Women denied an abortion appear to experience more psychological problems in the short term, compared with women who are able to access the procedure, according to findings published in JAMA Psychiatry.

The prospective, longitudinal Turnaway Study involved regular follow-up telephone interviews of 956 women recruited from 30 abortion facilities in 21 states. Of these women, 273 received abortions in the first trimester, 452 received abortions just under the facility’s gestational limit, 161 sought an abortion but were turned away because they were just past the limit and later gave birth (turnaway-births), and 70 were turned away but either miscarried or obtained an abortion elsewhere (turnaway-no-births).

At 1 week after seeking an abortion, women denied an abortion reported significantly more anxiety symptoms (turnaway-births, coefficient 0.57; 95% CI, 0.01 to 1.13; turnaway-no-births, 2.29; 95% CI, 1.39 to 3.18) and lower self-esteem (turnaway-births, –0.33; 95% CI, –0.56 to –0.09; turnaway-no-births, –0.40; 95% CI, –0.78 to –0.02), compared with women who received abortions near the gestational limit.

Similarly, women denied abortions experienced lower life satisfaction at 1 week (turnaway-births, –0.16; 95% CI, –0.38 to 0.06; turnaway-no-births, –0.41; 95% CI, –0.77 to –0.06).

The study found that levels of depression were similar between the abortion and no-abortion groups in the first week, and depression levels also declined significantly over time in all groups except among women who were turned away for an abortion and later gave birth (JAMA Psychiatry. 2016 Dec 14. doi: 10.1001/jamapsychiatry.2016.3478 ).

“Our findings add to the body of evidence rejecting the notion that abortion increases women’s risk of experiencing adverse psychological outcomes,” wrote M. Antonia Biggs, PhD, of the Bixby Center for Global Reproductive Health at the University of California, San Francisco, and her coauthors. “Women who had an abortion demonstrated more positive outcomes initially compared with women who were denied an abortion.”

At the last follow-up, 5-6 years after the seeking of an abortion, the differences in mental well-being between women who had received an abortion and those who had not had all but disappeared.

“These initial elevated levels of distress experienced by both turnaway groups may be a response to being denied an abortion, as well as other social and emotional challenges faced on discovery of unwanted pregnancy and abortion seeking,” the researchers wrote.

Of all the groups, women who were initially denied an abortion but later miscarried or received an abortion elsewhere showed the most elevated levels of anxiety and lowest self-esteem and life satisfaction 1 week after being denied an abortion. Women in the turnaway-no-birth group may have had higher levels of stress because they were trying to find and travel to another abortion facility, or to raise extra money to pay for the procedure, the researchers noted.

Given these study findings, there is no evidence to justify laws requiring women seeking abortion to be warned about negative psychological responses, according to the researchers. “Women considering abortion are best served by being provided with the most accurate, scientific information available to help them make their pregnancy decisions,” they wrote.

The study was supported by grants from the Wallace Alexander Gerbode Foundation, the David and Lucile Packard Foundation, the William and Flora Hewlett Foundation, and an anonymous foundation. The researchers reported having no relevant financial disclosures.