How do women see their past abortions? The received wisdom is that abortion equals unwanted pregnancy: most women want their abortion and are satisfied with their decision. When women are asked at the clinic to participate in follow-up research (as in the famous “Turnaway Study”), researchers cite figures as high as 99 percent for “decision rightness”, interpreted as abortion satisfaction.
But are women really so satisfied with their abortion decision – and are their abortions really wanted? A new peer-reviewed study in the journal Cureus – one of a series of Charlotte Lozier Institute studies in the journal – shows a more complex and troubling picture.
Authors David Reardon, Katherine Rafferty and Tessa Longbons are critical of Turnaway research methodology as used by the group Advancing New Standards in Reproductive Health (ANSIRH). Reardon, Rafferty and Longbons’ own survey of US women has a high participation rate: 91 percent of women in a more general survey completed an abortion survey after confirming a past abortion, so almost three times the Turnaway rate of 31 percent.
This is important, as low participation rates – common in abortion research – can skew the data. Moreover, when women are invited at the clinic to participate in a study, those with the most negative feelings at the time may be the least likely to say yes. Those who do agree to participate may drop out due to stress such studies can create – i.e. those women worst affected by abortion may not complete the study, if they ever begin it.
In contrast, the Cureus participants are an older group of women (41-45) who were not approached at the clinic to participate, but were more randomly selected, and were reflecting on their abortion at a distance. This may help account for the much higher rate of participation. As the study authors comment, “A narrow age range was chosen to eliminate the confounding effects of age while capturing the experience of women who have completed the majority of their reproductive lives.”
In place of what they call ANSIRH’s “dichotomous, yes-or-no assessment of decision rightness”, Reardon and colleagues developed their own, more sensitive scales for rating decision rightness and for identifying the type of decision (i.e. Wanted, Inconsistent, Unwanted, or Coerced). They found that “33% described their abortions as Wanted, 43% as Inconsistent [meaning, inconsistent with their own values and preferences] 14% as Unwanted and 10% as Coerced.”
Significantly, 60 percent of women testified that they would have continued their pregnancy if they had had more financial security and/or more emotional support from others. The subgroup most similar to ANSIRH’s sample was a minority group of women who described their abortions as Wanted, with 94.7 percent of them agreeing that their decision was the right decision.
Summarising the study’s findings, the authors point out that “only one in three women described their abortions as both wanted and consistent with their own values and preferences.” In contrast, “two-thirds experienced their abortion decision as a violation of their own values and preferences, with 24% describing their abortions as unwanted or coerced.”
This should alarm everyone. Regardless of anyone’s views on abortion, it is very concerning if women are having abortions unwillingly, particularly if this goes against their beliefs. It is no surprise that those who have unwanted abortions are particularly likely to experience detrimental effects on their emotions and mental health, as indeed the study confirmed.
Choosing an abortion – perhaps under serious pressure – does not mean that one is morally happy with the abortion at the time, much less that one will be happy with it afterwards. It is a common human experience to make choices that do not reflect one’s values, and such experiences, as in the case of abortion, can have lasting ill-effects.
In view of the stakes for the woman, the onus is clearly on society to offer and publicise pregnancy and parenting support from both the State and the voluntary sector. We must build a culture where women are empowered to resist abortion pressures, and also where partners, family members and others are more supportive of the woman’s desire to take her pregnancy to term.
Unwilling abortions chosen under pressure store up unhappiness for the woman concerned. Even those who sincerely believe they made – or tried to make – the best decision they could in their situation may still be very adversely affected.
There is, indeed, some agreement among abortion researchers that ambivalence and seeing the pregnancy as wanted or meaningful may lead to adverse effects. A study by Donald Sullins found that 14.7 percent of abortions were of wanted pregnancies, and that these abortions were particularly prone to have such effects as depression and suicide ideation.
Women’s thoughts and feelings about their abortions can be complex – unsurprisingly, given the event the woman is processing. Abortion is not a trivial matter, as many women are very aware. The “satisfaction” found in the selective Turnaway group may simply not reflect how most women feel.
Dr Helen Watt is Senior Research Fellow at the Bios Centre in the UK. She is a former Director of the Anscombe Bioethics Centre, Oxford, UK