Este artículo muestra cómo la palabra de la ciencia aporta un conocimiento directo e indiscutible acerca del comienzo de la vida de cada concebido de nuestra especie: dice cuándo estamos en presencia de un cuerpo humano en los procesos temporales de transmisión de la vida. Aporta también conocimiento directo acerca del carácter personal del embrión por la continuidad de su desarrollo, ya que lo decisivo no es que tenga lugar una continuidad desde el inicio, las etapas embrionarias y fetales, y el nacimiento, sino que esa continuidad suponga continuidad del cuerpo, que siempre es personal. Y un conocimiento indirecto del origen de cada ser humano, al mostrar qué es un cuerpo humano y cómo este tiene ese carácter peculiar exclusivo de los hombres, el carácter personal. En definitiva, la ciencia pone de manifiesto la presencia de una potencia real, distinta de la fuerza de la vida, involucrada en el origen de cada ser humano. El entrelazamiento en la vida única de cada hombre de la dimensión personal y la dimensión biológica es manifestación inequívoca de que existe un único sujeto personal con dos dinamismos. Un ser personal de naturaleza humana.

The U.S. Supreme Court viewed Roe v. Wade as the Court’s attempt to end the national abortion controversy. In 2019, pro-choice and pro-life state legislators are passing laws that undermine the Court’s resolution in Roe and move the debate toward an inflection point. This thesis reports a mixed-methods mediation of the U.S. abortion debate that assesses the conflict and how it could be reduced or resolved. A historical analysis of U.S. abortion laws shed light on how the debate has developed, analyses of online abortion discourse and polls on abortion attitudes outlined Americans’ common ground and irreconcilable differences, and studies were performed to contextualize the role that error and confusion have played in the debate.

Americans might see the national abortion controversy as an insurmountable issue because they believe pro-choice and pro-life Americans are diametrically opposed in their stances on abortion, but most Americans support certain abortion restrictions and legal abortion access in certain circumstances. Thus, discussions on whether fetuses are humans and whether they deserve rights distract from the core issue of when a pregnant person’s right to terminate a pregnancy outweighs a fetus’ right to life. While there is genuine disagreement on the permissibility of legal access to elective abortion in the first trimester, this thesis argues that Americans’ common ground can be used to reach a resolution. The question is if Americans, activists, and politicians want to compromise.

Carta al Editor

Sandoval-Baca Brigith, Chunga-Vallejos Enrique, Díaz-Vélez Cristian.

Antecedentes: La Organización Mundial de la Salud, para el 2014, estima que aproximadamente 22 millones de abortos inseguros ocurren cada año en el mundo, casi todos ellos en países en desarrollo. Los Objetivos del Milenio, como parte del quinto compendio, centrado en la salud materna al proponer que los estados miembros debería reducir la mortalidad materna al 75% para el 2015. Objetivo: Determinar, utilizando indicadores de salud materna, si el aborto en Chile es un problema de salud prioritario. Materiales y Métodos: Datos sobre mortalidad materna y sus causas entre 1982 y 2014, se obtuvo de las bases de datos disponibles en el Ministerio de Chile de salud. Los análisis de tendencia se llevaron a cabo utilizando modelos autorregresivos lineales. Resultados: Entre 1982 y 2012, las tasas de mortalidad materna descendieron de 51,8 a 18,3 por 100.000 nacidos vivos. Complicaciones del embarazo, parto y puerperio fueron las tres primeras causas y la última es el aborto. La proporción de abortos por causas no especificadas, incluido el aborto inducido, disminuyó de 36,6% a 26,1% entre 2001 y 2012. Conclusiones: El aborto no es un problema de salud pública en Chile. Para continuar reduciendo la mortalidad materna, los programas para la detección precoz de riesgos como la diabetes, la obesidad y la hipertensión ser implementado.

Anuario de Estadísticas Vitales, Chile 2012

Ministerio de Salud, Gobierno de Chile.

Background: Miscarriage and induced abortion are life events that can potentially cause mental distress. The objective of this study was to determine whether there are differences in the patterns of normalization of mental health scores after these two pregnancy termination events.

Methods: Forty women who experienced miscarriages and 80 women who underwent abortions at the main hospital of Buskerud County in Norway were interviewed. All subjects completed the following questionnaires 10 days (T1), six months (T2), two years (T3) and five years (T4) after the pregnancy termination: Impact of Event Scale (IES), Quality of Life, Hospital Anxiety and Depression Scale (HADS), and another addressing their feelings about the pregnancy termination. Differential changes in mean scores were determined by analysis of covariance (ANCOVA) and inter-group differences were assessed by ordinary least squares methods.

Results: Women who had experienced a miscarriage had more mental distress at 10 days and six months after the pregnancy termination than women who had undergone an abortion. However, women who had had a miscarriage exhibited significantly quicker improvement on IES scores for avoidance, grief, loss, guilt and anger throughout the observation period. Women who experienced induced abortion had significantly greater IES scores for avoidance and for the feelings of guilt, shame and relief than the miscarriage group at two and five years after the pregnancy termination (IES avoidance means: 3.2 vs 9.3 at T3, respectively, p < 0.001; 1.5 vs 8.3 at T4, respectively, p <0.001). Compared with the general population, women who had undergone induced abortion had significantly higher HADS anxiety scores at all four interviews (p < 0.01 to p < 0.001), while women who had had a miscarriage had significantly higher anxiety scores only at T1 (p < 0.01).

Conclusion: The course of psychological responses to miscarriage and abortion differed during the five-year period after the event. Women who had undergone an abortion exhibited higher scores during the follow-up period for some outcomes. The difference in the courses of responses may partly result from the different characteristics of the two pregnancy termination events.

Background: Suicidal behavior and its correlates remain relatively understudied in pregnant teenagers.

Methods: A cross-sectional study with a consecutive sample of pregnant teenagers recipient of prenatal medical assistance by the national public health system in the urban area of Pelotas, southern Brazil. Sample size was estimated in 871 participants. Suicidal behavior and psychiatric disorders were assessed with the Mini International Neuropsychiatric Interview; the Abuse Assessment Screen was used to identify physical or sexual abuse; social support was assessed with the Medical Outcomes Survey Social Support Scale; a self-report questionnaire was used to collect socio-demographic, obstetric and other psychosocial data.

Results: Forty three (4.94%) teenagers refused to participate, resulting in 828 participants. Prevalence of suicidal behavior was 13.3%; lifetime suicide attempts were referred by 7.4%, with 1.3% reporting attempting suicide within the last month. After adjustment, we found significant associations of suicidal behavior with the 18–19 years old subgroup, low education, prior abortion, previous major depression, and physical abuse within the last 12 months. Pregnant teenagers with high social support showed prevalence ratios (PR) 67% lower (PR: 0.33; 95%CI: 0.19–0.56) than those with low social support. Furthermore, a wide range of psychiatric disorders, most notably major depressive disorder (PR: 2.75; 95%CI: 1.34–5.63) and panic disorder (PR: 6.36; 95%CI: 1.61–25.10), remained associated with suicidal behavior after adjustment.

Limitations: The cross-sectional design precludes causal inferences.

Conclusions: We found that suicidal behavior is a relatively common feature in pregnant teenagers, frequently associated with psychiatric disorders.

During the 40 years since the US Supreme Court decision in Doe versus Wade and Doe versus Bolton, restrictions on termination of pregnancy (TOP) were overturned nationwide. The use of TOP was much wider than predicted and a substantial fraction of reproductive age women in the U.S. have had one more TOPs and that widespread uptake makes the downstream impact of any possible harms have broad public health implications. While short-term harms do not appear to be excessive, from a public perspective longer term harm is conceiving, and clearly more study of particular relevance concerns the associations of TOP with subsequent preterm birth and mental health problems. Clearly more research is needed to quantify the magnitude of risk and accurately inform women with the crisis of unintended pregnancy considering TOP. The current US data-gathering mechanisms are inadecuate for this important task.

Their mental health, social adjustment and educational level up to the age of 21.

Hans Forssman and Inga Thuwe

Aim: Women with a recent induced abortion have a 3-fold risk for suicide, compared to non-pregnant women. The increased risk was recognised in unofficial guidelines (1996) and Current Care Guidelines (2001) on abortion treatment, highlighting the importance of a check-up 2 – 3 weeks after the termination, to monitor for mental health disorders. We studied the suicide trends after induced abortion in 1987 – 2012 in Finland. Methods: We linked the Register on Induced Abortions (N = 284,751) and Cause-of-Death Register (N = 3798 suicides) to identify women who had committed suicide within 1 year after an induced abortion (N = 79). The abortion rates per 100,000 person-years were calculated for 1987 – 1996 (period with no guidelines), 1997 – 2001 (with unofficial guidelines) and 2002 – 2012 (with Current Care Guidelines). Results: The suicide rate after induced abortion declined by 24%, from 32.4/100,000 in 1987 – 1996 to 24.3/100,000 in 1997 – 2001 and then 24.8/100,000 in 2002 – 2012. The age-adjusted suicide rate among women aged 15 – 49 decreased by 13%; from 11.4/100,000 to 10.4/100,000 and 9.9/100,000, respectively. After induced abortions, the suicide rate increased by 30% among teenagers (to 25/100,000), stagnated for women aged 20 – 24 (at 32/100,000), but decreased by 43% (to 21/100,000) for women aged 25 – 49. Conclusions: The excess risk for suicide after induced abortion decreased, but the change was not statistically significant. Women with a recent induced abortion still have a 2-fold suicide risk. A mandatory check-up may decrease this risk. The causes for the increased suicide risk, including mental health prior to pregnancy and the social circumstances, should be investigated further.

The knowledge of important biopsychosocial factors linking women's reproductive health and mental health is increasing. This review focuses on psychological aspects of contraception, unintended pregnancy, and abortion because these are common reproductive health experiences in U.S. women's lives. This review addresses the mental-health antecedents and consequences of these experiences, mostly focusing on depression and depressive symptoms before and after unintended pregnancy and contraception. As mental-health antecedents, depressive symptoms predict contraceptive behaviors that lead to unintended pregnancy, and mental-health disorders have been associated with having subsequent abortions. In examining the mental-health consequences, most sound research does not find abortion or contraceptive use to cause mental-health problems. Consequently, evidence does not support policies based on the notion that abortion harms women's mental health. Nevertheless, the abortion-care setting may be a place to integrate mental-health services. In contrast, women who have births resulting from unintended pregnancies may be at higher risk of postpartum depression. Social policies (e.g., paid maternity leave, subsidized child care) may protect women from mental-health problems and stress of unplanned children interrupting employment, education, and pre-existing family care responsibilities.

Background: Controversy exists about whether abortion or childbirth is associated with greater psychological risks. We compared psychiatric admission rates of women in time periods from 90 days to 4 years after either abortion or childbirth.

Methods: We used California Medicaid (Medi-Cal) records of women aged 13–49 years at the time of either abortion or childbirth during 1989. Only women who had no psychiatric admissions or pregnancy events during the year before the target pregnancy event were included (n = 56 741). Psychiatric admissions were examined using logistic regression analyses, controlling for age and months of eligibility for Medi-Cal services.

Results: Overall, women who had had an abortion had a significantly higher relative risk of psychiatric admission compared with women who had delivered for every time period examined. Significant differences by major diagnostic categories were found for adjustment reactions (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.1–4.1), single-episode (OR 1.9, 95% CI 1.3–2.9) and recurrent depressive psychosis (OR 2.1, 95% CI 1.3–3.5), and bipolar disorder (OR 3.0, 95% CI 1.5–6.0). Significant differences were also observed when the results were stratified by age.

Interpretation: Subsequent psychiatric admissions are more common among low-income women who have an induced abortion than among those who carry a pregnancy to term, both in the short and longer term.

Objective: To identify short-term factors influencing psychological outcome of termination of pregnancy for fetal anomaly, in order to define those patients most vulnerable to psychopathology.

Study Design: A prospective cohort of 217 women and 169 men completed standardized questionnaires 4 months after termination. Psychological adjustment was measured by the Inventory of Complicated Grief (ICG), the Impact of Event Scale (IES), the Edinburgh Postnatal Depression Scale (EPDS), and the Symptom Checklist-90 (SCL-90).

Results: Women and men showed high levels of posttraumatic stress (PTS) symptoms (44 and 22%, respectively) and symptoms of depression (28 and 16%, respectively). Determinants of adverse psychological outcome were the following: high level of doubt in the decision period, inadequate partner support, low self- efficacy, lower parental age, being religious, and advanced gestational age. Whether the condition was Down syndrome or another disability was irrelevant to the outcome. Termination did not have an important effect on future reproductive intentions. Only 2% of women and less than 1% of men regretted the decision to terminate.

Conclusion: Termination of pregnancy (TOP) for fetal anomaly affects parents deeply. Four months after termination a considerable part still suffers from posttraumatic stress symptoms and depressive feelings. Patients who are at high risk could benefit from intensified support. Copyright  2007 John Wiley & Sons, Ltd.

Objective: To examine the links between pregnancy outcomes (birth, abortion, or involuntary pregnancy loss) and mental health outcomes for US women during the transition into adulthood to determine the extent of increased risk, if any, associated with exposure to induced abortion.

Method: Panel data on pregnancy history and mental health history for a nationally representative cohort of 8005 women at (average) ages 15, 22, and 28years from the National Longitudinal Study of Adolescent to Adult Health were examined for risk of depression, anxiety, suicidal ideation, alcohol abuse, drug abuse, cannabis abuse, and nicotine dependence by pregnancy outcome (birth, abortion, and involuntary pregnancy loss). Risk ratios were estimated for time-dynamic outcomes from population-averaged longitudinal logistic and Poisson regression models.

Results: After extensive adjustment for confounding, other pregnancy outcomes, and sociodemographic differences, abortion was consistently associated with increased risk of mental health disorder. Overall risk was elevated 45% (risk ratio, 1.45; 95% confidence interval, 1.30–1.62; p<0.0001). Risk of mental health disorder with pregnancy loss was mixed, but also elevated 24% (risk ratio, 1.24; 95% confidence interval, 1.13–1.37; p<0.0001) overall. Birth was weakly associated with reduced mental disorders. One-eleventh (8.7%; 95% confidence interval, 6.0–11.3) of the prevalence of mental disorders examined over the period were attributable to abortion.

Conclusion: Evidence from the United States confirms previous findings from Norway and New Zealand that, unlike other pregnancy outcomes, abortion is consistently associated with a moderate increase in risk of mental health disorders during late adolescence and early adulthood.

Introducción: Las consecuencias psiquiátricas del aborto inducido siguen siendo objeto de controversia. Las reacciones de cualquier mujer al descubrir que ha concebido pueden ser muy variables. El embarazo, inicialmente intencionado o no deseado, puede provocar estrés; y el aborto espontáneo puede acarrear sentimientos de pérdida y reacciones de duelo, por lo que no es de extrañar que el aborto inducido, con las implicaciones emocionales añadidas (sentimientos de alivio, vergüenza y culpa), sea vivido como acontecimiento de la vida adverso y generador de estrés.

Consideraciones metodológicas: Existe acuerdo entre los investigadores sobre la necesidad de comparar la evolución de la salud mental (o las complicaciones psiquiátricas) con grupos apropiados, que incluyen particularmente el de mujeres con embarazo no intencionado que dan a luz y el de mujeres con aborto espontáneo. Y también hay acuerdo en la necesidad de controlar el posible efecto, como factores de confusión, de múltiples variables asociadas: demográficas, contextuales, de desarrollo personal, de experiencias traumáticas previas o actuales y de salud psíquica antes del evento obstétrico. Cualquier desenlace psiquiátrico es de origen multifactorial; el impacto de los acontecimientos depende de cómo son percibidos, de los mecanismos psicológicos de defensa puestos en juego (en gran parte inconscientes) y del estilo de afrontamiento. El hecho de abortar voluntariamente tiene una indudable dimensión ética, en la que se entrelazan los hechos y las valoraciones.

Resultados: Ninguna investigación ha encontrado que el aborto inducido se asocie a mejor evolución de la salud mental, aunque los resultados de algunos estudios son interpretados como «neutros» o «mezclados». Algunos estudios de población general señalan asociaciones significativas con dependencia de alcohol y de drogas ilegales, con trastornos afectivos (incluida la depresión) y algunos trastornos de ansiedad; y algunas de esas asociaciones se han visto confirmadas, y matizadas, por estudios longitudinales prospectivos, que sostienen que se trata de relaciones causales.

Conclusiones: Con los datos disponibles, es razonable dedicar esfuerzos a los cuidados de salud mental de las mujeres que han tenido algún aborto inducido. De ninguna manera puede invocarse, sobre bases empíricas, razones de salud mental de la embarazada para provocar el aborto.

The objective of this study was to compare psychiatric morbidity and the course of posttraumatic stress, depression, and anxiety in two groups with severe complications during pregnancy, women after termination of late pregnancy (TOP) due to fetal anomalies and women after preterm birth (PRE). As control group women after the delivery of a healthy child were assessed. A consecutive sample of women who experienced a) termination of late pregnancy in the 2nd or 3rd-trimester (N=62), or b) preterm birth (N=43), or c) birth of a healthy child (N=65) was investigated 14 days (T1), 6 months (T2), and 14 months (T3) after the event. At T1, 22.4% of the women after TOP were diagnosed with a psychiatric disorder compared to 18.5% women after PRE, and 6.2% in the control group. The corresponding values at T3 were 16.7%, 7.1%, and 0%. Shortly after the event, a broad spectrum of diagnoses was found; however, 14 months later only affective and anxiety disorders were diagnosed. Posttraumatic stress and clinician-rated depressive symptoms were highest in women after TOP. The short-term emotional reactions to TOP in late pregnancy due to fetal anomaly appear to be more intense than those to preterm birth. Both events can lead to severe psychiatric morbidity with a lasting psychological impact.

Termination of pregnancy for fetal malformation is a traumatic event which any woman finds hard to withstand and which entails the risk of severe and complicated grieving. This paper presents three cases illustrating the trauma and coping mechanisms. Grieving continued for over 6 months in all cases and included pathological anxiety and depression. We offer advice and counselling to such women.

Background: Teenage pregnancy is associated with an increased risk of premature death. However, it is not known whether the outcome of pregnancy, i.e. induced abortion or childbirth, affects this risk. Methods: A Finnish population-based register study involving a cohort of 13 691 nulliparous teenagers who conceived in 1987–89; 6652 of them underwent induced abortion and 7039 delivered. The control group consisted of 41 012 coeval women without teenage pregnancy. Follow-up started at the end of pregnancy and lasted until 6th June 2013. Results: Women with teenage pregnancy had a higher risk of overall mortality vs. controls (mortality rate ratio [MRR] 1.6, [95% CI 1.4–1.8]) and were more likely to die prematurely as a result of suicide, alcohol-related causes, circulatory diseases and motor vehicle accidents. A low educational level appeared to explain these excess risks, except for suicide (adj. MRR 1.5, [95% CI 1.1–2.0]). After adjusting for confounders, the childbirth group faced lower risks of suicide (adj. MRR 0.5, [95% CI 0.3–0.9]) and dying from injury and poisoning (adj. MRR 0.6, [95% CI 0.4–0.8]) compared with women who had undergone abortion. Conclusions: A low educational level is associated with the increased risk of premature death among women with a history of teenage pregnancy, except for suicide. Extra efforts should be made to encourage pregnant teenagers to continue education, and to provide psychosocial support to teenagers who undergo induced abortion.

An investigation material consisting of 120 persons who were born after refusal of an application for therapeutic abortion, with the same number of controls, has previously been followed up by the writers to the age of 21 years. This follow-up study has now been extended to completion of the 35th year. It is found that in social-psychiatric respects the index cases as a group are still somewhat worse situated than the control cases. However, the differences have to a certain extent levelled out and during the later part of the observation period no statistically significant differences can be demonstrated for any single variable.

Abstract: Due to technological advances in antenatal diagnosis of fetal abnormalities, more women face the prospect of terminating pregnancies on these grounds. Much existing research focuses on women’s psychological adaptation to this event. However, there is a lack of holistic understanding of women’s experiences. This article reports a systematic review of qualitative studies into women’s experiences of pregnancy termination for fetal abnormality. Eight databases were searched up to April 2014 for peer-reviewed studies, written in English, that reported primary or secondary data, used identifiable and interpretative qualitative methods, and offered a valuable contribution to the synthesis. Altogether, 4,281 records were screened; 14 met the inclusion criteria. The data were synthesised using meta-ethnography. Four themes were identified: a shattered world, losing and regaining control, the role of health professionals and the power of cultures. Pregnancy termination for fetal abnormality can be considered as a traumatic event that women experience as individuals, in their contact with the health professional community, and in the context of their politico-socio-legal environment. The range of emotions and experiences that pregnancy termination for fetal abnormality generates goes beyond the abortion paradigm and encompasses a bereavement model. Coordinated care pathways are needed that enable women to make their own decisions and receive supportive care.

Objectives: We aimed to qualitatively evaluate factors that contribute to and alleviate grief associated with termination of a pregnancy for a fetal anomaly and how that grief changes over time.

Study design: We conducted a longitudinal qualitative study of decision satisfaction, grief and coping among women undergoing termination (dilation and evacuation or induction termination) for fetal anomalies and other complications. We conducted three post-procedure interviews at 1–3 weeks, 3 months and 1 year. We used a generative thematic approach to analyze themes related to grief using NVivo software program.

Results: Of the 19 women in the overall study, 13 women’s interviews were eligible for analysis of the grief experience. Eleven women completed all three interviews, and two completed only the first interview. Themes that contributed to grief include self-blame for the diagnosis, guilt around the termination decision, social isolation related to discomfort with abortion and grief triggered by reminders of pregnancy. Social support and time are mechanisms that serve to alleviate grief.

Conclusions: Pregnancy termination in this context is experienced as a significant loss similar to other types of pregnancy loss and is also associated with real and perceived stigma. Women choosing termination for fetal anomalies may benefit from tailored counseling that includes dispelling misconceptions about cause of the anomaly. In addition, efforts to decrease abortion stigma and increase social support may improve women’s experiences and lessen their grief response.

Implications: The nature and course of grief after second-trimester termination for fetal anomaly are, as of yet, poorly understood. With improved understanding of how women grieve over time, clinicians can better recognize the significance of their patients’ suffering and offer tools to direct their grief toward positive coping.

Objective: We examined women’s long-term psychological well-being after termination of pregnancy (TOP) for fetal anomaly in order to identify risk factors for psychological morbidity.

Methods: A cross-sectional study was performed in 254 women, 2 to 7 years after TOP for fetal anomaly before 24 weeks of gestation. We used standardised questionnaires to investigate grief, posttraumatic symptoms, and psychological and somatic complaints.

Results: Women generally adapted well to grief. However, a substantial number of the participants (17.3%) showed pathological scores for posttraumatic stress. Low-educated women and women who had experienced little support from their partners had the most unfavourable psychological outcome. Advanced gestational age at TOP was associated with higher levels of grief, and posttraumatic stress symptoms and long-term psychological morbidity was rare in TOP before 14 completed weeks of gestation. Higher levels of grief and doubt were found if the fetal anomaly was presumably compatible with life.

Conclusion: Termination of pregnancy for fetal anomaly is associated with long-lasting consequences for a substantial number of women. Clinically relevant determinants are gestational age, perceived partner support, and educational level. Copyright  2005 John Wiley & Sons, Ltd.

Cuadernos de extensión jurídica (U. de los Andes) Nº 27, 2015, pp. 249-259

Sebastián Illanes
Magíster en Ciencias Médicas por la Universidad de Chile
Profesor de Gineco-Obtetricia
Universidad de los Andes

Elard Koch
Director of Research
MELISA Institute

Errores en la “tercera causal” del proyecto de ley.

Objetivo. Evaluar y comparar la aparición de trastornos de depresión (TD) y de estrés postraumático (TEPT) en mujeres después de una pérdida gestacional inducida o involuntaria que solicitaron atención psicológica. Método. Participaron 287 mujeres de la Ciudad de México atendidas en el Instituto para la Rehabilitación de la Mujer y la Familia A.C. (IRMA), de 2013 a 2016, de las cuales 201 vivieron pérdida inducida y 86 pérdida involuntaria. En la primera sesión se aplicaron las escalas de Depresión de Beck, de Depresión del Centro de Estudios Epidemiológicos (CES-D), de Trauma de Davidson (DTS) y de Gravedad de Síntomas del Trastorno de Estrés Postraumático (GS-TEPT). Resultados. Se encontró que el 61.2% de las mujeres con pérdida inducida presentan TEPT. No se hallaron diferencias significativas entre los grupos de mujeres evaluadas. Por otro lado, en las pruebas de Beck y CES-D, los puntajes son significativamente más altos en las mujeres con pérdidas inducidas. Conclusión. Los resultados confirman que los dos tipos de pérdida gestacional, inducida o involuntaria, pueden causar TEPT intenso, y las mujeres con pérdidas inducidas pueden presentar estados depresivos más severos.

The objective of the study was to compare psychological responser of women following a pregnancy termination due to ultrasound-detected fetal anomalies (ultrasound group) with the psychological responses of women following a late spontaneous abortion or a perinatal death (perinatal loss group). The assessments, which were performed on four occasions in the year after the life event, included Montgomery and Asberg Depression Rating Scale, Goldberg General Health Questionnaire, Impact of Event Scale, State-Trait Anxiety Inventory and Schedule for Recent Life Events. In the acute phase, a few days after the life event, the women in the ultrasound group reported statistically significantly less depressive symptoms and less intrusion and avoidance symptoms than the perinatal loss group. No differences in psychological responser in the two groups were found at the examinations at approximately 7 weeks, 5 months or 1 year. A statistically significantly higher proportion of women in the ultrasound group reported that they had tried to become pregnant in the following year. A few subjects in each group reported persisting high psychological distress throughout the year, but only one woman fulfilled the criteria of a post-traumatic stress disorder. It is concluded that the long-term psychological stress response in women to pregnancy termination following ultrasonographic detection of fetal anomalies does not differ from the stress responses seen in women experiencing a perinatal loss.

The aim was to identify from empirical research that used quantitative or qualitative methods the reasons women give for having an abortion. A search was conducted of peer-reviewed, English language publications indexed in eight computerized databases with publication date 1996–2008, using keywords ‘abortion’ and ‘reason’ (Medline: ‘induced abortion’ OR ‘termination of pregnancy’ OR ‘elective abortion’ and ‘reason’). Inclusion criteria were empirical research on humans that identified women’s reasons for undergoing an abortion, conducted in ‘high-income’ countries. 19 eligible papers were found. Despite variation in methods of generating, collecting, and analysing reasons, and the inadequacy of methodological detail in some papers, all contributed to a consistent picture of the reasons women give for having an abortion, with three main categories (‘Woman-focused’, ‘Other-focused’, and ‘Material’) identified. Ambivalence was often evident in women’s awareness of reasons for continuing the pregnancy, but abortion was chosen because continuing with the pregnancy was assessed as having adverse effects on the life of the woman and significant others. Women’s reasons were complex and contingent, taking into account their own needs, a sense of responsibility to existing children and the potential child, and the contribution of significant others, including the genetic father.

Carlos Del Campo, MD, FRCS

Objective—To examine whether a first abortion increases risk of mental health disorders compared to a first childbirth, with and without considering prepregnancy mental health and adverse exposures, childhood economic status, miscarriage history, age at first abortion or childbirth, and race or ethnicity.

Methods—A cohort study compared rates of mental disorders (anxiety, mood, impulse-control, substance use, eating disorders, and suicidal ideation) among 259 women postabortion and 677 women postchildbirth aged 18 to 42 at the time of interview from The National Comorbidity Survey-Replication

Results—The percentage of women with no, one, two, and three or more mental health disorders before their first abortion was 37.8%, 19.7%, 15.2% and 27.3%, and before their first childbirth was 57.9%, 19.6%, 9.2%, and 13.3% respectively, indicating that women in the abortion group had more prior mental health disorders than women in the childbirth group, p < .001. Although in unadjusted Cox proportional hazard models, abortion compared to childbirth was associated with statistically significant higher hazards of postpregnancy mental health disorders, associations were reduced and became nonstatistically significant for five disorders after adjusting for the aforementioned factors. Hazard ratios (HR) and associated 95% confidence intervals dropped from 1.52 (1.08-2.15) to 1.12 (0.87-1.46) for any anxiety disorder; from 1.56 (1.23-1.98) to 1.18 (0.88-1.56) for mood disorders; from 1.62 (1.02-2.57) to 1.10 (0.75-1.62) for impulse-control disorders; from 2.53 (1.09-5.86) to 1.82 (0.63-5.25) for eating disorders; and from 1.62 (1.09-2.40) to 1.25 (0.88-1.78) for suicidal ideation. Only abortion and substance use disorders remained statistically significant, although the HR dropped from 3.05 (1.94-4.79) to 2.30 (1.35-3.92).

Conclusions—After accounting for confounding factors, abortion was not a statistically significant predictor of subsequent anxiety, mood, impulse-control, and eating disorders or suicidal ideation.

OBJECTIVE: We studied psychological outcomes and predictors for adverse outcome in 147 women 4, 8, and 16 months after termination of pregnancy for fetal anomaly.

STUDY DESIGN: We conducted a longitudinal study with validated self-completed questionnaires.

RESULTS: Four months after termination 46% of women showed pathological levels of posttraumatic stress symptoms, decreasing to 20.5% after 16 months. As to depression, these figures were 28% and 13%, respectively. Late onset of problematic adaptation did not occur frequently. Outcome at 4 months was the most important predictor of persistent impaired psychological outcome. Other predictors were low self-efficacy, high level of doubt during decision making, lack of partner support, being religious, and advanced gestational age. Strong feelings of regret for the decision were mentioned by 2.7% of women.

CONCLUSION: Termination of pregnancy for fetal anomaly has significant psychological consequences for 20% of women up to 1 year. Only few women mention feelings of regret.

Background: Arguments that abortion causes women emotional harm are used to regulate abortion, particularly later procedures, in the United States. However, existing research is inconclusive. We examined women’s emotions and reports of whether the abortion decision was the right one for them over the three years after having an induced abortion.

Methods: We recruited a cohort of women seeking abortions between 2008-2010 at 30 facilities across the United States, selected based on having the latest gestational age limit within 150 miles. Two groups of women (n=667) were followed prospectively for three years: women having first-trimester procedures and women terminating pregnancies within two weeks under facilities’ gestational age limits at the same facilities. Participants completed semiannual phone surveys to assess whether they felt that having the abortion was the right decision for them; negative emotions (regret, anger, guilt, sadness) about the abortion; and positive emotions (relief, happiness). Multivariable mixed-effects models were used to examine changes in each outcome over time, to compare the two groups, and to identify associated factors.

Results: The predicted probability of reporting that abortion was the right decision was over 99% at all time points over three years. Women with more planned pregnancies and who had more difficulty deciding to terminate the pregnancy had lower odds of reporting the abortion was the right decision (aOR=0.71 [0.60, 0.85] and 0.46 [0.36, 0.64], respectively). Both negative and positive emotions declined over time, with no differences between women having procedures near gestational age limits versus first-trimester abortions. Higher perceived community abortion stigma and lower social support were associated with more negative emotions (b=0.45 [0.31, 0.58] and b=-0.61 [-0.93, -0.29], respectively).

Conclusions: Women experienced decreasing emotional intensity over time, and the overwhelming majority of women felt that termination was the right decision for them over three years. Emotional support may be beneficial for women having abortions who report intended pregnancies or difficulty deciding.

Background: Induced abortion is a common medical intervention. Whether psychological sequelae might follow induced abortion has long been a subject of concern among researchers and little is known about the relationship between posttraumatic stress disorder (PTSD) and induced abortion. Thus, the aim of the study was to assess the prevalence of PTSD and posttraumatic stress symptoms (PTSS) before and at three and six months after induced abortion, and to describe the characteristics of the women who developed PTSD or PTSS after the abortion.

Methods: This multi-centre cohort study included six departments of Obstetrics and Gynaecology in Sweden. The study included 1457 women who requested an induced abortion, among whom 742 women responded at the three-month follow-up and 641 women at the six-month follow-up. The Screen Questionnaire-Posttraumatic Stress Disorder (SQ-PTSD) was used for research diagnoses of PTSD and PTSS, and anxiety and depressive symptoms were evaluated by the Hospital Anxiety and Depression Scale (HADS). Measurements were made at the first visit and at three and six months after the abortion. The 95% confidence intervals for the prevalence of lifetime or ongoing PTSD and PTSS were calculated using the normal approximation. The chi-square test and the Student’s t-test were used to compare data between groups.

Results: The prevalence of ongoing PTSD and PTSS before the abortion was 4.3% and 23.5%, respectively, concomitant with high levels of anxiety and depression. At three months the corresponding rates were 2.0% and 4.6%, at six months 1.9% and 6.1%, respectively. Dropouts had higher rates of PTSD and PTSS. Fifty-one women developed PTSD or PTSS during the observation period. They were young, less well educated, needed counselling, and had high levels of anxiety and depressive symptoms. During the observation period 57 women had trauma experiences, among whom 11 developed PTSD or PTSS and reported a traumatic experience in relation to the abortion.

Conclusion: Few women developed PTSD or PTSS after the abortion. The majority did so because of trauma experiences unrelated to the induced abortion. Concomitant symptoms of depression and anxiety call for clinical alertness and support.