Predictors of Posttraumatic Stress Disorder Following Abortion in a Former Soviet Union Country

Article excerpt

ABSTRACT: One hundred and fifty women who had abortions in Belarus (former Soviet republic) were interviewed regarding reproductive history, decision-making and psychological outcomes. Positive and negative responses (including PTSD, guilt, grief, depression, anxiety/panic and emotional numbness) were assessed during the interview with the Impact of Events-R Scale to objectively measure aspects of PTSD. It was hypothesized that a portion of the sample would evidence PTSD with recognition of life, attachment, time, number of weeks of pregnancy, coercion, supported decision-making, wantedness, and age all predictive of negative responses. Forty-six percent of the sample suffered PTSD the best predictors being recognition of the life of the fetus, attachment, time since the abortion, and number of weeks of pregnancy.

INTRODUCTION

Abortion in the former Soviet Union (FSU) and in Eastern Europe is extremely prevalent, even now utilized in many regions as a primary form of birth control. The psychological and health tolls of the use of abortion in this manner have never been closely examined. Indeed it is a situation of absence of "freedom of choice" for women, but in the reverse of what is often such a cause for concern in the United States. Women use abortion in the FSU and Eastern Europe (often against their principles and desires) due to economic pressures, housing shortages, job conditions, the need for severely limited family size, and lack of availability and information about modern contraceptives.

The concept of abortion as a psychological stressor capable of causing posttraumatic stress disorder (PTSD) has been described in the literature pertaining to American samples, but has only recently been examined in regard to former Soviet Union samples (Rue & Speckhard, 1996; Remennick & Segal, 2001; Mufel, 2000). Abortion turning from coping mechanism into posttraumatic stressor causing PTSD along the lines of the Diagnostic and Statistical Manual of Mental Disorders IV (APA, 1994) has been described in clinical and research writings by many authors (Bagarozzi, 1994; Barnard, 1990; Butterfield, 1988; Forst, 1992; Ney, 1982; Speckhard, 1987). When acting as a traumatic stressor, abortion is perceived as involving the death of a human being or a threat to bodily integrity. Flashbacks, strategies of avoidance and hyperarousal ensue, and when these combine to interfere significantly with life functions, causing impairment for duration of longer than 1 month, PTSD is diagnosed (Speckhard & Rue, 1992). Chronic and delayed PTSD reactions to abortion have also been described in the literature.

This study set out to examine the unique psychosocial stressors reproductive conditions in the former Soviet Union create for women. One hundred and fifty anonymous, semi-structured interviews were completed in Belarus, a former soviet republic (in urban and non-urban areas). These interviews included a reproductive and sexual history, questions about contraceptive knowledge and use, emotional and psychological responses to abortion, including a measure of posttraumatic stress symptoms. The authors were interested to learn, among other things, if abortion in a context of complete availability, with extensive social acceptance and little political controversy (i.e. absence of protestors), would still act as a traumatic stressor. If so, we were interested to learn if the presentation of abortion-related PTSD would be similar to or differ from that described in American samples. Measures similar to those used in American studies of abortion acting as a traumatic stressor (i.e. Impact of Events-R Scale) were used making cross-cultural comparisons possible (Weiss & Marmar, 1995). This paper describes the results of the study in regard to post abortion trauma.

METHOD

Sample and Procedures

One hundred and fifty women were recruited for anonymous semistructured interviews about their reproductive histories, experience with abortion and present psychological state. …