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

H Jochemsen2 Presentation 1.Scientific research on psychological sequela of Abortion 2.Focus of this study 3.Conclusions 4.Risk factors 5.Research among family physicians 6.What needs to be done

H Jochemsen3 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 Jochemsen4 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 Jochemsen5 Focus of this study Inventory of psychological post abortion sequela in general Nature of negative consequences Severity of negative consequences Prevalence

H Jochemsen6 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 Jochemsen7 Conclusion (2) Five most common negative psychological consequences are: Depression Feelings of guilt Anxiety Grief Regret

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

H Jochemsen9 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 Jochemsen10 Research among family physicians (1) 1.FP’s refer for 63% of all cases of abortion in The Netherlands 2.We interviewed 12 FP’s about the way they deal with abortion requests and psychological sequela 3.They give (some) time to talking to woman with a request for abortion 4.They provide information on the foetus, abortion and possible consequences if the woman asks about it – which she normally does not 5.They normally do not seriously discuss with the woman alternatives for abortion

H Jochemsen11 Research among family physicians (2) 6.They know about possible psychological sequela of abortion but find it difficult to recognize those in practice 7.They appear to work according to an ‘information’ model of patiënt-physician relationship with respect to abortion 8.Counselling patients according to deliberative model and providing information on alternatives would probably decrease number of abortions 9.Additional training of FP’s on recognizing psychological complaints that could be a consequence of abortion

H Jochemsen12 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 Jochemsen13 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