After the abortion: by ceding the counseling role to pro-lifers, pro-choicers may be doing their cause more harm than good.

A stone statue of Jesus Christ cradling a child stood before the mourners. Brenda Heyworth clutched the knit baby hat and little white booties she had bought for her son, whom she lost before she ever got to know. Tears rolled down her cheeks as she sank her high heels into Woodlawn Cemetery's moist soil, muddied from the morning's rain.

"Dear Jordan," the 42-year-old read slowly from a handwritten letter, taking deep breaths to maintain her composure. "I want you to know that I have always longed to hold you in my arms. That longing will only be fulfilled when we meet in heaven. Please forgive me, and if, you can, help me to forgive myself. The knowledge that I ended your life is almost more than I can bear. If I could make the decision today, I would do it differently. It was the worst mistake and worst sin in my life. If I hadn't allowed myself to be deceived, our lives or our deaths would have been different, in our Lord's hands. I love you." Her sobbing nearly overwhelmed her as she read her signature: "Your Mother."

For Brenda Heyworth, the memorial service was the beginning of the end of the grieving process. For 22 years she had lived with the guilt of having sacrificed her son's life for personal reasons when she chose to abort her pregnancy. "I hated myself," Heyworth says. "It hurt so bad emotionally I couldn't deal with it." So when she learned of a post-abortion counseling program near her home in Joliet, Ill., she sought help.

Heyworth is one of thousands of women each year who turn to such programs to deal with the lingering emotional effects of abortion. Dozens of groups dedicated to post-abortion counseling have sprung up around the country in the past decade, which is hardly surprising considering 1.4 million women terminate pregnancies each year. What is surprising, however, is that these counselors are not affiliated with abortion clinics or family planning agencies. In fact, they aren't even pro-choice. With names such as Women Exploited By Abortion and American Victims of Abortion, these groups firmly believe abortion is immoral, yet spend their time counseling women who have chosen to abort.

At the same time, the people one might expect to offer this type of counseling -- those dedicated to abortion rights and women's health issues -- rarely provide such services. Pro-choice groups maintain that such programs do more harm than good, and claim they're unnecessary because studies show that abortion causes women little psychological harm. But behind this ambivalence lies a deeper, political motive: Pro-choice advocates fear that, by counseling women who have had abortions, they would be acknowledging that abortions can, in fact, cause depression and emotional trauma -- and thus arm the pro-life camp. But by refusing to move beyond the political rhetoric, pro-choice advocates are in some ways abandoning the very women whose rights they claim to champion.

The Politics of Grief

At the heart of the post-abortion counseling issue is an intensely politicized debate over the psychological effects of abortion. Nowadays, one can find studies to back up any side of any cause, so it's not surprising that the right has a truckload of research demonstrating abortions negative psychological effects, while the left has just as many studies proving those effects are negligible. Pro-choicers maintain that the most common reaction to abortion is relief, because the procedure ends a stressful unwanted pregnancy. Pro-life advocates, on the other hand, cite evidence for what they call post-abortion stress or "Post-abortion Syndrome," whose symptoms are said to include abortion flashbacks, relationship problems, guilt, severe depression, low self-esteem, substance abuse, and even suicidal tendencies. They point to a 1985 doctoral dissertation by University of Minnesota psychologist Anne Speckhard, who compared post-abortion stress to the Post-traumatic Stress Disorder that afflicts many Vietnam veterans. Many women, wrote Speckhard, suffer flashbacks and hallucinations, while others report intense nightmares related to the experience, such as images of discarded fetuses in garbage heaps or babies trying to locate their mother.

The debate over abortion's psychological impact surfaced as a political issue in the late 1980s. As prolife groups realized they were losing the abortion battle on legal grounds, they began trying to scare women away from the procedure by painting it as a threat to women's health, both physically and psychologically. At the urging of such groups, in 1987 President Reagan asked then-Surgeon General C. Everett Koop to produce a report on the medical and psychological impact of abortion. Koop reviewed more than 200 studies on the subject. But upon completing the report in January l989 he refused to release it, saying that the research in the area was too flawed for him to draw any solid conclusions. "At this time, the available scientific evidence ... simply cannot support either the preconceived beliefs of those pro-life or those pro-choice," Koop wrote in a letter to Reagan.

Since Koop refused to release his findings, the American Psychological Association created a panel to produce its own report. The panel examined the same studies Koop had and in April 1990 concluded that while "some women experience severe distress or psychopathology after abortion and require sympathetic care ... the development of significant psychological problems related to abortion is minuscule from a public health perspective." Pro-life groups criticized the findings as politically biased because the members of the APA panel were pro-choice. They also said that studies done by pro-choicers are flawed because they're based on interviews with women within weeks of their abortions, whereas most symptoms of post-abortion stress don't appear until months or years later, because women repress their pain at first.

To address this flaw in the research, Koop called for a long-term, multimillion-dollar national study of the issue. But Reagan soon left office, and the issue was forgotten. Pro-life researchers believe Koop's request fell victim to politics, accusing pro-choice advocates of suppressing information that shows the negative effects of abortion. "Since they already have the political advantage so to speak, they're better off not to see the study done at all," says David Reardon, director of the pro-life Elliot Institute in Springfield, Ill. Pro-choice researchers counter that such a study would simply be a waste of resources. "Frankly, I think most researchers don't think it's an important enough question because there's so little evidence of it," says psychiatrist Nancy Adler, the lead author of the APA report. "Given that 1.5 million women have abortions every year, if there were such a thing as post-abortion syndrome, you would expect that the doors of mental health professionals would be being broken down."

But just because a woman doesn't suffer from an actual "syndrome" doesn't mean an abortion hasn't caused her grief. Even some studies by pro-choice researchers indicate that women often have difficulty coping with abortion. One of the studies cited by the APA panel, for example, found that 17 percent of women felt guilt after the procedure. A more neutral 1989 survey by the Los Angeles Times found that 56 percent of women experienced "a sense of guilt about having had an abortion," and 26 percent said they "mostly regret the abortion." Perhaps most significantly, even Planned Parenthood acknowledges in its abortion fact sheet that up to 10 percent of women experience "depression of a lingering nature"

"There is, with a pregnancy, the possibility of a human life," says Nada Stotland, a pro-choice Chicago psychiatrist who has testified in court as an expert on this issue. "And when that possibility is then wiped out, it's a loss. It's always a loss. I think feelings of grief are universal, but that's not a syndrome."

Still, relying just on Planned Parenthood's figure, we can safely estimate that, with 14 million abortions performed each year, up to 140,000 women will experience "lingering" depression. This may be a minority of those who have, abortions, but it is hardly a "minuscule" number. Certainly, it's enough to warrant the need for post-abortion counseling.

The Counseling Wars

Seeing political opportunity, pro-life advocates have opened their arms to these women, launching dozens of post-abortion counseling programs across the country, including ones run by the National Right-to-Life Committee and the Catholic dioceses. In 1994, the far-right Focus on the Family went so far as to sponsor a national post-abortion recovery summit, where many of these groups met and discussed their various counseling methods.

The philosophy behind the pro-life counseling is that abortion is a death experience that men and women need help resolving. Counselors say the people involved suffer pain, depression, and unresolved grief -- all magnified because they suffer silently. Thus the healing process requires individuals to acknowledge that a death has occurred and that grieving and forgiveness of their "sin" are necessary. In order to heal, the theory goes, a woman must personify the "baby" and accept its death before she can move on. That is why most recovery programs end by having the woman name the child and hold a memorial service.

Brenda Heyworth says her memorial service for Jordan -- the culmination of a 10-step recovery process run by Victims of Choice -- was the key to unlocking her grief "It was very emotional, and it was very difficult at the time, but looking back at it, it was very necessary," says Heyworth. "Without it, there would be no sense of closure." Heyworth believes the Victims of Choice counseling program has made her a better person, helping her regain control of her feelings and her life. "The most horrible thing is to really sit down and talk about it and face it honestly and realize that as a mother, you killed your child," says Heyworth, who still cries when recalling her abortion experience. "I had to feel all that pain before I could get beyond. It's not as though the pain is gone or I don't think about it, but I don't hate myself like I did."

The AAA Women's Services in Chattanooga, Tenn., a pro-life organization, has taken the mourning idea a step further by dedicating the National Memorial for the Unborn, a 50-foot black granite wall surrounded by a small garden and a "pool of tears." So far, more than 400 women from around the country have placed brass name plates on the wall to memorialize their aborted children.

Many pro-choice advocates accuse pro-life counseling groups of being politically motivated, saying they only counsel the women to make them feel guilty and use them as evidence of abortion's harmful effects. "I think sometimes those women are exploited, because so often those groups are trying to harness the women's pain for political purposes," says Ann Baker, who has been the director for counseling for 20 years at Hope Clinic for Women in Granite City, Ill. "They will suggest they go on TV shows and that they get really politically active and get out on the sidewalks and start screaming to other women how they had their abortions and were destroyed by it. I think that's really exploitive. That isn't to me good counseling."

Pro-life groups deny such accusations. "We're there simply to say, `All right, you've been there, this is what's done, this is what's happened to you, now what are you going to do with it?" says Victims of Choice director Elizabeth Verchio. Besides, she adds just because many women who complete counseling elect to speak out against abortion does not mean the counseling is politically motivated.

The programs' politics aside, many psychiatrist are concerned that the counseling methods used are harmful to women because they encourage feelings of guilt. "I think to have a place for women who are having feelings post-abortion is very important," says Adler, a professor of psychiatry at the University of California at San Francisco. "But if it's run by a political group, I would be concerned that it would be fostering guilt. If the same groups that are trying to prove that post-abortion trauma syndrome exists say, `Well, you must be experiencing trauma,' it may increase the likelihood that the women will experience it."

But if they're so concerned about the ulterior motives of pro-lifers, why aren't pro-choice advocates working to bring women an alternative? At present, post-abortion counseling remains almost exclusively in the hands of abortion opponents. The only listings for such counseling found in searches of telephone books and the Internet were for programs run by pro-lifers. Planned Parenthood of New York City had no information on the subject, but suggested calling the Women's Health Line, which referred the call to the Jewish Board of Family and Children's Services. A counselor there said they didn't offer post-abortion counseling, but suggested the Karen Horney women's clinic. The clinic had no post-abortion services or information to offer, and suggested calling Planned Parenthood. "I've been trying to find places where we can refer people that would be appropriate and helpful, but there's not a lot out there," says Vicki Breitbart, the director of clinical education for Planned Parenthood of NYC. "We haven't found anything so far."

The situation is similar across the country. "Most clinics will say, `We have a volunteer staff to do our counseling, we do decision-making counseling, we do birth-control counseling, but that's all we do, and that's all we can do,'" says Ava Torre-Bueno, a psychotherapist who served as director of counseling for Planned Parenthood of San Diego for 10 years. Some clinics do require follow-up visits after abortions, but primarily for physical check-ups.

Many pro-choicers will privately acknowledge the potential value of post-abortion counseling, but feel the political risks are too high to make it a public priority. "It would be nice if we could talk more about it, but unfortunately the anti-choice groups make that scary to do," says Stotland. "Those of us who are in favor of choice have learned to be very hyper, because there are groups so patently, overtly ready to jump on any data and misuse it, to use it to convince legislatures decrease access or legality. So it's very hard for any pro-choice-oriented professionals to work up a head of steam for organizing services when the data might be taken out of context the next second."

And so, having fought for so long to define the abortion debate in terms of legal rights and clinical procedures, pro-choicers have essentially ceded the moral and human aspects of the issue to the pro-life camp. In fact, even admitting that abortion can be emotionally difficult is considered anti-feminist. Author Naomi Wolf, whose feminist credentials are hard to question, was accused of betraying her sex after she argued in an October 1995 issue of The New Republic that abortion-rights backers are guilty of "self-delusions, fibs, and evasions" and that "the death of a fetus is a real death."

The politics behind the dearth of counseling options gives little comfort to women who need help. Two years after her abortion, 24-year-old Andrea still suffers feelings of grief and guilt. "I have been trying to find a support group for women who have experienced abortions," she says, "but so far the only one I have found is by one of those Crisis Pregnancy Centers, with a rather judgmental and religious base, which is not really what I am looking for. These are the same people that offer free pregnancy testing but then make you watch a propaganda film about abortion, and I don't believe that is right."

Pro-choice advocate Torre-Bueno agrees and wants women's groups to seize the issue back from the grasp of pro-lifers. After encountering many women who needed help coping with post-abortion emotions, Torre-Bueno left Planned Parenthood to counsel such women herself Torre-Bueno doesn't believe steps like memorial services are necessary in order for women to heal. All that's needed, she says, is for a counselor to guide the individual and give her permission to grieve. Many women feel as though they have no right to grieve since they made the decision to have the abortion, she explains. "Women come to me saying, `I chose to do this, therefore I have no right to grieve.' My question is, `Who says?' You can choose it, and you can grieve. These are feelings."

Torre-Bueno recently wrote a book on how to cope with the emotional after-effects of abortion, and has been teaching post-abortion counseling workshops at family-planning clinics around the country. "My real mission in life is to help make people in family planning recognize that some women have difficulty after an abortion and that we can help them" says Torre-Bueno. "And to make them realize doing so is in no way contrary to being an abortion provider, to being pro-choice."

One prominent women's advocate who shares Torre-Bueno's beliefs is Naomi Wolf Wolf suggests that offering post-abortion counseling could not only help individuals, but actually advance the pro-choice cause. "I think it would be, among other things, a public relations coup, because ... the sense of this being a conveyor belt or an assembly line would be done away with," says Wolf. "The sense of there being a compassionate embrace of the whole woman in the entirety of the trauma would be much greater. I think that that's why people turn against the pro-choice movement, because they are not sure that there's a compassionate heart encompassing the situation for every woman. I think that the gratitude that women would show for an organization that was there for them that way after the abortion would be strong."

For now, Wolf and Torre-Bueno hold the minority opinion on this issue, but there are signs that may change. Just last year, Torre -Bueno was asked to hold a workshop on post-abortion counseling at the National Abortion Federation conference. "I hope we can get to the point where we can address this issue," she says, "and have post-abortion care be just another part of taking care of our clients. Just think, if a woman got an infection after an abortion, we would have her pumped so full of antibiotics it wouldn't be funny. And I think that the thinking has got to shift so we can see psychological problems in the same light."

Because abortion is such a sensitive political issue, it may indeed be difficult for pro-choice advocates to discuss its psychological impact truthfully without opponents pouncing. But by ceding the post-abortion counseling issue to the pro-life activists, pro-choicers risk positioning themselves as interested only in the politics of the abortion issue, rather than in the needs of the people it affects. As things stand, women in need of support after an abortion may be inclined to either repress their problems, creating the potential for bigger trouble down the road, or turn to one of the many pro-life groups that offer such aid. Clearly, it's impossible to predict whether, as Wolf suggests, offering post-abortion counseling options would actually advance the pro-choice cause. But it would certainly help the women the movement claims to represent, many of whom now suffer in silence.