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June 23, 2008

Myth: Post-Abortion Syndrome

Abortion Myth #2:

Post-Abortion Syndrome

The term "post-abortion syndrome" was first used in 1981 by psychologist and trauma specialist Vincent Rue. The term has now been widely used by anti-choice activists to describe the emotional reactions and alleged post-traumatic stress disorder developed in response to abortion, however the efforts to popularize the term are mainly political.

Neither the American Psychological Association nor the American Psychiatric Association recognize Post Abortion Syndrome (or "Post Abortion Stress Syndrome" or "Post Abortion Trauma") as an actual condition or mental disorder.

Some studies have shown a correlation between abortion and depression, anxiety, or sexual dysfunction however these correlations are likely due to preexisting issues and other factors (including a lack of familial support).


We will be linking to a lot of sources here - while many are unbiased, scientific or news sources please be advised that some of them have a pro-choice slant, while others have a pro-life bias. Please consider where you're getting your information from, before you accept it as 'fact' and please be advised that we do not necessarily advocate or condone the information you may find once you leave our page.

The Alleged Syndrome

There are a number of emotional and psychological "symptoms" that anti-choicers have associated with abortion. These include guilt, anger, anxiety, depression, grief, shame, numbness, low self-esteem, helplessness, suicidal thoughts, anti-social behavior, eating disorders, broken relationships, codependency, etc.

If these symptoms seem familiar, it might be because they are the same as the common symptoms of Post-Traumatic Stress Disorder, a type of anxiety disorder that is triggered by an extremely traumatic event. PTSD may affect survivors or witnesses of traumatic events such as physical assault, torture, war, natural disasters, mass casualties, etc.

It's misleading to label these symptoms with the name Post-Abortion Syndrome, because having an adverse reaction to a stressful situation can occur after any traumatic event. The name implies that that abortion is typically traumatic. The actual evidence says otherwise. Now I suppose abortion could be considered a traumatic event for some people, but to suggest that PAS is worthy of its own diagnosis is a gross over-exaggeration.

Although the medical mainstream does not feel that the facts merit classifying adverse symptoms after abortion as their own syndrome, it is possible for some women to experience negative psychological feelings prior to abortion. (That's not to say that abortion necessarily causes these problems, but for a moment let's accept the argument that it does). Even if you accept that PAS does exist, there has still been extreme misrepresentation.

The anti-choice advocates would like us to believe that PAS is a common occurrence and probable risk of elective abortion. However the overall medical opinion is that adverse reactions after abortion are rare.

How Common are "PAS" Symptoms, Really?

This is what we tell our patients: abortion is a common life event similar to having a baby, getting a divorce, getting married, or losing a loved one. A range of emotions is normal. Most women do fine. ...Almost a third of US women have had abortions. If severe emotional reactions were common, it would be an epidemic and not a debate!" - Janet Colm, President & CEO of Planned Parenthood [Planned Parenthood]
"Some women who have abortions feel peaceful about their decision beforehand, have a pain-free and physically easy experience, feel relieved afterwards, and then live the rest of their lives with no problems or regrets." [AfterAbortion.com]
"Severe psychological reactions after abortion are infrequent" - Henry P. David, PhD, internationally known scholar in this area of research, 1996 [National Abortion Federation]
"About 20 percent of women who have abortions experience symptoms of depression that pass fairly quickly. ...Up to 10 percent of women who have abortions experience lingering symptoms of depression. This is also true of 10 percent of women after childbirth." [Teenwire.com]
"...for a vast majority of those who have voluntary abortions, 'sever negative reactions are infrequent in the immediate and short-term aftermath'... The greatest distress, it found, 'is likely to be before the abortion.' 'Severe negative reactions after abortions are rare and can best be understood in the framework of coping with a normal life stress'" - The Associated Press, 1990 [The New York Times]

"In general, the studies on the psychological sequelae of abortion indicate a low incidence of adverse mental health effects." - C. Everett Koop, U.S. Surgeon General, 1989 [Popline.org]
"...does not create psychological hazards for most women undergoing the procedure" - American Psychological Association [ReligiousTolerance.org]

Who Might Be at Risk for "PAS" Symptoms?
At the end of an eight-year study of 5,295 women, researchers concluded that the most important predictor of emotional well-being in post-abortion women was their well being before the abortion. They determined that women with preexisting emotional problems are at a slightly higher risk for negative emotional responses after an abortion.
Several studies have been done on this subject, and the bulk of the evidence indicates that factors other than the abortion itself plays the strongest role in what a woman's emotional state might be following abortion.
"Significant psychiatric illness following abortion occurs most commonly in women who were psychiatrically ill before pregnancy, in those who decided to undergo abortion under external pressure, and in those who underwent abortion in aversive circumstances, for example, abandonment." - Nada Stotland, M.D., former president of the Association of Women Psychiatrists, in JAMA [National Abortion Federation]

"The major predictor of a woman's well-being after an abortion, regardless of race or religion, is level of well-being before becoming pregnant [National Abortion Federation]

"...in women with no past psychiatric histories there was no significant difference between comparison groups in rates of psychiatric illness... women with a previous history of psychosis were more likely to experience a psychotic illness than those with no such history... termination of pregnancy did not appear to increase the risk" [Spiked Health]

"Post abortion syndrome would be a reflection of an unstable mindset at the time of abortion. Women who regret their decision and still undergo an abortion or those who are compelled into having an abortion due to undue pressure are maybe at a greater risks to be affected." [Buzzle.com]
"...even if mental health problems are more common among women who have had an abortion, abortion may not have been the real cause." [Guttmacher Institute]
"...the women most negatively impacted by abortion are those who have lower self-esteem to begin with, those who underwent the abortion in circumstances of extreme pressure or abandonment, and those who had a mental illness before abortion." [SearchWarp.com]
"How well a person copes with this stress depends on the individual's resiliency and the conditions under which the stress occurs. When a woman's psychological state is already fragile, the stress of an abortion can more easily overwhelm her. ...The risk factors for post-abortion psychological maladjustments can be divided into two general categories. The first category includes women for whom there exists significant emotional, social, or moral conflicts regarding the contemplated abortion. The second category includes women for whom there are developmental problems, including immaturity, or pre-existing and unresolved psychological problems." [AbortionFacts.com]

Distress after an abortion is often connected to another unresolved painful event in your life. " [Peace After Abortion]
"Women are not randomly assigned to have abortions... Women who are having abortions are having them in the context of an unwanted pregnancy, which usually has some other very stressful aspects. Their partners may have left them. They may have been raped." - Nancy E. Adler, PhD, a professor of medical psychology at the University of California, San Francisco [American Psychological Association]
"The truth is that most studies in the last 25 years have found abortion to be a relatively benign procedure in terms of emotional effect — except when pre-abortion emotional problems exist or when a wanted pregnancy is terminated, such as after diagnostic genetic testing" [Planned Parenthood]
Other factors that may contribute to negative feelings about an abortion, include going against your own beliefs about abortion, being heavily pressured into having an unwanted abortion, or having a lack of support before and after the abortion. This still doesn't prove that there is a legitimate syndrome related to post-abortion stress, however it does explain some of the 'evidence' supporting PAS.

A lot of the PAS advocates claim that symptoms of PAS might manifest years after the abortion and victims might not even realize that what they are experiencing is related to a past abortion. Yeah, because maybe in some cases it isn't. It might be comforting to find a 'reason' for emotional distress or to give your feelings a name, however, it's not fair to use abortion as a blanket excuse for an unexplained diagnosis of depression or anxiety. That's not to say that some women don't feel distress after an abortion; it's just unfair to treat abortion as a scapegoat for all your unexplained distress.

Is Abortion Actually to Blame?

"As with any trauma, individuals often "forget" the ordeal and deny or ignore any pain that may result. Many simply don't relate their distress to the abortion experience." [Ramah International]
"...she may even become vocally defensive of abortion in order to convince others, and herself, that she made the right choice and is satisfied with the outcome.

...unacknowledged post-abortion distress is the causative factor in many of their female patients, even though their patients have come to them seeking therapy for seemingly unrelated problems.

...Other women who would otherwise appear to have been satisfied with their abortion experience, are reported to enter into emotional crisis decades later" [AfterAbortion.org]
"Many simply don't relate their distress to the abortion experience. At some point, however, memories resurface and the truth of this loss can no longer be denied." [PostAbortionSyndrome.org]
"...listening to those who treat PAS in men, you realize that they are leading men to blame their abortion experiences for pre-existing and subsequent problems" [The Nation]

"..women who have experienced it are urged into denial so they do not talk about and process the normal feelings of anxiety, fear, shame, guilt and grief which often follow the abortion. When such emotions are denied and buried, they will often resurface having been magnified by time...

...Very often, she will not relate her anxiety to a past abortion...

The woman is not aware of any negative feelings that she may have had about the abortion. Suppression. This occurs when a woman erases any negative feelings about abortion from her mind and will not allow herself to contemplate her personal feelings." [Texans United for Life]

"The first stage in post-traumatic stress is denial. People will refuse to admit that they have a problem, or will blame their problems on something else." [Pregnant Pause]
Isn't it possible that if a woman is "unaware" of negative feelings about her abortion, it is because she doesn't have negative feelings about her abortion? Maybe if they're blaming their problems on something else, it actually is about something else? Where do you draw the line between denial about Post Abortion Syndrome and the absence of Post Abortion Syndrome?

The Truth Behind the Research

It's easy to be overwhelmed by the massive amount of information you can find when you do a search for "Post Abortion Syndrome". It's not always easy to decipher which sources might offer helpful information for someone who is struggling with the decision to have an abortion and which are merely anti-choice scare tactics.

Sources With an Agenda

We found a lot of websites that claim to want to help women deal with their post-abortion feelings, however we noticed a trend... Aside from the obvious (obvious to us at least, now that we've done the research) indicators like the misinformation and stretching of the truth, we found that the 'advice' given by the anti-choice sites are all about accepting that your abortion was wrong and forgiving yourself for it. (Now that might be helpful advice to women who feel that their abortion was wrong and have to come to terms with feelings guilt or shame, but that does not describe all post-abortion women).

"Bring this back into her consciousness and admit she was a party to killing her own baby. She must grieve over her lost child — tears, mourning as for another loved one. Seek Divine Forgiveness." [AbortionFacts.com]
"It is crucial for the post-abortive woman to come to a point of understanding that she aborted a real human baby. ...allows herself to lead a fulfilling life, despite her past sinful choices."  [Texans United for Life]
"Through healing you will become a better person in spite of your bortion." [AfterAbortion.org]

"One woman said that holding onto a belief that it was not a baby, from the time before her abortion until now, had enabled her to frame up the abortion in a reasonable (able to be reasoned) way and enabled her to cope with it, until she came to the realisation it was her ‘baby’ she lost, and then everything began to cave in on her, and the grief and guilt that surfaced soon gave way to despair." [Post Abortion Trauma Healing Center]
"... there is no healing outside of Jesus Christ. From many years of working in the crisis pregnancy ministry area, and from sharing with thousands of other ministry leaders, I know that God is the only healer." [Ramah International]

"Women become mothers at the moment of conception. Post abortive women commonly take many years before they begin to consider acknowledging that fact even to themselves. Though the acknowledgment of murder is repressed, the buried reality remains." [Life Enterprises]
There is a lot of loaded language being thrown around here and we think it's important that if you do seek out information about PAS, that you recognize what their biases are and accept their 'facts' with a grain of salt.

I know that if I was feeling a little bit sad about an abortion I'd just had, the last thing I need to read is that I'm a sinner because I killed my baby. I can also imagine that having people accost me on my way into (and out of) an abortion clinic might exacerbate any feelings of stress I might have had about my decision. Who knows how much of this alleged syndrome is due to the way that anti-choice protestors treat women who are seeking elective abortions?

We've already touched on the issue of false reporting last month, when we discussed another myth (Myth: Abortion Causes Breast Cancer). Abortion usually is a very personal and private subject. Therefore women do not always properly and honestly disclose their complete medical histories when it comes to abortion. Women who have had abortions might not always feel comfortable disclosing this information and healthy women are less likely to report their histories of abortion than those with medical problems. Additionally, depression and mental illness are also very personal and private matters to many people, so there is even more potential for recall bias.

Flawed or Inconclusive Findings

Overall, mainstream medical sources deny the existence of PAS as a legitimate disorder. In 1987, U.S. Surgeon General C. Everett Koop (upon the direction of President Regan) issued a report on the health effects of abortion. After reviewing over 250 studies on the psychological impact of abortion, Koop described the risk of significant emotional problems following abortion to be "minuscule" and reported that the quality of existing evidence was too poor to prepare a report that could "withstand scientific and statistical scrutiny".
"...scientific studies do not provide conclusive data about the health effects of abortion on women." -- C. Everett Koop [JSTOR]

"...obstetricians and gynecologists had long since concluded that the physical sequelae of abortion were no different than those found in women who carried pregnancy to term or who had never been pregnant." - C. Everett Koop [Guttmacher Institute]
"APA research review finds no evidence of 'post-abortion syndrome' but research studies on psychological effects of abortion inconclusive." [National Abortion Federation]
"Assessments of the physical effects of abortion, and assessments of the relationship between abortion and a woman's emotional state, must be approached differently. The key to assessing the emotional impact of abortion on a woman's emotional state is context-dependence. Where a discussion is to be had of women's emotional responses to abortion, attention must be focused on the social and personal situation in which abortion takes place. It therefore to makes no sense to contend that abortion has a particular, uniform mental health outcome." [Spiked Health]
"A review of methodologically sound studies of the psychological responses of U.S. women after they obtained legal, nonrestrictive abortions indicates that distress is generally greatest before the abortion and that the incidence of severe negative responses is low. Factors associated with negative response are consistent with those reported in research on other stressful life events." [Science Magazine]

"Studies that have concluded that terminating a pregnancy leads to an increased risk of anxiety or depression are often methodologically flawed. Their study populations are often at an increased risk for anxiety or depression before the abortion procedure" [Planned Parenthood]

"...women who had an abortion following an unintended pregnancy were not at any higher risk of subsequent mental health problems than were women whose unintended pregnancy was carried to term." [Guttmacher Institute]

Even Vincent Rue, the man who started the whole PAS controversy, concluded in his article "Post-Abortion Syndrome a Growing Health Problem":

"Attributing a woman's emotional problems to the simple fact that she had an abortion can detract from a full understanding of what is going on with her..."[Ms. Magazine]
"...at present, it is impossible to estimate with any degree of accuracy the incidence of Post Abortion Syndrome" [The Forerunner]
Can Abortion Be a Positive Experience?

While some women may experience sensations of regret, sadness or guilt after an abortion, the overwhelming responses are relief and happiness. Women who have had one abortion overall have higher self-esteem, greater feelings of worth and capableness, and fewer feelings of failure than do women who have had no abortions. The positive relationship of abortion to well-being may be due in part to the empowering aspect of being able to control one's own fertility.

According to in-depth interviews performed by Dr. Paul Sachdef, professor of social work at Memorial University (Newfoundland, Canada), almost 80% of women felt "relief and satisfaction" soon after the abortion. He also determined that elective abortion was often less traumatic than giving a child up for adoption.

One study indicates that 95 percent of birth mothers reported grief and loss after giving their child up for adoption. Researchers speculate that the psychological risks for adoption are higher for women than those of abortion because they reflect different types of stress (abortion-related stress is often acute, while the stress of adoption may be chronic for women who continue to worry about the fate of their child).

Research studies indicate that emotional problems resulting from abortion are less frequent than those following childbirth. (Postpartum depression is more widespread than this alleged PAS, but no one is suggesting we should all stop having children because of it). Mothers with unwanted births often have lower quality relationships with their children, which in turn can effect the children's development, self-esteem and mental health.

The Bottom Line

Whenever pro-choice advocates or medical experts try to refute PAS, anti-choicers jump to say that they're "blaming the victim" and telling women to "deny their feelings". This is not our intention. Even if we don't believe that PAS exists as an actual syndrome, if you are experiencing feelings of regret or sadness prior to an abortion those feelings are legitimate. By classifying it as a disorder, makes it seem as though there's something wrong with you if you feel a mix of emotions after a big decision. (Maybe it makes you feel better to give it a name, but it's not a mental illness).

It's not unusual for women to experience a range of contradictory emotions after having an abortion, just as it wouldn't be unusual for her to experience these emotions after giving birth, after getting married, after changing jobs, after moving to a new city... To anyone experiencing post-abortion distress, we recommend that you seek counseling in order to deal with these feelings. There appear to be tons of resources out there for women who are having difficulty dealing with a past abortion, however many seemingly well-intentioned organizations have anti-choice biases and judgmental viewpoints that might make you feel even worse.

You might be better off contacting Planned Parenthood and asking them to recommend a post-abortion counselor in your area. In our search for a non-judgmental post-abortion resources, we found Exhale, an after-abortion counseling talkline.
You may experience a range of feelings after an abortion; this is entirely normal. Women often experience feelings such as sadness, happiness, empowerment, anxiety, grief, relief and/or guilt. There is no “right” way to feel. Feelings are different for everyone and they often change over time.
We know your abortion can be hard to talk about and that finding the right person to talk with can be even harder. If you are looking for ideas about how to talk with your friends or family, take care of yourself, get through this experience or find peace, Exhale can help.
:: If you’ve just had an abortion, it’s important to remember to take care of yourself, physically and emotionally, after the procedure is over. Make sure to get enough sleep, eat complete meals and do things you enjoy like going to the movies, spending time with friends or taking a walk. Calling Exhale can be a part of how you take care of yourself. Be sure to read and follow all the after-care guidelines from your abortion provider.
:: If some time has passed since your abortion, it’s never too late to find a way to express your feelings or talk with someone who listens. Many women have found writing about their experience, whether in a journal or as a letter, a helpful tool for working through their emotions. Calling the Exhale talkline, praying, cooking, making art, adopting a pet or climbing a mountain have been known to work as well. What’s important is that you find something that works for you, and that fits your life, beliefs and needs.
:: If you have been diagnosed, or have self-diagnosed, as having Post-Abortion Stress Syndrome, Exhale understands that having a name for what you’re feeling and experiencing can feel important. Many women find the experience of identifying with this syndrome as positive and affirming. It is also important to know that having feelings about a significant life event doesn’t mean that you have a major psychological condition that requires medical care. For many women, naming and expressing their emotions, and having the space and support to do so, can be more empowering than being identified as having a disorder. Whether or not you think you have PASS, the most important thing is that you get support for what you’re feeling, not what someone else thinks you should be feeling. Exhale trusts you to know what feels right for yourself.
Exhale follows the findings of the American Psychological Association, which has not found a link between feelings that follow an abortion and a psychological condition in need of medical care.
Call Exhale to talk freely about your experience with abortion.

1-866-4 EXHALE
Monday – Friday: 5 p.m. – 10 p.m. Pacific
Saturday – Sunday: 12 p.m. – 10 p.m. Pacific
Exhale serves women who have abortions, and their partners, friends and family. They respect the cultural, social and religious beliefs of all our callers. All calls are confidential.

"...the best clue to a woman's mental well-being after an abortion is her state of mind before the pregnancy--in particular her level of self-esteem. In other words, those who found the procedure traumatic were generally troubled long before they showed up at an abortion clinic. ...much of the stress experienced by women who get abortions may stem not from the procedure itself but from the simple fact that the pregnancy is unwanted." [Psychology Today]
Some women may experience sadness or regret after undergoing an elective abortion, however that doesn't mean that they are suffering from a mental illness and it doesn't necessarily mean that the abortion caused those feelings.

There have been no studies that prove a causal relationship between abortion and negative psychological symptoms and no credible evidence to suggest that Post Abortion Syndrome is an actual disorder.


Victoria said...

I hate all abortion myths, but I really hate this one. It makes it really hard to express any negative feelings about your own abortion because you KNOW someone will use it either against you, or someone else. You are not permitted to feel any sadness after an abortion, unless you want to give more ammunition to anti-choicers.
There was that "sex" (abstinence? guilt?) talk woman who talked at high schools, Pam Stenzel, and she said things like, "I've counselled girls who have had abortions and have bulimia, depression, anorexia".
what the shit?
a) they might have always had those conditions - (maybe they were exacerbated by the stress of having an abortion surrounded by too many judgemental anti-choicers OR WHATEVER) but that's a pretty far leap.
"She has anorexia. She once had an abortion. The abortion caused the anorexia!"...?
You could do that with any mental illness or other illness and abortion, if you have no sense of logic.
"She once had an abortion. She has breast cancer...."
b) the people who seek out post-abortion counselling ARE THE ONES WHO HAD NEGATIVE EXPERIENCES. If you had a positive experience, you don't go talk to Pam.

Everyone who has had a positive abortion experience should write to Pam Stenzel, and other anti-choice "counselling" services, just to give them a more balanced view.

beth said...

Here in the UK (where we are generally a lot more pro choice than in the US, and putting a child up for adoption is extremely rare), post abortion stress is recognised by the Royal College of Psychiatrists due to the evidence of the adverse effects on mental health an abortion can have in recently published medical research done in Australia and New Zealand. It isn't a myth. It does exist.

I have met many women (and I'm one of them) who has had Post Abortion Stress. I've also met women who are perfectly fine with the decision they made, although they did feel sadness or loss at some stage. But that isn't quite the same thing.

I think really what the myth you are talking about here is that perhaps people who are wanting to push pro-life/anti-abortion policies are saying that ALL women who have an abortion will suffer from Post Abortion Stress. that is simply untrue.

I don't like how political this debate has become, and I feel that while people are arguing about what is and isn't true, the women and men who these choices are actually reality for are being forgotten. I wish people would lay down their placards and open their eyes to people needing support without judgement no matter what choices they make.

If you'd like to know more about what medical research that actually has been done on abortion I recommend checking out a database CareConfidential have started:


Lilith said...

I think maybe you should read the entire blog over on The Good Authority. The "Syndrome" IS a myth. That doesn't mean that everyone feels super-awesome after an abortion... but there it isn't a legitimate mental disorder.

Some studies have shown a correlation between abortion and depression, anxiety, or sexual dysfunction however these correlations are likely due to preexisting issues and other factors (including a lack of familial support). Some women may experience sadness or regret after undergoing an elective abortion, however that doesn't mean that they are suffering from a mental illness and it doesn't necessarily mean that the abortion caused those feelings.

A more appropriate term for what you're describing would be "Post Stress Syndrome". Pretending that there's a direct causal relationship between those symptoms and ABORTION specifically is purely a political move.

The website you linked to has a very strong anti-choice bias, and I'm guessing you do as well.

I'm sorry that you had negative feelings about your abortion. It's not the right choice for everyone and there should be more resources for people who are struggling with their choice. However we all need to be free to make our own choices. Exaggerations and misinformation meant to instill fear of "post abortion syndrome" or breast cancer, etc. only hinder women from making their own decisions.

Anonymous said...

The APA may not have recognized this as a disorder yet, however the APA also once listed homosexuality as a disorder simply because people did not have enough information on it. I don't understand how people can say that someone can not possibly develop stress disorder from something like an abortion. Although I don't think everyone who has had an abortion goes through this, there are definitely those who do. I do not think it is right for anyone to disregard these feelings.

Jen said...

I was just wondering if you had ever seen the results from this study out of Oregon State University and University of California, San Francisco?
The long short of this was teenagers who have abortions are no more likely to become depressed or have low self-esteem than their peers whose pregnancies do not end in abortion.

Anonymous, I do not think anyone is downgrading the fact that woman do get depressed after a abortion. It a matter of how this conversation is framed.