The decision to opt for abortion.

©FSRH J Fam Plann Reprod Health Care 2008: 34(3) Introduction More than 2001000 women have an abortion each year in Great Britain.1,2 There is extensive experience of providing abortion care; with this are associated some widely held but inaccurate views on how to assist (or in some cases obstruct) women at the decision-making stage. The socalled ‘post-abortion traumatic stress syndrome’ is not recognised by national or international bodies of psychiatrists.3 This review will demonstrate the wealth of evidence relating to abortion decision-making and will show how some common policies and service delivery practices are out of step with that evidence. The review starts by examining why women choose abortion and then looks at how this decision is reached. Finally, evidence is presented regarding the need for counselling. This review does not cover peri-abortion contraceptive use or men’s experiences of abortion. Nor does it consider research on the practicalities of the referral process, administrative reasons for delay, and attitudes of professionals consulted. Consideration of psychological consequences of abortion is limited to predictors of poor outcome. Finally abortion for fetal abnormality is not included. Reviews, guidance or recent studies covering all these topics are available.4–9 Only studies from developed countries are cited because of major differences in health systems. Only studies from settings with well-established legal abortion are cited because of the distorting impact on decisionmaking of restrictive legal systems, illegality or emphasis on psychiatric grounds. In this context, studies from the early years of legalised abortion are not given undue weight as professional opinion, not to mention societal values, changes and in time less emphasis is placed on psychiatric assessment. Scientifically rigorous studies on the emotions, psychology and psychiatry are hard enough to perform, but in the field of abortion there are particular difficulties. Women who choose abortion cannot ethically be subjected to endless questions on how they feel; baseline assessments before pregnancy are impossible and these women tend to be resistant to follow-up. Nevertheless, attempts at such studies are present in the literature. A literature search was conducted for the years 1967 (the year of the passage of the Abortion Act) to the present date using the terms ‘pregnancy’ or ‘abortion’ and ‘decision’ or ‘counsel’ as text words in MEDLINE, POPLINE, CINAHL and PsycINFO. Readers will see from the reference list that many studies identified are from the 1970s and 1980s. In the author’s opinion there are still applicable general principles in these studies even if methods of service delivery have moved on. If anything, the degree of psychological disturbance experienced by women nowadays is likely to be less as society has generally become more accepting of abortion. The decision to opt for abortion