More women who gave birth after wanting an abortion but not having it reported fair or poor health 5 years later compared with women who did receive abortions, researchers found.
A higher portion of women who gave birth reported “fair or poor health” (27%, 95% CI 21%-34%) versus women who received either a first trimester (20%, 95% CI 16%-24%) or second trimester abortion (21%, 95% CI 18%-25%), reported Lauren J. Ralph, PhD, of the University of California San Francisco, and colleagues.
Moreover, the women who gave birth reported more chronic health problems, such as headaches, migraines, and joint pain, than those who had abortions, Ralph and colleagues wrote in the Annals of Internal Medicine.
The authors noted that while there is myriad research about the effects of birth on a woman’s physical health, few studies have addressed the health consequences versus giving birth from an unwanted pregnancy compared with having an abortion.
“Given that more than 1 in 20 women cite concerns about their own health as a reason for abortion, additional research comparing the maternal health consequences of abortion with birth is needed,” Ralph’s group wrote.
In an accompanying editorial, Lisa H. Harris, MD, and Vanessa Dalton, MD, both of the University of Michigan in Ann Arbor, said that this type of data matters to internal medicine physicians because it illustrates the connections between reproductive health and overall health.
“Reports like this suggest that addressing rising rates of maternal morbidity and mortality in the United States is a job for all physicians, not just those providing pregnancy care,” the editorialists wrote. “These are important findings given that some antiabortion activists and lawmakers justify abortion restrictions with claims that they protect women’s health and well-being.”
Ralph and colleagues examined data from the Turnaway Study, a 5-year prospective study of women who sought, but did not necessarily receive, abortions from January 2008 to December 2010. The authors said that this particular study expanded on their prior work, which found women who gave birth after being denied an abortion “reported several potential life-threatening pregnancy complications,” and one woman who was denied an abortion died.
In this study, women were asked about their current overall health using a 5-point Likert scale, which was compared with their self-reported baseline health “just before they became pregnant.”
Of the around 3,000 initial participants in the study, 558 women completed the 5-year interview. Participants were an average age of 25, about a third were white, a third were African American, and 22% were Hispanic. Most were unmarried, and over a third were below the federal poverty level, the authors said. In addition, a quarter reported a history of depression or anxiety, and around 20% described their pre-pregnancy health as fair or poor.
A higher portion of women who had given birth reported chronic headaches or migraines at 5 years versus those with a first or second trimester abortion, and more women reported chronic joint pain who had given birth than those who had abortions as well, the authors wrote.
Almost 10% of women who gave birth were diagnosed with gestational hypertension, versus 1.9% and 4.2% of women with first and second trimester abortions, respectively.
Notably, eight women of 1,132 died during follow-up — four deaths occurred among women who were denied an abortion, and four among those who had a second trimester abortion.
Harris and Dalton argued that this study finds that “reproductive life events and overall health are entwined long after delivery and may be worse for women who cannot access abortion when they wish to,” regardless of whether these adverse outcomes are attributable to “term pregnancy, the birthing process itself, or parenting.”
They also cast an eye towards recent abortion bans, except in the cases when a woman’s life or health is at risk.
“[These data] emphasize that birth always carries more risks for morbidity and mortality than abortion. Through the lens of this study, health exceptions to abortion bans would apply … well, always,” the editorialists wrote.
Study limitations included the fact that there was no way to determine whether worse health among women who gave birth was attributable to childbirth itself or “cumulative effects of parenting and raising a child.” They also noted the large loss to follow-up from the original study, as well as its self-reported nature.
The study was supported by the Wallace Alexander Gerbode Foundation, the David and Lucile Packard Foundation, the William and Flora Hewlett Foundation, and an anonymous foundation.
Ralph disclosed support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
Harris disclosed support from the Society of Family Planning, Fellowship in Family Planning, Planned Parenthood of Michigan, the Bissell Family Foundation, the Anonymous Foundation, the American Society for Bioethics and Humanities, the American Association for the History of Medicine, Physicians for Reproductive Health, the American College of Obstetricians and Gynecologists, the American Society for Reproductive Medicine, and the Greenwall Foundation.
Dalton disclosed support from AHRQ, Bayer, the National Institute for Reproductive Health, the Blue Cross Blue Shield Foundation, and the NCI.