Abortion doesn't lead to emotional damage. Why does Minnesota fund centers that tell women otherwise?
Critics say warnings over "post-abortion syndrome" are unsupported by the best evidence and that the state Positive Alternatives Grant Program should not be funding crisis pregnancy centers that endorse it.
ROCHESTER, Minn. — In towns across the state, crisis pregnancy centers tell often economically disadvantaged and women of color they risk lasting emotional harm if they get an abortion.
According to authoritative medical research it's a false message. Yet in many cases it is delivered through centers subsidized by the Minnesota Department of Health.
The medical-sounding diagnosis in question is so-called post-abortion syndrome, and the apparent fallacy says abortion can lead to psychological trauma resembling post-traumatic stress disorder, a malady that can go unnoticed for years.
Owing to legislation created in 2005, a Minnesota Positive Alternatives Grant Program requires the state health department administer over $3 million annually to organizations that assist women facing unplanned pregnancies. A Forum News Service review found that websites for eight of these 27 MDH-funded crisis pregnancy centers mention "post-abortion syndrome," or the need for counseling about a previous abortion.
Critics point to such messaging as a part of a larger problem of inaccurate information provided by crisis pregnancy centers to vulnerable pregnant women. The issue, noted in a recent Rochester Post-Bulletin investigation of so-called "abortion-reversal" efforts within state-funded crisis pregnancy centers, has lately become the source of increasing scrutiny in the wake of the Supreme Court's decision to reverse federal protections to abortion access.
On Aug. 23, Minnesota Attorney General Keith Ellison joined California and Massachusetts in releasing a consumer alert about crisis pregnancy centers. That report warned that "CPCs may often make misleading and exaggerated claims about the health risks associated with obtaining an abortion." It cited research that included the notion of emotional trauma following abortion.
"They are offering treatment for a syndrome that there is not good evidence to support," said Dr. Jonas Swartz, referring to centers promoting the message. A board-certified obstetrician and gynecologist at Duke University and researcher of health disparities affecting the underserved, Swartz was coauthor of "Why Crisis Pregnancy Centers are Legal But Unethical," a 2018 article in the AMA Journal of Ethics.
"If state funds are limited, and often these clinics are serving a vulnerable population that needs help, it feels unethical to me to give money to organizations that ... have been shown overall to provide inaccurate counseling," Swartz said.
"Abortion is a social good. Abortion is health care," said Kimberly Kelly, a sociologist at Mississippi State who has studied the use of messaging about so-called post-abortion syndrome. "When you are telling a pregnant person if you have this abortion you will have PTSD for the rest of your life ... you're scaring someone away from having an abortion that is in fact in their best interest as determined by that person."
The belief that abortion leads to emotional harm has circulated in some form since the early 1960s, according to an early study in the American Journal of Psychiatry. It found such harms to be "very rare" in the years before Roe, however, "markedly less than mental illness related to pregnancy and childbirth."
The author wrote that this myth of psychiatric harms following abortion was resistant to correction, and that it likely functioned to provide "enforcement of a taboo" against abortion.
Today, even the Mayo Clinic website writes without providing evidence that "having a medical abortion is a major decision with emotional and psychological consequences," and that women "consider the impact the procedure may have on your future."
Although it does not cite "post-abortion syndrome" the site states that "after an abortion you may have a mix of emotions, including relief, loss, sadness or guilt." Mayo further advises that "if these feelings bother you it might help to talk to a counselor about them."
Asked for comment, Mayo Clinic communications provided a response which did not directly address questions about the statements concerning abortion on its website.
Well-designed studies counter that such concerns are unsupported. The publications refuting a risk of lingering distress following abortion include a 2008 task force by the American Psychological Association, a July 2018 Position on Abortion by the American Psychiatric Association, and results from the five-year Turnaway Study from the ANSIRH Center at the University of California, San Franciso, a project comparing women who had an abortion with those who wanted one but were too late.
All have concluded there is no evidence that having a wanted abortion leads in itself to mental harm.
To the contrary, the Turnaway Study found that risks of abortion were associated with those denied the procedure. Such women "were more likely to stay in contact with violent partners" the authors reported, "putting them and their children at greater risk than if they had received the abortion."
"The most common emotion immediately after an abortion is relief," Kelly said, citing Turnaway findings. Moving forward to a point years later, she adds, "the research is pretty clear there are a variety of emotions," ranging from happiness to indifference. "It can be regret that they weren't able to be a mother at that point in time, but that doesn't mean they regret the abortion."
"But what they have found is actually regretting the abortion, and wishing you did not have the abortion, is incredibly rare."
"Post-abortion syndrome" nonetheless figures prominently on the website of Life Connections of Alexandria, Minnesota, a crisis pregnancy center located in an office park on the state highway north of town.
As a State of Minnesota Positive Alternatives Grant Program recipient, Life Connections was recently selected for funding by the Minnesota Department of Health. That means for the next five years the facility will receive over $106,000 in state funding annually.
Those monies are designated to support maternity and family services which include crib and safe sleeping education and distribution, car seat education, Spanish translators, baby formula, diapers, pregnancy and parenting education and material assistance.
"Your health is worth asking questions about," reads a Life Connections webpage about their use of MDH-published materials on medical risks to pregnancy and abortion. "We will answer those questions using Mn Dept Of Health facts and information, so that you know it is not biased or untrue."
A few sentences later the facility warns that abortion "can have some very serious and long-lasting side effects," however, and that the "one effect that more women suffer from silently but is talked about the least is PAS, or Post-Abortion Syndrome."
"It’s a form of PTSD and it’s very real," the webpage reads. "Just like not all soldiers have obvious signs of PTSD, not all women who have had an abortion will notice PAS, but more recent numbers are showing that a good majority are being affected emotionally by a past abortion that was promised to 'make everything go away.'"
In an email, Life Connections' Julie Desautels and president Chris Wieberdink said the facility "is not funded by MDH for any activities or materials related to [post-abortion syndrome]." They said that "to date, the topic of PAS has never come up with our clients," and that should a need for counseling arise, Life Connections would refer to licensed mental health professionals only.
Asked for evidence of post-abortion distress, Life Connections noted the Mayo Clinic webpage and provided links to research published in a Turkish medical journal and papers by the founder of an Illinois-based anti-abortion organization known as the Elliot Institute.
"We respect that research in this area is very complicated," the center stated. They stressed the social assistance provided by their center including their work with Hispanic communities in particular, and stated that the criticism of crisis pregnancy centers is misdirected.
Other state-funded Minnesota crisis pregnancy centers have asserted the existence of such a syndrome as well.
It’s "important to remember there are emotional and mental side effects to abortion," reads the website of state-funded Options for Women in Sauk Center. "Many women experience feelings of loss, regret, guilt, depression, anxiety, and can have trouble bonding with their partner or other children as a result."
Forum News Service reached out to Options for Women in Sauk Center but received no response.
"Your choice for abortion may provide great relief initially," warns the website for state-funded Choices Pregnancy Center in Redwood Falls, Minn. "However, you may experience what many women have faced days, months and years after their abortion."
The website then lists 19 symptoms for "post-abortion syndrome," including anxiety disorders and irritability, difficulty concentrating, a sense of hopelessness about the future, and "repression or denial of feelings about the abortion."
Forum News Service reached out to Choices Pregnancy Center in Redwood Falls which directed media questions to the Virginia-based National Institute of Family and Life Advocates, who did not provide answers for emailed questions.
"The way activists have constructed post abortion syndrome and its symptoms," Kelly said of her research on this message as delivered elsewhere across the country, "it's so broad that any negative emotions a woman experiences after an abortion, even ten, twenty, thirty years later, is tied back to her abortion."
"That's really handy, right? Literally anything bad that happens, your marriage breaks up — you have unresolved trauma. You suffer from depression or addiction or you're having trouble bonding with your kids, it's all about the abortion, no matter when the abortion was, how you felt about the abortion, why you had the abortion."
"So they've wrapped this up in a very neat little bow where everything negative in your life is tied to your abortion, and if you don't agree, you're in denial, and that's also because of your abortion."
"This is a massive ethical problem," she said at another point of the practice. "You're taking someone who does not identify as struggling emotionally or mentally, and you are doing everything in your power to convince them that they have an untreated, very serious mental illness, and they are so ill, so deeply in denial, that they don't even know they are sick."
"Designed to Deceive" is the 2021 report cited by Minnesota attorney general Keith Ellison's consumer alert on misinformation and crisis pregnancy centers. It was produced by a multi-state alliance of abortion advocacy organizations that included Gender Justice of St. Paul.
As part of that project, Gender Justice made a Minnesota Data Practices Act request of MDH for materials explaining how it selects and oversees the awarding of Positive Alternatives Grant Funding.
For Gender Justice legal counsel Christy Hall, the data returned did not bolster faith in state oversight of Minnesota CPC's receiving funds.
"Based on what we were able to get, we don't think that the Minnesota Department of Health is really overseeing these grants very well,"Hall said.
Asked to explain how Positive Alternatives grantees can reference information contraindicated by expert opinion, MDH spokesperson Erin McHenry replied via email that the state's hands were tied.
"MDH is required by statute passed by the 2003 Minnesota Legislature to provide funding to eligible entities to deliver a specific set of services, outlined in statute," she wrote.
"Grantees may get funding from other sources, and the department would not have jurisdiction over materials developed or services performed using outside funds."
"We reiterate our position that information regarding pregnancy provided to Minnesotans should be accurate and up-to-date based on the body of scientific evidence."
Kelly, the Mississippi State sociologist, believes the very name of the state of Minnesota Positive Alternatives Grant Program reveals bias.
"By calling it 'Positive Alternatives' you're implying abortion is a negative," she says. "It's not. The only person who knows if it's the right choice is a pregnant person."
"Saying that any alternatives to abortion is a positive? We know that's just not true. The Turnaway Study is proof that not all alternatives to abortion are positive. So they are showing their bias right off the bat."