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Friday, February 18, 2005

Do women get adequate pre-abortion counseling in abortion clinics? The unanimous opinion of people who work in post-abortion support is "no". We've been discussing this here.

Julie has a great post up about abortion as a form of self-abuse. Part of what she discusses is pre-abortion counseling at abortion clinics:

A woman who is ambivalent about child-bearing needs a safe place in which to explore her feelings. Perhaps she doesn’t want to terminate the pregnancy, but she also doesn’t want to have the child. She cannot fulfill both of these desires, and a reasonable person will see that. If however, the woman lacks a personal history that helps her see what is reasonable, it is prudent and in her best interests for a professional to assist her. If she is choosing to abort because of perceived problems instead of real ones, as soon as she comes to the understanding that her problems at the time were not insurmountable after all (as in a subsequent pregnancy she doesn’t terminate), isn’t it likely she will find sorrow and regret for her abortion decision that will overwhelm her in later years?

Further, if abortion providers want to masquerade as health-care workers, then they shirk their responsibilities when they fail to screen for psychological risk factors that will identify the abortion as an extension of self-hatred and self-punishment, or as relived trauma and abuse. That they fail to do this is obvious from records-based studies of psychiatric admission rates that compared women who had abortions to women who carried their children to term. Cougle and Reardon found “…that psychiatric admission rates subsequent to the target pregnancy event were significantly higher for women who had had an abortion compared with women who had delivered during every time period examined. The greatest difference in admission rates occurred in the first 90 days. This was a counterintuitive result, because one would expect women who experience postpartum depression to be at greatest risk of admission within the first 90 days of delivery, whereas women who have an abortion would seem most likely to experience their highest levels of relief soon after the abortion.” (Citation: CMAJ.
I occasionally read two blogs written by people who work in abortion clinics, evidently in the role of counselors: Reproductive Rights and Abortion Clinic Days. Whether they have professional training, credentials or licensure as therapists isn't clear. Their blogs don't say.

What I know from reading these blogs is that in their accounts of how they handle counseling sessions, they don't report asking their clients questions that women who come into post-abortion support groups report that they wish had been asked of them at their abortion clinic.

Reproductive rights activists are fond of saying that there is no empirical research that supports the idea that women can have a negative psychiatric outcome after abortion, thus substituting their own judgment for the considered judgments of editorial boards and peer reviewers at prestigious medical journals.

But, surely, no one doubts--even workers at abortion clinics--that some women experience profound regrets, emotional disorders, and so forth, after abortion.

If you worked as a pre-abortion counselor in an abortion clinic, wouldn't you want to be extraordinarily scrupulous about identifying women who are not good candidates for this procedure? Aren't medical practitioners in general expected to be extraordinarily scrupulous about identifying which clients are good candidates for certain treatments, while others aren't?

One obvious way to learn more about women who aren't good candidates for this procedure is to find out from women who attend post-abortion support groups what went wrong for them. I'm not aware of any abortion clinic workers engaging in this type of investigation. Are you?

Instead, we have the spectacle of this clinic worker thinking that she has done her job by referring an abortion-ambivalent client to I'm Not Sorry. If a doctor who performed breast implants was speaking with a woman considering the surgery who was asking questions about potential future health consequences, would you expect that he had fulfilled his moral obligations to her by referring her to a website for women who are delighted about their reshaped breasts? (And, you know, isn't there considerably more at stake in abortion?)

Why aren't abortion clinic workers more curious about women who have adverse psychological reactions to abortion?

Update: I prescribed a healthy dose of reality.

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