This study examines the risk of depression, suicidal ideation, and lower self-esteem following an abortion versus a delivery, with and without adjusting for important correlates. Using the National Comorbidity Survey, we tested how first pregnancy outcome (abortion vs. delivery) related to subsequent major depression, suicidal ideation, and self-esteem. Models controlling for risk factors, such as background and economic factors, prepregnancy violence experience, and prepregnancy mental health, as well as a model with all risk factors, were examined. When no risk factors were entered in the model, women who had abortions were more likely to have subsequent depression, OR = 1.53, 95% CI [1.05–2.22], and suicidal ideation, OR = 2.02, 95% CI [1.40–2.92], but they were not more likely to have lower self-esteem, B = −.02. When all risk factors were entered, pregnancy outcome was not significantly related to later depression, OR = 0.87, 95% CI [0.54–1.37], and suicidal ideation, OR = 1.19, 95% CI [0.70–2.02]. Predictors of mental health following abortion and delivery included prepregnancy depression, suicidal ideation, and sexual violence. Policies and practices implemented in response to the claim that abortion hurts women are not supported by our findings. Efforts to support women’s mental health should focus on known risk factors, such as gender-based violence and prior mental health problems, rather than abortion history.