Originally posted on January 21, 2007.
The New York Times Magazine has a lengthy article on “post-abortion syndrome,” a psychological condition invented by anti-choice choice groups (it isn’t backed by any credible research, and none of the major psychological associations recognize it) that’s now being used to argue for the illegalization of abortion.
The argument goes like this: Abortion is inherently traumatic; all women are traumatized by their abortions, even if they don’t know it; because women are traumatized, they do a variety of anti-social things, making abortion the root cause of many of our social problems; therefore, abortion should be illegal.
It’s a truly strange argument. I haven’t ever heard of attempts to outlaw any other incredibly common medical procedure because of that procedure’s supposed negative psychological effects, none of which were scientifically proven. Pregnancy and childbirth, for example, have been shown to cause or aggravate depression — these findings are backed up by volumes of research. Should we outlaw that?
I feel truly sorry for the women who say they are experiencing post-abortion syndrome. And so perhaps this will sound cold, but I can’t but think that maybe they aren’t using their abortion as a catch-all for long histories of depression, anxiety, and often abuse and other problems. It makes sense, psychologically — abortion is something you can control, and if the rest of your life has been fully out of control, you can channel that pain inwards and deal with the one thing that you did. Further, many women who are going in to get abortions are in troubled situations anyway — at the very least, they’re pregnant when they don’t want to be pregnant. If that pregnancy was caused by abuse, or happened to a girl or woman from a strict anti-choice family, or happened to a woman who already suffered from depression, it logically follows that there will be some ongoing issues, and the abortion will be grouped in with that. One of the women that the author of this article interviewed is an illustrative example:
When Arias talks about the effects of abortion, she’s so fervent that it’s hard to maintain her gaze. But the idea that abortion is at the root of women’s psychological ills is not supported by the bulk of the research. Instead, the scientific evidence strongly shows that abortion does not increase the risk of depression, drug abuse or any other psychological problem any more than having an unwanted pregnancy or giving birth. For Arias, however, abortion is an act she can atone for. And this makes it different from the many other sources of anguish in her past. As a child, she was sexually abused by her stepbrother, she told me. An older boy forced her to have sex when she was 14; seven months later, she says, she woke in the middle of the night to wrenching cramps and gave birth to a baby girl who was placed for adoption. A year later, Arias’s father, a bricklayer to whom she was close, plummeted from several stories of scaffolding to his death. She left home and fell out of touch with her mother and two brothers.
By concentrating on the babies she feels she has lost (she has named the first two Adam and Jason), Arias has drained other aching memories of some of their power. “I think about the baby girl I gave up for adoption, and I think I made a good parenting choice. I know she had a good life,” she said. “I think about my sons, Adam and Jason, my sons who I never held in my arms, and I know I’m forgiven. But” — her voice cracked. “I didn’t give them life. And I am so very sorry.”
She has gone through heartbreaking ordeals — abuse, rape, drug addiction, multiple unwanted pregnancies — and those experiences, and her views of them, should not be discounted. The women who say that they were scarred by their abortions are making valid statements. I don’t doubt that they do feel very sad or regretful about their choices. I am truly sorry that they feel that way. What I can’t support, though, is the argument that because a very small percentage of women who terminate their pregnancies feel badly afterward, that the right to terminate a pregnancy should be taken away from all women. Especially when the argument itself is not only unsupported by research, but completely out of touch with reality:
Because of this knowledge, she is now equally certain, she slipped into years of depression, drinking and freebasing cocaine. One night when she was in her early 30s, she got as high as she could, lay down in the dark in a bathtub filled with water and slit her wrists. In her mind, all of her troubles — the drugs, the suicide attempt, the third and fourth abortions she went on to have, the wrestling match of a marriage she eventually entered — are the aftermath of her own original sin, the 1973 abortion. It’s a pattern she sees reflected everywhere: “In America we have a big drug problem, and we don’t realize it’s because of abortion.”
The big drug problem in America is because of… abortion?
The complete divorce from reality aside, this argument is also deeply paternalistic. It comes down to the idea that a handful of people know what’s medically best for all women, moreso than the women themselves. These people argue that women don’t know what’s in their best interests, and so we must protect them from themselves:
Thirty-four years ago this week, the Supreme Court decided Roe v. Wade, and since then the American abortion wars have pitted the rights of “unborn babies” against those of living women. Rhonda Arias and a growing number of abortion-recovery activists want to dismantle that framework and replace it with this: Abortion doesn’t help women. It hurts them. With that conviction, these activists hope to accomplish what the anti-abortion movement has failed to do for more than three decades: persuade the “mushy middle” of the American electorate — the perhaps 40 to 50 percent who are uncomfortable with abortion but unwilling to ban it — to see that, for women’s sake, abortion should not be legal. Spread across the country are anti-abortion groups that offer post-abortion counseling. The Catholic Church runs abortion-recovery ministries in at least 165 dioceses in the United States. The federal government finances at least 50 nonsectarian “crisis pregnancy centers,” like the one where Arias worked in Houston. Many of the centers affiliate with two national groups, Heartbeat International and Care Net, which train abortion-recovery counselors. Then there are small, private counseling and Bible-study groups, both Catholic and evangelical, which raise their own money. Some abortion-recovery counselors just minister to other women. But many also feel called to join the fight to end abortion.
Yes, you read that right — these people receive federal funding.
For all their supposed interest in women, they could genuinely care less. The focus on the actual living, born people in the abortion debate is a crass political move, utilized only because focusing on the ever-important fetus — and the ever-important goal of controlling women’s bodies — wasn’t playing well with many Americans.
If the activists have a Moses, it is David Reardon, whose 1996 book, “Making Abortion Rare,” laid out the argument that abortion harms women and that this should be a weapon in the anti-abortion arsenal. “We must change the abortion debate so that we are arguing with our opponents on their own turf, on the issue of defending the interests of women,” he wrote. The anti-abortion movement will never win over a majority, he argued, by asserting the sanctity of fetal life. Those in the ambivalent middle “have hardened their hearts to the unborn ‘fetus’ ” and are “focused totally on the woman.” And so the anti-abortion movement must do the same.
Grudgingly, strategically.
The fact is that these women are an incredibly significant minority. According to the article:
Reardon’s book, published during this time of dimmed hopes for the anti-abortion movement, imagined a future in which millions of women and men with experience of abortion would express outrage, demand reform and file lawsuits that would bankrupt abortion clinics.
These millions have not materialized. The number of women who seek out groups like Rachel’s Vineyard is a small fraction of the number of American women who have abortions. Almost 3 million of the 6 million pregnancies that occur each year in the United States are unplanned; about 1.3 million end in abortion. At the current rate, about one-third of women nationally will undergo the procedure by age 45. The number of women who go to abortion-recovery counseling is probably in the tens of thousands, and the number who become dedicated activists is at most a few hundred. And yet they and their cause are emerging as a political force. “These women were minority voices for a long time, and now they are gaining traction within the anti-abortion movement,” says Reva Siegel, a Yale law professor who favors abortion rights and has been tracing this grass-roots movement from its origins.
This movement, is must be emphasized, is not in any way about making women’s lives better. They’re trying to take an option away from women, rather than trying to give women more options, or even make it easier for them to give birth.
Abortion-recovery counselors like Arias could focus on why women don’t have the material or social support they need to continue pregnancies they might not want to end. They could call for improving the circumstances of women’s lives in order to reduce the number of abortions. Instead they are working to change laws to restrict and ban abortion.
These groups have been actively soliciting affidavits from women who say that their abortions were psychologically painful. They’ve thrown a ton of money and advocacy behind this, including dozens of abortion recovery centers, a legal organization, and even a television show that reaches 10 million homes. The result: 1,940 affidavits. Total. Out of the 1.3 million women who terminate pregnancies every year in the United States alone.
Their evidence is also, to be generous, iffy:
In 1985, Reardon started a social-science fight over the effects of abortion. He surveyed members of a group called Women Exploited by Abortion (since disbanded), which defined itself as a “refuge” for “post-abortive women.” Reardon distributed a survey to about 250 WEBA members and found high rates of nervous breakdowns, substance abuse and suicide attempts. He presented this as proof of a national link between abortion and these conditions.
Where to start?
You know, dentists have a higher rate of suicide than, I believe, any other profession. Attorneys have a high rate of substance abuse. If I were to go to a professional-class-orientated therapy group, and found that the people in that group experienced high levels of depression, nervous breakdowns, substance abuse and suicide attempts, would that be evidence of a “national link” between a professional career and these conditions? If I were to go to a therapy group targeted at women experiencing postpartum depression, would it be rational to come away with the conclusion that there is a national link between childbirth and depression, and therefore childbirth should be illegal?
But, hey, don’t take my word for it:
Soon after Koop’s refusal in 1987 to report on the health effects of abortion, the American Psychological Association appointed a panel to review the relevant medical literature. It dismissed research like Reardon’s, instead concluding that “well-designed studies” showed 76 percent of women reporting feelings of relief after abortion and 17 percent reporting guilt. “The weight of the evidence,” the panel wrote in a 1990 article in Science, indicates that a first-trimester abortion of an unwanted pregnancy “does not pose a psychological hazard for most women.” Two years later, Nada Stotland, a psychiatry professor at Rush Medical College in Chicago and now vice-president of the American Psychiatric Association, was even more emphatic. “There is no evidence of an abortion-trauma syndrome,” she concluded in an article for The Journal of the American Medical Association.
And there’s more:
Academic experts continue to stress that the psychological risks posed by abortion are no greater than the risks of carrying an unwanted pregnancy to term. A study of 13,000 women, conducted in Britain over 11 years, compared those who chose to end an unwanted pregnancy with those who chose to give birth, controlling for psychological history, age, marital status and education level. In 1995, the researchers reported their results: equivalent rates of psychological disorders among the two groups.
Brenda Major, a psychology professor at the University of California, Santa Barbara, followed 440 women for two years in the 1990s from the day each had her abortion. One percent of them met the criteria for post-traumatic stress and attributed that stress to their abortions. The rate of clinical depression among post-abortive women was 20 percent, the same as the national rate for all women ages 15 to 35, Major says. Another researcher, Nancy Adler, found that up to 10 percent of women have symptoms of depression or other psychological distress after an abortion — the same rates experienced by women after childbirth.
Researchers say that when women who have abortions experience lasting grief, or more rarely, depression, it is often because they were emotionally fragile beforehand, or were responding to the circumstances surrounding the abortion — a disappointing relationship, precarious finances, the stress of an unwanted pregnancy.
But who needs “experts” and “science” when we have misogyny, paternalism and ideology?
But David Reardon continues to research the psychological effects of abortion, and he no longer makes beginner’s mistakes. He is said to have a doctorate in biomedical ethics from Pacific Western University, an unaccredited correspondence school, according to Chris Mooney, the author of “The Republican War on Science.” (Reardon did not respond to several requests to be interviewed.) According to his Web site, in 1988, Reardon founded the Elliot Institute, a research center in Springfield, Ill., which in 2005 had a $120,000 budget. He has recently teamed up with Priscilla Coleman, a professor of family and consumer studies at Bowling Green State University in Ohio, and published more than a dozen papers in peer-reviewed journals. Reardon and Coleman cull data from national surveys and state records in which unplanned pregnancy is not the focus of the data collection. Using the National Longitudinal Survey of Youth, Reardon found a higher risk of clinical depression in a group of married women who had abortions, and published the results in a 2002 article in The British Medical Journal; using California Medicaid records, he and Coleman found a higher risk of psychiatric hospital and clinic admissions among poor post-abortive women, which they reported in 2003 in The Canadian Medical Association Journal; two years later, using the National Survey of Family Growth, they found a higher risk of generalized anxiety disorder post-abortion and published their results in The Journal of Anxiety Disorders.
Make note of The Elliot Institute. Without fail, any time you’re debating an anti-choicer online who argues that post-abortion syndrome exists, they’ll point to Elliot. But the Institute’s website is fairly telling. Not only does it feature pictures of sad-looking women on the front page, but it describes itself as:
This is the web’s most complete source of information on the aftereffects of abortion and post-abortion healing. We have over 500 hundred links to thousands of printed pages of original research, testimonies, articles, and resources. Most of these are drawn from articles and books published by the Elliot Institute, one of the nation’s leading authorities on post-abortion issues.
The web’s most complete source of information on the aftereffects of abortion — which pretty much only links to its own sources. Because there isn’t anything else out there that supports its obviously flawed conclusions and selective research. Back to the Times article:
Nancy Russo, a psychology professor at Arizona State University and a veteran abortion researcher, spends much of her professional time refuting Reardon and Coleman’s results by retracing their steps through the vast data sets. Russo examined the analysis in the 2002 and 2005 articles and turned up methodological flaws in both. When she corrected for the errors, the higher rates of mental illness among women who had abortions disappeared.
Well whaddaya know.
As usual, this fight isn’t just about abortion — it’s about contraception and basic sex education, too. Right down to what you teach your own kids:
Last March, Arias took Jessica on a monthlong ministry to Israel. They are both interested in Messianic Judaism — a mezuza is nailed to the doorpost of the family’s home. For Arias, the trip was glorious. She ministered on Ben Yehuda Street in Jerusalem. (On a previous trip she threw her wedding ring into a valley, pledging to live as a new virgin.) She returned home to the news that Jacqui [her teenage daughter] was pregnant. “I was the last person they told,” she said of Jacqui and her boyfriend, whom Jacqui met in church. Arias taught her daughters about saving themselves for marriage but not about contraception. “Abstinence works better than birth control, really,” she said. “It’s just that people don’t do it.”
Well, if people don’t do it, then that doesn’t really make it work better than birth control, does it? Interesting, too, that the pro-life lover-of-babies-and-pregnant-women was the last person told.
The Times article also delves into the pro-choice response to this phenomenon. The conclusion: Pro-choicers, at least, aren’t liars; but they also aren’t giving enough validity to the complexity of emotions that come along with terminating a pregnancy.
While it seems that some anti-abortion advocates exaggerate the mental-health risks of abortion, some abortion advocates play down the emotional aftereffects. Materials distributed at abortion clinics and on abortion-rights Web sites stress that most women feel relief after an abortion, and that the minority who don’t tend to have pre-existing problems. Both claims are supported by research. But the idea that “abortion is a distraction from underlying dynamics,” as Nancy Russo put it to me, can discourage the airing of sadness and grief. “The last thing pro-choice people, myself included, want to do is to give people who want to make abortions harder to get or illegal one iota of help,” says Ava Torre-Bueno, a social worker who was the head of counseling for 10 years at Planned Parenthood in San Diego. “But then what you hear in the movement is ‘Let’s not make noise about this’ and ‘Most women are fine, I’m sure you will be too.’ And that is unfair.”
I agree. Women must have space to grieve if they feel a need to grieve, to be joyful if they feel joyful, to be relieved if they feel relieved, or to not feel one way or the other, any more than they’d feel about any other medical procedure. The reality is that many women do feel conflicted about their abortions — how could they not? The dominant narrative is that abortion is always a tragic choice, that it is inherently devastating, that any decent person would feel immensely guilty for the choice she made. So women are stuck: Either you feel guilty, or you feel guilty for not feeling guilty. It’s hard to tell when the guilt is inherent, and when it’s put upon you. Even pro-choice women and feminist women may feel guilty about being so “stupid” to get pregnant in the first place when they should “know better;” the deeply ingrained idea that abortion is a tragedy can touch even the most pro-choice of people, who realize that abortion is the best choice for them given their circumstances.
There isn’t a lot of room for those voices. So either you’re ok, or you’re part of a religious anti-choice group that uses you as a pawn to outlaw abortion. For the women in the middle — who may feel conflicted, who may have internalized the anti-choice message that guilt and remorse are the only valid post-abortion feelings, who may not even know how to sort through the whole experience — there is Exhale, an inclusive organization which offers after-abortion counseling, but which recognizes the wide range of experiences that women come in with, and doesn’t attempt to give a one-size-fits-all solution. So there are pro-choice options. Unfortunately, though, these options are severely under-funded:
There is considerably more money for post-abortion counseling on the anti-abortion side. In addition to the diocese-based services paid for by the Catholic Church, the Bush administration, in its first four years, spent more than $30 million on the 50-some crisis pregnancy centers, according to a report by Representative Henry A. Waxman, a Democrat from California.
Last summer, Waxman’s office investigated some of the crisis pregnancy centers and found that when women there asked about abortion’s health effects, 20 of 23 centers gave out false information. At 13 centers, this included characterizing the psychological effects of abortion as “severe, long-lasting and common.” “One center said that the suicide rate in the year after an abortion ‘goes up by seven times,’ ” Waxman’s report states.
Religious abortion-recovery programs don’t qualify for government money. Rachel’s Vineyard relies on financing from Priests for Life, a $7 million anti-abortion group that is independent of the Catholic Church. Oil of Joy’s finances are tighter. Last year, Arias raised $34,000. She is straining to pay her mortgage; meanwhile, as the Texas leader of Operation Outcry, she is expected to make donations to the Justice Foundation, which has a $1 million annual budget and paid its lead lawyer, Allan Parker, $123,000 in 2005.
Even so, some of the more traditional and moneyed anti-choice groups don’t take the “woman-centered” approach not only because they’re so full of lies, but because, well, who cares about women?
Francis Beckwith, a professor of church-state studies at Baylor University who is anti-abortion, has criticized abortion-recovery activists for their “questionable interpretation of social-science data” and for potentially undermining the absolutist moral argument against abortion. “For every woman who has suffered trauma as a result of an abortion, I bet you could find half a dozen who would say it was the best decision they ever made,” he told me. “And in any case, suffering isn’t the same as immorality.” Beckwith speaks at churches and colleges, and he says that most anti-abortion leaders don’t want the woman-protective argument to supersede the traditional fetus-centered focus, “because that’s where the real moral force is.”
These tensions surfaced in the campaign to retain South Dakota’s abortion ban. The state leader for the anti-abortion side, Leslee Unruh, who had an abortion in her 20s, called on post-abortive women to campaign and started a state tour for them called Fleet for Little Feet. Unruh says, “My strategy was to put the women on TV and have them tell their stories.” But the national pro-life groups refused to send her money to run those TV ads early in the election cycle, she says. “They won’t acknowledge women as the first victim. We’re always second to the baby.”
Given that a cornerstone of the anti-choice movement is the idea that women are simply not worth as much as the fetus inside of them, should this come as any surprise?
The argument that “abortion hurts women,” though, isn’t just happening in the abstract or in small activist groups — it’s penetrated state law through so-called “informed consent” requirements, which force doctors to lie to their patients:
Cassidy is also involved in defending a 2005 South Dakota informed-consent law, which Planned Parenthood has challenged. In its 1992 ruling in Casey, which affirmed (with some caveats) the right to legal abortion enshrined in Roe, the Supreme Court said that states can require doctors to give patients “truthful and not misleading” information about abortion. Eighteen states include in their materials a description of abortion’s psychological effects. According to a 2006 analysis by the Guttmacher Institute, seven of these states describe only harmful effects. South Dakota’s informed-consent law requires physicians to give patients written state-approved information that supplies a link between abortion and an increased risk of suicide, though no causal connection has been found. Both the patient and the doctor must certify that the patient has read and understood the materials; failure to do so is a misdemeanor offense.
Does such a law violate a doctor’s constitutional right to free speech? Robert Post, a Yale law professor, argues that the state should not be able to force doctors to convey inaccurate or misleading information. South Dakota’s law “endangers the integrity of physician-patient communications, because it threatens to transform physicians into mouthpieces for political majorities,” he writes in a coming law-review article.
South Dakota’s law also requires abortion providers to tell their patients what Cassidy argues Acuna’s doctor should have told her in the New Jersey case — “that the abortion will terminate the life of a whole, separate, unique, living human being.” A federal district judge agreed with Planned Parenthood that the law would force doctors to articulate the state’s viewpoint on “an unsettled medical, philosophical, theological and scientific issue, that is, whether a fetus is a human being.” The judge granted a preliminary injunction that prevented the informed-consent provisions from taking effect. In October, a three-judge panel of the United States Court of Appeals for the Eighth Circuit affirmed that ruling. But the panel’s decision was vacated this month when the Eighth Circuit as a whole voted to rehear the case in April. The question of whether the state can require doctors to say that a fetus is a full human being and that abortion increases the risk of suicide is in legal limbo.
Truly disturbing.
The end of the article, though, is great. It offers insightful and historically-informed evaluation of this particular strain of anti-choice belief. And I think it’s spot on:
At the prison the day before, I watched the inmates drink in Arias’s preaching, too. Abortion-rights leaders would accuse her of manipulation, of instilling guilt in women to serve the anti-abortion movement’s political ends. But Rhonda Arias ministers from the heart; the lack of scientific support for her ideas merely underscores that she is a true believer.
Her ardor and influence is better explained, perhaps, by the theory of social contagion, which psychologists use to explain phenomena like the Salem witch trials or the wave of unfounded reports of repressed memories of sexual abuse. Reva Siegel of Yale compares South Dakota’s use of criminal law to enforce a vision of pregnant women as weak and confused to the 19th-century diagnosis of female hysteria. These ideas can make and change laws. The claim that women lacked reliable judgment was used to deny women the vote and the right to own property. Repressed-memory stories led states to extend their statutes of limitations. Women who devote themselves to abortion recovery make up for the wrong they feel they’ve done by trying to stop other women from doing it too — by preventing them from having the same choices.
And then there is the relief in seizing on a single clear explanation for a host of unwanted and overwhelming feelings, a cause for everything gone wrong. When Arias surveyed 104 of the prisoners she had counseled in 2004, two-thirds reported depression related to abortion, 32 percent reported suicide attempts related to abortion and 84 percent linked substance abuse to their abortions. They had a new key for unlocking themselves. And a way to make things right. “You have well-meaning therapists or political crusaders, paired with women who are troubled and experiencing a variety of vague symptoms,” Brenda Major, the U.C. Santa Barbara psychology professor, explained to me. “The therapists and crusaders offer a diagnosis that gives meaning to the symptoms, and that gives the women a way to repent. You can’t repent depressive symptoms. But you can repent an action.” You can repent an abortion. You can reach for a narrative of sin and atonement, of perfect imagined babies waiting in heaven.