Risk Factors

for Psychological Problems After Abortion 

While no one knows for sure, from present research, what percentage and how many women suffer from any specific psychological problems after abortion, it is clear that these problems do occur. Indeed, the published research demonstrates that serious emotional and psychological complications following an abortion are probably more common than are physical complications.

However, current research has identified some (statistically significant) factors which show which women are most at risk for experiencing psychological problems after abortion.

Examination of these risk factors suggests that many, if not most, women undergoing abortions have one or more of these high risk characteristics.

Risk Factors Predicting Post-Abortion Psychological Problems

I. CONFLICTED DECISION

A. Difficulty making the decision, ambivalence, unresolved doubts^{1,2,11,14,16,17,19,23,27,30,36,39,40}

1. Moral beliefs against abortion

a. Religious or conservative values^{1,17,27,31,35,36}

b. Negative attitudes toward abortion⁷

c. Feelings of shame or social stigma attached to abortion¹

d. Strong concerns about secrecy³⁷

2. Conflicting maternal desires^27,23

a. Originally wanted or planned pregnancy^{11,17,21,23,39}

b. Abortion of wanted child due to fetal abnormalities^{2,5,11,14,15,20,22}

c. Therapeutic abortion of wanted pregnancy due to maternal health risk^{2,11,14,20,32,36}

d. Strong maternal orientation^35,27

e. Being married⁶

f. Prior children^19,35

g. Failure to take contraceptive precautions, which may indicate an ambivalent desire to become pregnant⁴

h. Preoccupation with fantasies of fetus, including sex and awareness of due date.¹⁶

3. Second or third trimester abortion,^20,31,32,36 which generally indicates strong ambivalence or a coerced abortion of a "hidden" pregnancy.

B. Feels pressured or coerced^{11,12,14,27,33,35,39,40}

1. Feels pressured to have abortion

a. By husband or boyfriend

b. By parents

c. By doctor, counselor, employer, or others

2. Feels decision is not her own, or is "her only choice"¹⁴

3. Feels pressured to make the decision too quickly^13,18

C. Decision is made with biased, inaccurate, or inadequate information^13,35,36

II. PSYCHOLOGICAL OR DEVELOPMENTAL LIMITATIONS

A. Adolescence, minors having an increased risk^{3,9,12,13,23,26,32,35}

B. Prior emotional or psychiatric problems^{2,4,11,14,17,19,20,27,32}

1. Poor use of psychological coping mechanisms^1,23,27

2. Prior low self-image^27,33,35,40

3. Poor work pattern ^4,40

4. Prior unresolved trauma³⁵

5. A history of sexual abuse or sexual assault.^17,25,38

6. Blames pregnancy on her own character flaws, rather than on chance, others, or on correctable mistakes in behavior^23,24,29

7. Avoidance and denial prior to abortion¹⁰

C. Lack of social support

1. Few friends ^4,40

2. Made decision alone, without assistance from partner²⁸

3. A poor or unstable relationship with male partner ^{4,19,27,33,39}

4. Lack of support from parents and family, either to have baby or to have abortion^{1,7,8,14,23,28,40}

5. Lack of support from male partner, either to have baby or to have abortion^{1,4,7,8,14,19,23,27,28,32,34,39,40}

6. Accompanied to abortion by male partner²⁴

D. Prior abortion(s)^11,33,35,40

~~~

Learn more: Visit our Psychological Risks page for more information and fact sheets on the mental and psychological problems women and girls may experience after abortion.

Find help: If you or someone you know is pregnant or is struggling after abortion, download our Help & Healing Guide for more information and a list of resources and organizations that offer support.

Sources

1. Adler, et. al., "Psychological Responses After Abortion," Science, 248:41-44, (1990).

2. Ashton, "The Psychosocial Outcome of Induced Abortion", British Journal of Ob&Gyn., 87:1115-1122 (1980).

3. Babikian & Goldman, "A Study in Teen-Age Pregnancy," Am. J. Psychiatry, 755 (1971).

4. Belsey, et al., "Predictive Factors in Emotional Response to Abortion: King's Termination Study - IV," Soc. Sci. & Med., 11:71-82 (1977).

5. Blumberg, "The Psychological Sequelae of Abortion Performed for a Genetic Indication," Am. J. of Obstetrics and Gynecology 122(7):799-808 (1975).

6. Bracken, "A causal model of psychosomatic reactions to vacuum aspiration abortion," Social Psychiatry, 13:135-145 (1978).

7. Bracken, et al., "Coping with pregnancy resolution among women in an urban population," Sociology, 9, 225-254 (1978).

8. Bracken, et. al., "The decision to abort and psychological sequelae" Journal of Nervous and Mental Disease, 158:154-162 (1974).

9. Campbell, N.B., et. al., "Abortion in adolescence," Adolescence 23:813-823 (1988).

10. Cohen & Roth, "Coping With Abortion," Journal of Human Stress 10:140-145 (1984).

11. Council on Scientific Affairs, American Medical Association, "Induced Termination of

Pregnancy Before and After Roe v Wade: Trends in Mortality and Morbidity of Women," JAMA, 268(22):3231-3239 (1992).

12. Dunlop, "Counseling of Patients Requesting an Abortion," The Practioner, 220:847-852 (1978).

13. Franz W., Reardon, D., "Differential Impact of Abortion on Adolescents and Adults," Adolescence, 27(105):161-172 (1992).

14. Friedman, C., et. al., "The Decision-Making Process and the Outcome of Therapeutic Abortion," Am. J. of Psychiatry, 131(12):1332-1337 (1974).

15. Furlong, "Pregnancy Termination for Genetic Indications: The Impact on Families," Social Work in Health Care 10(1):17 (1984).

16. Gath & Rose, "Psychological Problems & Gynacological Surgery" in Psychological Disorders in Obstetrics and Gynaecology (London: Butterworths, 1985).

17. Hern, Abortion Practice, (Boulder, CO: Alpenglo Graphics, Inc., 1990).

18. Landy, "Abortion Counseling - A New Component of Medical Care," Clinics in Obs/Gyn, 13(1):33-41 (1986).

19. Lask, "Short-term Psychiatric Sequelae to Therapeutic Termination of Pregnancy," Br J Psychiatry, 126: 173-177 (1975).

20. Lazarus, "Psychiatric Sequelae of Legalized Elective First Trimester Abortion", Journal of Psychosomatic Ob&Gyn 4:141-150 (1985).

21. Lemkau, "Emotional Sequelae of Abortion," Psychology of Women Quarterly, 12:461-472 (1988).

22. Lloyd, "Sequelae and Support After Termination of Pregnancy for Fetal Malformation," British Medical Journal, 290:907-909 (1985).

23. Major & Cozzarelli, "Psychosocial Predictors of Adjustment to Abortion," Journal of Social Issues, 48(3):121-142 (1992).

24. Major, et. al., "Attributions, expectations and coping with abortion," Journal of Personality and Social Psychology, 48:585-599 (1985).

25. Makhorn, "Sexual Assault & Pregnancy," New Perspectives on Human Abortion, Mall & Watts, eds., (Washington, D.C.: University Publications of America, 1981).

26. Martin, "Psychological Problems of Abortion for Unwed Teenage Girls," Genetic Psychology Monographs 88:23-110 (1973).

27. Miller, "An Empirical Study of the Psychological Antecedents and Consequences of Induced Abortion," Journal of Social Issues, 48(3):67-93 (1992).

28. Moseley, et. al., "Psychological Factors That Predict Reaction to Abortion," J. of Clinical Psychology, 37:276-279 (1981).

29. Mueller & Major, "Self-blame, self-efficacy and adjustment to abortion," Journal of Personality and Social Psychology 57:1059-1068 (1989).

30. Osofsky & Osofsky, "The psychological reaction of patients to legalized abortion," American Journal of Orthopsychiatry, 42:48-60 (1972).

31. Osofsky, et. al., "Psychological effects of abortion: With emphasis upon the immediate reactions and followup," in H. J. Osofsky & J.D. Osofsky, eds., The Abortion Experience (Hagerstown, MD: Harper & Row, 1973), 189-205.

32. Rosenfeld, "Emotional Responses to Therapeutic Abortion," American Family Physician, 45(1):137-140, (1992).

33. Rue & Speckhard, "Informed Consent & Abortion: Issues in Medicine & Counseling," Medicine & Mind 7:75-95 (1992).

34. Shusterman, "Predicting the psychological consequences of abortion," Social Science and Medicine, 13A:683-689 (1979).

35. Speckhard & Rue, "Postabortion Syndrome: An Emerging Public Health Concern," Journal of Social Issues, 48(3):95-119 (1992).

36. Vaughan, Canonical Variates of Post Abortion Syndrome (Portsmouth, NH: Institute for Pregnancy Loss, 1990).

37. Wallerstein, "Psychological Sequelae of Therapuetic Abortion in Young Unmarried Women," Archives of General Psychiatry 27:828-832 (1972).

38. Zakus, "Adolescent Abortion Option," Social Work in Health Care, 12(4):87 (1987).

39. Zimmerman, "Psychosocial and Emotional Consequences of Elective Abortion: A Literature Review", in Paul Sachdev, ed., Abortion: Readings and Research (Toronto:Butterworth, 1981).

40. Zimmerman, Passage Through Abortion (New York: Praeger Publishers, 1977).

41. See also: Adler, David, Major, Roth, Russo, & Wyatt, "Psychological Factors in Abortion: A Review" American Psychologist 47(10):1194-1204 (1992).

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