Royal College of Psychiatrists changes view on abortion and mental health

Are there are psychiatric grounds for abortion? Does abortion lead to mental health problems?

The Royal College of Psychiatrists' new position statement on abortion and mental health significantly changes the College's view on these two key questions.

This is hugely important as the Human Fertilisation and Embryology Bill presently in the House of Commons opens up the Abortion Act for amendment.

In 1994 the RCPscyh found that 'the risks to psychological health from the termination of pregnancy in the first trimester are much less than the risks associated .with proceeding with a pregnancy which is clearly harming the mother's mental health'. It now says that 'the systematic reviews should consider whether there is evidence for psychiatric indications for abortion.'

In 1994 the College said that there was 'no evidence… of an increased risk of major psychiatric disorder or of long-lasting psychological distress' following abortion. It has now moved to a neutral position on the matter. The new statement concludes that 'the issue of whether or not induced abortion has harmful effects on women's mental health remains to be fully resolved' but concedes that 'some studies identify a range of mental disorders following abortion'.

The statement goes on to call for 'additional systematic reviews led by the Royal College of Psychiatrists into the relationship between abortion and mental health'. The shift has been brought about by the recent publication of a number of robust studies providing more evidence for a link, in particular the 2006 Fergusson study which showed for the first time that even women with no past history of mental illness were at increased risk of depression after abortion.

The College further recommends that 'healthcare professionals who assess or refer women who are requesting an abortion should assess for mental disorder and for risk factors that may be associated with its subsequent development' and that 'consent cannot be informed without the provision of adequate and appropriate information regarding the possible risks and benefits to physical and mental health.'

First, if psychiatrists are no longer confident that there are psychiatric indications for abortion then how can a registered medical practitioner in good faith justify an abortion under the mental health aspect of ground C of the Abortion Act? (under which over 90% of all abortions are authorised)

It will now be perfectly acceptable for a doctor to refuse to sign an abortion authorisation form on the basis that there no clear evidence that continuing with a pregnancy puts a mother's mental health at risk. Doctors who do authorise abortions on mental health grounds could similarly be challenged.

Second, if some studies identify a range of mental disorders following abortion then women contemplating abortion should be entitled to have this information in order to be able to make a fully informed decision. Furthermore the 2004 RCOG guidance on abortion, which denies such a link, should be amended.

The HFE Bill, currently awaiting its second reading in the House of Commons opens up the Abortion Act 1967 for amendment, and pro-life MPs are intending to put down amendments requiring doctors 'to provide women seeking abortion with comprehensive, evidence-based information about the psychological and physical health risks associated with the procedure and information on alternatives to abortion'.

There are interesting times ahead!

Royal College warns abortion can lead to mental illness (Sunday Times, 16 March 2008)

Abortion could you're your mental health (Mercator Net, 19 March 2008)

New RCPsych Statement

How they reached it

Previous 1994 RCPsych Statement