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Abortion and Mental Health: Studies based on the National Longitudinal Study of Youth (NLSY)

Editor's Note: The NLSY is one of the surveys of the National Longitudinal Surveys of Labor Market Experience (NLS) conducted by the Center for Human Resources Research (CHRR) at Ohio State University in collaboration with the U. S. Bureau of the Census. It conducts annual interviews with stratified, multi-stage random samples, including a national probability sample of noninstitutionalized civilian men and women age 14-21 years as of 1979, with oversampling of Blacks, Hispanics, and poor Whites. A more complete description of the method can be found in the NLS Handbook (CHRR, 1988). This section reports on three studies that have been based on NLSY data.


Citation: Russo, N. & Zierk, K. [Department of Psychology, Arizona State University, Box 871104, Tempe, AZ 87287-1104], (1992). Abortion, Childbearing, and Women's Well-Being. Professional Psychology, Research and Practice, 23, 269-280.

Introduction: These longitudinal analyses reflect a stress and coping perspective in which reproductive events such as unwanted pregnancy and abortion are considered to present both challenges and difficulties. Whether or not such stressful life events have negative psychological outcomes depends on a woman's resources - psychological, social, and economic - for coping with such events. The primary goal of the study was to determine the extent to which the relationship of abortion to well being can be explained by level of well being that existed before having an abortion or by childbearing and coping resources (i.e., education, income, employment, & marriage).

Method: This study is based on a secondary analysis of NLSY interview data from 5,295 women who were interviewed annually from 1979 to 1987. Among this group 773 women were identified in 1987 as having at least one abortion, with 233 of them reporting repeat abortions. Well-being was assessed in 1980 and 1987 by the Rosenberg Self-Esteem Scale. The researchers used analysis of variance (ANOVA) and multiple regression to examine the combined and separate contributions of preabortion self-esteem, contextual variables (education, employment, income, and marital status), childbearing (being a parent, numbers of wanted and unwanted children) and abortion (having one abortion, having repeat abortions, number of abortions, time since last abortion) to women's post abortion self-esteem.

Results: In 1987, women who had one abortion had higher self-esteem than women who reported no abortion or women who reported repeat abortions. Number of abortions was positively correlated with number of children and number of unwanted births. One out of three women having abortions had more than 2 children underscoring the importance of not assuming women who have abortions reject motherhood in general. Women who had unwanted births had the lowest levels of well-being, and were also more likely to have repeat abortions than other women. Multiple regression analyses revealed that when previous levels of self-esteem, contextual variables, childbearing, and abortion variables (one abortion, number of repeat abortions) were all included in the regression equation, the most important predictor of well-being in 1987 was well-being in 1980. In addition, employment, higher income, more years of education, and having fewer children all independently contributed to increased well being in 1987. Being married did not make a difference in women's well being, possibly because happy marriages could not be identified. Neither having one abortion nor having repeat abortions had an independent relationship to well being when the other variables were controlled, suggesting that the relationship of abortion to well-being reflects abortion's role in controlling fertility and its relationship to coping resources.

Evaluation: This study is an important contribution to the literature because it is longitudinal, based on a large national sample, and examines effects of having one abortion separately from having repeat abortions. It is of sufficient size and variability in the critical variables that if the claim that the experience of abortion has a widespread and substantial impact on women's well being were true, it should have been reflected in the findings. However the data collection occurred between 1979 and 1987 before the systematic attempt in the United States to stigmatize and shame women having abortions got underway. The negative mental health effects that would be expected from these efforts would not be reflected in these results.

The study would be stronger if there were multiple measures of mental health variables (e.g., depression, anxiety). However, the measure of well-being used, the Rosenberg Self-esteem Scale, has been shown to be a highly reliable and valid predictor of a variety of mood and anxiety disorders and is arguably one of the best all-around measures of global well-being. As the authors themselves point out (p. 278), in addition to the standard methodological limitations associated with any survey research and analyses of secondary data, there is the additional possibility that women who were most distressed would conceal having an abortion because they perceive it as having a stigma. Underreporting has been a problem with the NLSY (Jones & Forrest, 1992), and indeed, the staff at CHRR have later taken steps to overcome it. It is important to recognize that the study cannot be used to estimate numbers of women having abortions - in that case underreporting would be a concern and weighted data would have to be used to construct a profile of the population.

As the authors themselves note, however, underreporting problems do not pose major issues given the purpose of the study, particularly given that such problems cannot easily explain the pattern of results. The correlations among the abortion, demographic, and childbearing variables parallel the typical findings in the scientific literature, buttressing confidence in them. If it were true that the most distressed women in the sample did not report their abortions, a finding of no difference between women having an abortion and other women might indeed be explained by underreporting. Further, underreporting on the part of the most distressed women would blur the difference between women having one abortion and women having repeat abortions. But the expected difference between women having one abortion and repeat abortions was indeed found. Further, the main points of the study are based on regression analyses that examined the relative combined and independent contributions of abortion, contextual, and childbearing variables to subsequent well being.

Thus, the key findings are not challenged by the underreporting issue - indeed, the fact that they were obtained despite underreporting places more confidence in them. Consequently, in developing a list of significant and independent predictors of women's well being, well being before ever having an abortion is first on the list followed by contextual and childbearing variables. Whether or not a woman has had an abortion, as an independent predictor, does not make the list. As the authors point out, that is not to say that abortion is unimportant or has no effect. Repeated unwanted pregnancy, whether ending in unwanted birth or repeat abortion, was correlated with lower education, lower income, and greater likelihood of being in poverty. Insofar as having an abortion enables women to delay childbearing, obtain an education, get a job, and have a good income, even though it has no independent effect it is still contributing to positive mental health.

It has also been suggested that African-American and Catholic women would be both most distressed and more likely to underreport having an abortion, and these groups would be the primary source of underreporting bias in this study. Consequently, a second study based on NLSY data but focusing on race and religion was conducted.

Jones, E. F., & Forrest, J. (1992). Underreporting of abortion in surveys of U. S. women: 1976 to 1988. Demography, 29¸ 113-126.


Citation: Russo, N. [Department of Psychology, Arizona State University, Box 871104, Tempe, AZ 87287-1104], Dabul, A. (1997). The Relationship of Abortion to Well-being: Do Race and Religion Make a Difference? Professional Psychology, Research and Practice, 28, 23-31

Introduction: In response to criticisms of Russo & Zierk (1992, above), these analyses were based on data from 1,189 Black and 3,147 White women who participated in the National Longitudinal Study of Youth.

Method: Analyses of variance and regression analyses parallel to those conducted by Russo & Zierk (1992) were used to examine whether the relationship of abortion, contextual, and childbearing variables to well being separately by race (Black, White), religion's support for abortion rights (anti-, neutral- pro-) and whether or not the respondent was Catholic (Catholic, NonCatholic).

Results: The results were similar to the previous study in that education and income were positively and independently related to well being for all women, regardless of race or religion. Abortion was not independently related to well being when preexisting well being and the other variables were controlled, regardless of race or religion. This study used regression to examine the factors predicting well being among the women who had at least one abortion. Again, level of pre-existing well being was the most important predictor of postabortion well being.

Evaluation: This study is an effective response to the assertion that the findings of Russo & Zierk (1992) reflect underreporting on the part of Black women. It also provides evidence that underreporting due to having a religious background or being Catholic did not significantly influence the results. However, in addition to the cautions identified above, the authors point out that the Catholic Church's Operation Rescue had not begun to receive national attention at the time that religion and religious attendance was assessed. Thus, while the findings apply to women who identified and attended church when they were initially interviewed, 1987 church attendance was not measured. Further, insufficient sample size and the way that the NLSY asked about religion did not enable separation of conservative fundamentalist Christian groups from other Protestants. The lack of relationship of abortion to well being regardless of race, even when individual religions were examined, suggests that the result would remain unchanged even with a more precise classification, however.


Citation: Reardon, D. & Cougle, J. Depression and unintended pregnancy in the National Longitudinal Survey of Youth: a Cohort Study. British Medical Journal, 324, (12 Jan 2002), pp. 151-52.

Introduction: The authors seek to examine the question of whether "prior psychological state is equally predictive of subsequent depression among women with unintended pregnancies regardless of whether they abort or carry to term" (p. p. 151).

Method: The analyses are described as based on "Women scoring in 'high risk' range for clinical depression (CES-D score >15) who had their first abortion or first unintended childbirth between 1980 and 1992. Logistic regression stratified by marital status was used to compare the percentage with scores above the CES-D cut-off for the 128 women "with unintended births" and the 293 "aborting women." Because the findings are based on miscoded data they will not be repeated here.

Evaluation: Flawed conceptualization combined with miscoding of data make the findings of the study inaccurate and meaningless except as a source of prime examples of how research can go wrong. To enhance the usefulness of the article as a training exercise, the problems are listed in detail. Other comments can be found on the journal's website at http://bmj.com/cgi/eletters/324/7330/151#19026

First, a total of 795 women had at least one abortion by 1992. If the analyses are based on 293 "aborting women," what happened to rest of them? It appears that the researchers did not identify women who had an abortion on their first pregnancy - they identified women who had an abortion on their first pregnancy since their last NLSY interview, which was most likely in 1990, but could have been earlier depending on when the woman's last interview took place.

In addition, although the findings are generalized to "first pregnancies" in order to "control" for previous psychiatric state measured in 1979, 251 women who had their first pregnancies and abortions before 1979 are excluded from the analyses. These are the individuals who had first pregnancies at a younger age and who arguably are the most distressed.

But suppose that the data were not miscoded and the findings were not based on a selective sample of first pregnancies - the study still has several additional fatal methodological flaws:

  • It purports to control for previous psychiatric state by controlling for score on the Rotter Internal-External Locus of Control Scale. This is neither a measure of psychiatric state nor a measure of well being.
  • The authors suggest that marital status and first pregnancy outcome interact in their effects on depression, with differences found for married but not unmarried women. They argue that their results may be due to underreporting of abortions on the part of unmarried women, suggesting that their findings may reflect the stress of raising a child without support. However their data analyses are based on marital status in 1992, and not marital status at time of first pregnancy.

Further, as Russo & Zierk (1992) pointed out:

  • Women who "abort" and those who don't cannot be classified into two groups solely based on their first pregnancy outcome. Thus, many of the individuals classified in the 'not aborting" group based on first pregnancy (since last interview) have indeed had abortions, some multiple times.
  • Women who have one abortion differ from women who have repeat abortions. Grouping these women together on the one hand overestimates the relationship of abortion to mental health outcomes for women who have one abortion while on the other hand underestimates the relationship of abortion to mental health outcomes for women who have a pattern of repeated unwanted pregnancy.
  • A CES-D cutoff score is used to construct the depression variable. Although the scale is widely used as a screening tool, it was designed to determine the extent to which people differ along a continuum of psychological distress and not to detect depressive disorder (Radloff, 1977). As Santor and Coyne (1997) point out, a number of studies have documented overdiagnosis of depression resulting from the use of the CESD. They point out that in some cases, "as few as 11% of individuals classified as depressed using standard cutoff scores were actually diagnosed as depressed in a diagnostic interview (Roberts et al, 1991)" (p. 233). It would have been more appropriate also report the results of analyses that were based on a continuous CES-D score.
  • Claims for the implications of the findings made in the article as well as in the authors' press release are based on flawed logic and inappropriate generalization. Even were their findings not based on miscoded data, the results of this study could not be generalized to the mental health outcomes of unintended pregnancy in the context of illegal abortion. There is no random assignment to groups here. The fact that abortion is a legal alternative to unintended pregnancy means that women who are most severely distressed at the idea of having a child can choose to have an abortion. Taking them out of the childbearing population thus would lower the mean level of depression found among women bearing unplanned or unwanted children

Making abortion illegal, however, strengthens the link between unintended pregnancy and unwanted childbearing. Under illegal conditions the profile of women who give birth (and who place children for adoption) would be expected to perform more poorly on mental health indicators. For this reason, cross-national studies of pregnancy outcomes in contexts that vary in access to abortion are needed if the goal of a study is to generalize findings to those contexts.

Although not cited in the published article, the authors' press release, which can be found on the website of the Elliot Institute, suggests that the findings of this study contradict those of Russo & Zierk (1992). A comparison of the aims and methods of the two studies, however, reveals the fallaciousness of this claim. Russo & Zierk (1992) did not focus on first pregnancy - they examined whether having zero, one or more abortions made a difference in predicting a women's well being. The same measure was used to assess well being pre- and post- abortion. They compared their findings for women having abortions before and after 1980 to identify bias that might occur as a result of restricting the data to women having abortions after 1980.

In summary, the findings in this article are fatally flawed, and claims that it refutes the conclusions of Russo & Zierk (1992) are unfounded.

Radloff, L. (1977). The CES-D Scale: A self report depression scale for research in the general population. Applied Psychological Measurement, 1, 385-401.

Roberts, R. E., Lewinsohn, P. M. & Seeley, J. R. (1991). Screening for adolescent depression: A comparison of depression scales. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 58-66.

Santor, D. A. & Coyne, J. C. (1997). Shortening the CES-D to improve its ability to detect cases of depression. Psychological Assessment, 9, 233-243.

 
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