Rachel M. MacNair, Ph.D.

 

Introduction

      This paper takes a theoretical approach, asking what hypotheses can be derived from differing perspectives on the topic of abortion. It reviews much of the research literature for what has been discovered thus far, and proposes what further research needs to be done to better establish which perspective fits reality. Opposing hypotheses will cover the social and psychological impacts on children, post-abortion women, the male partner and other family, abortion staff, and women as a whole; pregnancy prevention; how to understand the opponents of the perspective, and possibilities for conflict transformation. The discussion will put these considerations in the context of peace studies concepts and approaches, with an emphasis on psychology. 

        The philosophical perspectives on abortion in contemporary controversies can be understood on a continuum from support to opposition, and as with most continuums more people are somewhere along the middle rather than at either extreme. Here we will call the two extremes abortion-as-option and abortion-as-violence, with the continuum between called abortion-as-tragic-necessity.Research_Agenda_2.jpg

         The term “pro-choice” is commonly used for abortion-as-option, and would be insisted upon by any peace advocates who favor abortion availability. Their reasoning is for the liberation of women and perhaps also for the alleviation of poverty. However, this extreme is also occupied by men who wish the women they impregnate to take this option whetheror not the women themselves actually desire it. Similarly, there are those that are interested in eugenics or who take a racist attitude. For purposes of this paper, we are only interested in aspects of interest to peace psychology and therefore will not be considering the views of those for whom the reasoning of an option of abortion is not for women’s benefit.

         Similarly, the term “pro-life” is commonly used for the abortion-as-violence perspective, but this view is held by many for whom sensitivity to a right-to-life concern is narrow and does not extend to opposing war or capital punishment or favoring effective anti-poverty programs. This has been particularly true in recent partisan politics in the United States and several other countries. In the same way, this paper is only considering the views of those who oppose all these forms of violence across the board, in what is commonly called the “consistent life ethic” (MacNair & Zunes, 2008). This view is officially held by many Catholic documents and the Mennonite church (Mennonites being a traditionally pacifist church) as well as a large number of people of varying religions and of secular orientation in the peace movement. The philosophies of pro-life feminism (Derr, MacNair, & Naranjo-Huebl, 2006) and the literature of the Prolife Alliance of Gays and Lesbians (www.plagal.org) will also be of more appeal to peace movement activists.

         In both cases, those that hold views not consistent with the actual meanings of the terms “choice” or “life” are not of interest because this paper is focused on the interests of peace psychology. We simply acknowledge at the beginning that both extremes hold adherents that are not of a peace orientation. We therefore use more descriptive, neutral terminology for the views; this should also help us focus on the meaning of the terms without reference to wording which have accrued a great deal of emotional meaning due to current debates.

         The “tragic necessity view” has at one end of its continuum people who are strong advocates of abortion availability and may even be abortion providers. An example is the title of the book, In Necessity and Sorrow, in which Magda Denes (1976) discusses abortion as an unfortunate need. Another is the statement of a woman abortion doctor: “Sorrow, quite apart from the sense of shame, is exhibited in some way by virtually every woman for whom I’ve performed an abortion, and that’s 20,000 as of 1995. The sorrow is revealed by the fact that most women cry at some point during the experience . . . The grieving process may last from several days to several years” (Poppema,  1996). These are eople who use the pro-choice label but nevertheless recognize in various degrees that abortion is more trying than a tooth extraction. On the other end are people who might use the term “pro-life” to describe themselves, but only because they believe it wise to discourage abortion as a matter of persuasion, with it still being readily available for extreme cases.

        The fact that peace advocates can be found on both sides and in the middle of the continuum has much to do with understanding the status of the human embryo and fetus. If the status is one of “products of conception” or tissue, then removing the growth is nothing more than ending an unwanted pregnancy, and the understanding that this is entirely a decision for the pregnant woman would be determinative; this goes with the “abortion-as-option” view. If the embryo or fetus has the status of a baby, a human being entitled to the rights all human beings have to be protected from being killed, then abortion is an act of violence subject to all the problems that using violence as a problem-solver commonly has, as would be understood in the “abortion-as-violence” view. If the embryo or fetus is understood to be a living organism but one with a status similar to an animal, then killing an animal is to be avoided when possible but
allowed when really needed. Persuasive abortion reduction programs are a good idea, but not legal bans; hence, abortion-as-tragic-necessity.

       Most of the hypotheses proposed in this paper will be in the abortion-as-option or abortion-as-violence alternatives because it is at the extremes where the hypotheses are, as a matter of logic. The tragic-necessity view will sometimes take the hypotheses generated under the option perspective, and at other times will take those generated by the violence perspective, but will rarely generate hypotheses of its own.

Propositions and Hypotheses

Psychological Impact on Children

Hypothesis 1: Child Abuse

Abortion as Option: Because unwanted children are for the most part not born, child abuse and neglect (excluding sexual abuse) will be lower in those places and times in which abortion is legal or otherwise readily available.

Abortion as Violence: Because abortion models violence as a way of solving problems and
diminishes the taboo against hurting children, child abuse will be higher in those places and times in which abortion is legal or otherwise readily available.

        The first line of evidence is epidemiological. In the United States, there was a sudden change in the status of abortion; while a few states had legalized it right beforehand, the United States Supreme Court decision of Roe v. Wade in 1973 made it legal in the entire country. This provided a sharp contrast to previous years. The statistics gathered show that the rate of child abuse took a sharp upturn at that point, which lasted throughout the 1980s. According to the U.S. Department of Health and Human Services, cases went from 167,000 in 1973 and 785,100 in 1980.

        There have been arguments about these data, since there may have been a concomitant rise in reporting the cases because of greater sensitivity. It may be that what was hidden before was no longer hidden, and it was the reporting that increased rather than the abuse itself – which would be a positive development. Additionally, the definitions of abuse changed to encompass more activity, which would of course make the figures incomparable.  In any event, when looking at outcomes for an entire society, innumerable variables could be explanations; we could never know that the abuse rates would not have been higher yet without abortion. Therefore, while this evidence by itself does not establish the abortion-as-violence hypothesis as more accurate, it does at least weaken the case for the abortion-as-option hypothesis.

         However, the abuse rates started going down in the 1990s. This was part of a downward trend in various types of violence, including street crime. In book for popular audiences, Freakonomics (Levitt, 2005), the idea was advanced that the abortion legalization of 1973, which led unwanted children to be aborted, had now borne fruit inasmuch as those aborted had not become the teenagers who would be most inclined to commit crime. The teenagers did not exist. The inherent racism of this argument caused a great deal of discomfort in many quarters; preventing crime by preventing people is not the normal peace-psychology approach to crime prevention. But from a purely epidemiological perspective, there was a more numerical objection: during this same period, in the 1990s, the abortion numbers and abortion rate and ratio of abortions to live births also started a steady decline. The abortion-as-violence hypothesis would understand this as consistent with a decline in child abuse; if the abortion numbers decline (perhaps as the result of state regulations that the Supreme Court allowed after the Planned Parenthood vs. Casey decision of 1992), then any physical abuse and neglect of children would also be expected to decline.

        Again, however, a large number of variables could account for anything that is society-wide, and speculation as to why ranges broadly (Finkelhor  & Jones, 2006).

         A more targeted approach is taken by Sen & Wingate (2006), by doing a longitudinal analysis of fatal injury to children in states that have passed regulations such as parental consent, informed consent, and waiting periods. They found an effect of increased injury
with this approach.

         However, if the abortion-as-violence hypothesis is correct, then this requires an even more targeted approach yet – rather than a society-wide epidemiological one, the question becomes more focused: Are mothers who have abortions more likely to be abusive to their children? This approach has been undertaken in several studies (Ney,  P. G., Fung, T., & Wickett, A.R, 1993; Coleman, P. K,, Reardon, D.C., & Cougle J., 2002; Coleman, P. K., Maxey, C. D.,  Rue, V. M., & Coyle, C. T., 2005; Coleman, P. K., Rue, V. M., Coyle, C. T., & Maxey, C. D., 2007). In these peer-reviewed studies, the answer is yes.

         Here we encounter a point that will be a constant problem throughout the research on abortion: those that study it the most are those that feel strongly on the topic, and therefore have a position on it. The approach they take will be informed by this position, as will the conclusion they take from the data. A recurring theme in this research agenda is the importance of having both viewpoints, along with the tragic-necessity viewpoint and those who care only that methodology is done correctly, represented among teams of scholars doing research. They can serve as checks on each other, challenging assumptions and offering alternative explanations and approaches. This would be most in line with the needs of science, and the conflict-transformation approach involved is most in line with the insights of peace psychology.            

         Other countries will also have evidence as their child abuse rates vary in relation to the availability and prevalence of abortion. Studies of this, those that have been done and those than yet need to be done, would be an area of research that could contribute much more insight to this question.

Hypothesis 2:
Developmental Impact

Abortion as Option: The children of women who wished to abort them but were unable to suffer in comparison to other children.

Abortion as Violence: The availability of abortion will be detrimental to those children who are born in spite of it when it was requested by their mothers.

        The research that most thoroughly addresses this hypothesis is coalesced in the book Born unwanted: Development effects of denied abortion (David, Dybrich, Matejcek, & Schuller, 1988). The largest study they report is the Prague Cohort Study, but there were smaller studies also in Sweden and Finland. The approach for the Prague Cohort is that there were historical periods in which, in the move from abortion bans to allowing some abortions, women could obtain legal abortions by making application to a committee. If the committee turned down the request, and then the appeal was also turned down, a woman would have made two requests for the same pregnancy and then, to be included in the study, given birth to the baby. If these babies were air-matched to those similar in social class, gender, exact time of birth, siblings, and so forth, how would they compare with the children from accepted pregnancies?

        The answer is complicated, of course, as they differed on some things and not on others. The author’s summary includes:

        "Inspection of the data reveals that the difference is not so much in UP [unwanted pregnancy] children failing more often, but rather in being substantially underrepresented amon0 the students graded above average, very good, or outstanding . . . the UP children consistently appeared worse, primarily due to underrepresentation in the above-average categories" (p. 88)

        To re-iterate: “the UP subjects are not so much overrepresented on the extremely negative indicators as they are underrepresented on the positive ones” (p. 124).

        If differences found were selection bias, in that all the children have mothers who are either
inarticulate or feel ambivalent  enough to be unable to convince a committee, then the authors believe this to be irrelevant The authors and editors of this book are unambiguously of the
“abortion-as-option” position, and their conclusion is that abortion should be completely legal so that no child goes through the disadvantages inherent in being “born unwanted.” Those of the “abortion-as-violence” position, however, are naturally unimpressed. If abortion is killing a human being, then doing so to avoid being underrepresented among the above average seems rather draconian.

       Yet the abortion-as-violence alternative hypothesis fits the results of the study every bit as well: putting women through the exercise of twice requesting their children be aborted may be the explanation for why the children have a slight tendency not to do as well. Taking a society-wide attitude that once a pregnancy occurs, that means a child with a right to life exists, may have been much more helpful to these children. The very exercise of making a judgment as to whether or not to allow the fetal life to continue may cast a shadow over subsequent events.

         The children themselves don’t seem to abide by the proposal that they are better off dead; out of all the studies with their longitudinal follow-up, only one suicide was found (p. 43). Many mothers changed their minds, as over a third – 36% – denied that they had even made the abortion request, and a solid majority of 73% of the women were satisfied with how the situation was resolved (p. 48). Only a small portion had placed the children for adoption.

         Peace psychology in particular has something to add to this debate, as one of the measures used to ascertain the “unwanted pregnancy” children as problematic was that they were significantly likely to have more votes of classmates “as the greatest coward, braggart, loner, most audacious . . .” (p. 70).  What kind of society has classrooms in which the teacher encourages children to vote on such labels, and records the vote in such a way as to make them available for data? This is not the kind of conflict-resolution or anti-bullying approach favored in peace education.

         If similar findings were found instead for racial or ethnic or social class differences among children, the response of peace advocates would be to find interventions to improve the outlook for such disadvantaged children. The differences are slight enough that such an approach appears quite workable.    

         In short, the known data fit both hypotheses, but mainly establish that the difference is not dramatic. It is unlikely that much further data will be gathered on this question, since the requirement of an authority that can grant or deny applications for abortion is a historical phenomenon that is repugnant to both pro-choice and pro-life advocates and will therefore lack political support to be re-established.


Psychological Impact on Post-Abortion Women
 

Accounting for Negative Aftermath

Abortion as Option:  Any negative aftermath can be accounted for by societal stigma, second-guessing a decision, or the fact that negative problems such as domestic abuse or substance abuse were already present independent of the abortion.

Abortion as Violence: Negative aftermath can be expected in the form of post-trauma reactions.

Prevalence of Negative Aftermath

Abortion as Option: The majority of women who undergo abortion will find it to have been beneficial and be grateful, given that they were pregnant.  

Abortion as Violence: A large portion of women who undergo abortion will have post-trauma or avoidant behavior. 

        Reasons for and prevalence of negative aftermath are covered in the same body of research evidence, and there are hundreds of studies that address this question. Unfortunately, the best predictor of the conclusion is the previous philosophical predilection of the researchers. Arguments over the validity of the methodology and the findings are therefore lengthy and ongoing.

        The ideal way to deal with this, as stated above, is to have a team of scientists from different points of view who could work out at least where there is consensus and where further work needs to be done.

        The American Psychological Association (2008) did appoint a Task Force to review all the literature. However, the voice of women who felt traumatized by their own abortions was excluded from the Task Force membership, which was selected without public notice. Reviewers did include 2 of the 20 from the abortion-as-violence perspective, but reviewers only commented on the first draft and the revision received no such review. Criticisms of the report include that it left out some very good studies on the grounds that they were not done in the United States, yet the major study cited in support of their conclusion was British. The political ramifications of the conclusion were clear in the APA Council’s discussion of the vote on the report, and are clear in the report itself. The report is best understood as an attempt by people from the abortion-as-option perspective to gather documentation for their own understanding as stated above in the hypotheses; for this purpose, it is excellent.

        What is admitted in this Report about negative aftermath can therefore be understood as a scientific consensus, with the remaining points still in dispute. The consensus points below are drawn out of the report itself without the agreement of the Task Force members, who did not take up a reviewer’s suggestion that they be included:

  • Evidence does not warrant assertions of high prevalence of problems, but neither
         does it warrant assertions of a lack of problems. Prevalence rates are
         simply not known.

 

  • Clients can be advised that it is known that the following situations lead to a
         greater likelihood of post-abortion distress: younger age, a wanted or
         meaningful pregnancy, a view of the fetus as a viable human being,
         pressure from others, low social support from others, keeping it secret,
         and feeling conflicted or ambivalent about wanting the abortion. However,
         social support and partner support predict better outcomes.

  • Counselors should also be aware that a history of pre-abortion depression, a lack of
         self-efficacy, and a vulnerable personality profile, have been associated
         with greater post-abortion distress

  • Due to a high number of women with pre-existing problems such as domestic abuse or
         drug abuse among those seeking abortions, it may be that screening for
         these may be helpful for ascertaining the need for psychological or other
         interventions. 

        While there is argument over the extent and causes of the negative aftermath, there is no argument that some women do have some. Accordingly, the particular therapeutic needs of those women would be another crucial area of research if such women are to be helped.

 

Psychological Impact on the Male Partner and Other Family  

Abortion as Option:  The impact of an abortion on people other than the pregnant woman will be minimal.  

Abortion as Violence:  Negative aftermath can be expected in the form of post-trauma reactions.

        Unlike the research on abortion’s impact on the women who undergo it, the impact on the men whose participation was necessary for the pregnancy to occur have rarely been considered by people from the abortion-as-option theoretical perspective.  There is sparse literature from the abortion-as -violence perspective as well, but there is a book that details cases entitled Fatherhood Aborted: The Profound Effects of Abortion on Men (2001). This is not the kind of topic that should be left entirely to only one of the theoretical orientations to explore, if
scientific findings are to be rigorous.   

Psychological Impact on Abortion Staff

Abortion as Option:  Any negative aftermath can be accounted for by societal stigma and, most particularly, the stress of picketers.

Abortion as Violence: Negative aftermath can be expected in the form of the post-trauma
reactions that come from doing violent acts.


        The literature here is sparse. There are two studies done on relatively large numbers of abortion staff by researchers who are not themselves abortion staff (Such-Baer, 1974; Roe, 1989). Both found symptoms of what Such-Baer called “combat fatigue,” the then-current term for Posttraumatic Stress Disorder. They regarded this as a problem that needed to be resolved so this necessary service could still be provided.

        Conversely, abortion doctors have written their own autobiographies in books (Sloan & Hartz, 1992; Peppema & Henderson, 1996; Wicklund & Kesselheim, 2007). Evidence of post-trauma reactions can be found there for those looking, but the doctors themselves do not understand it that way, and do note the stress of dealing with their opposition. A researcher observing an abortion clinic viewed the experience as positive (Lunnenborg, 1992).

        There are also several observations of negative reactions as case studies. An abortion nurse reflects in a popular magazine article (Tisdale, 1987), and some observations of a doctor with his own staff (Hern & Corrigan, 1980). See MacNair (2002) for a full review.

        While the literature is too scant to assert conclusions, it is ample to show that continued investigation is warranted. This suffers from the same difficulty of having the researchers most interested having pre-determined views as to what the outcome should be. Additionally, current abortion staff people are unlikely to wish to interact with people they know to be opponents in a way necessary to do research, or they may skew their answers with the knowledge that those to whom they were giving the answers were opponents. Former abortion doctors and nurses who have become abortion opponents can give valuable information about the details of their experiences, but there is a similar bias in the presentation of the material. In all cases, these highly educated people may be aware of the political implications of what they say, and adjust what they say accordingly. Therefore, creative approaches are still needed in this area. 

Psychological Impact on Women as Whole

        Here we will offer general questions rather than more clear-cut hypotheses, since several testable hypotheses could be derived from each one. 
 

Equality

Abortion-as-Option: Control of reproductive lives is necessary for women’s equality.

Abortion-as-Violence: Telling women they must have surgery order to be treated equally is disparaging female biology and therefore a form of privileging male characteristics.

Discrimination

Abortion-as-Option: Forcing women to continue pregnancies is itself a form of gender discrimination.

Abortion-as-Violence: When pregnancies are regarded as optional rather than a condition to be accommodated, then those employers and schools who understand themselves to be inconvenienced are more likely to discriminate against pregnant women.

Pressure for Sex

Abortion-as-Option: For women to have control over their own bodies is all of a piece, including both sex and pregnancy. They are freer to have the sex they wish with abortion as an option.

Abortion-as-Violence: We still live in a patriarchal culture in which men feel entitled to sex. The surgery of abortion is one that women undergo, but the man does not, so he is not the one that takes the consequences. 

Pressure to Abort: 

Abortion-as-Option: The option is for women; they make the decision.

Abortion-as-Violence: Employers, men who want to avoid child support payments, parents who don’t want their teenager to embarrass them – the rhetoric of “choice” can mask the fact that it’s their choice, not hers.

Understanding the Opponents of the Perspective

        These hypotheses have been pulled from the literature and from the rhetoric of advocates.

Abortion as Option: People who do not understand pregnancy termination as an option can be expected to have or be more likely to have:

a) an authoritarian personality.

b) an intolerance of ambiguity.

c) a punitive attitude, especially toward women.

d) conventional views of sexuality and sex roles.

Abortion as Violence: People who propose abortion as a problem-solver will share with other advocates of violence as a problem solver:

a) dehumanizing language

b) distancing mechanisms including euphemisms

c) discounting detrimental effects

d) cognitive dissonance-induced belligerency

        In the case of the personality of abortion opponents, no specific literature was found on the authoritarian personality or intolerance of ambiguity. However, some literature that looked at personality variables as a whole in an exploratory manner have ascertain no personality differences predict position differences on abortion or the death penalty (Lester, Hadley, & Lucas, 1990). Kimberly Cook has been the primary researcher on the question of punitive attitudes, having found them in a set of interviews of a small number of individuals (Cook, 1998a) and a logistic regression on some other data (Cook, 1998b). However, a direct test of this with a measure for punitive attitude found that pro-lifers and pro-choicers did not differ on this, except among those who favored the death penalty, where those who opposed abortion were less punitive and more saddened at executions compared to those who did not oppose abortion (MacNair, 2008) This study showed that more conventional views on sexuality do seem more prevalent among the anti-abortion, but the finding on sex roles shows no difference.

        As for the abortion-as-violence perception of abortion-as-option people, William Brennan (1995) has documented extensive dehumanizing and euphemistic language in a variety of situation of violence against various groups of victims, including women, ethnic and religious minorities, people seen as enemies, those with disabilities, and unborn children. Yet this feature so clearly turns on whether or not abortion is in fact the killing of a child that it becomes practically tautological.

Pregnancy Prevention

        Here we move from hypotheses to research on effectiveness, since everyone is agreed on the merits of pregnancy prevention. Even if abortion is an option, after all, just as it is an option to have a tooth cavity filled, it is always better to avoid the occasion for medical procedures than to have the procedures. For those who understand abortion as violence, such violence is never even contemplated if there is no pregnancy.

        Accordingly, there have been many psychological studies of the relative efficacy of contraception and sexual abstinence. Unfortunately, this is another field where the best predictor of the conclusion is a perusal of the pre-existing philosophy of the researcher in regard to what the best conclusion would be.

        Yet both sides of this debate are missing a large amount of the matter. Neither contraception nor abstinence will work to prevent pregnancy if couples are unskilled in life planning. Nor will either approach work if a woman is depressed, intoxicated, or in an abusive relationship.

        There are, however, three problems with either contraception or abstinence as the entire approach from the abortion-as-violence perspective. First, saying that preventing untimely pregnancies is the only way of stopping abortion would be like saying that preventing all conflict is the only way of stopping all war. While it may be strictly accurate, it is not realistic, and we need to have creative ways of dealing with unplanned pregnancy in the same way that we have constructive ways of dealing with conflict. Second, it is common for women who become pregnant to castigate themselves for the behavior that caused the condition – there is always a man who engaged in the same behavior as well, of course, but blaming the woman is customary in our patriarchal society – and therefore adding any sense of judgmentalism about having become pregnant is unhelpful. Once the pregnancy occurs, it is time for the celebration of a new life, not a sense of consternation that the event was not prevented. Third, if abortion is violence against unborn children, the children should not be required to avoid existing in order to be protected from it. Analogously, if undocumented immigrants were being subjected to random beatings, we would not say that the beatings would be prevented if only they would remain in their own countries. People are entitled to protection from violence once they exist.

        Nevertheless, it would clearly be the case that fewer abortions would occur if fewer pregnancies occurred under trying circumstances.

Possibilities of Conflict Transformation

        Finally, the question arises as towhether there are methods of going past the rigid positions each side holds, and looking at interests to find creative solutions. This has been most explored with “common ground” initiatives whereby certain public policies which would benefit those pregnant women who do choose to carry to term. These efforts have been limited in scope and success, but are still ongoing. Nevertheless, there are large segments of the public who are not active on the issue for either of the two extreme positions, and there may be some creative work that can be done there. This is still a matter for research exploration.  

Conclusion

         These suggestions may lead some scholars to design and carry out research along these lines which will be fruitful for developing the field. Yet while not an uncommon problem for all research, the study of abortion is especially fraught with the conclusion of the study being  foreordained by ascertaining the established philosophical orientation of the researchers. This is true for both ends of the continuum, where most of the people who take an interest in doing the research are. There is an urgent need for research teams who include a variety of views, both ends of the continuum, people more in the middle, and people who do not care what the results are so long as they are methodologically sound.

        Additionally, cross-cultural studies are crucial both to benefit people in different cultures and to address the extent to which there is underlying trauma which does not rely on culture alone.  

        These hypotheses and questions can lead to a more comprehensive and rigorous psychological analysis, useful to the therapeutic needs of those involved, but also to the interests of peace psychology, to ascertain the extent to which it is denying abortion or abortion itself that would most reasonably be seen as violence.


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