Post Abortion Report from Holland

1. Post Abortion Report from Holland T.W. van Laar-Jochemsen M.Sc. Charissa Zuidema Henk Jochemsen With the support of a quality committee A Research Project of: Prof.dr. G.A. Lindeboom Institute Centre for Medical Ethics, Netherlands

2. Presentation • Scientific research on psychological sequela of Abortion • Focus of this study • Conclusions • Risk factors • Research among family physicians • What needs to be done H Jochemsen

3. Scientific research on psychological sequela of Abortion • Ends of ’80: limited data and poor methodology • subjective vs. psychometric measurement • 1992 (Reardon) • agreement: some women negative reaction • disagreement: • Prevalence • Severity • what severity is problem? • classification of severe problems H Jochemsen

4. Research obstacles • The cooperation of the study population is inconsistent and unreliable • The variety of negative reactions reported by women is so broad that it is impossible to encompass every claimed dysfunction in a single study • The intensity of many reactions appears to be time variant, with many women reporting delayed reactions • The use of questionnaires and other standardized survey instruments may be inadequate for uncovering deep-seated reactions H Jochemsen

5. Focus of this study • Inventory of psychological post abortion sequela in general • Nature of negative consequences • Severity of negative consequences • Prevalence H Jochemsen

6. Conclusion (1) • No scientifically warranted conclusion is possible about the prevalence of psychological post-abortion consequences • Study population • Instruments • Ideology • Conclusion: ‘it’s a minor problem’ not warranted H Jochemsen

7. Conclusion (2) Five most common negative psychological consequences are: • Depression • Feelings of guilt • Anxiety • Grief • Regret H Jochemsen

8. Important: High intrusion and avoidance score on Impact of Event Scale

9. Risk factors: • Depression: depression before abortion, being young, shame, avoidance • Guilt: personal opinion, attachment, recognition of life • Anxiety: support, avoidance, shame • Grief: attachment, view on pregnancy • Regret: ambivalence before abortion H Jochemsen

10. Research among family physicians (1) • FP’s refer for 63% of all cases of abortion in The Netherlands • We interviewed 12 FP’s about the way they deal with abortion requests and psychological sequela • They give (some) time to talking to woman with a request for abortion • They provide information on the foetus, abortion and possible consequences if the woman asks about it – which she normally does not • They normally do not seriously discuss with the woman alternatives for abortion H Jochemsen

11. Research among family physicians (2) • They know about possible psychological sequela of abortion but find it difficult to recognize those in practice • They appear to work according to an ‘information’ model of patiënt-physician relationship with respect to abortion • Counselling patients according to deliberative model and providing information on alternatives would probably decrease number of abortions • Additional training of FP’s on recognizing psychological complaints that could be a consequence of abortion H Jochemsen

12. 5. What needs to be done • Further research! • Good prevention programmes of unwanted pregnancy and of abortion • Good help system (a.o. FP’s) for women who ask for an abortion and those with psychological sequela, with knowledge of cultural minorities • Good social policy, not least among cultural minorities! H Jochemsen

13. Thank you for your attention… A Research Project of: Prof.dr. G.A. Lindeboom Institute Centre for Medical Ethics P.O. Box 224, 6710 BE Ede, Holland lindinst@che.nl H Jochemsen