Original ResearchInduced abortion and intimate relationship quality in the Chicago Health and Social Life Survey
Introduction
Unintended pregnancy is unequivocally a stressful life experience with considerable potential to strain intimate relationships.1, 2 As a couple contemplates how to proceed with an unexpected pregnancy, many forms of conflict related to each partner's personal preferences, beliefs, morality and commitment to the relationship may arise. Even if a couple is in agreement regarding continuation vs termination of the pregnancy, the resolution chosen may prove stressful to one or both individuals and have an adverse effect on the relationship. Several studies have examined partner relationship quality following unintended pregnancy resulting in childbirth3, 4; however, the association between unintended pregnancy ending in abortion and partner relationship quality has received much less attention. Moreover, most published reports on associations between abortion and relationship issues have been from the female vantage point, with male perceptions largely ignored.5 To a large extent, this is not unexpected. Research interests have followed legal precedent wherein women with unwanted pregnancies may unilaterally decide the outcome of pregnancies, independent of their partner's knowledge, beliefs or feelings, under US law since 1976.6
A few studies have shown women with a history of abortion to be at increased risk for sexual dysfunction.7, 8, 9, 10, 11 Among the specific female sexuality variables examined in the literature are sexual desire, frequency of sexual intercourse, orgasm ability and sexual satisfaction. In a recently published study, 6.2% of Russian women and 24% of American women reported sexual problems that they attributed directly to a prior abortion.7 In addition, in a longitudinal Swiss study, 31% of women experienced one or more sexual symptoms, including decreased desire and orgasmic ability, associated with post-abortion anxiety, depression and sadness.8 Bradshaw and Slade reviewed the research on this topic and concluded that 10–20% of women experience sexual problems in the first weeks and months following an abortion, with 5–20% reporting sexual difficulties 1 year later.12
Although male responses to abortion have not been studied extensively, sexual problems at 1–3 weeks post-abortion were identified in 18% of a sample of men who self-identified as having been emotionally harmed by a partner's abortion.13 Research on abortion and male sexuality in more normative samples is absent from the literature.
Partner communication problems in the aftermath of an abortion have also been identified,14 and several studies have shown increased risk for separation or divorce following an abortion.7, 9, 14, 15 In one of the stronger prospective studies, which had a high initial consent rate, no attrition, a control group and standardized measures, 22% of German women's relationships with their partners had ended 1 year after an abortion.9 Rue et al. reported that 6.8% of Russian women and 26.7% of American women experienced relationship problems due to an abortion, whereas little relationship benefit was reported by either Russian women (2.2%) or American women (0.9%).7 Finally, 7.8% of Russian women and 19.8% of American women indicated that their relationships had ended as a direct consequence of the abortion. In an older study of 100 women with a history of abortion, conducted by Sherman et al. (1985), 46% reported that the abortion was a major life crisis and 48% considered that their relationship with their partner was altered significantly. Thirty-three percent of the respondents reported a negative effect on their sexual life.16
Very little research attention has focused on abortion as a risk factor for intimate partner violence; however, a few studies have shown an association between a history of abortion and increased risk for violence during a subsequent pregnancy.17, 18 Associations between abortion and relationship conflict and intimate partner violence are logical based on research indicating that anger is a common post-abortion emotional response.7, 19, 20 Intimate partner violence encompasses physical, sexual or psychological violence, and approximately 25–54% of women report exposure to intimate partner violence during their lifetime.21 The urgency of investigating previously unexamined correlates of intimate partner violence, such as induced abortion, is underscored not only by the numbers affected by this serious form of personal suffering, but by data suggesting that victims are at increased risk for medical and psychosocial comorbidity.21 This study examined women as perpetrators of intimate partner violence; however, according to statistics gathered by the US Department of Justice, 85% of victimizations by intimate partners in recent years were against women.22 Moreover, in the same report, 33% of female murder victims were identified as having been killed by an intimate, compared with 4% of male murder victims.
Correlations between abortion history and relationship quality could be explained by third variables associated with the choice to abort and relationship problems. Few previous investigations of associations between abortion and partner relationship quality have included sufficient controls for potentially confounding third variables. Among the possible third variables are age, sexual risk-taking behaviours (e.g. group sex, number of sexual partners), a childhood or adult history of sexual abuse, and other sources of stress including poverty and feelings of estrangement from one's parents.23, 24, 25, 26 Third variables which may decrease the likelihood of abortion and relationship problems include personal commitment to one's religion and marital status.7, 24, 26
In addition to insufficient attention to men and few controls for potential third variables, previous studies have focused exclusively on the impact of a prior abortion on the partnership of the woman who conceived the pregnancy and her partner. No studies to date have compared the relative psychological or relational impact of a history of one or more abortions prior to the current partnership with an abortion occurring in the context of the current partnership. Although very few studies have examined the long-term mental health implications of abortion, the available longitudinal data indicate that while some women do not manifest post-abortion psychological problems, others may carry the pain of a difficult abortion experience for years, emotionally cycling symptoms of intrusion and re-experience, denial and avoidance.7, 20, 27 If negative emotions associated with an abortion are not acknowledged or resolved, dysfunctional coping can carry over into relationships and create additional impairment.20, 28
Section snippets
Aims
The present study was designed to address some of the gaps in the previous research by examining associations between abortion history prior to and within a current partnership, and several indicators of adverse relationship functioning (perceptions of quality-of-life changes associated with relationship termination, sexual dysfunction, verbal conflict and intimate partner violence). Controls were instituted for a variety of demographic, personal, relational and situational variables found to
Data source
The data source for this investigation was the Chicago Health and Social Life Survey (CHSLS). Data were collected in 1995 and 1997 under the direction of Edward O. Laumann, PhD, George Herbert Mead Distinguished Service Professor, Department of Sociology, University of Chicago, USA. Designed to advance understanding of the causes and consequences of adult sexual behaviour in the USA, the CHSLS consists of 2114 cases, including 890 cases which constitute a representative cross-section of Chicago
Results
Correlational analyses were conducted to identify sociodemographic, family of origin, sexual abuse and risky sexual behaviour predictors of women's decision to abort and men's partner's choice to abort as covariates in the primary analyses. Using the female data, less frequent religious service attendance (P < 0.0001), not having been close to one's mother during childhood (P < 0.01), not having been close to one's father during childhood (P < 0.05), having left home at an early age (P < 0.05), having
Discussion
The results of this study provide strong evidence for increased risk of relationship problems associated with an abortion experience, as reported by both men and women. Specifically, for males and females in the sample, an abortion in the context of a previous relationship, compared with no abortion history, was associated with stronger perceptions that the quality of life of the respondent and his/her partner would be improved if the current relationship ended. In addition, male and female
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Cited by (20)
Relationship between induced abortion and the incidence of depression, anxiety disorder, adjustment disorder, and somatoform disorder in Germany
2019, Journal of Psychiatric ResearchCitation Excerpt :Secondly, it is possible that the induced abortion-mental health association is mediated by several factors. For example, abortion is a well-known risk factor for poor intimate relationship quality (Coleman et al., 2009b), while poor intimate relationship quality may be positively associated with several psychiatric conditions (Whisman et al., 2014). Another potential key mediator is sexual dysfunction, as induced abortion favors the risk of sexual dysfunction (Fok et al., 2006), and sexuality is strongly correlated with mental health (Blais et al., 2018).
Association between induced abortion, spontaneous abortion, and infertility respectively and the risk of psychiatric disorders in 57,770 women followed in gynecological practices in Germany
2019, Journal of Affective DisordersCitation Excerpt :These are often considered major events by women and are often associated with negative emotional reactions (e.g., guilt, grief, regret) (Hasanpoor-Azghdy et al., 2014; Madden, 1994). Second, abortion and infertility may foster the development of psychiatric disorders by means of several indirect factors such as poor quality of intimate relationships (Coleman et al., 2009b; Raval et al., 1987; Whisman, 1999), sexual dysfunction (Blais et al., 2018; Fok et al., 2006; Millheiser et al., 2010), or urinary tract infection (Chae and Miller, 2015; Lin et al., 2018). Finally, abortion, infertility, and psychiatric disorders may share some common vulnerability factors (e.g., psychological, environmental) (Mota et al., 2010).
Targeting sexual health services in primary care: A systematic review of the psychosocial correlates of adverse sexual health outcomes reported in probability surveys of women of reproductive age
2015, Preventive MedicineCitation Excerpt :Coleman et al. (2009) reported that less frequent religious service attendance and lack of closeness to mother and to father were associated with abortion as was leaving home at an early age. Coleman et al. (2009). Detailed findings, including reported statistical analyses for these associations, are presented in Tables 3 and 4.
Abortion among young women and subsequent life outcomes
2010, Best Practice and Research: Clinical Obstetrics and GynaecologyCitation Excerpt :Notwithstanding this dispersion, the authors concluded that there was a negative impact on the relationship, in a sizeable minority up to 3 years post-event. An interesting observation39 was that men as well as women reported negative reactions. For men, experiencing an abortion in the current relationship was associated with an increased risk of jealousy and conflict about drugs, while for women arguments focussed on money and relatives of the partner and of the subject.
Intimate relationships after receiving versus being denied an abortion: A 5-year prospective study in the United States
2022, Perspectives on Sexual and Reproductive Health