Identifying High Risk
David C. Reardon, Ph.D.
While there is intense controversy regarding how many women experience
post-abortion psychological problems, even pro-abortion researchers admit
that at least some women are negatively effected. According to the disposition
of the individual researcher, these negative reactions may be loosely labeled
as "serious," "significant" or "minor" and the number of women experiencing
these reactions may be vaguely described as "many," "some" or "only a few."
But statistics are less subjective than adjectives. In one review of the
literature, the lowest reported rate for adverse post-abortion outcomes
was 6 percent, with most reports ranging from 12 to 25 percent, and the
highest estimates rising above 50 percent. With such findings, only the
most biased of researchers are so rash to claim that "no one" experiences
Because the existence of post-abortion trauma is now almost universally
accepted, many researchers are now focusing on the factors which may identify
which women are at higher risk. From a political viewpoint, researchers
who favor abortion on demand are hoping to show that the "few" women who
do report negative post-abortion reactions were actually emotionally "unbalanced"
prior to the abortion. If this is true, they argue, then it is possible
that the abortion itself is not the cause of psychological injury, but
instead women who were previously "unbalanced" are unfairly blaming their
problems on abortion.
BLAMING THE VICTIM
This "politically correct" view of post-abortion trauma includes a kernel
of truth surrounded by a lot of "blaming the victim." It is certainly true
that women who are suffering from mental disorders or have previously suffered
psychological trauma are more likely to subsequently report more severe
negative post-abortion reactions. Indeed, if one thing is clear from post-abortion
research over the last forty years, it is that abortion is contraindicated
when a woman has mental health problems.
This is true because abortion is always stressful. How well a person
copes with this stress depends on the individual's resiliency and the conditions
under which the stress occurs. When a woman's psychological state is already
fragile, the stress of an abortion can more easily overwhelm her. But the
fact that she was more vulnerable to stress than others does not mean that
the abortion is not the cause of her psychological injuries.
If a glass plate and a plastic plate are both dropped, the glass plate
is likely to shatter, while the same stress may cause the plastic plate
to only crack or chip. In either case, the damage cannot be blamed on the
material; it must be blamed on the fall. While the extent of the
damage is related to the nature of the material, the fall itself is the
direct cause of the damage.
In the same way, while the nature of an individual psyche determines
the extent of post-abortion injuries, it is the abortion itself
which is the direct cause of these injuries.
This "blame the victim" strategy which is being employed by some pro-abortion
researchers is not new. It is identical to the type of reasoning used during
World War I when veterans suffering from "shell shock" were diagnosed by
military psychiatrists as "malingerers" or even cowards. In an age when
fighting for one's country was romantically idealized as adventurous passage
into manhood, this "politically correct" diagnosis was necessary to deflect
attention away from the fact that modern warfare was often more traumatic
than ennobling. Military officials therefore attempted to suppress reports
of psychiatric casualties because accurate reports would have had a demoralizing
effect on the public.
In the same way, when pro-abortion researchers are confronted with women
who suffer from post-abortion trauma, there is a tendency to blame the
woman for being "whiners" or "dysfunctional," since it is common knowledge
in pro-abortion circles that abortion normally "empowers" women. Some pro-abortion
researchers even argue that women should not be told of the psychological
risks associated with abortion because such "demoralizing" information
may make them even more prone to an adverse outcome. It is better, they
would claim, to be ignorantly optimistic about the future than informed
WOMEN AT RISK
The comments above are useful for understanding the impetus behind much
of the recent efforts of pro-abortion researchers. With this in mind, we
can now look at some of the very useful findings which these same researchers
have made in the area of cataloging pre-identifying factors which can be
used to predict post-abortion psychological sequelae.
The risk factors for post-abortion psychological maladjustments can
be divided into two general categories. The first category includes women
for whom there exists significant emotional, social, or moral conflicts
regarding the contemplated abortion. The second category includes women
for whom there are developmental problems, including immaturity, or pre-existing
and unresolved psychological problems. Women with characteristics in either
or both of these categories would properly be classified as high risk patients.
Conversely, a low risk patient 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.
The following outline summarizes the major risk factors and includes
pre-identifying characteristics upon which women can be screened for these
RISK FACTORS PREDICTING POST-ABORTION PSYCHOLOGICAL
(Reference Key to type of citation: bold - Statistically
Validated Study; italicized - Clinical Experience, Soft Data;
- Literature Review)
I. CONFLICTED DECISION
A. Difficulty making the decision, ambivalence,
1. Moral beliefs against abortion
II. PSYCHOLOGICAL OR DEVELOPMENTAL LIMITATIONS
a. Religious or conservative values1,2,5,23,34,39,40,48,49,54,56,58,59
2. Conflicting maternal desires1,29,30,33,34,46,51
b. Negative attitudes toward abortion1,8,27,57
c. Feelings of shame or social stigma attached to abortion2
d. Strong concerns about secrecy50
a. Originally wanted or planned pregnancy1,13,23,27,29,53,57,59
3. Second or third trimester abortion1,20,26,27,39,42,49
b. Abortion of wanted child due to fetal abnormalities3,7,13,18,19,20,26,27,28,41
c. Therapeutic abortion of wanted pregnancy due to maternal health risk3,13,15,18,20,26,27,37,42,49,54,55
d. Strong maternal orientation34,48
e. Being married1, 10
f. Prior children25,48,54,58,60
g. Failure to take contraceptive precautions, which may indicate an
ambivalent desire to become pregnant6
h. Delay in seeking an abortion1,2,26
4. Low coping expectancy1,27,29,30
B. Feels pressured or coerced13,16,18,27,34,43,45,48,49,53,51,52,55
1. Feels decision is not her own, or is "her only choice"14,18
2. Feels pressured to choose too quickly17,24
C. Decision is made with biased, inaccurate, or inadequate information17,48,49
A. Adolescence, emotional immaturity1,4,9,11,15,16,17,27,29,32,33,42,48,50,54
B. Prior emotional or psychiatric problems3,5,6,13,15,18,20,22,23,25,26,34,37,40,42,47,51,54,57
1. Poor use of psychological coping mechanisms2,29,34
2. Prior low self-image33,34,43,48,52
3. Poor work pattern or dissatisfied with job6,52
4. Prior unresolved trauma or unresolved grief48,51
5. A history of sexual abuse or sexual assault.23,31,51
6. Blames pregnancy on her own character flaws, rather than on chance,
others, or on correctable mistakes in behavior29,30,36
7. Avoidance and denial prior to abortion12,27
8. Unsatisfactory or mediocre marital adjustment6
9. Past negative relationship with mother5,40
C. Lack of social support1,9,27,33,46,54,55,56,58
1. Few friends, unsatisfactory interpersonal relations6,52
D. Prior abortion(s)13,37,43,48,52,58
2. Made decision alone, without assistance from partner35
3. A poor or unstable relationship with male partner6,25,34,40,43,53
4. Single and nulliparous9
5. Separated, divorced, or widowed14
6. Lack of support from parents and family2,8,9,18,27,29,33,35,52,56
- either to have baby or to have abortion
7. Lack of support from male partner2,6,8,9,18,25,27,29,33,34,35,42,46,52,53
- either to have baby or to have abortion
8. Accompanied to abortion by male partner21,30
9. Living alone56
E. Prior miscarriage 58
F. Less education 58
THE ROLE OF THE MALE
The attitude of the male partner toward the pregnancy is an important
factor in a woman's abortion decision and is also significantly related
to how she will adjust after the abortion. Because numerous studies have
found support from the partner to be an important predictor of good post-abortion
adjustment, researchers were recently startled by the finding that accompaniment
to the abortion by the male partner was actually a predictor of greaterpost-abortion
This finding suggests that an outward show of support, accompaniment
to the abortion clinic, is not an accurate measure of the emotional support
a woman feels. Instead, accompaniment by the male partner may actually
indicate one or more of the following: 1) greater pre-abortion anxiety
which led the woman to insist on accompaniment; 2) overt or subtle coercion
on the part of the male who is "making sure" she does the "right thing;"
or, 3) a more intimate relationship exists between the partners and this
greater intimacy is being stressed by the abortion. In this third scenario,
the unplanned pregnancy may be perceived by the woman as a "test" of her
partner's commitment to their relationship. She may privately be willing
to have the baby, and seal their mutual commitment, if he takes
this as opportunity to demonstrate his commitment. Instead, his lack of
enthusiasm for, or hostile reaction to, the pregnancy causes her to doubt
the depth and endurance of their relationship.
In short, when a woman is accompanied to an abortion by her male partner,
the woman is more likely to be choosing abortion because her partner has
manipulated her into doing so, or because he has exposed to her a lack
of commitment to their relationship. In neither case does she truly feel
While present research is unable to accurately establish what percentage
of women suffer from any specific symptom of post-abortion trauma, it is
clear that post-abortion psychological disorders do occur. Indeed, the
published literature demonstrates that serious emotional and psychological
complications following an abortion are probably more common than serious
The present literature has also successfully identified statistically
significant factors which can be used to pre-identify individuals who are
most vulnerable to experiencing post-abortion psychological sequelae. Examination
of these risk factors suggests that many, if not most women seeking abortion
have one or more of these high risk characteristics.
Based 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
about the types of psychological reactions which have been linked to a
negative abortion experience and the risk factors associated with these
adverse reactions; 2) provide adequate pre-abortion screening using the
criteria outlined above to identify women who are at higher risk of negative
post-abortion reactions; 3) provide individualized counseling to high risk
patients which would more fully explain why the patient is at higher risk
along with more detailed information concerning possible post-abortion
reactions; and 4) assist women who have pre-identifying high risk factors
in evaluating and choosing lower risk solutions to their social, economic,
and health needs.
Since these high risk factors have been well established for a considerable
of time, abortion providers who fail to utilize this information in their
screening and counseling procedures may incur greater liability for subsequent
injuries when malpractice suits are brought on these grounds.
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