Trauma Associated with Do-it-yourself Abortions

In February, a group of pro-abortion doctors penned a commentary for the New England Journal of Medicine explaining why the drug Mifepristone should be available in pharmacies, citing safety and convenience. This group was spearheaded by Dr. Daniel Grossman of the ANSIRH program at the University of California, San Francisco, the same program that produced this fatally-flawed study (which I wrote about here).

For the unfamiliar, Mifepristone is a progesterone blocker. A woman in the early stages of pregnancy can take the Mifepristone pill, and it will cause the lining of her uterus to detach. This in turn will deprive the child of nutrients, bringing about the child’s death. Between 24 to 48 hours later, the woman will take another pill, Misoprostol, which will cause contractions and allow her to deliver the dead child.

The push to expand usage follows the rise of so-called do-it-yourself (DIY) abortions in the United States. The FDA first approved the use of Mifepristone, also known as RU-486, in 2000 for the termination of pregnancy up to 7 weeks. In March of 2016, the FDA relaxed those restrictions, and Mifepristone can now be used for abortions up to 10 weeks. Currently, between 20-25 percent of abortions in the United States are medical abortions.

Yet despite this increase in usage, concerns linger regarding access to DIY abortions, many of which have been well documented. These concerns revolve around lack of medical attention in cases of complication, and inability of many women to recognize complications should they arise. But there is another bothersome aspect that deserves some attention.

While abortion advocates would like to deny it, it’s long been known that many women suffer trauma after abortion. Indeed, I have been working as a licensed mental health practitioner with the post-abortion ministry Rachel’s Vineyard for six years, and one of my most poignant early memories was hearing a woman describe her experience of a medical abortion. It involved lots of bleeding onto her floor, intense cramping, vomiting, and ultimately delivering her deceased child and having to dispose of the child herself. Her story is tragic, and it is traumatic. Over the years, I have heard and read many stories such as hers, many of them equally disturbing.

Symptoms of trauma can develop after any event that is physically or psychologically distressing. Certainly her story and the stories of many others who have chosen abortion are distressing in many ways, and it’s not surprising that trauma responses occur in some of these instances. These traumatic responses can take the form of nightmares, flashbacks, intrusive thoughts or memories regarding the abortion experience, acute anxiety, panic, or intense distress when exposed to triggers or reminders of the abortion.

While abortion, no matter where it’s performed, is always an intrinsic evil and should be rejected as such, medical abortions have the capability to produce a unique type of trauma. It is a trauma that is different from that potentially produced by surgical abortion in a few ways. First, during a surgical abortion, the woman is at least mildly sedated; during a medical abortion she is not. This means that any memories that she has of the abortion experience are more vivid and more easily remembered. Second, and perhaps the larger concern for the potential development of trauma, medical abortion changes the locus of the abortion from a surgical center to one’s residence.

On the surface, this may not seem like a big deal. But if we acknowledge that some women experience traumatic responses to abortion, it is equally vital to acknowledge that with a medical abortion, the locus of that trauma moves from a surgical center to the woman’s home.

This is problematic because, as noted, with a trauma response comes intensified negative thoughts and emotions when exposed to reminders of the experience. Sensory stimuli associated with the traumatic experience might trigger acute anxiety, disturbing mental images or other negative sensory flashbacks. Sometimes these triggers happen consciously, and sometimes they do not. But if a woman has a negative abortion experience, she is likely to develop negative thoughts and emotions that can be triggered by any reminders of that experience.

If the locus of a negative abortion experience is a surgical center, it is less difficult to avoid triggers that might elicit negative thoughts or emotions. If driving by the abortion clinic on the way home from work brings anxiety, it is easy to take a different route home. If reminders of the sound of the abortion machine bring a sense of panic, it is easy to escape a situation and move oneself to a different location.

In these cases, a woman might be able to avoid triggering events or stimuli which cause distress, and while this is not optimal or even healthy, it is advisable until such a time as she is ready to face the traumatic experience and learn to manage the negative thoughts and emotions related to it. Conversely, it is not advisable to flood a woman’s sensory experience with reminders of the trauma, leaving her in distress with no coping skills or tools to manage that distress.

But medical abortions change the locus of the trauma. It is no longer possible to take a different route home from work to avoid reminders of the trauma. It is no longer feasible to escape sensory reminders by moving to a new location. Now these triggers and reminders wait for the woman at home, and there is nowhere to flee. Her sensory experience is flooded with reminders of the abortion at her own residence. Oftentimes, the woman is ill-prepared to manage these triggers, which in turn can cause more distress and the trauma experienced during the abortion is compounded.

The only conceivable way that a woman could avoid the triggers or reminders at her home would be to change residences, but this suggestion is problematic for several reasons. First, moving to a new home is not feasible for everyone. About ¾ of women obtaining abortions are low-income. This is generally a population that has fewer housing options and limited housing mobility. Second, even for those who are able to move, it almost never happens immediately. This results in a prolonged exposure to the distressing stimuli, which can result in severe psychological damage. Third, as with any trauma, avoiding the triggering events or stimuli is still neither optimal nor healthy. It may be the best choice for the woman’s short-term mental health, but it does nothing to address the trauma that will continue to manifest in the woman’s life until she acknowledges and reconciles the event that caused the traumatic response in the first place.

This concern regarding medical abortions is especially valid considering that the FDA now approves the use of Mifepristone later into pregnancy. A woman given a DIY abortion at 9 weeks gestation will have to deliver that child, and while an unborn child at 4 weeks gestation might look like a mass of tissue, an unborn child at 9 weeks is easily discernible as a human being. There is little question that the experience of seeing one’s deceased child increases the possibility of a traumatic response.

These concerns need to be taken into account when considering the well-being of women who may be inclined to choose abortion. Unless steps are taken to understand and acknowledge the possibility of trauma produced by DIY abortions, we are doing a grave disservice to those who experience this painful and ugly practice. Withholding information regarding possible negative reactions after any abortion procedure is not only unethical, it deprives a mother of vital information that would help her make a better, more informed choice.