Introductory Material
Below are the Thomas W. Strahan's notes from the 2001 version of Detrimental Effects of Abortion. A printed copies of this work are still available here.
Introductory Material
Supplements and Updates
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Editor's Introduction
This annotated bibliography has now been retitled Detrimental Effects of Abortion: An Annotated Bibliography with Commentary. The earlier two versions were entitled Major Articles and Books Concerning the Detrimental Effects of Induced Abortion, the most recent of which was last published in 1996.
As in past versions, the citations contain key findings or conclusions of the authors as well as additional comments by myself which are designated as (Ed. Note). The findings and conclusions set forth represent only a portion of the research and interested persons are encouraged to consult the complete work.
In this version there has been an expansion of subjects relating to pregnancy decision making including sections on pregnancy as a crisis, responses to pregnancy, and personality changes shortly before abortion. In addition, there has been an attempt to separately categorize the various negative psychological responses such as ambivalence, denial, grief, guilt etc., and add other aspects such as dissociation and self- punishment. Various consequences of abortion have also been categorized which include psychiatric hospitalization or consultation, and deteriorating social and economic status with repeat abortion. In regard to physical and reproductive consequences, a section on endometritis has been added along with other sections relating to adverse consequences due to postabortion infections. Other additions include pregnancy-related mortality and homicide of pregnant women. Other subject areas have also been expanded. Many of the additional citations were located from search engines from the National Library of Medicine, including MEDLINE.
Most of the references are based upon studies of U.S. populations since abortion was legalized in 1973. Some references from Canada, England, Australia, Scandinavian countries are also included. References from third world countries were generally excluded. Virtually all citations are from studies of first-trimester abortion using the vacuum aspiration method which is, by far, the most common. Where other abortion methods are used the reference will so indicate. The listing of articles and books does not necessarily include all articles and books on a particular subject. Interested persons are encouraged to contact the author for possible additional references in specific subject areas of interest.
Editor's Discussion of Key Research Findings and Conclusions
Abortion Decision-Making
Anticipatory distress in women prior to abortion which may be marked by anxiety, depression or denial is frequently present in women seeking abortion. Distress may arise from grief reactions which appear to be initiated by the decision to terminate a pregnancy by abortion. This temporary depression, distress or denial will impair rational decision-making ability and the woman may be unable to fully comprehend the necessary information on risks or alternatives which interferes with the legal requirement of informed consent.
Pregnancy is a crisis for many women with many adjustments needed. Reactions to pregnancy are varied and transitional. The degree of emotional and social support is an important factor as to whether or not a pregnancy is carried to term or abortion takes place. Boyfriends or husbands frequently instigate the decision for abortion or urge or encourage abortion or act with indifference which is likely to result in a stressful crisis situation for the prospective mother.
Effect on Male-Female Relationships
Induced abortion appears to be generally detrimental to male-female relationships. Casual or relatively uncommitted or conflicted relationships are particularly likely to break up after the abortion. The incidence of break-up of relationships appears to increase over time. Where couples do not break up sexual dysfunction, communication problems and increased isolation are reported.
Repeat Abortion
If a woman has a first abortion, she is approximately 4 times more likely to repeat abortion compared with women who have not had a prior abortion. Presently, about 50% of the abortions in the United States are repeat abortions. Moral and social deterioration is increasingly evident as abortion is repeated. Women who repeat have increasingly less stable relationships, are more likely to be separated or divorced, are more likely to be on public welfare, are increasingly isolated, have more difficulty in getting along with others, are more likely to smoke or abuse alcohol or other drugs, are more likely to be hospitalized for psychiatric problems, are increasingly likely to suffer from anxiety disorders, have greater difficulty in sleeping and are more likely to attempt suicide.
Impact on Men
The impact on induced abortion on men has been greatly neglected and there is little available literature on the subject. However, some recent research has improved the situation to a degree. It appears from what is known that the reaction is one of guilt, sense of loss, regret, sadness, coldness or real or apparent indifference. Where abortion takes place despite the male objections, men may report a tremendous sense of helplessness. There is evidence that men may suppress their reactions to abortion to a greater degree than women.
Impact on Siblings
The impact of induced abortion on siblings in a family has been little studied. Small children are surprisingly aware of a pregnancy or abortion even when told nothing about it. Reactions of sibling to an abortion may be very severe. Fear of the mother, afraid of the world in general, self-blame, violent acting-out, despair and self-destructive behavior have been noted in various case studies.
Anxiety or Self-Punishing Behavior
There is growing evidence that women who have induced abortions will frequently exhibit a high level of anxiety, may fear they will be punished or deserve punishment, show paranoid behavior or fear of death. This may manifest itself in a number of contexts, such as fear of a dead child or deformed child in a subsequent pregnancy or self-destructive behavior such as drug or alcohol abuse or suicide attempts.
Cancer Risk
Whether or not induced abortion is an independent risk for breast cancer is controversial. Several recent studies have added to the existing research which concludes that an induced abortion increases the likelihood of breast cancer. This is of particular significance because approximately 44,000 women die each year from breast cancer in the U.S. Induced abortion, particularly of the first pregnancy, results in the loss of the protective effect against breast cancer because a pregnancy carried to term at an early age is protective against breast cancer. There is substantial evidence that induced abortion is an independent risk factor for breast cancer in women. Childbirth has been found to be protective against ovarian and endometrial cancer while induced abortion provides a lesser degree of protection or no protection. Induced abortion may be implicated in other types of cancer as well.
Substance Abuse
Women who have had abortions frequently report their first heavy use of alcohol or drugs to attempt to alleviate the stress related to abortion. Substance abuse in women following abortion may occur in an attempt to overcome nightmares or insomnia, as an attempt to reduce grief reactions and to attempt to repress the abortion experience itself.
Induced abortion contributes to fetal risk as women with prior abortions are significantly more likely to consume alcohol or drugs during subsequent pregnancies intended to be carried to term compared to women with other pregnancy outcomes.
Smoking
Postabortion women have a higher incidence of smoking than women with other reproductive outcomes. Some of the difference may be attributed to lifestyle, but there are at least three studies which implicate abortion directly as a factor in increased smoking in women. This has important health and social implications.
Suicide Attempts
Adolescents from dysfunctional homes or those who have run away from home have been found to have significantly elevated incidence of suicide attempts following induced abortion. Also, women who repeat abortion have a higher rate of suicide attempts than women with one abortion, according to a survey of women in a patient-led, post-abortion support group. A recent Finnish study has found that the incidence of suicide in women following induced abortion is six times higher than suicide following childbirth.
Maternal Death
This is an area which is currently the subject of interest to researchers. The definition of maternal death is very inadequate at present and reliance on death certificate information is very misleading. Research into pregnancy-associated deaths which have not been included as a pregnancy-related death but perhaps should be is underway. Additional research implicates induced abortion as substantially contributing to reproductive complications, low birth weight, risk of retardation or other serious illnesses in newborns, and increased risk of maternal death.
/s/ Thomas W. Strahan, Esq. August 2001