ArticlePDF Available

Induced abortion and traumatic stress: A preliminary comparison of American and Russian women

Authors:
  • Alliance for Post-Abortion Research & Training
  • Elliot Institute

Abstract and Figures

Individual and situational risk factors associated with negative postabortion psychological sequelae have been identified, but the degree of posttraumatic stress reactions and the effects of culture are largely unknown. Retrospective data were collected using the Institute for Pregnancy Loss Questionnaire (IPLQ) and the Traumatic Stress Institute's (TSI) Belief Scale administered at health care facilities to 548 women (331 Russian and 217 American) who had experienced one or more abortions, but no other pregnancy losses. Overall, the findings here indicated that American women were more negatively influenced by their abortion experiences than Russian women. While 65% of American women and 13.1% of Russian women experienced multiple symptoms of increased arousal, re-experiencing and avoidance associated with posttraumatic stress disorder (PTSD), 14.3% of American and 0.9% of Russian women met the full diagnostic criteria for PTSD. Russian women had significantly higher scores on the TSI Belief Scale than American women, indicating more disruption of cognitive schemas. In this sample, American women were considerably more likely to have experienced childhood and adult traumatic experiences than Russian women. Predictors of positive and negative outcomes associated with abortion differed across the two cultures. Posttraumatic stress reactions were found to be associated with abortion. Consistent with previous research, the data here suggest abortion can increase stress and decrease coping abilities, particularly for those women who have a history of adverse childhood events and prior traumata. Study limitations preclude drawing definitive conclusions, but the findings do suggest additional cross-cultural research is warranted.
Content may be subject to copyright.
Induced abortion and traumatic stress: A preliminary
comparison of American and Russian women
Vincent M. Rue1ABCDEFG, Priscilla K. Coleman2CDEF, James J. Rue3AEF,
David C. Reardon4CDEF
1 Institute for Pregnancy Loss, Jacksonville, FL, U.S.A.
2 Human Development and Family Studies, Bowling Green State University, Bowling Green, OH, U.S.A.
3 Sir Thomas More Clinic, Downey, CA, U.S.A.
4 Elliot Institute, Springfi eld, IL, U.S.A.
Source of support: Partial funding for this study was made possible by grants from the Trust Funds Foundation
and the Alberto Vollmer Foundation.
Summary
Background:
Individual and situational risk factors associated with negative postabortion psychological seque-
lae have been identifi ed, but the degree of posttraumatic stress reactions and the effects of culture
are largely unknown.
Material/Methods:
Retrospective data were collected using the Institute for Pregnancy Loss Questionnaire (IPLQ)
and the Traumatic Stress Institute’s (TSI) Belief Scale administered at health care facilities to 548
women (331 Russian and 217 American) who had experienced one or more abortions, but no oth-
er pregnancy losses.
Results:
Overall, the fi ndings here indicated that American women were more negatively infl uenced by their
abortion experiences than Russian women. While 65% of American women and 13.1% of Russian
women experienced multiple symptoms of increased arousal, re-experiencing and avoidance as-
sociated with posttraumatic stress disorder (PTSD), 14.3% of American and 0.9% of Russian wom-
en met the full diagnostic criteria for PTSD. Russian women had signifi cantly higher scores on the
TSI Belief Scale than American women, indicating more disruption of cognitive schemas. In this
sample, American women were considerably more likely to have experienced childhood and adult
traumatic experiences than Russian women. Predictors of positive and negative outcomes associat-
ed with abortion differed across the two cultures.
Conclusions:
Posttraumatic stress reactions were found to be associated with abortion. Consistent with previous
research, the data here suggest abortion can increase stress and decrease coping abilities, partic-
ularly for those women who have a history of adverse childhood events and prior traumata. Study
limitations preclude drawing defi nitive conclusions, but the fi ndings do suggest additional cross-
cultural research is warranted.
key words: abortion • trauma • posttraumatic stress disorder • psychological sequelae •
women’s reproductive health
Full-text PDF: http://www.MedSciMonit.com/pub/vol_10/no_10/4923.pdf
Word count: 4645
Tables: 7
Figures: 1
References: 50
Author’s address: Vincent M. Rue, Institute for Pregnancy Loss, 1574 Scottridge Lane, Jacksonville, FL 32259, U.S.A.,
e-mail: vincerue@bellsouth.net
Authors’ Contribution:
A Study Design
B Data Collection
C Statistical Analysis
D Data Interpretation
E Manuscript Preparation
F Literature Search
G Funds Collection
Received: 2004.02.03
Accepted: 2004.04.22
Published: 2004.10.01
SR5
Special Report
WWW.MEDSCIMONIT.COM
© Med Sci Monit, 2004; 10(10): SR5-16
PMID: 15448616
SR
Indexed i n: Current Con tents/Clinica l Medicine • SCI Ex panded • ISI Aler ting Syste m • Index Medicus/MEDL INE • EMBASE/E xcerpta Med ica • Chemical Abs tracts • In dex Copernicu s
BACKGROUND
Beyond politics, increasing public health concern is focus-
ing on the adverse emotional outcomes women can experi-
ence following abortion [115]. Researchers on both side of
the abortion debate agree that some womens mental health
is negatively impacted by abortion and that more investiga-
tion is warranted to better assist those women and to pre-
vent future harm to others.
Extensive research has documented how traumatic stress
can signi cantly alter individuals lives [16]. Traumatic stres-
sors are strong predictors of PTSD. While the lifetime prev-
alence of PTSD has been estimated to be up to 12% of U.S.
women [17], limited research has examined the role of in-
duced abortion as a traumatic stressor.
Anxiety and depression have long been associated with in-
duced abortion [18]. In a major review of the literature,
anxiety symptoms were identi ed as the most common ad-
verse postabortion response [19]. As an anxiety disorder,
posttraumatic stress disorder (PTSD) can be identi ed with
an overwhelming and life-threatening event and with an in-
ability to process the trauma. Earlier research reported a
connection between experiencing a traumatic abortion and
the onset of posttraumatic stress related symptoms [2024].
These studies were limited due to their reliance upon either
case studies or small samples, with the exception of one larg-
er study that reported a 1% incidence of PTSD following
abortion [25]. The present study focused on the degree to
which induced abortion was associated with posttraumatic
stress and whether or not posttraumatic responses follow-
ing abortion were evident in another culture.
Womens psychological responses to abortion are likely in-
uenced by complex socio-cultural factors. In some nations
the social environment surrounding abortion is de ned by
strong moral sanctions against it; whereas in other parts of
the world abortion is a passively accepted medical practice.
The present study represents an exploratory comparison of
abortion reactions of American and Russian women. The
comparison of these two groups is especially interesting be-
cause abortion continues to be a highly charged political is-
sue in the United States since its legalization in 1973, while
there has been very little political controversy about abor-
tion in Russia following its legalization in 1955. For many
years, Russian women have used abortion as one of their
principle means of birth control due to the relative scarci-
ty of other birth control options; although more restrictive
policies are emerging [2628].
Some research has suggested that PTSD is not just limited to
Euro-Americans [29]. However, assessment of PTSD symp-
toms may vary widely due to ethnocultural in uences [30
32]. While there is some evidence of PTSD following abor-
tion in the U.S. [2024], no equivalent research has been
conducted with Russian women. Hence, the primary pur-
pose of this research was to examine whether or not abor-
tion was perceived as traumatic, and if so, whether or not its
manifestations were equivalent to PTSD symptoms in both
American and Russian women. The secondary purposes of
this research included identifying demographic and preg-
nancy circumstances most predictive of possible negative
outcomes, as well as evaluating the extent to which negative
responses could be due to cultural factors, rather than indi-
vidual characteristics in American and Russian women.
MATERIAL AND METHODS
Participants
Women who had experienced a pregnancy loss (sponta-
neous abortion, induced abortion, stillbirth, or adoption)
were asked to participate in a study of womens reactions
to a pregnancy loss. Data were collected in 1994 at U.S. and
Russian healthcare facilities (public and private hospitals,
and health care clinics). All women between the ages of 18
and 40 were surveyed on a continuous basis until 992 wom-
en with at least one pregnancy loss had been identi ed. The
sample used in the current study includes only those women
who had one or more induced abortion and no miscarriages,
stillbirths, or adoptions (n=548 or 55.2% of the larger sam-
ple). If multiple abortions were reported, the respondent
was asked to identify and only report on the most stressful
one. As to nationality, the sample used in the current study
included 331 Russian and 217 American women.
At the time of their reported abortion experience, the mean
age of the Russian women was 22.11 (SD=5.80) and for
the American women, the mean age was 23.07 (SD=5.71).
The mean age at the time the women completed the ques-
tionnaire was 28.24 (SD=9.67) for the Russians and 33.86
(SD=8.85) for the American. Among Russian women, the
mean number of weeks pregnant at the time of the abor-
tion was 6.75 (SD=3.19); whereas among the American
women, the mean number of weeks pregnant was 10.07
(SD=4.55).
Procedure
Data were collected at one urban hospital in Russia and
one urban hospital and two medical outpatient clinics in
the United States. At the Russian national hospital, which
specialized in womens health, all women seeking health
care were asked by a staff physician to participate in the re-
search. After several consultations with Russian physicians
and demographers, as well as piloting the Russian version
of the IPLQ, it was determined that the optimum form of
data collection to ensure completeness and patient com-
prehension was to have staff doctors interview the patient/
respondents. The considerable dif culty in translating the
avoidance criteria of PTSD into Russian and concern re-
garding patient comprehension motivated the use of in-
terviews as opposed to questionnaires in Russia. The par-
ticipating Russian physicians were trained on the research
purposes and particulars of using the IPLQ as an interview
guide. Mental health facilities were purposefully excluded
as data collection sites to prevent the selection of subjects
from a pathology-oriented population.
In the U.S, each subject completed a written questionnaire.
A study monitor at each of the three data collection sites was
available to respond to any questions or concerns. In Russia,
a staff physician interviewed each female patient and com-
pleted the questionnaire on her behalf in order to minimize
cross-cultural misinterpretations of question wording. In all
cases, respondents were informed of the following: (1) that
their participation in the research was voluntary; (2) that all
Special Report Med Sci Monit, 2004; 10(10): SR5-16
SR6
responses were anonymous; (3) that they had the right to
refuse participation and that non-participation would not
in uence their healthcare; (4) that they had the right to
discontinue participation in the research at any point; and
(5) that counseling was available afterwards if so requested.
The administration time was 15 to 20 minutes. Due to fund-
ing and staff limitations, no data were collected on women
who chose not to participate.
Measures
The two data collection instruments used were the Institute
for Pregnancy Loss Questionnaire (IPLQ) and the standard-
ized Traumatic Stress Institutes (TSI) Belief Scale - Version
K originally developed by Pearlman [33]. The scale was
subsequently revised to Version L [34] and has now been
renamed the Trauma & Attachment Belief Scale [35,36].
A university-based human subjects review panel approved
the use of the IPLQ and it was pre-tested using college age
students.
The IPLQ included two major sections. The rst section in-
cluded demographic and background information. The lat-
ter included questions related to likely control variables in-
cluding stressors that might pre- or postdate the abortion.
The second section of the IPLQ presented subjects with a
cognitive/emotional/behavioral checklist of positive and
negative effects of abortion that had been previously re-
ported in the literature. Subjects were asked to indicate
whether or not they had experienced the various responses
before and after the abortion, and whether or not they be-
lieved the abortion caused the items endorsed. Only those
symptoms women speci cally attributed to their abortions
were reported here.
Items included in the second section of the IPLQ were drawn
from a pool of variables identi ed by experts in the eld
of pregnancy loss with additional items culled from the re-
search literature. The determination of which items to in-
clude was made by a panel of clinician raters for purposes
of content validation. Thirty-one items pertaining to pos-
sible negative effects met the nal selection criteria for in-
clusion in the cognitive/emotional/behavioral checklist,
with 14 of these items indicative of PTSD symptomatolo-
gy. On the 14-item PTSD scale, Cronbachs alpha was 0.89.
Cronbachs alpha for the 17-item negative effects scale (all
negative items minus the PTSD symptoms) was 0.87. For
the three subscales of the PTSD measure, corresponding
to symptoms of arousal (4 items), re-experience (4 items),
and avoidance (6 items), Cronbachs alpha coef cients were
found to equal 0.67, 0.74. and 0.81 respectively. The four-
teen items on this scale correspond to the 14 symptoms of
PTSD outlined in the fourth edition of the Diagnostic and
Statistical Manual of Mental Disorders (DSM-IV) [37]. In
order to meet the DSM-IV criteria for PTSD diagnosis a per-
son must endorse at least two symptoms of arousal, one re-
experiencing symptom, and three avoidance symptoms for
at least one month. Four positive outcome items were in-
cluded as well: relief, improved self-image, improvement in
partner relationships, and feeling more in control of ones
life. These four items were included both to address re-
sponse set bias and because they were repeatedly reported
in the literature. Cronbachs alpha was found to equal 0.45
for the four-item positive response total scale.
A single item self-report measure of the level of stress ex-
perienced as a result of the abortion served as another out-
come measure. The range of scores on this item was from 1
to 4, with lower scores indicative of minimal stress and high-
er scores suggesting overwhelming stress.
In addition to the IPLQ, the standardized Traumatic Stress
Institutes (TSI) Belief Scale was employed. The TSI Belief
Scale is intended to measure disruptions in beliefs about
self and others that can arise from exposure to psychologi-
cal trauma. The scale consists of 90 items and uses a 6-point
Likert scale. The TSI Belief Scale is based on Constructivist
Self Development Theory, integrating self psychology, ob-
ject relations, interpersonal and social cognition theories
[38,39]. Internal consistency reliability of the TSI Belief Scale
was reported to be 0.98 (Cronbachs alpha). Subscale reli-
abilities ranged from 0.77 (other-control) to 0.91 (self-es-
teem); however, only total summed scores were used in this
study [33]. The TSI Belief Scale has been used with a variety
of populations and has reliably discriminated between trau-
ma survivors and non-trauma survivors [33,34].
RESULTS
Various demographic and psychosocial background varia-
bles were assessed. In this sample, as to ethnicity, most of
the women from the former Soviet Union identi ed them-
selves as Russian (78.2%); in the American sample, 59.4%
were white, 24.9% Hispanic, and 10.1% black. Most Russian
women worked full-time (63.4%) compared to 34.3% of
the women in the American sample. In both cultures, the
majority of women worked in the professional/ business
sector (62% Russian v. 57.9% American). More Russian
women were married (59.1%) compared to American
women (49.1%), and Russian women had slightly more
years of education than American women (48.9% had 16
years of education v. 42.9%). As to number of children,
52% of Russian women had none compared to 30.4% of
American women.
Regarding the psychosocial variables, these data generally
suggest that women in the Russian sample perceived their
childhoods (8.5% Russian v. 51.6% American) and adoles-
cence (74.2% Russian v. 36.6% American) to be happier
than American women. American women were considera-
bly more likely to report being physically or sexually abused
before age 18 (42.3% American v. 11.4% Russian). When
asked about religious convictions, 63.1% of the Russian sam-
ple and 89.4% of the American sample indicated having re-
ligious beliefs. The mean rating of the importance of these
beliefs was 2.49 (SD=0.73) for the Russian sample and 1.49
(SD=0.71) for the American sample on a scale of 1 to 4, with
scores closer to 1 suggesting more importance.
Table 1 contains the descriptive statistics for all the out-
come measures for both the Russian and American sam-
ples. On a 1 to 4 scale, women in both countries general-
ly reported their abortion experiences as stressful. Overall,
when compared to Russian women, American women who
chose to abort were more than twice as likely to experience
negative psychological effects and report PTSD symptoms
of arousal, re-experience, and avoidance, particularly the
latter. Russian women only scored higher than American
women on the TSI scale.
Med Sci Monit, 2004; 10(10): SR5-16 Rue VM et al Induced abortion and traumatic stress
SR7
SR
Table 2 provides zero-order correlations re ecting associa-
tions between particular psychosocial stressors and outcome
measures based on nationality. Table 3 provides zero-or-
der correlations among all the outcome measures conduct-
ed separately for the two samples. Signi cant correlations
were detected between PTSD symptoms (total and subscale
scores) and the other measures of negative effects in both
samples. In addition, the subscales of the PTSD measure
were signi cantly intercorrelated with data collected from
the Russian and American samples.
Table 4 contains descriptive data for all the abortion con-
text variables. In both countries, women perceived abortion
as morally wrong in equal proportion. More Russian wom-
en than American women felt prepared for their abortion
in that they were counseled on alternatives, felt the coun-
seling they received was adequate, and found their partner
was supportive. On the other hand, more American wom-
en in this sample versus Russian women felt they needed
more time to make their decision, felt pressured by others
to abort, and were less sure of their decision at the time of
the abortion.
Table 5 presents both positive and negative outcomes fol-
lowing abortion which were unrelated to PTSD. As for pos-
itive outcomes, few women in either country felt relief or
more in control of their lives after their abortion; fewer still
experienced relationship improvement or enhanced self-
esteem after the procedure. On the other hand, the ma-
jority of women in both countries felt badly following their
abortions, including feeling considerable guilt. American
women were almost twice or more likely than their Russian
counterparts to have sexual problems, overprotect their chil-
dren, experience suicidal thoughts, report dif culty at work,
Russian (N=331) American (N=217)
Variable Potential
range Observed range M SD Observed range M SD
Negative eff ects 0–17 0–15 4.57 3.18 0–17 10.56 3.59
PTSD Total scores 0–14 0–13 3.42 3.21 0–14 8.95 3.84
PTSD Arousal 0–4 0–4 1.13 1.23 0–4 2.29 1.27
PTSD Re-experience 0–4 0–4 1.14 1.17 0–4 2.75 1.39
PTSD Avoidance 0–6 0–6 1.14 1.40 0–6 3.92 1.76
Disruption in cognitive
schemas (TSI total
scores)
90–540 115–383 274.61 38.33 127–399 258.65 56.57
Self-reported stress
associated with the
abortion
1–4 1–4 2.85 0.69 1–4 3.34 0.77
Positive eff ects after
abortion 0–4 0–3 0.71 0.84 0–4 0.88 1.04
Table 1. Descriptive statistics for the outcome measures based on nationality.
Harshly
disciplined
as a child
Abused
as a minor
Parents
divorced
before 18
Unwanted
Sexual contact
before 18
Sexually abused
by relative
before age 18
Raped after
age 18
Physically or
emotionally
abused after 18
Self-reported
stress
0.03
0.04
0.01
0.08
0.03
0.12
0.12*
–0.04
0.13*
–0.06
0.01
0.10
0.01
0.00
TSI
scores
0.07
0.10
0.02
0.05
0.10
0.01
0.03
0.11
0.12
0.01
0.09
0.18*
0.15*
0.14*
Negative eff ects
Total scores
0.13*
0.01
0.08
0.04
0.07
0.06
0.16**
0.06
0.16**
0.04
0.22**
0.01
0.28**
0.01
PTSD
Total scores
0.16**
0.00
0.07
0.04
0.11
0.05
0.11
0.06
0.01
0.03
0.21**
0.04
0.27**
0.01
Table 2. Zero-order correlations refl ecting associations between particular psychosocial stressors and outcome measures based on nationality
(Russian data in bold).
* p<0.05;
** p<0.0l.
Special Report Med Sci Monit, 2004; 10(10): SR5-16
SR8
1234567
1. Self-reported stress
associated with the abortion 0.25** 0.29** 0.30** 0.13* –0.04 0.10
2. Negative eff ec ts after
abortion 0.14* 0.71** 0.65** 0.61** 0.14* 0.41**
3. PTSD Arousal 0.04 0.68** 0.60** 0.55** 0.15** 0.40**
4. PTSD Re-experience 0.07 0.64** 0.63** 0.56** 0.08 0.47**
5. PTSD Avoidance 0.16* 0.70** 0.66** 0.61** 0.09 0.28**
6. Disruption in cognitive
schemas (TSI total scores) –0.01 0.31** 0.32** 0.25** 0.31** –0.01
7. Positive eff ects after
abortion –0.19** 0.07 0.03 –0.006 0.01 –0.07
Table 3. Zero-order correlations among the outcome measures based on nationality (Russian data above the diagonal and American data below
the diagonal).
* p<0.05;
** p<0.0l.
Russian (N=331) American (N=217)
Abortion-related variables Percent “yes” Percent “no” Percent “unsure” Percent “yes” Percent “no” Percent “unsure”
Desired pregnancy 14.8 71.1 14.2 17.7 76.7 11.6
Pregnancy desired by partner 14.6 56.4 29 14 71.2 14.9
Received counseling beforehand 64 34.7 1.3 29.4 66.8 3.8
Needed more time to make
decision 33.3 54.5 12.2 51.9 32.4 15.7
Counseled on alternatives 48.8 45.1 6.1 17.5 79.2 3.3
Felt pressured by others 37.2 54.9 7.9 64 28.5 7.5
Felt abortion was morally wrong 50.5 35.7 13.8 50.7 19.2 30
Had health complications
afterwards 21.4 60.9 17.8 30.5 62.6 6.7
Believed in a woman’s right to
have an abortion 79 6.2 14.8 40.1 26.4 33.5
Received adequate counseling
beforehand 63.4 30.5 6.0 10.8 84 5.2
Partner was supportive 50.7 41.1 8.3 23.8 64.3 11.9
Parents involved in the decision
making 27.1 70.3 2.6 19.7 78.4 1.9
Parental involvement was helpful 23.1 72.6 4.3 12.4 79.7 7.9
Was not sure about the decision
at the time 38 49.7 12.3 54.2 27.8 17.9
Received counseling afterwards 11.9 88.1 0 21 79 0
Eff ectiveness of counseling 80.6 19.4 0 78.8 21.2 0
Felt emotionally close or attached
to the pregnancy, child 37.2 24 38.8 39.3 24.8 36
Table 4. Single item frequencies for the abortion circumstance variables and the outcome measures based on nationality.
Med Sci Monit, 2004; 10(10): SR5-16 Rue VM et al Induced abortion and traumatic stress
SR9
SR
increase their use of alcohol or drugs, have fears concern-
ing future pregnancy and parenting, experience feelings
of loss and sadness, report relationship problems, feel part
of them died, feel sadness and loss at anniversaries (of due
date or abortion date), and report the end of their relation-
ship with their partner.
Figure 1 presents the posttraumatic stress related symp-
toms included in the IPLQ by diagnostic criteria for PTSD:
arousal, avoidance and re-experience. For American wom-
en, the top 5 most commonly endorsed PTSD symptoms
were the following: dif culty remembering, ashbacks,
avoiding thinking or talking about the abortion, unwanted
memories of the abortion, and dif culty concentrating. For
Russian women, the top 5 most commonly endorsed PTSD
symptoms included: unwanted memories of the abortion,
dif culty sleeping, being hyperalert, having ashbacks, and
avoiding thinking or talking about the abortion. Additional
analysis revealed that 65% of American women and 13.1%
of Russian women experienced multiple symptoms of in-
creased arousal, re-experiencing and avoidance. When the
analysis was further restricted to only those symptoms the
subjects attributed to their abortions, 14.3% of American
and 0.9% of Russian women met the full diagnostic criteria
for abortion-related PTSD (at least two symptoms of arousal,
one re-experiencing symptom, and three avoidance symp-
toms persisting for at least one month).
Eight analyses of covariance (ANCOVAs) were conducted
in an effort to compare American and Russian women with
respect to positive and negative outcomes associated with
the experience of an induced abortion. In each analysis,
statistical controls were introduced relative to the number
of abortions, amount of time elapsed since the pregnancy,
the number of weeks pregnant at the time of the procedure,
severe stress-related symptoms prior to the experience, and
other stressors postdating the abortion in addition to de-
mographic and psychosocial variables found to be signi -
cantly related to nationality. More speci cally, these varia-
bles included the following: divorce, current marital status,
number of children, employment, age, holding religious be-
liefs, the importance of religious beliefs held, self-reported
happiness during childhood and adolescence, having expe-
rienced harsh discipline, sexual abuse, physical abuse, or
parental divorce prior to age 18, having experienced un-
wanted sexual contact before age 18, having experienced
physical or emotional abuse after age 18, and having been
raped after age 18.
The results of these analyses are presented in Table 6.
Compared to Russian women, American women reported
signi cantly more negative effects, including more symp-
toms of PTSD (subscale scores and total scores), and high-
er levels of stress associated with the abortion experience.
Russian women, on the other hand, reported signi cantly
higher rates of disruption in cognitive schemata. No nation-
ality differences were observed relative to positive effects.
The amount of variance attributed to nationality on the tests
that were signi cant ranged from 1% to 24%.
A series of eight multiple regression analyses were conduct-
ed for the Russian and American samples for the purpose
of identifying possible demographic and pregnancy circum-
stance variables that were predictive of positive and negative
outcomes. Controls were instituted for severe stress-related
symptoms prior to the experience, other stressors postdat-
ing the abortion, and psychosocial history variables likely to
have been associated with high levels of stress (harsh disci-
pline, sexual abuse, physical abuse, or parental divorce pri-
or to age 18, unwanted sexual contact before age 18, physi-
cal or emotional abuse after age 18, and rape after age 18).
In each analysis, the control variables were entered into the
rst block, with the demographic and pregnancy-related
variables entered into the second and third blocks respec-
tively. Demographic variables included the following: age,
marital status, history of divorce, number of children, em-
ployment, and education. The pregnancy circumstance pre-
dictors of interest included the following: number of weeks
pregnant, time elapsed since the procedure, number of
abortions, feelings of being bonded to the fetus, desire for
the pregnancy, partners desire for the pregnancy, partners
supportiveness of the decision, con dence in the decision,
needing more time to decide, having received counseling
beforehand, having received counseling afterwards, hav-
Russian American
Relationship with partner
improved 2.2% 0.9%
Felt better about myself 0.3% 0.9%
Felt relief 6.9% 13.8%
Felt more in control of my life 1.6% 3.7%
Felt badly 47.0% 53.9%
Thoughts of suicide 2.8% 36.4%
Diffi culty at work 2.5% 11.5%
Increase in alcohol or drugs 4.4% 26.7%
Guilt 49.8% 77.9%
Fears concerning future
pregnancy and parenting 34.9% 36.9%
Feelings of sadness and loss 38.6% 55.8%
Sexual problems 5.9% 24.0%
Felt overwhelmed 14.0% 30.4%
Overprotecting my child(ren) 6.2% 12.4%
Need help to deal with this loss 8.4% 29.0%
Relationship problems 6.8% 26.7%
Felt part of me died 33.6% 59.5%
Sadness at loss anniversaries 9.7% 39.2%
Unable to forgive self 10.9% 62.2%
Relationship ended with
partner 7.8% 19.8%
Psychiatric hospitalization 0.9% 2.3%
Table 5. Percent positive and negative outcomes attributed
to abortion by nationality.
Special Report Med Sci Monit, 2004; 10(10): SR5-16
SR10
ing felt pressure from others to abort, having felt abortion
was morally wrong, believing in a womans right to have an
abortion, having had health complications afterwards, and
parental involvement in the decision.
Table 7 provides the outcomes of these analyses. Demo-
graphic predictors of negative psychological outcomes in-
cluded being younger, more religious, and having more
children in the Russian sample. Abortion circumstances pre-
dicting negative psychological outcomes in the Russian wom-
en included having bonded to the fetus, not believing in a
womans right to abort, having a partner who desired the
pregnancy, having experienced health complications, hav-
ing felt pressured into the decision, having experienced am-
biguity surrounding the decision, not having received coun-
seling before the procedure, and having been farther along
in the pregnancy at the time of the abortion. Russian wom-
en experiencing more positive responses tended to be less
religious, but there were no other signi cant demographic
predictors of positive reactions. More time elapsed since the
procedure and not having felt pressured into the decision
were the only two abortion-circumstance variables associat-
ed with positive reactions in the Russian sample.
Using data generated from the American sample, demo-
graphic predictors of negative psychological outcomes in-
AVOIDANCE
Emotionally numb
Difficulty being near babies
Loss of interest
Withdrew from family and friends
Avoided thinking or talking about abortion
Difficulty remembering
Percent with 3 or more avoidance symptoms
RE-EXPERIENCE
Nightmares
Unwanted memories of abortion
Preoccupation with abortion
Flashbacks
Percent with 1 or more re-experience symptoms
AROUSAL
Difficulty concentrating
Difficulty controlling anger
Hyperalert
Difficulty sleeping
Percent with 2 or more arousal symptoms
Russian American
Percent
010203040506070
SYMPTOMS
12
3
25
4
24
4
30
6
50
19
46
9
36
3
30
8
47
26
30
17
46
18
65
48
18
6
24
5
8
8
23
14
17
8
Figure 1. PTSD symptoms following abortion by nationality and percent.
Med Sci Monit, 2004; 10(10): SR5-16 Rue VM et al Induced abortion and traumatic stress
SR11
SR
cluded being younger, a history of divorce, not having been
employed full-time, and more years of education. Abortion
circumstance variables that predicted negative psychologi-
cal outcomes included having bonded to the fetus, not be-
lieving in a womans right to have an abortion, not having
been counseled before the abortion, having felt pressured
into the decision, and having experienced more abortions.
None of the demographic variables predicted positive adjust-
ment reactions among the American women. Abortion cir-
cumstance predictors of positive reactions in the American
women included believing in a womans right to an abortion,
not having needed more decision time, having a partner
who did not desire the pregnancy, and being fewer weeks
along at the time of the procedure.
DISCUSSION
Women from Russia and the U.S. were compared with respect
to negative and positive outcomes after an induced abortion.
Compared to Russian women, American women exhibited
more negative effects, more symptoms of PTSD, and reported
higher levels of stress associated with experiencing an abor-
tion. However, the Russian women reported signi cantly high-
er rates of disruption in cognitive schemata. No nationality
differences were observed relative to positive effects.
In the present study, American women were exposed to
considerably more preabortion traumatic events than their
Russian counterparts. The percentage of American women
reporting preabortion trauma is high but roughly equivalent
to an earlier study that found 40% of females reported un-
wanted sexual experiences prior to age 18 [40] and anoth-
er which found 38% reported childhood emotional abuse
[41]. Approximately half of women who experience early
childhood trauma also experience PTSD at some point [42].
Other research has con rmed that childhood traumata are
more likely to result in subsequent high risk-taking behaviors,
including a signi cantly higher number of abortions [43
45]. The ndings here suggest that abortion may well exac-
erbate prior posttraumatic stress symptoms, even if in remis-
sion. Hence, an individuals trauma history should be fully
explored in counseling prior to obtaining an abortion.
In this study, for Russian women, the least endorsed PTSD
subscale was that of avoidance. This nding corroborates
prior research that the PTSD subscale of avoidance is more
dif cult to assess in non Euro-American cultures, and that
failure to diagnose PTSD is often due to lack of cultural
comprehension of avoidance symptoms [29].
The TSI Belief Scale was used in this study to examine dis-
ruption of cognitive schemata relative to basic needs impact-
ed by trauma: self/other-safety, self/other-trust, self/other-
esteem, self/other-intimacy, and self/other-control. The
higher the total score, the greater the degree of disrupt-
ed cognitive schemata. Numerous factors may explain why
Russian women scored higher on this scale than American
women, e.g., repeated exposure to abortion as birth con-
trol, or a combination of that with repeated and cumula-
tive re-experiencing of other traumata in Russian life, i.e.,
severe economic shortages, exposure to criminal/gang vi-
olence, enduring regimes which were totalitarian and de-
humanizing, and disintegration of family life.
Comparing the overall TSI score with other known pop-
ulations of impacted individuals in the U.S. may help
Outcome F-test Potential
range
Russian adjusted mean (SE), 95% CI
American adjusted mean (SE), 95% CI
Partial Eta
squared
Positive eff ects 0.23
p=0.630 0–4 0.75 (0.06),.63–0.88
0.81 (0.08),.65–0.97 0.00
Negative eff ects 119.09
p<0.0001 0–17 5.08 (0.22), 4.65–5.52
9.80 (0.29), 9.23–10.38 0.19
PTSD arousal subscale 25.16
p<0.0001 0–4 1.28 (0.08), 1.12–1.45
2.08 (0.11), 1.97–2.30 0.05
PTSD re-experience subscale 71.68
p<0.0001 0–4 1.24 (0.08), 1.07–1.40
2.62 (0.11), 2.40–2.83 0.12
PTSD avoidance subscale 160.07
p<0.0001 0–6 1.21 (0.11), 1.01–1.42
3.81(0.14), 3.54–4.09 0.24
PTSD total scores 112.03
p<0.0001 0–14 3.73 (0.23), 3.28–4.19
8.51 (0.31), 7.91-9.11) 0.18
Self-reported stress associated with the
abortion
6.22
p=0.013 1–4 2.95 (0.05), 2.86–3.05
3.19 (0.06), 3.06–3.32 0.01
Disruption in cognitive schemas 13.61
p<0.0001 90–540 277.22 (3.12), 271.09–283.34
254.82 (4.12), 246.75–262.88 0.03
Table 6. Outcome comparisons based on nationality.
In every ANCOVA, controls were included for the number of abortions, the number of weeks pregnant, amount of time elapsed since the procedure,
severe stress-related symptoms prior to the experience, other stressors pre- and post-dating the abortion, and psychosocial history variables (harsh
discipline, sexual abuse, physical abuse, or parental divorce prior to age 18, unwanted sexual contact before age 18, physical or emotional abuse
after age 18, and rape after age 18).
Special Report Med Sci Monit, 2004; 10(10): SR5-16
SR12
Russian sample
outcomes Block variables Change in r2Change in F
Negative eff ects
Block 2: Signifi cant demographic predictors:
• Younger age (p=0.001)
• More children (p=0.010)
• Religious (p=0.004)
Block 3: Signifi cant abortion-related predictors:
• More bonded to fetus (p=0.010)
• Not believing in a woman’s right to abort (p<0.001)
• Unsure of decision (p=0.020)
• More weeks pregnant (p<0.001)
0.07
0.15
3.62, p=0.001
4.11, p<0.0001
PTSD Total scores
Block 2: Signifi cant demographic predictors:
• Younger age (p=0.010)
• More children (p=0.031)
• Religious (p=0.019)
Block 3: Signifi cant abortion-related predictors:
• No counseling before abortion (p=0.031)
• Having experienced health complications (p<0.001)
• More weeks pregnant (p=0.001)
0.04
0.13
2.35, p=0.024
3.26, p<0.001
PTSD Arousal subscale
scores
Block 2: Signifi cant demographic predictors:
• Younger age (p=0.001)
• More children (p=0.042)
• Religious (p=0.014)
Block 3: Signifi cant abortion-related predictors:
• Having experienced health complications (p<.008)
• Not believing in a woman’s right to have an abortion (p=0.040)
• Unsure of decision (p=0.024)
• More weeks pregnant (p<0.001)
0.06
0.13
3.08, p=0.004
3.00, p<0.001
PTSD Re-experience
subscale scores
Block 2: Signifi cant demographic predictors:
• None
Block 3: Signifi cant abortion-related predictors:
• Partner desired pregnancy (p=0.026)
• More bonded to fetus (p=0.022)
• Having experienced health complications (p<0.002)
• More weeks pregnant (p<0.001)
0.02
0.13
1.28, p=0.260
3.09, p<0.001
PTSD Avoidance
subscale scores
Block 2: Signifi cant demographic predictor:
• More children (p=0.038)
Block 3: Signifi cant abortion-related predictors:
• More bonded to fetus (p=0.033)
• No counseling after abortion (p=0.018)
• Having felt pressured (p=0.034)
• Having experienced health complications (p=0.001)
0.04
0.10
1.91, p=0.068
2.26, p=0.003
Positive eff ects
Block 2: Signifi cant demographic predictor:
• Less religious (p=0.010)
Block 3: Signifi cant abortion-related predictors:
• Not having felt pressured (p=0.004)
• More years since abortion (p=0.041)
0.03
0.10
1.58, p=0.14
2.14, p=0.006
Disruption in cognitive
schemas
Block 2: Signifi cant demographic predictors:
• None
Block 3: Signifi cant abortion-related predictor:
• No counseling before abortion (p=0.007)
0.01
0.08
0.37 p=.918
1.55, p=.078
Self-reported stress
associated with the
abortion
Block 2: Signifi cant demographic predictors:
• Younger age (p=0.011)
• Religious (p=0.002)
Block 3: Signifi cant abortion-related predictor:
• More weeks pregnant (p<0.001)
0.07
0.10
3.21, p=0.003
2.04, p=0.01
Table 7. Results of multiple regression analyses.
Med Sci Monit, 2004; 10(10): SR5-16 Rue VM et al Induced abortion and traumatic stress
SR13
SR
provide a better understanding of the meaning of the
cognitive disruption identified here. For example, the
mean total TSI score in a study of battered women was
242 [46], and 244 in a population of outpatient men-
tal health clients [33]. In the present study, American
women who aborted had a mean total TSI score of 260
whereas Russian women had a mean total TSI score
of 276.
The amount of variance attributed to nationality on the tests
that were signi cant ranged from 1% to 24%, suggesting
that most of the variability in womens responses to an abor-
tion may be attributable to other personal or situational fac-
tors. Cultural factors may play a role in how stress is experi-
enced and reported. More speci cally, the higher rates of
behavioral and emotional manifestations reported by the
American women are perhaps consonant with a social en-
American sample
outcomes Block variables Change in r2Change in F
Negative eff ects
Block 2: Signifi cant demographic predictors:
• Younger age (p=0.001)
• History of divorce (p=0.004)
Block 3: Signifi cant abortion-related predictors:
• None
0.11
0.08
3.65, p=0.001
1.04, p=0.418
PTSD Total scores
Block 2: Signifi cant demographic predictors:
• None
Block 3: Signifi cant abortion-related predictors:
• More bonded to fetus (p=0.036)
• Not believing in a woman’s right to have an abortion (p=0.013)
0.12
0.12
3.92, p=0.001
1.74, p=0.039
PTSD Arousal subscale
scores
Block 2: Signifi cant demographic predictors:
• None
Block 3: Signifi cant abortion-related predictor:
• No counseling before abortion (p=0.036)
0.09
0.09
2.79, p=0.009
1.28, p=0.212
PTSD Re-experience
subscale scores
Block 2: Signifi cant demographic predictors:
• Not being employed full-time (p=0.038)
• More years of education (p=0.050)
Block 3: Signifi cant abortion-related predictors:
• More bonded to fetus (p=0.001)
• Not believing in a woman’s right to have an abortion (p=0.006)
0.14
0.14
5.06, p<0.001
2.24, p=0.005
PTSD Avoidance subscale
scores
Block 2: Signifi cant demographic predictor:
• More years of education (p=0.029)
Block 3: Signifi cant abortion-related predictor:
• Not believing in a woman’s right to have an abortion (p=0.046)
0.09
0.11
2.94, p=0.006
1.58, p=0.073
Positive eff ects
Block 2: Signifi cant demographic predictors:
• None
Block 3: Signifi cant abortion-related predictors:
• Believing in a woman’s right to have an abortion (p=0.001)
• Not needing more time to decide (p=0.041)
• Partner did not desire pregnancy (p=0.015)
• Fewer weeks pregnant (p=0.006)
0.03
0.18
0.94, p=0.477
2.85, p<0.001
Disruption in cognitive
schemas
Block 2: Signifi cant demographic predictor:
• History of divorce (p=0.040)
Block 3: Signifi cant abortion-related predictor:
• Not believing in a woman’s right to have an abortion (p=0.007)
0.07
0.10
2.29, p=0.029
1.45, p=0.118
Self-reported stress
associated with the
abortion
Block 2: Signifi cant demographic predictors:
• More years of education (p=0.044)
• Younger age (p=0.041)
Block 3: Signifi cant abortion-related predictors:
• More bonded to fetus (p=0.045)
• Having felt pressured (p=0.021)
• More abortions (p=0.030)
0.07
0.15
2.24, p=0.033
2.32, p=0.003
In every regression analysis, fi rst block controls were included for severe stress-related symptoms prior to the experience, other stressors pre- and
post-dating the abortion, and psychosocial history variables (harsh discipline, sexual abuse, physical abuse, or parental divorce prior to age 18,
unwanted sexual contact before age 18, physical or emotional abuse after age 18, and rape after age 18).
Table 7. Continued. Results of multiple regression analyses.
Special Report Med Sci Monit, 2004; 10(10): SR5-16
SR14
vironment that is more con icted on the issue of abortion.
On the other hand, in a cultural context wherein abortion
is normative and a much less volatile social issue, women
who do suffer from the experience, may be more inclined
to deal with the stress on an intellectual or cognitive level.
Russian women may also be more stress-experienced and
less prone to verbalizing than American women given the
harshness of economic, political and social conditions they
have endured over the past decades.
Using multiple regression, several common variables were
determined to be predictive of adverse psychological adjust-
ment following abortion. In both the U.S. and in Russia,
these predictive risk factors included: being younger, hav-
ing bonded to the fetus, not believing in a womans right to
abort, having felt pressured into the decision, and not hav-
ing received counseling before the procedure. Social poli-
cies in both countries that enhance informed consent and
professional counseling opportunities for women seeking
abortions would appear to be bene cial. Furthermore, pub-
lic policies that increase the protections afforded younger
women would also appear warranted.
Despite the strengths of the study, limitations are apparent.
The data were derived through the exclusive use of retro-
spective self-report measures. As with most of the prior re-
search on postabortion adjustment, self-selection precludes
generalization of the results to the entire population of wom-
en having abortions, in either the U.S. or Russia. In the U.S,
at least, it is known that many women will not report a prior
abortion even on an anonymously submitted questionnaire
[47]. Research has shown that women who conceal their
abortion experience from others, compared to those who
do not, are more likely to suppress thoughts of the abor-
tion, experience more intrusive abortion-related thoughts,
and feel greater psychological distress [48].
While this study is the rst to survey postabortion women
from two different cultures with the same instrument, the
comparisons between American and Russian women must be
cautiously interpreted due to several limitations. First, while
the TSI scale has been validated among American women,
we have no information about its validation among Russian
women. Second, we have no information on the women who
declined to participate. Third, while the mean age of wom-
en in both groups at the time of their abortions is similar,
there was a ve-year difference between the mean number
of years that had elapsed between the abortion and the time
each group responded to the survey (10.6 years for American
women, 5.8 years for Russian women). Although it is unclear
why this time discrepancy occurred, it may re ect some differ-
ence in the age groups served by the American and Russian
health care institutions collecting the data or a cultural bias
as to why and when women are willing to disclose informa-
tion about a past abortion. If the experience of negative re-
actions to abortion or the willingness to disclose negative
reactions increase over time, the longer period of time be-
tween the abortion and the data collection observed among
the American women may play a role in explaining why the
American women generally reported more negative reactions.
This hypothesis is supported by evidence that negative reac-
tions to abortion may increase over time [25,49,50]. Case re-
ports have also shown that suppressed traumatic reactions
to abortion can be triggered by later events, such as a subse-
quent birth or death [2,11]. The fourth limitation is that for
the Russian women the hospital where the physician inter-
viewed them was often the same site at where their abortions
were performed. Being questioned about a past abortion in
the facility where the abortion was performed may have re-
sulted in stress that altered responses or increased the refusal
rate. Fifth, while American women completed the question-
naire themselves, a physician interviewed the Russian wom-
en. The use of an orally presented questionnaire in Russia
and a written questionnaire in the U.S. may have resulted in
signi cant differences in the results that were not related to
cultural factors but to the administrative mode.
CONCLUSIONS
In conclusion, this study provides increased insight into the
manifold reactions of women to induced abortion while
also identifying convergent predictors of adverse psycho-
logical adjustment following abortion in two diverse cul-
tures. This study furthers our understanding of traumatic
responses across cultures, and in particular, suggests that
for some women, abortion is a traumatic stressor capable
of causing PTSD symptoms. Finally, the results also signi -
cantly expand our knowledge of risk factors associated with
negative postabortion outcomes, and therefore may help to
improve preabortion screening and counseling.
Acknowledgements
The authors gratefully acknowledge the generous assistance
of Suzi Tellefsen, Susan Stanford-Rue, Ph.D, Frida Rotlewicz,
Ph.D, Anne Speckhard, Ph.D, B. Hudnall Stamm, Ph.D, Cui
Xinja, M.D, Teri Reisser, M.A, Paul Reisser, M.D, Svetlana
Sysoeva, M.D, Nina Kirbasowa, M.D, Michael Mannion, S.T.D,
Kerry Cielinski, Ph.D, Eugenia Riordan Mule, Alexander
Rodriguez, Nancy Austin & Elizabeth Blake.
REFERENCES:
1. Thorp JM, Hartman KE, Shadigian EM: Long-term physical and
psychological health consequences of induced abortion: Review of the
evidence. Ob Gyn Survey, 2002; 58: 6769
2. Burke T, Reardon DC: Forbidden grief: the unspoken pain of
abortion. Spring eld (IL): Acorn Books, 2002
3. Coleman PK, Reardon DC, Rue VM, Cougle JR: State-funded
abortions vs. deliveries: A comparison of outpatient mental health claims
over four years. Amer J Ortho, 2002; 72: 14152
4. Coleman PK, Reardon DC, Rue VM, Cougle JR: A history of in-
duced abortion in relation to substance abuse during pregnancies car-
ried to term. Amer J Ob Gyn, 2002; 187: 167378
5. Reardon D, Ney P: Abortion and subsequent substance abuse.
Amer J Drug Alcohol Abuse, 2000; 26: 6175
6. Reardon DC, Cougle JR: Depression and unintended pregnan-
cy in the National Longitudinal Survey of Youth: A cohort study. BMJ,
2002; 324: 15152
7. Reardon DC, Cougle JR, Rue VM et al: Psychiatric admissions of
low income women following abortion and childbirth. Can Med Assoc
J, 2003; 168: 125256
8. Ostbye T, Wenghofer E, Woodward C et al: Health services utili-
zation after induced abortions in Ontario: A comparison between com-
munity clinics and hospitals. Amer J Med Quality, 2001; 16: 99106
9. Rue V, Speckhard A: Post abortion trauma: Incidence and di-
agnostic considerations. Med & Mind, 1992; 6: 5774
10. Russo N, Denious J. Violence in the lives of women having abortions.
Prof Psych, 2001; 32: 14250
11. Stotland N: Abortion: Social context, psychodynamic implications. Am
J Psychiatry, 1998; 155: 96467
Med Sci Monit, 2004; 10(10): SR5-16 Rue VM et al Induced abortion and traumatic stress
SR15
SR
12. Cougle JR, Reardon DC, Coleman PK: Depression associated with abor-
tion and childbirth: A long term analysis of the NLSY cohort. Med Sci
Monit, 2003; 9(4): CR157CR164
13. DePuy C, Dovitch D: The healing choice. New York, Fireside, 1997
14. Ring-Cassidy E, Gentles I: Womens health after abortion: The medical
and psychological evidence. Toronto: De Veber Institute, 2002
15. Soderberg H, Janzon L, Sjoberg N: Emotional distress following induced
abortion: A study of its incidence and determinants among adoptees in
Malmo, Sweden. Eur J Obstetr Gyn Reprod Biol, 1998; 79: 17378
16. Litz B, Roemer L: Post-traumatic stress disorder: An overview, Clin Psych
& Psychotherapy, 1996; 3: 15368
17. Resnick H, Kilpatrick D, Dansky B et al: Prevalence of civilian trauma
and posttraumatic stress disorder in a representative national sample
of women. J Consult Clin Psychol, 1993; 61: 98491
18. Illsley R, Hall MH: Psychological aspects of abortion: A review of issues
and needed research. Bull World Health Organ, 1976; 53: 83106
19. Bradshaw Z, Slade P: The effects of induced abortion on emotional
experiences and relationships: A critical review of the literature. Clin
Psych Rev, 2003; 23: 92958
20. Bagarozzi D: Post traumatic stress disorders in women following abor-
tion: Some considerations and implications for marital/couple thera-
py. Int J Family Marriage, 1993; 1: 5168
21. Congleton GK, Calhoun LG: Postabortion perceptions: A comparison
of self-identi ed distressed and non-distressed populations. Int J Soc
Psychiatry, 1993; 39: 25565
22. Barnard C: The long-term psychosocial effects of abortion.
Jacksonville(Florida): Institute for Pregnancy Loss, 1990
23. Hanley D, Piersma H, King D et al: Women outpatients reporting con-
tinuing post-abortion distress: A preliminary inquiry. Paper presented
at the annual meeting of the International Society for Post-Traumatic
Stress Studies, Los Angeles, 1992
24. Pope L, Adler N, Tschann J: Postabortion psychological adjustment: Are
minors at increased risk? Unpublished paper, Exhibit 2, Af davit of Nancy
E. Adler, Ph.D. in North Florida Womens Health and Counseling Services,
Inc, et al. v. State of Florida, et al. In the Circuit Court of the Second
Judicial Circuit in and for Leon County, Tallahassee, Florida, 1999
25. Major B, Cozzarelli C, Cooper ML et al: Psychological responses of wom-
en after rst-trimester abortion. Arch Gen Psych, 2000; 57(8): 77784
26. Vishnevsky AG: Family, fertility and demographic dynamics in Russia:
Analysis and forecast. In: DaVanzo J, editor. Russias demographic cri-
sis. Santa Monica, CA: Rand Conference Proceedings, 1996; 135
27. Vikhlayeva EM, Nikolaeva E: Epidemiology of abortions in Russia. Entre
Nous Cph Den, 1996; 3435: 18
28. Par tt T: Russia moves to curb abortion rates. Lancet, 2003; 362: 968
29. Marsella AJ, Friedman MJ, Gerrity ET, Scur eld RM: Ethnocultural as-
pects of ptsd: Some closing thoughts. In: Marsella AJ, Friedman MJ,
Gerrity ET, Scur eld RM, editors. Ethnocultural aspects of posttraumat-
ic stress disorder: Issues, research and clinical applications. Washington,
DC: American Psychological Association, 1996; 52938
30. Frey C: Post traumatic stress disorder and culture. In: Yilmaz AT, Weiss
MG, Riecher-Rossler A, editors. Cultural psychiatry: Euro-internation-
al perspectives. Basil, Switzerland: Karger, 2001; 10316
31. Kleber RJ, Figley CR, Gersons BP, editors: Beyond trauma: Cultural and
social dynamics. New York, Plenum, 1995
32. Resick PA: Stress and trauma. London: Psychology Press, 2001
33. Pearlman L, MacIann P: The TSI Belief Scale: Normative Data from
Four Criterion Groups. Unpublished manuscript. South Windsor, CT:
Traumatic Stress Institute, 1992
34. Pearlman LA: Psychometric review of TSI Belief Scale Revision L. In:
Stamm BH, editor. Measurement of stress, trauma and adaptation.
Lutherville, Md.: Sidran Press, 1996
35. The TSI Belief Scale was recently renamed the Trauma, Attachment &
Belief Scale as described at http://www.tsicaap.com/research.htm and is be-
ing made available through Western Psychological Services
36. Pearlman LA: Traumatic Stress Institute Belief Scale. Revision L.
Unpublished. Copyright Western Psychological Services, Los Angeles,
2000
37. American Psychiatric Association: Diagnostic criteria for posttraumatic
stress disorder. In: Diagnostic & statistical manual of mental disorders
IV. Washington, D.C.: American Psychiatric Press, 1994; 42728
38. Janoff-Bulman R: Shattered assumptions: Towards a new psychology of
trauma. New York: Free Press, 1992
39. McCann I, Pearlman L: Psychological trauma and the adult survivor:
Theory, therapy and transformation. New York: Brunner/Mazel, 1990
40. Kellogg ND, Huston RL: Unwanted sexual experiences in adolescents.
Clin Ped, 1995; June: 30612
41. Walker EA, Koss MP, Katon WJ: Medical sequelae of sexual and phys-
ical victimization of women. NASPOG Annual Meeting Abst, 1995; 5:
7778
42. Kessler RC, Sonnega A, Bromat E et al: Post-traumatic stress disorder in the
National Comorbidity Survey. Arch Gen Psychiatry, 1995; 52: 104860
43. Walker EA et al: Costs of health care utilization by women HMO mem-
bers with a history of childhood abuse and neglect. Arch Gen Psychiatry,
1999; 56: 54955
44. Walker EA, Katon WJ: Research the health effects of victimization: The
next generation. Psychosom Med, 1996; 58: 1617
45. Green BL, Schnurr PP: Trauma and physical health. Clin Qrtly Nat
Center for Post-Traumatic Stress Disorder, 2000; 9: 35
46. Dutton M et al: Battered womens cognitive schemata. J Traumatic Stress,
1994; 7: 23755
47. Jones EF, Forrest JD: Under reporting of abortion in surveys of U.S.
women: 1976 to 1988. Demography, 1992; 29: 11326
48. Major B, Gramzow RH: Abortion as a stigma: cognitive and emotional im-
plications of concealment. J Person Soc Psychol, 1999; 77(4): 73545
49. Miller WB: An empirical study of the psychological antecedents and
consequences of induced abortion. J Soc Iss, 1992; 48: 6793
50. Miller WB, Pasta DJ, Dean CL: Testing a model of the psychological con-
sequences of abortion. In: Beckman LJ, Harvey SM, editors. The new
civil war: The psychology, culture, and politics of abortion. Washington:
American Psychological Association, 1998
Special Report Med Sci Monit, 2004; 10(10): SR5-16
SR16
... history of one or more abortions, 64 the 18% of abortion patients who are minors, 115 the 11% of patients beyond the first trimester, 116 the 7% aborting for therapeutic reasons regarding their own health or concerns about the health of the fetus, 117 and the 11%-64% whose pregnancies are wanted, were planned, or for which women developed an attachment despite their problematic circumstances. 38,50,51 The above example demonstrates that the same set of facts, presented and interpreted by AMH minimalists in a way that suggests that few women face any risk of negative reactions to abortion, could also have been worded by AMH proponents in a way that would have underscored a conclusion that most women having abortions are at greater risk compared to the minority who have no risk factors. ...
... Positive and negative feelings can co-exist and frequently do. 38,39,48,50,166,172 In one study, Almost one-half also had parallel feelings of guilt, as they regarded the abortion as a violation of their ethical values. The majority of the sample expressed relief while simultaneously experiencing the termination of the pregnancy as a loss coupled with feelings of grief/emptiness. ...
... 174 Similarly, retrospective questionnaires of women also reveal that over half attribute at least some negative reactions to their abortions. 50 The opinion that negative reactions are experienced by the majority of abortion patients is also shared by a number of abortion providers, such as Poppemna and Henderson: 175 Sorrow, quite apart from the sense of shame, is exhibited in some way by virtually every woman for whom I've performed an abortion, and that's 20,000 as of 1995. The sorrow is revealed by the fact that most women cry at some point during the experience …. ...
Article
Full-text available
The abortion and mental health controversy is driven by two different perspectives regarding how best to interpret accepted facts. When interpreting the data, abortion and mental health proponents are inclined to emphasize risks associated with abortion, whereas abortion and mental health minimalists emphasize pre-existing risk factors as the primary explanation for the correlations with more negative outcomes. Still, both sides agree that (a) abortion is consistently associated with elevated rates of mental illness compared to women without a history of abortion; (b) the abortion experience directly contributes to mental health problems for at least some women; (c) there are risk factors, such as pre-existing mental illness, that identify women at greatest risk of mental health problems after an abortion; and (d) it is impossible to conduct research in this field in a manner that can definitively identify the extent to which any mental illnesses following abortion can be reliably attributed to abortion in and of itself. The areas of disagreement, which are more nuanced, are addressed at length. Obstacles in the way of research and further consensus include (a) multiple pathways for abortion and mental health risks, (b) concurrent positive and negative reactions, (c) indeterminate time frames and degrees of reactions, (d) poorly defined terms, (e) multiple factors of causation, and (f) inherent preconceptions based on ideology and disproportionate exposure to different types of women. Recommendations for collaboration include (a) mixed research teams, (b) co-design of national longitudinal prospective studies accessible to any researcher, (c) better adherence to data sharing and re-analysis standards, and (d) attention to a broader list of research questions.
... One in every five ongoing pregnancies (19.6 percent) in a French sample was unintended by the male partner (Kågesten et al. 2015), while an international US survey (National Surveys of Family Growth) involving 10,000 male respondents found that four in every ten children were born after a pregnancy not intended by the male partner (Lindberg and Kost 2014). In another US survey, 14 percent of female respondents (N ¼ 217) reported to have terminated their pregnancy against their partner's will (Rue et al. 2004), and 39 percent of 345 Alabama women reported a pregnancy they chose to terminate, while their partner would like to have had a baby (Kroelinger and Oths 2000). ...
... The probability of referring to the male partner as the reason for abortion was higher among women with tertiary education as compared to those with lower education (odds ratio [ Men may exert pressure on their female partner to terminate a pregnancy they consider unwanted. The prevalence of such cases is hard to estimate (primarily due to the difficulty of measurement); certain studies suggest that the proportion of women subjected to social pressure among those undergoing an abortion may be as large as 64 percent (Rue et al. 2004). However, these findings are exclusively based on the concerned women's (subjective) responses nor are the form and extent of pressure defined adequately. ...
... Of those women who were discontent with their abortion decision after terminating a pregnancy, 73 percent reported to have been subjected to their partner's pressure, and 39 percent of these women experienced intense pressure (Reardon 1987, cited by Shuping 2011)-it is a question, due to the abovementioned methodological issues, to what extent these responses reflect male partners' actual pressure and to what extent respondents' shifting responsibility or cognitive dissonance reduction. Some studies found that women choosing abortion due to perceived social pressure showed more negative psychological outcomes and poorer adaptation (Rue et al. 2004;Kimport, Foster, and Weitz 2011), but the underlying intrapsychic processes and/or interpersonal factors or relationship dynamics are yet to be clarified. ...
Article
Full-text available
Although a man is as well concerned in each case of induced abortion as a woman is, the amount of existing studies that attempt to describe and gain insight into the psychological effects of induced abortion on men is extremely small, either when considering this number in itself or when comparing it to the number of related studies focusing on women. The present article gives an overview of the existing psychological knowledge of men’s perspective on induced abortion including their typical reactions; roles; participation in, and responsibility for, decision-making; and their impact on the female partner. Furthermore, a number of related but understudied issues are addressed.
... This strategy essentially entails a suspension of suffering through processes of removal and negation. Neimeyer points out that overcoming trauma requires a deep awareness of what has been suffered (98), which is achieved by thoroughly reconstructing the existential meanings of the experience of loss (99,100). Because this awareness was inaccessible to the participants during this study, they seemed more vulnerable to the effects of COVID-19 and the discourse caused by the pope's announcement. ...
Article
Full-text available
This qualitative study considers the relationship between abortion, bereavement, and the effects of the COVID-19 lockdown nine women who had undergone an elective abortion, which is voluntarily termination of a pregnancy at the woman's request. These women were interviewed in three time points (1 month, 6 months, and 1 year after the event) to consider the possible evolution of their experience. The third phase was concurrent with the COVID-19 pandemic and particularly with Pope Francis's Easter declaration against abortion. All the interviews were conducted and analysed through qualitative research in psychology. Results showed that the abortion experience led to physical, relational, and psychological suffering, similar to perinatal grief. Participants were non-practising Catholics and religiosity did not help them to overcome their sorrow. Though religiosity is a possible resilience factor in other stressful conditions, in this case it is a factor that aggravated suffering. Finally, we discuss the difficulties experienced by Catholic women who choose to have an abortion and assert the necessity of psychological and spiritual interventions to support these women.
... For example, high impulsivity and an avoidance style of coping with negative emotions are risk factors for risky sexual behavior, substance use, delinquent behavior, and educational underachievement (Cooper et al., 2003) [21]. • According to Obertinca, 2016, decision of the couple until, anomalies of central nervous system, genetic syndromes, multiplex fetal anomaly, abnormality of the urinary tract, anomaly of the gastrointestinal system, feto-maternal pathology, maternal chronic disease, cardiovascular system anomalies, musculoskeletal system anomalies, pathology of placental are the basic causes of the occurrence of abortion [22][23][24][25][26][27][28][29][30][31] (Table 2). • Other 31 factors are listed in Table 3. ...
Article
Full-text available
This review intends to provide brief data about the psychological consequences of induced unsafe abortion. The data were collected from different articles, journals, guidelines and related published materials. Emerging data report 30% of women worldwide who practiced abortion experience negative and persistent psychological distress afterward. It is estimated that there are 3.27 million pregnancies in Ethiopia every year, of which approximately 500,000 ends in either spontaneous or unsafely induced abortion. Reasons for seeking abortion are socioeconomic concerns (including poverty, no support from the partner, and disruption of education or employment); family-building preferences (including the need to postpone childbearing or achieve a healthy spacing between births); relationship problems with the husband or partner; risks to maternal or fetal health; and pregnancy resulting from rape or incest; poor access to contraceptives and contraceptive failure. Smoking, drug abuse, eating disorder, depression, anxiety disorders, attempted suicide, guilt, regret, nightmare, decreased self-esteem, and worry about not being able to conceive again were the psychological consequences of abortion.
... Women who live away from their partners also appear to feel more capable of taking sole decisions on abortion, which is likely to contribute to actual experiences of abortion. It is important to recognize that given the noted higher desired fertility among men, compared to women, in developing countries [21], abortion may cause challenges and stress within the relationship, leading to separation or divorce [8,29,41]. This indicates some potential for reverse causality in the relationship between partner presence and abortion. ...
Article
Full-text available
Background: Unsafe abortions remain a major global public health concern and despite its prevalence, unsafe abortions remain one of the most neglected global health challenges. The proportion of women in Ghana who have experienced unsafe abortions has increased from 45% in 2007 to 62% in 2017. Given the noted consequences of (unsafe) abortions on women health, it is important to explore factors correlated with women's abortion decisions and why they opt for safe or unsafe methods. The study also examines determinants of over 6,000 Ghanaian women's self-efficacy in abortion decision-making, given that this is likely to affect the likelihood of future abortions. Methods: Using cluster-level Geographic Information System data from the 2017 Ghana Maternal Health Survey, the study provides a hot spot analysis of the incidence of abortion in the country. The study also makes use of Probit multivariate analyses also show the correlates of abortion with socio-economic factors. Results: Results suggest that abortion among women is positively correlated with the absence of partners, low education levels, higher household wealth, lower parity and family size, polygyny and Christian religious background. Conclusion: It is observed that the groups of women with higher abortion self-efficacy are the same groups of women who are more likely to opt for safer abortion methods, indicating some correlation, albeit indirect, between abortion self-efficacy and women's abortion behaviors in Ghana. Relevant policy applications are adduced from these research findings.
Book
У виданні вміщено фахові поради і свідчення, підготовлені й зібрані завдяки співпраці з Проектом «Рахиль» у США. Вони допоможуть щиро послужити людям, які шукають зцілення від травми аборту, щоб у кожному серці, зраненому втратою дитини, відновити віру в милосердя Бога і Його всеогортаючу любов. Для священиків, медичних капеланів, психологів, психотерапевтів та зацікавлених осіб.
Article
Full-text available
For several decades, a handful of studies have examined the relationship between religion and abortion; they particularly pay attention to public attitudes. However, fewer quantitative studies have considered Muslims’ attitudes toward abortion. This study explores a new religious and traditional perspective that comes from Islam and also enhances the existing literature on the topic of religion and abortion. The significance of this study is based on the fact that Turkey, as well as its importance of geographical location and cultural heritage in today’s world, is one of two Muslim-populated countries in which performing abortion is legal. In order to measure the pulse of the public about this topic, we used data from the fourth wave of the European Value Study (2008). Our purpose is to display how religious factors influence people’s attitudes toward practicing abortion in the cases, “Women who are not married” and “A couple who does not want more children.” The findings indicate that people who have a high level of religiosity are more likely to disapprove of the practice of abortion. This finding also can be a considerable indicator of public attitudes regarding abortion to contribute to probable changes in the abortion policy of Turkey.
Article
Din ve kürtaj arasındaki ilişkiyi yirmi-otuz yıldır inceleyen iki elin parmakları kadar çalışma vardır ve bu çalışmalar özellikle halkın kürtaj konusundaki tavırlarını göz önünde bulundurmuşlardır. Bununla birlikte, daha az niceliksel çalışma Müslümanların kürtaja karşı tutumlarını ele almıştır. Bu çalışma, İslam'dan gelen yeni bir dini ve geleneksel perspektifi araştırıyor ve aynı zamanda din ve kürtaj konusundaki mevcut literatürü zenginleştiriyor. Bu çalışmanın önemi, Türkiye'nin günümüz dünyasında coğrafi konumu ve kültürel mirasının önemi kadar, kürtaj yapmanın yasal olduğu iki Müslüman nüfuslu ülkeden biri olduğu gerçeğine dayanmaktadır. Halkın bu konudaki nabzını ölçmek için Avrupa Değer Çalışmasının (2008) dördüncü dalgasından elde edilen verileri kullandık. Amacımız, "Evli olmayan kadınlar" ve "Daha fazla çocuk istemeyen bir çift" gibi durumlarda, dini faktörlerin insanların kürtaja yönelik tutumlarını nasıl etkilediğini bulmaktır. Bulgular, yüksek dindarlık düzeyine sahip kişilerin kürtaj uygulamasını onaylamama olasılıklarının daha yüksek olduğunu göstermektedir. Bu bulgu aynı zamanda, Türkiye'nin kürtaj politikasında olası değişikliklere katkıda bulunmak için kürtaja ilişkin halkın tutumunun önemli bir göstergesi olabilir.
Article
The abortion advocacy group Advancing New Standards in Reproductive Health (ANSIRH) has published over twenty papers based on a case series of women taking part in their Turnaway Study. Following the lead of ANSIRH news releases, major media outlets have described these results as proof that (a) most women who have abortions are glad they did, (b) there is no evidence of negative mental health effects following abortion, and (c) the only women really suffering are those who are being denied late-term abortions due to legal restrictions based on gestational age. Buried in ANSIRH’s papers are the facts that over 68 percent of the women they sought to interview refused, their own evidence confirms that the remnant who did participate were atypical, there are no known benefits from abortion, their methods are misleadingly described, and their results are selectively reported. Summary: Widely publicized claims regarding the benefits of abortion for women have been discredited. The Turnaway Study, conducted by abortion advocates at thirty abortion clinics, reportedly proves that 95 percent of women have no regrets about their abortions and that abortion causes no mental health problems. But a new exposé reveals that the authors have misled the public, using an unrepresentative, highly biased sample and misleading questions. In fact, over two-thirds of the women approached at the abortion clinics refused to be interviewed, and half of those who agreed dropped out. Refusers and dropouts are known to have more postabortion problems.
Book
Full-text available
The editors of Beyond Trauma: Cultural and Societal Dynamics have created a volume that goes beyond the individual's psychological dynamics of trauma, exploring its social, cultural, politica!, and ethical dimensions from an international as well as a global perspective. In the opening address as International Chair of the First World Conference of the International Society for Traumatic Stress Studies on Trauma and Tragedy: The Origins, Management, and Prevention of Traumatic Stress in Today's World, June 22-26, 1992, Amsterdam, The Netherlands, the conference that formed the foundation for the col­ lected chapters in this volume, 1 commented: This meeting is a landmark in accomplishing the Society's universal mission. Our distinguished International Scientific Advisory Committee and Honor­ ary Committee, whose membership was drawn from over 60 countries, the cooperation of six United Nations bodies, and the participation anei endorse­ ment of numerous nongovernmental organizations and institutions attest to the Society's emerging presence as a major international forum for profes­ sionals of ali disciplines working with victims and trauma survivors.
Article
Background: Data were obtained on the general population epidemiology of DSM-III-R posttraumatic stress disorder (PTSD), including information on estimated lifetime prevalence, the kinds of traumas most often associated with PTSD, sociodemographic correlates, the comorbidity of PTSD with other lifetime psychiatric disorders, and the duration of an index episode.Methods: Modified versions of the DSM-III-R PTSD module from the Diagnostic Interview Schedule and of the Composite International Diagnostic Interview were administered to a representative national sample of 5877 persons aged 15 to 54 years in the part II subsample of the National Comorbidity Survey.Results: The estimated lifetime prevalence of PTSD is 7.8%. Prevalence is elevated among women and the previously married. The traumas most commonly associated with PTSD are combat exposure and witnessing among men and rape and sexual molestation among women. Posttraumatic stress disorder is strongly comorbid with other lifetime DSM-III-R disorders. Survival analysis shows that more than one third of people with an index episode of PTSD fail to recover even after many years.Conclusions: Posttraumatic stress disorder is more prevalent than previously believed, and is often persistent. Progress in estimating age-at-onset distributions, cohort effects, and the conditional probabilities of PTSD from different types of trauma will require future epidemiologic studies to assess PTSD for all lifetime traumas rather than for only a small number of retrospectively reported "most serious" traumas.