PASS – It’s a Complex Kind of Grief

First trimester termination of pregnancy is an elective procedure for ending an unwanted, or unplanned pregnancy. In the USA alone approximately 1.4 million of these pro-choice procedures take place annually. Despite the fact that a woman or couple have made a conscious choice for abortion, there is increasing concern regarding post-abortion psychological outcomes. Grief and loss are experienced, and this is a complex type of grief.

PASS is Post Abortion Stress Syndrome, which is a long-term stress reaction to the act of terminating pregnancy. It is in the same group of psychological syndromes a Post-Traumatic Stress Disorder. Research has documented that in women who repress the emotional component of a traumatic abortion, then PASS may occur. This condition has now become an emerging public health concern.

Living with grief, regret, and pain is at its core very traumatic. As is the case with most trauma, the distress of an ordeal is heartrending, and sufferers may attempt to deny, ignore or try to forget the pain they are enduring. These painful memories get left alone, only to resurface when the truth that a loss has been suffered can no longer be negated. It is at this time that PASS will reveal itself, together with a whole host of physical, and even imagined symptoms.

Millions of lives are being affected by an illness that has seen experts slow to respond to. This is more than likely due to the complexities of moral legal implications on the subject. At one time individuals were required to consult with a psychologist, or even psychiatrist prior to choosing to terminate a pregnancy, this scenario no longer applies since abortion has been made legal.

PASS sufferers may find themselves feeling guilty, and this is one of the most overriding emotions which becomes a symptom of the syndrome. A number of other symptoms may or may not appear – some immediately after the procedure – others at a later date. The burden of guilt can be inexorable, with so little consolation in the belief that one of the strongest instincts of nature has been transgressed. The instinct to procreate, and rear a child.

Anxiety may become a constant companion, and its attendant apprehension, tension, and physical responses. Symptoms such as headaches, dizziness, palpitations, stomach upsets, lack of concentration and libido, and sleep disturbances may be experienced. The problem is that women often feel conflicted between the decision they took and saw through, and their own moral standards. Avoidance and psychological “numbing” are coping mechanisms too, with depression, melancholy, even suicidal thoughts being experienced by many post-abortive women.

The problem is that certain circumstances have become recognised as being appropriate to mourn. In the case of an elective termination of pregnancy, society has sort of dictated that this is not a recognised right for the mother to mourn. It is a loss situation which complicates grief.

It is important to understand that abortion has the ability to disenfranchise grief in a situation where a death has occurred. There understandably may still be emotional bond to the fetal child, no matter how much of a crisis the pregnancy might have presented. Chronic, delayed and acute grief reactions are being observed in a significant amount of women who have undergone abortion, and women are psychologically at risk.

With the removal of the stigma surrounding what was clandestine procedure prior to the Roe v. Wade Supreme Court ruling in 1973, it was believed that abortion-related mental health risks would be marginal. This is not the case. It is no longer a benign psychological procedure, and therefore it is important for women considering abortion to seek psychological support. It is also vital for women to learn that grieving is normal when abortion takes place, and that sympathetic counselling is available.

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