Negative Abortion Experiences: Predictors and Development of the Post-Abortion Psychological and Relational Adjustment Scale

By Coleman, Priscilla K. | Issues in Law & Medicine, Fall 2018 | Go to article overview

Negative Abortion Experiences: Predictors and Development of the Post-Abortion Psychological and Relational Adjustment Scale


Coleman, Priscilla K., Issues in Law & Medicine


Introduction

The U.S. abortion rate has steadily declined over the last several decades; however just under 20% of pregnancies still end in abortion each year (Finer & Zolna, 2016). Despite how common elective abortion is in the population, for a significant percentage of women, abortion marks the beginning of a tumultuous journey colored by feelings of regret, loss, sadness, depression, anxiety, suicidal behaviors, and alienation from others (Coleman, 2011; Dingle, 2007; Fergusson, Horwood, & Boden, 2008; Kero, Hogberg, & Lalos, 2004; Kero & Lalos, 2000; Kero, Wulff, & Lalos, 2009; Kimport, 2012; Kimport, Foster, & Weitz, 2011; Söderberg, Janzon, & Sjöberg, 1998).

The last several decades have witnessed little debate among practitioners and academics alike regarding the well-established risk factors for heightened post-abortion mental health problems. For example, in a chapter written for the Clinician's Guide to Medical and Surgical Abortion back in 1999, Baker, Beresford, Halvorson-Boyd, and Garrity provided a table of pre-disposing factors for negative reactions that the authors recommended identifying prior to abortion to allow providers to address specific patient needs. These included belief that the fetus is the same as a 4-year-old, that abortion is murder, low self-esteem, ambivalence about the decision, intense guilt and shame about the abortion, perceived coercion to have an abortion, and commitment to the pregnancy.

In the National Abortion Federation textbook for abortion providers titled 'Management of Unintended and Abnormal Pregnancy: Comprehensive Abortion Care," Paul, Lichtenberg, Borgatta, and colleagues (2009) list the following risk factors for adverse psychological reactions to abortion: 1) commitment and attachment to the pregnancy, 2) perceived coercion to have the abortion, 3) significant ambivalence about the abortion decision, 4) putting great effort into keeping the abortion a secret for fear of stigma, 5) pre-existing experience of trauma, 6) past or present sexual, physical, or emotional abuse, 7) unresolved past losses and perception of abortion as a loss, 8) intense guilt and shame before the abortion, 9) an existing emotional disorder or mental illness prior to the abortion, 10) appraisal of abortion as extremely stressful before it occurs, 11) expecting depression, severe grief or guilt, and regret after the abortion, and 12) belief that abortion is the same act as killing a newborn infant.

Similarly, the American Psychological Association Task Force on Abortion and Mental Health described several personal and contextual risk factors for psychological distress in their report released in August 2008. The risk factors included terminating a wanted or meaningful pregnancy, feelings of commitment to the pregnancy, ambivalence about the decision, low perceived ability to cope, pressure from others to abort, opposition to the abortion from partners, family, and/or friends, and a lack of social support from others. Finally, Coleman (2014, 2016) reviewed the world literatures on risk factors for adverse post-abortion mental health and the more robust predictors overlapped with those described above.

A number of studies over the last four decades have documented the prevalence of several of the primary risk factors. For example, employing several variables, Belsey and colleagues (1977) reported that 68% of 326 abortion patients were at high risk for negative post-abortion psychological reactions necessitating counseling. At three months post-abortion, 72% of those identified as high-risk based on predisposing factors actually had developed adverse reactions (guilt, regret, disturbance of marital, sexual, or interpersonal relationships, or difficulty in coping with day-to-day activities). In Allanson and Astbury's (1995) study, 65% of the women believed that someone would suffer if they continued the pregnancy, 35% reported others advised termination, and 20% reported they considered other people's opinions in their decision. …

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