ABORTION AS A LIFE CRISIS Carole Browner Introduction. Every pregnancy, however normal it may be and however joyfully it may have been anticipated, involves certain physio- logical, psychological and social adjustments which, in the broadest sense, represent "stress". Conversely, the artifi- cial interruption of any pregnancy, however dangerous its continuation may be and however undesirable it may seem psy- chologically, socially and economically, also involves basic physiological, psychological and social readjustments which likewise represent "stress".1 This broad statement is exemplary of traditional beliefs about preg- nancy and abortion. Its assumption is a simple one: that both are breaks in the normal life cycle and universally represent stress. The degree and form of the stress are clearly subject to cultural interpretation. Ameri- can health professionals consider both experiences extremely significant ones, and they emphasize this belief in books and articles addressed to the lay public. One psychiatrist, in a book devoted to the psychological experience of pregnancy wrote, . . .there is a certain quality of inner experience which seems to be distinctive of the pregnant state and which sets it slightly apart from life at any other time. It seems univer- sally true that women experience pregnancy as a psychological crisis. It could not be otherwise. Shifts in body image, secretions of hormones, and cultural expectations are inevit- ably mirrored in the psyche, in the mental life of the preg- nant woman.2 Like pregnancy, abortion is similarly considered a crisis, but of another magnitude. While the pregnant woman is seen as different from the non-pregnant one, the differences are integrated into the expected life cycle of all women, and the set of social and cultural expectations is well-established. The beliefs about altered eating habits and emotional 86 ability and conventional expressions of deference and respect all help to demonstrate that the pregnant woman is to be set apart from the rest. She is subject to a different set of rules, standards, and expectations. The woman who intends to terminate her pregnancy by abortion is placed in another category. The "unnaturalness" of this act subjects her to a different set of cultural expectations. In this case, the "crisis of pregnancy" is a psychopathogenic phenomenon. As one prominent psychia- trist remarked, Abortion . . . is not to be looked upon as the origin of, but rather as a linkage in, a long chain of socio-psychopathology involving psychic, cultural, environmental, educational, and other factors . . . In analyzing the abortion setting and the personality involved, we are likely to find on one hand that the person is inadequate, and on the other, the matrix in which the person operates is inimical.3 But the "crisis of abortion" goes deepqr than this, for abortion is felt to deny a woman her natural fulfillment. Another psychiatrist and spe- cialist on abortion stated, . . .the most positive side of the fate of being a woman has to do with her natural creativity. The need, when such arises, to have an abortion goes against this basic feminine creativ- ity, and, though the conscious and even the subconscious wish is for an abortion, this is rarely the entire story: the basic feeling that she is being deprived of something necessary to her fate and to the completion of her life is in the background for every woman under these circumstances.+ Attitudes of this type have become ingrained in the scientific liter- ature on therapeutic abortion, and now that abortion has been legalized in several states, these attitudes have become part of the operating ideology of hospitals and abortion clinics as well. One doctor, in characterizing the role of the hospital in legal abortion, wrote, We now recognize that her request for an abortion reflects a crisis that involves how she lives, and that it may affect how she looks at herself and what kind of future she will have 87 * . . A service that does nothing but abort a woman deals with only one symptom of her total problem.5 Many authorities thus consider abortion a "life crisis" in the full- est sense of the word. Since a woman's "natural" function lies in repro- duction, disruption of this process is liable to have traumatic or disas- terous results. But the source of the crisis is even more basic: since reproduction is her natural role, a woman's failure to want to bear a child once it has been conceived is seen as both unnatural and pathologi- cal. The basis of this study. The anti-abortion advocates who spawned this view had little evi- dence to support their position. They relied on psychiatric case reports, anecdotal information, and unsystematic studies to demonstrate the trauma inherent in abortion. Althoigh they lacked scientific validity, these re- ports were tremendously influential in generating an environment in which "frustration, hostility, and guilt"7 were assumed the appropriate emotional responses to induced abortion. In the last several years proponents of these traditional views have met serious challenge, both from researchers 8 who question the methodology and conclusions of the original studies and by those with actual data to support the opposing position.9 Although more recent studies have supported the view that abortion is not associa- ted with significant psychological after-effects, at the present time the data are too meager to allow firm conclusions to be drawn. In addition to the lack of clarity and precision which has charac- terized early abortion studies, two further shortcomings may be noted. First, they concentrate on psychiatric sequelae and do not offer data on 88 the pre-abortion state. Second, the social context of the abortion is generally not considered. This study goes beyond earlier research by examining these particu- lar aspects of the abortion experience. Although abortion is often viewed as a "life crisis," there has been no systematic exploration of this as- sumption. Therefore, this study is concerned with three questions: 1) Does the woman contemplating abortion view the impending event as a cri- sis? 2) Is she functioning in an objectively observable crisis state dur- ing the pre-abortion period? 3) If abortion is not a crisis for all wo- men, what psychological and sociological characteristics predispose a woman to experience an abortion as a highly stressful event? Methodology. The study was formulated as an exploratory one, with the generation of testable hypotheses concerning the experience of therapeutic abortion as the primary goal. Twenty-two women, all of whom had come to a well- known family planning agency in San Francisco for pregnancy and abortion counselling and referral, were interviewed. The agency maintained a coun- selling service and I was trained as a volunteer counsellor, working in that capacity for three months prior to commencement of the research. Interviews were conducted in October of 1972 during the counselling ses- sions. A ten question, open-ended interview schedule was prepared for the study (see App. A). Counselling lasted between one and two hours, with the interview itself taking 15 to 45 minutes. The project was des- cribed to each woman and her participation requested. Only one woman re- fused to participate, and she gave no reason for doing so. The only wo- men excluded from the study were those under 19 years of age, since I was 89 concerned with adult rather than teenage pregnancy. Findings . The women in the sample tended to form a homogeneous group, pro- bably a function of the type of woman served by the particular family planning agency and not necessarily indicative of the type of woman who seeks abortion either in California or in the United States in general. The sample was predominantly under 25 (73%), single (77%), white (73%), without children (73%), and no longer practicing the religion within which they were raised (77%W), which was either Protestant (41%) or Catholic (50%). About half the women were employed (45%), and as a group they were highly educated, with 41% having completed college or gone beyond. The women, with the exception of one, were all in the first trimester of pregnancy; half the group was between 8 and 12 weeks pregnant, the other half, less than 8 weeks. In the majority of cases (68%), no method of contraception, or only the rhythm method, was used (see App. B). Superficial examination of the data revealed that all the women did not appear to regard the impending abortion as a crisis. A "crisis" and a "non-crisis" category were devised, and women were tentatively placed in one or the other on the basis of whether or not they seemed to be in a "crisis state". This placement was possible because there was signifi- cant similarity of response, and the data fell into two fairly discrete groups. Systematic examination of the two groups revealed that there were two variables which appeared to indicate whether the abortion would be viewed as a source of major upset. These were ambivalence about con- tinuing the pregnancy and the acknowledgment of circumstances under which the woman would consider having the baby. Thus all women in t1e non-crisis 9o category expressed no doubts about having the abortion and said there were no circumstances under which they would have a baby at this time. Those in the crisis category were ambivalent about having the abortion and said they could easily imagine conditions under which they would have a child, e.g., if they were earning enough or if their boy friends were encouraging. There were 9 women (41l%) in the crisis category and 13 women (59%) in the non-crisis category. Once the initial division was made, the remaining data were ana- lyzed to determine the specific components of the "crisis state". Using the interview schedule as a guide, I devised an eight parameter test for this purpose. The parameters were: 1. Did the woman herself perceive the abortion as a life crisis? 2. Did she exhibit physiological or psychological symptoms characteris- tic of a state of crisis? 3. Did she consider her relationship with her sexual partner to be a satisfactory one? Were they in agreement about the decision to have the abort ion? 4. Did she appear to have an adequate external social support system? 5. What did she imagine she would do if she ever experienced an unplanned pregnancy? 6. Was the deicision to have the abortion a difficult one? 7. How did she think she would feel when the abortion was completed? 8. Had this been a good year for her? Had she other difficult decisions to make? The responses were tested within the two groups, and following is a summary of the results. A complete statistical analysis is found in 91 Appendix C, but the reader is cautioned against generalizing from the small sample that is shawn. 1. Most women (6/9) in the crisis group considered the abortion a life crisis; none in the non-crisis group felt this to be the case. 2. Most women (6/9) in the crisis group experienced a variety of physio- logical and psychological symptoms, such as depression, vomiting or sleep- lessness; far fewer (5/13) in the non-crisis group experienced similar symptoms. 3. Most crisis women (8/9) were involved in what they considered unsatis- factory emotional relationships. Few non-crisis women (3/13) considered the relationship an unsatisfactory one. 4. Most crisis women (6/9) did not have a supportive group of friends and relatives to help them through the abortion period. Only a small num- ber of non-crisis women (2/13) did not have this type of emotional support available. 5. Every crisis woman except for one said she would keep the baby in the event of an unplanned pregnancy; no non-crisis woman said she had ever made a similar assumption. 6. More crisis (4/9) than non-crisis (1/13) women said the abortion de- cision was a difficult one, but the difference was not striking. A far greater number of women in both groups said that the decision was not dif- ficult to make. 7. More crisis (4/9) than non-crisis (0/13) women said they expected to feel some regret once the abortion was over, but again the difference was not striking. Most women in both groups expected to feel happy and re- lieved once the abortion was completed. 92 8. It has been suggested that an unplanned pregnancy is symptomatic of a woman s unhappy life situation. The data do not substantiate this hypothesis. There was little difference in the number of women who re- ported that the past year had been a bad one (3/9 crisis, 3/13 non-crisis); the majority of women in both groups said their life had been satisfac- tory, if not happy, for the past several months. An examination of the demographic material reveals little corres- pondence within the two groups (see App. D). This situation may be a function of the homogeniety of the sample, but other studies also demon- strate no correlation between demographic variables and abortion outcome. It might be mentioned, however, that the crisis group contained a greater percentage of non-white and Catholic women; all crisis non-white women were Catholic. Such a grouping may be a reflection of the size of the sample, since other studies show that Catholics and non-whites have abor- tions in the same proportion as they are present in the San Francisco pop- ulation. However, it is not known whether abortion is more traumatic for them. Non-crisis women tended to come for abortion counselling ear- lier than crisis women, a fact probably related to the ambivalence the crisis women felt. And while nearly half the non-crisis pregnancies re- sulted from failure of a contraceptive method, only one crisis pregnancy had a similar source. Discussion. The tentative nature of these findings must again be stressed. Not only is the sample population a small one, but we are dealing with a group of women who may not be representative of a larger population. California has had a liberal abortion law for the past five years, so that residents 93 of this state are accustomed to the idea of legal abortion. Roughly two- thirds of the women personally knew at least one other person who had had an abortion, a situation which may be uncommon in other parts of the coun- try. All of the women lived in the San Francisco area, where an abortion 13 d4 is relatilvely easy to obtain. Few requests for abortion are denied, and merely wanting to terminate the pregnancy is generally regarded as sufficient grounds for an abortion to be granted. The sample may thus represent an "abortion sophisticated" grouip of women who consequently regard the abortion as a less traumatic event. 1. The non-crisis group. An examination of the data revealed a number of clear-cut trends. The first was that abortion did not appear to be a "life crisis" for all women faced with an unwanted piegnancy. For a large number of the women (13 out of 22), the abortion was a significant event, but it by no means caused a total disruption of their lives. Most were not completely casual, but they felt that the abortion was an experience they could, with some reflection, place in perspective. As one woman said, Being pregnant is not such a serious thing because I can get an abortion. If I couldn't, then it would be a real crisis. I believe it involves a certain responsibility to make a de- cision one way or the other, but I believe that it's my de- cision to make. Nbny of the non-crisis women recognized that if their own situations were different, the abortion could have been a crisis for them. One remarked, It can be a life crisis for certain people. I had a preg- nancy scare two years ago. Then it would have been a bigger crisis. I was living at home and had no financial resources. I felt guilty and couldn't tell anyone. But now I don't be- lieve I 'm making a decision that affects this fetus as a human being. It will certainly remain a significant event in my life . . . but it won't be a life long trauma. 94 The stress for these women was situational, rather than inherent in the abortion experience. Not being able to get an abortion, living at home without financial resources, these are among the circumstances under which an unplanned pregnancy would be experienced as a stress of crisis propor- tion. Some women were very casual about the impending abortion. For them, it was "just another experience" or "just part of life". More than one woman referred to the augmented status the abortion would ensure, and one said, Deep down I feel a kind of prestige about having an abortion. Like losing your virginity, it's something to discuss in your women's groups--m abortion, my experience. I feel it's just one of the little events that my friends and I would always go through . . . I consider it a very interesting experience. If I went through life and didn't have things like this happen, life wouldn't be interesting. It is difficult, if not impossible, to speculate on the amount of de- nial or underlying anxiety that may have been present in these non-crisis women. No formal psychological tests or interviews were administered. However, my aim was to examine perceived feelings of crisis and psycho- logical upset; and among these women such feelings did not exist. Since none of the women wanted babies, the decision to have the abortion was not a difficult one. Thus, on a conscious level, there was no conflict involved. Of course, the situation was more complicated. There were other factors in the lives of these women which enabled them to make and carry out their decision with less psychic stress, such as a stable love relationship or a strong social support system. These factors will be considered below in greater detail. But on the conscious level, the wo- men did not regard the abortion as a life crisis. 95 I am reluctant to discuss in detail the reasons these women failed to use adequate contraceptives. This question involves consideration of individual psychology, unconscious desires to become pregnant, total life situation, and previous experience with contraceptives. It has been con- sidered in detail elsewhere. 15 I will, however, briefly mention the cause of pregnancy in the case of the non-crisis sample. Of the 13 women, 6 pregnancies resulted from failure of contraceptive method (IUD = 3, con- traceptive foam = 3); 4 from failure of the rhythm method and 3 from the use of no contraceptives whatsoever. The women who used rhythm had usually been successful with it for a number of years. Because it had worked for them in the past, they expected it to continue to work in the future. For some, the use of pills was medicaUly contraindicated: one woman developed "varicose veins", another "an allergy". One woman's doctor was also op- posed to the IUD. These women did not have many contraceptive alterna- tives open to them. The situation was similar for the women who had used no contraceptives. One woman was unable to use either pills or the IUD for physiological reasons. Another was unsophisticated about contracep- tives and knew of only the pill, which she was afraid to take. The third was also unable to use pills for physiological reasons and routinely used foam instead. However, she was careless at the time of conception and did not take contraceptive precautions. It becomes clear that a unique set of circumstances leads to each pregnancy. But the point that concerns me here is not the cause of pregnancy, which appears to demonstrate little "unconscious motivation" on the part of the women involved, but the fact that when pregnancy did occur, it did not manifest itself as a crisis for the women concerned. 96 2. The crisis group. For a sizable number of the sample (9/22), the abortion is to be regarded as a life crisis. The women tended to view it as such and gave evidence that they were operating in a manner that differed from their normal way of functioning. As one woman said, I guess you can call it a crisis. I never had such a problem before. I never considered this the last time I was pregnant. This is the worst thing that has ever happened to me I've been very confused, I want to cry all the time I hate to have to do it, but there doesn't seem to be any other way . . . I can work at my job, but once I get home I don't want to do anything. I feel tense and depressed all the time. Some women found that they could do little but think about the pregnancy. One remarked, I've been very moody and sometimes I have trouble falling asleep, or I wake up for no reason and can't fall asleep. I just can't stop thinking about it. I can't read a book because I can't concentrate. I keep wondering what kinds of changes my body is going through. One woman contemplated getting herself into an automobile accident if she could not get the abortion. Another took an overdose of sleeping pills soon after conception, following a fight with her boyfriend; she said, however, that the overdose was a reaction to the fight and not the preg- nancy. These were the most extreme responses, but all women in this group experienced some degree of psychic disturbance. While they all continued to function on some level (none quit their jobs, for example, or sought psychiatric counselling), for most it was an extremely stressful time. These crisis women shared certain characteristic responses to the pregnancy: they were ambivalent about having the abortion, and they would have continued the pregnancy under other circumstances. Usually, these 97 were circumstances of a concrete nature. Of the 9 women, 2 could not have the baby because they did not have the financial resources to sup- port another child. Both these women had children and would have liked more, but could not afford to have them at the present time. Two women found their boyfriends extremely unsupportive and uninterested when they learned of the pregnancy, and they did not want to have a baby on their own. Neither had anticipated a reaction of this type, and one immediately terminated her three year relationship. The other seriously considered doing so. It is possible that the women wanted to "test" the relation- ship by forcing a confrontation, and they did not discount this possibil- ity. One woman felt she could not continue the pregnancy because her mother would never accept an out-of-wedlock baby. Four said they did not want to have a child unless they were involved in a stable, happy rela- tionship. Thus, the ambivalence these women expressed stemmed from real and concrete sources, rather than merely inability to reach a decision. Thus the crisis for these women was based in the conflict created by their ob- jective life conditions, rather than in the act of abortion itself. These women would have liked a baby; and though they were not making a conscious attempt to become pregnant, it seems possible that if abortion were not so readily available they might have chosen to continue the pregnancy ra- ther than seek illegal abortion or adoption. But faced with a choice, a conflict is created. And their choice is made more difficult by the fact that society is undergoing a value transition, so that abortion is now available but not considered an acceptable means of bi:rth control. Further evidence of the differences in the two groups concerning 98 ambivalence about having a child is seen in the responses to the question, "What did you imagine you would do if you ever experienced an unplanned pregnancy?" While no non-crisis woman said she assumed she would have had and kept the baby, every crisis woman, with one exception, did. It is possible that the non-crisis women, in their desire to block out feelings of uncertainty, said that they would have sought to terminate any unwanted pregnancy. However, the crisis women seemed to feel that a baby could easily be integrated into their life at any time, and they were surprised to discover that this would not be possible. As one remarked, "I always imagined I would work for the first three months and save money for the baby. I assumed I would have it, and never considered abortion. But the reality of the pregnancy made the decision to keep the baby impossible." Another said, "I thought I might have the baby if I ever got pregnant. But that wasn't in reality; it's easier to think about those things in fantasy. " An examination of contraceptive use among these women demonstrates that there was ambivalence in this area as well. In some cases it is dif- ficult to determine if a subconscious desire to become pregnant was oper- ating, or if the need to be conscientious about contraception was not as great, since the possibility of pregnancy did not seem as traumatic as it turned out to be. Of the 9, 1 pregnancy was the result of contraceptive method failure, 4 the result of rhythm failure, anci 4 due to failure to use any form of contraception. Of the 4 using rhythm, all had had suc- cess with the method to date, and 2 had experienced unpleasant side ef- fects with birth control pills previously. The other 2, however, were ambivalent about getting pregnant: one thought that she might be able to 99 manage another child; the other realized that it was, perhaps, a bad time to have intercourse, but was too depressed to care. Of the 4 women who had used no contraceptives, one had been told by a doctor that she was sterile; one was "half-trying" to become pregnant, thinking that she would be able to manage another child; and the final 2 had stopped their pills because their boyfriends had left town, but had unexpectedly returned be- fore they began taking pills again. Both knew that intercourse at that time might result in pregnancy, but niether took the prospect too ser- iously, thinking, "It won't happen to me." It is noteworthy that both women would not continue the pregnancy because of the lack of support and encouragement from their boyfriends. The ambivalence seen in response to the pregnancy itself is similarly manifested with regard to the conjugal tie. 3. Sources of support. The factors discussed provide a starting point for understanding differential response to abortion, but other elements seem to be operat- ing as well. I will consider two hypotheses: 1) that during a time of stress, external social networks16 are more likely to be utilized for emotional support if the relationship is an unsatisfactory one; that is, if her partner is not supportive during the crisis, the woman is apt to turn to friends and relatives; and 2) that the combination of an unsati - factory relationship and a weak social support system will result in per- ception of the abortion as a crisis. Fbr the purposes of comparative ana- lysis, I will continue to uxtilize the crisis/non-crisis dichotomnr to ex- plore the behavior of the women. I will first examine the relationship with their partners and then contacts with others during the pre-abortion period. 100 It has been noted that 10 of the 13 women in the non-crisis group were involved in what they characterized as happy and satisfying relationships. Eleven of the 13 agreed with their partners about having the abortion. On the other hand, only 3 of the 9 women in the crisis group were involved in satisfying relationships, and in none of these 3 cases was there agree- ment between the partners on the subject of an abortion. It becomes clear that no crisis woman found a solid base of emotional support within the relationship, while almost every non-crisis woman did. Turning now to other contacts, three areas will be examined: 1) the number of people the woman told of her pregnancy, that is, how large a network segment was activated; 2) their relationship to her; and 3) whe- ther they were supportive of her decision. The women in the crisis group told between 2 and 6 people (median 3, mode 3) of the pregnancy. One wo- man told 2 people, the rest told 3 or more. The women in the non-crisis group told between 1 and 7 people (median 1, mode 1). Nine women told 2 or fewer, 4 told 3 or more. No woman in either group told no one. It thus appears that there was a significant difference in the number of peo- ple each group of women consulted.17 All of the crisis women told the man, 3 told relatives (one mother, the rest siblings), 7 told friends, 5 told acquaintances. Eleven of the non-crisis women told the man, 4 told relatives (one mother, one sister-in-law, the rest siblings), 6 told friends, none told acquaintances. These data are tabulated below: Person told Crisis Non-crisis an 9/9 lOO1% 11/13 85% Kin 3/9 33% 4/13 31% Friends 7/9 78% 6/13 46% Acquaintances 5/9 56% 0/13 0% Lacking a supportive base within the relationship, the crisis women were more likely to discuss their situation with friends and acquaintances in an attempt to mobilize support for their decision. Non-crisis women told fewer people, and were more selective of whom they told. Often they told only the man, and because of accord between them, they had no need to seek '18 help of others. An examination of the character of the social networks revealed that while 11 of the 13 non-crisis women had supportive networks, only 3 of the 9 crisis women had similarly supportive ones. A supportive network was defined as a consensus among those consulted on the question of the abortion, regardless of whether it favored the abortion or opposed it. If the woman told only the man, but they were in agreement, the support system was considered adequate. If the man was not supportive, but friends and relatives were, this was also considered an adequate support system. However, if neither the man nor the others consulted were supportive of the woman's decision, she was considered to have a non-supportive network. In brief sumry, the crisis women told many more people about their pregnancy, and they were more likely to consult with friends and acquain- tances, but in doing so they were unable to mobilize a supportive social system. Their own ambivalence, coupled with the lack of support in their immediate social environment (i.e., the conjugal relationship) led them to consult with a progressively larger number of people in the hope of find- ing help in making the abortion decision and implementing it with a mini- mum of distress. Usually, they were not successful and had to make the decision alone in an environment characterized by conflicting advice. The result was their experiencing the pre-abortion period as one of con- 102 fusion, uncertainty and stress. On the other hand, non-crisis women were likely to tell only the man, who usually was supportive; but if they did not get his support, they could generally turn to a friend or relative who would provide it. Lack of personal ambivalence and the absence of interpersonal conflict together created an atmosphere in which a decision could be quickly and easily made and carried out. Conclusion. A series of internal and external factors operate together to deter- mine a woman's response to an impending abortion. Among the internal fac- tors are ambivalence regarding continuation of the pregnancy, and the ac- knowledgment of circumstances under which continuation of the pregnancy would occur. The external factors pertain to interpersonal relationships. If the woman has a satisfactory relationship with her sexual partner, and they agree about the abortion decision, she will not view the abortion as a crisis. If she does not have a satisfactory relationship, but has a supportive social network, she will also be able to bandle the abortion without significant emotional upset. However, if she has neither a solid emotional base within the relationship nor an externally supportive social netwoxk, she will probably find herself in a crisis state. Among the cri- sis women there appears to be a significant correspondence between an un- satisfactory conjugal relationship and a weak social support system; most crisis women experienced both. The reasons underlying this observation are worthy of further study. Also worth exploring is the extent to which weak social support systems contribute to an emotional crisis. 103 NOTES 1Devereux, 1954, p . 99. 2Colman and Colman, 1971, p. 6. 3Galdston in Calderone, 1958, pp. 119-120. Litz in Calderone, 1958, p. 120. 5Connell, 1972, p. 143. 6"Crisis in its simplest terms is defined as 'an upset of a steady state'. This definition rests on the postulate that an individual strives to maintain for himself a state of equilibrium . . . Throughout a life span many situations occur which lead to sudden discontinuities by which the homeostatic state is disturbed . . . In response to many such situa- tions, the individual may possess adequate adaptive or re-equilibrating mechanisms. However, in a state of crisis, by definition, it is postu- lated that the habitual problem-solving activities are not adequate and do not lead rapidly to the previously achieved balance state." Rapoport, 1965 P 24. 7Galdston in Calderone, 1958, p. 120. 8Beck, 1971; David, 1972; Lader, 1966; Pohlman, 1971; Shainess, 1970; and Simon and Senturia, 1966. 9Kretzschmar and Norris, 1967; Kummer, 1963; Niswander and Patterson, 1967; Osofsky and Osofsky, 1972; Pare and Raven, 1970; and Peck and Marcus, 1966. Cf., Calderone, 1958, pp. 117-153; and Connell, 1972. 104 Cf., Barnes, Cohen, Stoeckle, and McGuire, 1971. Tow, 1971, p. 2. 13Abortion requests are granted under the "mental health" clause of the Abortion Act. It states that an abortion will be granted if "there is substantial risk that continuance of the pregnancy wauld gravely impair the physical or mental health of the mother" (The California Therapeutic Abortion Act of 1967). In the San Francisco area, the expression "mental health" tends to be defined in the broadest sense. 1 I know this to be true in public agencies, such as hospital out- patient departments and family planning agencies, but I do not know the exact situation among private doctors. My impression is that most doc- tors use the same criteria as agencies do. I know of no woman who came to the agency where I worked to request an abortion after her request to a private doctor had been denied. 15Lowry, 1971; and Sandberg and Jacobs, 1971. I am using network analysis as described in Barnes, 1954; Bott, 1971, and Mitchell, 1969. 17Impersonal sources such as doctors and welfare workers were not included unless the woman stated that that person played a decision-making or supportive role. l8It is noteworthy that so small a number of kin were consulted. However, the nature of the stress, and the geographical mobility of the women make it likely that friends will be chosen over relatives in this case. Of the 16 women for whom I have information pertaining to family 105 residence, 9 live outside the immediate proximity of the family. But the nature of the stress probably presents a greater deterrent. Most women felt they could not tell their parents because the parents would express criticism or disapproval. I do not have information on the availability of other relatives and the reasons for not consulting with them. 106 APPENDIX A Interview Schedule. 1. How did you feel when you first found out that you were pregnant? 2. (a) How do you feel now? (b) Have you been having trouble sleeping, been unusually moody or depressed, felt unusually tired, been crying alot, having trouble getting your work done? (c) How do you feel when you get up in the morning; at night before bed? 3.(a) Who knows about your pregnancy? (b) How do they feel about it? (c) How do they feel about the abortion? 4.(a) How did you get to [this agency]? (b) What was the first thing you did when you thought you might be pregnant? (c) When you found out for sure? (d) Had you ever thought about what you would do if you be- came pregnant? (e) Ever had fantasies about being pregnant? 5.(a) Was it difficult for you to make the decision to have an abortion? (b) Is it usually easy for you to make decisions? (c) Have you had other difficult decisions to make in the past several months? 6.(a) Do you know anyone who has had an abortion? (b) Would you tell me about their experience? 7. (a) Has this been a good year for you? (b) In what way? 8.(a) Do you see this pregnancy as a "life crisis"'? (b) Where would you place this experience in terms of the high and low points of your life (i.e., is this one of the best or worst things that has ever happened to you)? 9. How do you think you will feel when the abortion is over with? lO.(a) Have you had any dreams about your pregnancy? (b) Do you remem- ber any dreams you have had since you thought that you were pregnant? 107 APPENDIX B Demographic data. Below is a demographic analysis of the 22 Since the number is small, statistics should be trends but not as conclusive fundings. Number Gestation -7 weeks 8-12 weeks 13+ weeks Cause of Pregnancy No contraceptive method used Method failure Rhythm Foam IUD 10 11 1 8 14 7 4 3 6 10 4 2 16 6 17 1 2 2 11 9 2 3 6 11 2 Age 19-21 22-25 26-30 31+ Children None 1 or more Marital Status Single Married Divorced Widowed Religious Background Catholic Protestant None, no response Present Religious Status Semi -active Inactive None Other, no response women in the sample. read as indicative of Percent 45 50 5 36 64 32 18 14 27 45 18 9 73 27 77 5 9 9 50 41 9 14 27 50 9 108 Numiber Percent Education Less than 12 years 5 23 12-15 years 8 36 16+ years 9 41 Occupation Employed 10 45 Unemployed 9 41 Student 3 14 109 APPENDIX C The Cri sis State. I. Criteria for inclusion in the "Crisis" group were (1) ambivalence, and (2) an acknowledgment of the existence of circumstances under which the woman would have the baby.* Ambivalence Acknowledgment II. Parameters used in def'ining Parameter Self -definit ion Symptomatology Unsupportive Re- lationship: No relationship Disagree about decision Weak social support system Past year - bad Pregnancy plan Have baby No plan Decision diff'icult Expected regrets Cri si s 8/9 89 9/9 100 the "Crisis" Cri sis 6/9 67 6/9 67 3/9 5/9 6/9 3/9 8/9 1/9 4/9 4/9 33 56 67 Non-crisis /1 0 0/13 0 0/13 0 state. Non-crisis 0/13 0 5/13 39 1/13 2/13 2/13 3/13 0/13 3/13 1/13 0/13 33 89 11 44 44 8 15 15 23 0 23 8 0 If the woman fulfilled one of in the crisis group. Every woman in both criteria. these two criteria, she the crisis group except was placed one fulfilled 110 APPEINDIX D Demography of Crisis and Non-crisis Groups. Crisis Non-crisis Gestation 4-7 weeks 3/9 33 7/13 54 8-12 weeks 6/9 67 5/13 39 13+ weeks 0/9 0 1/13 8 Cause of Pregnancy No contraceptive method used 5/9 56 3/13 23 Method failure 1/9 11 6/13 46 Rhythm failure 3/9 33 4/13 31 Less than 25 7/9 78 9/13 69 25+ 2/9 22 4/13 31 Children None 7/9 78 9/13 69 1 or more 2/9 22 4/13 31 Marital Status Not presently married 9/9 100 12/13 92 Married 0/9 0 1/13 8 Religious Background Catholic 7/9 78 4/13 31 Protestant 2/9 22 7/13 54 None, no response 0/9 0 2/13 15 Present Religious Status Semi-active 2/9 22 1/13 8 Inactive 3/9 33 3/13 23 None 3/9 33 8/13. 60 Other, no response 1/9 11 1/13 8 Ethnic Group White 5/9 56 11/13 85 Non-white 4/9 44 2/13 15 Education Less than 12 years 1/9 11 4/13 31 12-15 years 5/9 56 3/13 23 16+ years 3/9 33 6/13 46 111 Non-crisis # 70 Occupation Employed Unemployed Student 6/9 3/9 0/9 67 33 0 4/13 6/13 3/13 31 46 23 112 Crisis BIBLIOGRAPHY Barnes, Ann B., Cohen, Elizabeth, Stoeckle, John D., and McGuire, Michael T. 1971 Therapeutic abortion: Medical and social sequels. 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