I've been asked to speak as a psychiatrist concerning the numerous grassroots abortion recovery programs that exist to help women, men, and families heal after abortion. If you've already been involved with the growing abortion recovery movement, you can readily understand why a psychiatrist might be involved in abortion recovery. For those who are only now learning about abortion recovery, I'll explain the connection by starting with a true story of one of my first patients.
I graduated medical school and started residency in psychiatry in 1984. During that first year, during my first two months on a psychiatric inpatient unit, I had a patient who had recently obtained an abortion. She had been a happily married stay-at-home-mom with a couple of kids already, in a comfortable home, with an upper middle class lifestyle. She was happy when she found out she was pregnant again, and had already given her heart to the new baby on the way. But her husband felt he had no room in his life for another child, and he asked her to abort. When she hesitated to terminate the life a baby she already loved, he persuaded her to go with him to talk to their pastor, who took his side.
After the abortion took place, my patient became severely depressed, unable to function in her role as mom and homemaker, and she ended up being admitted to the hospital. When I talked to her at the time of admission, she identified the abortion as the cause of her problems.
When I discussed the case with my supervisor, wanting to know how to help my patient, I was told that she was suffering from a chemical imbalance and that she would probably stop obsessing about the abortion as soon as the medication took effect.
Looking back, I realize that if my patient had identified a rape, or domestic violence, or childhood sexual abuse as a contributing cause of her serious symptoms, there would have been no shortage of support groups, treatment protocols, books or journal articles, even in the mid-1980's. Using Google Scholar today, you can search for publications on these topics from that time period and find thousands of hits specifically dealing with treatment issues and treatment protocols. If my patient had been depressed following a rape, the treatment team would likely have believed her when she attributed her symptoms to the rape, and would likely have been prepared with treatment options that offered more than medication only.
But in the case of abortion, it was very different. The fact that she attributed her symptoms to the abortion was of no consequence - her thoughts merely reflected a chemical imbalance. I received no guidance on psychotherapeutic approaches to her self-identified issue, and no books or articles were suggested to guide me. Indeed, even today, the professional literature is very limited in regard to treatment approaches for grief and trauma issues after abortion. Professional societies have been committed to the fiction that women do not suffer from their abortions; if there is no problem, there is no need for treatment protocols or treatment guidelines on how to help with this issue.
In the case of this patient, her emotional pain was extreme, and she specifically wanted help with her abortion issues. I was able to make contact with one of the earliest grassroots post-abortion support groups - Women Exploited by Abortion, WEBA. My supervisor gave permission for a support group leader to visit our patient, to give her the help she wanted, that we were not prepared or equipped to provide.
That experience led me to seek out peer counselors, support group leaders, their books, their workshops and conferences, so that I could know at least as much as the nonprofessional helpers if I were called upon to help in future cases -- as I have been many times.
The plain truth is this. Although some individual professionals do help women and men to deal with the impact of abortion in their lives, the professional societies have abdicated in this arena creating a vacuum, an absence of help, which has been filled by the women themselves. Women suffering from after-effects of abortion have risen in a huge grassroots movement to help others without waiting for help that has not been forthcoming from the professional societies.
Even today, after 35 years of legal abortion, there is little to be found in the professional literature about mental health treatment for those affected by abortion. One of the very few studies related to treatment is by Susan Layer and colleagues, published in 2004 in Research on Social Work Practice.1 This study evaluated three spiritually based post-abortion grief group interventions, drawing from three faith-based programs in Florida, two non-denominational Christian and one Catholic. The results, which were statistically significant, indicated that these faith-based group programs were effective in reducing shame and in reducing symptoms of Posttraumatic Stress Disorder.
In addition to obtaining quantitative data, the researchers invited women to give feedback as to which aspects of the programs were believed by the participants to have been particularly helpful. The researchers stated that a prominent theme throughout this qualitative data was forgiveness and reconciliation, which included the women extending forgiveness toward themselves and forgiveness toward others involved in the abortion, in addition to reconciliation with God.
For those without experience within the abortion recovery movement, the concept of forgiveness toward others may be surprising. Why would a woman find this important to her healing? Who is being forgiven and why? A true story about an abortion experience will make this clear.
My friend was 17 years old, and engaged to be married. Her fiance was employed in the military and was away at training when she discovered she was pregnant. She concealed the pregnancy for as long as she was able. When her mother found out, the mother made an appointment at an abortion clinic. My friend, still in high school and not employed, was told that she could not live at home and continue with this pregnancy. She sought help from a pro-life crisis pregnancy service but was not able to find alternative living arrangements in time. The day arrived, and her mother drove her to the clinic. My friend says she looked the doctor in the eye and told him she did not give consent for this abortion. She wanted her baby.
My friend was tied down and drugged, and her first baby was aborted against her expressed wishes because her mother wanted the abortion and had paid for it.
The situation of women being coerced or pressured into abortions of wanted babies is not at all unusual or infrequent. In a 2004 study by Rue and colleagues in Medical Science Monitor, 64% of American post-abortive women reported having been pressured in regard to their abortion decision.2 This situation is so common, it has been mentioned in both an abortion providers' textbook3 and in a 1993 Planned Parenthood Fact Sheet,4 which identify coercion or perceived coercion as a risk factor for having adverse mental health consequences after abortion.
Since it is clear that abortion providers acknowledge that forced or coerced abortions occur and that they are detrimental to women's mental health, one might hope that screening to prevent coerced abortions would be taking place routinely. There is no evidence that this is the case, and in fact, there are many reports to the contrary. The Elliot Institute's report on Forced Abortion in America5 (available at http://www.unfairchoice.info/ and at http://www.afterabortion.org) gives more information on this subject, but from my experience, I would say it is probably the tip of the iceberg.
By way of comparison to another serious problem affecting many women, consider the issue of domestic violence. Today, in 2008, it is a standard of care that when domestic violence is suspected, physicians are to interview the woman privately, apart from her husband or partner, to determine whether the woman is being beaten or harmed. One can readily find journal articles telling physicians to screen for domestic violence, and studies can be found evaluating which questions should be asked and in what manner they should be asked in order to elicit information that will lead to women being helped with their domestic violence situations. However, in regard to coerced abortions, a similar screening process does not seem to be taking place, nor is this discussion taking place within professional journals or professional societies.
Returning to my friend and to the issue of forgiveness, one can understand the strained relationship she experienced with her mother and with other adult family members who had endorsed the forced abortion, a strain that continued for more than a decade. My friend's first marriage and her relationships with subsequent children suffered from the isolation and from the mental health problems that followed the abortion. Only after many years did she participate in an abortion recovery weekend retreat that led to profound healing in regard to the abortion, and which included forgiveness of her mother and other family members.
Considering what my friend experienced, one can imagine that forgiveness of her mother was not an easy task for her, and facilitation by others in a structured program as well as the resources of her religious faith proved helpful to her. It is not likely that she could have accomplished this on her own; indeed, she had not been able to for more than a decade.
A motto of the Rachel's Vineyard program which my friend attended has always been, "No one is forced to do anything, but the more you do, the more you heal." No one is pressured to forgive when they are not ready to do so, or to engage in any actions or exercises against their wishes. However, the program provides a safe environment where women and men can share freely about their abortion experiences, and make peace with their past and their future.
Today, the abortion recovery movement has come a long way since the early days of WEBA. Numerous choices are available, for example, once a week support groups, or programs complete in one weekend. Choices of location could be conveniently close to home or a hundred miles away for a feeling of greater privacy.
Abortion Recovery InterNational,6 ARIN, is an important resource for those looking for healing after abortion. The organization serves as a network of recovery, research, awareness and educational resources that provide information concerning post-abortion issues. The ARIN Directory7 is an online, international listing of abortion recovery centers and programs providing opportunities for healing to those who are hurting after abortion. The directory serves 30,000 people annually.
Stacey Massey, President of ARIN, says that there are more than 1500 healing programs currently offered throughout the U.S. This includes a wide range of options. For example, many pregnancy resource centers (in the past often referred to as crisis pregnancy centers) offer abortion recovery programs in addition to their pregnancy related services. Pregnancy resource centers affiliated with the national organization Care Net provided abortion recovery services to 13,000 women and men in 2006 alone. Heartbeat International estimates that their affiliate centers are serving 8,000 to 10,000 clients annually.
But in addition to the abortion recovery programs associated with pregnancy resource centers, there are many independent abortion recovery ministries, and also programs that affiliate with national organizations such as Rachel's Vineyard.8 Many Catholics are aware of the Catholic network of programs and individual counseling options under the umbrella of Project Rachel.9
The existence of so many programs demonstrates both that large numbers of women and men are coming forward to ask for help with abortion issues, and that help for anyone is only a phone call or a mouse click away.
The Rachel's Vineyard retreat, a copyrighted, trademarked, program using a specific format, is widely available throughout the United States as well as at international locations on six continents, providing 600 weekend retreats per year. The program has spread quickly, because as women are helped, they want to bring this help to others. A unique feature of this program is that it is presented by team which includes a mental health professional, a minister or priest, and lay volunteers, some of whom have had abortions themselves. Both men and women are welcome, and couples sometimes choose to go through the weekend together.
The retreat has been translated into Spanish, Chinese, and Russian, with other languages near completion, and is also available in non-denominational as well as Catholic formats.
An outcome study of Rachel's Vineyard was conducted by me and presented at the Rachel's Vineyard international leader's conference in 2004.10 Two hundred and forty one past retreat participants from 22 states completed a survey about their experience. They were asked to rate the program, using negative numbers if the program harmed them, giving a zero if the program neither harmed nor helped, or using numbers 1 through 5 to show the degree of benefit they had obtained. There were no negative numbers and no zeros. The average rating was 4.75.
Considering that published studies indicate an increased risk of suicide after abortion, one concern among sponsoring faith-based organizations has been: Is this program safe for vulnerable men and women? We asked survey participants about their prior mental health for the period after their abortion until the time of the retreat, and found that 70% had required prior mental health treatment, with 65% admitting to suicidal thoughts, 17% admitting to suicide attempts, and 48% reporting problems with substance abuse. So this was a group which had experienced some significant problems during the time period from the abortion until the retreat, but at the same time, there was no one who rated the retreat as having caused harm, and the benefit was perceived as very high.
Additionally, for 58.9% of those responding, more than one year had passed since their retreat, with the average time being 3.1 years post retreat. An additional 33.2% were responding at a time from one to ten months after their retreat, with the average for this group being 4.8 months. This indicates that those responding continued to feel that the retreat had given them significant benefit, even after many months or even years had passed. The healing is not something temporary, but something enduring with benefit that is sustained over time.
The Rachel's Vineyard retreat, like many of the abortion recovery programs, is rooted in the Christian faith and Christian Scriptures. This is appropriate for many participants, considering Layer's study which indicated that 86% of the women in her study reported that "their religious beliefs played a strong to very strong role" in their experience of healing. Layer also cites a 2001 Gallup poll indicating that 70% of Americans identify themselves as Christian, reinforcing the appropriateness of faith-based Christian programs for many.
Many individuals also find it helpful to be able to share their grief with others who have had similar experiences, as well as to engage in exercises to process grief. Here are some comments from women who have attended the Rachel's Vineyard retreats (comments which participants have written in their evaluations and for which permission given to share with others):
"At the end of the retreat, I felt relief and hope."
"I felt so safe in sharing my experience and emotions. It was exactly what I needed."
"This retreat touched a part of me that I didn't even realize was there. I feel healed from the inside out."
"To any woman considering the need to reconcile their abortion, the retreat is a wonderful gift you could give to yourself. You are able to experience the sadness, grief and shame in the company of others feeling very much the same. You are able to turn pain into hope."
For those who are hesitant to connect with others for their healing, there are self-help books that can help people to begin to address this issue. The paperback book, The Four Steps to Healing11 was written by Debbie McDaniel and me to help those who needed to explore the issue privately at home as their first step. Other options include checking out websites such as http://www.abortionrecovery.org or http://www.rachelsvineyard.org to look for resources or to email your questions to someone who can help.
In Layer's study nearly half the participants stated initially that only two or fewer others knew of their abortion. But after completion of the intervention, 80% expressed willingness to tell others about their abortion if it would help another person. The decrease in shame experienced by the participants in Layer's study removes a barrier to disclosing the abortion to others.
In fact, many women and men who have experienced healing after abortion want to help others. One significant area often revolves around informed consent. A retreat participant told me, "I received better informed consent when my dog had surgery compared to what I received when I had my abortion." In the study by Rue and colleagues, 84% of American post-abortive women said they did not receive adequate counseling beforehand.
Those who experienced a relative lack of information in making their decision or who made the decision without adequate counseling want to make sure that others are fully informed before an irrevocable choice is made. So, many post-abortive women choose to serve as volunteers at pregnancy care centers where they can help with information and counsel that may otherwise be lacking.
Others choose to tell their stories in public gatherings through the Silent No More Awareness Campaign or through Operation Outcry. By telling their stories, they are giving information about abortion to young women among the general public who may not yet have had an abortion, so that information is accessible in advance of a crisis pregnancy. In addition, telling stories publicly helps to let other post-abortive women know they are not alone, and to know that help is available. One of my friends, who had years of psychiatric treatment following her abortion, found out about abortion recovery through the Operation Outcry TV program Faces of Abortion. She was then able to access further information and find healing through a weekend retreat.
The women of Operation Outcry take the additional step of writing their testimony in a Declaration format that can be used as legal testimony in legislative hearings and in court cases. The testimony of 180 post-abortive women was submitted to the Supreme Court as part of an amicus curiae brief filed by the Justice Foundation in the partial birth abortion case, Gonzales v. Carhart. The Supreme Court alluded to the women's testimonies in its decision. For the first time, the Supreme Court recognized that "some women come to regret their choice to abort the infant life they once created and sustained," and that some women experience severe depression, grief and sorrow following abortion.
In Gonzales, the Court highlighted the importance of informed consent, confirming that "The state has an interest in ensuring that so grave a choice is well informed," and stating that it is "self-evident" that women would experience even a greater degree of grief and sorrow to learn "only after the event" information concerning the details of the procedure and the effects on her baby.
The Gonzales decision was cited in a recent 8th Circuit Court of Appeals decision which upheld a South Dakota informed consent statute, and which specifically referenced the testimony of the Operation Outcry women regarding the adverse effects of abortion that they had experienced. The South Dakota law requires that women be informed that abortion terminates the life of a unique living human being, and that abortion is associated with increased risk of depression, psychological distress, suicidal ideation and suicide.
More than 3000 women have signed Declarations to date and many more are mobilizing and speaking out. The women of Operation Outcry have adopted the song "Million Voices," by Barlow Girl, as their theme: "With a million voices breaking silence… they'll remember we were here."12 Post-abortive women are finding their voices, and making a difference. As they gain momentum, one million voices may be just the beginning.
Author Contact Information:
Martha Shuping, M.D.
Email: rachelnetwork@sprynet.com
Author's websites: http://www.postabortionhealing.net
http://www.rachelnetwork.org
1 Layer S, Roberts C, Wild K, Walters J. Postabortion Grief: Evaluating the possible efficacy of a spiritual group intervention. Research on Social Work Practice. Vol. 14, No.5, 344-350 (2004) DOI: 10.1177/1049731504265829 (click here)). [Back]
2 Rue VM, Coleman PK, Rue J, Reardon DC. Induced abortion and traumatic stress: A preliminary comparison of American and Russian women. Medical Science Monitor 10(10): SR5-16 (2004). [Back]
3 Planned Parenthood Federation of America, Fact Sheet: The Emotional Effects of Induced Abortion (PPFA Communications Division, FS-A4, revised 1993). [Back]
4 Baker A., et al., Informed Consent, Counseling, and Patient Preparation, in A Clinician's Guide to Medical and Surgical Abortion, ed. Maureen Paul, et. al., (New York: Churchill Livingston, 1999) 29. [Back]
5 Forced Abortion in America, The Elliot Institute, available at http://www.afterabortion.org and http://www.unfairchoice.info/ (Accessed 10/7/08). [Back]
6 Abortion Recovery InterNational (click here) [Back]
7 Abortion Recovery Directory (click here) [Back]
8 Rachel's Vineyard Ministries (click here) [Back]
9 Project Rachel (click here) [Back]
10 Shuping, M. Rachel's Vineyard Outcome Study, Presented at Rachel's Vineyard International Leader's Conference, Greensboro, North Carolina, June, 2004. [Back]
11 Shuping M, McDaniel D, The Four Steps to Healing, (2007). High Point: Tabor Garden Press. (ISBN-10: 0972876944). [Back]
12 Barlow Girl, Million Voices, Word Music, 2007. [Back]