Identifying High Risk Abortion Patients
– David C. Reardon, Ph.D.
While there is intense controversy regarding how many women experience post-abortion psychological problems, even pro-abortion researchers admit that at least some women are negatively effected. According to the disposition of the individual researcher, these negative reactions may be loosely labeled as “serious,” “significant” or “minor” and the number of women experiencing these reactions may be vaguely described as “many,” “some” or “only a few.” But statistics are less subjective than adjectives. In one review of the literature, the lowest reported rate for adverse post-abortion outcomes was 6 percent, with most reports ranging from 12 to 25 percent, and the highest estimates rising above 50 percent. With such findings, only the most biased of researchers are so rash to claim that “no one” experiences post-abortion trauma.
Because the existence of post-abortion trauma is now almost universally accepted, many researchers are now focusing on the factors which may identify which women are at higher risk. From a political viewpoint, researchers who favor abortion on demand are hoping to show that the “few” women who do report negative post-abortion reactions were actually emotionally “unbalanced” prior to the abortion. If this is true, they argue, then it is possible that the abortion itself is not the cause of psychological injury, but instead women who were previously “unbalanced” are unfairly blaming their problems on abortion.
Blaming the Victim
This “politically correct” view of post-abortion trauma includes a kernel of truth surrounded by a lot of “blaming the victim.” It is certainly true that women who are suffering from mental disorders or have previously suffered psychological trauma are more likely to subsequently report more severe negative post-abortion reactions. Indeed, if one thing is clear from post-abortion research over the last forty years, it is that abortion is contraindicated when a woman has mental health problems.
This is true because abortion is always stressful. How well a person copes with this stress depends on the individual’s resiliency and the conditions under which the stress occurs. When a woman’s psychological state is already fragile, the stress of an abortion can more easily overwhelm her. But the fact that she was more vulnerable to stress than others does not mean that the abortion is not the cause of her psychological injuries.
If a glass plate and a plastic plate are both dropped, the glass plate is likely to shatter, while the same stress may cause the plastic plate to only crack or chip. In either case, the damage cannot be blamed on the material; it must be blamed on the fall. While the extent of the damage is related to the nature of the material, the fall itself is the direct cause of the damage.
In the same way, while the nature of an individual psyche determines the extent of post-abortion injuries, it is the abortion itself which is the direct cause of these injuries.
This “blame the victim” strategy which is being employed by some pro-abortion researchers is not new. It is identical to the type of reasoning used during World War I when veterans suffering from “shell shock” were diagnosed by military psychiatrists as “malingerers” or even cowards. In an age when fighting for one’s country was romantically idealized as adventurous passage into manhood, this “politically correct” diagnosis was necessary to deflect attention away from the fact that modern warfare was often more traumatic than ennobling. Military officials therefore attempted to suppress reports of psychiatric casualties because accurate reports would have had a demoralizing effect on the public.
In the same way, when pro-abortion researchers are confronted with women who suffer from post-abortion trauma, there is a tendency to blame the woman for being “whiners” or “dysfunctional,” since it is common knowledge in pro-abortion circles that abortion normally “empowers” women. Some pro-abortion researchers even argue that women should not be told of the psychological risks associated with abortion because such “demoralizing” information may make them even more prone to an adverse outcome. It is better, they would claim, to be ignorantly optimistic about the future than informed and worried.
Women at Risk
The comments above are useful for understanding the impetus behind much of the recent efforts of pro-abortion researchers. With this in mind, we can now look at some of the very useful findings which these same researchers have made in the area of cataloging pre-identifying factors which can be used to predict post-abortion psychological sequelae.
The risk factors for post-abortion psychological maladjustments can be divided into two general categories. The first category includes women for whom there exists significant emotional, social, or moral conflicts regarding the contemplated abortion. The second category includes women for whom there are developmental problems, including immaturity, or pre-existing and unresolved psychological problems. Women with characteristics in either or both of these categories would properly be classified as high risk patients.
Conversely, a low risk patient can be described as a woman who has maturely, thoughtfully, and freely arrived at her abortion decision and has no emotional, social, or moral conflicts which challenge that decision.
The following outline summarizes the major risk factors and includes pre-identifying characteristics upon which women can be screened for these risk factors.
Risk Factors Predicting Post-Abortion Psychological Sequela
I. Conflicted Decision
A. Difficulty making the decision, ambivalence, unresolved doubts       
     
1. Moral beliefs against abortion
a. Religious or conservative values      
b. Negative attitudes toward abortion 
c. Feelings of shame or social stigma attached to abortion 
d. Strong concerns about secrecy
2. Conflicting maternal desires  
a. Originally wanted or planned pregnancy     
b. Abortion of wanted child due to fetal abnormalities       
c. Therapeutic abortion of wanted pregnancy due to maternal health risk 
    
d. Strong maternal orientation  
e. Being married 
f. Prior children  
g. Failure to take contraceptive precautions, which may indicate an
ambivalent desire to become pregnant 
h. Preoccupation with fantasies of fetus, including sex and awareness of due
3. Second or third trimester abortion, which generally indicates strong
ambivalence or a coerced abortion of a “hidden” pregnancy.    
B. Feels pressured or coerced        
1. Feels pressured to have abortion
a. By husband or boyfriend
b. By parents
c. By doctor, counselor, employer, or others
2. Feels decision is not her own, or is “her only choice” 
3. Feels pressured to choose too quickly  
C. Decision is made with biased, inaccurate, or inadequate information   
II. Psychological or Developmental Limitations
A. Adolescence, minors having an increased risk        
B. Prior emotional or psychiatric problems         
1. Poor use of psychological coping mechanisms   
2. Prior low self-image    
3. Poor work pattern  
4. Prior unresolved trauma 
5. A history of sexual abuse or sexual assault.   
6. Blames pregnancy on her own character flaws, rather than on chance, others,
or on correctable mistakes in behavior   
7. Avoidance and denial prior to abortion 
C. Lack of social support
1. Few friends  
2. Made decision alone, without assistance from partner 
3. A poor or unstable relationship with male partner    
4. Lack of support from parents and family, either to have baby or to have
an abortion       
5. Lack of support from male partner, either to have baby or to have abortion  
          
6. Accompanied to abortion by male partner 
D. Prior abortion(s)   
The Role of the Male
The attitude of the male partner toward the pregnancy is an important factor in a woman’s abortion decision and is also significantly related to how she will adjust after the abortion. Because numerous studies have found support from the partner to be an important predictor of good post-abortion adjustment, researchers were recently startled by the finding that accompaniment to the abortion by the male partner was actually a predictor of greaterpost-abortion depression.
This finding suggests that an outward show of support, accompaniment to the abortion clinic, is not an accurate measure of the emotional support a woman feels. Instead, accompaniment by the male partner may actually indicate one or more of the following: 1) greater pre-abortion anxiety which led the woman to insist on accompaniment; 2) overt or subtle coercion on the part of the male who is “making sure” she does the “right thing;” or, 3) a more intimate relationship exists between the partners and this greater intimacy is being stressed by the abortion. In this third scenario, the unplanned pregnancy may be perceived by the woman as a “test” of her partner’s commitment to their relationship. She may privately be willing to have the baby, and seal their mutual commitment, if he takes this as opportunity to demonstrate his commitment. Instead, his lack of enthusiasm for, or hostile reaction to, the pregnancy causes her to doubt the depth and endurance of their relationship.
In short, when a woman is accompanied to an abortion by her male partner, the woman is more likely to be choosing abortion because her partner has manipulated her into doing so, or because he has exposed to her a lack of commitment to their relationship. In neither case does she truly feel supported.
While present research is unable to accurately establish what percentage of women suffer from any specific symptom of post-abortion trauma, it is clear that post-abortion psychological disorders do occur. Indeed, the published literature demonstrates that serious emotional and psychological complications following an abortion are probably more common than serious physical complications.
The present literature has also successfully identified statistically significant factors which can be used to pre-identify individuals who are most vulnerable to experiencing post-abortion psychological sequelae. Examination of these risk factors suggests that many, if not most women seeking abortion have one or more of these high risk characteristics.
Based on these findings, most of which have been published by researchers who favor legalized abortion, it would appear reasonable to expect, and demand, that abortion providers: 1) provide pre-consent information about the types of psychological reactions which have been linked to a negative abortion experience and the risk factors associated with these adverse reactions; 2) provide adequate pre-abortion screening using the criteria outlined above to identify women who are at higher risk of negative post-abortion reactions; 3) provide individualized counseling to high risk patients which would more fully explain why the patient is at higher risk along with more detailed information concerning possible post-abortion reactions; and 4) assist women who have pre-identifying high risk factors in evaluating and choosing lower risk solutions to their social, economic, and health needs.
Since these high risk factors have been well established for a considerable period of time, abortion providers who fail to utilize this information in their screening and counseling procedures may incur greater liability for subsequent injuries when malpractice suits are brought on these grounds.
1. Originally published in The Post-Abortion Review 1(3),Fall 1993. Revised version published in Making Abortion Rare. Copyright 1993 Elliot Institute
2. See also: Adler, David, Major, Roth, Russo, & Wyatt, “Psychological Factors in Abortion: A Review” American Psychologist 47(10):1194-1204 (1992).
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