What do we learn from the professional field of Crisis Intervention, or Critical Incident Stress Management (CISM) that especially informs the work of pregnancy crisis intervention (PCI)?
In this final installment, let’s consider what the abortion training textbooks teach about pregnancy crisis intervention counseling. For example, consider Management of Unintended and Abnormal Pregnancy: Comprehensive Abortion Care. This major textbook is endorsed by the National Abortion Federation. There are two lessons that seem especially relevant to us, and even more powerful coming from abortion-training textbooks.
Lesson #1: The principle (doctrine) of informed consent is the ethical foundation for all medical procedures.
Conversely, despite the disquieting elements of a medical procedure and its risks, it is unethical to withhold or shield people from a full explanation of treatment and establish explicit consent.
So says the textbook, Comprehensive Abortion Care.
“Informed consent must include three elements: (1) patients must have the capacity to make decisions about their care; (2) their participation in these decisions must be without coercion or manipulation; and (3) patients must be given appropriate information germane to making the particular decision. The goal of the informed consent process is to protect personal well-being and individual autonomy by providing information on the procedure, risks, and alternatives to the medical intervention being considered.”
Grounding your counseling in the principle of informed consent not only justifies educating women and couples considering abortion about the procedure and possible negative physical and emotional consequences, it obligates us to do so. It also makes it right for us to assure women that it is illegal and unethical to be forced into a medical treatment they do not want (consent to).
The pressure imposed on a woman to abort is a major risk factor for PTSD according to abortion training textbooks. If she is being threatened or coerced, or if she perceives that she is being manipulated into doing what she does not truly want to do, then she is exposed to a much higher risk of trauma after the abortion. Mandy’s story should never happen.
“My boyfriend did not change his opinion with regards to my pregnancy: I was to have an abortion…A doctor joined and he too said: ‘It is better to have it done…the father does not want it.’ I was not to think about myself, not to be selfish…When I finally got the strength to get up and leave, I felt broken.”
Lesson #2: Proper pregnancy counseling requires screening for risk factors predictive of after-abortion trauma.
Comprehensive Abortion Care has a section titled, “Risk Factors for Negative Emotional Sequelae” It lists 18 risk factors that should be screened for as part of pre-abortion counseling, all of which are predictors of after-abortion trauma.
Among the 18 risk factors there are 2 that are especially noteworthy for PCI counselors. The first one has already been mentioned, “Perceived coercion to have an abortion.” I will only add the insight of Dr. Martha Shuping. She writes, “Studies show 11% to 64% of women experience coercion or pressure in abortion decision. If 11% of abortions are coerced, that would mean that more than 6 million abortions in U.S. have been coerced since 1973.”
The second noteworthy risk factor that abortionists are trained to screen for is “Attachment to the pregnancy.” Maternal-Fetal Attachment (MFA) refers to the “emotional tie or bond that normally develops between the pregnant woman and her unborn infant.” Over seventy years of research, involving women from diverse cultures, confirm that MFA is a universal experience, even for those intending abortion. Dr. Martha Shuping survey of MFA reaches the same conclusion that abortion training textbooks warns about. “The degree of bonding that is established during pregnancy is predictive of the degree of emotional distress and trauma symptoms that are experienced after the abortion.”
In concluding this series, I would add that there are further insights from CISM textbooks that I have not introduced in this series, but ought to be integrated into our training. There are also a few corrective lessons from textbook CISM that we ought to listen to and discuss as a PHO movement. And simplify the complex will always increase our training effectiveness.