Mental and physical risks and effects of induced abortion on women Ward Biemans SJ. MSc. SThL. 1

Structure 1) Global and regional incidence of induced abortion 2) Existing research on the mental health risks and effects of induced abortion 3) A possible link between abortion and breast cancer? 4) The risk of preterm births in pregnancies following abortion 5) Conclusion & Significance

Figure 1 Global and regional abortion incidence rate estimates (per 1000 women aged 15–44 years), 1990–94 to 2010–14 Source: Sedgh G et al (2016) The Lancet, 388: 262.

Methodological difficulties: 2) Existing research on the mental health risks and effects of induced abortion Methodological difficulties: Controlling for confounding factors The use of different measuring instruments The use of different systems of classification The duration of the empirical research

Current research shows contradictory results Van Ditzhuijzen et al. (2016): risk on incidence of mental disorders not significantly higher for women who have had an abortion Sullins (2016) After extensive adjustment for confounding, other pregnancy outcomes, and sociodemographic differences, abortion was consistently associated with increased risk of mental health disorder. Daugirdaite et al. (2015): 12.6% of women who had a non- medical induced abortion met criteria for PTSD

More on the association between abortion and PTSD Biggs et al. (2016): shortly after seeking an abortion, about 39% of the participating women experienced one or more symptoms of PTSD, and 16% scored high enough to be considered at risk. Hamama et al. (2010): of the 405 women who were interviewed, 32.6% ranked the elective or spontaneous abortion as their worst or second worst trauma exposure.

Conclusion part 2 Although earlier reports concluded that the relative risk of mental health problems after abortion is no greater for women with an induced abortion than for women who gave birth, some recent studies point at the risk of PTSS and PTSD for a significant percentage of women after abortion.

3) Is induced abortion an independent risk factor for breast cancer? Joel Brind, Angela Lanfranchi and others: induced abortion can be a risk factor for the development of breast cancer, because of the interruption of the hormonal growth process of mammalian breast cells.

Known risk and preventative factors for breast cancer: Risk factors Preventative factors - age; - family history of breast cancer; - use of oral contraceptives; - Hormone Replacement Therapy (HRT); - overweight; - smoking; - alcohol consumption; - etc. - having given birth - breastfeeding

Results from studies on the association between abortion (IA) and breast cancer Author Odds Ratio (OR) Huang et al. (2014, China) OR = 1.44 for one or more IA; OR = 1.76 for two or more IA; OR = 1.89 for three or more IA Jabeen et al. (2013, Bangladesh) OR = 20.62 Bhadoria et al. (2013, India) OR = 6.26 DeLellis Henderson et al. (2008, U.S.) No association Michels et al. (2007, U.S.)

4) The relation between induced abortion and subsequent preterm birth Meta-analysis by Lemmers et al. (2016): risk of preterm birth increased in women with surgical abortion, as compared with women without a history of surgical abortion, with an adjusted odds ratio of 1.43 (95% CI 1.25; 1.64) The risk of very preterm birth showed an adjusted odds ratio of 1.49 (95% CI 1.26; 1.76)

Oliver-Williams et al. (2013) also showed a previous abortion to be a risk factor for spontaneous preterm birth in the 1980s and 1990s. However, that association progressively weakened and disappeared altogether by 2000.

Conclusions and relevance (1) 1) The global abortion rate almost remains on the same level for the last twenty years. 2) Women who have had trauma experiences in the past and/or have had symptoms of mental distress need special care and counseling 2A) Research on mental health effects after abortion requires both qualitative and quantitative research strategies

Conclusions and relevance (2) 3) Asian women who consider an abortion should be informed about the risk for women with a history of induced abortion to develop breast cancer. 3A) Future Western studies to the abortion and breast cancer link should have a sufficient time span (data of 40-50 years) and control for all possible confounding factors. 4) Given the risk of subsequent (very) preterm birth after surgical abortion, women who consider a surgical abortion should be informed about this risk.