Rape-Related Pregnancy and Pregnancy Loss

Possible Risks in Terminating a Pregnancy

Photo by Oliver Burston, Wellcome Images

Physical Risks:

Carrying a pregnancy to term and terminating it both carry risks.  This is why many of our criminal codes classify pregnancy as a form of grievous bodily harm.  So how do the risks balance?

Medical termination can be performed up to 7 weeks of pregnancy and involves taking medication which causes a process like a miscarriage.  Surgical termination can be performed up to 20 weeks of pregnancy and involves a surgical procedure with local anaesthetic, intravenous sedation or general anaesthetic.  Like any medication or surgical procedure, termination of pregnancy involves risks.  This page talks about immediate risks and how to manage them.  This page also has a balanced discussion of the risks.  The Merck Manual discusses the different types of procedures and gives some percentage odds for risks.

According to reputable sources, such as the Victorian Government's Better Health Channel, terminations in first trimester are much safer than giving birth.  (Most terminations happen in first trimester - WA's statistics for 2004, probably typical in Australia, show 95% of abortions are performed in first trimester, US CDC's surveillance shows 88% in first trimester, and the UK Family Planning Association gives a figure of 90%).  This statement's based on a comparison of overall maternal death rates and death rates from terminations. Some well-conducted Finnish studies have found higher deaths rates in women after terminations or miscarriages than after giving birth.  These studies used used a different method: linking death from all causes with records of pregnancy events in the prior 12 months.  One of the Finnish studies compared death rates from natural causes among women who'd been pregnant in the last year with all other women of reproductive age.  Death rates for women who'd given birth or had a miscarriage were lower than other women - this is sometimes called the "healthy pregnant woman effect".  Death rates for women who'd had a termination were slightly (1.46 x) higher.  Another study in 2005 found that death rates from accidental injury, suicide and homicide were higher in women who'd had a termination than in non-pregnant women, or women who'd given birth.  But the authors said, "It is unlikely that induced abortion itself causes death due to injury; instead, it is more likely that induced abortions and deaths due to injury share common risk factors".  This is also true of terminations and deaths from suicide or homicide.  A women who chooses to terminate a pregnancy may already be in a violent situation, or one that compromises her mental health (this is certainly true of women pregnant through rape).  There's also evidence that violence against women increases during pregnancy (see the Finding Out and Telling page here).  Another similar Californian study is often mentioned, but I've got some concerns about its principal author and am confused by its representation of the Finnish studies.  I'll let you form your own opinions!  .

In Australia, information about the maternal death rate and causes of death from pregnancy in any site, of any duration, up to 42 days after birth or termination, from 1994-2005 is available from the Australian Institute of Health and Welfare (AIHW).  Maternal death is rare in Australia.  Between 1994 and 1996 the age-adjusted maternal death rate for deaths directly caused by pregnancy complications was 0.37 of 100,000 of the female population of reproductive age. 767, 448 women gave birth, there were 46 direct maternal deaths and 3 of those from termination of pregnancy.  From 1996-2005 there were a total of 2,285,179 women who gave birth and no recorded deaths from termination of pregnancy.  There’s no reason to think the AIHW stopped recording deaths from this cause or recorded them under a different heading.

If you’re not in Australia, this information may help: 

Of course, death (which remains unlikely) is not the only long-term outcome to consider.  You may want to know how a termination could affect later pregnancies.  There are many studies on the effects of termination on later pregnancies, some showing no effects and others showing effects.  This page provides a good summary of the information we have about rates of miscarriage and termination of pregnancy.  A recent German study found that "the rate of pre-term births increases with the number of preceding abortions.  Similarly symptoms associated with prematurity are more common."  In this study the highest increased rate of pre-term birth, in women who'd had more than two previous abortions, was 1.31 x the normal rate.  But "the rate of small-for-gestational age newborns was not affected by preceding terminations of pregnancy".  Other studies, such as this US study, found an association between numbers of preceding terminations of pregnancy and the rate of small-for-gestational age newborns.  Time Magazine has a good article on the reliability of this study.  This study of the results of different studies in 2009 found women were 1.25-1.64 x more likely to have a pre-term birth after 1 or 2 or more induced abortions.  One Danish study on prematurity demonstrated the difficulty of interpreting results given that those who've had previous terminations may differ from those who haven't in factors such as age, number of previous pregnancies, diseases, gynaecological operations, medication, smoking habts and socioeconomic factors.  As with other possible statistical risks, if you're concerned about effects on later pregnancies, please discuss your own likely risks with your doctor.

There's been a lot of debate about whether termination increases the risk of breast cancer and other cancers.  The consensus is it doesn't.  These pages contain more information:
WHO Fact Sheet 240, Induced Abortion Does Not Increase Risk of Breast Cancer, 2000  Outcome of Workshop Conducted by the US National Cancer Institute, 2003
Findings of the Collaborative Group on Hormonal Factors in Breast Cancer, 2004
American Cancer Society - Can Having an Abortion Cause or Contribute to Breast Cancer? 

 

Photo by Kelliem, Dreamstime

Emotional and Psychological Risks:

I think there’s no doubt being pregnant through rape and having to decide what to do is very difficult emotionally and psychologically.  But does choosing a termination put you at greater risk of being traumatized? 

Again, it’s worth noting that all decisions once a woman’s pregnant carry emotional and psychological risks.  The risks of going through a pregnancy are discussed on the After Birth page here and this paper discussed some of the risks of denying a termination to someone who wants it.  It’s difficult to assess the risks of termination because there are so many other factors affecting things like depression and anxiety.  When someone’s pregnant through rape it can be hard to separate effects of trauma due to being raped, being in a violent situation, or becoming pregnant this way, from trauma due to termination.  Women may be relieved by termination, but still significantly traumatized by those other factors.  They might experience termination as another trauma, but one that’s unavoidable.  Or they might experience depression, anxiety or post-traumatic stress disorder as a result of termination.  The emotional and psychological risks of termination seem greater when a woman has a past history of psychiatric illness, poor social support, is younger, is pregnant with more than one fetus (which can cause a higher rate of failure of the procedure itself), or belongs to a social or cultural group that’s against termination. 

In August 2008, the American Psychological Association published the report of their task force on Mental Health and Abortion.  According to the Executive Summary, “The best scientific evidence published indicates that among adult women who have an unplanned pregnancy the relative risk of mental health problems is no greater if they have a single elective first-trimester abortion than if they deliver that pregnancy. The evidence regarding the relative mental health risks associated with multiple abortions is more equivocal. Positive associations observed between multiple abortions and poorer mental health may be linked to co-occurring risks that predispose a woman to both multiple unwanted pregnancies and mental health problems.”

This page gives detailed information about the some of the most reliable scientific opinion on mental health and termination.  This page provides information about a large British study.  And this page gives a good critical analysis of studies said to support the existence of post-abortion syndrome.  This page gives a balanced view of what you might expect to feel after a surgical termination.

Abortion services, such as Marie Stopes International can provide referrals for post-abortion counselling.  It’s probably a good idea to take up that offer and deal with any issues before they grow.

It’s common for women to experience to experience grief and loss after termination, but this doesn’t usually develop into long-term mental health problems.  If you’re worried about your emotional or psychological state after a termination, please don’t hesitate to ask for help and support – however you’re feeling, you deserve kindness and support!

You can ask the service that provided the termination or your doctor for a referral.  You may also also find help through the Crisis Links page here.  Given the trauma you’re likely to be experiencing through being raped, it’s a good idea to see a counsellor in any case, if you can.  Here’s some information about how to find a counsellor or therapist.

Photo by Adrian Cousins, Wellcome Images

Spiritual Risks:

Dear friends, it's important that you do what you believe is right in this particular circumstance.  But it's also very important to remember that you didn't cause this circumstance and aren't responsible for it.  If you can, set aside some time, do what you can beforehand to calm yourself down (there are some hints here or here, as well as just doing something you enjoy) and then consider realistically what resources you have and what you feel you're able to do.  If you feel you're unable to do what you believe is the right thing to do, please ask for all the help you can.  If you can't find the help you need and aren't able to do what you feel is right, please be very kind to yourself.  When we act under duress the person responsible for those actions isn't us but the person who's trapped us into the situation or forced us to make a choice we wouldn't make if we were truly free to choose.  Please try to put the blame where it belongs!

If you'd like to hear about the Ethics of Termination from someone who understands what it's like to be pregnant through rape, this page has some of my own feelings and thoughts.