Risk Factors for Psychological Problems After Abortion

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 physical complications.

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 problems. Examination of these risk factors suggests that many, if not most women seeking abortion have one or more of these high risk characteristics.

Risk Factors Predicting Post-Abortion Psychological Problems

I. CONFLICTED DECISION

A. Difficulty making the decision, ambivalence, unresolved doubts1,2,11,14,16,17,19,23,27,30,36,39,40

1. Moral beliefs against abortion

a. Religious or conservative values1,17,27,31,35,36

b. Negative attitudes toward abortion7

c. Feelings of shame or social stigma attached to abortion1

d. Strong concerns about secrecy37

2. Conflicting maternal desires27,23

a. Originally wanted or planned pregnancy11,17,21,23,39

b. Abortion of wanted child due to fetal abnormalities2,5,11,14,15,20,22

c. Therapeutic abortion of wanted pregnancy due to maternal health risk2,11,14,20,32,36

d. Strong maternal orientation35,27

e. Being married6

f. Prior children19,35

g. Failure to take contraceptive precautions, which may indicate an ambivalent desire to become pregnant4

h. Preoccupation with fantasies of fetus, including sex and awareness of due date.16

3. Second or third trimester abortion,20,31,32,36 which generally indicates strong ambivalence or a coerced abortion of a “hidden” pregnancy.

B. Feels pressured or coerced11,12,14,27,33,35,39,40

1. Feels pressured to have abortion

a. By husband or boyfriend

b. By parents

c. By doctor, counselor, employer, or others

2. Feels decision is not her own, or is “her only choice”14

3. Feels pressured to choose too quickly13,18

C. Decision is made with biased, inaccurate, or inadequate information13,35,36

II. PSYCHOLOGICAL OR DEVELOPMENTAL LIMITATIONS

A. Adolescence, minors having an increased risk3,9,12,13,23,26,32,35

B. Prior emotional or psychiatric problems2,4,11,14,17,19,20,27,32

1. Poor use of psychological coping mechanisms1,23,27

2. Prior low self-image27,33,35,40

3. Poor work pattern 4,40

4. Prior unresolved trauma35

5. A history of sexual abuse or sexual assault.17,25,38

6. Blames pregnancy on her own character flaws, rather than on chance, others, or on correctable mistakes in behavior23,24,29

7. Avoidance and denial prior to abortion10

C. Lack of social support

1. Few friends 4,40

2. Made decision alone, without assistance from partner28

3. A poor or unstable relationship with male partner 4,19,27,33,39

4. Lack of support from parents and family, either to have baby or to have abortion1,7,8,14,23,28,40

5. Lack of support from male partner, either to have baby or to have abortion1,4,7,8,14,19,23,27,28,32,34,39,40

6. Accompanied to abortion by male partner24

D. Prior abortion(s)11,33,35,40

Sources

1. Adler, et. al., “Psychological Responses After Abortion,” Science, 248:41-44, (1990).

2. Ashton, “The Psychosocial Outcome of Induced Abortion”, British Journal of Ob&Gyn., 87:1115-1122 (1980).

3. Babikian & Goldman, “A Study in Teen-Age Pregnancy,” Am. J. Psychiatry, 755 (1971).

4. Belsey, et al., “Predictive Factors in Emotional Response to Abortion: King’s Termination Study – IV,” Soc. Sci. & Med., 11:71-82 (1977).

5. Blumberg, “The Psychological Sequelae of Abortion Performed for a Genetic Indication,” Am. J. of Obstetrics and Gynecology 122(7):799-808 (1975).

6. Bracken, “A causal model of psychosomatic reactions to vacuum aspiration abortion,” Social Psychiatry, 13:135-145 (1978).

7. Bracken, et al., “Coping with pregnancy resolution among women in an urban population,” Sociology, 9, 225-254 (1978).

8. Bracken, et. al., “The decision to abort and psychological sequelae” Journal of Nervous and Mental Disease, 158:154-162 (1974).

9. Campbell, N.B., et. al., “Abortion in adolescence,” Adolescence 23:813-823 (1988).

10. Cohen & Roth, “Coping With Abortion,” Journal of Human Stress 10:140-145 (1984).

11. Council on Scientific Affairs, American Medical Association, “Induced Termination of Pregnancy Before and After Roe v Wade: Trends in Mortality and Morbidity of Women,” JAMA, 268(22):3231-3239 (1992).

12. Dunlop, “Counseling of Patients Requesting an Abortion,” The Practioner, 220:847-852 (1978).

13. Franz W., Reardon, D., “Differential Impact of Abortion on Adolescents and Adults,” Adolescence, 27(105):161-172 (1992).

14. Friedman, C., et. al., “The Decision-Making Process and the Outcome of Therapeutic Abortion,” Am. J. of Psychiatry, 131(12):1332-1337 (1974).

15. Furlong, “Pregnancy Termination for Genetic Indications: The Impact on Families,” Social Work in Health Care 10(1):17 (1984).

16. Gath & Rose, “Psychological Problems & Gynacological Surgery” in Psychological Disorders in Obstetrics and Gynaecology (London: Butterworths, 1985).

17. Hern, Abortion Practice, (Boulder, CO: Alpenglo Graphics, Inc., 1990).

18. Landy, “Abortion Counseling – A New Component of Medical Care,” Clinics in Obs/Gyn, 13(1):33-41 (1986).

19. Lask, “Short-term Psychiatric Sequelae to Therapeutic Termination of Pregnancy,” Br J Psychiatry, 126: 173-177 (1975).

20. Lazarus, “Psychiatric Sequelae of Legalized Elective First Trimester Abortion”, Journal of Psychosomatic Ob&Gyn 4:141-150 (1985).

21. Lemkau, “Emotional Sequelae of Abortion,” Psychology of Women Quarterly, 12:461-472 (1988).

22. Lloyd, “Sequelae and Support After Termination of Pregnancy for Fetal Malformation,” British Medical Journal, 290:907-909 (1985).

23. Major & Cozzarelli, “Psychosocial Predictors of Adjustment to Abortion,” Journal of Social Issues, 48(3):121-142 (1992).

24. Major, et. al., “Attributions, expectations and coping with abortion,” Journal of Personality and Social Psychology, 48:585-599 (1985).

25. Makhorn, “Sexual Assault & Pregnancy,” New Perspectives on Human Abortion, Mall & Watts, eds., (Washington, D.C.: University Publications of America, 1981).

26. Martin, “Psychological Problems of Abortion for Unwed Teenage Girls,” Genetic Psychology Monographs 88:23-110 (1973).

27. Miller, “An Empirical Study of the Psychological Antecedents and Consequences of Induced Abortion,” Journal of Social Issues, 48(3):67-93 (1992).

28. Moseley, et. al., “Psychological Factors That Predict Reaction to Abortion,” J. of Clinical Psychology, 37:276-279 (1981).

29. Mueller & Major, “Self-blame, self-efficacy and adjustment to abortion,” Journal of Personality and Social Psychology 57:1059-1068 (1989).

30. Osofsky & Osofsky, “The psychological reaction of patients to legalized abortion,” American Journal of Orthopsychiatry, 42:48-60 (1972).

31. Osofsky, et. al., “Psychological effects of abortion: With emphasis upon the immediate reactions and followup,” in H. J. Osofsky & J.D. Osofsky, eds., The Abortion Experience (Hagerstown, MD: Harper & Row, 1973), 189-205.

32. Rosenfeld, “Emotional Responses to Therapeutic Abortion,” American Family Physician, 45(1):137-140, (1992).

33. Rue & Speckhard, “Informed Consent & Abortion: Issues in Medicine & Counseling,” Medicine & Mind 7:75-95 (1992).

34. Shusterman, “Predicting the psychological consequences of abortion,” Social Science and Medicine, 13A:683-689 (1979).

35. Speckhard & Rue, “Postabortion Syndrome: An Emerging Public Health Concern,” Journal of Social Issues, 48(3):95-119 (1992).

36. Vaughan, Canonical Variates of Post Abortion Syndrome (Portsmouth, NH: Institute for Pregnancy Loss, 1990).

37. Wallerstein, “Psychological Sequelae of Therapuetic Abortion in Young Unmarried Women,” Archives of General Psychiatry 27:828-832 (1972).

38. Zakus, “Adolescent Abortion Option,” Social Work in Health Care, 12(4):87 (1987).

39. Zimmerman, “Psychosocial and Emotional Consequences of Elective Abortion: A Literature Review”, in Paul Sachdev, ed., Abortion: Readings and Research (Toronto:Butterworth, 1981).

40. Zimmerman, Passage Through Abortion (New York: Praeger Publishers, 1977).

41. See also: Adler, David, Major, Roth, Russo, & Wyatt, “Psychological Factors in Abortion: A Review” American Psychologist 47(10):1194-1204 (1992).

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