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Health Effects of Abortion


A.I.R.V.S.C.
Association for Interdisciplinary Research in Values and Social Change
Vol. 2, No 2, Spring 1989
Franz, et al.
Reproduced with Permission

In This Issue:

Report on Health Effects of Abortion on Women: Conflicts and Needed Research
by Wanda Franz, Ph.D., President

Surgeon General Koop was asked last year by President Reagan to prepare a report on the effects of abortion on women's health. The Association for Interdisciplinary Research in Values and Social Change sponsored the development of a White Paper on the psychological aftermath of abortion, which was presented in June 1988 to Surgeon General Koop. We believe that we presented him with academically solid information which could have been the basis for a report which would have benefitted American Women.

Instead of a report, he delivered a letter to the President in January, 1989 stating that no report could be prepared because the research was so methodologically flawed that no firm conclusions could be drawn. Specialists and professionals on both sides of the issues are in agreement that the current studies are flawed. Both the reports of the American Psychological Association and our Association argued that current data are poor. However, the conclusions drawn by the two groups are very different.

For example, the American Psychological Association (APA), in its report to the Surgeon General, pointed out all of the methodological flaws in the research and then drew the conclusion that the results supported their contention that abortion causes no negative psychological after-effects. Clearly, this conclusion cannot be supported by existing data. They further state that there are too few studies on long term effects, but the conclusions include the completely unsupported assumption that, although women may have a difficult time with their abortions, that this negative effect diminishes with time.

The position of the Association for Interdisciplinary Research was quite different. In our report to the Surgeon General, we emphasized the lack of good research data to support the claim that abortion is psychologically safe. We argued that this is the body of data which can be demonstrated to be methodologically flawed and, therefore, the conclusion that abortion is safe for women is inaccurate and unsupported by the data. Thus, we draw the opposite conclusion of the APA, arguing that there is no support for the long – held position of the pro-Abortion Lobby.

Instead, we reviewed findings from the clinical data, which presented repeated evidence of true psychic harm to women, much of it occurring long after the abortion experience should have been forgotten (as claimed by the representatives of the APA). Women who report negative after-effects know exactly what their problem is. They report horrible nightmares of children calling to them from trash cans, of body parts, and blood. When they are reminded of the abortion, they re-experience it with terrible psychological pain. They feel worthless and victimized because they have failed at the most natural of human activities, the role of being a mother. In addition, studies indicate attempted suicide, drug and alcohol abuse, relationship disorders, sexual dysfunction, repeated abortions, communication impairment, damaged self-esteem, and other psycho-social problems among women who have had abortions.

The position of our Association differs from the APA in another important respect. In addition to the methodological flaws in the current research, there is a basic theoretical flaw. Most of the research treats negative after-effects of abortion as trauma due to crisis resolution and short-term reactions to surgery. These studies have never looked beyond six months for evidence of reactions. The APA findings have primarily uncovered reactions of relief, although sadness, loss and grieving are common. Relief would be expected since abortion was chosen as a solution to a problem-pregnancy and relief is a common emotion following a crisis.

However, the negative effects of abortion appear to resemble more the pattern of Post Traumatic Stress Disorder (PTSD) which affected Vietnam War Veterans. This is characterized by a strong emotional reaction to a negative event which builds over time as the persons struggle to reconcile their actions with their conscience and the roles society expects one to fulfill. These are problems which may emerge long after the entire crisis is over and the person begins to attempt to integrate the results of her decisions into her life.

If one accepts this assumption, then the reactions women report in Abortion Clinic contexts can be easily explained. The delay in reaction, the severe adverse emotional behaviors, the crying and depression, and the inability to overcome the feelings of guilt are all typical of both PTSD, as well as the Post Abortion Women. It is only in the few studies that have investigated long-term effects and which have asked women to talk about their feelings that findings of negative after-effects of abortion become clear.

If the Surgeon General's recommendation for additional research is undertaken, it must be done with this syndrome in mind: it must be methodologically clean but also theoretically correct. At least two conditions must be met: (1) sufficient time must be included so that the long-term effects of the experience can appear, and (2) in-depth clinical tests should be used in order to evaluate the woman's total well-being. Only in this way can the severe effects of individual abortion be uncovered. We need to respond to the Surgeon General's call for research with honest, carefully designed studies to give us more information about the reactions and events we can already see. A scientifically tenable approach would be to assume that women are suffering from Post Abortion Syndrome, a variant of Post Traumatic Distress Disorder, and then attempt to validate this assumption.

It is important for social policy reasons to do a large, systematic study of the broadly based sample population in order to obtain information on the numbers of women who are affected. This is certainly critical to an understanding of the full impact this will have on health care providers. However, we do not need such a study to show that women are affected or to argue for support for these women. This has already been established.

Characteristics of Women Seeking Services at an Independent Crisis Pregnancy Center
by Wanda Franz, Ph.D

The United States has the largest number of unplanned pregnancies per population of any country in the world.1 When a woman has an unplanned pregnancy, she is often in a state of personal crisis. It is possible that she may be unmarried, still in school, pursuing a career, etc. She must make a decision to resolve the problem caused by the unexpected pregnancy.

Statistics indicate that this is a relatively recent phenomenon. Both the numbers of sexually active unmarried women and the numbers of abortions have increased since abortion was legalized in 1973.2 Clearly, this represents a new health need among the women in this country. It is important to have some understanding of how women resolve this crisis, what health care institutions assist them in the crisis resolution, and what kinds of women seek the services of the various health care systems available to women in need of crisis resolution.

Most of the research on women with crisis pregnancy has been done on women at an abortion clinic.3 But these studies are limited, because they do not study women during crisis resolution but only after abortion has been chosen. In addition, this research does not include those women who chose an alternative other than abortion. Another limitation is that most of the clinics being researched are in large urban areas where such facilities tend to be clustered. There is relatively little known about the women in a small town remote from large-scale health facilities and clinics who primarily, or exclusively serve abortion clients.

A new form of health care service has been evolving in the United States, in recent years. These programs generally go under the name of "crisis pregnancy centers," are usually nonprofit, volunteer groups, and are sometimes, though not always, connected with a church or "pro-life" organization. It is estimated that there are thousands of these groups all over the country, but relatively little is known about the kind of health care services they are providing, the women they serve, or the number of women being helped outside of the more traditional health facilities.

The purpose of this study is to examine the data gathered at one such facility in order to develop a profile of the women who sought services and to do some preliminary analysis of the kinds of decisions they make and some of the variables associated with the various choices made in resolving the problem of an unwanted pregnancy. This study constitutes a preliminary step toward developing a better understanding of this alternative form of crisis pregnancy resolution.

Methods

This study is a profile of all 159 women seeking services at one center over a recent one-year period, in a city of approximately 50,000 population, located in the Appalachian area of the U.S. The center is a non-profit organization supported by contributions from concerned individuals in the community. It is not affiliated with a church or national organization. It is staffed five days a week by volunteers under the supervision of a trained counselor, who volunteers time for training and organizational duties. The center advertises in the local paper and the university newspaper. Most clients hear about the center by word of mouth. The center is located in a community, where a large state-supported University is located. The University provides Counseling and Medical Care, including Physicians. The local Public Health Department also provides clinic care and pregnancy testing.

Procedures

Each woman included in the study came to the center with a urine sample. While the staff performed the pregnancy test, the women were asked to wait in a comfortable room. During the waiting period, the women were asked to fill out a brief one-page questionnaire. The form contained information on age, occupation, marital status, previous abortions, birth control use, and sexuality education.

The women's name does not appear on the form. Instead, each client is assigned a number and this number and her name is kept in a permanent and confidential file. The results of the pregnancy test are placed on the form. Counselling is then done, whether or not the woman is pregnant. If she is pregnant, an effort is made to discuss her options and a follow-up is done whenever that is possible. The woman's decision for resolving her unplanned pregnancy is then noted in the permanent file, which is updated if follow-up information is available. For purposes of this study, the latest known information was included: abortion, keeping the child, or undecided. One woman was considering adoption. Since she would not make a final legally-binding decision until after the birth of the baby, she was placed in the "undecided" category.

Data Analysis

Two research question were asked given the method of data collection. Is there a difference between women whose pregnancy tests are positive or negative on the various variables? Is there a difference between women who make different choices regarding their unplanned pregnancy on the various variables? Tests of significance were performed on the relevant data. The variables included age, employment (college students, full-time employment, and other, including housewives and welfare cases), marital status, previous abortions, birth control type (effective methods including pill, sponge, IUD, and diaphragm; ineffective methods, including rhythm and withdrawal; condom; or unstated), sexuality education (yes or no), and place of sexuality education (school, clinic and other, including home).

These variables were used to compare women who had a positive pregnancy test versus those whose test was negative. They were also used to compare women who made different choices for resolving their crisis pregnancy situation: Choosing abortion, keeping the baby, or undecided. A GLM test was used for the variable age and all other analyses were done using chi-square.

Results

Of the total 159 women, 103 (65%) were not pregnant and 56 (35%) were pregnant. Of the 56 who were pregnant, 24 (43%) indicated their intention to abort, 21 (37%) indicated their intention to carry the pregnancy to term and keep the baby, and 11 (20%) were undecided, including the one woman considering adoption.

The ages of the women ranged from 15 to 33 with the average being 20.9 The majority (92 or 58%) were college students, 34 (22%) were employed full time, and 31 (20%) fell into a category of "other." This category included housewives, women on welfare and high school students. Only 23 (15%) of the sample were married. The other 135 (85%) were not married.

In this group of women, only 17 (11%) had an abortion in the past and 142 (89%) said that they had not had an abortion. Although questions were also asked regarding the client's perceived physical and emotional condition following abortion, the numbers are too small to make analysis meaningful.

The women were asked how often they used birth control. Twenty-one (14%) said never, 25 (17%) said sometimes, 41 (27%) said often, and 63 (42%) said always. The women were then asked to indicate the type of birth control used. This data was compiled into four categories; none, which contains only one woman (1%), effective methods, which includes the majority of 106 (72%), ineffective methods, which includes only 18 (12%), and the condom, which was the single type used by most of the women: 22 (15%).

Sexuality education questions were included in order to obtain some information on the educational background of the clients. Only 33 (21%) reported having no sexuality education while 125 (79%) claimed to have had some form of sexuality education. The women were then asked to mark the place where their sexuality education took place. The majority 98 (79%), indicated they obtained their education in the school, 14 (11%) listed the health clinic, and 13 (10%) indicated other places including the home.

Data Analysis on Pregnancy Outcome

A GLM test was run on the variable age. There was a significant difference at the .04 level (F = 4.37, d.f. = 1) between the pregnant and non-pregnant groups. The pregnant women were more likely to be older than those not pregnant. The chi-square analysis was run on the other variables. There was no effect of employment, marital status, previous abortions, or sexuality education. There was a significant effect of birth control use (X2 = 16.5, p < .001) with the pregnant women less likely to report using birth control "often" and "always" and more apt to report using birth control "sometimes." The variable "type of birth control" approached significance (p < .07). It is interesting that identical numbers of pregnant and non-pregnant women used condoms or an ineffective method. It was only in the area of effective methods that more than twice as many non-pregnant women claimed to use them as pregnant women.

Data Analysis on Choice of Pregnant Women

The variable employment had a significant effect on the choice of the women to abort, keep the baby, or be undecided. The college students were significantly more apt to abort, while the women in the "other" category were more apt to keep their babies (p < .04, X2 = 10.0). The variable marital status was significant at the .003 level (X2 = 11.49) with married women more likely to keep the baby and unmarried women more likely to abort. The variable "birth control type" was significant at the .04 level (X2 = 9.85). Those using the most effective methods were most apt to abort or keep the baby and least apt to be undecided. Those using ineffective methods were most apt to keep their babies. Those using condoms were split between aborting and being undecided. None of the other variables was significant.

Discussion

Profile of Women

The women seeking help at this crisis pregnancy center were primarily college students from the nearby University. The category of "other" included the married housewives, women on welfare and the few high school students in the sample. Most of the women using this facility were unmarried, suggesting that they might have been avoiding the usual health care facilities in their desire for anonymity. A surprising finding was the large number in the sample who regularly used birth control and who used effective methods. This may be due in part to the large proportion of college educated and the generally older population of clients.There were very few high school students.

Another interesting finding was the large proportion who had sexuality education in the schools. Most states in this region are just beginning to mandate sexuality education in the schools. It was interesting that so many of the clients had already received some form of education. But it was not possible to evaluate the quality of that education. However, it is clear that the education they received did not prevent them from having an unplanned pregnancy. Sexuality education also had no effect at all on the tendency of the woman to be pregnant or to influence her decision regarding the pregnancy. Study does not provide support for the contention that education will contribute toward preventing unplanned pregnancy and supports similar findings in a large national sample.4

Factors effecting pregnancy

In this sample, the older subjects were more likely to be pregnant than the younger ones. In order to understand this result, it is necessary to look at the ages of the subjects. The average age was 20 years, but there were very few adolescents, so that the "younger" subjects in the sample were the college students. The "older" subjects were the married women and the single woman raising their families on welfare. The "older" women were more likely to be pregnant.

The other variable that accounted for the tendency to be pregnant was the use of birth control. Those women who were pregnant were more apt to report that they used birth control "sometimes." It would appear that the older, more mature women were not as highly motivated to prevent the pregnancy as were the younger college women who presumably had more to lose in terms of freedom of action and educational opportunities. This is in keeping with other findings that college girls are inclined to have abortions as a means of solving the crises of an unwanted pregnancy.5 It is perhaps encouraging to note that the college students were attempting to be responsible in their use of birth control and did, in fact, have fewer pregnancies. On the other hand, of the 92 college students, 35 or 38% were pregnant. This is a very high probability of pregnancy if it is suspected, particularly if the woman truly does not wish to be pregnant. Clearly, sexual activity does carry a risk, even in a population that claims to be conscientious about using birth control.

Factors Affecting Decision-Making Regarding the Pregnancy

There were three variables which predicted the choice of the pregnant woman as part of her crisis resolution. These were the variable "employment", marital status and birth control type. Women were more apt to abort the pregnancy if they were unmarried college women and if they were using effective methods of birth control. They were more apt to keep the baby if they were married housewives raising their families. These women were also more apt to use ineffective birth control. This is a logical outcome, since it is the older women who are already involved with establishing their families who are more apt to be able to manage a child, even if it was unplanned. The college student has more to lose, especially if she is unmarried. These findings are similar to those from other studies.6

The choice of abortion for this population is in keeping with other research, which has shown that abortion is the method of choice for resolving unplanned pregnancy for women in college. The group using condoms differs from the others. They are equally likely to abort or be undecided but least likely to keep the baby. Those using effective methods are split between aborting and keeping the baby. The condoms using group seems most unwilling to bear children. These findings clearly indicate that future researchers should separate the groups by type of birth control method. Some method of meeting the needs of these students is essential. The community in which this study was carried out had available a public health service program and a University health program. However, a fairly large group, nearly 100 in one year alone, chose to use the private off campus non-profit program instead. It would be useful to know how this population differed from the one choosing the more traditional facilities. It does appear, in any case, that this alternative form of service is being used and appears to have an important role to play in the overall health care service needs of the community.

Footnotes

1 Mosher, W.D. (1988) Fertility and Family Planning in the United States: Insights from the National Survey of Family Growth. Family Planning Perspectives, 20 (5), 207-217 [Back]

2 Ventura, S., Toffel, S., and Mosher, W. (1985) Estimates of Pregnancies and Pregnancy Rates for the United States 1976-1985 (1988) American Journal of Public Health 78, 506 and Jones, E et al (1985) Teenage Pregnancy in Developed Countries:Determinates and Policy Implications Family Planning Perspectives, 17, 53 [Back]

3 Rue, V.M., Speckhard, A, Rogers, J.L, and Franz, W.K (1987) The Psychological Aftermath of Abortion: A White Paper Presented to C. Everett Koop, M.D., Surgeon General of the United States [Back]

4 Saunes, A 1; Supra, note 1 [Back]

5 Henshaw, S.K and Silverman, J. (1988) The Characteristics and Prior Contraceptive use of U. S. Abortion Patients Family Planning Perspectives, 20(4),158-168 [Back]

6 Torres, A. and Forrest, J. (1988) Why do Women have Abortions? Family Planning Perspectives, 20 (4),169-176 [Back]

Increased Smoking Rates In Women Following Induced Abortion
by Thomas Strahan

Introduction

Cigarette smoking is a serious health problem in the United States. It has been identified as the chief avoidable cause of death with the total of smoking attributable deaths in 1984 at 315,120, of which 106,063 were women.1 It has been recently estimated that 25.7% of adult women smoke as compared with 31.5% of men in the U.S.12 However, today's female smoker is a heavier smoker than in the past. Over a 20 year period, the percentage of women who smoke more than 25 cigarettes per day has almost doubled, from 13% in 1965 to 23% in 1985. More young women than young men smoke today. Among high school seniors the frequency of smoking among girls has exceeded that of boys for a decade. Nationally, 38% of women smoke between the ages of 18-29 compared to 25% of men in the same age group.3

Increased smoking rates in women who have had an induced abortion is a universal phenomenon. A study by the World Health Organization concluded," Women who have had an induced abortion are not a random sample of the population, but the degree to which they deviate from the norm varies with the attitude of their society. In general,they are more likely to smoke, to have failed contraception, and to be uncertain of menstrual dates when compared with primigravidae of similar age or with women who had a previous spontaneous abortion.4

Personality Characteristics Of Smokers

Personal characteristics and habits of smokers tend to show the type of person who is more likely to abort a child. Smokers are less likely to use contraceptives or plan the pregnancy. Smokers are more likely to drink coffee, beer or whiskey, while the non-smoker tea, milk or wine. Smokers are more likely to indulge in these habits to excess. Smokers are more likely than non-smokers to attempt to hide mistakes.

In a study of 595 college students at the University of Arizona in 1973, it was found that smokers favored spontaneity, while non-smokers tended to attach greater importance to deliberate and planned action. Smokers tended toward uncontrolled complexity rather than organized simplicity in their preferences and thought processes. Smokers tended to manifest aesthetic rather than practical interests. Smokers tended to show more tolerance, if not actual hunger, for varied ideas, emotional and perceptual effects, complexity and perhaps even confusion. Smokers had a higher level of anxiety, manifest more psychosomatic symptoms, more guilt proneness, more unrealistic fantasy content, less self-control over internal processes, and more nervous tension than non-smokers in the study. Smokers appeared to dwell more on the past and female smokers had the lowest rating of recent conversation related to the future.5

Adolescents who smoke have been found to be more impatient to grow up, more rebellious and more inclined toward impulsivity and risk-taking.6 Smokers have often expressed the wish to be older than they were and this has been particularly noticeable in girls.7 Promiscuous sexual behavior has been correlated with smoking in a British study of adolescent girls.8 Others have found that heavy smokers had less satisfactory relationships with authority in general and parents in particular, and were less likely to conform to rules and behavior codes.9 Still another study concluded that smokers are less well integrated and tend to demonstrate lack of purpose and values compared with non-smokers.10 Women in a state of bereavement following a loss will tend to increase smoking.11 And women who smoke during pregnancy will tend to have increased rates of child abuse compared with women who do not smoke during that time.12

Research conducted in 1971 identified two basic reasons why people smoke. One is to relieve boredom or depression and move from a low state of arousal to an increased state of arousal. Another reason for smoking involves a high arousal state i.e. feeling worried, angry, or upset and the person smokes in an attempt to reduce arousal i.e. to relieve the stress-inducing situation. Women tended to smoke for this latter reason. Heavy smokers have a tendency for any reason.13 A 1975 report by the United States Public Health Service confirmed that women are more likely to report that they use cigarettes to deal with emotional upsets than men. Women are more likely than men to affirm, " When I feel blue or want to take my mind off troubles, I smoke cigarettes," and "I light up when I feel angry about something."14 A recent article on smoking by women concluded that "smoking can be a pause in which a threatening impulse is avoided."15

Persons who smoke as a function of negative personal perceptions constitute only one sub-group of smokers, and this type of smokers seems to be more prominent among females.16 Heavy female smokers have been found to be more depressed or neurotic than non-smokers.17 Several studies reporting results indicate that in treatment programs, women are less successful in achieving and maintaining abstinence.18

Studies On Induced Abortion And Smoking

The correlation between induced abortion and increased smoking in women, although known for over 40 years, has had no detailed discussion in the literature. The relationship, although mentioned in several of the early official reports of the Surgeon General of the United States on smoking, has not been mention at all since 1972. Since the mid 1960s studies including the two subjects have been relatively few in number and mostly confined to populations outside of the United States. Virtually all studies involve interviews with a woman currently pregnant and intending to keep her child and who has made contact with or become a patient at a hospital. None included in-depth interviews or sought to ascertain why the woman was smoking. None reported smoking rates prior to the first pregnancy outcome. Despite these limitations the available studies provide valuable information.

The leading study of increased smoking rates in women following induced abortion is a study of 7327 women at two hospitals in Copenhagen, Denmark, conducted between April 1, 1974 to December 31, 1975 among women registered for delivery.19 Smoking rates were as set forth in Table 1.

Table 1
Total No. of Women % Smoking at First Interview % Smoking at 28 Weeks gestation
Last Pregnancy Terminated by Abortion 567 63.1 43.1
Last Pregnancy Ended in Stillbirth or Spontaneous Abortion 1009 51.1 39.3
Last Pregnancy Ended in Life Birth 2900 49.0 32.1
No Previous Pregnancies 2785 55.7 30.2

The abortion group had an 85% incidence of one prior reported abortion and 15% incidence of more than one prior abortion. Initial smoking rates were highest among aborters (63.1%) and lowest among those with last pregnancy ending with a live birth (49.0%). When women were interviewed after 28 weeks into their current pregnancy, the abortion group still had the highest percentage (43.1%) still smoking, followed by stillbirth or miscarriage (39%).

This has important health implications both to the woman and the health of her future offspring. Smoking during pregnancy generally results in a 150-200 mg. reduction in birth weight, a 20% increase in neonatal death for those smoking less than a pack a day, and a 35% greater chance of neonatal death for those smoking a pack or more per day. There is also a possible increase in congenital anomalies, decrease in growth rate, and a compromise in cognitive function (mental retardation) in early and middle childhood. Recently it has been estimated that 4600 of the 8700 infant deaths during the prenatal period in the U.S. would have been prevented if their mothers had not smoked.120

Cigarette smoking during pregnancy is not only a significant threat to neonatal health but also a sizeable economic burden to the medical care system. Maternal smoking during pregnancy was responsible for 35,816 (14.5%) of the low birth weight babies in the United States in 1983 and an estimated 14,978 (6.6%) of the 228,297 admissions to neonatal intensive care units. Total intensive care costs amounted to $180 million or approximately 5.7% of the total national expenditures on neonatal intensive care in 1983. It represents 175 million dollars additional cost of care that would not have been incurred in the absence of smoking during pregnancy. The study concluded that the cost of neonatal care in the U.S. in 1983 was higher by $189 per infant born to women who smoked compared with infants born to women who did not smoke.21

Another large scale study on smoking characteristics in women and induced abortion was conducted by the World Health Organization on 9874 Arab and Jewish women. Table 2 describes the results.22

Table 2
Smoking Characteristics Percentage of Women Reporting Induced Abortion
Crude Standardized Significance
Current Smokers (977) 14.4 12.3 P .001
Non smokers or gave up smoking (737) 11.0 9.9 P .001
Never Smoked (8160) 6.0 6.3 —

This study also reported increased smoking rates among women who had aborted. Abortion rates were lower among former smokers than current smokers and lowest of all among those who never smoked. This same study also found that smoking is related to breaking away from traditional values. Orthodox Jewish women who reported abortions were less likely to be strict regarding religious observance. Orthodox Jewish women who observed the tradition of going to the ritual bath after each menstruation had an abortion rate of 1.1%; those who observed pan of the ritual had a rate of 3.8%; nonobservant women had a rate of 12.7%

The emancipation of women has been identified as one of the reasons for smoking by women. Cigarette advertising directed to women uses the phrase, " You've come a long way, baby" and for many women smoking may still signify defiance and independence. The feminist movement has also come under criticism with respect to smoking. The National Women's Health Network which represents over 1000 women's health organizations has "no formal position on smoking." MS Magazine, which regularly takes cigarette ads, is curiously devoid of articles warning women of the hazards of smoking. Recently, in a 1987 article in the New England of Medicine, the author (a physician) bluntly stated, " Organizations that have been working for women's rights might consider devoting some attention to helping wean themselves from a habit that is usually unwanted and is know to be self-destructive."23 The New York State Journal of Medicine in 1983 and again in 1985 in a comprehensive series of articles has also attacked the Tobacco Institute and the feminist movement for its indifference to the hazards of cigarette smoking.24

Table 3
Swedish Study of 4719 Women (1970-1978)
Cigarette Consumption Aborters Parity Matched Controls All Swedish Women (1975)
None 41.7 59.7 61.5
1-9 Cigarettes per day 20.7 19.3 18.9
10 or more cigarettes per day 37.4 21.1 18.9
Total Percent smokers 58.1 40.4 37.8

The Swedish study25 (Table 3) found higher abortion rates as the intensity of smoking increased both with respect to parity matched controls as well as compared with Swedish women generally. Although there was little difference in smoking percentages when smoking was only 1- 9 cigarettes per day, there were 37% of the aborters smoking 10 or more cigarettes per day vs. only 21% for the matched control group and 19% of Swedish women generally. Thus, women who have had abortions and smoke may find it more difficult to quit.

The Swedish study also reported that the prior aborters were more often teenagers and unmarried at delivery than controls, and further found that maternal smoking was more prevalent among the abortion group. This seems to indicate that an early abortion may initiate or intensify smoking behavior that will impair maternal health at a later date when a subsequent pregnancy will be carried to term.

Table 4
Women Patients entering Boston Hospital For Women (1976-1978)
Abortion History Number of Women Percentage of Smokers
No Prior Abortion 995 31.7
One Prior Abortion 254 40.3
Two or More Prior Abortions 63 51.7

The Boston Hospital for Women study26 (Table 4 ) found that smoking rates of women entering the hospital increased as the number of prior abortions increased. This may be considered evidence of increased development of personality characteristics often found in smokers as described earlier. These would include characteristics such as bereavement, hostility, less self-control, guilt proneness, nervous tension, impulsivity and risk taking, psychosomatic symptoms etc,. The study calls into serious question whether elective induced abortion is "therapeutic", considering the well known adverse consequences of smoking on health.

Conclusion

Increased smoking rates are observed in women whose last pregnancy was terminated by induced abortion compared with woman whose last pregnancy ended in spontaneous abortion, a live birth or with no previous pregnancy. The increased smoking rates were also observable during subsequent pregnancy that was intended to be carried to term. Women currently smoking have higher rates of prior abortion experience compared with women who once smoked and since gave it up or who never have smoked. Women who have had abortions tend to smoke more heavily and increasing numbers of prior induced abortion also correlates with increasing rates of cigarette smoking in women.

However, the correlation between increased smoking and an adverse impact from induced abortion should be considered as tentative because there are yet important areas of research to be explored. For example, there is a lack of studies reflecting smoking behavior prior to abortion or other pregnancy outcome in comparison with post-abortion smoking behavior. There is a general lack of anecdotal reports from women who have had abortion experience that included smoking behavior. And there are no in-depth interviews with women where reasons for smoking could be ascertained or where woman might be able to recall specific events in their lives that brought about initial or intensified smoking. Because of these limitations there yet remains the possibility that those who seek abortions are simply more likely to be drawn from a population of women that tend to smoke, i. e. rebellious, impulsive, confused, angry, and that induced abortion per se has no direct impact on smoking behavior. Additional research can clear up that point one way or the other.

But whether or not induced abortion is directly implicated in smoking behavior, evidence strongly suggests that deliberate risk-taking, impulsiveness, anxiety, disorder, confusion, rebellion are prominent in the personality profile of many women who smoke (and who obtain abortions), not careful planning and orderly behavior. Irrational maladjustment is more likely to be the life style, not a conscientious informed consent. The model of a planned parenthood does not fit the personality characteristics of the population in question.

The personality and thought processes of many of these smokers (and aborters) does not fit a medical model. Modern medical theory requires a calculation of risks and benefits by rational logical analysis. But this is exactly contrary to the personality characteristics of the women at issue. Their motivations and thought processes are of a much different kind. The nature of their personalities reveals much deeper needs which are outside the medical model. Clearly, what no woman needs is a so-called liberation that is, in fact, one of increased maladjustment and increased health problems either in their private lives or in their maternal role. But increased smoking rates after induced abortion is evidence that abortion is leading them in that direction.

Footnotes

1 Smoking-Attributable Mortality and Years of Potential Life Lost - United States,1984, JAMA, Vol. 258, No. 19, p. 2648, Nov. 20, 1987 [Back]

2 Cigarette Smoking in the United States, 1986, Morbidity and Mortality Weekly Report,36: 581-585, 1987 [Back]

3 Smoking and Women. Tragedy of the Majority, J.F. Fielding, New England Journal of Medicine, Vol. 317, No. 21, p. 1343-1345, Nov 19,1987 [Back]

4 Gestation, Birth-Weight and Spontaneous Abortion in Pregnant Women After Induced Abortion. Report of Collaborative Study by World Health Organization Task Force on Sequelae of Abortion, The Lancet, p. 142-145, January 20, 1979 [Back]

5 Personality Variables Associated with Cigarette Smoking, Coan, J. of Personality and Social Psychology, Vol. 26, No. 1, p. 86-104, 1973 [Back]

6 Recent Increase in Adolescent Cigarette Smoking, Tamerin, Arch Gen. Psychiatry, Vol. 28, p. 116, Jan. 1973 (also citing several studies) [Back]

7 Adolescent Smoking as Compensatory Behavior. Newman, L. M., J. School Health, Vol.40, p. 316-321, 1970 [Back]

8 The Sexual Behavior of Young People, Schofield, London, Longmans Green & Co Ltd. (1965) [Back]

9 Smoking and Rebelliousness: A Longitudinal Study from Childhood to Maturity, Stewart and Livson, J. Consult Psychology, Vol 30, p. 225-229 (1966); Personality Differences between Smokers and Non-Smokers, Salber and Rochman, Arch. Environ. Health, Vol. 8, p. 459-465 (1964) [Back]

10 Differences between smokers and non-smokers. Archives of Internal Medicine (Chicago) Vol 101: 377-388 (1958) [Back]

11 Health after Bereavement. A controlled study, Parks et al, Psychosom. Med 34:449-461 (1972) [Back]

12 Smoking During Pregnancy and Child Maltreatment, Cheesan and Pascoe, Intl J. for Bio- Social Res. 8: 1-6 (1986) [Back]

13 Smoking Behavior and its Relation to the Smokers Immediate Experience, Frith, Br. J. Soc. Clin. Psychol., Vol. 10, p. 73-78 (1971) [Back]

14 United States Public Health Service, Adult Use of Tobacco, U.S. Dept of Health, Education and Welfare, CDC, Bureau of Health Education (1975) [Back]

15 You've Come the Wrong Wav Baby, Johnson, Medical Self-Care, Fall, 1984. p. 18 [Back]

16  [Back]

Supra, note 13; Predictors of Outcome and Recidivism in Smoking Cessation Treatment, Addictive Behaviors, Vol. 3, p 65-70 (1978)

17 Personality Implications of Cigarette Smoking Among College Students, Schubert, J. Consult. Psychology, Vol. 23, p. 276 (1959); Smoking and Neuroticism, Waters, Br. J. Preventive and Social Med., Vol. 25, p. 162 (1971) [Back]

18 Woman's Smoking Trends and Awareness of Health Risk, Tagiacozzo and Vaughn, Prev. Med., Vol. 9, p. 384-387 (1980); Predictors of Outcome and Recidivism in Smoking Cessation Treatment, Addictive Behaviors, Vol 3, p. 65-70 (1978) [Back]

19 Pregnancy Complications Following Legally Induced Abortion: An Analysis of the Population with Special Reference to Prematurity, Obel, Danish Medical Bulletin, Vol. 26, p. 192-199 (1979) [Back]

20 An Overview: Maternal Nicotine and Caffeine Consumption and Offspring Outcome, Martin, Neurobehavioral Toxicology and Teralology, Vol. 4, No. 4, p. 421-427, July-August, 1982; Health Consequences of Smoking: A Report of the Surgeon General of the United States. [Back]

21 The Effects of Cigarette Smoking During Pregnancy on the Incidence of Low Birth Weight and the Costs of Neo-Natal Care, Harvard University John F. Kennedy School of Government, Institute for the Study of Smoking Behavior and Policy, Cambridge, Mass., Discussion Paper Series S-86-01, Jan 1986, 13 pp. [Back]

22 Characteristics of Pregnant Women Reporting Previous Induced Abortions, Harlap and Davies, Hull. World Health Org., Vol. 52, p. 149 (1975) [Back]

23 Smoking and Women, Tragedy of the Majority, New England J. Med., Fielding, Vol. 317, No. 21, Nov. 19, 1987 [Back]

24 Mixed Messages for Women: A Social History of Cigarette Smoking, N.Y. State J. of Med., p. 1258, Dec., 1983 [Back]

25 Outcome of First Delivery After 2nd Trimester Two-Stage Induced Abortion: A Controlled Historical Cohort Study. Meirik, Nygren, Acta Obstetricia et Gynecologica Scandinavia, Vol. 63, No. 1, p. 45-50 ( 1984) [Back]

26 Association of Induced Abortion with Subsequent Pregnancy Loss, Levin et al, JAMA, Vol. 243, p. 2495-2499, June 27, 1980 [Back]

Did You Know?

Abortion adversely impacts upon the parental attitude towards the legal obligation of a parent to provide for the care and support of a child. In a study conducted at a state-supported university in Texas, male and female students were asked whether or not a woman should be able to legally sue the father for child support if he was willing to pay for an abortion and the woman decided to keep the child. 59% of the men and 40% of the women thought the woman should not be able to sue for child support under those circumstances. The Rights and Responsibilities of Men in Abortion Situations, Shirley Rosenwasser et al, Journal of Sex Research, 23: 97-105 (February, 1987)

In the leading study in the United States on attitudes of 1,000 men interviewed at abortion clinics, Arthur Shostock found that 48% of the men (37% of the married men and 52% of the unwed males) did not think a man should be required to pay child support - as at present - if the woman refused his request that she have an abortion. A Report on 1,000 Men and the Impact of Abortion on their Family Life, Arthur B. Shostock, presented at meeting of American Sociological Society, August 29, 1984

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