CMAJ letter

"Abortion is often her abuser's first choice."
 

"For some women the first experience of abuse will coincide with a pregnancy the woman welcomes but her partner opposes. Physicians must be aware of this dynamic and prepared to offer authentic help."

The association between domestic violence and abortion is well known.(1) Fisher and colleagues(2) contribute the finding that the association strengthens with repeat abortions.

Their recommendation to screen for a history of abuse is welcomed, but it should be augmented by the additional question: “Is anyone pushing you to have this abortion?”

Abortion is often a woman’s last choice but her abuser’s first choice. Thirty to 60 percent of American women having abortions describe pressure from others as a key reason for having an abortion.(1,3,4) Many report that they submit to unwanted abortions only because of abuse.(4) Pregnancy increases the risk of abuse (5,6) and homicide is the leading cause of pregnancy associated deaths.(7) Also, among pregnant women, the focus of partner physical abuse shifts from the face to the abdomen.(8)

Abortion is also linked to subsequently higher rates of substance abuse,(9) anxiety,(10) anger and rage among women,(4) all of which may contribute to a cycle of domestic violence. Victims of one coerced abortion are more prone to being repeated victimization, which may include elements of self-punishment.(4)

This study would have shed more light on these issues if it had distinguished if abuse occurred before or after the first abortion. Are women abused prior to a first pregnancy more likely to have multiple abortions, or does a first abortion increase the risk of subsequent abuse? It is quite possible that both are true. Furthermore, for some women the first experience of abuse will coincide with a pregnancy the woman welcomes but her partner opposes. Physicians must be aware of this dynamic and prepared to offer authentic help, including referrals for interventive counseling.


David C. Reardon, Ph.D.
Elliot Institute

 
References:

(1) Reardon DC, Strahan TW, Thorp JM, Shuping MW. Deaths associated with abortion compared to childbirth: a review of new and old data and the medical and legal implications. J Contemp Health Law Policy 2004; 20(2):279-327.

(2) Fisher WA, Singh SS, Shuper PA, Carey M, Otchet F, MacLean-Brine D, et al. Characteristics of women undergoing repeat induced abortion. CMAJ 2005;172(5):637-41.

(3) Rue VM, Coleman PK, Rue JJ, Reardon DC. Induced abortion and traumatic stress: A preliminary comparison of American and Russian women. Med Sci Monit, 2004 10(10): SR5-16.

(4) Burke T, Reardon DC. Forbidden grief: the unspoken pain of abortion. Springfield (IL): Acorn Books, 2002.

(5) McFarlane et al. Abuse During Pregnancy and Femicide: Urgent Implications for Women's Health. Obstet Gynecol 2002;100:27-36.

(6) Gazmararian JA, Adams MM, Saltzman LE, Johnson CH, Bruce FC, Marks JS, Zahniser SC. The relationship between pregnancy intendedness and physical violence in mothers of newborns. The PRAMS Working Group. Obstet Gynecol. 1995 Jun;85(6):1031-8.

(7) Horon IL, Cheng D. Enhanced surveillance for pregnancy-associated mortality—Maryland, 1993-1998. JAMA. 2001;285(11):1455.

(8) Hilberman E, Munson K. Sixty battered women. Victimology 1977-78; 2:460-470

(9) Reardon DC, Coleman PK, Cougle JR. Substance use associated with unintended pregnancy outcomes in the National Longitudinal Survey of Youth. Am. J. Drug and Alcohol Abuse. 2004; 26(1):369 - 383.

(10) Cougle JR, Reardon DC, Coleman PK. Generalized anxiety following unintended pregnancies resolved through childbirth and abortion: a cohort study of the 1995 National Survey of Family Growth. J Anxiety Disord. 2005;19(1):137-42.