Partner conflict may logically arise during the abortion decision-making process if there are differences in opinion regarding how the pregnancy should be resolved and/or if relationship-based information, such as commitment, desire to ever have children, confidence in a partner's parenting abilities, life-style factors, and long-term intentions such as school or career plans are addressed. Post-abortion psychological effects on the part of one or both parties may conceivably add to earlier conflicts and/or new relationship problems could emerge following the procedure. For example, the abortion could lead to negative emotions including anger, guilt, grief, depression, and/or anxiety (reviewed in detail below), which can elevate the risk for ambivalent, withdrawn, antagonistic, or aggressive partner-directed behavior.

Partner communication problems following abortion exist (₁₅), and there is an increased risk for separation or divorce following an abortion (₁₅,₁₆,₁₇,₁₈,₁₉). In one study by Lauzon and colleagues (₁₈), 12% of the women and 18% of the men indicated that an abortion performed up to 3 weeks earlier had adversely affected their relationship. Rue and colleagues (₁₉) reported that 6.8% of Russian women and 26.7% of American women indicated relationship problems caused by an abortion experience; whereas relationship benefit was reported by very few Russian women (2.2%) and American women (0.9%). These authors provided hypotheses regarding the cross cultural difference in rates of negative consequences. They specifically suggested that Russian women may become more desensitized to the procedure due to the common practice of using abortion as birth control. Or alternatively, significant economic, social, and political stressors associated with Russian life may render Russian women more “stress experienced” than American women. Based on cultural norms, Russian women are conceivably more reluctant to disclose personal information as well.

Other studies suggest few post-abortion relationship changes (₈,₂₀,₂₁,₂₂). The contradictory findings in the literature may be due to variability in methodological rigor across the published research. The few studies that have examined abortion and relationship quality with results suggesting no meaningful impact of abortion generally relied on retrospective data and/or used only brief unstandardized measures of relationship quality (₂₀,₂₁,₂₂). There is a prospective study (₂₃) that followed couples from late pregnancy until 21 months postpartum and reported only a 5% separation rate. However, this is the exception as other prospective studies report much higher rates of separation [e.g., (₁₆).

Minimal research attention focuses on abortion as a predictor of domestic violence. However, a few studies show an association between a history of abortion and increased risk for partner-perpetrated aggression during a subsequent pregnancy (₂₄,₂₅).

Research demonstrates that women with an abortion history are at an increased risk for sexual dysfunction (₁₉,₂₀,₂₂,₂₆,₂₇,₂₈). For example, in a recently published study, 6.2% of the Russian women and 24% of the American women reported sexual problems that they directly attributed to a prior abortion (₁₉). In a Swiss longitudinal study of over 100 women, 31% reported a minimum of one sexual problem 6 months after an abortion (₂₇). Sexual desire, frequency of sexual intercourse, orgasm ability, and sexual satisfaction are among the female sexuality variables explored in the literature. In a recent review, Bradshaw and Slade (₈) concluded that 10-20% of women experience abortion-related sexual problems in the early weeks and months after an abortion, while 5-20% of women report sexual difficulties a year later. Male responses to a partner's abortion have not been extensively studied; however, post-abortion sexual problems in the first three weeks post-abortion were indicated by 18% of men, who were significantly affected by a partner's abortion (₁₈). More research on abortion and male sexuality, particularly the long-term impact is needed.

The available studies generally indicate that sexual problems after an abortion are higher than in the general population. For example, in a study by Mercer et al. (₂₉), persistent sexual problems lasting at least 6 months in the preceding year were identified in 6.2% of men and 15.6% of women. Sexual problems in women and men may be due to depression which is a common mental health problem following abortion (₈,₉) or the reasons may be more complex. Very few of the existing studies on abortion-related sexual difficulties probe deeply into why the problems arise. Results of one study revealed that decreased sexual desire was associated with not feeling worthy of one's partner (₂₂). Further, in studies examining sexual problems associated with involuntary perinatal loss and/or loss of a child in which sexual problems have been identified in over 60% of couples, reasons for disinterest in sexual activity have been described and include depression, fatigue, numbness, preoccupation, and discomfort with sexual activity (₃₀). The discomfort was based on sexual activity serving as a reminder of the previous conception, fear of pregnancy and another possible loss, and viewing sexual pleasure as incompatible with mourning. In this literature, gender differences have been documented wherein bereaved men are more inclined to find sexual intimacy comforting and to experience significantly less loss of interest as compared to women (₃₀,₃₁).

Although studies designed to examine the issues behind post-abortion declines in sexual activity are generally missing from the literature, variables that researchers might logically explore in future studies include any of the following: 1) perceptions of a partner as insensitive or insufficiently supportive, 2) negative abortion related emotions on the part of one or both individuals, 3) altered self-perceptions which may result in feelings of estrangement from one's partner, 4) anger due to relationship-based information (e.g., commitment, long-term plans, etc.) derived through the abortion decision-making process, and/or 5) history of unresolved grief and trauma in one or both partners.

Correlations between abortion history and relationship quality could be explained by confounding additional variables associated with the choice to abort and with relationship problems. Few previous investigations of associations between abortion and partner relationship quality have incorporated controls for potentially confounding additional variables. Among the more obvious possible confounding variables are relationship problems or partner violence prior to the abortion, age, sexual risk taking behaviors, a childhood or adult history of physical or sexual abuse, history of prior voluntary (abortion, adoption) or involuntary pregnancy losses (miscarriage, stillbirth), and other sources of stress including poverty that could be associated with the abortion decision as well as relationship problems afterwards. Future research will ideally be prospective in nature, measuring relationship quality before and after the abortion, while incorporating controls for a wide range of additional potentially confounding variables.

In the published literature, with the possible exception of sexuality variables and communication, the dependent variables have been broadly defined assessments of relationship quality, conveying very little information regarding the aspects of relationship functioning that may be more likely to be impacted by an abortion experience. Prospective assessments addressing specific aspects of relationship quality such as conflict, affection, reciprocity, equity, interdependence, trust, commitment, and respect administered before and after an abortion would provide valuable data pertaining to relationship vulnerabilities as well as insight into mechanisms through which an abortion is likely to impair relationship quality. Ideally the pre- and post-abortion assessments would incorporate both open-ended questions designed to examine the respondents' thoughts and feelings regarding how the abortion may have affected various aspects of relationship functioning and standardized relational and psychological testing. Without a substantially developed literature on particular relationship outcomes associated with abortion, discussion of how abortion affects relationships remains limited and lacks the specificity necessary to realistically guide future investigations. What is known is that there is considerable correlational evidence associating abortion with general indicators of relationship problems. There is also documentation of abortion-related intrapersonal responses. Therefore, one logical place to turn in efforts to understand why abortion is often linked with relationship difficulties is to examine how intrapersonal variables associated with abortion may predispose a couple to distinct relationship challenges. This approach of addressing individual responses with an emphasis on intrapersonal processes most likely to influence interpersonal dynamics should provide a foundation for understanding how relationships are influenced by this common medical procedure. Without a well-developed understanding of personal responses to abortion, attempts to elucidate relationship issues are thwarted and could lead into fruitless directions.

No one would deny that an induced abortion is the voluntary termination of a pregnancy, but considerable ambiguity surrounds interpretations of the meaning of this reproductive outcome. Abortion may be viewed by some people as little more than the removal or destruction of a cluster of cells, which carry the potential to develop into a human being. Others might consider abortion, particularly medical termination, as the process of initiating menstruation, attending very little if at all to the status of the embryo. For still others, abortion is viewed as the termination of an immature human life. Each conceptualization undoubtedly fosters distinct notions regarding normative responses to abortion. For example, if abortion is primarily viewed as a simple medical procedure designed to revert the woman's body back to its pre-pregnancy state, one would expect the choice to abort to be met with predominantly positive feelings, such as relief and satisfaction and few, if any, negative psychological effects once the physical discomfort has abated. On the other hand, if abortion is viewed as the deliberate taking of a human life, one would anticipate profound feelings of guilt, remorse, and bereavement among others.

Abortion is often experienced as both a relief as well as a psychosocial stressor (₃₁). In a Swedish study, two-thirds of the respondents expressed both positive and negative emotions in conjunction with an abortion, with the remaining one third reporting only negative feelings (₃₂).

A woman's personal understanding of abortion is likely to impact her post-abortion adjustment. For example, in a large scale study by Conklin and O'Connor (₃₃), women who believed the fetus was human and aborted were found to have more negative affect and significantly lower self-esteem and life satisfaction than women who had not aborted a pregnancy. Even weak beliefs in the humanity of the fetus resulted in associations between abortion and compromised well-being. Women who had an abortion but did not consider the fetus human scored similarly to those without a history of abortion relative to the three post-abortion adjustment measures. The authors noted that the results held up even after statistically controlling for contextual variables and they emphasized the significance of the findings based on how difficult it is to identify moderator effects in field research.

The idea of the fetus possessing at least some degree of personhood and moral objection to abortion seem to be commonly held beliefs. For example, research on women who had first trimester miscarriages revealed that 75% felt they had lost more than a pregnancy (₃₄). Further, 25% of women facing an abortion decision considered the fetus to be human and regarded abortion as the taking of life (₃₅). Allanson and Astbury (₁₁) report that 25% of women seeking an abortion agreed with the statement “abortion is against my beliefs.” A number of other studies show that many women have abortions despite moral opposition to the procedure (₁₁,₃₅,₃₆). In a recent study, 50.7 % of American women and 50.5% of Russian women who had an abortion felt abortion was morally wrong (₁₉). Further, the results of a study by Lauzon et al. (₁₈) revealed that the presence of a moral dilemma was identified as the greatest contributor to men's anxiety prior to a partner's abortion. Specifically, over a third of the men who reported being anxious about a partner's pending abortion (56% of those sampled) identified moral issues as the source of their anxiety. This indicates that for a significant number of women who abort and their partners, the decision is not an easy one and it is likely to have been resorted to in response to personal and/or situational pressures.

Each partner brings his or her personal perspective regarding the meaning of the abortion into the experience of an unintended pregnancy and its resolution. However, no quantitative studies have specifically examined each partner's beliefs about abortion as predictors of post-abortion relationship quality. The probability of discrepant views initiating conflict would seem to be quite high, particularly if one individual views abortion as the taking of a human life and the other views it as a simple medical intervention absent from any moral dimension. There are studies suggesting that women who feel pressured into an abortion by a partner have more post-abortion mental health problems (₃₁), as do men whose partners have opted to abort against their will (₃₆,₃₇); however relationship factors were not examined as dependent variables in the studies conducted to date. With opinions regarding abortion varying greatly in our society and personal beliefs likely to affect the post-abortion psychological functioning of the individual, any effort to understand post-abortion relationship issues should begin by examining the history and strength of each partner's convictions regarding abortion.

Like mainstream society, professionals within the medical community and researchers alike continue to adopt disparate views of abortion, resulting in very conflicting messages regarding what constitutes normal post-abortion psychological adjustment. Such conflict is perhaps inevitable given the complexity of issues surrounding an abortion. Nevertheless, a lack of consensus may have slowed progress toward understanding the real-life experiences of women and their partners. Efforts to support men and women in resolving any psychological pain or relationship difficulties resulting from an abortion are likely to have been compromised as well. In an interesting admission pertaining to her efforts to assist a client working through an abortion, psychotherapist Kluger-Bell (₃₉) states “What kept coming up in session after session was her guilt and regret over the abortion she had had six years before. Probably because of my own commitment to the legal right to abortion, I considered first-trimester abortion a fairly straightforward medical procedure with few if any long-lasting effects….I failed to recognize that in her present circumstances the abortion felt like a huge, irrevocable mistake.” (p.7) According to psychiatrist Philip Sarrel (₄₀): “Abortion is frequently a negative turning point in a relationship leaving scars which can undermine the future of the couple either together or as individuals.” (p. 244)

Research shows that women's reasons for choosing abortion are overwhelmingly tied to their life situation as opposed to abstract, moral, or religious principles (₄₁). Many women who are ethically opposed to abortion can make the decision to abort despite their personal views about abortion. This incongruence between women's beliefs and behavior is likely to engender guilt feelings, which are very common among women who have aborted. Available evidence specifically indicates that between 29% and 75% of women acknowledge feelings of abortion-related guilt (₁₀,₂₁,₃₂). The results of a major national poll by the Los Angeles Times, revealed that 56% of women who had an abortion experienced a sense of guilt (₄₂). Moreover, Rue and colleagues (₁₉) found that even among Russian women residing in a culture that is very accepting of abortion, levels of self-reported guilt are quite high (49.8%). As the crisis of the pregnancy and the pressure to make a decision regarding termination pass and women have had time to process the experience, those who are morally opposed to abortion may begin to feel as though their reasons for terminating the pregnancy (e.g., in order to stay in school, save money, please a partner, etc.) were insufficient justification for terminating a human life. In a recent study (₄₃) in which women were asked to choose words expressing their feelings about an abortion when facing the procedure and one year later, only 11% selected “injustice,” at the time of the procedure, but 24% chose the word one year after the abortion.

Feelings of guilt may take on an existential dimension that becomes more pronounced with time, leading to preoccupation with the ramifications of the abortion. For example, women who feel as though they really should have carried to term may find the guilt causing them to obsess on what the child's life would have been like. For those who experience abortion as traumatic and are guilt-ridden, there may be continual self-punishment and an inability and/or unwillingness to be free of the attendant guilt. In an analysis of qualitative data, many women who had experienced an abortion in the distant past felt as though they had been on an emotional roller coaster for decades and found themselves frequently thinking about their abortions and the children they never delivered (₄₄). Similarly, in another study (₄₅), 73% of college women who had an abortion and 64% of college men whose partner had a past abortion reported having thought about what the child would have been like.

Guilt is an often associated feature of posttraumatic stress disorder, and although related, shame is a distinctive affective state that can further debilitate an individual and/or couple following an abortion (₄₆). In the context of an elective abortion, guilt implies the act of having done something wrong and feeling the need to make amends. In contrast, shame tends to be more consuming wherein the entire self is negatively evaluated, resulting in feelings of worthlessness, powerlessness, and the need to hide or escape from others (₄₆).

Many human behaviors that lead to feelings of guilt can be compensated for by apologizing to the offended party and/or by engaging in corrective behaviors; however, the finality of an abortion precludes engagement in such restorative behaviors to absolve one from guilt. Pregnancy termination is irreversible and if women are unable to come to terms with an abortion that evokes considerable guilt, the negative feelings may lead to more generalized feelings of self-reproach and/or they may cause the individual to engage in negative behaviors targeted towards one's partner. As psychotherapist Kluger-Bell (₃₉) has noted “many women carry around unresolved feelings of guilt and shame which can tend to get expressed in self-punishing thoughts and behavior.” For example, a woman who is consumed by abortion-related guilt may begin to feel as though she does not deserve to be happy or to be the recipient of a partner's love. As a result, she may consciously or unconsciously engage in antagonistic behaviors that lead to relationship problems.

Nonvoluntary forms of perinatal loss are sometimes associated with intense, uncontrollable anger which becomes so unacceptable to the individual that it is turned inward and transformed into guilt and self-reproach (₄₇,₄₈). As noted by Hebert (₄₈), women's efforts to understand the loss and reduce feelings of guilt may lead to preoccupation, intense introspection, and feelings of alienation, which result in the partner pulling away or feeling shut out. Anger after abortion has only received scant attention, but a small-scale clinical study of 30 women distressed by an abortion showed that 92% experienced intense anger, rage, and/or hostility (₄₉). A few other studies have identified anger as one of various negative post-abortion emotions (₄₃). In one study (₄₆), abortion-related anger was reported by 13% as they faced the abortion and by 14% one year later. If a woman has a negative abortion experience, anger may be directed inward or outward. Externally projected anger could be targeted toward professionals involved in the abortion or significant individuals, such as a partner who is perceived as not having provided sufficient emotional support prior to, during, or after the procedure. Anger may also be logically directed at a partner because he encouraged or pushed for an unwelcome abortion. In addition to precipitating anger, guilt may cause psychological problems. Guilt has a well-established history of an association with mental illness, particularly depression (₅₀,₅₁).

Many women undoubtedly get beyond feelings of guilt, anger, and self-reproach through social and spiritual means and find ways to effectively forgive themselves (₅₂). Kluger-Bell (₃₉) notes that “Finding a place to remember and talk about one's abortion experience in support groups, in psychotherapy, or among friends – and demonstrating one's caring through rituals or ceremonies, which honor the aborted beings, can help in the process of reconciling one's view of oneself as a good person with the fact of having terminated a pregnancy.” (p. 76) Women often report that the feelings of abortion-related guilt prompted a religious conversion or a deepening of a religious commitment in order to experience forgiveness and peace (₄₃,₅₃). For example, a woman who had been particularly distressed by an abortion four months prior stated “a week ago I asked the child and God to forgive me and now I have started to talk to my partner …and this past week I have felt much better” (p. 2566) (₄₃). More research is needed to examine guilt and self-reproach as mediators of relations between an abortion and relationship problems and to more systematically explore how personal efforts to resolve guilt may ameliorate any personal or relationship problems that develop after an abortion.

Abortion may initiate feelings of loss, as in nonvoluntary pregnancy terminations. In this section, research pertaining to nonvoluntary perinatal loss is examined, similarities and differences between nonvoluntary and voluntary perinatal loss are explored, and associations between post-abortion bereavement and relationship issues are discussed.

Grief involves a wide range of emotional and cognitive responses to a death (₃₀) and it frequently draws the individual toward the missing person in response to awareness of the discrepancy between the way life is and the way one believes life should be (₅₄). The nonlinear nature of bereavement results in many individuals revisiting various components of their grief numerous times as they work their way through the process (₃₀). Grief has been conceptualized as “a voyage of healing and a rebuilding of meaning and representations of self” (₅₅).

Nonvoluntary forms of perinatal loss are often experienced as a personal tragedy with substantial grief reactions. Approximately 25-50% of women who experience a nonvoluntary perinatal loss will suffer from clinically significant psychological distress (₅₆,₅₇,₅₈,₅₉). Fathers to be, like expectant mothers, are prone to experiencing significant levels of perinatal grief (₆₀). Resolution of perinatal loss is believed to be particularly difficult, because memories of interacting with the child are lacking (₆₁,₆₂) and the significance of the loss may not be acknowledged by others in the individual's life (₆₃). Due to inadequate opportunities to grieve and frequent insufficient social support, a distinct form of grief termed “shadow grief” is sometimes associated with perinatal loss. Rather than resolving more or less completely after a few years, this form of grief involves a life-long tendency to re-experience feelings of loss in response to cues, such as the anniversary of the loss (₆₄). Because men are less likely to receive assistance and support in grieving a perinatal loss, they are believed to be more susceptible to shadow grief (₆₅,₆₆).

Compared to studies pertaining to nonvoluntary forms of perinatal loss, far fewer studies explore bereavement associated with voluntary loss. However, Williams (₆₇,₆₈) provided evidence of a common grief response among women who aborted and described abortion as a distinct form of perinatal loss. In one study (₆₉), 77% of women who terminated a pregnancy due to fetal malformation reported acute grief. Further, another study (₄₅) found that approximately 30% of college students who had an abortion or had a partner who had an abortion agreed or strongly agreed with the following statement: “I sometimes experience a sense of longing for the aborted fetus.” In another study (₄₃), approximately 20% of women described severe emotional distress in conjunction with an abortion, with 43% reporting grief right before the abortion and 31% reporting feelings of grief one year post-abortion. Lastly, in another study (₁₉), 33.6% of Russian women and 59.5% of American women who had an abortion responded affirmatively to the statement “I felt a part of me died.” Only one study measuring male bereavement was identified (₇₀) and the results revealed that nearly 35% reported feelings of grief and/or emptiness four months after a partner's abortion.

One study (₇₁) investigated the psychosocial sequelae of second trimester abortions for fetal anomalies two years post-event. This study revealed that most couples report a state of emotional turmoil after abortion. Twenty-percent of wives still complained of crying bouts, sadness, and irritability, while husbands reported increased listlessness, loss of concentration, and irritability one year post-event. The authors of this study concluded that a lack of synchrony in the grieving process, increased social isolation, and lack of communication resulted in marital disharmony in the aftermath of the abortion.

Bereavement is a complex and dynamic process marked by considerable individual variation (₃₀); however healthy bereavement is generally accepted as resulting in the ability to resume other relationships and engage in new ones (₆₃). Women who experience prolonged perinatal grief reactions indicative of unhealthy bereavement have difficulty thinking rationally about other aspects of their lives including relationships (₇₂). Without sufficient opportunity to grieve a fetus lost through abortion, problems in relationships with partners may develop if one or both partners view the abortion as a loss.

No studies examine feelings of post-abortion grief as predictors of relationship problems occurring in the aftermath of abortion. A few studies indicate that nonvoluntary perinatal death is related to feelings of enhanced closeness between couples (₇₃,₇₄); whereas other studies indicate that up to 90% of bereaved parents separate or divorce within a year of a stillbirth or neonatal death (₇₅). Women bond earlier to an unborn child than men (₇₆); therefore at the time of the loss (whether nonvoluntary or voluntary), it is possible that women have a stronger connection to the fetus than men and may be more inclined to suffer from a significant grief reaction.

If both partners do experience grief in association with an abortion, the nature and timing of their bereavement responses may differ considerably based on evidence of gender differences related to other forms of loss. For example, men tend to exert greater control over the expression of painful emotions, intellectualize grief, and cope alone; whereas females tend to be more expressive and employ process-oriented forms of coping (₃₀,₆₄,₇₇). Men are also inclined to identify their primary role as supporter for their partners following perinatal loss (₇₈). One study (₆₆) found that although men displayed less immediate “active grief,” they were more prone to frequent feelings of despair long after a perinatal loss than women. In a long-term study of paternal responses to perinatal loss, grief intensity diminished over time, but remained mild to moderate 5 years later (₇₉). Men are apparently more inclined to experience a chronic form of grief with perinatal loss, because they tend to be overlooked for support at the time of the loss (₆₅).

There is evidence indicating that differences between a woman's and her partner's perinatal grieving can introduce conflict and stress in their relationship (₆₄,₈₀); however these studies have dealt exclusively with nonvoluntary perinatal loss. Discrepant grief responses are perhaps even more probable with abortion than with nonvoluntary forms of loss due to the higher probability of one partner not experiencing the abortion as a form of perinatal loss. With the nonvoluntary loss of a pregnancy that is wanted or at least accepted, one would expect a majority of expectant parents to experience some form of grief reaction. On the other hand, with abortion, only individuals who viewed the fetus as a person or developed some form of bond to the fetus prior to termination would be expected to experience grief. Under these circumstances, one individual may experience profound grief while his/her partner does not grieve at all and as one is eager to move on with his or her life, the other will have substantial grief concerns. When post-abortion responses are so dramatically different, the potential for conflict would seem to be quite high. Even in the situation wherein both individuals experience grief, the nature and duration of each person's grief could be highly variable based on the degree to which they would have preferred to continue the pregnancy in addition to their views of abortion and the humanity of the fetus. Future research on post-abortion relationships should explore the degree and nature of each individual's perinatal grief response while also examining each individual's perceptions and emotions regarding their partner's response to the abortion.

Mental health problems triggered or exacerbated by an abortion experience may be involved with relationship problems occurring after an abortion. In the text that follows, the post-abortion mental health literature is reviewed initially and is then analyzed with reference to possible bases for mental health problems leading to relationship difficulties. The best evidence indicates that a minimum of 10-30% of women who undergo an abortion experience report pronounced and/or prolonged psychological difficulties attributable in large part to the abortion (₇,₈,₁₀,₈₁,₈₂). Although the causal question has not been definitively resolved, the methodological rigor of studies pertaining to mental health correlates of abortion has increased considerably in recent years, thereby increasing confidence in the conclusion that for many women abortion does trigger psychological problems (₈₃). More specifically, several published studies have now employed the following: 1) unintended pregnancy carried to term as the control group, 2) collection of data for several years beyond the abortion, 3) use of medical claims (with diagnostic codes assigned by trained professionals), which eliminates the problem of women concealing an abortion, 4) controls for prior psychological problems and a variety of potentially confounding personal and socio-demographic variables, and 5) use of large and often nationally representative samples (₈₃,₈₄,₈₅,₈₆,₈₇,₈₈,₈₉).

The results of one particularly well designed study (₈₉) indicate that while 42% of the women who had abortions reported major depression by age 25, 39% of women post-abortion suffered from anxiety disorders. In addition, 27% reported experiencing suicidal ideation, 7% had alcohol dependence, and 12% were abusing drugs. This was a longitudinal study which followed 1265 children born in Christchurch in 1977 and was strengthened by the use of comprehensive assessments of mental health using standardized diagnostic criteria, considerably lower estimated abortion concealment rates than in previously published studies, and the use of extensive controls. Variables that were statistically controlled in the primary analyses included maternal education, childhood sexual abuse, physical abuse, child neuroticism, self-esteem, grade point average, child smoking, history of depression, anxiety, and suicidal ideation, living with parents, and living with a partner.

With 1.3 million abortions performed each year in the United States, a substantial number of women are likely to suffer from new mental health problems each year. Women who are negatively affected by an abortion may experience any of the following mental health problems: anxiety (₃₇,₈₆), depression (₃₇,₄₅,₈₅,₉₀,₉₁,₉₂), sleep disturbance (₉₀,₉₃,₉₄), substance use/abuse (₈₄,₈₈,₉₅,₉₆,₉₇), and/or increased risk of suicide (₈₇,₉₈). A number of the studies pertaining to mental health effects of abortion have focused on anxiety and a recent literature review indicates that 8-40% of women experience anxiety in the aftermath of abortion, with up to 30% of women suffering from clinical levels of anxiety and/or high levels of generalized stress at one month post-abortion (₈).

Compared to the amount of research on women's post-abortion psychological responses, considerably less attention has been given to men's psychological adjustment to a partner's abortion. Nevertheless, the available data do indicate that male responses to a partner's abortion may include guilt, depression, anxiety, feelings of voicelessness/powerlessness, repressed emotions, and anger (₉,₁₉, ₃₈,₄₅,₉₉,₁₀₀). A recent review of the literature on male responses to abortion (₉) found that many men defer the abortion decision to their female partners and tend to repress their own emotions in an attempt to support their partners. Long-term studies are therefore needed to accurately gauge effects of abortion on men.

Many of the studies that have identified negative effects of abortion regrettably assess outcome variables with very brief measures. However, in one well-designed study, Swedish researchers conducted a study of 854 women one year after an abortion using a lengthy semi-structured interview and found that rates of negative experiences were substantially higher than in earlier studies relying on brief assessments (₁₀₁). Specifically, more than half of the women sampled reported emotional distress of some form (e.g., mild depression, remorse or guilt feelings, a tendency to cry without cause, or discomfort upon meeting children) and 16.1% reported serious emotional distress necessitating therapeutic intervention from a professional or being unable to work because of depression. This literature suggests that if one or both partners experience negative psychological effects of an abortion, the risk for relationship problems is likely to increase, particularly if those affected fail to seek outside help for pronounced difficulties.

There are numerous mechanisms through which post-abortion mental health problems may adversely affect relationships. Logical mediators include reduced emotional energy, withdrawn behavior, communication difficulties, feelings of self-doubt, limited personal control, decreased self-esteem, and/or blaming one's partner for suffering incurred. There is also a well-established link between mental health problems, particularly anxiety, and substance use and the development or exacerbation of a substance use problem would be expected to increase the probability of relationship difficulties (₁₀₁,₁₀₃). A final possibility is that individuals who suffer from post-abortion psychological disturbances may dismiss the abortion as the cause of their suffering based on common views of abortion as a benign medical procedure and look for reasons for their suffering within the partnership. Research is needed to examine how post-abortion psychological responses of various forms in one or both partners may adversely affect relationship quality.