Social and Emotional Aspects of Abortion

Studies of women’s experiences with abortion: Women’s anticipated emotional responses to elective abortion, Understanding Abortion Emotion Study, Measuring abortion stigma and Heartland Abortion Regulation Project

Studies of emotional support services: Provided at the time of abortion care and Provided after abortion

Dr. Lori Freedman and Kate Cosby Cockrill, MPH, of ANSIRH's Social and Emotional Aspects of Abortion Program

Kate Cosby Cockrill, MPH, Research Analyst and Project Manager (left); and Dr. Lori Freedman, Medical Sociologist.

The Social and Emotional Aspects of Abortion (SEAA) Program is a collection of research projects aimed at understanding how women’s lived experiences of abortion are influenced by their own life situations; by the attitudes and actions of others; by viewpoints women encounter or expect to find in their immediate communities, in the media, or on the internet; and by judicial, political, religious, and scientific debates regarding abortion.

Projects in the SEAA program utilize both qualitative and quantitative research methods to investigate women’s anticipated feelings about having an abortion, the feelings they experience during their abortion care and afterward, the availability, timing and types of social and emotional support for women who have abortions, and the challenges that abortion providers face in meeting women’s social and emotional needs related to abortion care. Projects in the SEAA program are also concerned with social stigma surrounding abortion and how women experience and manage stigma when they have had an abortion.

In addition, see our bibliography of research regarding mental health and abortion.

Studies of women’s experiences with abortion

Women’s anticipated emotional responses to elective abortion

Most women who terminate pregnancies do not experience adverse psychological sequelae after the event [Report of the APA task Force on Mental Health and Abortion, 8/13/08]. However, women do experience a range of emotions following abortion. How these emotional responses vary according to demographic and socioeconomic characteristics of women and gestation of pregnancy is not known.

Using data from over 5,000 medical records and counseling needs assessment forms from a large Midwestern abortion clinic, this study examines women’s reported emotional state prior to abortion and their anticipated response to abortion. We will assess differences in abortion attitudes, emotions, and anticipated coping by degree of social support, religious beliefs, and mental health history of abortion patients. In multivariate analyses we control for women’s age, race/ethnicity and education as well as gestational age of the pregnancy.

These data will provide needed background information about the counseling and social support needs of women.

Understanding Abortion Emotion Study

The Understanding Abortion Emotion Study investigates the emotions associated with having an abortion in the United States. Using qualitative methods, the study examines women’s lived experiences of abortion emotion as well as various judicial, political, religious and scientific discourses regarding abortion emotion. The goal of this work is to contextualize and depolarize the debate about women’s emotional responses to abortion while documenting the ways that individual emotional experiences shape social discourses and vice versa.

We have conducted in-depth interviews with women who had an abortion, including women who expressed emotional difficulty following their abortion. We find three primary sources for this difficulty: social disapproval, relationship loss, and a head v. heart conflict about having the abortion. Overall, respondents articulated a need to feel that the decision to have an abortion was their own and a need for non-judgmental social support following the procedure. Data also yield insights into how the clinic experience itself can make the overall experience more or less difficult.

In addition to interviews with women who have had abortions, we conducted focus groups and in-depth interviews with staff and/or volunteer counselors at four peer counseling services. We have also completed a content analysis of websites that forward a claim of abortion regret. We are in the processing of analyzing these data.

Now that data collection for this study is complete, we are in the process of data analysis and manuscript writing. In the near future, we plan to publish our findings in peer-reviewed journals and present our results at academic conferences.

This research is funded by the Ford Foundation.

Measuring abortion stigma

Understanding abortion stigma is an important aspect of understanding women’s emotional experiences with abortion in the United States. Currently there is no standard measure for understanding abortion stigma experienced by women. ANSIRH is currently developing and testing an abortion stigma scale to measure several types of stigma that are potentially experienced by women who have abortions: enacted, felt, perceived and anticipated. The scale also seeks to measure how women manage the stigma they feel through behaviors like keeping their abortions secret or sharing their experiences of abortion with others to reduce feelings of isolation.

This research is funded by an anonymous donor.

See “A pivotal position” (Because, Ipas: Fall, 2011, pp. 12-16) on stigma and its impact on U.S. abortion providers and Lori Freedman’s book Willing and Unable.

The Heartland Abortion Regulation Project (now completed)

The Heartland Abortion Regulation Project (HARP) sought to understand how abortion patients interpret the policies that regulate their abortion experiences. State-level regulations that prohibit public funding for abortion services, mandate waiting periods prior to obtaining an abortion, require the provision of state-authored informational material, and/or compel parental involvement are considered key barriers to abortion access. Several studies have quantified the negative effects that these regulations have on women and teens. The most common findings are that regulations lead to out-of-state travel and delays in obtaining care. Despite these conclusions, public support for regulations is high and little is known about how women seeking abortion care understand and interpret abortion regulation.

Using qualitative methods, including in-depth interviewing and ethnography, we explored women’s experiences with and understandings of abortion regulation. Study participants expressed a diversity of views ranging from approval and acceptance of regulation to mistrust of government intervention in abortion decision making. Women were most likely to approve of regulations that they perceived as informing their abortion decision and were most likely to disapprove of regulations that prevented them from making their own abortion decision.

We have presented our findings at several conferences including the American Public Health Association, the Population Association of America’s PsychSocial Meeting, the Midwestern Sociological Society, the American Sociological Association, and the Pacific Sociological Association. We are currently working on three manuscripts from our research. The first explores our basic findings about women’s attitudes toward regulation, the second considers women’s experiences with ultrasound in the context of their abortion, and the third describes women’s experiences with their own doctors around abortion care and decision making.

This research was funded by the David and Lucile Packard Foundation.

Studies of emotional support services

For most women, an abortion is a significant life event. Women experience their pregnancies and pregnancy decisions in the context of their own beliefs and values, their family and romantic relationships, and community and social norms regarding abortion. ANSIRH is undertaking several studies to understand better the social and emotional support services that are available to women who have abortions in the United States.

Study of social and emotional support services provided at the time of abortion care

At the clinic level, health care professionals teach patients all they need to know about the procedure while making sure they are mentally safe to undergo it. Most clinics provide a combination of informed consent and some type of social and emotional triage for patients seeking abortion services. Abortion clinics around the U.S. approach social and emotional support differently. This study proposes to understand the landscape of social and emotional support offered by abortion providers. Using a social psychology lens, the research will investigate how clinics assess and attempt to meet client’s social and emotional needs, taking into account clinic constraints on time, resources, and cultural or linguistic competence. This ethnographic study of social and emotional support will involve focus groups of abortion counselors, in-depth interviews with counselors from diverse clinics around the U.S., and observation of counseling in the clinics themselves.

This research is being funded by an anonymous donor.

Study of emotional support services for women after abortion

Many women seek emotional support after their abortions. While most find support through partners, family and friends, some women seek support in on-line forums, through phone based peer-counseling programs, through on-line or in-person support groups, or through one-on-one counseling with a licensed therapist. Using a social psychology lens, we will explore the availability and types of services for women after abortion. This ethnographic study of emotional support services will combine with our study of women’s emotional needs to help us to identify gaps in service and identify new places for evaluation, training and intervention.

This research is being funded by the Ford Foundation and we are seeking additional funding for this research.