Many state laws regulating abortion are premised on the notion that having an abortion is a uniquely agonizing decision. Seventeen states require women to receive counseling beforehand, where they receive information on topics including fetal pain and the long-term mental health effects of abortion on women. More than half of all states mandate a waiting period between counseling and the procedure. And 10 require abortion providers to perform an ultrasound on every woman seeking an abortion and then offer her the chance to view the image.
The logic is obvious, if unstated: Women seeking abortions need extra time, extra information, and extra guidance before they are allowed to make up their minds on a difficult quandary. As a conservative legal aid group defending Florida’s 24-hour waiting period put it recently, “Including such a period of reflection before choosing a decision with serious long-term consequences is critically important.” Even pro-choice groups like Planned Parenthood and NARAL Pro-Choice America often refer to abortion as “a difficult decision.” Hillary Clinton has called it a “personal, difficult” choice.
A study published Thursday in the journal Contraception, however, suggests that most women who seek abortions are really quite sure of themselves, thank you very much. Using an established scale devised to measure uncertainty around health care decisions, researchers from the University of California–San Francisco found that women seeking abortions are at least as confident as women making choices about breast cancer treatments, antidepressant use during pregnancy, and invasive prenatal testing. The new findings “directly challenge the narrative that decision-making on abortion is somehow exceptional,” the study’s lead author, epidemiologist Lauren Ralph, said. “And it calls into question whether women would universally benefit” from restrictions such as waiting periods and mandatory counseling services.
Ralph and her co-authors surveyed 500 women seeking abortions at four clinics in Utah, a state that mandates a 72-hour waiting period before the procedure. The women filled out a survey before they met with anyone at the clinic, with questions about things such as whether they feel pressured in their decision and whether they understand the benefits and risks of each option. The women were also asked about common pro-life myths about abortion, such as the notion that it causes breast cancer (it doesn’t) or that childbirth is safer than abortion (it’s not, and they’re both very safe).
Ralph and her co-authors used a 16-point measure called the Decisional Conflict Scale, which is used widely by researchers and providers to assess attitudes toward decisions related to health care. The scale can be applied to any kind of patient facing just about any kind of medical procedure. It is designed to measure things such as a patient’s uncertainty, her clarity about the benefits and risks that are important to her, and whether she has a support system and is well-informed about the procedure in question. Since the Decisional Conflict Scale is used to study a variety of decisions related to health care, the results could be directly compared with patients’ certainty about other kinds of medical procedures.
As it turns out, women seeking abortions are not unusually uncertain at all. They are significantly more sure about their decision, for example, than people facing reconstructive knee surgery. (The mean score on the conflict score for women getting abortions was 15.5 out of 100; previous research on men and women facing knee surgery found them at 40.) And that certainty turned into action, even with Utah’s three-day waiting period: When researchers followed up three weeks after the initial survey, 89 percent of the women had gone through with having an abortion. Of regulations like Utah’s, the study concludes, “Our findings challenge these laws’ implicit characterization of women making abortion decisions—as compared to other healthcare decisions—as particularly conflicted.”
None of this means the decision to have an abortion is uncomplicated, of course. Slightly more than half of the women in Ralph’s survey agreed that the decision was “easy”; less than 30 percent disagreed. (Previous research suggests that more than half of women who get an abortion report afterward that the decision was difficult.) But almost 90 percent of the women in the new study agreed with the statement, “I feel sure about what to choose.” Unsurprisingly, the women who endorsed more of the myths about abortion’s dangers were less certain about their decisions.
The after-effect of hesitancy is regret, which has become another weapon in the anti-abortion activist’s arsenal. “Post-abortion ministries” like Rachel’s Vineyard counsel women experiencing grief and shame, and activists now apply the clinical-sounding term “post-abortion syndrome” to women who struggle psychologically after having an abortion. The condition is not recognized in the American Psychiatric Association’s DSM-V, but that hasn’t stopped activists from promoting it.
But again, research suggests that crippling post-abortion regret is not a common experience. A large study published last year found that 95 percent of women who had abortions felt that it had been the right decision; these women were surveyed regularly over the course of three years, and the “overwhelming majority” of them did not regret the decision in the short term and continued to feel that way over time. (That study was conducted by the same University of California–San Francisco research center behind the new work on uncertainty.)
Meanwhile, anecdotal evidence suggests that lasting regret over parenthood is more common than we like to admit: After Nebraska decriminalized child abandonment in 2008, for example, hospitals and police stations were deluged with adults dropping off children of all ages; legislators had to quickly rewrite the law to clarify that it applied only to newborns. “The regret hit me when the grandmas went home and my husband went back to the office and I was on my own with him,” an anonymous woman told Marie Claire in a recent piece on the growing phenomenon of mothers willing to admit their second thoughts about parenthood. “I realized that this was my life now—and it was unbearable.”
It’s not surprising that some women experience hesitation before an abortion or anguish afterward. For one, there’s a vocal activist community backed by religious authorities insisting that abortion is murder. But aside from that, the question of whether or not to have a baby is the ultimate road not traveled. Of course women reflect on those choices and wonder what might have been. And many women who experience post-partum depression struggle with feelings of regret, too. What if I didn’t have the baby? What if I did? Would things be easier then, or happier? The pain of these questions lies in their unknowability. But there’s no reason that women need extra hand-holding from the government in order to work through these “personal, difficult”—or not-so-difficult—choices.