It is becoming increasingly difficult for pro-abortion
forces to deny that abortion harms women. Often enough, however, those who
do try to deny it invoke a letter which then Surgeon General C. Everett Koop
sent to President Reagan in 1989, reporting to the President on the question
of the health effects of abortion on women. They claim he told the President
there were no negative effects of abortion.
The key point to realize about the letter, reprinted below, is that it is
non-conclusive. The Surgeon General did not say there were no
negative effects of abortion. He said that there were not enough
properly-conducted studies to answer the question, and in fact proposed to the
President that comprehensive research be done. One of the key problems, the
Surgeon General noted, is the lack of record-keeping by abortion clinics, and
the problem that so many women who had abortions deny having had them (and
therefore, of course, cannot speak of the connection between their abortion and
Research on the scale that was recommended by Dr. Koop in 1989 has still not
yet been funded or conducted.
What this means, therefore, is that when abortion supporters make such
assertions as "abortion is safer than childbirth" or that there are only
"minimal negative effects" from the procedure, they have no basis for saying
what they are saying.
Evidence continues to mount, however, that the physical and psychological
harm of abortion is widespread, and anyone committed to women's health
should be paying attention to the studies that continue to be released, and
should be calling for the kind of comprehensive analysis which Dr. Koop
recommended to President Reagan.
A very helpful resource, just published, is Detrimental Effects of
Abortion by Thomas Strahan. This book is the only publication to list, all
in one place, all the major statistically significant studies on abortion. It
includes brief descriptions of the findings of the studies. Topics include
abortion decision-making, standard of care, adolescents and abortion, and the
physical, psychological, and social effects of the procedure. (ISBN Number
0-9648957-0-6, Published in 2001 by Acorn Books/Elliot Institute, PO Box 7348,
Springfield, IL 62791-7348, Phone 217-525
The letter from C. Everett Koop follows:
January 9, 1989
Mr. Ronald Reagan
The President of the United States
The White House
1600 Pennsylvania Avenue, NW
Washington, DC 20500
Dear Mr. President:
On July 30, 1987, in remarks at a briefing for Right to Life leaders, you
directed the Surgeon General to prepare a comprehensive report on the health
effects of abortion on women. It was clear from those remarks that such a report
was to cover the mental, as well as the physical, effects of abortion. A review
of the scientific literature, the expertise of the Public Health Service, and
the experience of national organizations with an interest in this issue form the
basis for my conclusion.
The health effects of abortion on women are not easily separated from the
hotly debated social issues that surround the practice of abortion. Therefore,
every effort has been made to eliminate the bias which so easily intrudes even
into the accumulation of scientific data. In this study I have purposely avoided
any personal value judgement vis-à-vis abortion as a social issue.
I have approached this task as I did in writing the AIDS report which you
requested in 1986. Scientific, medical, psychological, and public health experts
were consulted. I met privately with 27 different groups which had
philosophical, social, medical, or other professional interests in the abortion
issue. The process involved groups such as the Right to Life National Committee,
Planned Parenthood Federation of America, the U.S. Conference of Catholic
Bishops, the American College of Obstetricians and Gynecologists, and women who
had had abortions.
In summary of the situation, each year approximately 6 million women become
pregnant; of that number 54 percent or 3.3 million of those pregnancies are
unplanned. Over 1.5 million women, or 25 percent of those pregnant, elect
abortion each year. Since the legalization of abortion in 1973, over 20 million
abortions have been performed. Even among groups committed to confirming a
woman's right to legal abortion there was consensus that any abortion
represented a failure in some part of society's support system, - individual,
family, church, public health, economic, or social.
At the time the report was requested, there were those advising you and
intimately involved with the social issues of abortion who truly believed that
such a report could be put together readily. In the minds of some of them, it
was a foregone conclusion that the negative health effects of abortion on women
were so overwhelming that the evidence would force the reversal of Roe v. Wade.
There were also others who truly believed differently. While they acknowledge
that any surgical procedure done 1.5 million times a year may have some negative
health effects on women, in their minds the positive effects of abortion -
release from the unwanted pregnancy - far outweighed the perceived negative
It is difficult to label the opposing groups in the abortion controversy.
Those against abortion call themselves pro-life. On the other hand, those who
are not pro-life say the are not pro-abortion; rather, they refer to themselves
as pro-choice and supporters of a woman's right to choose abortion.
It is also true that some who are pro-choice are personally opposed to
abortion. It is not clear to them where the lines should be drawn between the
right of the fetus and the right of the mother. So the pro-choice forces are not
Nor are the pro-life forces monolithic. Many ardent pro-life individuals who
are dedicated to preserving the life of the fetus do not consider contraception
to be ethically, morally, or religiously wrong. But others in the pro-life camp
do; indeed, some equate contraception with abortion.
I believe that the issue of abortion is so emotionally charged that it is
possible that many who might read this letter would not understand it because I
have not arrived at conclusions they can accept. But I have concluded in my
review of this issue that, at this time, the available scientific evidence about
the psychological sequelae of abortion simply cannot support either the
preconceived beliefs of those pro-life or of those pro-choice.
Today considerable attention is being paid to possible mental health effects
of abortion. For example, there are almost 250 studies reported in the
scientific literature which deal with the psychological aspects of abortion. All
of these studies were reviewed and the more significant studies were evaluated
by staff in several of the Agencies of the Public Health Service against
appropriate criteria and were found to be flawed methodologically. In their view
and mine, the data do not support the premise that abortion does or does not
cause or contribute to psychological problems. Anecdotal reports abound on both
sides. However, individual cases cannot be used to reach scientifically sound
conclusions. It is to be noted that when pregnancy, whether wanted or unwanted,
comes to full term and delivery, there is a well documented, low incidence of
adverse mental health effects.
For the physical situation, data have been gathered on some women after
abortions. It has been documented that after abortion there can be infertility,
a damaged cervix, miscarriage, premature birth, low birth weight babies, etc.
But, I further conclude that these events are difficult to quantify and
difficult to prove as abortion sequelae for two reasons. First, these events are
difficult to quantify because approximately half of abortions are done in
free-standing abortion clinics where records which might have been helpful in
this regard, have not been kept. Second, when compared with the number of
abortions performed annually, 50 percent of women who have had an abortion
apparently deny having had one when questioned. Further, these events are
difficult to prove, as sequelae of abortion because all of these same problems
can and do follow pregnancy carried to term or not carried to term, - indeed can
occur in women who have never been pregnant previously. Clearly, however, the
incidents of physical injury is greater in instances where abortions are
performed or attempted by those not qualified to do them or under less than
I have consulted with the National Center for Health Statistics and Centers
for Disease Control about the design of appropriate studies which could answer
the questions dealing with the physical and psychological effects of abortion.
There has never been a prospective study on a cohort of women of
child-bearing age in reference to the variable outcomes of mating. Such a study
should include the psychological effects of failure to conceive, as well as the
physical and mental sequelae of pregnancy, - planned and unplanned, wanted and
unwanted - whether carried to delivery, miscarried, or terminated by abortion.
To do such a study that would be above criticism would consume a great deal of
time. The most desirable prospective study could be conducted for approximately
$100 million over the next five years. A less expensive yet satisfactory study
could be conducted for approximately $10 million over the same period of time.
This $10 million study could start yielding data after the first year.
There is a major design problem which must be solved before undertaking any
study. It is imperative that any survey instrument be designed to eliminate the
discrepancy between the number of abortions on record and the number of women
who admit having an abortion on survey. It is critical that this problem of
"denial" be dealt with before proceeding with further investigations.
That is where things stand at this moment. I regret, Mr. President, that in
spite of a diligent review on the part of many in the Public Health Service and
in the private sector, the scientific studies do not provide conclusive data
about the health effects of abortion on women. I recommend that consideration be
given to going forward with an appropriate prospective study.
C. Everett Koop, M.D., Sc.D.
Surgeon General, U.S.P.H.S