Physical Dangers Associated With Abortion
Approximately 10% of women undergoing induced abortion suffer from immediate complications, of which one-fifth (2%) were considered major.19 However the majority of complications take time to develop and will not be apparent for days, months or even years.
Negative psychological reactions to abortion are more common than physical complications. These are described in a later section.
The major physical risks and complications of abortion are described below. Citations to the medical literature regarding each danger or risk are included as end notes at the bottom of this page.
ELEVATED RISK OF DEATH
According to the best record based study of deaths following pregnancy and abortion, a 1997 government funded study in Finland, women who abort are approximately four times more likely to die in the following year than women who carry their pregnancies to term. In addition, women who carry to term are only half as likely to die as women who were not pregnant.16 (Click here for more details on this important study.)
The Finland researchers found that compared to women who carried to term, women who aborted in the year prior to their deaths were 60 percent more likely to die of natural causes, seven times more likely to die of suicide, four times more likely to die of injuries related to accidents, and 14 times more likely to die from homicide.
Researchers believe the higher rate of deaths related to accidents and homicide may be linked to higher rates of suicidal or risk-taking behavior.16 (Click here for details on the latest research regarding abortion associated deaths.)
The leading causes of abortion related maternal deaths within a week of the surgery are hemorrhage, infection, embolism, anesthesia, and undiagnosed ectopic pregnancies. Legal abortion is reported as the fifth leading cause of maternal death in the United States, though in fact it is recognized that most abortion-related deaths are not officially reported as such.2 (Click here for more details on the underreporting of abortion related deaths in the U.S.)
Two studies of the entire population of women in Denmark published in 2012 have shown similar results. The first found that the risk of death following abortion remains higher in each of the first ten years following the abortion. The second found that the risk of death increases with each abortion, 45% after one abortion, 114% after two abortions, and 192 percent after three or more abortions.
For a complete review of the literature see Deaths associated with abortion compared to childbirth: a review of new and old data and the medical and legal implications (2004).
CERVICAL, OVARIAN, AND LIVER CANCER
Women with a history of one abortion face a 2.3 times higher risk of having cervical cancer, compared to women with no history of abortion. Women with two or more abortions face a 4.92 relative risk. Similar elevated risks of subsequent ovarian and liver cancer have also been linked to single and multiple abortions. These increased cancer rates for post-aborted women may be linked to the unnatural disruption of the hormonal changes which accompany pregnancy and untreated cervical damage or to increased stress and the negative impact of stress on the immune system.4
Between 2 and 3% of all abortion patients may suffer perforation of their uterus, yet most of these injuries will remain undiagnosed and untreated unless laparoscopic visualization is performed.5 Such an examination may be useful when beginning an abortion malpractice suit. The risk of uterine perforation is increased for women who have previously given birth and for those who receive general anesthesia at the time of the abortion.(6) Uterine damage may result in complications in later pregnancies and may eventually evolve into problems which require a hysterectomy, which itself may result in a number of additional complications and injuries including osteoporosis.
Significant cervical lacerations requiring sutures occur in at least one percent of first trimester abortions. Lesser lacerations, or micro fractures, which would normally not be treated may also result in long term reproductive damage. Latent post-abortion cervical damage may result in subsequent cervical incompetence, premature delivery, and complications of labor. The risk of cervical damage is greater for teenagers, for second trimester abortions, and when practitioners fail to use laminaria for dilation of the cervix.7
Abortion increases the risk of placenta previa in later pregnancies (a life threatening condition for both the mother and her wanted pregnancy) by seven to fifteen fold. Abnormal development of the placenta due to uterine damage increases the risk of fetal malformation, perinatal death, and excessive bleeding during labor.8
SUBSEQUENT PRE-TERM DELIVERIES AND OTHER COMPLICATIONS OF LABOR
Women who had one, two, or more previous induced abortions are, respectively, 1.89, 2.66, or 2.03 times more likely to have a subsequent pre-term delivery, compared to women who carry to term. Prior induced abortion not only increased the risk of premature delivery, it also increased the risk of delayed delivery. Women who had one, two, or more induced abortions are, respectively, 1.89, 2.61, and 2.23 times more likely to have a post-term delivery (over 42 weeks).17 Pre-term delivery increases the risk of neonatal death and handicaps.
HANDICAPPED NEWBORNS IN LATER PREGNANCIES
Abortion is associated with cervical and uterine damage which may increase the risk of premature delivery, complications of labor and abnormal development of the placenta in later pregnancies. These reproductive complications are the leading causes of handicaps among newborns.9
Abortion is significantly related to an increased risk of subsequent ectopic pregnancies. Ectopic pregnancies, in turn, are life threatening and may result in reduced fertility.10
PELVIC INFLAMMATORY DISEASE (PID)
PID is a potentially life threatening disease which can lead to an increased risk of ectopic pregnancy and reduced fertility. Of patients who have a chlamydia infection at the time of the abortion, 23% will develop PID within 4 weeks. Studies have found that 20 to 27% of patients seeking abortion have a chlamydia infection. Approximately 5% of patients who are not infected by chlamydia develop PID within 4 weeks after a first trimester abortion. It is therefore reasonable to expect that abortion providers should screen for and treat such infections prior to an abortion.11
Endometritis is a post-abortion risk for all women, but especially for teenagers, who are 2.5 times more likely than women 20-29 to acquire endometritis following abortion.12
Approximately 10% of women undergoing elective abortion will suffer immediate complications, of which approximately one-fifth (2%) are considered life threatening. The nine most common major complications which can occur at the time of an abortion are: infection, excessive bleeding, embolism, ripping or perforation of the uterus, anesthesia complications, convulsions, hemorrhage, cervical injury, and endotoxic shock. The most common “minor” complications include: infection, bleeding, fever, second degree burns, chronic abdominal pain, vomiting, gastro-intestinal disturbances, and Rh sensitization.13
INCREASED COMPLICATIONS FOR WOMEN SEEKING MULTIPLE ABORTIONS:
In general, most of the studies cited above reflect risk factors for women who undergo a single abortion. These same studies show that women who have multiple abortions face a much greater risk of experiencing these complications. This point is especially noteworthy since approximately 45% of all abortions are for repeat aborters.
LOWER GENERAL HEALTH:
In a survey of 1428 women researchers found that pregnancy loss, and particularly losses due to induced abortion, was significantly associated with an overall lower health. Multiple abortions correlated to an even lower evaluation of “present health.” While miscarriage was detrimental to health, abortion was found to have a greater correlation to poor health. These findings support previous research which reported that during the year following an abortion women visited their family doctors 80% more for all reasons and 180% more for psychosocial reasons. The authors also found that “if a partner is present and not supportive, the miscarriage rate is more than double and the abortion rate is four times greater than if he is present and supportive. If the partner is absent the abortion rate is six times greater.” (15)
This finding is supported by a 1984 study that examined the amount of health care sought by women during a year before and a year after their induced abortions. The researchers found that on average, there was an 80 percent increase in the number of doctor visits and a 180 percent increase in doctor visits for psychosocial reasons after abortion.18
INCREASED RISK FOR CONTRIBUTING HEALTH RISK FACTORS:
Abortion is significantly linked to behavioral changes such as promiscuity, smoking, drug abuse, and eating disorders which all contribute to increased risks of health problems. For example, promiscuity and abortion are each linked to increased rates of PID and ectopic pregnancies. Which contributes most is unclear, but apportionment may be irrelevant if the promiscuity is itself a reaction to post- abortion trauma or loss of self esteem.
INCREASED DANGERS FROM ABORTION FOR TEENAGERS:
Teenagers, who account for about 30 percent of all abortions, are also at much high risk of suffering many abortion related complications. This is true of both immediate complications, and of long-term reproductive damage.14
Psychological Risks Associated with Abortion
REQUIREMENT OF PSYCHOLOGICAL TREATMENT
A study of the medical records of 56,741 California medicaid patients revealed that women who had abortions were 160 percent more likely than delivering women to be hospitalized for psychiatric treatment in the first 90 days following abortion or delivery. Rates of psychiatric treatment remained significantly higher for at least four years.1,3
In a study of post-abortion patients only 8 weeks after their abortion, researchers found that 44% complained of nervous disorders, 36% had experienced sleep disturbances, 31% had regrets about their decision, and 11% had been prescribed psychotropic medicine by their family doctor. (2) A 5 year retrospective study in two Canadian provinces found significantly greater use of medical and psychiatric services among women with a history of abortion. Most significant was the finding that 25% of women who had abortions made visits to psychiatrists as compared to 3% of the control group. (3) Women who have had abortions are significantly more likely than others to subsequently require admission to a psychiatric hospital. At especially high risk are teenagers, separated or divorced women, and women with a history of more than one abortion. (4)
Since many post-abortive women use repression as a coping mechanism, there may be a long period of denial before a woman seeks psychiatric care. These repressed feelings may cause psychosomatic illnesses and psychiatric or behavioral in other areas of her life. As a result, some counselors report that unacknowledged post-abortion distress is the causative factor in many of their female patients, even though their patients have come to them seeking therapy for seemingly unrelated problems. (5)
Researchers have identified a large number of statistically significant risk factors that identify which women are at greatest risk of experiencing one or more severe reactions to abortion. The following is list of risk factors identified 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
- exposure to antiabortion 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)
Please see “Identifying High Risk Abortion Patients” or “Abortion decisions and the duty to screen: clinical, ethical, and legal implications of predictive risk factors of post-abortion maladjustment” for a more complete list of risk factors, including citations to the studies identifying each risk factor.
SUICIDAL IDEATION AND SUICIDE ATTEMPTS
Approximately 60 percent of women who experience post-abortion sequelae report suicidal ideation, with 28 percent actually attempting suicide, of which half attempted suicide two or more times.(13)
Researchers in Finland have identified a strong statistical association between abortion and suicide in a records based study (see figure at the right). They found that the mean annual suicide rate for all women was 11.3 per 100,000 but the rate for women following abortion was 34.7 per 100,000, three times higher. The suicide rate associated with birth, by contrast, was half the rate of all women and less than one-sixth the rate of suicide among women who had abortions.(13)
Suicide attempts appear to be especially prevalent among post-abortion teenagers. Numerous other studies have also revealed higher rates of suicide and suicide attempts associated with abortion.(13)
ALCOHOL AND DRUG ABUSE
Over twenty studies have linked abortion to increased rates of drug and alcohol use.1 Abortion is significantly linked with a two fold increased risk of alcohol abuse among women.(16) Abortion followed by alcohol abuse is linked to violent behavior, divorce or separation, auto accidents, and job loss.(17) In addition to the psycho-social costs of such abuse, drug abuse is linked with increased exposure to HIV/AIDS infections, congenital malformations, and assaultive behavior. (18)
For at least some women, post-abortion stress is associated with eating disorders such as binge eating, bulimia, and anorexia nervosa. (19)
Thirty to fifty percent of the women who experience difficulty adjusting to a past abortion report experiencing sexual dysfunctions, of both short and long duration, beginning immediately after their abortions. These problems may include one or more of the following: loss of pleasure from intercourse, increased pain, an aversion to sex and/or males in general, or the development of a promiscuous life-style. (12)
CHILD NEGLECT OR ABUSE
Abortion is linked with increased depression, violent behavior, alcohol and drug abuse, replacement pregnancies, and reduced maternal bonding with children born subsequently. These factors are closely associated with child abuse and would appear to confirm individual clinical assessments linking post-abortion trauma with subsequent child abuse. (20)
POST-TRAUMATIC STRESS DISORDER (PTSD or PAS)
While psychological reactions to abortion fall into many categories, some women experience all or some of they symptoms of post-traumatic stress disorder (PTSD). The lowest incidence rate of PTSD reported following abortion is 1.5%, which would translate to over 600,000 cases of abortion induced PTSD.2 Another study found that 14% of American women have all the symptoms of PTSD and attribute them to their abortions, with as many as 65% reporting some, but not all symptoms of PTSD.3
Yet another random study found that a minimum of 19% of post-abortion women suffer from diagnosable post-traumatic stress disorder (PTSD). Approximately half had many, but not all, symptoms of PTSD, and 20 to 40 percent showed moderate to high levels of stress and avoidance behavior relative to their abortion experiences. (6)
PTSD is a psychological dysfunction which results from a traumatic experience which overwhelms a person’s normal defense mechanisms resulting in intense fear, feelings of helplessness or being trapped, or loss of control. The risk that an experience will be traumatic is increased when the traumatizing event is perceived as including threats of physical injury, sexual violation, or the witnessing of or participation in a violent death. PTSD results when the traumatic event causes the hyperarousal of “flight or fight” defense mechanisms. This hyperarousal causes these defense mechanisms to become disorganized, disconnected from present circumstances, and take on a life of their own resulting in abnormal behavior and major personality disorders. As an example of this disconnection of mental functions, some PTSD victim may experience intense emotion but without clear memory of the event; others may remember every detail but without emotion; still others may reexperience both the event and the emotions in intrusive and overwhelming flashback experiences. (7)
Women may experience abortion as a traumatic event for several reasons. Many are forced into an unwanted abortions by husbands, boyfriends, parents, or others. If the woman has repeatedly been a victim of domineering abuse, such an unwanted abortion may be perceived as the ultimate violation in a life characterized by abuse. Other women, no matter how compelling the reasons they have for seeking an abortion, may still perceive the termination of their pregnancy as the violent killing of their own child. The fear, anxiety, pain, and guilt associated with the procedure are mixed into this perception of grotesque and violent death. Still other women, report that the pain of abortion, inflicted upon them by a masked stranger invading their body, feels identical to rape. (8) Indeed, researchers have found that women with a history of sexual assault may experience greater distress during and after an abortion exactly because of these associations between the two experiences. (9) When the stressor leading to PTSD is abortion, some clinicians refer to this as Post-Abortion Syndrome (PAS).
The major symptoms of PTSD are generally classified under three categories: hyperarousal, intrusion, and constriction.
Hyperarousal is a characteristic of inappropriately and chronically aroused “fight or flight” defense mechanisms. The person is seemingly on permanent alert for threats of danger. Symptoms of hyperarousal include: exaggerated startle responses, anxiety attacks, irritability, outbursts of anger or rage, aggressive behavior, difficulty concentrating, hypervigilence, difficulty falling asleep or staying asleep, or physiological reactions upon exposure to situations that symbolize or resemble an aspect of the traumatic experience (eg. elevated pulse or sweat during a pelvic exam, or upon hearing a vacuum pump sound.)
Intrusion is the reexperience of the traumatic event at unwanted and unexpected times. Symptoms of intrusion in PAS cases include: recurrent and intrusive thoughts about the abortion or aborted child, flashbacks in which the woman momentarily reexperiences an aspect of the abortion experience, nightmares about the abortion or child, or anniversary reactions of intense grief or depression on the due date of the aborted pregnancy or the anniversary date of the abortion.
Constriction is the numbing of emotional resources, or the development of behavioral patterns, so as to avoid stimuli associated with the trauma. It is avoidance behavior; an attempt to deny and avoid negative feelings or people, places, or things which aggravate the negative feelings associated with the trauma. In post-abortion trauma cases, constriction may include: an inability to recall the abortion experience or important parts of it; efforts to avoid activities or situations which may arouse recollections of the abortion; withdrawal from relationships, especially estrangement from those involved in the abortion decision; avoidance of children; efforts to avoid or deny thoughts or feelings about the abortion; restricted range of loving or tender feelings; a sense of a foreshortened future (e.g., does not expect a career, marriage, or children, or a long life.); diminished interest in previously enjoyed activities; drug or alcohol abuse; suicidal thoughts or acts; and other self-destructive tendencies.
As previously mentioned, Barnard’s study identified a 19% rate of PTSD among women who had abortions three to five years previously. But in reality the actual rate is probably higher. Like most post-abortion studies, Barnard’s study was handicapped by a fifty percent drop out rate. Clinical experience has demonstrated that the women least likely to cooperate in post-abortion research are those for whom the abortion caused the most psychological distress. Research has confirmed this insight, demonstrating that the women who refuse followup evaluation most closely match the demographic characteristics of the women who suffer the most post-abortion distress. (10) The extraordinary high rate of refusal to participate in post-abortion studies may interpreted as evidence of constriction or avoidance behavior (not wanting to think about the abortion) which is a major symptom of PTSD.
For many women, the onset or accurate identification of PTSD symptoms may be delayed for several years. (11) Until a PTSD sufferer has received counseling and achieved adequate recovery, PTSD may result in a psychological disability which would prevent an injured abortion patient from bringing action within the normal statutory period. This disability may, therefore, provide grounds for an extended statutory period.
INCREASED SMOKING WITH CORRESPONDENT NEGATIVE HEALTH EFFECTS
Post-abortion stress is linked with increased cigarette smoking. Women who abort are twice as likely to become heavy smokers and suffer the corresponding health risks. (14) Post-abortion women are also more likely to continue smoking during subsequent wanted pregnancies with increased risk of neonatal death or congenital anomalies. (15)
DIVORCE AND CHRONIC RELATIONSHIP PROBLEMS
For most couples, an abortion causes unforeseen problems in their relationship. Post-abortion couples are more likely to divorce or separate. Many post-abortion women develop a greater difficulty forming lasting bonds with a male partner. This may be due to abortion related reactions such as lowered self-esteem, greater distrust of males, sexual dysfunction, substance abuse, and increased levels of depression, anxiety, and volatile anger. Women who have more than one abortion (representing about 45% of all abortions) are more likely to require public assistance, in part because they are also more likely to become single parents. (21)
Women who have one abortion are at increased risk of having additional abortions in the future. Women with a prior abortion experience are four times more likely to abort a current pregnancy than those with no prior abortion history. (22)
This increased risk is associated with the prior abortion due to lowered self esteem, a conscious or unconscious desire for a replacement pregnancy, and increased sexual activity post-abortion. Subsequent abortions may occur because of conflicted desires to become pregnant and have a child and continued pressures to abort, such as abandonment by the new male partner. Aspects of self-punishment through repeated abortions are also reported. (23)
Approximately 45% of all abortions are now repeat abortions. The risk of falling into a repeat abortion pattern should be discussed with a patient considering her first abortion. Furthermore, since women who have more than one abortion are at a significantly increased risk of suffering physical and psychological sequelae, these heightened risks should be thoroughly discussed with women seeking abortions.
The most complete listing of psychological problems associated with abortion can be found at at AbortionRisks.org
NOTES Regarding Physical Risks
1. Detrimental Effects of Abortion: An Annotated Bibliography with Commentary (Third Edition) is the most complete review of medical studies relevant to abortion. It includes brief summaries of major finding drawn from medical and psychology journal articles, books, and related materials, divided into major categories of relevant injuries. An online version of the bibliography can be found at www.AbortionRisks.com2. Kaunitz, “Causes of Maternal Mortality in the United States,” Obstetrics and Gynecology, 65(5) May 1985.3. H.L. Howe, et al., “Early Abortion and Breast Cancer Risk Among Women Under Age 40,” International Journal of Epidemiology 18(2):300-304 (1989); L.I. Remennick, “Induced Abortion as A Cancer Risk Factor: A Review of Epidemiological Evidence,” Journal of Epidemiological Community Health, (1990); M.C. Pike, “Oral Contraceptive Use and Early Abortion as Risk Factors for Breast Cancer in Young Women,” British Journal of Cancer 43:72 (1981).4. M-G, Le, et al., “Oral Contraceptive Use and Breast or Cervical Cancer: Preliminary Results of a French Case- Control Study, Hormones and Sexual Factors in Human Cancer Etiology, ed. JP Wolff, et al., Excerpta Medica: New York (1984) pp.139-147; F. Parazzini, et al., “Reproductive Factors and the Risk of Invasive and Intraepithelial Cervical Neoplasia,” British Journal of Cancer, 59:805-809 (1989); H.L. Stewart, et al., “Epidemiology of Cancers of the Uterine Cervix and Corpus, Breast and Ovary in Israel and New York City,” Journal of the National Cancer Institute 37(1):1-96; I. Fujimoto, et al., “Epidemiologic Study of Carcinoma in Situ of the Cervix,” Journal of Reproductive Medicine 30(7):535 (July 1985); N. Weiss, “Events of Reproductive Life and the Incidence of Epithelial Ovarian Cancer,” Am. J. of Epidemiology, 117(2):128-139 (1983); V. Beral, et al., “Does Pregnancy Protect Against Ovarian Cancer,” The Lancet, May 20, 1978, pp. 1083-1087; C. LaVecchia, et al., “Reproductive Factors and the Risk of Hepatocellular Carcinoma in Women,” International Journal of Cancer, 52:351, 1992.
5. S. Kaali, et al., “The Frequency and Management of Uterine Perforations During First-Trimester Abortions,” Am. J. Obstetrics and Gynecology 161:406-408, August 1989; M. White, “A Case-Control Study of Uterine Perforations documented at Laparoscopy,” Am. J. Obstetrics and Gynecology 129:623 (1977).
6. D. Grimes, et al., “Prevention of uterine perforation During Curettage Abortion,” JAMA, 251:2108-2111 (1984); D. Grimes, et al.,”Local versus General Anesthesia: Which is Safer For Performing Suction Abortions?” Am. J. of Obstetrics and Gynecology, 135:1030 (1979).
7. K. Schulz, et al., “Measures to Prevent Cervical Injuries During Suction Curettage Abortion,” The Lancet, May 28, 1983, pp 1182-1184; W. Cates, “The Risks Associated with Teenage Abortion,” New England Journal of Medicine, 309(11):612-624; R. Castadot, “Pregnancy Termination: Techniques, Risks, and Complications and Their Management,” Fertility and Sterility, 45(1):5-16 (1986).
8. Barrett, et al., “Induced Abortion: A Risk Factor for Placenta Previa”, American Journal of Ob&Gyn. 141:7 (1981).
9. Hogue, Cates and Tietze, “Impact of Vacuum Aspiration Abortion on Future Childbearing: A Review”, Family Planning Perspectives (May-June 1983),vol.15, no.3.. Jacobsson B, Hagberg G, Hagberg B, Ladfors L, Niklasson A, Hagberg A. Cerebral Palsy in preterm infants: a population-based case-control study of antenatal and intrapartal risk factors. Acta Paediatrica 2002;91:946-951. Calhoun BC, Shadigian E, Rooney B. Cost consequences of induced abortion as an attributable risk for preterm birth and informed consent. J Reprod Med 2007;52:929-939.
10. Daling,et.al., “Ectopic Pregnancy in Relation to Previous Induced Abortion”, JAMA, 253(7):1005-1008 (Feb. 15, 1985); Levin, et.al., “Ectopic Pregnancy and Prior Induced Abortion”, American Journal of Public Health (1982), vol.72,p253; C.S. Chung, “Induced Abortion and Ectopic Pregnancy in Subsequent Pregnancies,” American Journal of Epidemiology 115(6):879-887 (1982)
11. T. Radberg, et al., “Chlamydia Trachomatis in Relation to Infections Following First Trimester Abortions,” Acta Obstricia Gynoecological (Supp. 93), 54:478 (1980); L. Westergaard, “Significance of Cervical Chlamydia Trachomatis Infection in Post-abortal Pelvic Inflammatory Disease,” Obstetrics and Gynecology, 60(3):322-325, (1982); M. Chacko, et al., “Chlamydia Trachomatosis Infection in Sexually Active Adolescents: Prevalence and Risk Factors,” Pediatrics, 73(6), (1984); M. Barbacci, et al., “Post- Abortal Endometritis and Isolation of Chlamydia Trachomatis,” Obstetrics and Gynecology 68(5):668-690, (1986); S. Duthrie, et al., “Morbidity After Termination of Pregnancy in First-Trimester,” Genitourinary Medicine 63(3):182-187, (1987).
12. Burkman, et al., “Morbidity Risk Among Young Adolescents Undergoing Elective Abortion” Contraception, 30:99-105 (1984); “Post-Abortal Endometritis and Isolation of Chlamydia Trachomatis,” Obstetrics and Gynecology 68(5):668- 690, (1986)
13. Frank, et.al., “Induced Abortion Operations and Their Early Sequelae”, Journal of the Royal College of General Practitioners (April 1985),35(73):175-180; Grimes DA, Cates W Jr. Abortion: Methods and complications. In: Hafez ESE, ed. Human reproduction: Conception and contraception (2nd ed). Hagerstown, Maryland: Harper and Row, 1980:796‑813.; M.A. Freedman, “Comparison of complication rates in first trimester abortions performed by physician assistants and physicians,” Am. J. Public Health, 76(5):550- 554 (1986).
14. Wadhera, “Legal Abortion Among Teens, 1974-1978″, Canadian Medical Association Journal, 122:1386-1389,(June 1980).
15. Ney, et.al., “The Effects of Pregnancy Loss on Women’s Health,” Soc. Sci. Med. 48(9):1193-1200, 1994; Badgley, Caron, & Powell, Report of the Committee on the Operation of the Abortion Law, Supply and Services, Ottawa, 1977: 319-321.
16. Gissler, M., et. al., “Pregnancy-associated deaths in Finland 1987-1994 — definition problems and benefits of record linkage,” Acta Obsetricia et Gynecolgica Scandinavica 76:651-657 (1997).
17. Zhou, Weijin, et. al., “Induced Abortion and Subsequent Pregnancy Duration,” Obstetrics & Gynecology 94(6):948-953 (Dec. 1999). Klemetti R, Gissler M, Niinimäki M, Hemminki E. Birth outcomes after induced abortion: a nationwide register-based study of first births in Finland. Hum Reprod 2012 Aug 29. [Epub ahead of print]. Rooney B, Calhoun BC. Induced Abortion and Risk of Later Premature Births. Journal American Physicians & Surgeons 2003;8(2):46-49 Bhattacharya S, Lowit A, Bhattacharya S, Raja EA. -et al. Reproductive outcomes following induced abortion: a national register-based study in Scotland. BMJ OPEN Summer 2012. Swingle HM, Colaizy TT, Zimmerman MB, et al Abortion and the risk of subsequent preterm birth: a systematic review and meta-analysis. J Reproductive Med 2009;54:95-108.
18. D. Berkeley, P.L. Humphreys, and D. Davidson, “Demands Made on General Practice by Women Before and After an Abortion,” J. R. Coll. Gen. Pract. 34:310-315, 1984.
19. Frank, et.al., “Induced Abortion Operations and Their Early Sequelae”, Journal of the Royal College of General Practitioners (April 1985), vol.35,no.73,pp175-180. and Grimes and Cates, “Abortion: Methods and Complications”, Human Reproduction, 2nd ed., 796-813.
NOTES RELATIVE TO SECTION ON PSYCHOLOGICAL RISKS:
1. An excellent resource is Thomas Strahan’s Detrimental Effects of Abortion: An Annotated Bibliography with Commentary (Third Edition) This resource includes brief summaries of major finding drawn from medical and psychology journal articles, books, and related materials, divided into major categories of relevant injuries. An online version can be found at AbortionRisks.org
2. Ashton,”They Psychosocial Outcome of Induced Abortion”, British Journal of Ob&Gyn., 87:1115-1122, (1980).
3. Badgley, et.al.,Report of the Committee on the Operation of the Abortion Law (Ottawa:Supply and Services, 1977)pp.313-321.
4. R. Somers, “Risk of Admission to Psychiatric Institutions Among Danish Women who Experienced Induced Abortion: An Analysis on National Record Linkage,” Dissertation Abstracts International, Public Health 2621-B, Order No. 7926066 (1979); H. David, et al., “Postpartum and Postabortion Psychotic Reactions,” Family Planning Perspectives 13:88-91 (1981).
5. Kent, et al., “Bereavement in Post-Abortive Women: A Clinical Report”, World Journal of Psychosynthesis (Autumn-Winter 1981), vol.13,nos.3-4.
6. Catherine Barnard, The Long-Term Psychological Effects of Abortion, Portsmouth, N.H.: Institute for Pregnancy Loss, 1990).
7. Herman, Trauma and Recovery, (New York: Basic Books, 1992) 34.
8. Francke, The Ambivalence of Abortion (New York: Random House, 1978) 84-95.
9. Zakus, “Adolescent Abortion Option,” Social Work in Health Care, 12(4):87 (1987); Makhorn, “Sexual Assault & Pregnancy,” New Perspectives on Human Abortion, Mall & Watts, eds., (Washington, D.C.: University Publications of America, 1981).
10. Adler, “Sample Attrition in Studies of Psycho-social Sequelae of Abortion: How great a problem.” Journal of Social Issues, 1979, 35, 100-110.
11. Speckhard, “Postabortion Syndrome: An Emerging Public Health Concern,” Journal of Social Issues, 48(3):95-119.
12. Speckhard, Psycho-social Stress Following Abortion, Sheed & Ward, Kansas City: MO, 1987; and Belsey, et al., “Predictive Factors in Emotional Response to Abortion: King’s Termination Study – IV,” Soc. Sci. & Med., 11:71-82 (1977).
13. Speckhard, Psycho-social Stress Following Abortion, Sheed & Ward, Kansas City: MO, 1987; Gissler, Hemminki & Lonnqvist, “Suicides after pregnancy in Finland, 1987-94: register linkage study,” British Journal of Medicine 313:1431-4, 1996.C. Haignere, et al., “HIV/AIDS Prevention and Multiple Risk Behaviors of Gay Male and Runaway Adolescents,” Sixth International Conference on AIDS: San Francisco, June 1990; N. Campbell, et al., “Abortion in Adolescence,” Adolescence, 23(92):813-823 (1988); H. Vaughan, Canonical Variates of Post-Abortion Syndrome, Portsmouth, NH: Institute for Pregnancy Loss, 1991; B. Garfinkel, “Stress, Depression and Suicide: A Study of Adolescents in Minnesota,” Responding to High Risk Youth, Minnesota Extension Service, University of Minnesota (1986).
14. Harlap, “Characteristics of Pregnant Women Reporting Previous Induced Abortions,” Bulletin World Health Organization, 52:149 (1975); N. Meirik, “Outcome of First Delivery After 2nd Trimester Two Stage Induced Abortion: A Controlled Cohort Study,” Acta Obsetricia et Gynecologica Scandinavia 63(1):45-50(1984); Levin, et al., “Association of Induced Abortion with Subsequent Pregnancy Loss,” JAMA, 243:2495-2499, June 27, 1980.
15. Obel, “Pregnancy Complications Following Legally Induced Abortion: An Analysis of the Population with Special Reference to Prematurity,” Danish Medical Bulletin, 26:192- 199 (1979); Martin, “An Overview: Maternal Nicotine and Caffeine Consumption and Offspring Outcome,” Neurobehavioral Toxicology and Tertology, 4(4):421-427, (1982).
16. Klassen, “Sexual Experience and Drinking Among Women in a U.S. National Survey,” Archives of Sexual Behavior, 15(5):363-39 ; M. Plant, Women, Drinking and Pregnancy, Tavistock Pub, London (1985); Kuzma & Kissinger, “Patterns of Alcohol and Cigarette Use in Pregnancy,” Neurobehavioral Toxicology and Terotology, 3:211-221 (1981).
17. Morrissey, et al., “Stressful Life Events and Alcohol Problems Among Women Seen at a Detoxification Center,” Journal of Studies on Alcohol, 39(9):1159 (1978).
18. Oro, et al., “Perinatal Cocaine and Methamphetamine Exposure Maternal and Neo-Natal Correlates,” J. Pediatrics, 111:571- 578 (1978); D.A. Frank, et al., “Cocaine Use During Pregnancy Prevalence and Correlates,” Pediatrics, 82(6):888 (1988); H. Amaro, et al., “Drug Use Among Adolescent Mothers: Profile of Risk,” Pediatrics 84:144-150, (1989)
19. Speckhard, Psycho-social Stress Following Abortion, Sheed & Ward, Kansas City: MO, 1987; J. Spaulding, et al, “Psychoses Following Therapeutic Abortion, Am. J. of Psychiatry 125(3):364 (1978); R.K. McAll, et al., “Ritual Mourning in Anorexia Nervosa,” The Lancet, August 16, 1980, p. 368.
20. Benedict, et al., “Maternal Perinatal Risk Factors and Child Abuse,” Child Abuse and Neglect, 9:217-224 (1985); P.G. Ney, “Relationship between Abortion and Child Abuse,” Canadian Journal of Psychiatry, 24:610-620, 1979; Reardon, Aborted Women – Silent No More (Chicago: Loyola University Press, 1987), 129-30, describes a case of woman who beat her three year old son to death shortly after an abortion which triggered a “psychotic episode” of grief, guilt, and misplaced anger.
21. Shepard, et al., “Contraceptive Practice and Repeat Induced Abortion: An Epidemiological Investigation,” J. Biosocial Science, 11:289-302 (1979); M. Bracken, “First and Repeated Abortions: A Study of Decision-Making and Delay,” J. Biosocial Science, 7:473-491 (1975); S. Henshaw, “The Characteristics and Prior Contraceptive Use of U.S. Abortion Patients,” Family Planning Perspectives, 20(4):158-168 (1988); D. Sherman, et al., “The Abortion Experience in Private Practice,” Women and Loss: Psychobiological Perspectives, ed. W.F. Finn, et al., (New York: Praeger Publ. 1985), pp98-107; E.M. Belsey, et al., “Predictive Factors in Emotional Response to Abortion: King’s Termination Study – IV,” Social Science and Medicine, 11:71- 82 (1977); E. Freeman, et al., “Emotional Distress Patterns Among Women Having First or Repeat Abortions,” Obstetrics and Gynecology, 55(5):630-636 (1980); C. Berger, et al., “Repeat Abortion: Is it a Problem?” Family Planning Perspectives 16(2):70-75 (1984).
22. Joyce, “The Social and Economic Correlates of Pregnancy Resolution Among Adolescents in New York by Race and Ethnicity: A Multivariate Analysis,” Am. J. of Public Health, 78(6):626-631 (1988); C. Tietze, “Repeat Abortions – Why More?” Family Planning Perspectives 10(5):286-288, (1978).
23. Leach, “The Repeat Abortion Patient,” Family Planning Perspectives, 9(1):37-39 (1977); S. Fischer, “Reflection on Repeated Abortions: The meanings and motivations,” Journal of Social Work Practice 2(2):70-87 (1986); B. Howe, et al., “Repeat Abortion, Blaming the Victims,” Am. J. of Public Health, 69(12):1242-1246, (1979).
Abortion Risks and Complications, copyright 1997, 2000 Elliot Institute.