Psychological Responses After Abortion Nancy E. Adler; Henry P. David; Brenda N. Major; Susan H. Roth; Nancy F. Russo; Gail E. Wyatt Science, New Series, Vol. 248, No. 4951. (Apr. 6, 1990), pp. 41-44, ‘Science is currently published by American Assoviation for the Advancement of Science Your use of the JSTOR archive indicates your acceptance of JSTOR's Terms and Conditions of Use, available at bhup//www jstor orglahout terms html. JSTOR's Terms and Conditions of Use provides, in par, that unless you have obtained prior permission, you may not download an entire issue of a journal or multiple copies of articles, and you may use content in the ISTOR archive only for your personal, non-commercial use. Pease contact the publisher regarding any further use of this work. Publisher contact information may be obtained at up! jstor org/ioumals/aans bil Each copy of any part of a JSTOR transmission must contain the same copyright notice that appears on the screen or printed page of such transmission, JSTOR is an independent not-for-profit organization dedicated to and preserving a digital archive of scholarly joumals. For ‘more information regarding !STOR, please contact support@jstor.org, pi www jstorone Wed Feb 28 08:51:47 2007Psychological Responses After Abortion Nancy E. ADLER, HENRY P. Davip, BRENDA N. MAJOR, SusAN H. ROTH, ‘Nancy EF. Russo, Gary E. WYATT ‘A review of methodol sound studies of the pay- otopial responses of G3. women ater they ebeacd legal, nonrestrictive abortions indicates that distress is generally greatest before the abortion and that the inc: dene of severe negative responses is low. Factor oct ated with increased risk of negative response are consist- ent with those reported in research on other stressful life events, BORTION MAS BEEN A LUGAL MEDICAL PROCEDURE ‘hroughout the United States since the 1973 Supreme Court decison in Roe v. Wade, with 1.5 million to 1.6 iillon procedures performed annually. U.S. sborcon. parents refect all segments of the population. In 1987, almost 60% of horton patents were under 25 years of age. Most (82%) were 20t marred, and half had ro priot births. Nearly 69% of women ‘busing aborions were white (1). Abortions are most often per formed in the frst trimester; the median gestational age is 9.2 weeks; 979 of abortions are performed by instrumental evacuation @, ‘Although much literature exists on the psychological conse- ‘quences of abortion, contradictory concusions fave been reached, Disparate interpretations are due in part to limastions of the research methods and in pat to politcal, value, or moral influences Inthis review of studies with the most rigorous eseuch designs, we report consistent findings on the peychological status of women ‘who have had legal abortions under nonrestrcdive circumstances (G). This ail is limited to U.S, studies; however, resus from a study in Denmark are azo relevant because of the existence of 2 “uniform national population registration system not available in the United States (4) Responses After Abortion Responses after abortion reflect the entire course of experiencing and resolving an unwanted. pregnancy. Although there may be fensations of regret, sadnes, or gulf the weight ofthe evidence fiom scientific studies (3) indieates that legal abortion of an ‘unwanted pregnancy inthe fist erimester does noc pose a pycho- logical hazard for most women NE Aion de Unni ofall Src ip Fon ho N hap athe Ste Unive f New Yok. Bll, Buti, 1426057 Rothe bute Uae Bur, NC 278 NF Ramo Atos See Streit, Pp, KE BSA OE Wye wa he Unter of Cater, Lae og Tar Angee, CA 9038 APRIL 1990 Descriptive studies have shown the incidence of severe negative responses afer abortion to be low (5-10). After fstirimeser abortion, women most frequently report feling relief and happi ress, In’ + study by Lazarus (5), 2 weeks afer fstsrimester boron, 76% of women reported feeling relief, while the most ‘common negative emotion, guilt, was reponed by only 17%. [Negative emotions reflecting intemal concems, such a5 loss, oF social concems, such as social disapproval, typically ate not exper cnced as strongly as positive emotions afer abortion (5-8). For ‘example, Ader (6) obtained ratings of feelings over a2- to 3-month patiod afer abortion on Liker-type scales, with 5 representing ‘scongest intensity. Mean ratings were 3.96 for posiive emotions, 2.26 for ineemally based negative emotions, nd 1.89 for socially ‘based negative emotions ‘Women show lite evidence of psychopathology after abortion For example, on the short form of the Beck Depression Inventory, scores below § are considered nondepressed (11). In a sample of fise-trimester patients, Major eral. (9) obtained mean scores of 4.17 (SD = 3.92) immediately after the abortion and 1.97 (SD = 2.93) 13 weeks later. Mearures used in most studies were not designed t0 asess psychopathology, but, rather, emotional distress within noemal Popalitions. These indicators show significant (12) decreases in Aisuess from before abortion to immediatly after and from before abortion or immediately afer to several weeks later (9,10). For ‘example, Cohen and Rech (10) found 2 drop in che depression subscale of the Symptom Checklist 9 (SCL-90) from a mean of 24.1 (SD = 11.8) a the time of arival at a clinic to amean of 184 (SD = 12.2) in the recovery room. Similar drops were shown on the anxiety see ofthe SCL-90 and on the Impact of Events sale anindicator of distress ‘Onis wo studies compared responses afer abortion with those afer birth. Athanasou «a. (13) studied women aftr ealy (suc ‘ion) abortion ate (saline) abortion, and term bin. Staring with 4373 women, reeerchers matched 38 patients in each group for ‘ethniciy, age, party, and marital and socioeconomic stats. Thr. teen to seen months afr aborcion or delivery, women completed the Minnesota Mulsiphasic Personality Inventory (MMPI and the SSCL. None ofthe groups had a mean score on any subscale ofthe MMPI above 70, the cutoff indicating. peychopathology. Few dferences among groups were shown [{4), and the authors con- ‘ded thatthe tice groups were “staring similar” Zabin er al (15) interviewed 360 adolescents seeking pregnancy tests and compared those wino had negaive results, tase who were pregnant and catied to term, and those who were pregnant and bored. All three groups showed higher levels of sate (transient) anxiety at bax line than they di 1 or 2 year later (for example, for the abortion group X = 74.6 a bas ine versus 45.6 and 43.631 and 2 years later). Two years after the initial interview, che abortion ‘r0up showed, if anything, 2 more positive psychological profilethan cither of the other wo groups. There were no differences on ‘sate ancy, but the abortion group was significantly lower on tait, anaiety than either of the other ©Wo groupe, was higher on sl ‘esteem than the negative pregnancy group, and had a greater sense (of intemal contol than the childbearing group. Factors Relating to Psychological Responses though most women donot experince negative paying ssponic afer sboron, cae statis document some gave Capen. Vasou spec ofthe boron experience may cer ttewo das Anbivaknc about the wantedns ofthe pregnancy may engender seme of los Confic abot the meaning of abortion and i claon to deeply eld values o bi, pees {oct ga or ack of support may als indus nega eons. Tae eon pron. The gree the diel of deciding 0 serminate& pemancy, the more likely there will be nese responses aftr abordon (6-8, 16. For sample, Ade (6) fou thee dfcay of decdng to sor, reported srl days before abortion, was pone acted with he experience of wgatie rncon fing ke 20 3 month afer abortion (= O37), bt Sr eed toa sail signin ene tothe experece Sf pees cnotou or of eyeive enocons rebcng socal sapprova ‘Although most women do not Sind the decision o abr dif, some do {16 and appar tobe more ic fx women seking teminsion ier in pregnaney Wheres nly 7% of 100 fist Sener pens sed by Oraity a al (17) reported inal inden and 12% reported diy in dciing above sboron, corresponding igure among 200 second rimester pases wee 26 td 81%. Women undergoing second-timexer aborons 0 ‘port mee emotional dstessfer boron than do hose tem Shing Ginter pregancis (7°19), ‘Wernen who perceive more support the dco osbor are sore sised with thi decision (7,20, Tose wih fever conti tvs aboron ate also more sed; in» sample of sleet, sen and Zelman (27) fond that satsfacion withthe dcion 6 trons afr an sorton war weed with fevorble opinion of 2borsin in general a wel a for thems. "The move peganmey b wanted and it viewed ss paomily imeaninghl by the woman, the more fel sboon may be Major al. (9) found hae among 247 fsetmester sordon paver, women wo deseibed ther pregnancy a being “highy freanigfa” compared wo thore who found ther pregnancy tobe ls personaly meaning repored more physical compas ome diately after the abortion and anticipated more negative conse- gees. Tce weeks afer the abortion, women who fad inte tEving had o itenton to become pregiant soed Iowet onthe Bok Depron imentry (= 1.68, SD = 233) than dd he nor of women who ad st kas soe ntcton £0 become pregnant = 371, SD = $08). in surmary, women wo repos ie fc ic making their deskinn, who re more sued with ter ok, and who a tena prac that wete unintended and hold ie pe torel meat er than show moe postive reponse afer bor ten, Women with neptvearuies toward sboron and who perce lite apport er thir decison have more iy dei Ing shout aborton These factors may aso conribute vo delay in hing aborion (1), potently sketing women tothe {pester sre of eerste procedures (119 Pein ol npn. Pereve socal support can br some advone ict of rei ie evers (2 However, soil oppo comple, Sappor fo tng the sboron neds o be dierent « fom support in general; the former is associned with more favorable outcomes; the later may not be. ‘Women with greater support for their abortion from parents and the male parner generally show more posive responses ater abordon (8, 23, 24). Intimacy with and involvement of the male parmer was a significant predictor of emorional reaction in two Samples (8). Together with saifacion wih the decision and the ‘woman's inital emotional response to becoming pregnant, partner "support accounted for almost 40% ofthe variance in psychological response 2 to 3 weeks after abortion Moteey «tal. (24) found that having negative feclings toward one’ parmer, making the abortion decision alone, and experiencing opposition from parents were astoated with greater emotional distress on the Multiple Aafecrve Adjective Check List both before a fist-srimester abortion and immediately affer. However, Robbins (25) found that single ‘women who maintained a strong relationship with their parmer ‘reported more negative change onthe MMPI 6 weeks afer abortion ad mor rege yea ter han those wheels dete Tn 4 seudy of acral social support, Major eta. (9) tecorded ete women Wer acpi the cin by a ale pate women, 83 were accompanied. Compared to accom Faied women, those with partners were younger and expect {pest wel beforehand; women who ware more diet about the abortion may hive expresed greater need fo ther parr © accompany chem. Accompanied women were signicany more ‘epreeed and reported more piysksl complains immediately afer Soin dan macnn Yom Dien een abortion remained afer contol ad coping Sons, bar hey did noe remain in a 3weck flows ofa subuet of Coping pres and expectancies, Generalised positive outcome expectancies and sinaion specie coping expectancies and proce ‘have been linked to a variety of healhv-levant outnes (2). Major a. (9) found that among aboron patent, thee who expec to cope wall scored lower onthe Beck Depesion leven tor than those with more negative expecatons (X= 298, 5.04 vers X = 5.93, SD = 441, respectively). Those expecing 1 cope well ao showed more positive mood, andcpsted fewer repaive consequence, and had fewer physical complins both immediatly after abortion and 3 weck ater. Colin and Roth (10) examined coping sls and lve of soiery aod depression before and immediacy afer abortion. As noted Cate, ansey and depression decreased sigicancy Fom before the abortion to afervards forall women, but those who used approach strategies (for example, thinking about che procedure taking abou i showed a greater decrease n antcy from Before 0 ser abortion than those not uting these strategies. Women who ‘ied. denial scored signicanly higher in depresion and asics than dd hove who didnot deny Limitations of Research and Future Directions Although each study has methodological shortcomings an limi tations, the diversity of methods used provides strength in dawing {general conclusions, Despite the diversity, the suds are consistent fn thei findings of relatively rate instances of negative responses after abortion and of decreases in pychologial distress after abortion compared to before abortion. However, weaknesses and i3ps found among studies provide challenges for future tesatch. Fir, sampler of well-defined populations and information on subjects who choose not to participate are needed. Studies have tampled women from speci clinics or hospitals. Both public and SCIENCE, VOL. 248private clinics ave been wed, and samples have vated in thee nie and socioeconomic character. Women wioee aborions art fprfomed by private pipiens are not represented they ae Shel belbens fo momenhrng sorts 2) ‘Gk more concern isthe necesary ws of volumeer, which cn inocace bin if women who gre fo patie in escarch ier from dae who donot on chars inked wo more poste or epee encom. An anays of ries that provide dta on ‘Siac of research parcpans vers the popliton from ‘eich the sample was drawn suger chat women who ae more itely to find te abortion experence sacl nay be underepre- setted in volutet samples. However, the amoutt of bi intro. diced by this underepresentaton appears vo be minor and unlikely to infenes the gener conclisions (2) Second, the timing of measurement has been limited. Many seule ck bate ine data fom before the abortion, We know of 0 tres with data clleced ble the pregnancy, making tipo {eto conto for variables tha may be asoclited with the nial ‘occurence ofthe pregnancy and which could infcace responses “Sher abortion. One ofthe bes preicors of womans payiolog Gal satura abortion ly tobe het ore the Ccnurence of the unwanted pregnancy (29), Borner Surgeon Gener. Bvret: Koop has elle for prospective snudy of 2 ‘ational representative ample of women of cikbeating ge (30, Sachs study would addres both ues of represttatvencer and of thse line mesuremene Tuning of axesment afer abortion has also bee ited, Somme seule obtained measures within a few hours afer the procedie, ‘le the woman wa ail inthe cnc. Response tt sme may tot be indicate of longer tam response. A few ates have Chained meaner afew weks or mone afer abordon; helongest folowup #2 year. Therefore no definive conchsons can be drrwn about longer tem effec. Akhough individual case sities have Wenifed insanecs in which individuals develop severe prob des that they atibute to an eater aborionexpenence (1) the numberof ch cases comparatively smal. Moreve, seach on (ther ie reas sugges thar women who donot expeience vere ‘gave responses within 3 few months afer the even ar ulitely {0 devdop fire significant prychologkal problems related tothe ‘tet (2), Longer fem ses ae needed to confi this ober. Son and to xcrain the nfuence of other fe events abated ‘eroepcivey to the abortion experienc. nal, in sadying pychologa responses air abortion, et imporant to sparte te experience of abortion fom the care. ists of women secking abortion and fom the context of reohing an uwaned pregnancy. A usc comparion would be women ith cary an unwanted pregnancy totem and sumender the did {or adoption; hs would control both forthe unwvantedns ofthe ronan andthe experience of. The say by Athan (G3) matched women who were eminatng pregnancies with those Srying to tr on Key demographic vrs but they were not ‘matched on "wantedne” of te pregnancy. Smal, the compa ‘son used jin the Danish study (4) for women aborting their Pregnancies wat women crying o term mos of whom were key {0 be delnering wanted. pregnancies ‘One would expec More dren outcomes for women canying unwanted. pregianccs 0 tem (3. ‘A number of quccions canbe aldresed without 2 comparison group. Theoretcly grounded rude exting condional hypothe {5s sbot factors that may put women at relive greater fk or Segue responses ae paricusiy important. Sach suds an Iles cana qucsdont about the nature ofthe abortion exer ave and is alrmath an can poi the way to interwensons ened. 6 APRIL 990° Conclusion. Scie ai on pagal rapnses to ap sone sve atoron in the United Stes sugges that severe nepite trconr accu in he ined ed short Ma Partly for Geenener aborts. Women who a emit prepuce Cat ac wanted wd prsoaly emg ws isk suppor om tr paneror patents fr te abonion, o who fave more confing Rings orate ler se of ter decison telarcand may beat eelely higher fk for aegave conse * ‘Case studies have established that some women experience severe dare or pychopaiogy ater aorson and eue symp Gare As former Surgeon General © Ere Koop ted one Congres eating it oe of texcach on pelo eco shorn sch pons canbe overing ta gven da, Berth developmen of igen prycblope bene ld 2Sorson “numa em» pic he perpen (3) ‘espe mehdalogial shocomings of iy tng uy the sggepes, roach wid dere ample, diferentes of Spee an diferentes of scant ave come 9 cna ConconThe tne of ress ire Thy wo be faethe Storie. Seve nee rection fr sorion ar rareand can fest be ndenood nthe Eamenesk of coping with 4 normal 1, $.X Hera and |. Sherman Fm. Ram Ppt, 20,158 (988. 2 § Mamie 1 $0907 © Teac nd 8 en et Aerie: A it Rene (A Guta. Now York 198) Pomel ene Moa Set 36 he 81 094). 2 a a ete tig ei Eembe Used Sox and) fe women sg Sapien ‘Stel and onencie oefeampl women de ote (Fay Gren proce on be bo rt piel or mene a) Th rete mani pencaotiny 0 U5 wom nr cur ce Spout They Sng x bh SSE comnsn cen mtv Sepa osm Sippey we eh ore erase ore ce ee Hab Sap pe sae rein gg SSE pe ofan sean eee rd Ean tgeP ame le Tash tee pap cope ‘Sherced, of widowed women who rr 7 ai eS SSATP i ne lm pay et geil gly mort tamed Baath eae Pal rere pes a Pi Fi Ce Cay SP) ib doaiy sali Only. Ad 43,48 0970) Soe ie tty fe 2 ya 86 G0 ene fer bt lwp iene repel eS nt mach mea pad Sogn Bete cnn ipa pike caso Reales ioe Se 4 Eman ASB ae Sr 1,10 40. ea reraa emer tC 1 A ans ol ei pe my r 13, Rina, We'Oppe Machen, T Gag, M. Yager, Fon lo Pepe 871973) Bony aay ccs on wr ons) women he, ene onetime rt ® m6) SD = 14) hn ad women nar sors pg OF 589 124 men rns sod Tv sha 80 = Dune pr) erento toate er isle oto day pen “mike 148 50 = 93 rapecch. 18. 8b A Banh MR. Ea, Fon Pam, Pepe 21,248 1989) ARTICLES 4316 MB Bete, Sc Ppa 13,135 1978. Onerriary 4508 597. If Sb ont ovtayr R Ryan D Spt Me Smt J Ma 2.486.0975, 29. S°C7Bye AR Res MT: Nem} V Andere, Ar en Pry 1g [Recs lot W. Cargo Poe Rope 9.206 rye Raton,” $a Gas Gard E. Mebebo HS Gear a LAS E tavern iGreen eto Tt oon ve 0 C8 oot W Regi, 9 Jan 1988 BB MER batew Valor Bran a. 130,281 0978, BT KG Speake Postel pe of le ling Atrion (Shed ard BL Em and LZ, J Pet 148,21 (1984), a Ra i 987, HES cake ng AW fal But 10 U9) Ker aD. 32. Cr Warman od MC Set, J. Cota CPt 57 39 (189). cd Sa Spent abe oS Spe Ba (Ac ren, 3. Ome my aS mor bee tren ele aa sea of (anda 198) pp 219-20. ‘Seanad peggy iL Dead © Dye Man, V Sha, Bor 25 ME teain a Ham Gan, Jw Mei 18, 186 Smt Br i Dr An Se er 18) ah Det Moy at, J. i dl 37,276 158 ite ang eM Sed tg of MH, Te 2 Pac nanees SeAalhBeondy 2 caesh Berni TOW Hose Rego 1015985, 1B Wt Strand Cae Jo 8, 1691987) A Bakr, yl 38, Tac achom ow coc ppl come ie Aen pda! Acton The thom wee ab ote pe We ak) 1 Hen J.D. Fre J. Van Va i. Finn, Pmt 19, 63,1987), Geneynt h. Wik rcotrnsone othe maaan Maman nd A ile Tape Pda 300 COTE EW. Frcan am). Sal or mame Pepacon BS zee wes 3