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Post Abortion Stress Syndrome
Anti-abortion advocates say abortions cause debilitating stress. Find out what you need to know about their campaign.

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Post-abortion stress syndrome" — PASS or PAS — sounds scientific, but don't be fooled — it's a made-up term. Not recognized as an official syndrome or diagnosis by the American Psychiatric Association , the American Psychological Association, or any other mainstream authority, it is a bogus affliction invented by the religious right. Those who claim its existence define it loosely as a raft of emotional problems that they say women suffer after having an abortion — nightmares, feelings of guilt, even suicidal tendencies — and compare it to post-traumatic stress disorder.

Using the allure of outward compassion, dozens of anti-choice PAS organizations have sprung up in the last ten years, accompanied by books, pamphlets, billboards, and Web sites. From SafeHaven and Healing Hearts Ministries to Victims of Choice and Rachel's Vineyard — a project of the anti-choice American Life League that operated its varied programs on a $7 million annual budget in 1999 — all of them insist that women who have had abortions suffer severe psychological damage that can be alleviated only with their assistance. Even though they call it a "syndrome," they don't recommend medical intervention.

It's anti-choice dirty-play at its worst. Because the groups believe that abortion is always a wrong choice, they often engage women in three steps toward recovery: confession of their mistake; reconciliation, usually through a ritual (Project Rachel, which is affiliated with the Catholic Church, takes women on retreats that include a "name your baby" ceremony and a "Mass for the Unborn"); and, finally, restitution of some sort. Of course, "the way to make recompense is usually to speak out against abortion," says Rev. Cynthia Bumb, an activist who has followed PAS activity closely. The groups tell PAS sufferers to lobby for anti-choice legislation; helps women get started with model bills, like the "Protection from High Risk and Coerced Abortion Act." Another route to "recovery" is to sue an abortion provider for malpractice. At the Web site of the anti-choice Justice Foundation — actually a malpractice firm, not a foundation — viewers are greeted by a burst of thunder, followed by a voice: "If you've been physically or emotionally injured by abortion, don't suffer in silence." You can "talk to an aggressive attorney today," the voice says. "You don't have to be a victim for the rest of your life." Their hope is that malpractice claims will eventually put abortion clinics out of business, even if protesters do not.

Claiming that abortion causes women psychological suffering conveniently flips the debate so that the anti-choice movement seems less callous toward women's concerns and more focused on women's "health." This cynical pro-woman/pro-life scheme was honed by David C. Reardon, director of the anti-choice Elliot Institute in Springfield, Illinois — the organization behind — who realized that the fetus imagery of the "pro-life" movement was failing to sway the masses because too much of the public believes that women will suffer if abortion is criminalized. In fact, an October 2000 Gallup poll found that two-thirds of Americans surveyed said they are against a constitutional amendment that would overturn the right to abortion established in Roe v. Wade. In March 2001, only 18 percent of the people polled told Gallup they want abortion to be illegal in all circumstances. But Reardon asserts that many people who support abortion are "uneasy pragmatists" who "have hardened their hearts to the baby because they think at least women are being helped." In his book, The Jericho Plan: Breaking Down The Walls Which Prevent Post-Abortion Healing, Reardon describes his new strategy for making the anti-choice movement appear pro-woman, bringing down the walls of choice by convincing the public "about the dangers of abortion." And since legal abortion is, in fact, a very safe surgical procedure and is far less dangerous than childbirth, Reardon and his allies seek to foment mental pain. "So as we educate [the public] about how abortion hurts women, it changes the whole equation," Reardon told Priests for Life. "The potential of post-abortion healing . . . can rapidly change the whole dynamic of the abortion debate in this country. And I am really confident that we will see an end to abortion within the decade."

His formula calls for "stealth healers" (his term) to offer mercy and forgiveness to women who have had abortions — he calls them "post-aborted women" — and then use them as "compelling advocates for the unborn." Says Reardon: "By demanding legal protection for women forced into unwanted abortions and greater rights for women to sue for post-abortion trauma, we force our opponents to side with us in defending women's rights or [to] be exposed as defending the abortion industry at the expense of women." He wants the message of the antiabortion movement to be, "abortion hurts women." And he's getting his wish. During the Republican National Convention in Philadelphia last year, a string of anti-choice protesters spread out on a street in a "human life chain," holding the same sign: abortion hurts women.

Of course, the overwhelming scientific evidence shows that abortion does not hurt women — physically or mentally. In the late 1980s, President Reagan tried a strategy similar to Reardon's and asked his like-minded surgeon general, C. Everett Koop, to conduct a study on the mental pain caused by abortion. To everyone's surprise, Koop determined that there was insufficient evidence of trauma. Psychological problems were "minuscule from a public health perspective," he said. The American Psychological Association followed up by asking a group of six experts to undertake a special review. The panel concluded in 1989 that terminating an unwanted pregnancy posed no hazard to women's mental health. The predominant sensation women felt following an abortion was relief, the group said.

And in August 2000, a study conducted by Brenda Major at the University of California at Santa Barbara — the latest among many — confirmed those findings. Severe post-abortion psychological distress is extremely rare, affecting just one percent of patients. "Most women were satisfied with their decision, and believed that they had benefited more than they had been harmed," said Major, who, along with other researchers, tracked women for two years after they had first-trimester abortions (88 percent of abortions are performed in the first trimester, and therefore represent the typical experience). The best predictor of post-abortion mental health, it turns out, is a woman's mental health prior to the abortion.

"Abortion does not cure depression or bipolar disorders; nor does it cause them," says Suzanne Poppema, a retired Seattle abortion provider, now an international consultant on reproductive health issues. She and many others have little tolerance for PAS — "because it doesn't exist," she says. The overwhelming emotion she witnessed at her clinic, she says, was relief; PAS is merely an attempt to scare women, and she points out that if women do feel negative emotions, they are probably a result of the antiabortion movement itself. After all, the picketers who scream "murderer" at women entering clinics are significant stress-inducers, too.

Like Poppema, abortion rights organizations are quick to denounce PAS as the myth that it is. "The shame here is they look for women and seek to exploit them," says Ron Fitzsimmons, executive director of the National Coalition of Abortion Providers in Alexandria, Virginia, an association of independent clinics. When Project Rachel began its multicity anti-choice ad campaign in the Spring of 2000, the National Abortion Federation, the largest professional association of abortion providers, countered with a press conference that cited scientific studies disproving post-abortion stress. "This is an invention of those who oppose choice," says Vicki Saporta, NAF's executive director.

Abortion does not "hurt" women and there is no such thing as "Post Abortion Syndrome," but it's also true that women who feel relief after having an abortion may also have normal feelings of sadness, grief, or regret. An unwanted pregnancy alone can create significant anxiety. With the clock ticking, a woman is forced to decide between very limited options, each of them stressful. The alternatives to abortion — carrying a pregnancy to term and either keeping the child or making an adoption placement — can have a serious impact on a woman's mental health. Rosemary Candelario, a longtime abortion rights activist and current director of the Massachusetts Religious Coalition for Reproductive Choice, points out that it is important for pro-choice organizations to recognize that some women, especially those with religious backgrounds, may have difficulty making the decision to terminate the pregnancy: "I think the fear in the movement is if we admit abortion is hard for some women, then we're admitting that it's wrong, which is totally not the case. I've heard from women who are having problems dealing with their abortion who are still ardently pro-choice."

Attributing a woman's emotional problems to the simple fact that she had an abortion can detract from a full understanding of what is going on with her," says Nancy Russo, a professor of psychology and women's studies at Arizona State University and the author of multiple studies on the subject. Ava Torre-Bueno, a psychotherapist and the author of Peace After Abortion, says most of the women who come to her seeking counseling say, "I'm pro-choice. I'm still pro-choice. So why do I feel so bad?" Many are recovering from the sheer stress of making the decision to have an abortion. About one-quarter, she says, are grieving-sometimes for the fetus or what they might see as a life or potential life. Others are grieving another kind of loss: a breakup with a boyfriend or rupture with parents.

Women's real-life responses to abortion are "complex," notes Gail B. Williams, an associate professor of nursing at the University of Texas, and are "associated with a mixture of feelings." And the current political climate has only made things worse. In the days of back-alley abortions, "women felt lucky if they didn't die," says Susan Brownmiller, author of the feminist memoir In Our Time. Now, however, the atmosphere surrounding abortion is saturated with anti-choice rhetoric. "Women who sit in my clinic don't see it as a right," says Peg Johnston, director of Southern Tier Women's Services near Binghamton, New York. "They're scared."

What they are scared of is stigma, according to a little-noticed 1999 study by Brenda Major, the lead researcher of the U.C. Santa Barbara study, and psychologist Richard H. Gramzow, who found that approximately half the women in their study who had abortions felt a need to keep them secret from friends and/or family for fear of social disapproval. The effort of concealment itself was a major source of distress for women, the study said. "Women are hypersensitive to the sociopolitical climate and how it affects their feelings. This is the only medical procedure you can't talk about," says Dana Dovitch, a psychotherapist in Los Angeles and coauthor with Candace De Puy of The Healing Choice, a therapeutic handbook on abortion. In interviews across the country, women described to Dovitch the difficulty of creating a pretense at work, lying to relatives, avoiding friends. Torre-Bueno agrees. She noticed that emotional issues, especially feelings of guilt, began rising along with anti-choice efforts to restrict abortion. "More and more often, women would say, 'I hope you won't judge me,'" she says.

In response to these forces, some pro-choice activists are trying new approaches. NAF has a hot line, staffed with trained personnel who are willing to help women sort through their issues and give referrals to psychotherapists. Both The Healing Choice and Peace After Abortion provide exercises to help women review why they made the decision to have an abortion and their feelings about it. Many clinics, depending on the community, offer in-house post-abortion counseling. Northland Family Planning Centers in Michigan offer referrals for counseling as standard service. Hope Medical Group for Women in Shreveport, Louisiana, which attracts patients from a wide geographic swath in the region, publishes "After Your Abortion . . . A Natural Response" on its Web site. It describes ways to cope with grief, anger, and sadness. Recently in St. Louis, Rev. Cynthia Bumb set up pro-choice counseling as an alternative to the local anti-choice post-abortion projects. "A woman can process her decision from a faith-based perspective without an assumption that she was wrong," she says.

In Binghamton, New York, Johnston offers women a polished stone before the abortion, and describes Native American and Buddhist rituals to help the healing process. "I tell them, 'There is no Hallmark card for you, but it doesn't mean you can't honor your loss,'" she says. The touch is personal, but Johnston also sees this approach as a political act to erase the stigma of abortion and silence the anti-abortion thunder. "A lot of the rhetoric of the anti-choice movement has really burdened women," says Johnston. "This is about listening to women-that's what the women's movement is about."

Cynthia L. Cooper writes about reproductive health issues.
She lives in New York City.

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