A study published last week in the journal JAMA Psychiatry claims to show that women facing an unwanted pregnancy do not suffer any negative impact on their mental health after abortion. Carried out by the ANSIRH (Advancing New Standards in Reproductive Health) program at the University of California, San Francisco, the study sought to respond to former Surgeon General Everett Koop who articulated in 1989 that there was not enough conclusive evidence to determine the effect of abortion on a woman’s mental health.

The longitudinal study attempted to show the differences in mental health outcomes between women who had an abortion and women who wanted an abortion but were unable to have one. The study claims to be the first of its kind because it measures only women who wanted abortions, noting that this demographic of women has a qualitatively different experience of pregnancy than women who do not want abortions and proceed to give birth.

The data from the longitudinal study indicate that over the course of 5 years, there was no statistically significant difference in the self-report assessments between those who had abortions versus those who wanted abortions but were turned away. The study also found that turning away a woman seeking an abortion led to an increase in mental health symptoms in the short-term, but no statistical differences in the long-term.

Thus, with no statistical difference, they reached the conclusion that having an abortion in response to an unwanted pregnancy does not cause any significant mental health problems for women. The study itself lays out this blanket conclusion: “findings do not support restricting abortion on the basis that abortion harms women’s mental health.”

News outlets were quick to report on the study, eager to help divert attention from the well-documented experiences of the countless women who do suffer psychological distress after their abortion. Time ran the headline “Abortion Doesn’t Negatively Affect Women’s Mental Health,” while Slate gleefully proclaimed “New Longitudinal Study Confirms That Women Who Get Abortions Do Not Suffer Psychological Harm.” Self joined in with the headline “Abortion Doesn’t Harm Women’s Mental Health.”

Yet while abortion advocates are stumbling over themselves to herald the conclusiveness of this study, some problems persist. Digging into the methodology used in the study reveals the way in which the researchers measured outcomes:

Using validated scales, we examined 4 mental health and 2 psychological well-being outcome measures. Mental health outcomes included 2 measures of depression and 2 measures of anxiety. Depression and anxiety symptoms were assessed using the Brief Symptom Inventory depression and anxiety subscales, where respondents are asked to indicate the intensity of distress felt in the past 7 days… Well-being outcomes included self-esteem and life satisfaction. Self-esteem was assessed using a 1-item measure of global self-esteem, which has been validated as an alternative approach to the Rosenberg self-esteem scale… One item from the 5-item Satisfaction With Life Scale was selected to measure life satisfaction.

It’s clear that the researchers reached their conclusions based on the premise that any mental anguish experienced by women after an abortion would happen within five years and be detectable using simple symptom inventories and single Likert rating scale items about self-esteem and life satisfaction. But to believe that a simple inventory or a Likert scale could capture enough information about the post-abortion experience is to ignore both the long-term role that defense mechanisms play in the covering of negative emotions and the complexity of people’s lives.

Indeed, the fatal flaw of this study is that it neglects to recognize the vast, intricate complexities of the post-abortion experience. The study itself attempts to reduce emotional anguish into a binary of depression and anxiety, when the reality is that people’s emotions and psyches are far more complex.

Theresa Burke notes in her book Forbidden Grief: The Unspoken Pain of Abortion :

Drawing conclusions from research regarding the emotional aftereffects of abortion is exceptionally difficult because… the variety of negative reactions reported by women is so broad that it may be impossible to examine every claimed dysfunction in a single study.

In the same book, Dr. Burke discusses her own experience of counseling post-abortive women, noting that she treated women with depression, anger, grief, sexual maladjustment, post-traumatic stress disorder, eating disorders, intrusive memories, self-destructive behaviors, chronic guilt, anxiety, and substance abuse. Her experiences certainly fit with studies that show a correlation between abortion and a multitude of other problems, including mental health problems, suicide (remember this story?), substance abuse, post-traumatic stress disorder, increased psychiatric hospitalizations, and sexual promiscuity.

The truth is that the negative impact of abortion can be felt or expressed in an infinite number of ways and over many years.

Additionally, an important study conducted by David Reardon at the Elliot Institute found that, among a host of other things, almost two-thirds of women who eventually recognized the negative impact of their abortion admitted that they had been through a significant period of denial after the abortion. Further, among that group, the average length of time identified for how long the women denied their negative emotions was over five years. This indicates that the average woman suffering mental anguish as a result of her abortion would not even acknowledge or recognize the fact for over five years. It is thus not realistic to expect that a five-year longitudinal study would be able to yield useful data on the effect of abortion on a woman’s mental health or her overall sense of well-being.

A dear friend of mine who shares her abortion story acknowledges that she denied any problems related to her abortion for over a decade before finally admitting that abortion was at the root of some of the problems she was experiencing. Her emotional anguish would not have shown up on any of these inventories or scales, and yet she would tell you now that she was miserable in the months and years after her abortion.

Her story is an extremely accurate representation of what I’ve encountered in 6 years of working with post-abortive women and men. In those years, I’ve met very few people who expressed a need for healing or who were able to verbalize the negative impact of abortion on their lives within five years of their abortion. Their stories are all vastly different and infinitely complex. But almost to a person, the pain caused by their abortions has been hidden for years by denial and other defense mechanisms meant to shield them from the reality of abortion and the pain it brought them. Their relationships have suffered, they have turned to substance abuse, they have felt isolated, some have felt angry, some have felt emotionally numb, some carry burdens of resentment for the people who could have helped them make a different decision, most express remorse, guilt, or shame that they have been unable to express to anyone else.

These experiences are not uncommon. One needs only to read the testimonies (or these, or these) of women who suffer to know that abortion has a deep and profound impact on a woman’s mental health. That impact does not happen on a set schedule and cannot be measured using overly simplistic inventories or scales.

The reason I began writing was to give a voice to the women and men who suffer after abortion. My goal was to fight against this notion that abortion brings no adverse reactions because in addition to being untrue, the larger danger is that it serves to isolate the women and men who really do suffer after abortions. Studies such as this, which normalize non-adverse reactions, serve to pathologize the reactions of those who are experiencing emotional anguish and are perhaps in need of help.

Indeed, there is little worse for a person than hearing about how his or her experience is abnormal. Yet, that’s exactly the result this study will have on those who are struggling with the negative emotions commonly experienced after abortion. This only serves to discourage them from seeking the help they may need and further isolate them from others who may be experiencing the same thing.

Instead of making sweeping statements about how abortion has no impact on a woman’s mental health, we should acknowledge that all women grieve abortion differently, that it’s always good to inform them of the psychological risks of choosing abortion, and that adverse reactions to abortion are both non-pathological and legitimate. The women who suffer emotional anguish after abortion deserve to be heard and validated.

Perhaps most importantly, we should recognize that the complexity of the post-abortion experience is such that it cannot be captured by a single, non-comprehensive study. This is, without question, a fact that was missed by this team of researchers.