Adverse Psychological Reactions - A Fact Sheet

Introduction

This Project Rachel program is intended to reach out in the Year 2000 -- a Jubilee year of forgiveness and reconciliation in the Christian tradition -- to women experiencing grief from the loss of a child by abortion, and to offer them reconciliation and healing. It is based on the Catholic Church's 16 years of experience counseling women who have come to our Project Rachel programs, suffering because of their abortions.

The Project Rachel messages do not speak about, or for, those women who have experienced only relief or satisfaction after abortion. But they can and do reflect -- in their own words -- women who have suffered because of their abortions.

This outreach is not about the debate in the medical literature regarding whether or not abortion has predictable, adverse psychological consequences for women. At the same time, it would be naive to believe that the visibility of Project Rachel's messages will not cause some discussion about abortion's psychological effects. So, it seems necessary to say a few words about the scientific research in this area.

A Vast Literature on Post-Abortion Response

There is a vast -- indeed daunting -- literature on the topic of psychological consequences of abortion for women. At first glance it seems to be composed predominantly of two kinds of articles: those claiming that there is an identifiable "post abortion syndrome" suffered by women who have abortions, and those claiming that abortion poses virtually no threat of adverse psychological consequences. A closer review of this literature, however, reveals more. Not a precise catalog of responses to abortion experienced by a precise percentage of women, but significant findings in this vein -- even by those who hold generally that abortion's availability benefits women. Findings which help explain why programs offering help to women suffering after abortion receive thousands of calls each year:

1. A long history of concern

The possibility that abortion might cause adverse psychological consequences to women has been recognized by researchers for over 50 years. At a 1942 medical conference a psychiatry professor at Yale University, Theodore Lidz, MD, reported this. "At times the guilt over the abortion draws into its dragnet many old guilts, leading to severe depression. In other instances, the overwhelming guilt cannot be managed and leads to pathologic projection. The immediate assimilation of the traumas is no assurance of successful integration: in later years new guilts may reawaken the dormant guilt, and one sees women at the menopause suffering torment over an abortion performed many years before."[1]

2. International scope

Academic researchers in a great variety of countries have investigated women's psychological reactions to abortions, and a number have reached very similar conclusions. Their studies appear straightforward, and their conclusions are not embedded in tortured language about the possible political use of their findings in the abortion debate. Possibly this is because the abortion debate in other countries is less complex than here in the United States. Elsewhere, abortion policy is more often decided by the populace, through their elected leaders; in the United States, it was made by the U.S. Supreme Court in one decision. Foreign academic research is cited below, throughout.

3. The state of current research

In the words of the editor of the Journal of Social Issues, Gregory Wilmoth: "There is now virtually no disagreement among researchers that some women experience negative psychological reactions post-abortion. Instead the disagreement concerns the following: (1) the prevalence of women who have these experiences..., (2) the severity of these negative reactions..., (3) the definition of what severity of negative reactions constitutes a public health or mental health problem ..., [and] (4) the classification of severe reactions...."[2]

A summary of the more significant and apparently uncontested findings:

3a. Grief after pregnancy loss: The medical community is coming to accept more generally that grief is a natural and expected reaction to the loss of a child through abortion, prematurity, stillbirth, etc. Hospital obstetrical units are developing teams of doctors, nurses and social workers to help parents deal with the issues of grief, anger and guilt raised by perinatal deaths.[3]

3b. There is no single study examining all possible negative consequences for women, and the risk of each, from abortion. There are, however, a significant number of studies which show a substantial number of women, suffering moderate to severe negative psychological reactions, of a wide variety, as a consequence of their abortions. These are cited below.

3c. Increased Usage of Psychiatry: A Canadian study found that 25% of women who had had abortions made visits to psychiatrists over a 5 year period, as compared to 3% of the control group.[4]

In a widely respected Danish "register linkage" study -- i.e. one reviewing state records of women's lifetime medical histories -- researchers found that the rate of psychiatric admissions within three months after the end of a pregnancy was 53% higher among women who had aborted compared to women who delivered their children.[5]

3d. Suicide: In one of the most complete register linkage studies to date, researchers in Finland examined women's lifetime medical histories and discovered that women who had abortions had a rate of suicide in the year following their abortion three times greater than all women of reproductive age, and six times greater than women who gave birth. The researchers drew two possible conclusions: either abortion poses a risk to mental health, or there are common risk factors for both abortion and suicide.[6]

A Welsh study which followed the Finnish study indicated that the former explanation is more likely. It looked at the medical records of women both before and after their abortions. It did not find any increased risk of suicide before abortion among women having abortions. But it did find that the rate of suicide among women after having induced abortions was twice the rate of women giving birth.[7]

3e. Research Generally Dismissing Negative Abortion Aftermath: Even researchers most reluctant to conclude the existence of any significant amount of post-abortion grief, write that some women experience severe psychological reactions following abortions. They seem satisfied that the percentages of women suffering negative reactions are, by their account, less than 50%. Considering that about 1.5 million abortions annually have been performed for more than 20 years, however, a finding that even a few percentage points of women suffer severe post-abortion reactions represents tens of thousands of women.[8]

4. Factors indicating greater risk of adverse reactions

A rather remarkable consensus among researchers on opposite sides of the psychological question, and researchers from around the world, has formed around the question of what risk factors likely predispose a woman to suffer negative consequences post-abortion. Even a cursory review of the following list reveals two remarkable things: first, it is a rather long list; and second, many of the categories describe potentially very large numbers of women having abortions in the United States:

Youth.[9] Twenty-two percent of all abortions in the United States are had by teenagers.[10]

Multiple abortions.[11] In the United States today, 47% of all abortions (611,000 annually) are repeats. Seven percent of abortion patients (91,000) have had three or more abortions.[12]

Being divorced, separated, or widowed at the time of the abortion.[13]

Medical or genetic indications (or in the words of another researcher, a "meaningful or intended" pregnancy gone wrong).[14] In the United States today, about 13% of women having abortions (169,000 annually) cite a suspected or confirmed fetal anomaly (mild to severe) among their reasons for having an abortion.[15]

Pregnant women and new mothers who have had a prior abortion.[16]

Having a "complicated reason" for the abortion, including "abortions you were pressured into."[17] In the United States, 24% of abortion patients say that they are having their abortion, in part, because their parents or boyfriend want them to have it.[18]

Experiencing conflict with important others at the time of the abortion, or other disturbing life events.[19] Fifty-one percent of U.S. abortion patients (765,000 annually) say that one reason they are seeking their abortion is relationship problems or fear of single parenthood, and 31% (403,000) say they are having an abortion because they don't want significant others to know they are pregnant or had sex. Another 1% (13,000) cite rape or incest. [20]

Having a history of sexual assault.[21]

Mid-trimester abortions.[22] In the United States today, about 12% (156,000) of abortions per year occur in the second or third trimester of pregnancy.[23]

Those outside a woman's normal values or morality.[24]

5. The American Psychiatric Association

Although the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM III-R)[25] does not officially recognize a specific "post-abortion stress or trauma disorder," it does list abortion as a life event which can produce post-traumatic stress disorder.

6. Common flaws in research methods which underestimate the numbers of women negatively affected

Many researchers -- including those on opposing sides of the issue of psychological harm -- have exposed flawed research methodologies which are likely to produce underestimations of the numbers of women suffering adverse reactions to abortion. Some of these flawed methodologies are:

6a. Failing to account for the fact that -- when asked in a survey whether or not they have ever had an abortion -- up to 50% of women who have had abortions, do not admit to one.[26] This denial may itself be an indication of an adverse psychological response to abortion, yet these women are not accounted for in studies. In one poll, however, which did not ask individuals to answer any personal questions about abortion, 67% of women and 55% of men 18-29 chose "being involved in an abortion," as the number one situation that would make a person feel "bad about himself." [27]

6b. Following women's psychological state for too short a time after their abortions.[28] Often researchers attempt to measure women's state of mind very soon after the abortion, and not later. Immediately after abortion, women regularly report relief. But empirical evidence indicates that this relief "fades" over the next several months and years.[29] Also, overwhelming anecdotal evidence from post-abortion counseling programs reveals that women seek help for their suffering 5-12 years after their abortion.

6c. A high drop out rate (50% is common) of women between the time they are first asked about their reaction to abortion, and a second or third time weeks or months later. Furthermore, studies show that the women most likely to drop out are those more likely to be experiencing adverse reactions to their abortions.[30]

6d. Time variance problems. No survey asking a woman's emotional state at a given point in time can claim to show with certainty that the woman will continue to cope at a later time, or that she has not been distressed in the past.

6e. Using inaccurate measurements of post-abortion well-being. A good example: in a study by Nancy Russo, Ph.D., Russo measures "well-being" solely by the women's self-reported self-esteem.[31] This neglects completely to account for the fact that exceedingly high rates of self-esteem (which were found among post-aborted women in her study) could also be explained by the presence of narcissistic disorders, which post-abortion counselors have regularly noted in some of their clients.[32]

Conclusion

Abortion is the most commonly performed surgery on women in the United States -- with approximately one out of every 5 women of childbearing age having had a legal abortion. For decades, our nation's abortion rate has fluctuated between 1 and 1.6 million abortions annually. If even a small percentage of these women are suffering -- whether at the level of extreme psychological distress or with less traumatic grief, spiritual pain, and family dysfunction--a vast number of women are affected.

This is the experience of the Catholic Church in the United States. For 15 years we have counseled women and men seeking solace after abortion. It is also the experience reflected in numerous web-sites where women share their stories after abortion. It was the reaction of former Surgeon General Koop, to the misreporting of his 1989 review of post-abortion literature. In a later conversation he said: "Instead of saying I could Înot find sufficient evidence to issue a scientifically statistically accurate report about whether or not abortion caused women predictable harm,' I was wrongly reported as saying I could Îfind no evidence,' of post-abortion trauma." But, he continued, "I know there are detrimental effects [of abortion]. I have counseled women with this problem over the last 15 years. There is no doubt about it."[33]

Notes

1. "The Abortion Problem: The Proceedings of the Conference of the National Committee on Maternal Health, Inc., at the New York Academy of Medicine."

"At times the guilt over the abortion draws into its dragnet many old guilts, leading to severe depression. In other instances, the overwhelming guilt cannot be managed and leads to pathologic projection. The immediate assimilation of the traumas is no assurance of successful integration: in later years new guilts may reawaken the dormant guilt, and one sees women at the menopause suffering torment over an abortion performed many years before."

2. "Abortion, Public Health Policy, and Informed Consent Legislation," Journal of Social Issues, 1992; 48 (3): 1-17.

3. Wathan, "Perinatal bereavement," British Journal of Obstetrics and Gynecology, 1990; 97: 759-60. Michels, et. al., eds. Psychiatry, vol. 1, Ch. 41, Philadelphia: B. Lippincott Co., 1990:8.

4. Badgley, et.al., Report of the Committee on the Operation of the Abortion Law, Ottawa: Supply and Services, 1977: 313-21.

5. David, et. al., "Postpartum and Postabortion Psychotic Reactions," Family Planning Perspectives, vol. 13, no. 2, 1981: 88-91, 89.

6. Gissler, Hemminki, Lonnqvist, "Suicides after Pregnancy in Finland, 1987-94; Register Linkage Study," British Medical Journal, 1996; 313: 1431-34.

7. Morgan, et. al., Letters, British Medical Journal, 1997; 314: 903. Another study that would indicate for the former explanation was published by L.G. Peppers, "Grief and Elective Abortion: Implications for the Counselor,"in "Disenfranchised Grief: Recognizing Hidden Sorrow, ed. Kenneth J. Doka, Lexington Books: MA, 1989:135 (Grief measurements of the same women pre- and post-abortion showed that significantly different groups of women suffered high grief reaction scores at the two points in time.)

8. One researcher, cited regularly by supporters of legal abortion as determining conclusively the absence of significant post-abortion grief, found the following: two years post-abortion, 19% percent of women (this would translate annually to 260,000 women in the United States) reported that they would not do it again; 12% more were undecided. When asked if their decision was right or wrong two years later, 16% (208,000) said it was the "wrong" decision. This same researcher found that 1% (10,000 women per year) suffer symptoms meeting the clinical definition of post traumatic stress syndrome. Brenda Major, Ph.D. "Beyond Choice: Myths and Facts about Adjustment to Abortion," Oct 9, 1997 California Wellness Foundation Lecture, University of California Wellness Lecture Series:1-34.

9. Gary B. Melton, ed. Report of the Interdivisional Committee on Adolescent Abortion, American Psychiatric Association, 1986: 84 (On average, teens have more negative responses following abortion than adults); Campbell, et. al., "Abortion in Adolescence," Adolesence, 1988; vol 23, no. 92: 813; Major, Beyond Choice: 23.

10. Alan Guttmacher Institute, Kaiser Family Foundation, National Press Foundation, "Emerging Issues in Reproductive Health: Fact Sheet: Abortion in the U.S." A Briefing Series for Journalists, 1998:1.

11. Franco, et. al., "Psychological profile of dysphoric women postabortion," Journal of the Amer. Med. Women's Assn.,1989; 44(4):113; Somers, "Risk of Admission to Psychiatric Institutions among Danish Women who Experienced Induced Abortion: An Analysis on National Record Linkage," Dissertation Abstracts International, Public Health 2621-B, Order No. 7926066 (incidence of psychiatric hospitalization increased in direct relationship to number of abortions had); Freeman, et. al., "Emotional Distress Patterns Among Women Having First or Repeat Abortions," Obstetrics and Gynecology, 1980; 55(5): 630.

12. Henshaw and Kost, "Abortion Patients in 1994-95: Characteristics and Contraceptive Use," Family Planning Perspectives, vol. 28, no.4 (1996):143; Alan Guttmacher Institute, "Facts in Brief: Induced Abortion," 1998.

13. Hedegaard, et. al., "Psychological Distress in Pregnancy and Preterm Delivery," British Medical Journal; 307:234-38, 1993 (divorced, separated and widowed women who aborted had rate of psychiatric admissions within 3 months of abortion, 5 times higher than other women who have abortions); see also David, et. al., "Postpartum and Post-abortion Psychotic Reactions," Family Planning Perspectives, 1981;13: 88-91.

14. Buchegger, "Couple treatment following abortion in prenatal diagnosis," Schweiz Med Wochenschr (Switzerland), 127(3): 69-72, 1977 (couples feel short-term relief but require "long-term counseling"; grief is similar to that following stillbirth); Chandler and Smith, "Prenatal screening and woman's perception of infant disability: a Sophie's Choice for every mother," Nursing Inquiry (Australia), 5(2): 71-6, June, 1998 (post-abortion grief and guilt, and marital breakdown occur following abortion due to problems detected in prenatal screening); Ashton, "The Psychiatric Outcome of Induced Abortion,"British J. of Obstetrics and Gynecology, 1980; 1115-22.

15. Torres and Forrest, "Why do Women Have Abortions?" Family Planning Perspectives, 1998: vol. 20, no. 4:169-176, 170.

16. For both pregnant women and for mothers shortly after delivery of a baby, having had an abortion is one of the most significant predictors of clinical depression. Kitamura, et. al., "Clinical and Psychosocial correlates of antenatal depression: a review," Psychother Psychosom (Japan),1996; 65 (3): 117-23. Bergant, et. al., "Prevalence of Depressive Disorders in Early Puerperium,"Gynakol Geburtshilfliche Rundsch (Austria), 1998; 38(4): 232-37; Bradley, "Abortion and Subsequent Pregnancy," Canadian Journal of Psychiatry, 1984; 29:494.

17. Nada Stotland, MD, Abortion: Facts and Feelings, American Psychiatric Press, Inc.: Washington D.C., 1998: 110.

18. Torres and Forrest, "Why do Women Have Abortions?" Family Planning Perspectives 1988; vol. 20, no. 4:169-176, 170.

19. Major, Beyond Choice: 24-24.

20. Torres and Forrest, "Why do Women Have Abortions?" Family Planning Perspectives: 170.

21. Women with a history of sexual assault tend to have greater distress before, during and after their abortions due to association between the abortion and the sexual assault. Zakus, "Adolescent Abortion Option," Social Work in Health Care, 1987;12(4): 87; Makhorn, "Sexual Assault and Pregnancy," in New Perspectives in Human Abortion, eds. Mall and Watts, University Publications of America:Washington, DC: 1981.

22. Osofsky and Osofsky, et. al., Mt. Sinai Journal of Med., 1975; 42: 456; Rooks and Cates, Jr., Family Planning Perspectives, 1977; 9: 276. Adler, David, Major, Roth, and Russo, "Psychological Factors in Abortion, A Review,"American Psychologist, 1992: 1194-1204.

23. Alan Guttmacher Institute, "Facts in Brief: Induced Abortion," 1998:3.

24. Adler, "Emotional Responses of Women Following their Abortion," Amer. J. of Orthopsychiatry, 1975; 45:446-54. Major "Beyond Choice": 23-25.

25. Washington, DC: American Psychiatric Assn.; 1987.

26. Jones, and Forrest, "Under reporting of Abortion in Surveys of U.S. Women: 1976-1988," Demography, 1992; 29(1): 113-26.

27. Adler, "The Curse of Self-Esteem," Newsweek, February 17, 1992; 119:46-51.

28. Major, "Beyond Choice": 9.

29. Major, "Beyond Choice":14 (Positive reactions to abortion faded beginning with period immediately following abortion, to 2 years later. Even though relief was always the experience of more than 50%); Kent, et al, "Emotional Sequelae of Therapeutic Abortion: A Comparative Study," presented at the annual meeting of the Canadian Psychiatric Assn. of Saskatoon, Sept. 1977; B. Raphael, The Anatomy of Bereavement, Basic Books: NY; 1983: 238; Miller, et al., "Testing a Model of the Psychological Consequences of Abortion," in The New Civil War. The Psychology, Culture and Politics of Abortion, eds. Beckman, et al., American Psychological Assn.: Washington, D.C., 1998. (Guilt and uncertainty about the decision increased from 2 weeks to 6-8 months post-abortion. Recommended post-abortion longitudinal research from 2-20 years).

30. H. Soderberg, "Selection Bias in a study on how women experienced induced abortion," Eur J Obstet & Gynecol (Sweden), 1998; 77(1):67-70 ( Thirty three percent of women who dropped out of study had characteristics associated with increased vulnerability, illness, and increased childbirth rate in the following two years); Adler, "Sample Attrition in Studies of Psycho-social Sequelae of Abortion: How great a problem," Journal of Social Issues, 35, 100-10. (1979).

31. Russo and Zierk, "Abortion, Childbearing, and Women's Well-Being," Professional Psychology: Research and Practice, 1992 vol. 23, no. 4: 269-280.

32. Reardon,"The Complexity and Distortions of Post-Abortion Research," chapter in forthcoming book, posted at www.afterabortion.org.

33. Interview with the Rutherford Institute, Spring 1989.