Sally, aged 38, called her GP to her home, suffering from perineal bleeding. She had never presented with psychological problems. The GP noted that her flat was remarkable for the number of soft toys that occupied every available space.

When the GP asked Sally routine gynaecological questions, she burst into tears and said she had ‘never been happy’ since she ‘lost’ her son. It emerged that when she was 19, unemployed and still living with her parents, she had fallen pregnant. Her parents insisted that she had no further contact with the father and that she had a termination. After only a brief chat with her doctor, she had a termination and felt she was never asked what she really wanted.

Sally had vivid recollections of the procedure and commented that a ‘prolife’ nurse told her she had killed a perfectly formed little boy. She later married, but did not have children. She said that not a day goes by when she does not cry for her son. This was the first time that she had told anyone, apart from her husband, about her suffering.[1]

CARE Centres Network (CCN)

In 1985, the first independent pregnancy counselling centre opened in Basingstoke, largely due to the concerns of a local health visitor who felt that women needed better support for unplanned pregnancies and postabortion problems. The Firgrove Centre then opened independently in Southampton in 1987 and links were made. To our constant surprise there are now 150 centres across Britain. Each one is accountable to their local church and affiliated to CCN, which acts as an umbrella organisation to provide resources and encouragement. We have been a department of CARE for some years now. Our national pregnancy and post-abortion help line ‘care confidential’ has received over 2,000 calls since September 1999.[2]

As most of our 2,000 counsellors know, Sally’s story is not an unusual one. Many women like her need support the damage to women and a safe place to talk through an abortion experience. We realised early on that it is not enough just to say ‘abortion is wrong’. God wants us to bring his truth, grace, compassion and love to each woman.

When facing an unexpected pregnancy, women and their partners need accurate information and an opportunity to look at all the options available - parenting, adoption or abortion. They also need time to explore all their feelings without pressure or judgement. Our counsellors respect the fact that each woman has her own Godgiven free will. Our job is not to manipulate a woman into choosing the outcome we want. Whilst we believe that abortion helps neither mother nor child, our goal is to inform her accurately and explore her feelings so that she can come to her own conclusion. After she has left we pray that God will ‘open the eyes of her heart’[3]; that she will connect with her deepest God-given instinct to protect and nurture life, rather than listen to the voice of anxiety caused by her circumstances.

For those who choose to parent, the centres provide practical help in terms of baby clothes and ongoing support. For those who choose adoption, support is available for the birth mother throughout pregnancy and beyond. For those who choose abortion, there is post-abortion counselling in a group or a one-to-one setting. All our services are free.

Is abortion damaging?

We are told that abortion is a woman’s ‘healthcare need’ yet Sally’s story and countless others from the centres tell us that women aren’t as comfortable with abortion as many in society would like to think. The law on abortion admittedly had a positive intention with regard to women’s health (as listed in Schedule 2 of the Abortion Regulations, 1968) but we feel it has backfired in many ways.

The 1967 Abortion Act provides six grounds for the legal termination of a pregnancy. The majority of abortions (98.6% in 1981-9) are performed on the grounds that the continuance of the pregnancy would involve risk of injury to the physical or mental health of the pregnant woman or her existing children greater than if the pregnancy were terminated.

The wording does not suggest how to assess the ‘risk’ to a woman’s mental health. There are no guidelines for evaluating a woman’s ability to live with an unplanned baby. Her subjective assessment of her own situation may therefore be accepted as sufficient reason to go ahead with an abortion.

Similarly, there are no clear guidelines for assessing how she would fare after a termination. Women may be unaware of how they will cope with an abortion experience, and the secrecy that often accompanies an abortion may prevent a woman from making a realistic appraisal of the psychological consequences.

One counsellor spoke with an 18 year old girl who had undergone an abortion some six months previously. The girl recalled how she had visited the clinic for a pregnancy test on Monday, had a scan on Tuesday and the abortion on Wednesday. ‘It happened too quickly. No-one asked me if I was sure’, she said. Given that she may be blaming the health professionals to some degree, it is also possible that an assessment of the risk involved for her was not adequately made.

What evidence is there of damage to women?

There are six areas worth reviewing. They are not without flaws, but nevertheless of interest.

1. Suicide rates

A 1996 study of suicide rates in Finland found that an increased risk of suicide after an induced abortion could indicate the harmful effects of abortion on mental health.[4] The authors speculated that, although for many women abortion may be the answer to their current problems and a relief, for some an abortion may compound their lack of self-worth and contribute to the decision to commit suicide.

2. Admission to psychiatric units

A study in South Glamorgan, conducted over a four-year period, linked admissions for attempted suicide to admissions for miscarriage, induced abortion and normal delivery.[5] The results suggest a higher rate of attempted suicide following induced abortion. Women who later had an abortion had a higher rate of attempted suicide than those who carried to term, though this was not a statistically significant increase. This could signify underlying mental illness and some would argue that the women in this group are more likely to have an unwanted pregnancy and then need an abortion rather than abortion being the cause of suicide attempts. However, 46% of these admissions were within the 90 days prior to termination and could therefore be a consequence of the crisis pregnancy. The significant increase in suicide attempts after an abortion indicates that the procedure is deleterious to mental health.

3. Rates of consultations for psychological problems

Studies of consultations for psychiatric complications have only been conducted within 21 days of the termination. Whilst it is commonly accepted that around 10% of women suffer psychological disorders following abortion,[6] figures for GP diagnosis in the 21 days after termination appear quite low (2.5%) but this could be due to a reluctance among women with abortion related disturbances to return to the original referrer. Original referrers are sometimes apportioned blame by women who have found their abortion experience difficult or traumatic. Secondly, 21 days is far too early for studies to take place as denial mechanisms are often in place for some time. Appropriate long-term studies need to be made.

4. Follow up studies

Studies of women following abortion have a problem with drop-out rates. Women who have found the procedure most traumatic, or who wish to avoid painful feelings, are most likely to avoid follow up consultations or questionnaires. This obviously affects the outcome of such studies.

In addition, most follow up studies are done only in the short-term. The overwhelming feeling during the first three to six month period after abortion is relief. One study followed 119 women through pregnancy and showed that serious neurotic disturbances were significantly more frequent in those who had had a previous termination. This could suggest an emergence of suppressed mourning and unresolved guilt or shame from the abortion.[7]

5. Longitudinal studies

An analysis of the National Longitudinal Study of Youth suggested an association between depression and unintended pregnancy.[8] Some people have argued that these results merely show that women who have abortions are more predisposed to depression, or have more chaotic lifestyles as shown by the unplanned pregnancy. We have not previously been able to compare the outcome of women who decide to keep their unplanned baby. However, David C Reardon has drawn out markers for depression and linked them with unplanned pregnancies.8 These clearly show that women who carried an unintended pregnancy to term and had the social support of a marriage had significantly less depression than those who aborted their unplanned pregnancy (whether married or unmarried). Rates of depression were similar among unmarried women whether they aborted or carried the pregnancy to term, however. This may be due to the stress unmarried women may experience in raising a child without support, or it may be related to this group’s higher rate of concealing past abortions.

6. Evidence from individual cases

In 2001, 655 women came for postabortion counselling at CCN’s pregnancy counselling centres. With approximately 186, 000 abortions each year in England and Wales, there are likely to be at least 18,000 women having to cope with emotional problems of varying degrees following abortion each year.

We believe that abortion is not a simple operation that will get rid of an unwanted pregnancy and allow a woman to live her life as if nothing has happened. It is different from any other operation, and different from miscarriage, as the conscious decision to abort is one that hangs over many women as an unbearable responsibility.

Claire was 17 when she came to one of our centres for help. She had contracted chlamydia, been treated for it successfully but was worried about infertility. In an attempt to ‘test’ her fertility, she stopped taking her contraceptive pill without her boyfriend’s knowledge. She was extremely shocked when she found that she was pregnant. Her boyfriend’s negative response contributed to her decision to abort. Shortly after, Claire was unable to keep to her studies; she was constantly tearful, deeply regretting her decision and wanting another baby straight away. Her symptoms were severe and she was finally admitted to the Department of Psychiatry. Some time later, she fell pregnant again. She had no previous psychological problems.

Risk factors

In our experience, it is rare to find a woman who is 100% for abortion without feeling any discomfort. Most women have an internal conflict between their instinct, conscience or beliefs and the pressures of a difficult situation. Circumstances often appear reason enough to terminate an unexpected pregnancy, but the internal pressures can militate against such a decision and result in psychological difficulties afterwards if they are disregarded. Women with an increased risk of developing psychological problems are the following:

• teenagers[9]
• women who have terminations on medical grounds
• women who have terminations later in pregnancy
• those who have children already
• those who are ambivalent about the decision
• those with poor social support
• those with a history of previous psychiatric problems, including depression
• those who are subject to undue pressure from partners and/or parents
• those who feel pressured by circumstances
• those who struggle with value conflicts
• women who lack prior information about the procedure and/or foetal development

Symptoms and diagnosis

Post-abortion difficulties include Post- Traumatic Stress Disorder (PTSD) as well as problems caused by unresolved grief. General symptoms of PTSD may include; substance abuse, anger, panic attacks, depression, disruption in relationships, disturbance in sleep patterns, regret and guilt, psychological numbing, and suicidal tendencies. Symptoms specific to post-abortion reactions are:

• Anniversary syndrome (an increase of symptoms around anniversary dates of the conception, abortion or due date)
• Anxiety over infertility
• Avoidance behaviours (avoiding pregnant friends, babies, vaginal examinations)
• Eating disorders
• Inability to bond with children
• Preoccupation with becoming pregnant again (atonement babies)
• Psychosexual disorders (inability to engage in sexual activity or sexually acting out)
• Sudden, uncontrollable crying[10]

Relief is a common first response after a termination since the circumstantial pressures have been lifted. Denial is often already in place, a protective mechanism against the truth of what has really occurred, but postabortion problems may be triggered at any time by anniversary dates; a subsequent loss that rebounds onto the abortion loss, or a subsequent pregnancy.

CCN’s counselling programme

Many women are forced to grieve in a vacuum. Abortion loss is often not recognised or understood by partners, family or friends, whereas our postabortion counselling acknowledges that abortion involves a death and therefore a loss that needs to be grieved.

Using CCN’s unique programme, The Journey, counselling involves telling the story - something that a woman may never have done before, even if the abortion took place many years ago. She is able to come out of denial - that it didn’t affect her, that it wasn’t really a baby, that she had no choice - and begin to face the emotions that have been frozen within.

Guilt and shame are particularly difficult. Many women are unable to separate the origin and effect of these two emotions. Guilt is a legitimate emotion that tells us we have made a mistake. Shame on the other hand attacks the very core of our being and tells us that we are a mistake.

The woman caught in adultery could not deny that she was caught in sin and was made to stand before a crowd who stared at her and judged her.11 Jesus, however, did not look at her; he knew that we experience shame when others look at us in judgment. He - the True Judge - refused to judge her, averting his gaze to the ground, only looking at her when everyone had left. Then he could look at her with God’s eyes. He did not condemn her, but restored her, removing her guilt and shame and giving her the opportunity to live again. She did not even have to say sorry!

Dealing with these issues effectively means that a woman can then deal with accountability, finding forgiveness and acceptance for herself and others, before looking to the way ahead.

Forgotten fathers

Abortion has a diminishing effect on fatherhood. Many men involved in abortion are forgotten fathers. Only a quarter of them accompany their partners applying for a termination. The other 75% are not sought by the clinics, thus treating this interpersonal event as if only one person is involved.

John, aged 20, experienced his partner’s abortion as an attack on his manhood. He hoped to marry his girlfriend when she became pregnant. His parents insisted that she had an abortion because he was ‘too young to take the responsibility and had his life to live’. About three months afterwards, he presented at the surgery with depression. He said he was devastated by the two-fold attack on his manhood - not only had he lost his baby but his own parents did not consider him man enough to take responsibility for his family.[12]

Adoption - God’s alternative

God always has a way through for us. Adoption is something close to his heart - a life-giving alternative to abortion for the child and the mother. Adoption is something God invented; it is not of human origin. He chose to adopt us as his sons and daughters. When Moses’ mother was facing difficult circumstances in Egypt, she had a choice.[13] She could have hidden Moses and brought him up in the shadows, as a slave boy. She could have given him up to the soldier with the sword and seen her son die. Or she could place her baby in a basket, release him onto the river and watch to see what God would unfold. As we all know, God took care of Moses’ destiny. His adoption was part of who he was. It is a radical question: if adoption is part of God’s redemptive pattern for Moses, for a fallen world, then surely it can be part of God’s purpose for a mother and her child?

Adoption has redemptive power because it is about the fatherhood of God. Jesus carried the pain so that we could be adopted into God’s family. We see adoption as a positive, if painful, choice. The birth mother unselfishly chooses pain in order to provide the best she can for her child. With loving support, she can, over time, work through her grief, be at peace and retain her self-worth.

Conclusion

As we have seen, abortion is always a tragedy because it damages everyone involved. Thankfully, we have seen many women helped through postabortion counselling. Our telephone help-line - ‘care confidential’ - is now able to reach many more (see below).

Thirty five years of legal abortion has caused literally untold damage to many people. We feel that God has given the church the task of bringing healing and forgiveness to women following an abortion, providing support for those choosing to parent and offering hope through adoption as one of God’s lifeaffirming patterns for our world.

Care Centres Network

CARELINE
PO Box 6906
Chelmsford CM1 3YQ