Abortion, Motherhood and Mental Health

Abortion, Motherhood and Mental Health, by Ellie Lee, Aldine de Gruyter, 2004

Every now and again you read a book that shatters assumptions you have held for a long time. This is one of them. Academic Ellie Lee looks at discussions around post-abortion syndrome (PAS) and post-natal depression (PND). Her conclusions are like a stone dropped in the pool of complacency of most pro-choice feminist thinking. Abortion, Motherhood and Mental Health has the potential to make waves – if those outside the academic community can be persuaded to shrug off philistinism and grapple with a book that refuses to simplify complex ideas.

Post-abortion syndrome and post-natal depression are both widely researched phenomena, with claims of their existence and prevalence debated by the medical community, psychiatrists, psychologists and sociologists as well as the advocacy community. As Lee indicates, what the syndromes have in common is that they suggest that women are unbalanced mentally by the reproductive process.

PAS assumes that once a pregnancy has begun a woman can’t end it without suffering a degree of mental illness – even if the mental illness is so suppressed that she doesn’t recognise it. The current discussion on PND is not so extreme. Even the most vociferous promoters of PND accept that some women keep their sanity during early motherhood – but the prevailing view is that PND is underestimated, and that it devastates a significant proportion of new mothers.

Lee’s observation that there are similarities between claims for PAS and PND are startling because, for most of us, PAS is regarded as a cranky allegation made by those who wish to construct a case that abortion damages women. PND, by contrast, is part of the received canon of maternal care. Those who laugh at the diagnostic criteria for PAS (some of which are as vague as ‘sense of foreshortened future and punishment’) tend to accept that PND is under-diagnosed and that new mothers are under-supported. The only proponents of PAS are those with a mission to save ‘unborn babies’ and who, as Lee explores, find medical claims about the supposed problems of abortion far more effective than moral claims in a secular, relativist society. By contrast, the medical establishment is united behind claims for better post-natal services to support new mothers and their families.

Lee suggests that credibility of the claims-makers and their ability to key into contemporary concerns and win the ear of the media matters far more than the intrinsic merits of the claims. PND is regarded as an authoritative claim because it is made from within the medical establishment, whereas PAS is a claim made by a marginalised minority. One could argue that research demonstrates widespread evidence for PND, but not for PAS. However, Lee suggests that the research in support of post-natal depression needs to be subject to the same kind of scrutiny as that for post-abortion syndrome. When it is, she suggests, it is found as wanting.

Of course, there is a profound difference between abortion and childbirth that would lend weight to the argument that there is a basis for PND but not PAS. When a woman has an abortion she is taking action to restore the status quo ante. She is putting right what has gone wrong in her life and holding on to what is familiar. When a woman has a child her life changes utterly.

Lee accepts this and acknowledges that, at a time when women – particularly professional women – expect to balance a career and a family, the tensions can be particularly pronounced. However, she insists that there is a difference between accepting that women struggle to juggle their lives, and diagnosing them as mentally ill. Her study suggests that there is an inconsistency between the way some dismiss the suggestion that the post-abortion sadness, weepiness and transient feelings of regret are symptomatic of PAS, yet accept that in a post-natal situation they are indications of a form of mental illness, PND.

Lee discusses a further reason why we view claims with regard to abortion differently to those of childbirth. While abortion has become increasingly acceptable, current society, she argues, problematises parenting and child-rearing. There is an expectation that parents will not be able to cope without external support from a raft of experts and professionals. She discusses the evidence for this, from sources as divergent as policy programmes and popular literature. Today, it is assumed that motherhood is a stressor and that the demands of parenting are likely to tip formerly well-balanced women over the edge.

For many years now, first as advocate of abortion services and now as a provider, I’ve ridiculed the notion of mandatory abortion counselling. I’ve argued that it is perverse that a pregnant woman opting to end her pregnancy is subjected to counselling about whether she has considered the consequences, while a pregnant woman accessing antenatal care is not. Childbirth, I argued, changes your life utterly, yet nobody quizzes you on whether you’ve considered the effect it will have on your career, your social life or your relationship. So why should women seeking abortion be subject to counselling?

It was a rhetorical device to suggest that post-abortion counselling was unnecessary, which I won’t be using any more. If Ellie Lee is correct, we may well see antenatal counselling taking its place.

Ann Furedi is chief executive of bpas: abortion advice & care (Ann.Furedi@bpas.org).

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