Psychological aftereffects of abortion: the rest of the story.

Over the last decade, a consensus has been reached in the medical and scientific communities that most women who have an abortion experience little or no psychological harm. Yet a woman's ability to cope psychologically after an abortion continues to be the subject of heated debates. Vocal anti abortion advocates claim that most women who have abortions will suffer to some degree from a variant of post traumatic stress disorder called post abortion syndrome, characterized by severe and long lasting guilt, depression, rage, and social and sexual dysfunction. Why is there such a major discrepancy between the scientific con sensus and anti abortion beliefs?

Conflicting studies done over the last thirty years have con tributed to this atmosphere of confusion and misinformation. A 1989 review article that evaluated the methodology of seventy-six studies on the psychological aftereffects of abortion noted that both opponents and advocates of abortion could easily prove their case by picking and choosing from a wide range of contradictory evidence. For example, many studies--especially those done between 1950 and 1975--purport to have found significant negative psychological responses to abortion. Such studies, though, often suffer from serious methodological flaws. Some were done when abortion was still illegal or highly restricted, thereby biasing the conclusions in favor of considerable (and understandable) psychological distress. In some cases, research was based on women who were forced to prove a psychiatric disorder in order to obtain the abortion. Further, a large number of studies, both early and recent, consist simply of anecdotal reports of a few women who sought psychatric help after their abortion. In short, many studies which favor anti abortion beliefs are flawed because of very small samples, unrepresentative samples, poor data analysis, lack of control groups, and unreliable or invalid research questions.

Researcher bias on the part of scientists and physicians has also been a serious problem. In earlier times, society's views on how women "should" feel after an abortion were heavily skewed toward the traditional model of women as nurturing mothers. In one study done in 1973, postdoctoral psychology students taking psychoanalytic training predicted psychological effects far more severe than those predicted by women themselves before undergoing an abortion. This might be because traditional Freudian theory teaches that a desire to avoid childbearing represents a woman's denial of her basic feminine nature.

Some psychiatric studies, along with much of today's anti abortion literature, tend to cast women who have abortions into one of two roles: victim or deviant (although these terms are not necessarily used). Victims are coerced into abortion by others around them, in spite of their confusion and am bivalence, and against their basic maternal instincts. Deviants have little difficulty with the abortion decision, which is made casually for convenience sake. Such women have no maternal instinct and are often characterized in a derogatory or pitying fashion as selfish, callous, unfeminine, emotionally stunted, and neurotic.

Books written by anti abortion advocates that deal with post abortion effects are, by and large, heavily infected with bias. Not only is contrary evidence unrefuted, it is rarely even mentioned. Incorrect and out of date "facts" abound. The authors' pop psychology often seems to be based on little more than their own wishful projections about the nature of women and how they should feel. Here are two typical examples from essays in the anti abortion book The Psychological Aspects of Abortion (1977):

It is interesting that women who need self punishment

do not abort themselves more often.... Abortion is

done "to" the women, with her as only a passive

participant. This is further indication of masochism.

(Howard W. Fisher, "Abortion: Pain or Pleasure")

. . . sooner or later {after the abortion}, the truth will

make itself known and felt, and the bitter realization

that she was not even unselfish enough to share her

life with another human being will take its toll. If she had ever

entertained a doubt as to whether her parents and

others really considered her unlovable and worthless,

she will now be certain that she was indeed never any

good in their eyes or her own. A deep depression will

be in evitable and her preoccupation with thoughts of

suicide that much greater.

(Conrad W. Baars, "Psychic Causes and

Consequences of the Abortion Mentality")

With the advent of safe, legal, routinely performed abortions, a wealth of good evidence has come to light that is quite contrary to common anti abortion assertions. The typical abortion patient is a normal, mentally stable woman who makes a strongly resolved decision for abortion within a few days after discovery of the pregnancy and comes through the procedure virtually unscathed. Several scientific review articles--published from 1990 to 1992 in highly respected journals such as Science and American Journal of Psychiatry--support this conclusion. The reviews evaluated hundreds of studies done over the last thirty years, noting the unusually high number of seriously flawed studies and pointing out common methodological problems. Based upon the more reliable studies, all the reviews concluded that, although psychological disturbances do occur after abortion, they are uncommon and generally mild and short-lived. In many cases, these disturbances are simply a continuation of negative feelings caused by the pregnancy itself. Serious or persistent problems are rare and are frequently related to the circumstances surrounding the abortion rather than the abortion itself.

Further, many women who were denied an abortion showed ongoing, long term resentment, and their resulting children were more likely to have increased emotional, psycho' logical, and social problems in comparison with control groups of children. These differences between children widened throughout adolescence and early adulthood. Finally, many studies show that giving birth is much more likely than abortion to be associated with severe emotional aftereffects, such as post-partum depression.

The review articles largely concluded that the most frequently reported emotions felt by women immediately following an abortion (experienced by about 75 percent of women) are relief or happiness. Feelings of regret, anxiety, guilt, depression, and other negative emotions are reported by about 5 per cent to 30 percent of women. These feelings are usually mild and fade rapidly, within a few weeks. Months or years after an abortion, the majority of women do not regret their decision. In fact, for many women, abortion appears to improve their self esteem, provide inner strength, and motivate them to refocus their lives in a meaningful way.

Studies on abortion are done primarily through self report measures, however, and it is possible that some women may be reluctant to admit negative feelings after their abortion. To help quantify this, consider these figures: every year since 1977, 1.3 million to 1.6 million abortions are performed in the United States; about 21 percent of all American women between the ages of fifteen and forty four have had an abortion. These are very large numbers indeed. The American Psychological Association has pointed out that, even if only 10 percent of the millions of women who have had abortions experienced problems, there would be a significant mental health epidemic, clearly evident by large numbers of dysfunctional women requesting help. There is no evidence of any such epidemic, thereby supporting the general reliability of self report measures.

Some women who are disturbed or unhappy with their abortion decision belong to support groups like Women Explotted by Abortion and Victims of Choice. Several anti-abortion studies and books purporting to demonstrate the overall harmfulness of abortion limit their samples to the membership of such groups. Not only does this introduce an immediate and fatal flaw to their argument, it shows deliberate obfuscation on the part of the authors. This does not mean, however, that post abortion support groups are valueless to women. The very existence of such groups points to the strong need for health professionals to identify and provide extra help to women who are most at risk for developing psychological problems related to abortion. Many studies have shown that women at greater risk tend to include:

* emotionally immature teenagers

* women with previous psychiatric problems

* women aborting a wanted pregnancy for medical or genetic

reasons

* women who encounter opposition from their partner or

parents for their abortion decision

* women who have strong philosophical or religious

objection to abortion

* women who are highly ambivalent or confused about their

abortion decision and had great difficulty making it

* women who are coerced by others into having an abortion

* women undergoing second trimester abortions

In spite of psychological problems suffered by a few women after abortion, the existence of post abortion syndrome is doubted by most experts. There is little need to posit a unique disorder in this case, since abortion is not significantly different from any other stressful life experience that might cause trauma in certain people. Former Surgeon General C. Everett Koop, himself anti abortion, noted this in 1988. Unfortunately, facts, evidence, and common sense rarely get in the way of anti abortion advocates who are determined to prove that women suffer terribly from post abortion syndrome. Certainly, if this syndrome were real it would be a lethal weapon in the fight to reverse Roe v. Wade. This was, in fact, the motivation behind a 1989 surgeon general's report on the health effects of abortion on women, which was called for by former President Ronald Reagan on behalf of anti abortion leaders. Although the report was duly prepared, the surgeon general chose not to release it, apparently because it did not support the anti abortion position. Meanwhile, anti abortion literature continues to churn out the myth that women are severely harmed by abortion.

Because abortion is such a volatile issue, it is probably unrealistic to expect this aspect of the controversy to die down soon, if at all. However, by recognizing that a small subset of women may require increased counseling and support during their abortion decision and afterward, the women's community and health professionals can do much to minimize the damage wrought by the anti-abortion movement's dangerous and irresponsible campaign of misinformation.

Joyce Arthur is a freelance and technical writer from Vancouver, British Columbia. An activist in the abortion rights movement, she is the editor of the Canadian newsletter, Pro Choice Press.