Hiding the Truth
The Unspoken Pain of Abortion

Promoting False Expectations

A few abortion counselors, like Charlotte Taft, may challenge women to explore their decision and their preparedness to live with the consequences of an abortion. But since the early seventies, the prevailing view of abortion counselors has been that their function is to be facilitators. Most assume that by the time the woman enters the clinic her decision is already well thought out and final. As counselors, then, their job is to reduce the woman's stress and avoid raising doubts about what is already a settled decision. They often see their roles as companions, handholders, and cheerleaders for women who are about to undergo what is inevitably an emotionally draining and physically ugly experience.

As facilitators rather than counselors, they tend to avoid probing any emotional or moral conflicts the woman may have not yet resolved. When patients ask questions about abortion's risks or the stages of fetal development, abortion counselors are afraid that too much candor will arouse anxiety and doubts. They tend toward answers that will evade, dismiss, or minimize the patient's concerns. This approach has been taught as the norm since the early 1970s.15

As a result, most women undergoing abortion will be explicitly told either (1) that there are no psychological risks to abortion, or (2) that significant emotional problems are extremely rare. They are typically reassured that most women experience tremendous relief after abortion. Some counselors may admit that a few women may have some sadness or "the blues" for a little while, but they insist that this will go away quickly. At least some counselors will even suggest that these temporary "blues" occur only because the woman's body undergoes a hormonal shift from a pregnant to a non-pregnant state. Sandy shares what happened to her:

The private counselor I talked to before I had my abortion told me that I might be a little sad or agitated for about a month after my abortion. I shouldn't worry because this was just my hormones getting back to their normal levels. She said that I might think about my abortion once in a while for the first year, but then it would become a distant memory. When things weren't back to normal after a month I thought there was something wrong with me. I tried going back to the counselor, but she didn't want to talk about my abortion at all. She insisted that it was something else bothering me. When a year passed and I still thought about my abortion every day, I thought I must be really crazy. It seemed like my life should be going on like normal, but in reality it was quickly falling into a million pieces, and I didn't know if I would ever be able to put all the pieces back together. I tried so hard to put on a front for everyone that I knew because I thought if they saw what was really going on inside of me that they would have me committed to a mental institution. I thought I was the only person who had this kind of reaction to their abortion.

Abortion advocates justify such deliberate efforts to conceal the full range of emotional risks by citing a study published by Brenda Major that evaluated women just before their abortions and then again three weeks later. In this study, the researchers found that women who expected to cope poorly after their abortions did indeed report more emotional problems than women who expected to cope well.16 Since its publication, this study has been used to justify withholding potentially upsetting information from women on the grounds that exposing women to "unnecessary" information about potential risks will strengthen their anxiety and thereby increase their risk of subsequent emotional problems.

There are many problems with this theory. First, it violates the patients' fundamental right to full disclosure of risks. It treats women like little children who are too fragile and naive to hear the truth and weigh it for themselves. Instead, abortion counselors either (1) paternalistically decide what women need to know and what they don't need to know, or (2) give women only the information that will most likely encourage them to proceed with an abortion.

Second, when properly interpreted, Major's study actually shows that women with low coping expectations are predictably at higher risk of suffering negative reactions soon after the abortion. It is very likely that these women have lower expectations of coping well precisely because they are very conscious of internal conflicts over their abortion decision. In many cases, these women are submitting to unwanted abortions in violation of their maternal desires or moral conscience. Many feel forced to give up their wish to have their babies because they "have no choice" but to abort. No wonder they expect to feel grief, loss, regret, and guilt. For such women, these are realistic expectations. At best, dismissing this reality with false assurances may help to reduce short-term anxiety, but only at the high price of exacerbating long-term reactions. If women later discover that they were deceived, they may experience, in addition to the "normal" post-abortion reactions, a deep-rooted inability to trust themselves or others, especially health care workers. Lorrie describes her difficulties:

For years I had a difficult time making any kind of decision. I couldn't trust my own judgement. I found it difficult to trust doctors, counselors, and even boyfriends who would make any kind of recommendations to me. I became paranoid of doing the "wrong thing." At the time I did not understand why choices were so diffficult for me to make, but I am certain now that it is because of my abortion -- and the feeling in my gut that I had made such a horrible choice because I had allowed others to lead me. This problem has affected my entire life.

The third problem with the theory that women should be "protected" from upsetting information is that even if screening of information could reduce feelings of grief, loss, regret, and guilt in the first few weeks after an abortion, there is no evidence to support the belief that this will produce any long-term benefits. Instead, it is quite likely simply to delay and aggravate negative reactions. For example, Jane had an abortion when she was three months pregnant at the age of 19. As her life went on, she thought little about the procedure until she attended nursing school. During one of her classes she learned about fetal development and saw her first ultrasound. Jane was utterly traumatized when she was confronted with this information -- the reality that the clinic had intentionally withheld.

I remember raising many questions before my abortion. All my questions were brushed aside as "nothing to worry about." I asked how far my baby had developed. The counselor pressed her pencil on a paper, making a micro-dot. "That's what the 'product of conception' looks like," she said. I was 12 weeks along in my pregnancy -- this was such a lie! As I learned the truth in nursing school, I can't tell you how betrayed I felt! The new information also made me completely sick. I almost dropped out of nursing school because of my grief. Thinking about that little baby … and how … how in God's name I could have destroyed it.

Jane is an example of the dangers inherent in efforts to paternalistically shield women from the truth. What assurance is there that the truth will always remain hidden? Who will be there for these women when they see the images of a developing human fetus on a television documentary, or on the cover of a news magazine? When they are pregnant with a child they are carrying to term and go to look at a poster on prenatal development at their doctor's office, who will be there to explain why the child they aborted was any less human than the child in their womb?

The fourth problem with concealing anxiety-provoking truths about abortion is that inadequate, inaccurate, or biased counseling is statistically linked to more frequent and severe negative psychological problems following the abortion.17 Women who discover, too late, that their expectations were wrong are more likely to feel exploited and angry, both at themselves and the people involved in their abortions.

Finally, if low expectations are a risk factor for more negative reactions, the proper solution is not to withhold information and encourage falsely optimistic expectations. The ethical obligation of health care workers is to screen for this risk factor, provide additional counseling, and, if it becomes clear that the woman's low expectations arise from the fact that abortion violates her own needs or desires, to assist her in resolving the problems surrounding the pregnancy so she no longer feels "forced" into an unwanted abortion.

Clearly, in failing to correct the false expectation that abortion is without psychological risks, abortion clinics are exposing women to the risk of making ignorant, tragic, and irreversible decisions. Women like Rayna:

Everything I read on abortion before I experienced it told me that 99.9 percent of women who have abortions do not suffer from depression or regret afterwards. In fact, the information told me that I could expect to feel relieved just as all these other women did at not being pregnant anymore! Where did they get that from? I will never be the same again! My entire life has changed, and I just want to know that there are other women who go through this trauma and feel like me.

Distortions of Koop's Letter

Research on the psychological after-effects of abortion has been extremely difficult and highly politicized. Appendix A describes some of the difficulties involved in post-abortion research and examines some of the most blatant examples of how the conclusions of researchers have been twisted for political reasons.

Distorted reviews of the literature are actually the rule rather than the exception. For example, in 1989, Surgeon General C. Everett Koop attempted to clarify this state of uncertainty in a letter to President Reagan, in which he reported that after a one-year review of the scientific literature on abortion, it was his conclusion that all of the existing research was "flawed methodologically." While acknowledging that some women do experience physical and psychological complications following abortion, Koop properly concluded that "scientific studies do not provide conclusive data about the health effects of abortion on women." Therefore, he said, it was impossible to accurately measure the frequency or severity of these complications. Koop concluded his letter with a recommendation for a five-year study on abortion, at a price tag of 10 to 100 million dollars.18

Abortion advocates immediately interpreted Koop's letter as meaning that no health risks to abortion could be found. Indeed, abortion proponents blocked Koop's recommendation for a federally funded study by claiming that since abortion was already known to be safe, the study would be a waste of tax dollars.

Distortions of Koop's conclusions continue to surface even to this day. For example, in a letter to the editor of The Wall Street Journal, Planned Parenthood's Gloria Feldt complained about a guest editorial that discussed abortion-related injuries. Feldt claimed that the question of abortion risks was "fully researched" by Koop and his staff and that it was "concluded that abortion does not pose a health risk to women."19

For his part, Koop has consistently refuted this distortion of his conclusions and has stated, "I know that there are short- and long-term adverse effects of abortion psychologically on women . . . there is no doubt in my mind that problems exist."20 Koop has repeatedly and correctly asserted that the existing research was (and still is) too flawed to document with any accuracy the true extent or frequency of both the risks and the perceived benefits, if any, of abortion.

Despite these clarifications, whenever the issue of abortion safety is raised in the press, abortion proponents like Feldt will routinely make misleading statements to the effect that "Since even Surgeon General Koop couldn't find any risks to abortion, there must not be any. There is no scientific basis to this anti-choice propaganda. Abortion is safe."

The impact such misleading statements have in perpetuating false expectations regarding the safety of abortion cannot be underestimated. Not only do they mislead those who make public policy, they mislead women and families who are faced with problem pregnancies. They lead them to believe that the "experts" and government officials have determined that abortion is "safe." It is most particularly tragic when young women who do not want to have an abortion, knowing that it will emotionally devastate them, are convinced by loved ones to set aside their fears because the "experts" have proven that there are no psychological risks to abortion.

Approaching the Truth

For all the reasons described in Appendix B, no one knows how widespread the post-abortion problems described in this book really are. Anyone who claims that he does is, at best, offering an informed guess.

We do, however, have a reasonable profile of that group of women who do report experiencing post-abortion problems. Appendix C in this book includes the summary statistics of an Elliot Institute survey of 260 women who, on average, had their first abortions 10.6 years prior to being surveyed. The women who volunteered to answer this survey were either seeking counseling for post-abortion emotional problems, had received post-abortion counseling, or had a history of abortion and were seeking help at a crisis pregnancy center to carry a subsequent pregnancy to term. The findings in this study appear to be representative of the group of women who experience negative emotional reactions to abortion. But it would be inappropriate to project the percentages reported in this study on the entire population of women who have had abortions, of whom very little is known.

Perhaps the biggest challenge we face concerns women who conceal their abortions. We simply have no way of knowing what the postabortion experience is of women who, when approached by researchers, will deny having had an abortion. Through a variety of means, researchers have found that approximately 50 percent of women who have had an abortion will conceal that fact from interviewers.21 Demographic comparisons of women who refuse to be interviewed about a past abortion are more likely to match the profile of women who report the greatest post-abortion distress.22 Breanne offers some insight into this problem:

Most of us who are suffering after our abortions are too ashamed to admit it. The feeling is that you just want to forget about the whole horrible thing. If anyone ever mentioned abortion I became frozen. Either I would leave the room or keep quiet. I didn't want anyone to know what I had done. If I was questioned about abortion, I didn't want to talk about it because I was afraid I might start into one of my uncontrollable crying fits. Those were moments I reserved for my bedroom where no one else could see the tears.

The only available approach to the problem of women concealing their past abortions is to look at record-based studies. Record-based studies do not rely on surveys of women, but instead on looking directly at their medical records. Unfortunately, there are only four such studies.

The first of these is a study using government records in Finland. Because all health care costs, including abortion, are covered by the Finnish government, the results of this study could not be distorted by women concealing a past abortion. Unfortunately, the study was limited by both the time frame and the post-abortion "symptoms" that were studied. Specifically, the researchers only looked at all cases of suicide that had occurred during a seven-year period. They then examined the medical records and linked the death certificates to records for giving birth or having an abortion in a one-year period prior to the suicide. Their finding was that women who had had an abortion were three times more likely to commit suicide within a year of their abortions than women in the general population, and more than six times more likely to commit suicide than women who carried their pregnancies to term.23

The second study linked medicaid claim records for 173,279 lowincome women in California to death records. In this case, the researchers found that the death rates among aborting women remained elevated for at least eight years. Compared to women who delivered, those who aborted were 154 percent more likely to die from suicide and 82 percent more likely die from accidents (which may be related to suicidal behavior). The higher suicide rates were most pronounced in the first four years following the pregnancy outcome.24

The third record-based study used government records in Denmark, which, like Finland, has government-funded health care. In this study, the records of women who carried their pregnancies to term or who aborted were examined for admissions to psychiatric hospitals during a three-month period following the abortion or delivery. The researchers found that "at all parities, women who obtained abortions are at higher risk for admission to psychiatric hospitals than are women who delivered." The admission rate into psychiatric hospitals during the first three months post-event was 18.4 per 10,000 for aborting women, 12.0 for delivering women, and 7.5 for all Danish women. Even more troublesome are the findings concerning women who lacked the support of a spouse at the time of abortion or delivery because of divorce, separation, or widowhood. The rate of psychiatric admission was 63.8 per 10,000 for women who aborted versus 16.9 for similar women who carried to term.25

The significantly higher rates of psychiatric admissions after abortion are particularly noteworthy given the fact that the researchers in this study limited their report to only the first three months following the abortion or birth. While three months is adequate to identify virtually all cases of post-partum depression following birth, it is quite likely that the bulk of psychiatric admissions following abortion occur after three months. In other words, the researchers were comparing virtually all post-partum psychiatric hospitalizations to what is likely only the earliest phase of post-abortion reactions.

This shortcoming was addressed by the fourth record-based study, which also examined psychiatric admissions over a period of four years following the pregnancy outcome. In this study, aborting women had a significantly higher relative risk of subsequent psychiatric admission compared to delivering women across all age groups. After controlling for prior psychiatric history, age, and number of pregnancies, the relative rate of admission among aborting women ranged from a high of 4.26 times higher than delivering women at 90 days after the pregnancy event to a low of 1.67 times higher in the fourth year. In other wc.rds, while the risk of being hospitalized for psychiatric problems steadily decllined, even four years later it remained 67 percent higher. Aborting women were especially more likely to be admitted for adjustment reactions, depressive psychosis, and neurotic and bipolar disorders.26

These record-based studies were limited in the scope of reactions studied (suicide and psychiatric hospitalization), the length of followup (three months to eight years), and by incomplete obstetric histories (many women in the childbirth groups used for comparison actually had a history of abortion prior to the study period examined). Despite these limitations, these are the best-designed studies published to date, and they clearly show that abortion can cause or exacerbate severe psychological problems, at least for some women.

The extent of less severe problems is hinted at by a major national poll of 3,583 people that was conducted in 1989 by the Los Angeles Times. In that survey, pollsters found that 56 percent of women admittiing to a past abortion reported a sense of guilt, and 26 percent regretted choosing abortion. Among men admitting involvement in a past abortion, the negative responses were even more pronounced. Two-thirds reported feelings of guilt, and over one-third said they regretted the choice to abort.27 As with all abortion surveys, the number of people admitting a past abortion in this survey was far below the national average. Only 8 percent of women and 7 percent of men admitted having a past abortion experience. This suggests that at least two out of three people surveyed who had a past abortion concealed it from the pollsters. Also, as previously mentioned, it is probable that the rate of guilt and regret among the "concealers" is higher than that reported by the "revealers."28

But even if we apply the 56 percent guilt rate and 26 percent regret rate to the general population, this is clearly suggestive of a widespread problem. What other medical procedure has such a high dissatisfaction rate? No one wants to undergo surgery, but would one in four heart attack patients regret their decision to undergo heart bypass surgery? Probably not. I suspect this high rate of regret is unique to abortion and is indicative of the psychological conflict that continues to haunt women and men for years after their abortions.

Similarly, do 56 percent of patients report feelings of guilt persisting for years after any other surgery? No. Such widespread feelings of guilt following abortion are clearly indicative of the fact that most women and men who have experienced abortion are neither psychologically nor emotionally at peace with their experience.

Approximately 60 million women and men have lost one or more unborn children to a legal abortion. Even if only 34 million (56 percent) are still feeling guilt and only 16 million (26 percent) regret their choice, this represents a multitude of negative feelings that we, as a nation, are keeping bottled up.

In the next chapter, we will look at why these millions of people are being denied a healing environment where they can safely explore, understand, and release these negative feelings.


1 Letter from an aborted mother, "An Apology to a Little Boy I Won't Ever See," Evening Bulletin, Providence, Rhode Island, April 23, 1980. [Back]

2 Arthur Lazarus, "Psychiatric Sequelae of Legalized Elective First Trimester Abortion," I. Pscyhosomatic Obstet. Gynec. 4:141-150 (1985). Many women reported both negative and positive reactions at the same time. In interviews conducted with women immediately after their abortions, Lazarus observed that "denial and rationalization seemed to play a major role in assuaging negative effect for many women." These findings support the view that abortion is a complex experience. [Back]

3 Colman McCarthy, "A Psychological View of Abortion," Washington Post, March 7, 1971. Dr. Fogel, who did 20,000 abortions over the subsequent decades, reiterated the same view in a second interview with McCarthy in 1989: "The Real Anguish of Abortions," The Washington Post, Feb. 5, 1989. [Back]

4 Reardon, Aborted Women, Silent No More, op. cit. (introduction, no. 1) 15-19. [Back]

5 For discussions of heightened psychological accessibility of persons in crisis, see Gerald Caplan, Principles of Preventive Psychiatry (New York: Basic Books, 1964) and Howard W. Stone, Crisis Counseling (Minneapolis: Fortress Press, 1976). [Back]

6 Zimmerman, Passage Through Abortion, op. cit. (introduction, no. 1) 139. [Back]

7 Zeckman and Warrick, "Abortion Profiteers," Special Reprint, Chicago SunTimes, 1978. [Back]

8 Reardon, Aborted Women, Silent No More, op. cit. (introduction, no. 1) 215-243. [Back]

9 Ibid, 256. [Back]

10 David C. Reardon, Making Abortion Rare: A Healing Strategy for a Divided Nation (Springfield, IL: Acorn Books, 1996) 77-79. [Back]

11 Vincent M. Rue, Examining Postabortion Trauma: Controversy, Diagnosis Defense (Demon, TX: Life Dynamics, 1994); citing Magyari, et. al. (1987). [Back]

12 Patricia King and Melinda Beck, "Persuasion, Not Blame: Now, a 'kinder, gentler' pro-life movement," Newsweek, March 25, 1996, 61. [Back]

13 William West, M.D., "Honesty at issue," The Dallas Morning News, Feb. 1995, 3J:1. [Back]

14 Cecily Barnes, "Pregnant Silence," Metro, Feb. 18-24, 1999. [Back]

15 Paul Marx, The Death Peddlers: War on the Unborn (Collegeville, MN: St. John's University Press, 1971) 18-21, citing transcripts from a national conference for abortion providers. [Back]

16 B. Major, P. Mueller, and K. Hildebrandt, "Attributions, Expectations, and Coping With Abortion," J. Personality and Social Psychology, 48(3):585-599. [Back]

17 Wanda Franz and David Reardon, "Differential Impact of Abortion on Adolescents and Adults," Adolescence, 27(105):161-172 (1992). See also Vaughan, Canonical Variates of Post Abortion Syndrome (Portsmouth, NH: Institute for Pregnancy Loss, 1990); and Steinberg, "Abortion Counseling: To Benefit Maternal Health," American Journal of Law & Medicine 15(4):483-517 (1989). [Back]

18 Surgeon General C. Everett Koop, Department of Health and Human Services, Letter to President Ronald Reagan, Jan. 9, 1989. [Back]

19 Gloria Feldt, "AntiChoice Spinrnaster," The Wall Street Journal, letters section, circa Aug. 31, 1996; responding to Candace C. Crandall, "Legal but Not Safe," The Wall Street Journal, guest editorial, July 1996. [Back]

20 John Whitehead and Michael Patrick, "Exclusive Interview: U.S. Surgeon General C. EvereH Koop," The Rutherford Institute, Spring 1989, 31. In a letter to David Reardon of Oct. 14, 1998, Dr. Koop agreed that Gloria Feldt, like others, had misrepresented the positron he reported to President Reagan. Unfortunately, it is impossible for Dr. Koop's corrections to keep up with all the distortions. [Back]

21 E.F. Jones and J.D. Forrest,"Underreporting of Abortion in Surveys of U.S. Women: 1976 to 1988," Demography, 29(1):113-126 (1992). [Back]

22 Nancy Adler,"Sample Attrition in Studies of Psychosocial Sequelae of Abortion: How Great A Problem?" J. Applied Soc. Psych., 6(3):240-259 (1976). [Back]

23 Mika Gissler, Elina Hemminki, Jouko Lonnqvist, "Suicides after pregnancy in Finland: 1987-94: register linkage study," British Medical Journal, 313:1431-4 (1996). [Back]

24 D.C. Reardon,, P.G. Ney, F.L Scheuren, J.R. Cougle and P.K. Coleman, "Suicide deaths associated with pregnancy outcome: a record linkage study of 173,279 low income American women." Archives of Womens's Mental Health, 3(4) Suppl. 2:104 (2001). See also Reardon et. al., "Deaths Associatied with Pregnancy Outcome: A Record Linkage Study of Low-Income Women," Southern Medical Journal, 2002. In press. [Back]

25 Henry P. David, "Postabortion and post-partum psychiatric hospitalization," Abortion: Medical Progress and Social Implications (Pitman, London: Ciba Foundahon Symposium 115, 1985) 150-164. [Back]

26 J.R. Cougle, D.C. Reardon V.M. Rue, M.W. Shuping, P.K. Coleman, and P.G. Ney, "Psychiatric admissions following Abortion and childbirth: a record-based study of low-income women," Archives of Women's Mental Health 3(4) Suppl. 2:47 (2001). [Back]

27 George Skelton, "Many in Survey Who Had Abortion Cite Guilt Feelings," Los Angeles Times, March 19, 1989, 28. [Back]

28 H. Soderberg, C. Andersson, L. Janzon, N.O. Sjöberg, "Selection bias in a study on how women experienced induced Abortion," Eur. J. Obstet. Gynecol. Reprod. Biol., 77(1):67-70 (1998); Adler, "Sample Attrition in Studies of Psychosocial Sequelae of Abortion?" op. cit. (ch. 2 no. 22). [Back]

Additional Resources on Post-Abortion Issues

  1. Forbidden Grief by Theresa Burke and David C. Reardon
  2. Making Abortion Rare by David C. Reardon
  3. The Jericho Plan by David C. Reardon
  4. Victims and Victors by David C. Reardon et alii
  5. Aborted Women, Silent No More by David C. Reardon
  6. Detrimental Effects of Abortion by Thomas W. Strahan

Available through Acorn Books at 1-888-412-2676
Acorn Books,
PO Box 7348
Springfield, IL. 62791

Theresa Burke, Ph.D., is a psychotherapist and founder of Rachel's Vineyard, a post-abortion training and healing ministry that annually serves thousands of women and couples throughout North America and overseas.

David C. Reardon, Ph.D., is one of the nations's leading researchers and authors on post-abortion issues and the founding director of the Elliot Institute.

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