•What is the Psychological Impact

on Women who had an Abortion?

by: Sandra Persaud Tellini

November 30th, 2012

1

MY “I” STATEMENTOne of the most common surgical procedures in US

My interest stems from my personal experience

I volunteered as a peer counselor for ten yrs at women in

crisis centers

I have facilitated many support groups for post abortion

women who came forward to reconcile suppressed feelings

of the impact

Many women need to be educated before

making any rash decisions and what to expect after

High success rate of women finding holistic healing and

closure and free from internal negative self-talk to live fuller

lives 2

Why many women experience psychological reaction to their abortion decision

• Colbert (as cited in, Koterski, 2004 p.79) commented, “Post Abortion Stress Disorder brings together many symptoms, signs, and behaviors with which women that experience after abortion present for help.”

• Colbert further explains that what causes the psychological symptoms of this disorder is, what Freud describes as, “the resulting guilt which is often repressed within the person’s unconscious in order to protect the personality from conflict.”

• This, Freud said, is the mental mechanisms of defense that keep intact the personality that is in conflict.

• Abandonment upon discovery of the pregnancy often leaves women feeling forced and backed into a corner to abort the baby (Kimport, Foster, & Weitz, 2011). 3

Four Fundamental Factors of PASD

• Exposure to or participation in an abortion experience, which is perceived as the traumatic and deliberate destruction of one’s unborn child.

• An uncontrolled negative re-experiencing of the abortion event.

• Unsuccessful attempts to avoid or deny painful abortion recollections, resulting in reduced responsiveness.

• Experiencing associated symptoms not present before the abortion, including guilt about surviving (Speckhard & Rue, 1992, p. 95).

4

Definitions Abortion: The word “abortion” is the intentional termination of

gestation by any means and at any time during pregnancy from conception to full term. (Mohr, 1979)

A “flashback” as relates to mental health is when memories of past traumas feel as if they are taking place in the current moment.

Acute Stress Disorder (ASD) is a psychological dysfunction which results from a traumatic experience and characterized by the development of severe anxiety, dissociative, and other symptoms that occurs within one month after exposure to an extreme traumatic stressor and last 2 days to four weeks. It overwhelms a person’s normal mechanisms resulting in intense fear, feelings of helplessness or being trapped, or loss of control.

PTSD is similar to ASD except the duration of experiencing the above symptomology is greater than one month (Bowles et al., 2006, p. 970).

5

Definitions Cont’d• (DSM-IV-TR) changed its language from

mental illness or disease to mental disorder. “a

clinical significant behavior or psychological syndrome or pattern that occurs in an individual and is associated with present distress and disability. It must be a manifestation of a behavioral, psychological or biological dysfunction in the individual”. (CDC, 2008)

• Rue, as cited in Colbert (2003), first described PASD falls under PTSD which is a sub-category of Anxiety Disorder

• PTSD is not a disease; it describes symptom clusters and behaviors and recurrent events associated with severe trauma.

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Delimitations•To exclude women who have experienced an

abortion due to rape or for medical reasons.•The implications including moral, theological and political concerns are not be part of my research.

Limitation• For the purpose of this research we will only

focus on women and the psychological impact of the abortion.

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Significance of the Study

My hope is that through this project I can make my

findings available to women in crisis centers so that

they can either determine the need for closure

and/or healing while equipping others to make an

informed choice.

Awareness to the sensitivity of the impact of an

past abortion on a client …so that clinicians can

probe and determine if presenting problem is

primary or secondary.8

Literature Review Risk factors by the American Psychological Association Task Force on Mental Health and Abortion in their 2008 report:

• Terminating a pregnancy that is wanted or meaningful.

• Perceived pressure from others to terminate a pregnancy.

• Perceived opposition to the abortion from partners, family, and/or friends.

• Lack of perceived social support from others.

• Various personality traits (e.G., Low self-esteem, a pessimistic outlook, low-perceived control over life).

• A history of mental health problems prior to the pregnancy.

• Feelings of stigma.

• Perceived need for secrecy.9

Literature Review Cont’dRisk factors by the American Psychological Association Task Force on Mental Health and Abortion in their 2008 report:

• Exposure to anti-abortion picketing• Use of avoidance and denial coping strategies• Feelings of commitment to the pregnancy• Ambivalence about the abortion decision• Low perceived ability to cope with the abortion• History of prior abortion• Late term abortion• Being an adolescent (not an adult)• Having a non-elective (therapeutic or coerced) abortion• Prior history of abortion (having a second or third abortion,

or more)

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Statistics from US Census of Bureau

11,270, 1%

1,700, 0%

19,500, 2%4,890, 0%

California 214,190

15,960, 1%

17,030, 1%

7,070, 1%

4,450, 0%

FLorida 94,360

39,820, 3%

5,630, 0%

1,800, 0%

54,920, 5%NJ

10,680, 1%

6,560, 1%

9,770, 1%

4,430, 0%14,860, 1%

2,800, 0%

34,290, 3%

24,900, 2%

36,790, 3%

13,060, 1%2,770, 0%

7,440, 1%2,230, 0%

2,840, 0%13,450, 1%

3,200, 0%

54,160, 4%

Illinios6,150, 1%

New York 153,110 37.6%

33,140, 3%

1,400, 0%33,550, 3%

7,160, 1%

12,920, 1% 41,000, 3%

5,000, 0%7,300, 1%

850, 0%

19,550, 2%

84,610, 7%Texas

4,000, 0%

1,510, 0%

28,520, 2%

24,320, 2% 2,280, 0%

8,230, 1% 90, 0%

Abortions by State of Occurrence and Residence 2008

1 2

3 4

5 6

7 8

9 10

11 12

13 14

15 16

17 18

19 20

21 22

23 24

25 26

27 28

29 30

31 32

33 34

35 36

37 38

39 40

41 42

43 44

45 46

47 48

49 50

51

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Age of woman: %

.Less than 15 years old 3.0%

..15 to 19 years old 18.7%

..20 to 24 years old 38.8%

..25 to 29 years old 28.7%

..30 to 34 years old 18.1%

..35 to 39 years old 10.1%

..40 years old and over 3.4%

Race and ethnicity of woman in 2008:

Abortion rate per 1,000 women

..White 13.8%

..Black 48.2%

..Other 21.6%

..Hispanic 26.0%

..Non-Hispanic White 10.6%12

58%14.20%

19.00%

8.50%

Whites

Black

Hispanics or Latino

Other

Literature Review Cont’d – Low Risk for

post-abortion psychological maladjustments

Can be described as a woman who has

• maturely,

• thoughtfully,

• and freely arrived at her abortion decision and

• has no emotional, social, or moral conflicts which challenge that decision..

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Literature Review Cont’d - Risk Factors Predictive of Greater Post-

abortion Psychological Sequelae with Citations to Authorities

• I. CONFLICTED DECISION A) Difficulty making the decision, ambivalence,

unresolved doubts

• 1. Moral beliefs against abortion

• 2. Conflicting maternal desires

• 3. Second or third trimester abortion

• 4. Low coping expectancy

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Literature Review Cont’d - Risk Factors Predictive of Greater Post-abortion Psychological Sequelae with Citations to Authorities Cont’d

• B. Feels pressured or coerced

– a. Feels decision is not her own, or is “her only choice”

– b. Feels pressured to choose too quickly

• C. Decision is made with biased, inaccurate, or inadequate information

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Literature Review Cont’d - Risk Factors Predictive of Greater Post-abortion Psychological Sequelae with Citations to Authorities Cont’d

II . PSYCHOLOGICAL OR DEVELOPMENTAL LIMITATIONS

A. Adolescence, emotional immaturity

B. Prior emotional or psychiatric problems

C. Lack of social support

D. Prior abortion(s)

E. Prior miscarriage

F. Less education

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Literature Review Cont’d –Resources available

• Counseling - one-on-one or group therapy or a combination of both.

• In-person support (attending a weekend retreat, working with a therapist, a clergyperson or a peer counselor, or going to a weekly group)

• Online support (online chats, internet message boards, e-mail groups). Several organizations offer a combination of email or internet-based group support and in-person support.

Finding the right resources that is best suited to the individual woman is important.

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Methodology• Participatory action research

• Survey – population targeted - post-abortion women who sought help at crisis pregnancy centers.

• Characteristics – various cultural backgrounds, socio-economic levels, varying age ranging from twelve years old to mid seventies and from various religious backgrounds at the time of the abortion

• Who responded to a community service invitation, in Broward and Volusia counties in Fl to attend a support group for post-abortion women seeking healing and closure.

• I contacted the participants by either telephone or emailed and then email the questionnaire and consent form.

• Random sample population of 20 post-abortion participants in Fl

• 13 questions - 2 open ended questions & 11 closed-ended questions. (8 closed ended dichotomous questions, 2 numerical questions, 2 Likert-scale questions, 1 Likert scaled question which comprised of twenty-eight parts.

• Designed to uncover attitudes, opinions, knowledge and experience 18

Results of the QuestionnaireThe first question was a rule out question in case my survey did not reach my target population.

1. Have you experienced an abortion in the past?

Yes No In bold letters it stated

IF YES, PLEASE CONTINUE. IF NO, PLEASE STOP HERE. THANK YOU FOR YOUR TIME.

100% =yes.

2. What is your age? Under 18 yrs 18- 25 yrs 26 – 40 yrs 40 and over

10% were between 18-25 years old, 30% were between 26-40 years old, 60% were between 40 and over years old.

3. (If you had more than one abortion) at what stage of the pregnancy did you have the abortion that affected you the most?

<6 wks 7-10 wks 11-15 wks 16 - 20 wks > 20 wks

<6 wks =20% 7-10 wks = 40% 11-15 weeks = 40% 4.What is your ethnic background? ___

70% were Caucasian, 20% were Hispanic, and 10% were Black.

5. Please rate your feelings/experience from 0-3 (0= No Effect; 1 = Some Effect; 2 = Great Effect; 3 = Very Intense). The first column (1) applies to the weeks immediately following the abortion experience. The second column (2) applies to how you feel now or felt at the time you sought help to cope with the any distressful feelings from the past abortion.

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COL#1

results %

0 1 2 3

Measures their psychological

experience in each below

category

COL#2

results

%

0

1 2 3

5 0 5 90 Guilt 0 10 55 35

5 0 45 50 Emotional ‘Numbing’ 10 10 35 45

30 15 30 25 Dreams/Nightmares 30 20 20 30

5 15 25 55 Change In Relationships 10 40 25 25

5 15 30 50 Inferiority Feeling 5 30 25 40

70 5 20 5 Dizziness/Fainting 80 10 10 0

20 40 30 10 Sleep Disturbances 45 35 20 5

25 30 35 10 Can’t Make Friends 25 35 30 10

15 20 20 45 Preoccupation With Abortion 20 60 20 0

5 10 30 55 Sexual Problems 0 20 60 20

5 15 75 5 Relief 0 20 60 20

15 25 15 45 Depressed 10 45 20 25

5 10 40 45 Sad 20 35 30 15

25 35 20 25 Anxiety 35 40 15 10

30 15 30 25 Suicidal Ideas 40 20 30 10

Results of Questionnaire Q 5

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Results of Questionnaire Q 5

25 20 15 40 Alcohol/Drugs 45 20 15 20

5 35 22 25 Loneliness 5 40 30 25

5 15 25 55 Sense Of Loss 40 40 10 10

5 10 25 60 Secretive 0 15 35 50

10 25 15 50 Crying Spells 15 40 35 10

5 20 15 60 Regret 0 0 50 50

10 35 20 35 Angry 15 35 25 25

25 25 20 30 Helplessness 35 30 25 10

45 30 10 15 Headaches 60 30 10 0

25 25 25 25 Eating Disorder 60 20 15 5

40 35 15 10 Panic Feelings 50 40 10 0

10 40 35 15 Unable To Relax 40 30 30 0

5 25 55 15 Fear Of Failure 0 50 35 15 21

Results of Survey6. Did you feel pressured into having an abortion? Yes No 70%= yes and

30%= no.

7.Do you experience a disconnect with bonding with your children since

having the abortion? Yes No NA 40% = yes, 50% = no and 10% = NA

8. Have you experienced in the past recurring "flashbacks" of the abortion

episode, with no apparent explanation for what is causing them? Yes No

70% = yes 30% = no.

9. Since the abortion have you experienced anxiety over fertility issues?

Yes No 70% = yes, and 30% = no.

10. Since the abortion have you experienced anxiety over childbearing issues?

Yes No 65% = yes and 35% = no.

11. Since the abortion have found you had difficulty with intimacy?

Yes No 80% = yes and 20% = no.

12. Did you have a change of mind about the abortion just before the event?

Yes No 50% = yes and 50% = no.22

Question 13 – last words“Public awareness of the after effects of an abortion & a high risk on a woman’s fertility”.

“Once it is done, it’s done and can’t be undone. check your options and be sure about your decision

Women need to be valued & supported as they r presented all options and allowed to ponder.

“The abortion had a profound impact on my life and everything including my relationship with others and created sexual issues and how I viewed my partner”.

You need to pause and take a deep breath, explore all your choices and after listening to everyone around you, process it then you make your own decision. It is a final decision that can’t be undone”.

“I was quite functional because I buried it for years. When I finally went through a support group and had to name the unborn baby to bring closure … it was then I realized I had never acknowledged his personhood. It opened the door for me to grieve and finally be healed. For years I lived with secret shame.

“I was for abortion because I thought women should be in charge of their bodies. I had managed to hide away a lot of hurt and pain from my own abortions for a long time, but the cost in other areas of my life was too much.

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DiscussionThe Survey says:….• Even though all abortions occurred in a woman’s fertility cycle, most

unplanned pregnancies occurred prior to age thirty• 60% of sample were over 40yrs old - most women sought help many years

after the abortion experience.• Cultural biases was reflected in those who sought help 70% Caucasian , 20%

Hispanic, 10% Black• First Column - Soon after the event very intense feelings were:

#1 Guilt, Regret (90%), #2 Secretive (60%), #3 Change in Relationships, Sexual Problems, & Sense of Loss (55%), #4 Emotional Numbing, Inferiority feeling, & Crying Spells (50%)No Effect –# 1 Dizziness/Fainting (70%), #2 Headaches (45%), #3 Panic Feelings (40%)

2nd column Feedback -Recently or at the time they sought help • Very Intense feelings –• #1 Regret” and “Secretive(50%) #2 Emotional Numbing (45%), #3 Inferiority

Feeling (40%), #4 Guilt (35%) No Effect, #1 Dizziness/Fainting (80%), #2 Headaches & Eating Disorder (60%) #3 Panic Feelings (50%).Not one of them was left unaffected by their abortion experience.

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Q uestion#6 70% - felt pressured into having an abortion.

Q #7 Regarding whether the woman experienced a disconnect with bonding with their children since having the abortion 40 % YES, 50 % NO 10 % NOT APPLICABLE

Question #8 Whether the participants had experienced in the past recurring "flashbacks" of the

abortion episode, with no apparent explanation for what is causing them? 70 % YES 30 % NO.

• Question #9 asked, since the abortion have you experienced anxiety over fertility issues?

• 70 % YES• 30 % NO • Question #10 a response to anxiety over childbearing issues. The

response was very similar to question 9 as 65 % YES35% NO .

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• Q#11 asked whether since the abortion, the participant found has had difficulty with intimacy;

• 80 % YES , 20 % NO.

• Q #12 asked did she have a change of mind about the abortion just before the event.

• 50 % YES , 50 % NO.

• Q#13 Comments: Revealed that their regret about their abortion decision and had many words of advice to those who may be in a crisis pregnancy and still looking to explore their choices.

• Though they could not reverse their prior decision had gotten pass the blaming on to others,

• Seemed to have reached a place where they took responsibility for their actions,

• Made peace with their past and experienced closure26

A few common threads… • Firstly, unexpected pregnancies are always stressful. • And stress is a major cause of both mental illness and

physical illness. • Real need for emotional adjustments after abortion. • Strong link between abortion and mental health problems

in women. • Repression as a coping means, may be a long period of

denial before a woman seeks psychiatric care• Repressed feelings may cause psychosomatic illnesses and

psychiatric or behavior in other areas causing her to seeking therapy for apparently unrelated problems.

•

•

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Why should you care?• Everyone knows someone directly affected, no

one is untouched • Women represents > ½ population • An average of fifty percent of pregnancies are

unwanted and • 4 in 10 of these are terminated by abortion. 22 %

of all pregnancies end in abortion (CDC)• An unacknowledged post-abortion distress may

be contributory – Clinician can probe and determine if presenting problem is primary or secondary

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RecommendationsBased on these findings, most of which have been published by

researchers who favor legalized abortion, it would appear reasonable to expect, and demand, that abortion providers:

1) Provide pre-consent information.

2) Provide adequate pre-abortion screening using the criteria outlined above.

3) Provide individualized counseling to high risk patients.

4) Assist women who have pre-identifying high risk factors in evaluating and choosing lower risk solutions to their social, economic, and health needs.

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Closing StatementThe significance of this study is to identify that a considerablenumber of women who experienced an abortion did not walkaway unharmed by their decision.

Rather, the psychological effects they sustain require thenecessity to make available a safe place for them to findhealing; whether in a group or individual setting.

To this end, this study is important to the field of mental healthcounseling.

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