The Four F's
What factors contribute to PASS? What determines if a woman will suffer from PASS or not? Well, we donít know for sure. My studies so far indicate that one possible cause is something I call the "Four Fís".
Father (of the baby) - If the Father of the baby is unsupportive, unwilling to be a father to the child, unenthusiastic, or someone not around at all (i.e. pregnancy resulting from one night stand or rape).
Finances - If Finances are a problem, if the woman is struggling to support herself, or her existing family, or if the burden of the baby would cause financial hardship.
Family - If the woman's Family is unsupportive, or negative about the pregnancy. (especially in a situation where the baby's father is not supportive)
Friends - If the woman's Friends are unsupportive or negative about the pregnancy. (especially in a situation where the baby's father is not supportive)
If a woman makes her decision to abort based on one or more of these four factors, then she seems more likely to get Post Abortion Stress Syndrome. In contrast, a woman who said she would choose abortion, regardless of the above factors, i.e., enough money, support from the babyís father, friends or family, seems to do much better.. .If the woman feels like she has made a decision completely of her own free will, she seems to be at peace. So far, in my survey, the financial aspect seems very strong. In cases of women who stated they were 'at peace' with their abortion, and glad they did it, 100% of these women were already supporting themselves, and said that they could have afforded everything necessary for a baby. If you make your decision to terminate the pregnancy based on pressure from one of the four Fís, problems may follow. Many times these feelings don't start causing problems until months or years later. One day you see a woman, pregnant, and you feel a little "funny" inside. And aren't quite sure why yet..Then later, as you see a woman holding a cute toddler, more feelings may surface. It (the guilt) hits me especially hard when I hear of women who were in situations like mine, only worse, and they decided to keep the pregnancy going anyway, and now, a few years in the future from their struggle, they have a beautiful little child, sitting next to them and smiling, and everything worked out fine.. That's when the feelings really slam me, and I think "Why didn't I have more faith? Look at all *that* woman put up with, and everything turned out fine! Why was I such a coward?" and then the guilt can collapse me for days..
When women are thinking about what to do, when they first find themselves unexpectedly pregnant, the mind can go wild with ruminating. When pregnancy first occurs, the hormonal levels raise.. These hormones can make you weepy, edgy, like a very severe PMS day.. If you are feeling the effect of those hormones, it makes it difficult to look at things in clear termsÖ As you start thinking about a baby, a future, how this pregnancy will impact your immediate future, life as a mother, your own life in general, your mother, how you want things to be for you and your child, how this isn't the way you pictured yourself starting a family...All these overwhelming thoughts start to face you.. If you have had a pretty carefree life before, you suddenly face the responsibility of having to settle down, be mature, give up your spare time. If you already have children, you're even more aware of how time consuming, emotionally draining and financially difficult raising children can be. Of course, you also know the 'sweet' parts, but when you are frightened and scared, the bad parts loom so much larger.
Now you have to face the future.. That scary thought, along with the hormones going through your body, along with any pressure at all from the four Fís, and abortion suddenly looks like a clear, logical, easy choice.. Letís examine the Four F factors further, to help understand them.
Father of the baby - If the woman does not get support(emotionally) from the babyís father about continuing the pregnancy, this could influence her decision. For example, you ask the guy what he's been thinking about, in regards to the 'unexpected surprise'. A non-committal response occurs, and the woman feels strangely uneasy.. If you were in a loving, committed relationship with the father of the baby before the surprise occurred, you may begin to feel upset, as his lack of enthusiasm starts to show. If you discuss reasons why you are considering keeping the pregnancy going, he may begin to start telling you why you canít.. Why itís a Ďbadí idea. Why the most logical, intelligent choice is to terminate the pregnancy.. This may start the woman towards a feeling of rejection. First, it feels like the man is rejecting part of you, a part he helped create. He certainly wasn't negative or unsupportive of the fun part, was he? But now that you are pregnant, suddenly he changes. This can be so upsetting to the woman, faced not only with the fact that she is the one that will have to undergo the abortion, but also that suddenly there are cracks in the relationship with the significant other. Especially if in this relationship, you had discussed this possibility before.. and you had decided, beforehand, not to have an abortion in case of an accident.. This feeling of rejection may hit the woman deep inside.. So to avoid feeling that pain, she may put on the 'brave frontí, and suddenly agree, with an assured confidence that "Yes, heís right, this is indeed the best solution for them.. This Ďmakes senseí." The man seems relieved that the woman is going along with the 'easiest' solution, and the woman stuffs all the pain deep inside.If you feel the relationship was a little unstable to begin with, like you were not sure he *really* loved you, then this happens, well that confirms it in your mind! "He doesnít really love me, and so why do I want to have a baby with someone who doesnít really love me?" Why have a child with someone who doesn't care enough about you to take responsibility for his actions? Why do you want to be a single mom, and suddenly be faced with finding daycare, or quitting school, or moving? Comments and complaints from your parents perhaps, or friends. They may not always say it out loud, but you get the feeling "Why doesn't she just 'get rid' of the problem?" Abortion seems, at the time, such an easy way to resolve it.. One quick procedure, and itís over with, forever.. You can get on with your life, you can keep the relationship with your significant other going like it was before, everything will be fine..It all sounds so logical, before the abortion. If the father of the baby was someone who abused you, either through rape or incest, then it's an even more troubling situation. Will the pregnancy and resulting baby remind you of something you'd rather forget and put behind you? How can you heal, when you will have a reminder, this child, with you every day for the rest of your life? For an upset and hurting woman, desperate to get past a traumatizing event in her life, aborting the pregnancy seems like a good thing. Logical as it seems, many women have just as hard a time emotionally after abortion as women who conceived in a 'loving relationship'.
(to be continued, still under construction, more of my theories to come)
Here's some brief PASS research study bits, to give you something to read as I finish my four f essay.
- Paralyzing ambivalence:
Some ambivalence about pregnancy is normal, even optimal. It indicates a recognition of the seriousness of parenthood. However, a woman who simply cannot decide between terminating and continuing a pregnancy, or whose conflicting feelings are interfering with her ability to sleep, eat, or carry out her usual life activities, is at risk for psychiatric sequelae whatever her decision. The decision to have an abortion is a weighty one, but one that a healthy woman can make without professional assistance. The health care provider who recognizes that a woman is experiencing extreme stress in struggling with a decision or who knows that the woman has a history of psychiatric problems preceding her pregnancy needs to consider a professional referral.
- Duress and coercion:
The most important predictors of positive abortion outcome for a woman are an autonomous decision and social support for that decision. The woman who terminates her pregnancy because her husband, lover, parents, or friends would be embarrassed by it, because she is threatened with the loss of financial support for herself or for her children already born, or because she fears abandonment or abuse is at increased risk for adverse psychological sequelae to abortion. The same is true for a woman who undergoes an abortion over the objections of significant others in her life.
- Medical or genetic indications for abortion:
Not surprisingly, a woman who would otherwise prefer to have a baby, but is advised to terminate her pregnancy because of preexisting medical illness, medical complications, or fetal abnormality, is more likely to become clinically depressed than a woman who did not wish to remain pregnant. Not only does she lose a desired conception, but she also must cope either with the fact that her body cannot provide a safe gestational environment for a developing fetus or that she has produced an abnormal one.
- Baillieres Clin Obstet Gynaecol 1989 Dec;3(4):769-790
The loss of early pregnancy:
"It is often assumed that early loss of pregnancy is not followed by emotional distress. When such distress does occur, it often goes undetected. Early loss of pregnancy is frequently followed by typical grief such as that occurring after any bereavement. Most recent studies have shown that although social termination of pregnancy in the first trimester has few adverse psychological sequelae for most women, there are vulnerable women who do experience significant emotional distress afterwards. Risk factors for poor psychological outcome include poor social support, past psychiatric history and ambivalence about the termination. The procedures used for second trimester terminations of pregnancy are likely to be a particular source of distress. Psychiatric disorder may also follow if termination is refused. Careful assessment of all women before social termination will identify vulnerable women who may benefit from counseling and support afterwards. After spontaneous abortion or miscarriage, many women experience significant emotional distress, which persists for several months. Guilt and anger are common. Some women are particularly vulnerable to developing psychiatric disorder after spontaneous abortion, for example women with a past psychiatric history, poor social support, previous spontaneous abortion and personality traits such as neuroticism. Many women would benefit from follow-up and support afterwards; extra support and reassurance are often needed during the next pregnancy. Termination for fetal abnormality is more likely to induce grief than relief for many women; these pregnancies are usually wanted, second trimester terminations are distressing, and there is often guilt at destroying a life and/or opting out of rearing a handicapped child. Recent research has demonstrated substantial levels of psychiatric morbidity after termination for fetal abnormality, particularly in those with a past psychiatric history, those with poor social support, and those who feel they have opted out of bearing a handicapped child. Women receive little support of follow-up after such terminations, yet many would benefit from it. Such women are in particular need of reassurance and support during a subsequent pregnancy."
- J Am Med Womens Assoc 1989 Jul;44(4):113-115
Psychological profile of dysphoric women postabortion.
"Women who identified themselves as having poorly assimilated the abortion experience were surveyed using a demographic questionnaire, the Beck Depression Inventory (BDI), and the Million Clinical Multiaxial Inventory (MCMI)...Women with multiple abortions scored significantly higher on the BDI and also scored higher on the borderline personality subscales of the MCMI. Besides multiple abortions, other risk factors for postabortion dysphoria identified in this study were premorbid psychiatric illness, lack of family support, ambivalence, and feeling coerced into having an abortion."
- Int J Soc Psychiatry 1993;39(4):255-265
Post-abortion perceptions: a comparison of self-identified distressed and nondistressed populations.
"This study investigated the experiences of 25 women who described themselves as responding in an emotionally distressed manner to abortion and a comparison group of 25 women reporting more relieving/neutral responses...The distress group had significantly higher scores on initial stress response and religiosity, were more often currently affiliated with conservative churches, and reported lower degree of social support and confidence in the abortion decision."
- Science 1990 Apr 6;248(4951):41-44
Psychological responses after abortion:
"A review of methodologically sound studies of the psychological responses of U.S. women after they obtained legal, nonrestrictive abortions indicates that distress is generally greatest before the abortion and that the incidence of severe negative responses is low. Factors associated with increased risk of negative response are consistent with those reported in research on other stressful life events."
- J Pers Soc Psychol 1990 Sep;59(3):452-463
Perceived social support, self-efficacy, and adjustment to abortion:
"Prior to their having a 1st trimester abortion, women's perceptions of social support from their partner, family, and friends and self-efficacy for coping were assessed...As predicted, perceived social support enhanced adjustment indirectly through its effects on self-efficacy. Women who perceived high support from their family, friends, and partners had higher self-efficacy for coping. Higher self-efficacy, in turn, predicted better adjustment on the psychological measures but not on the physical complaint measure. No direct path between social support and adjustment was observed. In addition, women who told close others of their abortion but perceived them as less than completely supportive had poorer postabortion psychological adjustment than either women who did not tell or women who told and perceived complete support."
- South Med J 1990 Jul;83(7):736-738
Postabortion dysphoria and religion:
"This study explores psychosocial factors, especially religion, in women identified as dysphoric 1 to 15 years after abortion. The Millon Clinical Multiaxial Inventory (MCMI) and a demographic questionnaire were mailed to patient-led support groups for women who had poorly assimilated a previous abortion experience. Of the 150 surveys mailed, 71 (47%) were returned. Thirty-three women (46%) stated they had changed to a Fundamentalist or Evangelical church. On the MCMI, members of these conservative denominations scored significantly lower on the subscales for passive-aggressive behavior, ethanol abuse, and avoidance. Religion was strongly perceived by the women as playing a healing role. These findings suggest that conservative personal values may be more critical in understanding attitudes toward abortion than other demographic characteristics. Previous follow-up studies that reported no change in postabortion religiosity may have been too short to detect changes in religion. Implications for treatment of postabortion dysphoria include sensitivity to patients' religious beliefs, with support for the healing aspects of their religion."
- Eur J Obstet Gynecol Reprod Biol 1998 Aug;79(2):173-178
Emotional distress following induced abortion: a study of its incidence and determinants among abortees in Malmo, Sweden:
OBJECTIVE: To study incidence and determinants of emotional distress following induced abortion...SUBJECTS: A series of 854 participants at 12-month postabortion follow-up, representing 66.5% of the 1285 women undergoing induced abortion at Malmo, 1989. METHODS: Analysis of data elicited at a semistructured interview 1 year after induced abortion, risk factors for emotional distress being determined in a "case" subgroup (n = 139) of women satisfying all the inclusion criteria (i.e., postabortion emotional distress, doubts about abortion decision, would not consider abortion again), as compared with a control group (n = 114) satisfying none of the inclusion criteria...In the subgroup with emotional distress (duration ranging from 1 month to still present at 12-month follow-up), the following risk factors were identified: living alone, poor emotional support from family and friends, adverse postabortion change in relations with partner, underlying ambivalence or adverse attitude to abortion, and being actively religious. CONCLUSIONS: Thus, 50-60% of women undergoing induced abortion experienced some measure of emotional distress, classified as severe in 30% of cases. The risk factors identified suggest that it may be possible to ameliorate or even prevent such distress."
- Acta Obstet Gynecol Scand 1995 Nov;74(10):813-817
Ambivalence among women applying for abortion:
"Our purpose was to characterize women expressing ambivalence when applying for abortion. MATERIAL AND METHODS. Data were collected, by self-administered questionnaires, from 339 women. Thirty percent were in doubt about the decision when the abortion was due. Socioeconomic factors more often influenced the choice among ambivalent women than among those not in any doubt. RESULTS. Ambivalent women more often felt exposed to social pressure and some felt that the abortion was not their own choice. Their decision-making was marked by doubt during the entire process. CONCLUSIONS. There is a need for professional support during this decision-making process. Many of the ambivalent women stated that their decision might not have been the same under different personal circumstances."
- J Pers Soc Psychol 1985 Mar;48(3):585-599
Attributions, expectations, and coping with abortion:
"We examined cognitive predictors of coping with a negative life event...As predicted, women who blamed their pregnancy on their character coped less well than low self-character blamers, but contrary to predictions, self-behavior blame was unrelated to coping. Women who had high coping expectations before the abortion coped much better than those with low coping expectations. Women who found their pregnancy highly meaningful, however, coped worse immediately after the abortion than did women who found their pregnancy less meaningful. Intentionally of the pregnancy was related to depression three weeks after the abortion, and women accompanied by their partner to the abortion clinic coped less well immediately after the abortion than women unaccompanied by their partner."