ABORTION COMPLICATION STATISTICS

Concern is growing over the number of unreported complications that occur.

It has come to our attention, working with women after abortion and hearing from others dealing with women who have had abortions, that the limited reporting of complications to the Abortion Supervisory Committee (ASC) fails to fully show the picture of the extent of even the physical complications afterwards.

We wrote to the ASC requesting information as follows:

"We provide post-abortion counselling to those who for whatever reason feel adversely affected by their abortions.

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SYNOPSIS OF

RECENT POST-ABORTION RESEARCH

Extensive research has documented how traumatic stress can  significantly alter individuals’ lives. Traumatic stressors are strong  predictors of post-traumatic stress disorder or PTSD (Foy, Osato, Houskempt & Neuman 1992).

While the  prevalence of PTSD has been estimated to affect up to 12% of the U.S. population (Breslau, Davis, Andreski & Peterson 1991) , limited research has examined the role of elective abortion as a traumatic stressor causing symptoms of PTSD. Most trauma victims encounter feelings of horror or terror at the time of the traumatic episode.  Bagarozzi has reported that women who came for mental health treatment were in complete denial that they had experienced an abortion and that indeed it was a traumatic and horrific experience for them.  ”This denial was seen as a major contributing factor to the development of post traumatic stress in these women” (1993:67) .

Clinical research findings highlighting the power of denial before, during and after an abortion have also been reported by Torre-Bueno (1996) .  As a pro-choice advocate and long-time Planned Parenthood abortion counselor, her assertion is all the more compelling: “I believe passionately that I can be supportive of every woman’s right to make her own pregnancy decisions, and still recognize the fact that her decision may cause her tremendous suffering.  While many women do not have emotional or spiritual difficulty after an abortion, I know from twenty years of experience working with women before, during, and after abortions, that many women have more emotional and spiritual pain after abortion than the current research suggests.” (1996:3)

In another clinical study, pro-choice psychotherapists De Puy and Dovitch (1997:13-14) reported that 10% of women experience “severe emotional trauma” following abortion.  According to these clinicians/researchers: “Many women acknowledge a feeling of relief after their abortion, yet are understandably upset by facets of the experience that they had never anticipated.  Many are distressed and unaware of the ways in which their choice has changed their lives and, sometimes, the lives of those around them.”   In a study of 80 women in the U.S., Barnard (1990) used standardized posttraumatic stress disorder (PTSD) instruments and found: 3-5 years following the abortion, l8% of the sample met the full diagnostic criteria for posttraumatic stress disorder (PTSD) and 46% displayed high stress reactions to their abortion.   Her findings were not explained by religiosity as 68% reported that at the time of the abortion they had little to no religious involvement. Subsequently, similar findings were also reported by Hanley et al. (1992) in a comparison study of women distressed postabortion which also used standardized PTSD instruments and interviews.  They found: “Women who were distressed following an abortion scored significantly higher than the non-distressed group on PTSD symptoms of intrusion and avoidance.”

The investigators evaluated whether some women in outpatient mental health treatment with a presenting problem of postabortion distress met Diagnostic & Statistical Manual of Mental Disorders III Revised (DSM-III-R) criteria for the posttraumatic stress disorder (PTSD) categories of intrusion, avoidance, and hyperarousal.  One hundred and five women were administered the SCID-PTSD module, the Impact of Event Scale, as well as the Social Support Questionnaire and the Interview for Recent Life Events, in addition to completing a semi-structured interview.

The researchers concluded: “the data from this study are suggestive that women can report abortion-related distress similar to classic PTSD symptoms of intrusion, avoidance and hyperarousal and that these symptoms can be present many years after the abortion.”

Posttraumatic reexperiencing has also been documented in anniversary reactions.  In a small study conducted by Franco et al. (1989:154) , 30 out of 83 women reported experiencing anniversary reactions that included intense emotional psychosomatic pain.  They noted: “Unresolved grief and preexisting dysphoria have been suggested as increasing the likelihood of anniversary reactions.”  Another recent study compared two groups of 25 women who elected abortion: those who identified themselves as distressed (D) and those who reported more neutral or non-distressing responses (ND).  PTSD symptomatology was found in the distressed group: changes in male-female relationships, suppression of feelings/thoughts about the abortion, reactions to catalytic events that aroused thoughts/feelings about the abortion, trying to get pregnant again, becoming promiscuous, and avoiding reminders of babies.  More than two out of three women in Group D were distinguished by reports of “suppression” or “denial” of parts of the abortion experience or negative emotional reactions to it. Additionally, women in the distressed group were more than twice as likely to report abortion trauma related symptoms on the Impact of Event Scale than those in the non-distressed group (Congleton and Calhoun 1993) . In this same study, women who identified themselves as distressed postabortion indicated feeling:  a sense of loss/emptiness (48%); shock/detachment (28%); anger toward partner/others (24%); depression (20%); loneliness, betrayal, loss of self-worth, and relief (16%); guilt and sorrow (12%); confusion (8%); fear of dying and suicidal thoughts (4%). Interestingly, in the group of women who elected abortion and did not believe they were distressed, 20% had symptoms of depression, an equivalent percentage experienced by the distressed group.

The authors concluded:

(1) for some women, abortion is a “critical event” which produces high levels of psychological distress;

(2) informed consent should ensure accurate information is conveyed about physical pain and possible negative and positive emotional reactions; and

(3) when dealing with depression among women, exploring reproductive history for unresolved emotional reactions to pregnancy termination may prove beneficial.

In a large scale prospective cohort study (N=13,261, of whom 6410 experienced a pregnancy termination) conducted in the United Kingdom, Gilchrist et al. (1995) found evidence of the traumagenic nature of abortion when examining relative risks of suicidal behavior in women who had previously terminated their pregnancy, and who had no prior history of psychiatric illness.  A recent study in Finland of all deaths of women of childbearing age concluded: “Our data clearly show, however, that women who have experienced an abortion have an increased risk of suicide which should be taken into account in the prevention of such deaths” (Gissler, Hemminki and Lönnqvist 1996:8).

A recent Swedish study examined emotional distress (ranging from 1 month to 12 months follow-up) after abortion at a university hospital. Risk factors identified were: living alone, poor emotional support from family and friends, adverse postabortion change in relations with partner, underlying ambivalence or adverse attitude to abortion, and being actively religious.  The researchers concluded: “Thus, 50-60% of women undergoing induced abortion experienced some measure of emotional distress, classified as severe in 30% of cases.” (Soderberg, Janzon & Sjoberg, 1998:173)

In a study just published, Reardon & Ney (2000) examined the mental health risks of abortion relating to subsequent substance abuse. They found that women who aborted a first pregnancy were five times more likely to report subsequent substance abuse than women who carried to term, and they were four times more likely to report substance abuse compared to those who suffered a natural loss of their first pregnancy due to miscarriage, ectopic pregnancy or stillbirth.

Rue (2001) applied a trauma sensitive perspective to the understanding of how women coped with pregnancy losses, particularly induced abortion.  He conducted a transnational retrospective descriptive study of 765 women in the United States and Russia.  In this study, the average number of years since the abortion was 11 years for American women and 6 years for Russian women.  Similar to preceding studies, the most common positive emotional outcome for women in both countries was relief with 11% of U.S. women attributing this positive feeling to their abortion compared to 8% in Russia. In the U.S. sample, 58% of women who aborted experienced 6-10 posttraumatic stress disorder symptoms following the abortion, compared to 12% in the Russian sample. Overall, the findings indicated that women in the U.S. sample were more likely to experience posttraumatic stress related symptoms following their abortion than Russian women.  Using Pearlman’s traumatic stress scale (TSI), Russian women who obtained an abortion had higher mean total TSI scores than U.S. women (276 vs. 260), indicating considerable disruption of cognitive schemas.

Cougle, Reardon & Coleman (2001) employed the National Longitudinal Survey of Youth (NLSY) a general purpose study which has interviewed 6283 women since 1979.  They found using standardized assessments: “Compared to post-childbirth women, aborting women (n=735) were found to have significantly higher depression scores as measured an average of 10 years after their pregnancy outcome.  Controlling for age, total family income, and locus of control scores prior to the first pregnancy event, post-abortive women were found to be 41% more likely than non-aborting women to score in the ‘high risk’ range for clinical depression.  In response to a self-assessment question, aborting women were 73% more likely to complain of ‘depression, excessive worry, or nervous trouble of any kind’ an average of 17 years postabortion.’”

And finally, in the first record linkage study conducted in the U.S. on 173,279 low income women who had aborted,  Reardon et al. (2001) found the following: “Compared to women who delivered, those who aborted had a significantly higher age adjusted risk of dying during the subsequent eight years from suicide (2.54), accidents (1.82), and all causes (1.62). Higher suicide rates were most pronounced in the first four years. Notably, the average annual suicide rates per 100,000 in our sample, 3.0 for delivering  women and 7.8 for aborting women, bracketed the national average suicide rate of 5.2 for women ages 15-44.” In addition to the above, there are a number of reviews of the literature on postabortion sequelae that are instructive (Speckhard & Rue, 1992; Rue, 1995; Speckard, 1997; Ney & Wickett, 1989; and Angelo, 1992).


References

Angelo, J. (1992) Psychiatric sequelae of abortion: The many faces of Post-Abortion Grief.  Linacre Quarterly, 59:2, 69-80.

Bagarozzi, D. (1993) Post traumatic stress disorders in women following abortion: Some considerations and implications for marital/couple therapy. International Journal of Family and Marriage 1:51-68.

Barnard, C.  (1990) The Long Term Psychosocial Effects of Abortion. Institute for Pregnancy Loss. Stratham, New Hampshire.

Breslau, N., Davis, G., Andreski, P. & Peterson, E. (1991) Traumatic events & posttraumatic stress disorder in an urban population of young adults. Archives of General Psychiatry 48: 216-222.

Congleton, G. and Calhoun, L. (1993) Post-abortion perceptions: A comparison of self-identified distressed and non-distressed populations. International Journal of Social Psychiatry 39:255-265.

Conklin, M. and O’Connor, B. (1995) Beliefs about the fetus as a moderator of postabortion psychological well-being.  Journal of Social Psychiatry 39: 76-81.

Cougle, J., Reardon, D. & P. Coleman (2001) Depression associated with abortion and childbirth: A long-term analysis of the National Longitudinal Survey of Youth.  Presented at the 1st World Congress on Women’s Mental Health, Berlin, Germany and published in Archives of Women’s Mental Health, Vol. 3/4, Supplementum 2.

Foy, D., Osato, S., Houskamp, B. & Neuman, D. (1992) Etiology of posttraumatic stress disorder.  In P. Saigh (ed.), Posttraumatic Stress Disorder (pp. 28-49).  Boston: Allyn & Bacon.

Franco, K. et al.  (1989) Anniversary reactions and due date responses following abortion.  Psychotherapy and Psychosomatics 52:151-154.
Gilchrist, A., Hannaford, P., Frank, P., and Kay, C.  (1995) Termination of pregnancy and psychiatric morbidity.  Bri. Journ. of Psychiatry 167:243-248.

Gissler, M., Hemminki, E., and Lönnqvist, J. (1996) Suicides after pregnancy in Finland, 1987-94: Register linkage. Brit. Med. Journal 313:1-11.

Ney, P. & Wickett, A. (1989) Mental health and abortion: Review and analysis.  Psychiatric Journal of the University of Ottawa, 14:4, 506-516.

Reardon, D. & Ney, P. (2000) Abortion and subsequent substance abuse. American Journal of Drug and Alcohol Abuse. 26:1, 61-75.

Reardon, et al. (2001) Suicide deaths associated with pregnancy outcome: A record linkage study of 173,279 low income American women.   Presented at 1st World Congress on Women’s Mental Health, Berlin Germany,  published in Archives of Women’s Mental Health, Vol. 3/4, Supplementum 2.

Rue, V. (1995) Post-Abortion Syndrome: A Variant of post-traumatic stress disorder.  In P. Doherty (ed.) Post-Abortion Syndrome: Its Wide Ramifications.  Dublin: Four Courts Press, 15-28.

Rue V. (2001) Posttraumatic stress symptoms following induced abortion: A comparison of U.S. & Russian Women.  Presented at the 1st World Congress on Women’s Mental Health, Berlin, Germany and published in Archives of Women’s Mental Health, Vol. 3/4, Supplementum 2.

Soderberg, H., Janzon, L. & Sjoberg, N. (1998) Emotional distress following induced abortion.  A study of its incidence and determinants among abortees in Malmo, Sweden.  European Journal of Obstetrics & Gynecology, 79, 173-178

Speckhard, A.  (1997) Traumatic death in pregnancy: The significance of meaning and attachment.  In Figley, C., Bride, B. & Mazza, N. (Eds.) Death & Trauma: The Traumatology of Grieving.  Washington, D.C.: Taylor & Francis, 67-100.

Speckhard, A. & Rue, V. (1992) Postabortion syndrome: An emerging public health concern.  Journal of Social Issues, 48 95-120.

Torre-Bueno, A. (1996) Peace after abortion.  San Diego: Pimpernel Press.

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A Spirituality of Trauma

I have plummeted into a darkness where there seems to be no God,

only pain and loss - and, surprisingly, I have found that

something beautiful is happening, which as yet I cannot identify.

Oddly enough, there is something beautiful about working with trauma in my life... What on earth could be good about working with violence and trauma? Can anything good come from trauma?

Trauma is any experience that overwhelms a person’s normal coping mechanisms. It is what the victim does with trauma that liberates or destroys. Trauma has taken me on a faith journey and has brought me into a deeper intimacy with myself, others and God. Before coming into therapy for post-traumatic stress disorder, I thought I was healthy, functional and relational. I did not realize how sick and anemic my spirit was. I had armored myself against life. This kept me away from my soul, spirit and essence - the very way of being known.

In trauma therapy, many of my defenses have cracked, permitting me to begin finding the woman God always intended me to be. The joy of healing is finding this essence within and relating to others through it. Relationships flow with greater ease.

When you have been touched by trauma, you are never the same. Someone who has been demolished by trauma has the unique opportunity to allow the hand of God to refashion him or her, like living stones being built into a spiritual house.

Therapy has helped me to reclaim my breath and to once again breathe...When you have been traumatised, you lose your breath and your spirit. The spirit is known as "Ruha", the breath of life. When someone is traumatized, the breath and the spirit are cut off. Recovery from trauma then, is also about recovery of the wounded spirit within us.

I have walked in the valley of denial, powerlessness, lack of trust, terror, shame, pain, grief and isolation. The gift received in darkness has been accepting my vulnerability and my limitations and finding the wonders of my humanity... The call of today is to transform our pain istead of ignoring it.

The process of unmasking my hidden trauma has removed the coverings that I had allowed to hide the real me... I have learned that the way of healing and reconciliation is to travel into the darkness of my own woundedness. It has been a journey into nothingness, pregnant with fullness. In this journey, I have heard for the first time a call to live, not just survive - a call to compassion and a call to companionship with others on the journey.

JOURNEY THROUGH HEALING

The journey of grieving and sorrow is a journey into acceptance of who you are now and how trauma has affected you. New shoots will spring up from the trauma wound. The goal, in the journey through healing, is to regenerate life. This is done by working through the steps of denial, powerlessness, trust and safety, shame, grief, emptiness and new relationships.

I believe that God calls us to wholeness in life. We are called out of isolation and into intimacy - from being bound in shame to being known as friend. I never imagined that pain could be so painful. Yet my wound has now turned into a great blessing.

Excerpts from the article of the same name written by Sister Jo Wardhaugh, FMSA, a missionary to Uganda and Kenya in recent years. (The article appeared in Human Development, Vol21, No.3, Fall 2000)

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The shame is all-consuming. Yet, I am not a religious person. I believe that women have the ‘right’ to have an abortion. That does not stop me feeling like a murderer for terminating my child. I did not terminate a ‘bunch of cells’ but a real human being.

And yet, "I do not expect to be shamed by my community. This is not an issue for the moral majority. I have fought the stigma of the majority - on both sides - who talk of my abortion as if it is a ‘right’ or a ‘wrong’. These are simplistic terms which cannot convey what it means to me: a regret and a grief."….

"Abortion is an issue which every woman approaches differently. I have spoken to women who have terminated and who have never looked back. This is not how it is with me. I have looked back and am constantly remembering and grieving.

I grieve and see no end to the grief because what I did, rightly or wrongly, was irreversibly and irrevocably permanent. Do you see? I cannot, for all the riches in the world, get my child back?"

I am grateful for the opportunity given to me to put words to my grief and am glad that I saw Reist’s article in the paper rather than receiving a tick-the-box survey - did you make the right decision or not? - because that would have been too simplistic.

What saddens me most is this: despite my efforts and the efforts of many women who participated in Reist’s ground-breaking and compassionate book - none of us have been heard.

The abortion debate has simply continued in its age-old unenlightened way through the obliteration of the voices of those who sought to give a human face to the debate.

The mechanism for this obliteration is a common one - blame the "victim". Or, rather, label the speaker as a "victim" first, and through this ungracious process of impeachment, discredit the message they have to give.

In this sense and only in this sense, Reist’s book is an unmitigated failure. She did not achieve what she set out to achieve - which was to give voice to women who are suffering from post-abortion grief. However, in Reist’s favour, it ought to be said that giving a voice to people is bound to fail when those voices fall on deaf ears.And they are deaf ears.

What is most telling about the "academic" response to this book is that, instead of concentrating on what is being said by the contributors, reviewers2 choose to impeach Reist herself in an attempt to discredit her views as well. To what end?

When feminism loses sight of the women it seeks to represent, it has failed. I am a feminist and I have been let down. Paradoxically, I have no thanks to give to "pro-choicers" because they systematically refuse to hear what it is women who suffer post-abortion grief have to say.

Notes:

1. ‘Marguerite’ is the pseudonym used by the author in the book Giving Sorrow Words, written and compiled by Melinda Tankard-Reist, Australia.

2. ‘Reviewers’ here refers to reviewers in Australia such as feature in Opinion.

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No matter how or when an abortion happens -

grief signifies the loss

The controversial abortifacient pill RU486 is hitting New Zealand.

What are the implications for women who take this pill likely to be?