Abortion and mental health – a psychiatrist’s experience

Dr Sean O’Domhnaill
By Dr. Seán Ó Domhnaill

Let me leave no-one under any illusions as to where my loyalties lie. I am most firmly pro-woman, pro-child and pro-life. I have been an active campaigner on this issue all of my adult life. I believe in the right to life from conception until natural death and I have come to that position based upon 30 years of exposure to the abortion debate and as a human rights campaigner. Sure, there have been times  (long ago it seems) when I felt the need to examine more closely certain areas of the debate and to seek the advice and opinion of others. In truth, no-one has ever felt restrained from expressing their opinion on the various life-related issues to me.

Most people have an opinion on abortion, in particular, and these opinions have been splashed all over the international media once again in recent weeks. I believe that this most recent episode was deliberately exploited by those who campaign for abortion to push their agenda. I am not deluded. I have seen the emails on Google chat discussing how best to use the tragic death of a young mother to further an agenda – five days before the story of Galway hit the papers. I know that those emails revealed n intention to manipulate this tragic case to achieve the legalisation of abortion in Ireland.

Doctors Office

The abortion campaigners have long sought legislation on the X-case judgement. Their belief is that if we legislate for the ruling in “X”, then the gateway to abortion-on-demand is only a small step away. In 1992, no-one would have believed that the Pro-life Amendment of 1983 would have been interpreted to indicate that the Irish people wanted legal abortion, especially in that most dubious of cases where the abortion might be sought on the grounds of suicidal threat if the abortion were not allowed. Most legal commentators would agree that the X-case judgement was seriously flawed. Many have publicly done so, both at home and abroad.

I am a mental health professional. I work in the public, private and voluntary sectors. In 15 years, I have had one instance where a woman demanded that the “social welfare” provide the means for her to terminate her pregnancy. After a short conversation and a modicum of reassurance, she decided to forego the abortion. I have treated approximately 75 women who have asked for help in dealing with mental health issues arising from their abortions. I have treated many more women with mental illness who had abortions prior to becoming mentally unwell, the overwhelming majority of whom regretted their decision to deliberately end their unborn child’s life. The very first overdose victim I treated after I started in Psychiatry in 1997 was a nineteen year-old lady who lived in the Channel Islands and who had undergone an abortion some 6 months previously. I remember well her rhetorical question to me, as I tried to reassure her that her depressive negative cognitions would abate with treatment; “Will treatment stop me knowing that I killed my baby?” .That was a real baptism of fire. This past year I have treated a woman who terminated her pregnancy 22 years ago. Her husband, the father of the child, told me that she goes through a black and bleak period of about three weeks every single year around the time of the anniversary of the abortion. She has sought solace with Rachel’s Vineyard, a group for women who regret their abortions and she has been very much helped by her interaction with them. I remember the 19 year-old rape victim who developed post-traumatic stress after being raped in the back of a car. The flashbacks were to being restrained by the nurse and her aunt in the clinic in England when she was 14 years old and was found to be pregnant. In many thousands of interactions with women in psychiatry, I have never once come across a woman who indicated that she would kill herself if she was not allowed to have an abortion. This is subjective evidence from a person clearly biased toward life-affirming management of unexpected or unplanned “crisis” pregnancies. More importantly, it is the truth.

The Evidence

The abortion debate has often revealed conflict between those who argue that abortion is a negative factor in relation to mental health and those who argue that abortion has no impact upon mental health. The evidence provided by both sides conflicts, as one would expect. Apart from the obvious case of someone being pressured into aborting a pregnancy that they want and suffering with post-abortion mental illness as a result of the subsequent contemplation of having ended the life of one’s own child against one’s will, there appear to be other factors which I will attempt to address here. In a recent meta-analysis of 119 studies, Coleman revealed the following risk factors for the development of post-abortion mental health difficulties:

  1. Coercion into abortion ( 9 studies supported this)
  2. She is religious or views abortion to be in conflict with her personal values (10 studies)
  3. Ambivalent about abortion or associated with high degree of decisional distress ( 21 studies)
  4. Committed to the pregnancy or wanted to carry the child to term ( 7 studies)
  5. Belief that abortion terminates the life of a human being and /or mother develops a bond with the unborn ( 6 studies )
  6. Pre-abortion mental health or psychiatric problems ( 31 studies)
  7. Pregnant woman was an adolescent or young adult ( 15 studies )
  8. Conflicted unsupportive relationship with the father of the child ( 5 studies)
  9. Character traits indicating emotional immaturity, instability or difficulties coping were present ( 42 studies).

Of course many of these risk factors are inter-related. For example, a woman who feels attached to her fetus and desires to continue the pregnancy may also be pressured from her partner to abort if the relationship is unstable, leading to feelings of ambivalence and stress surrounding the decision. If she suffers from low self-esteem and has trouble articulating her feelings, she may be particularly prone to yielding to the pressure. II

I believe that it is reasonable to deduce these risk factors based on a modicum of common sense, albeit that such sense is no longer common. It is interesting that, given the sensibility and relatively obvious nature of these listed risk factors, the detractors from the study that produced them decided to attack the statistical methods used rather than attack the obvious nature of the factors themselves. Better to muddy the waters than to allow any clarity at all?

In terms of the frequency of occurrence of the risk factors outlined, Husfeldt et al ( 1995) indicated that 44% of women experience ambivalence about their decision to terminate once the pregnancy is confirmed. In a study by Rue et al (2004) 50% of American women were found to believe that aborting their pregnancies was morally wrong. Another study by Kero et al ( 2001) reported that 46% of the women interviewed described a “conflict of conscience”.

Interestingly, aborting doctors seem to agree that abortion can cause psychological difficulties. Hern ( 1990) emphasised the central role of evaluating mental status, circumstances and abortion readiness to prevent psychological “complications”. He also advocated the training of counsellors to evaluate the presence of “subtle coercion”. Similarly Baker (1995) in her book entitled “Abortion and Options Counselling”  states that “(in) the cases where women do react negatively after an abortion, there appear to be predisposing factors linked to those reactions. There is enough valid research from which we can attempt to assess a client’s potential for negative reactions after an abortion…”. And this from the advocates of legal abortion.

When I was studying for my psychiatric membership examinations in 2002, I remember my Revision Notes in Psychiatry by Puri and Hall stating that “only” 10% of women undergoing abortion suffer severe and/or prolonged psychological sequelae. Recent studies suggest 20%, but even if one accepts the lower figure, that means that 15,000 women from Ireland have suffered severe and or prolonged mental health difficulties as a result of having terminations over the past 40 years and that 19,000 British women suffer such difficulties as a result of abortion each year. Pity America with 10% of 1.4 million abortions each year!

Abortion is the hot potato issue in Irish politics. It is a subject that terrifies politicians and that causes otherwise reasonable people to become utterly embittered toward the opposing side. This is tragic in so far as it impacts on the capacity for reasoned debate, but much more so because it neglects to recognise that abortion does cause problems for its victims, one dead and one wounded. As we approach possible legislation on the X-case, it behoves us as clinicians to be aware of the potential for adverse sequelae from legal abortion and not to hide behind statistical semantics in avoiding the provision of accurate information to those who come to us for advice on whether or not they should continue to carry their child to full term. The use of emotive language is inevitable. We are discussing matters of life and death. But, we should seek to generate more heat than light, or we serve no-one.

Dr. Seán Ó Domhnaill is a Director of the Life Institute, a Special Rapporteur for the Irish United Nations Association and a Consultant Psychiatrist.

With special thanks to http://www.thelifeinstitute.net

This entry was posted in Uncategorized and tagged , , , , , . Bookmark the permalink.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s