Mental Health and Abortion:  A Neutral Stance

Philip G. Ney, M.D., F.R.C.P.(C.)

Presented: American Psychiatric Association 1997

Introduction

There is clinical evidence that unresolved grief associated with pregnancy losses contributes to maternal ill health. This paper reports the study of the effects on the health of women from a variety of pregnancy losses and concludes that unless and until the conflicts surrounding the pregnancy losses are resolved, ill health is more likely to follow. 

Method

With the support of the College of Family Physicians (Victoria, BC, Canada), we provided questionnaires the first 30 women of child-bearing age or older who walked into a family practice on a particular week. The questionnaires provided for confidentiality and the unrestrained option of not participating. There were 7 visual analogue scales regarding the woman's health, her attitude toward family, etc., and the pregnancy outcome and how much support she received during and after each pregnancy for up to nine pregnancies. We compared the patient's subjective estimate of her health to that of her physician and that of a nurse researcher, who examined the patient's file. In 84 % of the cases, the researcher's estimate was within 2 points of the patient's and the physician's estimate was within 1 of 9 points of the patient in 44% of the cases. 

Of the 1420 women in the sample, 1167 had 2961 pregnancies. Using demographic data from Statistics Canada, it appears the sample is representative of Canadian women, although there is a slight predominance of married women 

Results

Table 1 (tables not inluded in web posting of this article) indicates the outcome of the first pregnancy in various age groups. It appears that if the abortions are subtracted, teenage women are as able as any other age group to have full-term, normal birth weight pregnancies. The abortion rate diminishes and the miscarriage rate increases with age in this sample. Table 2 indicates that of all the variables we examined, quality of family life, previous pregnancy loss and the supportiveness of a partner were the 3 most important factors (multiple regression analysis) in determining women's health. 

It appears that abortion has a greater impact than other types of pregnancy loss in its deleterious effect on a woman's health (Table 3, Table 4). Compared to miscarriages, abortion appears to approximately double the number of people who moderately believe that their health was effected moderately or strongly by a previous loss (Table 5). 

It appears that there is a close correlation between the outcome of the second pregnancy and the outcome of a previous pregnancy (Table 6). If the first pregnancy was full-term, there is approximately a 76.9% chance that the second pregnancy will be full-term. If the first pregnancy ended in an abortion, there is a 51.4% chance that the second pregnancy will be full-term, normal birth weight, but a 21.5% chance that the second pregnancy will end in abortion and a 14% chance that it will end in a miscarriage. This is an approximately 1.8% increase over the chance of a miscarriage if the pregnancy was full-term. 

At the time of this survey, approximately 30% of the women indicated a need for professional help to a moderate or strong degree if the last pregnancy was a loss (Table 7). It appears that there is some effect of time and the number who required professional help diminishes so that some grieving appears to take place spontaneously. Of the 44 factors that we examined that determined whether a woman will abort her first pregnancy, the amount of partner support is by far the most important (Table 8). The effect of lack of partner support continues right up until the fifth pregnancy. The number of abortions if the partner is present but not supportive is four times greater, and if the partner is absent is six times greater (Table 9). The lack of partner support also appears to increase the rate of miscarriages. 

Table 10 indicates that members of the Christian Medical and Dental Society have a lower rate of both abortions and miscarriages. 

Discussion

The reason that pregnancy losses interfere with general health is that if these losses are not properly mourned, they result in pathological grief. Research has confirmed the presence of symptoms typical of both acute and prolonged grief in women who have suffered a pregnancy loss.  Though longer and more intense mourning was seen in mothers for whom pregnancy was a positive experience, the mothers grieved whether an infant lived one hour or twelve days, whether he weighed 3,000 grams or a non-viable 580 grams and whether the pregnancy was planned or unplanned. The acute grief phase generally lasts 6-12 months,  and possibly as long as 2 years. Pathological grief is likely to result in depression Depression appears to interfere with the function of the immune system. Irwin et al. found the severity of depressive symptoms in women was associated with the impairment of the natural killer cell activity, an absolute loss of suppressor/cytotoxic cells, and increase in the ratio of T-helper to T-suppressor/cytotoxic cells. Kiecolt-Glzer et al. found poor marital quality and partner loss to be associated with greater depression. A poorer response of immune function was found among separated or divorced women. More recent losses were associated with poorer immune function and greater depression. 

All pregnancy losses appear to adversely affect a woman's health, but abortion seems to have approximately twice the compared to miscarriages, even though the miscarried pregnancy was usually longer than the one aborted. Abortions may be more difficult to mourn for the following reasons; 

1.The mother does not get to hold, examine and caress the dead infant, make it part of her psychological self, name the child, and bury the baby. Both medical workers and researchers have stressed the importance of the mother or couple actually seeing and holding the dead infant, making the dead baby a "tangible person," and "creating memories."      

2.The mother has contributed to the death of the person she now must mourn. Any contribution, in fact or fantasy, to a loss prolongs grief. 

3.There is little social support for grieving an aborted infant. Many women are made to feel abnormal if they want to talk about their abortion because much of society appears to consider abortion is a non-event and the unborn infant a non-person. 

4.There is very little professional interest, and even less professional skill, in helping women grieve abortion losses. 

5.There is greater ambivalence and conflict regarding infant loss from abortions which interfere with the grieving processes. 

Our findings agree with those of Berkeley and Humphreys, who studied the number of visits by women to their family physicians for a year prior to and a year following abortions. After the termination of pregnancy, they found there was an 80% increase in women visiting their doctor for all reasons, and 180% increase for psycho-social reasons. Drower and Nash, who compared similar women who were granted abortion to those who refused abortion, found that, twelve to eighteen months after the initial presentation, a greater proportion who were terminated were under psychiatric treatment, admitted to a greater increase in the use of alcohol or tobacco, used more tranquilizers, experienced more adverse personality changes and had more social isolation than those who were not terminated. Theirs is an important study because they were able to control for many factors. 

For many, it is not surprising that the most important of 44 factors that we examined that might contribute to the rate of abortions is the lack of partner support. Since lack of partner support also effects the number of miscarriages, it is possible that there is a combined neuro-hormonal and psychological impact. Unfortunately, in almost every western country, men are discouraged from supporting their pregnant spouses. Whenever tested in court, men have learned they have no right to restrain their partner from aborting their (collective) baby. Because she may kill their baby at any point without his awareness or consent, men do not allow themselves to emotionally attach to the unborn infant. Because they are unattached to the infant, they do not support their spouses. Because they do not support their spouses, women are more likely to have abortions. Because they are more likely to have abortions, men are less likely to support them. The government's coercive attempts to ensure financial support from putative fathers increases some men's tendency to insist unborn babies are aborted. 

It appears that members of the Christian Medical and Dental Society have 2.5 times fewer abortions and 2.47 times fewer miscarriages then their colleagues. This is not likely to be explained by the difference in the nature of their patient population. It may be due to the more supportive style of their practice. The other possibility is that they are not as likely to approve abortions, and therefore the women also have fewer miscarriages. 

It appears that the outcome of the first pregnancy is the best predictor of the outcome of the second pregnancy. If this is the case, then it is important that physicians help women have a full-term, normal birth weight pregnancy the first time. It appears teenagers are more likely to abort their babies because they are much less likely to have supportive partners (51.5%). Whereas in the 20-25 age group, partner support is 77.9%. The other possible reason is that abortion creates difficult to resolve conflicts that the individual attempts to resolve by repeatedly re-enacting them. 

The point estimate of the need for professional help to deal with a pregnancy loss (29.1%) is conservative. Although some women have been able to resolve their conflicts arising before, during or after the abortion, it is likely many more required help at some time. Often this need is unrecognised, and therefore unresolved mourning continues untreated. Women may feel they should not complain about pregnancy losses to family or professionals to avoid guilt or shame or blame. The collusion of denial prolongs the mourning. Incomplete grieving is more likely to end in depression, the suppression of the immune system, and consequently poor health. If these results and arguments are correct, abortion is significantly contributing to poor health in women and the size of the health care bill in many countries. 

Before 1940, most indications for therapeutic abortions were medical. By the 1950's, psychiatric reasons accounted for more than 50% of all abortions. Today, where physicians are required to stipulate the reasons for abortion, over 90% are for so-called psychiatric reasons. However, standard texts state that there are no psychiatric indications, e.g. "psychiatric indications for therapeutic abortion did not stand the test for scrutiny." "Patients who were sicker before abortions had more serious post-abortion problems." The Canadian Psychiatric Association has stated that, "Justification of a decision to terminate a pregnancy under pseudo-psychiatric rubrics is to be deplored." There are no studies that show psychiatric benefit from abortion, and all but a few show that there are psychiatric hazards. The best evidence is that psychiatric illness is a contraindication for abortion. 

Although proponents of abortion contend maternal health has improved with abortion, there is no convincing evidence that abortion is beneficial for physical, psychiatric or social ills. Many medical and social indices have worsened in countries with freely available abortion. It was frequently claimed that freely available abortion would result in fewer unwanted children, and consequently less child abuse.  There is no evidence to support this notion; in fact, evidence shows child abuse and abortion are positively correlated.

Throughout modern medical history, the burden of proof has always rested with those who perform or support a medical or surgical procedure to show beyond reasonable doubt that is both safe and therapeutic. This has never been done with abortion. There has not even been an animal study. It would be very easy to abort 500 pregnant guinea pigs, randomly selected at different stages of their pregnancy, to determine the physical and psychological consequences, but this has never been attempted. 

It is hard to conceive of any situation where an individual or group can benefit at the expense of their neighbours. If it is not good for the neighbour, it is not good for anyone. If it is not good for black, it is not good for white. If it is not good for men it is not good for women. If it is not good for the baby, it is not good for the mother and father. This Universal Ethic of Mutual Benefit always applies and accords with the best science we know.

Summary

Our research shows that all kinds of unresolved pregnancy loss have a deleterious effect on women's general health and that abortion does significantly more damage than miscarriages, etc. Until such time as benefit and safety are proven, every organisation should take a sceptical and neutral stance on abortion. If the medical profession is unable to be scientific, there is historic precedence to show that the public may take the matter into their own hands.