Abortion

Extensive research has documented how traumatic stress can significantly alter individuals= lives. Traumatic stressors are strong predictors of PTSD (Foy, Osato, Houskempt & Neuman 1992). While the prevalence of PTSD has been estimated to affect up to 12% of the U.S. population (Breslau, Davis, Andreski & Peterson 1991), limited research has examined the role of elective abortion as a traumatic stressor causing symptoms of PTSD.

Most trauma victims encounter feelings of horror or terror at the time of the traumatic episode. Bagarozzi has reported that women who came for mental health treatment were in complete denial that they had experienced an abortion and that indeed it was a traumatic and horrific experience for them. AThis denial was seen as a major contributing factor to the development of post traumatic stress in these women@ (1993:67). Clinical research findings highlighting the power of denial before, during and after an abortion have also been reported by Torre-Bueno (1996). As a pro-choice advocate and long-time Planned Parenthood abortion counselor, her assertion is all the more compelling:

AI believe passionately that I can be supportive of every woman=s right to make her own pregnancy decisions, and still recognize the fact that her decision may cause her tremendous suffering. While many women do not have emotional or spiritual difficulty after an abortion, I know from twenty years of experience working with women before, during, and after abortions, that many women have more emotional and spiritual pain after abortion than the current research suggests.@ (1996:3)

In another clinical study, pro-choice psychotherapists De Puy and Dovitch (1997:13-14) reported that 10% of women experience Asevere emotional trauma@ following abortion. According to these clinician/researchers: AMany women acknowledge a feeling of relief after their abortion, yet are understandably upset by facets of the experience that they had never anticipated. Many are distressed and unaware of the ways in which their choice has changed their lives and, sometimes, the lives of those around them.@

In a study of 80 women in the U.S., Barnard (1990) used standardized Post-traumatic stress disorder (PTSD) instruments and found: 3-5 years following the abortion, l8% of the sample met the full diagnostic criteria for Post-traumatic stress disorder (PTSD) and 46% displayed high stress reactions to their abortion. Her findings were not explained by religiosity as 68% reported that at the time of the abortion they had little to no religious involvement.

Subsequently, similar findings were also reported by Hanley et al. (1992) in a comparison study of women distressed postabortion which also used standardized PTSD instruments and interviews. They found: "Women who were distressed following an abortion scored significantly higher than the non-distressed group on PTSD symptoms of intrusion and avoidance.@ The investigators evaluated whether some women in outpatient mental health treatment with a presenting problem of postabortion distress met Diagnostic & Statistical Manual of Mental Disorders III Revised (DSM-III-R) criteria for the Post-traumatic stress disorder (PTSD) categories of intrusion, avoidance, and hyperarousal. One hundred and five women were administered the SCID-PTSD module, the Impact of Event Scale, as well as the Social Support Questionnaire and the Interview for Recent Life Events, in addition to completing a semi-structured interview. The researchers concluded: "the data from this study are suggestive that women can report abortion-related distress similar to classic PTSD symptoms of intrusion, avoidance and hyperarousal and that these symptoms can be present many years after the abortion.@

Post-traumatic reexperiencing has also been documented in anniversary reactions. In a small study conducted by Franco et al. (1989:154), 30 out of 83 women reported experiencing anniversary reactions that included intense emotional psychosomatic pain. They noted: "Unresolved grief and preexisting dysphoria have been suggested as increasing the likelihood of anniversary reactions."

Another recent study compared two groups of 25 women who elected abortion: those who identified themselves as distressed (D) and those who reported more neutral or non-distressing responses (ND). PTSD symptomatology was found in the distressed group: changes in male-female relationships, suppression of feelings/thoughts about the abortion, reactions to catalytic events that aroused thoughts/feelings about the abortion, trying to get pregnant again, becoming promiscuous, and avoiding reminders of babies. More than two out of three women in Group D were distinguished by reports of "suppression" or "denial" of parts of the abortion experience or negative emotional reactions to it. Additionally, women in the distressed group were more than twice as likely to report abortion trauma related symptoms on the Impact of Event Scale than those in the non-distressed group (Congleton and Calhoun 1993).

In this same study, women who identified themselves as distressed postabortion indicated feeling: a sense of loss/emptiness (48%); shock/detachment (28%); anger toward partner/others (24%); depression (20%); loneliness, betrayal, loss of self-worth, and relief (16%); guilt and sorrow (12%); confusion (8%); fear of dying and suicidal thoughts (4%). Interestingly, in the group of women who elected abortion and did not believe they were distressed, 20% had symptoms of depression, an equivalent percentage experienced by the distressed group. The authors concluded: (1) for some women, abortion is a "critical event" which produces high levels of psychological distress; (2) informed consent should insure accurate information is conveyed about physical pain and possible negative and positive emotional reactions; and (3) when dealing with depression among women, exploring reproductive history for unresolved emotional reactions to pregnancy termination may prove beneficial.

In a large scale prospective cohort study (N=13,261, of whom 6410 experienced a pregnancy termination) conducted in the United Kingdom, Gilchrist et al. (1995) found evidence of the traumagenic nature of abortion when examining relative risks of suicidal behavior in women who had previously terminated their pregnancy, and who had no prior history of psychiatric illness. A recent study in Finland of all deaths of women of childbearing age concluded: AOur data clearly show, however, that women who have experienced an abortion have an increased risk of suicide which should be taken into account in the prevention of such deaths@ (Gissler, Hemminki and Lönnqvist 1996:8).

A recent Swedish study examined emotional distress (ranging from 1 month to 12 months follow-up) after abortion at a university hospital. Risk factors identified were: living alone, poor emotional support from family and friends, adverse postabortion change in relations with partner, underlying ambivalence or adverse attitude to abortion, and being actively religious. The researchers concluded: AThus, 50-60% of women undergoing induced abortion experienced some measure of emotional distress, classified as severe in 30% of cases.@ (Soderberg, Janzon & Sjoberg, 1998:173)

In a study just published, Reardon & Ney (2000) examined the mental health risks of abortion relating to subsequent substance abuse. They found that women who aborted a first pregnancy were five times more likely to report subsequent substance abuse than women who carried to term, and they were four times more likely to report substance abuse compared to those who suffered a natural loss of their first pregnancy due to miscarriage, ectopic pregnancy or stillbirth.

Rue (2001) applied a trauma sensitive perspective to the understanding of how women coped with pregnancy losses, particularly induced abortion. He conducted a transnational retrospective descriptive study of 765 women in the United States and Russia. In this study, the average number of years since the abortion was 11 years for American women and 6 years for Russian women. Similar to preceding studies, the most common positive emotional outcome for women in both countries was relief with 11% of U.S. women attributing this positive feeling to their abortion compared to 8% in Russia. In the U.S. sample, 58% of women who aborted experienced 6-10 Post-traumatic stress disorder symptoms following the abortion, compared to 12% in the Russian sample. Overall, the findings indicated that women in the U.S. sample were more likely to experience Post-traumatic stress related symptoms following their abortion than Russian women. Using Pearlman=s traumatic stress scale (TSI), Russian women who obtained an abortion had higher mean total TSI scores than U.S. women (276 vs. 260), indicating considerable disruption of cognitive schemas.

Cougle, Reardon & Coleman (2001) employed the National Longitudinal Survey of Youth (NLSY) a general purpose study which has interviewed 6283 women since 1979. They found using standardized assessments: ACompared to post-childbirth women, aborting women (n=735) were found to have significantly higher depression scores as measured an average of 10 years after their pregnancy outcome. Controlling for age, total family income, and locus of control scores prior to the first pregnancy event, post-abortive women were found to be 41% more likely than non-aborting women to score in the >high risk= range for clinical depression. In response to a self-assessment question, aborting women were 73% more likely to complain of >depression, excessive worry, or nervous trouble of any kind= an average of 17 years postabortion.=@

And finally, in the first record linkage study conducted in the U.S. on 173,279 low income women who had aborted, Reardon et al. (2001) found the following: ACompared to women who delivered, those who aborted had a significantly higher age adjusted risk of dying during the subsequent eight years from suicide (2.54), accidents (1.82), and all causes (1.62). Higher suicide rates were most pronounced in the first four years. Notably, the average annual suicide rates per 100,000 in our sample, 3.0 for delivering women and 7.8 for aborting women, bracketed the national average suicide rate of 5.2 for women ages 15-44.@

In addition to the above, there are a number of reviews of the literature on postabortion sequelae that are instructive (Speckhard & Rue, 1992; Rue, 1995; Speckard, 1997; Ney & Wickett, 1989; and Angelo, 1992).

Contrary to the opinions expressed by pro-choice advocates, abortion is not a benign experience in the lives of women and girls. Several studies have reported that following an abortion, women are likely to experience continuing depression, lowered life satisfaction, decreased decision satisfaction, and a diminished positive outlook. (Russo & Denious, 2001; Major et al., 2000; Miller et al., 1998; Reardon & Cougle, 2002) Nada Stotland (1998), has recently acknowledged the “psychological complexities of induced abortion” in a woman’s reproductive history, that abortion is not insignificant, and that it can be contributory to subsequent emotional maladjustment necessitating treatment. Furthermore, Stotland (1998: p. 967) rightly cautions that politics can adversely eclipse both the reality of a “woman’s authentic, multilayered emotional experience” with abortion, as well as the perception of the treating therapist.”

In another study, pro-choice psychotherapists DePuy and Dovitch (1997, pp.13-14) reported that 10% of women experience Asevere emotional trauma@ following abortion, and that this outcome typically follows from preabortion emotional fragility. According to these clinician/researchers: AIn reality, women who find themselves confronted with the decision to abort do not always walk away from the experience unscathed, even though they move forward with their lives. . . Many have been unwilling to speak of their choice in a world that is openly conflicted about abortion. Many are wracked with religious guilt and a fear that they have killed an unborn child. These reactions are not felt on the day of the abortion, but may arise over time – sometimes years later – as women reflect back upon their experience.” (p. 14) “Women further hesitate to mourn their terminated pregnancies because society does not recognize abortion as a loss.” (p. 161)

The association between greater negative emotional reactions to abortion and higher levels of shame, secrecy, and thought suppression has been reported by Major et al., 1999. These same researchers, who have expressed political support for abortion, have also found that a small minority of women experience Post-traumatic stress disorder (PTSD) when abortion is the identified traumatic stressor event associated with PTSD symptoms (Major et al., 2000). Examining a nationwide cohort of 12,686 American youths aged 14-21, Reardon and Cougle, (2002b) conducted secondary data analysis of the National Longitudinal Survey of Youth and found young women who elected to abort were more likely to be at higher risk for clinical depression than women who delivered (OR=1.39, 95% CI: 1.02 – 1.90).

The most severe mental health risk from induced abortion is suicide. When compared to women who have not aborted, women who have elected abortion are more likely to have considered suicide (Commonwealth Fund, 1993; Gissler, 1996). Russo & Denius (2001). reported that women who had an abortion were twice as likely as non-aborting women to experience suicidal thinking after their abortion. In another study, 29% of one sample of adolescent aborters made suicidal gestures. (Campbell, N., Franco, K. & Jurs, 1988). In one state study, if a girl had undergone an abortion within the last 6 months she was 10 times more likely to have attempted suicide than if she had not had an abortion in that period. (Garfinkel, 1986) Another study found the risk of suicide for adolescents can increase during the “anniversary period” of the abortion or around the date when the pregnancy would have gone to term (Tischler, 1981). Finally, in a large European study of unplanned pregnancies in the practices of family physicians, those who aborted or desired to abort but were denied, demonstrated an increased incidence of deliberate self-harm behavior, most often overdoses (Gilchrist et al, 1995).

Note: You can contact Dr. Rue at the Institute for Pregnancy Loss, 1591 Scottridge Lane, Jacksonville, FL, 32259. Phone: 904-342-0352. Fax: 904-342-0353.

References

Angelo, J. (1992) Psychiatric sequelae of abortion: The many faces of Post-Abortion Grief. Linacre Quarterly, 59:2, 69-80.

Bagarozzi, D. (1993) Post traumatic stress disorders in women following abortion: Some considerations and implications for marital/couple therapy. International Journal of Family and Marriage 1:51-68.

Barnard, C. (1990) The Long Term Psychosocial Effects of Abortion. Institute for Pregnancy Loss. Stratham, New Hampshire.

Breslau, N., Davis, G., Andreski, P. & Peterson, E. (1991) Traumatic events & Post-traumatic stress disorder in an urban population of young adults. Archives of General Psychiatry 48: 216-222.

Congleton, G. and Calhoun, L. (1993) Post-abortion perceptions: A comparison of self-identified distressed and non-distressed populations. International Journal of Social Psychiatry 39:255-265.

Conklin, M. and O=Connor, B. (1995) Beliefs about the fetus as a moderator of postabortion psychological well-being. Journal of Social Psychiatry 39: 76-81.

Cougle, J., Reardon, D. & P. Coleman (2001) Depression associated with abortion and childbirth: A long-term analysis of the National Longitudinal Survey of Youth. Presented at the 1^st World Congress on Women=s Mental Health, Berlin, Germany and published in Archives of Women=s Mental Health, Vol. 3/4, Supplementum 2.

Foy, D., Osato, S., Houskamp, B. & Neuman, D. (1992) Etiology of Post-traumatic stress disorder. In P. Saigh (ed.), Post-traumatic Stress Disorder (pp. 28-49). Boston: Allyn & Bacon.

Franco, K. et al. (1989) Anniversary reactions and due date responses following abortion. Psychotherapy and Psychosomatics 52:151-154.

Gilchrist, A., Hannaford, P., Frank, P., and Kay, C. (1995) Termination of pregnancy and psychiatric morbidity. British Journal of Psychiatry 167:243-248.

Gissler, M., Hemminki, E., and Lönnqvist, J. (1996) Suicides after pregnancy in Finland, 1987-94: Register linkage. British Medical Journal 313:1-11.

Ney, P. & Wickett, A. (1989) Mental health and abortion: Review and analysis. Psychiatric Journal of the University of Ottawa, 14:4, 506-516.