A
List of Major Psychological Sequelae of Abortion
by
David C. Reardon, Ph.D
In a study of post-abortion
patients only 8 weeks after their abortion, researchers found that 44%
complained of nervous disorders, 36% had experienced sleep disturbances, 31% had
regrets about their decision, and 11% had been prescribed psychotropic medicine
by their family doctor. (2) A 5 year retrospective study in two Canadian
provinces found significantly greater use of medical and psychiatric services
among aborted women. Most significant was the finding that 25% of aborted women
made visits to psychiatrists as compared to 3% of the control group. (3) Women
who have had abortions are significantly more likely than others to subsequently
require admission to a psychiatric hospital. At especially high risk are
teenagers, separated or divorced women, and women with a history of more than
one abortion. (4)
Since many post-aborted
women use repression as a coping mechanism, there may be a long period of denial
before a woman seeks psychiatric care. These repressed feelings may cause
psychosomatic illnesses and psychiatric or behavioral in other areas of her
life. As a result, some counselors report that unacknowledged post-abortion
distress is the causative factor in many of their female patients, even though
their patients have come to them seeking therapy for seemingly unrelated
problems. (5)
A major random study found
that a minimum of 19% of post- abortion women suffer from diagnosable
post-traumatic stress disorder (PTSD). Approximately half had many, but not all,
symptoms of PTSD, and 20 to 40 percent showed moderate to high levels of stress
and avoidance behavior relative to their abortion experiences. (6) Because this
is a major disorder which may be present in many plaintiffs, and is not readily
understood outside the counseling profession, the following summary is more
complete than other entries in this section. PTSD is a psychological dysfunction
which results from a traumatic experience which overwhelms a person's normal
defense mechanisms resulting in intense fear, feelings of helplessness or being
trapped, or loss of control. The risk that an experience will be traumatic is
increased when the traumatizing event is perceived as including threats of
physical injury, sexual violation, or the witnessing of or participation in a
violent death. PTSD results when the traumatic event causes the hyperarousal of
"flight or fight" defense mechanisms. This hyperarousal causes these
defense mechanisms to become disorganized, disconnected from present
circumstances, and take on a life of their own resulting in abnormal behavior
and major personality disorders. As an example of this disconnection of mental
functions, some PTSD victim may experience intense emotion but without clear
memory of the event; others may remember every detail but without emotion; still
others may reexperience both the event and the emotions in intrusive and
overwhelming flashback experiences. (7)
Women may experience
abortion as a traumatic event for several reasons. Many are forced into an
unwanted abortions by husbands, boyfriends, parents, or others. If the woman has
repeatedly been a victim of domineering abuse, such an unwanted abortion may be
perceived as the ultimate violation in a life characterized by abuse. Other
women, no matter how compelling the reasons they have for seeking an abortion,
may still perceive the termination of their pregnancy as the violent killing of
their own child. The fear, anxiety, pain, and guilt associated with the
procedure are mixed into this perception of grotesque and violent death. Still
other women, report that the pain of abortion, inflicted upon them by a masked
stranger invading their body, feels identical to rape. (8) Indeed, researchers
have found that women with a history of sexual assault may experience greater
distress during and after an abortion exactly because of these associations
between the two experiences. (9) When the stressor leading to PTSD is abortion,
some clinicians refer to this as Post-Abortion Syndrome (PAS).
The major symptoms of PTSD
are generally classified under three categories: hyperarousal, intrusion, and
constriction.
Hyperarousal is a
characteristic of inappropriately and chronically aroused "fight or
flight" defense mechanisms. The person is seemingly on permanent alert for
threats of danger. Symptoms of hyperarousal include: exaggerated startle
responses, anxiety attacks, irritability, outbursts of anger or rage, aggressive
behavior, difficulty concentrating, hypervigilence, difficulty falling asleep or
staying asleep, or physiological reactions upon exposure to situations that
symbolize or resemble an aspect of the traumatic experience (eg. elevated pulse
or sweat during a pelvic exam, or upon hearing a vacuum pump sound.)
Intrusion is the
reexperience of the traumatic event at unwanted and unexpected times. Symptoms
of intrusion in PAS cases include: recurrent and intrusive thoughts about the
abortion or aborted child, flashbacks in which the woman momentarily
reexperiences an aspect of the abortion experience, nightmares about the
abortion or child, or anniversary reactions of intense grief or depression on
the due date of the aborted pregnancy or the anniversary date of the abortion.
Constriction is the numbing
of emotional resources, or the development of behavioral patterns, so as to
avoid stimuli associated with the trauma. It is avoidance behavior; an attempt
to deny and avoid negative feelings or people, places, or things which aggravate
the negative feelings associated with the trauma. In post-abortion trauma cases,
constriction may include: an inability to recall the abortion experience or
important parts of it; efforts to avoid activities or situations which may
arouse recollections of the abortion; withdrawal from relationships, especially
estrangement from those involved in the abortion decision; avoidance of
children; efforts to avoid or deny thoughts or feelings about the abortion;
restricted range of loving or tender feelings; a sense of a foreshortened future
(e.g., does not expect a career, marriage, or children, or a long life.);
diminished interest in previously enjoyed activities; drug or alcohol abuse;
suicidal thoughts or acts; and other self-destructive tendencies.
As previously mentioned,
Barnard's study identified a 19% rate of PTSD among women who had abortions
three to five years previously. But in reality the actual rate is probably
higher. Like most post-abortion studies, Barnard's study was handicapped by a
fifty percent drop out rate. Clinical experience has demonstrated that the women
least likely to cooperate in post-abortion research are those for whom the
abortion caused the most psychological distress. Research has confirmed this
insight, demonstrating that the women who refuse followup evaluation most
closely match the demographic characteristics of the women who suffer the most
post-abortion distress. (10) The extraordinary high rate of refusal to
participate in post-abortion studies may interpreted as evidence of constriction
or avoidance behavior (not wanting to think about the abortion) which is a major
symptom of PTSD.
For many women, the onset or
accurate identification of PTSD symptoms may be delayed for several years. (11)
Until a PTSD sufferer has received counseling and achieved adequate recovery,
PTSD may result in a psychological disability which would prevent an injured
abortion patient from bringing action within the normal statutory period. This
disability may, therefore, provide grounds for an extended statutory period.
Thirty to fifty percent of
aborted women report experiencing sexual dysfunctions, of both short and long
duration, beginning immediately after their abortions. These problems may
include one or more of the following: loss of pleasure from intercourse,
increased pain, an aversion to sex and/or males in general, or the development
of a promiscuous life-style. (12)
Approximately 60 percent of
women who experience post-abortion sequelae report suicidal ideation, with 28
percent actually attempting suicide, of which half attempted suicide two or more
times. Researchers in Finland have identified a strong statistical association
between abortion and suicide in a records based study. The identified 73
suicides associated within one year to a pregnancy ending either naturally or by
induced abortion. The mean annual suicide rate for all women was 11.3 per
100,000. Suicide rate associated with birth was significantly lower (5.9). Rates
for pregnancy loss were significantly higher. For miscarriage the rate was 18.1
per 100,000 and for abortion 34.7 per 100,000. The suicide rate within one year
after an abortion was three times higher than for all women, seven times higher
than for women carrying to term, and nearly twice as high as for women who
suffered a miscarriage. Suicide attempts appear to be especially prevalent among
post-abortion teenagers.(13)
Post-abortion stress is
linked with increased cigarette smoking. Women who abort are twice as likely to
become heavy smokers and suffer the corresponding health risks. (14)
Post-abortion women are also
more likely to continue smoking during subsequent wanted pregnancies with
increased risk of neonatal death or congenital anomalies. (15)
Abortion is significantly
linked with a two fold increased risk of alcohol abuse among women. (16)
Abortion followed by alcohol abuse is linked to violent behavior, divorce or
separation, auto accidents, and job loss. (17) (see also New
Study Confirms Link Between Abortion and Substance Abuse)
Abortion is significantly
linked to subsequent drug abuse. In addition to the psycho-social costs of such
abuse, drug abuse is linked with increased exposure to HIV/AIDS infections,
congenital malformations, and assaultive behavior. (18)
For at least some women,
post-abortion stress is associated with eating disorders such as binge eating,
bulimia, and anorexia nervosa. (19)
Abortion is linked with
increased depression, violent behavior, alcohol and drug abuse, replacement
pregnancies, and reduced maternal bonding with children born subsequently. These
factors are closely associated with child abuse and would appear to confirm
individual clinical assessments linking post-abortion trauma with subsequent
child abuse. (20)
For most couples, an
abortion causes unforeseen problems in their relationship. Post-abortion couples
are more likely to divorce or separate. Many post-abortion women develop a
greater difficulty forming lasting bonds with a male partner. This may be due to
abortion related reactions such as lowered self-esteem, greater distrust of
males, sexual dysfunction, substance abuse, and increased levels of depression,
anxiety, and volatile anger. Women who have more than one abortion (representing
about 45% of all abortions) are more likely to require public assistance, in
part because they are also more likely to become single parents. (21)
Women who have one abortion
are at increased risk of having additional abortions in the future. Women with a
prior abortion experience are four times more likely to abort a current
pregnancy than those with no prior abortion history. (22)
This increased risk is
associated with the prior abortion due to lowered self esteem, a conscious or
unconscious desire for a replacement pregnancy, and increased sexual activity
post-abortion. Subsequent abortions may occur because of conflicted desires to
become pregnant and have a child and continued pressures to abort, such as
abandonment by the new male partner. Aspects of self-punishment through repeated
abortions are also reported. (23)
Approximately 45% of all
abortions are now repeat abortions. The risk of falling into a repeat abortion
pattern should be discussed with a patient considering her first abortion.
Furthermore, since women who have more than one abortion are at a significantly
increased risk of suffering physical and psychological sequelae, these
heightened risks should be thoroughly discussed with women seeking abortions.
NOTES:
1.
An excellent resource for any attorney involved in abortion malpractice is
Thomas Strahan's Major Articles and Books Concerning the Detrimental Effects of
Abortion (Rutherford Institute, PO Box 7482, Charlottesville, VA 22906-7482,
(804) 978-388.) This resource includes brief summaries of major finding drawn
from medical and psychology journal articles, books, and related materials,
divided into major categories of relevant injuries.
2. Ashton,"They
Psychosocial Outcome of Induced Abortion", British Journal of Ob&Gyn.,
87:1115-1122, (1980).
3.
Badgley, et.al.,Report of the Committee on the Operation of the Abortion Law
(Ottawa:Supply and Services, 1977)pp.313-321.
4. R. 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 (1979); H. David, et al.,
"Postpartum and Postabortion Psychotic Reactions," Family Planning
Perspectives 13:88-91 (1981).
5. Kent, et al.,
"Bereavement in Post-Abortive Women: A Clinical Report", World Journal
of Psychosynthesis (Autumn-Winter 1981), vol.13,nos.3-4.
6. Catherine Barnard, The
Long-Term Psychological Effects of Abortion, Portsmouth, N.H.: Institute for
Pregnancy Loss, 1990).
7. Herman, Trauma and
Recovery, (New York: Basic Books, 1992) 34.
8. Francke, The Ambivalence
of Abortion (New York: Random House, 1978) 84-95.
9. Zakus, "Adolescent
Abortion Option," Social Work in Health Care, 12(4):87 (1987); Makhorn,
"Sexual Assault & Pregnancy," New Perspectives on Human Abortion,
Mall & Watts, eds., (Washington, D.C.: University Publications of America,
1981).
10. Adler, "Sample
Attrition in Studies of Psycho-social Sequelae of Abortion: How great a
problem." Journal of Social Issues, 1979, 35, 100-110.
11. Speckhard,
"Postabortion Syndrome: An Emerging Public Health Concern," Journal of
Social Issues, 48(3):95-119.
12. Speckhard, Psycho-social
Stress Following Abortion, Sheed & Ward, Kansas City: MO, 1987; and Belsey,
et al., "Predictive Factors in Emotional Response to Abortion: King's
Termination Study - IV," Soc. Sci. & Med., 11:71-82 (1977).
13. Speckhard, Psycho-social
Stress Following Abortion, Sheed & Ward, Kansas City: MO, 1987; Gissler,
Hemminki & Lonnqvist, "Suicides after pregnancy in Finland, 1987-94:
register linkage study," British Journal of Medicine 313:1431-4, 1996.C.
Haignere, et al., "HIV/AIDS Prevention and Multiple Risk Behaviors of Gay
Male and Runaway Adolescents," Sixth International Conference on AIDS: San
Francisco, June 1990; N. Campbell,
et al., "Abortion in Adolescence," Adolescence, 23(92):813-823 (1988);
H. Vaughan, Canonical Variates of Post-Abortion Syndrome, Portsmouth, NH:
Institute for Pregnancy Loss, 1991; B. Garfinkel, "Stress, Depression and
Suicide: A Study of Adolescents in Minnesota," Responding to High Risk
Youth, Minnesota Extension Service, University of Minnesota (1986).
14. Harlap,
"Characteristics of Pregnant Women Reporting Previous Induced
Abortions," Bulletin World Health Organization, 52:149 (1975); N. Meirik,
"Outcome of First Delivery After 2nd Trimester Two Stage Induced Abortion:
A Controlled Cohort Study," Acta Obsetricia et Gynecologica Scandinavia
63(1):45-50(1984); Levin, et al., "Association of Induced Abortion with
Subsequent Pregnancy Loss," JAMA, 243:2495-2499, June 27, 1980.
15. Obel, "Pregnancy
Complications Following Legally Induced Abortion: An Analysis of the Population
with Special Reference to Prematurity," Danish Medical Bulletin, 26:192-
199 (1979); Martin, "An Overview: Maternal Nicotine and Caffeine
Consumption and Offspring Outcome," Neurobehavioral Toxicology and
Tertology, 4(4):421-427, (1982).
16. Klassen, "Sexual
Experience and Drinking Among Women in a U.S. National Survey," Archives of
Sexual Behavior, 15(5):363-39 ; M. Plant, Women, Drinking and Pregnancy,
Tavistock Pub, London (1985); Kuzma & Kissinger, "Patterns of Alcohol
and Cigarette Use in Pregnancy," Neurobehavioral Toxicology and Terotology,
3:211-221 (1981).
17. Morrissey, et al.,
"Stressful Life Events and Alcohol Problems Among Women Seen at a
Detoxification Center," Journal of Studies on Alcohol, 39(9):1159 (1978).
18. Oro, et al.,
"Perinatal Cocaine and Methamphetamine Exposure Maternal and Neo-Natal
Correlates," J. Pediatrics, 111:571- 578 (1978); D.A. Frank, et al.,
"Cocaine Use During Pregnancy Prevalence and Correlates," Pediatrics,
82(6):888 (1988); H. Amaro, et al., "Drug Use Among Adolescent Mothers:
Profile of Risk," Pediatrics 84:144-150, (1989)
19. Speckhard, Psycho-social
Stress Following Abortion, Sheed & Ward, Kansas City: MO, 1987; J.
Spaulding, et al, "Psychoses Following Therapeutic Abortion, Am. J. of
Psychiatry 125(3):364 (1978); R.K. McAll, et al., "Ritual Mourning in
Anorexia Nervosa," The Lancet, August 16, 1980, p. 368.
20. Benedict, et al.,
"Maternal Perinatal Risk Factors and Child Abuse," Child Abuse and
Neglect, 9:217-224 (1985); P.G. Ney, "Relationship between Abortion and
Child Abuse," Canadian Journal of Psychiatry, 24:610-620, 1979; Reardon,
Aborted Women - Silent No More (Chicago: Loyola University Press, 1987), 129-30,
describes a case of woman who beat her three year old son to death shortly after
an abortion which triggered a "psychotic episode" of grief, guilt, and
misplaced anger.
21. Shepard, et al.,
"Contraceptive Practice and Repeat Induced Abortion: An Epidemiological
Investigation," J. Biosocial Science, 11:289-302 (1979); M. Bracken,
"First and Repeated Abortions: A Study of Decision-Making and Delay,"
J. Biosocial Science, 7:473-491 (1975); S. Henshaw, "The Characteristics
and Prior Contraceptive Use of U.S. Abortion Patients," Family Planning
Perspectives, 20(4):158-168 (1988); D. Sherman, et al., "The Abortion
Experience in Private Practice," Women and Loss: Psychobiological
Perspectives, ed. W.F. Finn, et al., (New York: Praeger Publ. 1985), pp98-107;
E.M. Belsey, et al., "Predictive Factors in Emotional Response to Abortion:
King's Termination Study - IV," Social Science and Medicine, 11:71- 82
(1977); E. Freeman, et al., "Emotional Distress Patterns Among Women Having
First or Repeat Abortions," Obstetrics and Gynecology, 55(5):630-636
(1980); C. Berger, et al., "Repeat Abortion: Is it a Problem?" Family
Planning Perspectives 16(2):70-75 (1984).
22. Joyce, "The Social
and Economic Correlates of Pregnancy Resolution Among Adolescents in New York by
Race and Ethnicity: A Multivariate Analysis," Am. J. of Public Health,
78(6):626-631 (1988); C. Tietze, "Repeat Abortions - Why More?" Family
Planning Perspectives 10(5):286-288, (1978).
23. Leach, "The Repeat
Abortion Patient," Family Planning Perspectives, 9(1):37-39 (1977); S.
Fischer, "Reflection on Repeated Abortions: The meanings and
motivations," Journal of Social Work Practice 2(2):70-87 (1986); B. Howe,
et al., "Repeat Abortion, Blaming the Victims," Am. J. of Public
Health, 69(12):1242-1246, (1979).
Fact Sheet Courtesy of the Elliot Institute, PO Box 73478
Springfield, IL 62791-7348