THE IMPACT OF POST-ABORTION DISTRESS ON THE INTERPERSONAL RELATIONSHIPS OF

190 Pages·2011·5 MB·English

THE IMPACT OF POST-ABORTION DISTRESS ON THE INTERPERSONAL
RELATIONSHIPS OF WOMEN: AN INTERPRETATIVE PHENOMENOLOGICAL
ANALYSIS

by
SUNÉ BOTHA

Submitted in partial fulfilment of the requirements for the degree of

MAGISTER ARTIUM
CLINICAL PSYCHOLOGY

In the
FACULTY OF HUMANITIES

at
THE UNIVERSITY OF PRETORIA

Supervisor: DR L.M. ESKELL-BLOKLAND

JANUARY 2011

©© UUnniivveerrssiittyy ooff PPrreettoorriiaa
We shall not cease from exploration
And the end of all our exploring
Will be to arrive where we started
And know the place for the first time.

T.S. Eliot

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ACKNOWLEDGEMENTS

I would like to sincerely thank and acknowledge the following people:
(cid:1) My husband to be, Anton, you are my inspiration. This project came into being
because you believed in me. Words cannot express what your encouragement has
meant to me. Thank you for the countless cups of tea, the technological support and
for always understanding.
(cid:1) My supervisor, Linda Eskell-Blokland, for her guidance and insight that helped shape
this project. Thank you for your patience and for allowing me the space to claim my
voice.
(cid:1) My parents, for all the love and support throughout the years and for providing me
with the means and opportunity to become who I was meant to be. I am eternally
grateful.
(cid:1) My friends and colleagues at Weskoppies Hospital, in particular, Melissa, Rümando
and Junaid, your support and wisdom helped me through what felt like never-ending
darkness.
(cid:1) Finally, I am greatly indebted to the remarkable women who, by sharing their stories
with me, enriched my understanding. Thank you for giving so generously of

yourselves.

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TABLE OF CONTENTS

Abstract.....................................................................................................................................9

Key Terms............................................................................................................................... 9

CHAPTER 1 ...............................................................................................................................

Introduction ............................................................................................................................ 10

Overview .............................................................................................................................. 10
Journey to Discovery............................................................................................................ 10
The Research Problem ......................................................................................................... 13
Value of the Study Pertaining to the Field of Psychology ................................................... 15
The Importance of Studying Post-Abortion Phenomena in South Africa ........................... 18
The Concept of Abortion as Defined in this Study .............................................................. 18
The Phenomenon of Post-Abortion Distress ........................................................................ 20
Objectives of the Research ................................................................................................... 20

Research Design ................................................................................................................... 21

Assumptions and Personal Views ........................................................................................ 22
My Position on Abortion and Post-Abortion Distress ........................................................ 23
Limiting Bias ........................................................................................................................ 25

Summary .............................................................................................................................. 26

CHAPTER 2 ...............................................................................................................................

Literature Review .................................................................................................................. 28

Introduction .......................................................................................................................... 28
Background .......................................................................................................................... 28
The Role of the Political Debate in Understanding Abortion and Subsequent Mental
Health.................................................................................................................................. 29
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Research Findings on Abortion and Subsequent Mental Health......................................... 30
Post-Abortion Outcomes ...................................................................................................... 34
Positive Outcomes Following Abortion ....................................................................... 35
Negative Outcomes Following Abortion ..................................................................... 37
Abortion and anxiety .................................................................................................... 39
Post-abortion syndrome (PAS) .................................................................................... 39
Abortion and Substance Abuse .................................................................................... 42
Depression and Suicide ................................................................................................ 42
Factors Believed to Influence Abortion Outcomes and Ways of Coping ............................ 43
Abortion and Interpersonal Relationships ............................................................................ 47
Partner Relationships ................................................................................................... 50
Parent-Child Relationships .......................................................................................... 52
Existing or Future Children .......................................................................................... 53
Friendships and New Relationships ............................................................................. 53
Personal Reflection .............................................................................................................. 55

Summary .............................................................................................................................. 56

CHAPTER 3 ...............................................................................................................................

Research Methodology .......................................................................................................... 57

Introduction .......................................................................................................................... 57
Rationale for a Qualitative Research Design ....................................................................... 57
Qualitative Research ............................................................................................................ 58
Phenomenology: Theory and Method .................................................................................. 61
Being-in-the-world ........................................................................................................ 63
Being-in-the-world-with-others ..................................................................................... 63
Reflective ....................................................................................................................... 64
Co-constitution of meaning ........................................................................................... 64
Perspectivity .................................................................................................................. 64
Unique experiences and essential themes ...................................................................... 65
Interpretative Phenomenological Analysis .......................................................................... 65
Sample ........................................................................................................................... 68
Data Collection.............................................................................................................. 71
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Data Analysis ................................................................................................................ 73
Ethical Considerations ......................................................................................................... 76
Dissemination of Results ..................................................................................................... 77
Ensuring Quality Research ................................................................................................... 77

Summary .............................................................................................................................. 78

CHAPTER 4 ...............................................................................................................................

Results ..................................................................................................................................... 80

Introduction .......................................................................................................................... 80
Overview of the Research Process ....................................................................................... 81
Introducing the Participants ................................................................................................. 82
Gayle: lingering sadness ................................................................................................ 83
Hayley: unremitting doubt ............................................................................................. 85
Emily: judgement .......................................................................................................... 88
Mona: deep despair ........................................................................................................ 90
Contemplating the Stories .................................................................................................... 92

Emergent Themes................................................................................................................. 92

Naming of the themes: A personal reflection ................................................................ 94
Stigma, judgement, and disclosure ................................................................................ 96
Participants’ reflections on abortion .............................................................................. 98
The moral dilemma ..................................................................................................... 98
Abortion as a selfish act............................................................................................ 102
The brutality of abortion ........................................................................................... 104
Unspoken distress ........................................................................................................ 105
The awakening ............................................................................................................. 108
The body and post-abortion distress ............................................................................ 110
Meanings attached to bleeding after the abortion ..................................................... 110
The meaning of pain ................................................................................................. 111
Emotional responses after abortion ............................................................................. 113
Loss, sadness, guilt and shame ................................................................................ 114
Triggers ........................................................................................................................ 115
Pregnancy, children and motherhood as triggers of distress .................................... 116
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Specific times, dates or places .................................................................................. 119
Conversations ........................................................................................................... 120
Avoidance Behaviours after Abortion ......................................................................... 121
Isolation and withdrawal as a means of avoidance .................................................. 122
Atonement .................................................................................................................... 123
Finding Healing.......................................................................................................124
Crisis Leads to Evaluation and Growth ....................................................................... 125
Post-Abortion Distress and Interpersonal Relationships.................................................... 126
Significant relationships in the aftermath of abortion .................................................. 127
Post-abortion ties ..................................................................................................... 127
Conflict .................................................................................................................... 128
The impact of post-abortion distress on new relationships .......................................... 129
Altered self-perception and interactional patterns within relationships ........................ 131
Relationship needs after abortion .................................................................................. 133
Communication ............................................................................................................. 134
Distancing and intimacy ................................................................................................ 136
Impact on sexual activity ......................................................................................... 137
Positive impact .............................................................................................................. 138

Summary ............................................................................................................................ 139

CHAPTER 5 ...............................................................................................................................

Discussion ............................................................................................................................. 140

Introduction ........................................................................................................................ 140
Critical Appraisal of Themes ............................................................................................. 140
Stigma, judgment and disclosure .................................................................................. 142
Participants’ reflections on abortion ............................................................................. 145
The moral dilemma and abortion as a selfish act ..................................................... 145
The brutality of abortion ........................................................................................... 146
Unspoken distress ......................................................................................................... 148
The body and post-abortion distress ............................................................................. 149
Emotional responses to abortion ................................................................................... 151
Sadness and loss (grief reactions) ................................................................................... 152
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Shame and guilt .............................................................................................................. 153
Triggers ............................................................................................................................ 155
A note on post-traumatic stress following abortion...................................................... 157
Avoidance behaviours after abortion ............................................................................... 157
Atonement ........................................................................................................................ 159
Crisis leads to Evaluation and Growth ............................................................................. 161
The Impact of Post-Abortion Distress on Interpersonal Relationships ............................. 162
Implications for Women’s Psychological Well-being ...................................................... 170
Practical implications for the field of psychology ................................................................ 171
Strengths and Limitations of the Study ............................................................................. 172
Recommendations for Further Research ........................................................................... 174
Final Reflections ............................................................................................................... 175

Summary ........................................................................................................................... 176

REFERENCES ..................................................................................................................... 177

APPENDIX - Informed consent form................................................................................191
List of tables

Table 4.1........................................................................................................................ .94

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ABSTRACT

Historical and contemporary literature on post-abortion issues draws attention to the
complexity of women’s experiences in this regard. The literature observes a vast range of
potential effects of abortion on the mental health of women. This study contributes to the
current understanding of post-abortion issues, by exploring women’s subjective experiences
of post-abortion distress and the impact on interpersonal relationships. The relational impact
is further situated in the context of its importance to psychological well-being.
Four women, between the ages of 23 and 45, described their lived experiences of
post-abortion distress during semi-structured interviews. Each participant gave detailed
accounts of the abortion event, the difficulties experienced afterwards and the perceived
impact that this kind of distress had on their lives and specifically, their relationships with
others. The data was subsequently analysed using interpretative phenomenological analysis
(IPA).
Twelve main themes emerged from the transcripts, each of which is discussed
separately as well as in relation to other pertinent literature. The critical examination of the
findings presented in this study revealed divergent aspects to those found in some of the
existing literature, as well as understandings comparable with previous research.
The meanings that emerged from these women’s stories revealed intense cognitive,
emotional and behavioural dilemmas, all of which highlight the subjective experience of
post-abortion distress as a complicated and deeply personal issue, with profound effects on
their relational worlds.

Key terms
Abortion; post-abortion distress; women; interpersonal relationships; psychological well-
being; South Africa, phenomenology; interpretative phenomenological analysis; reflexivity;
qualitative research; subjective meaning.

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CHAPTER 1

INTRODUCTION

Overview

This study explored the phenomenon of post-abortion distress and its impact on
interpersonal relationships as described by women who are living with the hardship of
their own abortion experiences. Through in-depth interviews, they described the
abortion event, the difficulties they experienced afterwards, and the impact that this
kind of distress had on their lives and, specifically, their relationships with others.

In this chapter, I introduce myself as the researcher by guiding the reader
through my own process of becoming aware of the existence of the incidence of
post-abortion distress and the need for research into this phenomenon. In addition, I
endeavour to describe the research problem, in its complexity and to elucidate the
context of the study, by highlighting the significance of the research within the South

African context and within the field of psychology. Thereafter the objectives of the

investigation are sketched, followed by a brief overview of the research design as it
relates to the research question. In conclusion, my personal assumptions and worldview
are illuminated and their influence on the conduct and writing of this research study
reflected on.

Journey to Discovery

My interest in this research topic developed largely through my own
interactions, both personally and professionally, with women who had terminated their
pregnancies. Through these exchanges, I became increasingly aware that the occurrence
of an abortion remains in the thoughts and hearts of women long after the procedure is
over, and that it appears to colour their perceptions and their experience of being in the
world.

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