In the US, abortion was formally legalized in 1973. Despite this legalization, the abortion debate continues to elicit vigorous emotional, moral, and legal problems. An important element of abortion emphasizes the impact on the mental health of women (Bazelon 45). The public debate on abortion in the US can be traced to the year 1987 when the Surgeon General was requested to formulate a report concerning the physical and psychological effects of abortion (Lee 26). After reviewing the scientific literature comprehensively, the Surgeon General, Dr. Kroop refused to present the report; dispatching a letter to President Regan instead in 1989.
In the letter, Dr. Koop had concluded that the available research was insufficient to support scientific knowledge about the mental risks caused by abortion (Koop 195). In his Congressional address, he explained why his letter did not address the physical health risks of abortion. According to him, “obstetricians and gynecologists had long since made conclusions that the physical effects of abortion were no different than those found in women who carried their pregnancies to full term or who had never been pregnant” (195). He further testified that the mental risks following abortion were minimal despite the fact that psychological responses following an abortion can be too much to a given individual (Koop 241). Following his letter and his unofficial draft as read to Congress, both pro-choice and anti-choice activists claimed both the availability and absence of scientific research showing mental health risks on abortion (Bazelon 45). This paper reviews related literature on the potential association of mental health risks and abortion; enumerating the key perspectives for understanding potential health risks of abortion. Abortion has a direct impact on women’s mental health. However, in some cases, such as; rape, teenage pregnancies, and others, abortion can be used as a therapy.
A Review of Related Literature
The Link Between Abortion and Mental Health Risks
There are a number of theories that have helped in the understanding of potential mental health problems and abortion. These frameworks are complementary in most cases. They are not always mutually exclusive and they include one, psychological stress and coping regards abortion as a source of stress in life compared to other events a woman may experience; two, traumatic experiences of abortion; three, the occurrence of abortion within a socio-cultural environment; four, abortion and co-occurring mental risks issues; five, behavioral risk factors; lastly systemic risk factors of abortion (Lee 34).
Mental Stress and Coping Theories
Considerable concern has been there that the abortion of unwanted pregnancy can be stressful and might cause emotional disruptions in women. Typical reactions after an abortion are keen to the experiences of the unwanted pregnancies, the decision to have an abortion, and the physical challenges. According to Major (2005 394), recent reviews on the subject conclude that the evidence to date shows that an early legal abortion of unwanted pregnancy does not pose a psychological threat for most women. About 76% of women were found to report relief, with only 17% reporting guilt feelings two weeks after procuring an abortion (Major 394). Positive emotions typically outweigh negative emotions. Women who do show negative psychological reactions have been discovered to have been more likely to have intended to get pregnant and to have found the decision to procure an abortion rather difficult. Where the woman’s indecision has led to a later abortion, it is probable that the physical trauma is greater than in the early termination of unwanted pregnancy, so that physical stressors add to the psychological stress. Studies on available support suggest that women with more social support for abortion from parents and partners show more positive reactions. Less evidence of depression was shown by women who expected to cope well than those with negative expectations. Women applying avoidant coping strategies prior to abortion showed more anxiety and depression afterward than those using intentional strategy (Reardon 1097). In summary, the available research evidence indicates that those who continue to be distressed after the abortion are those who have not resolved their ambivalent feelings prior to an abortion (Reardon 1098)
According to Lazarus (1984 2034)), stress and coping psychological theories are often used for understanding the psychological experience of abortion in women. This theory looks at abortion as a stressful life occurrence close to other ordinary stressors in life. Since abortion happens in the context of a second life stressful experience, such as; unwanted pregnancy, unintended pregnancy, and others, stress and coping framework stress the difficulties involved in isolating out psychological aspects linked with abortion from psychological experiences linked to other issues of the unwanted or unintended pregnancy. Sometimes abortion can be used as a way of dealing with the stress associated with pregnancies that are not wanted and can lead to relief to affected women. Nevertheless, abortion is also capable of engendering challenges of its own (Lazarus 2033).
Although abortion can cause challenges and difficulties to women, it does not necessarily bring about unfavorable psychological experiences for women (Adler et al 337). The psychological experience of abortion on a woman depends on: the woman’s appraisal of abortion and the significance it portends to her life; the way she copes with emotions subsequent to abortion; and her ability to cope with those events (Rosebaum 783). These experiences are shaped by a woman’s environmental conditions, such as age, presence or absence of a supportive partner, or material resources (Rosebaum 783). They are also shaped by a woman’s personal characteristics, such as personality, attitudes and values. For instance, women who view abortion as differing from their own deeply held spiritual, religious, or cultural beliefs but who nonetheless proceed to procure an abortion, may appraise that experience as more stressful than would women who do not see abortion as in conflict with their own values or those of others in their social networks (Major 390).
McNaire (2008) posits that “stress and coping theory identifies factors associated with negative psychological reactions among women who have procured an abortion” (11). These factors include; women ending pregnancies that are meaningful and wanted, perceived pressure from others to end a pregnancy, partner’s, family, or friends’ perceived opposition to the abortion, and lack of perceived social support from others (McNaire 11). In sum, mental stress and coping strategy posit that women vary markedly in how they appraise, cope, and adjust to abortion. In it is important to note that this perspective does not rule out the possibility that some women may experience severe negative mental risks following abortion. However, it locates such responses in women’s appraisal and coping processes, rather than the nature of abortion itself (Major 380).
Traumatic Experiences of Abortion
Abortion can uniquely present a traumatic experience to women. This theory argues that traumatic experience due to abortion involves a human death experience, particularly, the intentional termination of one’s unborn child, and the witnessing of violent death, as well as a violation of parental instincts and responsibility, the severing of maternal attachments to the unborn child, and unacknowledged grief (Reardon 3). The early studies of psychological implications of abortion suggest that women who procure abortion will feel grief, guilt, depression, loss, remorse and others (Reardon 4).
Rue (2005 16) stated that the traumatic experience of abortion can result in severe mental risks, commonly named post-abortion syndrome (PAS). Rue (2005 16) conceptualized post-abortion symptoms as a specific form of posttraumatic stress disorder (PTSD) comparable to symptoms such as depression, anger, grief, substance abuse, and others. In addition, a number of other studies have reinforced post-abortion syndrome views which indicate that women are likely to suffer from an anxiety disorder, depression, psychotic problems, or suicidal behavior; then women who follow their pregnancies to full term (Cooper et al 395). The debate about the nature of abortion has highly been politicized between pro-choice activists and anti-choice activists. Despite this politicization, there are no available methodological true research studies that indicate the presence of post-abortion syndrome or other severe emotional abuse that can be associate with abortion directly. The World Health Organization Report (Lee 2005 45)) estimated around 46 million the number of women around the world has committed abortions. These constituted about 25% of all pregnancies reported. In terms of physical health, the difference is striking when abortions are legal and safe as compared to those nations where women seek illegal and unsafe abortion as a means to end pregnancies that are not wanted. Further, the WHO (Lee 2005 45)) reported over 40% of the abortions done around the world were done under unsafe conditions and resulted in about 68,000 maternal deaths. Consequently, anti-choice activists have concentrated on emotional harm as a reason to legislate against abortion (Rue 16).
In the US, abortion has been legal for a number of years. Approximately 20% of all childbearing American women were estimated to have already committed an abortion (Lee 46). From this statistic, we realize that if there were such a constellation of symptoms of long-term nature related to the abortion procedure, the anti-abortion activists would have discovered it (Rue 16). Notably, fewer women do develop emotional problems after procuring an abortion, specifically provided the constraints to reaching safe abortion centers. However, research indicates that even these emotions are temporary and fade after a few days to weeks. Women who may exhibit emotional symptoms that are long-lasting have been discovered to possess other factors that are related to these emotions; including their past history of emotional problems, sexual abuse, or other situations that could result in similar difficulties (Adler et al 342). In addition, the woman’s mental health prior to an abortion is a strong indicator of adverse symptoms (Lazarus 2033). Mental health risks of abortion have been closely associated with the exposure of women to sexual or physical abuse and lack of support and resource among women due to poverty (Lee 31).
Occurrence of Abortion within Social and Cultural Contexts
This perspective on abortion focuses on the impact of social issues within which abortion happens on women’s psychological experience of these events. Abortion does not happen in social isolation (Major 392). For instance, the current social and political environment of the US causes a lot of stigma to some women who commit an abortion (Major 1999). Furthermore, nurses and physicians who procure these abortions also face stigma. From socio-cultural frameworks, social practices and messages that cause stigma on women who procure abortions may directly lead to negative psychological experiences (Cooper et al 395).
Major (2005) found profound psychological implications of stigma. Some experimental research has discovered stigma can cause negative cognitions, emotions, and behavioral responses that can affect a woman’s social, psychological, and biological wellbeing (Adler 339). The perceived effects of stigma may include; deficits in terms of cognition and performance, excessive alcohol consumption, depression and anxiety, social withdrawal and avoidance, and a rise in physiological stress responses. Stigmatization by society can be pernicious, particularly if this stigma is internalized. Women who internalize abortion-related stigma, for instance, viewing themselves as morally deficient, tainted, and others, are likely to be vulnerable to post-abortion psychological distress (Adler et al 340).
In sum, the sociocultural theory concentrates on women’s mental experiences of abortion which are shaped by the immediate and larger sociocultural context within which abortion is procured. This perspective brings out the message of the stigma women who have had abortions experience from society. It makes them feel bad about themselves and causes negative psychological experiences (Major 401).
Abortion and Co-existing Mental risk Factors
This perspective assists in understanding the post-abortion mental health in women. It focuses on systemic, social, and personal factors that may cause the unwanted pregnancy, and therefore, put women at risk of procuring abortion or predispose them to experience mental health problems. This theory posits that mental health problems may reflect other factors related to having an abortion, such as poverty, violence by intimate partners, history of emotional problems, and others (Adler et al 340). In essence, this perspective stresses aspects of women’s life situations, and psychological elements prior to or co-existing with their pregnancy should be placed into consideration to make sense of mental health problems seen after abortion (Major 394).
Poverty portends a systemic problem for abortion. Women at high risk of an intentional pregnancy and abortion tend to be young, poor, and unmarried. Exposure of women to physical or sexual abuse during childhood and exposure to intimate partner violence involving rape are associated with the likelihood of abortion. The greater exposure to adverse life circumstances such as, poverty, intimate violence and abuse among women who have abortions compared with other women indicates the correlation between mental health risks and abortion. According to Reardon (2002, 1098) studies indicate that poverty was strongly related to an increased likelihood of psychiatric disorder. The majority of children who are raised in poor neighborhoods are at higher risk for substance abuse, teen pregnancy, dropping out of schools, and others (Rue 16). All these are risk factors for mental problems. Too much exposure to these risks can lead to mental health risks, including posttraumatic stress disorder, suicide, depression, and substance abuse. As a consequence, exposure to these events places a woman who has had an abortion at greater risk of developing a mental disorder.
Substantial evidence from research indicates that behavioral problems tend to co-occur among individuals (Lee 69). For instance, women who have had abortions are more likely than other women to have previously engaged in unfavorable behaviors such as smoking, unprotected sexual activities, early sexual activity, and taking alcohol and illicit drugs (Reardon 61). The involvement of behavioral problems follows a definite route wherein which specific factors put women who have participated, say, use of drugs at risk of exposure to activity such as unprotected sexual activity, which puts that woman at risk of another event, such as unintended pregnancy, which in turn puts her at high risk for abortion (Major 393). The National Longitudinal Study of Youth (NLSY) data indicated drug use among young women immensely increased their risk of early sexual activity when other risk factors were controlled (Rosenbaum 780). Again, drug use was predictive of both subsequent premarital teen pregnancies and the decision to abort the pregnancy. The study also discovered that premarital teen pregnancy risk was nearly four times as high for women with no history of prior substance involvement. In addition, the use of illicit drugs strongly predicted later abortion (Rosebaum 784).
Women who engage in bad behaviors such as early sexual activity, alcohol, or illegal drug use share personality traits that predispose them to engage in risky behaviors that raise the likelihood of abortion problems (Reardon 61). These systemic factors associated with increased risk of abortion have been indicated to be related to increased risk for mental health risks. Behavioral factors that reduce a woman’s ability to regulate negative emotions may place her at risk for engaging in risk behaviors. Cooper and colleagues (2003) in a longitudinal study they conducted on black and white adolescents discovered that impulsivity and avoidance strategy of coping with negative emotions were risk factors for involvement in behavioral problems. These behavioral problems may include; risky sexual behavior, substance use, and delinquent behavior. These in turn are risk factors for unwanted or unintended pregnancies, which leads to eventual abortion and the stigma associated with the vice (Cooper et al 393). Tellingly, behavioral characteristics that women at risk of behavioral problems and abortion, also expose them at risk for mental health risks (Adler et al 340).
In sum, there is a need for longitudinal prospective research to assess the incidents and prevalence of mental health risks of abortion. This research is also required to determine what antecedent mental factors may contribute to mental health risks. Despite abortion being a safe procedure under qualified clinician’s supervision, it carries an emotional significance for an individual woman, given that it represents the termination of pregnancy (Cooper et al 392). The decision to procure an abortion is always painful and difficult; should be considered carefully, and should be considered against the benefits and costs of carrying the pregnancy to full term. There is a need to develop various options for women in this regard, with adequate resources provided to support them. As postulated in Surgeon General’s Report (1989),
“If our society wants fewer abortions, it must be willing to support not only those children who are so born but also the women who make that choice. As a society, we must commit to providing loving families for all children placed for adoption. When women decide to bear their own children, rather than stigmatize them, we must sustain them by ensuring subsidized prenatal and delivery costs, foster care, daycare benefits for the working mother, and educational and job guarantees during maternity leave (23).
Abortion remains a necessary solution for many women lacking the emotional, social, and financial resources essential to carry through pregnancy to full term. For various reasons, abortion represents an option of choice for those women who do not want complete unwanted pregnancies. Therefore, it is essential that an elaborate investment in the prevention of abortion. This is necessary since every abortion is an indication of failure of both the individual and society to use knowledge of appropriate strategies such as contraceptives. The importance of therapy in decisions about abortion must be emphasized. Comprehensive information on abortion should be presented in an unbiased manner. Both pre-abortion and post-abortion therapy together with careful psychiatric and medical history records and others should be used to minimize the negative consequences of the procedure (Koop 14).
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