at all, but they still reported that they felt confident addressing the issue with a client. Some of the participants also held erroneous beliefs about abortion access in the United States and believed 1 in 10 women in the U.S. would have an abortion by age 45, when the actual number is 1 in 4 women.
“The combination of assumed proficiency and misinformation may further prevent clients from receiving accurate information about abortion during a counseling experience,” the research said.
But the options available are often fraught as well for those seeking truly impartial emotional support. An organization called Support After Abortion offers a free hotline and says it is nonpartisan and non-judgmental, but its CEO, Lisa Rowe, has appeared on podcasts and spoken at conferences with an explicit anti-abortion stance. She has also partnered with anti-abortion organizations to provide literature for crisis pregnancy centers across the country. The American Council of Obstetricians and Gynecologists has said crisis pregnancy centers operate unethically and with the intention to dissuade, deter or prevent people from seeking abortions.
One of the organization’s board members, Joan Kane, has publicly advocated an anti-abortion stance, including on the Support After Abortion blog, and the chairman of the board, Janine Marrone, lists “pro-life philanthropy” on her biography page. Angela Minter, another board member, is the director of Sisters for Life and calls abortion a “holocaust.”
As a guest on a podcast called “Explicitly Pro-Life” by Students for Life of America on YouTube in 2022, Rowe said the approach she takes with those who come to them looking for support is not focused on shame.
“Most of the women and men that we work with know what they’ve done,” Rowe said. “They know that they’ve killed their baby. They know that they’re a murderer, but when we’re screaming in their face that they’re a murderer … they are already shaming themselves, we (shouldn’t) further shame them.”
A recent study found 51% of those surveyed in the week after their abortion reported feeling mostly positive emotions, while 20% said they felt few to no emotions. About 29% reported mostly negative or negative and positive emotions. There is little academic research on the effects of abortion on men.
Alex said she didn’t seek help or support specifically about her abortion, and neither did her partner at the time. But she wishes they had, because they broke up about eight months later after three years together, even though she said at the time he was supportive of her decision.
“If he had just talked to me about his emotions and talked about the abortion and how he was feeling with me, it would have been better than both of us kind of hiding it and spiraling and turning to other things to cope with the fact that we weren’t talking to each other about it,” Alex said. “I don’t know if we would be broken up right now if we had (gone to counseling).”
Exhale Pro-Voice says it offers ‘space in the middle’ in its support approach
Support After Abortion’s network of referral agencies includes crisis pregnancy centers and some religiously affiliated organizations, but it also refers to organizations such as Exhale Pro-Voice, an anonymous text line run entirely by volunteers that offers emotional support after abortion. On its website, Exhale says their support is “abortion-positive” and centers around following the individual’s specific emotional needs within their own social and cultural context. The text line is available in the U.S. and Canada in English, Spanish and French.
Rowe told States Newsroom that Support After Abortion refers to both types of entities because it is the most supportive approach of letting the client lead their own healing process.
“Some women find healing options which are not affirmative of abortion to be shaming. Other women might be triggered by having their suffering dismissed by options which only affirm abortions,” Rowe said. “Support After Abortion doesn't tell people how to feel, we support them through their feelings in a safe, non-judgmental way.”
Rachel Dyer, who is Exhale’s executive director and also a PhD candidate in counseling psychology, started working with Exhale in 2020 as she studied the relation between mental health and abortion.
She said the focus of Exhale is to provide non-judgmental emotional support amid the stigma that surrounds abortion. Since the Dobbs decision in June 2022, the text line has experienced a 200% increase in volume.
“Because abortion is such a politicized topic, it tends to be talked about in a very either-or sort of way, where if you’re on the pro-choice side you’re relieved, and on the pro-life side it’s sort of the opposite,” Dyer said. “There isn’t really space in the middle that centers the person, so that’s what we do. We hold that space.”
Dyer said most often, people just want to know if what they’re feeling after an abortion is normal or acceptable, especially if they held one view before needing an abortion and experienced opposite emotions afterward.
Dyer is also working with the American Psychological Association and other accrediting organizations to craft professional practice guidelines around providing support for patients after an abortion, as well as advocating for more continuing education courses around the topic.
“It’s often seen as a specialized area, which is funny given the universality of it,” Dyer said. “I think therapists should be more well-equipped to handle it than they are right now, which is not at all.”
‘I regret how shameful I felt’
Alex D. said she is still working through some aspects of the experience, but in the end, she is confident she made the right decision and that provides her the most comfort.
“I wouldn’t say that I’m proud of it, but I’m proud that I was strong enough to have trust in myself, and to move forward with that,” she said.
While she doesn’t regret the abortion, Alex said she regrets how she felt in the aftermath.
“I regret how shameful I felt, because I didn’t need to, and how I put the blame on myself after me and my boyfriend broke up, because I don’t need to,” she said. “I don’t need to, because I chose me, and that’s what’s important. I chose myself.”