Abortion was legalized across the country in 1973, but 44 years have not reconciled the American public to the practice. In January, many thousands of people marched in Washington, as they do every year, around the anniversary of Roe v. Wade. Many, if not most, of those marchers were women, and the signs they carried often proclaimed: “Abortion Harms Women.”

This harm comes in various forms, the most obvious being the destruction of the roughly half of fetuses who are female. But the marchers are also highlighting the psychological harm experienced by mothers who aborted.

Scientific studies have shown significantly increased risks of depression, anxiety, substance abuse, and suicidal behavior in post-abortive women, indicating the procedure may “free” a woman from an unwanted pregnancy, but not from the negative psychological consequences of her choice. Six states require counselors in abortion clinics to inform patients of these risks before the procedure.

A study published in JAMA Psychiatry was touted by abortion activists as proof that women don’t actually experience increases in anxiety and depression after abortion. The study concludes, therefore, that “there is no evidence to justify laws that require women seeking abortion to be forewarned about negative psychological responses.” Activists are also energetically promoting another study conclusion about the women “turned away.” The authors contend that women turned away from an abortion clinic because their babies were too far along for a first-trimester abortion were more anxious and depressed than those who got there in time to have the procedure.

So which is it? Are abortions psychologically damaging for women? Or does the real injury come from being “turned away” from a clinic? The scientific way to answer these questions is to compare the actual studies.

Negative Psychological Findings Are Frequent and Broad

The finding that women suffer higher rates of anxiety, depression, and even suicidal ideation has been reproduced by academic researchers in numerous countries using various straightforward techniques. The largest study was published in 2011 in the prestigious British Journal of Psychiatry and was a meta-analysis involving a total of 877,181 women, of whom 163,831 had abortions.

Rigorous analysis found women who have had an abortion have an 81 percent higher risk of subsequent mental health problems compared to women that have not. This breaks down to higher rates of anxiety (34 percent), depression (37 percent), alcohol abuse (110 percent), and suicidal behavior (155 percent). Priscilla Coleman, PhD, the professor who conducted the study, controlled for variables such as a prior history of mental health problems and used appropriate comparison groups to come up with these numbers.

The “Turnaway Study” that purports to debunk Coleman’s findings consisted of phone interviews of women one week after having an abortion (or being turned away) and then every six months for five years. They were asked about “the intensity of distress felt in the past 7 days” and whether they “felt satisfied with life” and “felt high self-esteem.”

At the end of five years, only 558 women participated through the last interview and only the responses of those 558 women were used to draw conclusions. The authors tell us that most women did not suffer psychologically from having an abortion, and that the only ones who did suffer significantly were those who were initially turned away from a clinic due to advanced fetal age and had to go elsewhere, or continue their pregnancies.

The Turnaway Study Confirms Abortions Are Traumatic

The study authors write: “Women considering abortion are best served by being provided with the most accurate, scientific information available to help them make their pregnancy decisions.” This is absolutely true. But no scientist would call the “Turnaway Study” more accurate or scientific than Coleman’s. It’s simply not substantial or rigorous enough.

The part that has been particularly reported is the “Turnaway” section. Here the authors’ ground is even shakier. The turned-away women were asked about feelings of distress and life satisfaction just after learning that, being in their second or third trimester, terminating the pregnancy would be a much more complicated and painful procedure. Aborting a baby that is 13 weeks or more is done at fewer places and is much more costly, as well as more traumatic for the mother. Feelings of distress and lack of satisfaction are to be expected for women in this scenario.

Pro-abortion activists who deny that a woman may experience significant guilt, sadness, and distress after the loss of a pregnancy are closing their eyes to scientific evidence, but also to human experience. Many of our sisters and friends are walking around wounded from an abortion they regret—sometimes one that happened years before. On the other hand, states that inform women of the psychological risks of abortion are using sound science to back them up.