Social Effects and Implications of Abortion

Thomas W. Strahan Memorial Library
Index
Standard of Care for Abortion
Abortion Decision-Making
Psychological Effects of Abortion
Social Effects and Implications
Physical Effects of Abortion
Abortion and Maternal Mortality
Adolescents and Abortion
Definition of Terms
Women's Health After Abortion
Material Yet to be Cataloged
Strahan Summary Articles

Social Effects and Implications of Abortion

Outcome - Refused Abortions

"Therapeutic Abortion on Psychiatric Grounds," SJ Drower and ES Nash, South Africa Medical Journal 54:604-608, 1978.

A South African study of women who were seeking abortion on psychiatric grounds followed up women who were refused abortion as well as women who were granted abortion for 12-18 months. Those who had abortions were more likely to be under psychiatric treatment, admitted to increased use of alcohol, tobacco, or tranquilizers, had experienced adverse personality changes, and had greater social isolation compared to women who had been refused abortion and had a variety of other pregnancy outcomes.

"Abortion Denied - Outcome of Mothers and Babies," (editorial), Carlos Del Campo, Canadian Medical Association Journal 130(4): 361-362 ,1984.

Summarizes various studies including those related to the outcome of refused abortions and concludes that abortion is not the answer to social ills.

"Women Refused Second Trimester Abortion: Correlates with Pregnancy Outcome," N. Binkin, C. Mhango, W. Cates, B. Slovis, M. Freeman, American Journal of Obstetrics and Gynecology, Feb. 1,1983, pp. 279-284.

United States study reported that 80 percent of the women had their babies.

"One Hundred and Twenty Children Born Alter Application or Therapeutic Abortion Refused," H. Forssman and I. Thuwe, Acta Psychiatrica Scandinavica 42:48-59(1966).

This study attempted to ascertain the mental health, social adjustment and educational level of 120 children up to age 21. The study concluded that unwanted children did not have the advantage of a secure family life, had more psychiatric care, more often displayed anti-social behavior and did less well in school than controls. However, there were other confounding variables. For example, 26.7 percent of the unwanted children were born out of wedlock, compared with 7.5 percent of the control children.

"Children Born Following Refused Abortion," Wanda Franz, Association for Interdisciplinary Research Newsletter 2(4):1-6, Fall 1989

Data does not support the conclusion that 'unwanted' children should be aborted.

"The Swedish Children Born to Women Denied Abortion Study: A Radical Criticism," P. Cameron and Tichenor, Psychological Reports 39:391-394(1976).

(Concludes that re-examination of the data advanced in the light of differences in social class and proneness toward psychiatric consultation indicates that children issuing from a denied abortion turn out much as children in general.

"Follow-Up Study of Children Born to Women Denied Abortion," Z. Matejcek, Abortion: Medical Progress and Social Implications, Pitman, (London: Ciba Foundation Symposium 115, 1985) 136-148.

Comments of the author:

In child psychology and psychiatry the opinion is generally accepted that an unwanted pregnancy can have a very negative influence on the development of the child. However, the published work on this subject is extremely sparse. (Concluded from 1970 study): Although the differences between unwanted and control children were not dramatic, they were consistent and tended to support the major hypothesis that the development of children born to women denied abortion would be more problem prone.

Unwanted pregnancy represents, in the life history of the child, something of an "aggravating circumstance," i.e., a certain risk that may or may not materialize in a particular situation in life. (Concluded from 1977 study):

Differences in school achievement in ratings of the child's personality and parental attitudes were more pronounced. (Some questionable aspects of the study-later 38 percent of the mothers denied they ever wanted to get rid of the child; many now said they were very grateful abortion was denied; others said they hated the commission; parents were paid to participate; school problems could be alcohol-related, which was not considered; 20 percent divorce rate of unwanted group is a possible confounding factor.

Pregnancy Resolution Decisions: What If Abortions Were Banned?," J. Murphy, B. Symington, S. Jacobson, Journal of Reproductive Medicine 28 (II): 789-797 (1983)

Availability of another person to help with an unplanned child was most closely associated with the decision to carry the baby to term or abort it.

Sex Selection Abortion

"Attitudes Toward Abortion as a Means of Sex Selection," Richard N. Feil, G Largey and M. Miller, Journal of Psychology, 116:269-272(1984).

Acceptance of abortion as a means of sex selection varied widely among students at Mansfield University in New England. Religiosity based on church attendance proved to be the most dominant variable. Thirty-two percent of those who attended church once a month or less were accepting/compared with those who attended more often [8.5 percent]. Overall, about 18 percent of the students showed acceptance of amniocentesis followed by abortion for purposes of sex selection. Attitudes toward other sex-testing methods were also studied.

"Some Social Implications of Sex Choice Technology," L. Fidell, D. Hoffman and P. Keith Spiegel, Psychology of Women Quarterly, 4:32-41(1979).

In a California State University at Northridge study of 770 undergraduates, 85 percent wanted male first-born children; 73 percent wanted a second-born girl; 60 percent said they would probably not use sex choice methods; 29 percent said they probably would; and 11 percent said they would use them to guarantee the second child was of the opposite sex to the first.

"Guidelines for the Ethical, Social and Legal Issues in Prenatal Diagnosis," T Powledge and J. C. Fletcher, New England Journal of Medicine, 300:168-172(1979).

"Although we strongly oppose any movement aimed at making diagnosis of sex and selective abortion a part of ordinary medical practice and family planning, we recommend that no legal restrictions be placed on the ascertainment of fetal sex.... We think most couples should not seek the information however."

"A Medical View," Haig Kazazian, Jr., Hastings Center Report, 10:17-20(1980).

Responses to John Fletcher: John Fletcher argues cogently that if the Supreme Court has given women the right to choose whether or not a pregnancy is carried to term, sex selection is merely an extension of that right.... [But] wholesale acceptance of Fletcher's view on this issue could indirectly be disastrous for legal abortion in this country.

"Gender Ethics," Gertrud Lenzer, Hastings Center Report, 10:17-20(1980).

Responses to John Fletcher: Surely it can hardly be the legal moral intent of the Supreme Court's position to guarantee women the right of self-determination for the purpose of discriminating against their own kind by doing away with the fetuses of their own sex or by choosing male children as firstborns by means of newly developed preconceptive technology.

"Negative and Positive Rights," James F. Childress, Hastings Center Report, 10:17- 20 (1980).

Responses to John Fletcher: Contrary to Fletcher, the Supreme Court did not make "the conscience of the individual woman the sole arbiter of the reasons." Even if this claim holds for noninterference it does not hold for assistance.

"The Supreme Court and Sex Choice," Margaret O'Brien Steinfels, Hastings Center Report, 10:17-20(1980).

Responses to John Fletcher: Gender should not be turned into a disease subject to medical "cure"; one should not foster cultural and social prejudice that values one sex over the other; one should not confirm the prejudice that sex is the governing factor in behavior, status and vocation.

"Preselecting the Sex of Offspring: Technologies. Attitudes and Implications," S. Hartley and L. Pietraczyk, Soc. Biol. 26:232-246(1979).

In northern California, 2,138 respondents indicated widespread acceptance of ongoing biomedical research to perfect preselection methods and of making these procedures available to potential parents. Almost half agreed that they might want to use such techniques. Variation in levels of agreement were assessed by sex, race, marital status, child-parity, religious affiliation and attendance, level of education, class and general attitudes toward medical and scientific leaders. The implications of the general acceptability of sex selection go far beyond the freedom of parental choice to such matters to socialization patterns of first son, second daughter ordering, sex role inflexibilities, sex ratio imbalances, and include possibilities for curtailing rapid population growth.

"Ethics of Testing a Baby's Sex," U.S.A. Today, October 14,1987.

One-third of the medical geneticists in the U.S. are willing to order prenatal tests to determine a child's sex, even if it meant the parents might abort a fetus that wasn't the sex they wanted. Dr. John C. Fletcher of the University of Virginia School of Medicine, who conducted the study, said, "Giving prenatal diagnosis for sex choice is morally objectionable."

"What Happens When We Get the Manchild Pill?," Colin Campbell, Psychology Today, 10(8):86-89 (1976).

Clearly sex control could shake up the human race to its roots. "It is hard to find a scientist in this field who doubts that a cheap, carefree and reliable method of sex control will become available. If large numbers of parents began having boys as eldest children, certain sex role types might harden forever."

"The Slippery Slope of Science," A. Etzioni, Science, 183, pp. 1041(1974).

Sex pre-determination may lead to policies of eugenics.

"Sex Determination: Its Impact on Fertility," G. Markle and C. Nam, Social Biology18:73- 83(1971).

A review of the literature suggests that people favor sex choice so that they may have smaller families.

"Abortion for "Wrong" Fetal Sex: An Ethical-Legal Dilemma," J. Elliott, Medical News, 242:1455-1456(1979)

"Social Acceptance of New Techniques of Child Conception," R.L. Matteson, and G. Terranova, Journal of Social Psychology 101:225-229(1977).

"Sex Preselection in the United States: Some Implications," Charles F. Westoff and Ronald R. Rindfuss, Science, 184(4127):633-636, May 10,1974

"An Abuse of Prenatal Diagnosis," M. Stenchever, JAMA, 221:408(1972).

Genetic Engineering

"A Support Group for Couples Who Have Terminated a Pregnancy after Prenatal Diagnosis: Recurrent Themes and Observations," L. Suslak, A. Scherer, G. Rodriguez, J. Genetic Counseling 4(3): 169,1995

The impact of terminating a pregnancy for a birth defect is a devastating and isolating experience; devastating because the dream of parenthood, of family life and of giving love and nurture is gone. Isolating because in our society there is no formal recognition or acceptable mourning period for grief.

"The Return of Eugenics," Richard John Neuhaus, Commentary, 86:15, April, 1988

The reach of the eugenic vision is to eliminate the limits and risks in what was once deemed natural.

"Patient Response to Genetic Amniocentesis," Goldstein and Hyun, Journal of Perinatology 5(1):9-12, Winter 1985

Twenty-six out of 107 respondents commenting on abortion said they would consider abortion if results of amniocentesis had shown abnormalities. Despite this response, the authors, based upon other data, concluded that amniocentesis is likely a live-saving procedure.

"CVS for first-trimester fetal diagnosis," Brambiti and Oldrini, Contemporary OB/GYN 25(5):94-104, May 1985

Chronic villus sampling (CVS) in the first 250 cases resulted in 22 genetic-induced abortions, 3 non-genetic-induced abortions, 10 fetal losses (4.4%); 11, pre-term deliveries (4.9%); 214 full-term deliveries. Complications included 4 threatened abortion, 42 (18.6%) vaginal bleeding, 7 malformations, 14 intrauterine growth retardation (6.2%). The authors conclude that the sampling technique is safe.

"Pregnancy Termination for Genetic Indications: The Impact on Families. R," Furlong and R. Black, Social Work in Health Care 10(1): 17, Fall 1984

In a study of 26 families at Yale New Haven Hospital in 1979-1982, in which mothers underwent abortion because of a serious defect in the unborn child, it represented a difficult and painful chapter of their lives. Fathers were particularly adversely impacted. Nineteen out of 22 children in the families studied had mild to severe reactions based upon observations of the parents.

"Sequelae and Support After Termination of Pregnancy for Fetal Malformation," J. Lloyd and K.M. Laurence, British Medical Journal 290:907-909, March 1985.

Some 77% of the women studied experienced an acute grief reaction. Some 46% still remained symptomatic after six months, some requiring psychiatric support. Several would have liked burial or some recognition of death. Several had problems severe enough to influence reproductive behavior.

"The Psychological Sequelae of Abortion Performed for a Genetic Indication, B," Blumberg,M. Golbus and K. Hanson, Am. J. of Obstet and Gynecol 122(7):799-808, August, 1975.

Stresses attendant to selective termination produce undesirable marital consequences that threatened marital stability.

Deterioration of Economic and Social Conditions Following Abortion

One reason advanced for legalized abortion is that it is necessary for the economic and social advancement of women. However, several studies have found that abortion, and particularly repeat abortion, is related to a poorer economic and worsened social condition of women. Overall, 60% of U.S. women who have an abortion will have a repeat abortion by age 30.

"Contraceptive Practice and Repeat Induced Abortion: An Epidemiological Investigation," MJ Shephard and MB Bracken, Journal of Biosocial Science 11:289, 1979.

A U. S. study of low income women found that women with repeat abortions were more likely to be divorced, and be on welfare compared to women with first abortions.

"Association of Induced Abortion with Subsequent Pregnancy Loss," AA Levin et al, JAMA 243(24): 2495, June 27, 1980.

Women entering Boston Hospital for Women with a history of one or two prior abortions, were more likely to be a welfare recipient (26%-27%) compared to women with no prior abortion. (16.9%)

"Repeat Abortion in Denmark,"Osler et al, Danish Medical Bulletin 39(1): 89, 1992.

Danish women repeating abortion were more likely to be unemployed, less likely to have a partner, and were more likely to live alone compared to women with first abortions.

"The First Abortion-And the Last? A Study of the Personality Factors Underlying Repeated Failure of Contraception," P Niemela et al, Int'l J Gynaecol Obstet 19:193, 1981

Finnish women seeking a second abortion had less net household income, poorer housing, weaker relationships with their partner, and were poorer at building up the socioeconomic aspect of their lives than women with first abortions.

"Repeat Abortion: A Comparative Study," M Tornbom et al, J Psychosomatic Obstet Gynecol 17:208, 1996.

Swedish women applying for a repeat abortion were more likely to have had contact with the social service system, were less satisfied with their partner relationship, and had a more unstable relationship compared to women with a first abortion or women carrying to term.

"The influence of social class on parity and psychological reactions in women coming in for induced abortion," B Hamark et al, Acta Obstet Gynecol Scand 74(4): 302-306, 1995

Among women living in Gotenberg, Sweden and seeking a first trimester abortion, previous abortion experience was more likely among women living in lower socioeconomic districts in the city.

"Psychosocial Correlates and Antecedents of Abortion: An Exploratory Study," F. Costa et al, Population and Environment 9:3, 1987

A long term study of primarily Anglo women found that women with an abortion history were more likely to exhibit multiple problem behavior, have lower occupational prestige, be similar in educational attainment, and have only slightly higher personal income compared to women with no abortion history.

Abortion and Race or Poverty

"The African-American Cancer Crisis, Part I: The Problem," L.A. Clayton, W.M. Byrd, J. of Health Care for the Poor and Underserved 4(2): 83,1993

Contemporary African-Americans have the highest age-adjusted rates of cancer incidence and mortality of any racial or ethnic group in the United States.

"Early Adult Psychological Consequences for Males of Adolescent Pregnancy and Its Resolution," M. Buchanan, C. Robbins, J. Youth and Adolescence 19(4): 413,1990

In a Texas study of 2522 young men who were first surveyed as 7th grade students in 1971,15% had been involved in a non-marital pregnancy by age 21. 56% of black men had girlfriends who had the child but did not marry or cohabitate, while 28% married and had the child while 16% were ended by abortion. White adolescent males tended to end non-marital adolescent pregnancies by abortion (58%) and 34% chose to marry or cohabitate. Although numbers were small, 55% of Hispanic men married or cohabitated as a result of an adolescent pregnancy. Men whose girlfriends had abortions were more distressed than the men whose girlfriends carried the pregnancy to term.

"A Case Study of Race Differences Among Late Abortion Patients," J. Lynxwiler, M. Wilson, Women & Health 21(4): 43,1994

A study of 240 women who had second trimester abortions in a private womens clinic in a large southern city in 1988-1989 found that black women who delayed abortion had lower incomes, were more likely to live with their family of orientation, less likely to live alone, be more religious, more likely to have children, less likely to have pro-choice attitudes and less likely to have support for the abortion decision compared to white women who delayed abortion.

"Abortion Patients in 1994-1995: Characteristics and Contraceptive Use," SK Henshaw, K. Kost, Family Planning Perspectives 28(4): 141, July/August 1996.

In a national survey of U.S. women who obtained induced abortions in 1994-1995 61.3% were reported to be white, 31.1% black, 7.6% other races and 20.2% Hispanic. Because of over-lap the total exceeds 100%.

"The Characteristics and Prior Contraceptive Use of U.S. Abortion Patients," SK Henshaw, J. Silverman, Family Planning Perspectives 20(4)158-168, July/Aug. 1988.

In a 1987 study of 9,480 women who obtained abortions at 103 clinics, hospital and doctor's offices, 12.8% were Hispanic vs. 8.4% Hispanic (all women); 31.4% were non- white vs. 16.7% non-white generally.

"Abortion Surveillance, United States. 1988," L.M. Koonin, K.D. Kochanek, J.C. Smith, M. Ramick, MMWR, V. 140, No. SS-1, June, 1991, pp 15-42.

In 1988 the Centers For Disease Control reported 1,371,285 legal abortions in the U.S.; 35.6% of the abortions were by black women and other women of color. Black or other women of color were more likely to have abortions at a later stage of gestation than white women (14.5 v. 12.0), (8.0 vs. 5.8) and (5.9 vs. 4.0) at 11-12 weeks, 13-15 weeks and 16- 20 weeks gestation respectively.

"Why Do Women Have Abortions?," A. Torres, J.D. Forrest, Family Planning Perspectives, 20(4):169-176, July/Aug. 1988.

A 1987 Survey by the Alan Guttmacher Institute of 38 abortion facilities across the U.S. found substantive differences in abortion decision by race. For example, black women were less likely (25%) to have elected to have an abortion in order to keep others from knowing they were have sex or had become pregnant than whites (33%) and other women (Asian, Native American, Hispanic) (40%). White women (26%) were more likely than black women (17-18%) to say they were influenced by their partner's desire for them to have an abortion.

"Fears of Genocide Among Black Americans as Related to Age, Sex and Region," C. Turner and W.A. Darity, American Journal of Public Health, 63(12): 1029-1034, December 1973.

This study conducted in Philadelphia and Charlotte, North Carolina concluded that black Americans, especially young, black males, are suspicious that genocide is the aim of family planning programs controlled by whites. Black women are more positively inclined to use birth control than black men.

"Unmarried Black Adolescent Father's Attitudes Toward Abortion. Contraception and Sexuality: A Preliminary Report," Leo E. Hendricks, Journal Adolescent Health Care 2: 199- 203(1982).

In a study of attitudes of unmarried black adolescent fathers in Tulsa, Chicago and Columbus, Ohio, 77 to 95 percent agreed with the statement, "If I got a girl pregnant, I would not want her to have an abortion because it's wrong." From 44 to 66 percent answered false to the statement, "Birth control is for girls only."

"Contraceptive Needs and Practices Among Women Attending an Inner-city STD Clinic," D. Upchurch, M. Fanner, D. Glasser and E. Hook American Journal Public Health, 77(11): 1427-1430, November 1987.

In a Baltimore study of contraceptive use among black women, 46 percent were not using contraception. Substantial numbers had formerly used contraception but had discontinued use. Fifty-one percent indicated an interest in receiving contraceptive services in a STD clinic setting.

"Delivery or Abortion in Inner-City Adolescents," Susan A. Fischman, American Journal Orthopsychiatry, 47(1):127-133, January 1977.

Adolescent sexual behavior does not automatically change as the ink dries on new, liberal laws. Birth control methods and legal abortions have been ignored by many, and young unwed girls are increasingly expressing their desire to have babies. Deliverers tended to enjoy a greater degree of emotional support from their mothers. The girl's relationship with her boyfriend was an important factor in the decision-making process-the more stable and long-term the relationship, the lower the abortion incidence. The deliverer's boyfriend was more likely to be working full time as opposed to the aborter's boyfriend, who was apt to be attending school full or part-time. Aborters were more likely to be attending school at their appropriate grade level, while deliverers' had a higher probability of having discontinued school. The pregnancy per se was not the primary reason for school discontinuance and frequently occurred after the girl had left school. Very few of the deliverers planned to marry in the near future. Deliverers attached greater importance to religion. Welfare status of nearly half of the deliverers was not viewed as a deterrent to childbearing. Mere availability of contraceptives was not a deterrent to pregnancy. The decision to become a teenage mother was not affected by such global factors as improved contraception, delayed marriage, changes in roles of women, and general concerns with population and environment.

"The Social and Economic Correlates of Pregnancy Resolution Among Adolescents in New York City, by Race and Ethnicity: A Multivariate Analysis," Theodore Joyce, AmJ. Public Health 78(6):626-631, June, 1988.

Availability of abortion had little association with outcome among various ethnic groups in New York City. For blacks, white, and Puerto Rican, the unmarried women least likely to seek abortions and nulliparous, are receiving Medicaid, have no previous abortions and had low levels of schooling. Teenagers who have experienced 1 prior abortion are approximately 4 times more likely to terminate a current pregnancy. Young married black women were more likely to abort than comparable Puerto-Rican, Latinos or white women. Married women were much less likely to abort than single women.

"Predicting the Psychological Consequences of Abortion," L.R Shusterman, Social Science and Medicine, 13A: 683-689,1979.

A Chicago study interviewed 345 women pre-abortion with follow-up interviews 2-3 weeks post-abortion; 77% were Caucasians, 23% blacks. Black women claimed the least intimate and least positive relationships with their male partners compared to whites or Orientals. Oriental women were most likely to inform the father whereas blacks were least likely to inform him.

"Race, Motherhood and Abortion," Candace Clark, Ph.D. Thesis, Columbia Univ. (1979) Dissertation Abstracts Intl 40(10), April, 1980 Order no. 8008711.

A study of women in the New York area (1973-1976) found that black mothers were much less likely than white mothers to have planned their pregnancies and were much more likely to have terminated unplanned pregnancies. White mothers were no more likely than blacks to hold negative attitudes toward abortion. Many mothers who had opposed having abortions subsequently terminated pregnancies. Data suggested medical personnel may act as barriers to birth or abortion. Findings support a social structural, rather than attitudinal or values interpretation of racial differences in pregnancy outcome among mothers. Ed Note: This study is evidence of racism among facilities where decisions are made for birth or abortion.

The Connecticut Mutual Life Report on American Values in the '80s: The Impact of Belief, Commissioned by Connecticut Mutual Life Insurance Co., (Hartford, Connecticut: Factors Affecting Perceived Morality of Abortion, 1981) 92.

In response to the question, "Do you believe abortion is morally wrong, or is it not a moral issue?" 64 percent of whites thought it morally wrong, 73 percent of blacks, 74 percent of people with annual income under $12/000, 64 percent of people with annual income of $12,00- $25,000, and 56 percent of people with annual incomes above $25/000:64 percent male, 67 percent female.

"Abortion Attitudes in Poverty Level Blacks," C.E. Vincent, C.A. Haney, and C.M. Cochrane Seminars in Psychiatry 2:309-317(1970),

In a study by the Bowman-Gray Medical School on poverty level blacks, 79 percent of 776 black females, 86 percent of 500 of their sex partners, and 70 percent of 215 low- to middle-income black females were found to be "not in favor of abortions under any circumstances."

"Abortion, Poverty and Black Genocide," Erma Clardy Craven, Abortion and Social Justice, ed. T. Hilgers and D. Horan, Thaxton, (Virginia: Sun Life, 1972,1980) 231-243.

Except for the privilege of aborting herself, the black woman and her family must fight for every other economic and social privilege. The quality of life for the poor, the black and the oppressed will not be served by destroying their children. Those who openly propose abortion as a solution to almost any problem openly deny that it has racial implications, yet a social worker in recent testimony before the Minnesota State legislature cited the case where the parents of a white pregnant teenager, learning the father was black, changed their minds from adoption to abortion. The social worker used this incident as an example of why abortion should be available on demand.

Men and Abortion: Lessons. Losses and Love, Arthur Shostak and Gary McLouth, (New York: Praeger, 1984).

The authors interviewed 1000 men who accompanied women to abortion clinics. Substantially more black men than white men opposed the abortion.

"Legal abortion mortality in the United States: 1972 to 1982," H.K. Atrash, H.T. MacKay, N. J. Binkin, C.J.R. Hogue, AmJ. Obstet Gynecol. 156:605-612,1987.

Based on data from the Centers For Disease Control the rate of mortality from legal abortions and abortion related deaths from 1977 to 1982 was 0.6% per 100,000 abortion procedures for white women and 1.8 per 100,000 abortions from women who were black or other races.

"Deaths From Second Trimester Abortion by Dilatation and Evacuation: Causes, Prevention, Facalitus," W. Cates, Jr., D.A. Grimes, J. Am. College Obstetricians and Gynecologists 58(4):401, Oct. 1981.

Among the 18 deaths of U.S. Women from 1972 through 1978 by dilation and evacuation, 11 were black women.

"The Father of the Infant of the Unwed Mother," Dorothy Hollingsworth, K. Thompson, J.A. Carlson and Jackson, University of Kentucky Med. Center, Lexington (1975). Abstract printed in Pediatric Research 9:260(1975).

In a study of 411 consecutive pregnancies in women ages 12-18 years, information was collected from mothers on social status, education, income, and relationship with father of infant. The population was unusual [46 percent white, 54 percent black], from low socioeconomic families (mean annual income $4/200]. Primary support was from parental earnings in 60 percent of whites and 48 percent blacks. Striking racial differences were: [1] 44 percent of black fathers were in school vs. 14 percent of whites; [2] unemployment was 24 percent in whites vs. 9 percent for blacks; [3] before conception, 86 percent of fathers in both groups had a close relationship with the mother. By first maternal clinic visit [mean 5.6 months gestation], 36 percent white fathers had abandoned the patient vs. 18 percent blacks; 63 percent black fathers continued dating or planned marriage vs. 34 percent of whites; [4] blacks were more concerned with infant plans: 73 percent of black fathers requested mother to keep child vs. 41 percent of whites; black fathers and/or their families offered infant support significantly more often than whites [70 percent vs. 40 percent]. Post partum, 59 percent of black fathers maintained a close relationship with mother and infant compared with only 36 percent of whites.

"Rising Incidence of Breast Cancer Among Young Women in Washington State," E. White, J.R. Daling, T.L. Norsted and J. Chu, Journal of the National Cancer Institute 79(2):239- 243, August 1987

Although on the basis of small numbers, the risk for breast cancer among black women aged 25-44 years doubled from 1974-77 to 1982-84 in the state of Washington compared with a 22% increase for white women of the same age. It was noted that black women have a higher rate of induced abortion than white women which may be a contributing factor to the increased incidence.

"Breast Cancer Risk Factors in African-American Women: The Howard University Tumor Registry Experience," A.E. Laing, F.M. Demenais, R. Williams, V.W. Chen, G.E. Bonney, J. National Medical Association 85(12): 931-939, Dec. 1993.

In a Howard University case control study of African-American women seen at their hospital from 1978-1987, the multiple logistic estimates of the odds ratio for breast cancer among women under 40 years of age, between 41-49 years and over 50 years was 1.5, 2.8, and 4.7 respectively among women with a history of induced abortions compared to women with no history of induced abortions.

"Akron Pregnancy Services Survey-," 126 Self-Reported Responses to Questionnaires Completed by African-American Women, November, 1988-August, 1994

A long- term study of young African-American women receiving a variety of services at Akron Pregnancy Services in Akron, Ohio and who reported one or more prior induced abortions found that 81% had one or more psychological complaints including guilt (60%), crying/depression (55%), regret/remorse(49%), inability to forgive self (35%), anger/rage (26%), desire to get pregnant again (23%), lower self-esteem (21%), despair/ helplessness ( 17%), failure to make decisions (15%), drug/alcohol abuse (6%).; 75% said they would not have their abortion again; 28% said they desired further post abortion support , and 41% said the relationship with the father of the aborted baby soon ended after the abortion.

"Cocaine Use During Pregnancy: Prevalence and Correlates," D.A. Frank, H. Amaro, H. Baucher, R. Hingson, S. Parker, H. Reece and R. Vinci, Pediatrics 82(6):888-895, December 1988

A study of 697 Boston inner-city women during 1984 to determine the extent of cocaine use during pregnancy found that a history of two prior abortions doubled the rate of cocaine use (19% vs. 9%) and a history of three or more abortions tripled the risk of cocaine use (9% vs. 3%) compared with non-cocaine users. Some 62% of the cocaine users were North American blacks, 4% were identified as other blacks, 47% of the non- cocaine users were North American blacks and 19% were identified as other blacks.

"Drug Use Among Adolescent Mothers: Profile of Risk," H. Amaro, B. Zuckerman and H. Cabral, Pediatrics 84:144-150, July 1989.

A study of 253 inner-city Boston adolescents served at Boston City Hospital during 1984- 86 found that a history of a prior elected abortion increased by twice (33.0% vs. 16.3%) the likelihood that the adolescent mother was using alcohol, marijuana or cocaine. Some 67.9% of the drug users were American blacks, 8.9% were foreign-born blacks; 44% of the non-users were American blacks, 14.9% of the non-users were foreign-born blacks.

"Emotional Distress Patterns Among Women Having First or Repeat Abortions," E. Freeman, K. Rickels, G.R. Huggins, C. Garcia and J. Polin, Obstetrics and Gynecology 55(5): 630, May 1980

Some 413 women between the ages of 14-40 who underwent first trimester abortions at the University of Pennsylvania in 1977-78 were rated on emotional symptoms on pre- abortion and post-abortion tests. Some 35% of the women were repeating abortions. Seventy percent of the women undergoing a first abortion were black and 93% of the women undergoing a repeat abortion were black. Post-abortion scores of emotional distress of repeat abortion patients compared with women who had a first-time abortion were significantly higher on interpersonal sensitivity, paranoid ideation, phobic anxiety and sleep disturbance.

"Association of Drug Abuse and Child Abuse," Jaudes et al, Child Abuse and Neglect 19:1065, 1995.

An urban medical center which served a black population on the south side of Chicago studied children who were exposed to drugs in utero and found that the risk of subsequent child abuse or neglect increased 80% among children whose mothers had previously planned abortions.

"Violence during Pregnancy and Substance Abuse," H Amaro et al, American Journal Public Health 80(5): 575, May, 1990.

A predominantly, poor, urban, minority group of women attending clinics at Boston City Hospital who had prior elective abortion were 68% more likely to be a victim of violence during pregnancy compared to women with no abortion history.

"Contraceptive Practice and Repeat Induced Abortion: An Epidemiological Investigation," M Shephard and M Bracken, Journal of Biosocial Science 11:289, 1979.

Black women with repeat abortions were more likely to be on welfare compared to black women with one abortion.

"Induced Abortion and Congenital Malformations in Offspring of Subsequent Pregnancies," MB Bracken and TR Holford, Am J Epidemiology 109(4): 425, 1979.

Black women with prior induced abortion were more likely than white women with prior induced abortion to have subsequently delivered a malformed child.

"Risk Factors Accounting for Racial Differences in the Rate of Premature Birth," E Lieberman et al, New England Journal of Medicine 317:743-748, 1987.

Black women at the Boston Hospital for Women who delivered had a 91% increased risk of premature birth where there was a history of two or more abortions.

"Ectopic Pregnancy in the United States. 1970-1986," H. Lawson, H. Atrash, A. Saftlas and E. Finch, CDC Surveillance Summaries, MMWR 1989, 38(SS-2):1-10, September 1989.

In 1986 the rate of ectopic pregnancy per 1,000 pregnancies was 12.4 for white women and 20.1 for black and other minority races. In 1986 there were 36 reported deaths from ectopic pregnancy in the U.S. 17 white and 19 black and other minority races. Teenagers of black and other minority races have a rate of death from ectopic pregnancy almost six times higher than that for white women of the same age group.

"Ectopic Pregnancy Concurrent with Induced Abortion: Incidence and Mortality," H.K Atrash, H.T. MacKay, C.J.R. Hogue, Am J. Obstet Gynecol 162:726-730, 1990.

Among 24 U.S. women identified from 1972 through 1985 , who underwent an induced abortion and died as a result of concurrent ectopic pregnancy, 58.3% were black women or other women of color.

"Induced Terminations of Pregnancy: Reporting States. 1985-1986," Kenneth Kochanek, National Center for Health Statistics, Monthly Vital Statistics Report 34(4), Supplement 37(12), April 28,1989

Data received from Colorado, Kansas, Missouri, Montana, New York, Oregon, Rhode Island, South Carolina, Tennessee, Utah, Vermont, Virginia. Some 43.7% of white women and 59.4% of black women in the reporting states had a repeat abortion in 1986. Black women who had abortions tended to be older than white women who had abortions regardless of marital status. Married women had fewer than one induced abortion for every 10 live births while unmarried women had nine induced abortions for every 10 live births. Among married women, the abortion rate was nearly three times as high for black as for white women. However, among unmarried women the ratio was reversed. For white unmarried women the abortion rate was two- and-a-half times that for black unmarried women.

Abortion and Religion

(see also Abortion and Decline of Religious Involvement)

"A Therapeutic Approach to Reduce Postabortion Grief in University Women," S.C. Tentoni, J. American College Health 44: 35, July, 1995

Women who considered themselves to be extremely pro-life and religious and who had undergone elective abortion experienced tremendous guilt and grief 4-6 months after the abortion.

"Post-Abortion Perceptions: A Comparison of Self-Identified Distressed and Non- Distressed Populations," G. Kam Congleton, L.G. Calhoun, The Intl J. Social Psychiatry 39(4): 255-265,1993.

Women reporting distress were more often currently affiliated with conservative churches and reported a lower degree of social support and confidence in the abortion decision. They were also more likely to recall experiencing feelings of loss immediately post- abortion.

"Abortion Patients in 1994-1995: Characteristics and Contraceptive Use, S.K," Henshaw, K. Kost, Family Planning Perspectives 28(4): 140, July/August 1996

In an Alan Guttmacher Institute National Survey of 9985 U.S. women obtaining abortions in 1994-1995 Catholics were found to be as likely as women in the general population to have an induced abortion, while Protestants were only 69% as likely and Evangelicals or born-again Christians were only 39% as likely.

"Characteristics of Pregnant Women Who Report Previous Induced Abortions," S. Harlap and A. Davies, Bulletin World Health Organization 52:149(1975).

Women who reported abortions were less likely to be strict regarding religious observance. Orthodox Jewish women who observed the tradition of going to the ritual bath after each menstruation had an abortion rate of 1.1 percent. Those who observed part of the ritual had a rate of 3.8 percent. Non-observant women had a rate of 12.7 percent.

"Delivery or Abortion in Inner-City Adolescents," Susan F. Fischman, American Journal of Orthopsychiatry 47(1)127-133, January 1977.

Black women who delivered attached greater importance to religion than those who aborted.

"Psychological Problems of Abortion for the Unwed Teenage Girl," Cynthia D. Martin, Genetic Psychology Monographs 88:23-110(1973).

Among teenagers undergoing abortion for mental health reasons, 60% had strong post- abortion guilt. A substantial number changed their moral and religious convictions following pregnancy and abortion including feeling differently about sex, abortions or killing, changes in formal religious faiths, and changed feelings about their view of God and what was sinful.

"Psychological Sequelae of Therapeutic Abortion," Judith Wallerstein, Archives of General Psychiatry 27:828-832, Dec, 1972.

In a study of unmarried women seeking abortion for mental health reasons. Catholic women were more concerned than other women with protecting their families from knowledge of their pregnancy and abortion. This secrecy remained a continuing source of guilt and difficulty following the abortion.

The Connecticut Mutual Life Report on American Values in the '80s: The Impact of Belief, Commissioned by Connecticut Mutual Life Insurance Co., (Hartford, Connecticut: Factors Affecting Perceived Morality of Abortion, 1981) 92.

In answer to the question "Do you believe abortion is morally wrong, or is it not a moral issue?", 65 percent of the general public thought it morally wrong, 43 percent with lowest level of religious commitment, 58 percent with low level of religious commitment, 75 percent with moderate level of religious commitment, 78 percent with high level of religious commitment, and 85 percent with the highest level of religious commitment.

"Post-abortion Dysphoria and Religion," M. Tamburrino, K. Franco, N. Campbell, J. Pentz, C. Evans and S. Jurs, Southern Medical Journal 83(7):736-738, July 1990.

In a study of a patient led post-abortion support group 1-15 years following abortion, 46% of the women stated they had changed to a Fundamentalist or Evangelical church. Women members of these groups scored significantly lower on the MCMI inventory in areas of passive-aggressive, ethanol abuse and avoidance.

The Psycho-Social Aspects of Stress Following Abortion, Anne Catherine Speckhard, (Kansas City: Sheed and Ward, 1987).

Religious beliefs that included a concept of a forgiving God were often engaged as a means of coping with guilt following abortion. It was an unexpected result that joining a social system with conservative religious beliefs regarding abortion would serve as a coping mechanism for many subjects.

"Justifiable Abortion," Eugene Quay, Georgetown Law Journal, 49(395) (1961).

Summarizes early laws on the history of abortion and statements of various religions opposing abortion.

Abortion and the Early Church, Christian, Jewish and Pagan Attitudes in the GrecoRoman World, Michael German, (Downers Grove, Illinois: Inter-varsity Press, 1982).

"Abortion, the Bible & the Church. Survey of 150 Denominational Views," T.J. Bosgra, Hawaii Right to Life Educational Foundation, P.O. Box 10129, Honolulu, Hawaii 96816 (1976,1980).

"Women Exploited. The Other Victims of Abortion," Paula Ervin, Our Sunday Visitor, Inc., 200 Noll Plaza, Huntington, Indiana (1985).

In a survey of Women Exploited by Abortion, the author reports: "the vast majority of the women had no true religious affiliation. Some belonged half-heartedly to a church. [But] their grapplings with body and soul, flesh and spirit, came some time after the abortion experience. For some it came years afterward" [p. 142]. Insofar as they have come to the feet of Christ, weeping with Magdalene, they have found a sense of peace and self-worth. This does not happen in a day. Some lives have been broken for so long-have wandered down so many twisted side paths-that clergy and support groups will have to join forces to repair the damage. Many professional counselors tend to trivialize guilt. This angers the woman and deepens her sense of isolation, [p.141].

"Post-Abortion Syndrome and the Whole Person," James Burtchaell, Healing Visions Conference, University of Notre Dame, July 1987.

Abortion was defined as a sin in need of forgiveness. A need to recover the meaning of the word sin was underscored. Sin was described as a deterioration of reflection and consent of the will. Sin may often be committed casually, frivolously or impulsively. Sin is both a result and a cause of deteriorating behavior.

Abortion's Second Victim, Pam Korbel, (Wheaton, Illinois: Victor Books/ a Division of Scripture Press, 1986).

This book, written by a woman who had an abortion in 1971, offers women torn apart by the aftermath of abortion emotional healing and forgiveness through the peace that only God can give.

"After Abortion Helpline-Soft Data From Calls," Joan C. Pendergast, presented to Annual Meeting of the Association of Interdisciplinary Research, June 1987.

Providence, Rhode Island ministry advertised "Troubled About Abortion" in predominantly Catholic [65 percent] area. From November 21,1985 to March 13/1987,164 calls were received; 103 women after abortion; 16 men before and after abortion; and 45 others. Seventy-five percent of the callers who gave a religious affiliation were Roman Catholic. Most women expressed guilt, depression, loss, confusion, regret, sorrow, relationship changes, anxiety, loneliness, isolation. Callers were often secretive, not trusting anyone with their double scandal, i.e., getting pregnant and then having an abortion.

"The Use of Theological Classics in Teaching Medical Ethics," Fred Rosner, Queens Hospital Center, affiliation of the Long Island Jewish Medical Center (letter). Journal of the American Medical Association 258(2):204, July 10,1987,

Modem medicine has moved into new areas in which great moral issues are involved. Organ transplantation, hemodialysis, genetic engineering, abortion, contraception, euthanasia and drug addiction raise serious moral issues. In those areas religion offers a message and an opinion. It emphatically insists that the norms of ethical opinion may be governed neither by the accepted notions of public opinion nor by the whims of the individual conscience. Moral values are not matters of subjective choice or personal preference. Right and wrong, good and evil are absolute values that transcend the capricious variations of time, place and environment as well as human intuition or expediency, [emphasis added])

Toward a Psychology of Being, Abraham Maslow, (Princeton: D. Van Nostrand Co., 1962).

"Intrinsic conscience" is the necessity of being true to one's inner self, and not denying it out of weakness or for special advantage.

Conscience and Guilt, James A. Knight (N.Y.: Appleton Century-Crofts, 1969).

The bond between the principle and the act is conscience. There is something wrong with psychology's emphasis on "adjustment" rather than "goodness." Real guilt follows in the wake of wrongdoing, seen and accepted as such by the doer, who seeks expiation and makes restitution.

Decline of Religious Involvement After Abortion

"Characteristics of Pregnant Women Who Reported Previous Induced Abortions," S Harlap and A Davies, Bulletin World Health Organization 52:149, 1975.

Orthodox Jewish women who strictly observed the ritual bath after menstruation had a lower incidence of abortion compared to women who observed part of the ritual or compared to non-observant women.

"Psychosocial Correlates and Antecedents of Abortion: An Exploratory Study," F Costa et al, Population and Environment 9L1): 3, 1987.

Women who had an abortion attended church less often and were less religious compared to women without a history of abortion.

Post-Abortion Trauma: 9 Steps to Recovery, Jeanette Vought (Grand Rapids: Zondervan, 1991)

Many women in a religiously-based postabortion recovery group said they felt alienated from God following their abortion and that God would not forgive them.

"The Repeat Abortion Patient," Judith Leach, Family Planning Perspectives 9(1):37, 1977

Women repeating abortion were more likely to report no religious affiliation compared to women aborting for the first time.

"Repeat Aborters-First Aborters, A Social-Psychiatric Comparison," L Jacobsson et al, Social Psychiatry 11:75, 1976

Pregnant women carrying to term were more likely to report they were religious (25.5%) compared to women seeking a first abortion (12.0%) or women repeating abortion (2.2%).