Mental Health Issues after Abortion - Research Paper Example

Mental Health Issues after Abortion Abstract Abortion is a difficult social issue, as much as it is a medical issue. Because of the impact of social belief systems, environment of the living situation of a woman, and of the support system on the way in which the event is experienced, women can suffer from an impact on their mental health after having gone through the surgery. While there is no evidence to suggest that the physical event of an abortion has any impact on the mental health of a woman, there are high levels of evidence to the impact it will have from a psychosocial point of view. Because of the high levels of shame, guilt, and socially imposed stigma on a woman for having gone through the event of an abortion, mental well-being may be disrupted as the emotions of the decision may overwhelm the coping capabilities available to her. The way in which an abortion impacts a woman is founded in the external support and the internal ability to cope that she has available. Mental health issues after abortion Introduction The issue of abortion concerns a great number of factors that involve both moral and ethical social considerations. As a medical procedure, abortion is an effective means of terminating a pregnancy with the result of little to no ill physical effects in the long term. However, do women suffer mental health issues after experiencing an abortion? While both sides of the issue have research that has validity in regard to the effects of an abortion on mental health, from a psychosocial point of view the answer of the potential for mental health being affected by the event of an abortion is clearly possible. Yes, women may suffer from an impact on their mental health from the experience of having an abortion. The effect on having done the procedure on a woman’s psychological health may create problems as her emotional state, where it concerns her reproductive health, can be affected. In addition, guilt and shame may impact her psychological profile over the long term. An abortion also has the potential of complicating an existing mental health issue through emotions that come in conflict with the manifestations of the disease. While there are some studies that show that there are little to no psychological issues after an abortion, it is more likely that such a socially controversial decision which is accompanied with enormous levels of guilt and shame will have long-term psychological ramifications on the mental health of a woman who undergoes the procedure. Reproductive emotions Miller and Green (2002) conducted a meta-analysis of 24 studies which concerned the mental health of women after they had gone through an abortion. In an inquiry that asked the question of ill effects in mental health after an abortion, their conclusion was that, “the simple answer to this question in the vast majority of cases is no” (p. 313). They furthered their broad based, simplified answers on this subject by suggesting that most women felt better after their procedure than they did while they were still pregnant. Posavac and Miller (1990) found that levels of well-being had little measurable difference between women who have had an abortion and women who have not had an abortion. Mental health differences were observed to be less than one tenth of a difference. Because of the criteria and methodologies of these studies, the conclusions found little to no difference in the mental health and well-being of women who took their pregnancies to term in comparison to those who had abortions. One of the issues in measuring post-abortion emotions is that the disruption that pregnancy causes within a woman is so extreme that differences between those who have had an abortion and those who have not had an abortion are difficult to measure. According to Hewson (2001), “Attitudes to pregnancy are, however, inextricably bound up with how society views sex, women, and the fertile woman in particular. Pregnancy and birth are not minor inconveniences…They constitute a major life event, which even when welcome causes immense discomfort and disruption to many women” (p. ii10). Women who have had children have a deep disruption in their mental well-being due to hormonal changes that effect emotional health. Therefore, in seeing that there are little differences between bringing a woman to term and those who do not, suggests that the abortion has affected the emotional well being in place of the more natural emotional developments of fully experienced pregnancy. One of the emotional illnesses in regard to pregnancy can be observed in the high incidence of post-partum depression. In 11% of all births, mothers will experience severe post-partum depression which manifests in a series of symptoms and manifestations. Women who suffer from post-partum depression are susceptible to depression, anxiety, impaired cognitive abilities, increased marital difficulties, and are more likely to abuse their children or commit infanticide (Rosenfield, 2006). Riordan (2005) suggests that the number of women who go through ‘blues’, or mild post-partum depression, has a more likely event of 70-80%. Women with deeper levels of post-partum run at about 20%. In addition, this mental state can evolve into post-partum psychosis in which a mother experiences “insomnia, irrational ideas, feelings of failure, self-accusatory thoughts, depression, fatigue, and hallucinations; sometimes, she may threaten suicide” (Riordan, 2005, p. 476). With the number of emotional problems available to consider for women who have had children, studies that compare women who have had abortions to women who have carried to term and given birth do not reflect a minimized effect of the event of an abortion on a woman. Posavac and Miller (1990) observed a one tenth difference in the mental health of women who had abortions compared to those who had carried to full term, with that one tenth represented a insignificant, but present higher degree of mental health issues in women who had terminated their pregnancies. However, when you consider that women who carry to term have as much as an 80% chance of having emotional difficulties in regard to post-partum depression manifestations (Riordan 2005), then it can be inferred that women who have had abortions are suffering because of the impact of the emotional issues surrounding the experience PAS The debate on PAS (Post-abortion syndrome) was cause for a report to be done between 1987 and 1989 by U.S. Surgeon General C. Everett Koop in which the issue was examined through investigating over 250 studies on the subject. Koop was a known pro-life supporter and had hoped to find a medical reason that abortion should be made illegal. However, The Koop Report found the issue to be unsatisfied in either direction, leaving the results to be considered inconclusive. The report did support the idea that the procedure was physically safe, but it did not conclude on the effects of the event on mental health. Those who support pro-choice sides of the issue considered this to be a victory in continuing the legal support of the right to choose (Lee, 2003, p. 116). The Koop Report discovered that the claims of the legitimacy of PAS had no real empirical support, thus there could be no real conclusion about the issue. The decision against the conclusiveness, however, must be considered for the strength needed in order to support the end of legalized abortion. The results would have to represent indisputable proof, which cannot be made when the subjectivity of its provability is in place. What the Surgeon General intended with his proof was to impact legislation, not explore the issue for the reasons of improving the nature of the well-being of women after an abortion. The impact of abortion on the mother as a subjective component to mental health means that the subject cannot be used for legislative impact, but it can be assessed for the possible complications that PAS can have on the future mental well-being and health of a woman who has experienced an abortion. Therefore, the inconclusive nature of The Koop Report does not negate PAS, but supports that it is a possible factor in post-abortion recovery. Although it cannot be used to support making abortion illegal, it should be considered in treating the post-abortion patient. PAS must be considered for its possible manifestation in women who have undergone an abortion procedural. The overall mental health of a woman is significant in coming to a conclusion about addressing issues of the development of mental illness after having had an abortion. According to Bryant (2003), the mental health issues before the event of an abortion can greatly be exacerbated in the event of the procedure. In other words, if a woman is inclined towards depression, then the event of depression is more likely after an abortion. There are a great number of variables, as well, that will affect the effects of an abortion. As an example, younger women in their teens who face an abortion more often have higher incidents of negative feelings about having gone through the experience and have a higher relationship with issues of self-esteem. The most important indicators of PAS after abortion is in understanding the psychological history and level of self-esteem before pregnancy in assessing the level of PAS after an abortion. The effect of abortion on young women There are a great number of factors that must be considered when determining the reasons behind mental health difficulties post-abortion. Needle and Walker (2008) discuss the results of a nationwide study in 1992 done by Russo and Zierk in which 5,295 women were studied in order to assess the negative impact of having an abortion on their mental health. This study came to the conclusion that there the trauma of abortion had little impact on the mental health of a woman and that socio-economic difficulties in regard to child rearing had a much higher incidence of impact on mental well-being. Needle and Walker (2007) go on to discuss in a later study in 1997 by Russo and Dabul in which 4,336 women were studied with a similar result. Women had a higher level of problems in regard to socio-economic problems associated with having children than they did with the event of having an abortion. One of the conclusions drawn by Needle and Walker (2007) is that having a child when economic circumstances are not sufficient for raising a child has a greater impact on well-being than delaying childbirth in favor of educational and career opportunities. According to Fergusson, Boden, and Harwood (2007), young women under the age of 21 who have abortions on average have a much higher educational level and attain a greater socio-economic status than those who carry their unplanned pregnancies to term. However, this study is influenced by circumstances outside of the finite incidence of abortion. Fergusson, Boden and Harwood (2007) state that “Relative to women who either had an abortion or had not become pregnant by the age of 21, those who had been pregnant but not sought an abortion tended to come from economically and disadvantaged backgrounds. They had significantly lowered intelligence scores and were significantly more likely to leave school without educational qualifications” (p. 9). The results of the study were influenced by an association between the past as it related to probable furthering of education for reasons that were irrelevant to pregnancy. Therefore, to suggest that women are better off educationally and financially solely because they chose an abortion rather than carrying their child to term is created through false associations that do not take into consideration all aspects of the socio-economic opportunities available for women when they become pregnant. Incidents of PAS must then be understood for being a part of an overall collection of circumstances in which the mental health and well-being of a woman is the result of her position in life. The kind of support that exists at home can be a great influence on the way in which abortion affects the mental health of a woman. According to Bryant, (2003), “independent women who did not feel the need to have the approval of family members, partners or friends but had mutually supportive relationships with stable partners were least likely to experience post-abortion distress (p. 270). However, the described circumstance is not the common position of a woman. That kind of independence from the social influences of her family and support of a partner with whom she is in a stable relationship is not the more common set of dynamics for a woman who feels the need to abort. In 1991, Rodman discussed the issue of the legal issue of whether or not young women under the age of consent should need parental consent in order to obtain a relationship. The issues raised concern the reaction of the parents to finding out that their child has become pregnant. The reaction can range from support to physical abuse, thus putting the child/woman in the path of an unpredictable support system. This speaks to the core of the issue. The mental health of a woman is predicated on the social atmosphere in which the decision to abort is made. According to Needle and Walker (2008), a study done by Fergusson Horwood and Riddler in 2006 suggested that abortions in young women led to increases in mental health issues later in life. This is primarily due to the impact of secrecy, shame, and guilt upon young women due to the pressures involved in the societal problems associated with the moral and ethical nature of abortion is it relates to the way in which her family supported her during the incident. Mental illness due to abortion According to Ussher (2000), “abortion occurs in a stressful context; it can be difficult to disentangle psychological effects of pregnancy - wanted and unwanted - from abortion” (p. 437). The effect of society on the fact of pregnancy, the way in which it is accepted, represented, and influenced by the socially constructed traditions of belief and habit where it is involved, must be considered for the event of abortion as it affects the woman who must go through it. Ussher (2000) goes on to say that “It is important to remember that the meaning of abortion is socially constructed. This common experience in women’s lives can be made to seem wrong and shameful, and women in turn can suffer from this social construction” (p. 437). Meaning is relevant to the way in which a woman sees her reproductive place within society, and in the context of that meaning, aspects of mental illness can be created or exacerbated due to the pressures that are involved. Therefore it is through a psychosocial lens that understanding the impact of abortion on mental health must be examined. Newman and Newman (2009) state that a “factor related to post-abortion adjustment is a woman’s views about the acceptability of abortion within the cultural context of her family’s and community’s beliefs” (p. 126). They go on to state that “For women whose support systems do not sanction abortion, the decision to have an abortion is likely to be associated with strong negative emotions” (p. 126). The impact of the social belief systems as they relate to mental health is to create a quagmire of emotional difficulties that can feed mental health problems and, furthermore, create those problems when the belief systems within the community of a woman cannot be internally reconciled with the choice to abort (Fergusson, Boden, and Horwood, 2007, p. 11). Discussion and further study While there is not conclusive proof of a specific consequence of mental health problems post-abortion, there is enough evidence of its influence on mental health as it relates to social and existing issues to suggest that abortion contributes to the poor mental health of many women who go through the experience. While it does not serve as a medical reason for which to make abortion illegal as it is not a predictable consequence for every woman, there is enough evidence to support that it does not have a positive impact on mental illness issues and in some instances can be the cause of problems of mental well-being. The similarity in the figures between women who take their pregnancies to birth and those who have abortions suggest that abortion has an impact on mental health because of the provable high figures associated with post-partum depression syndromes post birth. If abortion had no impact, the figures would reflect a significant decrease in mental-illness issues in women who aborted their fetuses. While there are a great number of issues that go into the impact that abortion has on the mental health of women who undergo the procedure, the impact appears to have significance. When women must make the decision whether or not to carry a child to term, they are making a decision that is filled with social shame, pressured by the reproductive imperative that all species experience, and many times endured in a lonely, non-supportive environment of secrecy. This type of experience, with the importance of the decision and the depth in which it is involved in the social context, impacts a woman through her history of mental health, the ethics of her community, and her own feelings upon the decision she has made. One of the ways in which the topic needs to be studied is from the perspective of understanding how the abortion relates to the impact it has on mental illness, rather than from a perspective of comparing women who have had children and those who have not. There are too many factors of post-birth mental illness for it to be specifically relevant from a statistical perspective. In addition, the defining elements of impact are involved with the sociological factors that define the experience for a woman. Therefore, it is essential to categorize different factors as they associate to abortion in order to create a better understanding of the influences the experience has upon mental health. Further qualitative study will help to create a better understanding of the phenomena that occurs post-abortion in relationship to mental illness. As an agent for change in the community, it is important to come to an understanding of the nature of the event of abortion in regard to the mental pressure that it creates. Observing the changes that can be measured post-abortion through a long term study will help to further define the impact that abortion has upon mental health. In addition, by accepting that the event has an impact, even if it cannot as yet be defined through specific psychological frameworks that pinpoint PAS, counselors and medical professionals can more easily treat those who have experienced an abortion in regard to mental health and give appropriate care. References Bryant, C. D. (2003). Handbook of death & dying: 1. Thousand Oaks, Calif. [u.a.: Sage Publications. Fergusson, D.M., Boden, J. M. & Horwood, L. J. (March 2007). Abortion among young women and subsequent life outcomes. Perspectives on sexual and reproductive health. 39(1): pp. 6-12. Hewson, B. (2001). Reproductive autonomy and the ethics of abortion. Journal of Medical Ethics. 27, pp. ii10-ii14. Lee, E. (2003). Abortion, motherhood, and mental health: Medicalizing reproduction in the United States and Great Britain. Hawthorne, N.Y: Aldine de Gruyter. Miller, D., & Green, J. (2002). The psychology of sexual health. Oxford: Blackwell Science. Needle, R. B., & Walker, L. E. (2008). Abortion counseling: A clinician's guide to psychology, legislation, politics, and competency. New York: Springer. Newman, B. M., & Newman, P. R. (2009). Development through life: A psychosocial approach. Australia: Wadsworth/Cengage Learning. Posavac, E. J. & Miller, T. Q. (1990). Some problems caused by not having a conceptual foundation for health research: An illustration from studies of the psychological effects of abortion. Psychology and Health. 5(13): pp. 13-23. Riordan, J. (2005). Breastfeeding and human lactation. Sudbury, Massachusetts: Jones and Bartlett. Rodman, H. (April 1991). Should parental involvement be required for minors’ abortions. Family Relations. 40(2): pp. 155-160. Rosenfield, A. I. (2006). New research on postpartum depression. Hauppauge, N.Y: Nova Science Publishers. Ussher, J. M. (2000). Women's health: Contemporary international perspectives. Leicester: BPS Books. Read More