ABORTION TRAUMA

Abstract

Worldwide there are an estimated forty-two million induced abortions per year, with one in five pregnancies ending in induced abortion. Among American women, nearly one and one quarter million abortions were performed in 2005 and it is estimated that twenty-two percent of all pregnancies (excluding miscarriages) ended in abortion. The reasons for abortion vary widely from convenience, inaccessibility of birth control, an ill-timed pregnancy, coercion, use of abortion as a de facto form of birth control, economic pressures, young age, etc. Types of abortion and timing in the pregnancy also vary widely. Most American women cite ill timing of a pregnancy, in terms of economic and life circumstance, as their reason for abortion and many of these women abort early on in their pregnancies.
Coping Mechanism Turned Stressor
Abortion is normally resorted to as a coping mechanism – as a means to escape the stressor of a pregnancy by terminating it. While most women are believed to fare well after abortion, there is clear evidence that for some women abortion precipitates negative psychosocial consequences with symptoms ranging from short-term mild distress to major psychological disorders including: depression, anxiety, panic disorder, acute and posttraumatic stress disorder (PTSD), and even psychotic responses. This entry examines the ways in which abortion can act as a traumatic stressor; exploring the numbers of women likely involved; how pre-existing conditions as well as issues inherent in the abortion itself, may make it more likely for abortion to be experienced as traumatic; the types of symptoms that unfold when abortion acts as a traumatic stressor - including complicated grief and guilt responses; and considers controversies over post abortion stress research.

Full text

ABORTION TRAUMA
by
Anne Speckhard & Vincent Rue
Introduction
Worldwide there are an estimated forty-two million induced abortions per year,
with one in five pregnancies ending in induced abortion. Among American women,
nearly one and one quarter million abortions were performed in 2005 and it is estimated
that twenty-two percent of all pregnancies (excluding miscarriages) ended in abortion.
The reasons for abortion vary widely from convenience, inaccessibility of birth control,
an ill-timed pregnancy, coercion, use of abortion as a de facto form of birth control,
economic pressures, young age, etc. Types of abortion and timing in the pregnancy also
vary widely. Most American women cite ill timing of a pregnancy, in terms of economic
and life circumstance, as their reason for abortion and many of these women abort early
on in their pregnancies.
Coping Mechanism Turned Stressor
Abortion is normally resorted to as a coping mechanism – as a means to escape
the stressor of a pregnancy by terminating it. While most women are believed to fare well
after abortion, there is clear evidence that for some women abortion precipitates negative
psychosocial consequences with symptoms ranging from short-term mild distress to
major psychological disorders including: depression, anxiety, panic disorder, acute and
posttraumatic stress disorder (PTSD), and even psychotic responses. This entry examines
the ways in which abortion can act as a traumatic stressor; exploring the numbers of

women likely involved; how pre-existing conditions as well as issues inherent in the
abortion itself, may make it more likely for abortion to be experienced as traumatic; the
types of symptoms that unfold when abortion acts as a traumatic stressor - including
complicated grief and guilt responses; and considers controversies over post abortion
stress research.
Estimates of the Numbers of Women Involved
To estimate the numbers of women psychologically distressed by their abortions a
representative study is necessary comparing women terminating pregnancies by all
possible forms (i.e. induced abortion, miscarriage, stillbirth and birth) and that takes into
account pre-existing conditions that may factor into a distress response. Thus far no such
study of American women exists. It is possible however to extrapolate from small-scale
clinical studies of women who are distressed following their abortions and see that the
numbers of symptomatic women generally hovers around twenty percent. Given the huge
numbers of women having abortions, even a small percentage having negative
psychological symptoms constitutes a significant number of women.
Controversies over Post Abortion Stress Research
In the nineteen eighties, when posttraumatic responses to abortion were first being
documented by researchers there was considerable controversy in the United States over
the possibility of abortion to act as a traumatic stressor and over the numbers of women
effected. Even today, those who oppose abortion rights often claim large percentages of
women affected. Whereas those who favor abortion rights diminish the numbers and cite
pre-existing conditions (poor mental health, abusive relationships, coercion, etc.) as the

main, or only, reasons women are distressed after abortion - rather than anything inherent
in the abortion experience itself.
While pre-existing conditions do make women more vulnerable to post-abortion
distress there is no doubt that some subset of women, with or without pre-existing
vulnerabilities, do suffer psychologically as a direct result of their abortion experience.
Some suffer severely and immediately, others with delayed responses.
In-depth clinical research makes it possible to describe in detail the types of
distress responses that occur in these women and give estimates across many small
samples of the numbers of women likely to be involved. The best estimates that can be
made today based on clinical research is that up to twenty percent of all women having
abortions suffer post abortion distress responses.
Controversies exist over abortion research with political motivations attributed to
researchers who study the phenomena and certain methods may either inflate or deflate
results. Research conducted at abortion clinics with a short-term follow-up period may
underestimate post-abortion trauma responses as the primary short-term responses to
abortion are often relief and psychological numbing with trauma responses developing
later on. Those studies miss the most distressed women, as those traumatized by their
abortion are unlikely to participate with providers of a service that caused them traumatic
stress. Nearly all of the clinical research that documents posttraumatic responses in
women falls short methodologically in providing pre-pregnancy measures and exploring
pre-existing issues. However many excellent in-depth clinical studies of posttraumatic
responses to abortion exist using clinically validated measures and methods. These

studies clearly indicate post abortion trauma following the generally accepted
understandings of posttraumatic stress and acute stress disorders.
Abortion as a Traumatic Stressor
PTSD theory defines a trauma as involving a horrific and inescapable threat to life
in which one feels psychologically overwhelmed. Traumatic stressors are always
subjectively defined. In the case of abortion acting as a traumatic stressor it has involved
for the woman, on a subjective level, a threat to her own life or physical integrity, a threat
to the life or physical integrity of another human being (i.e. the embryo or fetus or
herself) and she has responded to the abortion with intense feelings of fear, helplessness
and horror.
Abortion and pregnancy by scientific definition are events that involve a new life
that is terminated. However, when it comes to having a psychological response to
abortion, the woman herself, within her familial, social, religious and cultural context
defines the abortion experience, both at the time of its occurrence and retrospectively
over time. That definition, and no other objective definition of abortion, will define
whether or not the abortion for her acts as a traumatic stressor.
For instance some women will say, “I’m having a baby,” immediately upon
learning they have conceived, whereas others may withhold any attribution of humanity
or attachment to the fetus/embryo until farther on in the pregnancy or after childbirth.
Thus in understanding abortion trauma it is important to acknowledge that the abortion
experience itself, while controversial in many cultures, is ultimately individualistically
defined when it comes to its ability to act as a traumatic stressor.

Studies of post abortion trauma reveal that there are clear pre-disposing factors of
women who are most likely to experience their abortion as traumatic. One indicator is
subjectively recognizing human life in the embryo or fetus (defining a “fetal child”),
which defines the abortion as involving a death event. The proclivity to experience
abortion as traumatic also increases with attachment to that life, because the abortion then
becomes in their minds not only the death of a human life, but also the death of their
“fetal child”. A woman who is able to completely detach from defining her pregnancy as
involving a human life, and its termination as a death event, is far less likely to
experience abortion as traumatic. Women who have borne children already often
attribute humanity and attach to their pregnancy earlier and stronger than those who have
no experience with childbearing, thus previous motherhood is a predisposing factor as
well.
Posttraumatic responses also arise in women who experience their abortion as
physically painful, threatening to their organs or life, or who receive abusive treatment by
their abortion provider or others involved in the abortion milieu such as demonstrators.
Specific aspects of abortion can also make it traumatic. An abusive partner, or
controlling parents may coerce a woman into an unwanted abortion. Young women who
fear social condemnation may abort pregnancies they wished to keep out of fear of
rejection by parents, peers or society. Variations in the freedom of access to obtaining
birth control and abortion, and socio-cultural and familial responses to abortion - from
complete acceptance to social condemnation – are widely distributed within and across
cultures and these too affect psychological responses to abortion.

Early abortion is often viewed by women as involving an embryo/fetus that is still
undeveloped and therefore disposable, in favor of the woman’s individual needs apart
from her pregnancy. Yet, first trimester surgical and vacuum abortions may also be
physically invasive and painful, and medical abortions (RU-486) carry the risks of
viewing the embryo/fetus as it is expelled from the body - perhaps leaving the woman
with an increased sense of culpability and personal involvement in the abortion
procedure. Later term abortions carry risks of being perceived as horrific if one becomes
aware of fetal dismemberment or chemical burning of the fetus, perceptions that may be
difficult to deal with emotionally.
The voluntary nature of abortion is also confusing, as it is infrequent that people
chose coping mechanisms that become themselves a traumatic stressor. Likewise shame
and secrecy shrouding an abortion may make it difficult to find help in dealing with a
traumatic abortion.
Delayed Traumatic Responses
Various experiences following an abortion may cause the experience to
retrospectively be redefined as a traumatic stressor. For instance, infertility following an
abortion may redefine the aborted pregnancy as “the only pregnancy I could have had” or
the woman may blame herself or her abortion provider for damaging her fertility.
Likewise being confronted with information that causes the subjective definition of the
pregnancy and abortion to change - pictures, sonograms or other items that reinforce the
humanity inherent in embryonic and fetal life – may suddenly change a benign event to
“the death of my fetal child.” Subsequent pregnancy experiences, infertility, miscarriage,

viewing sonograms, and other death experiences are the most likely triggers for a
retrospective shift in viewing the abortion experience as traumatic.
Posttraumatic Responses to Abortion
Acute stress responses to a traumatic abortion include high arousal, dissociation,
amnesia, feeling depersonalized or even a feeling of derealization (separating from
reality) and these symptoms may overtime transition into PTSD.
Re-experiencing - Re-experiencing includes distressing dreams; nightmares; intrusive
thoughts and flashbacks; intense psychological distress to reminders of the event;
physiological reactivity to cues that symbolize or resemble an aspect of the traumatic
abortion and acting or feeling as if the event were recurring. These may be vivid and
horrifying and resemble psychotic episodes. Re-experiencing can make it difficult to
enjoy sexual intercourse; to get calmly through a gynecological examination or
subsequent pregnancy; to be around babies, etc.
Avoidance - Intensely distressing re-experiencing engenders avoidance of thoughts,
feelings, conversations, activities, places and people that arouse recollections of the
abortion. Other symptoms include: amnesia for parts of the event; marked disinterest in
participating in significant activities (feeling depressed); feeling detached or estranged
from others; feeling a strong sense of emotional pain, guilt and shame that creates a
barrier in relationships; a restricted range of affect (i.e. feel unable to have loving
feelings) and a foreshortened sense of the future (feeling they may die, their children may
die, or if they become pregnant again that the pregnancy will not succeed).

Physiological Arousal - Increased arousal includes: difficulty falling or staying asleep;
irritability or outbursts of anger; difficulty concentrating; hypervigilance and exaggerated
startle response.
Duration and Impairment in Functioning - Significant impairment in functioning
associated with abortion related PTSD includes: psychological difficulties with parenting,
sexual relationships, partners, family or work and symptoms that endure beyond one
month following the abortion. Conflict between partners following an abortion is
common, particularly if the resolution of the pregnancy symbolized a test of commitment,
or if there was a difference of opinion on how to resolve the pregnancy, or coercion
involved. Likewise PTSD in one partner can be very difficult for the other to understand
or cope with.
Survivor Guilt and Shame - Guilt responses to abortion are socially mediated. Women
who come from a religious or cultural background that condemns abortion are more
likely to feel guilt. Picketers and anti-abortion propaganda attacking the morality of their
decision may also contribute to guilt responses.
Guilt can also arise from personal recognition of life inherent in pregnancy. This
is especially true if the fetus was highly developed. A woman who has subjectively
humanized or feels attached to the embryo/fetus has terminated a life to whom she
perceived a relationship. This can lead her to feel that she has failed to protect “her fetal
child” or is less maternal than she wished to be.
Women who fear a punitive “God” may fear subsequent miscarriage, fetal
deformation, or infertility later when she wants to bear a child and she may overprotect
subsequently born children out of fear of punishment. Any loss subsequent to the

abortion may be interpreted as confirmation that she doesn’t deserve to be a mother.
Intense PTSD and guilt responses can also manifest in a fear of harming one’s
subsequently born child. A crying newborn may also trigger flashbacks and feelings of
guilt interfering with a healthy maternal bond with a subsequent birth.
Women who suffer deep social shame over an abortion feel separated from others
and unable to reconnect in a meaningful way. They fear that they exist beyond
forgiveness and will be ostracized if others learn of their experience.
A woman’s own spiritual tradition is often the best pathway to work through her
feelings of guilt and shame while also helping her to mediate her hyperarousal and re-
experiencing. Group therapy also helps mediate the shame and sense of being alone with
post abortion grief, guilt and trauma. Some groups however are very proscriptive,
requiring that members adhere to their views of abortion, take part in rituals of naming
their “fetal child” and repenting for the abortion – activities that may not serve all women
well.
Complicated Grief - Grief arises from the subjective view of the life terminated
in abortion. Such grief is often complicated because of PTSD. It is difficult to grieve
fully when having flashbacks, avoidance and dissociative responses and it is confusing to
grieve or ask for social support because the experience was entered into voluntarily.
Abortion still carries a social stigma and many women are uncomfortable discussing that
they had an abortion, much less that they are suffering from post abortion grief. Likewise
our culture lacks mourning rituals for abortion. However, in recent years the Catholic
Church (Project Rachel) and some post-abortion healing groups have developed rituals to

aid in grieving although these are generally Christian based and may require adhering to
beliefs that not all women will share.
Co-Morbid Disorders – PTSD symptoms may also range into depression, panic
disorders, and involve co-morbidity with addictions, eating disorders, etc. Drinking,
drugs, or eating disorders may be engaged as attempts to calm hyperarousal states and
physiological reactivity. Intense flashbacks can lead to psychotic breaks in women who
relive intensely distressing aspects of their abortion experience. Somatization also occurs
with cervical pain with intercourse (flashbacks to the forced cervical opening in a
vacuum or surgical abortion) and gaining weight as a psychological attempt to “regain”
the pregnancy, etc.
Preoccupation with the Fetal Child – Women who have PTSD following an abortion
may develop a preoccupation with the deceased “fetal child”. This plays out in fantasies
where the woman develops an entire identity of her aborted child and often passes
important anniversary events (the due date as birthday) with imagining the “child”
growing as though it were alive. Pathologically the child is kept psychologically present
while physically it was terminated in the abortion procedure.
Relief and Psychological Numbing as a Response to Abortion
Relief is the most common response immediately following an abortion.
However an immediate response of relief does not preclude also having a deeply
distressful response shortly thereafter, or in the longer term. Relief is predominant as a
first response because abortion procedures are nearly always physically, if not also
psychologically stressful. Psychological numbing or dissociation engaged in order to
make the decision to abort, or to get through the procedure, may be misunderstood as

relief, when in fact it is not. Severe dissociative responses before and during an abortion
are not unheard of and peritraumatic dissociation can be an indicator that PTSD will
follow.
Summary
Abortion is capable of acting as a traumatic stressor and the generalized nature of
the responses are universal for those who experience post abortion distress. These
responses involve grief, guilt and shame, and acute and posttraumatic stress responses.
Women most likely to be distressed by abortion are those who have humanized the
embryo/fetus and made an attachment to it. Additional risk factors are youth; socially
condemning religious or cultural backgrounds; prior childbirth, as well as conditions
inherent in the experience itself that may include: abuse, condemnation, coercion and/or
physical pain during the procedure, as well as viewing the fetus or fetal parts. In every
culture the choice for abortion and its psychosocial consequences are influenced by
societal practices. Likewise abortion is a highly individualized experience with it at
times being personally defined by the woman as involving the termination of a human
life with the potential of having formed an attachment to that life. This individualized
definition of the abortion event is not static and may change over time throughout a
woman’s life as she encounters events that may cause her to reflect back on the
experience and redefine it – possibly in a way that causes it retrospectively to act as a
traumatic stressor.
Further Readings and Cross References:
Charles, V.A., Polisa, C.B., Sridharab, S.K., Bluma, R.W. (2008). Abortion and long-term mental
health outcomes: a systematic review of the evidence. Contraception, 78, 436–450.

Coleman, P.K. (2011). Abortion and mental health: quantitative synthesis and analysis of research
published 1995–2009. British Journal of Psychiatry, 199:180–186.
Coleman, P.K., Coyle, C.T, Shuping, M. & Rue, V.M. (2009). Induced abortion and anxiety,
mood, and substance abuse disorders: Isolating the effects of abortion in the national comorbidity
survey. Journal of Psychiatric Research, 43, 770–776.
Coyle,C. T., Coleman, P.K., & Rues, V.M. (2010). Inadequate Preabortion Counseling and
Decision Conflict as Predictors of Subsequent Relationship Difficulties and Psychological Stress
in Men and Women. Traumatology, 25, 1-15.
Mota, NP, et al. (2010). Associations between abortion, mental disorders and suicidal
behavior in a nationally representative sample” Canadian Journal of Psychiatry, 55(4):
239 – 246.
Mufel, N., Speckhard, A. & Sivuha, S. (2002). Predictors of Posttraumatic Stress Disorder After
Abortion in a Former Soviet Union Country. Journal of Prenatal & Perinatal Psychology &
Health, 17 (1), 41-61.
Rue, V., Coleman, P., Rue, J. & Reardon, D. (2004). Induced abortion and traumatic stress: A
preliminary comparison of American and Russian women. Medical Science Monitor, 10 (10):
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Speckhard, A. (l996). Traumatic Death in Pregnancy: The Significance of Meaning &
Attachment in Charles Figley, Brian Bride, & Nicholas Mazza (Eds.), Death & Trauma: The
Traumatology of Surviving (pp. 67-101). Washington, D.C.: Taylor & Francis.
Speckhard, A. & Mufel, N. (2003). Universal Responses to Abortion? Attachment, Trauma and
Grief Responses in Women Following Abortion. Journal of Prenatal & Perinatal Psychology &
Health 18 (1), 3-37.
Speckhard, A & Rue, V. (1993). Complicated Mourning: Dynamics of Impacted Post
Abortion Grief. Journal of Pre- and Peri-Natal Psychology, 8, 6-12.
Speckhard, A. & Rue, V. (1992). Post Abortion Syndrome: An Emerging Public Health Concern.
Journal of Social Issues 48(3): 95-119.