The abortion decision: reasons and ambivalence

J Psychosom Obstet Gynaecol. 1995 Sep;16(3):123-36. doi: 10.3109/01674829509024461.


Self-in-relation theory and pilot data responses to an Abortion Decision Balance Sheet by 20 women attending an abortion-providing clinic challenge previous formulations of the abortion decision. Pilot data suggest that: women may make an abortion decision based primarily on pragmatics, a belief in their right to choose and knowledge of the safety and simplicity of the procedure. A discrepancy may exist for a significant minority of women between their abstract beliefs/knowledge and the personal meaning for them of the pregnancy, abortion and its safety. Important links may exist between maternal attachment and anxiety about the safety of the abortion procedure. Ramifications for counselling and future research are discussed.

PIP: This study reviews the literature on the psychological impact of the abortion decision and finds that the data consistently indicate that 1) most women experience relief, heightened self-esteem, and easing of emotional distress after an abortion; 2) the active resolution of a problem pregnancy decision may promote personal development and maturation; 3) about 10% of women experience emotional difficulties following an abortion; and 4) women most at risk for distress (excluding the cases of medical or genetic indications or women with history of psychiatric problems) are those who feel conflicted about or coerced into the decision. Most researchers also agree that ambivalence is an intrinsic part of any pregnancy. The topic of ambivalence as it affects the abortion decision is explored, therefore, and the concept of an abortion decision "balance sheet" with "pros" and "cons" is discussed as a decision-making aid. The dearth of research and theoretical focus on the woman in relation to the pregnancy (self-in-relation theory) in the context of abortion decision-making is noted. Finally, pilot study findings are presented to highlight the issues discussed and stimulate research and theoretical development. For the pilot study, an abortion/problem pregnancy decision balance sheet was created which includes reasons for terminating and for continuing the pregnancy. The tool was used with 20 women who were undergoing abortion counseling. It was found that a valid analysis of the decision to abort must include both reasons to continue the pregnancy and reasons to abort. Most women based their abortion decision on practical and pragmatic concerns, a belief in their right to control their fertility, and the safety and simplicity of the procedure. Use of the abortion balance sheet allows women to conceptualize the meaning and the ambivalence of the abortion decision. It also allows inclusion of items about relationships important to the abortion decision. It is possible that the unique aspects of the abortion decision may generate new concepts about decision-making in general.

MeSH terms

  • Abortion Applicants / psychology*
  • Abortion, Induced / psychology*
  • Adolescent
  • Adult
  • Choice Behavior
  • Decision Making*
  • Family Planning Services
  • Female
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Mother-Child Relations
  • Pilot Projects
  • Pregnancy / psychology*
  • Pregnant Women*
  • Problem Solving
  • Qualitative Research
  • Research