Thursday, November 17, 2011

When Abortions Get Familiar

A few years ago, I counseled a client who was caring for a critically ill child and felt that she had to choose between the child she already had and the one that she could potentially have. She chose to terminate this pregnancy in order to better care for her child, but truly, she wanted them both. Around the same time, there was another client, not someone I counseled, but someone who was crying hysterically in the recovery room and I went to her to comfort her in whatever way I could. I don't know her story, but I know she was devastated by having to make the decision to have an abortion. It was the first abortion for each of these women, and after I talked to them about coping and about how they were still good women and how they would manage to be OK, they both declared that it would be their last abortion, and that they were confident, if not glad about their decisions. I don't hold them to that promise, of course. And I don't hold myself responsible for making them feel OK.

The interesting thing, though, is that it was neither of their last abortions. In fact, they both went on to have several more abortions. Did I make them feel so OK about their decisions that they decided that abortion was the way to go? I doubt it, even though I don't see anything really wrong with that plan. Did they feel so bad that they thought, "F*** it; I had one abortion, so I might as well have five"? Were they engaging in that Russian Roulette coping mechanism where they subconsciously (or consciously) want to test their fertility by having unprotected sex, then realize, "Oh. I guess that worked. I didn't actually want that to work"? Had they not been particularly sexually active prior to the first abortion, and afterward, they didn't quite get the hang of birth control?

As usual, I'm not at all judging reproductive health decisions, but some of them certainly are perplexing. Anyone have any insight? If not, want to launch a study? (You're paying...I only make an abortion clinic staffer's salary.)


  1. I dunno, isn't it usually the case that making a vow is the first step towards breaking one? I feel like self-promises are more coping mechanisms than anything else, when you try to convince yourself that you're not a bad person for doing/not doing whatever it is you vow to/not to do. It's like a New Year's Resolution; nobody ever keeps them, and yet life goes on.

  2. Maybe those women who have had multiple abortions were more lax about their birth control than a women who hadn't had an abortion, perhaps because they had already 'survived' an abortion and knew consciously or unconsciously that they could always get another if they were to become untimely pregnant again.

    Also -
    Just as with women having their first abortion, however, the majority of women having their second or even their third abortion were using contraceptives during the time period in which they became pregnant. In fact, women having a repeat abortion are slightly more likely to have been using a highly effective hormonal method (e.g., the pill or an injectable).

    . . . it suggests that women having abortions—especially those having more than one—are trying hard to avoid unintended pregnancy, but are having trouble doing so.

    *Did these women have birth control failures that led to their second,, third ect abortion?

    Ps - If my IUD failed me I would join the ranks of women who had more than one abortion. I refuse to have more than one baby/toddler at a time in diapers or potty training.

  3. I had two abortions this calendar year. I assure you this was not because I was ignorant or "lax" about contraception, didn't switch to more effective methods after the first one or consult a medical profession to find the best birth control method for me, felt bad or not in control of my sexual decisions, was having risky sex, was unconcerned about the financial cost or health risks, was familiar with the procedure, was "testing my fertility", or treated avoiding pregnancy as a freaking New Year's promise.

    I had two unplanned pregnancies this year because my birth control failed twice. I had two abortions this year because didn't want to be pregnant.

    Reading the Guttmacher article Oubli linked to, my experience is not abnormal.

  4. Thanks for sharing, notmygnome. Rest assured that The Abortioneers in no way pass judgment against women who have multiple abortions; we've seen this time and again and we no longer consider it remarkable.

    I think what has us puzzled is not why someone would have multiple abortions, but why they would vow that it won't happen again only to end up back in the clinic. Since the women referenced in this post seemed to feel bad about having abortions, I suspect they attempted to clear their consciences by promising that it would be the last time. We all know this doesn't work, of course (how many times have you promised not to have that second helping of pie?), so I'm assuming it's used as a self soothing mechanism. Of course there's nothing wrong with having more than one abortion, but some women definitely beat themselves up over it.

  5. Yeah, some un/lucky women are just more fertile than others. So those women are more likely to experience birth control failure despite correct use -- and in turn more likely than other women to need an abortion in their lifetime, and more likely to need MORE than one abortion in their lifetime. Their risk for unintended pregnancy is just higher, all else being equal. On the plus side, their risk for infertility when they DO want a pregnancy is much lower :)

    There's an interesting (to me, I guess) takeaway from the fertility effect, a point about the statistics which our conversations tend to gloss over. Contraceptive effectiveness rates are really not about the risk for one individual person! The figure "99% effective," for example, means that in one year, out of 100 people using a given method, one person will become pregnant. It doesn't account for frequency of sexual activity, timing of sex relative to ovulation, each partner's age or medical history, or many other things that obviously could affect your chances of getting pregnant.


This is not a debate forum -- there are hundreds of other sites for that. This is a safe space for abortion care providers and one that respects the full spectrum of reproductive choices; comments that are not in that spirit will either wind up in the spam filter or languish in the moderation queue.