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By Dr Kizito Lubano
Miscarriage and abortion are both stressful events, but a study from Norway suggests that abortion may be associated with more long-term psychological distress.
Researchers interviewed 40 women who had miscarriages and 80 women who had abortions and followed them for five years.
Women who had miscarriages suffered more anxiety and depression immediately after the event and six months later. But abortion was associated with more stress and anxiety two years, and even five years after the event.
The women who had miscarriages were often psychologically traumatised for several months. Nightmares and flashbacks were not uncommon, but within half a year, most of these mental responses were over and they were managing well.
Guilt and shame
Women who had abortions had fewer problems earlier on, and their long-term issues did not approach the level of trauma. But these women were also twice as likely to feel guilt about the event five years later and 60 per cent more likely to feel shame as measured by psychological testing.
At five years, both groups had few intrusive thoughts about the event. But the women who had abortions were seven times as likely to report that they actively avoided thinking about it.
When compared with the general population, women who had abortions had higher anxiety scores at all measured time points — from ten days after the pregnancy termination to five years later. Women who had miscarriages had higher than normal anxiety scores at only one of the measured time points — ten days after their pregnancy ended.
It is not clear from the study if having an abortion contributed to the higher anxiety scores or if the women who had abortions were more anxious to begin with.
Kenyan scenario
Abortion is not permitted unless, in the opinion of a trained health professional, there is a need for emergency treatment, or the life or health of the mother is in danger, or if permitted by any other written law.
Thus, abortion is illegal. It is however, it is estimated that more than 100 abortions take place every week under unhygienic conditions and by unskilled providers, thereby contributing to a large number of immediate complications such as bleeding and death. Other complications include, injury to pelvic and sometimes abdominal organs such as perforation of the bladder or intestines. The long-term consequences include loss of future reproductive potential, permanent deformity with pain as well as emotional trauma with suicidal tendencies.
At least 2,600 Kenyan women die in public hospitals each year after having botched backstreet abortions. Many more die at home without seeking medical care. And another 21,000 are admitted for treatment of abortion-related complications. Unsafe abortions account for 35 per cent of maternal deaths in Kenya, versus the global average of 13 per cent.
Abortion stress
Abortion is recognised as an emotive, sensitive and even divisive issue all around the world. The case is no different here in Kenya.
The debate over the emotional impact of abortion is a contentious one, with pro-choice and anti-abortion advocates not surprisingly having varying views of the issue.
Some people contend that a form of post-traumatic stress is common among women who have had elective abortions.
There is no denying that the experience of unwanted pregnancy is stressful for most women, and so is the decision about what to do about it. But we are not seeing evidence of long-term trauma at the clinical level.
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