Copyright 1996 David C. Reardon. Excerpted with permission for from Making Abortion Rare, published by Acorn Books, PO Box 7348, Springfield, IL 62791-7348 for internet posting exclusively at www.afterabortion.org. All Rights Reserved.

The following is a brainstorming tool of check list items, concrete suggestions, and half-baked concepts which may be useful to others who are looking to develop post-abortion research strategies and tools. 

I believe it should be emphasized that a "perfect" study of post-abortion problems is impossible. One of the biggest obstacles to accurate research is the requirement for voluntary participation. "Concealers" may not only refuse to participate, there may be no record of their having had an abortion because many women give false names at the time of their abortions. In record based studies, looking at breast cancer for example, cancerous women who conceal a history of abortion will be added to the control group (women with no abortion history) and will thereby artificially depress the reported relative risk. Similarly, in psychological studies, because "concealers" are most likely to be experiencing shame and unresolved stress over a past abortion, their refusal to participate will result in a sample which is artificially "packed" with women who are the least disturbed by their experience. All of these distortions will bias studies in one direction - toward underreporting of abortion related complications. Therefore, even a modest elevation of risk should be interpreted as a minimum complication rate.
 
 

I. Control Groups. Compare women who have had legal elective abortions to women who have had the following experiences:

A. Childbirth of unplanned pregnancy
B. Miscarriage
C. Adoption
D. Neonatal loss (under 6 mos. of age)
E. Death of a child (over 6 mos. of age)
F. Death of a spouse
G. Illegal abortion
H. Childbirth of handicapped child
I. Victim of rape
J. Victim of sexual abuse

A. Any nation with socialized medicine, such as Denmark, Canada, Sweden, or Britain.
B. Insurance company records
C. Medicare records
D. Military records
E. Prison records

III. Detailed analysis of abortion related data should be done with existing major data sets gathered in government funded projects such as:

A. Yearly survey programs by the Office of Demographic Programs 

B. National Longitudinal Study of Youth. Suffers from severe underreporting (those admitting abortion represent only 40% of the expected total), but may still show elevated risks for those who do admit abortion.
        1. Scales in NLSY which can be evaluated
            a. Self-Esteem Scale
            b. Mastery Scale
            c. Center for Epidemiologic Studies Depression (CES-D) Scale
            d. Internal-External Locus of Control Scale
        2. Also includes extensive histories on substance abuse
        3. NLSY also includes interviews with the children of NLSY women which provides a basis for intergenerational analysis. 

C. Other national surveys which have collected information about abortion history which are probably accessible to non-governmental researchers are the National Survey of Family Growth (NSFG) - an ongoing project of the National Center for Health Statistics, and the National Surveys of Young Women. Like NLSY there is very significant underreporting of abortions in both these sets, but they may still prove to be useful.

V. Tap into existing private data bases

A. Ask psychiatric counseling groups, (such as large Catholic Charities group in Delaware which employs over 20 counselors), to review records over the last ten years to note trends in rising number of post-abortion related cases. 

B. Specialized counseling centers, such as drug and alcohol rehabilitation centers, eating disorder facilities, suicide treatment programs, juvenile delinquent programs, etc. 

C. The Elliot Institute has three data sets available for additional analysis 

D. Insurance company data on health care benefits, cross tabulate abortion payments to higher level of claims for general health care, reproductive health problems, mental health care, drug abuse, suicide, accidental injuries, etc. It may be possible to convince insurance companies that this issue has an economic impact on their insurance programs.

A. Health Insurance Providers who fund abortion

1. If abortion injures a woman's overall health, this is very costly. Insurer's who fund abortion may be driving up their own expenses. 

2. We should try to convince the health insurance industry to analyze long term health care patterns of women who have requested insurance payments for abortion. Are they more likely to make subsequent claims for mental health or reproductive health? Are they more likely to drop coverage, change jobs, or exhibit other transitory behavior? 

3. Insurers could generate a list of women who received payments covering an abortion (and a control group who did not) and then go out and do a study with questionnaires or field interviews of these women. (Could this include women who are no longer covered?) These followup interviews would not have to include any questions regarding the abortion, since this is already known from insurance records, and could therefore be double-blind studies.

Present the military with the question: Does an abortion effect the military readiness of a female (and male?) soldier? If an abortion increases self-destructive behavior, or reduces one's sense of self-preservation, this abortion related dysfunction may place the unit at risk. If an abortion increases drug and alcohol abuse, especially during times of stress, it may place a unit at risk. If an abortion can cause PTSD, the disordered defense mechanisms can place a unit at risk. If an abortion can cause difficulty concentrating, memory loss, increased anxiety and outbursts, and greater difficulty in interpersonal reactions, this reduces a soldiers effectiveness in both peace time and war.
 

  A. Undertake random retrospective surveys of all reproductive experiences of subjects, including pregnancy outcomes, complications of pregnancies, birth control patterns at each pregnancy, satisfaction level with each pregnancy outcome, and present state of fertility (i.e. fertile, sterilized, hysterectomy patient, post-menopause), and demographics for each pregnancy. Include psycho-social history including questions regarding any history of major psychological illnesses, substance abuse, and suicidal ideation with time frame references to start and recovery from said problems for cross reference to pregnancies.

B. Survey women facing a crisis pregnancy at abortion clinics and crisis pregnancy centers to evaluate beliefs and pressures faced by aborting women using a series of questions related to decision-making and prior attitudes to get a "time slice" of mental state of women in the midst of their crisis, and compare against results of retrospective studies asking the same questions. Use for comparing dropouts ("concealers") to those who agree to a followup interview. 

C. Develop a survey for women who are known to have experienced post-abortion grief which concentrates on identifying and charting the "time delay" of post-abortion reactions among this population of women. This approach would help develop a "time delay standard" by which all past and future studies must be evaluated. Compare curve to post partum depression reaction time. The following is some data from one of our Elliot Institute surveys relevant to the delayed reaction effect, and the numbers seeking psychiatric counseling.
 

1. Only 21% experienced the majority or worst of their negative reactions almost immediately, 19% experienced the majority of their negative reactions within the first six months; and 60% did not experience majority of their reactions until a year or more post-abortion. 

2. 33% sought help from psychologist/psychiatrist, 24% from a social worker, 35% from clergy. 

3. 10% reported being hospitalized for pscychological treatment because of the abortion and 20% reported suffering a nervous breakdown at sometime after their abortion. 

4. 55% stated they experienced symptoms too severe to function normally at work or at home.

D. Contact a random sample of ob/gyn's, general practitioners, and mental health providers and request that they survey the reproductive history of their next 20 female patients and do a psycho-social history including CASE and CAPS-1. If the study population is confined to women seeking pre-natal care, concern for their present pregnancies may help to motivate "concealors" to reveal their past abortions and so help to mitigate the research problems caused by high concealment rates. 

E. In suits against abortion clinics, especially class action suits, seek a court order requiring clinic to allow a survey of women coming into the clinic to determine the prevalence of predictive high risk factors. This would be relevant to establishing a pattern of negligence. It may also be possible to seek a court order to release records of previous patients for a survey of post-abortion reactions to determine if other patients also experienced the post-abortion sequelae at issue. 

F. It may be of value to duplicate any or all of the above studies in a culturally foreign country such as Japan, India, or China in order to determine if any negative reactions to abortion are universal.
.
.
.

To read the rest of this chapter, order Making Abortion Rare, today.
.
.
.
.

Order Making Abortion Rare Today

---

Copyright 1996 David C. Reardon. Excerpted with permission for from Making Abortion Rare: A Healing Strategy for a Divided Nation, published by Acorn Books, PO Box 7348, Springfield, IL 62791-7348 for internet posting exclusively at www.afterabortion.org. All Rights Reserved.