The Royal College of Obstetricians & Gynaecologists (RCOG) states that a significant number of women (1 in 3) will have an abortion in their lifetime. With such a high number of women impacted, it’s important to take a deeper look at some of the lingering views that abortions lead to poor mental health – this is often the message pushed by anti-abortion campaigners. But there is no evidence to support this claim. In fact, international studies have shown quite the opposite – that getting an abortion does not increase the risk of anxiety, depression or suicidal thoughts.

The Turnaway study, conducted by the University of California San Francisco is the largest and most comprehensive study to examine women’s experience of abortion and the impact of unwanted pregnancy. The researchers of this longitudinal study followed almost 1,000 women across 21 states for 5 years.

It found that there were no long-term negative impacts to having an abortion. In fact, when the researchers followed up with women 5 years after their abortion, they found 97.9% felt it was the right decision. The study did, however, find that there were serious psychological consequences to being denied an abortion for unwanted pregnancy, with many experiencing anxiety and low self esteem. It also found:

• 2% of women reported suicidal ideation after being denied abortion
• Women reported increased stress levels after being denied an abortion
• Women denied an abortion experienced more anxiety than women who were not
• Women denied an abortion had worse economic outcomes that women who were not

It is important to note that carrying an unwanted pregnancy is also more likely to have life-long consequences. It is associated with poor maternal bonding, which can have implications on the mother and child throughout their life. (Foster et al. 2018, JAMA Pediatrics).

And it isn’t just the psychological impact to consider. Denial of abortion also resulted in women being more likely to have physiological complications including preeclampsia, gestational hypertension and chronic pain.

What are the laws on abortion in the UK?

Unfortunately around over 40% of women across the world live in countries where abortion is restricted according to the centre for reproductive rights. Even in places where it is legal there are still big barriers to abortion access and getting good care.

In England and Wales we are lucky enough to have reasonably good access to abortion care, but that does not mean it is without its issues. In England, Scotland, and Wales it is possible to have an abortion up to 23 weeks and six days of pregnancy. After this point, abortion is legal if there is a severe fatal anomaly detected or if there is risk to the mother's life.

According to the Department of Health and Social Care, the number of abortions in England and Wales have steadily grown since 2016, with the latest figures from 2022 seeing 251,377 terminations carried out. This is the highest number since the Abortion Act was introduced to protect women’s health. It is also a 17% increase on 2021 figures.The abortion rate has also increased for women aged over 35. In 2022 the majority of abortions (98%) were carried out due to the risk to the woman's mental health. 

And although the majority of abortions were carried out by the NHS, a small percentage were carried out independently by licensed private abortion clinics. Most abortions are carried out early on in pregnancy with the use of medical abortion pills either at a clinic or with pills by post. As medical abortion is non-invasive, and has relatively few complications, this is generally considered the safest way of ending an unwanted pregnancy.

Different types of abortion

When it comes to terminating an unwanted pregnancy, there are two routes, but both have the same goal.

Medical abortion is one of the most common methods of pregnancy termination, and is suitable for early pregnancy (up to 10 weeks). Women can choose to have a medical abortion with a pill in a clinic, or opt for abortion pill by post. 

Up until the pandemic in 2020, medical abortion in the clinic was the most common method, but changes to the law made it possible for healthcare professionals to prescribe abortion pills without seeing patients in person but via telephone or video call. Pills by post are now very common. After the initial appointment, if eligible, women will be sent abortion pills by post to be taken from the comfort of their own home.

This involves taking two forms of medication to induce a miscarriage: mifepristone to block the hormones that support a pregnancy in the uterus; misoprostol to encourage the uterus to contract to expel the tissue from the body. You can buy the abortion pill online but this should only be done through a registered clinic for obvious safety reasons. In some rare instances, the tissue does not all pass, and a surgical abortion will be required, so having the support of a licensed clinic is vital.

Pregnancies later than 10 weeks will require a surgical abortion. This is an outpatient procedure and involves light sedation. A local anaesthetic is injected into the cervix, and it is dilated so that a small cannula can be inserted into the uterus. The practitioner will use gentle manual vacuum aspiration (MVA) to remove the pregnancy tissue from inside the uterus. At this stage bad period pain will be felt. The consultant will carry out an ultrasound to ensure there is no remaining tissue as this can lead to infection and serious complications. The procedure usually lasts around 30 minutes at most. There is no need to stay overnight at the clinic or hospital after the procedure but patients do need to be accompanied home. 

Accessing safe abortion care in England

In 2022, according to the Department of Health and Social Care, the majority of abortions (98%) were shown to be carried out due to the risk to the woman's mental health. The good news is that evidence does not show that having an abortion has any long-term negative impact on mental health. 

Although there has been easier access to abortion care in recent years, thanks to changes in the law as a result of the COVID-19 pandemic, there are still many hurdles to overcome. Abortions still need to be approved by two different doctors – without this, it can be considered a criminal offence. The issue with criminalising abortion is that it leads to women resorting to unregulated abortion services, can delay safe access to abortion, and can discourage women from seeking help if it is needed. Much more work needs to be done to modernise abortion law and decriminalise it, to make it more accessible.