Induced abortion has mostly been studied from one particular point of view. Hence, sociologists, political scientists and anthropologists often focus on the analysis of prevailing norms, values and laws regarding induced abortion; psychologists like to study women’s individual emotional wellbeing pre- and post-abortion; and medical doctors mostly pay attention to the study of the best abortion techniques. The starting point of the current analysis of the decision to have an abortion is a systemic-contextual perspective on the issue. From that point of view, attention is being paid to the different levels at which a decision for abortion occurs: the societal and group level (who is being confronted with an unintended pregnancy; who decides to have an abortion and why?), the very often neglected relational and interpersonal level (who else is involved in this decision and how do these people play a role?) and finally the individual and intrapersonal level (how does the woman experience the decisional process herself?). By making use of five empirical studies, described in the doctoral thesis of the main author, an answer is given to remaining research questions at each of these three levels. For the purpose of the doctoral thesis, a population based survey on sexual and reproductive health, administrated to men and women living in Flanders (Sexpert, 2013), was combined with specific survey studies in women opting for induced abortion and male partners involved in the abortion process. The results provide an insight into the complexity of this issue and inform the reader about three different stories.
Research in the field of potential mental health consequences of abortion is characterized by methodological limitations. To offer insight in the mental health of women who have abortions, both before and after the pregnancy termination, a prospective longitudinal cohort study has been conducted, the “Dutch Abortion and Mental Health Study” (DAMHS). This study was designed in a similar way as the large scale Dutch population study into mental health, the “Netherlands Mental Health Survey and Incidence Study-2” (NEMESIS-2). Compared to the NEMESIS-2 reference cohort, DAMHS women more often had experienced mental disorders in the past. The risk of incident mental disorders was however not increased for DAMHS as compared to the reference cohort. Women with a psychiatric history experienced a more stressful pre- and postabortion period, and within this group the risk on recurrent mental disorders might have been slightly elevated (marginally significant) of the short term (2.5 to 3 years) but not on the long term (5 to 6 years). Previous mental disorders were a consistent risk factor, as well as other negative life events and having an unstable relationship with the conception partner. This study does not support the idea that abortion ‘causes’ mental disorders. When post-abortion mental disorders do occur, they are mostly related to vulnerability factors. In this type of research, it is important that psychiatric history is taken into account, as it may explain associations between abortion and post-abortion mental health. In abortion care practice, clinicians could be extra attentive to underlying pre-existing mental health problems.