Abortion, mental distress,
By Ellie Lee
June 14, 2002
based on the consequences of reproductive choices has become something
of a fashion in the UK. Class actions have been brought by Pill
users against the manufacturers of oral contraceptives, and women
have brought a case against the company that makes the natural
family planning device 'Persona'.
BBC Radio Four's flagship news
programme, Today, broke the story on 12 June that a woman
intends to sue the NHS because of the mental distress that followed
her decision to have an abortion - distress that she believes
could have been prevented if she had had more counselling before
It is becoming commonplace for
people to sue public and private bodies for the psychological
effects of their experiences. Cases where litigants (often successfully)
make claims on the grounds that they have post-traumatic stress,
or simply 'stress', mean that compensation based on harm to our
minds has taken its place alongside compensation based on physical
This putative case has a particular
dynamic. The anti-abortion organization Life is supporting the
woman bringing the claim. In both the USA and Britain, anti-abortion
organisations have made the issue of mental distress following
abortion - often labelled 'post-abortion trauma' or 'post-abortion
syndrome' - central to their arguments. Women, these organisations
claim, are often traumatised by abortion and respond by 'repressing'
or 'denying' their negative emotions.
One counsellor from Life told
me that: 'Post-abortion syndrome is what happens to a woman when
she's had an abortion, she hasn't recognised she is traumatised
by it, she's pushed it under and hasn't been allowed to grieve,
and she gets post-abortion stress. Some can have really serious
This argument about the effects
of abortion adopts the fashionable tendency to present many people
as 'in denial'. On the basis of this, anti-abortion organisations
engage in two kinds of activities. They offer women post-abortion
counselling, through which women are encouraged to 'bring their
negative feelings about abortion to the surface'. And they argue
that women should sue abortion providers on the grounds that they
were not warned about their 'negative feelings' in advance of
In 1998, Life announced they were
setting up a 'helpline' for women to call, when have suffered
emotionally after abortion. April 1998 was the tenth anniversary
of the implementation of the 1967 Abortion Act, and Life used
this occasion publicise its new 'service' for women. Jack Scarisbrick,
Life's national chairman, claimed that a growing body of medical
evidence showed that abortions left women at 'vastly increased
risk of conditions including cancer, infertility and increased
incidence of later miscarriages as well as psychiatric illness.'
Scarisbrick said: 'We want women
who have suffered either physical or mental trauma as a result
of abortion to contact us. We will encourage them to take the
doctors responsible to court. We believe the only way we are going
to get the medical profession to acknowledge the truth is by going
to the courts and forcing the issue out into the open. It will
have a deterrent effect on all sides. We already have enough to
conclude that procured abortion is one of the most dangerous things
that can happen to a woman'.
What is going in here? Anti-abortionists'
moral objection to abortion relies on the belief that a fetus
is a person and should be offered legal protection. This position
has consistently failed to win support and undermine the legal
provision of abortion. So it seems that opponents to abortion
have turned to other means to further their cause. They are attempting
to use the distress women feel into a legal strategy to undermine
the provision of abortion.
Back to the case of the woman
suing the NHS for mental distress. This is not the first time
a case of this kind has been muted (although it is the first against
the NHS). In 1999 a woman said she had been diagnosed with post-traumatic
stress disorder after an abortion performed at a private clinic,
and issued High Court proceedings against the clinic and two of
its doctors. In 2001, a mother of six threatened to sue an abortion
provider for failing to give her adequate counselling before she
terminated a pregnancy.
But these cases came to nothing.
And it seems unlikely that this recent case will get very far.
The information that women receive
as part of procedures to establish 'informed consent' prior to
abortion are guided by 'evidence based' approach to medicine.
The Royal College of Obstetricians and Gynaecologists (RCOG) has
an 'evidence-based' guideline that shapes the way in which abortion
services are provided. This provides guidance for abortion providers
on what information to give to women about both the physical and
mental health effects of abortion. It has become standard practice
to treat the 'psychological effects of abortion' like the 'physical
effects of abortion', and to look to the available research evidence
to provide information about the risks of the procedure.
On this basis, women who request
abortion are informed that, for the vast majority of women, there
is no risk that their mental health will be damaged by abortion.
The RCOG guideline, for example, includes information about the
psychological effects of abortion alongside that for risk of haemorrhage,
uterine perforation and so on. The guideline draws on a review
of published research evidence, in particular a well-regarded
study by the psychiatrist Paul Dagg, and recommends that abortion
providers inform women that 'only a small minority of women experience
any long term, adverse psychological sequelae after abortion'.
Were there space to do so, the
guideline could justify this approach in relation to an extensive,
well-established field of research, which emerged in the 1960s
and which expanded rapidly in subsequent decades when abortion
had become legal. By the late 1980s it was estimated that there
were over 1000 published pieces of research on the subject, making
the psychological effects of abortion according to one North American
obstetrician, 'the most extensively researched of all medical
This body of research was partly
impelled by the growing sense that abortion should be approached
as a health issue, and its risks assessed scientifically. This
approach emerged against a prior view, based on a cultural assumption
rather than research evidence, that motherhood was psychologically
harmless and abortion would make women mentally ill.
The accumulation of research during
this time was given a further impetus in the USA in the late 1980s.
As part of his campaign against abortion, then US President Ronald
Reagan commissioned a review by then Surgeon General Everett Koop
about the health effects of abortion. Reagan's reasoning was that
was opposition to abortion would be boosted by the finding that
abortion was bad for women's health. In the event, even though
Koop was well known for his strongly anti-abortion views, the
enquiry found that its mental health risks were 'miniscule from
a public health perspective'. Research that endorsed this view
has subsequently accumulated.
It is surely unreasonable to ask
that abortion providers could do anything other than to go by
this evidence. Abortion in Britain is considered a medical procedure,
and providers of a medical service can be expected to base the
information they give on the best available evidence. Current
practice in abortion provision can therefore be considered entirely
The only alternative to informing
women in line with the current RCOG guideline would be for abortion
providers to provide information that emphasises the experience
of the minority - in other words, to emphasise the fact that some
women do find it impossible to 'get over' their abortion. But
what would this mean for those women who experience no such thing?
Should they sue for being 'over counselled' and encouraged to
feel miserable and guilty when they really feel no such thing?
Whatever the outcome of this recent
case, it focuses attention on the issue central to the inclusion
of mental distress as a ground for litigation. To what extent
should other parties be expected to take responsibility for our
state of mind? The abortion issue addresses this question so directly
because abortion is an elective procedure. Women request to terminate
pregnancies, they are not compelled to do so. If the outcome of
that request is that the woman concerned intensely regrets her
decision, and experiences all of the negative feelings that accompany
this, should another party be held accountable?
It is surely unreasonable to expect
that third parties should be accountable for women's decisions.
This would deny the fact that when women request abortion we are
making a choice - and we should take responsibility for its outcome.
Most people will sometimes reconstruct and reinterpret past events
in the light of subsequent experience. Some people may do so to
the extent that they become unable to move on from the past, and
experience extreme negative feelings as a result. But to say this
is someone else's fault is a highly problematic approach.
The fact that women can get abortions
legally depends in large part on the idea that it women are best
placed to decide whether it is better to bear a child or have
an abortion. While the law in Britain does not provide for 'abortion
on request', in practice abortion provision takes place on the
basis of the assumption that reproductive decisions are private
ones, best made by those who will bear the consequences of them.
This idea - usually termed reproductive autonomy - is crucial
in any civilised society.
The zone of freedom in this area
of our lives is something we should cherish - and this means us
accepting that if things go wrong, it is part of parcel of the
great advantage given to us when we are free to choose. Ultimately
the notion that somebody else is liable when we feel badly after
the exercise of choice is tantamount to saying we are not capable
of making the choice - which is precisely why the discussion of
the mental distress allegedly caused by abortion is so attractive
to opponents of legal abortion.
The claim that more should be
done to respond to the possibility of negative psychological responses
to abortion constitutes an assault on the idea of choice, and
degrades the notion that women are responsible adults who can
act autonomously when making decisions about their reproductive
Dr Ellie is a sociologist at Southampton
University. She is editor of Compensation Crazy: Do We Blame
and Claim Too Much, published by Hodder & Stoughton, available
at any good bookshop and via the Institute of Ideas.