Copyright 1996 David C. Reardon. Excerpted with permission for from Making Abortion Rare, published by Acorn Books, PO Box 7348, Springfield, IL 62791-7348 for internet posting exclusively at www.afterabortion.org. All Rights Reserved.

Any strategy proposed for the pro-life movement must first be subjected to a moral self-examination. Specifically, can we pursue a pro-woman/pro-life strategy without compromising our moral opposition to abortion? Is it right to focus our efforts on the women, men, and siblings who are being hurt by abortion? Or do we have an obligation to focus on the fact that children are being killed by abortion? 

While disputes about the moral fitness of the pro-woman/pro-life strategy have never been widely discussed in an open way, private concerns have resulted in several major setbacks for the post-abortion movement. This is because many pro-life leaders believe it is both strategically and morally wrong to concentrate the public's attention on anyone other than abortion's primary victim, the unborn child. 

The most significant example of the damage which has been caused by this unresolved conflict occurred in 1989 when Surgeon General C. Everett Koop gave a letter to President Reagan stating that conclusive data on the health effects of abortion on women does not exist. In a subsequent interview, Koop criticized the efforts of pro-lifers who were working to increase public awareness of abortion complications for women, saying: "I think it is wrong for the prolife forces to get all upset about the health effects of abortion on women and get away from the health effects of abortion on the fetus. This is the marker issue there... [A]s soon as you contaminate the morality of your stand by getting worried about the health effects of abortion on women, you have weakened the whole thing..."⁽¹⁾

This moral view almost certainly played an important part in Koop's handling of the report which President Reagan requested of him in 1987. On at least two occasions Koop attempted to convince the President to withdraw his request. When his petitions were rejected, Koop assigned the task to an assistant explaining that he wanted to "distance" himself from the report. He also gave his staff the Catch-22 instruction that only "unassailable" data could be included in the report. Because there are no studies above criticism, especially in the field of behavioral science, "unassailable" data simply doesn't exist. Koop had found his way out.⁽²⁾ In the end, the "report" which he delivered to President Reagan was not a report at all. It was merely a brief letter explaining that "scientific studies do not provide conclusive data about the health effects of abortion on women," a statement which was widely construed by the media as proving that health risks don't exist. 

Some critics of Koop believe he sidestepped his assignment because he feared that a report emphasizing abortions risks would result in vicious attacks from the pro-choice media and Congress. Others have claimed that he had developed "Hollywood eyes," a yearning for popularity, after being lifted up in national prominence by the liberal media because of his promotion of "safe sex" in response to the AIDS crisis. Koop's repeated complaints that the report was forcing him to walk "a political tightrope" suggest that there is some truth to these claims. Still, Koop has a history of taking unpopular stands. Courage is not his short-suit. This is why I believe it was Koop 's moral view that post-abortion issues "contaminate" the pro-life cause which was the most significant factor in his decision to drop the ball. 

President Reagan had handed Koop the opportunity to focus national attention on abortion's health risks. Koop was aware of very specific, and scientifically defensible, conclusions which could have been made which would have dramatically affected the ground rules of the public debate on abortion.⁽³⁾ But Koop did not believe the issues of the debate should be changed. Instead, he believed it was fundamentally wrong to move away from abortion as a moral issue by allowing it to become a public health issue. A report which validated concerns about abortion's health risks for women, he believed, would undercut the moral high ground of opposing abortion simply because all human life is sacred. 

Other avid pro-lifers share this view. Indeed, there are not a few who have very little sympathy for women who suffer post-abortion problems. Some have even expressed their disdain for women injured by abortion with comments such as: "They deserve what they get." Less punitive pro-lifers are simply idealists. They want to believe that somehow, with just a better education program, or a more articulate argument, we will be able to awaken America to the moral superiority of our position. To advance this moral argument, evidence of fetal development is relevant but scarred uteruses are not. 

These views have posed a major obstacle to the development and spread of post-abortion and pro-woman initiatives. Within the overall pro-life movement, post-abortion issues remain at best just an add-on--an extra argument, an extra service. They are still not generally accepted as being an essential ingredient to our efforts. 

This kind of bias inhibits the efforts of post-abortion workers every day. In my own experience the most recent example occurred when I submitted an article on post-abortion issues to a prominent religious magazine. This publication is zealously pro-life, and the submissions editor's initial response was filled with praise for my article's "thoughtful insights" and "well argued" points. But when the article went before the review board, it was subsequently rejected because the editorial board felt it could be construed as turning abortion into a "medical-legal issue, rather than a moral issue." And no, Koop was not on the board. 

In short, many pro-lifer leaders, and certainly many more grassroots activists, are far more comfortable with the familiar "defend the baby" arguments than with our new "defend the woman" arguments. One reason is that they do not fully understand the strategic importance of the pro-woman approach. The bulk of this book addresses this concern. The second reason arises from the feeling they have that the pro-woman approach involves a shift away from the moral center of our argument. It is this second concern which is addressed in this chapter. It is my goal here to show that the pro-woman approach is not only consistent with the pro-life moral imperative, it is in fact a fuller and more complete expression of it. 

The Natural Order of Things

We begin with a very simple observation. In God's ordering of creation, it is only the mother who can nurture her unborn child. All that the rest of us can do, then, is to nurture the mother. To help a child, we must help the child's mother. 

There is nothing startling about this observation. Crisis pregnancy centers have known this truth, and have been living it out for decades. But we must explore this insight a little deeper to understand all that it can teach us. 

God has created a connection between a mother and her children that is so deeply personal and intimate that the welfare of each is dependent on the other. As every mother knows from personal experience, this interdependence is for both good and ill. When a mother's children are joyful, their joy lifts her heart. When they are troubled by sorrow, their sorrows weigh on her as well. This principle can be summed up in the following truism: One cannot help a child without helping the mother; one cannot hurt a child without hurting the mother.

This is why, from a natural law perspective, we can know in advance that abortion is inherently harmful to women. It is simply impossible to rip a child from the womb of a mother without tearing out a part of the woman herself--a part of her heart, a part of her joy, a part of her maternity. 

One does not need to be a "biased" pro-life Christian to see this truth. Consider the testimony of Dr. Julius Fogel, a psychiatrist and obstetrician who has been a long-time advocate of abortion and has personally performed over 20,000 abortions. According to Dr. Fogel: 

Every woman--whatever her age, background or sexuality--has a trauma at destroying a pregnancy. A level of humanness is touched. This is a part of her own life. When she destroys a pregnancy, she is destroying herself. There is no way it can be innocuous. One is dealing with the life force. It is totally beside the point whether or not you think a life is there. You cannot deny that something is being created and that this creation is physically happening.... Often the trauma may sink into the unconscious and never surface in the woman's lifetime. But it is not as harmless and casual an event as many in the proabortion crowd insist. A psychological price is paid. It may be alienation; it may be a pushing away from human warmth, perhaps a hardening of the maternal instinct. Something happens on the deeper levels of a woman's consciousness when she destroys a pregnancy. I know that as a psychiatrist.⁽⁴⁾

If there is a single principle, then, which lies at the heart of the pro-woman/pro-life agenda, it would have to be this: the best interests of the child and the mother are always joined. This is true even if the mother does not initially realize it, and even if she needs a tremendous amount of love and help to see it. Thus, the only way that we can help either the mother or her child, is to help both. Conversely, if we hurt either, we hurt both. 

This is not an optional truth. It is God's ordering of creation. This principle is so important that I must repeat it again: Only the mother can nurture her unborn child. All that the rest of us can do is to nurture and protect the mother.

Saving the unborn, then, is a natural byproduct of helping women. Conversely, we can never hope to succeed in our efforts to protect the unborn without first and foremost protecting women. Brute force bans on abortion will not create a pro-life society. But helping mothers through an aggressive defense of women's legitimate rights, will. It is in this very same sense that John Paul II has insisted that it is necessary for those who oppose abortion to become "courageously 'pro-woman,' promoting a choice that is truly in favor of women. It is precisely the woman, in fact, who pays the highest price, not only for her motherhood, but even more for its destruction, for the suppression of the life of the child who has been conceived. The only honest stance...is that of radical solidarity with the woman."⁽⁵⁾ [Italics added.] 

Learning Our Lessons, Too

Many pro-lifers scratch their heads in confusion wondering how God can allow this holocaust of abortion to go on so long. So many millions have died, and we seem no closer to converting our nation than we were twenty years ago. When will God stop this slaughter? 

This is an important question. As Christians we believe that from every evil happening God can resurrect something good--at the very least repentance and a change of spirit, and often much more. And with the terrible onslaught of abortion which is occurring, we must pray with hope that there is a very tremendous good which God intends to resurrect from this great evil. Greater respect for the unborn and the sanctity of life is one lesson which our society is certainly intended to learn, but it is by no means the only lesson we are meant to learn. 

I believe that at least some of us are so focused on what others need to learn that we are neglecting to see what God may be asking us to learn. In short, before we can help others to see we may still need to extract a plank or two from our own eyes. I honestly believe that, short of Christ's return, God will not bring an end to the abortion holocaust until Christians learn all that they are meant to learn, namely: greater compassion for sinners. 

Compassion for Those Pregnant Out-of-Wedlock 

Po-lifers have clearly done a tremendous job in the last two decades in promoting a more charitable understanding of women who are pregnant out-of-wedlock. But there is clearly much more that must be done. Churches, families, friends, and employers must make even greater efforts to be supportive of every pregnant woman or single parent, no matter how the child was conceived. There is no denying the fact that in previous decades righteous and judgmental Christians discriminated against and shamed women who were pregnant out-of-wedlock. And it is equally true that this condemning attitude shamed, and continues to shame, many women into seeking abortions. For this, we too share in the guilt of abortion. 

If we are to be truly Christian, we must strive to live by and promote the principle that every pregnancy, every birth, is a gift from God. No matter how the pregnancy occurred, no matter what the physical gifts or handicaps of the child, every child is a blessing from God, an opportunity and challenge to follow Him in the way of love. When this gift is received by an unmarried couple, it is accompanied by the message that now is the time to become mature and responsible adults. Such couples are given children not as a punishment for fornication, but as a cure for fornication. 

As a Christian community, then, we must cherish life and charitably invite others to seek God's will in their lives. To do this, we must believe in, and emphatically spread the message that every child is a gift from God. Therefore, the birth of every child should be an occasion of joy, not of shame. 

Similarly, without ever granting approval to fornication (which causes its own long list of social injuries), we must cultivate a society which does not view extra-marital intercourse as the greatest of sins, much less an unforgivable one. Embarrassed young girls announcing a pregnancy to their parents do not need to be reminded of their sins, of which they are already too pointedly aware, so much as reminded that God is now calling upon them to grow up. And they need to know that we, their families, their church, and their society want to continue to help them along that path over which we too must struggle. 

During the last twenty years, Christians have truly come a long way in learning this first lesson. But it is doubtful that we would have learned it if we had not been shocked into greater compassion for young pregnant women out of our concern for their unborn children who are threatened by abortion. Nonetheless, the witnessing work of our many crisis pregnancy centers and the compassion of so many parents toward their single mother/daughters is evidence that this lesson is being learned. Let us pray that it is never forgotten. 

Compassion for the Post-Aborted 

As a Christian community, however, we are not as far along in learning the lesson of compassion toward those who have actually been involved in abortion. Many good-hearted people continue to recoil in horror at anyone who could "kill their baby." They wonder what kind of monster could do such a thing? For many, judgmentalism comes much easier than compassion because they lack insight into the tremendous pressures and feelings of despair which lead to abortion. 

This is the second lesson which we must learn from the abortion holocaust before we can expect to conquer it. We must learn that abortion is an act of despair. It is not something women do with vindictive hearts. It is something they do when they feel trapped and helpless. Over seventy percent of women undergoing abortions believe it is morally wrong. They are acting against their consciences because they feel they have no other choice. 

This is one way in which books like Aborted Women - Silent No More have helped to increase the understanding of pro-lifers. By reading the stories of women who have had abortions, by seeing what drives them to choose abortion, pro-lifers are learning more and more that "there, but for the grace of God, go I." After ten years of effort, this understanding and lived compassion has finally established a firm foot hold within the pro-life movement, but it is still far from being universal among Christians in general. 

This issue, too, will be discussed at length in Chapters Ten through Twelve. Let it suffice for now to say that Christians must refrain from condemning and judging the women and men who have been involved in abortions. Judging them will not free them from the shame and guilt they already feel. Instead, we must concentrate on sharing with them the hope of God's great mercy. To do this effectively we must give them more than our words; we must give them our hearts. 

Who Can Best Speak for the Unborn? 

The following chapter will discuss more fully why the middle majority of Americans choose to ignore appeals on behalf of the unborn. For now it is enough to say that they are uneasy pragmatists. While they firmly believe that abortion is the killing of a human being, they also believe it is sometimes necessary and almost always beneficial to the woman. 

Because the middle majority is uncomfortable with the truth about abortion, they have a psychological need to push out of their minds any arguments or evidence on behalf of the unborn. In fact, when presented with evidence, such as pictures of the unborn, whether charmingly angelic or horridly dismembered, they are likely to resent pro-lifers for rubbing their noses into a truth which they already know but have deliberately chosen to ignore. Indeed, one drawback of such pictures is that they may actually serve to increase the middle majority's calloused attitude by forcing them to repeatedly exercise their pattern of denial. This is why the millions of dollars spent on showing pictures of the unborn to the public have not brought about the mass conversion of hearts for which pro-lifers have frequently, and naively, hoped. 

In other words, when hearts are closed, pounding heads with proofs of the unborn child's humanity are ineffective. The truth must enter in a round about way. This way is through the testimony of women who grieve over their lost children. Since the middle majority is open to the concerns of women, they will empathize with the grief of post-aborted women, and in so doing they will be drawn into implicitly acknowledging the unborn for whom the tears are wept. 

Clearly, the most powerful witnesses for the humanity of the unborn are not scientists, but mothers who mourn. All can see that these mothers weep not over the destruction of "products of conception" but over the deaths of their children. While pictures of aborted babies may increase the resentment of the middle majority, the tearful stories of women who have paid the terrible price of abortion open eyes and hearts. Wherever facts of fetal biology will not change hearts, facts of familial relationship will: "It was my innocent little daughter who died that day!" 

In this very real way, the issue of the unborn child's human rights is not replaced by a focus on post-abortion issues, it is subsumed into it. In the final analysis, the humanity of the unborn child is revealed to be the only explanation for why abortion causes women so much grief and suffering. 

Thus, for those of us who have not had an abortion, the best way that we can draw attention to the humanity of the unborn is by drawing attention to the testimony of those who can speak of this loss from personal experience. By our advocacy for women's rights, we draw attention to wounded mothers. By our hushing the din of our own cries on behalf of the unborn, we are allowing the grief-filled voices of the unborn's mothers and fathers to be heard by all. We are not leaving the unborn voiceless; we are offering their parents the chance to be heard. Who is more entitled to speak for their children than they? 

Looking at this same issue from another perspective, we must remember that the interests of a mother and child are permanently intertwined. This means that the morality of abortion is built right into the psychological effects of abortion. Everyone knows there is no psychological trauma associated with the discarding of menses. But the discarding of an unborn child's life? That, as Dr. Fogel reminds us, is inherently traumatic. 

Therefore, when we are talking about the psychological complications of abortion, we are implicitly talking about the physical and behavioral symptoms of a moral problem. By focusing public attention on the symptoms of post-abortion trauma we will inevitably draw the middle majority back to understanding the cause of the problem: the injustice of killing unborn children and the guilt of weakness and betrayal which haunts the mother's heart. 

With much less ferocity, this same guilt is gnawing at the hearts of the middle majority of Americans who know the truth but have chosen to ignore it. In helping them to recognize the psychological suffering abortion causes women, we will lead them to rediscover the horror of abortion for themselves. 

A Pro-Life Lesson Plan 

The discussion above is not meant to imply that appeals on behalf of the unborn are never effective. The fact that the middle majority is uneasy with abortion can be used to our advantage. My point, however, is that we are misusing our resources when we press this advantage first. Our first order of business must be shaking their belief that abortion helps women. 

The importance of this order cannot be overstated. It is only after the dangers of abortion for women are fully understood by the middle majority, much less pro-abortion activists, that we can even begin to open their minds and hearts to the unborn child. If women are not being helped, they will ask themselves, then why are we killing their babies? 

In a very real sense, this pro-woman/pro-life agenda is nothing more than a "lesson plan" for leading our nation to an understanding of this reality. It is a process which follows the reverse path of the pro-abortion movement. 

The pro-abortion movement was born in a social vision which separated the mother's interests from her unborn baby's. If their interests are separate, than there is the potential conflict between the woman's rights and her unborn child's rights, one of which must prevail. 

We cannot accept any part of this reasoning. We must reject every ideology which frames the abortion issue as one of a mother versus her child. We are both pro-woman and pro-child. We believe that we can and should help both the mother and her child. We believe that the legalization of abortion was not an advance for women's rights, but an advance for social engineers and others who are exploiting women in times of personal crisis. 

Teaching Morality By Teaching Science 

Believers know that God's moral law is given to us not to enslave us, or even to take the fun out of life. It is given to us as a path toward true happiness. Christians rightly anticipate, then, that any advantage gained through violation of the moral law is always temporary; it will invariably be supplanted by alienation and suffering. 

This insight gives us an alternative way of evangelizing. Whenever we cannot convince others to acknowledge a moral truth for the love of God, our second best option is to appeal to their self interests. If an act is indeed against God's moral law, it will be found to be injurious to our happiness. Thus, if our faith is true, we would expect to find compelling evidence which demonstrates that acts such as abortion, fornication, and pornography, lead in the end not to happiness and freedom, but to sorrow and enslavement. By finding this evidence, and sharing it with others, we bear witness to the protective good of God's law in a way which even unbelievers must respect. 

Research and education about the dangers of abortion, then, is not just grist for political reform. It is also leaven for spiritual reform. As people become more aware of all the hardships abortion causes to women, men, siblings and society, they will begin to respect the wisdom of God's law. They will begin to think: "Maybe all these religious folk weren't so crazy after all. If they were right about this, when every other power in society said they were wrong, maybe they're right about other things, too." 

This approach also recognizes another fundamental aspect of human nature: where there is not love of God, there is an exaggerated love of self. As a corollary to this truth, we should also recognize that wherever there is only self-love, appeals to self-sacrifice will fail and only appeals to self-preservation can possibly succeed. Often our warnings will be rejected. But even in these cases, by giving the warning we are planting the seeds for repentance and belief when they inevitably hit bottom. This is another reason why we should never be focused on condemning those who are considering or have had abortions. Instead we should be focused on warning them and offering them mercy. 

Both Pure and Pragmatic 

Before leaving the issue of the moral imperative behind this strategy, some notice should be given to how other strategic issues which have divided the pro-life movement in the past. These previous moral conflicts have led to destructive infighting and a waste of resources fighting allies rather than opponents. It is my belief that this pro-woman/pro-life strategy can help to heal the ideological divisions which have developed, restore unity, and provide a guiding vision for our movement. 

In the last twenty years the pro-life movement has been split by the very serious moral question regarding what type of laws should be sought. The key issue is whether pro-lifers can morally pursue legislation which would allow exceptions for the "hard cases," such as in cases of pregnancy resulting from rape and incest, or pregnancies where there is a suspected fetal malformation. These "hard cases" are the ones for which the middle majority of Americans most support access to abortion. 

Seeking to capitalize on the opinion of the middle majority, pro-life "pragmatists" support an incremental approach to outlawing abortion by allowing abortion in these "hard cases." Such laws would save 95 percent of all the children being killed by abortion, they say. We must save as many as we can, as soon as we can, and go back to tighten the laws later. 

"Purists" object that by allowing exceptions in "special circumstances" we are abandoning our claim that all human life is sacred. We are, in essence, agreeing that some lives are more sacred than others, or at least that if the woman's hardship is great enough, then the sacrifice of her child is justified, or at least tolerable. But if it is justified under any single circumstance, why not some other compelling circumstance? In essence, by wavering from our stand on behalf of an absolute right to life, we are lending moral credence to the claims of the other side. Instead of debating about the fundamental principle--the sacredness of human life--we will end up in negotiating about who can be killed and under what circumstances. 

For the record, I side with the purists. But I also sympathize with the pragmatists. Pragmatists desperately want to save lives now. If we can save some by drafting laws which match the profile of public opinion polls, they think, we must do so. But this approach has many pitfalls. First, any exception will be exploited to provide far more abortions than legitimately fit into the allowed category. Second, passing a partial ban will dissipate the drive for a ban on the remaining categories. Third, this approach really does nothing toward making abortion unthinkable, it only makes the remaining abortions more politically tolerable. Indeed, the incremental approach actually reinforces the public view that abortion can be beneficial to women, at least in these "hard cases." 

This is one reason why I maintain that the pro-woman/pro-life strategy is a superior approach. It is pragmatic, meaning achievable, but is also pure in that it does not differentiate between cases. Indeed, if anything, it would tend to place an abortionist who performs an abortion in a "hard case," such as rape or potential fetal malformation, at greater risk of punishment. Why? Because all the available research indicates that women who abort for these "hard cases" are at highest risk of suffering psychological problems post-abortion.⁽⁶⁾ 

Indeed, in the pro-woman approach, the inevitable debate over the "hard cases" will provide an excellent opportunity to educate legislators and the public about post-abortion psychological sequelae in general. Rather than run from the debate over these "hard cases," we must learn how to use this debate to our advantage. 

In short, the strategy outlined in this book is results oriented. It is pragmatic. But it is also free of compromise. Because we know that every abortion hurts a woman, as well as her child, we can defend every unborn child by defending the best interests of the mother, knowing that their best interests are never served by abortion. Out of ignorance or despair, a woman may believe that abortion will help her more than it will hurt her, but we know, from both experience and theory, that it will not. Our job is to ensure that she is freed from ignorance and helped to find hope. When we succeed in this, it is then that we will have a society which is both pro-woman and pro-life 

Summary

The pro-woman/pro-life strategy which places defense of women's rights at the center of our national debate is justified by the fact that in God's ordering of creation, only an unborn child's mother can nurture her child; all that we can do is to nurture and protect the mother. This need to focus on women rights is also necessary so that we, who want to live as Christians, should better learn the ways of mercy and compassion. 

In focusing attention on post-aborted women we are actually allowing their voices to be better heard. It is their witness on behalf of their unborn, not ours, which will soften hearts and open eyes. In this sense, by focusing on women's rights, we are not ignoring the unborn but instead preparing the stage for the most compelling advocates of all for the unborn--their mothers. 

Our pro-woman/pro-life strategy is actually a lesson plan for educating our nation about how the interests of a mother and her child are intractably intertwined. One cannot hurt a child without hurting the child's mother, and this is especially true in the case of abortion. As people learn this, they will not only reopen their hearts to the unborn, they will reopen their hearts to the beauty of God's moral law. 

None of what I have presented in this chapter is novel, as is demonstrated by a letter which Dr. O.E. Worcester wrote the Journal of the American Medical Association over 100 years ago. Dr. Worcester wrote this complaint against her male colleagues who treated women who were pregnant out-of-wedlock with great disrespect. Worst of all, she insisted, these same physicians willingly added to the guilt of these used and abandoned women by giving them abortions rather than true compassionate aid. When a colleague asked her to help perform abortions, she refused, saying: 

I loved woman too well to help her add murder to her other sin. If mother love and the touch of baby fingers did not save her to God and womanhood, nothing could. That it could, I had proof in many cases where forsaken mothers had, in spite of all, carved for themselves and their fatherless children an honorable place in the world.

I have never seen cause to hold the male element less responsible for the slaughter of the innocents than in the days of Herod. Then, as now, men seem to fear the coming of Christ born of woman... 

This is my plea: "What God hath joined together let not man put asunder," in the medical profession or elsewhere. 

Let men and women join forces under the banner of Him who said: "He that is without sin among you, let him first cast a stone at her," and also: "Neither do I condemn thee; go and sin no more." 

Let us join forces all along the line, and fight this hydraheaded monster to the death and save our nation.⁽⁷⁾

Notes

1. John Whitehead and Michael Patrick, "Exclusive Interview: U.S. Surgeon General C. Everett Koop," The Rutherford Institute, Spring 1989, 32, 34. 

2. Ibid., 31-34. 

3. In interviews after his letter to the President was released, Koop the existing evidence was sufficient to leave "no doubt in my mind" that there are serious physical complications and "tremendous psychological problems" resulting from abortion. But he excluded this informed "private" conclusion from his letter because the studies upon which it was based were open to criticism. Their statistics could not be generalized to the whole population, and they did not completely cover all the ramifications of the issue. 

What could Dr. Koop have reported? While it is true that there wasn't, and still isn't, any solid data for an accurate estimate of precisely how many women suffer from post-abortion psychological sequelae, there are three specific findings which are universally accepted upon which to build valid conclusions and specific recommendations. The following is a summary of these points, which I personally communicated to Dr. Koop in a letter dated July 1, 1988. 

First, at least some women are psychologically disturbed by abortion. From clinical evidence it is clear that some suffer severe psychological maladjustments, while others have more moderate or mild coping problems. Short term follow up studies, of less than six months, typically report 15 to 20 percent of patients reporting significant psychological problems linked to the abortion experience. These findings are confounded by the fact that approximately 50 percent of women who previously agree to participate in followup studies subsequently refuse to do so. This high refusal rate may itself signify post-abortion avoidance behavior which may be indicative of other psychological sequelae. 

Second, of the women who do experience post-abortion psychological sequelae, there are at least 14 clearly defined characteristics, such as feelings of being coerced into the abortion or strong feelings of attachment to the unborn child, which are predictive of poor post-abortion adjustment. 

Third, intake information at abortion clinics shows that 60 to 85 percent of abortion patients have one or more of these predisposing risk factors. 

From these three facts we can conclude not only that some unknown number of women experience psychological problems following abortion, but that the majority of women are at risk. How many of these at-risk women actually suffer post-abortion problems is not known. But the evidence is clearly sufficient to suggest that abortion may pose a significant public health threat. Therefore, further research must be given a high priority. In the meantime, a national effort should be undertaken to: 1) help high risk patients avoid abortions; 2) better inform and counsel patients prior to abortion; and 3) offer better care and understanding to women who are struggling with psychological problems after their abortions. 

In response to my recommendations Dr. Koop responded with a letter stating that he understood my line of reasoning and would keep it in mind when preparing his report. He also noted that he had a copy of my book which included the first longterm followup study, an average of ten years post-abortion, of women who have reported post-abortion problems. Because this study was limited to a sample of 253 WEBA members, Dr. Koop pointed out that "it is impossible to make national generalizations" from such a sample, which is of course true in terms of making statistical generalizations but not in terms of gaining insights to the potential size of the problem. After all, in any public health investigation one must always study the sick population before one can even begin to measure the extent of the illness in the general population. Unless the symptoms are identified first, it is impossible to ask the right questions of the general population. Indeed, the most common methodological flaw of pro-abortion studies is that researchers have concentrated their efforts on proving that psychiatric sequelae are rare without first defining the range of emotional and behavioral problems which women report. 

As one final note, it is curious that while Dr. Koop personally reported having seen my study, my research was not included in the extensive bibliography of materials which the Surgeon General's assistant claimed to have studied in preparing the "report." This omission is especially odd since all the other studies which were included in the bibliography were also dismissed as methodologically flawed. 

4. Colman McCarthy, "A Psychological View of Abortion," St. Paul Sunday Pioneer Press, Washington Post, March 7, 1971. Dr. Fogel who did 20,000 abortions over the subsequent decades reiterated the same view in a second interview with McCarthy in 1989 in disagreement with the Koop report. "The Real Anguish of Abortions," The Washington Post, Feb. 5, 1989. 

5. John Paul II, Crossing the Threshold of Hope (New York: Alfred Knopf, 1994) 207-207. 

6. Reardon, Aborted Women, 161-218. 

7. O.E. Worcester, M.D. "From A Woman Physician: An Open Letter to Dr. W.W. Parker." JAMA 1894; 22:599 reprinted in "JAMA 100 Years Ago," JAMA 271(15) April 20, 1994. 

Copyright 1996 David C. Reardon. Excerpted with permission for from Making Abortion Rare: A Healing Strategy for a Divided Nation, published by Acorn Books, PO Box 7348, Springfield, IL 62791-7348 for internet posting exclusively at www.afterabortion.org. All Rights Reserved.