In nine states, women who seek abortions must first sit through a counseling session on the procedure’s supposed negative psychological effects.

Women who have abortions might experience “depression or thoughts of suicide,” reads one example, the Texas “Woman’s Right to Know” booklet.

“Some women,” it continues, “after their abortion, have also reported feelings of grief, anxiety, lowered self-esteem, regret, sexual dysfunction, avoidance of emotional attachment, flashbacks, and substance abuse.”

Women’s-rights advocates have long questioned the evidence behind these mini-interventions, and a new study published Wednesday in the journal JAMA Psychiatry suggests they’re onto something: Women who had abortions aren’t any worse off, psychologically, than those who initially sought abortions but gave birth instead.

“We found no evidence that women who have abortions risk developing depression, anxiety or low self-esteem as a result of the abortion, either immediately following, or for up to five years after the abortion,” said M. Antonia Biggs, a social psychologist at the University of California, San Francisco and lead author on the study, in a statement.


Psychological Outcomes of Abortion-Seeking Women

“Near-limit” means the woman was close to the facility’s gestational limit, but still received an abortion. “First-trimester” women received an abortion early in their pregnancies. “Turnaway-birth” and “turnaway-no-birth” women were denied abortions. For self-esteem and life-satisfaction, “5” indicates “extremely high.” (JAMA Psychiatry.)

The study authors followed 956 women, who were recruited from 30 abortion clinics in 21 states. They interviewed the women a week after they sought an abortion, then twice a year for five years. Of the women who sought an abortion, 231 were turned away from the clinic because they were too far along in their pregnancies, and of those, 161 ended up giving birth.

If anything, being denied abortion caused worse mental-health outcomes, at least initially. A week after they visited the clinic, the women who were turned away had more anxiety, lower self-esteem, and lower life-satisfaction than those who were able to get abortions. But six months to a year later, their symptoms improved and were similar to those of the other groups.

“These initial elevated levels of distress experienced by both turnaway groups may be a response to being denied an abortion,” the authors write, “as well as other social and emotional challenges faced on discovery of unwanted pregnancy and abortion seeking.”

Over the years, it was among the women who were turned away from the abortion clinic, but gave birth anyway, that cases of depression and anxiety remained flat, as opposed to declining.


Depression Among Abortion-Seeking Women

Depressive symptoms in the previous seven days (JAMA Psychiatry)

Past studies have also supported the idea that abortion does not cause depression or anxiety, but this study is unique because it followed the women for years. By doing so, the study authors show that mental-health issues don’t simply creep up in abortion patients later on.

The authors recommend that rather than telling women an abortion will harm their mental health, states should arm them with “the most accurate, scientific information available to help them make their pregnancy decisions.”

“The effects of being denied an abortion may be more detrimental to women’s psychological well-being,” they write, “than allowing women to obtain their wanted procedures.”