Abortion Trauma in the Context of Our Current Social and Political Landscape.

New Frontier In Health Care

Abortion trauma is a serious mental health issue that frequently destroys relationships and shatters families. However, with historic parallels to both post traumatic stress disorder (PTSD) and child sexual abuse, it is an unsustainable diagnosis in the current political climate.

Neither PTSD nor child sexual abuse were new traumas, but it took a social movement in conjunction with health professionals willing to explore and advocate for their recognition, before the reality of these traumas was accepted.

Lack of Political Will
Contemporary society and most of the medical profession now regard abortion as an essential tool to combat social ills.

This approach has led to a general denial among medical professionals of any substantial negative aspects of abortion. In particular medical literature has trivialized abortion trauma to the point where it is seen as a contentious issue. As one doctor stated, ‘To speak of abortion trauma is professional suicide.’

The ongoing tragedy of not listening or responding to the needs of traumatized women and men is that we have failed to learn. Even more disturbing, we now have a situation where the manifestations of abortion trauma are being used to promote the need for abortion.

Major Mental Health Issue
South Australian statistics indicate that by the age of forty, one in three women have experienced at least one abortion¹, thus giving our communities a saturation level that makes abortion trauma a major mental health issue even if, as often claimed, the traumatised represent only a minority.

At present understood to be a type of PTSD, abortion trauma generally has a delayed presentation, often manifesting as a cocktail of self-destructive behaviours, relationship problems, mental health issues and replacement pregnancies, leading to either repeat abortions or what is termed the ‘atonement child’

The cardinal features are denial and suppression, meaning most women and men do not consciously connect their abortion experience with the problems they are having.

Substance Abuse
There are now at least 24 published studies linking abortion to substance abuse, including studies during pregnancies. One recent ground breaking Australian study published in The British Journal of Psychiatry (2008)² found that those who aborted were 3.6 times more likely to abuse hard drugs and twice as likely to be binge drinkers.

‘Self-medicating’ with alcohol and/or drugs is a typical coping mechanism for both women and men conflicted by their abortion experience. Australian research published in April (Pediatrics)³ showing a 40 fold increase in drug affected babies being born between 1980 and 2005 should have been a ‘wake-up call’.

However, true to a predictable mindset among our health authorities, one of this study’s authors, followed up by using the national media to call for more to be done to prevent ‘unplanned pregnancies in drug using women’. This further supports the perception of the necessity of abortion and the practice of women deemed ‘defective’, being pressured into unwanted abortions.

Institutional Denial
By ignoring growing international research linking abortion to substance abuse, suicide, depression, relationship problems, psychiatric illness, domestic violence, and premature death, health authorities have allowed current attitudes towards abortion to remain unchallenged. This has made it extraordinarily difficult for professionals to treat abortion trauma seriously. (See Recent Research)

Institutions and bureaucracies are evolving to address these growing manifestations of abortion trauma in our communities. However, unable or unwilling to confront this mental health issue, these institutions have tended to focus on the symptoms, even ‘normalizing’ these manifestations.

Their failure to identify abortion as a causative factor, has given further momentum to the culture of denial surrounding abortion trauma.

As recently as mid 2008, the American Psychological Association (APA) was still claiming, after ‘rigorous review’ of the best available science, there was no evidence that an abortion increased the risk of mental illness. They are not alone, other prominent medical institutions and publications, including Australian, have also undermined professionals developing their expertise in the area of abortion trauma.

Postnatal Depression
Nowhere is this more apparent than in the area of postnatal depression (PND), where health professionals work in close association with those providing abortion services.

A generalised term for depression following childbirth, PND has long been used to justify the claim that abortion is safer than childbirth; implicating even legal decisions regarding doctors responsibilities towards pregnant women.

However, giving birth can trigger the onset of abortion trauma and health professionals working with PND patients consistently report an over representation of women with abortion histories. While some studies support a link between PND and abortion, there has been precious little interest in further researching this relationship.

Suicide
In 1996, a landmark Finnish study alerted the international medical community to a high abortion suicide rate⁴ . This was followed by another major record linkage study of 173,000 low-income Californian women, which also found an alarming death rate associated with abortion that was still prevalent and increasing eight years later⁵ .

In 2005 a follow-up Finnish study was published⁶ . This record linkage study included records of more than 1.1 million pregnancies together with records of all Finnish women of childbearing age who died from suicide between 1987 and 2000. This study showed an average increase in the suicide rate of more than 600% in women within 12 months of an abortion, compared with within 12 months of childbirth.

This increased suicide rate applied to all age groups. However the younger women were shown to be most at risk. The largest increase was among 15 to 25 year olds, which had a more than twelve fold increased rate of suicide.

Lack of Accountability
Just as in previous generations when PTSD sufferers and child sexual abuse victims were blamed for their afflictions; so too are those suffering from abortion trauma, re-traumatized by the medical community’s lack of accountability.

Women are blamed for their poor abortion outcome. Either, it is claimed, because of their decision making ability in crisis or because of pre-existing emotional/psychological problems.

So successful has been the ‘blame the woman strategy’ that pro-choice researcher Professor David Fergusson believed the recent series of studies linking abortion to mental health issues could be attributed to previous mental health problems and so lead one of the largest, most comprehensive longitudinal studies in the world to demonstrate thus.

However, what he found convinced him, ‘… abortion was associated with increased risk of mental health problems independent of confounding factors.⁷ ’ He was scathing in his criticism of the APA’s interpretation of the research and told the Washington Times, ‘It borders on the scandalous that one of the most common medical procedures performed on women is so poorly researched and evaluated.’

Replacement Pregnancies
Abortion complications often interplay, further exacerbating the trauma. As a form of self-therapy, many women consciously or sub-consciously attempt to replace the pregnancy or ‘re-enact’ their traumatic experience.

Traumatic re-enactment is a concept most mental health professionals are familiar with, but as abortion is not considered traumatic, the connection is not made with replacement pregnancies. Unfortunately, women acting out their pain in this manner, particularly in conjunction with other maladaptive coping mechanisms, can expect harsh judgment, humiliation and enormous pressure to repeat their abortion experience.

Australia has a repeat abortion rate of 37%. For those under thirty it is nearly 50%⁸ , clearly indicating that a lack of contraception education is not the issue.

With an estimated annual abortion rate of 90,000, each year 33,000 women are exposed to repeat abortions.

Research consistently links repeat abortions with disintegrating mental health, dysfunctional relationships and welfare dependency in women. It also doubles the risk of very premature delivery, the leading cause of cerebral palsy in children.

Pitiful indeed is the plight of repeat aborters who end up in our chemical dependency units, trying to carry a pregnancy to term. Viewed with a contempt by all, that only serves to reinforce both their own sense of self loathing and victimization, while the root cause of their trauma is too confronting for our doctors to face. It is easier to blame the woman.

Government Funding Exacerbating the Trauma
Government funding for post-abortion counseling goes almost universally to institutions involved in the provision of abortion services, clearly creating a conflict of interest and placing these services in a position to suppress deeper investigation of abortion after-effects.

In addition, the role of these institutions involves ‘de-humanizing’ the unborn, making them unsuitable to be involved in the ‘grief work’ any therapy would need to include. Such has been the experiences of those wounded by abortion, that they are usually deeply sensitive to any form of ‘denial’ relating to the loss and its impact. A lack of congruency on the part of the counselor/therapist risks further isolating and aggravating suicidal tendencies.

Limited Help Available
Pro-life organizations, which should have an interest in addressing abortion trauma, do not have the expertise, the resources or the mental health focus to grasp the seriousness and/or deal with the magnitude of the problem.

Health care institutions not involved in the provision of abortion, are better placed to deal with abortion trauma and could provide the professional support needed, but are handicapped by a reliance on information from mainstream professional bodies.

Similarly to PTSD and child sexual abuse, the healing of abortion trauma requires community support without which, the effectiveness of early intervention and therapy programs will be limited.

Abandonment of the Traumatized
Unfortunately, the media has keep the issue of abortion polarized as a ‘rights’ issue, portraying empowered women freely choosing abortion, with little or no serious adverse after-effects.

This narrow focus has encouraged the abandonment of pregnant women to whatever fate they choose and a lack of accountability on the part of both the medical profession and our communities.

Professional Isolation
Abortion trauma is creating an underclass of dysfunctional mothers struggling to raise children in a society that has little patience or sympathy for their plight. Untreated, abortion trauma has a tendency to be trans-generational. Politically powerless and isolated these mothers have little hope of accessing the recognition, support or the professional help they need.

Health professionals are routinely witnessing the ravages of abortion, but are disadvantaged by a lack of peer support and professional isolation. With the exception of Abortion Grief Australia, there is no organization in Australia working to give health and welfare professionals the support structure needed to develop their expertise in identification, early intervention, healing and prevention of abortion trauma.

 

¹ Pregnancy Outcome Unit in South Australia 2007 / Pregnancy Outcome Unit Epidemiology Branch, Department of Human Services, SA Health.
² Dingle et.al. ‘Pregnancy loss and psychiatric disorders in young women: an Australian birth cohort study’, The British Journal of Psychiatry 193,452-454.doi:10.1192/bjp.bp.108.059550,2008.
³ O’Donnell et al, ‘Increasing prevalence of neonatal withdrawal syndrome: Population study of maternal factors and child protection involvement.’ Pediatrics 2009;123;e614-e621. DOI: 10.1542/peds.2008-2888.
⁴ Gissler et.al., “Suicides after pregnancy in Finland, 1987 - 94: register linkage study” British Medical Journal; Dec 1996; Vol. 313:1431 - 34.
Gisler et.al., Acta Obsetricia ET Gynecolgica Scandinavia 76:651-657 1997.
⁵ Reardon et.al., ‘Pregnancy outcomes Associated with deaths: a record linkage study of low income women’ Southern Medical Journal 2002: 95(8):834-841
⁶ Gissler M. et.al., “Injury, Deaths, Suicides and Homicides Associated With Pregnancy, Finland, 1987 - 2000”, European Journal of Public Health; Vol.15 (5):459-463, 2005.
⁷ Fergusson et.al., ‘Abortion in young women and subsequent mental health,’ Journal of Child Psychology and Psychiatry 47:1 pp 16-24, 2006
⁸ Pregnancy Outcome Unit in South Australia 2007 / Pregnancy Outcome Unit Epidemiology Branch, Departmnt of Human Services, SA Health.