This paper attempts to review some of the literature on the phychological sequelae of abortion, and to draw some working principles for the medical profession when faced with a request for legal termination of pregnancy. Ambivalence during the early stages of pregnancy is as common among expectant mothers as among applicants for abortion. The conflict of wanting or not wanting to interrupt a pregnancy must be resolved, preferably in a well-informed decision-making process. The psychological reactions involved during this process and after the abortion procedure are discussed. The at risk factors are also described, and pre/post abortion counseling is suggested.
Keywords: abortion, termination of pregnancy, psychological aspects, counselling, at risk factors.
Since the passing of the Abortion Law, the number of legal abortions done in How Kong has been rising while the number of child births hay been decreasing. In recent years, about 20,000 legal abortions were done, i.e.263 per 1,000 live births (Department of Health, 1991). This figure slowly follows that of the States with 346 per 1,000 for 1989 (Anonymous, 1991). The essence of the Abortion Law in Hong Kong is that termination of pregnancy can be performed legally if two registered medical practitioners are of the opinion, formed in good faith that: a) continuance of the pregnancy would involve risk to the life of the pregnant woman or of injury to the physical or mental health of the pregnant woman, greater than if the pregnancy were terminated; or b) there is a substantial risk that if the child were born, it would suffer from such physical or mental abnormality as to be seriously handicapped (Hong Kong Government, 1979). Late in 1992, the medical profession has been criticised for not giving adequate counselling before TOP (termination of pregnancy), which may lead to extreme guilt in women after abortion (South China Morning Post, 1992). This paper attempts to review some of the literature on the psychological sequelae of abortion and to draw some principles for reference by the medical professions when faced with a request for legal TOP.
EMOTIONAL REACTIONS TO PREGNANCY
The first few months of pregnancy are often described as a period of heightened emotional sensitivity, of elation and depression, of irritability and aggression (Baker, 1967; Caplan: 1961; Horobin et al, 1973; Kaig & Nilsson, 1972). Caplan (1957) reported that 80% of women expecting their first baby admitted conscious feelings of marked disappointment and anxiety when they found out they were pregnant. Bone (1973) reviewed that one-third of pregnancies of married women or women living in a stable cohabitation was unplanned. When faced with an unplanned pregnancy, a woman has to face the following stresses:
1. Financial problems and the arrangements for care of the new-born;
2. Readjustment of role to motherhood;
3. Fear for the unknown future of the unborn child;
4. Re-examination of her close relationships; and
5. To choose between career/study and baby care at home.
Nevertheless many who are initially horrified by their pregnancies eventually accept them willingly and cope successfully with motherhood (Breen, 1975).
PSYCHOLOGICAL, REACTION & FACTORS INVOLVED IN DECIDING OF TERMINATION OF PREGNANCY
If totally unprepared for an undesired pregnancy, a woman has to face the option of either continuing or terminating the pregnancy. During this decision making process, she may feel lost, confused, fearful, guilty, angry, agitated. depressed, helpless and hopeless. Such depressive symptoms during this period are often associated with poor family relationships, communicating difficulties with male partners, adverse pregnancy symptoms, contraceptive use and denial of the pregnancy (Bluestein & Rutledge, 1993).
In fact, two types of factors may influence a woman's decision on abortion (Osofsky & Osofsky, 1973):