There has been very little study on either short term (under 2 years) or long term psychological reactions to second trimester abortion. A British study of 40 women who had prostaglandin induced abortions between 20-24 weeks gestation and also had felt fetal movements, reported that among 25 women followed up at 3 months postabortion, five (25%) of these women reported feeling depressed as a consequence of their abortion.23 The Centers for Disease Control has identified suicide as the cause of death from second trimester abortion for both instillation and D&E abortion.24 A study of long term stress reactions following abortion had an over representation of women who had abortions in the second trimester.(12) Similarly, a religiously-based postabortion recovery group also was found to have an over representation of women with second or third trimester abortions.(14)
Severe adverse psychological reactions to second trimester abortions because of fetal abnormality have also been reported in several studies. A Scottish study of 129 women two years postabortion found that 84 participated in the study, 12 refused to participate, and 33 had moved. Sadness, fear. guilt anger, depression, failure, shame, relief and isolation as well as somatic symptoms and psycho-social problems were identified as sequelae. It was concluded that abortion for fetal abnormality was a emotionally traumatic, major life event for both the father and mother.25 Researchers at the University of California School of Medicine found that the incidence of depression following abortion for a genetic indication was as high as 92% among woman and as high as 82% among men and was greater than that for elective abortion performed for a social indication or for stillbirth. Due to the emotional trauma some family units disintegrated or the couple divorced.26
In a study of couples in a support group who had abortions by induction of labor or D&E after prenatal diagnosis of a fetal abnormality, loss of self-esteem, hindrance of socialization due to great difficulty in looking at pregnant women and new mothers with babies, guilt ("I killed my baby"), grief reactions, anniversary reactions, and loss of hopes and dreams were identified in both mothers and fathers.27 Another study found that other children in the family, in addition to the parents, were adversely impacted after an abortion for fetal defect. Nineteen of twenty-two children exhibited some adverse impact ranging from mild to severe. This included sleepwalking, regression in motor behavior, searching for the baby by touching the mothers stomach as well as sadness, guilt and separation anxiety.28
Women having late term abortions have been found to express more indecision or ambivalence, tend to exhibit more attachment to the unborn child, have more moral or religious objections, have conflicts with lovers or parents, be immature due to adolescence, or have a lack of social or economic support compared to women having first trimester abortions. These factors have been found to increase the risk of postabortion psychological problems.
Ambivalence- Women expressing ambivalence prior to abortion have been found to be at risk for psychiatric disturbance or adverse psychological reactions following abortion.2930
Lack of Satisfaction with Abortion Decision- If a woman is not satisfied with her decision before the abortion, she will be more likely to feel unhappy, guilty and resentful afterwards.31
Coercion- Psychiatric complications following abortion are more likely when there has been coercion;32 One-third of women in a postabortion support group, because they had poorly assimilated their abortion experience, felt they had been coerced into the decision.33
Attitude toward Unborn Child- One study found that fantasies about the fetus after the abortion, a sense of loss or emptiness, and a desire to replace the fetus were more likely to result in postabortion distress.34 Another study found that women who had an abortion but who believed that fetuses are human scored lower on well-being variables such as self-esteem, negative affect, and satisfaction with life compared to women who had not had an abortion.35
Moral Objections, Stronger Religiosity or Negative Attitude Toward Abortion- Stronger religiosity or negative religious and cultural attitudes toward abortion have been found to be risk factors for poor postabortion adjustment.36 (30)
Conflictual Relationships to Lovers- A conflictual relationship with a lover has been found to be a risk factor for negative psychological responses following abortion.(30)
Long Term Effects of Adolescent Abortions- Women members of Women Exploited by Abortion who had abortions as teenagers, were found to be less satisfied with the services at the time of abortion, were more likely to feel forced by circumstances to have the abortion, were more likely to report being misinformed, more often reported severe psychological distress, and more often wanted to give birth and keep the baby compared to older women. Some 45% of the women had abortions as teenagers and 19% had abortions between 13-24 weeks gestation.37 Women in a patient led support group of women who had abortions as teenagers and had poorly assimilated their abortion experiences were more likely to report parental marital difficulties, attempt suicide, have severe nightmares, and exhibit immature coping defenses such as drug abuse compared to women who had abortions after age 20. In this sample 49% were 15-20 years of age at the time of their abortion.38
A study of the characteristics of women in a religiously based postabortion recovery group had a disproportionally high number of women who had abortions as teenagers as well as women who had abortions in the second or third trimester. Some 39% had abortions at age 14-19 and 32% were at a gestational age of 11 weeks or more. A high incidence of guilt, anger, depression, alcohol and drug abuse and suicidal thoughts were reported.(14) In a small study of women who reported chronic and long term stress from their abortion, 50% of the women had their abortion at 12 weeks gestation or more and 31% were age 14-18 at the time of their abortion. Again, a sense of loss, anger, depression, lowered-self worth, suicide ideation, and increased alcohol and drug abuse was reported.(12)
Poor Social Support- Women most likely to have guilt, ambivalence or regret after abortion had a history of psychosocial instability, poor or no family ties, few friends, a poor work pattern, and commonly failed to take contraceptive precautions.39
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38 Abortion in Adolescence NB Campbell et al, Adolescence, Vol XXIII, No.92:813 (1988) [Back]
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