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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.
References
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
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