The Washington PostDemocracy Dies in Darkness

Why we’re still arguing about abortion and regret

Years of research have shown that having a wanted abortion does not increase the risk of mental health problems but that restricting access to safe, legal abortions can cause harm, according to the American Psychological Association. (Chelsea Conrad/Washington Post Illustration)

Katie Watson spotted the words on the billboard while driving along a stretch of Interstate 65 in her home state of Indiana: “Many women regret their abortion.”

Watson, a medical ethicist, reproductive health expert and author of a book about abortion, was stunned. “My first reaction was: That’s not true. Research tells us it’s just factually false.”

“Do you mean ‘many’ like over 50 years nationally?” she said, recalling her thoughts as she drove past the sign in 2013. “Maybe they could all fit in a ballroom, and that would be many people. But the implication is the majority of women, and so it felt abusive, because it was a false statement intended to make women feel insecure about their own decision-making capacity.”

But for Kristan Hawkins, president of Students for Life of America, one of the country’s largest antiabortion groups, the billboard’s sentiment reflects her experiences. “I meet people all the time who come up to me, unprompted, and express their abortion regret and tell me their abortion story.”

The five words on that billboard get at the heart of a question that has been long debated and researched: Do women and other abortion patients commonly regret their abortions?

Experts say the idea that people regularly experience regret, negative emotions or mental health effects post-abortion can largely be traced back decades to crisis pregnancy centers. This belief has persisted and continued to wield influence in Congress and even among Supreme Court justicesdespite years of research showing that having a wanted abortion does not increase the risk of mental health problems but that restricting access to safe, legal abortions can cause harm, according to the American Psychological Association. In fact, analysis of data from the Turnaway Study — a landmark body of research studying the mental health, physical health and socioeconomic consequences of having an abortion compared with carrying an unwanted pregnancy to term — found that even though many women reported initially having difficulty with their decision, most continued to believe they made the right decision years later, and that feelings about their abortions, positive or negative, faded over time.

But, experts say, much of the public discourse about post-abortion feelings tends to overlook a key point: “The reactions to abortion are as complex and as varied as women are,” said Kimberly Kelly, an associate professor of sociology at Mississippi State University who researches abortion activism in the United States.

With hundreds of thousands of abortions reported yearly in the United States, “it would be very weird if everybody had the same emotional experience,” said Katrina Kimport, a professor in the Advancing New Standards in Reproductive Health program at the University of California at San Francisco. “We certainly don’t expect that for really anything else. If we think about a live birth, people have a whole range of emotional responses to it.”

Origins of ‘abortion regret’

In the early 1970s, crisis pregnancy centers began developing and promoting “biblically based counseling programs” for women who have had abortions, according to a peer-reviewed paper titled “The spread of ‘Post Abortion Syndrome’ as social diagnosis.” The idea that people needed help coping with the purported psychological effects of abortions came to be known among antiabortion activists as “post-abortion syndrome,” or PAS. These centers have become the “dominant force in spreading PAS claims at the grassroots level and have increasing success translating these claims into federal and state policy despite staunch resistance from pro-choice advocates,” the article noted. (There are now about 2,500 centers nationwide, according to a map created by researchers at the University of Georgia.)

According to activists, the symptoms of PAS, also known as “post-abortion stress,” “post-abortion grief” and “post-abortion trauma,” include “depression; an inability to connect with one’s emotions; excessive use of drugs or alcohol; low self-esteem; isolation; nightmares; regret, grief; anxiety; flashbacks; denial that any negative event occurred; repression of one’s true feelings; and/or suicidal thoughts,” the paper said.

“Post-abortion syndrome is not real,” said Kelly, the paper’s author. “These advocates are arguing that PAS is a universal reaction to abortion and that justifies restricting it to prevent women from harming themselves and others.”

Although it is possible to feel regret after an abortion, it is “not common, and even when women do experience regret, that’s not a sign of mental illness,” she said. “You can have decision regret about abortion, about pregnancy, about motherhood, about many things without it actually triggering a serious mental health condition.”

Normalizing claims about “abortion regret” can serve additional purposes for the antiabortion movement, Kimport said. For one, she said, it was a way to address the movement’s challenge to present themselves as not only caring about the fetus, but also caring about the pregnant person.

And, Kelly said, telling women and others seeking abortions that “they would suffer terribly” after having one could be an effective strategy for dissuading people.

“The regret narrative is a weapon, not a reality,” said Krystale Littlejohn, a sociologist and assistant professor at the University of Oregon who studies race, gender and reproduction. “It’s used to communicate the false idea that people should feel ashamed for getting an abortion and that regret is a necessary part of that experience.”

This Texas teen wanted an abortion. She now has twins.

Understanding regret

There is a difference, experts say, between feeling the emotion of regret — for instance, regretting the circumstances around an unwanted pregnancy — and actually feeling that abortion was not the right decision. “When people express sad or complicated or negative emotions, we’re quick to call that regret, but that usually isn’t accurate,” said Watson, the author of “Scarlet A: The Ethics, Law, and Politics of Ordinary Abortion” and an associate professor at Northwestern University’s Feinberg School of Medicine.

“This is the key question: If you had a time machine and you could go back to that moment of unwanted pregnancy, but you can’t change anything else, … knowing what you know now, would you make a different decision?” she said. “That’s actually true decisional regret.”

Research efforts have been made to more closely examine regret and claims about the emotional harm of abortion. A paper published in 2020 that used data from the oft-cited Turnaway Study examined “decision rightness,” said Corinne Rocca, an epidemiologist at the University of California at San Francisco and the paper’s lead author. Researchers found that about 95 percent of the 667 women studied said that having an abortion was the right decision for them, even five years after. Over those five years, relief was the most commonly felt emotion at all times, according to the paper.

“We found no evidence of emerging negative emotions or abortion decision regret,” the study’s authors wrote.

Five years after an abortion, most women say they made the right decision

But those findings and other conclusions drawn from previous research on beliefs about the emotional and psychological effects of abortion appear to have had little effect on many people who oppose abortion.

In a 2018 paper in Linacre Quarterly, the ethics journal of the Catholic Medical Association, antiabortion activist David C. Reardon criticized the Turnaway Study, which has produced dozens of peer-reviewed research papers. The study sample, Reardon wrote, “is clearly biased toward a subset of women who expected the least negative reactions to their abortion, experienced the least stress relative to discussing their abortions, and perhaps may even have experienced therapeutic benefits from talking about their abortions with researchers who affirmed the ‘rightness’ of their abortion decisions.”

Hawkins, the president of Students for Life of America, is also critical of the Turnaway Study and highlighted the existence of published studies suggesting that abortion does have negative mental health effects. (The findings of many of these studies also have been called into question by outside researchers who expressed concerns that the work was “methodologically unsound” or failed to account for potential confounding factors.)

She added that her views on abortion and regret are also informed by her interactions with people who have gotten abortions, including those she encountered while volunteering at a center that offered post-abortion counseling.

“These women could speak very openly about their past abortions, the relief that they might have felt,” Hawkins said. But then they would talk about “that long-term regret, that sadness, knowing or remembering the birthday of the child that they would have had, the recurrent thoughts that they had about their child.”

Rocca, one of the members of the Turnaway Study team, said researchers “were really open to all possibilities in these data.” She remembered Diana Greene Foster, the study’s principal investigator, “saying early on: ‘If abortion harms women, we really need to know that. That’s an important piece of information, and we need to figure out who it’s harming and why it’s harming them.’ ”

“But we didn’t find any evidence whatsoever that having an abortion causes any mental health harms,” Rocca said.

Different analyses of the data found that people who had abortions weren’t at greater risk of experiencing mental health problems, such as depression, anxiety and suicidal ideation, than those who carried unwanted pregnancies to term. Leading medical and health organizations such as the American Psychological Association, American Psychiatric Association, American Medical Association, American College of Obstetricians and Gynecologists, and the American Public Health Association have also rebutted claims that it is common to experience long-lasting detrimental emotional and psychological effects after having an abortion.

But the complex emotions that often surround having an abortion can contribute to the spread of beliefs that aren’t supported by the bulk of scientific evidence, Rocca said. “It’s easier to perpetuate a false claim when the truth can be complicated.”

“For many people, having an abortion is very straightforward and clear, and people experience primarily positive or no strong emotions,” she continued. For others, “they can experience complex and mixes of negative and positive emotions. But experiencing negative emotions after an abortion is not the same thing as believing it was the wrong decision.”

When Elaine Sung found out she was pregnant during her first year of college, she made up her mind instantly.I knew right away I was going to have an abortion.”

“It’s one of those things you remember for the rest of your life,” said Sung, now 54, who was 21 weeks along at the time of her abortion. Still, even decades later, she doesn’t see her decision as a mistake. “I’m sad that it came to that point, but I do not regret it at all.”

But being certain that the right decision was made doesn’t always prevent grief.

“I spent a lot of time grieving my child and the future we thought we had,” said Megan Gaffey, 44, who, along with her husband, decided to terminate a pregnancy in 2011. Gaffey was pregnant with the couple’s third child when she learned at around 20 weeks that her “very wanted baby had spina bifida and clubbed feet,” serious birth defects that she knew could significantly affect quality of life. This was a situation, doctors told her, in which most people choose to terminate.

I spent probably two or three years feeling really sad,” she said. On top of terminating a wanted pregnancy, Gaffey also felt “shamed” by people in her life who couldn’t accept her decision. “But the sadness was the grief. It was never regret, never. The only regret was that I had that choice in the first place to make. It wasn’t that I made the choice.”

In Gaffey’s mind, her reaction was to be expected. “When you want a child, if you don’t end up with a child, that is inevitably a formula for grief,” she said. “That said, I think as a mother, it is my duty to make the best choices for my kids when they are unable to do it themselves.”

Ingrained beliefs

To Hawkins, regretting an abortion is “instinctual.”

“We as women understand that there’s something happening when we are pregnant, that we have this deep honor to grow and gestate another human being within us and it’s this awe-inspiring power that we have,” she said. “Naturally, as mothers, as women, we know that there is something wholly unique and special about this ability we have.”

That viewpoint, experts said, plays a major role in why ideas about abortion and regret persist.

Not only has Congress held hearings on “post-abortion syndrome” and debated related legislation, but the claims appeared in the Supreme Court’s 2007 decision in Gonzales v. Carhart, which approved the prohibition of a specific abortion procedure. In the majority opinion, Justice Anthony M. Kennedy wrote: “Whether to have an abortion requires a difficult and painful moral decision. … While we find no reliable data to measure the phenomenon, it seems unexceptionable to conclude some women come to regret their choice to abort the infant life they once created and sustained. … Severe depression and loss of esteem can follow.”

“It just shows how committed we are to this particular vision of what it means to be a woman,” Kelly said. “Apparently, we think what it means to be a woman is to be a mother or to want to be a mother, and suffer if one cannot or will not be a mother.”

Gender norms suggest that “motherhood is the epitome of what it means to live a fulfilling life,” and consequently, abortion is always a difficult decision, Littlejohn said. When the message to women is that wanting children should be a central goal, abortion can be framed as “forgoing that opportunity to experience this ultimately life-changing event, and I think people then assume it has to be accompanied by regret.”

The notion that difficult decisions about abortion are “somehow just so different than the other kinds of decisions that people have to make and that they have a hard time with,” is an example of “abortion exceptionalism,” Littlejohn added. “There is this belief that abortion must be this different kind of experience versus abortion is medical care.”

Additionally, claiming that regret is a common experience feeds into stereotypical perceptions that women can’t be trusted to make decisions, Kimport said. “It’s consistent with an overarching story we tell as a society about women as vulnerable, as not reliable decision-makers, and this idea that women need to be protected from, in some cases, their own bad decisions.”

A need for transparency and nuance

Myths and stereotypes about abortion can take hold, in part, “because people don’t talk about the real feelings,” said Parker Dockray, executive director of All-Options, a national organization that provides services and support around pregnancy, parenting, abortion and adoption.

“People feel nervous about talking about the hard feelings they’re having about an abortion,” she said. “But certainly people also feel very stigmatized about being like, ‘I had an abortion and I didn’t feel bad about it.’ That’s not an easy thing to say.

“There’s just not a lot of space for stories.”

Instead, it can seem as though “there’s these two polar competing narratives” that leave little room for complicated feelings, Dockray said. People, she noted, generally “like binaries.”

“We’re not good at the nuance of the mushy middle,” she said. “We’re not good holding that space or knowing what to do with it. We like things that are either-or in this country.”