Emotions and decision rightness over five years following an abortion: An examination of decision difficulty and abortion stigma.

Background: Despite weak theoretical grounding and ample research indicating women feel high levels of decision rightness and relief post-abortion, claims that abortion is inherently stressful and causes emergent negative emotions and regret undergirds state-level laws regulating abortion in the United States. Nonetheless, scholarship does identify factors that put a woman at risk for short-term negative postabortion emotions-including decision difficulty and perceiving abortion stigma in one's community-pointing to a possible mechanism behind later emergent or persistent post-abortion negative emotions.

Methods: Using five years of longitudinal data, collected one week post-abortion and semi-annually for five years from women who sought abortions at 30 US facilities between 2008 and 2010, we examined women's emotions and feeling that abortion was the right decision over five years (n=667). We used mixed effects regression models to examine changes in emotions and abortion decision rightness over time by decision difficulty and perceived community abortion stigma.

Results: We found no evidence of emerging negative emotions or abortion decision regret; both positive and negative emotions declined over the first two years and plateaued thereafter, and decision rightness remained high and steady (predicted percent: 97.5% at baseline, 99.0% at five years). At five years postabortion, relief remained the most commonly felt emotion among all women (predicted mean on 0-4 scale: 1.0; 0.6 for sadness and guilt; 0.4 for regret, anger and happiness). Despite converging levels of emotions by decision difficulty and stigma level over time, these two factors remained most important for predicting negative emotions and decision non-rightness years later.

Conclusions: These results add to the scientific evidence that emotions about an abortion are associated with personal and social context, and are not a product of the abortion procedure itself. Findings challenge the rationale for policies regulating access to abortion that are premised on emotional harm claims.