Pink and blue pastel colorsAbortion has long been one of the most controversial issues in the United States. The right to choose to terminate a pregnancy, up to the point when the fetus is viable outside the womb, is protected by federal law, but the process is often more complex than it seems, due to the stigmatization of those who have abortions, state restrictions on abortion, limited access to abortion, and so on. With the support of a counselor or other mental health professional, a woman who is considering abortion can obtain factual, unbiased information about her options, discuss her feelings, and come to a decision without pressure or judgment.

Challenges Associated with Unplanned Pregnancy

Nearly half of all pregnancies in the United States are unplanned. Those who find themselves unexpectedly pregnant have three options: parenting, abortion, and adoption. About 40% of women who experience an unplanned pregnancy will choose abortion, and 3 in 10 American women will have an abortion by age 45. Those who oppose abortion often claim that it is used as a form of birth control by women who did not use contraception, but in reality, statistics show that approximately half of all women who have abortions do so after a contraception method has failed.

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Pregnancy can be demanding on physical and mental health, but raising a child is a long-term commitment that a woman might feel she is not yet ready for. Studies show that women who choose to become pregnant may be, in general, both emotionally and financially more prepared to face the mental and physical challenges that are associated with pregnancy and parenthood than those who did not choose to become pregnant. Those who feel they are not ready to become mothers may choose to have an abortion or give the child up for adoption, and while they may not ever want children, they may also wish to have them in the future, when they are better equipped to care for a child. Many women who have abortions are already mothers and want to focus their time and resources on caring for the child or children they already have.

A woman may choose to have an abortion for many reasons. She may not have the resources or the desire to raise a child. Her health care may be nonexistent or inadequate to cover office visits, prenatal care, and a hospital stay during labor and delivery. She may not wish to put school or career on hold in order to deal with the challenges of pregnancy or the demands of caring for an infant, or she might not want to raise a child alone or with a partner who is ambivalent about children. Whatever her reasons, a woman has the right to choose whether she continues a pregnancy and raises the child, finds an adoptive family for the child, or has an abortion, and legally, this decision is hers alone.

Facts About Abortion

Abortion is legal in the U.S., and it has been proven to be a safe procedure with little risk. Fewer than .05% of women reported serious complications that required hospitalization or an additional procedure following an abortion performed in the first 13 weeks of pregnancy, while about 2.5% of women reported minor complications that did not require hospitalization. Myths propagated by those who do not support abortion claim that a woman may be less able to carry a child to term after having an abortion or that she may become sterile, but in the absence of certain rare complications, this is not the case. Research supported by the National Cancer Institute also refutes the claim that having an abortion increases a woman's risk of developing breast cancer.

Despite the legality of abortion, access to the procedure is often limited, as there are no abortion providers in 87% of counties in the U.S. Many states have bans on abortion in place that would take effect should Roe v. Wade, the decision allowing women the right to make decisions about their own bodies and pregnancies, be overturned.

Recent statistics show that the abortion rate in the U.S. is the lowest it has been since 1973. Researchers cite a drop in pregnancy and increased and improved contraceptive use, including the use of long-term methods such as the IUD. State efforts to restrict abortion and a decrease in the number of abortion providers were not cited as reasons for the declining rate. With an increase in access to age-appropriate sex education that provides accurate information, affordable or no-cost birth control, emergency contraception, and family planning services, the abortion rate is likely to further decrease. The statistics also show that women who seek abortions now are more likely to do so earlier in pregnancy: Though the abortion rate declined, the number of early medical abortions increased.

Legal Restrictions on Abortion

Some states also impose time restrictions on the procedure, prohibiting abortions after so many weeks of pregnancy. For example, in most states, abortion is not allowed after 24–26 weeks, as this is often considered to be the point in pregnancy where the fetus is considered to be viable outside the womb. However, new legislation in North Dakota and Arkansas bans abortions after 6 and 12 weeks, respectively. Kansas has also passed legislation to ban the dilation and evacuation procedure, which is generally used for abortions that take place after 14 weeks. Multiple states also set restrictions for providers involving clinic space, door and walkway size, proximity to hospitals, and so on. Many of these restrictions have little to no effect on the safety of the procedure and only serve to further limit access to abortion services.

In 17 states, a woman must receive counseling before the procedure can take place. This counseling often includes information regarding potential effects of abortion, such as long-term mental health consequences after an abortion or a fetus's ability to feel pain, although research and scientific evidence dispute both of these claims. In some states, a woman must receive an ultrasound and be offered the chance to view an image of the fetus. In 26 states, women must wait between appointments for a certain period of time, generally 24 hours, before the procedure can be performed, which often results in the necessity of two separate trips to the clinic. This restriction serves to further limit access to abortion, as it may make receiving abortion services difficult for women who live a significant distance from a provider and must miss work and pay for gas, a hotel room, and other expenses, in addition to the cost of the abortion. In 38 states, it is necessary for a minor to notify her parents or obtain their consent before seeking an abortion, but in cases of abuse or incest, this law may bring further harm to the minor. A judicial bypass is the only way for a minor to waive this requirement.

California recently passed legislation to allow nurse practitioners, nurse-midwives, and physicians' assistants to perform aspiration abortions once they have completed specified training. Only four other states allow non-physicians to perform this type of abortion, although several states allow non-physicians to administer a medical abortion. This new law increases access to abortions, and although concerns about the safety of the procedure have been raised, a six-year study undertaken by the University of California, San Francisco, shows that the complication rates were the same—less than 2%—whether the abortion was performed by a licensed physician or another trained health care professional.

Stigmatization of Abortion

The right to abortion is considered by many to be an important aspect of health care for women: Over a third of American women will have an abortion in their lifetime. However, the increase in restrictions on abortion in recent years and the view, held by many, that abortion is something shameful and something to keep quiet about help further the stigma surrounding abortion and those who have had one. This stigmatization of abortion can be harmful, because it often has the effect of isolating those who have had an abortion when they could potentially be better served by the sharing of stories and experiences. Instead, many individuals feel alone when deciding on abortion, especially when those who are anti-choice may tell them they should feel bad and regret their decision. This may have the effect of causing women to experience negative emotions, even if their decision was right for them, and they may experience a decline in self-esteem or symptoms of depression, due to what they perceive other people think of their decision.

Many of those who are considering abortion may, due to lack of knowledge or support or out of the desire to keep their decision private, find themselves in a crisis pregnancy center by mistake. These centers are generally not real health care centers, and they may not provide any actual medical information. Run by people who are opposed to abortion, these clinics operate with the goal of preventing abortion, which they often attempt to do by scaring those seeking abortions; providing them with false or misleading information, films, and images about pregnancy, abortion, and birth control; or by lying about the side effects of abortion. Because these clinics present false information as facts, many women may be misled and put off having an abortion until it is too late. Because abortion is not a widely discussed topic and because in some states, doctors are required to state unproven claims as facts, women may believe these claims to be accurate and may not know where to turn for reliable information.

Deciding what to do in the event of an unplanned pregnancy is a difficult choice for many, but all people have the right to unbiased and accurate information about their options, including abortion. Ending the stigmatization of abortion will likely help facilitate more informed decisions and lead to greater support for those who choose to have an abortion, while continued attempts to control one's reproduction health and rights is only likely to further the idea that abortion is something immoral and may ultimately lead to the birth of many children who are unplanned, unwanted, and/or who cannot be adequately cared for.

How Therapy Can Help: Before and After Abortion

An individual who is considering abortion may not wish to or be unable to confide in friends or family, she may receive conflicting information from family members and clinics, or she may be unsure of her own feelings about abortion. An unbiased therapist or counselor will generally be able to provide accurate information about abortion, as well as clinic or provider information, and a woman can explore her feelings and any reservations she may have about abortion, consider and discuss all of her options, and know that she is not alone. Those who are being pressured to have an abortion or to not have an abortion can also seek support in making the best decision for themselves.

A number of anti-abortion groups claim that after having an abortion many women may experience what is called post-abortion syndrome, a condition that is purported to have symptoms similar to posttraumatic stress. However, medical opinion, including that of the American Psychological Association, does not recognize this condition. Although some of those who have an abortion may experience feelings of anger, regret, guilt, or sadness, others may feel significant relief or feel grateful that they could have the procedure. Some may experience significant stress and difficulty after an abortion, while some may experience no psychological symptoms whatsoever. In general, studies indicate that the time of greatest distress is just before an abortion and that distress is more likely to occur in those who believe the fetus is a baby before it is born or who have other religious beliefs that conflict with abortion. Studies also suggest that emotional well-being before an abortion is the best predictor of one's emotional state after an abortion.

Women in a relationship who are considering abortion may wish to discuss their decision with their partner, and some may find it easier to do this in the presence of a therapist, who can act as a mediator or offer unbiased support, making it easier to tell a partner who may not agree with the decision. A couple who is married or cohabitating can discuss their goals for the future and their desire or readiness for children, and a woman may be able to make a better-informed decision with counseling and with the support and help of her partner, if she desires it.

Research shows that although many women experience feelings of guilt, sadness, or loss after choosing to have an abortion, these emotions are typically short-lived, and they are often overcome without professional help. However, feelings of shame and guilt may be exacerbated by a community where abortion is stigmatized, and feelings of loss or depression may be worse in cases where one felt pressured into having an abortion. Hormonal changes that occur as the body readjusts after the termination of the pregnancy may also lead to sadness in some individuals.

Someone who must terminate a planned or wanted pregnancy for medical reasons, who experienced mental health issues prior to the abortion, or who has a religious background that leads them to regret their decision to have an abortion may be more likely to experience long-term psychological issues following an abortion. Some women may also grieve the loss of the pregnancy while still being relieved that it is over and may struggle with other conflicting emotions. In these cases, therapy is often beneficial. Women who told no one about the abortion and feel isolated as a result may also find support in therapy or in support groups.

A woman's partner may experience feelings of anger, grief, or regret when learning of an abortion. These feelings are valid, and therapy may be helpful as the partner works through any sadness or negative feelings. In some cases it may be necessary for the partner to realize that the decision to terminate the pregnancy was not theirs to make, and a therapist may often be able to help them achieve understanding.

Case Examples

  • Teen seeks counseling to discuss options for unplanned pregnancy: Alicia, 17, seeks out her high school guidance counselor when she discovers that she is pregnant. She tells the counselor that she had sex with her then-boyfriend, but he lied to her about wearing an condom, and she could not obtain emergency contraception in time. Alicia states that she wants to go to college and that she knows she is not yet ready to be a mother but that if she tells her parents, who are religious, about the baby, they will insist she keep it and pressure her to marry her ex-boyfriend, which she does not want to do. Because Alicia's state requires parental consent and notification before an abortion, she cannot obtain one on her own, and she asks the counselor for help. The counselor tells Alicia that she can go before a judge and present her case in order to have the requirement for parental consent waived, and she helps her complete the necessary paperwork in order to do so. With the help of the counselor, Alicia is able to obtain a judicial bypass, and after the abortion, she reports to the counselor an immense feeling of relief and says that she looks forward to attending college, and that she plans to have a family someday, when she is ready.
  • Mother of two becomes pregnant, cannot afford another child: Justine, 38, contacts a therapist and expresses her wish to discuss conflicting feelings regarding abortion. She reports that she is pregnant after a casual sexual encounter, citing failure of the birth control pill, which she takes regularly. Justine tells the therapist that she is overwhelmed and confused. Both of her two children were unplanned, though she was happy to have them and never considered abortion. However, she is now a single mother and, although she is doing fairly well for herself, she cannot afford to take time off work for pregnancy-related illness or to spend time with the baby in its infancy. She does not have any family members who could help with care, and she also admits that she did not expect or desire to have another baby. Although she is pro-choice, she tells the therapist that abortion was never an option for her personally in the past and expresses feelings of guilt for her desire to terminate this pregnancy. The therapist tells Justine that it is normal to have conflicting feelings and encourages Justine to explore her feelings further in order to be certain that she is making the right decision for herself. Justine ultimately decides to have the abortion and visits the therapist twice more after the procedure in order to discuss her feelings of relief at making the best decision for her family and the sense of grief she feels for being unable to have and raise another child.
  • Young woman considers abortion in therapy: Nadia, 29, is receiving treatment for depression when she discovers that she is pregnant. She has been making good progress in therapy, but her mother encourages her to have an abortion, telling her she should "sort out (her) own issues" before having a baby. Nadia would like to keep the baby but wonders to her therapist if her mother is right. She tells the therapist that her boyfriend has been supportive throughout her depression and that she could see them raising a child together. However, she is seriously considering abortion, as she is not sure she is ready for parenthood at this point in her life. The therapist reminds Nadia that she has been doing well in therapy and that having a child is a decision only she can make and encourages her to consider what she really wants. Together, they explore the ways that a child and family might be a positive addition to Nadia's life and the potential stress that may accompany pregnancy and parenthood. In the end, Nadia decides that she is ready to become a mother and that she does not have to put her desire to have a family on hold as she continues treatment. During her pregnancy, Nadia continues to improve in therapy, and by the time her child is born, she feels empowered and able to face the challenges that parenthood might bring.

References:

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  3. Abortion Restrictions in States. (2013, June 17). Retrieved from http://www.nytimes.com/interactive/2013/06/18/us/politics/abortion-restrictions.html?_r=0
  4. Crisis Pregnancy Centers. (2014). Retrieved from http://www.plannedparenthood.org/learn/pregnancy/crisis-pregnancy-centers.
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    Parental Consent and Notification Laws. (2014). Retrieved from http://www.plannedparenthood.org/learn/abortion/parental-consent-notification-laws
  8. State Policies in Brief: An Overview of Abortion Laws. (2015, June 1). Retrieved from http://www.guttmacher.org/statecenter/spibs/spib_OAL.pdf
  9. Thinking about Abortion? | Information to Help you Decide. (n.d.). Retrieved from http://www.plannedparenthood.org/learn/pregnancy/pregnant-now-what/thinking-about-abortion
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