Physical and Psychological Injury in Women Following Abortion
Akron Pregnancy Services Survey

Association for Interdisciplinary Research in Values and Social Change
Newsletter Vol. 5, No. 4, September/October 1993
Lee Ellen H. Gsellman, M.A. NCC
Reproduced with Permission

The author, Lee Ellen H. Gsellman, M.A. NCC, is Director of Counseling and Post Abortion Teaching and Healing (PA.T.H) at Akron Pregnancy Services, Akron, Ohio. This article is a modified version of a paper presented at the annual meeting of the Association for Interdisciplinary Research in Values and Social change, Milwaukee, Wisconsin, June, 1993. She first became involved in post abortion research when a client suddenly and unexpectedly became preoccupied with suicide. The client lived a considerable distance from the pregnancy center, but had been referred by a friend of hers who knew her abortion history. The friend was knowledgeable about post abortion trauma and suspected that the woman's suicidal impulses, eight years following her abortion, and surfacing the anniversary week of her abortion, were the result of unresolved abortion trauma.

This study is based upon a self-reported questionnaire completed by 344 postabortal women at Akron Pregnancy Services in Akron, Ohio, between November 1988 and May 1993. The Open Arms Abortion Information Survey form1 was used which lists possible physical and psychological injuries as well as other demographic data and circumstances of the abortion.

Only 28 percent of the women in this study had presented for post abortion counseling. Most of the women were seeking other pregnancy-related services such as: pregnancy testing; material assistance; general counseling; adoption decision making help, referral, and post adoption grief counseling; prenatal care; nutrition assistance; childbirth, parenting, and self esteem classes; referrals to other community agencies, and referral for medical care. All services provided are free and confidential.

Physical Complaints (Table 1)

Table 1
Physical Complaints
None/No response:60%
Indicated 1 or More Complaints:40%
Infection/High Fever4%
Perforated Uterus0%
Cervical Lacerations.6%
Damage to Bowels0%
Blood Clotting Defect3%
Intense Pain16%
Incomplete Abortion1%
Adherent Placenta0%
Placenta Previa.6%
Tubal Pregnancies.3%
Premature Births3%
Neonatal Deaths0%
Long/Difficult Labor7%
Infertility/Difficulty Conceiving1%
Cervical Damage (Incompetent Cervix)1%
PID Tubal Infection1%
PID-Tubal/Ovarian Abscess.3%
Pelvic Inflammatory Disease - Unspecified3%
Scarred Uterus.6%
Menstrual Disorders/Spotting10%
Rh Problems0%
Abdominal Pain12%

The survey results found that 40% of the women reported one or more physical complaints, including 16% who reported immediate intense pain after their abortion and 12% who later reported abdominal pain. Some women say the pain during their abortion was lust like natural delivery without any anesthetic. It is important to realize that these are not women who are presenting exclusively because they have had an abortion. The women are presenting primarily for some other pregnancy-related service. Four percent reported infection and high fever as an immediate complication. Although this figure does not seem particularly high, it is not unusual for young women to call our service and say: "I have had an abortion. I am hemorrhaging. I have a high fever. The abortion clinic tells me they won't see me for 2 weeks until my checkup. What can I do? Lately, these women have been referred to the Attorney General's complaint office. That seems to get action so they can at least get medical treatment. There are also a few physicians who will see our clients. Some of the women do not want to go back to the abortion clinic. If they do not, then at least there is a choice of going somewhere else.

Akron Pregnancy Services research and our client reports also indicate that clinics and abortionists vary in the areas of counseling provided, sanitation, bedside manner, respect for patients, aftercare, emergency provisions and patients' rights. In rare cases there have been client reports of professional, caring, respectful abortion treatment. Fine treatment, however, has not prevented post abortion suffering in those same individuals.

One of the later physical complaints was menstrual disorders/spotting, which was reported by 10% of the women. This concurs with a Japanese study, which showed a similar complication.2

Twelve percent of the women surveyed reported abdominal pain. It is difficult to tell whether the abdominal pain is caused by actual physical damage or whether it is a matter of psychological factors affecting their physical condition. Some women report that when they hear abortion mentioned, they actually begin to cramp as if they were going into labor. Some have complained about this, years after their abortion experience. Thus, it appears that abdominal pain can occur either as result of physical damage or from psychological factors.

Psychological Complaints (Table 2)

Table 2
Psychological Complaints
None/No Response:19%
Indicated 1 or More Complaints:81%
Hostility/Hatred of Men22%
Feeling of Dehumanization17%
Failure to Make Decisions23%
Inability to Forgive Self46%
Drug/Alcohol Abuse17%
Desire for Others to Abort3%
Thwarted Maternal Instincts8%
Lower Self-Esteem38%
Child Abuse.6%
Suicidal Impulses16%
Preoccupation with Death7%
Preoccupation with Aborted Baby16%
Desire to Get Pregnant Again23%
Suicide Attempts7%

The extent of psychological injury is probably under-reported because for some women the abortion experience has been successfully repressed. It is important to remember that some women have never told anyone about their abortion. They may have lied to their doctors, husbands or boyfriends. Our volunteers often report that when they ask women about their pregnancy experiences, the women will get tears in their eyes and say they have never told anybody until now of their abortion experience. Thus, many haven't consciously thought about their abortion experience and have not identified some of their behavior and pain as being related to abortion.

Also, if the woman is a person who has been severely hurt in the past, she may be very concerned about the issue of control in her life. She is apt to respond "I'm prochoice no matter what, because its my body and I'm going to do with it what I want to. On a few of the survey forms, women have written "not appropriate", and therefore have not listed any psychological or physical complaints. However, if you ask them to state in a sentence how they feel about abortion, they will say "I hate it, or if you ask, "Would you do this again? they respond "No I wouldn't do this again." One young woman had not listed any complaints and then in one sentence she said, "I hate everything about it. These responses were not included as either physical or psychological complaints in the study.

Based upon experience working with women in post abortion groups, various psychological complaints arise over and over again, and as the women verbalize their pain they help me to better understand the post abortion data.

The hostility and hatred of men, reported by 22% of the women, as well as the feeling of dehumanization reported by 17%, has arisen in group meetings many times. Women will describe their experiences at the abortion clinics as being like an assembly line. Some say they felt like a piece of meat or they didn't feel they were treated as human beings. Also, they mention the fact that it was a man who impregnated them and usually the abortionist is a male doctor. In addition, they ended up getting married to a man. So some of them take a lot of hate and hostility with them into their marriages, and have difficulty working on the issue later.

The survey found that 66% of women reported guilt following abortion. This figure is close to the findings of a Los Angeles Times survey in 1989 in which 56% of the women surveyed by telephone said they felt guilt from their abortion and 26% said they mostly regretted their abortion.3 A Newsweek survey in 1992 found that 67% of women respondents, aged 1829, said that having an abortion would make them feel very bad about themselves.4

After experiencing the effects of abortion, many women believe they are incapable of making good decisions and largely rely upon others for advice…or may become very independent and insist upon personal control and exclude others.

The survey found that 23% of women experienced failure to make decisions. As women have animatedly discussed in group sessions the consequences of their abortions, two extreme positions have emerged in the decision making pattern. Some women will say, "I believe that I was primarily responsible for a very, very bad choice, and therefore I am incapable of making good decisions." Many of these women have resorted to using "everybody else" since then, to be their consultants and decision-makers. It sounds humorous, and they laugh at themselves as they tell about calling their sisters or mothers to ask them what to wear, what to make for dinner, when to go on vacation or whether to take a job. A young woman who was recently in my office and whom I have worked with for a long time, was getting ready to leave town. She has grown a lot. We were talking about such decision making dilemmas and she said "That's me. I am here wanting you to tell me whether or not I should move."

The other extremes in decision making are women who feel that others have coerced them or given them bad advice. These women seem to adopt a "take charge" attitude. No one else is going to tell them what to do, ever! And that has gotten many of them in trouble, primarily in their marriages. It is difficult for their husbands to have to relate to someone who is insisting on control. But these women also have a desperate need to be loved and taken care of, so the women themselves get confused. They want to let down and be protected, but still they do not want to give up control. We hope to help them find some pleasant middle ground.

The inability to forgive self was reported by 46% of the women. This is one of the biggest issues and most difficult for the women to resolve, following abortion. Many women say they know they have forgiveness from God, but more often the women say "I know God has forgiven me, but I will never, ever, forgive myself. So that is one of the issues worked on in personal and group counseling.

Anger and/or rage was reported by 36% of the women, and lower self esteem was reported by 38%. Self esteem appears to be related to shame, and depression appears to be the result of repressed anger.

By totaling preoccupation with death (7%), suicidal impulses (16%) and suicide attempts (7%), the survey found that up to 30% of the women had self-destructive tendencies following abortion. Suicide has been such an important issue with most of the women we have counseled, that we have them sign a "no suicide" contract the first day we begin counseling. It very simply says "I do not see suicide as a workable option to the stress I am experiencing. If it gets unbearable, I will call you or another person." Our program has a 24-hour hotline and our volunteers are trained to take suicide calls. I also give my home phone number in addition to the office number to each of the postabortal women who receives counseling.

General Information (Table 3)

Table 3
Client General Information
YesNoNo Response
Adequately informed about fetal development54%38%9%
Adequately informed about possible psychological and/or physical complications50%38%12%
Would have their abortion again20%73%7%
Desired further post abortion support28%53%20%
Had illegal abortions5%91%5%
Would have illegal abortions12%58%30%
Relationship with father of unborn child ended soon after the abortion49%46%5%

Informed Consent Issues

Our service tries to encourage the abortion clinics to be as accountable as possible. If pregnant women come to our service and insist, "Abortion is my choice", we give them a list of questions and suggest they take the list along with them to the abortion clinic. The questions ask about the possibility of physical damage, psychological damage, and the name of the doctor. It is suggested that they present it to the abortion clinic and ask their personnel to sign it. We do not know of any who have signed it yet, but it is a means of calling abortion clinics to accountability.

Crisis Decision Making

Most women see the unborn child as life, even at 6 weeks or 8 weeks gestation. But their final statement, if they decide for abortion, would generally be, "I am in crisis. I do not see any other way to handle this, so I am going to do it, because, after all, it's legal." And so it appears that the women are using the law as a basis of decision making rather than their own conscience. Often the same women, and in my experience, particularly women in the medical field who made decisions to abort, return to the center a few weeks or months later. They are angry at themselves and at society because they feel they were duped into thinking abortion was an easy solution to their problem. They knew all along that it was life. And they knew what they were doing; but it is easy to ignore one's conscience when one is concentrating on a career or when one does not see any hope. One medical student sabotaged her whole career. She had been an A student, but went from A's to Fs following her abortion. Her marriage was in serious jeopardy. I told her I was willing to go with her to talk to her professor to explain what was going on in her life, but she was too ashamed to do that, so she left school. I later heard from her and she was working a minimum wage job.

Reasons For Abortion (Table 4)

Table 4
Reasons For Abortion
Not Ready11%
Not married8%
Not want baby6%
Baby's father/boyfriend5%
Just had a baby2%
No choice2%
Incomplete Answer8%

Our study found that being too young was the primary reason women gave for aborting. But there was also a lot of parental control and coercion. This conclusion is based upon a review of the raw data although the survey only attributes this reason in 8% of the women. In addition, on the survey forms many of the sentences written by the women said, "My parents made me" or "My parents did not offer me any choice." It is supposed to be a matter of choice, but these women who had gone through the experience did not feel they had that choice.

Table 5
Who Paid For Abortion
Patient's parents30%
Baby's father8%
Health card3%
Other relative3%
Incomplete Answer3%

Summary And Conclusions

If abortion is such a painful choice, why is it "chosen" by women and men in the United States, approximately 1.6 million times per year?

First, there is a mistaken notion that abortion freedom means "empowerment" or "control over one's body". Where, however, is the power when a "harmless surgical procedure" often leaves women and/or their male partners filled with guilt, regret, and remorse more than 50% of the time? Where is the control when, according to the 344 post-abortion women studied, 30% have had self-destructive tendencies following abortion?

Are "empowered women" subject to crying and depression, which are reported by 57% of the postabortal women studied? And are empowered women despairing, helpless, filled with rage and unable to forgive themselves, as the results of this study indicate?

"Empowered" women should not end up with guilt, regret, crying and depression or self-destructive tendencies

Second, "because it is legal". Civil law, in direct contrast to Divine Law, allows capital punishment of the unborn for the sins of their parents, the carelessness of parents, the crises of parents, the privacy of parents, or the ignorance of their parents. We frequently hear from women that "the clinic personnel didn't tell me there were brain waves and a heart beat...they didn't let me see my ultrasound." Or, "my minister didn't discuss with me the origin of each human soul from a Biblical perspective."

Even though Biblically and biologically, a distinct individual begins at conception, unborn persons are, in the abortion context, considered less than human and are not guaranteed equal protection under the law, to life, liberty, and the pursuit of happiness.

As we have agonized with women considering abortion, their final response has sometimes been a troubled, "I do believe it is life, but I don't have any choice...and anyway, it is legal! One client reported she had gone so far as to apologize to her unborn child pictured on the ultrasound, for what she was about to do (abort). Later, she would have to suffer the additional guilt of premeditated destruction of that child she had so clearly seen.

Women often are not "choosing" abortion, but rather feel forced to abort because of presumed or real abandonment, parental or boyfriend pressures, limited resources, personal/family secrecy and shame

Oftentimes, those same women who had identified the unborn child as a living human being, and made a conscious choice to destroy it, are the ones that shortly afterwards come to our center. They have been immediately guilt ridden, are unable to forgive themselves, and are seeking comfort, compassion, and assurance of forgiveness. They are in need of a listener/teacher who can walk them through their emotional and spiritual healing, as well as refer for medical followup when indicated.

The third reason so many women abort is "because it is convenient. As one client explained, When I told my older sister I was pregnant, she said, You are so lucky it's easy and legal now. At least you won't have the hassle I had to go through.' Hassled or not, both sisters later suffered severe emotional aftereffects from abortion.

Fourth, women often are not choosing abortion, but rather feel forced to abort because of presumed or real abandonment, parental or boyfriends' pressures, limited resources, personal/family secrecy and shame because of lifestyle. In one of the most extreme cases involving one of our clients, a father's incest had been covered by abortion five times. In another, abortion and two miscarriages covered three pregnancies caused by incest. Both young women had been immediately forced back into their abusive homes because abortion hid the deeds of the perpetrator.

Media, medical, governmental and individual secrecy help to prevent public outrage over abortion

The issue of "making the decision to abort, or else "having the decision made by others" often becomes a factor in later decision-making confidence, as expressed by 23% of the women surveyed.

Two general kinds of reactions have emerged as I have worked with postabortal women in the teaching/support/recovery groups: "I believe I was primarily responsible for a very, very bad decision... and therefore I am incapable of making good decisions; or "Other people made a very bad decision for me. From now on I will be in control!" As the women have described themselves, they either tend to lean on others excessively for decision-making, or go through life without taking into account the views of others.

Survey data and client experience indicate that abortion, in most cases, hurts rather than helps women

Fifth, because of desensitization, denial, and the "everyone is doing it" mentality, the reality that abortion snuffs out a human life isn't recognized until it is too late. Later, it is truth that breaks denial, and truth can take many forms. Truth or reality may surface during a subsequent pregnancy carried to term, upon seeing someone's ultrasound "portraits, during the pregnancy of a friend or relative, in marriage, seeing or hearing a baby, when viewing photographs actually taken at conception, reading literature on prenatal development, studying medical texts which show both life and how to take it through abortion, and in reading the Bible.

Sixth, media, medical, governmental, and individual secrecy help to prevent public outrage over abortion and unethical abortion practices. These include botched abortions, medical emergencies caused by abortions, unsanitary conditions of some clinics, employing physical force to restrain clients at clinics, dehumanization of patients, or excruciatingly painful abortions. Rarely do these get media coverage. Postabortal women and their loved ones often suffer in silence for long periods of time because of fear, secrecy and shame. Those were the primary issues responsible for their seeking abortion in the first place.

As we reclaim our most basic instinct to protect and nurture our young, we will also need to nurture and offer hope and healing to abortion's adult victim

In conclusion, the data and client experience indicate that abortion, in most cases, hurts rather than helps. As a caring, civilized society, we need to value our smallest human beings and relearn how to protect and nurture all human life from conception to death.

Unplanned and unwanted pregnancies can be avoided by teaching and practicing abstinence outside of marriage; and married couples who choose to limit family size need to be aware of the difference between conception control and birth control.

We must learn from history that any effort to label a class of people as subhuman, in order to deny their inherent rights, has ended tragically. The destruction of our unborn children has become the greatest holocaust of all. As we reclaim our most basic instincts to protect and nurture our young, we will also need to nurture and offer hope and healing to abortion's adult victims.


1. The Abortion Information Sheet Project is an ongoing national post abortion statistical survey copyrighted by Open Arms. If anyone has had an abortion and would like to participate, or if a crisis pregnancy center would like to help collect data, please contact Open Arms, P.O. Box 1056, Columbia, MO 65205. (314) 4497672 for official survey forms. [Back]

2Increased Reporting of Menstrual Symptoms Among Women Who Used Induced Abortion, LH Roht, MA Fonner, H Aoyama, E Fonner, Am. J. Obstet. Gynecol., 127:356, (1977) [Back]

3Many in Survey Who Had Abortion Cite Guilt Feelings, George Skelton, Los Angeles Times, March 19, 1989, p.28 [Back]

4. Gallup Poll (1992), Newsweek, February 17, 1992 [Back]