Am Fam Physician. 2025;112(4):362
Author disclosure: No relevant financial relationships.
To the Editor:
I applaud the authors of the article “Options for Unintended Pregnancies” for including parenting and adoption as viable options, particularly the listed resources for adoption.1 I contend, however, that the authors inadequately answered the question of whether induced abortion is associated with poor long-term psychological outcomes. The authors referenced a single survey of 667 individuals, in which 99% of respondents indicated their abortions were the correct decision 5 years later, as proof of no poor long-term psychological outcomes. Not only does this study's outcome not actually address the psychological health of the survey respondents, the authors of the AFP article did not discuss the significant body of research that does answer this question.
The risk to psychological health following an abortion is well documented. A 2023 systematic review and meta-analysis of 15 studies with more than 18,000 participants found the pooled international prevalence of depression in women following abortions was 34.5%.2 The National Longitudinal Study of Adolescent to Adult Health found that, compared with those who gave birth, women who underwent abortions had increased odds ratios of anxiety (1.23 vs 0.86), depression (1.30 vs 0.72), suicidal ideation (1.69 vs 0.43), and cannabis abuse/dependence (2.51 vs 0.73).3 A 2025 cross-sectional survey of nearly 2,000 American women 40 to 45 years of age reported that those who underwent abortions were twice as likely to have attempted suicide than those who did not. Further, women who underwent abortions, particularly (but not exclusively) those whose abortions were coerced or unwanted, were significantly more likely to respond that pregnancy outcomes directly contributed to suicidal thoughts and behaviors.4
Feeling coerced or pressured to undergo abortion of an unintended pregnancy is not uncommon. According to a 2023 survey of 223 respondents, 61% reported “high levels of pressure” from sources such as male partners, family members, or financial considerations.5 Finally, the American Psychological Association's Task Force on Mental Health and Abortion concluded that emotional attachment to the pregnancy or perceived pressure to terminate the pregnancy increases the odds of adverse mental health effects.6
The medical literature clearly delineates the mental health risks associated with abortion. Our patients deserve full disclosure when being counseled about the options for unintended pregnancies.
In Reply:
Thank you for your thoughtful feedback on our article. We appreciate your engagement with this important topic and recognition of the inclusion of parenting and adoption resources.
Your concern regarding the adequacy of the article's discussion of the psychological outcomes following induced abortion is noted. We acknowledge that the body of literature on this topic is broader and includes studies suggesting associations between abortion and mental health challenges in some populations. As you point out, variables such as coercion, emotional attachment, and pressure to terminate can significantly influence postabortion experiences.
We recognize the relationship between abortion and mental health and emphasized in our article the importance of ongoing postabortion care and support through the resources provided in Table 2. We will consider your points carefully in future updates and welcome continued dialogue from clinicians who share our goal of patient-centered care.
