The growing weight of scientific studies and the voices of women themselves tell the story of abortion as a life-changing, adverse experience for many. Relying on Dr. Martha Shuping's experience as a psychiatrist, we can describe the psychological impact of abortion through the lens of her clinical counseling and the emerging scientific literature.
In 1973, as a 19-year-old pre-medical student, I worked as a volunteer at a clinic that helped women access abortion services. Although the clinic originally sent women to New York for their abortions, in the early days following Roe v Wade, we began referring to a clinic in our own back yard. In just one evening of training, I learned to tell women that the fetus was nothing more than a clump of cells and that the procedure was akin to having one's tonsils removed. There were no side effects or complications to consider with this "simple, safe procedure."
Thirty-five years later, abortion clinic staff are still reciting the same clich?s, but I would not give the same advice today. I know better. As a psychiatrist, I have helped women heal from the effects of their abortions for more than 20 years through individual psychotherapy and group programs for abortion recovery. Having been entrusted with the intimate details of hundreds of abortions, I now could not truthfully say there are no risks: Women's hearts are at risk with abortion, and peer-reviewed research increasingly confirms the risks to women's mental health.
When I met Jill,* she was reporting symptoms of severe clinical depression - she was unable to enjoy anything, had frequent crying spells, could not sleep for more than a few hours at night and had frequent thoughts of suicide. She also reported frequent, disabling panic attacks during which she felt like she was having a heart attack, with shortness of breath, rapid heartbeat and chest pain. Her symptoms were severe enough to prevent her from holding a job. She had been prescribed dozens of medications over a period of about ten years, but nothing had helped. Trying to get a handle on why treatment wasn't working, I asked her, "How did this start?"
Jill had become pregnant at 18, and her father had threatened her with homelessness if she did not have an abortion. That's pressure. He told her she could not live at home with her baby, so she had an abortion, not knowing of any other options. She pinpointed the abortion as the start of her symptoms.
Besides textbook symptoms of depression and panic, Jill also reported other symptoms that seemed specific to the abortion. She felt extremely upset when she was around her sister's baby, because it reminded her of her own baby whom she had wanted but lost. She felt guilty avoiding family gatherings, but it was too painful for her to be around her infant niece. She also couldn't stand the sound of a vacuum cleaner, which reminded her of the suction device used in her abortion.
It is not only teens who experience pressure to abort and the consequences of an unwanted abortion, but adult women, too. Melody was a married stay-at- home mom with two children and a husband who was well-established in a successful career. She was happy about her pregnancy and looking forward to the birth of another child. She was shocked to learn that her husband was unwilling to accept one more child into his busy life. When they met with their pastor, he also pressured for the abortion. If her husband felt he was too busy or lacked energy for one more, she should be supportive and respect his wishes.
Pressured by her husband and her pastor, Melody complied with the abortion, but found herself afterwards disabled by grief and depression. She would lie awake crying through the night and then find herself unable to get out of bed to face the day, unable to care for her two living children as she grieved the one she had lost. Despite her pastor's permission to abort, her own heart had given her no such permission. She believed she had committed a sin that could not be forgiven. She wanted to die.
Amazingly, abortion providers know that at least some women are pressured, and they also know that being pressured puts women at greater risk for mental health problems after abortion. A 1993 "Fact Sheet" from Planned Parenthood lists numerous risk factors known to put women at risk for negative psychological reactions, and being pressured or coerced is one of them.
In the textbook, A Clinician's Guide to Medical and Surgical Abortion, even "perceived" coercion is considered a risk factor for an adverse mental health outcome after abortion. If the woman feels that she is being coerced, she's more likely to have problems - whether or not others agree with her perceptions.
Many women, like Jill and Melody, have told me of being pressured. This is consistent with a 2004 study led by Dr. Vincent Rue (comparing Russian and American women after abortion), in which 64% of the American women reported feeling pressured to abort.
In light of this, one might expect this issue to be routinely explored in pre-abortion counseling. Is this abortion truly the woman's choice, or is she being pressured by someone? Has she been informed about options that may be available to her, such as maternity homes that offer a free place to live, plus job training and child care after the child is born? Information on the range of options may relieve some of the pressures.
Certainly, not all abortions are pressured. The word "choice" is often used when speaking of abortion. This would seem to assume that actual choices are available and accessible, perhaps even implying that women are informed of their choices during informed-consent counseling.
Julie was 16 when she became pregnant. She was happy and excited about the baby, and her mom was happy about becoming a grandmother. Julie already had a part-time job and was trying to think through a realistic plan to care for her child. She says she definitely wanted the baby and was still considering her options when her boyfriend's father made the appointment for the abortion.
Julie had the abortion without receiving any counseling or information on support services that might have helped her to make a different choice. She said she definitely wanted her baby but did not know what else she could do.
Julie was not given any information about the type of procedure or what would take place, only that it would stop the pregnancy. It was so painful, she was not able to walk afterwards, but had to be carried to the car. She was surprised to later pass the baby at home alone.
The majority of women who come to me report they had had little to no counseling. One woman said, "I received better informed-consent counseling when my dog had surgery, compared to what I received before my abortion."
For Jill, Melody and Julie, their abortions were clearly someone else's idea. But nobody pressured Rose at all. The abortion was her idea, and her secret. She told no one.
Rose was 17, and her pregnancy was far enough along that she had felt her baby move. She said, "I really wanted this child, but I didn't know what to do" - a statement I have heard from many women. A senior in high school, just weeks away from graduation, Rose worked and saved her money, and in the end, pawned some cherished possessions to get enough money for the abortion.
Still, even though Rose clearly had made her own choice for abortion and worked to pay for it herself, she is equally clear that she wanted her baby. I often hear this from women, that even though abortion was chosen, the baby was heartbreakingly wanted. Researchers often mistakenly assume that an unintended pregnancy is always an unwanted pregnancy and that the choice of abortion always implies that the baby was unwanted. But many woman report wanting their baby while choosing abortion.
Rue's study showed that 17.7% of the American women reported the pregnancy was "desired," even though abortion was chosen. Thus, perhaps more than 200,000 American women abort desired pregnancies every year. Why would it then be surprising if many women experience grief, loss and other powerful emotions after their abortion?
Rose says that immediately after the abortion she felt an overwhelming sense of loss and regret, beyond anything she had imagined. She named her son Joseph as she walked out the clinic door.
Soon after the abortion, she made two suicide attempts. First, she took a gun to a lonely place at night and tried to shoot herself. After the gun misfired, she hit it against the asphalt parking lot, and it went off, just grazing her. But when she put the gun to her head a second time, it again misfired. Giving up on the gun, she took a large overdose of medication and slept for two days, awakening unharmed.
Numerous studies confirm that this is not an isolated occurrence. A 2006 study from New Zealand under lead author Dr. David Fergusson found that young women had four times higher risk of having suicidal thoughts and attempts after abortion, compared to a group of young women who were never pregnant. The same group of post- abortive young women had three times higher risk of suicidal thoughts and attempts compared to another group of young women who became pregnant but did not abort. The study controlled for more than a dozen different factors and was statistically significant, with only a 1-in-1,000 probability of the result being due to chance.
Fergusson's study also revealed that the young women had a statistically significant increased risk of major depression after abortion, compared to those who were never pregnant and those who were pregnant but did not abort. (Major depression is a psychiatric disorder in which suicidal thoughts often occur.)
Dr. John Thorp, the McAllister Distinguished Professor of OB/GYN at the University of North Carolina Medical School, was lead author of a large review article which included all large, long term studies of abortion in English through 2002. The authors concluded that abortion is associated with depression serious enough to cause risk of self-harm and that women should be warned in the informed-consent process.
Several other peer-reviewed studies have uncovered an increased risk of suicide after abortion, a risk that persists over a period of years. But suicide and suicide attempts are the most extreme adverse outcome after abortion and appear to represent "the tip of the iceberg."
Many women have degrees of emotional reactions that may be causing distress to themselves and even those around them without ending in death or a suicide attempt. It is important to realize that there are many different symptoms and different psychiatric illnesses to which the abortion may be a contributing factor.
Dr. Priscilla Coleman, Associate Professor of Human Development and Family Studies at Bowling Green State University, says in her report, "Abortion and Mental Health," that studies using nationally representative samples and various controls have shown that abortion significantly increases risk for several mental health problems, including depression, anxiety, substance abuse and suicidal thoughts and behaviors.
In her report, "Does Abortion Cause Mental Health Problems?," Coleman identifies more than 40 studies from peer-reviewed literature that include controls and show a strong effect of abortion as a risk factor contributing to the development of these mental health problems.
There is not one set of reactions after abortion, or one type of psychiatric disorder that may result after abortion. Rather, a large body of solid research indicates that abortion can function as a stress that places women at higher risk for developing a range of mental health problems.
The 2006 Fergusson study illustrates this point. For total mental health problems, not only depression and suicidal ideation, the post-abortive young women had higher rates of mental health problems compared to the other two groups, after controlling for numerous factors.
Darla described her abortion experience as "very peaceful." She says, "Everyone was very kind," and she felt only relief that she could finish her college studies without interruption. She had no concerns about her abortion until almost 20 years later.
Working in a health profession, she found herself caring for premature babies in a hospital nursery. "That's when it really hit me." Somehow, the tiny preemies reminded her of the abortion and her own child who might have been similar in size and development.
The degree of distress she experienced was profound enough to lead her to mental health treatment and later to Rachel's Vineyard, an abortion recovery weekend. Telling others about her abortion in a confidential group setting was a key component in her healing. "There was a sense of laying down this burden, laying down this secret. I felt free being released from this secret."
Today, Darla has completed a degree in counseling and is now a Rachel's Vineyard facilitator, helping others to heal.
Rose's abortion issues did not end with the failed suicide attempts. She also went through a period of drug addiction. Even after resolving her addiction, thoughts of her baby persisted for many years.
When Rose was in nursing school, helping a woman during a miscarriage, "It made me think of my baby, and I wanted him back."
She said, "I thought about him every day. How old would he be? What color were his eyes?" Even after being married and having a daughter, she remembered her aborted child, Joseph.
She was afraid to bond with her infant daughter, believing that her daughter might die as a punishment for the past abortion. She wasn't able to feel emotionally close to her daughter, as she remembered Joseph and felt she should have nurtured him.
Rose's healing began with an abortion recovery support group. The memorial service at the conclusion was especially significant for her. She read a poem in memory of Joseph, later cross- stitching the poem into a keepsake. This and other mementos now help her to remember Joseph in a positive way.
After 30 years, she says that healing from her abortion has finally allowed her to develop a close relationship with her daughter.
Julie's grief was similar. After the abortion, "I named the little boy Dennis." She continued to remember him over the years. During pregnancy, childbirth and important events with her children, the thought of her missing first child was always there, taking away from the joy she should have felt. Constantly stuffing down grief "kept me from fully enjoying my life."
Her children knew she was depressed but could not understand why. One of her adult children says, "Now I understand - it is like a missing piece." Participation in an abortion recovery program has given Julie the peace of recognizing that her child is in heaven and has finally allowed her to enjoy closeness with her children.
Like Darla, Julie and Rose now share with others the peace and comfort they have received, as members of Rachel's Vineyard teams. The existence of a growing abortion recovery movement, with thousands of support groups and programs from which to choose, testifies to the need women have to grieve for their loss while offering true hope that healing can take place.
Only in vacant policy debates and politically sanitized clinical studies do abortion's effects on women seem minor and unworthy of recognition. The real voices of many women tell far different stories - stories of life-altering experiences marked by a profound sense of loss and the need for spiritual and emotional repair. Maria put it this way, "The day that my baby died I realized that I had died, too." She is not alone. Maria and many others like her deserve our acknowledgement, our help and our love.
© 2010 family research council
Founded in 1983, Family Research Council is a nonprofit research and educational organization dedicated to articulating and advancing a family-centered philosophy of public life. In addition to providing policy research and analysis for the legislative, executive, and judicial branches of the federal government, FRC seeks to inform the news media, the academic community, business leaders, and the general public about family issues that affect the nation.