P.A.T.H.S. 
POST ABORTION TRAUMA HEALING SERVICE

Breaking the silence - information, hope and healing after abortion
 
 
 


  Newsletter Excerpts 2016 



That Time of Year

That time of year is approaching. A festive season? For some not so.

Christmas for some is a holy time, a time to celebrate the birth of Christ. People of different religious persuasions and others in the community may not mark this time in that way at all and so for many it is largely just a holiday time. That is, a chance to spend time with family and friends, make the most of our New Zealand summer weather, rest and relax at the end of the working year.

For those who are estranged from families, or who have experienced losses, they may approach this time with dread or mixed emotions. For numbers of women, and men, who have had recent or past abortions, it can be a time where memories become triggered and pain may surface. For many it is not easy and not something they look forward to especially if they are aware of their loss, and there are issues around how they are able or allowed to acknowledge that loss and remember their experience with others, or not.

For some who have recent abortion/ termination experiences, they may be feeling raw, or confused, or fragile, or unsure what to think or feel. They may feel distant from people and celebrations, and may find themselves withdrawing. Or they may party hard in an attempt to numb out or forget.

For others, who have had past experiences, depending on what the experience has meant for them, this time of year can make them acutely aware of the something or someone that is missing. Their reality and feelings may or may not be spoken about.

For some who do remember their child lost in the abortion/termination and can effectively do something to acknowledge him/her in an ongoing way, it can be a poignant time. A time of togetherness and healing

For those who are struggling what can you do to make this time easier?

- Understand where you are at with your experience and what you may need for yourself at this time.

- Allow yourself space and find a way to be with how you are feeling in a positive or constructive way.

- Some distraction can be helpful e.g. music, movies, games.... as long as it is not self-harming.

- Balanced eating is important. Don’t overindulge in food or alcohol, and eat healthy food.

- Be active - exercise and enjoy the fresh air.

- Get some good sleep. If you have real problems getting to sleep or having enough sleep, see your doctor.

- If anxious or emotional try some mindful breathing or grounding. You can easily find effective techniques online.

- Journal how you are going through the days over this time allowing yourself to express whatever you are feeling and whatever is going on for you in an uncensored way.

- If you feel you are not coping, ring a helpline or visit your doctor and talk about it.

I am reminded with Christmas that “this too will pass”. Look ahead. Make some plans and set some positive goals for the coming year. Be realistic - make goals doable, and time-framed and ensure you have resources to realise them.

Above all be kind to yourself and go gently. Nothing comes from being self-critical or punishing. Be patient and take care of yourself.

- Carolina Gnad

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MY ECTOPIC LOSS


It was mid December, my husband and I were thrilled to be expecting another baby. We had been trying for quite some time. We were devastated when a couple of days later I started bleeding. I thought I had miscarried.

I went to the hospital to receive an anti D injection. I need this as I have rhesus negative blood type. They also did more blood tests and an ultrasound. That’s when things got complicated. According to the sonographer there was no sign of a baby in the uterus. I had to come back the following week for another scan. I wasn’t happy about this, I wanted this whole experience to be over. I just wanted to get back to trying again. I was in my early thirties and my biological clock was ticking.

It’s pretty quiet in the hospital in between Christmas and New Year. No surgeries scheduled, the usual busyness is not there. After the second ultrasound, I was told by one of the doctors in the emergency department that I had an ectopic pregnancy.

I don’t remember much of what happened from then on. I remember walking to the medical/surgical ward. My symptoms were not textbook in the least, I had no pain which the doctors could hardly believe. I don’t remember what they told me about the ectopic pregnancy. I do remember feeling very calm.

It wasn’t until after the surgery that I realized the magnitude of what had just happened. We not only lost our fourth child but I lost a fallopian tube also. They made a small cut about 9cm long along my bikini line and removed my right fallopian tube. My surgeon was just happy I was alive. The nurses cared for my physical needs, I got my wound checked; my blood pressure was low, they kept an eye on that; my heart rate was high, well, that’s to be expected. The assisting doctor came in and said everything went well!

Well? Are you serious? I just lost my child, why won’t anyone acknowledge this? Staff did not acknowledge this at the time which was hard.

I was so thankful for the great support I had around me, especially of my husband. It was a shock for many people because they didn’t even know I was pregnant in the first place. I knew it was hard for them to talk about it. I got meals brought to me, baking, cards, phone calls, my children were taken care of, someone came and tidied my house, but I felt so empty and so alone.

Since I was a little girl, I have had a strong faith in my Saviour, Jesus Christ. However, at this point, I couldn’t believe He allowed this to happen. I wanted and loved that baby so very much! Why did He do this to me? I was so angry! I continued to pray but it was more like a scream! I cried all the time, I didn’t want to eat, I stayed away from dear friends and even family. I couldn’t congratulate newly pregnant women, I had to walk away and shed some silent tears. If someone had a baby, I couldn’t hold the child, I sent my husband to take the gift and card. It was all just so hard. I just wanted to understand and find out why this happened.

Actually, I just wanted my baby back and that was never going to happen.

I was told that it was just “bad luck” that this happened. If you’ve read all the possible causes for a woman to have an ectopic pregnancy, I have none of those. I received from a very empathetic GP, the notes of the surgery, the copies of the scan reports, and the pathology report. I have read them numerous times; for some reason it just helps to have them.

I felt embarrassed to grieve so deeply for a child I never held in my arms. I felt mortified that I lost that child so unnaturally. I felt ashamed that I signed a consent form to have our baby removed from me albeit to save my life. I felt less like a woman knowing that the likelihood of conceiving another child would be less. I was so sorry that I lost my faith over this after all God has done for me.

I tried to convince myself that our baby was just a blob of tissue, but deep down for me I knew I lost a most precious wee baby. When I came to that realization and truly went through the steps of grief I felt like myself again. When we lose someone we love, our lives are never the same again. There is a gap that can never be filled and that’s ok. On my due date, a dear friend came over and gave me a canvas she had hand painted of a beautiful rose with some gold teeny tiny feet sitting on a petal. On it she wrote ‘Safely Home’ and the date of my surgery. A gift so precious has no words. What my friend did by giving me that painting was to acknowledge that we lost our baby, that our baby was very real and very truly a human little being. She renewed my belief in the wonderful heavenly Father that has our baby girl in His loving arms. She helped our healing process in ways words cannot express. I also got text messages and cards that day. I felt so alone and yet on this special they showed their love. I never knew they cared so deeply for me and our child.

The canvas painting hangs proudly in our lounge alone side the photos of our other three children. Sometimes when asked how many children I have, I think of four and only say “three” because it’s too complicated to explain.

As part of my grieving process, I wrote a letter to the medical/surgical ward of the hospital giving my feedback which has been received very positively.

We never knew what the gender of our child was, but we thought we were having a girl, we named her Naomi. We have told our other children that mum was pregnant and that the baby died and is now in heaven.

The anniversary of her death is coming up, so we will do something special with the family. My husband had a beautiful necklace made with the names of our live children on it and a pair of feet for our little girl. When I see my nephew, who would have been three weeks older than Naomi, I smile and think of her. I miss her terribly, I miss what could have been, but I smile because she is where she belongs. She is safely home.

- Alexandra

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Health Professionals Have an Important Role in Termination Experiences


Talking with health professionals around termination issues and healing is always interesting. Some are directly involved in abortion services, others in allied health care and counselling areas. Some work in the public sector, others in the private or NGO areas. These are the frontline workers who as part of their roles meet women, and men affected by abortion/termination or making pregnancy decisions. Part of my brief is to raise awareness about the context of abortion/termination, attitudes and approaches of healthcare professionals, possible impacts of abortion/ termination and the needs of those affected and recovery aspects.

To present around this topic can at times be challenging. I am aware that in any group I talk to, there will be numbers of women, and men, who may have had an abortion/ termination as part of their history, or someone close to them may have experienced one. Or, as part of their role or service they may provide support for those considering an abortion/termination or availing themselves of the procedure or care after the event.

Abortion/termination is invariably a sensitive topic to talk about, and I am mindful that the same non-judgmental approach is important in approaching health professionals with information and questions, as we hold in our work with our clients. There is no judgement. Just offering insights, sharing stories and experience, wondering with and being curious together to open awareness and understanding and create helpful considerations for those working with people considering termination and responses by healthcare professionals to people affected.

For me the most powerful thing that speaks about what an abortion/termination experience is like or means for someone is through hearing their story. It is in the details of the client’s story that we uncover the reality of what the abortion/termination did and what it has meant for that person. Each person is unique and each story is individual. One cannot argue with a person’s lived experiences. It is deeply personal and very real.

What can be difficult for any health professional is managing their own views and beliefs and the effects of any personal abortion/termination experience they have, in relation to the work they do. We often will hold a view because of what we have experienced and we may risk making assumptions about situations for others. Or we might advise what is best in different situations from our own view., rather than just what may be medically necessary.

Certainly, as in the story My Ectopic Loss, there are certain situations which require intervention which is beyond the control of the patient or client. That something has to be done to save a mother’s life is not up for debate or question. However, in the clinical setting, all too often we miss the opportunity to relate as human beings. We can fail to acknowledge the reality of the importance of something for a patient or client, if we do not take the time to be with, wonder with and be curious around what is happening for our patient or client as they are going through an intervention or procedure.

As health professionals sometimes it can be easy to forget that a procedure that is routine for us can feel huge for a patient or client. We can assume from our own perspective that something is insignificant without checking out what it means for the person concerned.

We often hear stories from clients about experiences with health professionals. Sometimes they report really good experiences, in terms of people’s kindness, care and attention. At other times they feel disempowered, frightened, unsure what is happening, or they feel that their feelings around their experience are minimised or dismissed or ignored, or not even asked after. In clinical settings a clinical approach is often taken which is efficient and effective, but the risk is missing the human connection and response.

One matter with abortion or termination, that often surfaces afterwards, is the issue of informed consent. Clients sometimes share how there was information they had not known or received from the healthcare provider. We are aware that sometimes clients are offered information, but if in crisis they are not always in a space to process that information. Health professionals have a huge responsibility to ensure not only that a client has all the relevant information they need to make an informed choice, but that they actually understand what is entailed and what it may means. The possibility of complications and short and long term impacts (physical, mental, emotional, spiritual, relational...) ought to be discussed and fully explored. This is particularly important with abortion / termination as for numbers of people this experience is life changing.

With many medical or surgical procedures it is fairly straightforward, however, abortion/termination is much more complicated. It is not like extracting a tooth or an appendix in the clinical sense. It is ending a pregnancy and the developing human life with it. It is a deeply human relational experience. It is an artificially induced miscarriage or unnatural death event. By its very nature termination is not as innocuous as may be assumed.

Extra care and consideration needs to be had in exploring feelings, values, relationships and issues in the decision making time and beyond, to come to appreciate the complexity of the situation for the person.

In offering presentations to health professionals there is a call to become more mindful around not just best practice needs, but also around human relating in this critical area of health care. Making time and taking the time to listen is all important. To slow down the process and enable a pregnant woman time to move beyond crisis in her decision making process, and encourage full exploration and processing of information, walking through options and the possible short and long term implications, mindful that negative reactions are often unanticipated and can surface at any point in the future.

Health professionals play a vital role in how terminations are experienced. Attitudes, words, actions, lack of action, can have critical impacts on how a woman may experience her termination procedure. It is important to attend to the clinical needs but it is equally important to attend to the human needs of the patient or client, if one is to not contribute to or exacerbate negative reactions.

- Carolina Gnad

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Adolescents, Pregnancy and Abortion

By Carolina Gnad


Fear. This word sums up my reaction to my unplanned pregnancy at the tender age of 17. Fear of being a disappointment to my family. Fear of being judged for being pregnant at such a young age. Fear of not having what it took to raise a child when I had so much growing up to do myself. Honestly, I cried and cried. I contemplated my options but my head wasn’t clear, so in the end I spoke to my mum. I was one of the lucky ones to have had such a supportive mother. We talked through the pros and cons of each option and I made the decision to keep my baby. Kayla was born on 26/04/03. I will never regret my decision to keep her. What a blessing. What an angel. Now 13 years on I can see the differences between my 30 year old mind and my 17 year old mind. My 17 year old mind wasn’t great at seeing reason or reality. It didn’t properly evaluate risk or reward. I was lucky to have had guidance. After 9 months my fears became jubilation when I held my daughter for the first time. I didn’t choose motherhood. Motherhood chose me.
(Francie)


WHO defines adolescence as occurring between ages of 10 to 19 years. Each year worldwide more than 14 million adolescents give birth, over 90% in developing countries, accounting for an estimated 13% of maternal deaths. Further, between 2.2 and 4 million of an estimated 19 million illegal abortions each year involving adolescents. (Cook et al 2007).

Looking at the research around adolescents, pregnancy and abortion has offered many insights into this age group, their views and attitudes and reactions.

Altshuler et al explored US adolescent abortion attitudes. They say that unlike abortion socialization, sexual socialization has been studied extensively and results suggest that informal non-didactic channels such as peers, media sources and family messaging shape attitudes towards sex. Abortion and sexual socialization may have similarities. This study employed internet-based recruitment and data collection to gather information about young people’s abortion attitudes, The questions about abortion were mixed with others about sex, love, relationships, pregnancy, parenting and adoption. The language was middle-school education level .

A small minority indicated they had not learned about sex or abortion. Learning about sex and abortion was mostly through the media. A few selected a ‘religious figure’ or ‘health provider’ Next to media for learning about sex was friends. Parents, media and friends had the most influence on abortion stance, with parents having the greatest influence, followed by media and then friends. Those with the least supportive stance for abortion cited ‘religious figure’ with relatively more frequency having at least some influence, and marked ‘media’ with relatively less frequency than the group with the most supportive abortion stance.

The majority of participants felt that abortion should be allowed but the circumstances under which they would have an abortion or want their partners to have an abortion varied. Those who had had sex were more likely to select abortion stances that were more supportive of abortion than those who had not had sex. Those who choose parenting often have negative views or abortion or adoption. Adolescents who value family and kinship have fewer practical concerns about costs and difficulties of parenting. Those who choose abortion have less concern for life and family and kinship. (Loke and Lam 2014)

Personal values and views of the pregnant adolescent can have a bearing on the decision they make. Those that regarded the fetus as a living being with life were more likely to carry on to parent. (Loke and Lam 2014) Two girls in the Ekstrand et al research stated: It would have been unfair – both for me and the baby (16 year old, first time pregnant) .....because it was so small, I didn’t feel it was a child or anything, but more that (the pregnancy) was a hassle since there was so much going on in school. It really wasn’t a good time… I mean, it’s not right to do it, but I still don’t look at it as ‘a life’, since it can disappear just as easily as it came. It was just, I don’t know… a clot of blood in a way. (A first time pregnant 17 year old)

Views on adoption are interesting. The idea of giving the baby to others was mostly rejected through worry whether or not their baby would be treated nicely by his/her adoptive parents. (Loke and Lam 2014) New Zealand adolescents also generally appear to reject adoption as a valid option. Personal experiences or experiences of people close to them may colour their views. There is a legacy around closed adoption in this country, though open adoption has been more favourable in recent times. Even more recently, a Home for Life is offered through CYFS (Child Youth and Family Services). Unlike adoption where the child receives a new name by the adoptive parents, when a child is placed in a Home for Life they retain their own name. A Home for Life is effectively a permanent foster care situation.

Cultural considerations are particularly relevant around adolescents’ unexpected pregnancies. Different cultures have different attitudes to age appropriate sex, premarital sex, and pregnancy out of wedlock. One study in India (Sowmini 2013) reports the experiences of 34 unmarried adolescent girls and young women aged 10-24 years, who obtained an induced abortion from a tertiary care abortion clinic in 2004, ten of whom were below 19 years of age. Only eight of the 34 girls were less than 12 weeks gestation. The reasons for delay were fear of disclosure, lack of any support system and scarcity or resources. The decision to terminate was made jointly with family members, especially the mother. Only half knew about contraception or some did not understood much about their menstrual cycles or pregnancy. Because of the conflict between wanting to have sex and feeling guilty about it, these young people experienced terrible distress in the course of their unwanted pregnancy. Of those who knew the person with whom they became pregnant 14 became pregnant with a neighbour, seven with a relative (mostly brothers in law), and five with a workplace senior. Six participants reported being coerced into sex and two were raped. Nine continued relationships because of promises of marriage given by the partner.

There may be similarities to these experiences for adolescents of Indian descent living in New Zealand. Practitioners need to be mindful of particular cultural aspects in their approach to counselling and support through pregnancy or abortion / termination decision-making.

Adolescents from Maori families, and from other cultures living in New Zealand, such as Pacific Island (e.g. Tonga, Samoa), or Asia, (e.g. China. Korea, Japan, Russia) have their own views and beliefs around adolescent pregnancy and for many becoming pregnant outside of marriage carries huge shame. To protect family honour and hide their sense of shame numbers of pregnant adolescents from these places feel they have no choice but abortion / termination. It can feel hugely difficult for those who wish to continue a pregnancy to do so without support and the advocacy of trained help.

There may be issues for those of other cultures who are non-resident and need to pay for an abortion / termination in New Zealand. Some girls or young women may be here on visas for work or study, isolated and separated from family with little support. They may not want the pregnancy known about. so opt for termination. Anecdotal evidence shows that there is currently an increasing incidence of self-abortion attempts and back street abortions occurring for this subgroup which is posing concern. These abortions are illegal and the risk of complications significantly higher.

Adolescents’ growing physiological sexual maturity is often accompanied by parental or social acceptance of their psychological maturity to act responsibly as sexual beings….. Adolescents have a greater tendency to engage in sexual experimentation than adults, including unprotected sex and concurrent sexual partners. Most adolescent sex remains unprotected worldwide… A deplorably high proportion of adolescents and particularly females, are vulnerable to sexual abuse and exploitation of dependency, so that their participation in sexual acts is non-consensual even when non-violent….. (Cook et al 2007)

Teenagers are unprepared to face or to deal with an unexpected pregnancy. Adolescents do not necessarily possess the cognitive ability needed to clearly evaluate such a situation or to determine how to resolve their pregnancy. On discovering that they are pregnant, some make the immediate decision to terminate the pregnancy without considering other options. …When facing an unexpected pregnancy, teenage girls experience fear, confusion, guilt and worry; some even deny the existence of the pregnancy. The fear of being stigmatised may prevent them receiving early advice. (Loke and Lam 2014)

With regards to adolescents making informed choice there are questions around an adolescent’s competence to make such a life-changing decision. What criteria might one use to gauge such competence?

Ambuel and Rappaport (1992) provided the most direct evidence regarding adolescents’ versus adults’ competence with respect to abortion decision-making. Patient’s interviews with a pregnancy counselor were evaluated on four indicators of competence:

a. Volition, or the voluntary and independent nature of the decision

b. Global quality of reasoning

c. Awareness of consequences of the decision – future life perspective

d. The types of considerations expressed regarding the decision.

Their findings were that neither younger nor older adolescents considering abortion differed from legal adults on any of the components of competency. Among patients not considering abortion, there was no difference in competency between those ages 16-17 and those ages 18-21, but the youngest adolescents who planned to carry to term were significantly lower in volition, awareness of consequences and global quality of the decision. The findings of Ambuel and Rappaport are consistent with the view that adolescents seeking abortion are relatively more capable than their peers of making an informed choice.

In my experience as a counsellor my sense is that it would take quite some time in relationship with a young person to truly determine individual level of competence. How someone presents on a given day is not necessarily the sum total of their functioning or ability to fully reason or process situations, or uncover deeper motivations and meanings. One of the big questions is how well in effect does the young person understand the consequences of whatever decision they make? This remains a topic for discussion.

The impact of negative discourses about teenage pregnancy from others was identified as a significant issue. Fear of being seen as a “typical teenager who’s got pregnant and doesn’t care about anything.” Those considering termination of pregnancy often view teenage pregnancy negatively themselves. One teenager with a child commented that she had to prove she can be a good mum, as it is assumed that teenage mums do not do anything with their lives. If teenagers identify with negative stereotypes, this may lead to them caring less or not having a good future. (Erkstrand et al 2009)

It was weird. I became so influenced by everyone else. I never had the chance to actually sit down and think it through properly… Everyone was really against it… Since I was so insecure, I wanted to hear both positive and negative stuff from my family, rather than just the negative…. I was the only one being optimistic about it. (17 year old, first time pregnant)

Social norms and the negative attitudes of family and friends can strongly influence a pregnant adolescent’s decision, as can concern about impact on others especially impact on boyfriend and family. Generally partners and parents are regarded as the most important sources of influence or support.

Teenagers were more likely to approach their boyfriend or the father first. Relationship with the putative father greatly influenced their pregnancy decisions. One study reported that young boys usually do not know how to handle the situation when faced with the news of their girlfriend’s pregnancy… boyfriends when hearing the news from their impregnated girlfriends grumbled, denied, or even left the girls. (Loke and Lam 2014) The absence of the father was usually important. Some do not want the father in the picture, others feel without the father they would not have enough support. (Bell et al 2013)

The partner involved in the pregnancy was the most consulted by the young women during the decision-making process. A few women wished their partners had been more present throughout. One 16 year old girl said If he’d been there, I’m sure he’d have a better understanding of what I was going through! …A small number who had partners supportive of continuing the pregnancy, did not view this as a real option, partly because of concerns over the risk of ending up in an unequal position in relation to the partner. Some were pressured by partners. In a way I felt forced into the decision, I didn’t want to do it. He (the partner) was more pushing towards an abortion than I was… But I kind of had to put the feelings aside and try not to think about it… I realized we did the only right thing. (20 year old, second abortion) Without the partner’s support and agreement on how to cope with eventual parenthood, women viewed abortion as the only reasonable solution; as a result, they felt torn between their partner’s wishes and their own. (Ekstrand et al 2009)

The attitudes, relationships and support of parents may put pressure on them about the pregnancy and contribute to their resolution decision. What parents thought mattered…. Scared if they went mad. Worried they wouldn’t stand by me. (Bell et al 2013) My mom was very negative! Her words echoed in my head… which kind of made me feel forced to do it. I had the abortion against my will. (18 year old, first time pregnant) Not all pregnant teenagers find it possible to reveal their situation to their parents. Since my parents are immigrants and Muslims, it was totally out of the question for me to tell them about the pregnancy… They would have turned me away if they’d known. I felt I was forced to choose between my family and my unborn child. (An 18 year old, first time pregnant) (Ekstrand et al, 2009)

In 2014 a study by Ralph et al revealed the role of parents and partners in minors’ decision making around unplanned pregnancy. Younger minors 10-15 were more likely to have informed parents than those over 17 years of age. Minors who indicated their partner was supportive of their decision were less likely to report maternal awareness. Other factors, including the young woman’s race / ethnicity, attitudes towards abortion and characteristics of pregnancy were not significantly associated with maternal awareness. Among minors whose mothers were aware of their decision, 93% indicated maternal support for their decision. The minor’s age, mental health history, abortion history and male partner’s support were not significantly associated with likelihood of the mother’s support. The teenagers who thought that abortion was akin to killing were 60% less likely to report that their mother supported their decision.

Practical considerations, the ability to raise a baby and financial situation are often major concerns. Own resources, and in particular financial resources were a major concern. Some would have support but did not want to rely on others. (Bell et al 2013) Most young women stressed that stable finances, a job and a potentially long-lasting loving relationship were all basic necessities to raising a child. (Ralph et al 2014) Teenagers with children already mentioned negative impacts on their child and previous pregnancy experiences as reasons for TOP. Experience of first motherhood can change attitudes to TOP. (Ekstrand et al 2009)

Future orientation. Consideration of views of the future (future-orientation) appears to play an important part in teenage girl’s decisions to continue with a pregnancy or not. In a study exploring pregnant teenagers’ views of the future and their decisions to continue or terminate their pregnancy the termination group had more clearly developed and longer term plans for the future with a focus on career and desires around family. There is a sense that there was an expectation with termination of pregnancy that they would be more likely to get the life they wanted. (Bell et al 2013)

Adolescents often present late to medical or health professionals around a suspected pregnancy for various reasons that might include: inappropriate information or referrals, logistical difficulties such as getting to appointments, not being able to rely on the absence of regular menstrual cycle to signal a pregnancy or failure to recognise early signs of pregnancy, ambivalence about whether to continue the pregnancy or not once confirmed through a pregnancy kit test, or prolonged denial of being pregnant when testing positive. Some may also have an unconscious desire to not be put in a position to have to choose abortion / termination and so may delay organising a medical appointment or scan in the hope that it might be too late to have an abortion / termination. (Cook at al 2007)

Pregnant adolescents appear to use distancing, and teenagers in the TOP groups distance themselves from the ‘pregnant teenager’ stereotype by emphasising that they do care and have plans. Whilst teenagers often use distancing to cope with negative stereotypes, this may impact on help-seeking regarding their pregnancy, if they will not come forward as a ‘pregnant teenager’. After the abortion, combined feelings of sadness, relief, regret and emptiness were dominant. Some women were worried they might not be able to become pregnant again. Many were not prepared for what they would experience. After the abortion, the women felt pressured by contraceptive counsellors to use highly effective contraceptives despite their previous negative experiences or worries about side effects. (Ekstrand et al 2009)

In conclusion. The issues around adolescent pregnancy and abortion are complex. It is impossible to make gross generalisations, as there are many facets, and aspects of a given situation to consider. Assessing the young person’s competence to make such a decision, looking at family and other relationships with a view to disclosure wherever possible, exploring cultural aspects, future orientation, personal values and beliefs, confronting and working with ambivalence, and providing all relevant information and support through the decision-making time is essential, to ensure the young woman does not make a decision that she might later regret, or is unprepared for what an abortion/termination might mean, not just in the short term but also later in her life.

In our post abortion healing work, our task is to help the client unpack the abortion / termination experience, including the decision-making time as it was then, and what it means for her now. The clients who terminated a pregnancy when young, may present soon afterwards, in which case they need to be able to share their story in a safe place and need emotional holding and support to work through initial reactions. Many young people will not engage in ongoing therapeutic counselling immediately after an abortion / termination, as the drive to restore stability and re-engage with their lives is invariably strong. If they present months, years or decades after the experience, it is often as real and raw as the time the abortion / termination occurred. Supporting and allowing grief and dealing with trauma are important for her to integrate the experience and move on in a more healthy way.



BIBLIOGRAPHY

Adler NE, Ozer EJ, Tschann J, Abortion among Adolescents, American Psychologist 2003, 58 (3):211-217

Altshuler AL, Gerns Storey HL, Prager SW, Exploring abortion attitudes of US adolescents and young adults using social media, Elsevier, Contraception 2015, 91:226-233

Anderson J, American College of Pediatricians, Parental Notification/ Consent for Treatment of the Adolescent, Revised 2010

Aruda MM, McCabe M, Burke P, Litty C, Adolescent Pregnancy Diagnosis and Outcomes: A Six Year Clinical Sample, Journal Pediatric Adolescent Gynaecology 2008, 21:17-19

Bell ER, Glover L, Alexander T, An exploration of pregnant teenagers’ views of the future and their decisions to continue or terminate their pregnancy: implications for nursing care, Journal of Clinical Nursing 2013, 23:25032514

Brown S, Is counsellling necessary? Making the decision to have an abortion. A qualitative interview study, The European Journal of Contraception and Reproductive Health Care, 2013, 18:44-48

Cook RJ, Erdman JN, Dickens BM, Respecting adolescents’ confidentiality and reproductive and sexual choices, International Journal of Gynaecology and Obstetrics 2007, 98:182-187

Dobkin LM, Perrucci AC, Dehlendorf C, Pregnancy Options Counseling for Adolescents: Overcoming Barriers to Care and Preserving Preference, Curr Probl Pediatr Adolesc Health Care 2013, 43:96-102

Ekstrand. Tyden T, Darj E, Larsson M, An Illusion of Power: Qualitative Perspectives on Abortion Decision-Making Among Teenage Women in Sweden, Perspectives on Sexual and Reproductive Health, 2009, 41(3):173-180

Loke AY, Lam P, Pregnancy resolutions among pregnant teens: termination, parenting, adoption?, BMC Pregnancy and Childbirth 2014, 14:421

Ralph L, Gould H, Baker A, Greene Foster D, The Role of Parents and Partners in Minors Decisions to Have an Abortion, The Journal of Adolescent Health, 2014, 54:428-434

Somini CV, Delay in termination of pregnancy among unmarried adolescents and young women attending a tertiary hospital abortion clinic in Trivandrum, Kerala, India, Reproductive Health Matters, 2013 Retrieved contents online:www,rhm-elsevier.com


 
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