Limitations on Post-Abortion Research: Why We Know So Little
- David C. Reardon, Ph.D.
While there have been many studies regarding the emotional aftermath of abortion, very little has been firmly established. It is extremely difficult, if not impossible, to complete a study in this field that would be generally conclusive and above reproach. Among other complications, (1) the cooperation of the study population is inconsistent and unreliable; (2) the variety of negative reactions reported by women is so broad that it is impossible to encompass every claimed dysfunction in a single study; (3) the intensity of many reactions appears to be time variant, with many women reporting delayed reactions; and (4) the use of questionnaires and other standardized survey instruments may be inadequate for uncovering deep-seated reactions.
In longitudinal and retrospective studies, approximately 50 percent of women who have had an abortion will conceal their past abortion[s] from interviewers.(1) Even in short-term follow-up studies, there are high sample attrition rates, typically in the range of 20 to 60 percent. Demographic comparisons of those who initially consent to follow-up and subsequently refuse to be interviewed indicate that those who exclude themselves from the final sample are more likely to match the profile of women who report the greatest post-abortion distress.(2)
There is also no agreement about which symptoms researchers should attempt to quantify (relief, depression, impacted grieving, intrusive recollections, self-destructive behavior, etc.) nor what level of symptoms should be considered significant. Some abortion reactions may fit into the model of complicated bereavement or pathological grief.(3) In other cases, clinicians have reported that at least some women exhibit symptoms that fall within the diagnostic criteria for post-traumatic stress disorder (PTSD).(4) Still other therapists may offer different schemas for categorizing and understanding post-abortion reactions. Indeed, it appears likely that women experience a wide variety of psychological reactions to abortion.
Reactions also vary over time. Women who are initially filled with grief and self-reproach may subsequently find emotional healing, whereas women who initially coped well may subsequently find themselves shattered. In one study of 260 women who reported negative post-abortion reactions, 63 to 76 percent claimed there was a period of time during which they would have denied any negative feelings connected to their abortions. The average period of denial reported by the survey population was 63 months.(5)
The effectiveness of standardized questionnaires has also been called into doubt, since these research instrument may be inadequate for uncovering repressed feelings.(6) Kent reports that in the course of psychotherapy for 50 women, none of whom were originally seeking treatment for abortion-related problems, deep feelings of pain and bereavement about a prior abortion emerged during the time the patient was recovering from the presenting problem.(7) Kent's subsequent research with women who were not in psychotherapy led him to conclude that an initial reaction of emotional numbness may distort questionnaire based studies. He concluded that an underlying sense of loss and pain can only be reliably identified in a clinical setting.(8)
Given such complexities, it is understandable that Surgeon General C. Everett Koop concluded, in 1987, that the research in this field is entirely inadequate for drawing any general conclusions about either the efficacy or the dangers of induced abortion.(9) The same criticism holds to this day.
There is progress, however, in (1) a general acknowledgment that at least some women experience negative post-abortion reactions, and in (2) identifying characteristics that predict a higher risk of a negative reaction.
In a special issue of the Journal of Social Issues dedicated entirely to research relating to the psychological effects of elective abortion, editor Gregory Wilmoth concluded: "There is now virtually no disagreement among researchers that some women experience negative psychological reactions postabortion. 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 . . . "(10)
There are no clear answers to the issues identified by Wilmoth. Opinions, especially regarding the prevalence of post-abortion maladjustments, tend to be divided along ideological lines. If there is any agreement among researchers, pro-choice researcher Mary K. Zimmerman suggests, it exists in the consensus that abortion is usually "stressful and emotionally difficult for most women."(11)
Zimmerman may be too optimistic in claiming even this minimal consensus, however, since a few abortion proponents continue to insist that psychological sequelae post-abortion simply "does not exist."(12) Critical analysis of these overly broad claims, however, shows that the sweeping conclusions offered by these authors are internally contradicted by the very studies and data they cite.(13)
It should also be noted that the research obstacles discussed above, concealment, attrition, multiple symptoms, time variance, and inadequate research tools, all tend to suppress the reported rate of negative reactions in individual studies. Reported rates of negative reactions, therefore, should always be interpreted as low, conservative estimates.
Furthermore, great care should be taken to avoid overgeneralizing findings or advocating a "majority rules" perspective. As an example of the latter, research reports showing that 15 to 20 percent of abortion patients experience certain negative reactions have been reported in the media as proof of the "fact" that "the majority of abortion patients" benefit from abortion or that "post-abortion trauma does not exist."(14) Such interpretations improperly dismiss the suffering of the minority, neglect the limitations of the study population and methodology, and project the unsubstantiated conclusion that women who do not complain of a specific symptom within the time frame of a study must necessarily have benefited from their abortions. Clearly, lack of injury does not necessarily equate to therapeutic benefit, which is a separate issue that has been the subject of even less research. Overly broad assertions about the purported safety of abortion are often compounded by the political motivations of both researchers and reporters. Such false assurances may reduce appropriate circumspection of abortion decisions and may make it more difficult for high risk patients to refuse coerced abortions.
Predictive Factors of Post-Abortion Sequelae
The above discussion explains why it is currently impossible to estimate how many women are negatively affected by their abortion experience, or how significant these negative reactions may be. There is however one area in which there is considerable certainty: predictive factors of post-abortion sequelae.
In the course of many attempts to quantify post-abortion reactions, researchers have consistently found that some portion of women, usually a minority, report negative symptoms within the time frame of the study. In an attempt to understand why and how these women react differently from those who do not report the difficulties under study, researchers have naturally attempted to identify the individual characteristics or situational factors that are statistically associated with negative post-abortion reactions. In this respect, studies that are otherwise weak in predicting the overall incidence of post-abortion reactions over time, are very valuable in identifying the factors that place women at higher risk of a negative reaction. It should also be noted that most of these studies have been undertaken by researchers who profess a pro-choice perspective.
The table in Identifying High Risk Abortion Patients is a preliminary attempt to classify and summarize the predictive risk factors of post-abortion emotional sequelae. This list is certainly incomplete, but includes all the most widely reported risk factors as well as several less widely recognized factors. The references provided for each high risk factor include citations for both original research and review articles. The latter citations are provided as useful for identifying authorities who have agreed that the identified risk factor is significant and as references to additional citations.
1. Jones, E.F. & Forrest, J.D., "Underreporting of Abortion in Surveys of U.S. Women: 1976 to 1988," Demography, 29(1):113-126 (1992).
2. Adler, N., "Sample Attrition in Studies of Psychosocial Sequelae of Abortion: How Great A Problem?" J Applied Soc Psych, 6(3):240-259 (1976).
3. Angelo, E.J., "Psychiatric Sequelae of Abortion: The Many Faces of Post-Abortion Grief" Linacre Quarterly, 59(2):69-80, 1992; Brown, D., Elkins, T.E., Lardson, D.B., "Prolonged Grieving After Abortion," J Clinical Ethics, 4(2):118-123 (1993).
4. Speckhard, A. & Rue, V., "Postabortion Syndrome: An Emerging Public Health Concern," J Social Issues 42(3):95-119, 1992; Barnard, C.A., The Long-Term Psychosocial Effects of Abortion (Portsmouth, NH: Institute for Pregnancy Loss, 1990).
5. Reardon, D., "Psychological Reactions Reported After Abortion," The Post-Abortion Review, 2(3):4-8 (1994).
6. Lazarus, A. & Stern, R., "Psychiatric Aspects of Pregnancy Termination," Clin Obstet Gynaecol, 13:125-134 (1986).
7. Kent, I., et.al., "Emotional Sequelae of elective Abortion," BC Med J, 20:118-9 (1978).
8. Kent, I. & Nicholls, W., "Bereavement in Post-Abortion Women: A Clinical Report," World J Psychosyn 13:14-17 (1981).
9. Koop, C.E., Letter to President Reagan, January 9, 1989.
10. Wilmoth, G., "Abortion, Public Health Policy, and Informed Consent Legislation," J Social Issues, 48(3):1-17 (1992).
11. Zimmerman, M.K., "Psychosocial and Emotional Consequences of Elective Abortion: A Literature Review," Abortion: Readings and Research ed. Paul Sachdev (Butterworths: Toronto, 1981), 69.
12. Stotland, N., "The Myth of the Abortion Trauma Syndrome," JAMA 268:2078-9 (1992); Russo, N.F., "Abortion, Childbearing, and Women's Well-Being," Professional Psychology, 23(4):296-280 (1992).
13. Reardon, D., "JAMA Gymnastics: Jumping Through Hoops to Prove Abortion is Safe," The Post Abortion Review, 1(2):3-5 (1993); Reardon, D., "Feminist Researcher 'Proves" Abortion Increases Self-Esteem" The Post-Abortion Review, 3(2):4-7 (1995).
14. "Post-Abortion" USA Today Feb. 10, 1988; Brody, J. "Study Disputes Abortion Trauma" New York Times Feb. 12, (1997).
Copyright 1997 Elliot Institute