Physical Risks
About 10% of women who have a first-time abortion face immediate physical complications, according to a study reported in the American Journal of Pubic Health and the Journal of the Royal College of General Practitioners.1 Most physical complications develop as a result of an incomplete evacuation of the uterus, infection, or injury from instruments used during the procedure. The risk of complications rises significantly when abortions are performed in the second trimester over the first trimester.
Excessive bleeding
Some bleeding after an abortion is normal. But when excessive or uncontrolled bleeding occurs after an abortion (often from a torn cervix or punctured uterus) a transfusion may be required.2 RU486 increases risk of heavy bleeding, with 1% women users requiring surgery to stop bleeding.3
Infection
A pelvic infection can lead to high fever, hospitalization, and pelvic organ scarring. Moreover, Pelvic Inflammatory Disease (PID), caused by bacteria entering the body during or after an abortion, can spread from the cervix to uterus, fallopian tubes, and ovaries.4 Fetal or placenta parts left inside a woman’s body (known as an incomplete abortion) can breed infection and can necessitate repeating the abortion procedure. A number of RU486 users have died as a result of sepsis (total body infection).
Incompetent cervix
During a normal pregnancy, the cervix remains tightly closed until term. An incompetent cervix is one that undergoes premature opening during pregnancy. It is also referred to as cervical incompetency. Forcible opening of the cervix from repeated abortions can damage or weaken it, causing miscarriages or difficulties in sustaining the weight of the baby in subsequent pregnancies.
Perforated uterus, bowel, or bladder
Abortion instruments can puncture abdominal organs, requiring emergency surgery to repair the damage. Occasionally perforation requires removal of the uterus (hysterectomy).
Scarring
A fertilized embryo seeks to implant itself in the soft lining of the uterus. Suction tubing, curettes, and other abortion instruments may cause scarring of the uterine wall if an infection is present at the time of the abortion. Scar tissue may prevent the embryo from implanting, leading to miscarriage or other complications in subsequent pregnancies.
Sterility
The Journal of Epidemiology and Community Health reports that women who have abortions more than double their risk of future sterility.
Breast Cancer
The relationship between abortion and breast cancer has been the subject of substantial study. In 2003, the National Cancer Institute convened to evaluate the evidence. A world-wide meta-analysis of 83,000 women examined the relationship between abortion and breast cancer and found that induced abortion is not associated with an increase in breast cancer risk. Studies published since 2003 continue to support this conclusion.5
Ectopic pregnancy
Abortion increases the risk of subsequent ectopic pregnancies (pregnancy that develops outside the uterus, most often in the fallopian tubes).6 Ectopic pregnancies, in turn, are life-threatening and may reduce fertility.
Complications from anesthesia
Use of general anesthesia during an abortion can lead to loss of uterine muscle tone, which can cause excessive bleeding and hemorrhaging. Other potential complications include hypoxia (whole or part of the body is deprived of an adequate oxygen supply) and breathing difficulties. Local anesthesia complications include seizure, cardiopulmonary arrest, allergic reaction, or severe whole-body reaction.
Death
Recent statistics from the Centers for Disease Control (CDC) report fewer than one death per 100,000 legal abortions due to complications.7 Though rare, abortion can directly cause death as the result of bleeding, infection, organ damage, or other complications. Long term, women who have abortions are four times more likely to die within the year following their pregnancy than women who carry to term. Most causes (though not all) are associated with risk-related behavior including suicide, injury, accident, and homicide.8
Psychological and Emotional Risks
A significant number of women experience psychological and emotional difficulties after an abortion. A recent study found that more than 85 percent of women who aborted reported at least one negative reaction to abortion, such as such as sorrow, grief, regret or disappointment.9 About 35% reported five or more negative reactions. Up to 10% of surveyed women developed “serious psychiatric complications.”10
Depression and Anxiety
Women who have experienced abortion have a 65% higher risk for developing long-term clinical depression than non-abortive women.11 Women with no history of anxiety are 30% more likely to develop generalized anxiety symptoms after an abortion.12
Substance Abuse
Women with no prior history of substance abuse are 5 times more likely to abuse drugs and/or alcohol after an abortion than those who give birth.13 In one study, 60% women admitted increased alcohol use after an abortion.14
Sleep Disturbances
More than one third of aborting women experience sleep disturbances or nightmares.15
Eating Disorders
39% post-abortive women battle subsequent eating disorders including bulimia, binge eating, and anorexia nervosa.16
Relationship and Sexual Difficulties
At least seven documented studies report that women who have had one or more abortions are significantly more likely to have shorter relationships and more divorce. Moreover, 30-50% post-abortive women experience difficulties in subsequent relationships, including aversion to men, aversion to sex, painful intercourse, and promiscuity.17
Repeat Abortions
Among women having abortions in the United States, about one-half have already had a prior abortion.18 Abortion places a woman at higher risk for another abortion.
Smoking
Women who abort are twice as likely to become heavy smokers.19
Suicide
A study reported port-abortive women were six to seven times more likely to commit suicide in the following year than were women who gave birth.20
Post-Abortion Stress Syndrome (PASS)
Women who have experienced abortion and who present a specific set of symptoms are diagnosed with Post-Abortion Stress Syndrome (PASS), now widely accepted as a subset of Post-Traumatic Stress Disorder (a condition triggered by a traumatic experience that renders the victim unable to cope). PASS symptoms include depression, inability to function normally, inability to manage personal responsibilities, self-harm, self-destructive behavior, suicidal thoughts or activity, and the desire to get pregnant.
Additional psychological and emotional risks associated with abortion include difficulties with normal functioning, (maintaining school, job, or family responsibilities), child abuse, avoidance behavior, irritability, outbursts of anger, and violent behavior.
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Notes
1Frank, et.al., “Induced Abortion Operations and Their Early Sequelae,” Journal of the Royal College of General Practitioners (April 1985) ,35(73):175-180; Grimes and Cates, “Abortion: Methods and Complications,” Human Reproduction, 2nd ed., 796-813; M.A. Freedman, “Comparison of complication rates in first trimester abortions performed by physician assistants and physicians,” American Journal of Public Health, 76(5):550- 554 (1986).
2J.A. Stalworthy, et al, “Legal Abortion: A Critical Assessment of its Risks;” The Lancet, (1971).
3Interview with Dr. Joel Brind, endocrinologist, “RU486 Mifepristone: Are Women At Risk?” Heritage House, 2007.
4M. Spence, “PID: Detection and Treatment,” Sexually Transmitted Disease Bulletin, Johns Hopkins University, 3:1 (1983).
5American College of OB/GYN Committee Opinion, 434 (2009).
6J.R. Daling et al, “Ectopic Pregnancy in Relation to Previous Induced Abortion,” Journal of the American Medical Association. 1985; 253 (7).
7L.T. Strauss et al, “Abortion Surveillance – United States, 2003,” MMWR Surveillance Summaries. Centers for Disease Control: 2006; 55(SS11); 1-32, Table 19.
8Gissler, M., et. al., “Pregnancy-associated deaths in Finland 1987-1994 — definition problems and benefits of record linkage,” Acta Obsetricia et Gynecolgica Scandinavica 76:651-657 (1997).
9David M. Ferugsson, L. John Horwood and Joseph M. Boden, “Reactions to abortion and subsequent mental health,” The British Journal of Psychiatry 195: 420-426 (2009).
10Friedman,et.al.,”The Decision-Making Process and the Outcome of Therapeutic Abortion,” American Journal of Psychiatry 131: 1332-1337 (1974).
11J.R. Cougle, D.C. Reardon, P.K. Coleman, “Depression Associated With Abortion and Childbirth: A Long-Term Analysis of the NLSY Cohort,” Medical Science Monitor 9(4):
CR105-112, 2003.
12J.R. Cougle, D.C. Reardon, P.K. Coleman, “Generalized Anxiety Following Unintended Pregnancies Resolved Through Childbirth and Abortion: A Cohort Study of the 1995 National Survey of Family Growth,” Journal of Anxiety Disorders 19:137-142 (2005).
13 D.C. Reardon, P.G. Ney, “Abortion and Subsequent Substance Abuse,” American Journal of Drug and Alcohol Abuse 26(1):61-75, 2000.
14A. Speckhard, Psycho-Social Stress Following Abortion, Ph.D. Thesis, University of Minnesota, 1985.
15 Ashton,”The Psychosocial Outcome of Induced Abortion,” British Journal of Obstetrics & Gynecology 87: 1115-1122, 1980.
16Burke, Teresa K. with David C. Reardon. Forbidden Grief. Springfield, IL: Acorn Books, 2007, p. 187.
17Speckhard, “Psycho-social Stress Following Abortion,” Sheed & Ward, Kansas City: MO, 1987; and Belsey, et al., “Predictive Factors in Emotional Response to Abortion: King’s Termination Study – IV,” Social Science and Medicine 11:71-82 (1977).
18R.K. Jones et al, “Repeat Abortion in the United States,” The Guttmacher Institute Occasional Report No. 29 (2006).
19Harlap, “Characteristics of Pregnant Women Reporting Previous Induced Abortions,” Bulletin World Health Organization, 52:149 (1975); N. Meirik, “Outcome of First Delivery After 2nd Trimester Two Stage Induced Abortion: A Controlled Cohort Study,” Acta Obsetricia et Gynecologica Scandinavia 63(1):45-50(1984); Levin, et al., “Association of Induced Abortion with Subsequent Pregnancy Loss,” Journal of the American Medical Association, 243:2495-2499, June 27, 1980.
20 M. Gissler et. al., “Injury deaths, suicides and homicides associated with pregnancy, Finland 1987-2000,” European Journal of Public Health 15(5):459-63 (2005).