Abuse Often Takes the Form of Forced Abortions is a letter from David Reardon of The Elliot Institute to the Canadian Medical Association Journal.
David's letter responds to a fascinating study published in the March 2005 CMAJ on Characteristics of women undergoing repeat induced abortion by Fisher, Singh, et. al.
Fisher and Singh's study concludes that:
Among other factors, a history of physical or sexual abuse was associated with repeat induced abortion. Presentation for repeat abortion may be an important indication to screen for a current or past history of relationship violence and sexual abuse.Indeed. Abortion clinics should most certainly screen for this, as well as much more, as we have argued.
David's letter (minus citations) reads:
Dear Editor,I wonder how abortion clinics will respond to this study's implications for pre-abortion counseling practices.
The association between domestic violence and abortion is well known. Fisher and colleagues contribute the finding that the association strengthens with repeat abortions.
Their recommendation to screen for a history of abuse is welcomed, but it should be augmented by the additional question: “Is anyone pushing you to have this abortion?”
Abortion is often a woman’s last choice but her abuser’s first choice. Thirty to 60 percent of American women having abortions describe pressure from others as a key reason for having an abortion. Many report that they submit to unwanted abortions only because of abuse. Pregnancy increases the risk of abuse and homicide is the leading cause of pregnancy associated deaths. Also, among pregnant women, the focus of partner physical abuse shifts from the face to the abdomen.
Abortion is also linked to subsequently higher rates of substance abuse, anxiety, anger and rage among women, all of which may contribute to a cycle of domestic violence. Victims of one coerced abortion are more prone to being repeated victimization, which may include elements of self-punishment.
This study would have shed more light on these issues if it had distinguished if abuse occurred before or after the first abortion. Are women abused prior to a first pregnancy more likely to have multiple abortions, or does a first abortion increase the risk of subsequent abuse? It is quite possible that both are true. Furthermore, for some women the first experience of abuse will coincide with a pregnancy the woman welcomes but her partner opposes. Physicians must be aware of this dynamic and prepared to offer authentic help, including referrals for interventive counseling.
David C. Reardon, Ph.D.