Discussions about abortion's mental health effects often overlook the emotional complexity of the abortion experience, from the decision making to the aftermath of the procedure. Data from the Turnaway Study, a project that examines the consequences of both having an abortion and being denied one, permit a broad view, as Corinne H. Rocca and colleagues report in this issue of Perspectives on Sexual and Reproductive Health (see article). One week after having an abortion, the investigators found, women had a mix of emotions about it—sadness and regret, but also relief and happiness. What is more, women expressed more negative feelings about the pregnancy itself than about the abortion, and more positive feelings about the abortion than about the pregnancy. Most women—even most of those who expressed regret—said one week later that having the abortion was the right decision. Meanwhile, women who sought an abortion but were turned away because they were beyond a facility's gestational limit felt more anger and regret, and less happiness and relief, one week later than did those who had the procedure. Of all characteristics studied, the extent to which women had grappled with the abortion decision had one of the strongest associations with reports of negative emotions one week later.
The researchers conclude that it is important to “[disentangle] emotions regarding an unwanted pregnancy from those regarding an abortion” and that “mechanisms targeting all women, such as regulations or information requirements,” are not the way to avert postabortion mental health problems. Rather, they write, “efforts may be better directed toward identifying women having difficulty with the abortion decision and guiding them to individualized counseling.”
Also in This Issue
Does having sexual health resources on campus help students engage in safer sex? Findings from a study of Minnesota colleges suggest that the notion is worth exploring, according to Marla E. Eisenberg and her team (see article). Although not all results were in expected directions, levels of various types of sexual health resources at a college were inversely associated with the likelihood that students had had unprotected intercourse or been involved in an unplanned pregnancy. If further research can identify causal mechanisms underlying these associations, the authors note, it could help in the development of effective risk reduction interventions for students.
In analyses of data from the 1995 and 2006–2010 cycles of the National Survey of Family Growth (see article), Josephine Jacobs and Maria Stanfors find that a gap has opened between black and white women in the use of effective reversible contraceptives. By contrast, white and Hispanic women's use of these methods has remained similar over time. Although the analyses rule out socioeconomic characteristics as the reason for the black-white disparity, the researchers acknowledge that they lacked measures of many other potentially important variables. They urge future investigations to explore “supply-side and policy factors, in addition to demand-driven ones,” as possible factors in racial differences in contraceptive choice.
Marion Carter and coauthors help extend the examination of correlates of unintended pregnancy by showing how a wide range of relationship characteristics related to feelings about pregnancy for both women and men in a sample of black and Puerto Rican young adults (see article). They found, for instance, that in this high-risk sample, feelings toward one's partner, as well as perceptions of the partner's feelings about a possible pregnancy, were positively associated with one's own feelings about a possible pregnancy with that partner. The findings lead the authors to call for research on pregnancy intentions and feelings to use “a comprehensive framework for conceptualizing relationships,” rather than “distant proxies.”
Julia A. Rivera Drew explores the association between women's disability status and their risk of having a hysterectomy—which has been suggested by small-scale studies—using pooled data from three rounds of the National Health Interview Survey (see article). While the results of her multivariate analysis confirm that women with disabilities are at increased risk of undergoing this major and usually elective surgery, they also show that the increase is concentrated among women with multiple disabilities and at relatively young ages. More research is necessary to explore possible reasons for the differentials revealed in this study, including women's individual circumstances and local policy contexts.
Theoretically, making progestin-only oral contraceptives available over the counter should expand access to them and thereby reduce the risk of unintended pregnancy. However, Jennifer McIntosh and coauthors argue in a viewpoint article (see article) that such a switch may not benefit all women equally, because of a number barriers—prescription requirements, formulary restrictions and exemptions for coverage under the health care reform act. The authors recommend several “policy-focused and insurer-targeted strategies to get public and private insurance coverage of over-the-counter contraceptives, ideally without a prescription.”