Post Abortion Distress—The Politically Incorrect Trauma

The recent trial and guilty verdict of Philadelphia Dr. Gosnell for murdering three children delivered alive after late term abortions has raised the controversial issue of U.S. abortion rights once again. It also reminds me of years of research I conducted documenting high stress reactions to abortion and the inability of many to discuss this issue in a rational and caring manner.  Having interviewed and treated women with high stress responses—including posttraumatic stress disorders and traumatic bereavement—as a result of abortion, I found myself deeply embroiled in the politics of abortion versus a genuine concern with whether or not all women do well with, and find abortion a useful coping mechanism for a problematic pregnancy. 

As my research carefully documented what a high stress reaction to abortion looked like, I found myself facing such career blocks thrown in my path as having the head of the National Planned Parenthood office write a letter to Harper & Row asking them to not publish my book on the subject—and to have the contract I was about to be offered suddenly rescinded—what seemed to me to be a clear violation of my First Amendment rights.  As a result, I found myself presenting my research in academic circles in a defensive manner so much so that I began to talk about post-abortion traumatic stress responses as “the politically incorrect trauma”. 

Unfortunately the politics of arguing over abortion rights has made many blind to the fact that women fall all over the spectrum of potential psychological responses to abortion—and while some find it a useful coping mechanism, experiencing it with minimal distress—others are deeply distressed by it.  And among academics and activists there are those who for decades now have refused to admit that there are a group of women who do not do well with abortion—and are even psychologically harmed by it.  Yet the fact remains that some women are harmed by the “politically incorrect trauma”.

The potential traumatic stressors involved in abortion are many.  For most they involve perceiving the pregnancy as a human being and the abortion being experienced as a traumatic death event.  This is worsened if they have formed an attachment to the embryo or fetal child in that they likewise experience a traumatic severing of the maternal attachment bond and deep questions about what severing this bond then says about them as women and mothers. 

While many women feel none of this—others are deeply disturbed by abortions that they go through for various reasons.  And let us not forget that many women—particularly young women and victims of domestic abuse (by parents or spouses) are forced into abortions they do not want.   Far more women are forced into abortions than anyone likes to admit.

Abortions are also physically intrusive and frightening for some.  The cramping and suction or viewing of fetal remains can be terrifying for some.  And in some cases the traumatic nature of abortion is a result of the doctor who performs it—his or her abusive nature or failure to perform the procedure in a medically sound manner.

While we would hope that Dr. Gosnell—if he can even properly be referred to as a doctor—is the rare case, I have unfortunately heard too many first person stories of similar although lesser horrors. 

Many women have told me of pregnancies that were not properly dated as the doctor only did their examination once they had already paid for and were fully committed to their abortions—as in up in stirrups and fully prepped for it.  And as pregnancy by physical examination and recall of last menstruation is not as accurate as ultrasound, one woman I worked with found herself with an incomplete abortion—she left the clinic thinking she had been given a first term abortion—when in fact she went home with the head and shoulder of an aborted seventeen week fetal child still left inside. Likewise a nurse told me of a hysterectomy done on a woman in which a live fetus was removed along with her uterus—the doctor never bothering to tell his patient that he had mistaken a tumor for a live fetus that he had then removed under anesthesia along with her uterus.  One abortion clinic doctor in Wisconsin admitted performing an abortion on a woman who was so distraught that she had moved into a dissociated state during her abortion and was talking baby talk during the procedure.  That doctor apparently never thought to stop the procedure and deal with the distress of her patient.

Likewise I have argued for years that most U.S. based abortion clinics fail to obtain a true informed consent.  When a distressed woman shows up at their door she is in many cases asked to fill out paper work including signing an informed consent and to pay for her procedure prior to meeting with any health care provider.  And the abortion procedure is often explained in many clinics in group settings (in a mill like format) often by a non-medically educated informant who explains the procedure without explaining all the options, nor insuring that each group member understands how pregnant she is, and what the procedure entails. 

Most women at U.S. abortion clinics only meet their doctors once they are up on the table in stirrups—hardly a time to carry out a careful informed consent procedure—to have time to respond with any careful deliberation to accurate dating of her gestational stage, etc. Women also leave such clinics often with little understanding of what to expect in terms of possible negative outcomes—particularly psychological ones such as traumatic grief, acute stress responses, overwhelming guilt, etc.  And if they do feel traumatized by their abortions they often don’t want to return to the source of the trauma and don’t know where to turn.  These issues of course are compounded for underage minors who may be acting in an acute state of fear without the protective guidance of an adult that truly cares for their well-being.

Some years ago I attended a U.S. medical panel over which Dr. Nada Stotland presided—a psychiatrist who has for years denied that women can be traumatized by the actual experience of abortion.  She and the other panelists bemoaned the fact that medical schools could no longer force unwilling doctors to learn to perform abortions, and that young American doctors were increasingly finding providing abortions unsavory and that increasingly, ill-reputed doctors who were forced out of their practices by lawsuits and the like were becoming abortion providers—with all the attendant scandals that same with them.  Apparently Dr. Gosnell was of this ilk.

Today we see a doctor convicted of murder for taking the lives of fetuses he had just taken from the womb.  I’ve always wondered about the teenagers who get similar convictions for denying to themselves or possibly even dissociating the fact of their pregnancies—until they deliver—often in inconvenient circumstances—such as at a high school dance or party.  Totally in shock at the delivery of a full term infant they toss the child aside and when the evidence of the “trash can baby” catches up to them they also receive convictions for manslaughter.  Yet if they had gone for a late term abortion and the doctor had managed to end the fetal child’s life while still inside the teen’s body it would have been a medical procedure.  There’s something highly schizophrenic about that—hardly something we can expect a young troubled teen in a high state of distress to fully comprehend.

Likewise we must admit that abortion is often also used against women.  Women all over the world have been forced into abortions they didn’t want—in China because of the one child policy.  Likewise female fetuses have been the subject of massive gendercide in both China and India.  Here in the states, some women are forced and coerced into abortions they don’t want by family members and many women feel ill equipped to stand up to a partner who believes paying for an abortion absolves him of his duty to pay child support if the woman opts to carry the pregnancy to term.  When it comes to abortion far more women than we care to admit, face choice-less choices.

The truth is every abortion represents a crisis of sorts—a failure of some kind—birth control, relationship, timing, one’s ability to provide for self and baby, etc.  And every abortion says something about the society we live in—where parents don’t have access to good day care and may not have health insurance or the wherewithal to provide for their children.  Whether one sees abortion as a life option, tragic necessity or as violence, we need as a society to find useful ways to discuss abortion, the way it’s provided and its effect on women and society. 

Dr. Gosnell was a sick doctor.  But there is also something wrong with a public health system that received numerous complaints about him and seemingly for political concerns did nothing to stop him.

Politics have also stood in the way of good research being conducted to examine psychological responses in a nationally representative sample to all pregnancy outcomes: live birth, miscarriage, induced abortion, and still birth (and perhaps even including adoption).  I offered in 1987 to our National Center for Health Statistics a simple mechanism for collecting such data via a short interview to be attached to an already existing survey—but fear of the answers—on both sides of the issue staunchly squelched the idea.

The politics of abortion and our inability to objectively seek the truth on these matters in a rational manner have for years thwarted my attempts to collect objective, nationally representative data on postpartum pregnancy outcomes.  And feminist researchers like myself—who have tried for years to painstakingly document and truthfully address the fact that not all women do well with abortion, have been all but silenced. 

The truth is not all, but some women having abortions—are traumatized, have anxiety responses, panic disorders, depression, acute and posttraumatic stress responses, psychosis, traumatic bereavement, etc.  There is an entire spectrum of psychological responses to abortion and when some women don’t do well with it, or are even abused by their provider, and become traumatized—that trauma should not be one more statistic under the rubric of  “the politically incorrect trauma” just because we wish to keep all options open for all women.  We must be able to talk rationally about these issues and to conduct good research on the subject.

And we must acknowledge that some women don’t do well with abortion—and sometimes—rarely so—but sometimes—it’s because the person who provided it was a butcher.

Anne Speckhard, Ph.D. is Adjunct Associate Professor of Psychiatry in the Georgetown University Medical School and author of Fetal Abduction: The True Story of Multiple Personalities and Murder and Talking to Terrorists: Understanding the Psycho-Social Motivations of Militant Jihadi Terrorists, Mass Hostage Takers, Suicide Bombers & “Martyrs” She is also currently serving as the co-chair of the American Psychological Association, Division 48, Presidential Task Force on “Research Agenda on Abortion from a Peace Psychology Perspective”.


4 thoughts on “Post Abortion Distress—The Politically Incorrect Trauma

  1. Na

    While there are certainly bad doctors we need to also give attention to the status of these clinics; many locations are so terrorized that they can’t even get sufficient personnel to work there or the new trend in lawmaking is to prevent doctors from working at these clinics. Politics is once again interfering with the health and well being of women. Some women may not deal well with the surgery but what solution is your research offering? Sounds likes your are only fueling the debate between Pro-life and Pro-choice when you don’t offer some proactive steps that can be taken. What about actually supporting those doctors who are doing it right? What about setting reasonable standards for hiring these doctors? What about providing private support groups with women who are doing well with the decision? Every person that I have know was not forced into it and if some one is being forced into it then how about providing personnel to whom they can speak to about options?? and on tht note you cite China and India as examples of forced abortions but what are the statistics in the Unite States? How many women in the US who are abused by a parent, relative, significant other or stranger want to have the child that is a result of that abuse? How many are forced?

    Lets be proactive instead of destructive and look for solutions.

  2. Anne Speckhard, Ph.D. Post author

    Thank you Na for your comment. You are right it is only a small minority of women forced into abortion–yet no one should be forced or have abortion be a part of their domestic abuse which in some cases it sadly is and as I know it now there are no good mechanisms in place for preventing that. The most famous case that comes to mind for me is Lorena Bobbit whose defense team I served on. A year before her crime she claimed her husband took her to a clinic and stood over her making sure she had an abortion she did not want. And many women who are in abuse circumstances do want to bear their child even if their partner stinks… it may seem counter-intuitive but it’s not necessarily so. Likewise those who work with domestic abuse know that men often beat their pregnant wives to cause miscarriage–coerced and forced abortions are likely an extension of that.

    My research solutions would start with good nationally representative data that is simple to collect and I have advocated for years for that and just run into politics that I agree with you are interfering with and standing in the way of women and their health.

    We already have a National Survey of Maternal and Child Health and the National Survey of Family Growth (or whatever they have become over the years) to which good objective questions could be added to study all the potential outcomes of pregnancy – stillbirth, miscarriage, live birth and abortion asking about postpartum stress responses to those outcomes. That way we would have some idea of what percentage of women do well with abortion and who does not.

    We also have good national abuse surveys but I do not know of any researchers who collect good data on coerced abortion or for that matter forced miscarriage (as a result of beating). And I have met many researchers at conferences who refuse to share their abortion related data because it contains disturbing information about women who are abused or harmed in abortion and they fear their data will be manipulated in the abortion rights debate. This isn’t right. We shouldn’t be afraid of the truth. That some use it to try to prevent women from having free choice is another matter entirely but until we begin to see this as an important mental and physical health issue for which we need good data collection by responsible noninvolved parties (i.e. not profiting from the procedure) we will not be able to offer solutions that are strongly based in evidence.

    As for holding support groups for women who do well with abortion I wouldn’t see a need. If they are doing fine that’s great. But those that are not need our support. Not every solution is going to be right for every woman. There are millions of women getting abortions every year. That they would fall on an entire spectrum of responses to abortion–from acute distress to positive coping makes complete sense. Those that fall on the distress end of the spectrum need our care and attention without politics getting in the way.

  3. Jo

    Thank you, Anne. It’s always a relief and sense of delight that there are people out there that understand what is happening for many women. I don’t agree with Na that it’s rare that women are coerced into abortions they don’t want. It happens, in my experience, all to frequently. I myself was coerced many years ago, and it still remains the most traumatic event of my life – and I’m in my 50’s now, so you can imagine there have been many events in my life!
    I have also met others that have suffered similarly.
    You are right, Anne, that it is a politically incorrect trauma! Women who do suffer this way have nowhere to go – neither the prolifers nor the prochoicers want anything to do with their emotional distress. The prochoicers don’t believe it, and the prolifers want to use it to help their cause. Meanwhile, many women suffer deep and devastating trauma -which in its turn leads to poor lifestyle choices, such as addictions or abusive relationships, which then in turn also makes it easy to judge the ones who suffer as dysfunctional.
    It’s a great wrong in our age. The voices of real women are still as muffled as they ever were, and the wisdom of experience has difficulty finding its way to young women who are suffering as we speak.
    Abortion has little to do with politics in reality. It’s so deeply personal.
    I can see how it needs to exist, and I can see how for many women it’s a godsend in certain situations. For other women, it’s just a weapon of the war between men and women.
    Anyway, this is an old post, but I was heartened to read such a sensitive and honest article on what goes on out there for many women.
    And there really are many! It’s not much talked about because the ones that suffer are suffering enough, they don’t need to hold themselves up for scrutiny of political rights and wrongs about the way they feel.
    Thank you, Anne.

    1. Anne Speckhard, Ph.D. Post author

      Dear Esmerlda, I’m sorry to hear about your suffering. There are now good pro-life grief groups but they often require buying into a certain religious viewpoint on abortion which can make it difficult for those who don’t, but very helpful for those that do. And you are right traumatic experience that is shame-based and untreated then often leads to more problems–using substances, bad choices etc. We need to simply publicly acknowledge on both sides of the debate that abortion for some women is a very difficult choice that can cause PTSD in some, not all by any means. And for those some we need to offer caring support and helpful screening that would lead to prevention in the first place. Abortion in all cases reflects some sort of failure–birth control, decision making, relationship,etc. and it would be good if it were openly discussed. Thanks for your comment!!


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