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Saturday, June 12, 2010

How do women feel after an Abortion? Relieved.

What's the most common feeling reported by women after an abortion? Relief. Yes. Really. And you thought it was something negative. Just shows how you've bought into the anti-choice views of abortion. I don't blame you. That is the version seen most often in pop culture. But let's look a little deeper, shall we?

There's some great reading on this from the World Health Organization, in a report called "Mental Health Aspects of Women's Reproductive Health: A Global Review of the Literature." Published in 2009, this is a fantastic resource for anyone looking for the best current information on abortion and mental health.

One thing I really like about this report is its balance. Count on WHO for that. As I've mentioned before, sources are important. The report notes that the conditions under which women become pregnant and seek an abortion matter to their emotional health afterwards. This makes sense. A woman who conceives under conditions of violence will feel differently than one who did not. A woman seeking an abortion in an atmosphere where it is illegal and unsafe will feel differently than a woman who seeks an abortion where it is legal and safe. The report finds more is known about women's emotional health in developed countries and in countries where abortion is legal. This makes sense too because it's more difficult to do research in an environment where abortion is clandestine. And it finds that even where research exists, there are flaws such as "methodological problems [which] have included ideologically motivated research seeking to demonstrate that abortion is either harmful or benign, and a relative scarcity of rigorously designed studies." (p. 54) Also, research into mental health outcomes has been overshadowed by research into physical health outcomes which are seen as a priority particularly in areas where abortion is unsafe. Given all of the problems and lack of data, what do we know for sure? For sure, we know we need more research. But what else?

We know for sure that most women do not regret their choice. "In a study of 386 American women, Cozzarelli et al. (2000) found that depression scores were significantly lower, and self-esteem scores significantly higher, at two hours, one month and two years after abortion, compared with some hours before the abortion. One month after abortion, mean scores indicated that women felt more relief than positive or negative emotions, and overall more positive emotions than negative emotions." (pp. 54-55).  And regarding adolescents, specifically,  "Eisen & Zellman (1984) reported similar findings: 80% of 148 adolescents who had an abortion reported satisfaction with the decision six months later" (p. 55). From the summary, "Typically, women (including adolescents) experience heightened distress facing a problem pregnancy and prior to safe elective abortion, but show significant improvement on mental health indices afterwards" (p. 55).

Wow. Relief. Most women report feeling relieved. What a relief. Let the bells ring out. At least for these American women. Again, it could be really different for someone else in another study, who terminates under different conditions, perhaps facing poor care in a situation where the procedure is illegal.

But wait, there is more. And in my fairmindedness, I will share it with you because it deserves examination. "However, 10.8% reported that they felt dissatisfied and had made the wrong decision. At two-year follow-up, the number of women reporting dissatisfaction had increased to 16.3%, and 19% said that the abortion was the wrong decision." (p. 55) Some anti-choicers use this to validate something they call some version of "post abortion syndrome."

First, before I really take this up, I want to emphasize and take heart in the fact that the vast majority of women feel RELIEF. It's normal. And look at another website I really like called "I'm Not Sorry," where women share their stories of abortion and aren't sorry.

Let's play a little game. It's called "Invent a Bogus Syndrome." It's fun. Are you ready?

According to the same report by WHO, there is considerable evidence to suggest there is a negative psychological impact of bearing an unwated child. "A rigorous, longitudinal study in the Czech Republic to examine the effects of denied abortion (David et al., 1988; David, Dytrych & Matejcek, 2003; Kubicka et al., 2003) found that women go to great lengths to obtain an abortion when one is initially denied. A significant minority of women who were twice denied abortion in a pregnancy experienced difficulties with longterm adjustment and mother–infant attachment and their children had higher rates of long-term, adverse developmental and emotional consequences than those born to a matched cohort of mothers who desired the pregnancy... [Others have] made similar observations in a 50-year study of unwanted babies in Quebec, Canada." (p. 53). Given this, let's invent a syndrome, and call it "post abortion denial syndrome." We can say that there is evidence to support it. The syndrome makes it difficult for women denied the right to choose to bond with their children. Now, let's get more money to do more research to validate the findings further.

Of course, this is as bogus as claiming that there is a "post abortion syndrome" and women are traumatized by their decision to terminate. See what I'm getting at?

We can't take the statistical edges of a group and call them the statistical centre. There is simply no evidence in any longitudinal study done anywhere that this invented "post abortion syndrome" is real. It's as bogus as the "post abortion denial syndrome" I just invented.  But that doesn't mean that some women don't feel regret. And it doesn't mean that women who are forced to continue unwanted pregnancies don't face psychological problems afterwards.

Just because these two groups of women are statistically small, doesn't mean they should be completely ignored. I'm concerned about both of them. The way to help the second group, the group who are forced to carry unwanted pregnancies to term, is to ensure all women have choice. But what about the statistically small number of women who exercise their choice and feel regret?

I say, let's do some more research and find out what happens to them in that time period. Any PhD students out there looking for a project? Meanwhile, I'm going to postulate a couple of theories, because it's my blog and I can do what I want.

Firstly, given the current judgemental, vitriolic and punitive narrative about abortion, it's not surprising that women start to feel bad sometimes. There's a lot of name calling going on, sign waving, a lot of people telling women to feel bad. It has to take a toll. I might suggest to those doing the name calling and sign waving that if you don't want women to feel bad and are concerned about their post abortion mental health, stop causing their trauma.

Secondly, it's hard to look at the road not taken and not wonder about it. It's human nature to think about what might have been if we'd taken that other job, married that other guy. Women are allowed to do this in only one direction though when it comes to motherhood. If we've terminated a pregnancy, we can think ruefully about what might have been if we hadn't. We can imagine some pastoral scene of a chubby healthy child running towards us in a field of wildflowers, (like in the opening credits to Little House on the Prairie). But we are not permitted outside of our heads to think ruefully about how great our lives might have been if we had not had that baby screaming in the nursery, that teenager in drug rehab, that adult child in prison who murdered eighteen people. That is unthinkable (outside our heads). So we see a kind of "survivor bias" being expressed.

There was an interesting take on this in Slate recently, kind of tucked into an article about Tim Tebow and the anti-choice superbowl abortion ad. Survivor bias is a skew in perspective, a wearing of rose coloured glasses. Just think, says the superbowl ad, a great football player may never have been born. Meanwhile, as William Saletan points out so well in the article, other women who failed to heed their doctor's advice and chose not to terminate a dangerous pregnancy may not have had such positive outcomes. They may be dead, as may the offspring. Our bias is towards the survivor.

Thirdly, there is another way in which we look at the world with rose coloured glasses. When our lives improve, we forget how bad the bad times were. Who wants to dwell on that? I wonder how many of these women had some significant improvement in their lives in the year(s) following a decision to terminate. We have a tendency to impose current life conditions, especially if they are better, on past life decisions. If really honest about the conditions under which they made their decision to terminate, could they still see it as the right decision at the time?

But this is what I really want to say. What would happen if we women lived in an evironment that was supportive of our choice, and our right to make it? Just as the research outcomes change based on the legal environment in which choices are made, it stands to reason that one's perspective also is affected by the emotional and social and cultural environment in which a decision to terminate is made. So let's do what we can to affirm women.

And remember, the most common feeling expressed after an abortion is... relief.

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