Copyright holder: Tyndale University, 3377 Bayview Ave., Toronto, Ontario, Canada M2M 3S4 Att.: Library Director, J. William Horsey Library Copyright: This Work has been made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws of Canada without the written authority from the copyright owner. Copyright license: Attribution-NonCommercial-NoDerivatives 4.0 International License Citation: Lanfranchi, Angela, Ian Gentles and Elizabeth Ring-Cassidy. Complications: Abortion’s Impact on Women. Toronto: The deVeber Institute of Bioethics and Social Research, 2013. ***** Begin Content ****** Tyndale University 3377 Bayview Avenue Toronto, ON M2M 3S4 TEL: 416.226.6620 www.tyndale.ca Note: This Work has been made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws of Canada without the written authority from the copyright owner. Lanfranchi, Angela, Ian Gentles and Elizabeth Ring-Cassidy. Complications: Abortion’s Impact on Women. Toronto: The deVeber Institute of Bioethics and Social Research, 2013. Complications Abortion's Impact on Women By Angela Lanfranchi Ian Gentles Elizabeth Ring-Cassidy The deVeber Institute for Bioethics and Social Research Copyright 2013 by Angela Lanfranchi, Ian Gentles and Elizabeth Ring-Cassidy All rights reserved. No part of this book may be reproduced, transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, or stored in a retrieval system, without written permission from the publisher, except by a reviewer who may quote brief passages in a review. First published in 2013 by The deVeber Institute for Bioethics and Social Research 415 Oakdale Road, Suite 215 Toronto M3N 1W7 Ontario, Canada www.deveber.org Email: bioethics@deveber.org Phone: 416-256-0555 Cataloging data available from Library and Archives Canada. ISBN 978-0-920453-36-0 Printed in Canada Complications: Abortion's Impact on Women Table of Contents Preface and Acknowledgements i Introduction 1 I The Big Picture Abstract 5 1. Spiritual and psychological healing after abortion 9 2. Maternal and infant mortality: A global perspective 17 3. So many missing girls: Abortion and sex selection 45 4. Has abortion reduced the crime rate? 57 5. Informed consent: A woman's right 75 II The Medical Impact Abstract 89 6. Immediate physical complications of abortion: An overview 95 7. Biology and epidemiology confirm the abortion-breast cancer link 109 8. Prenatal testing and abortion for fetal anomaly 143 9. Physical complications: Infection and infertility 167 10. Physical complications: Injury miscarriage, placenta previa 183 11. Physical complications: Autoimmune diseases 195 12. Physical complications: Maternal mortality from abortion 201 13. Medical or drug-induced abortion: How safe? 211 14. Multi-fetal pregnancy reduction (MFPR) 221 15. Premature or preterm births after abortion 235 16. Pain during and after abortion 247 III The Psychological and Social Impact Abstract 253 17. Psychological outcomes: Abortion and family formation 257 18. Depression, suicide, substance abuse: Contested research 271 19. Intimate partner violence and abortion 285 IV Women's Voices Abstract 301 20. Who are the experts? What 101 women told us 303 21. Women's voices: Narratives of the abortion experience 319 Conclusion: Abortion's impact on women 357 References 367 Glossary of terms 411 Index 421 About the Authors and the deVeber Institute's Contact Information 433 i Preface and Acknowledgements This book has been nearly ten years in the making. It arises out of a concern that the steadily growing body of information about the harmful complications of abortion for women and their subsequent children should become widely known. These complications are physical, psychological, social, and spiritual. In order to present direct evidence of the malaise brought on by abortion in contemporary society, we have included in our study the results of interviews of over 100 women who have undergone that experience. Words cannot express our gratitude to the women who shared with us the stories of their abortions. Complications could not have been finished without the help of many people. We are deeply grateful to Deborah Zeni, MD, Will Johnston, MD, Rene Leiva, MD, Paul Ranalli, MD, David Reardon, PhD, Priscilla Coleman, PhD, Daniel Bader PhD, and Barbara McAdorey for their valuable contributions. Brent Rooney answered many questions about preterm births. We thank the Edward Jackman Foundation, as well as many private donors who financed the publication costs. Special thanks to Martha Crean and Lorraine McCallum who have worked tirelessly to perfect the book. Kathy Matusiak supplied indispensable administrative assistance. Jean Echlin, Mary Pon, Angelina Steenstra, Denise Mountenay and Patricia Dolente interviewed women about their abortions. We thank Bambi Rutledge for her continued support. A host of volunteers and summer student interns did an immense amount of research, writing, checking of references and other tasks. They include Petra Gombos, Nadia Tanel, Duc Mai, Raphael Ma, Elaine Drake, Elaine Zettel, Jennifer Zettel, Madeleine Gubbels, Katie Hanlon, Catherine Farrell, Peter O'Hagan, Regine Leung, Genevieve Bonomi, Shannon Brown, Barbara Farlow, Amy MacInnis, Safina Allidina, Thien-An Nguyen, Mary Webb, Adam Giancola, and Lorraine Smith-MacDonald. Brian Hurley, LLB, provided information about women who laid charges against their abortion providers. Paul Broughton and Aimée Rochard provided invaluable editorial support. Finally, we gratefully acknowledge the commitment and labour of our Board of Directors, Advisors and Associates who ensured the Institute's completion of this work. Chapter 1 Spiritual and psychological healing after abortion "I don't feel scared any more...I do believe that I can be forgiven. Isn't that great? A miracle at last!" Key Points • Many women and families grieve deeply after an abortion, as with other pregnancy losses. • Grief, which is not openly acknowledged, publicly mourned, or socially supported can become disenfranchised and complicated. • Healing has many dimensions—physical, social, psychological, and spiritual. • Each person heals in her own way and on a unique timeline. • There are many resources and supports available to those seeking healing after abortion. • Forgiveness is an essential step in healing after abortion. • Many people find it helpful to memorialize and name the child. 10 Introduction In this book we explore current research and personal stories about the impact of abortion on women and families. While there are similarities that can be statistically analyzed, each woman's experience of abortion is unique. Her reaction to her pregnancy, the reaction of those around her, her sense of herself and her purpose in life, her social situation, support offered to her or criticism, or conflict, judgment and coercion to abort will all influence whether she continues her pregnancy, or has an abortion.1 These same factors influence her response after the abortion. Many women experience grief for the lost child. This grief may manifest itself in symptoms of depression, anxiety, anger, coldness, a resort to non-medical drugs, and suicidal thoughts. Abortion can be traumatic and feelings of grief can be suppressed for many years before resurfacing. However, some women can experience healing after abortion. In this chapter we explore that phenomenon of healing. We recognize too that not only women, but also fathers, siblings, grandparents, extended family and friends may grieve after an abortion. Healing occurs on many levels. Physical healing is generally short term. Immediate complications that should be reported to a physician include excessive bleeding, fever and infection. Long-term complications arising from abortion have also been identified, and are discussed in Section II. Psychological and spiritual healing is often more complex and is related to the way that abortion has affected a particular woman. The decision to abort may involve friends, the father, and the woman's family, which means that healing of these relationships may be a necessary component of overall healing from an abortion. Because abortion involves a death, women often seek religious consolation and spiritual healing. A re-examination of moral and religious beliefs also occurs because abortion results from deliberate human action. There is no specific timeline for healing, which can occur at different times and in different ways throughout a woman's life. Healing After Pregnancy Loss Grief after abortion is like grief after other pregnancy losses. Unlike the loss of an older child or adult, loss during pregnancy is the loss of a child ______________ 1 Cozzarelli C, Sumer N and Major B. Mental models of attachment and coping with abortion. Journal of Personality and Social Psychology 1998 February; 74(2): 453-67. 11 that the parents, family and friends have not seen or touched. The grief felt, however, is very real. The Perinatal Bereavement Services of Ontario explains: When a pregnancy ends with miscarriage, ectopic pregnancy, medical termination, stillbirth or neonatal death, the parents may experience anger, hopelessness, lowered self esteem and other feelings. It is healthy and helpful to allow the parents to feel, name and express their emotions. Holding in feelings may cause delayed grief reactions. The shared grief felt by parents, families and friends will be expressed in different ways. No two people grieve alike.2 Those grieving the loss of a pregnancy may find support among family, friends and professionals. Some take part in individual or group therapy, and online support is available. Support is also offered during subsequent pregnancies as women continue to heal from previous losses during later pregnancies. Healing After Induced Abortion Healing after induced abortion has both similarities to healing after miscarriage or stillbirth, and unique aspects. It is normal to grieve after an abortion, and to grieve the lost child. This grief is personal and each person experiences it differently and will take a different path to healing and finding peace. Grief after abortion, however, is often disenfranchised, because the loss is not openly acknowledged, publicly mourned, or socially supported.3 Because abortion carries a social stigma, those who grieve from it perceive little or no support from friends and family for their feelings of loss. They feel equally unable to express their desire to grieve to those who supported their choice, for fear (if not the actual experience) of being told there is nothing to grieve.4 The prevailing view of abortion as a psychologically benign procedure5 and the fierce political controversy surrounding it mean _____________ 2 Pregnancy and Infant Loss Awareness Network (PAIL Network). Pregnancy and infant loss: about us. PAIL Network 2012. www.pailnetwork.ca . 3 Speckhard A and Rue V. Complicated mourning: dynamics of impacted post abortion. Pre- and Peri-natal Psychology Journal 1993; 8(1): 5-32. 4 Ibid., p. 16. 5 This is the current position of the American Psychological Association (APA). 12 that the grief of those who have suffered abortion is often unacknowledged or dismissed. This disenfranchisement of grief can further complicate it.6 Complicated grief occurs when the painful emotions of sorrow, numbness, guilt and anger following a loss are long lasting and do not resolve in acceptance of the loss. Instead they continue to debilitate and interfere with the life of the grieving person.7 Openly acknowledging the loss that occurs with abortion and the grief accompanying that loss is the first step in healing. In certain situations, the risk of complicated grief may be particularly high. In one study of women who aborted after learning of an adverse prenatal diagnosis, 25 per cent became critically affected after the loss, while 13.7 per cent continued to experience complicated grief fourteen months after the abortion. Kersting recommended developing specific interventions and programs to prevent that grief.8 Increasingly, the medical and counselling communities are identifying women's need for assistance after abortion as more research shows the psychological risks, and as women seek help for themselves. Healing—A Journey An important part of grieving after abortion is for a woman to tell the story of her pregnancy and abortion. It can require great courage and strength for a woman to do this, and allow herself to feel the pain of grief. She may seek assistance when she is ready to tell her story, or she may need first to listen to others' stories and be assisted with other symptoms that she is experiencing, before being ready to share her own story. There are many organizations, individuals and online resources that offer assistance after an abortion. These services are available on both a short and long-term basis. It should be stressed that women who experience thoughts of suicide should immediately seek professional help. Psychotherapy can be helpful especially for women who are experiencing complicated grief or for those struggling with destructive behaviours, or severe anxiety or depression. Through individual counselling or group discussion women find support to explore their emotions, build support networks around them, and find _____________________ 6 Speckhard and Rue. See n. 3, p. 16. 7 Mayo Clinic. Complicated grief. December 2012. http://www.mayoclinic.com/ health/complicated-grief/DS01023. 8 Kersting A, Kroker K, Steinhard J, Ludorff K, Wesselmann U, Ohrmann P, Arolt V and Suslow T. Complicated grief after traumatic loss: a 14-month follow up study. European Archives of Psychiatry and Clinical Neuroscience 2007 December; 257(8): 437-43. 13 forgiveness and peace. For some, the anonymity of visiting websites that offer online support is preferable, and this can also be a simple and convenient way to take the first step towards healing. Women may rely on a variety of forms of assistance at different stages of their healing journey. By telling the story of her abortion and beginning to explore her emotions about that event, a woman embarks on a journey that helps her to find peace, and decrease the suffering she may still be experiencing. Abortion Recovery International (ARIN) is an international affiliate organization that connects abortion recovery centres, programs and services. Its affiliates must provide services that are "personal, confidential, non- judgmental and open to all."9 ARIN encourages individuals and families to seek out care that is confidential, does not pressure them to tell their story, provides a prompt response to inquiries, has no political component, is respectful and professional, and avoids "quick fixes." They provide referral to counselling services in both the United States and Canada. Some other major organizations that offer healing after abortion include: • Lumina, which offers group therapy, retreats, referrals to professional therapists for one-on-one therapy, and a network of people who have experienced abortion. • Rachel's Vineyard, which offers weekend retreats and weekly support groups, in addition to training for mental health professionals. • Ramah International, which promotes Christian post-abortion ministry and offers resources that can be used by recovery groups. • Project Rachel, which provides post-abortion outreach through the Catholic Church, making local referrals to trained therapists, clergy, retreats and support groups. Pregnancy resource centres and crisis pregnancy centres often host abortion support groups. These centres can be found locally or through Optionline.10 ______________________ 9 Abortion Recovery International (ARIN). About us: principles of care. Abortion Recovery International: Restoring Lives and Relationships after Abortion. 2013. http:// www.abortionrecovery.org/aboutus/principlesofcare/tabid/247/Default.aspx. 10 www.optionline.org, or 1-800-712-HELP. 14 Online support is available through many websites, including Abortion Changes You (abortionchangesyou.org), which guides the reader through pathways to healing. In addition, many books and self-help manuals have been written on this topic, designed to help the reader along her path to healing and to provide awareness to those providing support during the healing process. Whether they receive support through group therapy or one-on- one therapy, online resources or print materials, women who have had abortions are encouraged to continue seeking healing using a variety of means until their symptoms lessen, their depression or anxiety eases up, their self-destructive behaviours end, and their relationships are restored. Forgiveness Forgiveness is considered an essential part of healing after abortion. Many women have unresolved feelings of shame and guilt arising from the volitional nature of abortion. It can be painful to revisit and re-evaluate the decisions that they and the people around them made that led to the abortion. Both pro-abortion and anti-abortion women report that the act of forgiveness is a very important step in the healing process.11 Christian Counselling Christian counsellors assure women of God's mercy and forgiveness towards those who genuinely desire it. The woman must not only accept external forgiveness, but in turn forgive herself, as well as the other people involved in the abortion.12 Project Rachel, the Catholic Church's approach to healing after abortion, recommends that those who counsel women after abortion: affirm her courage in seeking healing, acknowledging how difficult it can be to talk about decisions that evoke guilt and shame, and how difficult it is to reveal the painful emotional and behavioral ________________________ 11 Hess RF. Healing after abortion: a search for forgiveness. Journal of Christian Nursing 2009; 26(3): 154-8. 12 Wilson BK and Haynie L. Experiences of women who seek recovery assistance following an elective abortion: a grounded theory approach. DNS dissertation, Louisiana State University Health Sciences Center School of Nursing, 2004. 15 consequences of having made poor choices.13 Project Rachel lists other steps towards healing after abortion, which can include, in no particular order: recounting one's story, dissipating anger, forgiving others, understanding abortion and accepting it as the death of her child, grieving for the lost child, remembering or considering the child's sex, naming the child, beginning a new relationship with the child, surrendering her child to God, memorializing the child, assurance of God's mercy, and self-forgiveness.14 Japanese Buddhist “Mizuko" Japanese Buddhist tradition includes the mizuko kuyo ritual for post- pregnancy loss, which requires a full apology from the parents to make amends to an aborted child. Mizuko means water child, referring to a baby that was conceived and lived in the womb but was not born alive. "In contrast to the child in darkness because of an ordinary miscarriage or by natural death after being born, the child here discussed is in its present location because its parents took active steps to prevent it from being born alive in our world. If the parents merely carry out ordinary memorial rites but fail to make a full apology to their child, their mizuko will never be able to accept their act."15 Forgiveness allows a woman to restore her relationship with herself, the people around her, and her God. It can also allow her to begin a new relationship with the child she has lost, and continue the grieving process. Memorializing The Child In restoring their relationship with the child, women often find healing by writing a letter to their child, and naming him or her. Some choose to remember their aborted child in a more public way. In the United States there is a National Memorial for the Unborn where families can share their grief with others who have suffered a similar loss and name plaques are _________________ 13 United States Conference of Catholic Bishops (USCCB), Committee on Clergy, Consecrated Life, and Vocations. Project Rachel Ministry: a post-abortion resource manual for priests and Project Rachel leaders. Washington, DC: USCCB, 2009: p. 14. 14 Project Rachel Ministry. See n. 13, pp. 15-20. 15 Wilson JT. Mourning the unborn dead: American usage of Japanese Buddhist post-abortion rituals. PhD Dissertation [Unpublished], University of North Carolina at Chapel Hill, 2007. http://udini.proquest.com/view/mourning-the-unborn-dead-american- goid:304844080/. 16 mounted to memorialize aborted babies.16 In Japan and Taiwan there are mourning rooms in temples and programs to help parents grieve and atone for abortions.17 Memorializing the child can help women and families to find peace after the loss from abortion. Pregnancy loss, particularly if caused by a medical or surgical abortion, can be a very difficult experience. It is unique for each individual; hence, grieving and healing occur in different ways and on different timelines for each person. Healing and peace is attainable, and with appropriate assistance women are able to restore their relationships with themselves, their child, God and the people around them. Today there are more counsellors and programs available than ever before, and every day women are journeying towards healing after abortion. The remainder of this book reports the latest medical, psychological and sociological evidence about the effects of abortion, as well as the stories of many women who have experienced abortion first hand. The topic is controversial, and discussion of the research presented in the following chapters is often avoided, especially in North America. But the voices of women who have had abortions cannot be silenced. Attempting to deny their narratives will only hinder the healing process for these women and their families. While we document much bias in recent research, we do not promote any specific political or religious approach. Our aim is to share the stories accurately, to summarize research findings honestly, and to offer clarity and real hope to those who are suffering. Their emotional and spiritual agony is often acute, but so is the peace that can be found when it is recognized and women are helped on their journey towards healing. __________________ 16 National Memorial for the Unborn. 2010. http://www.memorialfortheunbom.org/ tabid/55/default.aspx. 17 Thom V. Project Rachel: Faith in action, a ministry of compassion and caring. In Post-abortion aftermath, ed. Mannion M, Kansas City, MO: Sheed and Ward, 1994:144-63. ***** This is the end of the e-text. This e-text was brought to you by Tyndale University, J. William Horsey Library - Tyndale Digital Collections *****