• Coerced Abortions

• New Marketing Techniques to Quell Women’s Regrets (USA)

• Rationalisations may Appear to Help but Ultimately Can be Destructive

• Pro-Choice or Poor Choice Rhetoric

• Reaching out for help

• The Problem of Concealment

• Synopsis of Recent Post-Abortion Research

• I Am A Feminist... And I Have Been Failed By Feminism

• No Matter How or When an Abortion Happens, Grief Signifies Loss

• NEWSLETTER INDEX

Coerced Abortions

Coercion is occurring. It is common knowledge that abortion often suits lovers and parents more than it suits the pregnant women themselves.

It takes no leap of imagination to understand how these persons often pressure, badger and blackmail a woman into accepting an unwanted "safe" abortion because it "will be best for her" and "best for everyone". Prominent abortion defender Daniel Callahan wrote "That men have long coerced women into unwanted abortion when it suits their purposes is well known but rarely mentioned." Population control zealots may defend forced abortions but most people would not wish to recognise or admit it is happening here in good old New Zealand. Where is the line between ordinary ‘pressures’ that may influence a decision and coercion?

There is significant heartache for women who feel pressured into doing something they would rather not. They can come around to thinking it is for the best and feeling there is no other choice, but afterwards are often faced with disillusionment and disappointment. For example, the relationship that the abortion was supposed to save or enhance may end, or the pretence to save face for themselves or others may dissolve, and often they do not feel better about themselves for the decision they made.

For the woman who is coerced there may be an added sense of violation or injustice for which anger is a natural response both at the time or afterwards.

Who should be held responsible for ensuring a woman’s choice to have an abortion is totally her own and that she is not being pressured into this decision by others? Where is the accountability?

- By Carolina Gnad

New Marketing Techniques to Quell Women’s Regrets (USA)

Excerpts from "Culture and Cosmos" (USA) Vol 1, Number 6, September 9, 2003. Copyright - Culture of Life Foundation www.culture-of-life.org

A group calling itself the November Gang that is connected to abortion providers has started a new effort to help women overcome their reluctance and regrets concerning abortion. In some clinics, women are "permitted to pray over their fetuses, even to sprinkle them with holy water in impromptu baptismal rites." Organisers say they are "intent on taking as much care with a patient’s heart as with her body."

The National Coalition of Abortion Providers is more revealing about the rationale: "if you don’t talk about (the fact that some women do regret their abortions), don’t acknowledge things, the anti-abortion movement will fill in the blanks, which is what they’ve been doing for years" For instance, pro-life crisis pregnancy centres counsel pregnant women in order to help them understand the reality of abortion and help the women explore other options, such as adoption or financial and medical assistance.

One of the members of the "Gang" describes how years ago she administered a questionnaire to patients two weeks after their abortion, asking how they felt about their abortion and if they wished they had any more information. She was surprised when a percentage of them were not OK... this did not match my pro-choice message of "Everybody’s fine, it’s just tissue." I need to help women work through their feelings."

Patients are prompted with questions such as "Can you see abortion as a ‘loving act’ toward your children and yourself?" or "Does being a good mother sometimes mean acknowledging that I can’t be a mother right now?" A clinic staffer said, "A lot of them... actually think about it and they’re like ‘Yeah, that’s what I’m doing. I do love this child, but I can’t (have) it right now."

Clinic workers do not attempt to educate the women about fetal development, and if a patient believes that her child is "just a bunch of cells", the staff don’t "make (the patient) talk about what’s not there"; "I call it whatever the patient calls it," said one worker.

Clinic workers also do not make referrals to adoption agencies, centres for prenatal care, or financial assistance in helping the women to have their babies.

Rationalisations may Appear to Help but Ultimately Can be Destructive

Every abortion situation involves unique individuals and partnerships with a complex situation of circumstances and relationship aspects which creates a real melting pot in crisis. There are an infinite numbers of ways to rationalise the need for an abortion, and whilst at the time these appear to serve the individual or the partnership well, enabling a woman (with/without her partner or spouse) to proceed with termination, at the end of the day these rationalisation are mostly destructive and inevitably carry a price - usually in the form of disease or dis-ease of some kind.

An abortion decision may in the first instance not take into account the life of the baby, or if it does then even this is rationalised against the ‘well-being’ of the mother and the relationship or whatever else. The huge problem is that when ‘in crisis’ our thinking does extraordinary leaps and jumps that can even run contrary to our fundamental beliefs and deepest desires, and our decisions are not always congruent with who we are as persons.

Like an animal caught in a trap will do anything to escape so too when faced with such seemingly ‘life-threatening’ (in the broadest sense) or life-changing dilemmas we will think ourselves around to a solution which appears to solve the matter at hand, but without always allowing ourselves to consider or to consider fully, the real ramifications or possible impacts on our self or our lives. The immediate outcome is usually the problem is resolved or eradicated. But what happens all too often is that what we imagined or were deceived into believing might be the benefits or consequence(s), do not fit with the lived reality. The rationalisations that once seemed clear and reasonable are suddenly not so rational - they stand out as distortions of the truth.

There is no denying that when looked upon with compassionate eyes the situations people find themselves in and what they face with an unplanned or difficult pregnancy can be horrendous. And yes, we all make the best decisions we can at the time with what we have and we live with the consequences of our actions. But what if someone could’ve told us what it might’ve been like or what the risks might be? What if we heard about the lived experiences of others and what it was really like? What if there was more information and support, would we be subject to the same rationalisations that so often lead to regret, anxiety, despair, depression, guilt... Could we perchance have done it differently and given our baby a chance at life after all?

- By Carolina Gnad

PRO-CHOICE or POOR CHOICE RHETORIC

Abortion advocates’ consistent appeal for "choice" suggests that choice, in and of itself is the highest ideal of free people…. This however does not equate if the choice or decision is uninformed, dangerous and regrettable." (Dr David Reardon)

Pro-choice wrt abortion implies “freedom to choose”. It conjures up images of women freely and autonomously making decisions that are ‘right’ for them. It indicates a proactive process that requires all the relevant information and facts available to sort and sift through before making a decision, as well as a full exploration of all the options and one’s position and feelings around each possibility. Pro “fully-informed” choice could go some way to ensuring that a decision made is an affirmative action in a person’s life.

Current ‘pro-choice’ rhetoric gives the impression that by virtue of having the (supposed) choice one is ultimately empowered. At one level, for some women, it may be about having the power over their own bodies, which is primary we are told by some in certain feminist circles, but it is also about the power to say ‘yes’ or ‘no’ to the life growing within. Many women do not realise, acknowledge or see the life growing within in terms of it being a human being - they are often led to believe it is merely a blob of tissue, not yet formed and therefore insignificant. Though interestingly, if a woman miscarries often the reality of a ‘baby’ growing and developing in the womb is readily accepted and the loss openly acknowledged.

Many women who decide to abort consider abortion to be wrong and so they violate their own consciences, and when they come to grief afterwards it is their own inner deep knowing that convicts them of the reality they denied at the time. Maybe information (written or graphic) may shock them into such realisation. Some who have a head awareness of the scientific facts around foetal development, continue to deny the reality and significance of the life developing within the womb. Lack of attachment to the developing baby often compounds the denial and may make the choice to abort seem more innocuous. Emotional detachment is seen to be a necessary aspect of the abortion decision-making process and the ability to proceed with the unwanted procedure.

Abortion is supposed to be about ‘choice’ and ‘empowerment’, yet for numbers of women before and afterwards their decision has left them bereft of a sense of self-power or self-determination. For numbers of women with an unwanted pregnancy the decision-making process is often curtailed and not always well facilitated. The difficulty is not solely due to the sometimes maybe insufficient or biased counselling received prior to the decision being made, but other factors such as time constraints. Also, the state of being “in crisis” may render women more vulnerable to outside influences and they are often more dependent on the opinions and directions of others. The drive to re-establish stability in a person’s life, to be free of crisis, may create a state of heightened psychological accessibility, where a relatively minor force acting for a relatively short time, can switch the whole balance of a situation from one side to the other. The reality is that sometimes if something in the equation were even slightly different the woman may have chosen to keep the baby, for example if a woman ‘felt’ supported by her husband or partner.

If we concur that people make the best decision they can in a given situation we understand that there are many variables and factors that play a significant part in the process. In the case of a woman with an unplanned or unwanted pregnancy the issues around decision making and the notion of ‘choice’ are complex indeed. So many aspects, which may at first glance appear to be relevant across the board in such situations, are for each person unique to their experience of it.

The individual’s perception of reality at that point in time is important, for the perception held strongly then may later change when more facts and feelings come to light or surface from within, often only after the event. This is sometimes seen when women, assuaged with grief and/or guilt, front up later and say they could probably have coped if…., or if only... then…., or if I knew then what I know now…, or I was pregnant with a child…… It is often only after the event they discover what the ramifications are as they live through the sequelae. Some factors at the time may be experienced as co-ercive, where the feeling is one of “no real choice” other than an abortion. The sad truth is that many women undergo unwanted abortions to please someone else or because of pressure or co-ercion by their sexual partners, parents, social workers, counsellors, employers.... There often seem to be major conflicts in a woman’s thinking and feelings and processing at the time of crisis. The need is often to get rid of the problem, get it sorted as quickly as possible with the least amount of fuss. Were they to really take the time and be open to explore all the issues involved it might, or might not, make a difference in the short term. Some women who believe abortion to be wrong and would never think they could contemplate having one themselves, when faced with the situation, out of fear, desperation and panic can follow through terminating despite their often deep-seated views or beliefs. Nothing is ‘normal’ when in crisis.

A decision made in desperate circumstances or under pressure may not ultimately be the preferred choice. I doubt anyone would wholeheartedly embrace abortion as the most life-giving and uplifting choice for themselves and certainly if they were honest for their unborn baby. The pro-choice legacy may in fact be a ‘poor choice’ legacy. Some say it is an easy option. For most involved it is rarely ‘easy’ and most women I and others working in the field have encountered both before and after abortion indicate it was a really difficult decision. And the whole ordeal is not something they would wish to repeat. Those who go on to have further terminations, reluctantly or as a matter of course, often seem well-defended against the reality of what is happening in the abortion and what is means for them more personally or deeply.

“There is no evidence that abortion is ever a good choice. Specifically, there is not a single known, statistically validated study that demonstrates that abortion generally makes women’s lives better. The only claims of benefits are anecdotal; and, even in these cases, the women often say that while they don’t regret having chosen abortion, they have struggled with it, or at best, have not had any major problems ‘yet’. Given the fact that women who suffer emotional reactions to abortions often suppress these emotions, this anecdotal evidence is weak indeed.” (Dr Reardon, leading researcher on post-abortion issues in the USA.)

For many their decision has ‘cost’ them or disempowered them in a multitude of ways. Many experience physical discomfort and complications, emotional distress and stress, relationship problems and spiritual alienation. Many struggle with ongoing decision-making, finding it harder to trust themselves especially in significant relationships or life events. Many become ‘angry’ or depressed. Many do not feel stronger or more confident, more pleased with themselves or satisfied with life as one might expect had the decision been a wholly affirmative choice in keeping with their deepest beliefs, desires and aspirations.

One woman wrote “I am trying to learn to live with this and how to put on a show for the world. Sometimes I feel like I won’t be able to keep this show going much longer. On the outside it seems like life has gone on like normal, but on the inside I feel like I am falling apart....”

“If as a society we want to contribute to the mental health of women and men, we must be willing to make a more critical look at the many complex ways abortion can affect their lives”, write American researchers Theresa Burke and David Reardon. Are the medical fraternity and mental health communities ignoring women’s pain because of fear that acknowledging this hidden side of abortion will weaken pro-choice support? Healing should not be held hostage to pro-choice sentiments!

I share these thoughts from what I have observed, from what post-aborted women have shared with me, from material I have read and what I have gleaned from others working in the field. It is a difficult position to be heard from, but the reality is that much of what I speak of is confirmed by women who have been there, and in my mind there is no stronger testimony. And yes, I am aware that just as there are women who admit to experiencing these struggles before and problems afterwards there are others who claim no difficulties or adverse effects or long-term impacts. So be it. Personal awareness and reflection, growth and knowledge can change our understanding of our experiences. Only time will tell for those involved who at this time claim no adverse reactions or who cannot see the hurt and harm abortion can cause.

For those who afterwards speak about how they bought the lie about the baby ‘not being a real life’ and that abortion will render them ‘free’ and things would return to normal i.e as they were before, rhetoric parts company with reality and the choice they made often seems a poor choice indeed.

- By Carolina Gnad

Reaching out for help after an abortion can be difficult.

A major problem is that women and men may feel unable to share their grief with others.

"When they turn to people who are ‘pro-choice’, they may be told to "Forget about it. It wasn’t really a baby, yet, so there’s nothing to feel bad about." Such ‘comforting’ words actually deny the reality of one’s grief and stymies the healing process. On the other hand, women and men are likely to feel afraid to share their pain with people on the ‘pro-life’ side because they fear they will be rejected and condemned. As a result, women and men who are struggling with a past abortion are likely to feel ‘boxed’ on both sides. To whom can they turn? Who will acknowledge the reality of their grief without making them feel even more guilty? This is why so many carry the burden of grief alone, and this burden can place an enormous strain on their ability to function and relate to others." (From ‘Finding Real Answers About Abortion’ - http://www.afterabortion.org)

Overcoming personal guilt and shame sufficient to face another person with the truth of what happened and what it meant can be huge. There is sometimes a fear of being odd or different or a feeling of going crazy.

Often the expectation is that there ought to be no problems after an abortion as it is supposed to be a simple safe surgical procedure to remove the problem of an unwanted pregnancy. However when that does not fit a person’s perception or experience then they can tend to blame themselves, consider themselves to be defective, that it is their problem once again to ‘fix’ somehow, not realising that much of what they experience is shared by others who have had abortions too.

When hurt by health ‘professionals’ it may feel risky to reach out to other professionals. The ability to trust again and to be sure they are doing the right thing may be a concern.

The fear of not being understood, of being judged, of someone else thinking them abnormal or crazy can be a deterrent, as it would confirm what they themselves fear.

Often it is when a person feels ‘desperate’ or has a sense they cannot go on the way they are will they pluck up the courage to make contact, to pick up the phone and ask for help.

That initial call can be a hard! So if you know someone who has had an abortion and appears to be not coping too well or struggling physically or emotionally, affirm them in their experience and encourage them to reach out for help!

- By Carolina Gnad

The Problem of Concealment

We are in a postmodern era where being pregnant out of wedlock is common and supposedly more ‘acceptable’. One might expect that with a climate where abortion is readily available, government funded, and even promoted at times, that there ought be no problems around talking openly and freely about the experience. This does not seem to be the case.

In the first instance numbers of women often still keep the fact they have unintentionally fallen pregnant hidden. To be pregnant is not always, even in the best circumstances, celebrated in our society. To become pregnant when there is already so much promotion of safe sex may imply to some they have ‘failed’, it is their own fault and they need now to deal with it. There is little promotion of alternatives such as saying ‘no’ to sex or waiting or establishing good relationships.

Some women, for whom abortion is viewed as wrong and harmful, may proceed with the pregnancy. When they feel well supported they are more likely to continue with the pregnancy despite the odds .

Some women may go through the decision-making process about what to do about it with some or little support, feeling abandoned or they may choose not to involve people for fear of what people might think, fear of judgement or for some there may be a fear of exposure, the ‘world will know’. They may feel they have let themselves and/or others down and that can be a powerful force for concealment.

Numbers who have had an abortion say they feel the stigma still. They suppress their real feelings, approach life with an air of pretense, pretending things are okay and ‘normal’ but somewhere inside they know things are not normal.

They carry this secret and then need to expend considerable energy protecting the secret. There is often a fear of the secret being discovered. For example, in conversations when the topic of abortion comes up some women become quite self conscious and worry that something they say or the way they look might give them away.

For something that has seemingly become commonplace and socially acceptable there is still a sense of taboo around the subject and the silence can be deafening. Either that or people’s strong opinions may silence someone who has had an abortion or cause them to overreact or react defensively.

The need to conceal the truth about being pregnant and the reality of abortion experiences and aftermath is real.

- By Carolina Gnad

SYNOPSIS OF RECENT POST-ABORTION RESEARCH

(by  Vincent M. Rue, Ph.D. Institute for Pregnancy Loss, Stratham, New Hampshire)

Extensive research has documented how traumatic stress can  significantly alter individuals’ lives. Traumatic stressors are strong  predictors of post-traumatic stress disorder or PTSD (Foy, Osato, Houskempt & Neuman 1992).

While the  prevalence of PTSD has been estimated to affect up to 12% of the U.S. population (Breslau, Davis, Andreski & Peterson 1991), limited research has examined the role of elective abortion as a traumatic stressor causing symptoms of PTSD. Most trauma victims encounter feelings of horror or terror at the time of the traumatic episode.  Bagarozzi has reported that women who came for mental health treatment were in complete denial that they had experienced an abortion and that indeed it was a traumatic and horrific experience for them.  ”This denial was seen as a major contributing factor to the development of post traumatic stress in these women” (1993:67).

Clinical research findings highlighting the power of denial before, during and after an abortion have also been reported by Torre-Bueno (1996).  As a pro-choice advocate and long-time Planned Parenthood abortion counselor, her assertion is all the more compelling: “I believe passionately that I can be supportive of every woman’s right to make her own pregnancy decisions, and still recognize the fact that her decision may cause her tremendous suffering.  While many women do not have emotional or spiritual difficulty after an abortion, I know from twenty years of experience working with women before, during, and after abortions, that many women have more emotional and spiritual pain after abortion than the current research suggests.”(1996:3)

In another clinical study, pro-choice psychotherapists De Puy and Dovitch (1997:13-14) reported that 10% of women experience “severe emotional trauma” following abortion.  According to these clinicians/researchers: “Many women acknowledge a feeling of relief after their abortion, yet are understandably upset by facets of the experience that they had never anticipated.  Many are distressed and unaware of the ways in which their choice has changed their lives and, sometimes, the lives of those around them.”   In a study of 80 women in the U.S., Barnard (1990) used standardized post traumatic stress disorder (PTSD) instruments and found: 3-5 years following the abortion, l8% of the sample met the full diagnostic criteria for posttraumatic stress disorder (PTSD) and 46% displayed high stress reactions to their abortion.   Her findings were not explained by religiosity as 68% reported that at the time of the abortion they had little to no religious involvement. Subsequently, similar findings were also reported by Hanley et al. (1992) in a comparison study of women distressed post abortion which also used standardized PTSD instruments and interviews.  They found: “Women who were distressed following an abortion scored significantly higher than the non-distressed group on PTSD symptoms of intrusion and avoidance.”

The investigators evaluated whether some women in outpatient mental health treatment with a presenting problem of post abortion distress met Diagnostic & Statistical Manual of Mental Disorders III Revised (DSM-III-R) criteria for the post traumatic stress disorder (PTSD) categories of intrusion, avoidance, and hyperarousal.  One hundred and five women were administered the SCID-PTSD module, the Impact of Event Scale, as well as the Social Support Questionnaire and the Interview for Recent Life Events, in addition to completing a semi-structured interview.

The researchers concluded: “the data from this study are suggestive that women can report abortion-related distress similar to classic PTSD symptoms of intrusion, avoidance and hyperarousal and that these symptoms can be present many years after the abortion.”

Posttraumatic reexperiencing has also been documented in anniversary reactions.  In a small study conducted by Franco et al. (1989:154), 30 out of 83 women reported experiencing anniversary reactions that included intense emotional psychosomatic pain.  They noted: “Unresolved grief and preexisting dysphoria have been suggested as increasing the likelihood of anniversary reactions.”  Another recent study compared two groups of 25 women who elected abortion: those who identified themselves as distressed (D) and those who reported more neutral or non-distressing responses (ND).  PTSD symptomatology was found in the distressed group: changes in male-female relationships, suppression of feelings/thoughts about the abortion, reactions to catalytic events that aroused thoughts/feelings about the abortion, trying to get pregnant again, becoming promiscuous, and avoiding reminders of babies.  More than two out of three women in Group D were distinguished by reports of “suppression” or “denial” of parts of the abortion experience or negative emotional reactions to it. Additionally, women in the distressed group were more than twice as likely to report abortion trauma related symptoms on the Impact of Event Scale than those in the non-distressed group (Congleton and Calhoun 1993). In this same study, women who identified themselves as distressed post abortion indicated feeling:  a sense of loss/emptiness (48%); shock/detachment (28%); anger toward partner/others (24%); depression (20%); loneliness, betrayal, loss of self-worth, and relief (16%); guilt and sorrow (12%); confusion (8%); fear of dying and suicidal thoughts (4%).  Interestingly, in the group of women who elected abortion and did not believe they were distressed, 20% had symptoms of depression, an equivalent percentage experienced by the distressed group.

The authors concluded:

(1) for some women, abortion is a “critical event” which produces high levels of psychological distress;

(2) informed consent should ensure accurate information is conveyed about physical pain and possible negative and positive emotional reactions; and

(3) when dealing with depression among women, exploring reproductive history for unresolved emotional reactions to pregnancy termination may prove beneficial.

In a large scale prospective cohort study (N=13,261, of whom 6410 experienced a pregnancy termination) conducted in the United Kingdom, Gilchrist et al. (1995) found evidence of the traumagenic nature of abortion when examining relative risks of suicidal behavior in women who had previously terminated their pregnancy, and who had no prior history of psychiatric illness.  A recent study in Finland of all deaths of women of childbearing age concluded: “Our data clearly show, however, that women who have experienced an abortion have an increased risk of suicide which should be taken into account in the prevention of such deaths” (Gissler, Hemminki and Lönnqvist 1996:8).

A recent Swedish study examined emotional distress (ranging from 1 month to 12 months follow-up) after abortion at a university hospital. Risk factors identified were: living alone, poor emotional support from family and friends, adverse post abortion change in relations with partner, underlying ambivalence or adverse attitude to abortion, and being actively religious.  The researchers concluded: “Thus, 50-60% of women undergoing induced abortion experienced some measure of emotional distress, classified as severe in 30% of cases.” (Soderberg, Janzon & Sjoberg, 1998:173)

In a study just published, Reardon & Ney (2000) examined the mental health risks of abortion relating to subsequent substance abuse. They found that women who aborted a first pregnancy were five times more likely to report subsequent substance abuse than women who carried to term, and they were four times more likely to report substance abuse compared to those who suffered a natural loss of their first pregnancy due to miscarriage, ectopic pregnancy or stillbirth.

Rue (2001) applied a trauma sensitive perspective to the understanding of how women coped with pregnancy losses, particularly induced abortion.  He conducted a transnational retrospective descriptive study of 765 women in the United States and Russia.  In this study, the average number of years since the abortion was 11 years for American women and 6 years for Russian women.  Similar to preceding studies, the most common positive emotional outcome for women in both countries was relief with 11% of U.S. women attributing this positive feeling to their abortion compared to 8% in Russia. In the U.S. sample, 58% of women who aborted experienced 6-10 post traumatic stress disorder symptoms following the abortion, compared to 12% in the Russian sample. Overall, the findings indicated that women in the U.S. sample were more likely to experience post traumatic stress related symptoms following their abortion than Russian women.  Using Pearlman’s traumatic stress scale (TSI), Russian women who obtained an abortion had higher mean total TSI scores than U.S. women (276 vs. 260), indicating considerable disruption of cognitive schemas.

Cougle, Reardon & Coleman (2001) employed the National Longitudinal Survey of Youth (NLSY) a general purpose study which has interviewed 6283 women since 1979.  They found using standardized assessments: “Compared to post-childbirth women, aborting women (n=735) were found to have significantly higher depression scores as measured an average of 10 years after their pregnancy outcome.  Controlling for age, total family income, and locus of control scores prior to the first pregnancy event, post-abortive women were found to be 41% more likely than non-aborting women to score in the ‘high risk’ range for clinical depression.  In response to a self-assessment question, aborting women were 73% more likely to complain of ‘depression, excessive worry, or nervous trouble of any kind’ an average of 17 years post abortion.’”

And finally, in the first record linkage study conducted in the U.S. on 173,279 low income women who had aborted,  Reardon et al. (2001) found the following: “Compared to women who delivered, those who aborted had a significantly higher age adjusted risk of dying during the subsequent eight years from suicide (2.54), accidents (1.82), and all causes (1.62). Higher suicide rates were most pronounced in the first four years. Notably, the average annual suicide rates per 100,000 in our sample, 3.0 for delivering  women and 7.8 for aborting women, bracketed the national average suicide rate of 5.2 for women ages 15-44.” In addition to the above, there are a number of reviews of the literature on post abortion sequelae that are instructive (Speckhard & Rue, 1992; Rue, 1995; Speckard, 1997; Ney & Wickett, 1989; and Angelo, 1992).

References:

1. Angelo, J. (1992) Psychiatric sequelae of abortion: The many faces of Post-Abortion Grief.  Linacre Quarterly, 59:2, 69-80.
2. Bagarozzi, D. (1993) Post traumatic stress disorders in women following abortion: Some considerations and implications for marital/couple therapy. International Journal of Family and Marriage 1:51-68.
3. Barnard, C.  (1990) The Long Term Psychosocial Effects of Abortion. Institute for Pregnancy Loss. Stratham, New Hampshire.
4. Breslau, N., Davis, G., Andreski, P. & Peterson, E. (1991) Traumatic events & post traumatic stress disorder in an urban population of young adults. Archives of General Psychiatry 48: 216-222.
5. Congleton, G. and Calhoun, L. (1993) Post-abortion perceptions: A comparison of self-identified distressed and non-distressed populations. International Journal of Social Psychiatry 39:255-265.
6. Conklin, M. and O’Connor, B. (1995) Beliefs about the fetus as a moderator of post abortion psychological well-being.  Journal of Social Psychiatry 39: 76-81.
7. Cougle, J., Reardon, D. & P. Coleman (2001) Depression associated with abortion and childbirth: A long-term analysis of the National Longitudinal Survey of Youth.  Presented at the 1st World Congress on Women’s Mental Health, Berlin, Germany and published in Archives of Women’s Mental Health, Vol. 3/4, Supplementum 2.
8. Foy, D., Osato, S., Houskamp, B. & Neuman, D. (1992) Etiology of posttraumatic stress disorder.  In P. Saigh (ed.), Posttraumatic Stress Disorder (pp. 28-49).  Boston: Allyn & Bacon.
9. Franco, K. et al.  (1989) Anniversary reactions and due date responses following abortion.  Psychotherapy and Psychosomatics 52:151-154.
10. Gilchrist, A., Hannaford, P., Frank, P., and Kay, C.  (1995) Termination of pregnancy and psychiatric morbidity.  Bri. Journ. of Psychiatry 167:243-248.
11. Gissler, M., Hemminki, E., and Lönnqvist, J. (1996) Suicides after pregnancy in Finland, 1987-94: Register linkage. Brit. Med. Journal 313:1-11.
12. Ney, P. & Wickett, A. (1989) Mental health and abortion: Review and analysis.  Psychiatric Journal of the University of Ottawa, 14:4, 506-516.
13. Reardon, D. & Ney, P. (2000) Abortion and subsequent substance abuse. American Journal of Drug and Alcohol Abuse. 26:1, 61-75.
14. Reardon, et al. (2001) Suicide deaths associated with pregnancy outcome: A record linkage study of 173,279 low income American women.   Presented at 1st World Congress on Women’s Mental Health, Berlin Germany,  published in Archives of Women’s Mental Health, Vol. 3/4, Supplementum 2.
15. Rue, V. (1995) Post-Abortion Syndrome: A Variant of post-traumatic stress disorder.  In P. Doherty (ed.) Post-Abortion Syndrome: Its Wide Ramifications.  Dublin: Four Courts Press, 15-28.
16. Rue V. (2001) Posttraumatic stress symptoms following induced abortion: A comparison of U.S. & Russian Women.  Presented at the 1st World Congress on Women’s Mental Health, Berlin, Germany and published in Archives of Women’s Mental Health, Vol. 3/4, Supplementum 2.
17. Soderberg, H., Janzon, L. & Sjoberg, N. (1998) Emotional distress following induced abortion.  A study of its incidence and determinants among abortees in Malmo, Sweden.  European Journal of Obstetrics & Gynecology, 79, 173-178
18. Speckhard, A.  (1997) Traumatic death in pregnancy: The significance of meaning and attachment.  In Figley, C., Bride, B. & Mazza, N. (Eds.) Death & Trauma: The Traumatology of Grieving.  Washington, D.C.: Taylor & Francis, 67-100.
19. Speckhard, A. & Rue, V. (1992) Postabortion syndrome: An emerging public health concern.  Journal of Social Issues, 48 95-120.
20. Torre-Bueno, A. (1996) Peace after abortion.  San Diego: Pimpernel Press.

I AM A FEMINIST AND... I HAVE BEEN FAILED BY FEMINISM

No matter how or when an abortion happens - grief signifies the loss

The controversial abortifacient pill RU486 is hitting New Zealand. What are the implications for women who take this pill likely to be?

RU486, generic name Mifepristone, is an artifical steroid developed in France in the early 1980’s, and it works by counteracting the action of progesterone in a normal pregnancy. Progesterone relays the signal to the body that there is a growing baby implanted in the uterine wall and needing nourishment. RU486 effectively blocks that signal by taking over progesterone’s chemical binding sites, so that the body no longer gets the signal that the woman is still pregnant. RU486 shuts down the process, so the developing baby eventually starves and/or suffocates to death.

The introduction of the abortifacient RU486 may ease and increase abortion access in New Zealand, but it will mean general practitioners need to be involved in what can become a time-consuming regimen, there may be need for additional patient counselling, heightened costs and the requirement of additional equipment.

Evidence from pharmaceutical literature and the experiences of women already subjected to its use, demonstrate that this pill may not be as harmless as it is purported to be. On the surface it would appear abortion brought about by the use of such a pill may be experienced as less intrusive or invasive, less exposing and less of a violation for women, but there are still physical and emotional and other drawbacks with which to contend.

The public may come to view RU486 like a ‘miracle pill’ - imagine being pregnant, swallowing a pill, and hey presto not being pregnant any longer! The process however is often more cumbersome and challenging, and may involve longer, drawn-out, multi-drug, multiple visits to the doctor and take weeks to complete.

The first visit and medical exam is used to date her pregnancy to decide if the chemical method would work, and to determine whether or not she has any physical conditions that prohibit using the abortifacient tablet. Contraindications for use, or possible side effects as outlined in pharmaceutical guidelines, need to be vigilantly heeded and monitored by GPs least women put themselves at risk of additional harm. Some women may experience severe pain if contractions are lengthy and majorly strong through the abortion process. Others may experience nausea and diarrhoea as side effects.

If the pregnant woman is given the RU486 there and then, over the next 48 hours the RU486 works on her reproductive systems to shut down the life-support system for the developing child. Returning for her second visit two days later, the woman receives a prostaglandin, usually Misoprostol, to stimulate uterine contractions to expel the then dead baby. She may need to remain at the consulting rooms as the abortion begins.

Whilst many women abort during this second visit, numbers abort later, at home or work... The passing of their unborn child, whole or in parts, particularly if ‘seen’ can be upsetting for some women. The often longer periods of bleeding which could extend up to six weeks and the sometimes unpredicatability of the timing of the abortion can be problematic and distressing for women.

A follow up visit is usual two weeks or so from the first visit to determine if the abortion is complete or not. If the abortion is incomplete, a woman may require surgical dilatation and curettage to complete the process.

Women who miss their second or third visits may mistakenly believe they have aborted when they experience bleeding. If the baby dies but is not expelled there could be serious health consequences for the mother. If the baby survives, his or her development could be affected by the drugs.

Sometimes this method of procuring an abortion gives women the illusion that an abortion has not taken place at all. A woman needs to be able to make a free and fully informed choice and this may mean she needs some counselling to fully understand what is involved and explore what it means and what it will mean for her to have an abortion and have it like this.

Counselling prior to medical abortion also necessitates determining whether the woman is suitable for the method, whether she is responsible enough to return for the necessary visits, whether she is likely to report complications promptly and whether she has an adequate support systems, especially in case there is an emergency.

Whether an abortion is performed surgically by suction curettage or effected through the medical RU486 intervention, the effects of the resultant termination of a pregnancy and what it ultimately means for a woman may be similar. For some women who do not view the developing foetus as a ‘baby’ and deny any attachment to their offspring, there may be little visible impact initially or over time, though for many women the effects may only surface later, with future pregnancies, if a woman has later gynaecological problems, mid or other life crises such as death of a loved one or some other significant loss or stressor.

Feelings of guilt following surgical abortion are not uncommon and it is known through experiences of women in other countries, that feelings of guilt associated with the use of RU486 can be heightened, as the element of self-responsibility is often felt to be greater with the use of the tablet. A woman may feel more instrumental in the termination of her pregnancy and death of her baby. Those for whom abortion goes against their own moral code may experience similar degrees of post-abortion stress whatever method is used.

Women’s upset and anger over unwanted pregnancies and the situations they find themselves in may be little different in either case - they may feel equally as unsupported in either situation and still face the dilemma, whether to continue with the pregnancy and keep the baby or give him/her up for adoption, or to abort. "To abort or not to abort?" is most often the question they face in the moment of crisis. It is most often the women themselves who are forced to "deal with it and to it" one way or another, as well as cope with adverse reactions.

The hurt or anger a woman may experience following an abortion or induced miscarriage, by whatever means and at whatever stage of gestational development of the baby, may be turned inward and manifest physically and emotionally in symptoms such as headaches, insomnia, gastrointestinal disturbances, fatigue, alcohol abuse, eating disorders, depression, which if severe may lead to suicidal ideation or impulses... Or else the anger may be projected outwards to those involved in the abortion decision or process, or others close to the person and relationships may suffer.

Other aspects of post-abortion stress may manifest just the same with the use of the tablet RU486. An abortion is an abortion is an abortion is an abortion... Essentially the abortion experience is a death experience but for many women this is often not realised until the grief is experienced and realised some time soon or much later after the event - they wonder why the sadness, why the tears, why the anger, why the feelings of numbness or emptiness...?

Although numbers of women may "appear to function normally" afterwards many become adept at not letting the pain show, and hiding from their grief or pushing it down. Part of this may be due to the fact that in our society grief following abortion is disenfranchised. Society does not yet fully recognise, openly acknowledge or accept as real post-abortion grief and how it affects women, men and families. Post-abortion grief is real for numbers of women who have abortions each year, and predictably will be also for those who undertake the procedure medically using RU486.