Emotional sequelae of abortion: implications for clinical practice

For women in therapy who have had abortions, an exploration of the context and aftermath of each abortion has been suggested. This inquiry should include: characteristics of the woman herself before and at the time of the abortion, the nature of the interpersonal and cultural milieu at the time, characteristics of the medical environment and procedure, and any events subsequent to the abortion that may evoke regrets about the earlier decision.
Whether or not such an inquiry results in the identification of unresolved issues surrounding the abortion, it is likely to enhance one's general understanding of the client. Exploring a woman's decision to have an abortion can bring into relief developmental and family issues, relationship conflicts, and her aspirations for education, work, and family. A woman's approach to establishing and asserting her priorities and values in making difficult personal decisions becomes clear as does her ability to tolerate and resolve the ambivalence inherent in making difficult decisions.
In psychotherapy, it is important to understand and address those aspects of experience that women have difficulty resolving. Hence, the emphasis on categories of experience that may have a negative impact on a woman's emotional well-being after abortion. Nevertheless, the clinician should remember that even women who report negative post-abortion sequelae overwhelmingly report that they feel that the decision was the right one for them. Having ambivalent feelings to resolve does not necessarily mean that one has made a wrong choice, only that one has made an emotionally significant choice with far-reaching personal implications, in a sociocultural environment that reinforces the ambivalence inherent in such decisions.     

A COMPARATIVE STUDY OF RECIDIVISTS AND CONTRACEPTORS ALONG THE DIMENSIONS OF LOCUS OF CONTROL AND IMPULSIVITY

The research examined personality differences between repeat aborters, initial aborters, and nulliparas. A review of the literature in the area has documented the demographic characteristics of women who continually seek repeated abortion. This study was an attempt to differentiate between women who contracept from those who seek abortion repeatedly on the basis of personality differences. The findings indicate that repeaters who seek abortion at the time of personality testing perceive themselves low in impulsivity, a finding similar to that for women who have never been pregnant and are seeking contraceptive services. Results are examined from the perspective of inaccurate vs accurate self-perceptions. No differences were found with respect to locus of control.     

Women's self-reported responses to abortion

The legalization of abortion in many states has allowed an alternative for women with unplanned or unwanted pregnancies who do not wish to deliver and raise their children or to place them for adoption. Of 158 women asked to recall their responses to the experience, 21% reported psychosocial satisfaction at the time of abortion, and 45% reported satisfaction several months later; over half reported an improved outlook on life, and nearly half found abortion preferable to other alternatives for future unplanned pregnancies. It may prove important to make counseling or therapy available to about 10% of women who report negative responses (guilt and confusion) to the abortion.     

The psychosocial factors of the abortion experience: a critical review

The literature on the psychosocial factors of abortion is critically reviewed. It is concluded that due to faulty methodology no general statements can be made about these factors for women receiving illegal abortions. It appears that the data showing that women receiving therapeutic abortions experienced favor- able psychological conseuqences are stronger than the data indicating negative consequences. Studies of abortion on request, which, for the most part, have been methodologically sound, indicate that the new abortion patients are mostly young, unmarried women who are not in a social position to bear and care for a child. They tend to end their pregnancies for social and economic reasons. Further, they are either not aware of or not concerned about the possibility of getting pregnant at the time of intercourse, or they have a contraceptive failure. Finally, the psychological consequences of abortion on request appear to be most1 y benign.     

The Morning After: Gender Differences In Attributions About Alcohol-Related Sexual Encounters1

Traditional sex role characteristics suggest that women may be more dissatisfied with casual sex than men. We investigated this notion by examining the reactions of women and men to a hypothetical, first-time sexual encounter. An additional factor that was hypothesized to affect reactions was the presence of alcohol, which may serve as a cue for sexual disinhibition. College students read a scenario depicting a consensual sexual encounter between two people who met at a party, and made judgments about the partners' behavior and characteristics. Four versions of the scenario varied the alcohol consumption of both characters. Results showed that men were more likely than women to find the behavior of each partner socially acceptable, to foresee a positive future for the couple as a result of their sexual encounter, and to predict that they themselves would engage in similar behavior. Although no main effects for alcohol consumption were found, alcohol consumption interacted with gender to influence judgments about the characters' sexuality. Results are discussed in terms of sex role stereotyping and the tendency of both sexes to misunderstand or misperceive each other's sexual feelings.     

Abortion as stigma: cognitive and emotional implications of concealment.

This study examined the stigma of abortion and psychological implications of concealment among 442 women followed for 2 years from the day of their abortion. As predicted, women who felt stigmatized by abortion were more likely to feel a need to keep it a secret from family and friends. Secrecy was related positively to suppressing thoughts of the abortion and negatively to disclosing abortion-related emotions to others. Greater thought suppression was associated with experiencing more intrusive thoughts of the abortion. Both suppression and intrusive thoughts, in turn, were positively related to increases in psychological distress over time. Emotional disclosure moderated the association between intrusive thoughts and distress. Disclosure was associated with decreases in distress among women experiencing intrusive thoughts of their abortion, but was unrelated to distress among women not experiencing intrusive thoughts.     

Connotative meaning of abortion and attitude towards M.T.P

Acceptance of India's Medical Termination of Pregnancy Bill, enacted in 1972 to liberalize abortion, has been affected by cultural and psychological factors. To clarify the affective meaning accorded the term "abortion," the Osgood Semantic Differential technique was used with 354 subjects from South Delhi. Attitudes toward abortion were more favorable among men than women, unmarried women than married women, women with at least 2 living children, and those with at least a high school education as opposed to less educated men and women. The 6 abortion-related factors with the highest loadings were: volition, safety, morality, evaluation, legality, and potency. Analysis of mean composite attitude scores revealed a polarity profile of concepts, with rape, infanticide, promiscuity, and premarital abortion eliciting negative association and physician, baby, small family, and marital relationship eliciting positive associations. Of the 20 concepts that emerged from factor analysis, 2 clusters were identified: 1) goal-oriented concepts baby, doctor, small family, fertility, pregnancy, marital relationship, delivery, population control, birth control, and child as gift of God; and 2) means-oriented concepts Medical Termination of Pregnancy Act, sterilization, abortion, infertility, morbidity, premarital abortion, promiscuity, quacks, infanticide, and rape. These findings suggest that minimal use of the term "abortion" should be made when referring to the Medical Termination of Pregnancy Act, since this term provokes a negative affective meaning. Moreover, given the positive affective connation awarded doctors, more emphasis should be placed on their role in imparting health education material.     

Severity and cost of unsafe abortion complications treated in Nigerian hospitals

CONTEXT: Each year, thousands of Nigerian women have unintended pregnancies that end in illegal abortion. Many such procedures occur under unsafe conditions, contributing to maternal morbidity and mortality. METHODS: In a 2002-2003 survey of women and their providers in 33 hospitals in eight states across Nigeria, 2,093 patients were identified as being treated for complications of abortion or miscarriage or seeking an abortion. Women's abortion experiences and the health consequences and associated costs were examined through bivariate analysis. Multivariate analysis was used to examine the characteristics of women by type of pregnancy loss and to compare characteristics among three groups of women who had induced abortions in differing circumstances. RESULTS: Among women admitted for abortion-related reasons, 36% had attempted to end the pregnancy before coming to the hospital (including 24% with and 12% without serious complications), 33% obtained an induced abortion at the facility (not withstanding the country's restrictive law) without having made a prior abortion attempt and 32% were treated for complications from a miscarriage. Of women with serious complications, 24% had sepsis, 21% pelvic infection and 11% instrumental injury; 22% required blood transfusion and 10% needed abdominal surgery. The women in this group were poorer and later in gestation than those who sought abortions directly from hospitals. They paid more for treatment (about 13,900 naira) than those who went directly to the hospital for an abortion (3,800 naira) or those treated for miscarriage (5,100 naira). CONCLUSIONS: Policy and program interventions are needed to improve access to contraceptive services and postabortion care in order to reduce abortion-related morbidity and mortality.     

The Experience of Genetic Counselors Working with Patients Facing the Decision of Pregnancy Termination after 24 Weeks Gestation

Prenatal genetic counselors are health care professionals who counsel women making reproductive decisions which include decisions such as terminating pregnancies due to fetal anomalies. Little is known about the experiences and practices of prenatal genetic counselors working with women who have the option of termination after 24 weeks gestation. In this national survey of 168 genetic counselors who have practiced prenatal genetic counseling, we asked about their general practice patterns, including indications for which termination is offered and types of abortion care services that are coordinated by genetic counselors. We report respondents’ self-assessments of level of understanding of federal abortion law and abortion procedures. Seventy-six percent of respondents have offered and counseled on termination after 24 weeks and 93% of respondents believe it is the responsibility of the counselor to discuss this option with patients. However, one-third report that they have some or no understanding of the procedures and three-quarters report that they have some or no understanding of federal abortion law. The results of this study provide insight into knowledge and experiences of genetic counselors working with these patients, allowing for improved genetic counselor training and continuing education to provide better guidance and develop more effective means of assisting patients.     

Emotional response to abortion: a critical review of the literature

Anti-abortion groups in the US cite the existence of a post-abortion syndrome--a sense of loss, emptiness, and grief similar to that reported by trauma survivors. Although research on the longterm effects of induced abortion is marred by methodological errors, most studies have found no adverse psychological sequelae; rather, there appears to be a sense of relief and opportunity for personal growth. Nevertheless, there is a small group of women who do experience emotional distress after abortion and it is important to identify the demographic, social, and psychological factors that place women at risk of such a reaction. In terms of demographic factors, young age (adolescence), low or nulliparity, 2nd-trimester procedures, and Catholicism have been characteristics of women who suffered post-abortion depression. Of the social variables that have been examined, a lack of support from significant others (parents or partner) has been linked in some studies to emotional distress after abortion. A relatively consistent finding is that women who feel coerced to abort or are ambivalent about their decision at the time of the procedure are most likely to experience regret, depression, and anger. Women whose coping style involves avoiding responsibility are also prone to post-abortion distress. As noted, the literature does not support the contention that abortion causes longterm trauma. On the other hand, given the fact that 1.5 million abortions take place each year in the US, the existence of some post-abortion distress in even as small percentage of acceptors is enough to indicate a need for pre- and post-abortion counseling to help women determine the meaning of the experience and own their decisions.     

Reasoning in the personal and moral domains: Adolescent and young adult women's decision-making regarding abortion

The present investigation of adolescent and young adult women's reasoning, and decision-making about abortion was conducted to determine whether reasoning about abortion could be described by moral, social-conventional, and personal concepts and to examine relationships between domain of reasoning and action choices. Seventy single women, ranging in age from 13 to 31 and divided between 25 women having abortions, 23 women continuing their pregnancies, and 22 never-pregnant women, were administered a semi-structured clinical interview about abortion and two hypothetical moral judgement dilemmas. A classification task was developed to provide an additional measure of reasoning in different domains. Another 29 single, first-pregnant women provided a comparison of the effects of these procedures on decision-making. Content analysis of the protocols revealed that responses to the abortion interview could be reliably distinguished between concepts of morality and personal issues and their coordination or lack of coordination. Subjects treating abortion as a moral issue were more likely to continue their pregnancies while subjects treating abortion as a personal issue were more likely to obtain an abortion. Differences in reasoning between pregnant and nonpregnant subjects were not observed. Moral responses to the abortion interview were found to be highly related to hypothetical moral judgments.     

Body Image and Self-Esteem Across Age and Gender: A Short-Term Longitudinal Study

This study examined the relationship between body image and self-esteem across time and age for men and women. Participants were 150 men and 239 women aged between 20 and 86 years (M?=?59.73), recruited from the general population in Australia. They completed a questionnaire assessing self-esteem, body dissatisfaction, body importance, and a range of other domains of life satisfaction at baseline and 2 years later. Cross-sectionally, we found that higher self-esteem was associated with lower body dissatisfaction, but there was no consistent relationship between these variables across time for age and gender. Women were more dissatisfied with their bodies than men; yet, men placed greater importance on their appearance than women, and also reported high levels of body dissatisfaction.     

Locus of control and decision to abort

The relationship of locus of control to deciding on an abortion was investigated by administering Rotter's Locus of Control Scale to 118 women immediately prior to abortion and 2 weeks and 3 months following abortion. Subjects' scores were compared across the 3 time periods, and the abortion group's pretest scores were compared with those of a nonpregnant control, group. As hypothesized, the aborting group scored significantly more internal than the general population but no differences in locus of control were found across the 3 time period. The length of delay in deciding to abort an unwanted pregnancy following confirmation was also assessed. Women seeking 1st trimester abortions were divided into internal and external groups on the Rotter Scale and the lengths of delay were compared. The hypothesis that external scores would delay the decision longer than internal ones was confirmed. The results confirm characteristics of the locus of control construct and add information about personality characteristics of women undergoing abortion.     

Judgement Accuracy in Body Preferences Among African Americans

Perceptions of body size vary by gender and ethnicity. Women are more dissatisfied with their bodies than are men and Caucasian women are more dissatisfied with their bodies than are African American women. The purpose of this study was to examine if African American men and women accurately estimate the level of thinness preferred by the opposite gender. We predicted that African American women would correctly estimate the level of thinness found attractive by African American men, thereby providing support for the explanation that African American women are partially protected from experiencing similar levels of body dissatisfaction as Caucasian women do because they correctly estimate that African American men like larger women. Participants were 68 African American women and 34 African American men. The results supported our prediction, African American women accurately estimate the level of thinness preferred by African American men.     

Sexual Dissatisfaction in a Sample of Married Iranian Women

This article investigates the sexual relationships of dissatisfied couples from the viewpoint of the female spouse. There are two basic approaches toward sexual dissatisfaction: the first regards sexual dissatisfaction as the cause of marital dissatisfaction; the second asserts that marital dissatisfaction leads to sexual dissatisfaction. This study aims at an understanding of the causes and mechanisms of women’s sexual dissatisfaction and its relationship to marital dissatisfaction. The research was organized using the Grounded theory for a holistic and deep understanding of the phenomenon. Findings drawn from the interviews with 20 severely sexually dissatisfied women indicated a discrepancy between the attitudes of men and women toward sexual relationships. This difference builds a sense of sexual inequality amongst women. This is accompanied by an increased importance of sexual satisfaction compared to the past, or “sexualization” of marital relationships and the resulting sexual dissatisfaction within women. Our study suggests that marital dissatisfaction may precede and cause sexual dissatisfaction and that this link ultimately becomes reciprocal.     

Interrole conflict among married women: The influence of husband and wife characteristics on conflict and coping behavior

The present research investigated the conflict that women experience between their home and nonhome roles. All of the women in the sample (N = 115) were married and living with their husbands, had at least one child living at home, and were college students. It was found that women who placed a similar level of importance on work as their husbands experienced less intense conflict than women who differed from their husbands in career orientation. In addition, the number of children at home was positively related to a woman's conflict when her husband was highly work oriented. A woman's use of reactive coping strategies was negatively related to her life satisfaction when her husband was dissatisfied with his own life.     

Psychological factors related to post-abortion 'subtle' contraceptive unreliability

The psychological functioning of 29 women who had successfully prevented conception during four years after an induced abortion was studied, focusing on those who were using less effective contraception methods and who were less regular and responsible in birth control, i.e. who were "subtly" unreliable in the use of contraception. These women were found to be less compentent also in their work, to have a lower emotional stability and self-esteem, to be less realistic about life and to have a less satisfying sexual relationship with less open communication. Key words: contraceptionlpsychology abortion, induced .     

Ethnicity and body dissatisfaction among women in the United States: a meta-analysis

The prevailing view in popular culture and the psychological literature is that White women have greater body dissatisfaction than women of color. In this meta-analysis, 6 main effect sizes were obtained for differences among Asian American, Black, Hispanic, and White women with a sample of 98 studies, yielding 222 effect sizes. The average d for the White-Black comparison was 0.29, indicating that White women are more dissatisfied, but the difference is small. All other comparisons were smaller, and many were close to zero. The findings directly challenge the belief that there are large differences in dissatisfaction between White and all non-White women and suggest that body dissatisfaction may not be the golden girl problem promoted in the literature. Implications for theory and treatment are discussed.     

The consequences of abortion legislation

This article examines the consequences of the 1973 US Supreme Court decision legalizing abortion as well as potential implications of proposed legilation aimed at nullifying this decision. In addition to giving women the right to determine their own reproduction, legal abortion had had beneficial health effects for both mothers and infants. The partial reversal of abortion gains due to restrictions on public funding and limitations on how and where abortions can be performed has produced a slight increase in abortion mortality, but the impact has not been dramatic. Moreover, each year since 1973, women have been obtaining abortions earlier in pregnancy. Abortion may be experienced as a loss by the mother, but there is no evidence of serious psychological sequelae. In contrast, a large body of evidence supports the physical, psychological, and social benefits of legal abortion to women, children, and families. However, proponents of the proposed Human Life Amendment place protection of the rights of the fetus over all other considerations. Their antiabortion actions have challenged the medical tradition of privacy and the confidentiality of the doctor-patient relationship. Most supporters of legal abortion would prefer that there be fewer abortions; such a decrease is more likely as a result of better education and contraceptive methods rather than coercion.